Miracle-dz/UniFAR-FTUs huggingface dataset:
12-year Temporal Trend in Referral Pattern and Test Results of Stress Echocardiography in a Tertiary Care Referral Center with Moderate Volume Activities and Cath-lab Facility

Background: Data on stress echocardiography (SE) time-related changes in referral patterns and diagnostic yield for detection of inducible ischemia could enhance Echo Lab quality benchmarks and performance measures. Aim: This study aims to evaluate temporal trends in SE test results among ambulatory patients with suspected or known coronary artery disease (CAD) in a tertiary care referral center with moderate (>100/year) volume SE activities and Cath-Lab facility. Methods: From January 2004 to December 2015, 1954 patients (mean age 62 ± 12 years, 42% women, 27% with known CAD) underwent SE (1673 exercise SE, 86%, 246 pharmacological SE, 12%, 35 pacing SE, 2%). Time was grouped into three 4 year periods, where clinical data and test results were evaluated. Results: Our series comprised low-to-intermediate pretest probability of CAD throughout the observation period (overall pretest probability of CAD 19% ± 15%). A progressive decline over time in the rate of pharmacological SE instead of a dramatic increment of exercise SE (79%–96%, P < 0.0001) was noted. The use of beta-blockers increased (from 43% to 66%, P < 0.0001), while the use of nitrates decreased (from 11% to 4%, P < 0.0001) over time. We noted a very uncommon occurrence of abnormal test results with a further decrease in the last period (from 11% to 3%, P < 0.0001). Conclusions: We observed, over a 12-year period, a progressive decrease in the frequency of inducible myocardial ischemia among patients with known or suspected CADe referred to our Echo Lab for SE with Cath-Lab facility, and this trend was parallel to changes in SE referral practice. These findings are particularly relevant if we consider the practical implications on diagnostic SE accuracy and risk assessment.
Climatic variability in Princess Elizabeth Land (East Antarctica) over the last 350 years

Abstract. We use isotopic composition (δD) data from six sites in Princess Elizabeth Land (PEL) in order to reconstruct air temperature variability in this sector of East Antarctica over the last 350 years. First, we use the present-day instrumental mean annual surface air temperature data to demonstrate that the studied region (between Russia's Progress, Vostok and Mirny research stations) is characterized by uniform temperature variability. We thus construct a stacked record of the temperature anomaly for the whole sector for the period of 1958–2015. A comparison of this series with the Southern Hemisphere climatic indices shows that the short-term inter-annual temperature variability is primarily governed by the Antarctic Oscillation (AAO) and Interdecadal Pacific Oscillation (IPO) modes of atmospheric variability. However, the low-frequency temperature variability (with period > 27 years) is mainly related to the anomalies of the Indian Ocean Dipole (IOD) mode. We then construct a stacked record of δD for the PEL for the period of 1654–2009 from individual normalized and filtered isotopic records obtained at six different sites ( PEL2016 stacked record). We use a linear regression of this record and the stacked PEL temperature record (with an apparent slope of 9 ± 5.4 ‰ °C−1) to convert PEL2016 into a temperature scale. Analysis of PEL2016 shows a 1 ± 0.6 °C warming in this region over the last 3 centuries, with a particularly cold period from the mid-18th to the mid-19th century. A peak of cooling occurred in the 1840s – a feature previously observed in other Antarctic records. We reveal that PEL2016 correlates with a low-frequency component of IOD and suggest that the IOD mode influences the Antarctic climate by modulating the activity of cyclones that bring heat and moisture to Antarctica. We also compare PEL2016 with other Antarctic stacked isotopic records. This work is a contribution to the PAGES (Past Global Changes) and IPICS (International Partnerships in Ice Core Sciences) Antarctica 2k projects.
Molecular Characterization of Carbapenem-Resistant Klebsiella pneumoniae Species Isolated From a Tertiary Hospital, Ankara, Turkey

Background: Carbapenem-resistant Klebsiella pneumoniae isolates can spread among the hospitalized patients and result in serious infections and increase mortality. Molecular studies provide useful information about resistance mechanisms and cross-transmission among the resistant isolates. Objectives: The current study aimed at investigating phenotypic and molecular characteristics of the carbapenem resistance and clonalrelationshipamongthe K.pneumoniae isolatesrecoveredfrominfectionsitesandrectalswabsof thepatientshospitalizedin a tertiary hospital. Methods: Resistance to carbapenems was investigated by disc-diﬀusion and E-test methods. Modiﬁed Hodge test (MHT) and ethylenediaminetetraacetic acid (EDTA)-combine disc (ECD) methods were performed to determine carbapenemases. Carbapenemase-encoding genes including bla OXA-48, bla NDM-1, bla KPC, bla IMP, and bla VIM were investigated by multiplex poly-merasechainreaction(PCR). Clonalrelationshipamongtheisolateswasdeterminedbythepulsed-ﬁeldgelelectrophoresis(PFGE). Results: Carbapenem resistance was observed in 93 (5.8%) of the 1605 K. pneumoniae isolates. Majority (n = 66, 71%) of the resistant isolateswererecoveredfromthepatientsinintensivecareunits(ICUs). Almostallcarbapenem-resistant K.pneumoniae isolates(n= 91,97.8%)werepositivewithMHT.Only6(6.5%)of theresistantisolateswerepositivewithECDmethod. The bla OXA-48and bla NDM1 were found in 90.3% (n = 84) and 6.5% (n = 6) of the resistant isolates, respectively. The pulsed-ﬁeld gel electrophoresis yielded 55 diﬀerent pulsotypes. Fifteen pulsotypes were identiﬁed as clusters with ≥ 2 isolates and a clustering rate of 57%. Based on the similarity coeﬃcient higher than 85%, a total of 75 (80.6%) isolates were clonally related to each other. Conclusions: Thehighrateof carbapenemresistanceand80.6% clonalrelationshipbetweentheisolatescollectedina3-yearperiod indicated a serious potential threat for the hospital-acquired infections and pointed longtime cross-contamination.
Contribution of Intrasellar Pressure Elevation to Headache Manifestation in Pituitary Adenoma Evaluated With Intraoperative Pressure Measurement

BACKGROUND Headache frequently occurs in patients with pituitary adenoma and is reported in large as well as small adenomas. However, the exact mechanism of headache derived from pituitary adenoma remains unknown. OBJECTIVE To evaluate the contribution of intrasellar pressure (ISP) to headache manifestation by using intraoperative ISP measurement. METHODS The records of 108 patients who had first-time transsphenoidal surgery for pituitary adenoma were reviewed retrospectively. Measurement of intraoperative ISP was undergone using intracranial pressure monitoring sensors and compared with radiological assessment. RESULTS Among 30 patients with headache, 29 (96.7%) presented with significant headache (Headache Impact Score-6, 50 or greater). Intraoperative ISP measurement was conducted successfully in all cases, and revealed higher ISP in patients with headache (35.6 ± 9.2 mm Hg) than in those without headache (15.8 ± 5.2 mm Hg). The ISP reduction after sella floor decompression was greater in patients with headache than that in patients without headache. In patients with headache, the frequency of invasion into the cavernous sinus or sphenoid sinus was significantly lower, and the diameter of the foramen at the diaphragm sellae was narrower. In addition, intratumoral cyst or hematoma was more common in patients with headache. Postoperatively, headache was either diminished or improved in 28 patients (93.3%). CONCLUSION Headache in patients with pituitary adenomas associated with ISP elevation, results from compromised dural integrity at the sella and intratumoral hemorrhage. The increased stretch force of the sella dura may be a notable etiology of headache in patients with pituitary adenoma.
Analysis of forced convection in pipes and channels with the simpli ® ed Phan-Thien ± Tanner ̄ uid

Analytical solutions are derived for the temperature distribution and heat transfer coecient in forced convection of a viscoelastic ̄uid obeying the simpli®ed Phan-Thien±Tanner constitutive equation in laminar pipe and plane channel ̄ows. The results are valid for fully developed thermal and hydrodynamic ̄ow conditions with a constant heat ̄ux imposed at the wall and include the investigation of the eects of viscous dissipation. A nonvanishing value of the extensional parameter of the ̄uid model is shown to be essential for the solution to dier signi®cantly from that for a Newtonian, or an elastic ̄uid without extensibility. Elasticity, only when combined with extensibility, is shown to increase the heat transfer and to reduce the range of temperatures present inside a duct. These bene®cial eects of ̄uid elasticity are enhanced by viscous dissipation. 7 2000 Elsevier Science Ltd. All rights reserved.
Clinical outcomes of the simultaneous bilateral percutaneous nephrolithotomy (PCNL) in patients with kidney stones: A prospective cohort study

Background Urinary tract stones is one of the most frequent medical emergencies which leads to life-threatening complications, namely obstructive uropathy as well as renal failure in some situations. Previously, bilateral stones were treated with either open surgery or percutaneous nephrolithotomy (PCNL). However, these treatment options were associated with lengthy operation time, need for more anesthesia, further bleeding, and long hospitalization. Therefore, much effort has been made to treat both sides simultaneously. Objective The aim of this study was an attempt to prospectively review cases undergoing simultaneous bilateral PCNL in terms of the therapy outcomes, complications, and consequences. Methods In this prospective cohort study, 39 adult patients with bilateral renal stones were randomly recruited at Imam Reza hospital in Mashhad, Iran between January 2016 and January 2017. Adult patients with bilateral renal stones were included in this study. Exclusion criteria were as follows: Patients with severe heart or lung disease, patients with coagulation disorders, pregnant women, and cases with any contraindications for general anesthesia. After insertion of bilateral ureteral catheters, all patients underwent simultaneous bilateral PCNL in prone position. Transureteral lithotripsy was performed for patients with ureteral stones. The surgery was initially carried out on the symptomatic side and then iterated on the remaining kidney. Major complications including bleeding, fever, pain, urine leakage, and residual stones were recorded. SPSS software was used for data analysis. Data were expressed as percentage and mean ± SD. P value less than 0.05 was considered significant. Results A total of 39 patients (27 males with mean age of 37.6 years and 12 females with mean age of 45.7 years) were studied. As many as 15 (38%) patients received a unilateral nephrostomy. Three underwent totally tubeless surgery. Bleeding (41.0%) was the most common complication, followed by residual stones (20.5%) and fever (20.5%), urine leakage (15.3%), pain (12.8%), blood transfusion (2.5%) and colon perforation (2.5%). Conclusions It was concluded that simultaneous bilateral PCNL was not associated with higher morbidity than the unilateral method.
Vitamin D deficiency in sickle cell disease patients in the Eastern Province of Saudi Arabia

BACKGROUND Vitamin D deficiency (VDD) is a major global health problem. In sickle cell disease (SCD), VDD is highly prevalent, reaching up to 96% of populations. VDD may contribute to many of the complications of SCD. OBJECTIVE Estimate the 25-hydroxyvitamin D [25(OH)D] level and the frequency of VDD and insufficiency among among SCD patients by age group and disease status. DESIGN Analytical cross-sectional. SETTING Ministry of Health (MOH) secondary care hospital. PATIENTS AND METHODS Non-probability purposive sampling was used to select SCD patients, aged 12 years and older, of both sexes, who had visited the hospital during a period of 5 years (2010–2014). Blood samples were processed by electrochemiluminescence technology. MAIN OUTCOME MEASURE(S) 25(OH)D levels by demographic data, and disease activity. SAMPLE SIZE 640 patients. RESULTS Of those, 82% (n=523) had suboptimal 25(OH)D (0-<30 ng/mL), and 67% were deficient (0-<20 ng/mL). Patients with any SCD crisis (20.7%, 144/694) had lower 25(OH)D (median, IQR: 10.1 ng/mL [8.6] ng/mL) compared to patients without crisis (71.0%, 493/694) (15.7 ng/mL [18.2] ng/mL) (P<.001). Deficiency was more common in the younger age groups and in sickle cell anemia patients with crisis. CONCLUSIONS VDD is highly prevalent in this population. Established vitamin D screening is a necessity, so that affected patients can be treated. LIMITATIONS Presence of residual confounders such as nutritional status, physical activity, lack of sun exposure, medications that alleviate SCD crises (such as hydroxyurea), and comorbid illnesses. The relationship between sickle cell disease genotype and vitamin D level was not analyzed.
Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders

Importance Patients with schizophrenia have a substantially higher suicide rate than the general public. Early intervention (EI) services improve short-term outcomes. However, little is known about the association of EI with suicide reduction in the long term. Objective To examine the association of a 2-year EI service with suicide reduction in patients with first-episode schizophrenia-spectrum (FES) disorders during 12 years and the risk factors for early and late suicide. Design, Setting, and Participants This historical control study compared 617 consecutive patients with FES who received the 2-year EI service in Hong Kong between July 1, 2001, and June 30, 2003, with 617 patients with FES who received standard care (SC) between July 1, 1998, and June 30, 2001, matched individually. Clinical information was systematically retrieved for the first 3 years of clinical care for both groups. The details of death were collected up to 12 years from presentation to the services. Data analysis was performed from October 30, 2016, to August 18, 2017. Main Outcomes and Measures Suicide rate during 12 years was the primary measure. The association of the EI service with the suicide rates during years 1 through 3 and years 4 through 12 were explored separately. Results The main analysis included 1234 patients, with 617 in each group (mean [SD] age at baseline, 21.2 [3.4] years in the EI group and 21.3 [3.4] years in the SC group; 318 male [51.5%] in the EI group and 322 [52.2%] in the SC group). The suicide rates were 7.5% in the SC group and 4.4% in the EI group (McNemar &khgr;2 = 5.55, P = .02). Patients in the EI group had significantly better survival (propensity score–adjusted hazard ratio, 0.57; 95% CI, 0.36-0.91; P = .02), with the maximum association observed in the first 3 years. The number of suicide attempts was an indicator of early suicide (1-3 years). Premorbid occupational impairment, number of relapses, and poor adherence during the initial 3 years were indicators of late suicide (4-12 years). Conclusions and Relevance This study suggests that the EI service may be associated with reductions in the long-term suicide rate. Suicide at different stages of schizophrenia was associated with unique risk factors, highlighting the importance of a phase-specific service.
Knockdown of Tubulin Polymerization Promoting Protein Family Member 3 Suppresses Proliferation and Induces Apoptosis in Non-Small-Cell Lung Cancer

Our previous studies demonstrated that depletion of tubulin polymerization promoting protein family member 3 (TPPP3) inhibits proliferation and induces apoptosis of HeLa cells. However, the expression and roles of TPPP3 in cancers remain largely unknown. In this study, we investigated the expression of TPPP3 in clinicopathological correlations in non-small-cell lung cancer (NSCLC) samples by immunohistochemistry. TPPP3 expression was significantly upregulated in NSCLC tissues, and high TPPP3 expression was positively associated with tumor size, lymph node metastasis, clinical stage, and poor survival. Furthermore, knockdown of TPPP3 by shRNA significantly inhibited cell proliferation and induced cell apoptosis and cell cycle arrest in vitro. In addition, depletion of TPPP3 inhibited lung cancer growth in vivo in the xenografts of H1299 cells; this effect was accompanied by the suppression of Ki67 expression. Our data suggested that TPPP3 might act as an oncogene in NSCLC. TPPP3 warrants consideration as a therapeutic candidate with anti-tumor potential.
Mechanism of Preconditioning by Isoflurane in Rabbits: A Direct Role for Reactive Oxygen Species

Background Reactive oxygen species (ROS) contribute to myocardial protection during ischemic preconditioning, but the role of the ROS in protection against ischemic injury produced by volatile anesthetics has only recently been explored. We tested the hypothesis that ROS mediate isoflurane-induced preconditioning in vivo. Methods Pentobarbital-anesthetized rabbits were instrumented for measurement of hemodynamics and were subjected to a 30 min coronary artery occlusion followed by 3 h reperfusion. Rabbits were randomly assigned to receive vehicle (0.9% saline), or the ROS scavengers N-acetylcysteine (NAC; 150 mg/kg) or N-2-mercaptopropionyl glycine (2-MPG; 1 mg · kg−1· min−1), in the presence or absence of 1.0 minimum alveolar concentration (MAC) isoflurane. Isoflurane was administered for 30 min and then discontinued 15 min before coronary artery occlusion. A fluorescent probe for superoxide anion production (dihydroethidium, 2 mg) was administered in the absence of the volatile anesthetic or 5 min before exposure to isoflurane in 2 additional groups (n = 8). Myocardial infarct size and superoxide anion production were assessed using triphenyltetrazolium staining and confocal fluorescence microscopy, respectively. Results Isoflurane (P < 0.05) decreased infarct size to 24 ± 4% (mean ± SEM; n = 10) of the left ventricular area at risk compared with control experiments (43 ± 3%; n = 8). NAC (43 ± 3%; n = 7) and 2-MPG (42 ± 5%; n = 8) abolished this beneficial effect, but had no effect on myocardial infarct size (47 ± 3%; n = 8 and 46 ± 3; n = 7, respectively) when administered alone. Isoflurane increased superoxide anion production as compared with control experiments (28 ± 12 vs. −6 ± 9 fluorescence units;P < 0.05). Conclusions The results indicate that ROS produced following administration of isoflurane contribute to protection against myocardial infarction in vivo.
Analog network coded modulation with maximum Euclidean distance denoising-and-mapping

Physical-layer network coding (PNC) holds the great potential of improving the power efficiency and the spectral efficiency for its two-stage transmission scheme. In this paper, we investigate the joint network-coded modulation design of the two stages. A universal modulation framework is built, referred to as Analog Network-Coded Modulation Strategy, which is more general than the former modulation design mechanism. More explicitly, we propose a joint design criterion for the modulation and the network coding to guarantee the forwarding reliability at the relay node. That is, the neighboring superposed constellation points, among which the Euclidean distance (ED) is less than a given threshold, are constrained to be mapped to an identical constellation point for broadcasting. This yields a non-convex polynomial optimization problem, for which we propose a joint modulation design algorithm, termed as Enhanced Semidefinite Relaxation (Enhanced-SDR) Algorithm, based on the SDR technique. Simulation results will demonstrate the effectiveness of the proposed algorithm by comparing symbol error rate (SER) performance with the exhaustive search and the existing modulation design methods.
New developments in the diagnosis of fibromyalgia syndrome: Say goodbye to tender points?

The Symptom Intensity Scale score can be used to identify and quantify fibromyalgia syndrome from information supplied by a simple questionnaire. In this paper, the author describes how this test was developed and argues in favor of its use in clinical practice in diagnosing fibromyalgia syndrome. The Symptom Intensity Scale score can be used to identify and quantify fibromyalgia syndrome from information supplied by a simple questionnaire.
Investigation of 3-D Printed, Electrically Small, and Thin Magnetic Dipole Antenna

A novel design of electrically small, extremely thin, and horizontally polarized magnetic dipole antenna is proposed. It is composed of multiple folded arms packed in an extremely thin height of 0. 0016λ, with the electrical size ka of 0.276. The radiation efficiency is 87% from the simulation. The radiation properties are investigated, and its operation as a small magnetic dipole antenna is confirmed. A three-dimensional printing technology is used for building the prototype due to the complexity of the proposed structure. The experimental results show good agreement with the computed expectation values.
Acetic acid dressings: Finding the Holy Grail for infected wound management

ABSTRACT Background: Wounds have since long, contributed majorly to the health-care burden. Infected long-standing non-healing wounds place many demands on the treating surgeon and are devastating for the patients physically, nutritionally, vocationally, financially, psychologically and socially. Acetic acid has long been included among agents used in the treatment of infected wounds. In this study, we have evaluated the use of acetic acid for topical application in the treatment of infected wounds. Materials and Methods: A total of 100 patients with infected wounds were treated with topical application of 1% acetic acid as dressing material after appropriate cleaning. A specimen of wound swab was collected before first application and further on days 3, 7, 10 and 14. Daily dressings of wounds were done similarly. Minimum inhibitory concentration (MIC) of acetic acid against various organisms isolated was determined. Results: The patients treated ranged between 9 and 60 years, with the mean age 33 years. Nearly 70% of patients were male. Aetiologies of wounds: infective 35, diabetic 25, trauma 20, burns 10, venous ulcers 5 and infected graft donor site 5. Various microorganisms isolated include Pseudomonas aeruginosa (40%), Staphylococcus aureus (2%), Acinetobacter (12%), Escherichia Coli (5%), Proteus mirabilis (3%), Klebsiella (18%), methicillin-resistant S. aureus (10%), Streptococcus (2%) and Enterococcus (1%), Citrobacter (1%). Few wounds (6%) also isolated fungi. About 28%, 64% and 8% of patients isolated no growth on culture after 7, 14 and 21 days, respectively. MIC of all isolated organisms was ≤0.5%. Conclusion: pH of the wound environment plays a pivotal role in wound healing. Acetic acid with concentration of 1% has shown to be efficacious against wide range of bacteria as well as fungi, simultaneously accelerating wound healing. Acetic acid is non-toxic, inexpensive, easily available and efficient topical agent for effective elimination of wound infections caused due to multi-drug resistant, large variety of bacteria and fungus.