Miracle-dz/UniFAR-FTUs huggingface dataset:
Genomische Diagnostik thrombophiler Gerinnungsstörungen bei Frauen

Zusammenfassung Die Aufklärung der DNA-Sequenzen sowohl der Gerinnungsfaktoren als auch der Gerinnungsinhibitoren hat die Erforschung genetischer Ursachen einer venösen Thromboseneigung ermöglicht. Da die Entstehung venöser Thrombosen ein multifaktorielles Geschehen ist, weisen Frauen auf Grund frauenspezifischer Risikosituationen (z. B. hormonale Kontrazeption, Schwangerschaft, Wochenbett) in bestimmten Lebensphasen ein zusätzliches expositionelles Thromboserisiko auf. Von wesentlicher Bedeutung ist es, die thrombophilen Neigungen zu definieren, bei denen eine genetische Diagnostik von besonderer klinischer Relevanz ist, zumal auch eine habituelle Abortneigung, schwangerschaftsinduzierte hypertensive Erkrankungen und frustrane In-vitro-Fertilisationen in Zusammenhang mit einer Thrombophilie gebracht werden. Trotz der vielfältigen Möglichkeiten einer genomischen Diagnostik ist eine DNA-Analyse nur in wenigen Fällen klinisch notwendig: Sinnvoll ist eine Mutationsanalytik bezüglich einer Faktor- V-Leiden-Mutation, da die Risiken zwischen homo- und heterozygoter Ausprägung differieren und von klinischer Relevanz in der Schwangerschaft und bei Schwangerschaftskomplikationen sind. Ebenso bewiesen ist dies für die Prothrombinmutation G20210A, wobei die Datenlage für deren homozygote im Vergleich zur heterozygoten Form auf Grund der Seltenheit unzureichend ist. Die Analytik der homozygoten Form der MTHFR-Mutation C677T ist nicht zu empfehlen, da die klinische Relevanz für die meisten Indikationen nicht ausreichend belegt ist. Für angeborene Mangelzustände von Antithrombin, Protein C und Protein S ist die Datenlage auf Grund ihrer geringen Inzidenzen selbst in venösen Thrombosekollektiven sehr gering. Die Mutationsanalytik kommt hier nur in Frage, wenn die Aktivitätsuntersuchungen der Proteine trotz wiederholter Messungen keine eindeutige Beurteilung zulassen. Alle übrigen Mutationsanalysen (z. B. PAI-1-Polymorphismus, Faktor-XIII-Val34Leu-Polymorphismus) sind bei Frauen zurzeit ohne klinische Relevanz.
THE EFFECT OF THE MUSIC LISTENING AND THE INTENSIVE CARE UNIT VISIT PROGRAM ON THE ANXIETY, STRESS AND DEPRESSION LEVELS OF THE HEART SURGERY PATIENTS CANDIDATES

A B S T R A C T Aims: Heart surgery is an invasive procedure which results in more anxiety, stress and some complication among the patients. Nurses should choose measures to reduce anxiety and stress for these patients. Studies have suggested that music can decrease anxiety in hospitalized patients. This study focused on the music listening and intensive care unit (ICU) visits effects for the control of anxiety, stress, and depression levels of patients who were candidates for heart surgeries. Methods: In a quasi-experimental, pretest-posttest design, 150 patients were randomly assigned to either control or experimental groups. Experimental groups received music listening or a visit from ICU program. Levels of variables measured before and after interventions, by using the Depression,
Helical CT evaluation of the preoperative staging of gastric cancer in the remnant stomach.

OBJECTIVE The objective of our study was to evaluate the diagnostic performance of helical CT for evaluating the preoperative staging of gastric cancer in the remnant stomach. MATERIALS AND METHODS Preoperative helical CT images of 67 patients with gastric cancer in the remnant stomach were independently analyzed regarding staging of the tumor by two radiologists who were blinded to histopathologic and surgical results. The differences in their assessments were resolved by consensus including the opinion of a third radiologist. The radiologists were asked to determine the depth of tumor invasion of the gastric wall (T stage), classifying it as </= T2, T3, or T4; local lymph node involvement (N stage); and solid organ metastasis or peritoneal involvement (M stage). TNM staging on CT was correlated with the histopathologic results of the resected specimen or with the surgical findings. Interobserver agreement was assessed using weighted kappa statistics. RESULTS The overall accuracy of T staging for reviewers 1 and 2 and for the consensus reading were 83.6%, 78.2%, and 85.4%, respectively. Five of 34 </= T2 lesions were misdiagnosed as T3. The cause of the overstaging was the misconception of the postoperative fibrotic change of the anastomotic site as perigastric tumoral infiltration. Three of 18 T4 lesions were understaged because of inadequate gastric distention (n = 1) and misinterpretation of adjacent organ involvement as partial volume averaging (n = 2). The accuracy of N staging and M staging were 81.8% and 94.0% for reviewer 1; 78.2% and 91.0% for reviewer 2; and 81.8% and 94.0% for the consensus reading, respectively. The weighted kappa values of T staging, N staging, and M staging were 0.676, 0.619, and 0.924, respectively. CONCLUSION Contrast-enhanced helical CT can be used successfully to preoperatively evaluate the staging of remnant stomach cancer in patients who have undergone previous gastric resection.
Cardiac MRI for detection of unrecognized myocardial infarction in patients with end-stage renal disease: comparison with ECG and scintigraphy.

OBJECTIVE The purposes of this study were to use the myocardial delayed enhancement technique of cardiac MRI to investigate the frequency of unrecognized myocardial infarction (MI) in patients with end-stage renal disease, to compare the findings with those of ECG and SPECT, and to examine factors that may influence the utility of these methods in the detection of MI. SUBJECTS AND METHODS We prospectively performed cardiac MRI, ECG, and SPECT to detect unrecognized MI in 72 patients with end-stage renal disease at high risk of coronary artery disease but without a clinical history of MI. RESULTS Fifty-six patients (78%) were men (mean age, 56.2 +/- 9.4 years) and 16 (22%) were women (mean age, 55.8 +/- 11.4). The mean left ventricular mass index was 103.4 +/- 27.3 g/m(2), and the mean ejection fraction was 60.6% +/- 15.5%. Myocardial delayed enhancement imaging depicted unrecognized MI in 18 patients (25%). ECG findings were abnormal in five patients (7%), and SPECT findings were abnormal in 19 patients (26%). ECG findings were false-negative in 14 cases and false-positive in one case. The accuracy, sensitivity, and specificity of ECG were 79.2%, 22.2%, and 98.1% (p = 0.002). SPECT findings were false-negative in six cases and false-positive in seven cases. The accuracy, sensitivity, and specificity of SPECT were 81.9%, 66.7%, and 87.0% (not significant). During a period of 4.9-77.9 months, 19 cardiac deaths were documented, but no statistical significance was found in survival analysis. CONCLUSION Cardiac MRI with myocardial delayed enhancement can depict unrecognized MI in patients with end-stage renal disease. ECG and SPECT had low sensitivity in detection of MI. Infarct size and left ventricular mass can influence the utility of these methods in the detection of MI.
Safety and effectiveness of analgesia with remifentanil for percutaneous transhepatic biliary drainage.

OBJECTIVE The purpose of this study was to evaluate the safety and effectiveness of analgesia with remifentanil for percutaneous transhepatic biliary drainage. SUBJECTS AND METHODS Analgesia for percutaneous transhepatic biliary drainage was induced with remifentanil in 186 patients over a 1-year period. Remifentanil was administered IV with an infusion pump at 0.1 microg/kg/min as the usual dose and 0.15 microg/kg/min as the maximal dose. Selected patients with severe anxiety also received a 1-mg bolus of midazolam. Vital signs, sedation levels, and side effects were checked every 5 minutes during the procedure and recovery. The patients scored their pain subjectively on an 11-point numerical rating scale. RESULTS The mean total dose of remifentanil was 116.3 microg (range, 32.5-200 microg). Midazolam was administered to 15 patients. Transient bradycardia occurred in 19 patients (10%). Hypotension did not develop in any patient. Respiratory depression occurred in four patients (2%). An appropriate level of sedation was obtained in 182 patients (98%), the modified Ramsay score being 2 (n = 164, 88%) or 3 (n = 18, 10%). Forty-nine of the patients (26%) indicated no pain (numeric rating, 0), 120 (64%) indicated mild pain (numeric rating, 1-3), and 16 (9%) indicated moderate pain (numeric rating, 4-6). One patient (1%) indicated severe pain (numeric rating, 7). CONCLUSION Remifentanil is safe and highly effective for pain control during percutaneous transhepatic biliary drainage. This drug is a suitable option for analgesia during painful interventional radiology procedures.
CNS complications of hematopoietic stem cell transplantation.

OBJECTIVE With the worldwide increase in the use of hematopoietic stem cell transplantation (HSCT), a high level of diligence is required for radiologists to understand HSCT-related complications in the CNS. This article describes the clinical background of HSCT and complications that occur in a time-dependent manner through the course of HSCT and addresses pivotal issues in diagnostic imaging. CONCLUSION Acknowledging the realm of imaging manifestations and the underlying mechanism of HSCT will enhance diagnostic accuracy and optimize treatment decisions.
Liver metastases of neuroendocrine tumors: treatment with hepatic transarterial chemotherapy using two therapeutic protocols.

OBJECTIVE The objective of our study was to retrospectively determine the effectiveness of hepatic transarterial chemotherapy using two therapeutic protocols-mitomycin C alone and combined mitomycin C and gemcitabine-on local tumor control and survival rate in patients with liver metastases from neuroendocrine tumors. MATERIALS AND METHODS This article describes a retrospective study of 48 patients (age range, 37-77 years; mean age, 61.1 years; SD, 10.3) with liver metastases from neuroendocrine tumors who underwent repetitive selective hepatic artery chemotherapy using mitomycin C alone (group 1, n = 18 patients who underwent 182 therapeutic sessions; mean, 10.11 sessions per patient) and combined mitomycin C and gemcitabine chemotherapy agents (group 2, n = 30 patients who underwent 312 therapeutic sessions; mean, 10.4 sessions per patient) with 4-week intervals between treatment sessions. RESULTS Both treatment protocols were well tolerated by all patients. Only minor side effects occurred in both groups, and no major complications developed. Local tumor control evaluation according to the Response Evaluation Criteria in Solid Tumors (RECIST) revealed the following for group 1: partial response, 11.1%; stable disease, 50%; and progressive disease, 38.9%. RECIST criteria for group 2 indicated partial response in 23.33%, stable disease in 53.34%, and progressive disease in 23.33%. The survival rate from the initial diagnosis to the fifth year for group 1 was 11.11% and for group 2, 46.67%. The median survival time from the initial diagnosis of group 1 was 38.67 months, whereas in group 2 it was 57.1 months. CONCLUSION Transarterial hepatic chemotherapy using mitomycin C and gemcitabine can be an effective therapeutic protocol for controlling local metastases and improving survival time in patients with hepatic metastases from neuroendocrine tumors.
Incidence of bleeding after 15,181 percutaneous biopsies and the role of aspirin.

OBJECTIVE The objective of our study was to report the incidence of bleeding after imaging-guided percutaneous core biopsy at a single center using a standardized technique. MATERIALS AND METHODS We performed a retrospective review of percutaneous core biopsies performed at our institution from January 2002 through February 2008. Data were collected at the time of biopsy, and clinical information was obtained 24 hours and 3 months after the biopsy. The specific information that was collected included the results of coagulation studies, aspirin use, the organ biopsied, the size of the biopsy needle, and the number of needle passes. Bleeding complications were defined using the Common Terminology Criteria for Adverse Events (CTCAE, version 3.0) established by the National Cancer Institute. RESULTS Among the 15,181 percutaneous core biopsies performed during the study period, 70 hemorrhages (0.5%) that were CTCAE grade 3 or greater were identified within 3 months of biopsy. The incidence of bleeding in patients taking aspirin within 10 days before biopsy was 0.6% (18/3,195), which was not statistically different compared with the incidence of bleeding in those not taking aspirin (52/11,986, 0.4%; p = 0.34). The incidence of bleeding after liver biopsy was 0.5%; kidney biopsy, 0.7%; lung biopsy, 0.2%; pancreas biopsy, 1.0%; and other biopsy, 0.2%. There were significant associations between major bleeding and serum platelet count and international normalized ratio (p < 0.001), although the association between major bleeding and the size of the biopsy needle was not significant (p = 0.97). CONCLUSION The overall incidence of major bleeding after imaging-guided percutaneous core needle biopsy is low. Recent aspirin therapy does not appear to significantly increase the risk of such bleeding complications.
Mental health, poverty and development

Purpose – This paper, which builds on the findings of WHO's Report on Mental Health and Development, aims to highlight the health, social, economic, and human rights effects of unaddressed mental disorders in low and middle income countries (LMICs) and to propose effective strategies to address mental disorders and their impacts as part of an overall development strategy.Design/methodology/approach – The paper first reviews the findings of relevant research on mental disorders and poverty and then proposes solutions that can be adopted by countries to promote development.Findings – This evidence of strong links between poverty and mental disorder supports the argument that mental disorders should be an important concern for development strategies. Mental disorders have diverse and far‐reaching social impacts, including homelessness, higher rates of imprisonment, poor educational opportunities and outcomes, lack of employment and reduced income. Targeted poverty alleviation programmes are needed to break t.
MR spectroscopy for differentiation of recurrent glioma from radiation-induced changes.

AJR 2009; 193:W568–W569 0361–803X/09/1936–W568 © American Roentgen Ray Society MR Spectroscopy for Differentiation of Recurrent Glioma From RadiationInduced Changes We read with interest the meticulous investigation by Smith et al. [1] into the complex topic of differentiation of recurrent tumor from radiation change in the February 2009 issue of the AJR. In their retrospective study, Smith et al. proposed a prediction model to aid in the differentiation of new contrastenhancing lesions into recurrent tumor or radiation change using metabolite ratios obtained by 2D MR spectroscopy (MRS). However, certain methodologic details that can facilitate widespread clinical as well as investigational application of their prediction model are not clear to us. In the study by Smith et al. [1], new contrast-enhancing lesions in 13 of the 33 patients were classified on the basis of histopathology. However, of these 13 patients, the exact number of patients in whom the outcome of the lesion was determined by stereotactic biopsy is not evident. Furthermore, we do not know whether the part of the lesion biopsied corresponded to the 1 × 1 × 1 cm voxel from which the highest metabolite ratios were obtained during 2D MRS. This knowledge is critical because new contrastenhancing lesions in clinical practice most often tend to be a heterogeneous mixture of tissue components (tumor and treatmentinduced necrosis) regardless of whether the disease is a tumor or radiation necrosis [2]. In such lesions, biopsy is known to miss tumor cell clusters because of inherent tissuesampling error [3]. In fact, even morphologically intact tumor cells in a biopsy sample may not consistently indicate tumor recurrence because the tumor cells may not be viable after treatment [4]. In addition, data about the grade of recurrent tumor (whether the same grade as the primary tumor or higher) are pertinent because metabolite ratios are known to vary between different grades of glioma [2]; hence, the validity of the proposed prediction model may be influenced by this information. Moreover, in the 20 patients in whom the outcome of the new lesion was determined by imaging follow-up, it would be useful to know whether any treatment was administered between the initial MRS examination and the subsequent follow-up MRI. The variable effect of chemotherapy on the imaging appearance of the newly detected lesions during the subsequent follow-up period can render final characterization of these lesions extremely tricky (Fig. 1). The experience of Smith et al. [1] in tackling the confounding effect of treatment given during the follow-up period may be extremely valuable to others investigating this intricate problem that continues to be the bane of neurooncology.
Obesity and Increased Risk for Atherosclerosis and Cancer

During obesity and overweight is present in adipose tissue an imbalance in macrophage activation polarization with prevalence of M1 phenotype. This functional phenotype promotes a proinflammatory state characterized by Th1 type response sustained with a mechanism of cross-talk between macrophages and adipocytes. Obesity-related dysregulation in adipokines secretion and derangement in sex steroid hormone metabolism such as insulin may concur also. These changes may contribute to the development of atherosclerosis and cancer.
ASSESSING SCHOOL ENGAGEMENT: A GUIDE FOR OUT-OF-SCHOOL TIME PROGRAM PRACTITIONERS

BACKGROUND Students who are disengaged from school are at risk for poor academic achievement, skipping classes, sexual activity, substance use, and ultimately dropping out of school. The nation has moved to establish rigorous academic performance standards, such as those required by the No Child Left Behind Act (NCLB). However, some evidence shows that levels of school engagement are declining, and that these engagement levels are particularly low among boys. Just one-half of girls and only 25 percent of boys aged 14-15 were engaged in school in 1999. By 2002, these levels fell further: only 39 percent of girls and 20 percent of boys were reported by their parents to be engaged in school. Out-of-school time programs can play a role in increasing school engagement. , 5
Comparison of respiratory motion artifact from craniocaudal versus caudocranial scanning with 64-MDCT pulmonary angiography.

OBJECTIVE The purpose of this article is to compare respiratory motion artifact between craniocaudal versus caudocranial 64-MDCT acquisition for CT pulmonary angiography. MATERIALS AND METHODS We retrospectively reviewed 100 consecutive emergency radiology CT pulmonary angiography examinations acquired on a 64-MDCT scanner between April 2007 and February 2008 for two groups of patients: caudocranial acquisition (mean age, 50.5 years; range, 16.6-84.2 years; mean [+/- SD] scan duration, 9.1 +/- 1.1 seconds) and craniocaudal acquisition (mean age, 56.5 years; range, 22.4-94.2 years; mean scan duration, 7.1 +/- 0.9 seconds). Two blinded readers reviewed randomized coronal reformatted images in lung windows and scored the severity of respiratory motion artifact in the upper, middle, and lower lung zones on a 4-point scale (0, no artifact; 1, mild; 2, moderate; and 3, severe). Caudocranial versus craniocaudal differences in artifact severity were assessed using the concordance statistic. The Student's t test was used to compare incidence of diagnostically limited examinations containing moderate or severe artifact. RESULTS There were no statistically significant differences between scans obtained in the caudocranial versus craniocaudal scan direction in any lung zone or on the basis of the most severe artifact score per patient (p > 0.3). There were no significant differences between the groups with regard to the incidence of diagnostically limited scans (p > 0.25) containing either moderate or severe artifact. CONCLUSION Craniocaudal CT pulmonary angiography multislice acquisition with a slight decrease in scan duration had a similar degree of respiratory motion artifact to caudocranial scanning, performing equivalently in all lung zones and on an overall patient-by-patient basis.
Axial oblique CT to assess femoral anteversion.

OBJECTIVE The objective of our study was to compare anteversion measurements of a human cadaveric femur obtained using axial CT slices with axial oblique reformations along the femoral neck and assess how accuracy changes across a range of simulated femur positions. CONCLUSION Axial oblique reformations allow more accurate anteversion assessment than axial images with femoral flexion, extension, and internal and external rotation. Centers should consider replacing the standard straight axial technique with the axial oblique method for CT determination of femoral anteversion.
Tamoxifen-related chronic aphthous stomatitis: Case report

Tamoxifen-related chronic aphthous stomatitis: Case report Tamoxifen is a member of the selective estrogen modulator (SERM) family. SERMs exert selective agonist or antagonist effects on various estrogen target tissues. Tamoxifen is used as an adjuvant treatment in early and advanced breast cancer patients. Aphthous oral ulcers are painful lesions of the oral mucosa and are common in the general population. Usually the etiology is unknown. Herein we present a patient with breast cancer who had recurrent oral aphthous lesions that occurred following tamoxifen treatment.
Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of breast tumors.

OBJECTIVE The purpose of our study was to evaluate the diagnostic value of an imaging protocol that combines dynamic contrast-enhanced MRI (DCE-MRI) and diffusion-weighted imaging (DWI) in patients with suspicious breast lesions and to determine if additional information provided by DWI improves the diagnostic value of breast MRI. MATERIALS AND METHODS Eighty-four patients with breast tumors (37 benign, 47 malignant) underwent DCE-MRI and DWI before biopsy. Morphologic and kinetic analyses were performed on DCE-MRI and findings were classified according to the BI-RADS lexicon. Apparent diffusion coefficient (ADC) values were calculated from the DWI. The ADCs of the benign and malignant lesions were compared. For the combined MRI protocol, morphologic kinetic features and ADCs were evaluated together. Diagnostic values of DCE-MRI, DWI, and combined MRI were calculated. RESULTS Median ADCs of the benign and malignant lesions were 1.26 × 10(-3) mm(2)/s and 0.75 × 10(-3) mm(2)/s, respectively. Cutoff value of 0.92 × 10(-3) mm(2)/s for ADC provided 91.5% sensitivity and 86.5% specificity. DCE-MRI alone showed 97.9% sensitivity and 75.7% specificity. The combination of DCE-MRI with DWI provided 95.7% sensitivity and 89.2% specificity. The specificity of breast MRI improved by 13.5% (p = 0.063) without a significant decrease in the sensitivity (p = 1.000). CONCLUSION The combination of DWI and DCE-MRI has the potential to increase the specificity of breast MRI.