Miracle-dz/UniFAR-FTUs huggingface dataset:
Accurate Classification of Diminutive Colorectal Polyps Using Computer-Aided Analysis.

BACKGROUND & AIMS Narrow-band imaging is an image-enhanced form of endoscopy used to observed microstructures and capillaries of the mucosal epithelium which allows for real-time prediction of histologic features of colorectal polyps. However, narrow-band imaging expertise is required to differentiate hyperplastic from neoplastic polyps with high levels of accuracy. We developed and tested a system of computer-aided diagnosis with a deep neural network (DNN-CAD) to analyze narrow-band images of diminutive colorectal polyps. METHODS We collected 1476 images of neoplastic polyps and 681 images of hyperplastic polyps, obtained from the picture archiving and communications system database in a tertiary hospital in Taiwan. Histologic findings from the polyps were also collected and used as the reference standard. The images and data were used to train the DNN. A test set of images (96 hyperplastic and 188 neoplastic polyps, smaller than 5 mm), obtained from patients who underwent colonoscopies from March 2017 through August 2017, was then used to test the diagnostic ability of the DNN-CAD vs endoscopists (2 expert and 4 novice), who were asked to classify the images of the test set as neoplastic or hyperplastic. Their classifications were compared with findings from histologic analysis. The primary outcome measures were diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic time. The accuracy, sensitivity, specificity, PPV, NPV, and diagnostic time were compared among DNN-CAD, the novice endoscopists, and the expert endoscopists. The study was designed to detect a difference of 10% in accuracy by a 2-sided McNemar test. RESULTS In the test set, the DNN-CAD identified neoplastic or hyperplastic polyps with 96.3% sensitivity, 78.1% specificity, a PPV of 89.6%, and a NPV of 91.5%. Fewer than half of the novice endoscopists classified polyps with a NPV of 90% (their NPVs ranged from 73.9% to 84.0%). DNN-CAD classified polyps as neoplastic or hyperplastic in 0.45 ± 0.07 seconds-shorter than the time required by experts (1.54 ± 1.30 seconds) and nonexperts (1.77 ± 1.37 seconds) (both P < .001). DNN-CAD classified polyps with perfect intra-observer agreement (kappa score of 1). There was a low level of intra-observer and inter-observer agreement in classification among endoscopists. CONCLUSIONS We developed a system called DNN-CAD to identify neoplastic or hyperplastic colorectal polyps less than 5 mm. The system classified polyps with a PPV of 89.6%, and a NPV of 91.5%, and in a shorter time than endoscopists. This deep-learning model has potential for not only endoscopic image recognition but for other forms of medical image analysis, including sonography, computed tomography, and magnetic resonance images.
Natural mentoring relationships and adolescent health: evidence from a national study.

OBJECTIVES We used nationally representative data to examine the impact of natural (or informal) mentoring relationships on health-related outcomes among older adolescents and young adults. METHODS We examined outcomes from Wave III of the National Longitudinal Study of Adolescent Health as a function of whether or not respondents reported a mentoring relationship. Logistic regression was used with control for demographic variables, previous level of functioning, and individual and environmental risk. RESULTS Respondents who reported a mentoring relationship were more likely to exhibit favorable outcomes relating to education/work (completing high school, college attendance, working >/= 10 hours a week), reduced problem behavior (gang membership, hurting others in physical fights, risk taking), psychological well-being (heightened self-esteem, life satisfaction), and health (physical activity level, birth control use). However, effects of exposure to individual and environmental risk factors generally were larger in magnitude than protective effects associated with mentoring. CONCLUSIONS These findings suggest a broad and multifaceted impact of mentoring relationships on adolescent health. However, mentoring relationships alone are not enough to meet the needs of at-risk youths and therefore should be incorporated into more comprehensive interventions.
Expression of Animal Anti-Apoptotic Gene Ced-9 Enhances Tolerance during Glycine max L.–Bradyrhizobium japonicum Interaction under Saline Stress but Reduces Nodule Formation

The mechanisms by which the expression of animal cell death suppressors in economically important plants conferred enhanced stress tolerance are not fully understood. In the present work, the effect of expression of animal antiapoptotic gene Ced-9 in soybean hairy roots was evaluated under root hairs and hairy roots death-inducing stress conditions given by i) Bradyrhizobium japonicum inoculation in presence of 50 mM NaCl, and ii) severe salt stress (150 mM NaCl), for 30 min and 3 h, respectively. We have determined that root hairs death induced by inoculation in presence of 50 mM NaCl showed characteristics of ordered process, with increased ROS generation, MDA and ATP levels, whereas the cell death induced by 150 mM NaCl treatment showed non-ordered or necrotic-like characteristics. The expression of Ced-9 inhibited or at least delayed root hairs death under these treatments. Hairy roots expressing Ced-9 had better homeostasis maintenance, preventing potassium release; increasing the ATP levels and controlling the oxidative damage avoiding the increase of reactive oxygen species production. Even when our results demonstrate a positive effect of animal cell death suppressors in plant cell ionic and redox homeostasis under cell death-inducing conditions, its expression, contrary to expectations, drastically inhibited nodule formation even under control conditions.
Serious infection across biologic-treated patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis

Objectives To compare the incidence of serious infection (SI) across biologic drugs used to treat rheumatoid arthritis (RA) using data from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis (BSRBR-RA). Methods The BSRBR-RA is a prospective observational cohort study. This analysis included patients with RA starting a new biologic. The primary outcome was SI defined as an infectious event requiring admission to hospital, intravenous antibiotics or resulting in death. Event rates were calculated and compared across biologics using Cox proportional hazards with adjustment for potential confounders. Secondary outcomes were the rate of infection by organ class and 30-day mortality following infection. Results This analysis included 19 282 patients with 46 771 years of follow-up. The incidence of SI was 5.51 cases per 100 patient years for the entire cohort (95% CI 5.29 to 5.71). Compared with etanercept, tocilizumab had a higher risk of SI (HR 1.22, 95% CI 1.02 to 1.47) and certolizumab pegol a lower risk of SI (HR 0.75, 95% CI 0.58 to 0.97) in the fully adjusted model. The 30-day mortality following SI was 10.4% (95% CI 9.2% to 11.6%). Conclusions The rate of SI was lower with certolizumab pegol than etanercept in the primary analysis but the result was no longer significant in several sensitivity analyses performed suggesting residual confounding may account for the observed difference. From these results, it would be wrong to conclude that certolizumab pegol has a lower rate of SI than other biologics; however, the risk does not appear to be significantly higher as has previously been suggested.
Violence at the workplace increases the risk of musculoskeletal pain among nursing home workers

Background Despite the high prevalences of workplace physical violence and musculoskeletal symptoms among health care workers, very few studies have examined the relationship between these two phenomena. Methods We surveyed 920 clinical nursing home workers by questionnaire regarding musculoskeletal pain in the low back, shoulders, wrists or hands, and knees. Information was also collected on exposure to physical assaults at work during the preceding 3 months, other workplace safety features, physical workload and psychosocial work environment. Log-binomial regression was used to estimate the prevalence ratios (PR) with 95% CIs. Results Almost one-half of respondents reported being assaulted at least once during the preceding 3 months by a resident or resident's visitor. The prevalence of low back pain increased from 40% among non-assaulted workers to 70% among those assaulted three or more times. The highest risk was found for widespread pain (three or more areas), with an adjusted PR of 2.7 (95% CI 1.8 to 3.9) for workers assaulted three or more times. Good workplace safety buffered the effects, so that violence increased the risk of most pains considerably less in a work environment perceived to be safe. Conclusions To our knowledge, this is the first study to show a dose–response association between physical assaults and musculoskeletal pain in a health care setting where violence is a frequent occurrence. This emphasises the need to address violence as a workplace hazard through practical measures for prevention as well as in future aetiological research on musculoskeletal disorders.
Microstructure, strength and structural integrity of heat-treated beech and spruce wood

Abstract Heat treatment of wood is an effective method by which to improve the dimensional stability and biological durability, but the mechanical strength is decreased at the same time. Besides chemical modification of cell-wall constituents, physical weakening of the microstructure owing to heat-induced defects may also contribute to strength loss. Therefore, anatomical properties of heat-treated beech (Fagus sylvatica L.) and spruce (Picea abies Karst.), studied by light microscopic and scanning electron microscopic analysis, and their interrelation with strength properties and structural integrity were investigated. For determination of structural integrity, the high-energy–multiple-impact (HEMI) test was applied. Microscopic analyses showed frequent formation of radial cracks in heat-treated beech close to the rays as well as tangential cracks in the latewood of spruce. In addition, the modulus of rupture was more affected by the heat treatments than the resistance to impact milling (RIM) determined by the HEMI test, because RIM is based on multiple fractures on the microlevel that are not affected by the formation of intercellular cracks or other defects due to the heat treatment. It was concluded that heat-induced defects in the wood microstructure contribute to the substantial strength loss of thermally modified timber.
Bruton's Tyrosine Kinase and Protein Kinase C µ Are Required for TLR7/9-Induced IKKα and IRF-1 Activation and Interferon-β Production in Conventional Dendritic Cells

Stimulation of TLR7/9 by their respective ligands leads to the activation of IκB kinase α (IKKα) and Interferon Regulatory Factor 1 (IRF-1) and results in interferon (IFN)-β production in conventional dendritic cells (cDC). However, which other signaling molecules are involved in IKKα and IRF-1 activation during TLR7/9 signaling pathway are not known. We and others have shown that Bruton's Tyrosine Kinase (BTK) played a part in TLR9-mediated cytokine production in B cells and macrophages. However, it is unclear if BTK participates in TLR7/9-induced IFN-β production in cDC. In this study, we show that BTK is required for IFN-β synthesis in cDC upon TLR7/9 stimulation and that stimulated BTK-deficient cDC are defective in the induction of IKKα/β phosphorylation and IRF-1 activation. In addition, we demonstrate that Protein Kinase C µ (PKCµ) is also required for TLR7/9-induced IRF-1 activation and IFN-β upregulation in cDC and acts downstream of BTK. Taken together, we have uncovered two new molecules, BTK and PKCµ, that are involved in TLR7/9-triggered IFN-β production in cDC.
Bmc Medical Informatics and Decision Making Script Concordance Tests: Guidelines for Construction

Background: SCT is used to assess clinical reasoning in ambiguous or uncertain situations. It allows testing on real-life situations that are not adequately measured with current tests. It probes the multiple judgments that are made in the clinical reasoning process. Scoring reflects the degree of concordance of these judgments to those of a panel of reference experts.
Clinical Presentation and Frequency of Risk Factors in Patients with Breast Carcinoma in Pakistan.

BACKGROUND Breast cancer is known to be one of the most prevalent cancers among women in both developing and developed countries . The incidence of breast cancer in Pakistan has increased dramatically within the last few years and is the second country after Israel in Asia to have highest proportional cases of breast cancer. However, there are limited data for breast cancer available in the literature from Pakistan. OBJECTIVES The study was conducted to bring to light the common clinical presentation of breast cancer and to evaluate the frequency of established risk factors in breast carcinoma patients and furthermore to compare the findings between premenopausal and postmenopausal women in Pakistan. MATERIALS AND METHODS A 6 months (from July 2012 to Dec 2012) cross sectional survey was conducted in Surgical and Oncology Units of Civil Hospital, Karachi. Data were collected though a well developed questionnaire from 105 female patients diagnosed with carcinoma of breast and analyzed using SPSS version 17. Institutional ethical approval was obtained prior to data collection. RESULTS Out of 105 patients, 43 were premenopausal and 62 were postmenopausal, 99 being married. Mean age at diagnosis was 47.8 ± 12.4 years. A painless lump was the most frequent symptom, notived by 77.1%(n=81). Some 55.2% (n=58) patients had a lump in the right breast and 44.8%(n=47) in the left breast. In the majority of cases, the lump was present in upper outer quadrant 41.9% (n=44). Mean period of delay from appearance of symptoms to consulting a doctor was 5.13 ± 4.8 months, from the shortest 1 month to the longest 36 months. Long delay (> 3 months) was the most frequent figure 41.9%. Considering overall risk factors most frequent were first pregnancy after 20 years of age (41%), physical breast trauma (28.6%), lack of breast feeding(21.9%), and early menarche <11 years (19%), followed by null parity (16.2%), consumption of high fat diet (15.2%), family history of breast cancer or any other cancer in first degree relatives (9.5% and 13.3%, respectively). Some of the less common factors were late menopause >54 years (8.6%), use of oral contraceptive pills (10.5%), use of hormone replacement therapy (4.7%),smoking (4.7%) and radiation (0.96%). Significant differences (p<0.005) were observed between pre and post menopausal women regarding history of physical breast trauma, practice of breast feeding and parity. CONCLUSIONS A painless lump was the most frequent clinical presentation noted. Overall age at first child > 20 years, physical breast trauma, lack of breast feeding ,early menarche <11 were the most frequent risk factors. Physical breast trauma, lower parity, a trend for less breast feeding had more significant associations with pre-menopausal than post-menopausal onset. Increase opportunity of disease prevention can be obtained through better understanding of clinical presentation and risk factors important in the etiology of breast cancer.
Estimation of Population PK Measures: Selection of Sampling Grids

In clinical pharmacokinetic (PK) studies multiple blood samples are taken for each enrolled patient, and various population PK measures, such as area under the curve (AUC), maximal concentration (Cmax) and time to maximal concentration (Tmax) are estimated. In this talk we compare a model-based approach, where parameters of a compartmental model are estimated and the explicit formulae for PK measures are used, and an empirical, or model-independent, approach, where numerical integration algorithms are used for AUC and sample estimates for Cmax and Tmax. In our earlier studies we have discussed how to optimize sampling schemes for compartmental models (model-based approach) and showed that the number of collected samples may be reduced with minimal loss of precision; see Fedorov, Gagnon and Leonov (2002), Gagnon and Leonov (2005). Moreover, once costs are introduced (e.g. costs of enrolling patients and costs of analyzing samples) then sampling schemes with smaller number of samples which mix sampling sequences may outperform more dense sampling schemes. Since regulatory agencies usually require the model-independent estimation of PK measures, this presentation will focus on the empirical approach while using the model-based approach as a benchmark. We show how to split a single sampling grid into two or more subsets, which substantially reduces the number of samples taken for each patient, but often has little effect on the precision of estimation of PK measures in terms of mean squared error (MSE). For a number of special cases we derive explicit formulae for the MSE of the empirical estimator of AUC. When costs are taken into account, these formulas allow the optimal selection of the number of patients and samples per patient. References: Fedorov, V. , Gagnon, R. and Leonov, S. (2002). Design of experiments with unknown parameters in variance. Appl. Stoch. Models Bus. Ind. v.18, 207-218. Gagnon, R. , and Leonov, S. (2005). Optimal population designs for PK models with serial sampling. J. Biopharm. Stat. v. 15 (1), 143-163.
Effects of Grazing Regimes on Plant Traits and Soil Nutrients in an Alpine Steppe, Northern Tibetan Plateau

Understanding the impact of grazing intensity on grassland production and soil fertility is of fundamental importance for grassland conservation and management. We thus compared three types of alpine steppe management by studying vegetation traits and soil properties in response to three levels of grazing pressure: permanent grazing (M1), seasonal grazing (M2), and grazing exclusion (M3) in the alpine steppe in Xainza County, Tibetan Plateau. The results showed that community biomass allocation did not support the isometric hypothesis under different grassland management types. Plants in M1 had less aboveground biomass but more belowground biomass in the top soil layer than those in M2 and M3, which was largely due to that root/shoot ratios of dominant plants in M1 were far greater than those in M2 and M3. The interramet distance and the tiller size of the dominant clonal plants were greater in M3 than in M1 and M2, while the resprouting from rhizome buds did not differ significantly among the three greezing regimes. Both soil bulk density and soil available nitrogen in M3 were greater than in M1 at the 15–30 cm soil depth (P = 0.05). Soil organic carbon and soil total nitrogen were greater in M3 than in M1 and M2 (P = 0.05). We conclude that the isometric hypothesis is not supported in this study and fencing is a helpful grassland management in terms of plant growth and soil nutrient retention in alpine steppe. The extreme cold, scarce precipitation and short growing period may be the causation of the unique plant and soil responses to different management regimes.
Influence of Autonomic Control on the Specific Intermittent Performance of Judo Athletes

Abstract Judo is a high-intensity intermittent combat sport which causes cardiac adaptations both morphologically and related to the autonomic nervous system (ANS). Therefore, this study aims to verify the correlation between heart rate variability (HRV) at rest with performance in the Special Judo Fitness Test (SJFT) and whether groups with different RR values at rest show different performance in the SJFT and during post-test recovery. Sixteen judo athletes with 7.2 ± 3.9 years of training experience participated in the study. Before and after the SJFT execution HRV and lactate measurements were conducted. For HRV analysis, we used the mean interval RR, the standard deviation of the RR interval (SDNN), the root mean square of successive differences in RR intervals (RMSSD), the low frequency (LF) and high frequency (HF) in normalized and absolute units. The sample was split into two groups (low RR and high RR) to verify if this variable could differentiate between specific performance. For the SDNN, a significant and moderate correlation (r = 0.53) was found with the total number of throws and throws in the series A (r = 0.56) and B (r = 0.54) and for the RMSSD a correlation with throws during series B (r = 0.59) in the SJFT. However, the groups did not differ in performance and recovery. Therefore, HRV is related to intermittent judo performance; however, it cannot differentiate between judokas at different levels of performance.
Patient-Physician Communication in the Era of Mobile Phones and Social Media Apps: Cross-Sectional Observational Study on Lebanese Physicians’ Perceptions and Attitudes

Background The increased prevalence of virtual communication technology, particularly social media, has shifted the physician-patient relationship away from the well-established face-to-face interaction. The views and habits of physicians in Lebanon toward the use of online apps and social media as forms of patient communication have not been previously described. Objective The aim of this study is to describe the views of Lebanese physicians toward the use of social media and other online apps as means of patient communication. Methods This was a cross-sectional observational study using an online survey that addressed physicians’ perceptions on the use of virtual communication in their clinical practice. The study took place between April and June 2016, and was directed toward physicians at the American University of Beirut Medical Center. Results A total of 834 doctors received the online survey, with 238 physicians completing the survey. Most of the participants were from medical specialties. Most responders were attending physicians. Less than half of the respondents believed that Web-based apps and social media could be a useful tool for communicating with patients. Email was the most common form of professional online app, followed by WhatsApp (an instant messaging service). The majority of participants felt that this mode of communication can result in medicolegal issues and that it was a breach of privacy. Participants strictly against the use of virtual forms of communication made up 47.5% (113/238) of the study sample. Conclusions The majority of physicians at the American University of Beirut Medical Center are reluctant to use virtual communication technology as a form of patient communication. Appropriate policy making and strategies can allow both physicians and patients to communicate virtually in a more secure setting without fear of breaching privacy and confidentiality.