Miracle-dz/UniFAR-FTUs huggingface dataset:
Wire-Guided Cannulation Versus Contrast-guided Cannulation In Pediatric Endoscopic Retrograde Cholangiopancreatography

Background/Aim: Wire-guided cannulation (WGC) of the common bile duct may be associated with fewer complications and higher success rate compared with contrast-guided cannulation (CGC) in adults. Data in children are lacking. The aim of this study was to compare the successful cannulation and complication rate of WGC and CGC in pediatric endoscopic retrograde cholangiopancreatography (ERCP). Patients and Methods: We report a retrospective cohort study comparing WGC to CGC in a pediatric cohort. We reviewed the medical records of 167 children who underwent ERCP over a 10-year time period (CGC, 1999-2003, WGC, 2003-2009). Indications, findings, and success were analyzed. Results: A total of 93 patients (56%) underwent WGC and 74 (44%) CGC. Children in the WGC group were younger (9.5 ± 4.7 vs. 11.5 ± 4.6 years in CGC; P = 0.006) and underwent more therapeutic ERCP interventions (70% vs. 40% in CGC), whereas diagnostic ERCP was more common in the CGC group (60%; P < 0.005). The overall success (96%) and complication rate (8%) were identical in both groups but a trend toward a reduction in the complication rate over time was noted in the WGC group. Post-ERCP pancreatitis (PEP) was documented in one patient in the WGC group (1.1%) and three patients (4.2%) in the CGC group (P-NS). Conclusion: The success and complication rate in both CGC and WGC are comparable in children but considering the patient and procedure complexity and the trend toward lower PEP in the WGC group, WGC may be the preferable cannulation technique for ERCP in children.
Acute Liver Failure in Pregnancy: Causative and Prognostic Factors

Background/Aims: Acute liver failure (ALF) in pregnancy is often associated with a poor prognosis. In this single-center observational study we aim to study the incidence, causes, and factors affecting mortality in pregnant women with ALF. Patients and Methods: Sixty-eight pregnant women reporting with clinical features of liver dysfunction were enrolled as cases. Their clinical course was followed and laboratory studies were performed. The presence of ALF was defined as the appearance of encephalopathy. The results were compared with a control group of 16 nonpregnant women presenting with similar complaints. The cases were further subdivided into two groups of survivors and nonsurvivors and were compared to find out the factors that contribute to mortality. Results: ALF was seen in significantly more number of pregnant women than the controls (P = 0.0019). The mortality rate was also significantly higher (P = 0.0287). Hepatitis E virus (HEV) caused jaundice in a higher number of pregnant women (P < 0.001). It also caused ALF in majority (70.3%) of pregnant women, but HEV infection was comparable between the survivors and nonsurvivors (P = 0.0668), hence could not be correlated with mortality. Conclusions: Pregnant women appear to be more susceptible for HEV infection and development of ALF. The mortality of jaundiced pregnant women increased significantly with appearance of ALF, higher bilirubin, lower platelet count, higher international normalized ratio, and spontaneous delivery.
Plerixafor for mobilization of blood stem cells in autologous transplantation: an update

Introduction: About 99% of all autologous transplants are now performed with blood stem cells. G-CSF alone or combined with chemotherapy have been used to mobilize CD34+ cells. Plerixafor is a novel drug used for mobilization purposes. Areas covered: We have evaluated recent data in regard to plerixafor use in predicted or proven poor mobilizers. In addition, we have looked for preemptive strategies to optimize the use of this expensive drug. Also cost-efficacy issues and effects of plerixafor on graft composition and post-transplant outcomes will be discussed. Expert opinion: Plerixafor added to G-CSF is superior than G-CSF alone for mobilization of CD34+ cells. This combination is also efficient in patients who have failed a previous mobilization attempt with other methods or in patients with risk factors for poor mobilization. Addition of plerixafor to G-CSF or chemotherapy plus G-CSF mobilization in patients who appear to mobilize poorly is under active investigation and algorithms for a preemptive use of this expensive agent have been proposed. Grafts collected after plerixafor appear to contain more lymphoid cells than the grafts collected without it. Whether this affects post-transplant outcomes such as immune reconstitution and risk of relapse needs to be evaluated.
Non-apprenticeship VET courses : participation, persistence and subsequent pathways.

The non-apprenticeship VET sector provides a successful pathway from school to further education and training for young Australians from all socioeconomic backgrounds, according to Julie McMillan, Sheldon Rothman and Nicole Wernert. They find that around 20 per cent of young Australians had enrolled in a non-apprenticeship VET course by age 19. By age 20 in late 2001, 60 per cent of the non-apprenticeship VET entrants had completed their first course while 14 per cent were still enrolled in their first course. Students from lower socioeconomic backgrounds were not disadvantaged in terms of course progress. Gender, language background and region were also unrelated to continuing with non-apprenticeship study.
The relationship between traffic-related air pollutants and cardiac autonomic function in a panel of healthy adults: a further analysis with existing data

Context: Epidemiological studies have linked particulate matter (PM) and carbon monoxide (CO) exposures with alterations in cardiac autonomic function as measured by heart rate variability (HRV) in populations. Recently, we reported association of several HRV indices with marked changes in particulate air pollution around the Beijing 2008 Olympic Games in a panel of healthy adults. Objective: We further investigated the cardiac effects of traffic-related air pollutants over wide exposure ranges with expanded data set in this panel of healthy adults. Methods: We obtained real-time data on nine taxi drivers’ in-car exposures to PM ≤2.5 µm in aerodynamic diameter (PM2.5) and CO and on multiple HRV indices during a separate daily work shift in four study periods with dramatically changing air pollution levels around the Beijing 2008 Olympic Games. Mixed effect models and a loess smoother method were used to investigate the associations of exposures with HRV indices. Results: Results showed overall negative associations of traffic-related air pollutants with HRV indices across periods, as well as differences in period-specific and individual associations. After stratifying the individuals into two different response groups (positive/negative), cardiac effects of air pollutants became stronger within each group. Exposure–response modeling identified changed curvilinear relationships between air pollution exposures and HRV indices with threshold effects. Discussion and conclusion: Our results support the association of exposure to traffic-related air pollution with altered cardiac autonomic function in young healthy adults free of cardiovascular compromises. These results suggest a complicated mechanism that traffic-related air pollutants influence the cardiovascular system of healthy adults.
Prevalencia de anemia en niños y adolescentes mexicanos: comparativo de tres encuestas nacionales

Objective. To describe the prevalence of anemia in Mexican children and adolescents from ENSANUT 2012. Materials and methods. Data had the power to make distinctions at the national, regional and rural/urban dwelling. Hemoglobin was measured by Hemocue. Descriptions were made by adjusted frequencies and 95%CI. Confounders were tested in a logistic regression models. Results. The prevalence of anemia in 2012 was: in children 1-4 y, 23.3%; 5-11y, 10.1%, and 12-19 y, 5.6%. The prevalence in female adolescents was 7.7% and 3.6% in males. Reductions in the prevalence of anemia from 1999 was 8.3pp in <5y, 5.1pp in children 5-11y and 3.6pp from 2006 in adolescents. Conclusions. Despite the decrease in the prevalence of anemia in children 1-4 y in the last 13 years, it still is of great concern. There is a need of awareness among social and medical communities about this, to extend the distribution of micronutrient supplements in children <3y, and to promote nutritional education to incentive mothers to provide foods rich in iron.
Kochia scoparia fruit attenuates allergic airway inflammation in ovalbumin (OVA)-induced murine asthma model

Kochia scoparia fruit has been used in Asia for a long time. It possesses anti-inflammatory, antiallergic, and antipruritic actions. We investigated the role of a K. scoparia fruit ethanolic extract (KSEE) in allergic airway inflammation in a mouse asthma model. BALB/c mice were sensitized with ovalbumin (OVA) and, upon OVA aerosol challenge, developed airway eosinophilia, mucus hypersecretion, elevations in cytokine, chemokine, and immunoglobulin levels, and upregulation of MMP-9, intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) expression. Intragastric administration of KSEE significantly attenuated OVA-induced influx of total leukocytes, eosinophils, neutrophils, macrophages, and lymphocytes into lungs, as well as attenuating levels of interleukin (IL)-4 and IL-5 in a dose-dependent manner. KSEE also significantly reduced the serum levels of total and OVA-specific immunoglobulin (Ig)E and OVA-specific IgG1 release into the airspace. Histological studies showed that KSEE inhibited OVA-induced lung tissue eosinophilia and airway mucus production. Moreover, in whole lung tissue lysates, immunoreactivity showed that KSEE markedly attenuated the OVA-induced increase in expression of ICAM-1, VCAM-1, and MMP-9. These results show that KSEE possesses protective effects against allergic airway inflammation, acts as an MMP-9 inhibitor, and induces a reduction in ICAM-1 and VCAM-1 expression.
Discriminant Value of Rome III Questionnaire in Dyspeptic Patients

Background/Aim: Rome III criteria has modified the description of functional dyspepsia (FD) and divided this into subgroups. However, the discriminative value of Rome III questionnaire-based diagnosis of FD is yet to be determined. Objectives: To evaluate the Rome III questionnaire for the diagnosis of FD and whether it can discriminate between postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) in patients with dyspeptic symptoms. Patients and Methods: Consecutive patients, who were not on proton pump inhibitors (PPI), were asked to participate. Patients who have previously established acid peptic disease or predominantly reflux symptoms or having alarm symptoms such as weight loss and hematemesis were excluded. Rome III questionnaire for FD was used to identify the patients as having FD and divide into its subgroups; PDS or EPS. Gastro-duodenal biopsies, liver function tests and ultrasound were done to establish the diagnosis of FD. Results: Out of 272 patients with upper gastrointestinal (GI) symptoms without alarm features, who were enrolled in the study, a total of 191 (70%) fulfilled the criteria of FD based upon Rome III questionnaire. EPS subgroup was found in 109 (57%), PDS in 17 (9%) patients, overlap between EPS and PDS was present in 56 (29%) patients. Nine (5%) patients remained indeterminate. Diagnosis of FD was established in 136/191 (71%) patients only. Gastritis was present in 116 patients (85%), Duodenitis in 44 (32%) and Helicobacter pylori infection in 70 (51%) patients. Among 55 patients (29%) who had organic diseases, EPS was seen in 35 (64%), PDS in 5 (9%) and overlap in 15 (27%) patients. Underlying organic causes were gastric or duodenal ulcers in 14 patients, Barrett esophagus in five, chronic liver disease in seven, gall stones in five, Giardiasis and celiac disease in three each. Gastric carcinoma, Crohns disease and gastric polyps were seen in one patient each. Conclusion: This study indicates that 30% of patients who fulfilled the Rome III criteria for FD actually had organic disease. Almost one-third of patients with functioanl dyspepsia did not qualify for one of the two subgroups of FD of Rome III. There is also a need to further define the Rome III-based subgroups of FD for research purpose.
Supporting self-management

No cure for cardiovascular disease (CVD) has yet been found, which means that prevention is the mainstay of treatment. The recently published Cardiovascular Disease Outcomes Strategy (Department of Health, 2013) shows that prevention is now centre stage either through efforts to prevent the initial development of CVD or to slow down its progression. As nurses our priority is to foster collaborative partnerships with patients and their families, supporting them to ‘self-manage’ their medications and make healthy lifestyle changes. Self-management is defined as ‘the sum of activities that a patient undertakes to control the symptoms and progression of chronic disease' (Marshall et al, 2005). Patients with CVD have to manage a constellation of symptoms such as angina pain, intermittent claudication, shortness of breath and fatigue, combined with complex medication regimes. Having to make lifestyle changes in addition to managing symptoms and medication regimes can seem overwhelming
Fecal microbiota transplantation for Clostridium difficile infection: back to the future

Introduction: Clostridium difficile infection (CDI) is a leading cause of diarrhea in the industrialized world. The estimated costs of this infection are impressive: over 3.2 billion dollars annually in the US. The introduction of fecal microbiota transplantation (FMT) to clinical practice can be considered a Copernican Revolution. The rationale of this approach consists of correcting the imbalance of the organisms dwelling in the gut by reintroducing a normal flora. Areas covered: This review focuses on the indication for FMT in CDI; it examines in-depth the most relevant aspects of the techniques used, and the safety and efficacy of this new ‘old’ therapy. Expert Opinion: Authoritative guidelines about the management of CDI strongly recommend FMT for multiple recurrent episodes of infection by C. difficile unresponsive to repeated antibiotic treatment. The cure rates are about 90%, with no serious adverse events having been reported. The main concerns are the long-term outcomes, lack of a standardized procedure for the delivery of donor material, and a cultural barrier to the transplantation of fecal microbiota. A promising solution to some of these problems could be the use of a more acceptable administration route of fecal material, namely, oral capsules.
Diversity of Genotype and Mode of Spread of Hepatitis C Virus in Northern India

Background/Aim: Hepatitis C is caused by hepatitis C virus (HCV), which is classified into 6 genotypes. It leads to chronic hepatitis in 80% of the cases. Genotype of the virus helps in predicting response to antiviral therapy and also the duration of treatment. Therefore, it is important to know the prevalence of each genotype. Knowledge regarding the route of entry of HCV in the blood is also necessary to formulate a strategy to prevent its spread. Patients and Methods: One hundred and two newly diagnosed patients with chronic hepatitis C, having anti-HCV antibody-positive were included in the study. Their HCV RNA viral load and genotype were determined by Reverse Transcriptase PCR assay on Roche Cobas Ampliprep analyzer. Results: Genotype 3 was commonly detected in 58.8% patients followed by genotype 1 in 20.6%. Twelve patients had genotype 4 (11.8%) and 9 had mixed infection with genotypes 3 and 4. Among these patients, 43.1% of patients had a history of multiple injection exposure. Blood transfusion received by 6.9% and 2.9% had donated blood. Only 1 patient had a history of drug abuse. Conclusion: The distribution of genotypes varies in different regions and therefore its knowledge is important, as it determines the response of the patient to the treatment. The use of autodisabled syringes, their proper disposal, following biomedical waste management guidelines, and organizing continued medical education and workshops will help in preventing the spread of HCV infection.
Correlates of Poverty and Partner Abuse Among Women on Methadone

This study explores the association between poverty and experiences of partner abuse among 204 women recruited from methadone maintenance treatment programs. Logistic regressions were used to examine the associations between extreme poverty and indicators of partner abuse. The findings show that extreme poverty was prevalent and associated with partner abuse. The study findings suggest that providers of methadone maintenance programs need to incorporate poverty indicators in their assessment because extreme poverty seems to correlate with all forms of partner abuse. The impact of welfare reform on partner violence should be on the agendas of policy makers and researchers.
Predictors of outcome in patients with severe aortic stenosis and normal left ventricular function : role of B-type natriuretic peptide ded from

Predictors of outcome in patients with severe aortic stenosis and normal left ventricular function: role of B-type natriuretic peptide ed rom http/academ ic.p.com /erhear Pascal Lim*, Jean Luc Monin, Mehran Monchi, Jérome Garot, Agnès Pasquet, Luc Hittinger, Jean Louis Vanoverschelde, Alain Carayon, Pascal Gueret a Department of Cardiology, Henri-Mondor Hospital, Créteil, Assistance Publique Hôpitaux de Paris, 51 Avenue De Lattre De Tassigny, 94010 Creteil, France b Department of Intensive Care Medicine, Institut Jacques Cartier, Massy, France c Department of Biochemistry, Pitié Salpetrière Hospital, Paris, France d Department of Cardiology, Saint Luc Hospital, Brussels, Belgium
Method of assessment and symptom reporting in veterans with mild traumatic brain injury

Objectives: We hypothesized that in a sample of veterans (1) frequency and consistency of post-concussive symptom endorsement would differ across assessment methods (detailed physician interview, brief screening interview, or self-report questionnaire checklist) and (2) that participants would endorse more symptoms on the self-report checklist than the screening interview or the physician interview. Methods: To assess the presence and severity of post-concussive symptoms, veterans and current military service members were recruited via newspaper advertisement for a research project to assess history of traumatic brain injury. Participants underwent evaluation, including a brief screening interview (the Rehabilitation Institute of Chicago Military Traumatic Brain Injury Screening Instrument), a detailed physician interview, and completion of a self-report questionnaire (the Rivermead Post-concussion Questionnaire). Results: Symptom reporting significantly differed across assessment methods for headaches [Q(2) = 65.45, p < . 001], dizziness [Q(2) = 52.55, p < . 001], and nausea [Q(2) = 58.58, p < . 001]. Symptoms were most likely to be reported in a brief screening interview followed by the self-report questionnaire, followed by a physician interview. Consistency of symptom reporting also differed: reporting of dizziness was more discordant across assessment methods than reporting of nausea or headaches. Discussion: Our findings support our first hypothesis, but provided only partial support for our second hypothesis. That is, the data confirm that differences exist in post-concussion symptom reporting based on data gathering technique and type of symptom. Yet, contrary to our expectations, participants endorsed more symptoms during a brief screening interview than on a self-report questionnaire. These findings may have implications for optimizing assessment of complaints after concussion, especially within a veteran population.
A randomized controlled trial comparing the physiological and directed pushing on the duration of the second stage of labor, the mode of delivery and Apgar score

In recent year, there has been an increased trend to the physiological approach to labor. Physiological (spontaneous) pushing in upright position is one of the practices that promote the normal physiological process. Effect of physiological pushing versus directed pushing on the duration of the second stage of labor, mode of birth and Apgar. A randomized controlled trial was completed on 191 women who gave birth at a maternity unit in Iran between August and December 2009. Randomization occurred upon confirmation of full dilatation of the cervix with using block randomization. In the intervention group (n = 100), with full dilatation of the cervix and a fetal head plus 1, the midwives providing care suggested they commenced pushing in upright position only when they felt the urge to do so and gave no specific instructions about the timing and duration of pushing. In the control group (n = 91), women were coached by the midwife to use closed-glottis pushing three to four times in supine position during each contraction immediately as the same period. Mean duration of the second stage of labor in the primiparous women was 47.38±36.75 and 57.12±33.10 min in the intervention and control groups, respectively; the difference was significant (p < 0.0001). In the multiparous, women in the second stage of labor lasted for 26.12±23.43 and 33.20±22.76 min in the intervention and control groups, respectively, which was significantly different (p < 0.0001). One woman in the control group and 2 mother in the intervention group undertook cesarean surgery (p = 1). Apgar scores were similar in both groups. Physiological pushing was not associated with demonstrable adverse outcome. It seems that this technique can reduce the duration of the second stage of labor and it can be a safe method during the second stage of labor without any harm for mother and baby. Key words: Spontaneous pushing, directed pushing, valsalva, second stage of labor
Lack of marked cyto- and genotoxicity of cristobalite in devitrified (heated) alkaline earth silicate wools in short-term assays with cultured primary rat alveolar macrophages

Abstract Alkaline earth silicate (AES) wools are low-biopersistence high-temperature insulation wools. Following prolonged periods at high temperatures they may devitrify, producing crystalline silica (CS) polymorphs, including cristobalite, classified as carcinogenic to humans. Here we investigated the cytotoxic and genotoxic significance of cristobalite present in heated AES wools. Primary rat alveolar macrophages were incubated in vitro for 2 h with 200 µg/cm2 unheated/heated calcium magnesium silicate wools (CMS1, CMS2, CMS3; heat-treated for 1 week at, or 4 weeks 150 °C below, their respective classification temperatures) or magnesium silicate wool (MS; heated for 24 h at 1260 °C). Types and quantities of CS formed, and fiber size distribution and shape were determined by X-ray diffraction and electron microscopy. Lactate dehydrogenase release and alkaline and hOGG1-modified comet assays were used, ± aluminum lactate (known to quench CS effects), for cytotoxicity/genotoxicity screening. Cristobalite content of wools increased with heating temperature and duration, paralleled by decreases in fiber length and changes in fiber shape. No marked cytotoxicity, and nearly no (CMS) or only slight (MS) DNA-strand break induction was observed, compared to the CS-negative control Al2O3, whereas DQ12 as CS-positive control was highly active. Some samples induced slight oxidative DNA damage, but no biological endpoint significantly correlated with free CS, quartz, or cristobalite. In conclusion, heating of AES wools mediates changes in CS content and fiber length/shape. While changes in fiber morphology can impact biological activity, cristobalite content appears minor or of no relevance to the intrinsic toxicity of heated AES wools in short-term assays with rat alveolar macrophages.