Miracle-dz/UniFAR-FTUs huggingface dataset:
Anti-tumor necrosis factor (TNF) therapy in rheumatoid arthritis: correlation of TNF-alpha serum level with clinical response and benefit from changing dose or frequency of infliximab infusions.

OBJECTIVE To determine the relationship between serum TNF-alpha level and clinical response in rheumatoid arthritis patients treated by infliximab. This could be of value to predict clinical response to infliximab and to determine the optimal dose and interval between dosing of infliximab. RA patients who did not respond adequately to conventional doses (3 mg/kg) of infliximab were studied to see if increasing the dose or frequency of infliximab infusions would be more effective. METHODS Fifty-five RA patients who fulfilled the American College of Rheumatology criteria and were receiving treatment by anti-TNF-alpha (infliximab 3 mg/kg body weight every 8 weeks) were evaluated by: clinical disease activity using the Richie score index before receiving their scheduled infliximab infusion. Serum level of TNF-alpha, as measured by competitive ELISA assay, was determined immediately before and 9-11 days after receiving infliximab. RA patients who did not respond adequately to treatment with infliximab were given either a larger dose of infliximab or given the infusion at six-week intervals. Their clinical response was then evaluated sixteen months later. RESULTS Patients were divided into 2 groups according to Richie score, active group with score > 10 (score 20.3 +/- 7.7 mean +/- standard deviation, n = 25) and inactive group with scores < or = 10 (score 4.1 +/- 3.2, n = 30). TNF-alpha serum levels pre-infliximab infusion were significantly higher in the active group 76.1 pg/ml than the inactive group 38.0 pg/ml (P < 0.02). Whereas TNF serum level significantly dropped post infliximab in the inactive group (P < 0.05), it did not drop in the active group. The mean level of the post-infusion TNF-alpha serum level was higher (76.6 +/- 93.4 ng/ml) in the-active than the mean level of the post-infusion serum TNF-alpha levels in the inactive group (26.4 ng/ml +/- 7.9) P < 0.01 using the t-test. Increasing the frequency was superior in RA patients' clinical outcome than increasing the dose of infliximab infusions. CONCLUSION RA patients who responded well to infliximab and had inactive disease at the time of the study have lower levels of serum TNF-alpha which could be further suppressed by the recommended doses of infliximab. RA patients with active disease have higher serum levels of TNF-alpha which could not be suppressed after the recommended doses of infliximab infusion. Changing the frequency of infliximab infusions in the active group was more effective than increasing the dose of infliximab in inducing improved clinical outcome. We suggest that the lack of suppression of TNF-alpha in the active group could be due to inadequate dosing of infliximab or to the presence of a neutralizing antibody directed against infliximab. It remains to be seen if serum TNF-alpha levels could be used as a guide in determining the dose and intervals between dosing of anti-TNF therapy in RA in order to achieve the desired clinical response.
High Frequency of Vα24+ Vβ11+ T-Cells Observed in Type 1 Diabetes

OBJECTIVE —Natural killer T-cells (NKT cells) are believed to play an important role in the regulation of immune response, and a numerical and functional deficit of NKT cells has been reported to be associated with the pathogenesis of autoimmune diseases. Thus far, it has been shown that subjects with type 1 diabetes have a lower frequency of NKT cells than nondiabetic subjects. In this study, we measured the frequency of peripheral Vα24 + Vβ11 + T-cells, which include human NKT cells, in Japanese diabetic patients. RESEARCH DESIGN AND METHODS —Peripheral blood samples were obtained from 164 Japanese diabetic patients and 67 healthy subjects. The diabetic patients were classified into four categories as follows: islet-associated autoantibody–positive (Ab + ) and –negative (Ab – ) classic type 1 diabetes, latent autoimmune diabetes in adults (LADA), and type 2 diabetes. We measured the frequency of peripheral Vα24 + Vβ11 + CD3 + triple-positive cells. RESULTS —Unexpectedly, a higher frequency of Vα24 + Vβ11 + T-cells was observed in Ab + and Ab − patients compared with LADA patients ( P = 0.0294 and P = 0.0021), type 2 diabetic patients ( P P P = 0.0046 and P = 0.0001). Moreover, an inverse correlation between Vα24 + Vβ11 + T-cell frequency and disease duration was observed in Ab + (ρ = −0.455; P = 0.0023) and Ab − (ρ = −0.432; P = 0.0162) patients. CONCLUSIONS —Our findings indicate that a high frequency of Vα24 + Vβ11 + T-cells is a unique finding in recent-onset classic type 1 diabetes, and measurement of Vα24 + Vβ11 + T-cell frequency may be useful to assess the disease activity of classic type 1 diabetes.
Economic influences on and impacts of the migration of health professionals

Migration has become an important feature of health labour markets due to the global shortage of health professionals. While there exists an extensive Labour Economics literature studying the general migration, policy development remains hampered by limited research undertaken in the health sector. This thesis fills some of that gap by examining the economic influences on and impacts of the migration of health professionals. The migration of skilled health professionals has exhibited strong sectoral properties, such as the motivation of career development and various regulatory regimes. We incorporate these features into the self-selection model by Borjas and Bratsberg (1996) and examine factors that influence the scale and skill composition of the migration flow. Our model suggests that the restrictive relicensing regime and work permit requirements for non-EEA professionals adopted by the British government to maintain practice standards and secure employment opportunities for native graduates, could only limit the migration from countries with higher returns to skills. The effect is ambiguous for most donor countries, which provide lower returns to skills. Using the administrative data derived from the Scottish dental system, we also examine the impacts of health professional migration within EU on the host country by investigating the performance of EEA dentists contracted under the Scottish NHS in terms of retention and treatment provision. A discrete-time survival analysis has been applied to characterize the time trend of the retention and identify factors associated with the likelihood of a dentist leaving the NHS. We also compare treatments provided by migrant and non-migrant dentists by estimating a difference-in-differences model. Unobserved heterogeneity in dentists is controlled using fixed effects. Our results suggest that EEA health professionals can be a good substitute to British graduates. They provide marginally different treatments and exhibit strong
Ankle mobility and postural stability

Impaired function of the ankle joint can decrease mobility in older adults. Age-related changes in function include increased passive resistance of the elastic tissue in opposing muscles, tendons, and articular structures, weakened agonist muscles, and impaired proprioceptive control. An individual with limited ankle joint mobility may be at risk for tripping and a fall, an event which sometimes leads to serious injury and dependence. Positive effects of exercise on joint stiffness and range of motion have been reported, leading to conclusions that both the connective tissue system and muscular control in older people are modifiable through an appropriate exercise programme. Stretching through range can be combined with other exercises which emphasise muscle strengthening at the ankle, especially those utilising functional positions in full weight-bearing. Finally, with respect to geriatric physical therapy, recent research has demonstrated encouraging evidence of adaptability of the connective and muscul.
Efeitos da castração pós-natal sobre o tecido pulmonar após sepse experimental de origem abdominal em ratos

PURPOSE: Analyse the effects of post-natal castration in the pulmonary response during inducible sepsis in rats. METHODS: Thirdy tree rats (Wistar) were separated in two groups: Control group (GC): five adults males rats in order to analyse the normal lungs; and Experimental group (GE): twenty eight rats submited to sepsis by ligature and perfuration of the cecum (LPC) divided in tree sub-groups: Males (SgM) nine males rats submited to sepsis by LPC, Females (SgF) nine female rats submited to sepsis by LPC, and Castration (SgC) ten males rats castrated in the 4o day after birth, and submited by sepsis in adult age using LPC. After LPC, all animals were observed until death. A fragment of the right lung in all animals was submited to histologic and morphometric analysis to evaluated the number of polymorphonuclear and mononuclear cells. RESULTS: 50% of the rats in the SgC have a survive time of 24 hs, against 33% of the animals in the SgF and 0% in the SgM. The number of polymorphonuclear cells and mononuclear cells in the lung in SgC and GC, shows no statistic differences, but in animals of SgM and SgF groups, we found an increase of these cells with significant statistic differences. CONCLUSION: Rats in the SgC shows a increase of survival time after LPC and the least alterations in the lung observed.
Neoadjuvant therapy as a paradigm to develop systemic cancer therapy

Neoadjuvant systemic therapy preceding definitive surgical resection permits the in vivo assessment of tumor response and induces pathologic downstaging in several malignancies. Since pathologic complete response (pCR) and biologic activity can be determined rapidly, the signal of efficacy of a systemic regimen is evident with a relatively small number of patients before long‐term follow‐up. Additionally, emerging data suggest that modulation of pharmacodynamic biomarkers after brief neoadjuvant therapy may correlate with long‐term clinical outcomes. Early evidence for in vivo resistance and elucidation of mechanisms of resistance may assist with selection of rational combinations of agents as subsequent therapy to improve outcomes. Evidence of biologic anti‐tumor activity in target‐enriched subsets can be determined with a small number of patients in proof of principal pilot trials. Biologic activity against molecular targets and downstream anti‐proliferative and pro‐apoptotic activity may help with the selection of the lowest effective dose, which may lead to efficacious and safe therapy. Therefore, this paradigm has the potential to enable the efficient use of resources and accelerate the pace of systemic therapy development. It may also be possible to determine molecular and biologic characteristics that predict for sensitivity. Drug Dev Res 69:388–397, 2008. © 2008 Wiley‐Liss, Inc.
Fetal Growth and Development: The Generation R Study

textabstractThe importance of the female womb and the mysterious processes that take place in the uterus before birth caused it to be a sacred symbol from ancient history onwards 1. Despite this ancient general acknowledgement of the importance of fetal growth and development for human existence on earth, the only thing, however, that was generally known about pregnancy was that it lasted circa 9 lunar months. -A concept that hasn’t changed considerably though- It wasn’t until the 20th century that science enabled unravelling some of the mysteries of pregnancy. In 1968, still little was known about human fetal development. Kloosterman, a Dutch professor in obstetrics, described knowledge of that time in the following way: ”How intrauterine growth processes during a normal pregnancy evolve and what regulates these processes in humans is practically unknown. This especially involves humans for the developing human conceptus is hardly accessible for observation. Fact is that fetal growth velocity diff ers and that it is malpractice to use birth weight as a measure for maturity at birth. An early born giant and a late born dwarf with a similar birth weight can diff er largely in maturity and development. ”
Risk Factors and Level of Acute Post-Operative Pain in Surgical Patients During the First 48 Hours after Surgery

수술 후 급성 통증은 수술 후 첫 72시간 동안에 발생하는 통증으로 마취 및 수술 관련 불만족의 첫 번째 요인이며(Oh, Kim, Choi, & Chung, 2005) 수술환자의 30-40%가 통증 4 이상의 중등증 통증을 경험하는 것으로 보고되어 있다(Crowe et al., 2008; McGrath et., 2004). 통증은 인체의 중요한 스트레스원으로 신경-내분비계 반응을 유도하여 노어에피네프린의 분비를 증가시켜 심혈관계 질환자에게 부담을 줄 수 있다. 또한 수술 후 통증은 심호흡과 적극적 기침을 방해하여 흡입마취 후 폐의 기능적 잔기량을 증가시키고, 호흡기 분비물의 제거를 방해하여 폐합병증을 유발시키며 조기이상을 방해하여 정맥성 혈전증의 위험을 증가시키기도 한다(Argoff, 2013; Pearse, Caldwell, Lockwood, & Hollard, 2007).
Informed consent in orthodontics: A Prospective RCT comparing two methods of information delivery

Objective: To assess the influence of two different methods of information delivery on recall of information during the consent process for orthodontic treatment. Design and setting: A prospective randomized controlled questionnaire based study conducted at the Royal London Hospital and Central Middlesex Hospital. Materials and Methods: 64 patients starting fixed appliance treatment aged between 10 and 15 years were recruited. The control group ( n = 31) and their parents received verbal information only regarding fixed appliance treatment. The study group ( n = 33) and their parents received verbal supplemented with written information concerning fixed appliance therapy. Supervised completion of questionnaires was conducted with subjects and their parents immediately after the consenting process and approximately 6 weeks later. Results: 61 patients and their parents completed the questionnaire (control group n = 30; study group n = 31). The study group was more aware about the possibility of pain from braces, the need for emergency visits or the possibility of breakages compared with the control group (OR 0.92, CI 0.11-0.79). The study group was three times more likely to know the correct answer to how long treatment would take to complete compared to the control group (OR 3.20, CI 1.11-9.22). Furthermore, the study group was 3.5 times more likely to give the correct answer to why it is necessary to wear retainers compared to the control group (OR 3.65, CI 1.16-11.44). Conclusions: Verbal information given to patients about fixed appliance treatment should be supplemented with additional written information.
The Coverage of Rape in the Israeli Popular Press

The article presentsan analysis of the coverage of two cases of rape in the daily Israeli popular press. The authors’ hypothesis that the younger victim who did not know most of her attackers will be portrayed as helpless and not responsible for her victimization and would enjoy more positive descriptions than the older victim who knew her aggressors was not supported. In both cases, the reports tended to focus on the victims’ behavior before the rape, emphasizing that they were not sexually innocent. It is argued that by focusing on the victims’ previous sexual experience and by identifying them as “bad girls,” the newspapers sustained and reinforced the myths that a woman who is having consensual sex cannot be raped, and if so, she is held culpable and perceived as “asking for it. ”
Prevalence of Sleep Disordered Breathing among Patients with Nocturia at a Urology Clinic.

OBJECTIVE We assessed the prevalence of sleep disordered breathing (SDB) and characteristics among patients who visited a urology clinic complaining of nocturia (URO group) and those who visited a sleep apnea (SA) clinic complaining of excessive daytime sleepiness (EDS) (SA group). Additionally, we evaluated the effects of continuous positive airway pressure (CPAP) therapy in the URO group patients with nocturia and SDB resistant to conventional therapy for nocturia. METHODS Questionnaires were used to assess EDS, nocturia and lower urinary tract symptoms in 34 URO group patients and 49 age-matched SA group patients. We also compared these factors in the male patients in both groups and the male and female patients in the SA group. Significant SDB was diagnosed as a 3% oxygen desaturation index (3%ODI) on pulse oximeter of >5/h. The treatment response was analyzed in six URO group patients treated with CPAP after not responding to the conventional medical treatment. RESULTS SDB was found in 91.8% of the SA group patients and 70.6% of the URO group patients. The level of EDS and lower urinary tract symptoms were similar in both groups. The SA group showed higher 3%ODI values, while the frequency of urination during bedtime was higher in the URO group. The frequency of nocturnal urination was reduced after CPAP in the subjects resistant to conventional therapy. CONCLUSION SDB is as prevalent in patients who visit a urology clinic complaining of nocturia as in those who visit a sleep apnea clinic. Patients who complains of nocturia must be assessed for SDB before starting therapy for nocturia.
Effect of Dietary Fish Oil on Lipid Abnormalities in Patients on Continuous Ambulatory Peritoneal Dialysis

Fifteen patients receiving continuous ambulatory peritoneal dialysis (CAPD) were given 10 mL of a dietary fish oil rich in omega-3 fatty acids (MaxEPA) b.i. d. for eight weeks without other dietary manipulation. Fasting lipids, vitamins A and E, and glucose were measured at 0, 4, and 8 weeks, and again at 4 and 8 weeks after the cessation of treatment. Basal serum triglyceride concentrations were raised, and fell by 29% (p < 0.005) with treatment, returning to baseline values over the washout period. The fall in triglyceride during treatment correlated with the initial value (As = 0.57; p < 0.05). Total, HDL and LDL cholesterol, apolipoprotein A, vitamin A, glucose, lean body mass, and dietary fat/CHO intake were unchanged throughout. Apolipoprotein B concentrations tended to rise during the first half of treatment but fell thereafter. Vitamin E concentrations rose significantly during supplementation and fell after withdrawal (p < 0.001 for both). Supplementation with dietary fish oil significantly reduced hypertriglyceridemia. Its long-term use might be accompanied by beneficial effects on the excess cardiovascular morbidity seen in patients on CAPD.
Flexor Tendon Injuries in the Hand: A UK Survey of Repair Techniques and Suture Materials—Are We Following the Evidence?

Introduction. Injuries to the hand are common, and poor functional outcomes can have significant long-term consequences affecting both work and social activities. Good outcomes following flexor tendon lacerations in the hand are dependent on a sound surgical repair allowing early active mobilisation. Materials and Methods. We reviewed the literature regarding the choice of suture material and repair technique. We then carried out a nationwide postal survey of plastic surgery hand units to assess the level of compliance with the evidence. Results. Fifty-four units were surveyed. The response rate was 72%, with the most popular core suture being Prolene (64%) and the most popular technique being the Kessler repair (36%). Discussion. Current evidence advocates a multistrand repair using Ethibond. We found that the majority of units are not following the evidence. We suggest the use of evidence-based departmental guidelines to improve the practice and outcomes following these common injuries.
Perceptions of the effects on professional role boundaries when introducing a nurse practitioner into general practice

This paper is concerned with how roles within one group general practice are perceived to have been affected by the introduction of the nurse practitioner into the primary health care team (PHCT) for a 2-year pilot period. The data presented are from data elicited during a single round of interviews with patients ( n = 30) and two rounds of interviews with all medical and nursing staff within the primary health care team on two occasions (40 interviews). The patient interviews were undertaken in the first year of the study, and interviews with staff were undertaken within 6 months of the commencement of the study and during the final 6 months. The overall aim was to evaluate the feasibility of the role and its possible future application to other primary health care settings. This paper will discuss the findings of that aspect of the study relating to the effects on role boundaries between doctors and nurses, and between nurse practitioner and nurses, midwives and health visitors in the practice as perceived by the patients, nurses and doctors involved. The nurse practitioner in this particular practice was a very experienced practice nurse with a wide range of knowledge and skills which she brought to the nurse practitioner role. This, together with well-organized teaching and supervision in the practice setting and a structured programme of formal education, resulted in a highly effective practitioner who was generally seen to have blurred the boundary lines between medical and nursing roles.
Neurodegeneration After Cardiac Arrest: Cell Death Mechanisms and Methods of Neuroprotection

Brain injury after cardiac arrest is a significant contributor to morbidity and mortality. Selectively vulnerable neuron populations undergo delayed neurodegeneration in the hours to days following reperfusion. Multiple factors influence neuronal death after global brain ischemia, including excitatory synaptic input, mitochondrial dysfunction, oxidative stress, inflammation, and disruption of intracellular Ca2+ homeostasis. In hippocampal CA1 pyramidal neurons, these factors activate cell death via pathologic activity of calpains, the family of Ca2+-dependent proteases, and calpain inhibition protects against neurodegeneration. Therefore, we hypothesized that pathologic calpain activity is necessary and sufficient for neurodegeneration in other selectively vulnerable neuron populations. In this thesis, the mechanism of calpain-mediated neurodegeneration and optimization of current therapeutic approaches were explored using adult rat models of brain ischemia. First, post-ischemic protease activity in mitochondria was characterized, specifically the mechanism of electron transport chain subunit proteolysis. Complex I subunit NDUFB8 and Complex V subunit  were cleaved in a Ca2+-independent manner in vitro by a mitochondrial cysteine protease. In addition, NDUFB8 proteolysis was detected in hippocampal synaptosomes after global and focal brain ischemia, indicating that proteolytic activity occurs in vivo and could play a role in post-ischemic mitochondrial dysfunction. Second, the role of calpain activity in neurodegeneration of cerebellar Purkinje cells was examined using an RNA interference approach to cause functional knockdown of calpain activity. Surprisingly, knockdown of calpain activity did not significantly alter Purkinje cell neurodegeneration 48 hours after cardiac arrest, suggesting that alternative mechanisms may be involved in post-ischemic neurodegeneration in the cerebellum. Finally, the optimal parameters of post-cardiac arrest therapeutic hypothermia to minimize Purkinje cell loss were explored. Based on the parameters tested, therapeutic hypothermia initiated 0-8 hours after return of spontaneous circulation and maintained for 24 or 48 hours resulted in similarly significant neuroprotection compared to normothermia seven days after cardiac arrest in the adult rat. In conclusion, these results paint a more complex picture of post-ischemic neurodegeneration, which may include contributions of multiple pro-cell death stimuli rather than pathologic calpain activity alone, and highlight the effectiveness of therapeutic hypothermia, which has broad effects on post-cardiac arrest pathology that could contribute to neuroprotection. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Neuroscience First Advisor Robert W. Neumar This dissertation is available at ScholarlyCommons: http://repository.upenn. edu/edissertations/681 Second Advisor Harry Ischiropoulous