nils-herrmann/clean_scirepeval huggingface dataset:
Pancreatic Resection Guided by Preoperative Intraductal Ultrasonography for Intraductal Papillary Mucinous Neoplasm

Successful treatment requires reliable preoperative assessment of the highly variable extension of intraductal papillary mucinous neoplasms (IPMNs). We aimed to determine the role of intraductal ultrasonography (IDUS) in predicting the extension of IPMN, and in selecting the method of pancreatic resection and the long-term outcome after surgery.Randomized prospective study. Forty consecutive patients who underwent IPMN resection were included in the study. Patients were randomly assigned to an IDUS group or control group, in which IDUS was not performed.Preoperative assessment by IDUS had an 85% (17 of 20) diagnostic accuracy for tumor extension of IPMN compared with 50% (10 of 20) in cases assessed by other imaging methods without IDUS (P=0.018). In 9 of 15 patients with invasive carcinoma, the tumor was located in the pancreatic head, and 11 had a main duct-type tumor. Recurrent disease was identified in 5 of 15 (33%) patients with invasive IPMN at a mean follow-up of 50 months; of them, 1 underwent preoperative IDUS and 4 were assessed by other imaging methods. None of the 25 patients with noninvasive IPMN had recurrent disease at follow-up. The overall cumulative 3-year survival rate was 79%.CONCLUSIONS:Preoperative IDUS was useful in determining the type of surgery and the extent of resection, especially in main-duct IPMN.
Long-term impairment of the lacrimal glands after radioiodine therapy: a cross-sectional study

Impairment of the lacrimal glands after external radiation has been well documented, but there are only a few reports on the effects of radioiodine therapy on the lacrimal glands. Long-term effects of high-dose radioiodine therapy on tear secretion have not previously been studied. We investigated 175 eyes of 88 patients with a history of radioiodine therapy for thyroid carcinoma (68 females, 20 males; mean age 55±16 years, range 17–81 years) and compared them with a sex- and age-matched control group (n=39). All patients had been given at least 2.96 GBq iodine-131 (maximal administered activity 22.3 GBq 131I). An ophthalmological investigation was performed 64±71 months (range 3–317 months) after initial radioiodine therapy by a single ophthalmologist. Lacrimal gland function was evaluated with three different function tests. External eye morphology was considered, and detailed ophthalmological history-taking was performed. Patients with factors known to affect lacrimal gland function (contact lenses, autoimmune disorders, history of additional radiation exposure) were excluded from the study. A total of 81 patients (92%) had at least one abnormal function test indicating impaired lacrimal gland function. Schirmer's tear test was decreased (<10 mm/5 min) in 47 of the 88 patients and definitely abnormal (<5 mm/5 min) in 35 patients. A tear film break-up time of <10 s was found in 78 patients, and 62 patients had a definitely abnormal break-up time of <5 s. The lacrimal lipid layer was impaired in 43 patients. The function tests were all significantly altered in the study group as compared with the controls (P<0.005, P<0.001, P<0.001, respectively). Both subjective symptoms of dry eye (P<0.01) and changes in the external eye morphology (P<0.001) were significantly more prevalent in the study group. Our findings suggest that in the majority of patients, lacrimal gland function may be permanently impaired after high-dose radioiodine therapy. All three layers of the tear film are involved and there is a pronounced long-term effect on the tear film stability.
Electrophysiological Effects of Carvedilol Administration in Patients with Dilated Cardiomyopathy

Several studies suggest the clinical efficacy of carvedilol in reducing atrial and ventricular arrhythmias in patients with left ventricular dysfunction (LVD) due to congestive heart failure (CHF) or following myocardial infarction. However, the mechanisms supporting its antiarrhythmic efficacy have been derived from experimental studies. In this prospective, placebo-controlled trial we examined the electrophysiological effects of a high oral dose of carvedilol in patients with CHF and LVD due to non-ischemic dilated cardiomyopathy. Thirty-one patients with stable CHF underwent electrophysiological study and were randomly assigned to treatment with carvedilol or placebo. After 2 months of treatment the study was repeated. Carvedilol prolonged almost all conduction times. In the same group atrial and ventricular effective refractory periods were significantly prolonged, while the parameters of repolarization remained virtually unchanged. The prolongation of refractoriness was most pronounced in the atrium. The change in ventricular refractoriness was correlated with ejection fraction (r = 0.94, p < 0.01) suggesting that patients with more preserved left ventricular function responded to treatment with greater prolongation. Even after a short period of administration carvedilol has marked and diffused electrophysiological effects that would be beneficial for patients with CHF and may contribute to the positive outcome of clinical trials.
Combination of flavonoids with Centella asiatica and Melilotus for diabetic cystoid macular edema without macular thickening.

The purpose of this study was to evaluate the orally administered combination of flavonoids desmin and troxerutin with Centella asiatica and Melilotus for the treatment of diabetic cystoid macular edema (CME) without macular thickening.



In this prospective, interventional, controlled study, 40 consecutive patients with type 2 diabetes and CME without macular thickening at optical coherence tomography were randomized into 2 groups of 20 subjects each (treatment and control groups). The treatment group received an oral combination of desmin (300 mg/day) and troxerutin (300 mg/day) with C. asiatica (30 mg/die) and Melilotus (160 mg/die) for 14 months. Best collected visual acuity, central retinal thickness at optical coherence tomography, retinal sensitivity (RS), and stability of fixation at microperimetry were measured at baseline and monthly for 14 months.



In both groups, mean best collected visual acuity, central retinal thickness, and stability of fixation did not show differences during follow-up (P > 0.05). At month 14, the RS was greater in the treated group (P = 0.01) and was significantly reduced in the control group only (P < 0.001). Five eyes in the study group showed disappearance of the intraretinal cysts after a mean time of 3.5 ± 0.3 months, which persisted in the following months. These 5 eyes presented a greater RS at each follow-up visit when compared with the control group (P < 0.05). Anatomic improvement was never reported in the control group.



The orally administered combination of flavonoids, C. asiatica, and Melilotus could be beneficial in preserving RS in diabetic CME without macular thickening.
Increased number of volatile organic compounds over malignant glottic lesions.

Electronic noses can identify diseases, including head and neck squamous cell carcinoma (SCC) by the fingerprint of volatile organic compounds (VOCs) in exhaled air. However, whether these VOCs originated from the malignant lesion itself remains unclear. The objective was to test for the presence and properties of VOCs directly over the vocal folds in malignant and benign lesions, as a potential tool for noninvasive screening.



Prospective observational case control study.



Samples of mucus directly covering vocal fold lesions were analyzed using gas chromatography mass spectrometry for detection of VOCs, and evaluation of the properties and quantity of VOCs in the samples. Additionally, samples of oropharyngeal mucus were analyzed to exclude VOCs found also in the vicinity of the lesion. Benign and malignant lesion groups were compared using a nonparametric (Mann-Whitney) test.



We studied 14 patients, six with SCC and eight with benign pathology. We found an increased number of discrete VOC types in patients with SCC both above the lesion (SCC = 4.333 ± 2.5, benign = 0.875 ± 0.6; Z=3, P < .001) and directly above the lesion with exclusion of its vicinity (SCC = 3.167 ± 1.9, benign = 0.5 ± 0.5; Z = 2.8, P < .003). VOCs detected in SCCs but not in benign samples included the straight-chain fatty acids: butyric acid, pentanoic acid, hexanoic acid, and heptanoic acid.



Compared with benign vocal fold lesions, the environment of vocal folds in SCC is enriched with VOCs. These preliminary findings highlight a unique pattern that may contribute to the development of a future minimally invasive technology for screening vocal fold lesions for malignancy.
Effects of Global Postural Reeducation on gait kinematics in parkinsonian patients: a pilot randomized three-dimensional motion analysis study

The Global Postural Reeducation (GPR) method is a physical therapy based on the stretching of antigravity muscle chains with the parallel enhancement of the basal tone of antagonistic muscles addressed to improve static and dynamic stability. Through a three-dimensional motion analysis (3DMA) system, our study aims to investigate whether in Parkinson’s disease (PD) patients a GPR program results in a more physiological gait pattern. The kinematic parameters of gait of twenty subjects with clinically diagnosed PD were calculated. The patients were randomly assigned to a study (10 or control (10) group. All subjects underwent neurological and 3DMA assessments at entry time (t 0), at 4 weeks (t 1, end of GPR program), and at 8 and 12 weeks (t 2 and t 3, follow-up evaluation). The study group underwent a four-week GPR program, three times a week, for 40 min individual sessions. Kinematic gait parameters of thigh (T), knee (K) and ankle (A) and UPDRS-III scores were evaluated. At the end of the GPR program, we observed an improvement of the kinematic gait pattern, documented by the increase in KΔc and TΔc values that respectively express the flexion amplitude of knee and thigh. The amelioration was persistent at follow-up assessments, with a parallel enhancement in clinical parameters. GPR intervention shows a long-term efficacy on gait pattern in PD patients. Furthermore, we validated 3DMA as a valuable tool to study the kinematics of gait thus refining the understanding of the effects of specific rehabilitation programs.
Primary care clinicians evaluate integrated and referral models of behavioral health care for older adults: results from a multisite effectiveness trial (PRISM-e).

Recent studies have shown that integrated behavioral health services for older adults in primary care improves health outcomes. No study, however, has asked the opinions of clinicians whose patients actually experienced integrated rather than enhanced referral care for depression and other conditions.



The Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) study was a randomized trial comparing integrated behavioral health care with enhanced referral care in primary care settings across the United States. Primary care clinicians at each participating site were asked whether integrated or enhanced referral care was preferred across a variety of components of care. Managers also completed questionnaires related to the process of care at each site.



Almost all primary care clinicians (n = 127) stated that integrated care led to better communication between primary care clinicians and mental health specialists (93%), less stigma for patients (93%), and better coordination of mental and physical care (92%). Fewer thought that integrated care led to better management of depression (64%), anxiety (76%), or alcohol problems (66%). At sites in which the clinicians were rated as participating in mental health care, integrated care was highly rated as improving communication between specialists in mental health and primary care.



Among primary care clinicians who cared for patients that received integrated care or enhanced referral care, integrated care was preferred for many aspects of mental health care.
Assessment of neuropathic pain in patients with cancer: the interobserver reliability. An observational study in daily practice.

Neuropathic pain (NeP) is a burdensome problem in all stages of cancer. Although clinical judgment is accepted as a surrogate for an objective gold standard in diagnosing NeP, no publications were found about its reliability.



Therefore, levels of agreement on the clinical examination of NeP were estimated by calculating kappa-value (K) and percentage of pair wise agreement (PA) to determine the interobserver reliability of diagnosing NeP.



The outpatient clinic of medical oncology of the Radboud University Nijmegen Medical Centre.



Patients with cancer with potential NeP complaints were recruited from the outpatient clinic of medical oncology. Physicians were recruited from the department of pain and palliative medicine. Physicians and patients were recruited for participation in an observational study in daily practice. Each patient (N = 34) was examined by 2 specialists via independent clinical assessment. All consultations were video recorded.  After each assessment, physicians were asked to indicate the most adequate characterization of the pain: pure NeP, pure nociceptive pain (NoP), mixed pain (MiP), or no pain (NP).



Kappa (K) for the diagnosis of the most adequate pain characterization was 0.50, PA 64.7%. For diagnosing pure NeP k was 0.78 (PA 91.2%), for the NeP component (NeP + MiP)  and NoP component (NoP + MiP), it was respectively 0.52 (PA  76.5%) and 0.61 (PA 82.4%). For the diagnosis on the basis of the grading system between physicians, K was 0.34 (PA 52.9%). The intrarater reliability for the diagnosis of an NeP component on the basis of clinical assessment and the NeP component on the basis of the grading system, for pain specialists K was 0.69 (PA 85.3%) and for palliative care specialists K was 0.61 (PA 79.4%).



The values of K and the PA for the existence of an NeP component are not satisfying and the clinical agreement between physicians around findings from physical examination should encourage a better standardization of the clinical assessment and classification of pain in patients with cancer in respect with the identification of NeP. 



A substantial level of agreement was found for the diagnosis of pure NeP and a moderate level of agreement for the diagnosis of the NeP component was found, both with a PA = 70%. There was only a fair agreement between the physicians regarding the grading system. However, there was a substantial level of (interrater) agreement for the diagnosis of an NeP component and the outcome of the grading system. The findings in this study also suggest that a better standardization of the clinical assessment and classification of pain in patients with cancer with respect to the identification of neuropathic pain is necessary.
The extraarticular symptoms influence ACR response in the treatment of rheumatoid arthritis with biomedicine: a single-blind, randomized, controlled, multicenter trial in 194 patients.

The extraarticular symptoms are important in the pattern differentiation of traditional Chinese medicine (TCM), and the present study is designed in an attempt to find the associations between the extraarticular symptoms and American College of Rheumatology (ACR) Response in 194 cases of rheumatoid arthritis (RA) treated with biomedicine.



The data were obtained from a randomized clinical trial. One hundred ninety-four RA patients were treated with the biomedical therapy (diclofenec, methotrexate and sulfasalazine). ACR20 response in 24 weeks was used for the efficacy evaluation. Eighteen symptoms (including 13 extraarticular symptoms) that TCM practitioners focus on were collected for exploration on the association between the symptoms and the efficacy of the biomedical therapy with association rules method.



After 24 weeks, a total of 135 patients receiving biomedicine had achieved an ACR20 response. The association rules analysis on each symptom showed that soreness in the waist was more associated with ACR20 response, but with lower support (selected sample size based, 20.10% and 14.95% respectively); cold intolerance and cold joint were found to be associated with ACR20 response with higher support (48.97% and 53.61% respectively), and the confidences (predicted effective rate) were 73.08% and 71.23% respectively. The associations between combination of symptoms (among them, there was at least one extraarticular symptom) and ACR20 response indicated that cold intolerance or cold joint with higher confidence and support were the most important extraarticular symptoms.



The RA patients with "cold intolerance" and "cold joints", which are the extraarticular symptoms that TCM practitioners focus on, may show higher ACR20 response when treated with the biomedical approach.
Variants for HDL-C, LDL-C, and triglycerides identified from admixture mapping and fine-mapping analysis in African American families.

Admixture mapping of lipids was followed-up by family-based association analysis to identify variants for cardiovascular disease in African Americans.



The present study conducted admixture mapping analysis for total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. The analysis was performed in 1905 unrelated African American subjects from the National Heart, Lung and Blood Institute's Family Blood Pressure Program (FBPP). Regions showing admixture evidence were followed-up with family-based association analysis in 3556 African American subjects from the FBPP. The admixture mapping and family-based association analyses were adjusted for age, age(2), sex, body mass index, and genome-wide mean ancestry to minimize the confounding caused by population stratification. Regions that were suggestive of local ancestry association evidence were found on chromosomes 7 (low-density lipoprotein cholesterol), 8 (high-density lipoprotein cholesterol), 14 (triglycerides), and 19 (total cholesterol and triglycerides). In the fine-mapping analysis, 52 939 single-nucleotide polymorphisms (SNPs) were tested and 11 SNPs (8 independent SNPs) showed nominal significant association with high-density lipoprotein cholesterol (2 SNPs), low-density lipoprotein cholesterol (4 SNPs), and triglycerides (5 SNPs). The family data were used in the fine-mapping to identify SNPs that showed novel associations with lipids and regions, including genes with known associations for cardiovascular disease.



This study identified regions on chromosomes 7, 8, 14, and 19 and 11 SNPs from the fine-mapping analysis that were associated with high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides for further studies of cardiovascular disease in African Americans.
Barriers to early presentation of self-discovered breast cancer in Singapore and Malaysia: a qualitative multicentre study.

To explore and compare barriers to early presentation of self-discovered breast cancer in Singapore and Malaysia.



A qualitative interview study with thematic analysis of transcripts.



67 patients with self-discovered breast symptoms were included in the analysis. Of these, 36% were of Malay ethnicity, 39% were Chinese and 25% Indian, with an average age of 58 years (range 24-82 years). The number of women diagnosed at early stages of cancer almost equalled those at advanced stages. Approximately three-quarters presented with a painless lump, one-quarter experienced a painful lump and 10% had atypical symptoms.



University hospital setting in Singapore and Malaysia.



Patients revealed barriers to early presentation not previously reported: the poor quality of online website information about breast symptoms, financial issues and the negative influence of relatives in both countries, while perceived poor quality of care and services in state-run hospitals and misdiagnosis by healthcare professionals were reported in Malaysia. The pattern of presentation by ethnicity remained unchanged where more Malay delayed help-seeking and had more advanced cancer compared to Chinese and Indian patients.



There are few differences in the pattern of presentation and in the reported barriers to seek medical care after symptom discovery between Singapore and Malaysia despite their differing economic status. Strategies to reduce delayed presentation are: a need to improve knowledge of disease, symptoms and causes, quality of care and services, and quality of online information; and addressing fear of diagnosis, treatment and hospitalisation, with more effort focused on the Malay ethnic group. Training is needed to avoid missed diagnoses and other factors contributing to delay among health professionals.
Serologic profile and mortality rates of scleroderma renal crisis in Italy.

To analyze clinical and serological characteristics of subjects with scleroderma renal crisis (SRC) in Italian patients with systemic sclerosis (SSc).



A retrospective analysis of medical records from 9 Italian rheumatologic referral centers was carried out. All patients with SRC and an available serum sample at the time of crisis were included. Antinuclear antibodies (ANA) by indirect immunofluorescence, anti-topoisomerase (topo) I by enzyme-linked assay (ELISA), anti-RNA polymerases (RNAP) by ELISA for the subunit III, and immunoprecipitation (IP) were performed.



Forty-six cases (38 female; 40 diffuse cutaneous SSc) were identified. Mean age at SSc and SRC onset was 52.8 years +/- 13.2 and 55.4 years +/- 11.8, respectively. ANA were present in 44 patients (96%). Anti-topo I antibodies were detected in 30 (65%), anti-RNAP I-III in 7 (15%). No differences emerged between these 2 groups for their main clinical characteristics. The proportion of patients in the anti-RNAP I-III group developing SRC early (< 18 mo) in the course of SSc was significantly higher (p = 0.03). Cumulative survival rates were 64%, 53%, and 35% at 1, 2, and 10 years of followup, respectively. Survival rates of SSc patients significantly differed according to their autoantibody profile, being lower in the anti-topo I than in the anti-RNAP I-III group (p = 0.034).



SRC is a rare manifestation of SSc in Italy but it is still associated with severe prognosis. Anti-topo I reactivity was more frequent than anti-RNAP I-III in our patients with SRC and was associated with delayed onset and high mortality rates.
Relationship of serum bisphenol A with diabetes in the Thai population, National Health Examination Survey IV, 2009.

Epidemiological studies of the association between bisphenol A (BPA) exposure and diabetes have been inconsistent. The present study determined serum BPA concentrations in the Thai population and their association with hyperglycemia and diabetes.



In all, 2581 serum samples from the Thai National Health Examination Survey (2009) were used to determine BPA levels. Impaired fasting glucose (IFG) was defined as fasting plasma glucose ≥100 and <126 mg/dL. Diabetes was defined as a history of a physician's diagnosis or fasting plasma glucose ≥126 mg/dL. Multinomial logistic regression was used to examine the association of serum BPA with IFG and diabetes.



Of 2581 samples tested, BPA was detected in 2135 samples (weighted percentage 78.1%), with a geometric mean concentration of 0.34 ng/mL BPA. Serum BPA levels were significantly higher among those with diabetes or IFG compared with normoglycemic individuals (0.52 and 0.38 vs 0.33 ng/mL, respectively; P < 0.001). After adjusting for potential confounders, compared with the first quartile (≤0.071 ng/mL), the overall adjusted odds ratios (OR) of serum BPA concentration in the third and fourth quartiles (0.319-0.745 and ≥0.746 ng/mL, respectively) for IFG were 1.72 (95% confidence interval [CI] 1.19, 2.49) and 1.23 (95% CI 0.80, 1.89), respectively; for diabetes, the adjusted OR were 1.88 (95% CI 1.18, 2.99) and 1.83 (95% CI 1.12, 2.95), respectively, with a slightly stronger association among men than in women.



Serum BPA concentrations were not associated with IFG, but were positively associated with diabetes in the Thai population. Further prospective studies are needed to confirm the relationship.