Miracle-dz/UniFAR-FTUs huggingface dataset:
An evidence-based review of enhanced recovery interventions in knee replacement surgery.

INTRODUCTION Total knee replacement (TKR) is a very common surgical procedure. Improved pain management techniques, surgical practices and the introduction of novel interventions have enhanced the patient's postoperative experience after TKR. Safe, efficient pathways are needed to address the increasing need for knee arthroplasty in the UK. Enhanced recovery programmes can help to reduce hospital stays following knee replacements while maintaining patient safety and satisfaction. This review outlines common evidence-based pre, intra and postoperative interventions in use in enhanced recovery protocols following TKR. METHODS A thorough literature search of the electronic healthcare databases (MEDLINE(®), Embase™ and the Cochrane Library) was conducted to identify articles and studies concerned with enhanced recovery and fast track pathways for TKR. RESULTS A literature review revealed several non-operative and operative interventions that are effective in enhanced recovery following TKR including preoperative patient education, pre-emptive and local infiltration analgesia, preoperative nutrition, neuromuscular electrical stimulation, pulsed electromagnetic fields, perioperative rehabilitation, modern wound dressings, different standard surgical techniques, minimally invasive surgery and computer assisted surgery. CONCLUSIONS Enhanced recovery programmes require a multidisciplinary team of dedicated professionals, principally involving preoperative education, multimodal pain control and accelerated rehabilitation; this will be boosted if combined with minimally invasive surgery. The current economic climate and restricted healthcare budget further necessitate brief hospitalisation while minimising costs. These non-operative interventions are the way forward to achieve such requirements.
Feline herpesvirus 1 infections in a domestic cat population in Ahvaz, Iran.

Summary Feline herpesvirus 1 (FeHV-1) and feline calicivirus (FCV), associated with upper respiratory tract disease, are highly prevalent in cats worldwide. With the aim of investigating the importance of FeHV-1 in a population of cats, samples were taken in a hospital in Ahvaz, south-west Iran, between June 2007 and June 2008. Oropharyngeal, nasal and ocular swabs were collected from 65 domestic cats, including 52 stray and 13 household animals and were tested for the presence of FeHV-1 DNA by polymerase chain reaction (PCR). The overall prevalence rate of FeHV-1 was 35.38%. There was a statistically significant association between the prevalence rate of FeHV-1 and the presence of respiratory signs. High prevalence of FeHV-1 infection strengthens the importance of applying hygienic and preventive measures in cats in the study area.
Classification and management of cervical paragangliomas.

INTRODUCTION Cervical paragangliomas are slow-growing tumours that eventually cause lower cranial nerve palsies and infiltrate the skull base. Surgical treatment may cause the same deficits and, in some, risks more serious neurological deficits. We describe a classification used to guide investigation, consent and management of cervical paragangliomas based on extensive experience. METHODS The case notes of patients managed by the senior author at a tertiary referral skull base unit between 1987 and 2010 were reviewed retrospectively. A total of 87 cervical paragangliomas were identified in 70 patients (mean age: 46 years, range: 13-77 years). Of these, 35 patients had 36 vagal paragangliomas, 43 patients had 50 carotid body paragangliomas and 8 had both. One cervical paraganglioma arose from neither the carotid body nor the nodose ganglion. The main outcome measures were death, stroke, gastrostomy and tracheotomy. RESULTS All tumours were classified pre-operatively based on their relationship to the carotid artery, skull base and lower cranial nerves. Type 1 tumours were excised with a transcervical approach, type 2 with a transcervical-parotid approach and type 3 with a combined transcervical-parotid and infratemporal fossa approach. Type 4 patients underwent careful assessment and genetic counselling before any treatment was undertaken. There were no peri-operative deaths; two patients had strokes, one required a long-term feeding gastrostomy and none required a tracheotomy. CONCLUSIONS The use of a pre-operative classification system guides management and surgical approach, improves accuracy of consent, facilitates audit and clarifies which patients should be referred to specialised centres.
Addressing the complex etiology of Alzheimer's disease: the role of p25/Cdk5

Alzheimer’s disease (AD) is an age-related neurodegenerative disorder characterized by the progressive loss of forebrain neurons and the deterioration of learning and memory. Therapies for AD have primarily focused upon either the inhibition of amyloid synthesis or its deposition in the brain, but clinical testing to date has not yet found an effective amelioration of cognitive symptoms. Synaptic loss closely correlates with the degree of dementia in AD patients. However, mouse AD models that target the amyloid-β pathway generally do not exhibit a profound loss of synapses, despite extensive synaptic dysfunction. The increased generation of p25, an activator of the cyclin-dependent kinase 5 (Cdk5) has been found in both human patients and mouse models of neurodegeneration. The current work reviews our knowledge, to date, on the role of p25/Cdk5 in Alzheimer’s disease, with a focus upon the interaction of amyloid-β and p25/Cdk5 in synaptic dysfunction and neuronal loss.
Paradoxical bleeding and thrombosis in a patient with afibrinogenemia and fibrinogen Mumbai mutation.

OBJECTIVES Thrombosis is rarely reported in cases of afibrinogenemia and is generally associated with thrombophilia or replacement therapy. Often, it is difficult to predict whether the patients will bleed or whether they are exposed to the risk of thrombosis. METHODS We report a patient with afibrinogenemia who presented with complete thrombosis of right hepatic, portal, and splenic veins and who described a lifelong history of bleeding. Direct sequencing of the three fibrinogen genes was performed to identify the mutation. RESULTS DNA sequencing showed the presence of a homozygous for G8017A substitution in exon 8 of the fibrinogen β-chain gene, resulting in a G434D missense mutation (Fibrinogen Mumbai). CONCLUSIONS Presence of both bleeding and thrombotic manifestations in a patient with afibrinogenemia in the presence of other associated risk factors warrants a very careful individualized approach in the management of patients with afibrinogenemia.
Developing referral and reassessment criteria for drivers with dementia

Background and Aims: Determining if a person with dementia should be referred for a driver assessment, at what stage of the illness and how often to repeat this are difficult decisions for health professionals. The aims of this study were to develop criteria for driver assessment referral and to explore the value of routine reassessment for drivers with dementia. Methods and Results: Twenty participants with a diagnosis of dementia were recruited from a memory clinic and underwent a standard occupational therapy driver assessment and reassessment 6 months later. Fifteen failed the initial assessment but 10 went on to pass local area assessments. Some participants in the early stages of the disease failed. Five of the nine participants suitable for reassessment at 6 months also failed. Conclusion: The results confirmed that routine referral following the diagnosis of dementia is appropriate. Change in performance was noted at reassessment, confirming that 6 months between assessments is an appropriate timeframe.
Acute Myeloid Leukemia With Recurrent Cytogenetic Abnormalities.

OBJECTIVES Session 1 of the 2013 Society for Hematopathology/European Association for Hematopathology Workshop was devoted to the cases of acute myeloid leukemia (AML) with recurrent cytogenetic abnormalities. METHODS Based on World Health Organization 2008 criteria, seven specific translocations are defined as "recurrent" in AML. Of these seven, three are considered to be AML defining regardless of blast percentage. Workshop cases provided the opportunity to consider potential new AML-defining cytogenetic mutations, as well as other unique aspects of AML with cytogenetic abnormalities. RESULTS Most of the 38 cases submitted were acute promyelocytic leukemia (APL) with t(15;17)(q24.1;q21.1) and so-called variants (12 cases), AML with t(8;21)(q22;q22) (seven cases), AML with inv(3)(q11q26.2) (six cases), and AML with 11q23 translocations (five cases). CONCLUSIONS This review focuses on providing updated recommendations for the rapid diagnosis of APL, discussing the types and significance of variant RARA mutations in APL-like leukemias, and refining low-blast-count (oligoblastic) AML. In addition, the significance of unique morphologic, immunophenotypic, and genetic variations in AML defined by a recurrent cytogenetic abnormality is included.
Diagnostik und Therapiestrategien bei Leukämien

Bei den akuten Leukamien handelt es sich in etwa 70 % der Falle um akute myeloische Leukamien (AML), die vor allem bei Erwachsenen auftreten. Die akute lymphatische Leukamie (ALL) ist hauptsachlich eine Erkrankung des Kindesalters. Sowohl in der Diagnosestellung als auch bei der Therapieauswahl spielen neben der Immunhistochemie und der Zytologie heute auch zytogenetische und molekularbiologische Erkenntnisse eine zunehmende Rolle. Es wird versucht, Subgruppen mit unterschiedlicher Prognose zu definieren und risikostratifizierten Therapien zuzufuhren. Akute Leukamien werden derzeit in grosen multizentrischen Studien therapiert. Die chronische myeloische Leukamie (CML) ist eine maligne Entartung der pluripotenten Stammzelle des Knochenmarks. Leitbefund der CML ist die Leukozytose. Die CML kann mithilfe einer Knochenmarkstransplantation therapiert werden. Ein neuer Therapieansatz ist die Blockade der Tyrosinkinase. Summary Diagnosis and therapy strategies of leukaemia Acute myeloid leukaemia (AML), which mainly occurs in adults, comprises 70 % of all leukaemia cases. Acute lymphatic leukaemia (ALL) on the other hand is a disease occurring mainly during childhood. Besides immune histochemistry and cytology, an increasing role is also played by cytogenetic and molecular biological knowledge in diagnosis establishment as well as therapy choice. This article attempts to define the sub-groups with various prognoses leading to risk stratified therapies. Presently, acute leukaemia is being therapised in large scale multicentric studies. Chronic myeloid leukaemia (CML) is a malignant degeneration of the pluripotential stem cell of the bone marrow. Leucocytosis is the main finding. CML can be therapised by means of bone marrow transplantation. A new therapy method for CML entails the inhibition of tyrosine kinase.
Gene Expression of FADS2 mRNA Linked to Intelligence in Exclusively Breast Milk Fed Preterms

Breastfeeding is important for brain development and was shown by many studies to result in higher scores Intelligent Quotient (IQ). However, the exact mechanism whereby Breastfeeding influences cognitive development remains unclear. This study aimed to study the expression of genetic code FADS2 linked to the cognitive function in relation to the mode of feeding. The study comprised 30 preterm infants of 32 to 34 weeks gestation age including 15 exclusively breastfed and 15 fed on Infant Milk Formula (IMF) selected from the Neonatal Intensive Care Unit (NICU) in Talkha Central Hospital in Dakahlia Governorate Egypt. Blood samples were drawn at birth and at 12 weeks of life and FADS2 mRNA gene expression-was measured using real time PCR at birth and at 12 weeks of life. Blood indices were measured at 12 weeks. FADS2 mRNA gene expression demonstrated a significant increase from birth to 3 months, with 109 folds rise in breast fed group compared to five folds rise in the artificially fed group at (p
Smoking and Diabetes: Helping Patients Quit

Cigarette smoking is the most important cause of preventable morbidity and mortality around the world. In the United States, smoking is responsible for one in five deaths. It costs the economy > $167 million in yearly health care costs and lost productivity. In 2004, an estimated 20.9% of people ≥ 18 years of age, equaling 44.5 million people, were current smokers. The prevalence of smoking in the United States decreased 40% between 1965 and 1990 but has remained level thereafter. Additionally, smoking rates have increased in people aged 18‐24 years recently, which may indicate higher initiation rates of smoking in young adults. 1 The prevalence of smoking in patients with diabetes is similar to that in the general population, but the health repercussions are more severe. 2 Cigarette smoking has been shown to increase the risk of cardiovascular disease (CVD) more in patients with diabetes than in those without diabetes, and CVD is responsible for 65% of deaths in patients with diabetes. 3‐6 Smoking also increases the risk of peripheral vascular disease and resultant amputations. 7 In addition to increasing the risk of macrovascular disease in patients with diabetes, smoking cigarettes increases the risk of microvascular disease, contributing to nephropathy, retinopathy, and neuropathy. 2,8‐11 Quitting smoking reduces the risk of mortality in patients with diabetes who smoke, but the risk of mortality is correlated with the duration of smoking, highlighting the importance of addressing the issue of smoking in all patients with diabetes. 12 To reduce the burden of illness
Insulin resistance induced by antiretroviral drugs: Current understanding of molecular mechanisms

Abstract The increase in incidence of HIV infection continues to be a major public health problem across the world, but more especially in sub-Saharan Africa. Treatment with highly active antiretroviral therapy (HAART) has improved the prognosis of patients with AIDS, but it has also increased the incidence of various metabolic disorders, in particular insulin resistance accompanied by dyslipidaemia, hyperglycaemia and lipodystrophy. This is often accompanied by frank type 2 diabetes and increased mortality from cardiovascular disease. It is important to understand the mechanistic basis for these side-effects as the incidence of these is likely to increase as the rollout of antiretroviral drugs continues.
Long-Term Efficacy and Safety of Fosamprenavir plus Ritonavir Versus Lopinavir/Ritonavir in Combination with Abacavir/Lamivudine over 144 Weeks

Abstract Purpose: The KLEAN study extension assessed the long-term efficacy and safety of fosamprenavir-ritonavir (FPV/r) and lopinavir-ritonavir (LPV/r), both administered with abacavir/lamivudine (ABC/3TC) fixed dose combination, over 144 weeks. Methods: KLEAN was an open-label, noninferiority study that randomised antiretroviral-naïve patients to FPV/r twice daily (bid) or LPV/r bid with ABC/3TC once daily (qd). Patients with a viral load of <400 copies/mL at Week 48 were eligible to participate in the KLEAN study extension (up to 144 weeks) and continued with their previously randomised therapy. Results: The KLEAN study extension (48 to 144 weeks) randomized 199 patients. The proportion of TLOVR responders (HIV-1 RNA <50 copies/mL) at Week 144 was 73% and 60% in the FPV/r and LPV/r arms, respectively. The proportion of TLOVR responders (<50 copies/mL) was the same irrespective of baseline HIV-1 RNA (>100,000 or ⩽100,000 copies/mL). The Week 144 median (interquartile range) change from baseline CD4+ cell count was 300 (236–433) cells/mm3 and 335 (225–444) cells/mm3 in the FPV/r and LPV/r arms, respectively. Diarrhea was the most frequently reported adverse event. A small proportion of patients (FPV/r, 13%; LPV/r, 9%) discontinued study medication due to adverse events. Three patients (FPV/r, 1; LPV/r, 2) experienced virological failure between Week 48 and Week 144. Conclusion: The findings of the KLEAN study extension (48 to 144 weeks) support durable viral suppression with both FPV/r and LPV/r treatment regimens when used in combination with ABC/3TC irrespective of viral load at baseline. Both regimens were well tolerated and had similar safety profiles.
Development of Diagnostic Criteria for Serious Non-AIDS Events in HIV Clinical Trials

Abstract Purpose: Serious non-AIDS (SNA) diseases are important causes of morbidity and mortality in the HAART era. We describe development of standard criteria for 12 SNA events for Endpoint Review Committee (ERC) use in START, a multicenter international HIV clinical trial. Methods: SNA definitions were developed based upon the following: (1) criteria from a previous trial (SMART), (2) review of published literature, (3) an iterative consultation and review process with the ERC and other content experts, and (4) evaluation of draft SNA criteria using retrospectively collected reports in another trial (ESPRIT). Results: Final criteria are presented for acute myocardial infarction, congestive heart failure, coronary artery disease requiring drug treatment, coronary revascularization, decompensated liver disease, deep vein thrombosis, diabetes mellitus, end-stage renal disease, non-AIDS cancer, peripheral arterial disease, pulmonary embolism, and stroke. Of 563 potential SNA events reported in ESPRIT and reviewed by an ERC, 72% met “confirmed” and 13% “probable” criteria. Twenty-eight percent of cases initially reviewed by the ERC required follow-up discussion (adjudication) before a final decision was reached. Conclusion: HIV clinical trials that include SNA diseases as clinical outcomes should have standardized SNA definitions to optimize event reporting and validation and should have review by an experienced ERC with opportunities for adjudication.
The Effects of Exercise Training on Metabolic and Morphological Outcomes for People Living With HIV: A Systematic Review of Randomised Controlled Trials

Abstract Purpose: To determine the effects of exercise on metabolic and morphological outcomes among people with HIV using a systematic search strategy of randomized, controlled trials (RCTs). Methods: Two independent reviewers assessed studies using a predetermined protocol. Results: Nine RCTs (469 participants, 41% females) of moderate quality were included. Compared to nonexercising controls, aerobic exercise (AE) resulted in decreased body mass index (weighted mean difference [WMD] −1.31; 95% CI, −2.59, −0.03; n=186), triceps skinfold thickness of subcutaneous fat (WMD −1.83 mm; 95% CI,−2.36, −1.30; n=144), total body fat (%) (standardised mean difference [SMD],−0.37; 95% CI, −0.74, −0.01; n=118), waist circumference (SMD −0.74 mm, 95% CI, −1.08, −0.39; n=142), and waist:hip ratio (SMD −0.94; 95% CI, −1.30, −0.58; n=142). Progressive resistive exercise (PRE) resulted in increased body weight (5.09 kg; 95% CI, 2.13, 8.05; n=46) and arm and thigh girth (SMD 1.08 cm; 95% CI, 0.35, 1.82; n=46). Few studies examined blood lipids, glucose, and bone density. Conclusions: Few RCTs exist and their quality varies. AE decreases adiposity and may improve certain lipid subsets. PRE increases body weight and limb girth. No additional effects of combining AE and PRE are evident. Larger, higher quality trials are needed to understand the effects of exercise on metabolic outcomes (eg, lipids, glucose, bone density) relevant to persons with chronic, treated HIV.
Surgery in superficial-lobe pleomorphic parotid adenoma

Study objective:To review the 1982-2003 literature for data comparing superficial and total parotidectomy in patients with superficial-lobe pleomorphic adenoma. Material and methods:Original articles selected from Medline were evaluated for data on postsurgical facial nerve dysfunction and recurrences. Results: All articles provided level IV evidence in the Sackett classification. Facial nerve dysfunction, for which classification was lacked standarization, was more common in patients older than 40 years and occurred with a mean rate of 1.3% and 2.9% after superficial-lobe and total parotidectomy, respectively. Recurrence rates were less than 2% with both techniques. Younger age at initial diagnosis was significantly associated with recurrence; mean ages at initial diagnosis were 30 and 45 years in patients who did and did not experience recurrences, respectively. Conclusion: Given the discrepancies across case-series, until prospective data are available, total parotidectomy seems preferable in patients younger than 40 years, since their recurrence rate is higher. Superficial-lobe parotidectomy may need to be reserved for patients older than 40 years, to reduce the rate of facial nerve dysfunction. ( Fr ORL 2005 ; 87 : 59 - 65) (Oral Communication presented in 2004 at the 111 th meeting of the French ENT Society)
Site Nurse–Initiated Adherence and Symptom Support Telephone Calls for HIV-Positive Individuals Starting Antiretroviral Therapy, ACTG 5031: Substudy of ACTG 384

Abstract Background: Effective and easy to implement interventions to improve adherence to antiretroviral therapy are needed. Objective: To compare site nurse–initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretroviral therapy to the study site’s standard of care. Methods: A randomized controlled trial of site nurse–initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretroviral therapy. Subjects were randomized to receive site nurse–initiated telephone calls (intervention) or no additional calls to the site’s standard of care (control). Subjects received calls 1 to 3 days after initiating antiretrovirals, on weeks 1, 2, 3, 6, 10, 14, 18, 22, and 26, and every 8 weeks thereafter. Self-reported adherence was captured during study visits. Results: A total of 333 subjects starting antiretrovirals as part of ACTG 384 were co-enrolled into ACTG 5031. Subjects were followed for up to 160 weeks and were contacted for 74% of scheduled calls. There was no significant difference in proportion of patients with >95% mean total adherence (87.9% and 91.2%; P = .34) and mean self-reported total adherence (97.9% and 98.4%) in the intervention and control groups, respectively, or in symptom distress and clinical endpoints. Conclusions: In the context of a clinical trial where self-reported adherence was exceptionally high, the site nurse–initiated telephone calls did not further improve self-reported adherence, symptom distress, or clinical outcomes.