Miracle-dz/UniFAR-FTUs huggingface dataset:
Clinical comparison of propofol-remifentanil TCI with sevoflurane induction/maintenance anesthesia in laparoscopic cholecystectomy

Objective : We aimed to compare the anesthetic characteristics between total intravenous anesthesia (TIVA) using propofol-remifentanil with target control infusion (TCI) and volatile induction and maintenance anesthesia (VIMA) using sevoflurane and sufentanyl for patients undergoing laparoscopic cholecystectomy. Methods: A total of 120 patients undergoing laparoscopic cholecystectomy were randomly assigned to two groups. Patients in group T received TCI of propofol-remifentanil for induction and maintenance. Patients in group S received sevoflurane-sufentanyl for induction and maintenance. Results: Patients in group S had a significantly faster induction time than patients in group T (109s vs.44s). The emergence time in terms of time to extubation was comparable between the two groups, while the time to eyes opening (419s vs.483s, p=0.006) and duration in PACU were longer in group S (44 min vs.53 min, p=0.017). Ten (17.2%) patients in group S were administered an antihypertensive drug when gallbladder issues were present, while only 1(1.7%) patient needed this drug in group T (p=0.004). More patients in group T than in group S received fentanyl for analgesia in PACU (88%vs.70%, p=0.013). The incidence of postoperative nausea and vomiting (PONV) in PACU was higher in group S than in group T (20% vs.38%, p=0.027). Conclusion: Both techniques had advantages and disadvantages in laparoscopic cholecystectomy; none of the techniques studied was superior.
Immunogenicity to infliximab is associated with HLA-DRB1

Dear Editor, We read with great interest the manuscript by Ungar and colleagues describing the temporal evolution of antibodies to infliximab (ATI) in patients with IBD treated with infliximab (IFX). 1 By prospectively following 125 patients with IBD, they showed that ATI formation is a dynamic process. Clinically relevant ATI were typically formed within the first 12 months but transient ATI, which are of little clinical significance, can be formed at any time during treatment. They furthermore demonstrated that the evolution of ATI correlates with clinical loss of response and that concomitant immunomodulator use prolonged ATI-free survival, which is in line with previous reports. Nevertheless, patient-related factors possibly influencing ATI formation weren't considered and haven't been studied extensively. We hypothesised that ATI formation may be triggered by HLA-DRB1 alleles, as was shown for immunogenicity to interferon-β therapy in multiple sclerosis.2 We retrospectively analysed 192 patients with IBD: 76 patients developed ATI during IFX maintenance treatment (=ATI+) (44 Crohn's disease (CD), 32 UC) and these were matched with 116 patients (64 CD, 52 UC) who never developed ATI (=ATI−). All patients were antitumour necrosis factor naive before IFX …
Cutpoints and resistance of random walk paths.

We construct a bounded degree graph $G$, such that a simple random walk on it is transient but the random walk path (i.e., the subgraph of all the edges the random walk has crossed) has only finitely many cutpoints, almost surely. We also prove that the expected number of cutpoints of any transient Markov chain is infinite. This answers two questions of James, Lyons and Peres [A Transient Markov Chain With Finitely Many Cutpoints (2007) Festschrift for David Freedman]. Additionally, we consider a simple random walk on a finite connected graph $G$ that starts at some fixed vertex $x$ and is stopped when it first visits some other fixed vertex $y$. We provide a lower bound on the expected effective resistance between $x$ and $y$ in the path of the walk, giving a partial answer to a question raised in [Ann. Probab. 35 (2007) 732--738].
Randomization Tests Under an Approximate Symmetry Assumption

This paper develops a theory of randomization tests under an approximate symmetry assumption. Randomization tests provide a general means of constructing tests that control size in finite samples whenever the distribution of the observed data exhibits symmetry under the null hypothesis. Here, by exhibits symmetry we mean that the distribution remains invariant under a group of transformations. In this paper, we provide conditions under which the same construction can be used to construct tests that asymptotically control the probability of a false rejection whenever the distribution of the observed data exhibits approximate symmetry in the sense that the limiting distribution of a function of the data exhibits symmetry under the null hypothesis. An important application of this idea is in settings where the data may be grouped into a fixed number of “clusters” with a large number of observations within each cluster. In such settings, we show that the distribution of the observed data satisfies our approximate symmetry requirement under weak assumptions. In particular, our results allow for the clusters to be heterogeneous and also have dependence not only within each cluster, but also across clusters. This approach enjoys several advantages over other approaches in these settings.
Equalization for non-coherent UWB Systems with approximate semi-definite programming

In this paper, we propose an approximate semi-definite programming framework for demodulation and equalization of non-coherent ultra-wide-band communication systems with inter-symbol-interference. It is assumed that the communication systems follow non-linear second-order Volterra models. We formulate the demodulation and equalization problems as semi-definite programming problems. We propose an approximate algorithm for solving the formulated semi-definite programming problems. Compared with the existing non-linear equalization approaches, such as in [1], the proposed semi-definite programming formulation and approximate solving algorithm have low computational complexity and storage requirements. We show that the proposed algorithm has satisfactory error probability performance by simulation results. The proposed non-linear equalization approach can be adopted for a wide spectrum of non-coherent ultra-wide-band systems, due to the fact that most non-coherent ultra-wide-band systems with inter-symbol-interference follow non-linear second-order Volterra signal models.
Upper Campanian to Maastrichtian foraminiferal assemblages of the Palmyra Region, Syria

The biostratigraphical and sedimentological results were obtained from cutting samples from four exploration wells (Al Mahr-1, Jihar-1, Jihar-5 and Palmyra-1) located in the Palmyra Region in Syria. The detailed micropaleontological analyses were performed on planktonic and benthonic foraminifera assemblages of the Campanian and Maastrichtian sediments. Upper Campanian to Lower Maastrichtian sediments in the Al Mahr-1 well are composed of argillaceous limestones of wackestone to wackestone/packstone types ; sediments in the Jihar-5 are consisted of argillaceous peloidal biomicrites, partly redeposited and thin layers of sandstone ; and sediments in the Palmyra-1 well are composed of marls to calcareous marls with occurrences of chert and glauconite. The Upper Maastrichtian interval of the Palmyra-1 well is presented by marls and limestones of mudstone/wackestone type, with occasional occurrences of dolomites. However, in the Jihar-1 and Al Mahr-1 wells sediments are mostly composed of dolomitized argillaceous wackestones and argillaceous limestones of mudstone/wackestone type, respectively. The micropaleontological investigation was focused on the vertical distribution, diversity and composition of the planktonic and benthonic foraminiferal assemblages according to Caron (1985), Kaiho (1998), Pessagno (1967), Premoli Silva & Verga (2004) and Robaszynski et al. (1984). Upper Campanian to Maastrichtian sediments are documented by the following index species of planktonic and benthonic foraminifera: Abathomphalus mayaroensis, Globotruncanella petaloidea, Globotruncanella havanensis, Globotruncanita stuarti, Globotruncanita stuartiformis, Globotruncanita conica, Gansserina gansseri, Contusotruncana contusa, Globotruncana aegyptica, Pseudotextularia elegans, Rugoglobigerina rugosa, Muricohedbergella monmouthensis, Lenticulina műnsteri, Lenticulina rotulata, Bolivina incrassata, Gaudryna laevigata, Gavelinella monterelensis, Cibicidoides dayi and Bolivinoides dracco. The rich and highly diversified foraminiferal association and lithological characteristics of the Campanian and Maastrichtian sediments suggest the Mediterranean bioprovince with tropical to subtropical climate, and the deposition in the outer shelf to deeper marine environment.
The Home Market Effect and Bilateral Trade Patterns

We test for home-market effects using a difference-in-difference gravity specification. The home-market effect is the tendency for large countries to be net exporters of goods with high transport costs and strong scale economies. It is predicted by models of trade based on increasing returns to scale but not by models of trade based on comparative advantage. In our estimation approach, we select pairs of exporting countries that belong to a common preferential trade area and examine their exports of goods with high transport costs and strong scale economies relative to their exports of goods with low transport costs and weak scale economies. We find that home-market effects exist and that the nature of these effects depends on industry transport costs. For industries with very high transport costs, it is national market size that determines national exports. For industries with moderately high transport costs, it is neighborhood market size that matters. In this case, national market size plus market size in nearby countries determine national exports.
Second Stage of Labor

Current American College of Obstetricians and Gynecologists’ definition of prolonged second stage diagnoses 10% to 14% of nulliparous and 3% to 3.5% of multiparous women as having a prolonged second stage. The progression of labor in modern obstetrics may have deviated from the current labor norms established in the 1950s, likely due to differences in obstetric population characteristics and variation in clinical practice. Optimal management of the second stage in women with and without epidural remains debatable. Although prolonged second stage is associated with increased risk of maternal morbidity, conflicting data exist regarding the duration of second stage and associated neonatal morbidity and mortality.
Efficient Hardware Debugging Using Parameterized FPGA Reconfiguration

Functional errors and bugs inadvertently introduced at the RTL stage of the design process are responsible for the largest fraction of silicon IC re-spins. Thus, comprehensive functional verification is the key to reduce development costs and to deliver a product in time. The increasing demands for verification led to an increase in FPGA-based tools that perform emulation. These tools can run at much higher operating frequencies and achieve higher coverage than simulation. However, an important pitfall of the FPGA tools is that they suffer from limited internal signal observability, as only a small and preselected set of signals is guided towards (embedded) trace buffers and observed. This paper proposes a dynamically reconfigurable network of multiplexers that significantly enhance the visibility of internal signals. It allows the designer to dynamically change the small set of internal signals to be observed, virtually enlarging the set of observed signals significantly. These multiplexers occupy minimal space, as they are implemented by the FPGA's routing infrastructure.
ANP Differentially Modulates Marinobufagenin-Induced Sodium Pump Inhibition in Kidney and Aorta

NaCl loading and plasma volume expansion stimulate 2 natriuretic systems, vasoconstrictor, digitalis-like Na/K-ATPase inhibitors and vasorelaxant ANP peptides. Several hormones, including ANP, regulate activity of the Na/K-ATPase by modulation of its phosphorylation state. We studied effects of ANP on Na/K-ATPase phosphorylation and inhibition by an endogenous sodium pump ligand, marinobufagenin, in the aorta and renal medulla from male Sprague–Dawley rats. Marinobufagenin dose-dependently inhibited the Na/K-ATPase in renal and vascular membranes at the level of higher (nanomolar) and lower affinity (micromolar) binding sites. Marinobufagenin (1 nmol/L) inhibited Na/K-ATPase in aortic sarcolemma (18%) and in renal medulla (19%). prepro-ANP 104 to 123 (ppANP) and α-human ANP ([α-hANP] both 1 nmol/L) potentiated marinobufagenin-induced Na/K-ATPase inhibition in the kidney, but reversed the effect of marinobufagenin in the aorta. Similarly, ppANP and α-hANP modulated the sodium pump (ouabain-sensitive 86Rb uptake) inhibitory effects of marinobufagenin in the aorta and renal medulla. In renal medulla, ppANP and α-hANP induced α-1 Na/K-ATPase phosphorylation, whereas in aorta, both peptides dephosphorylated Na/K-ATPase. The effect of ppANP on Na/K-ATPase phosphorylation and inhibition was mimicked by a protein kinase G activator, 8-Br-PET-cGMP (10 &mgr;mol/L), and prevented by a protein kinase G inhibitor, KT5823 (60 nmol/L). Our results suggest that α-1 Na/K-ATPase inhibition by marinobufagenin in the kidney is enhanced via Na/K-ATPase phosphorylation by ANP, whereas in the aorta, ANP exerts an opposite effect. The concurrent production of a vasorelaxant, ANP, and a vasoconstrictor, marinobufagenin, potentiate each other's natriuretic effects, but ANP peptides may offset the deleterious vasoconstrictor effect of marinobufagenin.
Outcome measurement in clinical genetics services: a systematic review of validated measures.

OBJECTIVE This systematic review aimed to inform researchers and policymakers about what validated outcome measures are available to evaluate clinical genetics services (CGS) and the need for new measures. METHODS Validated outcome measures used to evaluate CGS were identified from a systematic literature review. Subjective outcome measures were assumed to have been validated only if some form of psychometric assessment was reported. RESULTS A total of 1688 titles and abstracts were identified, and 61 articles met the inclusion criteria for the final review, which covered 67 validated outcome measures. There were 37 nongenetics-specific and 30 genetics-specific measures identified. No single validated outcome measure encompassed all potential patient benefits from using a CGS. A variety of different domains were identified, including anxiety and depression, coping, decision-making, distress, family environment, health status, knowledge, mood, perception of risk, perceived personal control, psychological impact, quality of life, satisfaction and expectations, self-esteem, spiritual well-being, and worry. Some important aspects of patient benefit from CGS are not covered by existing outcome measures. CONCLUSIONS New research is necessary to develop the array of outcome measures required to quantify the benefits CGS offer patients living with the effects of genetic conditions. These need to be suitable for use in prospective evaluation studies to provide robust evidence for decision-makers to inform service development and commissioning. This includes prioritization of the existing validated outcome measures in terms of their usefulness and relevance to the measurement and valuation of patient benefits from a CGS.
Knowing when to stop : futility in the intensive care unit

Purpose of the review—Decisions to withdraw or withhold potentially life-sustaining treatment are common in intensive care and precede the majority of deaths. Where families resist or oppose doctors’ suggestions that it is time to stop treatment it is often unclear what should be done. This review will summarize recent literature around futility judgements in intensive care emphasising ethical and practical questions. Recent findings—There has been a shift in the language of futility. Patients’ families often do not believe medical assessments that further treatment would be unsuccessful. Attempts to determine through data collection which patients have a low or zero chance of survival have been largely unsuccessful, and are hampered by varying definitions of futility. A due-process model for adjudicating futility disputes has been developed in Texas, and may provide a better solution to futility disputes than previous futility statutes. Summary—Specific criteria for unilateral withdrawal of treatment have proved hard to define or defend. However, it is ethical for doctors to decline to provide treatment that is medically inappropriate or futile. Understanding the justification for a futility judgement may be relevant to deciding the most appropriate way to resolve futility disputes.
Monoamine Oxidase is a Major Determinant of Redox Balance in Human Atrial Myocardium and is Associated With Postoperative Atrial Fibrillation

Background Onset of postoperative atrial fibrillation (POAF) is a common and costly complication of heart surgery despite major improvements in surgical technique and quality of patient care. The etiology of POAF, and the ability of clinicians to identify and therapeutically target high‐risk patients, remains elusive. Methods and Results Myocardial tissue dissected from right atrial appendage (RAA) was obtained from 244 patients undergoing cardiac surgery. Reactive oxygen species (ROS) generation from multiple sources was assessed in this tissue, along with total glutathione (GSHt) and its related enzymes GSH‐peroxidase (GPx) and GSH‐reductase (GR). Monoamine oxidase (MAO) and NADPH oxidase were observed to generate ROS at rates 10‐fold greater than intact, coupled mitochondria. POAF risk was significantly associated with MAO activity (Quartile 1 [Q1]: adjusted relative risk [ARR]=1.0; Q2: ARR=1.8, 95% confidence interval [CI]=0.84 to 4.0; Q3: ARR=2.1, 95% CI=0.99 to 4.3; Q4: ARR=3.8, 95% CI=1.9 to 7.5; adjusted Ptrend=0.009). In contrast, myocardial GSHt was inversely associated with POAF (Quartile 1 [Q1]: adjusted relative risk [ARR]=1.0; Q2: ARR=0.93, 95% confidence interval [CI]=0.60 to 1.4; Q3: ARR=0.62, 95% CI=0.36 to 1.1; Q4: ARR=0.56, 95% CI=0.34 to 0.93; adjusted Ptrend=0.014). GPx also was significantly associated with POAF; however, a linear trend for risk was not observed across increasing levels of the enzyme. GR was not associated with POAF risk. Conclusions Our results show that MAO is an important determinant of redox balance in human atrial myocardium, and that this enzyme, in addition to GSHt and GPx, is associated with an increased risk for POAF. Further investigation is needed to validate MAO as a predictive biomarker for POAF, and to explore this enzyme's potential role in arrhythmogenesis.
Recovery of HLA-restricted cytomegalovirus (CMV)-specific T-cell responses after allogeneic bone marrow transplant: correlation with CMV disease and effect of ganciclovir prophylaxis.

Protection from cytomegalovirus (CMV) disease in immunocompromised hosts has been shown to correlate with recovery of the host virus-specific CD8+ T-cell response. The administration of ganciclovir to immunosuppressed transplant recipients as antiviral prophylaxis has reduced the early risk of CMV disease, but late disease is observed with increased frequency, suggesting that recovery of the CMV-specific T-cell responses necessary for protective immunity may be delayed in these patients. Therefore, we evaluated reconstitution of CMV-specific T-cell responses in 47 bone marrow transplant (BMT) recipients entered on a randomized placebo-controlled study of ganciclovir. The study drug was initiated at a mean of 24 days after BMT. At day 30 to 40, a minority of patients had recovery of T-cell immunity to CMV and the frequency of reconstitution was equivalent in patients randomized to ganciclovir or placebo. The failure of ganciclovir to effect early reconstitution may reflect the short duration of treatment. Early recovery was associated with the infusion of BM from a CMV seropositive donor (P = .07 for CD8+ cytotoxic T cell (CTL), P = . 04 for CD4+ Th). Between day 40 and day 90, recovery of deficient CD8+ and CD4+ CMV-specific T-cell responses occurred in the majority of individuals that received placebo, but in a minority of ganciclovir recipients. Two cases of late-onset CMV disease occurred in ganciclovir recipients. In all patients, the presence of a CTL response to CMV conferred protection from subsequent CMV disease (P = .005), and these protective CTL responses are shown to be specific for structural virion proteins similar to the responses in immunocompetent CMV seropositive individuals. These data confirm the importance of CMV-specific T-cell responses and suggest that a delay in recovery of these responses as a result of ganciclovir prophylaxis may contribute to the occurrence of late CMV disease.
Integration of biological sources: current systems and challenges ahead

This paper surveys the area of biological and genomic sources integration, which has recently become a major focus of the data integration research field. The challenges that an integration system for biological sources must face are due to several factors such as the variety and amount of data available, the representational heterogeneity of the data in the different sources, and the autonomy and differing capabilities of the sources. This survey describes the main integration approaches that have been adopted. They include warehouse integration, mediator-based integration, and navigational integration. Then we look at the four major existing integration systems that have been developed for the biological domain: SRS, BioKleisli, TAMBIS, and DiscoveryLink. After analyzing these systems and mentioning a few others, we identify the pros and cons of the current approaches and systems and discuss what an integration system for biologists ought to be.
Overexpression of Nitric Oxide Synthase Restores Circulating Angiogenic Cell Function in Patients With Coronary Artery Disease: Implications for Autologous Cell Therapy for Myocardial Infarction

Background Circulating angiogenic cells (CACs) are peripheral blood cells whose functional capacity inversely correlates with cardiovascular risk and that have therapeutic benefits in animal models of cardiovascular disease. However, donor age and disease state influence the efficacy of autologous cell therapy. We sought to determine whether age or coronary artery disease (CAD) impairs the therapeutic potential of CACs for myocardial infarction (MI) and whether the use of ex vivo gene therapy to overexpress endothelial nitric oxide (NO) synthase (eNOS) overcomes these defects. Methods and Results We recruited 40 volunteers varying by sex, age (< or ≥45 years), and CAD and subjected their CACs to well‐established functional tests. Age and CAD were associated with reduced CAC intrinsic migration (but not specific response to vascular endothelial growth factor, adherence of CACs to endothelial tubes, eNOS mRNA and protein levels, and NO production. To determine how CAC function influences therapeutic potential, we injected the 2 most functional and the 2 least functional CAC isolates into mouse hearts post MI. The high‐function isolates substantially improved cardiac function, whereas the low‐function isolates led to cardiac function only slightly better than vehicle control. Transduction of the worst isolate with eNOS cDNA adenovirus increased NO production, migration, and cardiac function of post‐MI mice implanted with the CACs. Transduction of the best isolate with eNOS small interfering RNA adenovirus reduced all of these capabilities. Conclusions Age and CAD impair multiple functions of CACs and limit therapeutic potential for the treatment of MI. eNOS gene therapy in CACs from older donors or those with CAD has the potential to improve autologous cell therapy outcomes.