Miracle-dz/UniFAR-FTUs huggingface dataset:
Patterns of Warfarin Use in Subgroups of Patients with Atrial Fibrillation: A Cross-Sectional Analysis of 430 General Practices in the United Kingdom

Background Despite the proven efficacy of warfarin, its use in patients with Atrial Fibrillation (AF) is reportedly low. We investigated the underuse and overuse of warfarin in the management of AF in general practices in the United Kingdom (UK) against the National Institute of Clinical Excellence (NICE, UK) guidelines whilst seeking to identify subgroups of AF patients to inform efforts to optimise warfarin use. Methodology A retrospective database analysis to determine warfarin prescribing using tree models based on 50361 patients with AF (classified as low, moderate and high risk of stroke using CHADS2) from 430 general practices in the UK. Results Over one-third (37.0%, 4573/12351) of low risk AF patients were on warfarin, compared with 47.1% (8349/17709) moderate risk AF patients and 54.9% (11142/20301) high risk AF patients. Clinical subgroups (n = 15 low risk subgroups, n = 15 medium risk subgroups, n = 22 high risk subgroups) were identified. Several factors not supported by current guidelines (age, BMI, dementia, gender) were associated with the use of warfarin. Gender and BMI were associated with warfarin use in low and medium risk AF patients but not in high risk AF patients. Conclusion Whilst NICE guidelines suggest that all high risk AF patients should be on warfarin, half of those at moderate risk should be on warfarin and none of those at low risk should be on warfarin, we found evidence of over and under use of warfarin. Interventions to optimise warfarin therapy tailored to and targeting specific subgroups of AF patients identified by the tree models are required.
Dietary fats altered nephrotoxicity profile of methylmercury in rats

Weanling male Sprague–Dawley rats were administered semi‐purified isocaloric diet containing soy oil (SO), seal oil (SE), docosahexaenoic acid (DHA), fish oil (FO) or lard (LA) for 28 days, and then gavaged with 0, 1 or 3 mg MeHg kg−1 body weight per day and fed the same diet for 14 days. Serum and 24 h urine samples were collected on the day of necropsy, and analyzed for markers of kidney function and diseases. Kidney slices were analyzed for para‐amino‐hippurate (PAH) and tetraethylammonium (TEA) uptake, total mercury and MeHg content, and examined for pathological lesions. Total mercury and MeHg contents increased significantly and dose‐dependently in all dietary groups. MeHg significantly increased relative kidney weight in all groups, serum creatinine in all except SO group, serum uric acid in the DHA and LA groups, serum Mg in all except the LA group, and urinary protein in the SO group. MeHg significantly decreased serum urea nitrogen in SE, FO and LA groups, urinary creatinine in the DHA group, PAH uptake in all except the SE group, and TEA uptake in all groups. MeHg caused nephrosis in all dietary groups. MeHg also significantly increased neutrophil counts in all except the SE group, decreased serum albumin and triglyceride in all except the DHA group, and increased serum total cholesterol in all groups, suggesting a nephrotic syndrome‐like outcome. These results confirmed that kidney tubules are major targets of MeHg nephrotoxicity. Treatment with dietary fats did not prevent, but rather altered the profile of, nephrotoxicity of MeHg in rats. Copyright © 2008 John Wiley & Sons, Ltd.
Hearing aids as an adjunct to counseling: Tinnitus patients who choose amplification do better than those that don't

Abstract Hearing aids are commonly used for tinnitus management (16) but there is limited evidence to support their use. The purpose of this study was to quantify the effectiveness of hearing aids and counseling as a tinnitus treatment option. This study is a retrospective analysis of tinnitus handicap questionnaire (THQ, 17) results from 58 tinnitus patients with hearing loss who received counseling, and (1) chose to follow recommendations of hearing aid fitting, or (2) chose not to have hearing aids. The groups (N = 29 each) had similar audiometric configuration, tinnitus duration, and age. It was hypothesized that the use of hearing aids would provide greater reduction in THQ scores than counseling alone. THQ scores were reduced 12 months following counseling but improvement in THQ only reached statistical significance for the group that received hearing aids (p < 0.0001). The hearing aid group had reduced; psychosocial handicap (p < 0.0002); and tinnitus-hearing handicap (p < 0.0005). It is concluded that patients with hearing loss and tinnitus should trial amplification. Sumario Los auxiliares auditivos son usados comúnmente para el manejo del acúfeno (16) pero existe evidencia limitada para apoyar su uso. El propósito de este estudio fue cuantificar la efectividad de los auxiliares auditivos y de la consejería como una opción de tratamiento del acúfeno. Este estudio es un análisis retrospectivo del los resultados del cuestionario de desventaja por acúfeno (TQH, Luky col, 1990) de 58 pacientes con acúfeno y con hipoacusia, que recibieron orientación, y (1) escogieron seguir la recomendación de adaptación de un auxiliar auditivo, o (2) escogieron no utilizar auxiliares auditivos. Los grupos (N = 29 cada uno) tenían configuraciones audiométricas, duración del acúfeno y edades similares. Se estableció la hipótesis de que el uso de auxiliares auditivos proporcionaría una mayor reducción en los puntajes THQ que la orientación sola. Los puntajes THQ se redujeron 12 meses después de recibir consejería, pero la mejoría en THQ sólo alcanzó significancia estadística para el grupo que utilizó auxiliares auditivos (p < 0.0001). El grupo con auxiliares auditivos tuvo un impedimento psico-social reducido (p < 0.0002) y un impedimento acúfeno-audición reducido (p < 0.0005). Se concluye que los pacientes con hipoacusia y acúfeno deberían intentar la amplificación.
Validation of Ayurvedic formulations in animal models requires stringent scientific rigor

171 Sir, The paper by Priyadarshini, et al. entitled “Increase in Drosophila melanogaster longevity due to rasayana diet: Preliminary results,” published in April 2010 issue of Journal of Ayurveda and Integrative Medicine concludes that dietary supplement of a specially formulated “rasayana” to Drosophila melanogaster flies significantly enhances their lifespan and that this observation seemingly agrees with what is stated about rasayana in Ayurvedic literature. This can be an important finding. Unfortunately, however, the present paper falls significantly short of a scientific analysis and reporting.
Precesarean Prophylactic Balloon Catheters for Suspected Placenta Accreta: A Randomized Controlled Trial

OBJECTIVE: To examine the effect of prophylactic balloon catheters on bleeding morbidity among women with a prenatal diagnosis of placenta accreta. METHODS: In a randomized trial, women with a prenatal diagnosis of placenta accreta were randomized to either preoperative prophylactic balloon catheters (intervention group) or to a control group. Other than placement of the prophylactic balloon catheters in the anterior division of the internal iliac arteries, the same multidisciplinary approach was used in both groups. The primary study outcome was the number of packed red blood cell (RBC) units transfused. To detect a mean reduction of three packed RBC units with the prophylactic balloon catheters, 12 women in each group were needed. RESULTS: Between January 2009 and March 2015, 27 women were randomized: 13 in the intervention group and 14 in the control group. Demographic and obstetric characteristics were similar between the groups. Six (46.2%) women in the intervention and seven (50.0%) in the control group underwent cesarean hysterectomy (P=.84). There were no significant differences between the intervention and control groups in the mean number of packed RBC units transfused, 5.2 (±6.2) and 4.1 (±3.8), respectively (P=.90), or in the calculated blood loss, 4,950 (±5,051) and 4,709 (±3,434) mL (P=.72). The number of women with blood loss greater than 2,500 mL, number of plasma products transfused, duration of surgery, peripartum complications, and hospitalization length did not differ significantly between the groups. Reversible adverse effects related probably to prophylactic balloon catheter insertion were noted in 2 of 13 (15.4%) women. CONCLUSION: In women with preoperative suspicion of placenta accreta, preoperative placement of prophylactic balloon catheters did not affect the number of packed RBC units transfused. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials. gov, NCT01373255. LEVEL OF EVIDENCE: I
The functional consequences of glaucoma for eye-hand coordination.

PURPOSE To examine whether patients with glaucoma exhibit differences in visually guided reaching-and-grasping (prehension) behavior compared with normally sighted control subjects. METHODS Sixteen patients with glaucoma and 16 control subjects with no ocular disease participated. Participants were required to reach out and precision grasp one of two cylindrical objects placed on a table top in front of them in laboratory conditions in three viewing conditions (binocular, right eye alone, left eye alone). Lightweight reflective markers were placed on the subject's preferred hand for recording its movement in three-dimensional space. Three motion capture units recorded the motion of these markers as the subjects reached out and precision grasped household objects. Various indices of prehension planning, execution, and control were quantified. Visual fields (VF) were measured using standard automated perimetry generating monocular mean deviation (MD) scores. Binocular VF sensitivity was estimated by using the integrated visual field (IVF). Stereoacuity was measured with the Frisby stereoacuity test. Significant differences in prehension movement between patients and control subjects in each viewing condition were investigated, and associations between prehension kinematics and VF sensitivity were examined. RESULTS The patients and control subjects were of a similar age (median [range]: patient group, 72.2 years [62.5-86.9]; control group, 69.0 years [64.3-78.3]). The patient group had asymmetrical disease and relatively minor binocular overlapping defects (better eye MD, -5.7 dB [-16.7 to +0.45 dB]; worse eye MD, -11.8 dB [-29.3 to -1.5 dB]; IVF score, 3 [0-36]). They exhibited slightly poorer stereoacuity levels than did the control subjects (patient group, 55 sec arc [40-110]; control group, 40 sec arc [20-80; Mann-Whitney U test, P < 0.05]). They also showed statistically significant delays in average movement onset (MO: approximately 100 ms delay, Mann-Whitney U test P < 0.0001) and overall movement time (OMD: approximately 140 ms delay; Mann-Whitney U test P < 0.05), suggesting impairments in initial movement planning and control. Deficits were exhibited in the reaching component, with data suggesting that glaucomatous patients made more tentative movements when reaching for the object. These deficits correlated with both increasing severity of VF defect and impaired stereoacuity. There were no differences in grasping characteristics between patients and control subjects in this sample. CONCLUSIONS This study provides evidence that patients with glaucoma exhibit deficits in eye-hand coordination compared with the age-matched normally sighted control. Further study is needed to assess the specific effect of field loss location on prehension kinematics.
Plasminogen activator inhibitor type 1 production by rat type II pneumocytes in culture.

Co-secretion of plasminogen activator inhibitor type 1 (PAI-1) and urokinase-type plasminogen activator was identified in short-term cultures of primary type II pneumocytes isolated from adult rats. After separation by sodium dodecyl sulfate (SDS)-PAGE and reverse fibrin autography (reverse FA) of serum-free conditioned medium (SFCM), cellular lysate, and extracellular matrix (ECM), the inhibitor was seen as a zone of spared lysis at an apparent molecular mass of 46 to 48 kD. The plasminogen activator (PA) activity could only be visualized when human instead of bovine fibrin was used in the indicator gel. It presented as a single band of lysis at an apparent molecular mass of 45 kD when tested by regular FA and was found adjacent to PAI-1 when examined by reverse FA. Immunoblot analysis of type II pneumocyte SFCM, cellular lysate, and ECM revealed two bands at 46 and 48 kD, consistent with the apparent molecular masses (Mr) reported for rat PAI-1 from HTC hepatoma cells. Type II pneumocyte PAI-1 formed SDS-resistant complexes with tissue-type and urokinase-type plasminogen activator and was found to be stable to acid, to short-term exposure to heat, and to the denaturants guanidine HCl and SDS, while being sensitive to treatment with alkali and urea. When levels of type II pneumocyte PAI-1 activity were monitored over time during short-term culture conditions, the level of PAI-1 in SFCM remained stable, whereas activity in the lysate accumulated and activity in the ECM declined. (ABSTRACT TRUNCATED AT 250 WORDS)
A Comparison of Infraclavicular Nerve Block versus General Anesthesia for Hand and Wrist Day-case Surgeries

Background:General anesthesia (GA) and brachial plexus block have been used successfully for surgery on the upper extremities. Controversy exists as to which method is more suitable in outpatients undergoing hand and wrist surgery. The authors hypothesized that infraclavicular brachial plexus block (INB) performed with a short-acting local anesthetic would result in shorter time to discharge home as compared with “fast-track” GA. Methods:After obtaining written informed consent, 52 patients (aged 18–65 yr, American Society of Anesthesiologists physical status I–III) were randomly assigned to receive either an INB or GA under standardized protocols (INB = 3% 2-chloroprocaine + HCO3 + epinephrine 1:300,000, followed by propofol sedation; GA = 12.5 mg dolasetron, propofol induction, followed by laryngeal mask airway insertion and desflurane for maintenance; 0.25% bupivacaine for wound infiltration). At the conclusion of the procedure, nurses blinded to the study goals and the anesthetic technique used a modified Aldrete score to decide whether patients could bypass the postanesthesia care unit. Additional data were collected regarding time to postoperative pain, ambulation, home readiness, and incidence of adverse events. Results:More patients in the INB group (79%) met the criteria to bypass the postanesthesia care unit compared with patients in the GA group (25%; P < 0.001). Compared with patients in the GA group, fewer patients in the INB group had pain (visual analog scale score > 3) on arrival to the postanesthesia care unit (3% vs. 43%; P < 0.001). None of the patients in the INB group requested treatment for pain while in the hospital, compared with 48% of patients in the GA group (P < 0.001). Patients in the INB group were able to ambulate earlier (82 ± 41 min) compared with those in the GA group (145 ± 70 min; P < 0.001). Time to home readiness and discharge times were shorter for patients in the INB group (100 ± 44 and 121 ± 37 min) compared with those in the GA group (203 ± 91 and 218 ± 93 min; P < 0.001). Adverse events (e.g., nausea, vomiting, sore throat) occurred less frequently in patients undergoing INB as compared with those undergoing GA. Conclusion:Infraclavicular brachial plexus block with a short-acting local anesthetic was associated with time-efficient anesthesia, faster recovery, fewer adverse events, better analgesia, and greater patient acceptance than GA followed by wound infiltration with a local anesthetic in outpatients undergoing hand and wrist surgery.
On the Catalytic Effect of Water in the Intramolecular Diels–Alder Reaction of Quinone Systems: A Theoretical Study

The mechanism of the intramolecular Diels–Alder (IMDA) reaction of benzoquinone 1, in the absence and in the presence of three water molecules, 1w, has been studied by means of density functional theory (DFT) methods, using the M05-2X and B3LYP functionals for exploration of the potential energy surface (PES). The energy and geometrical results obtained are complemented with a population analysis using the NBO method, and an analysis based on the global, local and group electrophilicity and nucleophilicity indices. Both implicit and explicit solvation emphasize the increase of the polarity of the reaction and the reduction of activation free energies associated with the transition states (TSs) of this IMDA process. These results are reinforced by the analysis of the reactivity indices derived from the conceptual DFT, which show that the increase of the electrophilicity of the quinone framework by the hydrogen-bond formation correctly explains the high polar character of this intramolecular process. Large polarization at the TSs promoted by hydrogen-bonds and implicit solvation by water together with a high electrophilicity-nucleophilicity difference consistently explains the catalytic effects of water molecules.
Does Shave Biopsy Accurately Predict the Final Breslow Depth of Primary Cutaneous Melanoma?

Shave biopsy (SB) is used for the diagnosis of suspicious skin lesions, including melanoma. Its accuracy for melanoma has not been confirmed. We examined our experience with SB to determine its ability to predict true Breslow depth (BD). We performed a retrospective review of the tumor registry for all patients diagnosed with melanoma by SB from 1995 to 2004. Site and depth of lesion, tumor stage, correlation of BD between SB and wide local excision (WLE), and changes in surgical management due to discordance were examined. Melanoma-in-situ was defined as a depth of 0 for this analysis. One hundred thirty-nine patients were diagnosed with melanoma by SB. Pathology after WLE were as follows: 54 (39%) patients had no residual disease, 67 (48%) had a BD equal to or less than the SB, and 18 (13%) had a thicker BD compared with the SB. For these 18 patients, the median BD by SB and WLE was 1.1 mm (range 0-6.5) and 3.5 mm (range 0.5-20.5), respectively (P = 0.0017). Upstaging of final BD from SB to WLE was significantly associated with increasing tumor depth and higher stage of melanoma (P < 0.0001). Only seven of the 139 patients (5%) required further surgery because of the increased depth of the WLE. SB underestimated the final BD of melanoma in 13 per cent of patients, but changed the management of few patients. SB is a valuable tool for practitioners in the diagnosis of melanoma. Nevertheless, patients diagnosed with melanoma by SB should be counseled about the rare need for additional surgery.
The homologous recombination protein RAD51D protects the genome from large deletions

Abstract Homologous recombination (HR) is a DNA double-strand break (DSB) repair pathway that protects the genome from chromosomal instability. RAD51 mediator proteins (i.e. paralogs) are critical for efficient HR in mammalian cells. However, how HR-deficient cells process DSBs is not clear. Here, we utilized a loss-of-function HR-reporter substrate to simultaneously monitor HR-mediated gene conversion and non-conservative mutation events. The assay is designed around a heteroallelic duplication of the Aprt gene at its endogenous locus in isogenic Chinese hamster ovary cell lines. We found that RAD51D-deficient cells had a reduced capacity for HR-mediated gene conversion both spontaneously and in response to I-SceI-induced DSBs. Further, RAD51D-deficiency shifted DSB repair toward highly deleterious single-strand annealing (SSA) and end-joining processes that led to the loss of large chromosomal segments surrounding site-specific DSBs at an exceptionally high frequency. Deletions in the proximity of the break were due to a non-homologous end-joining pathway, while larger deletions were processed via a SSA pathway. Overall, our data revealed that, in addition to leading to chromosomal abnormalities, RAD51D-deficiency resulted in a high frequency of deletions advancing our understanding of how a RAD51 paralog is involved in maintaining genomic stability and how its deficiency may predispose cells to tumorigenesis.
Contribution of bacterial pathogens to evoking serological disease markers and aggravating disease activity in rheumatoid arthritis

Commensal bacteria and their pathogenic components in the gastrointestinal tract and oral cavity may play pathological roles in autoimmune diseases. To study the possible involvement of bacterial pathogens in autoimmune diseases, IgG and IgA antibodies against pathogenic components produced by three strains of commensal bacteria, Escherichia coli-lipopolysaccharide (E. coli-LPS), Porphyromonas gingivalis-LPS (Pg-LPS) and peptidoglycan polysaccharide (PG-PS) from Streptococcus pyogenes, were determined by an improved ELISA system for sera from two groups of patients with rheumatoid arthritis (RA), who met rapid radiographic progression (RRP) criteria and non-RRP, and compared to normal (NL) controls. Antibody responses to these bacterial pathogens are unique and consistent in individuals, and no fundamental difference was observed between RA and NL controls. Despite the similar antibody responses to pathogens, lower IgG or higher IgA and consequent higher IgA/IgG antibody ratio among the patients with RA related to disease marker levels and disease activity. Peculiarly, the IgA/IgG anti-Pg-LPS antibody ratio resulted from lower IgG and higher IgA antibody responses to Pg-LPS strongly correlated not only with rheumatoid factor (RF), but also correlated with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and disease activity score of 28 joints with ESR (DAS28-ESR) in the RRP group. In contrast, the IgA/IgG anti-E. coli-LPS and anti-PG-PS antibody ratio correlated or tended to correlate with RF, ESR, CRP, and DAS28-ESR in the non-RRP group, whereas either the IgG or IgA anti-Pg-LPS antibody levels and consequent IgA/IgG anti-Pg-LPS antibody ratio did not correlate with any clinical marker levels in this group. Notably, anti-circular-citrullinated peptide (CCP) antibody levels, which did not correlate with either IgG or IgA antibody levels to any pathogens, did not correlate with severity of arthritis in both RRP and non-RRP. Taken together, we propose that multiple environmental pathogens, which overwhelm the host antibody defense function, contribute independently or concomitantly to evoking disease makers and aggravating disease activity, and affect disease outcomes. Trial registration: UMIN CTR UMIN000012200