Miracle-dz/UniFAR-FTUs huggingface dataset:
Bringing out the best in people

Whether it is within the practice or within your home and personal relationships, bringing out the best in the people around you is one way to help your business, family and friends grow into happier and healthier places and individuals. To do this, you first have to truly and firmly believe that there is a ‘best’ in other people, or at the very least that they can do ‘better’. This article describes how to assess your own attitudes and beliefs, which can then be used to encourage others to improve their performance and achieve greater things.
Kombinierte Chemotherapie und regionale Tiefenhyperthermie eines hormonrefraktären, ossär und hepatisch metastasierenden Prostatakarzinoms in der 5. Therapielinie

Since 2003 Docetaxel seems to be widely accepted as systemic standard therapy for hormone refractory prostate cancer. This is due to the results of the TAX 327 crossover study , that documented a statistic significant prolongation of survival and symptom control, for the first time. Before the introduction of this new standard, chemotherapy of hormone refractory prostate cancer was considered without real benefit. For therapy failure under treatment with docetaxel, no established salvage therapy is available at the moment. This case report presents the course of disease and treatment of a patient with metastasizing prostate cancer until 5 th line chemotherapy combined with several complementary methods.
MRSA transmission between horses and vets: who's doing the infecting?

METICILLIN-resistant Staphylococcus aureus (MRSA) is a major health problem in people. About 30 per cent of the general population are nasal carriers of Staphylococcus aureus , and only a small proportion carry MRSA (Kluytmans and others 1997, Mainous and others 2006). However, in a hospital environment this proportion is generally much higher, although large differences exist between countries. Healthcare workers are regularly colonised (transiently or persistently) and are likely to play a role in the transmission within the hospital setting (Albrich and Harbarth 2008). In horses, MRSA seems to behave in a similar way. Healthy horses carry MRSA at low prevalence, but in equine hospitals the prevalence is much higher (Van Balen and others 2014, Tirosh-Levy and others 2015) and nosocomial MRSA infections in horses leading to serious and sometimes fatal conditions have previously been described (Kuroda and others 2015). However, the high prevalence of MRSA in equine hospitals is not only a risk for the horses, but also for the personnel involved. Veterinarians are at an increased risk of carrying MRSA compared to the general population, but equine veterinarians are at an even higher risk than veterinarians working with other animal species (Jordan and others 2011, Cuny and others 2016). Transmission from hospitalised horses to their veterinarians therefore seems to occur, but as in the human healthcare situation where healthcare workers may infect patients, …
Letter: is blood transfusion really a risk factor for rebleeding in nonvariceal gastrointestinal bleeding? Authors’ reply

sisting of blood urea nitrogen, haemoglobin, systolic blood pressure, pulse, presentation with melaena or syncope, and presence of hepatic or cardiac failure. In the transfusion group of Restellini et al.’s study, more patients with lower haemoglobin (8.21 vs. 11.46 g/dL), more shocked patients at presentation (43.5% vs. 18.4%), more patients presented with melaena (76.1% vs. 59.4%), and more cases of comorbidity (2.7 vs. 2.3) were found. Therefore, it is obvious that the transfusion group had higher Blatchford scores than those without transfusion. The higher the Blatchford score, the higher the rebleeding rate will be observed. If we checked with another frequently used system, the Rockall score, preadmission scores (age, shock comorbid illness) also indicate that the transfusion group was more severe than those without transfusion. From an endoscopic point-of-view, stigmata of recent haemorrhage (SRH) over the ulcer base are linked to rebleeding. There were more patients with SRH in the transfusion group (45.6% vs. 24.6%), and therefore, more endoscopic therapies were required in this group (44.6% vs. 24.3%). Therefore, rebleeding rates will be higher in the transfusion group. Thus, based on clinical data, the rebleeding rates are linked to the severity of bleeding within the patients rather than the blood transfusion itself. I agree with Restellini et al.’s suggestion that further studies are required before any firm conclusions can be drawn.
First Trimester Prenatal Diagnosis of Smith-Lemli-Opitz Syndrome(7-Dehydrocholesterol Reductase Deficiency)

In Smith-Lemli-Opitz syndrome (SLOs), 7-dehydrocholesterol (7-DHC) accumulates because there is a block in the pathway for synthesis of cholesterol via 7-DHC. Prenatal diagnosis of SLOs has been achieved by analysis of 7-DHC in amniotic fluid obtained at 16-18 wk from pregnancies at risk. The purpose of this study was to investigate 7-DHC and cholesterol concentrations in chorionic villus (CV) samples with a view to performing first trimester prenatal diagnosis. Using a sensitive gas chromatography-mass spectrometry assay it was possible to detect 7-DHC in CV samples obtained as early as 7 wk of gestation. The ratio of 7-DHC to cholesterol in placental tissue was shown to be relatively constant over the gestational period of 7-18 wk. We therefore proceeded to analyze the 7-DHC/cholesterol ratio in CV samples taken at 10-12 wk of gestation from three pregnancies at risk for SLOs. The results were as follows: patient A, 1.10 × 10-3; patient B, 1.80 × 10-3; patient C, 0.091; control range for CVS(8-12 wk), 3.10 × 10-4 to 1.62 × 10-3 (mean ± 2SD; n = 5). The fetus of patient C was diagnosed as affected by SLOs, and the parents requested termination. Analysis of cultured skin fibroblasts confirmed the diagnosis. Pregnancies A and B were diagnosed unaffected, and this was confirmed first by amniocentesis and then by the birth of normal infants at term. We conclude that synthesis of cholesterol via 7-DHC is occurring in the placenta and/or fetus at 10 wk of gestation and that prenatal diagnosis by CV biopsy is possible.
Pulsatile Release and Circadian Rhythms of Thyrotropin and Prolactin in Children with Growth Hormone Deficiency

We have measured mean concentrations and have appraised the pulsatile nature of thyrotropin (TSH) and prolactin (PRL) release in children with classical GH deficiency (GHD; n = 4) and neurosecretory GH dysfunction (NSD; n = 4) and have compared the results with those obtained in children with constitutional delay (control; n = 4). Blood samples were obtained at 20-min intervals for 24 h. Pulse analysis of TSH and PRL was undertaken using the Cluster pulse detection algorithm. Circadian rhythmicity of TSH and PRL was assessed using cosinor analysis. The mean 24-h concentration of GH in the control subjects was significantly higher than that obtained in the GHD and NSD groups. With regard to TSH, the mean serum concentration in the GHD and NSD group were higher than that of the control subjects. This augmentation reflects TSH pulses of large amplitude and area, and a higher interpulse valley mean rather than a difference in peak number or peak duration. No differences in mean PRL concentration or characteristics of PRL pulses were found between the control and GHD and NSD subjects. When the 24 h data sets were divided into day (0800-2000 h) and night (2000-0800 h), the mean nighttime TSH concentration was higher than the daytime concentration in the control, GHD, and NSD groups. Although there were no day versus night differences in TSH pulse frequency in either group, peak amplitude, area, and interpulse valley means were increased during the night in the control group, and peak area, duration, and amplitude mean in the NSD group. The nighttime mean PRL concentrations in the control, GHD, and NSD subjects were higher than those found during the day. This increase was accounted for by increases in PRL peak amplitude, area in the control group, and peak area, amplitude, and interpulse valley mean in the GHD and NSD groups. Cosinor analysis of the 24-h TSH and PRL data revealed clear circadian rhythmicity in all groups of subjects. These data suggest that GHD and NSD are associated with an increase in pulsatile TSH secretion due to an increase in pulse amplitude and interpulse valley mean.
Pre‐existing IgG antibodies cross‐reacting with the Fab region of infliximab predict efficacy and safety of infliximab therapy in inflammatory bowel disease

Infliximab (IFX) is a chimeric murine/human anti‐TNF antibody (Ab) used for the treatment of Crohn's disease (CD) and ulcerative colitis (UC). Loss of response is common and associated with development of anti‐IFX Abs during ongoing therapy. However, human anti‐murine immunoglobulin Abs are common and may cross‐react with the murine part of IFX.
The Angiogenesis Inhibitor TNP-470 Reduces the Growth Rate of Human Neuroblastoma in Nude Rats

A new animal experimental model of human neuroblastoma is described. The model involves xenotransplantation of a poorly differentiated human neuroblastoma cell line (SH-SY5Y) to the subcutaneous tissue in the hind leg of nude rats (WAG rnu/rnu). Injection of 20 million cells suspended in 0.2 mL of medium in each hind leg yielded an 89% tumor take (41/46) in 23 nude rats. Tumor take was evident after 2 wk. The tumors grew exponentially and reached a volume of 5.2 ± 1.6 mL 4 wk after transplantation. The tumor cells retained their morphologic phenotype at the ultrastructural level after transplantation and were immunohistochemically positive for neuron-specific enolase and for chromogranins A and B. Subcutaneous injections of the angiogenesis inhibitor TNP-470 (10 mg/kg of body weight) every other day gave a treated/control quotient for mean tumor volume of 0.34 after 12 d of treatment. This implies that angiogenesis inhibition may be of value as a complement to chemotherapy in the treatment of human neuroblastoma. The presented animal experimental model is designed for investigations of the effects of chemotherapy, angiogenesis inhibitors, radiotherapy, and/or surgery on the growth rate of human neuroblastoma.
Precocious Enhancement of Intestinal Fructose Uptake by Diet in Adrenalectomized Rat Pups

Intestinal fructose transport typically increases 3-fold after completion of weaning (>28 d of age) in rats allowed to wean normally. Precocious enhancement of fructose transport has been demonstrated in rats fed high fructose diets during early weaning. To determine the role of corticosterone in the enhancement of fructose uptake by diet, we fed 17-d-old rat pups, previously adrenalectomized or sham-operated at 10 d of age, high (65%) fructose or fructose-free diets for 3 d. Corticosterone levels in 20-d-old sham-operated and unoperated controls were 2.2-3.3-fold higher than those in adrenalectomized littermates and in unoperated 10-d-old pups. Fructose uptake per mg and per cm were each 2.0-2.5-fold higher in adrenalectomized and sham-operated pups fed high fructose diets compared with those in adrenalectomized and sham-operated littermates fed fructose-free diets or to those in unoperated littermates allowed to wean normally with the dam. An increase in levels of GLUT5 mRNA in pups fed high fructose diets paralleled the increase in rates of fructose uptake. Intestinal glucose uptake was independent of corticosterone levels and of diet. Thus, the corticosterone surge is not necessary for the precocious enhancement of intestinal fructose transport and of GLUT5 mRNA expression by dietary fructose during weaning.
Contributions by Individual Lungs to the Surfactant Status in Congenital Diaphragmatic Hernia

Laboratory evidence has recently confirmed clinical reports suggesting that the surfactant system is abnormal in congenital diaphragmatic hernia (CDH). Autopsy series show that, although both lungs are affected by the maldevelopment, the ipsilateral lung is more severely affected. The aim of this study was to examine the surfactant status in each lung in a lamb model of CDH. The lamb CDH model was created on the left side at 80 d of gestation and delivered near term. Subsequently, the lungs were removed and separated from each other. Bronchoalveolar lavage and type II pneumocyte isolations were performed on each side separately. Lavage analyses showed decreased phospholipid (0.12 versus 0.42 mg/g), per cent phosphatidylcholine(51% versus 79%) surfactant-associated protein A (0.20versus 2.68 mg/g), and surfactant-associated protein-B (0.35versus 2.21 mg/g) in CDH lungs compared with control lungs. However, no differences were seen between the ipsilateral and contralateral lungs of either CDH or control groups. This was in contrast to the phosphatidylcholine biosynthetic abilities of type II cells isolated from CDH lungs, which were not only lower than those from control lungs (0.15 versus 0.40 nmol/106 cells/h), but were also significantly worse in the ipsilateral CDH lung compared with the contralateral CDH lung (0.10 versus 0.20 nmol/106 cells/h). Further studies utilizing radiolabeled exogenous surfactant injected in the lower contralateral lung indicate that discrepancies between the presence of type II cell function differences between lungs, and the lack of biochemical differences between the two lungs in CDH, may be due to in utero mixing of lung fluid.
Immunostimulatory Effects of Aqueous Extract of Heracleum persicum Desf. on Mouse Peritoneal Macrophages

Background: The immune system provides protection against infectious diseases that are caused by various microorganisms, in particular pathogenic fungi. Utilization of herbal immunostimulants is one solution to improve the immunity of humans and to decrease their susceptibility to infectious diseases. Objectives: The current study aimed to investigate the immunostimulatory effects of the aqueous extract of Heracleum persicum on mouse peritoneal macrophages. Materials and Methods: The present in vitro study investigated the effect of the aqueous extract of H. perscium on the viability of macrophages and nitric oxide (NO) production using microculture tetrazolium (MTT) assay and Griess method, respectively. The effects on fungicidal activity and reactive oxygen species (ROS) production of stimulated peritoneal macrophages were also studied using killing method and nitroblue tetrazolium (NBT) assay, respectively. Results: The aqueous extract of H. persicum (Hp-W) at concentration of 10 mg/ mL resulted in a significant increase in NO production (8.17 nmol) by macrophages (P < 0.05). Moreover, H. persicum had a stimulatory effect on the level of ROS (P < 0.05) and a strong candidacidal activity in macrophages treated with 20 mg/ mL of the extract (P < 0.05). Conclusions: The aqueous extract of H. persicum showed a significant immunostimulatory activity on macrophages. To clarify the exact mechanisms of this activity, more studies should be done with purified immunostimulatory components of H. persicum in future.
Prostanoid Formation during Feeding of a Preterm Formula with Long-Chain Polyunsaturated Fatty Acids in Healthy Preterm Infants during the First Weeks of Life

The objective of this study was to evaluate the effect of conventional and long-chain polyunsaturated fatty acids (LCP)-enriched preterm formula on prostanoid formation in preterm infants during their first weeks of life. In a prospective, randomized, double-blind study, healthy infants received either formula enriched with LCP (n = 10), standard preterm formula(n = 10), or (expressed) breast milk (n = 10). Urine was sampled, and anthropometric measurements were taken at study entry and after the study period of 3 wk. In vivo formation of prostaglandin E2, thromboxane A2, and prostacyclin was evaluated by measuring the urinary excretion of the respective index metabolites by gas chromatography-mass spectrometry. There were no significant differences in urinary prostanoid excretion and anthropometric data between the groups at the end of the study period. We conclude that neither conventional formula nor supplementation of a preterm formula with LCP for a period of 3 wk substantially influence prostanoid formation in healthy preterm infants.
What Does it Take to Transfer Training?

Abstract Staff training is a necessary component in psychiatric rehabilitation programs, providing the basis of a skilled and integrated workforce. However, it has been found repeatedly that training is not sufficient to result in an improved quality of care for clients. What is required to make training effective is a parallel emphasis upon the organizational context within which these trained skills are to be applied. The present paper provides a review of the contextual factors that contribute to training effectiveness. A case study of the transfer of staff training (N=10) in psychiatric rehabilitation skills illustrates several of these factors. Conclusions are drawn about the factors that contribute to successful transfer of training, and about future research requirements.
Opening Pandora's box: The experiences of having an asymptomatic aortic aneurysm under surveillance

Abdominal aortic aneurysm (AAA) is a ballooning-out of the aorta that does not normally give any symptoms. Undetected and untreated an aortic aneurysm can rupture, which in most cases is fatal. Mass screening of 65-year old men for the early detection of AAA and, in selected cases, operation seem to reduce mortality due to rupture, although, screening has not reduced the overall mortality in this group. In Västra Götaland, the southwest part of Sweden, screening for AAA amongst 65-year old men started in 2009. There are controversies within the medical community about the benefits and adverse effects of screening. In order to explore men's experiences of being screened and knowing they had an aortic aneurysm, we undertook a qualitative interview study with 15 men who in the screening programme were identified as having an aortic aneurysm and who were to be followed-up with annual ultrasonic examinations for an indeterminate number of years. The interviews were analysed for categories and themes using content analysis. The study found that the men were ambivalent about the knowledge that they had an AAA and about the follow-up monitoring. They appreciated having the knowledge but it was accompanied by worry, feelings of anxiety and existential thoughts about the fragility and finiteness of life. We recommend that before a screening programme is implemented, the psycho-social consequences should be thoroughly investigated. Participants should be given adequate and understandable information about the consequences of screening so that they can make an informed choice whether to participate or not.
Response to Rosthøj et al

We thank Rosthøj and colleagues for their re-analysis of the data from the prospective Nordic study, which could not confirm a protective effect of intravenous immunoglobulin (IVIG) treatment against the development of chronic idiopathic thrombocytopenic purpura (ITP). We mentioned (Bruin et al, 2004) that, from the bivariate logistic regression analysis on the treatment variables performed in our study, one could only conclude that IVIG treatment was an independent factor, however, the validity of this analysis could be hampered by confounding by indication. Thus, IVIG treatment possibly protects against the development of chronic disease. To confirm this possible protective effect of IVIG, a future study, which randomises patients to ‘no treatment’ or ‘IVIG treatment’, is needed. As we discussed in our paper, neither the Nordic study (Rosthøj et al, 2003), the Canadian trial (Blanchette et al, 1993) nor the results from the Intercontinental Cohort (Kühne et al, 2001) point to a possible protective effect of IVIG. On the contrary, Imbach (1991) mentioned a possible effect of IVIG treatment in the development of chronic ITP. However, none of the above studies, including ours, were developed with the aim of comparing treatment modalities as risk factors for the development of chronic ITP. We are now investigating the possibilities of such a study, and intend to cooperate with other groups to determine whether treatment early in the course of acute ITP influences the development of chronic disease.
Do Fetal Electrocardiogram PR-RR Changes Reflect Progressive Asphyxia after Repeated Umbilical Cord Occlusion in Fetal Sheep?

The aim of this study was to determine whether there is a relationship between changes in PR-RR correlation of the fetal ECG and progressive changes in fetal acid-base status and blood pressure (BP) during repeated umbilical occlusion. Chronically instrumented fetal sheep at 126.8 ± 0.6 d (mean± SEM) were randomized to receive 1 min of total umbilical cord occlusion either every 5 min for 4 h (1:5 group; n = 8), or every 2.5 min until BP fell <2.7 kPa (20 mm Hg) on two successive occlusions (1:2.5 group; n = 8). The PR-RR correlation was determined in 5- or 2.5-min intervals. Umbilical cord occlusion caused variable decelerations with initial sustained hypertension. In the 1:5 group BP remained elevated throughout, and there was little change in acid-base status (pH = 7.34 ± 0.07, base deficit = 1.3 ± 3.9 after 4 h). In contrast, after the third occlusion the 1:2.5 group showed progressive hypotension during occlusions, and severe progressive metabolic acidemia (pH 6.92 ± 0.1, base deficit 17.0 ± 4.7 mmol/L after the last occlusion). In both groups, the PR-RR relationship switched from positive to negative with the onset of occlusions, then reverted to positive after a variable interval. In the 1:2.5 group later reversion of the PR-RR to positive was associated with earlier and more prolonged hypotension during the middle and end of the occlusion series (p < 0.001). We conclude that the initial switch to a negative PR-RR relationship during repetitive umbilical occlusion was due to a reflex-mediated response unrelated to fetal acidosis or hypotension. Both stable well compensated fetuses and severely hypoxic, hypotensive fetuses subsequently showed a positive PR-RR correlation.
Acute Maternal Alcohol Consumption Disrupts Behavioral State Organization in the Near-Term Fetus

Disturbed sleep regulation is often observed in neonates of women who drank heavily during pregnancy. It is unknown if (and how) an occasional drink affects fetal sleeping behavior. In 28 near-term pregnant women we examined the effects on fetal behavioral state organization of two glasses of wine (0.25 g of ethanol/kg of maternal body weight). Simultaneous 2-h recordings of fetal heart rate and body, eye, and breathing movements were made on two successive days, once without alcohol exposure and once during maternal alcohol consumption. The study was standardized for time of day and fetal sleep state, i.e. the start of recording was either during quiet sleep (n = 16) or during active sleep (n = 12). Alcohol intake reduced fetal eye movements, disorganized behavioral state organization (rapid eye movement sleep was affected in particular), and suppressed fetal breathing activity almost completely. Modest maternal alcohol intake affects fetal behavioral state organization, which reflects an immediate effect on fetal brain function.
Systematic review with meta‐analysis: the haemodynamic effects of carvedilol compared with propranolol for portal hypertension in cirrhosis

Propranolol is recommended for prophylaxis of variceal bleeding in cirrhosis. Carvedilol is a nonselective beta‐blocker with a mild anti‐alfa‐1‐adrenergic activity. Several studies have compared carvedilol and propranolol, yielding inconsistent results.