Miracle-dz/UniFAR-FTUs huggingface dataset:
In Vitro Biocompatibility of Preheated Giomer and Microfilled-Hybrid Composite

Objective The aim of this study was to evaluate cytotoxic potencies of two light cured composite materials after heating on different temperatures and cured directly and through CAD/CAM overlay. Materials and methods Composite materials (microfilled-hybrid Gradia Direct Posterior and Beautifil II) were heated in a Calset warming unit at three different temperatures (T1:37°C, T2:54°C, T3:68°C). A small amount of heated composite material was placed in a round mold (diameter 6mm; 0.65mm thick), covered with Mylar sheet, pressed and polymerized with Bluephase LED unit. One group of samples were polymerized directly, and the other group through 2mm thick CAD/CAM ceramic-reinforced polymer (CRP) and CAD/CAM lithium disilicate ceramic (LDC) overlay for 20 and 40 seconds. The polymerized samples were placed immediately after curing in a lymphocyte cell culture. The viability of peripheral blood lymphocytes was evaluated using a dye exclusion technique by simultaneous staining with ethidium bromide and acridine orange. Quantitative assessments were made by determination of the percentage of viable, apoptotic and necrotic cells. The Pearson chi-square test was used for statistical analysis. Results In case of 20 seconds polymerization, the highest number of viable cells polymerization were recorded when materials were heated at 37°C (T1), while in case of 40 seconds polymerization, the highest number of viable cells were recorded when the materials were heated at 54°C (T2). The samples polymerized through CAD/CAM overlays showed less cytotoxicity than samples polymerized directly. Conclusion Apart from composite material composition, the cell viability was also influenced by curing time, temperature of pre-heating and polymerization pattern.
Association of Prenatal Exposure to Valproate and Other Antiepileptic Drugs With Risk for Attention-Deficit/Hyperactivity Disorder in Offspring

Key Points Question What is the risk of attention-deficit/hyperactivity disorder in children prenatally exposed to valproate and other antiepileptic drugs? Findings In a population-based cohort study of 913 302 children in Denmark, prenatal exposure to valproate was significantly associated with a 48% increased risk of attention-deficit/hyperactivity disorder compared with children with no valproate exposure. No association was identified for other antiepileptic drugs. Meaning The findings of this study corroborate that counseling is appropriate for the use of valproate in pregnancy and in women of childbearing potential.
Measuring burden in caregivers of people with multiple sclerosis: psychometric properties of the CSI questionnaire

Background Understanding caregiver strain may be crucial to determine which interventions are most needed to mitigate the negative impact of caring for people with multiple sclerosis (MS). The Caregiver Strain Index (CSI) is a brief self-assessment tool for measuring the caregivers’ perceived level of burden. Limited information is available on the psychometric performance of the CSI in MS. Objective The objective of this study was to assess the factor structure and construct validity of the CSI in MS. Methods A multicenter, cross-sectional study in adults with relapsing-remitting and primary-progressive MS (McDonald 2010 criteria) was conducted. A non-parametric item response theory (IRT) procedure, Mokken analysis, was conducted to assess the dimensional structure of the CSI. A parametric IRT model for dichotomous responses, Rasch model, was conducted to assess item characteristics. Discriminative validity was assessed comparing the distribution of its overall score between people with mild and moderate-severe disability according to the Expanded Disability Status Scale. Results A total of 72 MS caregivers were studied. The prevalence of a high level of strain was 23.6% (n=17). Internal reliability was high (Cronbach’s alpha =0.91). According to Mokken analysis, CSI represented a unidimensional construct of caregiver burden although two of the total 13 items (#1 and #13) could not be assigned to any factor by an automatic item selection procedure. Without these items, the scalability moved from a weak (Hi =0.37) to a medium scale (Hi =0.44). However, the item characteristic curve of the Rasch model showed a range of appropriate difficulty and the item and person parameters showed good fit (Andersen likelihood ratio test =18.40, df =11; P-value =0.07; all item values for the infit). The CSI score showed a good discriminative validity between the levels of disability of the care recipient. Conclusion The CSI questionnaire shows appropriate psychometric characteristics being a useful instrument to assess different aspects of burden in MS caregivers in clinical practice.
Analysis in Choroidal Thickness in Patients with Graves' Ophthalmopathy Using Spectral-Domain Optical Coherence Tomography

Objectives The objective of the study is to observe changes in choroidal thickness (CT) in patients with Graves' ophthalmopathy using spectral-domain optical coherence tomography (SD-OCT). Methods The right eyes of 36 patients (27 females and 9 males) with Graves' ophthalmopathy (GO) and those of 36 age-, gender-, and diopter-level-matched healthy participants were evaluated. The patients' data were obtained within 3 months after the onset of Graves' disease (GD). Thyroid hormone levels and thyroid-stimulating hormone receptor antibody (TRAb) levels were measured, and the degree of exophthalmos was measured in all patients. Activity is measured by the clinical activity score (CAS). A horizontal scan centered on the fovea was performed in all participants. Five points of choroidal thickness were measured at the fovea (SFCT) and at 1500 μm nasal (N1500), 3000 μm nasal (N3000), 1500 μm temporal (T1500), and 3000 μm temporal (T3000) to the fovea. Results The CT measurements obtained were (mean ± SD) 313.47 ± 100.32 μm, 279.22 ± 85.80 μm, 214.64 ± 75.52 μm, 313.19 ± 80.36 μm, and 298.14 ± 82.75 μm in patients with GO and were 256.33 ± 50.18 μm, 223.14 ± 59.61 μm, 176.69 ± 60.66 μm, 250.92 ± 52.184 μm, and 239.47 ± 60.35 μm in the control group at the foveal, N1500, N3000, T1500, and T3000 measurement points, respectively. The CT in GO patients was significantly increased at all the points compared with the control group (P < 0.05). There was no relationship between the CT and CAS, the degree of exophthalmos, triiodothyronine (T3), tetraiodothyronine (T4), thyroid-stimulating hormone (TSH), or TRAb levels in GO. Conclusions CT was found to be increased in GO patients and had poor relationship with CAS, exophthalmos, and thyroid function tests.
Timing of initiation of low-molecular-weight heparin administration in pregnant women with antiphospholipid syndrome: a randomized clinical trial of efficacy and safety

Objective We aimed to evaluate the effect of different timing of initiation of low-molecular-weight heparin (LMWH) administration on the pregnancy outcomes in women with antiphospholipid syndrome (APS). Materials and methods A randomized controlled study was conducted on women with obstetrical APS. All participants were randomly divided at documentation of positive pregnancy test into two groups; early initiation group in which LMWH therapy was started once positive pregnancy test was established (in the fifth week of gestation), and later initiation group in which LMWH therapy was started after sonographic confirmation of fetal cardiac pulsation (in the seventh week of gestation). In both groups, LMWH (enoxaparin) was given at a dose of 40 mg/day subcutaneously and the therapy continued until end of pregnancy. The primary outcome measure was ongoing pregnancy rate and the secondary outcome measures were fetal loss, live birth rate, preterm labor before 34 weeks of gestation, intrauterine growth restriction (IUGR), and congenital fetal malformations. Results Ninety-four women (48 in the early initiation group and 46 in the later initiation group) were subjected to final analysis. The ongoing pregnancy rate was significantly higher in the early initiation group than in the later initiation group (81.2% vs 60.9%; P=0.040). However, both groups were similar in the incidences of fetal loss, preterm labor before 34 weeks of gestation, and IUGR, and live birth rate. No recorded congenital fetal malformations in both groups. Conclusion Early administration of LMWH for pregnant women with obstetrical APS reduces early pregnancy loss, but does not affect the incidence of late obstetrical complications.
Completeness of RET testing in patients with medullary thyroid carcinoma in Denmark 1997–2013: a nationwide study

Background The completeness of REarranged during Transfection (RET) testing in patients with medullary thyroid carcinoma (MTC) was recently reported as 60%. However, the completeness on a population level is unknown. Similarly, it is unknown if the first Danish guidelines from 2002, recommending RET testing in all MTC patients, improved completeness in Denmark. We conducted a nationwide retrospective cohort study aiming to evaluate the completeness of RET testing in the Danish MTC cohort. Additionally, we aimed to assess the completeness before and after publication of the first Danish guidelines and characterize MTC patients who had not been tested. Methods The study included 200 patients identified from the nationwide Danish MTC cohort 1997–2013. To identify RET tested MTC patients before December 31, 2014, the MTC cohort was cross-checked with the nationwide Danish RET cohort 1994–2014. To characterize MTC patients who had not been RET tested, we reviewed their medical records and compared them with MTC patients who had been tested. Results Completeness of RET testing in the overall MTC cohort was 87% (95% CI: 0.81–0.91; 173/200). In the adjusted MTC cohort, after excluding patients diagnosed with hereditary MTC by screening, completeness was 83% (95% CI: 0.76–0.88; 131/158). Completeness was 88% (95% CI: 0.75–0.95; 42/48) and 81% (95% CI: 0.72–0.88) (89/110) before and after publication of the first Danish guidelines, respectively. Patients not RET tested had a higher median age at diagnosis compared to those RET tested. Median time to death was shorter in those not tested relative to those tested. Conclusion The completeness of RET testing in MTC patients in Denmark seems to be higher than reported in other cohorts. No improvement in completeness was detected after publication of the first Danish guidelines. In addition, data indicate that advanced age and low life expectancy at MTC diagnosis may serve as prognostic indicators to identify patients having a higher likelihood of missing the compulsory RET test.
Reliability of the Maximal Step Length Test and Its Correlation with Motor Function in Chronic Stroke Survivors

Objective This study aimed to (1) investigate the interrater, intrarater, and test-retest reliabilities, as well as the minimal detectable change, of the Maximal Step Length test (MSL) in stroke survivors, (2) examine the concurrent validity of MSL with other stroke-specific impairment measurements in stroke survivors, and (3) compare the MSL performances of stroke survivors and those of age-matched healthy older adults in different directions. Design Cross-sessional study. Setting University-based research laboratory. Participants Stroke survivors (n = 48) and age-matched healthy older adults (n = 39). Methods Stroke survivors were assessed with MSL, lower limb muscle strength, Limits of Stability (LOS) Test, Berg Balance Scale (BBS), 5-meter walk test, and Activities-specific Balance Confidence (ABC) scale by two trained assessors in 1 session. Their performance on MSL was reassessed 1 week later to establish the test-retest reliability. Healthy older adults were assessed with MSL only. Intraclass correlation coefficient (ICC) was used to assess the reliability of MSL and Spearman's rho was used to quantify the strength of correlations between MSL and secondary outcomes. Between-group differences of MSL were assessed with the independent t-test. Results The MSL exhibited excellent intrarater, interrater, and test-retest reliabilities [ICC: 0.885–1.000]. Significant correlations (ρ: 0.447–0.723) were demonstrated between MSLs in most directions and muscle strengths of the affected legs, BBS scores, and walking speeds. The step lengths differed significantly between stroke survivors and healthy older adults in the forward, backward, and sideways directions on both the affected and less affected sides. Conclusions The MSL is a reliable, valid, and easily administered test of the stepping capabilities of stroke survivors. Stroke survivors had significant shorter MSLs in all directions than the age-matched healthy older adults.
Prevalence and Estimated Economic Burden of Substandard and Falsified Medicines in Low- and Middle-Income Countries

Key Points Question What are the prevalence and estimated economic burden of substandard and falsified medicines in low- and middle-income countries? Findings In this systematic review of 265 studies comprising 400 647 drug samples and meta-analysis of 96 studies comprising 67 839 drug samples, the prevalence of substandard and falsified medicines in low- and middle-income countries was 13.6% overall (19.1% for antimalarials and 12.4% for antibiotics). Data on the estimated economic impact were limited primarily to market size and ranged widely from $10 billion to $200 billion. Meaning Substandard and falsified medicines are a substantial health and economic problem; a concerted global effort is needed to secure the global supply chain, increase quality control capacity, and improve surveillance to better assess the problem and identify solutions.
Efficacy of Regular Exercise During Pregnancy on the Prevention of Postpartum Depression

Key Points Question Does regular exercise during pregnancy prevent postpartum depression? Findings In this randomized clinical trial of 639 pregnant women, individuals allocated to receive the exercise program did not have significant reductions in postpartum depression. However, noncompliance with the intervention protocol was substantial and may have resulted in underestimation of the possible benefits of the treatment (as suggested by the instrumental variable analysis). Meaning Future studies on how to promote regular exercise during pregnancy, particularly targeting young and less educated women, are warranted before further trials are undertaken.
Association of Antenatal Steroid Exposure With Survival Among Infants Receiving Postnatal Life Support at 22 to 25 Weeks’ Gestation

Key Points Question For infants born at the edge of viability who received postnatal life support, was the administration of antenatal steroids associated with higher rates of survival? Finding In a cohort study of 33 472 infants born at 22 to 25 weeks’ gestation between 2012 and 2016, the concordant receipt of antenatal steroids and postnatal life support was significantly associated with higher rates of survival compared with postnatal life support alone. Meaning There is an opportunity for reevaluation of national guidelines, allowing for shared decision making with concordant obstetrical and neonatal treatment plans.
Social and Emotional Learning Associated With Universal Curriculum-Based Interventions in Early Childhood Education and Care Centers

Key Points Question How effective are universal curriculum-based social and emotional learning programs delivered in early childhood education and care centers at improving children’s social and emotional development? Findings A systematic review and meta-analysis of 79 unique studies with 18 292 unique participants found children exposed to a universal social and emotional learning intervention showed significant improvement in social competence, emotional competence, behavioral self-regulation, emotional and behavioral problems, and early learning outcomes compared with control participants. Meaning Early childhood is a crucial period for children’s social, emotional, and cognitive development, and these findings highlight what appears to be benefit of social and emotional learning interventions for young children across developmental domains.
Facial application of high-concentration carbon dioxide prevents epidermal impairment associated with environmental changes

Purpose The transdermal application of carbon dioxide (CO2) gas dissolved in a solution and bathing in carbonated springs have been known to improve circulatory disorders. We aimed to elucidate and profile the effects of CO2 application on local skin function. Patients and methods A liquid formulation that included high-concentration CO2 or a control formulation was applied to the face of healthy men for 8 weeks. Quantitative analysis was performed during the dry winter months. Results At the site where the control formulation was applied, transepidermal water loss (TEWL) increased while the moisturizing function (conductance) of facial skin decreased during the study period. However, at the CO2-treated site, increases in TEWL and decreases in conductance were significantly suppressed. In addition, the deterioration in scaliness and wrinkles parameters were suppressed by ≥40% at the CO2-treated site. There were no significant differences in skin surface pH or color properties between the control and test sites. Conclusion This study suggests that the continuous application of a high-concentration CO2 formulation can affect skin physiology and has the potential to suppress reductions in the barrier and moisturizing functions of the stratum corneum accompanied by desquamation, which occurs during the winter.
Evaluation of Digital Breast Tomosynthesis as Replacement of Full-Field Digital Mammography Using an In Silico Imaging Trial

Key Points Question Can in silico imaging trials play a role in the evaluation of new medical imaging systems? Findings This diagnostic study used computer-simulated imaging of 2986 synthetic image–based virtual patients to compare digital mammography and digital breast tomosynthesis and found an improved lesion detection performance favoring tomosynthesis for all breast sizes and lesion types. The increased performance for tomosynthesis was consistent with results from a comparative trial using human patients and radiologists. Meaning The study’s findings suggest that in silico imaging trials and imaging system computer simulation tools can in some cases be considered viable sources of evidence for the regulatory evaluation of imaging devices.
Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016

Key Points Question During 2013 to 2016, what proportion of adults were living with hepatitis C virus (HCV) infection in each US state? Findings In this survey study, US national HCV prevalence during 2013 to 2016 was 0.93% and varied by jurisdiction between 0.45% and 2.34%. Three of the 10 states with the highest prevalence and 5 of the 9 states with the highest number of HCV infections were in the Appalachian region. Meaning Regions with long-standing HCV epidemics, and those with newly emergent ones partly driven by the opioid crisis, face substantial HCV prevalence.
Chronic fatigue syndrome in the emergency department

Purpose Chronic fatigue syndrome (CFS) is a debilitating disease characterized by fatigue, postexertional malaise, cognitive dysfunction, sleep disturbances, and widespread pain. A pilot, online survey was used to determine the common presentations of CFS patients in the emergency department (ED) and attitudes about their encounters. Methods The anonymous survey was created to score the severity of core CFS symptoms, reasons for going to the ED, and Likert scales to grade attitudes and impressions of care. Open text fields were qualitatively categorized to determine common themes about encounters. Results Fifty-nine percent of respondents with physician-diagnosed CFS (total n=282) had gone to an ED. One-third of ED presentations were consistent with orthostatic intolerance; 42% of participants were dismissed as having psychosomatic complaints. ED staff were not knowledgeable about CFS. Encounters were unfavorable (3.6 on 10-point scale). The remaining 41% of subjects did not go to ED, stating nothing could be done or they would not be taken seriously. CFS subjects can be identified by a CFS questionnaire and the prolonged presence (>6 months) of unremitting fatigue, cognitive, sleep, and postexertional malaise problems. Conclusion This is the first investigation of the presentation of CFS in the ED and indicates the importance of orthostatic intolerance as the most frequent acute cause for a visit. The self-report CFS questionnaire may be useful as a screening instrument in the ED. Education of ED staff about modern concepts of CFS is necessary to improve patient and staff satisfaction. Guidance is provided for the diagnosis and treatment of CFS in these challenging encounters.
Association of Childhood Social-Emotional Functioning Profiles at School Entry With Early-Onset Mental Health Conditions

Key Points Question What can population patterns of early childhood social-emotional functioning tell us about the emergence of mental health conditions? Findings In this cohort study that included 34 323 children in Canada, 6 latent social-emotional functioning profiles based on children’s relative strengths and vulnerabilities in social competence, internalizing, and externalizing symptoms at age 5 years were associated with the onset of subsequent mental health conditions between ages 6 and 14 years. Meaning This examination of early childhood social-emotional functioning profiles identified social disparities in profile membership and an association between profiles and the emergence of mental health conditions.
PET performance evaluation of the small-animal Hyperion IID PET/MRI insert based on the NEMA NU-4 standard

The Hyperion IID PET insert is the first scanner using fully digital silicon photomultipliers for simultaneous PET/MR imaging of small animals up to rabbit size. In this work, we evaluate the PET performance based on the National Eletrical Manufacturers Association (NEMA) NU 4-2008 standard, whose standardized measurement protocols allow comparison of different small-animal PET scanners. The Hyperion IID small-animal PET/MR insert comprises three rings of 20 detector stacks with pixelated scintillator arrays with a crystal pitch of 1 mm, read out with digital silicon photomultipliers. The scanner has a large ring diameter of 209.6 mm and an axial field of view of 96.7 mm. We evaluated the spatial resolution, energy resolution, time resolution and sensitivity by scanning a 22Na point source. The count rates and scatter fractions were measured for a wide range of 18F activity inside a mouse-sized scatter phantom. We evaluated the image quality using the mouse-sized image quality phantom specified in the NEMA NU4 standard, filled with 18F. Additionally, we verified the in-vivo imaging capabilities by performing a simultaneous PET/MRI scan of a mouse injected with 18F-FDG. We processed all measurement data with an energy window of 250 keV to 625 keV and a coincidence time window of 2 ns. The filtered-backprojection reconstruction of the point source has a full width at half maximum (FWHM) of 1.7 mm near the isocenter and degrades to 2.5 mm at a radial distance of 50 mm. The scanner’s average energy resolution is 12.7% (ΔE/E FWHM) and the coincidence resolution time is 609 ps. The peak absolute sensitivity is 4.0% and the true and noise-equivalent count rates reach their peak at an activity of 46 MBq with 483 kcps and 407 kcps, respectively, with a scatter fraction of 13%. The iterative reconstruction of the image quality phantom has a uniformity of 3.7%, and recovery coefficients from 0.29, 0.91 and 0.94 for rod diameters of 1 mm, 3 mm and 5 mm, respectively. After application of scatter and attenuation corrections, the air- and water-filled cold regions have spill-over ratios of 6.3% and 5.4%, respectively. The Hyperion IID PET/MR insert provides state-of-the-art PET performance while enabling simultaneous PET/MRI acquisition of small animals up to rabbit size.