Miracle-dz/UniFAR-FTUs huggingface dataset:
Comparison of the removal of uraemic toxins with medium cut-off and high-flux dialysers: a randomized clinical trial.

BACKGROUND Accumulation of middle-weight uraemic toxins in haemodialysis (HD) patients results in increased morbidity and mortality. Whether medium cut-off HD (MCO-HD) improves removal of middle-weight uraemic toxins remains to be demonstrated. METHODS This cross-over prospective study included 40 patients randomly assigned to receive either 3 months of MCO-HD followed by 3 months of high-flux HD (HF-HD), or vice versa. The primary endpoint was myoglobin reduction ratio (RR) after 3 months of MCO-HD. Secondary endpoints were the effect of MCO-HD on other middle-weight toxins and protein-bound toxins, and on parameters of nutrition, inflammation, anaemia and oxidative stress. RESULTS Compared with HF-HD, MCO-HD provided higher mean RR of myoglobin (36 ± 8 versus 57 ± 13%, P < 0.0001), beta2-microglobulin (68 ± 6 versus 73 ± 15%, P = 0.04), prolactin (32 ± 13 versus 59 ± 11%, P < 0.0001), fibroblast growth factor 23 (20 ± 21 versus 41 ± 22%, P = 0.0002), homocysteine (43 ± 7 versus 46 ± 9%, P = 0.03) and higher median RR of kappa [54 (48-58) versus 70 (63-74)%, P < 0.0001] and lambda free light chain (FLC) [15 (9-22) versus 44 (38-49)%, P < 0.0001]. Mean ± SD pre-dialysis levels of beta2-microglobulin (28.4 ± 5.6 versus 26.9 ± 5.1 mg/L, P = 0.01) and oxidized low-density lipoprote (6.9 ± 4.4 versus 5.5 ± 2.5 pg/mL, P = 0.04), and median (interquartile range) kappa FLC [145 (104-203) versus 129 (109-190) mg/L, P < 0.03] and lambda FLC [106 (77-132) versus 89 (62-125) mg/L, P = 0.002] were significantly lower. Mean albumin levels decreased significantly (38.2 ± 4.1 versus 36.9 ± 4.3 g/L, P = 0.004), without an effect on nutritional status as suggested by unchanged normalized protein catabolic rate and transthyretin level. CONCLUSIONS Compared with HF-HD, MCO-HD provides higher myoglobin and other middle molecules RR and is associated with moderate hypoalbuminemia. The potential benefits of this strategy on long-term clinical outcomes deserve further evaluation.
Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study

Abstract Objective To estimate benefits and harms of different colorectal cancer screening strategies, stratified by (baseline) 15-year colorectal cancer risk. Design Microsimulation modelling study using MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon). Setting A parallel guideline committee (BMJ Rapid Recommendations) defined the time frame and screening interventions, including selection of outcome measures. Population Norwegian men and women aged 50-79 years with varying 15-year colorectal cancer risk (1-7%). Comparisons Four screening strategies were compared with no screening: biennial or annual faecal immunochemical test (FIT) or single sigmoidoscopy or colonoscopy at 100% adherence. Main outcome measures Colorectal cancer mortality and incidence, burdens, and harms over 15 years of follow-up. The certainty of the evidence was assessed using the GRADE approach. Results Over 15 years of follow-up, screening individuals aged 50-79 at 3% risk of colorectal cancer with annual FIT or single colonoscopy reduced colorectal cancer mortality by 6 per 1000 individuals. Single sigmoidoscopy and biennial FIT reduced it by 5 per 1000 individuals. Colonoscopy, sigmoidoscopy, and annual FIT reduced colorectal cancer incidence by 10, 8, and 4 per 1000 individuals, respectively. The estimated incidence reduction for biennial FIT was 1 per 1000 individuals. Serious harms were estimated to be between 3 per 1000 (biennial FIT) and 5 per 1000 individuals (colonoscopy); harms increased with older age. The absolute benefits of screening increased with increasing colorectal cancer risk, while harms were less affected by baseline risk. Results were sensitive to the setting defined by the guideline panel. Because of uncertainty associated with modelling assumptions, we applied a GRADE rating of low certainty evidence to all estimates. Conclusions Over a 15 year period, all screening strategies may reduce colorectal cancer mortality to a similar extent. Colonoscopy and sigmoidoscopy may also reduce colorectal cancer incidence, while FIT shows a smaller incidence reduction. Harms are rare and of similar magnitude for all screening strategies.
Symmetry breaking in the embryonic skin triggers directional and sequential plumage patterning

The development of an organism involves the formation of patterns from initially homogeneous surfaces in a reproducible manner. Simulations of various theoretical models recapitulate final states of natural patterns, yet drawing testable hypotheses from those often remains difficult. Consequently, little is known about pattern-forming events. Here, we surveyed plumage patterns and their emergence in Galliformes, ratites, passerines, and penguins, together representing the three major taxa of the avian phylogeny, and built a unified model that not only reproduces final patterns but also intrinsically generates shared and varying directionality, sequence, and duration of patterning. We used in vivo and ex vivo experiments to test its parameter-based predictions. We showed that directional and sequential pattern progression depends on a species-specific prepattern: an initial break in surface symmetry launches a travelling front of sharply defined, oriented domains with self-organising capacity. This front propagates through the timely transfer of increased cell density mediated by cell proliferation, which controls overall patterning duration. These results show that universal mechanisms combining prepatterning and self-organisation govern the timely emergence of the plumage pattern in birds.
Primary cilia respond to intermittent low-magnitude high-frequency vibration and mediate vibration-induced effects in osteoblasts.

Objective: To investigate the role of primary cilia in low-magnitude high-frequency vibration (LMHFV) treatment of MC3T3-E1 osteoblasts (OBs). Methods: We used chloral hydrate (CH), which has a well-characterized function in chemically removing primary cilia, to elucidate the role of primary cilia in LMHFV-induced OB osteogenic responses through cell viability assay, western blot analysis, real time quantitative RT-PCR, and histochemical staining methods. Results: We observed a significant 30% decrease in the number of MC3T3-E1 OBs with primary cilia (reduced from 64.3 ± 5%) and an approximate 50% reduction in length of primary cilia (reduced from 3 ± 0.8 μm) after LMHFV stimulation. LMHFV stimulation upregulated protein expression of the bone matrix markers collagen 1 (COL-1), osteopontin (OPN), and osteoclacin(OCN) in MC3T3-E1 OBs, indicating that LMHFV induces osteogenesis. High concentration or long duration CH exposure resulted in inhibition of MC3T3-E1 OB survival. In addition, western blot analysis and RT-PCR revealed that CH treatment prevented LMHFV-induced osteogenesis. Furthermore, increased alkaline phosphate activity, reduced OB differentiation, mineralization, and maturation, were observed in CH-pretreated and LMHFV-treated OBs. Conclusion: We showed that LMHFV induces morphological changes in primary cilia that may fine-tune their mechano-sensitivity. In addition, we demonstrated the significant inhibition by CH of LMHFV-induced OB mineralization, maturation, and differentiation, which might reveal the critical role of primary cilia in the process.
The impact of perinatal nicotine exposure on fetal lung development and subsequent respiratory morbidity

Maternal smoking during pregnancy remains as a significant public health crisis as it did decades ago. Although its prevalence is decreasing in high‐income countries, it has worsened globally, along with a concerning emergence of electronic‐cigarette usage within the last two decades. Extensive epidemiologic and experimental evidence exists from both human and animal studies, demonstrating the detrimental long‐term pulmonary outcomes in the offspring of mothers who smoke during pregnancy. Even secondhand and thirdhand smoke exposure to the developing lung might be as or even more harmful than firsthand smoke exposure. Furthermore, these effects are not limited only to the exposed progeny, but can also be transmitted transgenerationally. There is compelling evidence to support that the majority of the effects of perinatal smoke exposure on the developing lung, including the transgenerational transmission of asthma, is mediated by nicotine. Nicotine exposure induces cell‐specific molecular changes in lungs, which offers a unique opportunity to prevent, halt, and/or reverse the resultant damage through targeted molecular interventions. Experimentally, the proposed interventions, such as administration of peroxisome proliferator‐activated receptor gamma (PPARγ) agonists can not only block but also potentially reverse the perinatal nicotine exposure‐induced respiratory morbidity in the exposed offspring. However, the development of a safe and effective intervention is still many years away. In the meantime, electropuncture at specific acupoints appears to be emerging as a more practical and safe physiologic approach to block the harmful pulmonary consequences of perinatal nicotine exposure.
Neurourology and Urodynamics

Correspondence Jason Kim, MD, Department of Urology, Stony Brook University Hospital, 101 Nicholls Rd, Stony Brook, NY 11790. Email: Jason.Kim@stonybrookmedicine.edu Abstract Aims: A new multidisciplinary clinic specializing in female pelvic medicine and reconstructive surgery (FPMRS) opened at our institution. We sought to assess patient preference in naming this new center, and how readability and word choice informs these preferences. Methods: We prospectively surveyed patient preference in naming this new center, as well as patient knowledge and societal perception of pelvic floor disorders. This survey was distributed to female patients presenting to general urology and gynecology clinics. Results: There were 300 respondents out of 1000 distributed surveys. Patients preferred titles with accessible readability scores and societally neutral vocabulary. Preferred titles for the clinic were at a 6th‐grade readability level. Patients preferred neutral titles that included the word “health” and disliked titles that contained the words “pelvic floor” and “dysfunction. ” In general, survey participants believed that “incontinence” was associated with negative connotations. Conclusion: Readable and neutral vocabulary in the title of the clinic are key components of patient‐preferred titles for an FPMRS clinic and affect patient comfort levels in scheduling an appointment.
Onsite investigation at a mail-order hatchery following a multistate Salmonella illness outbreak linked to live poultry—United States, 2018

ABSTRACT Centers for Disease Control and Prevention (CDC), health departments, and other state and federal partners have linked contact with live poultry to 70 human Salmonella outbreaks in the United States from 2000 to 2017, which resulted in a total of 4,794 illnesses, 894 hospitalizations, and 7 deaths. During human salmonellosis outbreaks environmental sampling is rarely conducted as part of the outbreak investigation. CDC was contacted by state health officials on June 12, 2018, to provide support during an investigation of risk factors for Salmonella infections linked to live poultry originating at a mail-order hatchery. From January 1, 2018, to June 15, 2018, 13 human Salmonella infections in multiple states were attributed to exposure to live poultry from a single hatchery. Two serotypes of Salmonella were associated with these infections, Salmonella Enteritidis and Salmonella Litchfield. Molecular subtyping of the S. Enteritidis clinical isolates revealed they were closely related genetically (within 0 to 9 alleles) by core genome multi-locus sequence typing (cgMLST) to isolates obtained from environmental samples taken from hatchery shipping containers received at retail outlets. Environmental sampling and onsite investigation of practices was conducted at the mail-order hatchery during an investigation on June 19, 2018. A total of 45 environmental samples were collected, and 4 (9%) grew Salmonella. A chick box liner from a box in the pre-shipping area yielded an isolate closely related to the S. Enteritidis outbreak strain (within 1 to 9 alleles by cgMLST). The onsite investigation revealed lapses in biosecurity, sanitation, quality assurance, and education of consumers. Review of Salmonella serotype testing performed by the hatchery revealed that the number of samples and type of samples collected monthly varied. Also, S. Enteritidis was identified at the hatchery every year since testing began in 2016. Recommendations to the hatchery for biosecurity, testing, and sanitation measures were made to help reduce burden of Salmonella in the hatchery and breeding flocks, thereby reducing the occurrence of human illness.
The optimal timing of laparoscopic cholecystectomy in patients with mild gallstone pancreatitis

Abstract Background: The optimal timing of laparoscopic cholecystectomy (LC) in patients with mild acute gallstone pancreatitis (MAGP) is controversial. The aim of this study was to systematically evaluate and compare the safety and efficacy of early laparoscopic cholecystectomy (ELC) and delayed laparoscopic cholecystectomy (DLC) in patients with MAGP. Methods: A strict search was conducted of the electronic databases, including PubMed, MEDLINE Embase, the ISI Web of Science, and Cochrane Library for all relevant English literature and RevMan5.3 software for statistical analysis was used. Results: A total of 19 studies comprising 2639 patients were included. There was no significant difference in intraoperative complications [risk ratio (RR) = 1.46; 95% confidence interval (CI) = 0.88–2.41; P = . 14)], postoperative complications (RR = 0.81; 95% CI = 0.58–1.14; P = .23), rate of conversion to open cholecystectomy (RR = 1.00; 95% CI = 0.75–1.33; P = .99), operative time (MD = 1.60; 95% CI = −1.36–4.56; P = .29), and rate of readmission (RR = 0.63; 95% CI = 0.19–2.10; P = .45) between the ELC and DLC groups. However, the ELC group was significantly correlated with lower length of hospital stay (MD = −2.01; 95% CI = −3.15 to −0.87; P = .0006), fewer gallstone-related events rates (RR = 0.17; 95% CI = 0.07–0.44; P = .0003), and lower endoscopic retrograde cholangiopancreatography (ERCP) usage (RR = 0.83; 95% CI = 0.71–0.97; P = .02) compared with the DLC group. Conclusion: Early laparoscopic cholecystectomy is safe and effective for patients with MAGP, but the indications and contraindications must be strictly controlled.
Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate. Dental arch relationships in 8 year-olds.

BACKGROUND AND TRIAL DESIGN The Scandcleft intercentre study evaluates the outcomes of four surgical protocols for treatment of children with unilateral cleft lip and palate (UCLP). Originally 10 cleft centres in Denmark, Finland, Norway, Sweden, and the UK participated in a set of three randomized trials of primary surgery. Three groups of centres (Trials 1, 2, and 3) tested their traditional local surgical protocols (Arms B, C, and D) against a common protocol (Arm A). OBJECTIVES To evaluate dental arch relationships at age 8 years after four different protocols of primary surgery for UCLP. These results are secondary outcomes of the overall trial. METHODS Study models of 411 children (270 boys, 141 girls) with non-syndromic UCLP at a mean age of 8.1 (range 7.0-10.0) years were available. Dental arch relationships were analysed using the GOSLON Yardstick by a blinded panel of 11 orthodontists. To assess reliability, Kappa statistics were calculated. The trials were tested statistically with t-tests. RESULTS Comparisons within each trial showed no statistically significant differences in the mean 8-year index scores or their distributions between the common protocol and the local team protocol. The mean index scores were Trial 1: Arm A 3.03, Arm B 2.82, Trial 2: Arm A 2.78, Arm C 2.64, and Trial 3: Arm A 3.06, Arm D 3.08. Comparisons between the trials detected a significantly (P < 0.005) better mean index score Trial 2 Arm C than in Trial 3 Arm D. The intra- and inter-rater reliabilities were acceptable. CONCLUSION The results of these three trials do not provide evidence that one surgical protocol is better than the others. TRIAL REGISTRATION ISRCTN29932826.
New‐onset atrial fibrillation predicting for complicating cardiac adverse outcome in scrub typhus infection

Scrub typhus is a well‐known infectious disorder of the Asia‐Pacific region. However, adverse cardiac outcomes are an under‐recognized complication of scrub typhus infection, and new‐onset AF has been reported to be a prognostic factor in other, more common infectious diseases. The present study investigated whether new‐onset atrial fibrillation (AF) is significantly associated with 3‐month mortality and adverse cardiac complications in scrub typhus infection.
Axillary lymph-node metabolic activity assessment on 18F-FDG-PET/CT in rheumatoid arthritis patients treated with biologic therapies

Objective: Recent studies have provided new insights into the role of lymph nodes (LNs) in rheumatoid arthritis (RA). The aim of this study was to evaluate the metabolic activity of the axillary LNs in relation to that of the upper limb joints and the clinical assessment of disease activity in RA patients treated with biologic therapies. Method: 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) scans were acquired for 64 patients with RA at baseline and after 6 months of biologic therapy, and the patients’ clinical status was evaluated. The maximum standardized uptake value (SUVmax), metabolic active volume, and total lesion glycolysis (TLG) were used to assess glucose metabolism in the LNs and 12 joints. Clinical evaluations included serum markers and the Disease Activity Score based on 28-joint count–erythrocyte sedimentation rate (DAS28-ESR). Results: Changes in the SUVmax and TLG for the axillary LNs correlated significantly with those of the ipsilateral wrist joints. There was a positive correlation between the changes in the three metabolic parameters of the axillary LNs and the changes in disease activity after treatment. After 6 months of biologic therapy, all metabolic parameters for the axillary LNs in patients with a DAS28-ESR < 3.2 were significantly lower than those of patients with a DAS28-ESR ≥ 3.2. Conclusion: A relationship between the glucose metabolism of the axillary LNs and the ipsilateral wrist joints was demonstrated by the 18F-FDG-PET/CT parameters. The metabolic activity and active volume of axillary LNs may reflect the therapeutic response to the biologic treatment of RA.
Outborn Birth Status Is Associated With Short- and Long-Term Morbidity in Extremely Preterm Neonates.

994 www.pccmjournal. org October 2019 • Volume 20 • Number 10 Postnatal stabilization of extremely preterm neonates depends on a variety of factors, starting with the quality of medical and nursing interventions. The complexity of caring for extremely preterm neonates after birth involves support of cardiorespiratory adaptation in the most physiologic way and stringent temperature management, while continuously taking the vulnerability of immature organs such as the CNS and the potentially long-lasting effect of necessary medical interventions on patient outcome into consideration. Hence, respiratory support including administration of surfactant (1, 2), adequacy of oxygen supply (3), stabilization of blood pressure (4), placental transfusion (5), and temperature management (6) are major topics of scientific effort worldwide. In addition, technical aspects of resuscitating extremely preterm neonates such as optimal patient monitoring (7) and vascular access (8) are studied extensively in order to inform practicing neonatologists, aiming at further optimizing patient outcomes. Given the complexity of delivery room care for extremely preterm neonates, even specialized healthcare professionals are challenged to perform according to current evidence-based recommendations (9). Besides gestational age and medical aspects of neonatal care after birth, several factors are relevant to estimate outcomes of extremely preterm neonates, including sex, exposure to antenatal corticosteroids, single versus multiple pregnancy, and birth weight (10). Outcome of extremely preterm neonates is further affected by mode of delivery, timing of delivery, level of neonatal intensive care, and hospital volume of very-lowbirth-weight infants. Minguez-Milio et al (11) found a lower agree with the authors that it would be of interest to perform a similar investigation in higher-risk CHD populations, such as those with palliated single ventricle circulation and those requiring more complex heart surgery.
Increasing physical activity in adult women with Prader-Willi syndrome: A transferability study.

BACKGROUND The present authors aimed (a) to objectively quantify spontaneous physical activity (PA) in adult patients with Prader-Willi syndrome (PWS) and (b) to evaluate the transferability of a home-based exercise training programme in these patients. METHOD Physical activity was compared between 10 adult women with PWS (PWS group) and 20 adult women with non-syndromic obesity (CON group, for cross-sectional comparison). In the PWS group, PA, body composition, walking capacity, quality of life and eating behaviour were then compared before and after a 16-week supervised exercise programme. RESULTS The PWS group displayed lower PA and higher sedentary time compared to the CON group. Median attendance to exercise sessions reached 100% (Q1-Q3: 97%-100%) sessions. Moderate-to-vigorous PA and walking capacity increased after the programme without significant effect on body composition. CONCLUSION Supervised home-based exercise sessions are an effective strategy to improve PA in women with PWS who are less active than women matched for adiposity.
Perceived factors associated with boda-boda (motorcycle) accidents in Kampala, Uganda

Abstract Objective: According to the United Nations, nearly 1.25 million people are killed and up to 50 million people are injured on the world’s roads every year. Uganda loses about 10 people daily to road accidents, costing about US$1.2 billion annually, which represents about 5% of the gross domestic product (GDP). The objective of this study was to identify causal factors that can be associated with boda-boda accidents in Uganda. Method: A cross sectional study assessed 200 boda-boda riders in the urban areas of Kampala, Uganda. Interviews using semistructured questionnaires were administered to all participants. Data were entered in Excel and imported to STATA for analysis. Multivariate and bivariate analyses were conducted to determine factors that influenced accident risk perception. All variables that were significant at a bivariate level and thought to be theoretically important in influencing the outcome variable were included in a logistic regression model. All tests were performed at a significance of P < . 05. Results: Competition for passengers with other public transport operators (83%), negligence of road safety rules (78%), and inadequate helmet usage (62%) were the main factors perceived to be associated with boda-boda accidents. Other factors identified by the respondents include age of the boda-boda rider (58%) and drug use (56%; P < .05). At multivariate analysis, competition for passengers (adjusted odds ratio [AOR] = 17; 95% confidence interval CI, 1.34–26.5) and being in between 18 and 25 years old (AOR = 19; 95% CI, 1.42–27.1) remained statistically significant. Conclusions: This study revealed behavioral factors by all public transport users as the main factors associated with boda-boda accidents in urban Kampala. This demonstrates the need for holistic interventions to address such boda-boda accidents in Uganda. Such interventions can be through digitization of transport system for clients to engage remotely with the transport operators, routine refresher trainings of all transport operators, and construction of lanes for boda-boda riders.