Miracle-dz/UniFAR-FTUs huggingface dataset:
Primary site surgery for elderly patients with distant metastatic pancreatic neuroendocrine tumor: to do or not to do?

Objective To investigate the effect of primary site surgery (PSS) on elderly patients (≥65 years) with pancreatic neuroendocrine tumor (pNET) distant metastasis. Patients and methods We reviewed Surveillance Epidemiology and the End Results database for elderly patients with distant pNET from 1973 to 2015. The variables and survival outcomes of patients with PSS were compared with that of patients with no PSS. After propensity score matching, the survival outcome was compared again between the two groups. Multivariable Cox proportional hazard model was used to identify variables associated with cancer-specific and overall survival. Four sub-groups were divided according to the age and differentiation: 1) age 65–74 years+ well or moderately differentiated; 2) age ≥75 years+ well or moderately differentiated; 3) age 65–74 years+ poorly differentiated or undifferentiated; and 4) age ≥75 years+ poorly differentiated or undifferentiated. Cancer-specific survival was compared between the patients with and without PSS in the above each group. Results A total of 210 elderly patients with distant pNET were finally confirmed. Of which, 148 patients did not undergo PSS, while 62 patients underwent PSS. Being female (p=0.049), locating on body/tail of pancreas (p=0.006), and well or moderately differentiated (p=0.032) were more likely received PSS. The patients underwent PSS had better survival outcomes both before and after propensity score matching. Multivariable Cox proportional hazard analysis proves PSS and higher histological grade to be protective and risk factors. PSS may improve cancer specific survival in patients of group 1), and no improvement was observed in patients of the other three sub-groups. Conclusion Not all elderly patients with pNET distant metastasis could benefit from PSS. Patients aged 65–74 years with well or moderately differentiated may benefit from primary lesion surgery, but should be evaluated carefully. Prospective randomized controlled trials are worth performing.
Impact of Identifying the Causative Agent of Sepsis From Blood Cultures on Treatment Cost

Objective: The aim of this study is to determine the impact of identifying the causative agent from blood cultures on treatment cost among septic patients in intensive care units of a tertiary care hospital. Methods: A total of 88 sepsis episodes developing in 53 patients from December 2015 to March 2016 were evaluated retrospectively. Thirty-seven episodes in which the causative microorganisms were isolated from blood cultures (positive episode: case group) were compared with 37 episodes with negative blood cultures (negative episode: control group) in terms of treatment cost. Reimbursement for the expenses were calculated to figure out the cost of the treatment in both groups. Statistical analyses were done using Statistical Package for the Social Sciences (SPSS) for Windows. Version 15.0 (SPSS Inc., Chicago, IL, USA) software. Results: Among 88 sepsis episodes, the expenses to treat sepsis consisted of the 39.2% of all treatment expenditures. 50.2% of expenses for drugs, %35.4 of expenses for diagnostic interventions, 57.7% of expenses for imaging studies, 23.8% of expenses for medical devices, 34.8% of expenses for hospital stay, and 26.5% of other expenses were in consequence of sepsis. In the positive episode group, total expenditure (9020.88 TL vs. 12 663.61 TL, p=0.07) and the expenses for drugs, diagnostic tests, imaging studies, medical devices, hospitalization, and other items were all lower than the control group. This difference was significant for hospital bed costs (p=0.011). Özet Amaç: Bu çalışmanın amacı bir üçüncü basamak hastanenin yoğun bakım ünitelerinde sepsis gelişen hastalarda kan kültüründe etken üretilmesinin tedavi maliyetleri üzerine etkisinin araştırılmasıdır. Yöntemler: Çalışmada Aralık 2015-Şubat 2016 arasında 53 hastada gelişen toplam 88 sepsis atağı retrospektif olarak incelenmiştir. Kan kültüründe infeksiyon etkeninin üretildiği 37 atağa (pozitif atak: vaka grubu) karşılık, infeksiyon etkeni üretilemeyen 37 atak (negatif atak: kontrol grubu), tedavi maliyetleri bakımından karşılaştırılmıştır. Her iki gruptaki tedavi maliyetleri, geri ödeme kurumu (Sosyal Güvenlik Kurumu) perspektifi kullanılarak hesaplanmıştır. İstatistiksel analizler, Statistical Package for the Social Sciences (SPSS) for Windows. Version 15.0 (SPSS Inc., Chicago, IL, ABD) programı yardımıyla yapılmıştır. Bulgular: 88 atakta sepsis tedavisi için yapılan harcamalar, toplam tedavi maliyetinin %39.2’sini oluşturmaktadır. Sepsis için yapılan harcamalar, maliyet türlerine göre incelendiğinde, harcamaların %50.2’si ilaç için, %35.4’ü tetkik için, %57.7’si görüntüleme için, %23.8’i tıbbi malzeme için, %34.8’i yatak ücretleri için ve %26.5’i diğer harcamalar için yapılmıştır. Pozitif atak grubunda, genel toplam maliyetin (9020.88 TL’ye karşılık 12 663.61 TL, p=0.07) yanı sıra; ilaç, tetkik, görüntüleme, tıbbi malzeme, yatak ücretleri ve diğer kalemler için yapılan harcamalar, kontrol grubu için yapılanlardan daha düşüktür. Bu fark, yatak maliyeti için istatistiksel olarak anlamlıdır (p=0.011). Özgün Araştırma / Original Article
The relationship between the surgical Apgar score and postoperative complications in patients admitted to an intensive care unit after surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright c the Korean Society of Anesthesiologists, 2019 The relationship between the surgical Apgar score and postoperative complications in patients admitted to an intensive care unit after surgery
Proportion of needle stick injury and its characteristics among nursing staffs in a tertiary care teaching hospital in Trivandrum, South India

Introduction: A cross-sectional study was conducted among health care workers (Nurses) at a tertiary care hospital in Trivandrum, Kerala to study the proportion of needle stick injury and associated factors. A semi structured questionnaire was used to collect data from the study participants at their work place. Participants were asked to recall needle stick injuries (NSIs) in the preceding 6 months and definition of needle stick injury was formulated. Factors such as work experience, type of procedure, action taken following injury etc were also studied. Results: The prevalence of NSIs was 94(47%). Mean age of 200 participants was 32.8 years (+ 6.8), all were female. Emergency department accounted for highest (62.8%) of NSIs. & it was maximum (42.6%) during injection procedure. Heavy work load (37.2%) followed by inattention (32%) were prime causes. Following injury 34% of nurses washed injury site with soap & water and applied antiseptics as well. usage of personal protective equipment(PPE) was 84%. Prime causes for not using PPEs were lack of supply and inappropriate size of gloves respectively. Usage of PPEs were found to be significant in preventing NSIs. Conclusion: Prevalence of NSI is high and measure for safety concern. There is urgent need of close monitoring and implementation of uniform NSIs programme like safe practices, safe disposal of sharps, mandatory reporting of needle stick injury at work station. Provision of post exposure prophylaxis following NSIs. Limitation: Small sample size, purposive-sampling and impact of information broacher regarding NSIs could not be accessed.
Intralesional Vitamin D3 versus Purified Protein Derivatives in The Treatment of Multiple Cutaneous Warts: Comparative Study

Background: Viral warts are caused by human papillomavirus. Many therapeutic options are available for treating warts. Newer and effective treatments include intralesional immunotherapy, has been tried in the recent times with variable success rates. Objective: The aim of this study was to compare the effect of intralesional vitamin D3 versus purified protein derivative (PPD) in the treatment of multiple cutaneous warts. Methods: A total of 62 patients were included in the study, each patient had at least 3 common warts, one or more of them injected with 0.1 of intralesional PPD, one or more injected with 0.5 of vitamin D3 and one or more were control according to number of warts of each patient and up to 4 sessions. The clinical assessment was done by photographic measurements at baseline, before each treatment session, and after the completion of treatment. Results: In PPD-injected lesions. 43 patients (69.4%) showed complete clearance (100%) and 13 patients (20.9%) showed partial response (25% - 99%). While, in vitamin D3-injected lesions, 22 patients (35.5%) showed complete clearance while 21 patients (33.9%) showed partial response. On comparing between PPD, vitamin D3 and control, both PPD and vit D3 were statistically significant compared to control and PPD was more statistically significant than vit D3 (P3 = 0.019) in effectiveness and less in recurrence rate. Conclusions: PPD and vitamin D3 were found to be effective, well-tolerated modalities of treatment of multiple common warts. Intralesional PPD was more statistically significant in effectiveness and less in recurrence rate than intralesional vitamin D3.
Procedural Terrain Generation and Path Searching in Education

Abstract This paper is primarily devoted to development of an educational desktop application, that describes terrain generating and pathfinding to students. The application is meant for lessons of Artificial Intelligence, that is one of compulsory optional subjects on Department of Informatics and Computers, University of Ostrava. Selected implemented algorithms enable to generate a terrain with adjustable parameters in three different implementations and it also enables pathfinding in three different ways. Used methods are compared according to different criteria for better understanding. Algorithms used in the application for terrain generating are fault method, hill algorithm and value noise. For pathfinding, there were used Dijkstra algorithm, A* and breadth-first search. The application enables camera movement around the terrain and graphical projection of costs of edges for pathfinding.
Insight in Scheduling Choices:A Visualisation Tool for SDF Graphs

Modern streaming applications are becoming increasingly demanding, requiring higher throughput, smaller buffer sizes and execute on less resources. Synchronous dataflow (SDF) graphs are a widely used formalism for the analysis of data flow in streaming applications, for both single processor and multiprocessor applications Despite state of the art scheduling methods for SDF graphs very little visualisations options are available for people who work with SDF graphs. Interviews have shown that these tools are self made and not very matured, even though they desire to have such tools. Therefore this project has developed a visualisation tool for SDF schedules called SDF Fish. The tool can load in data files of schedules and visualise these. The visualisations exist out of a Gantt-like chart and a snapshot visualisation of the resources. Users can navigate through the schedules by time controls. Furthermore, an automatic play function is featured. In order to provide overview for bigger schedules the tool offers zoom scale and filter capabilities.
The association of Q472H variant in the KDR gene with recurrent pregnancy loss in Southern Iran: A case-control study

Abstract Background Recurrent spontaneous abortion (RSA) often remains unclear and can be burden for the patient and time consuming for clinician. RSA may initiates from a genetic or non-genetic factors. It is well known that the quality of placental circulation is critical for implantation and embryo development. Because of angiogenic effects of VEGF–KDR pathway on placenta, the genes involved in this pathway (the KDR or VEGFR genes) are thought to be linked with RSA. Objective The aim of this study was to investigate the relationship between Gln472His (A/T) polymorphism of the KDR gene with RSAs in southern Iran. Materials and Methods In this case-control study, 50 aborted embryonic tissue obtained from fetuses and 50 umbilical cord blood of newborn babies were studied. Fetal sample from mothers with history of at least two consecutive miscarriages and controls from mothers who had at least one full-term infants born were taken. Genomic DNA was extracted by using PureLink genomic DNA kit (Life Technologies, CA). The Rotor-Gene Q real-Time PCR machine and High-resolution melting curve analysis (HRM) technique were used for genotyping. Results Based on the AA genotype as reference, it is shown that the T allele (OR = 2.447, 95% CI = 1.095–5.468, p = 0.029) as well as AT heterozygote genotype was significantly associated with an increased risk of miscarriage (OR = 2.824, 95% CI = 1.210-6.673, p = 0.016). Conclusion A positive correlation between Q472H polymorphism of the KDR gene and RSA may be the cause in southern Iran.
More Rapid Sleep Onset with Lingual-Spray vs Oral-Tablet Delivery Zolpidem

Insomnia and related sleep disorders (somnipathies) affect a large segment of the population, and result in a significant negative impact on quality of life and reduced or lost productivity. The speed of sleep onset is a critical characteristic of successful pharmacotherapeutic intervention for insomnia. Zolpidem, a non-benzodiazepine benzodiazepine receptor agonist (nBzRA) is widely used to treat insomnia. Although not itself a benzodiazepine (BZD), zolpidem has high binding affinity for the benzodiazepine receptor, which acts as a positive allosteric modulator of the GABAA receptor complex. It therefore increases the neuronal transmembrane influx of Cl- ions, thereby decreasing neuronal excitability and promoting sleep. In this four-way crossover, dose-ranging, multiple-treatment study, a lingual spray formulation of zolpidem was safe and well-tolerated and yielded more rapid pharmacokinetics (mean plasma concentration) and efficacy (visual analog scale and digit symbol substitution test) compared to oral tablets.
Surgical Treatment of Traumatic Type II Odontoid Fracture Using Polyaxial C1 Lateral Mass and C2 Pedicle Screws Fixation

Background Data: Posterior atlantoaxial fixation is indicated for C1-C2 instability or painful osteoarthritis. Different techniques were designed for atlantoaxial fixation as sublaminar wiring, transarticular screw fixation, and, recently, C1 lateral mass and C2 pedicle polyaxial screws and rod system. Purpose: To investigate the safety, advantages, and complications of posterior atlantoaxial fixation with polyaxial C1 lateral mass and C2 pedicle screws in C1-C2 instability. Study Design: A retrospective clinical case series. Patients and Methods: Fourteen consecutive patients, ten males and four females, with a mean age of 40.8±9.6 years were reported. All had traumatic C1-2 instability due to type II odontoid fractures and underwent posterior fixation with polyaxial C1 lateral mass and C2 pedicle screws. Nine patients suffered from motor vehicle accident (MVA) and 5 suffered from falls. All patients were neurologically intact except four patients who had neurological deficits. We used Japanese Orthopedic Association Score (JOA) for their functional evaluation. The average follow-up was 17±1.96 (range, 12–20 months). Operative time, operative blood loss, screw trajectory, screw length, and injury of neurovascular structures were reported. Fusion and construct stability were evaluated by plain radiography and/or CT. Visual Analogue Scale (VAS) of neck pain and JOA were used to evaluate the functional outcome. Results: The mean duration of surgery was 175.3±12.3 min. The mean blood loss was 553.6±106.5 ml and two patients required transfusion of one unit of blood. The mean length of C1 lateral mass and C2 pedicle screws were 30±1.6 mm and 16.4±1.8 mm, respectively. Correct screw placement and good stability were reported in all patients (100%) at the last follow-up. Mean neck pain on VAS was 2.8±0.8 and 2.3±0.5 at 6 and 12 months, respectively. The complications included moderate pain at iliac graft site for 3 months in 2 patients, pain and dysesthesia in C2 dermatome for 4 months in 3 patients, and superficial wound infection in 2 patients. Conclusion: Posterior atlantoaxial fixation with polyaxial C1 lateral mass and C2 pedicle screws is a safe and effective method in the treatment of traumatic atlantoaxial subluxation due to type II odontoid fractures. (2019ESJ176)
Factors Affecting Smoking Cessation Among Adolescents - An Application of Theory of Planned Behavior

: Smoking has become one of the biggest problems facing adolescents. The Theory of Planned Behavior is widely applied to predict and support behavior changes. Despite this, there is no sufficient study that considers the factors influencing smoking cessation among adolescents. The purpose of this study was to investigate attitudes, subjective norms, perception and self-efficacy relevant to smoking cessation through an application of the Theory of Planned Behavior. This study design used a cross-sectional approach. A total of 139 school-going adolescents completed a questionnaire to measure attitudes, subjective norms, perception, self-efficacy and intention for smoking cessation. Data were analyzed by using the statistical test Spearmen rho. The study showed that attitudes, subjective norms, perception and self-efficacy are significantly important regarding intention of smoking cessation (p = 0.000). Smoking cessation by adolescents is affected by multiple factors. In addition, understanding an application of the Theory of Planned Behavior helps adolescents quit smoking effectively. Further research should involve the various influencing factors such as social environment and attitudinal cognitions.
Tracking maneuver target using interacting multiple model-square root cubature Kalman filter based on range rate measurement

The problem of maneuvering target tracking is a hot issue in the field of target tracking. Due to the range rate measurement containing the maneuvering information of target, it has the important practical significance to study how to use the range rate measurement to improve the effect of maneuvering target tracking. In the framework of interacting multiple model algorithm, the range rate measurement is used to update target state estimate and the probability of motion model to improve the tracking performance. As the measurement equation including the range rate measurement is strongly nonlinear, square root cubature Kalman filter algorithm is selected as the filter in interacting multiple model algorithm. The normal acceleration is deduced from the range rate with the reality constraint. And through Monte Carlo simulation, the empirical distribution functions of the normal acceleration statistics corresponding to different motion models are obtained. Their approximate distribution functions are obtained by the use of the expectation maximization algorithm with Gaussian mixture model. Then the probability distribution and probability distribution of measurement prediction residual are combined into a new likelihood function to improve the efficiency of updating the model probability. The experimental results show that the interacting multiple model algorithm proposed in this article has the smaller root mean square error of position and velocity and has the smaller average Kullback-Leibler divergence of model probability during the motion model stable phase.
Naturally Derived Formulations and Prospects towards Cancer

Traditional Medicine (TM) and their secondary metabolites are being increasingly recognized as useful complementary treatments toward the cancer. A large number of clinical studies have reported and proven concern of cancer patients. Here we have also reported recent studies on the biochemical and cellular mechanisms of Traditional Medicine (TM). Nowadays, Chemotherapy and surgery are standard methods for treatment of cancer, but still it’s not been fully successful. Some progress has been made in cancer diagnosis and treatment, but high incidence rate of cancer and low survival rate of patient are still being reported worldwide. Since ancient times, a number of traditional medicines known as Ayurveda, Siddha, Unani, Iranian, Chinese, Korean, acupuncture, Muti, Ifa, and African medicine are widely used for therapeutic purposes and are becoming popular as Traditional Medicine (TM). It has been reported that plants synthesize plethora of “secondary metabolites” or “phytochemicals”, proven to possess anti-mutagenic and anti-cancer properties in many research studies. There are many possibilities for further organized research for screening of medicinal plants for their potential and efficacy against chronic diseases such as a cancer and other inflammatory diseases. Therefore, researcher’s interest should be in identification and standardization of new anti-cancer drug with low side effects and greater efficacy, that is easily acceptable in medical community and which may overcome the challenges in present and future cancer therapy. This review explores therapeutic value of certain bio-active principals of plant which could serve as potential pharmacologically active drug for treatment of cancer in future.
Directly Acting Oral Anticoagulants for the Prevention of Stroke in Atrial Fibrillation in England and Wales: Cost-Effectiveness Model and Value of Information Analysis

Objectives. Determine the optimal, licensed, first-line anticoagulant for prevention of ischemic stroke in patients with non-valvular atrial fibrillation (AF) in England and Wales from the UK National Health Service (NHS) perspective and estimate value to decision making of further research. Methods. We developed a cost-effectiveness model to compare warfarin (international normalized ratio target range 2–3) with directly acting (or non–vitamin K antagonist) oral anticoagulants (DOACs) apixaban 5 mg, dabigatran 150 mg, edoxaban 60 mg, and rivaroxaban 20 mg, over 30 years post treatment initiation. In addition to death, the 17-state Markov model included the events stroke, bleed, myocardial infarction, and intracranial hemorrhage. Input parameters were informed by systematic literature reviews and network meta-analysis. Expected value of perfect information (EVPI) and expected value of partial perfect information (EVPPI) were estimated to provide an upper bound on value of further research. Results. At willingness-to-pay threshold £20,000, all DOACs have positive expected incremental net benefit compared to warfarin, suggesting they are likely cost-effective. Apixaban has highest expected incremental net benefit (£7533), followed by dabigatran (£6365), rivaroxaban (£5279), and edoxaban (£5212). There was considerable uncertainty as to the optimal DOAC, with the probability apixaban has highest net benefit only 60%. Total estimated population EVPI was £17.94 million (17.85 million, 18.03 million), with relative effect between apixaban versus dabigatran making the largest contribution with EVPPI of £7.95 million (7.66 million, 8.24 million). Conclusions. At willingness-to-pay threshold £20,000, all DOACs have higher expected net benefit than warfarin but there is considerable uncertainty between the DOACs. Apixaban had the highest expected net benefit and greatest probability of having highest net benefit, but there is considerable uncertainty between DOACs. A head-to-head apixaban versus dabigatran trial may be of value.