Miracle-dz/UniFAR-FTUs huggingface dataset:
Adrenocortical carcinoma: Past, present, and future

Adrenocortical carcinoma (ACC) is a rare endocrine malignancy. Due to its rarity, heterogeneity, and a lack of a comprehensive understanding of the pathogenesis, little progress has been made in treatment and outcomes. The current review explores the past, present, and future of the understanding and treatment of this disease process. J. Surg. Oncol. 2012; 106:586–594. © 2012 Wiley Periodicals, Inc.
Human Sensorimotor Cortex Control of Directly Measured Vocal Tract Movements during Vowel Production

During speech production, we make vocal tract movements with remarkable precision and speed. Our understanding of how the human brain achieves such proficient control is limited, in part due to the challenge of simultaneously acquiring high-resolution neural recordings and detailed vocal tract measurements. To overcome this challenge, we combined ultrasound and video monitoring of the supralaryngeal articulators (lips, jaw, and tongue) with electrocorticographic recordings from the cortical surface of 4 subjects (3 female, 1 male) to investigate how neural activity in the ventral sensory-motor cortex (vSMC) relates to measured articulator movement kinematics (position, speed, velocity, acceleration) during the production of English vowels. We found that high-gamma activity at many individual vSMC electrodes strongly encoded the kinematics of one or more articulators, but less so for vowel formants and vowel identity. Neural population decoding methods further revealed the structure of kinematic features that distinguish vowels. Encoding of articulator kinematics was sparsely distributed across time and primarily occurred during the time of vowel onset and offset. In contrast, encoding was low during the steady-state portion of the vowel, despite sustained neural activity at some electrodes. Significant representations were found for all kinematic parameters, but speed was the most robust. These findings enabled by direct vocal tract monitoring demonstrate novel insights into the representation of articulatory kinematic parameters encoded in the vSMC during speech production. SIGNIFICANCE STATEMENT Speaking requires precise control and coordination of the vocal tract articulators (lips, jaw, and tongue). Despite the impressive proficiency with which humans move these articulators during speech production, our understanding of how the brain achieves such control is rudimentary, in part because the movements themselves are difficult to observe. By simultaneously measuring speech movements and the neural activity that gives rise to them, we demonstrate how neural activity in sensorimotor cortex produces complex, coordinated movements of the vocal tract.
[Orthostatic hypotension in elderly patients].

- Orthostatic hypotension is a condition in which there is insufficient recovery of the blood pressure drop which occurs after getting up, which causes a temporary reduction of cerebral perfusion. This increases the risk of falls resulting in injuries. - Orthostatic hypotension is most common in the elderly. The cause is usually multifactorial (including reduced circulating volume, reduced peripheral resistance and limited heart rate increase). Orthostatic hypotension caused by autonomic dysfunction is called neurogenic orthostatic hypotension. - The most important groups of drugs that may elicit orthostatic hypotension are: diuretics (but only if they lead to hypovolaemia), antidepressants (mainly tricyclic antidepressants), sympatholytics (alpha-blockers as well as beta-blockers) and vasodilators (for example, nitrates). - Treatment of the elderly with orthostatic hypotension starts with lifestyle advice (getting up slowly) and possible medication adjustments.
Challenges and opportunities in academic hospital medicine: report from the Academic Hospital Medicine Summit.

BACKGROUND The field of hospital medicine is growing rapidly in academic medical centers. However, few organizations have explicitly considered the opportunities for and barriers to hospital medicine's development as an academic field in internal medicine. OBJECTIVE The objective was to develop consensus around key areas limiting or facilitating hospital medicine's development as an academic discipline. DESIGN The design was a consensus format conference of key stakeholders in academic hospital medicine. RESULTS The consensus group identified several issues impeding the development of academic hospital medicine as a recognized entity in academic settings, including extraordinarily rapid growth, increasingly preponderant nonteaching roles, and demands to perform nonclinical duties (such as quality improvement) not generally viewed as academic pursuits. The consensus group developed recommendations for addressing these concerns, specifically: 1) characterizing the optimal job description for an academic hospitalist, 2) developing better local and at-a-distance opportunities for training academic hospitalists in key aspects of early career success, and 3) advocating for the development of fellows and junior faculty researchers in hospital medicine. SUMMARY Fostering academic hospital medicine will help address these issues more effectively and will help the field while also attracting the next generation of generalists needed to care for an increasingly complex inpatient population.
The association between parathyroid hormone 1–34 and the Wnt/β-catenin signaling pathway in a rat model of osteoarthritis

The aim of the current study was to determine the effect of parathyroid hormone (PTH) 1–34 on cartilage degeneration, and the association between PTH 1–34 and factors associated with the Wnt/β-catenin pathway following anterior cruciate ligament and medial meniscectomy-induced osteoarthritis (OA) in rats. A total of 64 Sprague-Dawley rats were randomly divided into the following four groups: Sham-operated rats with normal saline (NS)-treatment (n=16); anterior cruciate ligament transection with partial medial meniscectomy (ACLT + MMx) rats with NS-treatment (n=16); sham-operated rats treated with PTH 1–34 (n=16); and ACLT + MMx rats treated with PTH 1–34 (n=16). PTH (15 µg/kg/day) was administered via subcutaneous injection 5 days per week from the first postoperative day for 2 or 6 weeks. Staining with hematoxylin and eosin and safranin O, and a scoring system modified by Mankin were used to assess the histopathological features of cartilage. The present study detected the expression of PTH 1 receptor (PTH1R), sclerostin, dickkopf Wnt signaling pathway inhibitor 1 (DKK1), β-catenin and runt-related transcription factor 2 (RUNX2) in cartilage by immunohistochemical analysis to determine the association between PTH 1–34 and factors associated with the Wnt/β-catenin pathway. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was performed to detect the mRNA expression levels of PTH1R and β-catenin in cartilage. Histological analysis demonstrated that cartilage degeneration was present post-surgery and gradually increased over time. PTH 1–34 reduced the Mankin scores in ACLT + MMx rats compared with the NS-treated ACLT + MMx rats. Immunohistochemistry and RT-qPCR analysis demonstrated that, in cartilage, PTH 1–34 treatment increased the mRNA expression and protein levels of PTH1R and β-catenin, and decreased protein levels of sclerostin, DKK1 and RUNX2 in ACLT + MMx rats compared with the NS-treated ACLT + MMx group. The present study demonstrated that PTH 1–34 upregulated the Wnt/β-catenin signaling pathway and that PTH1-34 downregulated RUNX2 through an alternative pathway to the Wnt/β-catenin signaling pathway, in a rat model of OA.
Current eradication rate of Helicobacter pylori with clarithromycin-based triple therapy in a gastroenterology practice in the New York metropolitan area

Background In order to mitigate potential issues with antibiotic resistance in the treatment of patients with Helicobacter pylori infection, the selection of a therapeutic regimen is optimized by being aware of local eradication rates as well as the patient’s medication history and previous diagnoses. Purpose This study primarily aimed to calculate the eradication rate of H. pylori infection in the New York Metropolitan area when using clarithromycin-based triple therapy per the dosing instructions for Omeclamox®-Pak. A secondary objective was to determine risk factors for therapeutic failure. Patients and methods A retrospective analysis was performed on 156 patients treated with clarithromycin-based triple therapy between 2011 and 2017 at a gastroenterology practice in Edison, New Jersey. Results The cumulative eradication rate for the intent-to-treat population was 84%, while the per-protocol rate was 86%. No differences were seen in the rates of subgroups defined by demographics or medication history. Conclusion Despite evidence and predictions from other sources in the last decade that clarithromycin-based treatments for H. pylori are becoming less effective, the results of this study support the use of clarithromycin-based triple therapy as a first-line treatment in the New York Metropolitan region.
A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis

Our aim in this study was to compare the efficiency of 25G versus 22G needles in diagnosing solid pancreatic lesions by EUS-FNA. We performed a systematic review and meta-analysis. Studies were identified in five databases using an extensive search strategy. Only randomized trials comparing 22G and 25G needles were included. The results were analyzed by fixed and random effects. A total of 504 studies were found in the search, among which 4 randomized studies were selected for inclusion in the analysis. A total of 462 patients were evaluated (233: 25G needle/229: 22G needle). The diagnostic sensitivity was 93% for the 25G needle and 91% for the 22G needle. The specificity of the 25G needle was 87%, and that of the 22G needle was 83%. The positive likelihood ratio was 4.57 for the 25G needle and 4.26 for the 22G needle. The area under the sROC curve for the 25G needle was 0.9705, and it was 0.9795 for the 22G needle, with no statistically significant difference between them (p=0.497). Based on randomized studies, this meta-analysis did not demonstrate a significant difference between the 22G and 25G needles used during EUS-FNA in the diagnosis of solid pancreatic lesions.
Quality of life in patients with melasma in Turkish women

The aim of this study was to determine the impact of melasma on quality of life (QoL) using the dermatology life quality index (DLQI) questionnaire in a group of outpatients. This study is questionnairebased. A total of 101 Turkish women suffering from melasma, who themselves were able to understand and complete the Turkish version of the DLQI questionnaire, were enrolled. This questionnaire included 10 questions; each of each was scored on a scale of 0-3, with a maximum score of 30. The data were analyzed after the results had been collated and the higher the DLQI score, the poorer the QoL. The participants’ mean age was 29.53±6.87 years, and mean DLQI score was 6.02±4.94. When we divided the participants into two subgroups according to age, the DLQI scores for younger and older individuals were 7.44±4.99 and 4.33±4.36, respectively (P=0.001). When the melasma area and severity index (MASI) score was used, participants with mild and moderate disease had mean DLQI scores of 5.80±4.72 and 7.11±5.90, respectively. No patient had severe disease. Melasma might affect the participants’ QoL, especially that of the younger individuals, in our study population.
Untersuchungen zu ausgewählten mechanischen Eigenschaften von Eschenholz | Investigation into certain mechanical properties of ash

Ash originating from two locations in Switzerland was investigated for certain selected mechanical properties. Values were determined for raw density, sorption, swelling, tensile strength, MOE and work on bending strength as well as annual rings. In addition the influence of wood humidity on the tensile strength was investigated as well as the correlation between humidity/ tensile strength and annual rings density. The samples, as expected, were generally tough as far as breakage is concerned and the breakage energy required was higher than that of spruce. In view of its relative robustness and strong mechanical properties, there is a potential for the use of ash for the production of layered boards, but also for other wood parts for construction purposes with high requirements.
Dual cyclooxygenase–fatty acid amide hydrolase inhibitor exploits novel binding interactions in the cyclooxygenase active site

The cyclooxygenases COX-1 and COX-2 oxygenate arachidonic acid (AA) to prostaglandin H2 (PGH2). COX-2 also oxygenates the endocannabinoids 2-arachidonoylglycerol (2-AG) and arachidonoylethanolamide (AEA) to the corresponding PGH2 analogs. Both enzymes are targets of nonsteroidal anti-inflammatory drugs (NSAIDs), but NSAID-mediated COX inhibition is associated with gastrointestinal toxicity. One potential strategy to counter this toxicity is to also inhibit fatty acid amide hydrolase (FAAH), which hydrolyzes bioactive fatty acid ethanolamides (FAEs) into fatty acids and ethanolamine. Here, we investigated the mechanism of COX inhibition by ARN2508, an NSAID that inhibits both COXs and FAAH with high potency, target selectivity, and decreased gastrointestinal toxicity in mouse models, presumably due to its ability to increase levels of FAEs. A 2.27-Å–resolution X-ray crystal structure of the COX-2·(S)-ARN2508 complex reveals that ARN2508 adopts a binding pose similar to that of its parent NSAID flurbiprofen. However, ARN2508's alkyl tail is inserted deep into the top channel, an active site region not exploited by any previously reported NSAID. As for flurbiprofen, ARN2508's potency is highly dependent on the configuration of the α-methyl group. Thus, (S)-ARN2508 is more potent than (R)-ARN2508 for inhibition of AA oxygenation by both COXs and 2-AG oxygenation by COX-2. Also, similarly to (R)-flurbiprofen, (R)-ARN2508 exhibits substrate selectivity for inhibition of 2-AG oxygenation. Site-directed mutagenesis confirms the importance of insertion of the alkyl tail into the top channel for (S)-ARN2508's potency and suggests a role for Ser-530 as a determinant of the inhibitor's slow rate of inhibition compared with that of (S)-flurbiprofen.
Potential disruption of seed dispersal in the absence of a native Kauai thrush

Hawaii has experienced a catastrophic decline in frugivorous native birds coupled with the introduction of non-native species. Puaiohi (Myadestes palmeri), a critically endangered thrush, is the sole extant native songbird capable of dispersing fleshy fruited plants in the rainforest of Kauai island, Hawaii. As this species has declined to occupy a small proportion of its original range, a suite of largely omnivorous non-native birds have been introduced to this region, including the common and widespread Japanese White-eye (Zosterops japonicus). This reshuffling of the bird community could have long-term implications for plant community composition if introduced birds incompletely replace the ecological role of native species. The objective of this study was to evaluate the potential consequences of the local extirpation of Puaiohi for seed dispersal. Specifically, we compared the diet of Puaiohi and Japanese White-eye, vegetation characteristics, and seed rain at sites with and without Puaiohi in the Na Pali-Kona Forest Reserve on the island of Kauai. We found high overlap in the composition of seeds consumed by the two bird species, but differences in the characteristics of seeds consumed; Japanese White-eye appeared more likely to consume smaller seeded species compared with Puaiohi. Sites with Puaiohi received substantially higher seed rain during the study period, despite no significant differences in overall fruit abundance. Our results suggest that non-native birds are unlikely to completely replace the seed dispersal services provided by Puaiohi. If Puaohi continue to be rare and range restricted, we predict a shift in plant community composition through an increase in non-native and small-seeded plants, and possible dispersal failure of other native species. Our findings lend further support to efforts to conserve Puaiohi across its current and former range, and to consider introductions to other suitable areas to ensure the persistence not only of the species and but also its functional role in Hawaii’s montane ecosystems.
Effects of genetic factors to inhaled corticosteroid response in children with asthma: a literature review

Numerous studies have examined the association between pharmacogenetic effects and the response to inhaled corticosteroids (ICS) in patients with asthma. In fact, several single nucleotide polymorphisms of a number of candidate genes have been identified that might influence the clinical response to ICS in children with asthma. Their direct or indirect effects depend on their role in the inflammatory process in asthma or the anti-inflammatory action of corticosteroids, respectively. Among the genes identified, variants in T-box 21 (TBX21) and Fc fragment of IgE receptor II (FCER2) contribute indirectly to the variability in the response to ICS by altering the inflammatory mechanisms in asthma, while other genes such as corticotropin releasing hormone receptor 1 (CRHR1), nuclear receptor subfamily 3 group C member 1 (NR3C1), stress induced phosphoprotein 1 (STIP1), dual specificity phosphatase 1 (DUSP1), glucocorticoid induced 1 (GLCCI1), histone deacetylase 1 (HDAC), ORMDL sphingolipid biosynthesis regulator 3 (ORMDL3), and vascular endothelial growth factors (VEGF) directly affect this variability through the anti-inflammatory mechanisms of ICS. The results to date indicate various potential genetic factors associated with the response to ICS, which could be utilized to predict the individual therapeutic response of children with asthma to ICS. Clinical trials are underway and their results are greatly anticipated. Further pharmacogenetic studies are needed to fully understand the effects of genetic variation on the response to ICS in children with asthma.
Attachment Patterns and Complex Trauma in a Sample of Adults Diagnosed with Gender Dysphoria

The current study investigated attachment representations and complex trauma in a sample of gender dysphoric adults. Although it has been proven that the psychological wellbeing of gender diverse persons is largely mediated by family acceptance and support, research on their relationships with parental figures is scarce. A total of 95 adults took part in the study. The attachment distribution was as follows: 27% secure, 27% insecure and 46% disorganized. Regarding early traumas, 56% experienced four or more traumatic forms. Further, gender dysphoric adults showed significantly higher levels of attachment disorganization and polyvictimisation, relative to controls. Comparisons of subgroups, defined by natal gender, showed that trans women, compared to control males, had more involving and physically and psychologically abusive fathers, and were more often separated from their mothers; trans men, relative to female controls, had more involving mothers and were more frequently separated from and neglected by their fathers. The research has several implications for treatment, clinical health psychology, family support and education.
Efficacy and safety of supramaximal titrated inhibition of renin‐angiotensin‐aldosterone system in idiopathic dilated cardiomyopathy

The optimal dosing strategies for blocking the renin‐angiotensin‐aldosterone system in idiopathic dilated cardiomyopathy (IDCM) are poorly known. We sought to determine the long‐term efficacy and safety of supramaximal titration of benazepril and valsartan in patients with IDCM.
Are frail elderly patients treated in a CGA unit more satisfied with their hospital care than those treated in conventional acute medical care?

Objectives Our aim was to study whether the acute care of frail elderly patients directly admitted to a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit in terms of patient satisfaction. Design TREEE (Is the TReatment of frail Elderly patients Effective in an Elderly care unit? ) is a clinical, prospective, controlled, one-center intervention trial comparing acute treatment in CGA units and in conventional wards. Setting This study was conducted in the NÄL-Uddevalla county hospital in western Sweden. Participants In this follow-up to the TREEE study, 229 frail patients, aged ≥75 years, in need of acute in-hospital treatment, were eligible. Of these patients, 139 patients were included in the analysis, 72 allocated to the CGA unit group and 67 to the conventional care group. Mean age was 85 years and 65% were female. Intervention Direct admittance to an acute elderly care unit with structured, systematic interdisciplinary CGA-based care, compared to conventional acute medical care via the emergency room. Measurements The primary outcome was the satisfaction reported by the patients shortly after discharge from hospital. A four-item confidential questionnaire was used. Responses were given on a 4-graded scale. Results The response rate was 61%. In unadjusted analyses, significantly more patients in the intervention group responded positively to the following three questions about the hospitalization: “Did you get the nursing from the ward staff that you needed? ” (p=0.003), “Are you satisfied with the information you received on your diseases and medication? ” (p=0.016), and “Are you satisfied with the planning before discharge from the hospital? ” (p=0.032). After adjusted analyses by multiple regression, a significant difference in favor of the intervention remained for the first question (p=0.027). Conclusion Acute care in a CGA unit with direct admission was associated with higher levels of patient satisfaction compared with conventional acute care via the emergency room.
Ageing of the hypothalamo-pituitary-testicular axis in men.

In distinction to the course of reproductive ageing in women, men do not experience a rapid decline of Leydig cell function or irreversible arrest of reproductive capacity in old age. Hence, strictu sensu, the andropause does not exist. Nevertheless, both spermatogenesis and fertility as well as Leydig cell function do decline with age, as shown by a decrease of +/- 35% of total and of 50% of free testosterone levels between the age of 20 and 80 years. The origin of this decline of Leydig cell function resides on the one hand in the testes, and is essentially characterized by a decreased number of Leydig (and Sertoli) cells and on the other hand in the hypothalamo-pituitary complex characterized by a decreased luteinzing hormone (LH) pulse amplitude, LH pulse frequency being maintained. As the responsiveness of the gonadotrophs to gonadotropin-releasing hormone (GnRH) remains unimpaired, one may assume that the amount of GnRH released at each pulse is also reduced, possibly as the consequence of a reduction of the cellular mass of GnRH neurones. Plasma levels of testosterone below the lower normal limit occur, however, only in a minority of elderly men from 7% in the age group 40-60, to 20% in the age group 60-80 and 35% in the age group over 80 years old. Factors influencing testosterone levels in elderly men are multiple: hereditary, environmental (obesity, stress), psychosocial (depression, smoking, drugs) or socioeconomical (diet, hygiene). Whether these elderly men should be substituted with androgens remains controversial. (ABSTRACT TRUNCATED AT 250 WORDS)