cyrilzakka/clinical-trials huggingface dataset:
the Role of Laparoscopy in Lower Gastrointestinal Surgical Emergencies in Adults.

Introduction: causes of lower abdominal pain caused by various GIT emergencies, including acute appendicitis, intestinal obstruction, acute perforated diverticulitis, obstructed hernia, and iatrogenic colon perforation. The role of Laparoscopy may be of diagnostic and therapeutic value.

Methods: Between April 2017 and April 2020, 793 patients were admitted to Zagazig University Hospital's emergency surgery unit with lower GIT emergencies, including acute appendicitis, acute intestine obstruction, complicated colonic diverticulum, complicated hernias, and iatrogenic colonic perforations.

An acute lower abdomen is typically caused by peritoneal irritation caused by an abdominal organ's inflammation, rupture, or a hollow organ obstruction. Patients with severe acute lower abdominal pain either proceed to the operative room or additional investigations or diagnostic Laparoscopy (DL). Laparoscopy should not be used routinely for every acute lower abdomen case due to anesthetic risks and morbidity .

Most hospitals do emergency abdominal surgeries, and laparotomy in these procedures is associated with high death rates (14 to 20%) . Laparoscopic surgery has become a standard method for abdominal emergencies as a diagnostic and therapeutic tool. It has even been employed in some situations of lower abdominal crises in recent years .

The general surgeon frequently faces diagnostic challenges in emergency abdominal conditions. The diagnosis is crucial for planning the appropriate abdominal incision and avoiding unnecessary surgery. Noninvasive diagnostic approaches such as radiological examinations are not always conclusive. Furthermore, they are costly and cannot be performed 24 hours a day in all hospital circumstances . A retrospective observational study was designed to analyze the outcomes of a laparoscopic technique in emergent lower GIT surgeries regarding intraoperative and postoperative outcomes.

Eligibility Criteria:
Inclusion Criteria:

* \>18 years old, both sexes, and have undergone laparoscopic surgery for acute lower GIT emergencies such as acute appendicitis, acute intestine obstruction, complicated colonic diverticulum, complicated hernias, and iatrogenic colonic perforations

Exclusion Criteria:

* less than 18 years of age and open surgery
The Effects of Postisometric Relaxation Technique in Female Patients With Dyssynergic Defecation

Functional bowel diseases are defined as chronic disorders of the gastrointestinal tract characterized by abdominal pain, bloating, tension and/or defecation abnormalities. Functional bowel diseases are studied under five headings: functional constipation, functional diarrhea, functional abdominal bloating / tightness and unclassifiable functional bowel disorders. Functional constipation is divided into three categories as normal transition-time constipation, slow transition-time constipation and defecation disorders. Defecation disorders occur due to improper use of pelvic floor muscles and anorectal muscles or anatomical abnormalities and account for 1/3 of all constipation. Defecation disorders characterized by excessive straining, incomplete defecation sensation, difficult and painful defecation are defined as narrowing of the fecal exit path due to involuntary pelvic floor contractions or posterior compartment pelvic organ prolapse. Non-pharmacological treatment in the treatment of functional constipation is considered as the first-line treatment and includes information about the nutrition, fiber-liquid consumption, physical activity and toilet training of patients. Biofeedback therapy is often recommended in patients with defecation disorders in the literature, and there are studies showing that it is superior to laxative use and placebo applications in the studies conducted. However, the fact that it is difficult and costly to achieve Biofeedback treatment, the method used allows movement at a certain angle and does not include the stretching method seems to be a disadvantage. Postisometric Relaxation technique is used in cases of pain, muscle spasm and movement limitations. People with defecation disorders experience spasms, pain and movement limitations in the pelvic floor muscles. For this reason, the investigators think that the Postisometric Relaxation technique may be effective in patients with defecation disorders, and it will also provide advantages due to the fact that the method is easily accessible, does not require extra materials and devices, and has a stretching effect. The aim of this study is to investigate the effect of Postisometric Relaxation technique on constipation severity, quality of life, anal pain, muscle function and sexual function in patients with defecation disorder.


Eligibility Criteria:
Inclusion Criteria:

* Being the ages between 18-55
* Being a women
* Having been diagnosed with dyssynergic defecation by a physician
* Not using Laxatives

Exclusion Criteria:

* Having undergone anal region surgery in the last 6 months
* Having had Botox in the last 6 months
* Being in the menopause period
* Having been diagnosed with cancer
* Having a mental problem • Having previously received pelvic floor physiotherapy
Improving Well-Being After TBI Through Structured Volunteer Activity

The purpose of this project is to determine if participating in volunteer activity improves the psychological well-being of individuals with traumatic brain injury (TBI).


Eligibility Criteria:
Inclusion Criteria:

* Has sustained a documented TBI that required inpatient rehabilitation;
* is at least one year post TBI;
* is age 18 or older;
* is able to commit to completing the entire three month volunteer placement;
* is English or Spanish speaking;
* receives written medical release from a physician to participate in this intervention;
* is rated a level 1-2 on the Supervision Rating Scale (functionally independent during the day);
* provides informed consent to participate

Exclusion Criteria:

* Is employed or engaged in regularly scheduled volunteer work outside of the intervention;
* obtains a score of 25 or above on the SWLS, which is 0.5 SD above the TBIMS NDB mean;
* unable to travel to assessments and placement; even with study transportation assistance;
* has been convicted of a felony, which would prohibit volunteer placement;
* unable to communicate effectively to complete standardized assessments;
* has cognitive impairment that precludes completion of baseline testing;
Comparing Single Needle and Double Needle Arthrocentesis for Temporomandibular Joint Disorders

The purpose of this study was to compare the clinical success and efficacy of single-needle, double-cannula arthrocentesis with conventional arthrocentesis techniques in patients with temporomandibular joint disorders. Patients with nonreducible disc displacement complained of limited mouth opening and/or pain. All treated patients had baseline and follow-up (with mouth opening and VAS). Comparisons were made within and between groups.

The patients included in the study were evaluated in the preoperative, 1week, 1-3, and 6 months after the procedure. Double-needle group: two needles were inserted into the joint and washed. In the single-needle group, two needles were bent (from their lower parts) before the procedure and their pointed ends were joined by placing acrylic on the plastic parts from a single point. The resulting combined needle was directed to the upper joint space and washed. 13 underwent single-needle double cannula arthrocentesis and 15 underwent double needle arthrocentesis.

Eligibility Criteria:
Inclusion Criteria:

* with complaints of pain and restricted mouth opening and who had not received any previous treatment.
* Patients with a diagnosis of disc displacement without reduction characterized by persistent or frequent TMJ pain, history of joint clicking, limited mouth opening with deviation to the affected side, limited lateral movement to the opposite side, limited protrusive movements with deviation to the affected side were included.

Exclusion Criteria:

* Patients with systemic inflammatory joint disease, facial growth disorder, and direct trauma to the TMJ were excluded.
FGF-23 and PTH in Hemodialysis Patients

In this pilot study the investigator will examine the levels of fibroblast growth factor (FGF-23) and parathyroid hormone (PTH) levels during hemodialysis therapy in 30 patients and assess the correlation between these parameters and the T-50 calcification propensity, as well as further parameters of secondary hyperparathyroidism (sHPT), like serum calcium (sCa), phosphate (P), 25-hydroxy-vitamin D (25(OH)D) and 1,25 dihydroxy-vitamin D (1,25(OH)2D).

The investigator hypothesize that FGF-23 and PTH levels are at their highest at the beginning of dialysis and decrease during the treatment.

Background: The development of sHPT in hemodialysis patients is a common complication which induces an increase in calcification and atherosclerosis. Elevated FGF-23 levels are already found in early stages of chronic kidney disease (CKD) and it has been shown that high FGF-23 levels are associated with the development of cardiovascular disease and increased overall mortality.

Method: In this pilot study a total number of 30 patients on maintenance haemodialysis will be enrolled. The investigator will examine the course of FGF-23 and PTH levels during a single hemodialysis session. In addition, the T-50 time, a novel non-traditional cardiovascular risk factor as well as further parameters of sHPT, such as serum calcium (sCa), phosphate (P), 25-hydroxy-vitamin D (25(OH)D) and 1,25 dihydroxy-vitamin D (1,25(OH)2D) will be assessed.

Hypothesis and specific aims: The major end point of the study is the level of FGF-23 and PTH at three points during hemodialysis treatment. As secondary end points the T-50 calcification propensity and further parameters of sHPT, as well as the correlation between these parameters will be measured.

Hemodialysis is classified as a kidney replacement therapy and FGF-23 and PTH are partly metabolized and excreted by the kidneys. Based on this the investigator hypothesize that FGF-23 and PTH levels are at their highest at the beginning of dialysis and decrease during the treatment.

Eligibility Criteria:
Inclusion Criteria:

* \>18 years
* hemodialysis three times a week

Exclusion Criteria:

* Subject is currently enrolled or not yet completed at least 30 days since ending other investigational device or drug trial(s), or is receiving other investigational agent(s)
* Pregnancy
* Subject has any kind of disorder that compromises the ability of the subject to give written informed consent and/or to comply with the study procedures
Carnosine Loading and Periodized Training in MS and HC

Increasing evidence favours exercise therapy as an efficient tool to counteract inactivity related secondary symptoms in MS. Furthermore, exercise therapy may affect MS-associated muscle contractile and energy supply dysfunctions. So far, low to moderate intensity exercise rehabilitation has shown to induce small but consistent improvements in several functional parameters. High intensity exercise training in MS seems to further improve this. However, although results are promising, impairments in both muscle contraction and energy supply probably attenuate therapy outcome. In keeping with the above described physiological role of skeletal muscle carnosine and because muscle carnosine content may be lower in MS, the primary aim of the present project is to investigate whether carnosine loading improves exercise therapy outcome (exercise capacity, body composition) and performance in MS. If the latter hypothesis can be confirmed, muscle carnosine loading could be a novel intervention to improve exercise capacity and muscle function in this population.

Pilot data from the (co-)applicants' laboratories suggest that EAE rats (animal MS model) and MS-patients suffer from significantly reduced muscle carnosine levels compared to healthy counterparts. The potential of β-alanine supplementation to elevate muscle carnosine content has been shown in healthy volunteers. Furthermore, the investigators have recently investigated β-alanine and carnosine supplementation in EAE animals. In MS, this has not been investigated yet. Therefore, the researchers' next step is to investigate the impact of β-alanine intake on exercise performance in MS patients. The investigators hypothesize that oral β-alanine supplementation improves exercise therapy outcomes in MS patients.

So far, it is clear that β-alanine intake enhances exercise capacity of untrained, trained and aged individuals by improving contractile properties, maintaining higher intracellular energy levels and optimizing training adaptations. Because early fatigue of contracting musculature during rehabilitation is the predominant cause of exercise cessation, postponing exercise-induced fatigue by β-alanine supplementation will be clinically very relevant (improving exercise therapy efficiency). Consequently, the investigators aim to research the ergogenic potential of β-alanine intake in MS rehabilitation and hypothesize that β-alanine supplementation optimizes exercise therapy outcome (exercise capacity, muscle contractile characteristics) in this population.

Eligibility Criteria:
Inclusion criteria:

Diagnosis Multiple Sclerosis. Healthy control. Aged \>18y. Written informed consent.

Exclusion criteria:

Contraindications to perform moderate to high intensity exercise. Participation in another study. Experienced acute MS related exacerbation \<6 months prior to start of the study EDSS score \> 3.5
The Effects of rTMS in Rehabilitation Following Spinal Cord Injury

The project will investigate whether repetitive transcranial magnetic stimulation (rTMS) can be used to potentiate/prime spinal cord injured patients' nervous systems for more intense rehabilitation exercise of longer duration - thus leading to greater recovery of motion function. The technique, in which a magnetic coil is positioned above the scalp and forms a magnetic field that activates the desired center of the brain (eg motor cortex), is used in clinical practice for the treatment of a number of disorders. However, although a combination of rTMS and gait training in SCI patients previously has proven beneficial, it is unknown whether additional functional gains can be achieved by combining rTMS and supervised, high-intensity resistance training.

In this project, 30 newly-admitted patients will be recruited and randomized to receive either active rTMS and strength training (n = 15) or sham (imitated) rTMS + strength training, in parallel with standard care. The investigators hypothesize that the active rTMS group will have superior gains in locomotor function and muscle mass, compared to the sham group.


Eligibility Criteria:
Inclusion Criteria:

* sub-acute (\<6 months) incomplete spinal cord injury
* admitted at the SCIWDK for primary rehabilitation

Exclusion Criteria:

* Medical history of multiple central nervous system lesions,
* severe structural,
* inflammatory or degenerative cerebral disorders,
* epilepsy,
* other neurological diseases,
* lower limb peripheral injury,
* or orthopedic injuries that may limit maximal effort contractions
Eating Disorders With and Without Childhood Trauma

The combination of EDs (ED) and post-traumatic sequelae of childhood trauma leads to significant impairment, suffering and represents a public health concern because it is frequently associated with role impairment, and is frequently under-treated. Considering the severity of these conditions, there is a need to develop more effective treatments that are tailored to the specific needs of these patients as no conclusion has been made about the treatment of choice. To improve treatment it is critically important to study treatment effects and the mechanism of these effects.

The overall aim of the current project is; (1) To build knowledge on how to best treat patients with ED with and without childhood trauma, (2) To develop our understanding about how change happens for these patients. The investigators will do this by compare two treatment models; (1) Compassion-Focused Therapy (CFT) and (2) Cognitive Behavioural Therapy (CBT), for EDs both treatment types delivered at Modum Bad Psychiatric Center, department of ED.

Patients included in this randomized controlled trial will receive treatment at Modum Bad, satisfy DSM-V criteria for ED and half of the patients will in addition have a history of childhood trauma. A total of 86 patients who have received either CFT or CBT are followed up two year after completion of the treatment. The study utilises a rich data set collected outcome measures at altogether 5 time points and process and sub-outcome measures at 13 time points. The investigators will take advantage of our established collaborative networks, both nationally and internationally and existing procedures, where all patients are assessed with the same clinical instruments based on current state-of-the-art methods.

Eligibility Criteria:
Inclusion Criteria:

* satisfying DSM-V criteria for ED and for half of the patients in addition
* have a history of childhood trauma.

Exclusion Criteria:

* current suicidal risk
* current psychosis
* ongoing trauma (e.g. current involvement in an abusive relationship).
Study of the Efficacy of Darbepoetin Alfa in the Treatment of Renal Anemia

Anaemia is a common consequence of chronic renal failure. Darbepoetin alfa is a unique erythropoietic protein that stimulates erythropoiesis by the same mechanism as endogenous erythropietin and conventional recombinant human erythropoietin (rHuEPO). Darbepoetin alfa has been shown to have a serum half-life 3-fold longer than that of rHuEPO, which allows dosing at extended intervals and less frequent injection.

The objective is to evaluate the efficacy and safety of darbepoetin alfa therapy given at an extended once monthly dosing interval in the treatment of renal anaemia in continuous ambulatory peritoneal dialysis.


Eligibility Criteria:
Inclusion Criteria:

* Patients on continuous ambulatory peritoneal dialysis
* Patients receiving subcutaneous recombinant human erythropoietin (rHuEPO)
* Patients with haemoglobin level ?10 g/dL and remain stable for the past 3 months while receiving rHuEPO

Exclusion Criteria:

* Uncontrolled hypertension
* Severe congestive heart failure (NYHA class III or IV)
* Grand mal epilepsy
* Any kind of blood loss causing Fe depletion
* Presence of infection, either acute or chronic, or inflammatory conditions within 3 months preceding the study
* Malignancy
* Aluminum toxicity
* Severe hyperparathyroidism with marrow fibrosis or osteitis fibrosa _ PTH \> 20 times of normal
* Vitamin B12 or folate deficiency _ MCV \> 100fL
* Haemolysis
* Marrow dysfunction e.g. aplastic anaemia, myelodysplastic syndrome, multiple myeloma, etc
* Thalassaemia major, intermediate or minor, or red cell enzyme defects
* Blood transfusion within 3 months preceding the study
* Pregnancy or lactating mothers
Combined Stent Insertion and HIFU Ablation for Pancreatic Carcinoma With Biliary Obstruction

The purpose of this study is to compare the clinical effectiveness and long-term outcomes between patients with pancreatic carcinoma and biliary obstruction who are treated by stent insertion with or without high-intensity focused ultrasound ablation.

Distal malignant biliary obstruction is a common problem in patients with pancreatic carcinoma. In unresectable pancreatic carcinomas, percutaneous stent placement has been pivotal in providing relief from obstructive jaundice, improving the quality of life, and allowing the maintenance of anticancer treatment.

Venous chemotherapy, transcatheter arterial chemoembolization, or radiotherapy have been used to prolong stent patency and survival after stent insertion for patients with pancreatic carcinoma and biliary obstruction. High-intensity focused ultrasound ablation is a noninvasive and atoxic treatment of malignant tumor using focused ultrasound energy from an extracorporeal source that is targeted within the body resulting in thermally induced necrosis and apoptosis.

The purpose of this study is to compare the clinical effectiveness and long-term outcomes between patients with pancreatic carcinoma and biliary obstruction who are treated by stent insertion with or without high-intensity focused ultrasound ablation.

Eligibility Criteria:
Inclusion Criteria:

1. malignant distal biliary obstruction;
2. pathologically diagnosed pancreatic carcinoma;
3. unresectable cases.

Exclusion Criteria:

1. inability to obtain informed consent;
2. Eastern Cooperative Oncology Group performance status of 4;
3. life expectancy of 3 months or less;
4. biliary obstruction that was not directly caused by pancreatic carcinoma.
Using Social Incentives and Gamification for Weight Loss Promotion

This is a 36-week, three-arm randomized, controlled trial using a team-based model to compare two weight loss programs to control. Each intervention will use insights from behavioral economics to leverage social incentives and gamification.

Obesity is a leading risk factor for morbidity and mortality affecting more than one in three adults in the United States. Modifiable health behaviors contribute to this growing epidemic. Insights from behavioral economics have shown promise for motivating behavior change through the use of financial incentives. However, social incentives or those influences that impact individuals to adjust their inherent behaviors based on social ties and connections have not been well examined. Social incentives are a more patient-centered approach that leverages and enhances the existing connections and influences on the individual. Since one individual's behavior change is connected to many others within their network, social incentives have the potential to be a scalable intervention that impacts the community. Gamification, or the use of game design in non-game situations, is often used in the real world, but its effectiveness is unknown. In this study, investigators will conduct a 36-week, three-arm, randomized, controlled trial using a team-based model to compare two weight loss programs to control. Each intervention will use insights from behavioral economics to leverage social incentives and gamification.

Eligibility Criteria:
Inclusion Criteria:

* Age 18 to 70 years
* Ability to read and provide informed consent
* Has an iPhone 4 or newer
* Have self-reported body mass index of 30 or greater and in-person body mass index of 28 or greater

Exclusion Criteria:

* Conditions that would make participation infeasible such as inability to provide informed consent, illiteracy or inability to speak, read, and write English
* Conditions that would make participation unsafe such as current treatment for drug or alcohol use, myocardial infarction or stroke within the last 6 months, metastatic cancer, pregnant, breastfeeding or plan to become pregnant during study period, previous diagnosis of an eating disorder, or history of unsafe weight loss practices
* Already enrolled in another weight loss study
* Any other medical conditions or reasons that they could not complete a 36-week weight loss program