nils-herrmann/clean_scirepeval huggingface dataset:
Long term consequences of gastrectomy for patients’ quality of life: the impact of reconstructive techniques

During recent years considerable interest has been focused on quality of life as an additional therapeutic outcome measure in the surgical treatment of gastric carcinoma. However, the long term consequences of gastrectomy and the impact on quality of life of different reconstructive techniques are still a matter of controversy. To broaden the criteria for choice of treatment, we conducted a prospective randomized clinical trial to determine the impact of various gastrectomy procedures on quality of life during a 5-yr follow-up period.Consecutive patients (n= 64) eligible for curative gastric cancer surgery were randomized to have either total (n= 31) or subtotal (n= 13) gastrectomy or a jejunal S-shaped pouch (n= 20) as a gastric substitute after total gastrectomy. Assessments of quality of life were made on seven occasions during a 5-yr period: within 1 wk before surgery, 3 and 12 months after the surgical intervention, and then once/yr. All patients were interviewed by one of two psychiatrists, who rated their symptoms and introduced standardized self-report questionnaires covering both general and specific aspects of life. The raters were blinded for the patients’ group affiliations.Survival rates were similar in all treatment groups. Patients who had a total gastrectomy continued to suffer from alimentary symptoms, especially indigestion and diarrhea, during the entire follow-up period. However, patients who underwent subtotal gastrectomy had a significantly better outcome already during the first postoperative yr. Patients given a gastric substitute after gastrectomy improved with the passage of time and had an even better outcome in the long run.To optimize the rehabilitation after gastrectomy, patients’ quality of life must be taken into consideration. When subtotal gastrectomy is clinically feasible, this procedure has advantages in the early postoperative period. However, a pouch reconstruction after total gastrectomy should be considered in patients having a favorable tumor status suggesting a fair chance of long term survival.
Biventricular pacing diminishes the need for implantable cardioverter defibrillator therapy. Ventak CHF Investigators.

We sought to test the postulate that biventricular pacing diminishes the need for appropriate tachycardia therapy. We reviewed the frequency of therapy in patients, serving as their own controls, who were enrolled in the Ventak CHF (congestive heart failure) biventricular pacing study.



It is well established that both acute and chronic CHF contribute to the need for tachyarrhythmia therapy in recipients of an automatic implantable cardioverter defibrillator (ICD). Synchronized biventricular (BV) pacing is a new and promising therapy for symptomatic improvement of CHF in selected patients (low ejection fraction, intraventricular conduction delay). We postulate that this pacing therapy will diminish the need for tachyarrhythmia therapy.



Participants in the Ventak CHF trial received a triple-chamber biventricular ICD with a transvenous right ventricular lead and a left ventricular (LV) lead placed via thoracotomy. Of 54 patients enrolled in the Ventak CHF trial, 32 could be analyzed, with each completing three blinded months programmed to BV VDD pacing and a second randomly assigned three-month period of no pacing.



Of the 32 patients, 13 (41%) received appropriate therapy for a ventricular tachyarrhythmia at least once in the six-month monitoring period postimplant. Five patients (16%) had at least one tachyarrhythmic episode while programmed to BV pacing, whereas 11 (34%) had at least one episode while programmed to no pacing. Three patients (9%) received therapy in both pacing periods, two with BV pacing only. The decrease in necessary tachycardia therapy during the BV pacing period was statistically significant (p = 0.035).



In patients with standard ICD indications who also have CHF, LV dysfunction, and an intraventricular conduction delay, ICD therapy is less common with BV pacing. The mechanism for this improvement is unclear but may be related to hemodynamic improvement in CHF. Although BV pacing does not obviate the need for an ICD, it does diminish the need for appropriate tachyarrhythmia therapy in selected patients.
Drug use patterns in young adulthood and post-college employment.

The relationship between serious drug involvement and risk for unemployment is well recognized, but few studies have prospectively examined this relationship among college students. This study used longitudinal data to examine the association between drug use patterns during college and the likelihood of employment post-college, holding constant sociodemographic variables and personality characteristics. Second, we estimate the prevalence of alcohol and other drug use disorders among employed individuals.



Data were derived from the College Life Study. Participants entered college as traditional students and were assessed annually for six years, regardless of continued college attendance. Analyses were restricted to 620 individuals no longer enrolled in school by Year 6.



Using multinomial regression modeling, persistent drug users (i.e., used illicit drugs (other than marijuana) and/or nonmedical prescription drugs every year they were assessed during the first four years of study) were significantly more likely than non-users to be unemployed vs. employed full-time post-college. Persistent drug users and infrequent marijuana users were also more likely than non-users to be unemployed vs. employed part-time. In Year 6, 13.2% of individuals employed full-time and 23.7% of individuals employed part-time met DSM-IV criteria for drug abuse or dependence during the past year.



If confirmed, the results of this study suggest that persistent drug use among academically achieving young adults might increase risk for post-college unemployment. More research is needed to understand the processes underlying this association. Further attention should be directed at managing substance use problems among recent college graduates who have secured employment.
Influence of order and type of drug (bisoprolol vs. enalapril) on outcome and adverse events in patients with chronic heart failure: a post hoc analysis of the CIBIS-III trial.

Angiotensin-converting enzyme inhibitors (ACE-Is) and beta-blockers are associated with improved outcome in patients with chronic heart failure (CHF). In this post hoc analysis of the CIBIS III trial, we examined the influence of the order of drug administration on clinical events and achieved dose. We also assessed the relations between dose levels and baseline variables or adverse events.



In the CIBIS III trial, 1010 patients (mean age: 72.4 years; mean ejection fraction: 28.8%; male: 68.2%) with stable CHF were randomized to up-titration of monotherapy with either bisoprolol (target dose 10 mg o.d.) or enalapril (target dose 10 mg b.i.d.) for 6 months, followed by their combination for 6-24 months. Endpoints were mortality or all-cause hospitalization, mortality alone and mortality or cardiovascular hospitalization. The study drug (ACE-I or beta-blocker) was last prescribed at ≥50% of target dose to significantly more patients for the first initiated drug in both treatment groups (both P< 0.001). Sixty per cent of endpoints were reached during the monotherapy phase and randomized treatment during monotherapy was not a predictor of the three assessed outcomes. Monotherapy phase was the strongest independent predictor of outcome (P< 0.0001 for all endpoints). Older age, NYHA class III, impaired renal function, lower body weight and blood pressure at baseline, and hypotension, bradycardia and heart failure during treatment were associated with the inability to reach high dose of both study drugs.



The order of drug administration plays an important role in whether CHF patients reach target doses of bisoprolol and enalapril. For both study drugs, the dose level reached was associated with baseline characteristics and adverse events. In CHF patients not treated with an ACE-I or a beta-blocker, the duration of monotherapy with either type of drug should be shorter than 6 months.
Patient-ventilator asynchrony in a traumatically injured population.

Prolonged mechanical ventilation, longer hospital stay, and a lower rate of home discharge have been reported with patient-ventilator asynchrony in medical patients. Though commonly encountered, asynchrony is poorly defined within the traumatically injured population.



Mechanically ventilated trauma patients at an urban, level-1 center were enrolled. Breath waveforms were recorded over 30 min within the first 48 hours following intubation. Asynchronous breaths were defined as ineffective patient triggering, double-triggering, short-cycle breaths, and long-cycle breaths. Asynchronous subjects were defined as having asynchrony in ≥ 10% of total breaths. Demographic, injury, sedation/delirium scores, and clinical and discharge outcomes were prospectively collected.



We enrolled 35 subjects: median age 47 y, 77.1% male, 28.6% with penetrating injuries, 16% with a history of COPD, median (IQR) Injury Severity Score 22 (17-27), and median (IQR) chest Abbreviated Injury Scale score 2 (0-6). We analyzed 15,445 breaths. Asynchrony was present in 25.7% of the subjects. No statistical differences between the asynchronous and non-asynchronous subjects were found for age, sex, injury mechanism, COPD history, delirium/sedation scores, PaO2/FIO2, PEEP, blood gas values, or sedative, narcotic, or haloperidol use. Asynchronous subjects more commonly used synchronized intermittent mandatory ventilation (SIMV) (100% vs. 38.5%, P = .002) and took fewer median spontaneous breaths/min: 4 breaths/min (IQR 3-8 breaths/min) vs. 12 breaths/min (IQR 9-14 breaths/min) (P = .007). SIMV with set breathing frequencies of ≥ 10 breaths/min was associated with increased asynchrony rates (85.7% vs. 14.3%, P = .02). We found no difference in ventilator days, ICU or hospital stay, percent discharged home, or mortality between the asynchronous and non-asynchronous subjects.



Ventilator asynchrony is common in trauma patients. It may be associated with SIMV with a set breathing frequency of ≥ 10 breaths/min, though not with longer mechanical ventilation, longer stay, or discharge disposition.
Early experience of pediatric thoracoscopic lobectomy in the UK.

The aim of this study was to report on the early experience of pediatric thoracoscopic lobectomy in two UK centers (Royal Hospital for Sick Children, Edinburgh, and Addenbrookes Hospital, Cambridge).



Twelve patients between February 2000 and November 2005 were treated with a lobectomy for pulmonary disease.



Diagnoses included 7 congenital cystic adenomatous malformations, 4 patients with bronchiectasis, and 1 thoracic mature teratoma. The patients' ages ranged from 8 months to 15 years. In all patients, a thoracoscopic lobectomy was attempted. In all cases, the lobectomy was completed; however, in 6 patients, the conversion to either video-assisted thoracoscopic surgery (VATS) or open thoracotomy was required. Of note, 9 of the 12 patients had had previous lung infections prior to lobectomy. Five of 6 that required a conversion to VATS or open thoracotomy had had significant previous pulmonary infection, causing hilar lymphadenopathy and adhesions that complicated the dissection. The other case requiring a conversion to thoracotomy had abnormal hilar anatomy with an incomplete oblique fissure.



Patients with a previous history of pulmonary infection can cause difficulty in dissection of the hilum that can necessitate a conversion to VATS or open thoracotomy. An infection prior to lobectomy can cause difficulty in completing the procedure safely thoracoscopically. Consideration of patients with pulmonary disease for lobectomy should be made prior to the onset of infectious complications. The thoracoscopic lobectomy can still be performed in patients with a preceding history of infectious complications, though a higher rate of conversion is likely.
Effectiveness of a Low-Intensity Home-Based Aftercare for Patients with Severe Mental Disorders: A 12-month Randomized Controlled Study

To examine the effectiveness of a low-intensity home-based aftercare service, 130 patients with schizophrenia, schizoaffective disorder or bipolar disorder were randomized to receive either home aftercare or treatment-as-usual. In home aftercare, a general practitioner and a social worker made home visits once in a month after discharge from the hospital wherein they provided education and treatment. In a 1-year follow-up, home aftercare led to greater reduction in rehospitalization rate, more improvement in psychotic symptoms and global illness severity, as well as greater service satisfaction. The implementation of this low-intensity aftercare is recommended, especially in less resourceful settings.
Stem cell therapy in postinfarction chronic coronary heart disease

After acute myocardial infarction, bone-marrow-derived cells (BMDCs) improve cardiac function; it is conceivable, but not yet demonstrated, that BMDC therapy might also be useful in chronic infarction. We treated 18 consecutive patients who had chronic myocardial infarction (between 5 months and 8.5 years postinfarction) using intracoronary transplantation of autologous BMDCs and compared this group with a representative control group who did not receive cell therapy. After 3 months, infarct size in the transplantation group was reduced by 30% and both global left ventricular ejection fraction and infarction wall-movement velocity were increased significantly (15% and 57%, respectively), whereas in the control group no significant changes were observed. After transplantation of BMDCs, there was an 11% improvement in maximum oxygen uptake and a 15% increase in regional 18F-fluordeoxyglucose uptake into infarcted tissue, as determined by positron emission tomography. These results show that functional and metabolic regeneration of infarcted and chronically avital tissue can be achieved in humans using transplantation of bone-marrow-derived cells.
Single-Dose pharmacokinetics of sustained-release fampridine (Fampridine-SR) in healthy volunteers and adults with renal impairment.

Fampridine-SR is a sustained-release formulation of fampridine (4-aminopyridine), a potassium channel blocker demonstrated to improve walking ability in patients with multiple sclerosis. This study evaluated the pharmacokinetics of fampridine and its metabolites after administration of fampridine-SR 10 mg in healthy volunteers and in subjects with mild, moderate, or severe renal impairment (5 per group). Analysis of variance was used to calculate 90% confidence intervals (CIs) for the ratios (impaired/healthy) of least squares mean in maximum plasma concentration (C(max)) and area under the plasma concentration-time curve (AUC). Clearance was primarily through urinary excretion. In renally impaired subjects, fampridine plasma concentrations were consistently higher than in healthy individuals: ratios for C(max) ranged from 166.5% to 199.9% for mild and severe renal impairment, respectively. AUC(0-infinity) ratios ranged from 175.3% to 398.7%, respectively, for mild and severe renal impairment. Mean terminal disposition half-life was 6.4 hours in healthy individuals, compared with 7.4, 8.1, and 14.3 hours in patients with mild, moderate, and severe renal impairment, respectively. Regression analysis confirmed the significant relationship between creatinine clearance and extent of exposure as quantified by AUC for fampridine and its metabolites, suggesting cautious use in patients with mild renal impairment and avoidance in cases of moderate or severe renal impairment.
Clinical benefit of joint distraction in the treatment of severe osteoarthritis of the ankle: proof of concept in an open prospective study and in a randomized controlled study.

Osteoarthritis (OA) is a degenerative, disabling joint disease that affects >10% of the adult population. No effective disease-modifying treatment is available. In the present study, we used joint distraction, a relatively new treatment in which mechanical contact between the articular surfaces is avoided while intraarticular intermittent fluid pressure is maintained, to treat patients with severe OA of the ankle.



Patients with severe ankle OA (n = 57) who were being considered for joint fusion (arthrodesis) were treated with joint distraction in an open prospective study. In addition, a randomized trial was performed in 17 patients to determine whether joint distraction had a better outcome than debridement. A standardized evaluation protocol (physical examination, assessment of pain, mobility, and functional ability) was used, and changes in radiographic joint space width and subchondral sclerosis were measured. Thirty-eight patients in the open study have been followed up for >1 year, with up to 5 years of followup in 7 of them (mean +/- SD followup 2.8 +/- 0.3 years). Patients in the randomized study have been followed up for 1 year.



Significant clinical benefit was found in three-fourths of the 57 patients in the open prospective study. Most interestingly, the improvement increased over time. Radiographic evaluation showed increased joint space width and decreased subchondral sclerosis. Moreover, joint distraction showed significantly better results than debridement.



The clinical benefit of joint distraction in the treatment of severe OA is proof of the concept. Although the followup remains relatively short and effects over time remain unpredictable, our study creates possibilities for the treatment of severe OA in general. Considering the high prevalence of OA and the lack of a cure for it, joint distraction as a treatment of severe OA may have great medical, social, and economic impact.
ALGOL-E: An Experimental Approach to The Study of Programming Languages

A common approach to the teaching of Programming Languages (course 12, Curriculum 68) has been to teach several languages, each demonstrating a feature deemed significant, such as ALGOL, LISP, SNOBOL, and COBOL . The problem that exists with this method is that far too much time is spent learning the details necessary to use the languages, leaving time for only a few trivial programs in each language. A popular alternative to this approach is to teach the course using a single general-purpose language which has a broad repertoire of language features, such as PL/I. While this method successfully avoids much of the detail which characterizes the former, it too seems to have a serious drawback. The student can become quite talented at programming in the language and still have very little feel for the implications of the higher level language structures at the machine level. Moreover, these languages typically provide no means by which the student can readily investigate these implications. Hence, ALGOL-E is proposed as a programming language system which provides such a capability.
A prospective randomized pilot study on intermittent post-dialysis dosing of cinacalcet

Treatment of secondary hyperparathyroidism (SHPT) is important in management of patients with end-stage renal disease on hemodialysis (HD). Calcimimetic agent, cinacalcet provides an option for control of SHPT in patients who fail traditional therapy. It may not have optimal results in non-compliant patients. To enhance compliance, we evaluated effectiveness of post-dialysis dosing of cinacalcet (group AD) as compared to daily home administration (group D) in a prospective randomized trial of HD patients with refractory SHPT. After 2-week run-in phase, patients were randomly assigned to two treatment groups. In group AD (N = 12), patients were administered cinacalcet on the day of dialysis (3 times/week) by dialysis staff, while in control group D (N = 11), cinacalcet was prescribed daily to be taken by patients at home. Intact parathyroid hormone (i-PTH), serum calcium, phosphorus, and alkaline phosphatase were followed for 16 weeks and compared to baseline in both groups. Data were analyzed using between-groups linear regression for repeated measures. No significant decline in i-PTH occurred in group AD at 16 weeks as compared to a significant drop in group D (p = 0.006). However, subgroup analysis showed effectiveness of post-dialysis dosing in patients with less severe SHPT (p = 0.04). Although daily dosing overall was more effective for treatment of SHPT, dialysis dosing was effective in patients with less severe SHPT. This warrants a larger study considering the limitations of this pilot trial. In the meantime, dialysis dosing can be considered in non-compliant patients with less severe SHPT.
Multiwalled carbon nanotube-induced gene signatures in the mouse lung: potential predictive value for human lung cancer risk and prognosis.

Concerns over the potential for multiwalled carbon nanotubes (MWCNT) to induce lung carcinogenesis have emerged. This study sought to (1) identify gene expression signatures in the mouse lungs following pharyngeal aspiration of well-dispersed MWCNT and (2) determine if these genes were associated with human lung cancer risk and progression. Genome-wide mRNA expression profiles were analyzed in mouse lungs (n = 160) exposed to 0, 10, 20, 40, or 80 μg of MWCNT by pharyngeal aspiration at 1, 7, 28, and 56 d postexposure. By using pairwise statistical analysis of microarray (SAM) and linear modeling, 24 genes were selected, which have significant changes in at least two time points, have a more than 1.5-fold change at all doses, and are significant in the linear model for the dose or the interaction of time and dose. Additionally, a 38-gene set was identified as related to cancer from 330 genes differentially expressed at d 56 postexposure in functional pathway analysis. Using the expression profiles of the cancer-related gene set in 8 mice at d 56 postexposure to 10 μg of MWCNT, a nearest centroid classification accurately predicts human lung cancer survival with a significant hazard ratio in training set (n = 256) and test set (n = 186). Furthermore, both gene signatures were associated with human lung cancer risk (n = 164) with significant odds ratios. These results may lead to development of a surveillance approach for early detection of lung cancer and prognosis associated with MWCNT in the workplace.