Miracle-dz/UniFAR-FTUs huggingface dataset:
Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: a meta-analysis

Background A substantial body of evidence demonstrates that myocardial revascularisation using bilateral internal mammary arteries (BIMA) improves long-term survival compared with single/left internal mammary artery (LIMA) grafting. To date, limited analyses have been made regarding other short-term and long-term outcomes in BIMA strategy. Objectives The primary aim of the present review is to update the difference in long-term survival between BIMA and LIMA grafting and to thoroughly investigate other secondary short-term and long-term clinical outcomes between these two grafting procedures. Methods Electronic searches were performed using three databases from their inception to November 2015. Relevant studies comparing long-term survival between BIMA and LIMA grafting were identified. Data were extracted by two independent reviewers and analysed according to predefined clinical outcomes. Results Twenty-nine observational studies were identified, with a total of 89 399 patients. Overall, BIMA cohort had significantly improved long-term survival compared with LIMA cohort (HR 0.78; p<0.00001). BIMA cohort also had significantly reduced hospital mortality rates (1.2% vs 2.1%, p=0.04), cerebrovascular accidents (1.3% vs 2.9%, p=0.0003) and need for revascularisation (4.8% vs 10%, p=0.005), although the incidence of deep sternal wound infection (DSWI) was increased (1.8% vs 1.4%, p=0.0008) in this grafting strategy. Long-term cardiac-free, myocardial infarction-free and angina-free survivals were also superior for the BIMA cohort. Conclusions BIMA grafting is associated with enhanced overall long-term outcomes compared with LIMA grafting. While the BIMA cohort demonstrates an increased incidence of DSWI, the survival benefits and other morbidity advantages outweigh this short-term risk.
Frequency of chest pain in primary care, diagnostic tests performed and final diagnoses

Objective Observational study of patients with chest pain in primary care: determination of incidence, referral rate, diagnostic tests and (agreement between) working and final diagnoses. Methods 118 general practitioners (GPs) in the Netherlands and Belgium recorded all patient contacts during 2weeks. Furthermore, patients presenting with chest pain were registered extensively. A follow-up form was filled in after 30 days. Results 22 294 patient contacts were registered. In 281 (1.26%), chest pain was a reason for consulting the GP (mean age for men 54.4/women 53 years). In this cohort of 281 patients, in 38.1% of patients, acute coronary syndrome (ACS) was suspected at least temporarily during consultation, 40.2% of patients were referred to secondary care and 512 diagnostic tests were performed by GPs and consulted specialists. Musculoskeletal pain was the most frequent working (26.1%) and final diagnoses (33.1%). Potentially life-threatening diseases as final diagnosis (such as myocardial infarction) accounted for 8.4% of all chest pain cases. In 23.1% of cases, a major difference between working and final diagnoses was found, in 0.7% a severe disease was initially missed by the GP. Conclusion Chest pain was present in 281 patients (1.26% of all consultations). Final diagnoses were mostly non-life-threatening. Nevertheless, in 8.4% of patients with chest pain, life-threatening underlying causes were identified. This seems reflected in the magnitude and wide variety of diagnostic tests performed in these patients by GPs and specialists, in the (safe) overestimation of life-threatening diseases by GPs at initial assessment and in the high referral rate we found.
Scaling‐up HCV prevention and treatment interventions in rural United States—model projections for tackling an increasing epidemic

BACKGROUND AND AIMS Effective strategies are needed to address dramatic increases in hepatitis C virus (HCV) infection among people who inject drugs (PWID) in rural settings of the United States. We determined the required scale-up of HCV treatment with or without scale-up of HCV prevention interventions to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025 and 2030 in a rural US setting. DESIGN An ordinary differential equation model of HCV transmission calibrated to HCV epidemiological data obtained primarily from an HIV outbreak investigation in Indiana. SETTING Scott County, Indiana (population 24 181), USA, a rural setting with negligible baseline interventions, increasing HCV epidemic since 2010, and 55.3% chronic HCV prevalence among PWID in 2015. PARTICIPANTS PWID. MEASUREMENTS Required annual HCV treatments per 1000 PWID (and initial annual percentage of infections treated) to achieve a 90% reduction in HCV chronic prevalence or incidence by 2025/30, either with or without scaling-up syringe service programmes (SSPs) and medication-assisted treatment (MAT) to 50% coverage. Sensitivity analyses considered whether this impact could be achieved without re-treatment of re-infections, and whether greater intervention scale-up was required due to the increasing epidemic in this setting. FINDINGS To achieve a 90% reduction in incidence and prevalence by 2030, without MAT and SSP scale-up, 159 per 1000 PWID (initially 24.9% of infected PWID) need to be HCV-treated annually. However, with MAT and SSP scaled-up, treatment rates are halved (89 per 1000 annually or 14.5%). To reach the same target by 2025 with MAT and SSP scaled-up, 121 per 1000 PWID (19.9%) need treatment annually. These treatment requirements are threefold higher than if the epidemic was stable, and the impact targets are unattainable without retreatment. CONCLUSIONS Combined scale-up of hepatitis C virus treatment and prevention interventions is needed to decrease the increasing burden of hepatitis C virus incidence and prevalence in rural Indiana, USA, by 90% by 2025/30.
Extended‐release naltrexone for methamphetamine dependence among men who have sex with men: a randomized placebo‐controlled trial

BACKGROUND AND AIMS Methamphetamine use is increasingly prevalent and associated with HIV transmission. Early-phase human studies suggested naltrexone reduced amphetamine use among dependent individuals. We tested if extended-release naltrexone (XRNTX) reduces methamphetamine use and associated sexual risk behaviors among high-risk methamphetamine-dependent men who have sex with men (MSM). DESIGN Double-blind, placebo-controlled, randomized trial of XRTNX versus placebo over 12 weeks from 2012 to 2015. SETTING San Francisco Department of Public Health, California, USA. PARTICIPANTS One hundred community-recruited, sexually-active, actively-using methamphetamine-dependent MSM. Mean age was 43.2 years; 96% were male, 3% transfemale, and 1% transmale; 55.0% were white, 19.0% African American, and 18.0% Latino. INTERVENTIONS XRNTX 380 mg (n = 50) or matched placebo (n = 50) administered by gluteal injection at 4-week intervals. MEASUREMENTS Regression estimated average level and change in level of positive urines during the period 2-12 weeks (primary outcomes) and sexual risk behaviors (secondary outcome). FINDINGS Ninety per cent of visits were completed. By intent-to-treat, participants assigned to XRNTX had similar differences during 2-12 weeks in methamphetamine-positive urines as participants assigned to placebo [incidence rate ratio (IRR) = 0.95, 95% confidence interval (CI) = 0.76-1.20; Bayes factor < 0.3]. Observed urine positivity declined from 78 to 70% in the XRNTX arm and 74 to 64% in the placebo arm. Adherence to injections was 96.7% in the XRNTX arm and 91.3% in the placebo arm. Sexual risk behaviors declined similarly among participants in both arms (all P > 0.05). There were no serious adverse events related to study drug and no differences in frequency of adverse events by treatment arm. CONCLUSIONS Notwithstanding very high medication adherence for this study, extended-release naltrexone does not appear to reduce methamphetamine use or sexual risk behaviors among methamphetamine-dependent men who have sex with men compared with placebo.
Associations of parental alcohol use disorders and parental separation with offspring initiation of alcohol, cigarette and cannabis use and sexual debut in high‐risk families

BACKGROUND AND AIMS Parental alcohol use disorders (AUDs) and parental separation are associated with increased risk for early use of alcohol in offspring, but whether they increase risks for early use of other substances and for early sexual debut is under-studied. We focused on associations of parental AUDs and parental separation with substance initiation and sexual debut to (1) test the strength of the associations of parental AUDs and parental separation with time to initiation (age in years) of alcohol, tobacco and cannabis use and sexual debut and (2) compare the strength of association of parental AUD and parental separation with initiation. DESIGN Prospective adolescent and young adult cohort of a high-risk family study, the Collaborative Study on the Genetics of Alcoholism (COGA). SETTING Six sites in the United States. PARTICIPANTS A total of 3257 offspring (aged 14-33 years) first assessed in 2004 and sought for interview approximately every 2 years thereafter; 1945 (59.7%) offspring had a parent with an AUD. MEASUREMENTS Diagnostic interview data on offspring substance use and sexual debut were based on first report of these experiences. Parental life-time AUD was based on their own self-report when parents were interviewed (1991-2005) for most parents, or on offspring and other family member reports for parents who were not interviewed. Parental separation was based on offspring reports of not living with both biological parents most of the time between ages 12 and 17 years. FINDINGS Parental AUDs were associated with increased hazards for all outcomes, with cumulative hazards ranging from 1.19 to 2.71. Parental separation was also an independent and consistent predictor of early substance use and sexual debut, with hazards ranging from 1.19 to 2.34. The strength of association of parental separation with substance initiation was equal to that of having two AUD-affected parents, and its association with sexual debut was stronger than the association of parental AUD in one or both parents. CONCLUSIONS Parental alcohol use disorders (AUDs) and parental separation are independent and consistent predictors of increased risk for early alcohol, tobacco and cannabis use and sexual debut in offspring from families with a high risk of parental AUDs.
Speech Pathology: An Applied Behavioral Science

ABSTRACT What gives birth to a new profession or specialty? When does such an entity acquire independent status? For medical practitioners concerned with the development of cross disciplinary activity in general and with communication disorders in particular, some fascinating reading will be found in this text. Dr. Perkins has written a clear, succinct and welldocumented survey that commands attention for both its style and substance.The first section reviews the historic and scientific roots of the discipline of speech science and does so in terms of the dynamic nature of communication function. Motor, acoustic and perceptual phonetics, and the classical bases of speech (including linguistic, psychologic, social, and developmental aspects) are explored. Interactional elements requiring basic categorical information (eg, in neurology or psychology) are delineated, and provide the rationale for interdisciplinary training relative to the "speech" process. The second section of the book deals with the application of basic information to
Patterns of substance use and mortality risk in a cohort of ‘hard‐to‐reach’ polysubstance users

AIMS To examine the mortality risk in a cohort of 'hard-to-reach' polysubstance users and its putative associations with substance use. Specifically, we estimated all-cause mortality risk as a function of individual substance use indicators, and then as a function of their complex, 'real-life' patterns as identified through latent class analysis (LCA). DESIGN Prospective cohort study among street- and low-threshold service-recruited polysubstance users included between September and November 2013 and followed through the National Cause of Death Registry until 31 October 2015. SETTING Seven Norwegian cities. PARTICIPANTS A total of 884 users of illegal opioids and/or stimulants. Of these, 357 were in opioid substitution treatment (OST) at the time of inclusion. Forty-four participants died during follow-up. MEASUREMENTS Primary outcome: all-cause mortality risk. Unadjusted and adjusted Cox proportional hazard (PH) regression models (covariates: male, age, homelessness/shelter use, overdose experience, OST status, years of injecting, individual substance use indicators, city, use patterns). LCA models estimated separately for those in and those not in OST due to measurement invariance. FINDINGS The crude mortality rate was 2.52 per 100 person-years. Standardized mortality ratio was 26.11 [95% confidence interval (CI) = 10.06-54.87] for women and 10.71 (95% CI = 6.39-16.81) for men. No single drug use indicator, such as 'heroin injection' or 'number of drugs used', was associated with the mortality risk. However, meaningful use patterns were identified; three OST and non-OST patterns each. The non-OST patterns 'polysubstance injectors' [hazard ratio (HR) = 3.45, 95% CI = 0.98-12.14] and 'low frequent injectors' (HR = 3.17, CI = 1.05-9.56) were associated significantly with the mortality risk even when adjusted for other known risk factors. CONCLUSIONS In a Norwegian prospective cohort study, 'hard-to-reach' polysubstance users had a more than 10 times higher mortality risk than the general population. Mortality risk was not a function of any single drug use indicator, but two distinct combinations of substances, frequencies and routes of administration were associated with the mortality risk.
Adenosine pressor and depressor systems in the nucleus tractus solitarius of rats

This report discusses the neuronal and cardiovascular responses elicited by adenosine in two subareas of the nucleus tractus solitarius (NTS) of normotensive and spontaneously hypertensive (SHR) rats. Pressor and tachycardic responses were obtained from the rostral NTS (adenosine pressor system), and depressor and bradycardic responses were obtained from the caudal NTS (adenosine depressor system). In both areas, adenosine inhibited the firing rate of barosensitive neurons. Male Sprague‐Dawley (SD), SHR, and Wistar‐Kyoto rats (WKY) were anesthetized with urethane and prepared for blood pressure and heart rate recording, stereotaxic microinjection of adenosine into the NTS, and extracellular recording of single‐unit neuronal activity of NTS neurons. Chemical identification of the targeted neuronal pool was made by L‐glutamate (5 nmol) and confirmed by histology. Adenosine elicited dose‐related neuronal and cardiovascular responses. However, SHR exhibited differential alterations in both adenosine systems. Compared with WKY, SHR exhibited attenuated pressor, tachycardic, and neuronal responses mediated by the adenosine pressor system and exaggerated depressor, bradycardic, and neuronal responses mediated by the adenosine depressor system. The responses elicited by adenosine were virtually abolished by theophylline (10 mg/kg IV) and by microinjection of 8(p‐sulfophenyl)theophylline) into the same area, suggesting that these responses were mediated by adenosine receptors in the NTS. Furthermore, the theophylline‐evoked increase in blood pressure was twofold higher in SHR compared with WKY. These findings suggest: 1) adenosine pressor and depressor systems involve different neuronal pools in the NTS, and 2) the differential alterations in adenosine pressor and depressor systems in the NTS of SHR may be implicated in the pathophysiology of hypertension. Drug Dev. Res. 45:410–419, 1998. © 1998 Wiley‐Liss, Inc.
Nuclear reorganization in non-sporing bacteria

1. The process of nuclear fusion and reorganization as it occurs in members of the Bacteriaceae is described. 2. The chromosomes behave as pairs at all times, the normal bacillus, of smooth morphology, contains two pairs. 3. The fusion nucleus contains three pairs and is preceded by a corresponding trinucleate bacillus. 4. One division of the chromosomes takes place in the fusion nucleus, and another during the process of redistribution of the chromosomes. The second division is followed by fragmentation, and return to the bacillary condition.
Racial discrimination and alcohol use and negative drinking consequences among Black Americans: a meta‐analytical review

BACKGROUND AND AIMS Findings of the association between racial discrimination and alcohol use and related consequences are inconsistent, and the role of potential moderators in the association is largely unknown. This meta-analysis aimed to synthesize the discrimination-alcohol literature among Black Americans, estimate the magnitude of associations and explore differences as a function of sample characteristics. METHODS Empirical studies reporting the association of racial discrimination with alcohol-related behaviors in an all-black sample were identified via systematic literature search. A random-effects meta-analysis was conducted using 33 effect sizes extracted from 27 studies, all of which used US samples (n = 26 894). RESULTS Significant positive associations were found for racial discrimination with alcohol consumption [k = 9, confidence interval (CI) = 0.08, 0.17, I2 = 49%, r = 0.12], heavy/binge drinking (k = 12, CI = 0.02, 0.10), I2 = 27%, r = 0.06), at-risk drinking (k = 4, CI = 0.06, 0.23, I2 = 0%, r = 0.14) and negative drinking consequences (k = 5, CI = 0.09, 0.25, I2 = 94%, r = 0.25), but not with alcohol use disorder (k = 3, CI = -0.01, 0.20, I2 = 90%, r = 0.10). Only alcohol consumption and negative drinking consequences showed significant between-study heterogeneity and had a sufficient quantity of studies for moderation analysis (i.e., 4 or more studies). The positive association of racial discrimination with negative drinking consequences was stronger among younger samples; the association with alcohol consumption did not differ by age or proportion of men. CONCLUSIONS Experiences of racial discrimination are associated with diverse alcohol-related behaviors among Black Americans, with a stronger association with problematic alcohol use, particularly among younger individuals.
Epidemiology of new-onset atrial fibrillation following coronary artery bypass graft surgery

Objectives Postoperative atrial fibrillation (AF) following coronary artery bypass graft surgery (CABG) is significantly associated with reduced survival, but poor characterisation and inconsistent definitions present barriers to developing effective prophylaxis and management. We sought to address this knowledge gap. Methods From 2002 to 2010, 11 239 consecutive patients without AF underwent isolated CABG at five sites. Clinical data collected for the Society of Thoracic Surgeons (STS) Database were augmented with details on AF detected via continuous in-hospital ECG/telemetry monitoring to assess new-onset post-CABG AF (adjusted for STS risk of mortality); time to first AF; durations of first and longest AF episodes; total in-hospital time in AF; number of in-hospital AF episodes; operative mortality; stroke; discharge in AF; and length of stay (LOS). Results Unadjusted incidence of new-onset post-CABG AF was 29.5%. Risk-adjusted incidence was 33.1% and varied little over time (P=0.139). Among 3312 patients with post-CABG AF, adjusted median time to first AF was 52 (IQR: 48–55) hours; mean (SD) duration of first and longest events were 7.2 (5.3,9.1) and 13.1 (10.4,15.9) hours, respectively, and adjusted median total time in AF was 22 (IQR: 18–26) hours. Adjusted rates of operative mortality, stroke and discharge in AF did not vary significantly over time (P=0.156, P=0.965 and P=0.347, respectively). LOS varied (P=0.035), but in no discernible pattern. Conclusions Each year, ~800 000 people undergo CABG worldwide; >264 000 will develop post-CABG AF. Onset is typically 2–3 days post-CABG and episodes last, on average, several hours. Effective prophylaxis and management is urgently needed to reduce associated risks of adverse outcomes.
Home Studies for Diagnosing Sleep Apnea Hypopnea Syndrome

Sleep apnea hypopnea syndrome (SAHS) is a prevalent and potentially serious disorder that is often accompanied by problems of accessibility and cost when the diagnosis is performed with full polysomnography (PSG) in the sleep laboratory. A common disorder like SAHS should not be managed in the same way as other less commonly occurring illnesses. Therefore, simplified methods are needed to cope with the high demand for sleep studies in order to include all potential patients. We believe that full PSG and simplified methods performed at home are not mutually exclusive but can be complementary. High numbers of patients with suspected SAHS can be managed using a home study as an initial test. Only when clinical findings do not correlate with the home study should full PSG be required. Several papers have demonstrated that this strategy is useful and more effective from a cost-effectiveness point of view. However, in some cases such as patients with depression in whom somnolence may have several reasons, or when another sleep disorder like periodic leg movements or narcolepsy is suspected, a full PSG should be recommended as the initial study. Therefore, to manage such patients, the pretest probability of having SAHS combined with the intention to treat with continuous positive airway pressure, as well as the suspicion of other sleep diseases, is crucial to define properly the strategy for diagnosis in each individual patient. It goes without saying that coordination with a referral center and an adequate training in sleep medicine are essential.
Comparison of relative TLR-2 and TLR-4 expression level of disease and healthy gingival tissue of smoking and non-smoking patients and periodontally healthy control patients.

BACKGROUND Toll-like receptors are a family of sensor proteins that induce the inflammatory diseases in context of microbial infection. The role of these proteins in periodontal disease and their interaction with smoking status are yet to be investigated. The aim of the present study was to evaluate the effect of smoking on gene expression of toll like receptor 2 (TLR-2) and toll-like receptor 4 (TLR-4) in patients with periodontitis. METHODS RNAs were extracted from gingival biopsies of healthy sites (no bleeding on probing and pocket depth ≤3 mm) as well as diseased sites (with bleeding on probing and pocket depth ≥5 mm) of 20 smoker and 17 non-smoker subjects with chronic periodontitis. Gingival biopsies from eight periodontally healthy, never-smoker subjects served as control. Real-time PCR was carried out to evaluate the relative quantities of TLR-2 and TLR-4 mRNA concentrations. RESULTS Regardless of smoking status, the relative expression levels of TLR-2 and TLR-4 were significantly greater (about 3 fold) at diseased sites compared to healthy sites of patients with periodontitis and healthy controls (p < 0.05). In sites with periodontitis, smoking caused an increase of about 6.5 fold in mRNA levels of TLR-4 in gingival tissue (p < 0.05). CONCLUSIONS Although periodontitis might significantly increase TLR-2 and TLR-4 gene expression in gingival tissues, smoking habit in periodontitis subjects could selectively potentiate TLR-4 gene expression.