Miracle-dz/UniFAR-FTUs huggingface dataset:
The Checklist of Unit Behaviors (CUB): psychometric properties of a measure of patient milieu engagement on an acute inpatient psychiatric unit

Objective This paper presents the psychometric properties, including factor structure, internal reliability and relative validity of a 16-item questionnaire measuring patients’ relative activation with milieu activities while hospitalised in an acute psychiatric inpatient unit. Method 24 hours after admission, and before discharge, psychiatric inpatients (N = 132) completed a set of validated self-reports and the pilot questionnaire, the Checklist of Unit Behaviors (CUB). The CUB outlines items that reflect the extent to which the patient avoided or engaged with the treatment milieu within the previous 24 hours. Factor analysis, bivariate correlations and repeated-measures t-tests were used to analyse the data. Results Factor analysis identified two factors for the CUB: (1) Behavioural Approach; and (2) Behavioural Avoidance. Psychometric properties were satisfactory (Approach, Cronbach's α = 0.93; Avoidance, Cronbach's α = 0.79). Over the course of treatment, CUB-Approach increased (p Conclusions The CUB demonstrates strong psychometric properties, quantifying patients’ behavioural activation in the treatment milieu. Daily use of the CUB provides clinically useful information that has the potential to improve patient care and treatment planning.
Th17 and natural Treg cell population dynamics in systemic lupus erythematosus.

OBJECTIVE To investigate the relative abundance and activities of Th17 cells and natural Treg cells in systemic lupus erythematosus (SLE). METHODS Blood samples were collected from 50 adult patients with SLE. Samples were processed to detect Th17 cells and natural Treg cells by flow cytometry, and related gene expression was assessed by real-time reverse transcription-polymerase chain reaction. Skin biopsy specimens were collected for histologic assessment. The function of Th17 cells in relation to human umbilical vein endothelial cells (HUVECs) was studied in vitro. Th17 cells were also examined in lupus-prone MRL/Mp-lpr/lpr (MRL/lpr) mice. RESULTS We demonstrated the presence of Th17 cells among the peripheral blood mononuclear cells (PBMCs) and in the involved organs of patients with active SLE. Both the percentage of circulating Th17 cells and the ability to produce interleukin-17A (IL-17A) were increased in samples derived from patients with active SLE. The number of Th17 cells increased during SLE flare, especially in patients with vasculitis, and decreased following certain treatments. We observed that IL-17A from patients with SLE could induce adhesion molecule messenger RNA expression in HUVECs and adhesion of T cells to HUVECs. An increase in the percentage of Th17 cells was correlated with natural Treg cell depletion during disease flare. Finally, expansion of the Th17 cell population was detected in MRL/lpr mice. CONCLUSION SLE flare might be linked to the expansion of the Th17 cell population and the depletion of natural Treg cell subpopulations. Expansion of the Th17 cell population might be related to a distinct cytokine environment in active SLE. Th17 cells and microenvironmental IL-17A are involved in vascular inflammation in SLE. Antagonism of Th17 cells by IL-17A-blocking antibodies should be explored as a treatment of SLE.
Disease remission state in patients treated with the combination of tumor necrosis factor blockade and methotrexate or with disease-modifying antirheumatic drugs: A clinical and imaging comparative study.

OBJECTIVE For patients with rheumatoid arthritis (RA) in remission who are receiving disease-modifying antirheumatic drugs (DMARDs), radiographic progression correlates with imaging-detected synovitis as measured by power Doppler activity. In contrast, patients with disease in remission who are receiving the combination of tumor necrosis factor (TNF) blockade with methotrexate (MTX) (combination treatment) have reduced radiographic damage for the equivalent clinical state. We undertook this study to determine whether the difference in radiographic outcome is a result of more complete suppression of imaging-detected synovitis. METHODS One hundred patients with RA in remission (Disease Activity Score in 28 joints [DAS28] <2.6) for at least 6 months while receiving either combination treatment (n = 50) or DMARDs (n = 50) were matched for clinical variables. Ultrasound of metacarpophalangeal joints 1-5 and the wrist joints was performed. Remission according to imaging results was defined as a score of 0 for both grey scale synovitis and power Doppler activity. RESULTS In patients receiving combination treatment or DMARDs (median DAS28 1.65 versus 1.78, median disease duration 120 months versus 90 months, and median duration of remission 13 months versus 18 months), the proportion with remission according to imaging results was not significantly different (10% versus 16%, respectively). The combination treatment group had more grey scale synovitis (P < 0.001) but similar power Doppler activity (48% versus 60%, respectively; P = 0.229) in any joint as compared with the DMARD group. Results were not affected by stratification for duration of disease or remission. CONCLUSION In RA patients with disease in remission, imaging-detected synovitis persists, with power Doppler activity seen in >or=48% of the patients regardless of therapy. These results suggest that superior radiographic outcomes in patients treated with the combination of TNF blockade and MTX may not be due to complete suppression of imaging-detected synovitis.
Management of Single Fetal Demise in a Multiple Gestation

Intrauterine fetal demise of 1 twin in a multiple gestation is a complex clinical situation. Chorionicity, gestational age at diagnosis, problems specific to the pregnancy, and the emotional needs of the patient can impact management. Strategies to optimize outcomes may include a multidisciplinary team approach and fetal surveillance. The following article reviews (1) adverse fetal and neonatal outcomes associated with intrauterine fetal demise of 1 twin, (2) the potential maternal impact, and (3) the strategies to possibly prevent poor outcomes. It is important to remember that even the most vigilant care may not avoid adverse sequelae in a portion of at-risk pregnancies. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to outline the factors that impact outcome in patients with multiples complicated by a single IUFD, to describe the pathophysiology of adverse outcomes associated with IUFD of one twin, and to list potential strategies for twin pregnancies at risk for IUFD.
The Impact of Prefrontal Cortex for Selective Attention in a Visual Working Memory Task

In this study, a variant of the n-back task was used to investigate electrophysiological correlates of top-down processes in visual-object working memory. Event-related potentials were used to replicate results concerning an attention related modulation of neural processes and to investigate the involvement of prefrontal cortex in this modulation. 16 healthy subjects executed an n-back task with sequentially presented faces and scenes. Attention was selectively directed to only one stimulus category. We found an enhancement of the N170 amplitudes for relevant stimuli compared to irrelevant or neutral stimuli. Late frontal amplitudes were stronger positive for relevant compared to neutral stimuli indicating selective attention processes of working memory. Evidence for selective inhibition was not found.
Alterations of the synovial T cell repertoire in anti-citrullinated protein antibody-positive rheumatoid arthritis.

OBJECTIVE The association of HLA-DRB1 alleles with anti-citrullinated protein antibodies (ACPAs) in rheumatoid arthritis (RA) suggests the potential involvement of T lymphocytes in ACPA-seropositive disease. The purpose of this study was to investigate this hypothesis by systematic histologic and molecular analyses of synovial T cells in ACPA+ versus ACPA- RA patients. METHODS Synovial biopsy samples were obtained from 158 RA patients. Inflammation was determined histologically and immunohistochemically. RNA was extracted from peripheral blood mononuclear cells and synovial tissues obtained from 11 ACPA+ RA patients, 7 ACPA- RA patients, and 10 spondylarthritis (SpA) patients (arthritis controls). T lymphocyte clonality was studied by combined quantitative and qualitative T cell receptor CDR3 length distribution (LD) analysis and direct sequencing analysis. RESULTS ACPA+ and ACPA- RA patients were similar at both the clinical and histologic levels. At the molecular level, however, patients with ACPA+ synovitis displayed a marked elevation of qualitative CDR3 LD alterations as compared with those with ACPA- synovitis and with the SpA controls. These differences in CDR3 LD were not observed in the peripheral blood, indicating a selective recruitment and/or local expansion of T cells in the synovial compartment. The CDR3 LD alterations reflected true monoclonal or oligoclonal expansions, as confirmed by direct sequencing of the T cell receptor. The CDR3 LD alterations in RA synovium did not correlate with B cell clonal expansions but were inversely associated with synovial lymphoid neogenesis. CONCLUSION The T cell repertoire is specifically restricted in RA patients with ACPA+ synovitis. Whereas the origin and role of these clonal alterations remain to be determined, our data suggest the preferential involvement of T lymphocytes in ACPA-seropositive RA.
Pregnancy, Breast-feeding, and Marijuana: A Review Article

&NA; Marijuana is a commonly used drug. At present, it remains an illegal substance in most areas of the United States. Recent controversy regarding the perceived harms of this drug has resulted in debate in both legal and medical circles. &NA; This review examines evidence regarding the effects of marijuana exposure during pregnancy and breast-feeding. We examined studies pertaining to fetal growth, pregnancy outcomes, neonatal findings, and continued development of fetuses and neonates exposed to marijuana through adolescence. In addition, the legal implications for women using marijuana in pregnancy are discussed with recommendations for the care of these patients. &NA; The current evidence suggests subtle effects of heavy marijuana use on developmental outcomes of children. However, these effects are not sufficient to warrant concerns above those associated with tobacco use. &NA; Marijuana is the most commonly used illicit substance in the United States. It is predominantly used for its pleasurable physical and psychotropic effects. With the recent changes to legislature in Colorado and Washington State making the recreational use of marijuana legal, marijuana has gained national attention. This raises the question: If it is legal for a woman to consume marijuana, what is the safety of this activity in pregnancy and breast-feeding? Moreover, do the harms of marijuana use on the fetus or infant justify the mandatory reporting laws in some states? Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After completing this CME activity, physicians should be better able to assess the prevalence of marijuana use in the general obstetric population, evaluate the fetal, neonatal and childhood outcomes associated with marijuana use during pregnancy and breastfeeding, and care for pregnant women who are faced with the possible legal implications of screening for drug use.
Hypoxia and glucocorticoid signaling converge to regulate macrophage migration inhibitory factor gene expression.

OBJECTIVE Macrophage migration inhibitory factor (MIF) is a proinflammatory mediator involved in the pathogenesis of rheumatoid arthritis. This study was undertaken to identify the MIF promoter elements responsible for regulating gene expression. METHODS Luciferase reporter gene assays were used to identify the MIF promoter sequence responsible for basal activity. Bioinformatic analysis was used to predict transcription factor binding sites, and electrophoretic mobility shift assay (EMSA) was used to demonstrate transcription factor binding. Chromatin immunoprecipitation (ChIP) was used to demonstrate transcription factor loading on the MIF promoter. RESULTS We identified the minimal promoter sequence required for basal MIF promoter activity that was also capable of conferring glucocorticoid-dependent inhibition in a T lymphocyte model cell line. Deletion studies and EMSA revealed 2 elements in the MIF promoter that were responsible for basal promoter activity. The 5' element binds CREB/activating transcription factor 1, and the 3' element is a functional hypoxia-responsive element binding hypoxia-inducible factor 1alpha. Further studies demonstrated that the cis elements are both required for glucocorticoid-dependent inhibition. ChIP demonstrated glucocorticoid-dependent recruitment of glucocorticoid receptor alpha to the MIF promoter in lymphocytes within 1 hour of treatment and a concomitant decrease in acetylated histone H3. CONCLUSION Our findings indicate that hypoxia and glucocorticoid signaling converge on a single element regulating MIF; this regulatory unit is a potential interacting node for microenvironment sensing of oxygen tension and glucocorticoid action in foci of inflammation.
Resting Frontal EEG Asymmetry and Shyness and Sociability in Schizophrenia: A Pilot Study of Community-Based Outpatients

We conducted a pilot study to examine the relations among the patterns of resting regional electroencephalogram (EEG) alpha activity, trait shyness and sociability, and positive and negative symptoms scores in 20 adults with schizophrenia, attending a community-based treatment and rehabilitation center. As predicted, patients' positive symptoms were related to greater relative resting left frontal EEG activity, replicating earlier work. When only adults with low to no positive symptoms were considered, trait shyness was related to greater relative resting right frontal EEG activity, whereas trait sociability was related to greater relative resting left frontal EEG activity. This finding is similar to what is consistently noted in healthy adults. These pilot data suggest that positive symptoms in patients with schizophrenia may obscure the relations between personality and frontal EEG asymmetry measures observed in healthy adults.
A Special Case of Anencephaly in an Early-Born Baby with an Exagerated Prognastic Face: Further Example for Human Devolution

A 7-month-old baby was born in a village near Iskenderun (Turkey) where “Unertan Syndrome” with quadrupedality and primitive cognitive abilities was discovered. The clinical diagnosis was anencephaly. However, his head did not show the classical symptoms of anencephaly because it was covered with bony structures. The baby has an ape-like, prognasthic head with low-set ears and flapped ear flaps. The other parts of the body were similar to humans with broad shoulders and a short neck. This may be a further example of human devolution, which was first reported by ). A genetic defect affecting the head development including brain may be responsible for the reappearance of the ape-like head in a human being. This human devolution, or evolution in reverse, suggests that the same gene or gene-pool as well as the interactions between genes may be responsible for the transition from our ancestors into human beings with regard to an orthognasthic head, and brain development.
Dynamics of Manual Skill: A Computerized Analysis of Single PEG Movements and Stochastic Resonance Hypothesis of Cerebral Laterality

Hand skill was analyzed using a computerized peg moving task. The durations of single hand movements (PMTs) were accurately measured in right-hand (RH) and left-hand (LH) writers. One trial consisted of 10 movements of the right hand and 10 movements of the left hand. Each participant performed five trials. Women showed significantly higher percentage than men in right-handedness; men showed higher percentage than women in left-handedness. This sex difference completely disappeared after taking the same height range in participants. The mean RH- and LH-PMTs decreased in 5 successive trials, even within a single trial during 10 successive hand movements, indicating a learning effect of repeated hand movements. The LH- minus RH-PMTs exhibited fluctuations within a single trial between positive (faster right hand) and negative (faster left hand) values. LH–RH PMTs were significantly greater than zero, in favor of right hand, in RH-writers, but not significantly different from zero in LH-writers, exhibiting a true fluctuating asymmetry. Participants with no familial sinistrality (FS-) were preponderantly right-handed (ca. 90%), those with left-handed mother and right-handed father (FS+1) showed stochastic distribution of hand preference (50:50). Participants with right-handed mother and left-hander father (FS+2) were not different from FS- individuals. LH–RH PMT was significantly greater than zero in FS- participants, almost equal to zero in FS+1 participants, and greater than zero in FS+2 participants exhibiting greater asymmetry than that in FS- participants. These results suggest a genetic inheritance of direction and degree of handedness, being a a X-linked trait originating from mother's genotype. It was suggested that fluctuating asymmetries may reflect interactions between stochastic resonance phenomena within right and left brains. This property of brain may genetically transmitted from mother's X chromosome; a net effect of stochastic interactions between hemispheres may result in right- or left-handedness, a predominantly unidirectional coupling creating right-handedness, in favor of left brain, and a stochastic bi-directional coupling between hemispheres would be a main trait of left-handers. This new “stochastic resonance hypothesis of cerebral laterality” concerns with stochastic fluctuations in hand-skill asymmetry and inter-hemispheric coupling through corpus callosum, and seems to be important for new developments in handedness research.
European population substructure is associated with mucocutaneous manifestations and autoantibody production in systemic lupus erythematosus.

OBJECTIVE To determine whether genetic substructure in European-derived populations is associated with specific manifestations of systemic lupus erythematosus (SLE), including mucocutaneous phenotypes, autoantibody production, and renal disease. METHODS SLE patients of European descent (n=1,754) from 8 case collections were genotyped for >1,400 ancestry informative markers that define a north-south gradient of European substructure. Using the Structure program, each SLE patient was characterized in terms of percent Northern (versus percent Southern) European ancestry based on these genetic markers. Nonparametric methods, including tests for trend, were used to identify associations between Northern European ancestry and specific SLE manifestations. RESULTS In multivariate analyses, increasing levels of Northern European ancestry were significantly associated with photosensitivity (Ptrend=0.0021, odds ratio for highest quartile of Northern European ancestry versus lowest quartile [ORhigh-low] 1.64, 95% confidence interval [95% CI] 1.13-2.35) and discoid rash (Ptrend=0.014, ORhigh-low 1.93, 95% CI 0.98-3.83). In contrast, increasing levels of Northern European ancestry had a protective effect against the production of anticardiolipin autoantibodies (Ptrend=1.6x10(-4), ORhigh-low 0.46, 95% CI 0.30-0.69) and anti-double-stranded DNA autoantibodies (Ptrend=0.017, ORhigh-low 0.67, 95% CI 0.46-0.96). CONCLUSION This study demonstrates that specific SLE manifestations vary according to Northern versus Southern European ancestry. Thus, genetic ancestry may contribute to the clinical heterogeneity and variation in disease outcomes among SLE patients of European descent. Moreover, these results suggest that genetic studies of SLE subphenotypes will need to carefully address issues of population substructure based on genetic ancestry.
Electrophysiologic and Neuropsychologic Evaluation of Patients with Centrotemporal Spikes

The present study was designed to evaluate neurocognitive functions with endogenous potentials and neurophysiologic tests in patients with centrotemporal spikes who were not on any medication. Of the patients, 85.7% had seizures, 9.5% had pavor nocturnes, and 4.8% had atypical headache. The patients, especially who had atypical seizures or left-sided epileptic activity, were found to have significant visuomotor function impairment (p <.05). In P300 test, N2P3 amplitude was lower in the patients, particularly who had left sided epileptic activity (p <.05). MMN and LDN results were normal. Serial evaluations of such patients with endogenous potentials and neuropsychological tests may be helpful to show development of neurocognitive impairment.
Sex-specific responses of Populus yunnanensis exposed to elevated CO2 and salinity.

Populus yunnanensis Dode. , a native dioecious woody plant in southwestern China, was employed as a model species to study sex-specific morphological, physiological and biochemical responses to elevated CO2 and salinity. To investigate the effects of elevated CO2 , salinity and their combination, the cuttings were exposed to two CO2 regimes (ambient CO2 and double ambient CO2 ) and two salt treatments in growth chambers. Males exhibited greater downregulation of net photosynthesis rate (Anet ) and carboxylation efficiency (CE) than females at elevated CO2 , whereas these sexual differences were lessened under salt stress. On the other hand, salinity induced a higher decrease in Anet and CE, more growth inhibition and leaf Cl(-) accumulation and more damage to cell organelles in females than in males, whereas the sexual differences in photosynthesis and growth were lessened at elevated CO2 . Moreover, elevated CO2 exacerbated membrane lipid peroxidation and organelle damage in females but not in males under salt stress. Our results indicated that: (1) females are more sensitive and suffer from greater negative effects than do males under salt stress, and elevated CO2 lessens the sexual differences in photosynthesis and growth under salt stress; (2) elevated CO2 tends to aggravate the negative effects of salinity in females; and (3) sex-specific reactions under the combination of elevated CO2 and salinity are distinct from single-stress responses. Therefore, these results provide evidence for different adaptive responses between plants of different sexes exposed to elevated CO2 and salinity.
Cortisol: The Culprit Prenatal Stress Variable

Elevated prenatal cortisol has been associated with several negative conditions including aborted fetuses, excessive fetal activity, delayed fetal growth and development, prematurity and low birthweight, attention and temperament problems in infancy, externalizing problems in childhood, and psychopathology and chronic illness in adulthood. Given that maternal prenatal cortisol crosses the placenta and influences other aspects of the prenatal environment, these effects on the fetus and later development are not surprising. Cortisol would appear to be a mediating variable, resulting from prenatal stress in several forms including depression, anxiety, anger, and daily hassles. Cortisol effects are further complicated by its interaction with neurotransmitters such as norepinephrine, which may itself cause premature birth via intrauterine growth deprivation related to uterine artery resistance. Recent research has suggested that cortisol-reducing therapies such as massage therapy can reduce the risk of perinatal complications including prematurity and low birthweight.