nils-herrmann/clean_scirepeval huggingface dataset:
Intra-arterial carboplatin chemotherapy for brain tumors: A dose escalation study based on cerebral blood flow

To perform an intra-arterial dose escalation studyof carboplatin based on hemispheric blood-flow estimation inpatients with recurrent malignant glioma. The primary purposewas to determine the maximally tolerated intra-arterial dose.  selective intra-arterialdelivery performed with modern microcatheters, 2) pulsatile infusion,and 3) dosage based on local cerebral blood-flowestimation (middle cerebral artery 60%, anterior cerebral artery20%, posterior cerebral artery 15%, and anterior choroidalartery 5% of the hemispheric blood-flow). The deliverieswere performed above the ophthalmic artery in theanterior circulation, or above the anterior inferior cerebellararteries in the posterior circulation. The doses wereescalated from 200 mg/hemisphere at 50 mg increments.Twenty-one patients were studied (14 with glioblastoma multiforme,five anaplastic astrocytoma, one aggressive low-grade glioma, onemetastasis). Patients had recurrent glioma limited to onehemisphere and Karnofsky score of 50 or greater.Concomitant therapies were allowed.  Carboplatin was escalatedto a dose of 1400 mg/hemisphere. One patienthad a permanent neuromotor decline. The predominant toxicitywas hematopoietic. The median time to tumor progressionwas 22 weeks, median survival 39 weeks, andthe response rate 70% (50% SD and 20%PR) of 19 patients.  Hemispheric blood-flow estimationallowed us to escalate the dose of intra-arterialcarboplatin to twice what was previously considered safe.Responses compared favorably to previous studies. Further studiesare needed to determine if this method willprovide improved and durable responses.
The effect of high-flux hemodialysis on hemoglobin concentrations in patients with CKD: results of the MINOXIS study.

Hemodialysis treatment induces markers of inflammation and oxidative stress, which could affect hemoglobin levels and the response to erythropoietin use. This study sought to determine whether high-flux dialysis would help improve markers of renal anemia, inflammation, and oxidative stress compared with low-flux dialysis.



In a prospective, controlled study, 221 patients undergoing maintenance hemodialysis and receiving darbepoetin-alfa treatment (mean age, 66 years; 55% male) from 19 centers were screened in a 20-week run-in period of low-flux hemodialysis with a synthetic dialysis membrane. Thereafter, 166 patients were enrolled and randomly assigned to receive a synthetic high-flux membrane or to continue on low-flux dialysis for 52 weeks. Data on myeloperoxidase, oxidized LDL, high-sensitivity C-reactive protein, and the Malnutrition Inflammation Score were collected at baseline and after 52 weeks; routine laboratory data, such as hemoglobin, ferritin, and albumin, and the use of darbepoetin-alfa, were also measured in the run-in period.  After 52 weeks, the low-flux and the high-flux groups did not differ with respect to hemoglobin (mean ± SD, 11.7±0.9 g/dl versus 11.7±1.1 g/dl; P=0.62) or use of darbepoetin-alfa (mean dosage ± SD, 29.8±24.8 μg/wk versus 26.0±31.1 μg/wk; P=0.85). Markers of inflammation, oxidative stress, or nutritional status also did not differ between groups.



Over 1 year, high-flux dialysis had no superior effects on hemoglobin levels or markers of inflammation, oxidative stress, and nutritional status. These data do not support the hypothesis that enhanced convective toxin removal would improve patient outcome.
Mayo Clinic validation of the D'amico risk group classification for predicting survival following radical prostatectomy.

The D'Amico risk group classification was originally developed to estimate the risk of biochemical recurrence following treatment for localized prostate cancer. We externally validated the ability of the risk groups to predict clinical progression, and cancer specific and overall survival following radical prostatectomy, and identify predictors of outcome in patients with high risk disease.



We evaluated the records of 7,591 consecutive patients who underwent radical prostatectomy at our institution between 1987 and 2003. Postoperative survival was estimated using the Kaplan-Meier method. Cox proportional hazard regression models were used to analyze the ability of the risk groups to predict survival and to evaluate the impact of clinicopathological factors on outcome in patients at high risk.



Preoperative risk group stratification predicted the patient risk of biochemical and local recurrence, systemic progression, and cancer specific and overall survival (each p <0.001). The HR of death from prostate cancer after surgery in patients with high or intermediate risk disease was 11.5 (95% CI 5.9 to 22.3, p <0.0001) and 6.3 (95% CI 3.3 to 12.3, p <0.0001), respectively, compared to patients at low risk. In patients in the high risk group biopsy Gleason score (p = 0.006), pathological Gleason score (p = 0.006), pathological tumor stage (p = 0.04), positive lymph nodes (p = 0.02) and positive surgical margins (p = 0.008) predicted death from prostate cancer.



We validated the ability of the risk group stratification to predict disease progression and patient survival following radical prostatectomy. Additional prognostic information from surgical staging may assist in individualized postoperative management, particularly for patients at high risk.
Esophagus imaging for catheter ablation of atrial fibrillation: comparison of two methods with showing of esophageal movement

This study aims to evaluate whether visualization and integration of the computed tomography (CT) scan of the left atrium (LA) and the esophagus into the three-dimensional (3D) electroanatomical map the day before ablation is accurate compared with integration of an esophagus tag into the electroanatomic LA map visualizing the anatomic relationship during the radiofrequency ablation or whether esophagus movement prohibits esophagus visualization the day before ablation. Eighteen patients with highly symptomatic atrial fibrillation underwent cardiac CT imaging the day before pulmonary vein ablation. Before CT imaging, a gastric tube was introduced into the esophagus allowing its CT 3D reconstruction. During radiofrequency ablation, mapping of the esophagus was performed and integrated into the LA 3D map. By comparing the position of the gastric tube during CT on day 1 with real-time anatomical mapping using a 3D navigation catheter on day 2, an average distance of more than 10 mm was found in six of 18 patients (33%). In six of 18 (33%), the maximal distance between day 1 and day 2 was even more than 15 mm. Reliance on CT images, even if acquired within 24 h before ablation, does not ensure adequate intraprocedural localization of the esophagus or enhance recognition of esophageal motility.
Effect of gender on lipid-induced insulin resistance in obese subjects.

In obese subjects, chronically elevated plasma concentrations of non-esterified fatty acids (NEFAs) exert a marked risk to contract insulin resistance and subsequently type 2 diabetes. When NEFA is acutely increased due to i.v. infusion of lipid, glucose disposal during a hyperinsulinemic-euglycemic clamp is reduced. This effect has been explained by a NEFA-induced decrease in skeletal muscle insulin sensitivity caused by accumulation of the lipid intermediates such as ceramide and diacylglycerol in the myocytes. However, neither the lipid-induced reduction of glucose disposal nor the intramyocellular lipid deposition has been compared directly in obese females and males.



We studied eight obese females and eight obese males (body mass index (BMI): 32.6+/-1.4 and 32.8+/-0.8 respectively, non significant (NS)) matched for cardiorespiratory fitness relative to lean body mass (43.7+/-1.6 and 47.6+/-1.3 ml/kg min respectively, NS).



Each subject underwent two hyperinsulinemic-euglycemic clamps with infusion of lipid or saline respectively. Furthermore, the subjects exercised during the last half an hour of each clamp.



The lipid-induced reduction in glucose disposal during the clamp was similar in females and males (46+/-10 and 60+/-4% respectively, NS). However, whole-body insulin sensitivity as well as non-oxidative glucose disposal was higher in obese females compared with obese males both during lipid and saline infusion (P<0.001 and P=0.01 respectively). Muscle ceramide, triacylglycerol (TAG), diacylglycerol (DAG), and glycogen content were similar between sexes and remained unchanged during the clamp and when exercise was superimposed.



The lipid-induced inhibition of glucose disposal is similar in obese females and males. However, obese females are more insulin sensitive compared with obese males (both during saline and lipid infusion), which is not due to differences in the concentration of the muscle lipid intermediates such as ceramide and DAG.
Characterization of QT interval adaptation to RR interval changes and its use as a risk-stratifier of arrhythmic mortality in amiodarone-treated survivors of acute myocardial infarction

A new method is proposed to evaluate the dynamics of QT interval adaptation in response to heart rate (HR) changes. The method considers weighted averages of RR intervals (R~R~) preceding each cardiac beat to express RR interval history accounting for the influence on repolarization duration. A global optimization algorithm is used to determine the weight distribution leading to the lowest regression residual when curve fitting the [QT, R~R~] data using a patient- specific regression model. From the optimum weight distribution, a memory lag L/sub 90/ is estimated, expressing the delay in the QT adaptation to HR changes. On average, RR intervals of the past 150 beats (approximately 2.5 min) are required to model the QT response accurately. From a clinical point of view, the interval of the initial tens of seconds to one minute seems to be most important in the majority of cases. A measure of the optimum regression residual (r/sub opt/) has been calculated, discriminating between post-myocardial infarction patients at high and low risk of arrhythmic death while on treatment with amiodarone. A similar discrimination has been achieved with a variable expressing the character of QT lag behind the RR interval dynamics.
Changes in lung function and health status in patients with COPD treated with tiotropium or salmeterol plus fluticasone.

The effects of tiotropium, a long-acting anticholinergic drug, were compared with those of the combination of salmeterol, a long-acting beta(2)-agonist, and fluticasone, an inhaled corticosteroid, in patients with COPD.



A 4-month, randomized, open cross-over study of tiotropium, 18 microg once daily, versus salmeterol, 50 microg, plus fluticasone, 200 microg, twice daily, was conducted in patients with COPD. Efficacy was assessed by spirometry and responses to the St George's Respiratory Questionnaire (SGRQ). After 4 months, patients were asked to select their subsequent therapy and indicate the reasons for their selection.



A total of 78 patients completed the study. There were no significant differences in the improvements in FEV(1) or SGRQ scores between the therapies. Similar numbers of patients selected tiotropium (42.3%) and salmeterol plus fluticasone (57.7%). However, those who preferred one of the therapies demonstrated greater improvements in SGRQ scores with that therapy. One subgroup of patients (30.8%) showed greater improvements in dyspnoea and FEV(1) in response to tiotropium, and the other subgroup of patients (35.9%) showed greater improvements in dyspnoea and FEV(1) in response to salmeterol plus fluticasone. Some patients (14.1%) selected salmeterol plus fluticasone because of positive effects on sputum expectoration.



The study was unblinded and the results need to be interpreted with caution. However, tiotropium and salmeterol plus fluticasone had similar overall effects on pulmonary function and SGRQ scores in patients with COPD. Responses to the two therapies were heterogeneous, and the patients who showed greater improvements in FEV(1) or SGRQ scores with one of the therapies preferred it for their subsequent treatment.
Pharmacokinetics of phase I nevirapine metabolites following a single dose and at steady state.

Nevirapine is one of the most extensively prescribed antiretrovirals worldwide. The present analyses used data and specimens from two prior studies to characterize and compare plasma nevirapine phase I metabolite profiles following a single 200-mg oral dose of nevirapine in 10 HIV-negative African Americans and a steady-state 200-mg twice-daily dose in 10 HIV-infected Cambodians. Nevirapine was assayed by high-performance liquid chromatography (HPLC). The 2-, 3-, 8- and 12-hydroxy and 4-carboxy metabolites of nevirapine were assayed by liquid chromatography-tandem mass spectrometry (LC/MS/MS). Pharmacokinetic parameters were calculated by noncompartmental analysis. The metabolic index for each metabolite was defined as the ratio of the metabolite area under the concentration-time curve (AUC) to the nevirapine AUC. Every metabolite concentration was much less than the corresponding nevirapine concentration. The predominant metabolite after single dose and at steady state was 12-hydroxynevirapine. From single dose to steady state, the metabolic index increased for 3-hydroxynevirapine (P < 0.01) but decreased for 2-hydroxynevirapine (P < 0.001). The 3-hydroxynevirapine metabolic index was correlated with nevirapine apparent clearance (P < 0.001). These findings are consistent with induction of CYP2B6 (3-hydroxy metabolite) and a possible inhibition of CYP3A (2-hydroxy metabolite), although these are preliminary data. There were no such changes in metabolic indexes for 12-hydroxynevirapine or 4-carboxynevirapine. Two subjects with the CYP2B6 *6*6 genetic polymorphism had metabolic indexes in the same range as other subjects. These results suggest that nevirapine metabolite profiles change over time under the influence of enzyme induction, enzyme inhibition, and host genetics. Further work is warranted to elucidate nevirapine biotransformation pathways and implications for drug efficacy and toxicity.
Improving the Action Research Arm test: a unidimensional hierarchical scale.

The Action Research Arm (ARA) test is a performance test of upper extremity motor function which consists of 19 items divided into four hierarchical subtests. This multidimensionality has not yet been tested empirically.



To investigate the dimensionality of the ARA test.



Cross-sectional study involving a sample of 63 chronic stroke patients.



A Mokken scale analysis was performed.



The Mokken scale analysis revealed one strong unidimensional scale containing all 19 items, of which the scalability coefficient H was 0.79, while H per item ranged from 0.69 to 0.86. The reliability coefficient rho equalled 0.98, indicating a very high internal consistency. A subset of 15 out of 19 items showed an invariant hierarchical item-ordering.



The ARA test is a unidimensional scale. The use of subtests, as proposed in the original description of the instrument, is not supported by the present findings. The 15-item scale presented here can be used for adaptive testing, i.e. using only a selected subset of items based on prior knowledge about the patient's abilities, thus minimizing testing time.
Physical activity in adolescence as a predictor of alcohol and illicit drug use in early adulthood: a longitudinal population-based twin study.

We investigated prospectively whether physical activity level in adolescence predicts use of alcohol and illicit drugs in early adulthood. We studied 4,240 individual twins (1,870 twin pairs). We classified those who consistently reported frequent leisure physical activity at ages 16, 17 and 181/2 as persistent exercisers, those exercising less than three times monthly as persistently inactive, and all others as occasional exercisers. To control for familial confounds, within-family analyses compared activity-substance use associations in co-twins discordant for baseline physical activity. Individual-based analyses showed no clear association between baseline physical activity and subsequent weekly alcohol consumption. However, weekly alcohol intoxication (OR = 1.9, p = .002) and problems due to alcohol use (OR = 2.0, p < .001) were more common among persistently inactive participants. After excluding those reporting weekly intoxication at baseline, the risk for alcohol intoxication remained elevated among women occasionally (OR = 2.4, p = .017) or persistently (OR = 5.8, p < .001) inactive at baseline, but this association was not replicated within discordant twin pairs. Individual-based analyses showed that drug use in adulthood was more common among those persistently physically inactive in adolescence (OR = 3.7, p < .001) in comparison to those persistently active. This finding was replicated within discordant twin pairs. Among those with no drug experience during adolescence, persistent inactivity (OR = 1.9, p = .007) increased risk for drug use. We conclude that persistent physical inactivity in adolescence may increase the risk of later problems due to excess alcohol use. Sedentary lifestyle predicts illicit drug use even when controlling for familial factors.
Effectiveness of holistic physiotherapy for low back pain.

Low back pain is a term used to designate a wide and complete assemblage of symptoms that has become a cause of disability in the 21th century man. Until recently, it was believed that low back pain caused by intervertebral disc disease and degenerative progresses. At present, an increasing number of studies are linking the condition to conditions of osteoarticular and musculoligamentous structures in the spine and the associated statics of the pelvis.



The study compared the outcomes of two different plysiotherapeutic approaches to treatment of low pack pain in group of 60 female patients. In the experimental group, a customised programme of treatment was based on postisometric relaxation of muscles and ligaments, active mobilisation of the spine, Kibler Fold mobilisation, Kinesiology Taping and Maigne's relaxing exercises. the control group underwent electrotherapy procedures and performed a set of exercises usually recommended for low back pain. Intensity of pain and difficulty in performing daily activities were evaluated at baseline and on completion of the treatment: the measurements included mobility of the spine, static balance of the pelvis, tenderness and tension of muscles and ligaments and presence of cell-pain zones. Statistics analysis used basic statistics concerning the distribution of the examined characteristics and a comparison of means in independent groups using the Mann-Whitney U test.



As a result of the treatment, low back pain was reduced in about 90% of patients in the experimental group, while static balance of the pelvis, tone of the muscles and ligaments and spinal mobility improved in approximately 80% of these patients. In the control group, radiating pain decreased and ligaments in 25% of participants, white the other parameters did not change significantly. The results were statistically significant at < 0.05.



These results confirm a high holistic physiotherapy including elements of osteopathy such as post-isometric muscle relaxation, active mobilisation, Kibler Fold mobilisation, customised self-therapy and Kinesiology Taping.
Telemedicine Experience for Chronic Care in COPD

Information and telecommunication technologies are called to play a major role in the changes that healthcare systems have to face to cope with chronic disease. This paper reports a telemedicine experience for the home care of chronic patients suffering from chronic obstructive pulmonary disease (COPD) and an integrated system designed to carry out this experience. To determine the impact on health, the chronic care telemedicine system was used during one year (2002) with 157 COPD patients in a clinical experiment; endpoints were readmissions and mortality. Patients in the intervention group were followed up at their homes and could contact the care team at any time through the call center. The care team shared a unique electronic chronic patient record (ECPR) accessible through the web-based patient management module or the home visit units. Results suggest that integrated home telemedicine services can support health professionals caring for patients with chronic disease, and improve their health. We have found that simple telemedicine services (ubiquitous access to ECPR, ECPR shared by care team, accessibility to case manager, problem reporting integrated in ECPR) can increase the number of patients that were not readmitted (51% intervention, 33% control), are acceptable to professionals, and involve low installation and exploitation costs. Further research is needed to determine the role of telemonitoring and televisit services for this kind of patients
Quantitative bone marrow lesion size in osteoarthritic knees correlates with cartilage damage and predicts longitudinal cartilage loss

Bone marrow lesions (BMLs), common osteoarthritis-related magnetic resonance imaging findings, are associated with osteoarthritis progression and pain. However, there are no articles describing the use of 3-dimensional quantitative assessments to explore the longitudinal relationship between BMLs and hyaline cartilage loss. The purpose of this study was to assess the cross-sectional and longitudinal descriptive characteristics of BMLs with a simple measurement of approximate BML volume, and describe the cross-sectional and longitudinal relationships between BML size and the extent of hyaline cartilage damage.



107 participants with baseline and 24-month follow-up magnetic resonance images from a clinical trial were included with symptomatic knee osteoarthritis. An 'index' compartment was identified for each knee defined as the tibiofemoral compartment with greater disease severity. Subsequently, each knee was evaluated in four regions: index femur, index tibia, non-index femur, and non-index tibia. Approximate BML volume, the product of three linear measurements, was calculated for each BML within a region. Cartilage parameters in the index tibia and femur were measured based on manual segmentation.



BML volume changes by region were: index femur (median [95% confidence interval of the median]) 0.1 cm3 (-0.5 to 0.9 cm3), index tibia 0.5 cm3 (-0.3 to 1.7 cm3), non-index femur 0.4 cm3 (-0.2 to 1.6 cm3), and non-index tibia 0.2 cm3 (-0.1 to 1.2 cm3). Among 44 knees with full thickness cartilage loss, baseline tibia BML volume correlated with baseline tibia full thickness cartilage lesion area (r = 0.63, p< 0.002) and baseline femur BML volume with longitudinal change in femoral full thickness cartilage lesion area (r = 0.48 p< 0.002).



Many regions had no or small longitudinal changes in approximate BML volume but some knees experienced large changes. Baseline BML size was associated to longitudinal changes in area of full thickness cartilage loss.