Miracle-dz/UniFAR-FTUs huggingface dataset:
Mid-Term Outcome of Mitral Valve Repair and Coronary Artery Bypass Grafting for Ischemic or Degenerative Mitral Regurgitation

Aim of the study: To verify the impact of the etiology of mitral valve regurgitation on a 5-year outcome after repair and concomitant coronary artery bypass grafting (CABG). Methods: One hundred and eleven consecutive patients (mean age of 69±8 years) who underwent mitral valve repair, 65 for ischemic and 46 for degenerative mitral regurgitation, and concomitant CABG, were retrospectively analyzed. The mean follow-up was 40±28 (9-104) months. Five-year survival (including operative mortality), and survival free from events (postoperative low output syndrome, progression of mitral regurgitation, onset or worsening of congestive heart failure, recurrence of myocardial infarction, and the need for mitral valve replacement) were analyzed. Results: Compared with degenerative, ischemic mitral regurgitation was associated with a higher incidence of previous myocardial infarction (P<0.0001), left ventricular ejection fraction (LVEF) <0.45 (P<0.0001), and more diseased coronary vessels per patient (P<0.0001). Five-year all-cause mortality was 18% (20/111). Independent predictors of mortality were older age at operation (P=0.0008), LVEF<0.45 (P=0.04), and the ischemic etiology of mitral regurgitation (P=0.03). At five years, survival was 69%±7.6% for ischemic versus 87%±6.5% for degenerative etiology (P=0.03); event-free survival was 58%±8.4% versus 75%±8% (P=0.02), and freedom from late cardiac death was 85%±6.6% versus 100% (P=0.02). Freedom from mitral valve reoperation was 97±2.4%. Conclusions: Ischemic mitral regurgitation “per se” predicted limited survival and event-free survival. Left ventricular dysfunction is frequently associated with the ischemic etiology. An early surgi cal indication to prevent left ventricular dysfunction could be important to improve the mid-term outcome.
Outcomes of neonatal screening for congenital hypothyroidism

The introduction of screening for congenital hypothyroidism has led to a marked improvement in neurodevelopmental outcome that has largely been attributed to the introduction of early treatment in the form of thyroxine. However, recent research has shown that the effect of hypothyroidism on the developing brain can result in specific developmental defects regardless of the early commencement of treatment. These defects consist predominantly of defective motor skills, clumsiness, learning difficulties, and behavior problems.
Autologous hematopoietic progenitor cell transplantation for multiple myeloma through an outpatient program

Introduction: There are considerable concerns regarding the appropriate use of health care resources to reduce costs and waiting lists associated with autologous hematopoietic progenitor cell transplantation (AHPCT). One of the strategies to reach this goal is outpatient-based (OpB) AHPCT. Areas covered: We reviewed all the reported experiences in this field and illustrated the various models of OpB AHPCT. Expert opinion: The role of high-dose melphalan (HDM) followed by AHPCT in the treatment of Multiple Myeloma (MM) continues to evolve in the novel agent era and the International Myeloma Working Group recommends that AHPCT should be offered at some point in the course of the treatment program for a medically fit patient. The relatively short neutropenia and the limited extra-marrow toxicity after HDM support the hypothesis that MM patients are the most suitable for outpatient transplant programs. Various models have shown that the procedure is feasible and safe and may highly contribute to shorten waiting lists and to considerably cut health costs, with an improvement of quality of life. Ideal candidates may be those who are asymptomatic and fully active, who have a full-time caregiver and who can reside within easy reach from the transplant center.
History of Antibiotics: From Fluoroquinolones to Daptomycin (Part 2)

ABSTRACT In the Modern Era, physicians attested to the reciprocal influence among a technologically advanced society, rapid scientific progresses in medicine, and the need for new antimicrobials. The results of these changes were not only seen in the prolongation of life expectancy but also by the emergence of new pathogens. We first observed the advent of Gram-negative bacteria as a major source of nosocomial infections. The treatment of these microorganisms was complicated by the appearance and spread of drug resistance. We first focused on the development of two major classes of antimicrobials still currently used for the treatment of Gram-negative bacteria, such as fluoroquinolones and carbapenemes. Subsequently, we directed our attention to the growth of the incidence of infections due to Methicillin-Resistant Staphylococcus aureus (MRSA). Although the first MRSA was already isolated in 1961, the treatment of this new pathogen has been based on the efficacy of vancomycin for more than four decades. Only in the last 15 yr, we assisted in the development of new antimicrobial agents such as linezolid and daptomycin.
Does a single loading dose of tranexamic acid reduce perioperative blood loss and transfusion requirements after total knee replacement surgery? A randomized, controlled trial

Background: Total knee replacement (TKR) is associated with high-perioperative blood loss, which often requires allogenic blood transfusion. Among the many strategies to decrease the need for allogenic transfusion, tranexamic acid (TA) is used systemically in perioperative setting with promising outcome. Here we evaluated the efficacy of single preoperative bolus dose of TA on reduction in blood loss and red blood cell transfusion in patients undergoing unilateral TKR. Materials and Methods: 70, American Society of Anesthesiologists I-II patients scheduled for unilateral TKR were included. Patients were randomly allocated into two groups to receive either TA (Group-TA; 20 mg/kg diluted to 25 cc with normal saline) or an equivalent volume of normal saline (Group P). Hemoglobin concentration, packed cell volume, platelet count, fibrinogen level, D-dimer level was measured preoperatively and at 6th and 24th h postoperative period. Results: In Group P more blood, colloid and crystalloid solutions were used to replace the blood loss. 27 patients in Group TA did not require transfusion of any blood products compared to 6 patients in Group P (P < 0.0001) and only 3 units of blood was transfused in Group TA where as a total of 32 units of blood was transfused in Group P. Despite the more numerous transfusions, Hb% after 6 h and 24 h in Group P were considerably low in comparison with Group TA (P < 0.0001). Conclusion: Tranexamic acid while significantly reducing blood loss caused by TKR surgery collaterally reduced the need for postoperative blood transfusion.
Review of a new fully liquid, hexavalent vaccine: Hexaxim

Introduction: The introduction of injectable vaccines targeting new diseases into childhood immunization programs has resulted in the need for combination vaccines to reduce the number of injections given during early childhood and maintain acceptability of targeting multiple pathogens by vaccination. Currently, there is only one licensed hexavalent combination vaccine which targets diphtheria, polio, tetanus, Haemophilus influenzae type b, hepatitis B and pertussis. A new, fully liquid formulation hexavalent vaccine (Hexaxim) has been developed and is currently undergoing licensure for use in childhood immunization programs. Areas covered: Safety and immunogenicity studies of Hexaxim have been undertaken in a diversity of settings, been evaluated with different dosing schedules and in comparison to the other licensed hexavalent vaccine (Infanrix hexa). This review of published journal articles and conference proceeding is focused on the studies in which Hexaxim has been evaluated and which are contributing to its pending licensure. Non-inferiority was demonstrated at the level of proportion of children developing seroprotective titers or showing seroconversion following the primary series of vaccine compared to the same target-antigens included in licensed combination vaccines. Also, Hexaxim was associated with a favorable safety and tolerability profile when administered during the first 6 months of life. Adequate and robust memory responses were elicited following a booster dose in the second year of life. Expert opinion: The development of new hexavalent combination vaccines targeting established pathogens is likely to assist in improving compliance and timeliness of vaccination in infants. These formulations will, however, need to be monitored for medium- and long-term effectiveness amidst growing concern of waning immunity against diseases such as pertussis when using acellular-pertussis vaccine and possibly hepatitis B when using combination vaccines. Nevertheless, the development of such combination vaccines remains necessary to help with the introduction of other new vaccines into an already crowded childhood immunization schedules.
Hypothalamic lesions and adiposity in the rat

The association of lesions at the base of the diencephalon with abnormal obesity in both man and animals has been observed many times. As a result of these observations it is quite generally believed that some structure, either neural or glandular, situated in this region is involved in the metabolism of fats. There is, however, the most emphatic disagreement concerning the nature of the regulatory mechanism. Little advantage would accrue a t this time from an extensive review of the controversy between those who have championed an hypophysial origin of pathological adiposity as opposed to others who have maintained the primacy of hypothalamic factors. It may be worth while, however, to mention briefly those principal contributions which have suggested the importance of the hypothalamus. Shortly after Frohlich ( '01) published his well-known description of a still living patient, Erdheim ('04) announced that study of the pathology at the base of the brain of a number of cases whose history was known indicated that injury to the hypothalamus and not to the hypophysis must have been responsible for the symptoms. From the experimental side Aschner ('12) soon added evidence that at least in adult dogs something more than hypophysectomy seemed to be necessary to produce . marked obesity. Other workers,
Molecular target therapy for bone metastasis: starting a new era with denosumab, a RANKL inhibitor

Introduction: The skeleton is generally the primary, and sometimes the only, site of metastasis in patients with advanced solid tumors. Bone metastases are the most frequent cause of cancer-related pain and the origin of severe morbidity in patients. Among the treatment options available for the prevention of skeletal-related events (SREs) associated with bone metastasis, zoledronic acid, an antiresorptive treatment from the group of bisphosphonates, is currently the standard of care in this setting. Areas covered: Zoledronic acid, together with denosumab (a monoclonal antibody against the receptor activator of nuclear factor kappa B ligand), is the most frequent approach for the prevention of cancer-related events in skeleton. This paper reviews several trials evaluating the efficacy of denosumab in comparison with zoledronic acid in patients with solid osteotropic tumors. In this setting of skeleton-invading cancers, denosumab was demonstrated to be superior to zoledronic acid in preventing or delaying SREs. In comparison with zoledronic acid, denosumab significantly delayed the time to first SRE by 17%. Expert opinion: Current research on denosumab is addressed to prove the immunomodulator effect of this agent in humans. Other avenue of research is focused on its antitumor activity observed in some Phase III trials.
Radiative Boundary Layer Flow in Porous Medium due to Exponentially Shrinking Permeable Sheet

This communication pertains to the study of radiative heat transfer in boundary layer flow over an exponentially shrinking permeable sheet placed at the bottom of fluid saturated porous medium. The porous medium has permeability of specified form. The fluid considered here is Newtonian, without phase change, optically dense, absorbing-emitting radiation but a nonscattering medium. The setup is subjected to suction to contain the vorticity in the boundary layer. The radiative heat flux in the energy equation is accounted by Rosseland approximation. The thermal conductivity is presumed to vary with temperature in a linear fashion. The governing partial differential equations are reduced to ordinary differential equations by similarity transformations. The resulting system of nonlinear ordinary differential equations is solved numerically by fourth-order Runge-Kutta scheme together with shooting method. The pertinent findings displayed through figures and tables are discussed.
Provisional Advisory Levels (PALs) for phosgene (CG)

The Provisional Advisory Level (PAL) protocol was applied to estimate inhalation exposure limits for phosgene (CG). Three levels (PAL 1, PAL 2, and PAL 3), distinguished by severity of toxic effects, are developed for 24-hour, 30-day, 90-day, and 2-year durations of potential drinking water and inhalation exposures for the general public. For background on the PAL program and a description of the methodology used in deriving PALs, the reader is referred to accompanying papers in this Supplement. Data on humans are limited to occupational exposures or accounts from the use of phosgene as a chemical warfare agent in World War I. Animal studies with phosgene show a steep dose-response curve for pulmonary edema and mortality, with little species variability in effects. Although immediately upon exposure lacrimation and upper respiratory irritation can occur, the main effect in the target organ, a progressive pulmonary edema, occurs after a latency period of 1–24 hours. PAL estimates were approved by the Expert Consultation Panel for Provisional Advisory Levels in May 2007. Exposure limits for oral exposure to CG are not developed due to insufficient data. PAL estimates for inhalation exposure to CG are presented: The 24-hour PAL values for severity levels 1, 2, and 3 are 0.0017, 0.0033 and 0.022 ppm, respectively. The 30- and 90-day PAL values are 0.0006 and 0.0012 ppm for the PAL 1 and 2 values, respectively. These inhalation values were also accepted as the 2-year PAL 1 and 2 values because severity of lesions in the key study did not increase when exposures were extended from 4 weeks to 12 weeks. Data were not available for deriving 30-day, 90-day, and 2-year PAL 3 values.
Inflammation and tissue damage in mouse lung by single and repeated dosing of urban air coarse and fine particles collected from six European cities

The authors have previously demonstrated heterogeneities in the inflammatory activities of urban air fine (PM2.5–0.2) and coarse (PM10–2.5) particulate samples collected from six European cities with contrasting air pollution situations. The same samples (10 mg/kg) were intratracheally instilled to healthy C57BL/6J mice either once or repeatedly on days 1, 3, and 6 of the study week. The lungs were lavaged 24 h after the single dose or after the last repeated dosing. In both size ranges, repeated dosing of particles increased the total cell number in bronchoalveolar lavage fluid (BALF) more than the respective single dose, whereas cytokine concentrations were lower after repeated dosing. The lactate dehydrogenase (LDH) responses increased up to 2-fold after repeated dosing of PM2.5–0.2 samples and up to 6-fold after repeated dosing of PM10–2.5 samples. PM10–2.5 samples evoked a more extensive interstitial inflammation in the mouse lungs. The constituents with major contributions to the inflammatory responses were oxidized organic compounds and transition metals in PM2.5–0.2 samples, Cu and soil minerals in PM10–2.5 samples, and Zn in both size ranges. In contrast, poor biomass and coal combustion were associated with elevated levels of polycyclic aromatic hydrocarbons (PAHs) and a consistent inhibitory effect on the inflammatory activity of PM2.5–0.2 samples. In conclusion, repeated intratracheal instillation of both fine and coarse particulate samples evoked enhanced pulmonary inflammation and cytotoxicity compared to single-dose administration. The sources and constituents of urban air particles responsible for these effects appear to be similar to those encountered in the authors’ previous single-dose study.
Subchronic effects of nasally instilled diesel exhaust particulates on the nasal and airway epithelia in mice

Diesel exhaust is the major source of ultrafine particles released during traffic-related pollution. Subjects with chronic respiratory diseases are at greater risk for exacerbations during exposure to air pollution. This study evaluated the effects of subchronic exposure to a low-dose of diesel exhaust particles (DEP). Sixty male BALB/c mice were divided into two groups: (a) Saline: nasal instillation of saline (n = 30); and (b) DEP: nasal instillation of 30 µg of DEP/10 µl of saline (n = 30). Nasal instillations were performed 5 days a week, over 30 and 60 days. Animals were anesthetized with pentobarbital sodium (50 mg/kg intraperitoneal [i.p.]) and sacrificed by exsanguination. Bronchoalveolar lavage (BAL) fluid was performed to evaluate the inflammatory cell count and the concentrations of the interleukin (IL)-4, IL-10, and IL-13 by enzyme-linked immunosorbent assay (ELISA). The gene expression of oligomeric mucus/gel-forming (Muc5ac) was evaluated by real-time polymerase chain reaction (PCR). Histological analysis in the nasal septum and bronchioles was used to evaluate the bronchial and nasal epithelium thickness as well as the acidic and neutral nasal mucus content. The saline group (30 and 60 days) did not show any changes in any of the parameters. However, the instillation of DEP over 60 days increased the expression of Muc5ac in the lungs and the acid mucus content in the nose compared with the 30-day treatment, and it increased the total leukocytes in the BAL and the nasal epithelium thickness compared with saline for 60 days. Cytokines concentrations in the BAL were detectable, with no differences among the groups. Our data suggest that a low-dose of DEP over 60 days induces respiratory tract inflammation.
Is the female child being neglected? Immunization in India

A study designed to determine the age at which children receive their first vaccinations in India revealed a wide disparity between male and female children a finding that goes along with other reports of the countrys gender-based discrimination. The study involved 1000 children who were brought by their parents to the immunization clinic of the general hospital in Udaipur city. The study sought to determine: 1) the childrens age at 1st vaccination; 2) their sex and nutritional status; 3) their socioeconomic status; and 4) maternal literacy. The study found the 48.8% of the children were brought for their 1st vaccination between the ages of 6-10 weeks the ideal age at which to begin immunization. 21% received their 1st vaccination after age 9 months. The mean age was 3.4 months for male children and 6.1 months for female children -- a statistically significant difference. 84.8% of children in the highest income group received their first vaccine between the ages of 6-10 weeks while only 52.5% of the children in the middle income group and 24.2% of the lowest income group received their vaccinations during the ideal period. The study also found a direct correlation between maternal literacy and the age at 1st vaccination. 79.5% of children with literate mothers received their 1st vaccine during the optimal period a figure that decreased to 20.5% for children with illiterate mothers. 25.5% of all the children were suffering from malnutrition; for males the rate of malnutrition was 15.8% and for females 36.6%. The study concludes that in order for India to have a successful immunization program (currently the immunization coverage is a dismal 58%) parents must be instructed on the optimal immunization age and gender biases must be abolished.
Determinantes individuais e contextuais da prevalência de cárie dentária não tratada no Brasil

OBJETIVO: Descrever a prevalencia de carie dentaria nao tratada em adolescentes no Brasil e analisar a associacao da carie com fatores individuais e contextuais nos municipios onde esses adolescentes residem. METODOS: Utilizou-se um banco de dados gerado pelo Ministerio da Saude (projeto SB-Brasil) que inclui informacoes de 16 833 adolescentes (15 a 19 anos). A presenca de ao menos um dente permanente com carie nao tratada foi a variavel de estudo. As variaveis explicativas, em nivel individual, foram: sexo, grupo etnico, local de residencia e situacao escolar. As variaveis referentes ao municipio foram: indice de desenvolvimento humano municipal (IDH-M), proporcao de domicilios com ligacao de agua e presenca de fluor na agua de abastecimento ha 5 anos ou mais. Para ajustar o desfecho as condicoes individuais e municipais de interesse, foi realizada uma analise multinivel para estimacao em modelos multivariados de regressao logistica. RESULTADOS: Ser negro ou pardo (razao de chances ajustada, ORajust = 1,79; 1,68 a 1,92) e residir em area rural (ORajust = 1,31; 1,19 a 1,45) foram determinantes individuais de maior probabilidade de apresentar carie nao tratada. Ser estudante foi identificado como fator de protecao (ORajust = 0,67; 0,62 a 0,73). As variaveis de segundo nivel, IDH-M (coeficiente ajustado beta = -0,213), fluor na rede de agua (beta = -0,201) e proporcao de domicilios com ligacao de agua (beta = -0,197) foram identificadas como determinantes contextuais de carie. CONCLUSAO: Os resultados mostram que existe desigualdade na distribuicao dos servicos de saude nas diferentes regioes brasileiras e sugerem que pode haver desigualdade tambem na efetividade dos servicos prestados. Politicas de expansao do acesso a agua fluoretada e inclusao escolar podem contribuir para evitar a doenca carie em adolescentes.
Comparison of the Antiviral Effects of Different Nucleos(t)ide Analogues in Chinese Patients with Chronic Hepatitis B: A Head-to-Head Study

Background/Aims: To assess the antiviral efficacy of lamivudine (LAM), entecavir (ETV), telbivudine (LDT), and lamivudine and adefovir dipivoxil (CLA) combination in previously untreated hepatitis B patients at different time points during a 52-week treatment period. Patients and Methods: A total of 164 patients were included in this prospective, open-label, head-to-head study. Serum levels of alanine transaminase (ALT), hepatitis B virus (HBV) DNA, and hepatitis B e antigen (HBeAg) were measured at baseline, and at 12, 24, and 52 weeks of treatment. Results: Median reductions in serum HBV DNA levels at 52 weeks (log10 copies/mL) were as follows: LAM, 3.98; ETV, 3.89; LDT, 4.11; and CLA, 3.36. The corresponding HBV DNA undetectability rates were 83%, 96%, 91%, and 89%, respectively. These two measures showed no significant intergroup differences. Clinical efficacy appeared related to HBV DNA level reduction after 24 weeks of therapy. Patients were divided into three groups based on HBV DNA levels at week 24: Undetectable (<103 copies/mL), detectable but <104 copies/mL, and >104 copies/mL. Patients with levels below quantitation limit (QL) were analyzed at 52 weeks for HBV DNA undetectability rate (94%), ALT normalization rate (83%), and viral breakthrough rate (0%). The corresponding values in the QL-104 copies/mL group were 50%, 75%, and 13%, whereas those in the above 104 copies/mL group were 53%, 65%, and 18%. There were significant differences at week 52 for HBV DNA levels and viral breakthrough rate between the three groups. Conclusions: Different nucleos(t)ide (NUC) analogues tested exhibited no significant differences in effectiveness for Chinese NUC-naive HBV patients during 1-year treatment period.