Miracle-dz/UniFAR-FTUs huggingface dataset:
The effect of exercise on vastus medialis oblique muscle architecture: An ultrasound investigation

The vastus medialis oblique (VMO) is thought to be implicated in patellofemoral pain (PFP), and weakness in this portion of the vastus medialis muscle may lead to PFP. Management includes physiotherapy to strengthen the VMO. Although this intervention has been shown to be effective, the effects on the architecture of the muscle have not been investigated. This study aims to determine the changes in VMO architecture following a program of strengthening exercises. Twenty‐one male participants underwent an initial ultrasound scan to measure the fiber angle and the insertion level of the VMO on the patella. Each subject then undertook a 6‐week quadriceps femoris strengthening program; the scan and measurements were then repeated. A significant increase in VMO fiber angle and insertion length was observed. Average fiber angle increased by 5.24°; average insertion length increased by 2.7 mm. There was found to be a significant negative correlation between the initial values and the degree of change. Pearson's coefficient of correlation for measurements of patella length taken before and after exercise was 0.921, indicating a high degree of reliability. There was a significant positive correlation between fiber angle change and declared level of compliance (R2 = 0.796). The results reported here indicate that physiotherapy leads to a significant change in VMO morphology. Given the inverse correlation noted between initial architectural parameters and the degree of change, we suggest that patients who would benefit most from physiotherapy can be identified in clinic using a simple ultrasound technique. Clin. Anat. 29:752–758, 2016. © 2016 Wiley Periodicals, Inc.
Use of computer‐aided holographic models improves performance in a cadaver dissection‐based course in gross anatomy

A compelling, innovative approach to teaching gross anatomy is the use of computer‐aided holographic models. They allow for clean, time‐saving dissection, manipulation of structures and appreciation of anatomical relationships, and potential elimination of the need for cadavers. The present study tests the hypothesis that using holographic models improves mastery of anatomical information. First‐year medical students were taught gross anatomy using the dissection of donor cadavers, manipulation of digitized 3‐dimensional holographic renderings, and examination of plastinated specimens. The effectiveness of these approaches was assessed by comparing students' performance on identification questions on cadavers (qC), holographic models (qH), and plastinated specimens (qP). Students in the top quintile of the class performed strongly on qC, qH, and qP. In contrast, performance by students in the bottom quintile was uneven; they scored best on qH. Performance on the qP was relatively non‐discriminating. Students in the top quintile scored higher on the biological sciences section of the Medical College Admission Test (MCAT) than students in the lowest quintile, whereas students in the lowest quintile had higher scores on the verbal section of their MCATs. The availability of different approaches for presenting gross anatomy improves the success of students in mastering the material, particularly for students struggling with the information. The use of holographic models apparently reaches students who may be challenged to learn the material using traditional approaches. This may be linked to potentially predictive information gleaned through performance on the MCAT. Clin. Anat. 29:917–924, 2016. © 2016 Wiley Periodicals, Inc.
Five common clinical presentations in the elderly: An anatomical review

Elderly patients face distinct health challenges and have an increased demand for specific medical procedures. As the aging population continues to increase, age‐associated conditions such as congestive heart failure, hip fractures, spine degeneration, dementia, and airway compromise will increase in prevalence and procedures to correct these conditions will be increasingly performed. A clear understanding of the clinical anatomy of these diseases and procedures is imperative for anatomists and clinicians alike in order to best treat patients and continue to advance aging research and better teach future medical practitioners about the specific anatomy often involved in this group. The aging process mirrors in a variety of ways the common pathologies of the elderly, but it is key to draw the distinction between normal aging and pathology, particularly for congestive heart failure and dementia, in the clinical setting. This article aims to review the common presentations or procedures of the elderly and how the normal aging process is associated with the anatomy of these conditions or complications. Clin. Anat. 30:168–174, 2017. © 2017 Wiley Periodicals, Inc.
Extravascular lung water indexed to predicted body weight is a novel predictor of intensive care unit mortality in patients with acute lung injury*

Objectives:Acute lung injury and the acute respiratory distress syndrome are characterized by noncardiogenic pulmonary edema, which can be assessed by measurement of extravascular lung water. Traditionally, extravascular lung water has been indexed to actual body weight (mL/kg). Because lung size is dependent on height rather than weight, we hypothesized indexing to predicted body weight may be a better predictor of mortality in acute lung injury/acute respiratory distress syndrome. Design:Prospective observational cohort study. Setting:A tertiary referral intensive care unit. Patients:Patients were recruited within 48 hrs of fulfilling the American European Consensus Conference definition of acute lung injury/acute respiratory distress syndrome. Interventions:None. Measurements and Main Results:Demographics, severity of illness scores, and respiratory parameters were collected. Extravascular lung water was measured using the PiCCO system. This was indexed to actual and predicted body weight. Statistically significant predictors of mortality identified using single regressor logistic regression and additional variables known to be associated with outcome were entered into a multiple logistic regression analysis. Receiver operator characteristic curves were generated. Forty-four patients were recruited (septic 34%). Using single regressor logistic regression, six variables were statistically significantly related to mortality: Acute Physiology and Chronic Health Evaluation II, PaO2, PaO2/Fio2 ratio, oxygenation index, actual extravascular lung water, and predicted extravascular lung water. In multiple logistic regression analysis, predicted extravascular lung water but not actual extravascular lung water was a predictor of mortality with an odds ratio of 4.3 (95% confidence interval, 1.5–12.9) per sd. Although the area under the curve for predicted extravascular lung water (0.8; confidence interval, 0.65–0.94) was larger than for actual extravascular lung water (0.72; confidence interval, 0.53–0.91), this was not statistically significant (p = .12). A baseline predicted extravascular lung water value of 16 mL/kg predicted intensive care unit mortality with a sensitivity of 0.75 (confidence interval, 0.47–0.91) and specificity of 0.78 (confidence interval, 0.61–0.89). Conclusions:Early measurement of predicted extravascular lung water is a better predictor than actual extravascular lung water to identify patients at risk for death in acute lung injury/acute respiratory distress syndrome.
Anabolic resistance in critically ill patients

Most patients who are critically ill lose muscle as a result of an inability to maintain rates of protein synthesis above those of protein breakdown. In addition to the effects of a procatabolic hormonal and cytokine milieu, which accelerate protein breakdown, age and immobility also influence the ability of muscle to maintain itself. Although the basal rates of protein turnover are not altered with aging, age is associated with a smaller ability to capture blood-borne amino acids as protein, the results of a decreased capacity for protein synthesis (total RNA/DNA) and decreased sensitivity and capacity of signaling proteins to indicate the availability of amino acids. Furthermore, muscle of older individuals is resistant to the effects of insulin in decreasing muscle proteolysis. Both of these effects are part of “anabolic resistance”—the inability of muscle to maintain its protein mass by appropriate stimulation of muscle protein turnover and inhibition of protein breakdown. Overlain on the effects of age are the effects of immobility, which has some of the characteristics of anabolic resistance. Immobility per se causes a decrease in muscle protein synthesis with no apparent stimulation of muscle protein breakdown; furthermore, muscle of immobilized legs is unable to stimulate muscle protein synthesis to the same extent as that of nonimmobilized legs when amino acids are infused, even at high rates.
The Effects of Neuromuscular-Blocking Agents on Gas Exchange in Patients With Acute Respiratory Distress Syndrome

The use of neuromuscular-blocking agents (NMBA) in ventilated patients with acute respiratory distress syndrome (ARDS) is controversial and largely empiric. Few trials looked at their effectiveness on gas exchange or in improving lung mechanics in patients with ARDS. Only one randomized, controlled trial compared the effects of NMBA on gas exchange in patients with ARDS receiving NMBA as compared with patients receiving placebo throughout a period of 48 hours. In this trial, the early use of NMBA in patients with ARDS was associated with a sustained improvement in oxygenation. The muscular paralysis induced by NMBA could reduce the consumption of oxygen linked to the work of breathing. Muscular paralysis could facilitate mechanical ventilation by preventing spontaneous breaths responsible for the dys-synchrony and worsening of gas exchange. Muscular paralysis could increase compliance of the thoracic wall and improve mechanical ventilation during ARDS. However, these hypotheses are controversial. Finally, preliminary data show that the muscular paralysis could provide better adaptation to mechanical ventilation and better satisfaction with the protective criteria for reduction of ventilator-associated lung injuries by homogenizing the distribution of tidal volume and positive end expiratory pressure. The role of new NMBA (benzylisoquinolines) in the occurrence of critical illness neuromyopathy is largely questioned in the recent literature. It is important to design new studies to explain the mechanisms of the improvement in oxygenation associated with NMBA and to evaluate whether the use of NMBA modifies the outcome of patients with ARDS.
Medical students and professional anatomists do not perceive gender bias within imagery featuring anatomy

Previous studies suggest that, while both medical students and professional anatomists recognize the importance of gender issues and do not wish to associate with sexism, most are unaware of the possible negative aspects of sexism within anatomy (Morgan et al. , J. Anat. 224:352–365; , Clin. Anat. 29:892–910). To further investigate this issue, we provided second year medical students at Cardiff University (n = 293) and at the University of Paris Descartes, Sorbonne Paris Cité (n = 142) and professional anatomists (n = 208) with a questionnaire inviting them to address the possibility that gender factors within anatomical imagery (both historical and contemporary) hinder the dispassionate representation of anatomy. Ethical approval for the survey was obtained from the universities at both Cardiff and Paris. In the light of previous findings, the hypothesis tested was that medical students and professional anatomists do not perceive a gender bias when reflected in imagery that is based on anatomical iconography. Our survey results support this hypothesis and suggest that most students and anatomists are unaware of the possible negative aspects of sexism within the culture of anatomy. We consequently recommend that teachers of anatomy and authors of anatomical textbooks should be aware of the possibility of adverse effects on professional matters relating to equality and diversity issues when using imagery. Clin. Anat. 30:711–732, 2017. © 2017Wiley Periodicals, Inc.
Radiotherapy for Peyronie's Disease: A European survey

Background and purpose. Peyronie's Disease (PD) is a benign condition characterized by penile nodules, pain and curvature. Radiotherapy has been used for many years with positive outcomes, however all studies published were non-randomized or non-controlled. The purpose of this survey was to understand which treatment policy is followed in Europe before setting up a randomized trial. Materials and methods. A questionnaire was sent out to 908 European radiotherapy institutions, 402 questionnaires were sent back and filled out correctly (44.5%). The questionnaire consisted of different items, regarding number of patients referred, fraction dose, total dose and technique used, and eventually treatment outcome of clinical trials. Results. Seventy-three institutions irradiate PD (19%), 304 do not (81%). Reasons for not treating were insufficient referrals from urologists or no interest in treating benign diseases. The most common fraction dose is 2 (range 0.5–8) Gy and the total radiation dose 20 (range 3–30) Gy. Most of the institutions use electrons (n = 44) or orthovoltage (n = 32). Decreased pain is reported in about 80% of the cases, and side effects by eight institutions. Conclusions. So far, a large variation of treatment schedules for radiotherapy of PD has been detected in European countries. Although the results are good and side effects minimal, there is still a need to set up a European randomized trial to prospectively evaluate the efficacy of radiotherapy for PD.
Aurora kinase B is an independent protective factor in superficial bladder tumours with a dysfunctional G1 checkpoint

To investigate the clinical role of Aurora kinases (essential for regulating mitosis) in human bladder pathogenesis, by quantifying Aurora kinase A and B, phospho‐Aurora A, and phospho‐Rb and p53 in bladder tumours, analysing the correlations between expression and clinicopathological features.
The effect of near‐peer tutoring on medical students' performance in anatomical and physiological sciences

Healthcare professional schools across the world are implementing near‐peer tutoring (NPT) programs owing to numerous benefits to both tutors and tutees. This study determined whether higher attendance at NPT sessions led to improvements in course grades for high and low performing students. Fourth‐year medical students used the USMLE Step 1 question format to tutor first‐year medical students during the second half of the Structure and Function (SF) module, i.e., SF2. Attendance was recorded and students were accordingly divided into three groups: high, moderate, and low‐no attendance. Students’ performances in SF1 and SF2 were compared using Student's t‐test. Differences among the three groups were analyzed using ANOVA and Scheffé post hoc test (P< 0.05). Students who earned 70–79% (C) in SF1 were further examined on the basis of their attendance rate and performance in SF2. Those who attended three or more sessions completed a survey evaluating the NPT program. Course grades were significantly higher in SF2 than SF1 for all students, regardless of attendance rate. However, students who received a C grade in SF1 and had high or moderate attendance improved significantly in their SF2 course grade. Most students agreed that the NPT program was valuable and they evaluated the tutors highly. They also agreed that NPT prepared them for course exams and Step 1, but did not reduce anxiety and stress about Step 1. The positive effect of the NPT program resulted in its expansion to include all first‐year modules. Clin. Anat. 30:922–928, 2017. © 2017 Wiley Periodicals, Inc.
Update on Stenotrophomonas maltophilia Infection in the ICU

Stenotrophomonas maltophilia is emerging as an important opportunistic pathogen in nonimmunocompromised hosts. It has been widely described that bacteremia and ventilator-associated pneumonia due to S. maltophilia cause significant mortality and morbidity. However, a recent study suggests that a positive respiratory isolate in the absence of consolidation does not require specific therapy. Antimicrobial resistance among S. maltophilia strains is an escalating problem with significant consequences on morbidity, mortality and healthcare costs. Although trimethoprim–sulfamethoxazole (TMP–SMX) continues as the preferred agent, the marked multiresistance evidenced by some species, prompts the need to develop new antimicrobial agents and search for synergistic combinations. New fluoroquinolones seem to be an encouraging option for treatment and may become very useful in the treatment of severe infections due to S. maltophilia. Much remains to be understood of the epidemiology of S. maltophilia and more information on nosocomial reservoirs and routes of transmission of the bacterium is needed. Appropriate antimicrobial selection, surveillance systems, and effective infection-control procedures must be addressed to limit antimicrobial resistance and restrict the spread of this organism.
Complications of the neovagina in male‐to‐female transgender surgery: A systematic review and meta‐analysis with discussion of management

Gender‐affirmation surgery is often the final gender‐confirming medical intervention sought by those patients suffering from gender dysphoria. In the male‐to‐female (MtF) transgendered patient, the creation of esthetic and functional external female genitalia with a functional vaginal channel is of the utmost importance. The aim of this review and meta‐analysis is to evaluate the epidemiology, presentation, management, and outcomes of neovaginal complications in the MtF transgender reassignment surgery patients. PUBMED was searched in accordance with PRISMA guidelines for relevant articles (n = 125). Ineligible articles were excluded and articles meeting all inclusion criteria went on to review and analysis (n = 13). Ultimately, studies reported on 1,684 patients with an overall complication rate of 32.5% and a reoperation rate of 21.7% for non‐esthetic reasons. The most common complication was stenosis of the neo‐meatus (14.4%). Wound infection was associated with an increased risk of all tissue‐healing complications. Use of sacrospinous ligament fixation (SSL) was associated with a significantly decreased risk of prolapse of the neovagina. Gender‐affirmation surgery is important in the treatment of gender dysphoric patients, but there is a high complication rate in the reported literature. Variability in technique and complication reporting standards makes it difficult to assess the accurately the current state of MtF gender reassignment surgery. Further research and implementation of standards is necessary to improve patient outcomes. Clin. Anat. 31:191–199, 2018. © 2017 Wiley Periodicals, Inc.
Técnica Delphi na validação das intervenções de enfermagem

O saber, a ciencia sao universais e vem se desenvolvendo muito rapidamente e, o enfermeiro, tem conhecimento de sua responsabilidade neste desenvolvimento cientifico. Com o objetivo de analisar a Tecnica Delphi, descrevendo a sua utilizacao na validacao das intervencoes de enfermagem aos lesados medulares em reabilitacao, foi possivel resultados fidedignos, por meio de uma tecnica de carater flexivel e, sobretudo, por valorizar a opiniao ou o conhecimento de cada um dos enfermeiros que atuam junto aos lesados medulares. Delphi permitiu aos especialistas apontarem as intervencoes preconizadas a esta clientela, mas este contexto teve requisitos necessarios que identificam o pensar-fazer em enfermagem.
Review of MammoSite brachytherapy: Advantages, disadvantages and clinical outcomes

Background. The MammoSite® radiotherapy system is an alternative treatment option for patients with early-stage breast cancer to overcome the longer schedules associated with external beam radiation therapy. The device is placed inside the breast surgical cavity and inflated with a combination of saline and radiographic contrast to completely fill the cavity. The treatment schedule for the MammoSite monotherapy is 34 Gy delivered in 10 fractions at 1.0 cm from the balloon surface with a minimum of 6 hours between fractions on the same day. Material and methods. This review article presents the advantages, disadvantages, uncertainties and clinical outcomes associated with the MammoSite brachytherapy (MSB). Results. Potential advantages of MSB are: high localised dose with rapid falloff for normal tissue sparing, minimum delay between surgery and RT, catheter moves with breast, improved local control, no exposure to staff, likely side-effects reduction and potential cost/time saving (e.g. for country patients). The optimal cosmetic results depend on the balloon-to-skin distance. Good-to-excellent cosmetic results are achieved for patients with balloon-skin spacing of ≥7 mm. There have been very few published data regarding the long term tumour control and cosmesis associated with the MSB. The available data on the local control achieved with the MSB were comparable with other accelerated partial breast irradiation techniques. The contrast medium inside the balloon causes dose reduction at the prescription point. Current brachytherapy treatment planning systems (BTPS) do not take into account the increased photon attenuation due to high Z of contrast. Some BTPS predicted up to 10% higher dose near the balloon surface compared with Monte Carlo calculations using various contrast concentrations (5–25%). Conclusion. Initial clinical results have shown that the MammoSite device could be used as a sole radiation treatment for selected patients with early stage breast cancer providing good local control, minimal complication rate and excellent cosmesis.
Drug-induced acute kidney injury in the critically ill adult: Recognition and prevention strategies

Acute kidney injury is common in critically ill patients, with an incidence of 20% to 30%. It has been associated with increased mortality, hospital length of stay, and total cost. A number of strategies may be beneficial in identifying at-risk patients. In addition, using preventive measures and avoiding nephrotoxic medications are paramount in reducing the overall incidence. Although multifactorial, drug-induced acute kidney injury may account for up to 25% of all cases of acute kidney injury in this population. This review focuses on the mechanisms of drug-induced acute kidney injury in critically ill adults and offers preventive strategies when appropriate.