Miracle-dz/UniFAR-FTUs huggingface dataset:
Análise da correlação entre limiares auditivos, questionários validados e medidas psicoacústicas em pacientes com zumbido

One of the most criticized points in tinnitus clinical studies arise from the lack of consensus about measurement methods. AIM: To evaluate the correlation between audiometric thresholds, pitch matching (PM), minimum masking level (MML), Tinnitus Handicap Inventory (THI) and the Beck Depression Inventory (BDI) in tinnitus patients. STUDY DESIGN: Prospective, cross-sectional. MATERIALS AND METHODS: Subjects were submitted to tonal audiometry, PM and MML for tinnitus. They also filled out the THI and BDI. Data was statistically compared for correlation purposes between audiometric thresholds, psycho-acoustic measures and questionnaires. RESULTS: There was no statistically significant correlation between THI and MML, both in patients with BDI scores under and over 14 points. There was no statistically significant correlation between the worst hearing frequency and PM, as well as between the cut-off frequency and the PM in patients with descending hearing curves in their audiograms. CONCLUSIONS: There is no statistically significant correlation between psycho-acoustic measures (PM and MML), audiometric thresholds, THI and BDI. Tinnitus is a very complex symptom and isolated measures by psycho-acoustic methods; tinnitus and depression questionnaires are not satisfactory.
Pleth variability index predicts fluid responsiveness in mechanically ventilated adults during general anesthesia for noncardiac surgery.

OBJECTIVE To investigate whether the pleth variability index (PVI), derived noninvasively from a pulse oximeter probe, would predict fluid responsiveness in patients undergoing noncardiac surgeries. DESIGN A clinical, prospective, observational study. SETTING Operating room of a tertiary care hospital. PARTICIPANTS Twenty-nine adult patients undergoing a range of noncardiac surgeries, requiring general anesthesia, tracheal intubation, and mechanical ventilation. INTERVENTIONS Intravenous volume expansion with 500 mL of colloid following induction of general anesthesia and after a period of hemodynamic stability before the start of surgery. MEASUREMENTS AND MAIN RESULTS Baseline values for PVI and stroke volume index, derived from an esophageal Doppler monitor, were compared with final values after the volume expansion. Patients were classified into fluid responders and nonresponders based on a stroke volume index increase of ≥ 10%. The optimal cut-off value for baseline pleth variability index for predicting fluid responsiveness was determined. There were 17 responders (59%) to the 500-mL volume expansion. Baseline PVI value was significantly different between responders and nonresponders (16.5 ± 6.4% v 10.3 ± 2.7%; p = 0.004). Receiver operating characteristic analysis demonstrated significant predictive ability of an increase in stroke volume index for PVI with area under the curve of 0.84 (95% confidence interval = 0.69-0.99). The optimal cut-off value for baseline PVI was 10.5%, with a sensitivity of 88% and a specificity of 67%. CONCLUSIONS Pleth variability index is predictive of fluid responsiveness in adult patients undergoing noncardiac surgery.
Obstetric perineal trauma: An audit of training

SummaryThis study aimed to establish if trainee doctors and qualified midwives have adequate knowledge of perineal anatomy, if the classification of perineal tears is consistent, and to assess satisfaction with training. Seventy-five doctors (53 registrars and 22 senior house officers of at least 6 months training in obstetrics) and 75 qualified midwives were interviewed and a questionnaire was completed. More than half the doctors and midwives who named the muscles that were usually cut during an uncomplicated episiotomy wrongly named the levator ani. There was considerable variation in the definition of a third degree tear. Less than 20 per cent of doctors and less than 48 per cent of midwives considered their training in perineal anatomy, perineal repair and recognition and repair of anal sphincter tears to be of a good standard. Although perineal repair is frequently performed by doctors and midwives, perineal anatomy is poorly understood. Under-recognised trauma and inadequate repair can lead to dysp.
Meconium stimulates neutrophil oxidative burst.

Acute lung injury induced by meconium aspiration is characterized by rapidly developing pulmonary inflammation with influx of activated polymorphonuclear cells. To evaluate the role of meconium in the activation of these invading cells, we described the oxidative capacity of circulating neutrophils after intratracheal administration of thick human meconium in pigs. We also examined the direct effects of varying meconium concentrations on the oxidative burst of human neutrophils in vitro. In neutrophils isolated from meconium-insufflated pigs, phorbol myristate acetate stimulation led to an average 11.7-fold increase in production of reactive oxygen species, measured by chemiluminescence, whereas the increase in control cells from saline-instilled pigs was only 3.1-fold, p = . 012 between the groups. Activation of unstimulated human leukocytes by meconium resulted in a dose-dependent response. The lowest meconium concentration (0.2 mg/mL) had an inhibitory effect on neutrophil activation, whereas higher concentrations of meconium (1 and 2 mg/mL) increased neutrophil oxygen radical production progressively. These results thus indicate that moderate and high concentrations of aspirated meconium rapidly activate circulating neutrophils with a resulting oxidative burst contributing to pulmonary tissue injury, whereas low contamination of the aspirated material may in fact suppress the development of oxidative lung injury.
Expanded criteria for retinopathy of prematurity screening in moderately preterm infants: Single‐center pilot study

While developed countries seek to lower the gestational age and birthweight parameters in retinopathy of prematurity (ROP) screening, older, larger infants still develop ROP in other parts of the world. The aim of this study was therefore to define criteria to identify potential ROP developers who are outliers of the common screening range.
The Precision of Pulmonary Artery Catheter Bolus Thermodilution Cardiac Output Measurements Varies With the Clinical Situation.

OBJECTIVE To investigate the effects of ventilatory mode, injectate temperature, and clinical situation on the precision of cardiac output measurements. DESIGN Randomized, prospective observational study. SETTING Single university hospital. PARTICIPANTS Forty patients undergoing planned cardiac surgery, receiving a pulmonary artery catheter according to institutional routine. INTERVENTIONS Cardiac output was measured at 4 predefined time points during the perioperative patient course, twice during controlled and twice during spontaneous ventilation, using 2 blocks of 8 measurement replications with cold and tepid injectate in random order. MEASUREMENTS AND MAIN RESULTS The data were analyzed using a hierarchical linear mixed model. Clinical precision was determined as half the width of the 95% confidence interval for the underlying true value. The single-measurement precision measured in 2 different clinical situations for each temperature/ventilation combination was 8% to 10%, 11% to 13%, 13% to 15%, and 23% to 24% in controlled ventilation with cold injectate, controlled ventilation with tepid injectate, spontaneous breathing with cold injectate, and spontaneous breathing with tepid injectate, respectively. Tables are provided for the number of replications needed to achieve a certain precision and for how to identify significant changes in cardiac output. CONCLUSIONS Clinical precision of cardiac output measurements is reduced significantly during spontaneous relative to controlled ventilation. The differences in precision between repeated measurement series within the temperature/ventilation combinations indicate influence of other situation-specific factors not related to ventilatory mode. Compared with tepid injectate in patients breathing spontaneously, the precision is 3-fold better with cold injectate and controlled ventilation.
Influence of alterations in forgoing life-sustaining treatment practices on a clinical sepsis trial

Objectives: To evaluate the timing of forgoing life-sustaining treatments in patients enrolled in a sepsis trial and to determine their influence on patient outcome and trial results. Design: Subset of patients in a prospective, randomized, double-blind, placebo-controlled study. Setting: Twenty-three academic medical centers. Patients. Enrolled patients who had life-sustaining therapies withheld or withdrawn. Measurements and Main Results: The number of patients, types of disorders and interventions, reasons, and timing of withholding and withdrawing life-sustaining treatments and their effect on mortality and trial results were assessed. Forgoing of life-sustaining therapies took place in 117 (22%) of 543 patients and occurred within 72 hrs of study drug administration in 38 (32%) patients. Withholding treatment (60%) was more common than withdrawing treatment (40%), but withdrawing treatment was more frequent (51%) than withholding treatment (20%) in the first 72 hrs of the trial (p <.01). Sixty-one (52%) patients had severe underlying disorders with a poor prognosis. The hospital mortality rate was 94% (of the 117 patients). The mean time (SEM) from withholding or withdrawing of treatment until death was 2.83 ± 0.57 and 0.32 ± 0.13 days, respectively (p <.001). Patients who had therapies forgone in the first 24, 48, and 72 hrs after receiving the study drug had higher mortality rates in the first 72 hrs (p <.01). Conclusions: A substantial number of patients enrolled in a sepsis trial had severe underlying diseases and had forgoing of therapies early in the course of the trial, which led to a higher early mortality rate. Enrollment of patients in clinical trials with severe underlying disorders with a high likelihood of having therapies forgone may bias the potential for showing the efficacy of new therapeutic modalities. (Crit Care Med 1997; 25:383-387).
Fever and confusion

CASE PRESENTATION A 43-year-old man with a history of squamous cell carcinoma of the head and neck was admitted to the hospital with 24 hours of fever and confusion. The patient, a former smoker, originally presented with a left-sided neck mass 8 years ago. A modified radical neck dissection was performed, revealing poorly differentiated squamous cell carcinoma. The patient refused adjunctive radiation therapy at the time of diagnosis and resection. The tumor recurred one year later, at which time the patient underwent a second surgical resection followed by postoperative radiation. Five years ago, the patient developed a recurrence in his left cheek. He subsequently underwent left total parotidectomy, wide resection of the buccal lesion, partial maxillectomy, marginal mandibulectomy, dental extraction, and split-thickness radial skin graft reconstruction. Despite these aggressive surgical interventions, the patient developed recurrent maxillary sinus squamous cell carcinoma, not amenable to further operative measures. He refused further radiation and chemotherapy. Upon admission, the patient’s wife reported several days of thick yellow drainage from the surgical resection site. In the 24 hours before presentation, she noted that he was intermittently febrile, increasingly confused, and less responsive. Upon physical examination, the patient’s temperature was 96.98F, and pulse rate was 73 beats per minute; respiratory rate was 20 breaths per minute, and blood pressure was 101/63 mm Hg. He seemed lethargic but was arousable and responsive to simple commands. Consistent with prior examinations, the patient had left eye proptosis and a 6 8-cm left buccal defect with clean margins that communicated with the oropharynx. The alveolar ridge was absent, and so were the portions of the hard and soft palate. Portions of the mandibular angle and ramus were exposed, but the tongue and the floor of the mouth were intact. Of note, the open wound was malodorous, and a moderate amount of thick yellow pus was noted at the mandibular angle. In addition to preexisting cranial nerve deficits from prior surgeries, neurological examination demonstrated a new receptive aphasia. Laboratory results revealed a serum white blood cell count of 12,700 cells/mL, with 94% polymorphonuclear cells, hemoglobin of 9.6 gm/dL, and platelet count of 315,000 cells/mL. Chemistry values were notable for a serum sodium 128 mEq/L. Urinalysis was unremarkable. A computed tomography (CT) scan without contrast was performed (Fig. 1). The following day, gadolinium-enhanced magnetic resonance imaging (MRI) demonstrated a temporal lobe lesion with associated edema (Figs. 2, 3). Based on these clinical and radiographic findings, the patient was placed empirically on intravenous vancomycin and cefotaxime.
Stachyose increases absorption and hepatoprotective effect of tea polyphenols in high fructose-fed mice.

SCOPE The consumption of tea polyphenols (TP) and stachyose contributes to preventive effects on hepatic injury. This study examined the effects of stachyose on absorption and hepatoprotective effects of TP in mice. METHODS AND RESULTS GC-MS measurement showed that stachyose significantly increased serum total phenolic, ECG and EGCG contents in mice. The mice fed with high fructose (HF)-diet for 56 days exhibited oxidative stress observed by an increase in hepatic MDA levels and decreases in GSH-Px and SOD activities. Serum TC, TG, LDL-C and CRP levels, and ALT and AST activities were increased, while HDL-C concentrations were decreased following HF diet. Co-supplementation of stachyose and TP more effectively improved all parameters mentioned above when compared to administration of stachyose or TP alone. Histological observations of hepatic tissues also confirmed the beneficial effects of co-administration of stachyose and TP. CONCLUSION Our results suggest that stachyose enhances absorption and hepatoprotective effects of TP, and combined ingestion of stachyose and TP is a novel strategy for alleviating HF diet-induced hepatic injury.
Morus alba extract modulates blood pressure homeostasis through eNOS signaling.

SCOPE Morus alba is a promising phytomedicine cultivated in oriental countries that is extensively used to prevent and treat various cardiovascular problems. To date, despite its beneficial effects, the molecular mechanisms involved remain unclear. Thus, we investigate the vascular and haemodynamic effects of Morus alba extract in an experimental model focusing our attention on the molecular mechanisms involved. METHODS AND RESULTS Through vascular reactivity studies, we demonstrate that Morus alba extract evokes endothelial vasorelaxation through a nitric oxide-dependent pathway. Our molecular analysis highlights an increase in endothelial nitric oxide synthase (eNOS) phosphorylation. In vivo administration of Morus alba extract reduces blood pressure levels exclusively in wild-type mice, whereas it fails to evoke any haemodynamic effects in eNOS-deficient mice. Molecular analyses revealed that its beneficial action on vasculature is mediated by the activation of two important proteins that act as stress sensors and chaperones: PERK and heat shock protein 90. Finally, Morus alba extract exerts antihypertensive action in an experimental model of arterial hypertension. CONCLUSION Through its action on eNOS signaling, Morus alba extract could act as a food supplement for the regulation of cardiovascular system, mainly in clinical conditions characterized by eNOS dysfunction, such as arterial hypertension.
A grape seed procyanidin extract inhibits HDAC activity leading to increased Ppar&agr; phosphorylation and target‐gene expression

SCOPE Histone deacetylases (HDACs) have emerged as epigenetic regulators of risk factors associated with the metabolic syndrome (MetS), and certain botanical extracts have proven to be potent HDAC inhibitors. Understanding the role of dietary procyanidins in HDAC inhibition is important in exploring the therapeutic potential of natural products. METHODS C57BL/6 mice were gavaged with vehicle (water) or grape seed procyanidin extract (GSPE, 250 mg/kg) and terminated 14 h later. Liver and serum were harvested to assess the effect of GSPE on HDAC activity, histone acetylation, Pparα activity and target-gene expression, and serum lipid levels. RESULTS GSPE increased histone acetylation and decreased Class I HDAC activity in vivo, and dose-dependently inhibited recombinant HDAC2 and 3 activities in vitro. Accordingly, Pparα gene and phosphorylated protein expression were increased, as were target genes involved in fatty acid catabolism, suggesting increased Pparα activity. Serum fibroblast growth factor 21 (Fgf21) was elevated, and triglyceride levels were reduced by 28%. CONCLUSION GSPE regulates HDAC and Pparα activities to modulate lipid catabolism and reduce serum triglycerides in vivo.
Ist der Anstieg der Sectiofrequenz ein Qualitätsmangel oder ein Indikationswandel?

Die Sectiofrequenz ist kontinuierlich im Ansteigen. Die Berücksichtigung des Patientinnenwunsches bei der Indikationsstellung zum Geburtsmodus hat sich an der Grazer Klinik zu einem schwer einschätzbaren Faktor entwickelt. Lag die Sectiofrequenz im Jahr 1999 noch bei 13,8%, so wird sie im Jahre 2000 17,2% betragen. Die Akzeptanz der Wunschsectio ist bei den Frauen hoch. Der Anstieg der Sectiofrequenz wird wesentlich von paramedizinischen Faktoren beeinflusst. Die Geburtshilfe scheint sich immer mehr in Richtung Geburtschirurgie zu entwickeln. Ob dieser Wandel einen Qualitätsverlust darstellt, wird erst in Zukunft beantwortet werden können.
Curcumin improves glucose tolerance via stimulation of glucagon‐like peptide‐1 secretion

Scope: Glucagon‐like peptide‐1 (GLP‐1) is a type of incretin secreted from enteroendocrine L‐cells. Our previous studies demonstrated that curcumin (a yellow pigment of turmeric) significantly increases the secretion of GLP‐1 in enteroendocrine L cell line (GLUTag cells). However, it is not clear whether its action in vivo directly enhances GLP‐1 secretion, which then leads to a reduction in blood glucose levels via the stimulation of insulin secretion. In addition, the molecular target of curcumin‐induced GLP‐1 secretion has not been clarified. Methods and results: Glucose tolerance was significantly improved in rats after pre‐administered curcumin (1.5 mg/kg) followed by intraperitoneal glucose injections via the stimulation of GLP‐1 secretion and the induction of insulin secretion. In GLUTag cells, curcumin‐induced GLP‐1 secretion was associated with G protein‐coupled receptor (GPR) 40/120. Furthermore, the glucose‐lowering effect induced by curcumin was significantly reduced after the administration of a GPR40/120 antagonist in rats. Conclusion: These findings demonstrate the biological function of curcumin as a GLP‐1 secretagogue and the possible molecular target that mediates GLP‐1 secretion. Increases in the secretion of endogenous GLP‐1 induced by curcumin may allow the dosages of other diabetic medicines to be reduced and aid in the prevention of diabetes.
Short Stature in Scandinavian Women: An obstetrical risk factor

We have carried out a case‐controlled study on relations between short stature (i.e. less than 156 cm tall) and problems with childbirth in Danish women. Data obtained from 182 pregnant, short women (short mothers) were compared with those obtained from a control group of 2116 pregnant women who were between 166 and 175 cm tall (control mothers). The prevalence rate for acute cesarean section was three‐fold greater in short mothers than in controls, and the prevalence rate for elective cesarean section was twice as high in short mothers as in controls. Moreover, the prevalence rates of intra‐uterine asphyxia, intra‐uterine growth retardation and low Apgar scores were higher in babies of short mothers than in those of control mothers, despite the increased level of obstetric intervention in the former group. Since the findings show that short stature in pregnant women is an obstetrical risk factor, we recommend that it should be given attention in order to detect early signs of intra‐uterine asphyxia and to apply the best form of active management of labor if necessary.
Aerobic endurance training reduces bubble formation and increases survival in rats exposed to hyperbaric pressure

1 The formation of bubbles is the basis for injury to divers after decompression, a condition known as decompression illness. In the present study we investigated the effect of endurance training in the rat on decompression‐induced bubble formation. 2 A total of 52 adult female Sprague‐Dawley rats (300‐370 g) were randomly assigned to one of two experimental groups: training or sedentary control. Trained rats exercised on a treadmill for 1.5 h per day for 1 day, or for 2 or 6 weeks (5 days per week) at exercise intervals that alternated between 8 min at 85‐90 % of maximal oxygen uptake (V̇O2,max) and 2 min at 50‐60 % of V̇O2,max. Rats were compressed (simulated dive) in a decompression chamber in pairs, one sedentary and one trained, at a rate of 200 kPa min−1 to a pressure of 700 kPa, and maintained for 45 min breathing air. At the end of the exposure period, rats were decompressed linearly to the ‘surface’ (100 kPa) at a rate of 50 kPa min−1. Immediately after reaching the ‘surface’ (100 kPa) the animals were anaesthetized and the right ventricle was insonated using Doppler ultrasound. 3 Intensity‐controlled interval training significantly increased V̇O2,max by 12 and 60 % after 2 and 6 weeks, respectively. At 6 weeks, left and right ventricular weights were 14 and 17 % higher, respectively, in trained compared to control rats. No effect of training was observed on skeletal muscle weight. Bubble formation was significantly reduced in trained rats after both 2 and 6 weeks. However, the same effect was seen after a single bout of aerobic exercise lasting 1.5 h on the day prior to decompression. All of the rats that exercised for 1.5 h and 2 weeks, and most of those that trained for 6 weeks, survived the protocol, whereas most sedentary rats died within 60 min post‐decompression. 4 This study shows that aerobic exercise protects rats from severe decompression and death. This may be a result of less bubbling in the trained animals. The data showed that the increase in aerobic capacity per se was not the main mechanism, but rather an acute effect that was most notable 20 h after a single, or the last, exercise bout, with less effect after 48 h.