Miracle-dz/UniFAR-FTUs huggingface dataset:
Objective and Subjective Burden of Informal Caregivers 4 Years After a Severe Traumatic Brain Injury: Results From the PariS-TBI Study

Objective:Prospective assessment of informal caregiver (IC) burden 4 years after the traumatic brain injury of a relative. Setting:Longitudinal cohort study (metropolitan Paris, France). Participants:Home dwelling adults (N = 98) with initially severe traumatic brain injury and their primary ICs. Main Outcome Measures:Informal caregiver objective burden (Resource Utilization in Dementia measuring Informal Care Time [ICT]), subjective burden (Zarit Burden Inventory), monetary self-valuation of ICT (Willingness-to-pay, Willingness-to-accept). Results:Informal caregivers were women (81%) assisting men (80%) of mean age of 37 years. Fifty-five ICs reported no objective burden (ICT = 0) and no/low subjective burden (average Zarit Burden Inventory = 12.1). Forty-three ICs reported a major objective burden (average ICT = 5.6 h/d) and a moderate/severe subjective burden (average Zarit Burden Inventory = 30.3). In multivariate analyses, higher objective burden was associated with poorer Glasgow Outcome Scale-Extended scores, with more severe cognitive disorders (Neurobehavioral Rating Scale-revised) and with no coresidency status; higher subjective burden was associated with poorer Glasgow Outcome Scale-Extended scores, more Neurobehavioral Rating Scale-revised disorders, drug-alcohol abuse, and involvement in litigation. Economic valuation showed that on average, ICs did not value their ICT as free and preferred to pay a mean Willingness-to-pay = &OV0556;17 per hour to be replaced instead of being paid for providing care themselves (Willingness-to-accept = &OV0556;12). Conclusion:Four years after a severe traumatic brain injury, 44% of ICs experienced a heavy multidimensional burden.
CORRELATION OF HAND GRIP STRENGTH WITH ANTHROPOMETRIC VARIABLES AND QUANTIFYING HAND GRIP STRENGTH IN CHILDREN OF AGE 3 - 5.5 YEARS WITH MARTIN VIGORIMETER IN INDIAN POPULATION

Background: Hand grip strength is an important quantitative measure in evaluation of hand which is also considered as a predictor of general health status. Influence of various anthropometric variables on Hand Grip Strength has been studied in adult population. Martin Vigorimeter is a simple instrument which is considered to be appropriate for measuring hand grip strength in the age group 3-5.5 years for which norms have been established in Caucasian population. This study aims to analyse the correlation of hand grip strength with anthropometric variables and to quantify grip strength in children of age 3-5.5 years using Martin Vigorimeter in Indian population. Methods and Methodology: 211 children from five schools were included in this cross sectional study after getting consent from the principal of the schools. The anthropometric variables height, weight, BMI, hand anthropometric variables were measured. Hand grip strength was measured using Martin Vigorimeter, three trials were measured and best of the three was taken as the standard grip strength on both right and left sides. Results: Pearson’s correlation was used to analyse the relation between hand grip strength and anthropometric variables which showed a positive correlation between BMI and hand grip strength and independent t-test was used to compare hand grip strength of Indian and Caucasian population which showed a significant decrease in hand grip strength in Indian population with a p value <0.05. Conclusion: The study concludes that anthropometric variables should be considered while quantifying hand grip strength. A significant decrease in hand grip strength in Indian population when compared to Caucasian population demands a need to evaluate the cultural sensitivity of such instruments prior to clinical usage and to interpret clinically.
Efficiency and safety of speech recognition for documentation in the electronic health record

Abstract Objective To compare the efficiency and safety of using speech recognition (SR) assisted clinical documentation within an electronic health record (EHR) system with use of keyboard and mouse (KBM). Methods Thirty-five emergency department clinicians undertook randomly allocated clinical documentation tasks using KBM or SR on a commercial EHR system. Tasks were simple or complex, and with or without interruption. Outcome measures included task completion times and observed errors. Errors were classed by their potential for patient harm. Error causes were classified as due to IT system/system integration, user interaction, comprehension, or as typographical. User-related errors could be by either omission or commission. Results Mean task completion times were 18.11% slower overall when using SR compared to KBM (P = .001), 16.95% slower for simple tasks (P = .050), and 18.40% slower for complex tasks (P = .009). Increased errors were observed with use of SR (KBM 32, SR 138) for both simple (KBM 9, SR 75; P < 0.001) and complex (KBM 23, SR 63; P < 0.001) tasks. Interruptions did not significantly affect task completion times or error rates for either modality. Discussion For clinical documentation, SR was slower and increased the risk of documentation errors, including errors with the potential to cause clinical harm compared to KBM. Some of the observed increase in errors may be due to suboptimal SR to EHR integration and workflow. Conclusion Use of SR to drive interactive clinical documentation in the EHR requires careful evaluation. Current generation implementations may require significant development before they are safe and effective. Improving system integration and workflow, as well as SR accuracy and user-focused error correction strategies, may improve SR performance.
Arsenic trioxide and angiotensin II have inhibitory effects on HERG protein expression: Evidence for the role of PML SUMOylation

The human ether-a-go-go-related gene (HERG) channel is a novel target for the treatment of drug-induced long QT syndrome, which causes lethal cardiotoxicity. This study is designed to explore the possible role of PML SUMOylation and its associated nuclear bodies (NBs) in the regulation of HERG protein expression. Both arsenic trioxide (ATO) and angiotensin II (Ang II) were able to significantly reduce HERG protein expression, while also increasing PML SUMOylation and accelerating the formation of PML-NBs. Pre-exposure of cardiomyocytes to a SUMOylation chemical inhibitor, ginkgolic acid, or the silencing of UBC9 suppressed PML SUMOylation, subsequently preventing the downregulation of HERG induced by ATO or Ang II. Conversely, knockdown of RNF4 led to a remarkable increase in PML SUMOylation and the function of PML-NBs, further promoting ATO- or Ang II-induced HERG protein downregulation. Mechanistically, an increase in PML SUMOylation by ATO or Ang II dramatically enhanced the formation of PML and Pin1 complexes in PML-NBs, leading to the upregulation of TGF-β1 protein, eventually inhibiting HERG expression through activation of protein kinase A. The present work uncovered a novel molecular mechanism underlying HERG protein expression and indicated that PML SUMOylation is a critical step in the development of drug-acquired arrhythmia.
Endothelial to haematopoietic transition contributes to pulmonary arterial hypertension

Aims The pathogenic mechanisms of pulmonary arterial hypertension (PAH) remain unclear, but involve dysfunctional endothelial cells (ECs), dysregulated immunity and inflammation in the lung. We hypothesize that a developmental process called endothelial to haematopoietic transition (EHT) contributes to the pathogenesis of pulmonary hypertension (PH). We sought to determine the role of EHT in mouse models of PH, to characterize specific cell types involved in this process, and to identify potential therapeutic targets to prevent disease progression. Methods and results When transgenic mice with fluorescence protein ZsGreen-labelled ECs were treated with Sugen/hypoxia (Su/Hx) combination to induce PH, the percentage of ZsGreen+ haematopoietic cells in the peripheral blood, primarily of myeloid lineage, significantly increased. This occurrence coincided with the depletion of bone marrow (BM) ZsGreen+ c-kit+ CD45- endothelial progenitor cells (EPCs), which could be detected accumulating in the lung upon PH-induction. Quantitative RT-PCR based gene array analysis showed that key transcription factors driving haematopoiesis were expressed in these EPCs. When transplanted into lethally irradiated recipient mice, the BM-derived EPCs exhibited long-term engraftment and haematopoietic differentiation capability, indicating these EPCs are haemogenic in nature. Specific inhibition of the critical haematopoietic transcription factor Runx1 blocked the EHT process in vivo, prevented egress of the BM EPCs and ultimately attenuated PH progression in Su/Hx- as well as in monocrotaline-induced PH in mice. Thus, myeloid-skewed EHT promotes the development of PH and inhibition of this process prevents disease progression in mouse models of PH. Furthermore, high levels of Runx1 expression were found in circulating CD34+ CD133+ EPCs isolated from peripheral blood of patients with PH, supporting the clinical relevance of our proposed mechanism of EHT. Conclusion EHT contributes to the pathogenesis of PAH. The transcription factor Runx1 may be a novel therapeutic target for the treatment of PAH.
High‐Fat Diet–Induced Obesity Promotes Expansion of Bone Marrow Adipose Tissue and Impairs Skeletal Stem Cell Functions in Mice

Obesity represents a risk factor for development of insulin resistance and type 2 diabetes. In addition, it has been associated with increased adipocyte formation in the bone marrow (BM) along with increased risk for bone fragility fractures. However, little is known on the cellular mechanisms that link obesity, BM adiposity, and bone fragility. Thus, in an obesity intervention study in C57BL/6J mice fed with a high‐fat diet (HFD) for 12 weeks, we investigated the molecular and cellular phenotype of bone marrow adipose tissue (BMAT), BM progenitor cells, and BM microenvironment in comparison to peripheral adipose tissue (AT). HFD decreased trabecular bone mass by 29%, cortical thickness by 5%, and increased BM adiposity by 184%. In contrast to peripheral AT, BMAT did not exhibit pro‐inflammatory phenotype. BM progenitor cells isolated from HFD mice exhibited decreased mRNA levels of inflammatory genes (Tnfα, IL1β, Lcn2) and did not manifest an insulin resistant phenotype evidenced by normal levels of pAKT after insulin stimulation as well as normal levels of insulin signaling genes. In addition, BM progenitor cells manifested enhanced adipocyte differentiation in HFD condition. Thus, our data demonstrate that BMAT expansion in response to HFD exerts a deleterious effect on the skeleton. Continuous recruitment of progenitor cells to adipogenesis leads to progenitor cell exhaustion, decreased recruitment to osteoblastic cells, and decreased bone formation. In addition, the absence of insulin resistance and inflammation in the BM suggest that BMAT buffers extra energy in the form of triglycerides and thus plays a role in whole‐body energy homeostasis. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.
Surgical and oncologic outcomes after robotic radical hysterectomy as compared to open radical hysterectomy in the treatment of early cervical cancer

Objective The use of robotic radical hysterectomy has greatly increased in the treatment of early stage cervical cancer. We sought to compare surgical and oncologic outcomes of women undergoing robotic radical hysterectomy compared to open radical hysterectomy. Methods The clinic-pathologic, treatment, and recurrence data were abstracted through an Institutional Review Board-approved protocol at 2 separate large tertiary care centers in Seattle, Swedish Medical Center and the University of Washington. Data were collected from 2001–2012. Comparisons between the robotic and open cohorts were made for complications, recurrence, progression-free survival (PFS), and overall survival (OS). Results In the study period, 109 robotic radical hysterectomies were performed. These were compared to 202 open radical hysterectomies. The groups were comparable in terms of age and body mass index (BMI). Length of stay (LOS) was considerably shorter in the robotic group (42.7 vs. 112.6 hours, p<0.001) as was estimated blood loss (EBL; 105.9 vs. 482.6 mL, p<0.001). There were more complications in the open radical hysterectomy group, 23.4% vs. 9.2% in the robotic group (p=0.002). The recurrence rate was comparable between the groups (10.1% vs. 10.4%, p=0.730). In multivariate adjusted analysis, robotic surgery was not a statistically significant predictor of PFS (p=0.230) or OS (0.85). Conclusion Our study, one of the largest multi-institution cohorts of patients undergoing robotic radical hysterectomy, suggest robotic radical hysterectomy leads to comparable oncologic outcomes in the treatment of early stage cervical cancer with improved short-term surgical outcomes such as decreased LOS and EBL.
Multiplex genomewide association analysis of breast milk fatty acid composition extends the phenotypic association and potential selection of FADS1 variants to arachidonic acid, a critical infant micronutrient

Background Breast milk is the sole nutrition source during exclusive breastfeeding, and polyunsaturated fatty acids (FAs) are critical micronutrients in infant physical and cognitive development. There has been no prior genomewide association study of breast milk, hence our objective was to test for genetic association with breast milk FA composition. Methods We measured the fractional composition of 26 individual FAs in breast milk samples from three cohorts totalling 1142 Bangladeshi mothers whose infants were genotyped on the Illumina MEGA chip and replicated on a custom Affymetrix 30K SNP array (n=616). Maternal genotypes were imputed using IMPUTE. Results After running 33 separate FA fraction phenotypes, we found that SNPs known to be associated with serum FAs in the FADS1/2/3 region were also associated with breast milk FA composition (experiment-wise significance threshold 4.2×10−9). Hypothesis-neutral comparison of the 33 fractions showed that the most significant genetic association at the FADS1/2/3 locus was with fraction of arachidonic acid (AA) at SNP rs174556, with a very large per major allele effect size of 17% higher breast milk AA level. There was no evidence of independent association at FADS1/2/3 with any other FA or SNP after conditioning on AA and rs174556. We also found novel significant experiment-wise SNP associations with: polyunsaturated fatty acid (PUFA) 6/PUFA3 ratio (sorting nexin 29), eicosenoic (intergenic) and capric (component of oligomeric Golgi complex 3) acids; and six additional loci at genomewide significance (<5×10−8). Conclusions AA is the primary FA in breast milk influenced by genetic variation at the FADS1/2/3 locus, extending the potential phenotypes under genetic selection to include breast milk composition, thereby possibly affecting infant growth or cognition. Breast milk FA composition is influenced by maternal genetics in addition to diet and body composition.
Multilabeled versions of Sperner's and Fan's lemmas and applications

We propose a general technique related to the polytopal Sperner lemma for proving old and new multilabeled versions of Sperner's lemma. A notable application of this technique yields a cake-cutting theorem where the number of players and the number of pieces can be independently chosen. We also prove multilabeled versions of Fan's lemma, a combinatorial analogue of the Borsuk-Ulam theorem, and exhibit applications to fair division and graph coloring.
INTERSECTION THEORY ON MODULI SPACES OF HOLOMORPHIC BUNDLES OF ARBITRARY RANK ON A RIEMANN SURFACE

Let n and d be coprime positive integers, and define M(n,d) to be the moduli space of (semi)stable holomorphic vector bundles of rank n, degree d and fixed determinant on a compact Riemann surface E. This moduli space is a compact Kifhler manifold which has been studied from many different points of view for more than three decades (see for instance Narasimhan and Seshadri [41]). The subject of this article is the characterization of the intersection pairings in the cohomology ring1 H* (M (n, d)). A set of generators of this ring was described by Atiyah and Bott in their seminal 1982 paper [2] on the YangMills equations on Riemann surfaces (where in addition inductive formulas for the Betti numbers of M (n, d) obtained earlier using number-theoretic methods [13], [25] were rederived). By Poincare duality, knowledge of the intersection pairings between products of these generators (or equivalently knowledge of the evaluation on the fundamental class of products of the generators) completely determines the structure of the cohomology ring. In 1991 Donaldson [15] and Thaddeus [47] gave formulas for the intersection pairings between products of these generators in H* (M (2, 1)) (in terms of Bernoulli numbers). Then using physical methods, Witten [50] found formulas for generating functions from which could be extracted the intersection pairings between products of these generators in H* (M (n, d)) for general rank n. These generalized his (rigorously proved) formulas [49] for the symplectic volume of M (n, d): For instance, the symplectic volume of M (2, 1) is given by
Canine and feline obesity: a review of pathophysiology, epidemiology, and clinical management

Canine and feline obesity rates have reached pandemic proportions and are similar to those in humans, with approximately 30%–40% of dogs and cats being overweight to obese. Obesity has been associated with other health problems, including osteoarthritis, renal disease, skin disease, insulin resistance, and neoplasia in dogs, while in cats obesity is associated with dermatological issues, diabetes mellitus, neoplasia, and urolithiasis. The health issues appear to be slightly different across the two species, which may be due to some inherent differences in the hormonal milieu involved in obesity that differs between the dog and the cat. In this review, we discuss the complicated nature of the pathogenesis of obesity, the hormonal stimulus for orexigenic and anorexigenic behavior, adipose tissue as an endocrine organ, and most importantly, clinical management of the number one disease in canine and feline medicine.
Comparing and evaluating the efficacy of methotrexate and actinomycin D as first-line single chemotherapy agents in low risk gestational trophoblastic disease

Objective The aim of this study was to compare responses to single-agent chemotherapies and evaluate the predictive factors of resistance in low risk (LR) gestational trophoblastic disease (GTD). The chemotherapy agents included methotrexate (MTX) and actinomycin D (ACT-D). Methods We conducted a retrospective study of 126 patients with GTD who were treated between 2000 and 2013. A total of 71 patients with LR GTD were treated with MTX (8-day regimen or weekly regimen, n=53) or ACT-D (bi-weekly pulsed regimen or 5-day regimen, n=18). The successful treatment group and the failed treatment group were compared and analyzed to identify prognostic factors. Results The complete response rates were 83.3% for ACT-D and 62.2% for MTX, with no statistically significant difference. There was no severe adverse effect reported for either group. Longer interval durations from the index pregnancy (>2 months, p=0.040) and larger tumor size (>3 cm, p=0.020) were more common in non-responders than in responders; these results were statistically significant. Conclusion Based on our results, ACT-D may be a better option than MTX as a first-line single chemotherapy agent for LR GTD. The bi-weekly pulsed ACT-D regimen had minimal, or at least the same, toxicities compared with MTX. However, due to the lack of strong supporting evidence, it cannot be conclusively stated that this is the best single agent for first-line chemotherapy in LR GTD patients. Further larger controlled trials will be necessary to establish the best guidelines for GTD treatment.
Peer Support and Adolescents’ Physical Activity: The Mediating Roles of Self-Efficacy and Enjoyment

Objective The present study aimed to contrast the mediating magnitude of self-efficacy and enjoyment connecting peer support and adolescents' physical activity (PA). Methods Participants were 9th-12th grade students ( N = 409; 56.5% boys) who were randomly chosen from six public schools located in Fuzhou city in southeast China. The bootstrapping method in structural equation modeling was conducted to examine the direct and indirect effects of peer support on adolescents' PA. Results Peer support did not directly impact PA. Rather, peer support indirectly influenced PA through either self-efficacy or enjoyment, with self-efficacy demonstrating a stronger mediating effect. Additionally, we found a significant serial mediating effect with enjoyment, and self-efficacy sequentially mediated the relationship between peer support and PA. Conclusion The findings highlight the role of self-efficacy and enjoyment as mediators connecting peer support and PA. Self-efficacy seems to be more important, as it demonstrated a significantly greater mediating effect.
Brain Shift and Pneumocephalus Assessment During Frame-Based Deep Brain Stimulation Implantation With Intraoperative Magnetic Resonance Imaging.

BACKGROUND Brain shift and pneumocephalus are major concerns regarding deep brain stimulation (DBS). OBJECTIVE To report the extent of brain shift in deep structures and pneumocephalus in intraoperative magnetic resonance imaging (MRI). METHODS Twenty patients underwent bilateral DBS implantation in an MRI suite. Volume of pneumocephalus, duration of procedure, and 6 anatomic landmarks (anterior commissure, posterior commissure, right fornix [RF], left fornix [LF], right putaminal point, and left putaminal point) were measured. RESULTS Pneumocephalus varied from 0 to 32 mL (median = 0.6 mL). Duration of the procedure was on average 195.5 min (118-268 min) and was not correlated with the amount of pneumocephalus. There was a significant posterior displacement of the anterior commissure (mean = -1.1 mm, P < .001), RF (mean = -0.6 mm, P < .001), LF (mean = -0.7 mm, P < .001), right putaminal point (mean = -0.9 mm, P = .001), and left putaminal point (mean = -1.0 mm, P = .001), but not of the posterior commissure (mean = 0.0 mm, P = .85). Both RF (mean = -.7 mm, P < .001) and LF (mean = -0.5 mm, P < .001) were posteriorly displaced after a right-sided burr hole. There was a correlation between anatomic landmarks displacement and pneumocephalus after 2 burr holes (rho = 0.61, P = .007), but not after 1 burr hole (rho = 0.16, P = .60). CONCLUSION Better understanding of how pneumocephalus displaces subcortical structures can significantly enhance our intraoperative decision making and overall targeting strategy.