Miracle-dz/UniFAR-FTUs huggingface dataset:
Contribution of arterial blood pressure to the clinical expression of lacunar infarction.

BACKGROUND AND PURPOSE The relation between symptomatic lacunar infarction, silent stroke, and arterial hypertension is controversial. METHODS From 500 patients with ischemic or hemorrhagic stroke admitted to the Downtown Barcelona Stroke Registry between July 1992 and December 1994, we evaluated prospectively the prevalence of silent infarction in 249 patients who had a brain MRI. The association of risk factors with silent infarction was investigated with the use of logistic regression analysis. In a selected group of 43 patients with symptomatic lacunes, we performed at stroke follow-up transcranial Doppler sonography and 24-hour continuous blood pressure monitoring to evaluate whether blood pressure, cerebrovascular tone, and cerebral blood flow at rest and after the administration of 1 g acetazolamide correlated with silent infarction. RESULTS A total of 147 silent infarctions were observed in 83 patients (33%). Most silent infarctions corresponded to small deep lesions in the territory of the lenticulostriate arteries. Patients with silent infarctions had higher systolic and diastolic blood pressure at stroke onset. However, on multivariate analysis, age greater than 60 years was the only risk factor associated with silent infarction. In a subgroup of 43 patients with symptomatic lacunes and patent extracranial vessels, systolic and diastolic pressure at stroke onset and diastolic pressure and vascular resistance at stroke follow-up were higher when silent infarctions co-existed. However, cerebral blood flow at rest and after acetazolamide injection were unrelated to silent infarction. CONCLUSIONS Silent ischemia in patients with symptomatic lacunar and nonlacunar stroke was only associated with aging. However, a history of arterial hypertension was perhaps unrecognized, since hemodynamic testing and continuous blood pressure monitoring in patients with lacunar stroke suggested that the coexistence of silent lesions indicated a more generalized cerebral arteriolosclerosis.
Women's Recovery Experiences After Breast Cancer Reconstruction Surgery

Many women with early-stage breast cancer choose breast reconstruction following mastectomy with the goal to improve physical and psychological quality of life. Breast reconstruction procedures vary in surgical complexity, types of postsurgical complications, and time to recovery, all of which can affect a women's well-being. Although there is a growing body of literature on the satisfaction with aesthetic outcomes following breast reconstruction, there is little research addressing the recovery process. This qualitative study explores woman's physical and emotional recovery experiences. Findings may be useful for improving educational and counseling services for women who undergo breast cancer reconstructive surgeries.
EXPLORING VALUES OF HEALTH TECHNOLOGY ASSESSMENT AGENCIES USING REFLECTIVE MULTICRITERIA AND RARE DISEASE CASE

Objectives: Tackling ethical dilemmas faced by reimbursement decision makers requires deeper understanding of values on which health technology assessment (HTA) agencies are founded and how trade-offs are made. This was explored in this study including the case of rare disease. Methods: Representatives from eight HTA explored values on which institutions are founded using a narrative approach and reflective multicriteria (developed from EVIDEM, criteria derived from ethical imperatives of health care). Trade-offs between criteria and the impact of incorporating defined priorities (including for rare diseases) were explored through a quantitative values elicitation exercise. Results: Participants reported a diversity of substantive and procedural values with a common emphasis on scientific excellence, stakeholder involvement, independence, and transparency. Examining the ethical imperatives behind EVIDEM criteria was found to be useful to further explore substantive values. Most criteria were deemed to reflect institutions’ values, while 70 percent of the criteria were reported by at least half of participants to be considered formally by their institutions. The quantitative values elicitation highlighted the difficulty to balance imperatives of “alleviating or preventing patient suffering,” “serving the whole population equitably,” “upholding healthcare system sustainability,” and “making decisions informed by evidence and context” but may help share the ethical reasoning behind decisions. Incorporating “Priorities” (including for rare diseases) helped reveal trade-offs from other criteria and their underlying ethical imperatives. Conclusions: Reflective multicriteria are useful to explore substantive values of HTAs, reflect how these values and their ethical underpinnings can be operationalized into criteria, and explore the ethical reasoning at the heart of the healthcare debate.
Cardiac Hypertrophy: Mechanical, Neural, and Endocrine Dependence

C ardiac hypertrophy usually follows an increase in work load that is imposed on the heart. Usually, greater work is due to increased afterload in patients with hypertension or after myocardial infarction in which the remaining muscle must assume the work of the segment that was lost as a result of myocardial cell death and scar formation. In some instances, increased pressure or volume work of the left ventricle is associated with increased release of neurotransmitters or plasma concentrations of hormones that may also have direct effects on cardiac myocyte growth, including activation of the sympathetic nervous system, pheochromocytoma, hyperthyroidism, and high renin hypertension. In these cases, is hypertrophy of cardiac myocytes due to a direct effect of the neurotransmitter or hormone receptor binding, or is hypertrophy due to increased work load imposed on the heart? Does pressureoverload hypertrophy depend on receptor binding to generate the intracellular signals required to transduce increased work into cell growth? In addition to the classic neural and hormonal pathways for signal transduction, is there a third pathway originating within the cell itself due to stretching or other types of deformation that can generate intracellular signals, such as increased intracellular Na+, pH, cytosolic free Ca'+, cyclic AMP (cAMP), inositol phosphates, and diacylglycerol concentrations without reliance on receptors for neurotransmitters or hormones? How do the intracellular signals that are generated increase rates of protein synthesis, decrease rates of protein degradation, or both to result in growth of the heart? These questions will be addressed in dealing with the mechanisms that translate greater heart work to cardiac hypertrophy. This last question was discussed in recent reviews.1-3
Analysis of the Effects of Graded Levels of Hypoxia on Noradrenaline‐Evoked Contraction in the Rat Iliac Artery in vitro

In rings of rat iliac artery, contractions were evoked by noradrenaline (NA), the selective α1 adrenoceptor agonist phenylephrine (PE), and K+, which causes depolarisation‐induced contraction. There was no evidence of α2 adrenoceptor‐evoked contraction. Hypoxia, induced by reducing PO2 in the bath from 100 mmHg to 70, 55 or 40 mmHg, had similar effects on rings with (E+) and without (E‐) endothelium. In E‐ rings, the NA concentration‐response curve was biphasic, whereas that for PE was monophasic. Hypoxia reduced maximum contractions in response to NA and PE (NAmax and PEmax, respectively) without affecting the concentrations that evoked 50% of maximum contraction (EC50). At PO2 of 70 mmHg, NAmax of the high affinity α1 receptor for NA (NAmaxh) and PEmax were reduced by ∼15%, but at PO2 of 55 and 40 mmHg, NAmaxh was severely attenuated while PEmax fell by 45 and 75%, respectively. Similarly, the Ca2+ channel blocker nicardipine depressed NAmaxh and PEmax, but PO2 of 55 mmHg further reduced NAmax and PEmax. Hypoxia also reduced contractions evoked by NA, PE or K+ at the concentrations required to produce 80% of the maximum contraction (EC80), receptor‐mediated contractions being more affected. Ca2+‐free conditions reduced the contractions evoked by NA and PE, at the EC80, to ∼10% of control. The K+ channel inhibitors glibenclamide and tetraethylammonium did not prevent hypoxia‐induced depression of PE‐evoked contraction. Thus, contractions evoked in iliac artery by the high affinity subtype of α1 adrenoceptor for NA, which may respond to circulating levels of NA, and by the single α1 adrenoceptor subtype for PE, are especially vulnerable to PO2 levels ≤ 55 mmHg. We propose that this reflects hypoxia‐induced inhibition of Ca2+ influx through L‐type and receptor‐operated Ca2+ channels; K+ channel opening makes little contribution.
Neonatal oxygen exposure leads to increased aortic wall stiffness in adult rats: a Doppler ultrasound study

We have previously shown that neonatal high oxygen (O2) exposure in rats leads to hypertension and vascular dysfunction in adulthood. Pulse-wave velocity (PWV), an indirect measure of vascular biophysical properties (arterial stiffness or distensibility), is a sensitive marker of cardiovascular health. Its measurement in rats is mostly based on invasive hemodynamics measurements, prohibiting longitudinal studies particularly relevant in models of developmental programming of cardiovascular dysfunctions. With this study, we sought (1) to verify the feasibility and validity of measuring of aortic PWV in Sprague–Dawley rats by ultrasound; (2) to use the technique to compare aortic PWV in adult rats exposed to O2 as newborns (80% day 3–10 of life) v. controls; and (3) to develop an algorithm to calculate PWV in a non-invasive manner. We calculated aortic PWV using standard echocardiography and electrocardiogram, and validated the measures with PWV obtained by intraaortic catheters. Aortic full length was measured at sacrifice. PWV was significantly increased in O2 exposed (505 ± 18 cm/s) v. control animals (421 ± 17 cm/s, P < 0.01). With regard to weight, femur length and distance from the manubrium to the anal margin (MA length), the latter showed the best correlation (R = 0.84, P < 0.0001) with full aorta length derived from (L) = 0.339 × (MA length) + 4.281. The current data using echo-Doppler method demonstrated increased aortic stiffness in adult rats exposed to hyperoxia as newborns and suggests that non-invasive longitudinal studies of aortic PWV can be performed using the proposed algorithm for estimation of the full aorta length.
Crack users: the new AIDS risk group?

Crack cocaine, a smokable form of cocaine hydrochloride, is now widely available in American inner cities. Reports of high rates of unprotected sexual activity among crack users, coupled with reports of high rates of sexually transmitted diseases (STDs), have raised fears that this population of drug users may soon be contracting and disseminating sexually transmitted HIV. In a study of 205 black adolescent crack users conducted in Oakland and San Francisco, California, 101 respondents (49% of the sample) who reported using crack in combination with sexual activity were examined. Those respondents who reported having a history of one or more STD were compared using discriminant analysis (DA). A successful discrimination (canonical correlation = 0.61, p = 0.000) identified five variables that distinguished those with a STD history from those with no STD history: gender (being female) (p = 0.000), frequency of marijuana use (p = 0.005), response to the question; "Do you plan for sex or does it just happen? " (p = 0.002), response to the statement, "I use drugs to get away from my problems" (0.029), and response to the question, "Do you agree that sex doesn't feel as good when you use a condom? " (p = 0.006). The selection of these variables was thought to represent an underlying passivity in the way that crack users who combine crack use with sex approach sexual activity.
A Novel Tetrahydrofolate-Dependent O-Demethylase Gene Is Essential for Growth of Sphingomonas paucimobilis SYK-6 with Syringate

ABSTRACT Sphingomonas paucimobilis SYK-6 degrades syringate to 3-O-methylgallate (3MGA), which is finally converted to pyruvate and oxaloacetate via multiple pathways in which protocatechuate 4,5-dioxygenase, 3MGA dioxygenase, and gallate dioxygenase are involved. Here we isolated the syringate O-demethylase gene (desA), which complemented the growth deficiency on syringate of a Tn5 mutant of the SYK-6 derivative strain. The desA gene is located 929 bp downstream of ferA, encoding feruloyl-coenzyme A synthetase, and consists of a 1,386-bp open reading frame encoding a polypeptide with a molecular mass of 50,721 Da. The deduced amino acid sequence of desA showed 26% identity in a 325-amino-acid overlap with that of gcvT of Escherichia coli, which encodes the tetrahydrofolate (H4folate)-dependent aminomethyltransferase involved in glycine cleavage. The cell extract of E. coli carrying desA converted syringate to 3MGA only when H4folate was added to the reaction mixture. DesA catalyzes the transfer of the methyl moiety of syringate to H4folate, forming 5-methyl-H4folate. Vanillate and 3MGA were also used as substrates for DesA; however, the relative activities toward them were 3 and 0.4% of that toward syringate, respectively. Disruption of desA in SYK-6 resulted in a growth defect on syringate but did not affect growth on vanillate, indicating that desA is essential to syringate degradation. In a previous study the ligH gene, which complements the growth deficiency on vanillate and syringate of a chemical-induced mutant of SYK-6, DC-49, was isolated (S. Nishikawa, T. Sonoki, T. Kasahara, T. Obi, S. Kubota, S. Kawai, N. Morohoshi, and Y. Katayama, Appl. Environ. Microbiol. 64:836-842, 1998). Disruption of ligH resulted in the same phenotype as DC-49; its cell extract, however, was found to be able to convert vanillate and syringate in the presence of H4folate. The possible role of ligH is discussed.
Changes in anxiety and depression over 2 years in medically stable patients after myocardial infarction and their spouses in the Home Automatic External Defibrillator Trial (HAT): a longitudinal observational study

Objective To compare the long-term effects of cardiopulmonary resuscitation (CPR) training and CPR/automatic external defibrillator (AED) training on anxiety and depression of patients who were medically stable after myocardial infarction (MI) and of their spouses/companions. Design Longitudinal. Participants Post-MI patients (N=460) and their spouses/companions from the Home Automatic External Defibrillator Trial. Main outcome measures Depression (Beck Depression Inventory-II scores) and anxiety (State Trait Anxiety Inventory scores). Results At study entry, 25% of the patients and 15% of their spouses were depressed and 21% of the patients and 19% of the spouses were anxious. The prevalence of depression and anxiety did not change over time in the patients or their spouses. Average depression and anxiety decreased for patients but not for spouses. An intervention group did not contribute significantly to these changes. Psychological distress, indicated by depression or anxiety of the spouse or the patient, occurred in 191 couples. Among psychologically distressed patients (N=128), depression and anxiety decreased over time; the intervention group did not contribute to these changes. The reduction in anxiety among male patients was greater than in female patients (p=0.012, 95% CI 0.002 to 0.018). Among psychologically distressed spouses (N=118), depression decreased over time independently of the intervention. Changes in spouse anxiety depended on the intervention group (p=0.012, 95% CI 0.001 to 0.012); anxiety decreased significantly in the CPR and remained high in the CPR/AED group. Conclusion There was no evidence that home AEDs caused psychological distress among patients. Even among those who were psychologically distressed when they were assigned to receive either CPR training or CPR/AEDs, home AEDs did not influence changes in patients' depression or anxiety or spouses' depression in comparison with CPR training. Among psychologically distressed spouses, AEDs may keep anxiety higher than it would be otherwise. Interventions to reduce anxiety of spouses who are psychologically distressed may be indicated when their partners receive an AED.
Unmet Needs in the Treatment of Allergic Asthma: Potential Role of Novel Biologic Therapies

OBJECTIVES: To provide a review of the current status of the treatment of asthma and introduce new and developing forms of therapy by means of a review of published literature on asthma and publications on new and emerging therapies. Increased public awareness of asthma, improved patient and provider education, implementation of national treatment guidelines, and availability of safe and effective therapies have combined to provide an effective response to the increase in asthma prevalence. However, the number of persons with poorly controlled asthma and asthma-related complications remains unacceptably high. This is particularly true for the relatively small cohort of patients with moderate-to-severe asthma that is poorly controlled with inhaled corticosteroids and other standard-of-care medications. Consequently, these patients often experience frequent exacerbations, leading to a disproportionate consumption of asthma health care resources and a poor quality of life. The National Committee on Quality Assurance suggests that the negative impact of asthma can be minimized if health care providers implement aggressive asthma management programs that include patient education and appropriate medications. Newer therapies such as injectable anti-IgE may provide a benefit for many patients. SUMMARY: Currently available asthma medications have been proven to be generally safe and effective for most asthma patients. However, the subset of patients with difficult-to-treat asthma who experience frequent exacerbations requiring emergency department visits or hospitalizations may benefit from novel therapies designed to target specific mechanisms underlying airway inflammation. CONCLUSIONS: New therapies may help in the treatment of patients whose asthma is not controlled. These include anti-immunoglobulin E (IgE) antibodies, cytokine modulators, and DNA vaccinations. Future research will determine if these targeted biologic therapies are a cost-effective means to improve the clinical and economic outcomes of asthma management.
Intravenous N-acetylcysteine: still the treatment of choice for paracetamol poisoning.

One hundred cases of severe paracetamol poisoning were treated with intravenous N-acetylcysteine (acetyl-cysteine). There was virtually complete protection against liver damage in 40 patients treated within eight hours after ingestion (mean maximum serum alanine transaminase activity 27 IU/1). Only one out of 62 patients treated within 10 hours developed severe liver damage compared with 33 out of 57 patients (58%) studied retrospectively who received supportive treatment alone. Early treatment and acetylcysteine also prevented renal impairment and death. The critical ingestion-treatment interval for complete protection against severe liver damage was eight hours. Efficacy diminished progressively thereafter, and treatment after 15 hours was completely ineffective. Intravenous acetylcysteine was more effective than cysteamine and methionine and noticeably free of adverse effects. It is the treatment of choice for paracetamol poisoning.
Care needs and economic consequences after acute ischemic stroke: the Erlangen Stroke Project

The objective was to determine the functional outcome, location of care and economic consequences in the first 3 months after ischemic stroke. As part of the Erlangen Stroke Project, (ESPro) information was collected on patients suffering a first‐ever ischemic stroke. Three months after the stroke, location of care, dependence on caregivers and function based on Barthel Index: poor (0–55), moderate (60–90) or good function (95–100) were recorded. Data about health services used were combined with cost estimates for Germany (€2000 Euros, undiscounted). Of 491 patients hospitalized, 383 were alive 3 months afterwards, 79% residing in the community. The majority of patients with poor function (60%) were still in institutional care. Patients with good function typically accrued the lowest costs, whether in an institution (€17 965) or not (€11 032) compared with poorer function who were living in an institution (poor: €26 370; moderate: €28,121), or community (poor: €27,207; moderate: €19,350). Hospitalization and rehabilitation services were the major costs accrued at each level of function. Many patients were left requiring a substantial amount of care and the costs associated with providing institutional care has a major impact on the economic consequences of a stroke.
EEG spectral analysis during complex cognitive task at occipital

Normal oscillations in different frequency bands have an important role in cognitive processing in the frontal region. The key issue is whether frequency oscillations of Electroencephalography (EEG) are related to cognitive task or not in occipital region. All frequency bands delta (δ), theta (θ), alpha (α), beta (β) and gamma (γ) are involved in brain tasks. This study is conducted to investigate the functional relationship between EEG frequency bands and the cognitive task. In various studies theta, alpha and beta bands are discussed for cognitive tasks; however there are few studies which have been focused on delta band for cognitive tasks. In this paper, behavior of θ, α, β and γ is described but the primary focus is on delta (δ) band during cognitive task in occipital region as it had been ignored in the literature. In conclusion, this study explains how different frequencies change during cognitive task as compared to base line (eyes open) in occipital region and the results show that there is an increase in power during the task in delta and theta band.
The effects of SOM230 on cell proliferation and adrenocorticotropin secretion in human corticotroph pituitary adenomas.

CONTEXT There is no tumor-directed medical therapy available for Cushing's disease. OBJECTIVE The objective was to determine the in vitro effect of the somatostatin analog pasireotide (SOM230) on cell proliferation in human corticotroph tumors. DESIGN/METHODS Expression of somatostatin receptors (SSTR 1-5) was determined by quantitative RT-PCR in 13 human corticotroph tumors and by immunohistochemistry (IHC) in 12 of the 13 tumors. SOM230 effects on cell proliferation and ACTH release were evaluated in vitro using primary cultures of six of the 13 human corticotroph adenomas. RESULTS In our series, we found expression of SSTR subtypes 1, 2, 4, and 5 in human corticotroph tumors by quantitative RT-PCR. All receptor subtypes were detected by IHC, with SSTR subtype 5 having the highest IHC score in 83% (10 of 12) of the cases. Significant suppression of cell proliferation was observed in all tumors cultured (percent suppression range: 10-70%; P = 0.045-0.001). SOM230 inhibited ACTH secretion in five of the six tumors cultured (percent suppression range: 23-56%; P = 0.042-0.001). CONCLUSION Corticotroph tumors express multiple SSTR subtypes. SOM230 significantly suppressed cell proliferation and ACTH secretion in primary cultures of human corticotroph tumors. These in vitro results support the hypothesis that SOM230 may have a role in the medical therapy of corticotroph tumors.
An Iteration for Indefinite Systems and Its Application to the Navier-Stokes Equations

For large sparse systems of linear equations iterative solution techniques are attractive. In this paper we propose and examine the convergence of an iterative method for an important class of nonsymmetric and indefinite coefficient matrices based on the use of an indefinite and symmetric preconditioner. We apply our technique to the linearized Navier--Stokes equations (the Oseen equations).