nils-herrmann/clean_scirepeval huggingface dataset:
The utility of supplemental oxygen during emergency department procedural sedation and analgesia with midazolam and fentanyl: a randomized, controlled trial.

To determine whether supplemental oxygen reduces the incidence of hypoxia by 20% in study patients receiving midazolam and fentanyl for emergency department procedural sedation and analgesia.



Patients were randomized to receive either supplemental oxygen or compressed air by nasal cannula at 2 L per minute. Physicians were blinded to the gas used and end-tidal carbon dioxide (ETCO2) data. Respiratory depression was defined a priori as oxygen saturation less than 90%, ETCO2 level greater than 50 mm Hg, an absolute change from baseline of 10 mm Hg, or loss of the ETCO2 waveform.



Of the 80 patients analyzed, 44 received supplemental oxygen and 36 received compressed air. Twenty supplemental oxygen patients and 19 compressed air patients met at least 1 criterion for respiratory depression. Six supplemental oxygen patients and 5 compressed air patients experienced hypoxia (P=.97; effect size 0%; 95% confidence interval -15% to +15%). Fourteen patients in each group met ETCO2 criteria for respiratory depression but were not hypoxic. Physicians identified respiratory depression in 8 of 11 patients who became hypoxic and 0 of 28 patients who met ETCO2 criteria for respiratory depression but who did not become hypoxic. There were no adverse events.



Supplemental oxygen did not reduce (or trend toward reducing) the incidence of hypoxia in patients moderately sedated with midazolam and fentanyl. However, our lower-than-expected rate of hypoxia limits the power of this comparison. Blinded capnography frequently identified respiratory depression undetected by the treating physicians.
Full-dose CHOP chemotherapy combined with granulocyte colony-stimulating factor for aggressive non-Hodgkin's lymphoma in elderly patients: a prospective study

We assessed the efficacy and safety of full-dose CHOP regimen plus granulocyte colony-stimulating factor to treat aggressive non-Hodgkin's lymphoma in elderly patients. Forty-two patients with untreated disease were included in this study, aged 70–79 years, with stage II or higher disease and a performance status of 0–3, without severe organ dysfunction. Of the 40 patients who could be evaluated 87.5% achieved complete remission, with a 4-year survival rate of 69% and a 3-year progression-free survival rate of 49%. When stratified by the International prognostic Index, the 4-year survival rate was 90.9% for the low and low-intermediate risk group and 41.3% for the high-intermediate and high risk group, whereas the 3-year progression survival rate was 87.7% and 11.3%, respectively. Grade 3 or 4 hematological toxicity was found in 31 instances of granulocytopenia (77.5%) and 7 of anemia (17.5%). Nonhematological toxicity of grade 3 or 4 included pneumonia in two patients, heart failure in one, and gastrointestinal bleeding in one. Full-dose CHOP regimen with granulocyte colony-stimulating factor support could achieve a high-dose intensity in elderly patients whose general physical condition was good and hence achieved a high complete remission rate, but the disease often recurred within 2 years. Consequently, a new therapeutic strategy needs to be established, particularly for patients with high-intermediate or high risk.
Treatment of Hypertension: Favourable Effect of the Twice-Daily Compared to the Once-Daily (Evening) Administration of Perindopril and Losartan.

Little is known about the effect of twice daily administration of same dose of ACE inhibitor and ARB on the diurnal/nocturnal blood pressure (BP) ratio. We aimed to assess the effect of two widely used long-acting drugs: perindopril and losartan in the treatment of hypertension comparing the once-daily (evening) vs. twice-daily (morning and evening) administration with the same daily doses.



Untreated primary hypertensive patients without complaints (a total of 164: 65 men, 99 women, 55.7 ± 13.7 years of age, 41-41 patients per treated groups) were selected with non-dipper phenomenon, estimated by diurnal index (DI) <10%. The effect of evening (8 mg perindopril or 100 mg losartan) vs morning and evening (4-4 mg perindopril or 50-50 mg losartan) administration was determined on a 14-day treatment by ABPM.



The mean BP, the percent time elevation index, and the hyperbaric impact decreased in both drug groups. Significant difference was observed in the DI in the case of twice-daily administration vs once-daily evening dosing.



The twice-daily administration with the same daily dose of perindopril or losartan seems to be more effective compared to the once daily evening administration in eliminating the non-dipper phenomenon. According to some authors the non-dipping phenomenon increases cardiovascular risk, while others are of the opinion that the association of non-dipping with cardiovascular events does not necessarily mean that selective treatment of non-dipping improves cardiovascular outcomes.
Vorozole results in greater oestrogen suppression than formestane in postmenopausal women and when added to goserelin in premenopausal women with advanced breast cancer

The high potency and selectivity of new aromatase inhibitors has translated to greater efficacy and improved tolerability in comparison with established second‐line hormonal agents for advanced breast cancer in phase III clinical trials. Two pharmacological studies are reported which assess the use of one of these inhibitors, vorozole, in combination or comparison with well‐established methods of oestrogen deprivation in pre and postmenopausal patients. When combined with the gonadotrophin‐releasing hormone agonist (GnRHa) goserelin in 10 premenopausal patients, vorozole markedly enhanced the suppression of serum levels of oestrone, oestradiol and, oestrone sulphate beyond that achieved by goserelin alone (by a mean 74%, 83%, and 89%, respectively). The combination was well‐tolerated and had no significant effects on androgen levels. Vorozole was compared with formestane in 13 postmenopausal women and serum oestrone, oestradiol, and oestrone sulphate levels were suppressed by 47%, 30%, and 70%, respectively, more by vorozole than by the steroidal aromatase inhibitor. Again the tolerability was excellent. The plasma oestrogen levels in the postmenopausal patients on vorozole were lower than in the premenopausal patients on goserelin plus vorozole, indicating that ovarian oestrogen synthesis may be relatively resistant to aromatase inhibition, even during GnRHa treatment. Thus, in both pre and postmenopausal patients substantially greater suppression of oestrogen can be achieved by vorozole compared with alternative approaches. Existing clinical–pharmacological correlates suggest that these increases in pharmacological effectiveness may result in enhanced clinical effectiveness.
[Fiability Study of Diabetes Empowerment Scale: Short Version].

To compare the final score of the scale to the levels of HbA1c.



Cross-sectional observational study by applying the Diabetes Empowerment Scale-Short Form to diabetics at three primary care units in the central region of Portugal. The test-retest (in writing first and, five minutes later, orally) was performed to access Cronbach's alpha in 20 patients not studied in the next phase. Then, the scale was applied to diabetic patients after nursing consultation and prior to entering the medical consultation. Descriptive and inferential statistics after checking for the normality of the data were performed.



In the first phase Cronbach's alpha was 0.90 to 1.00 in all of eight scale items. The average result obtained in the written phase was 3.78 ± 0.71 and in the oral 3.79 ± 0.64, p = 0.629. The sample of the second stage was of 81 diabetic patients, 55.6% male. Sample's mean age was 68.5 ± 1.1 years, mean HbA1c of 6.8 ± 0.2 and mean time from diagnosis of 9.2 ± 0.9 years. The average final score of the scale was 4.1± 0.8. There was significant correlation between the final score and HbA1c levels (p= -0.114; p = 0.312).



The Portuguese version of the Diabetes Empowerment Scale-Short Form proved to be a reliable scale to measure empowerment in diabetic patients in Portugal. It was evident the presence of a statistically significant correlation between the results obtained at the end of the scale and HbA1c.
Long-term oral administration of amrinone for congestive heart failure: lack of efficacy in a multicenter controlled trial.

A number of uncontrolled studies have indicated that oral administration of amrinone, a phosphodiesterase inhibitor with potent positive inotropic effects in experimental preparations, may be beneficial in patients with chronic congestive heart failure. The present multicenter trial was designed to prospectively evaluate clinical response and change in exercise tolerance during 12 weeks of amrinone therapy in a double-blind, placebo-controlled protocol. Ninety-nine patients with NYHA functional class 3 or 4 congestive heart failure on digitalis and diuretics, of whom 31 were also receiving captopril, were enrolled. After baseline clinical assessment and determination of exercise tolerance, radionuclide left ventricular ejection fraction, and roentgenographic cardiothoracic ratio, patients were randomly assigned to receive amrinone or placebo, beginning at 1.5 mg/kg tid and increasing to a maximum dosage of 200 mg tid. After 12 weeks of therapy or at the last blinded evaluation in patients who did not complete this protocol, there were no significant differences from baseline values between treatment with amrinone or placebo with regard to symptoms, NYHA functional class, left ventricular ejection fraction, cardiothoracic ratio, frequency and severity of ventricular ectopy, or mortality. Exercise tolerance improved significantly from baseline by 37 +/- 10% (mean 163 sec) in patients on amrinone and 35 +/- 11% (mean 149 sec) in patients on placebo, but there was no significant difference between treatments. Adverse reactions were significantly more frequent and more severe on amrinone, occurring in 83% of patients and necessitating withdrawal in 34%.(ABSTRACT TRUNCATED AT 250 WORDS)
Effects of smoking cessation or alcohol restriction on metabolic and fibrinolytic variables in Japanese men.

We investigated the effects of smoking cessation or alcohol restriction on metabolic and fibrinolytic variables in Japanese men. In the smoking study, 35 male subjects [32+/-1 (S.E.M.) years] who habitually smoked cigarettes (29+/-3 cigarettes/day) were told either to keep their usual smoking habits for 1 week, or to abstain from cigarette smoking, using a randomized crossover design. In the alcohol study, 33 male subjects (37+/-1 years) who habitually drank alcohol (64+/-6 ml of ethanol/day) were told either to keep their usual drinking habits for 3 weeks, or to reduce alcohol intake by at least up to a half of their usual drinking amount, using a randomized crossover design. In each study, venous blood samples were drawn after a 12-h overnight fast on the last day of each period, and metabolic and fibrinolytic variables were measured. One-week smoking cessation significantly increased serum high-density lipoprotein (HDL) cholesterol levels (P<0.05), and significantly decreased serum lipoprotein (a) levels (P<0.01) and plasma plasminogen activator inhibitor-1 levels (P<0.05). In contrast, 3-week alcohol restriction significantly decreased serum HDL cholesterol levels (P<0.05) and plasma tissue plasminogen activator levels (P<0.05). These results suggest that smoking cessation has substantial and immediate benefits on lipid and fibrinolytic variables in habitual smokers, whereas alcohol restriction increases cardiovascular risks, in some respects, in habitual drinkers.
Influence of CD4+ status on the invasiveness of pneumococcal pneumonia in HIY patients

The frequency of bacterial pneumonia, mainly due to Streptococcus pneumoniae, in HIV-positive patients has increased (1). The risk is higher among those with CD4+ lymphocyte counts below 200/ml 3 (1). Furthermore, the incidence of pneumococcal pneumonia in i.v. drug abusers, whether H1V infected or not, is higher than that in homosexual or bisexual men (1, 2). Although the clinical characteristics of pneumococcal pneumonia are similar in HIV-positive and HIV-negative patients, the incidence of bacteremia is higher in the HIV-positive population (3).
Outcomes using extracorporeal life support for adult respiratory failure due to status asthmaticus.

Our objective was to describe the outcomes for extracorporeal life support (ECLS) use in adult respiratory failure because of status asthmaticus and to determine whether ECLS use in status asthmaticus is associated with greater survival than other indications for ECLS. This retrospective cohort study used the multicenter, International ECLS Organization Registry. The study population included 1,257 adults with respiratory failure requiring ECLS. Status asthmaticus was the primary indication for ECLS in 24 patients. A total of 83.3% of asthmatics survived to hospital discharge compared with 50.8% of nonasthmatics (n=1,233) [odds ratio (OR) favoring survival for asthmatics=4.86, 95% confidence interval (CI) 1.65-14.31, p=0.004]. The survival advantage for asthmatics remained significant after adjustment for potential confounders. Complications were noted in 19 of 24 asthmatics (79.2%). In conclusion, we found that status asthmaticus, as an indication for ECLS in adult respiratory failure, seemed to be associated with greater survival than other indications for ECLS. However, complications are common and whether ECLS confers a survival advantage compared with other salvage treatment options remains unknown. More detailed information and complete reporting of ECLS use for status asthmaticus are needed to determine whether and when the potentially life-saving intervention of ECLS should be initiated in the asthmatic failing conventional therapy.
The Value of Calcaneal Bone Mass Measurement Using a Dual X-Ray Laser Calscan Device in Risk Screening for Osteoporosis

To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL) correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA).



A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score < or = -2.5 received a referral for DXA of the spine and hip. Besides dual energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis.



Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO), dual energy X-ray laser calcaneal measurements showed that 13% of the subjects had osteoporosis, while another 56% had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT), covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (p<0.05). A significant correlation was observed between the calcaneal dual energy X-ray laser T-score and age (r= -0.465, p=0.001), body mass index (BMI) (r=0.223, p=0.001), number of live births (r= -0.229, p=0.001), breast feeding time (r= -0.064, p=0.001), and age at menarche (r= -0.050, p=0.008). The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001) at the spine, and calcaneal DXL and DXA T- scores (r=0.28, p=0.001) and calcaneal DXL and DXA Z-scores (r=0.33, p=0.001) at the femoral neck were statistically significant.



Bone mineral density measurements in the calcaneus using a dual energy X-ray laser are valuable for screening Turkish women over 40 years of age for the risk of osteoporosis.
Monitoring of polyomavirus BK replication and impact of preemptive immunosuppression reduction in renal-transplant recipients in China: a 5-year single-center analysis.

This provides the long-term patient/graft survival and outcome of BK viremia and BK virus allograft nephropathy (BKVAN) in renal transplant recipients in the setting of intensive monitoring and preemptive of reduction of immunosuppression. Quantitative BKV DNA PCR and urinary cytology surveillance were performed regularly after transplantation in 229 kidney recipients. Patients with BK viremia and BKVAN were treated with 30-50% reduction in doses of tacrolimus and/or mycophenolate mofetil and were monitored for BKV every 3-6 months. All the patients were followed for 5 years. Overall 5-year patient and graft survival were 95.6% and 92.1%, respectively, and independent of presence of decoy cells, BK viruria, viremia, or BKVAN. After reduction of immunosuppression, BK viremia (n = 38) resolved in 100% of patients, without increased acute rejection. Recurrent BK viremia was not observed in viremic patients without BKVAN (n = 30). All BKVAN patients (n = 7, 3.1%) cleared viremia with a mean time of 5.9 months (range 1-15 months) and manifested no decline in estimated glomerular filtration rate from 1 month to 5 years after transplantation. Viral monitoring and preemptive reduction of immunosuppression resulted in the successful resolution of BK viremia and BKVAN with excellent graft survival and renal function at 5 years.
Extracellular matrix components and regulators in the airway smooth muscle in asthma.

There is an intimate relationship between the extracellular matrix (ECM) and smooth muscle cells within the airways. Few studies have comprehensively assessed the composition of different ECM components and its regulators within the airway smooth muscle (ASM) in asthma. With the aid of image analysis, the fractional areas of total collagen and elastic fibres were quantified within the ASM of 35 subjects with fatal asthma (FA) and compared with 10 nonfatal asthma (NFA) patients and 22 nonasthmatic control cases. Expression of collagen I and III, fibronectin, versican, matrix metalloproteinase (MMP)-1, -2, -9 and -12 and tissue inhibitor of metalloproteinase-1 and -2 was quantified within the ASM in 22 FA and 10 control cases. In the large airways of FA cases, the fractional area of elastic fibres within the ASM was increased compared with NFA and controls. Similarly, fibronectin, MMP-9 and MMP-12 were increased within the ASM in large airways of FA cases compared with controls. Elastic fibres were increased in small airways in FA only in comparison with NFA cases. There is altered extracellular matrix composition and a degradative environment within the airway smooth muscle in fatal asthma patients, which may have important consequences for the mechanical and synthetic functions of airway smooth muscle.
The response of gastric secretion and serum gastrin to an insulin infusion test in patients with duodenal ulcer

The intravenous infusion of insulin 0.04 U/kg-hr for 2-1/2 hours was performed in 26 patients with chronic duodenal ulcer. In 15 patients this infusion test was compared with the standard test of a single intravenous injection of insulin 0.2 U/kg. The mean lowest blood glucose level in the infusion group (25.1 mg/100 ml) was significantly higher than in the standard test (17.4 mg/100 ml), and the interval from injection to acid stimulation about twice as long (75versus 45 minutes). The peak acid output and mean rise in acidity were comparable in the two procedures. Serum gastrin responded reciprocally to insulin-induced hypoglycemia with a significant inverse correlation between blood glucose and gastrin. In 13 patients tested after vagotomy, there was no significant difference in the rise in acidities in the two groups, and the Hollander status was the same in all but one patient. The mean basal, peak, and absolute rise of serum gastrin in unoperated patients and patients with “incomplete” vagotomy were almost identical. In patients with “complete” vagotomy there was no significant rise in serum gastrin after insulin infusion. Unpleasant side effects as assessed by an independent observer were fewer and less severe in patients undergoing infusion tests than in the standard test. The insulin infusion test is recommended as a safer and more acceptable test than the standard insulin test since it avoids severe hypoglycemia and has milder side effects yet achieves comparable acidity and acid outputs. Measurements of serum gastrin after either insulin test provide no additional information helpful in the assessment of the completeness of vagotomy.
Testosterone suppression in men with prostate cancer leads to an increase in arterial stiffness and hyperinsulinaemia.

The role of androgens in cardiovascular disease is uncertain. We aimed to determine the vascular effects of androgen suppression in men with prostate cancer. Arterial stiffness (or 'compliance') was measured in 16 men (71+/-9 years, mean+/-S.D.) prior to, and 3 months after, complete androgen suppression with gonadotrophin-releasing hormone analogues as treatment for prostate cancer. Fifteen control men (70+/-7 years) also had arterial stiffness studies at baseline and 3 months later. Two measures of arterial stiffness were employed: systemic arterial compliance (SAC) was measured by simultaneous recording of aortic flow and carotid artery pressure ('area method'), and pulse wave velocities (PWVs) were recorded with the 'Complior' system. The 16 cases underwent glucose-tolerance and fasting-lipids tests on both visits. After 3 months of testosterone suppression, there was a significant fall in SAC, which was not seen in the controls [mean change+/-S.E.M., -0.26+/-0.09 a.c.u. (arbitrary compliance unit) in the cases versus +0.06+/-0.11 in the controls; P =0.03). Central, but not peripheral, PWVs tended to increase in the cases (mean change+/-S.E.M. for aorto-femoral PWV, +0.5+/-0.4 m/s for cases versus -0.3+/-0.3 m/s for controls; P =0.08). After testosterone suppression, fasting insulin levels increased from 6.89+/-4.84 m-units/l to 11.34+/-8.16 m-units/l (mean+/-S.D.), total cholesterol increased from 5.32+/-0.77 mmol/l to 5.71+/-0.82 mmol/l and high-density lipoprotein cholesterol increased from 1.05+/-0.24 mmol/l to 1.26+/-0.36 mmol/l; P <0.005 for all. No significant change occurred in body-mass index, serum glucose, low-density lipoprotein cholesterol or triacylglycerol (triglyceride) levels. Our results indicate that loss of androgens in men leads to an increase in aortic stiffness and serum insulin levels, and may therefore adversely affect cardiovascular risk.