nils-herrmann/clean_scirepeval huggingface dataset:
Itraconazole versus amphotericin B plus nystatin in the prophylaxis of fungal infections in neutropenic cancer patients.

The efficacy and safety of itraconazole oral solution and a combination of amphotericin B capsules plus nystatin oral suspension were compared in the prophylaxis of fungal infections in neutropenic patients. In an open, randomized, multicentre trial, 144 patients received itraconazole oral solution 100 mg bd, and 133 patients received amphotericin B 500 mg tds plus nystatin 2 MU qds. Overall, 65% of itraconazole-treated patients were considered to have had successful prophylaxis, compared with 53% in the polyene group. Proven deep fungal infections occurred in 5% of patients in each group. Fewer patients receiving itraconazole than amphotericin plus nystatin had superficial infections (3 versus 8%; P = 0.066). This trend in favour of itraconazole was seen in patients with profound neutropenia (neutrophil count <0.1 x 10(9) cells/L at least once) or prolonged neutropenia (neutrophil count <1.0 x 10(9) cells/L for >14 days). The median time to prophylactic failure was longer in the itraconazole group (37 days) than in the polyene group (34 days). The number of patients with fungal colonization (nose, sputum, stool) changed more favourably from baseline to endpoint in the itraconazole group than in the polyene group. Both treatments were safe and well tolerated; however, patients receiving amphotericin plus nystatin had a higher incidence of nausea and rash. In conclusion, itraconazole oral solution at doses of 100 mg bd and oral amphotericin B plus nystatin have similar prophylactic efficacy against fungal infections in neutropenic patients. On the basis of reduced incidence of superficial fungal infections, fungal colonization and specific adverse events, itraconazole may be the preferred treatment.
RAPID SITUATION ASSESSMENTS OF ALCOHOL AND SUBSTANCE USE AMONG COMMERCIAL VEHICLE DRIVERS IN NIGERIA.

To describe the current situation with respect to substance use and related harms among commercial vehicle drivers, and to identify a range of interventions that could be feasibly implemented to minimise harms related to substance use.



Observational and group interviews.



Four different motor parks in Ibadan, Nigeria.



Data were obtained from a sample of commercial vehicle drivers, community and members of the law enforcement agencies.



Widespread use of psychoactive substances was reported. New trend of local alcohol beverage generally called 'sepe' tended to have replaced older ones such as palm wine. All substances of abuse were freely available and openly displayed at motor parks except for cocaine and narcotics. There was poor law provision and enforcement of laws prohibiting sale and use around motor parks or while driving.



This study shows the feasibility and value of conducting rapid assessments among commercial vehicle drivers in Nigeria. One outcome of this study is the development of a guide on rapid assessment of alcohol and other substance use assessment and a measure of brief intervention among them. Presentation of these findings should contribute to increased awareness and improved response from the government.
Rs710521[A] on chromosome 3q28 close to TP63 is associated with increased urinary bladder cancer risk

Single nucleotide polymorphism (SNP) rs710521[A], located near TP63 on chromosome 3q28, was identified to be significantly associated with increased bladder cancer risk. To investigate the association of rs710521[A] and bladder cancer by new data and by meta-analysis including all published data, rs710521 was studied in 1,425 bladder cancer cases and 1,740 controls that had not been included in previous studies. Blood samples were collected from 1995 to 2010 in Germany (n = 948/1,258), Hungary (n = 262/65), Venezuela (n = 112/190) and Pakistan (n = 103/227) supplemented by a meta-analysis of 5,695 cases and 40,187 controls. Detection of a A/G substitution (rs710521) on chromosome 3q28, position 191128627 was done via fast real-time polymerase chain reaction (rt–PCR). Rs710521[A] is associated with increased risk in the unadjusted analysis (OR = 1.21; 95% Cl = 1.04–1.40; P = 0.011) and in the recessive model adjusted for age, gender, smoking habits and ethnicity (OR = 1.23; 95% Cl = 1.05–1.44; P = 0.010). No difference between individuals occupationally exposed versus not occupationally exposed to urinary bladder carcinogens was observed concerning the relevance of rs710521[A]. Similarly, rs710521[A] did not confer different susceptibility in smokers and non-smokers. Performing a meta-analysis of 5,695 cases and 40,187 controls including all published studies on rs710521, a convincing association with bladder cancer risk was obtained (OR = 1.18; 95% Cl = 1.12–1.25; P < 0.0001). However, the odds ratio is relatively small.
Preoperative Low Serum Bicarbonate Levels Predict Acute Kidney Injury After Cardiac Surgery

Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Although lower than normal serum bicarbonate levels are known to be associated with consecutive renal function deterioration in patients with chronic kidney injury, it is not well-known whether preoperative low serum bicarbonate levels are associated with the development of AKI in patients who undergo cardiac surgery. Therefore, the clinical implication of preoperative serum bicarbonate levels on AKI occurrence after cardiac surgery was investigated. Patients who underwent coronary artery bypass or valve surgery at Yonsei University Health System from January 2013 to December 2014 were enrolled. The patients were divided into 3 groups based on preoperative serum bicarbonate levels, which represented group 1 (below normal levels) <23 mEq/L; group 2 (normal levels) 23 to 24 mEq/L; and group 3 (elevated levels) >24 mEq/L. The primary outcome was the predicated incidence of AKI 48 hours after cardiac surgery. AKI was defined according to Acute Kidney Injury Network criteria. Among 875 patients, 228 (26.1%) developed AKI within 48 hours after cardiac surgery. The incidence of AKI was higher in group 1 (40.9%) than in group 2 (26.5%) and group 3 (19.5%) (P < 0.001). In addition, the duration of postoperative stay in a hospital intensive care unit (ICU) was longer for AKI patients and for those in the low-preoperative-serum-bicarbonate-level groups. A multivariate logistic regression analysis showed that low preoperative serum bicarbonate levels were significantly associated with AKI even after adjustment for age, sex, hypertension, diabetes mellitus, operation type, preoperative hemoglobin, and estimated glomerular filtration rate. In conclusion, low serum bicarbonate levels were associated with higher incidence of AKI and prolonged ICU stay. Further studies are needed to clarify whether strict correction of bicarbonate levels close to normal limits may have a protective role in preventing further AKI development.
Echocardiographic evaluation of TASER X26 probe deployment into the chests of human volunteers.

Several animal studies have shown that the TASER X26 (TASER International, Scottsdale, Ariz) conducted electrical weapon can electrically capture the myocardium when discharged on the thorax. These results have not been reproduced in human echocardiographic studies. A primary limitation of those human studies is that the TASER device was connected by taping the wires into conductive gel on the skin surface of the thorax. This study overcomes those limitations. In this study, a training instructor discharged a TASER X26 into the chests of 10 subjects from a distance of 7 ft so that a 5-second discharge could be administered through the probes as in field exposures. Limited echocardiography was performed before, during, and after discharge. In agreement with 2 prior studies by these authors, the TASER X26 did not electrically capture the human myocardium when used with probe deployment. These data are contrary to animal studies in which capture occurred.
Enhanced inotropic state of the failing left ventricle by cardiac contractility modulation electrical signals is not associated with increased myocardial oxygen consumption.

Previous studies in patients and in dogs with experimentally induced heart failure (HF) showed that electrical signals applied to the failing myocardium during the absolute refractory period improved left ventricular (LV) function. We examined the effects these same cardiac contractility modulating (CCM) electrical signals on myocardial oxygen consumption (MVO(2)) in both patients and dogs with chronic HF.



Six dogs with microembolizations-induced HF and 9 HF patients underwent CCM leads and generator (OPTIMIZER II) implantation. After baseline measurements, CCM signals were delivered continuously for 2 hours in dogs and for 30 minutes in patients. MVO(2) was measured before and after CCM therapy. In dogs, CCM therapy increased LV ejection fraction at 2 hours (26 +/- 1 versus 31 +/- 2 %, P = .001) without increasing MVO(2) (257 +/- 41 versus 180 +/- 34 micromol/min). In patients, CCM therapy increased LV peak +dP/dt by 10.1 +/- 1.5 %. As with dogs, the increase in LV function after 30 minutes of CCM therapy was not associated with increased MVO(2) (13.6 +/- 9.7 versus 12.5 +/- 7.2 mL O(2)/min).



The study results suggest that unlike cAMP-dependent positive inotropic drugs, the increase in LV function during CCM therapy is elicited without increasing MVO(2).
The effect of left ventricular (LV) remodeling on ventricular arrhythmia in cardiac resynchronization therapy (CRT-D) patients (antiarrhythmic effect of CRT).

In patients with low ejection fraction and ventricular dyssynchrony, cardiac resynchronization therapy (CRT) is an accepted therapeutic modality. In these patients, CRT can improve the quality of life and exercise tolerance in addition to improved survival. On the other hand, antiarrhythmic effects of CRT is a place of debate.



In this study, we evaluated the effect of CRT-induced reverse remodeling on ventricular arrhythmia in heart failure patients. Patients with CRT were divided to two groups of responders and nonresponders. Responders were those with reduction of LVESD of more than 10% or increase in LVEF of more than 5%. They were visited and device analysis was performed during the follow-up.



One hundred and nineteen patients were enrolled in this study. Those with reverse remodeling experienced fewer ventricular arrhythmias after two years of follow-up (N = 2 vs 11, P = 0.001).



Reverse remodeling associated with CRT implantation can result in decreased frequency of ventricular arrhythmias.
Incidences of esophageal injury during esophageal temperature monitoring: a comparative study of a multi-thermocouple temperature probe and a deflectable temperature probe in atrial fibrillation ablation

The study aim was to compare the incidence of esophageal injuries between different temperature probes in the monitoring of esophageal temperature during atrial fibrillation (AF) ablation. One hundred patients with drug-resistant AF were prospectively and randomly assigned into two groups according to the esophageal temperature probe used: the multi-thermocouple probe group (n = 50) and the deflectable temperature probe group (n = 50). Extensive pulmonary vein (PV) isolation was performed with a 3.5-mm open irrigated tip ablation catheter by using a radiofrequency (RF) power of 25–30 W. In both groups, the esophageal temperature thermocouple was placed on the area of the esophagus adjacent to the ablation site. When the esophageal temperature reached 42 °C, the RF energy delivery was stopped. Esophageal endoscopy was performed 1 day after the catheter ablation. No differences existed between the two groups in terms of clinical background and various parameters related to the catheter ablation, including RF delivery time and number of RF deliveries at an esophageal temperature of >42 °C. Esophageal lesions, such as esophagitis and esophageal ulcers, occurred in 10/50 (20 %) and 15/50 (30 %) patients in the multi-thermocouple and deflectable temperature probe groups, respectively (P = 0.25). Most lesions were mild to moderate injuries, and all were cured using conservative treatment. The incidence of esophageal injury was almost equal between the multi-thermocouple temperature probe and the deflectable temperature probe during esophageal temperature monitoring. Most of the esophageal lesions that developed during esophageal temperature monitoring were mild to moderate and reversible.
Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community.

Despite national disease management plans, optimal asthma management remains a challenge in Australia. Community pharmacists are ideally placed to implement new strategies that aim to ensure asthma care meets current standards of best practice. The impact of the Pharmacy Asthma Care Program (PACP) on asthma control was assessed using a multi-site randomised intervention versus control repeated measures study design.



Fifty Australian pharmacies were randomised into two groups: intervention pharmacies implemented the PACP (an ongoing cycle of assessment, goal setting, monitoring and review) to 191 patients over 6 months, while control pharmacies gave their usual care to 205 control patients. Both groups administered questionnaires and conducted spirometric testing at baseline and 6 months later. The main outcome measure was asthma severity/control status.



186 of 205 control patients (91%) and 165 of 191 intervention patients (86%) completed the study. The intervention resulted in improved asthma control: patients receiving the intervention were 2.7 times more likely to improve from "severe" to "not severe" than control patients (OR 2.68, 95% CI 1.64 to 4.37; p<0.001). The intervention also resulted in improved adherence to preventer medication (OR 1.89, 95% CI 1.08 to 3.30; p = 0.03), decreased mean daily dose of reliever medication (difference -149.11 microg, 95% CI -283.87 to -14.36; p=0.03), a shift in medication profile from reliever only to a combination of preventer, reliever with or without long-acting beta agonist (OR 3.80, 95% CI 1.40 to 10.32; p=0.01) and improved scores on risk of non-adherence (difference -0.44, 95% CI -0.69 to -0.18; p=0.04), quality of life (difference -0.23, 95% CI -0.46 to 0.00; p=0.05), asthma knowledge (difference 1.18, 95% CI 0.73 to 1.63; p<0.01) and perceived control of asthma questionnaires (difference -1.39, 95% CI -2.44 to -0.35; p<0.01). No significant change in spirometric measures occurred in either group.



A pharmacist-delivered asthma care programme based on national guidelines improves asthma control. The sustainability and implementation of the programme within the healthcare system remains to be investigated.
Development and validation of LC-MS/MS assay for the simultaneous determination of methotrexate, 6-mercaptopurine and its active metabolite 6-thioguanine in plasma of children with acute lymphoblastic leukemia: Correlation with genetic polymorphism.

Individualized therapy is a recent approach aiming to specify dosage regimen for each patient according to its genetic state. Cancer chemotherapy requires continuous monitoring of the plasma concentration levels of active forms of cytotoxic drugs and subsequent dose adjustment. In order to attain optimum therapeutic efficacy, correlation to pharmacogenetics data is crucial. In this study, a specific, accurate and sensitive liquid chromatography tandem mass spectrometry (LC-MS/MS) has been developed for determination of methotrexate (MTX), 6-mercaptopurine (MP) and its metabolite 6-thioguanine nucleotide (TG) in human plasma. Based on the basic character of the studied compounds, solid phase extraction using a strong cation exchanger was found the optimum approach to achieve good extraction recovery. Chromatographic separation was carried out using RP-HPLC and isocratic elution by acetonitrile: 0.1% aqueous formic acid (85:15v/v) with a flow rate of 0.8mL/min at 40°C. The detection was performed by tandem mass spectrometry in MRM mode via electrospray ionization source in positive ionization mode. Analysis was carried out within 1.0min over a concentration range of 6.25-200.00ng/mL for the studied analytes. Validation was carried out according to FDA guidelines for bioanalytical method validation and satisfactory results were obtained. The applicability of the assay for the monitoring of the MTX, MP and TG and subsequent application to personalized therapy was demonstrated in a clinical study on children with acute lymphoblastic leukemia (ALL). Results confirmed the need for implementation of reliable analysis tools for therapeutic dose adjustment.
Effects of object size on intralimb and interlimb coordination during a bimanual prehension task in patients with left cerebral vascular accidents.

Stroke patients are often left with hemiplegia or hemiparesis of the upper extremities, severely limiting the ability to perform bimanual and functional activities. No studies have investigated how stroke patients adapt their movements to changes in object size in functionally asymmetric bimanual tasks. The influence of object size on intralimb and interlimb coordination during an asymmetrical, functional bimanual task was examined in patients with left cerebral vascular accidents (LCVA) and healthy controls. Fourteen LCVA patients and 13 age-matched controls were instructed to reach to grasp a large and a small jar with the right/affected hand and to open the cap with the other hand. Movement kinematics was analyzed for intralimb coordination (spatial and temporal planning of reaching and grasping) and interlimb coordination (bimanual synchronization and temporal association of the hands). The results demonstrate a spatial adaptation of reaching in the affected hand to the object size and deficits in temporal planning of grasping with the affected hand to object size in the stroke patients. Movement adaptations of the unaffected hand in the stroke patients were similar to those in the healthy adults. Bimanual coordination was independent of object size for both groups.
Selective mineralocorticoid receptor blocker eplerenone reduces resistance artery stiffness in hypertensive patients.

Some antihypertensive agents may improve resistance artery remodeling in hypertensive patients whereas other agents may not, for similar blood pressure reduction. We questioned whether the selective mineralocorticoid receptor blocker eplerenone improves resistance artery remodeling in hypertensive patients versus the beta-blocker atenolol. Sixteen hypertensive patients were randomly assigned to double-blind daily treatment with eplerenone or atenolol. Resistance arteries from gluteal subcutaneous tissue were assessed on a pressurized myograph. After 1 year of treatment, systolic and diastolic blood pressures were similarly well controlled in both groups. Endothelial function did not change with treatment in either group. Media/lumen ratio and cross-sectional area were unchanged in either the atenolol or the eplerenone group. In atenolol-treated patients, the arterial wall became stiffer, whereas in the eplerenone-treated patients, it became less stiff and similar to that of a normotensive control group. The media collagen/elastin ratio was reduced only after eplerenone treatment. Circulating concentrations of osteopontin, monocyte chemoattractant protein-1, basic fibroblast growth factor, interleukin-8, and interleukin-10 were significantly reduced only by eplerenone. However, plasma interleukin-1 receptor a concentration was significantly reduced by both drugs. In conclusion, in hypertensive patients, blood pressure control for 1 year with atenolol was associated with increased wall stiffness of resistance arteries, whereas eplerenone treatment was associated with reduced stiffness, decreased collagen/elastin ratio, and a reduction in circulating inflammatory mediators. These data raise the possibility that eplerenone treatment of hypertensive patients when normalizing blood pressure could potentially be associated with better vascular protection and outcomes than the beta-blocker atenolol, which remains to be demonstrated.
Interaction between isoprenaline and aminophylline in asthma.

Campbell, I. A., Middleton, W. G., McHardy, G. J. R., Shotter, Margaret V., McKenzie, R., and Kay, A. B. (1977). Thorax, 32, 424-428. Interaction between isoprenaline and aminophylline in asthma. Using a factorially designed study, 38 patients with bronchial asthma received a single dose of either isoprenaline by inhalation (9), aminophylline intravenously (10), isoprenaline and aminophylline (11), or placebo (8). The maximum expiratory flow (V max), the maximum expiratory flow at 50% of vital capacity (V max5,), and the concentrations of plasma cyclic AMP were measured at time intervals up to two hours. The combination of isoprenaline and aminophylline acted synergistically in terms of the percent increase in V max50. However, this was statistically significant only at 20 minutes. Plasma cyclic AMP concentration rose with a similar time course of response to the changes in small airways. The elevations in plasma cyclic AMP observed with the drug combination were higher than those for the individual drugs at 10, 20, 30, and 60 minutes but these differences were not statistically significant. These observations support the concept that changes in bronchial smooth muscle tone are mediated by concentrations of cyclic nucleotides and that combinations of isoprenaline and aminophylline, rather than the administration of each drug separately, may have therapeutic advantages in the treatment of bronchial asthma.
Predictors and Associations With Outcomes of Length of Hospital Stay in Patients With Acute Heart Failure: Results From VERITAS.

The length of hospital stay (LOS) is important in patients admitted for acute heart failure (AHF) because it prolongs an unpleasant experience for the patients and adds substantially to health care costs.



We examined the association between LOS and baseline characteristics, 10-day post-discharge HF readmission, and 90-day post-discharge mortality in 1347 patients with AHF enrolled in the VERITAS program. Longer LOS was associated with greater HF severity and disease burden at baseline; however, most of the variability of LOS could not be explained by these factors. LOS was associated with a higher HF risk of both HF readmission (odds ratio for 1-day increase: 1.08; 95% confidence interval [CI] 1.01-1.16; P = .019) and 90-day mortality (hazard ratio for 1-day increase: 1.05; 95% CI 1.02-1.07; P < .001), although these associations are partially explained by concurrent end-organ damage and worsening heart failure during the first days of admission.



In patients who have been admitted for AHF, longer length of hospital stay is associated with a higher rate of short-term mortality.