Miracle-dz/UniFAR-FTUs huggingface dataset:
Development of quality indicators for chronic obstructive pulmonary disease (COPD): A modified RAND appropriateness method

Abstract RATIONALE: Quality indicators are evidence-based structures, processes and outcomes of care associated with such a strong benefit that failure to address them reduces likelihood of good health outcomes. OBJECTIVES: Our objective was to use synthesized evidence and diverse expert opinion to create a comprehensive set of evidence-based COPD quality indicators spanning the health care continuum from prevention to outcome. METHODS: COPD quality indicators were developed using a modified RAND Appropriateness Method consisting of a systematic review of the medical literature followed by a Delphi method survey. The review took place in three parts: searching first for existing high quality COPD quality indicators, then for meta-analyses and systematic reviews and, lastly, for individual studies. The Delphi method had an expert panel rate and discussed the indicators in an in-person meeting followed by rounds of electronic surveys until consensus was reached. RESULTS: The systematic review produced 26 highly rated quality indicators, and 10,002 titles for further assessment. Of these, 32 full-text articles provided supporting evidence for 39 additional COPD quality indicators, for 65 in total. After rounds of review by the expert panel, a final list of 33 quality indicators was endorsed by all. CONCLUSIONS: We generated a comprehensive set of 33 evidence-based COPD quality indicators. These can be used to measure current quality of COPD health and healthcare, develop and implement strategies to improve it and otherwise provide a foundation for quality improvement. Before using in other jurisdictions, these made-in-Canada indicators should be validated to ensure they address their unique circumstances.
Relation Extraction from Clinical Narratives Using Pre-trained Language Models

Natural language processing (NLP) is useful for extracting information from clinical narratives, and both traditional machine learning methods and more-recent deep learning methods have been successful in various clinical NLP tasks. These methods often depend on traditional word embeddings that are outputs of language models (LMs). Recently, methods that are directly based on pre-trained language models themselves, followed by fine-tuning on the LMs (e.g. the Bidirectional Encoder Representations from Transformers (BERT)), have achieved state-of-the-art performance on many NLP tasks. Despite their success in the open domain and biomedical literature, these pre-trained LMs have not yet been applied to the clinical relation extraction (RE) task. In this study, we developed two different implementations of the BERT model for clinical RE tasks. Our results show that our tuned LMs outperformed previous state-of-the-art RE systems in two shared tasks, which demonstrates the potential of LM-based methods on the RE task.
[Analysis of risk factors for necrosis of femoral head after internal fixation surgery in young and mid-aged patients with femoral neck fracture].

OBJECTIVE To retrospectively analyze the risk factors of avascular necrosis of femoral head (ANFH) after internal fixation in young and mid-aged adults. METHODS From January 2007 to December 2017, femoral neck fracture patients (18-60 years old) treated by reduction and internal fixation were retrospectively studied in Peking University Third Hospital. We recorded their gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) grade, reason of injury, fracture side, interval between injury and surgery, location of fracture line, Garden classification, Pauwels classification, reduction method (open or closed), internal fixation and reduction quality. The diagnosis of ANFH was confirmed based on X-ray and MRI images during the follow-up. The internal fixation method included cannulated compression screw (CCS) or dynamic hip screw (DHS, with or without anti-rotation screw). χ2 test and Logistic regression analysis were used to analyze the relationship between the various factors and postoperative ANFH. RESULTS A total of 113 patients were included in this study, including 63 males and 50 females with an average age of (43.17 ± 12.34) years. They were followed up by (25.08 ± 16.17) months. ASA grade included grade I (21 cases), grade II (55 cases) and grade III (37 cases). The reasons of injury included low-energy trauma (76 cases) and high-energy (37 cases). The fracture line included subcapital type (37 cases), transverse type (74 cases) and basal type (2 cases). Garden classification included type I (3 cases), type II (46 cases), type III (39 cases) and type IV (25 cases). Pauwels classification included type I (21 cases), type II (55 cases) and type III (37 cases). Interval between injury and surgery was (3.88 ± 3.66) days, 108 patients and 5 patients performed closed and open reduction respectively. 63 patients performed CCS, and 50 patients performed DHS. The reduction quality included grade A (91 cases), grade B (18 cases) and grade C (4 cases). 18 patients developed ANFH after surgery, the incidence rate was 15.93% (18/113). The result of χ2 test showed the reason of injury (OR=0.19, P < 0.01), Garden classification (OR=0.13, P < 0.01), Pauwels classification (OR=0.12, P = 0.02), internal fixation method (OR=3.29, P = 0.04) and reduction quality (OR=0.33, P < 0.01) were significantly associated with ANFH. These five factors were further included into the Logistic regression analysis, and its results showed that the reason of injury (OR=4.11, P = 0.03) and Garden classification (OR=4.85, P = 0.04) were statistically significant. CONCLUSION The reason of injury, Garden classification, Pauwels classification, internal fixation and reduction quality may increase the risk of ANFH after surgery, and the reason of injury and Garden classification were much more significant.
Ceramide launches an acute anti‐adhesion pro‐migration cell signaling program in response to chemotherapy

Chemotherapy has been reported to upregulate sphingomylinases and increase cellular ceramide, often linked to the induction to cell death. In this work, we show that sublethal doses of doxorubicin and vorinostat still increased cellular ceramide, which was located predominantly at the plasma membrane. To interrogate possible functions of this specific pool of ceramide, we used recombinant enzymes to mimic physiological levels of ceramide at the plasma membrane upon chemotherapy treatment. Using mass spectrometry and network analysis, followed by experimental confirmation, the results revealed that this pool of ceramide acutely regulates cell adhesion and cell migration pathways with weak connections to commonly established ceramide functions (eg, cell death). Neutral sphingomyelinase 2 (nSMase2) was identified as responsible for the generation of plasma membrane ceramide upon chemotherapy treatment, and both ceramide at the plasma membrane and nSMase2 were necessary and sufficient to mediate these “side” effects of chemotherapy on cell adhesion and migration. This is the first time a specific pool of ceramide is interrogated for acute signaling functions, and the results define plasma membrane ceramide as an acute signaling effector necessary and sufficient for regulation of cell adhesion and cell migration under chemotherapeutical stress.
History of Diabetes Mellitus and Risk of Breast Cancer in Asian Women: A Meta-Epidemiological Analysis of Population-Based Cohort Studies

Objectives Previous quantitative systematic reviews conducting subgroup analyses by race have reported that the association between diabetes and breast cancer in Asian women was inconclusive. The aim of this meta-epidemiological study (MES) was to evaluate this association from additional population-based cohort studies. Methods The potential subjects of this MES were six Asian cohort studies selected by previous systematic reviews. Additional reports were found from the selected articles using citation discovery tools. The study with the longest follow-up period was selected among prospective studies of the same cohorts. A summary relative risk (sRR) and its 95% confidence intervals (CI) were calculated using random effect models. Results Four cohort studies on Asian women were finally selected. The participants were from the women population of Korea, Japan, China, and Taiwan and included a total of 1,448,254 women. The sRR (95% CI) (I-squared value) was 1.20 (0.98–1.46) (63.1%). Conclusions This MES found that the history of diabetes mellitus was not associated with the risk of breast cancer in Asian women. As breast cancer in this population develops at a younger age, additional cohort studies are necessary to conduct a subgroup analysis by menopausal status at diagnosis of breast cancer in Asian women.
Prognostic factors of good response to DMARDs in psoriatic arthritis: a narrative review

ABSTRACT Introduction The management of Psoriatic arthritis (PsA) has evolved in the last decade with a significant increase in treatment options making the choice for clinicians difficult. Thus, the different factors of good prognosis for each treatment are presented in this review. Areas covered Current available treatment and assessment tools for the response of treatment are presented. A systematic review of the literature, on Pubmed, Medline and Cochrane databases and abstracts from the last three EULAR and ACR annual conferences was performed. Factors associated with a good response to csDMARDs, tsDMARDs and bDMARDs are presented. Expert opinion Dactylitis and axial involvement are associated with a poor response to methotrexate. Leflunomide has shown better efficacy in the presence of established polyarticular involvement. TNF inhibitors are to be preferred in young men with an elevated CRP while obesity, high disease activity and long disease duration are factors associated with poor response. Apremilast and ustekinumab are more effective in mono and oligo articular disease. Abatacept is more effective in patients with high CRP, high disease activity and polyarticular involvement. Finally, there are no available data with the anti IL17 These factors are some arguments to help clinicians, but comparative study are needed to conclude.
Maternal Obesity and Diabetes Mellitus as Risk Factors for Congenital Heart Disease in the Offspring

Abstract Congenital heart disease (CHD) is the most common anatomical malformation occurring live‐born infants and an increasing cause of morbidity and mortality across the lifespan and throughout the world. Population‐based observations have long described associations between maternal cardiometabolic disorders and the risk of CHD in the offspring. Here we review the epidemiological evidence and clinical observations relating maternal obesity and diabetes mellitus to the risk of CHD offspring with particular attention to mechanistic models of maternal‐fetal risk transmission and first trimester disturbances of fetal cardiac development. A deeper understanding of maternal risk factors holds the potential to improve both prenatal detection of CHD by identifying at‐risk pregnancies, along with primary prevention of disease by improving preconception and prenatal treatment of at‐risk mothers.
Anti-obesity activity of Vitis vinifera by butter and progesterone induced models

Objective: The prevalence of obesity-associated comorbidities, enhance the risk for predominant health problems such as diabetes, osteoarthritis, and certain cancers. Natural product based intervention has been one of the crucial strategies for management of obesity ailments. The study was intended to investigate the anti-obesity activity of ethanolic extract of Vitis vinifera in butter and progesterone induced obese rats. Materials and Methods: Leaves of V. vinifera were subjected to Soxhlet extraction with alcohol. Obtained alcoholic extract was subjected to phytochemical screening and acute toxicity studies. In progesterone induced obesity model progesterone (10 mg/kg), standard drug, sibutramine (10 mg/kg), and V. vinifera (200 mg/kg, 400 mg/kg) were administered for 28 days. On the 29th day, blood samples were isolated for assessing biochemical parameters such as glucose, triglyceride (TG), highdensity lipoprotein (HDL), low-density lipoprotein (LDL), very LDL (VLDL), serum glutamate oxaloacetate transaminase (SGOT), and serum glutamate pyruvate transaminase (SGPT). Liver was isolated for histopathological studies. In Butter induced obesity model, 400 mg/kg butter, standard drug, atorvastatin (10 mg/kg), and V. vinifera (250 mg/kg and 500 mg/kg) were administered for 21 days. After 21 days blood was withdrawn for estimating LDL, VLDL, HDL, cholesterol, and TG. Results: Phytochemical screening revealed the presence of glycosides, alkaloids, flavonoids, steroids, and tannins. By acute toxicity studies, V. vinifera was found to be safe up to 1500 mg/kg. In progesterone induced obesity model, sibutramine and V. vinifera significantly (P < 0.01) decreased glucose, TC, TG, LDL, VLDL, SGOT, and SGPT along with an increase in HDL. In butter induced obesity model, atorvastatin and V. vinifera significantly (P < 0.01) decreased glucose, TC, TG, LDL, and VLDL level long with significant increase in HDL. Histopathological studies revealed reduced necrosis and fatty changes of liver in sibutramine (10 mg/kg), and V. vinifera (200 mg/kg and 400 mg/kg) treated group compared to progesteronetreated group. Conclusion: Results of the study reveal anti-obesity activity of V. vinifera.
Validation of Two Point of Care Devices for Hemoglobin Estimation in Blood Donors

Abstract Hemoglobin (Hb) estimation is a critical investigation in prospective blood donors. There are numerous techniques for Hb estimation, choosing an appropriate method is essential. Point of care devices (POC) have made quantification of Hb possible even in the field or community settings. Validation against a standard measure is necessary before implementing it for routine practice. With this background, we aimed to validate two new POC devices against a standard hematology analyzer for Hb estimation. An observational study on 100 donor venous blood samples was conducted. Hemoglobin was estimated using a Sysmex Hematology Analyzer (reference method) along with POC devices (CompoLab TM and True Hb Hemometer). Three statistical techniques were applied to validate Hb by the two POC devices. CompoLab TM measures 0.4 units more than the reference method and True Hb measures 0.4 units less than the reference method. Measures of Hb obtained from both the equipment showed moderate agreement with that of reference method (CompoLab TM ICC-0.74 and True Hb ICC-0.72). There were no systematic or proportional differences in the comparison of the two POC devices with the reference method. Within the limitations of this study, both the devices can be used for Hb estimation, as there was a substantial agreement of the measurements with the reference method. Other factors such as cost, turnaround time (TAT), ease of utilization should be considered to decide on the choice of equipment to be used.
Patient Decision Making Related to Maternal and Childhood Vaccines: Exploring the Role of Trust in Providers Through a Relational Theory of Power Approach

Immunization is one of the most effective ways to prevent infectious diseases. However, vaccination rates are suboptimal in the United States. Obstetric providers are critical in influencing vaccine decision making among pregnant women, as trust between a patient and provider may facilitate willingness to accept vaccination. Little is known about how power between a patient and provider affects vaccine acceptance. This study explored pregnant women’s trust in obstetric providers within the context of vaccines. Using concepts from the relational theory of power, we conducted 40 in-depth interviews with a purposive sample of pregnant women from four Ob-Gyn practices each in Georgia and Colorado. Results suggest that to enhance trust, providers could gain distributive power by conveying empathy. Designated power through medical experience was associated with both trust and distrust, as some women trusted their providers because of their authority and medical credentials, while others viewed authority and experience as reasons to distrust their provider. To increase acceptance, providers should acknowledge the underlying power dynamics within these interpersonal relationships and strengthen rapport with patients through empathy and dialogue.
CORTICOSTEROIDS - ASSETS AND LIABILITIES ON PERIODONTIUM

Corticosteroids are chemically similar to endogenous cortisol and are used fundamentally as replacement therapy in patients with adrenal insufficiency, and used as anti-inflammatory agents. They are widely used in systemic diseases such as rheumatoid arthritis, asthma, and connective tissue disorders. In dentistry primarily these are used to decrease post-operative pain and edema in inflammatory diseases such as oral lichen planus, pemphigus, and recurrent aphthous stomatitis. This action is predominantly due to eicosanoid formation that inhibits phospholipase A2 activity. Corticosteroids can be supplemented either topically systemically or as inhalational therapy. Research suggests that local application of corticosteroids shows favorable effect on the periodontal ligament and possesses antiresorptive effect, but long-term systemic therapy is a risk for periodontal diseases which may provoke attachment loss and disruption of transseptal fibers. Oral manifestations are common with the use of inhaled steroids and are dependent on dose, frequency, duration, and inhaler use. It is commonly associated with ulceration of tongue, buccal mucosa, and occasionally on the gingiva due to xerostomia and immune suppression. It also causes a decrease in bone mineral density. This review explains about various effects of different types of corticosteroids on periodontium used in dentistry.
Cobalt-based Multicomponent Oxygen Reduction Reaction Electrocatalysts Generated by Melamine Thermal Pyrolysis with High Performance in an Alkaline Hydrogen/Oxygen Micro-Fuel Cell.

A series of cobalt-based multicomponent electrocatalysts (Co-Cat-T) for the oxygen reduction reaction (ORR) were synthesized by thermal pyrolysis of activated carbon supported cobalt and melamine mixture from 500-800 °C. Their corresponding electrocatalytic performance was systematically investigated towards ORR in alkaline electrolyte. The electrocatalyst chemical composition and structure evolution (e.g., microstrain, crystallite size and cell volume) were confirmed by XRD Rietveld Analyses. The material generated at 550 °C (Co-Cat-T550) showed the largest cell volume of the C3N4 phase with a crystallite size of 4.1 ± 0.1 nm. Independent of the heat-treatment temperature, the cobalt atom was coordinated to nitrogen moieties. The following findings: cobalt inserted in the carbon nitride framework (Co-g-C3N4), abundant Co-Nx and pyridinic-N species, unique encapsulated cross-tubular structure, and disordered carbon domains performed better in the ORR with Co-Cat-T550 among the obtained electrocatalysts. In addition, Co-Cat-T550 showed performance comparable to Pt/C in an alkaline hydrogen/oxygen micro-fuel cell platform.
Leveraging Contextual Information in Extracting Long Distance Relations from Clinical Notes

Relation extraction from biomedical text is important for clinical decision support applications. In post-marketing pharmacovigilance, for example, Adverse Drug Events (ADE) relate medical problems to the drugs that caused them and were the focus of two recent shared challenges. While good results were reported, there was a room for improvement. Here, we studied two new improved methods for relation extraction: (1) State-of-the-art deep learning contextual representation model called BERT, Bidirectional Encoder Representations from Transformers; (2) Selection of negative training samples based on the "near-miss" hypothesis (the Edge sampling). We used the datasets from MADE and N2C2 Task-2 for performance evaluation. BERT and Edge together improved performance of ADE and Reason (indication) relations extraction by 6.4-6.7 absolute percentage (and error rate reduction of 24%-28%). ADE and Reason relations contained longer text between the entities, which BERT and Edge were able to leverage to achieve the performance improvement. While the performance improvement for medication attribute relations was smaller in absolute percentages, error rate reduction was still considerable.
Improvement in MR quality control workflow and outcomes with a web‐based database

Abstract Purpose To describe a custom‐built, web‐based MR Quality Control (QC) database, and to assess its impact on the QC workflow and outcomes in a large U.S. academic medical center. Methods The MR QC database was built with Microsoft Access 2010 and published on a Microsoft Sharepoint website owned and maintained by the authors' institution. Authorized users can access the database remotely with mainstream web browsers on any institutional computers. QC technologists were granted access to add, review, and print daily and weekly QC records. Qualified medical physicists (QMPs) were granted additional access to edit, review, and approve existing QC records and to change tolerance limits. A macro was utilized to conduct an automatic weekly review of QC status and to email the results to a QMP. This web‐based QC database was implemented on 17 clinical MRIs at the authors' institution. Weekly ACR QC findings within one year before and after implementation were compared. Results We analyzed 158 QC issues detected by the web‐based database and 127 QC issues identified in conventional paper records before we implemented the database. The web‐based database significantly reduced the number of QC issues due to technologist error (before/after: 59/24 cases, P < 0.0001) but did not affect the number of QC issues related to scanner performance (before/after: 49/46 cases, P = 1). Further analysis revealed that the web‐based database significantly reduced the average time for the QMPs to identify a QC issue (before/after: 177 ± 110/2 ± 2 days, P < 0.0001) and time to correction (before/after: 81 ± 102/7 ± 8 days, P < 0.0001). The correction rate also significantly increased (before/after: 22%/99%, P < 0.0001). Conclusion The web‐based QC database provides a positive impact on our MR QC workflow and outcomes. It simplifies QC workflow, enables early detection of quality issues, and facilitates quick resolution of problems that may affect the quality of clinical MRI studies.
Usability Evaluation of an Adaptive Information Recommendation System for Breast Cancer Patients

We report on the usability of a mobile application, MyPath, that connects patients with personalized information based on their diagnosis and care plan and adapts over time as they progress through the cancer trajectory. We conducted usability tests with cancer survivors and health professionals, measuring three usability factors which could be affected by adaptive content: learnability, errors, and effectiveness. Our results indicate that the adaptive information did not obstruct usability of the system. Participants identified several strengths of the application, including the integration of clinical and non-clinical information, the segmentation of a large information set to reduce mental burden, and the inclusion of multiple media types to accommodate different learning styles. Participants also identified potential barriers to use and offered ideas for future developments. We share how we integrated this feedback into the MyPath system design and reflect on lessons for future personal health information systems.