Miracle-dz/UniFAR-FTUs huggingface dataset:
The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma.

BACKGROUND Urgent débridement of open fractures has been considered to be of paramount importance for the prevention of infection. The purpose of the present study was to evaluate the relationship between the timing of the initial treatment of open fractures and the development of subsequent infection as well as to assess contributing factors. METHODS Three hundred and fifteen patients with severe high-energy lower extremity injuries were evaluated at eight level-I trauma centers. Treatment included aggressive débridement, antibiotic administration, fracture stabilization, and timely soft-tissue coverage. The times from injury to admission and operative débridement as well as a wide range of other patient, injury, and treatment-related characteristics that have been postulated to affect the risk of infection within the first three months after injury were studied, and differences between groups were calculated. In addition, multivariate logistic regression models were used to control for the effects of potentially confounding patient, injury, and treatment-related variables. RESULTS Eighty-four patients (27%) had development of an infection within the first three months after the injury. No significant differences were found between patients who had development of an infection and those who did not when the groups were compared with regard to the time from the injury to the first débridement, the time from admission to the first débridement, or the time from the first débridement to soft-tissue coverage. The time between the injury and admission to the definitive trauma treatment center was an independent predictor of the likelihood of infection. CONCLUSIONS The time from the injury to operative débridement is not a significant independent predictor of the risk of infection. Timely admission to a definitive trauma treatment center has a significant beneficial influence on the incidence of infection after open high-energy lower extremity trauma.
Falls and Depression in Older People

Background: Depression is one of the most common risk factors for falls, but links between falls and depression are still unclear. Few studies have examined the relationship between depression and gait alteration, which may increase the risk of fall. Objective: This study aims to assess a possible relationship between depression, postural and gait abnormalities, and falls. Methods: We conducted a 1-year prospective study on patients ≧70 years who were admitted to a geriatric unit for ‘spontaneous’ unexplained falls. Patients were tested for depression using the 30-item Geriatric Depression Scale (GDS). Their motor performances were assessed using the Mini Motor Test (MMT), which is an easy direct-observation test, validated in France, for assessment of frail old people who present with severe postural and gait impairment. This scale is composed of 4 categories of items: (1) abilities in bed; (2) quality of the sitting position; (3) abilities in the standing position, and (4) quality of gait. Results: Sixty-nine patients were included. Depression was found in 46 patients (66.7%). The MMT score was higher in the non-depressed fallers (NDF) group (GDS ≤10) compared to the depressed fallers (DF) group (GDS>10; p < 0.05). The 2 groups were compared for each of the 4 items of the MMT: the difference between the DF and NDF groups was mainly explained by the impairment of postural abilities in the standing position. Conclusions: Our results support the idea that depression is associated with postural abnormalities in the standing position, which may predispose to falls. In clinical practice, more attention should be given to old fallers concerning diagnosis and treatment of associated depression.
Secondary peritonitis -evaluation of 204 cases and literature review

Abstract Hypothesis: Even at the beginning of the new millennium, secondary peritonitis presents a common life-threatening condition associated with high mortality and morbidity. Objective: This article comments on epidemiology, diagnosis and general principles of surgical management in patients with secondary peritonitis. Methods and Results: The demographic data, clinical findings and surgical outcome of 204 patients who had a confirmed generalized secondary peritonitis were analyzed retrospectively. Our approach was laparotomy, surgical control of contamination, antibiotic therapy and modern intensive care support. Acid peptic disease was the most common cause of perforation peritonitis 60 (29,41%), following by the perforated appendicitis 45 ( 22,06%). The faecal peritonitis and colon perforation were found in 42 patients (20,59%). The morbidity rate was 50%; 41 (40,2%) patients had more than one complication. The morbidity rate was significantly the highest in patients with colon perforation (n=38, 90%) (Hi-square=40,1; p<0,001). The overall mortality rate in our study was 8,82%. The mortality rate was significantly the highest among the patients with mesenteric ischemia in 4 patients (66,67%), followed by colon perforation in 10 cases (23,81%), and 4(6,6%) deaths due to gastro-duodenal perforation (Hi-square=45,7; p<0,001). Discussion: This study has confirmed that the clinical presentation and outcome of the secondary peritonitis depend on duration of abdominal infection, the site of perforation and the general condition of the patient. Rapid surgical source control, modern intensive care and sepsis therapy may offer the chance of decreased morbidity and mortality of the intra-abdominal infections. Abbreviations Intensive Care Unit (ICU), Perforated Diverticular Disease (PDD), Inflammatory Bowel Disease (IBD), Multiple Organ Dysfunction Syndrome (MODS), Acute Respiratory Distress Syndrome (ARDS), Nonsteroidal Anti-inflammatory Drugs (NSAID), Peptic Ulcer Disease(PUD), Ultrasonography (US), Computer Tomography (CT), Colorectal Cancer (CRC), Postoperative Adhesive Disease (PAD), Acute Mesenteric Ischemia (AMI).
DNA-PKcs Controls an Endosomal Signaling Pathway for a Proinflammatory Response by Natural Killer Cells

DNA-dependent protein kinase and Akt are required for the activation of NF-κB by an endosomal receptor. Under the Surface In addition to serving as compartments in which signaling by internalized receptors is terminated, endosomes provide venues in which other receptors continue to signal or even trigger alternative pathways. Indeed, some receptors that fail to signal at the membrane function efficiently in endosomes. CD158d, an endosome-resident, immunoglobulin-like receptor found mostly in natural killer (NK) cells, triggers a proinflammatory and proangiogenic pathway in response to soluble human leukocyte antigen G (HLA-G). Uptake of fetal trophoblast–derived HLA-G by maternal NK cells may trigger the vascular remodeling required to establish an effective blood supply to the fetus, but how CD158d stimulates this response is unclear. Rajagopalan et al. found that endosomal CD158d activated nuclear factor κB (NF-κB) through a mechanism that depended on the kinase Akt, but not phosphatidylinositol 3-kinase (PI3K). In addition, CD158d associated with the catalytic subunit of DNA-dependent protein kinase (DNA-PKcs), which phosphorylated Akt at the endosome. In addition to expanding the known roles of DNA-PKcs, this study also highlights a PI3K-independent, endosomal function for Akt that is required for a proinflammatory response in NK cells. Endosomes are emerging as specialized signaling compartments that endow receptors with distinct signaling properties. The diversity of endosomal signaling pathways and their contribution to various biological responses is still unclear. CD158d, which is also known as the killer cell immunoglobulin-like receptor (KIR) 2DL4 (KIR2DL4), is an endosome-resident receptor in natural killer (NK) cells that stimulates the release of a unique set of proinflammatory and proangiogenic mediators in response to soluble human leukocyte antigen G (HLA-G). Here, we identified the CD158d signaling cascade. In response to soluble agonist antibody or soluble HLA-G, signaling by CD158d was dependent on the activation of nuclear factor κB (NF-κB) and the serine-threonine kinase Akt. CD158d associated with the catalytic subunit of DNA-dependent protein kinase (DNA-PKcs), promoted the recruitment of Akt to endosomes, and stimulated the DNA-PKcs–dependent phosphorylation of Akt. The sequential requirement for DNA-PKcs, Akt, and NF-κB in signaling by CD158d delineates a previously uncharacterized endosomal signaling pathway for a proinflammatory response in NK cells.
The effect of diagnostic confidence on the probability of optical colonoscopic confirmation of potential polyps detected on CT colonography: prospective assessment in 1,339 asymptomatic adults.

OBJECTIVE We sought to evaluate the effect of interpreter confidence on the likelihood that a lesion detected on CT colonography (CTC) will correspond to a matched polyp seen on optical colonoscopy. SUBJECTS AND METHODS Same-day CTC and optical colonoscopy were performed on 1,339 asymptomatic adults. A standard matching algorithm for polyp size and location was used. For each potential polyp detected on CTC, the level of diagnostic confidence was prospectively rated on a 3-point scale (1, least certain; 2, intermediate; and 3, most certain). RESULTS For CTC-detected lesions 6 mm or larger, diagnostic confidence levels of 1, 2, and 3 corresponded to matched polyps on optical colonoscopy in 33.3% (45/135), 50.0% (103/206), and 66.8% (157/235) of cases, respectively (p < 0.01). Similar trends were present for categories of lesions that measured 6-7 mm, 8-9 mm, and 10 mm or larger, rising to a match rate of 82.1% (55/67) for lesions 10 mm or larger that were diagnosed with a level-3 confidence rating. The likelihood that a matched polyp was adenomatous increased with greater levels of diagnostic confidence. Of note, level-3 confidence for lesions measuring 8-9 mm on CTC more often yielded a matching neoplasm on optical colonoscopy than level-1 or level-2 confidence for lesions measuring 10 mm or larger (60.3% [35/58] vs 20.8% [10/48]; p < 0.0001). CONCLUSION Greater diagnostic confidence for an individual lesion detected on CTC correlates with a significantly increased likelihood that a matching polyp will be found on optical colonoscopy and that this matched polyp will be neoplastic. Although polyp size represents the primary criterion for CTC screening algorithms, this data could help guide the decision to opt for noninvasive CTC surveillance versus optical colonoscopy for polypectomy.
Atypical antipsychotic agents in the treatment of violent patients with schizophrenia and schizoaffective disorder.

CONTEXT Violent behavior of patients with schizophrenia prolongs hospital stay and interferes with their integration into the community. Finding appropriate treatment of violent behaviors is of primary importance. OBJECTIVE To compare the efficacy of 2 atypical antipsychotic agents, clozapine and olanzapine, with one another and with haloperidol in the treatment of physical assaults and other aggressive behaviors in physically assaultive patients with schizophrenia and schizoaffective disorder. DESIGN AND SETTING Randomized, double-blind, parallel-group, 12-week trial. Physically assaultive subjects with schizophrenia or schizoaffective disorder who were inpatients in state psychiatric facilities were randomly assigned to treatment with clozapine (n = 37), olanzapine (n = 37), or haloperidol (n = 36). MAIN OUTCOME MEASURES Number and severity of physical assaults as measured by the Modified Overt Aggression Scale (MOAS) physical aggression score and the number and severity of all aggressive events as measured by the MOAS overall score. Psychiatric symptoms were assessed through the Positive and Negative Syndrome Scale (PANSS). RESULTS Clozapine was superior to both olanzapine and haloperidol in reducing the number and severity of physical assaults as assessed by the MOAS physical aggression score and in reducing overall aggression as measured by the MOAS total score. Olanzapine was superior to haloperidol in reducing the number and severity of aggressive incidents on these 2 MOAS measures. There were no significant differences among the 3 medication groups in improvement of psychiatric symptoms as measured by the PANSS total score and the 3 PANSS subscales. CONCLUSIONS Clozapine shows greater efficacy than olanzapine and olanzapine greater efficacy than haloperidol in reducing aggressive behavior. This antiaggressive effect appears to be separate from the antipsychotic and sedative action of these medications.
The Use of Community-Based Modified Directly Observed Therapy for the Treatment of HIV-Infected Persons

Directly observed therapy, which has been successful in the treatment of tuberculosis, is being adapted for the treatment of HIV to decrease long-term morbidity and mortality. We describe the experiences of 69 HIV-infected individuals who were enrolled in a community-based modified directly observed therapy (MDOT) program. Participants were referred by their primary care physicians based on nonadherence to antiretroviral therapy, and/or active substance use. A near-peer outreach worker initially delivered medications to participants 5 to 7 days per week, with visits subsequently tapered to 1 to 3 days per week after 3 or more months. Questionnaires were completed and laboratory values were obtained at baseline, 1 month, and every 3 months after enrollment. At enrollment, 96% of participants had a history of substance use, 71% had a history of incarceration, and 93% were experienced with highly active antiretroviral therapy (HAART). At the time of their 6-month assessment visit, 31 of 69 participants were receiving observed therapy visits. The median baseline plasma viral load (PVL) was 4.8 log, and the median individual change in PVL from baseline to 6 months among participants receiving MDOT was a decrease of 2.7 log. Reasons why participants were not receiving visits included medication holidays, hospitalization or assisted living, incarceration, discontinuation of program involvement, and death. These results support that MDOT should be included in the spectrum of options available to enhance adherence to HAART among patients who are unsuccessful with self-administration of their medications.
Hyperosmotic stress‐induced reorganization of actin bundles in Dictyostelium cells over‐expressing cofilin

Cofilin is a low‐molecular weight actin‐modulating protein, which binds to, severs, and depolymerizes actin filaments in vitro. Aip1, an actin‐interacting protein, was recently identified as a product of a gene on a multicopy plasmid which suppresses the temperature‐sensitive phenotype of a cofilin mutant in Saccharomyces cerevisiae. Actin cytoskeleton plays an essential role in resistance to hyperosmotic stress in Dictyostelium discoideum. The roles of cofilin and Aip1 in this resistance are not known.
Prospective Study on the Usefulness of Lung Scan in Patients with Deep Vein Thrombosis of the Lower Limbs

Summary Background: Asymptomatic pulmonary embolism (PE) is a common finding in patients with deep venous thrombosis (DVT) of the lower limbs, but the usefulness of seeking for silent PE in patients with acute DVT has not been evaluated. Patients and methods: This was a prospective study involving consecutive patients with acute symptomatic proximal DVT (confirmed by objective methods) and no clinical suspicion of PE. All patients underwent chest X-ray, ventilation-perfusion lung scan and arterial blood gases on admission, and received anticoagulant therapy. Those with scintigraphic evidence of PE underwent repeated lung scan and blood gases 7 days later. The aim of the study was to assess how many patients with silent PE develop symptoms while on heparin therapy, and in how many of them such symptoms are due to recurrent PE. Results: 946 consecutive patients with acute, proximal DVT had no contraindications to full-dose anticoagulant therapy. Baseline lung scan revealed high-probability defects (silent PE) in 200 (21%). Seven of these 200 patients had symptomatic recurrences during the 7-day study period, and an inferior vena cava filter was inserted. Besides, 6 patients developed PE symptoms, but no new perfusion defects were found on repeated scan. They switched to coumarin therapy, and they did not develop any further complications. Conclusions: Lung scan in patients with symptomatic DVT and no clinical suspicion of PE may be useful, since some patients with silent PE may develop symptoms while on heparin therapy. Without a baseline scintigraphy all these patients would have been considered to have recurrent PE, and vena cava interruption could have been performed.
X-ray absorption spectroscopy study of the effects of pH and ionic strength on Pb(II) sorption to amorphous silica.

Pb(III) sorption to hydrous amorphous SiO2 was studied as a function of pH and ionic strength using XAS to characterize the sorption products formed. Pb sorption increased with increasing pH and decreasing ionic strength. The XAS data indicated that the mechanism of Pb(II) sorption to the SiO2 surface was pH-dependent. At pH < 4.5, a mononuclear inner-sphere Pb sorption complex with ionic character dominated the Pb surface speciation. Between pH 4.5 and pH 5.6, sorption increasingly occurred via the formation of surface-attached covalent polynuclear Pb species, possibly Pb-Pb dimers, and these were the dominant Pb complexes at pH > or = 6.3. Decreasing ionic strength from I = 0.1 to I = 0.005 M NaClO4 significantly increased Pb sorption but did not strongly influence the average local coordination environment of sorbed Pb at given pH, suggesting that the formation of mononuclear and polynuclear Pb complexes at the surface were coupled; possibly, Pb monomers control the formation of Pb polynuclear species by diffusion along the surface, or they act as nucleation centers for additional Pb uptake from solution. This study shows that the effectiveness of SiO2 in retaining Pb(II) is strongly dependent on solution conditions. At low pH, Pb(II) may be effectively remobilized by competition with other cations, whereas sorbed Pb is expected to become less susceptible to desorption with increasing pH. However, unlike for Ni(II) and Co(II), no lead phyllosilicates are formed at these higher pH values; therefore, SiO2 is expected to be a less effective sink for Pb immobilization than for these other metals.
Oct4‐induced oligodendrocyte progenitor cells enhance functional recovery in spinal cord injury model

The generation of patient‐specific oligodendrocyte progenitor cells (OPCs) holds great potential as an expandable cell source for cell replacement therapy as well as drug screening in spinal cord injury or demyelinating diseases. Here, we demonstrate that induced OPCs (iOPCs) can be directly derived from adult mouse fibroblasts by Oct4‐mediated direct reprogramming, using anchorage‐independent growth to ensure high purity. Homogeneous iOPCs exhibit typical small‐bipolar morphology, maintain their self‐renewal capacity and OPC marker expression for more than 31 passages, share high similarity in the global gene expression profile to wild‐type OPCs, and give rise to mature oligodendrocytes and astrocytes in vitro and in vivo. Notably, transplanted iOPCs contribute to functional recovery in a spinal cord injury (SCI) model without tumor formation. This study provides a simple strategy to generate functional self‐renewing iOPCs and yields insights for the in‐depth study of demyelination and regenerative medicine.
High-dose melphalan with autologous stem-cell rescue in metastatic rhabdomyosarcoma.

PURPOSE The European Collaborative MMT4-91 trial was conducted as a prospective nonrandomized study to evaluate the potential benefit of high-dose melphalan as consolidation of first complete remission in children with stage IV rhabdomyosarcoma. PATIENTS AND METHODS Fifty-two patients in complete remission after six courses of chemotherapy received "megatherapy": 42 received melphalan alone, whereas 10 received melphalan in combination with etoposide, carboplatin/etoposide, or thiotepa/busulfan and etoposide. The outcome of this group of patients was compared with that observed in 44 patients who were also in complete remission after six courses of identical chemotherapy (plus surgery or radiotherapy) but went on to receive a total of up to 12 courses of conventional chemotherapy (four cycles). No differences were found between the two groups regarding clinical characteristics, chemotherapy received before complete remission, or response to chemotherapy. In particular, there was no significant difference between the groups for site of primary tumor, histologic subtype, age at presentation, presence of bone or bone marrow metastases, or number of metastases. RESULTS The 3-year event-free survival (EFS) and overall survival (OS) rates were 29.7% and 40%, respectively, for those receiving high-dose melphalan or other multiagent high-dose regimens and 19.2% and 27.7%, respectively, for those receiving standard chemotherapy. The difference was not statistically significant (P =.3 and P =.2 for EFS and OS, respectively). There was a significant prolongation in the time from the last day of high-dose chemotherapy or the end of chemotherapy cycle 4 to the time of relapse in those receiving megatherapy (168 days for patients receiving megatherapy v 104 days for those receiving standard therapy; P =.05). CONCLUSION The addition of a high-dose alkylating agent to consolidation therapy may have prolonged progression-free survival in this poor-risk patient group, but it did not significantly improve the ultimate outcome.
Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study.

BACKGROUND Decompression alone (D) is a well-accepted treatment for patients with lumbar spinal stenosis (LSS) causing neurogenic claudication; however, D is controversial in patients with LSS who have degenerative spondylolisthesis (DLS). Our goal was to compare the outcome of anatomy-preserving D with decompression and fusion (DF) for patients with grade I DLS. We compared patients with DLS who had elective primary 1-2 level spinal D at 1 centre with a cohort who had 1-2 level spinal DF at 5 other centres. METHODS Patients followed for at least 2 years were included. Primary analysis included comparison of change in SF-36 physical component summary (PCS) scores and the proportion of patients achieving minimal clinically important difference (MCID) and substantial clinical benefit (SCB). RESULTS There was no significant difference in baseline SF-36 scores between the groups. The average change in PCS score was 10.4 versus 11.4 (p = 0.61) for the D and DF groups, respectively. Sixty-seven percent of the D group and 71% of the DF group attained MCID, while 64% of both D and DF groups attained SCB. There was no significant difference between D and DF for change in PCS score (p = 0.74) or likelihood of reaching MCID (p = 0.81) or SCB (p = 0.85) after adjusting for other variables. CONCLUSION In select patients with DLS, the outcome of D is comparable to DF at a minimum of 2 years.