Miracle-dz/UniFAR-FTUs huggingface dataset:
Vitamin D and the immune system: Getting it right

1,25-dihydroxyvitamin D3 (1,25(OH)2D3), the active form of vitamin D, is an important player in calcium and bone metabolism, but 1,25(OH)2D3 also has a physiological role beyond its well-known role in skeletal homeostasis. Receptors for 1,25(OH)2D3 are present in various immune cells, including monocytes, macrophages and dendritic cells, as well as T and B lymphocytes, thus suggesting a role for 1,25(OH)2D3 in both innate and adaptive immune responses. Besides being targets, immune cells express vitamin Dactivating enzymes, allowing local conversion of inactive vitamin D into 1,25(OH)2D3 within the immune system. Data from epidemiological studies are clear: vitamin D deficiency, especially in early life, increases the risk of autoimmune diseases later on and is associated overall with an increased risk of infections. Moreover, higher levels of 25(OH)D3 are associated with relative protection against infections and autoimmune diseases. These association data are corroborated by experiments in preclinical animal models, where data exist that even supplementing with high doses of vitamin D or analogues of 1,25(OH)2D3 can interfere with the course of immune diseases, especially autoimmune diseases like colitis, multiple sclerosis and type 1 diabetes. In humans, however, intervention trials demonstrating strong protection are lacking. This Perspective discusses the complex immune-regulatory effects of 1,25(OH)2D3 on immune cells as well as its role in infectious and autoimmune diseases, using tuberculosis and type 1 diabetes as examples. IBMS BoneKEy. 2011 April;8(4):178-186. 2011 International Bone & Mineral Society
Relationship between body mass index and proteinuria in hypertensive nephrosclerosis: results from the African American Study of Kidney Disease and Hypertension (AASK) cohort.

BACKGROUND Few studies have examined the association between obesity and markers of kidney injury in a chronic kidney disease population. We hypothesized that obesity is independently associated with proteinuria, a marker of chronic kidney disease progression. STUDY DESIGN Observational cross-sectional analysis. SETTING & PARTICIPANTS Post hoc analysis of baseline data for 652 participants in the African American Study of Kidney Disease (AASK). PREDICTORS Obesity, determined using body mass index (BMI). MEASUREMENTS & OUTCOMES Urine total protein-creatinine ratio and albumin-creatinine ratio measured in 24-hour urine collections. RESULTS AASK participants had a mean age of 60.2 ± 10.2 years and serum creatinine level of 2.3 ± 1.5 mg/dL; 61.3% were men. Mean BMI was 31.4 ± 7.0 kg/m(2). Approximately 70% of participants had a daily urine total protein excretion rate <300 mg/d. In linear regression analyses adjusted for sex, each 2-kg/m(2) increase in BMI was associated with a 6.7% (95% CI, 3.2-10.4) and 9.4% (95% CI, 4.9-14.1) increase in urine total protein-creatinine and urine albumin-creatinine ratios, respectively. In multivariable models adjusting for age, sex, systolic blood pressure, serum glucose level, uric acid level, and creatinine level, each 2-kg/m(2) increase in BMI was associated with a 3.5% (95% CI, 0.4-6.7) and 5.6% (95% CI, 1.5-9.9) increase in proteinuria and albuminuria, respectively. The interaction between older age and BMI was statistically significant, indicating that this relationship was driven by younger AASK participants. LIMITATIONS May not generalize to other populations; cross-sectional analysis precludes statements regarding causality. CONCLUSIONS BMI is associated independently with urine total protein and albumin excretion in African Americans with hypertensive nephrosclerosis, particularly in younger patients.
Radiologic reporting for paranasal sinus computed tomography: A multi‐institutional review of content and consistency

To optimize clinical care, radiologic reporting should consistently include clinically pertinent information. The purpose of this study was to: 1) determine the current satisfaction of otolaryngologists with paranasal sinus computed tomography (CT) radiologic reporting and 2) evaluate the comprehensiveness of paranasal sinus CT radiologic reporting.
Microbial epidemiology of candidaemia in neonatal and paediatric intensive care units at the Children's Medical Center, Tehran

Invasive candidiasis is a major cause of morbidity and mortality in children. However, limited data are available on the epidemiology of this infection in paediatric settings in Iran. The aim of this study was to determine the prevalence, microbial epidemiology, risk factors and clinical outcomes associated with candidaemia in intensive care units at the Children's Medical Center, Tehran, Iran. All blood and other normally sterile specimen cultures positive for Candida species were included. Isolates were identified by morphological and molecular methods. Unidentified/doubtful yeast isolates were subjected to ITS sequencing. A total of 156 episodes of invasive candidiasis, with an overall incidence of 15.2 per 1000 ICU admissions, was recorded. Risk factors included presence of central venous lines (89.1%), mechanical ventilation (55.8%) and parenteral nutrition (51.3%). Candida albicans (57.1%) and Candida parapsilosis (24.4%) were the most commonly isolated species. Candida orthopsilosis, Candida glabrata, Candida dubliniensis, Candida lusitaniae, Candida kefyr and Candida intermedia accounted for about 11% of the cases. The overall mortality rate was 42.5%. Non‐albicans Candida species accounted for nearly half of the cases of paediatric candidaemia. This is the first prospective study of candidaemia in paediatric settings in Iran and serves to inform necessary interventions for the prevention of candidaemia.
Analysis of the readability of patient education materials from surgical subspecialties

Patients are increasingly using the Internet as a source of information on medical conditions. Because the average American adult reads at a 7th‐ to 8th‐grade level, the National Institutes of Health recommend that patient education material be written between a 4th‐ and 6th‐grade level. In this study, we assess and compare the readability of patient education materials on major surgical subspecialty Web sites relative to otolaryngology.
Circulatory response to hydrotherapy and dry heat in individuals with type 2 diabetes

In total, 33 subjects aged 23–74 years were examined to observe the effect of exposure to warm water hydrotherapy (40oC), local heating (40oC) and global (whole body) dry heat at 30oC and 40oC on their circulation. Data from patients with type 2 diabetes (n=16, mean age=58.3±11.5 years, mean weight=88.1±16.4 kg) were compared to data from control subjects (n=17, mean age=52±14.2 years, mean weight=80.4±12.3 kg). Vascular occlusion was used to assess endothelial damage. Subjects with type 2 diabetes had an impaired circulatory response to warm water immersion, dry heat and the application of local heat to increase skin temperature. Blood flow, in general, was diminished in diabetics by at least 50% when comparing resting blood flow in diabetics to that in control subjects. The response to heat under any condition studied here was also severely impaired in subjects with diabetes. These findings suggest that the application of warmth to increase circulation in patients with diabetes may not be as beneficial .
Factors that predict dissemination of evidence-based practice in one local authority in England: An assessment of introducing node-link mapping into substance misuse practice

Abstract Aims: Node-link mapping (NLM) has been strongly advocated as a cognitive tool that aims to enhance the treatment process and is supported by a large evidence-base. In one local authority area in England, NLM was systematically introduced and embedded into staff daily practice across five main services including non-statutory, NHS and young people’s services. The study aimed to assess training and adoption of NLM prior to implementation into daily practice. Methods/Results: In total, 123 staff members were trained in NLM concepts across a number of workshops. Staff responses were recorded in a Workshop Evaluation Survey that suggested a high degree of satisfaction with the training provided although “time” was identified as a pre-requisite to prepare for implementation. A random sample of staff (n = 44) were followed-up at 6 months and were asked to complete a Workshop Assessment Follow-up schedule alongside participation in focus group interviews. Despite a commitment to NLM, there were mixed perceptions into the efficacy of node-link mapping. Staff concerns focused on lack of perceived ownership of the implementation process and a lack of confidence in using mapping on a regular basis. Managers also reflected reservations with “traditional” training methods and how to incorporate new practices into supervision processes. Implications for the dissemination of evidence-base practices are discussed.
Tissue engineering airway mucosa: A systematic review

Effective treatments for hollow organ stenosis, scarring, or agenesis are suboptimal or lacking. Tissue‐engineered implants may provide a solution, but those performed to date are limited by poor mucosalization after transplantation. We aimed to perform a systematic review of the literature on tissue‐engineered airway mucosa. Our objectives were to assess the success of this technology and its potential application to airway regenerative medicine and to determine the direction of future research to maximize its therapeutic and commercial potential.
Effects of DA-6034 on aqueous tear fluid secretion and conjunctival goblet cell proliferation.

PURPOSE This study was conducted to evaluate the effect of DA-6034, a potent secretagogue, on aqueous tear fluid secretion and its quality in normal rabbit. We also evaluated, in animal models of experimentally induced dry eye disease, its effectiveness over time to stimulate aqueous tear production by ocular ferning test and goblet cell proliferation. METHODS Aqueous tear production, total protein levels, and glycoprotein levels in normal rabbits were evaluated after topical application of DA-6034 (0.3, 1, and 3%). Moreover, time course aqueous tear volume measurement and ocular ferning test in tear fluid were performed in dry eyes of rabbits that had been given 1% atropine sulfate, topically. Altogether, tear fluid production and conjunctival goblet cell numbers were measured in dry eyes of mice that had been given topical scopolamine. RESULTS Topical application of DA-6034 (0.3, 1, and 3%) significantly increased (P < 0.05) aqueous tear production in a concentration-dependent manner in normal rabbits. There was no change in total protein levels while glycoprotein levels were significantly increased (P < 0.05) at 3% DA-6034. The increase in aqueous tear fluid was significant (P < 0.05) and lasted for 2 h post-instillation in dry eyes of rabbits that had been given 1% atropine sulfate; 10-day repeated instillation of the drug in this model resulted in large and homogeneous fern-like tear patterns. In a mouse model, DA-6034 given as a 3% eyedrop solution significantly increased (P < 0.05) tear fluid production and conjunctival goblet cell number. CONCLUSIONS These results suggest that DA-6034 accelerates not only tear secretion but also mucin production and may be a potential therapeutic agent for the treatment of dry eye disease.
Topical cyclosporine 0.05% for the prevention of dry eye disease progression.

PURPOSE To assess the prognosis of dry eye in patients treated with cyclosporine 0.05% or artificial tears by using the International Task Force (ITF) guidelines. METHODS This was a single-center, investigator-masked, prospective, randomized, longitudinal trial. Dry eye patients received twice-daily treatment with either cyclosporine 0.05% (Restasis; Allergan, Inc., Irvine, CA; n = 36) or artificial tears (Refresh Endura; Allergan, Inc., Irvine, CA; n = 22) for 12 months. Disease severity was determined at baseline and month 12 according to the consensus guidelines developed by the ITF. Dry eye signs and symptoms were evaluated at baseline and months 4, 8, and 12. RESULTS Baseline sign and symptom scores and the proportion of patients with the disease severity level 2 or 3 were comparable in both groups (P > 0.05). At month 12, 34 of 36 cyclosporine patients (94%) and 15 of 22 artificial tear patients (68%) experienced improvements or no change in their disease severity (P = 0.007) while 2 of 36 cyclosporine patients (6%) and 7 of 22 artificial tears patients (32%) had disease progression (P < 0.01). Cyclosporine 0.05% improved Schirmer test scores, tear breakup time, and Ocular Surface Disease Index scores throughout the study, with significant (P < 0.01) differences compared with artificial tears being observed at months 8 and 12. CONCLUSIONS Treatment with cyclosporine 0.05% may slow or prevent disease progression in patients with dry eye at severity levels 2 or 3.
Review: Tau in biofluids – relation to pathology, imaging and clinical features

Tau is a microtubule‐binding protein that is important for the stability of neuronal axons. It is normally expressed within neurons and is also secreted into the brain interstitial fluid that communicates freely with cerebrospinal fluid (CSF) and, in a more restricted manner, blood via the glymphatic clearance system of the brain. In Alzheimer's disease (AD), neuroaxonal degeneration results in increased release of tau from neurons. Furthermore, tau is truncated and phosphorylated, which leads to aggregation of tau in neurofibrillary tangles of the proximal axoplasm. Neuroaxonal degeneration and tangle formation are reflected by increased concentrations of total tau (T‐tau, measured using assays that detect most forms of tau) and phospho‐tau (P‐tau, measured using assays with antibodies specific to phosphorylated forms of tau). In AD CSF, both T‐tau and P‐tau concentrations are increased. In stroke and other CNS disorders with neuroaxonal injury but without tangles, T‐tau is selectively increased, whereas P‐tau concentration often stays normal. In tauopathies (diseases with both neurodegeneration and neurofibrillary tangles) other than AD, CSF T‐tau and P‐tau concentrations are typically unaltered, which is a puzzling result that warrants further investigation. In the current review, I discuss the association of T‐tau and P‐tau concentrations in body fluids with neuropathological changes, imaging findings and clinical features in AD and other CNS diseases.
Marinesco bodies and substantia nigra neuron density in Parkinson's disease

Marinesco bodies (MB) are intranuclear inclusions in pigmented neurons of the substantia nigra (SN). While rare in children, frequency increases with normal ageing and is high in Alzheimer's disease, dementia with Lewy bodies and other neurodegenerative disorders. Coinciding with the age‐related rise in MB frequency is initiation of cell death among SN neurons. Whether MB have a role in this process is unknown. Our aim is to examine the association of MB with SN neuron density in Parkinson's disease (PD) in the Honolulu‐Asia Aging Study.
Infection control: behavioural issues for healthcare workers

Purpose – The purpose of this research is to explore healthcare workers' infection control practices from a behavioural viewpoint. Major behavioural theories are explored. Findings from a study which drew heavily from the PRECEDE theoretical framework are presented. The main purpose of this quasi‐experimental study was to observe health care workers' behavioural compliance with hand hygiene guidelines during patient care in an Intensive Care Unit in Ireland before (pre test) and after (post test) implementation of a multifaceted hand hygiene program. Health care workers' attitudes, beliefs and knowledge in relation to compliance with hand‐washing guidelines were also investigated.Design/methodology/approach – Data were collected through non‐participant observation and survey methods. A convenience sample of nurses, doctors, physiotherapists and care assistants (n=73 observational subjects, n=62 questionnaire respondents) was used.Findings – Data (n=314 observations, 62 questionnaires) were analysed descri.
O acesso e a dificuldade na resolutividade do cuidado da criança na atenção primária à saúde

ObjectiveTo learn how access is conducted in two primary care units, traditional and family health strategy, and assess whether there was resoluteness of assistance to child health.MethodsThis is a qualitative study, we used hermeneutic for understanding the data. The research instrument was non-participant observation technique; the data were analyzed using thematic analysis method.ResultsThere are four sub-categories: children, their family members and the first contact in primary care; the service organization and its influence on access; the therapeutic itinerary of the family and child in search of health care; scheduled access to health care.ConclusionAccess to health services showed weaknesses regarding the child health care and the proposed care service could build stable relationships and humanized care to child demand in primary health care.
Racial survival paradox of dialysis patients: robust and resilient.

The inception of the end-stage renal disease (ESRD) program in the United States some 40 years ago heralded the near-universal availability of life-saving kidney replacement therapy for all Americans who required this expensive treatment, irrespective of their race or ethnicity, with the intent ultimately to transplant the majority of these patients. Currently, minorities compose >50% of the approximately half-million US ESRD population, almost 35% of whom are African Americans or self-declared blacks.1 In contrast, the African American proportion of the US general population currently is 14%. 1,2 Dialysis patients continue to have an exceptionally high mortality rate, with ~20% of dialysis patients dying annually in the United States and a 5-year survival rate <35%. Most patients with terminal cancers live longer than dialysis patients.3 Despite poor overall survival, minority dialysis patients and black patients in particular surprisingly have better outcomes than whites. This phenomenon has been called a survival paradox because the lower mortality rate of African American dialysis patients is in sharp contradistinction to the general US population, in which whites have a longer life expectancy than blacks.1 A recent report by Kucirka et al2 in the Journal of the American Medical Association explored the effect of race on dialysis outcomes in more detail, finding that the commonly described African American survival advantage only holds for dialysis patients older than 50 years.
Bleeding complications of native kidney biopsy: a systematic review and meta-analysis.

BACKGROUND Kidney biopsy provides important information for nephrologists, but the risk of complications has not been systematically described. STUDY DESIGN Meta-analysis of randomized controlled trials and prospective or retrospective observational studies. SETTING & POPULATION Adults undergoing native kidney biopsy in an inpatient or outpatient setting. SELECTION CRITERIA FOR STUDIES MEDLINE indexed studies from January 1980 through June 2011; sample size of 50 or more. INTERVENTION Native kidney biopsy with automated biopsy device and real-time ultrasonographic guidance. OUTCOMES Macroscopic hematuria and erythrocyte transfusion rates and factors associated with these outcomes. RESULTS 34 studies of 9,474 biopsies met inclusion criteria. The rate of macroscopic hematuria was 3.5% (95% CI, 2.2%-5.1%), and erythrocyte transfusion was 0.9% (95% CI, 0.4%-1.5%). Significantly higher rates of transfusion were seen with the following: 14-gauge compared with smaller needles (2.1% vs 0.5%; P = 0.009), studies with mean serum creatinine level ≥2.0 mg/dL (2.1% vs 0.4%; P = 0.02), ≥50% women (1.9% vs 0.6%; P = 0.03), and ≥10% of biopsies for acute kidney injury (1.1% vs 0.04%; P < 0.001). Higher transfusion rates also were observed in studies with a mean age of 40 years or older (1.0% vs 0.2%; P = 0.2) and mean systolic blood pressure ≥130 mm Hg (1.4% vs 0.1%; P = 0.09). Similar relationships were noted for the macroscopic hematuria rate with the same predictors, but none was statistically significant. LIMITATIONS Publication bias, few randomized controlled trials, and missing data. CONCLUSIONS Native kidney biopsy using automated biopsy devices and real-time ultrasonography is associated with a relatively small risk of macroscopic hematuria and erythrocyte transfusion requirement. Using smaller gauge needles may lower complication rates. Patient selection may affect outcome because studies with higher serum creatinine levels, more women, and higher rates of acute kidney injury had higher complication rates. Future studies should further evaluate risk factors for complications.
Inflammatory pathology markers (activated microglia and reactive astrocytes) in early and late onset Alzheimer disease: a post mortem study

The association between the pathological features of AD and dementia is stronger in younger old persons than in older old persons suggesting that additional factors are involved in the clinical expression of dementia in the oldest old. Cumulative data suggests that neuroinflammation plays a prominent role in Alzheimer′s disease (AD) and different studies reported an age‐associated dysregulation of the neuroimmune system. Consequently, we sought to characterize the pattern of microglial cell activation and astrogliosis in brain post mortem tissue of pathologically confirmed cases of early and late onset AD (EOAD and LOAD) and determine their relation to age.
Renal services disaster planning: Lessons learnt from the 2011 Queensland floods and North Queensland cyclone experiences

In 2011, Queensland dialysis services experienced two unprecedented natural disasters within weeks of each other. Floods in south‐east Queensland and Tropical Cyclone Yasi in North Queensland caused widespread flooding, property damage and affected the provision of dialysis services, leading to Australia's largest evacuation of dialysis patients. This paper details the responses to the disasters and examines what worked and what lessons were learnt. Recommendations are made for dialysis units in relation to disaster preparedness, response and recovery.