Miracle-dz/UniFAR-FTUs huggingface dataset:
Parenteral Nutrition and Intestinal Failure

Severe short bowel syndrome (SBS) is a major cause of chronic (Type 3) intestinal failure (IF) where structural and functional changes contribute to malabsorption and risk of micronutrient deficiencies. Chronic IF may be reversible, depending on anatomy and intestinal adaptation, but most patients require long-term nutritional support, generally in the form of parenteral nutrition (PN). SBS management begins with dietary changes and pharmacologic therapies taking into account individual anatomy and physiology, but these are rarely sufficient to avoid PN. New hormonal therapies targeting intestinal adaptation hold promise. Surgical options for SBS including intestinal transplant are available, but have significant limitations. Home PN (HPN) is therefore the mainstay of treatment for severe SBS. HPN involves chronic administration of macronutrients, micronutrients, fluid, and electrolytes via central venous access in the patient’s home. HPN requires careful clinical and biochemical monitoring. Main complications of HPN are related to venous access (infection, thrombosis) and metabolic complications including intestinal failure associated liver disease (IFALD). Although HPN significantly impacts quality of life, outcomes are generally good and survival is mostly determined by the underlying disease. As chronic intestinal failure is a rare disease, registries are a promising strategy for studying HPN patients to improve outcomes.
Reduction of left ventricular hypertrophy after exercise and weight loss in overweight patients with mild hypertension.

BACKGROUND Hypertrophy and concentric remodeling of the left ventricle are important manifestations of hypertension that are associated with increased morbidity and mortality. Although lifestyle interventions are efficacious in lowering blood pressure, evidence that they have a beneficial effect on target organs has been lacking. OBJECTIVE To assess the effects of regular aerobic exercise or exercise plus weight management counseling on left ventricular mass and geometry in overweight, sedentary men and women with high-normal or mildly elevated blood pressure. METHODS Eighty-two participants in a randomized, controlled trial were assigned to supervised aerobic exercise only, a behavioral weight management program that included exercise, or a waiting-list control group for 6 months. Blood pressure and echocardiographic measures of left ventricular structure were measured at baseline and at the conclusion of the treatment phase. RESULTS The 45 women and 37 men had a mean +/- SD age of 47 +/- 9 years and had a mean +/- SD blood pressure of 140 +/- 10/93 +/- 5 mm Hg. Blood pressure fell by 7/6 mm Hg in the weight management group and by 3/4 mm Hg in the aerobic exercise group. In association with these decreases in blood pressure, participants in the intervention groups exhibited significant decreases in left ventricular relative wall thickness (P =.003), posterior wall thickness (P =.05), and septal thickness (P =.004) and a trend toward a decrease in indexed left ventricular mass (P =.08) relative to the control group. CONCLUSIONS In a cohort of overweight, sedentary men and women, exercise and weight loss reduced blood pressure and induced favorable changes in left ventricular structure.
Effects of L-Arginine supplementation on semen quality, testosterone concentration and testes histological parameters of Ross 308 breeder roosters

Objective: To assess the effects of dietary L-Arginine (L-Arg) supplementation on testes histological parameters and semen quality of male broiler breeder. Methods: Twenty male broiler breeders at 37 wk of age were distributed in a completely randomized design with 4 treatments and 5 replicates each. The treatments consisted of 4 dietary levels of L-Arg (0.00, 1.35, 2.33 and 3.22 g/kg of the diet) and fed to birds for 8 wk. At the end of the experiment semen samples were collected by abdominal massage to determination of semen quality. The blood samples were used to determination of serum testosterone concentration at the end of the experiment. Furthermore, testes from each rooster were used to evaluation of their weights and histological parameters. Results: The results of the experiment showed that dietary L-Arg at 2.33 g/kg improved testes weight, semen volume and sperm forward motility in roosters (P<0.05). Besides, serum concentration of testosterone was increased in roosters fed 2.33 g/kg L-Arg (P<0.05). The results of testes histology indicated that seminiferous tubules lumen diameter, leydig cells, spermatides and sperm cells counts were greater in birds received 3.22 g/kg dietary L-Arg (P<0.05). However, the birds fed diet supplemented with 2.33 g/kg L-Arg had greater seminiferous tubules diameter, sertoli and spermatogonia cell counts than other groups (P<0.05). Conclusion: According to the results of this experiment, it is concluded that dietary L-Arg had positive effects on reproductive traits in roosters.
Factors associated with maternal near miss: A study from Kerala

Severe life-threatening situations leading to a “near-miss” event may arise unexpectedly in pregnancy. Delay in seeking help, delayed access to care, and poor quality of emergency obstetric services can lead to undesirable outcomes. Women meeting the WHO “near-miss” criteria were assessed using a cross-sectional study design. These women were interviewed to evaluate the circumstances leading to a near-miss event. Reasons for delays in getting proper care were studied using the “3 delays’ model. ” Thirty-two women met the criteria for “near miss” during the 15-month study period, with a maternal near-miss incidence ratio of 9.27/1000 live births. One or more delays were identified in 21 (65.6%) near-miss cases. Delayed access to care was the most important factor for delay. A review of near-miss cases can be used to improve and optimize the existing obstetric services.
A Mobile Text Message Intervention to Reduce Repeat Suicidal Episodes: Design and Development of Reconnecting After a Suicide Attempt (RAFT)

Background Suicide is a leading cause of death, particularly among young people. Continuity of care following discharge from hospital is critical, yet this is a time when individuals often lose contact with health care services. Offline brief contact interventions following a suicide attempt can reduce the number of repeat attempts, and text message (short message service, SMS) interventions are currently being evaluated. Objective The aim of this study was to extend postattempt caring contacts by designing a brief Web-based intervention targeting proximal risk factors and the needs of this population during the postattempt period. This paper details the development process and describes the realized system. Methods To inform the design of the intervention, a lived experience design group was established. Participants were asked about their experiences of support following their suicide attempt, their needs during this time, and how these could be addressed in a brief contact eHealth intervention. The intervention design was also informed by consultation with lived experience panels external to the project and a clinical design group. Results Prompt outreach following discharge, initial distraction activities with low cognitive demands, and ongoing support over an extended period were identified as structural requirements of the intervention. Key content areas identified included coping with distressing feelings, safety planning, emotional regulation and acceptance, coping with suicidal thoughts, connecting with others and interpersonal relationships, and managing alcohol consumption. Conclusions The RAFT (Reconnecting AFTer a suicide attempt) text message brief contact intervention combines SMS contacts with additional Web-based brief therapeutic content targeting key risk factors. It has the potential to reduce the number of repeat suicidal episodes and to provide accessible, acceptable, and cost-effective support for individuals who may not otherwise seek face-to-face treatment. A pilot study to test the feasibility and acceptability of the RAFT intervention is underway.
Divergence Palsy due to Divalproex and Oxcarbazepine

Objective This case series is the first to describe divergence palsy as an adverse effect of antiepileptic drug use. Diplopia is a common adverse effect of antiepileptic drugs, but no explanatory motility deficit has ever been reported. Methods We present 2 patients, 1 on oxcarbazepine and 1 on divalproex, each with a normal examination result between spells and divergency palsy when symptomatic. Results Discontinuation of the antiepileptic medication led to resolution of the episodes in both cases. Rechallenge with the offending agent after washout in one patient resulted in recurrence of diplopia and divergence palsy, both resolving after subsequent withdrawal of the antiepileptic. Conclusions Antiepileptic drugs may cause divergence palsy.
The financial burden and distress of patients with cancer: Understanding and stepping‐up action on the financial toxicity of cancer treatment

“Financial toxicity” has now become a familiar term used in the discussion of cancer drugs, and it is gaining traction in the literature given the high price of newer classes of therapies. However, as a phenomenon in the contemporary treatment and care of people with cancer, financial toxicity is not fully understood, with the discussion on mitigation mainly geared toward interventions at the health system level. Although important, health policy prescriptions take time before their intended results manifest, if they are implemented at all. They require corresponding strategies at the individual patient level. In this review, the authors discuss the nature of financial toxicity, defined as the objective financial burden and subjective financial distress of patients with cancer, as a result of treatments using innovative drugs and concomitant health services. They discuss coping with financial toxicity by patients and how maladaptive coping leads to poor health and nonhealth outcomes. They cover management strategies for oncologists, including having the difficult and urgent conversation about the cost and value of cancer treatment, availability of and access to resources, and assessment of financial toxicity as part of supportive care in the provision of comprehensive cancer care. CA Cancer J Clin 2018;68:153‐165. © 2018 American Cancer Society.
The Failure of Null Hypothesis Significance Testing When Studying Incremental Changes, and What to Do About It

A standard mode of inference in social and behavioral science is to establish stylized facts using statistical significance in quantitative studies. However, in a world in which measurements are noisy and effects are small, this will not work: selection on statistical significance leads to effect sizes which are overestimated and often in the wrong direction. After a brief discussion of two examples, one in economics and one in social psychology, we consider the procedural solution of open postpublication review, the design solution of devoting more effort to accurate measurements and within-person comparisons, and the statistical analysis solution of multilevel modeling and reporting all results rather than selection on significance. We argue that the current replication crisis in science arises in part from the ill effects of null hypothesis significance testing being used to study small effects with noisy data. In such settings, apparent success comes easy but truly replicable results require a more serious connection between theory, measurement, and data.
Impact of Minimal Extrathyroid Extension in Differentiated Thyroid Cancer: Systematic Review and Meta-Analysis

Background Minimal extra-thyroid extension (mETE) in differentiated thyroid cancer (DTC) patients was defined as an intermediate risk feature in the 2015 American Thyroid Association guidelines. However, controversy persists as several studies suggested mETE has little effect on disease outcome. Objective To assess the impact of mETE on DTC patients' outcome. Methods Meta-analysis of controlled trials comparing DTC patients with and without mETE. Data Extraction and Synthesis Thirteen retrospective studies including 23,816 patients were included, with a median follow-up of 86 months. mETE in patients without lymph node involvement (N0 disease) was associated with increased risk of recurrence (7 studies, OR 1.73, 95%CI 1.03-2.92). The absolute risk of recurrence was 2.2% in patients without extension and 3.5% in patients with mETE (p=0.04). In studies including patients with and without lymph-node involvement (N1/N0 disease), mETE resulted in a significantly higher risk of recurrence (8 studies, OR 1.82, 95%CI 1.14-2.91). The absolute risk of recurrence was 6.2% in patients without extension and 7% in patients with mETE (p=0.01). In patients with micro-papillary carcinoma (<1cm) the impact of mETE was non-significant (OR 2.40, 95%CI 0.95-6.03). Minimal ETE had no impact on disease-related mortality (8 studies, OR 0.5, 95%CI 0.11-2.21). Conclusion mETE increases risk of recurrence in DTC patients. However, the absolute increase in risk is small, and in patients with N0 disease the risk is within the low-risk of recurrence category at 3.5%. Minimal ETE has no impact on disease-related mortality, and should not change tumor stage.
Sleep Disturbance May Alter White Matter and Resting State Functional Connectivities in Parkinson’s Disease

Study Objectives To clarify whether sleep disturbance would alter the patterns of structural and functional networks underlying cognitive dysfunction in patients with Parkinson's disease (PD). Methods Among the 180 patients with nondemented PD in our cohort, 45 patients were classified as the group with sleep disturbance according to the 5-item scales for outcomes in Parkinson's disease nighttime scale. Based on propensity scores, another 45 PD patients without sleep disturbance were matched to this group. We performed a comparative analysis of cortical thickness, diffusion tensor imaging-based white matter integrity, resting-state functional connectivity, and cognitive performance between PD patients with and without sleep disturbance. Results PD patients with sleep disturbance showed poorer performance in attention and working memory and a tendency toward a lower score in frontal executive function relative to those without sleep disturbance. The PD with sleep disturbance group exhibited widespread white matter disintegration compared to the PD without sleep disturbance group, although there were no significant differences in cortical thickness between the PD subgroups. On functional network analysis, PD patients with sleep disturbance exhibited less severely decreased cortical functional connectivity within the default mode network, central executive network, and dorsal attention network when compared to those without sleep disturbance. Conclusions The present study suggests that sleep disturbance in PD patients could be associated with white matter and functional network alterations in conjunction with cognitive impairment.
Opioids: Modulators of angiogenesis in wound healing and cancer

Opioids are potent drugs that are widely used to control wound or cancer pain. Increasing evidence suggest that opioids mediate clinically relevant effects that go beyond their classical role as analgesics. Of note, opioids appear to modulate angiogenesis - a process that is critical in wound healing and cancer progression. In this review, we focus on pro- and anti-angiogenic facets of opioids that arise from the activation of individual opioid receptors and the usage of individual concentrations or application routes. We overview the still incompletely elucidated mechanisms of these angiogenic opioid actions. Moreover, we describe plausible opioids effects, which - although not primarily studied in the context of vessel formation - may be related to the opioid-driven processes of angiogenesis. Finally we discuss the use of opioids as an innovative therapeutic avenue for the treatment of chronic wounds and cancer.
NRF2 promotes breast cancer cell proliferation and metastasis by increasing RhoA/ROCK pathway signal transduction

Nuclear factor erythroid 2-related factor (NRF2) is an important transcription factor in oxidative stress regulation. Overexpression of NRF2 is associated with human breast carcinogenesis, and increased NRF2 mRNA levels predict poor patient outcome for breast cancer. However, the mechanisms linking gain of NRF2 expression and poor prognosis in breast cancer are still unclear. Here, we provide evidence that NRF2 deletion inhibits proliferation and metastasis of breast cancer cells by down-regulating RhoA. Restoration of RhoA in MCF7 and MDA-MB-231 cells induced NRF2 knockdown-suppressed cell growth and metastasis in vitro, and NRF2 silencing suppressed stress fiber and focal adhesion formation leading to decreased cell migration and invasion. Mechanistic studies showed that NRF2 binds to the promoter region of estrogen-related receptor α (ERR1) and may function as a silencer. This may enhance RhoA protein stability and lead to RhoA overexpression in breast cancer cell. Our findings indicate that NRF2 silencing-mediated reduction of RhoA expression contributes, at least in part, to the poor outcome of breast cancer patients with high NRF2 expression.
The Immediate Effect of Foot Orthoses on Subtalar Joint Mechanics and Energetics

Purpose Foot orthoses maybe used in the management of musculoskeletal disorders related to abnormal subtalar joint (STJ) pronation. However, the precise mechanical benefits of foot orthoses for preventing injuries associated with the STJ are not well understood. The aim of this study was to investigate the immediate effect of foot orthoses on the energy absorption requirements of the STJ and subsequently tibialis posterior (TP) muscle function. Methods Eighteen asymptomatic subjects with a pes planus foot posture were prescribed custom-made foot orthoses made from a plaster cast impression. Participants walked at preferred and fast velocities barefoot, with athletic footwear and with athletic footwear plus orthoses, as three-dimensional motion capture, force data, and intramuscular electromyography of the TP muscle were simultaneously collected. Statistical parametric mapping was used to identify time periods across the stride cycle during which footwear with foot orthoses significantly differed to barefoot and footwear only. Results During early stance, footwear alone and footwear with orthoses significantly reduced TP muscle activation (1%–12%), supination moments (3%–21%), and energy absorption (5%–12%) at the STJ, but had no effect on STJ pronation displacement. Conclusions The changes in TP muscle activation and STJ energy absorption were primarily attributed to footwear because the addition of foot orthoses provided little additional effect. We speculate that these results are most likely a result of the compliant material properties of footwear. These results suggest that athletic footwear may be sufficient to absorb energy in the frontal plane and potentially reducing any benefit associated with the addition of foot orthoses.
External Validation of University of Wisconsin's Clinical Criteria for Obtaining Maxillofacial Computed Tomography in Trauma

Objectives: Patients sustaining multisystem trauma are at risk for oral and maxillofacial fractures. Although the University of Wisconsin established criteria to help guide the clinician in obtaining additional cross-sectional imaging to evaluate possible facial fractures, it has not been externally validated. Our aim was to evaluate whether the University of Wisconsin's Criteria is generalizable to external institutions through validation and to report modern practice patterns at a level 1 trauma center. Methods: A retrospective case study was performed of all patients who had computed tomography of the facial bones (CT face) at a tertiary, academic, Level 1 trauma center over the 6-month period ending on June 30, 2015. The electronic medical record was reviewed for the 5 University of Wisconsin criteria (bony step off or instability, periorbital ecchymosis, malocclusion, tooth absence, and glasgow coma scale). Final interpretation of CT face findings by board-certified radiologists (facial fractures, intracranial hemorrhage, and cervical spine injury) were also captured. Our modeling was similar to that described by the reference study, the internal validation study. Sensitivity, specificity, negative, and positive predictive values with 95% confidence intervals were evaluated. A P < 0.05 was considered significant. Results: The presence of any ≥1 of the 5 criteria identified on physical examination resulted in 81% sensitivity for any facial fracture, which is lower than the sensitivity initially described (98%) and subsequently internally validated (97%). The absence of all 5 physical examination criteria had a negative predictive value of 60%, again lower than that initially described (87%) and then internally validated (81%). Conclusion: We were unable to validate the University of Wisconsin criteria for predicting facial fractures. These criteria may be institutionally specific and not generalizable to other trauma centers. Further research to refine the criteria for CT of the face is needed to improve resource allocation.
Outcomes of a Psychoeducational Intervention to Reduce Internalized Stigma Among Psychosocial Rehabilitation Clients.

OBJECTIVE This community-based randomized controlled trial was carried out to test the Ending Self-Stigma (ESS) psychoeducational intervention, which is designed to help adults with serious mental illnesses reduce internalization of mental illness stigma and its effects. METHODS A total of 268 adults from five different mental health programs in Maryland took part. After baseline interview, consenting participants were randomly assigned to the nine-week ESS intervention or a minimally enhanced treatment-as-usual control condition. Participants were assessed by using symptom, psychosocial functioning, and self-stigma measures at baseline, postintervention, and six-month follow-up. Demographic characteristics were assessed at baseline. RESULTS Compared with participants in the control condition, ESS group participants showed significant decreases on the stereotype agreement and self-concurrence subscales of the Self Stigma of Mental Illness Scale, significant improvement on the alienation and stigma resistance subscales of the Internalized Stigma Mental Illness measure, and a significant increase in recovery orientation from baseline to postintervention. None of these differences were sustained at six-month follow-up. CONCLUSIONS Results indicate that ESS was useful in helping to reduce key aspects of internalized stigma among individuals with mental illnesses and that advances in the delivery, targeting, and content of the intervention in the field may be warranted to increase its potency.