Miracle-dz/UniFAR-FTUs huggingface dataset:
Management of Pregnancy in Women Who Have Undergone Bariatric Surgery

Importance As the problem of obesity continues to grow, more patients are choosing to undergo bariatric surgery to lose weight and treat comorbidities, such as diabetes. Of the more than 200,000 procedures performed each year, 80% are in women, many of reproductive age. Taking care of a pregnant woman who has undergone bariatric surgery requires understanding of the risks, the need for additional surveillance, and the limitations of our knowledge about how bariatric surgery affects pregnancy. Objective The aims of this study were to review the current literature on bariatric surgery and pregnancy and summarize the important evidence to help the obstetrician care for a pregnant woman after bariatric surgery. Evidence Acquisition Evidence for this review was acquired using PubMed. Conclusions Pregnancy after bariatric surgery is safe and may be associated with improved pregnancy outcomes; however, more research is needed to better understand how to manage pregnant women with a history of bariatric surgery. Relevance Obstetricians will increasingly be caring for women who have undergone bariatric surgery and subsequently become pregnant. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After participating this activity, the learner should be better able to understand the indications for bariatric surgery and how different types of bariatric procedures change gastrointestinal physiology and nutrient metabolism; appropriately counsel patients about the risks and benefits of pregnancy after bariatric surgery; and understand the importance of monitoring nutritional status and supplementation in pregnancies after bariatric surgery.
Development and testing of an expectations survey for patients undergoing lumbar spine surgery.

BACKGROUND Patients' expectations of lumbar spine surgery have not been obtained with valid and reliable scales derived from patients' perspectives. The objective of this cross-sectional study was to develop and to test a patient-derived expectations survey. METHODS The survey was developed in three phases. Phase 1 involved interviews with patients with open-ended questions about expectations and assembly of a draft survey. Phase 2 involved administering the survey twice to assess test-retest reliability. Phase 3 involved selection of final items based on concordance of responses and clinical relevance, and the development of a scoring rubric. RESULTS In Phase 1, 118 preoperative patients with diverse lumbar spine diagnoses volunteered 583 expectations, from which thirty-one discrete categories were discerned and became the items for the draft survey. In Phase 2, another fifty-six preoperative patients completed the draft survey twice, four days apart. In Phase 3, twenty-one items were retained for the final survey addressing symptom relief, return to basic mobility, resumption of activities, and improvement in psychosocial well-being. An overall score was calculated on the basis of the number of expectations and amount of improvement expected and ranged from 0 to 100 points; a higher score indicates more expectations. For patients in Phase 2, the mean scores for both administrations were 66 and 65 points, the Cronbach alpha coefficients for both administrations were 0.90 and 0.92, and the intraclass correlation coefficient between scores was 0.86. CONCLUSIONS We developed a patient-derived survey that is valid, reliable, and applicable to diverse diagnoses and includes physical and psychosocial expectations. The survey generates an overall score that is easy to calculate and to interpret, and thus fills a gap in the assessment of lumbar spine surgery by offering a practical and comprehensive way to record patients' expectations.
[Correlations between DNA mismatch repair (MMR) and prognosis and prediction of treatment efficacy in stage II/II colon cancer].

OBJECTIVE To investigate the role of DNA mismatch repair (MMR) as a prognostic indicator of radical resection and a predictor of fluorouracil-based adjuvant therapy benefit in patients with stage II/III colon cancer. METHODS The clinicopathological characteristics of 172 patients with stage II/III colon cancer who underwent radical resection were retrospectively analyzed. Immunohistochemical staining was used to detect the expression of DNA mismatch repair (MLH1/MSH2/MSH6/PMS2) in the tumor tissues. RESULTS Among a total of 172 patients, there were 38 (22.1%) cases with defective DNA mismatch repair (dMMR) and 134 (77.9%) cases with proficient DNA mismatch repair (pMMR). Among the 115 patients who did not receive adjuvant chemotherapy, those with tumor displaying dMMR had a better 5-year overall survival (OS) rate and disease-free survival (DFS) rate than the patients with proficient DNA mismatch repair (pMMR) (88.0% vs. 66.7%, P = 0.040; 84.0% vs. 60.0%, P = 0.034). The benefit of adjuvant chemotherapy differed significantly according to the MMR status. Adjuvant 5-Fu chemotherapy improved the 5-year overall survival rate among 134 patients with pMMR (86.4%) than that in patients treated by surgery alone (66.7%, P = 0.012). By contrast, there was no benefit of adjuvant 5-Fu chemotherapy in the patients with dMMR (61.5% vs. 86.4%, P = 0.062), which was even more clear the 5-year disease-free survival rate (53.8% vs. 84.0%, P = 0.038). CONCLUSIONS MMR status is a predictor of the benefit of adjuvant chemotherapy with fluorouracil in stage II/III colon cancer. Patients with stage II/III colon cancer displaying dMMR have a better prognosis than those with pMMR.
Evidence against flat dysplasia as a regional field defect in small bowel adenocarcinoma associated with celiac sprue.

OBJECTIVE To determine whether diffuse flat dysplasia, akin to that seen with chronic ulcerative colitis, occurs as a mucosal field defect accompanying small bowel adenocarcinoma in patients with celiac sprue. DESIGN A pathologic investigation of archival tissue was undertaken. MATERIAL AND METHODS From the tissue archives at Mayo Clinic Rochester for the period from January 1978 to January 1993, resected sprue-associated adenocarcinomas with adequate adjacent mucosa for study were identified. On the basis of multiple strip biopsy specimens obtained at the tumor margins and within 4 cm distal and proximal to the tumor, histologic maps were created. RESULTS Among 94 patients with primary adenocarcinoma of the small bowel, 8 had a concurrent diagnosis of celiac sprue. Of these eight cases, six surgically resected specimens (five duodenal and one jejunal adenocarcinoma) were adequate for study. A thin rim of benign dysplasia was demonstrated at the tumor margin in three of the six specimens; however, contiguous fields of flat dysplasia were not present in any of these cases. CONCLUSION These data support focal dysplasia (for example, adenoma) rather than sheets of flat dysplasia as the premalignant lesion in sprue-associated small bowel adenocarcinoma. Blind endoscopic biopsies of small bowel mucosa are not justified for neoplasia surveillance in patients with celiac sprue.
Pruritus in hemodialysis patients: Results from the Japanese Dialysis Outcomes and Practice Patterns Study (JDOPPS)

Pruritus affects many patients undergoing hemodialysis (HD). In this study, pruritus and its relationship to morbidity, quality of life (QoL), sleep quality, and patient laboratory measures were analyzed in a large sample of Japanese patients undergoing HD. Severity of patient‐reported pruritus symptoms experienced during a 4‐week period was collected from 6480 Japanese patients undergoing HD in three phases of the Dialysis Outcomes and Practice Patterns Study (DOPPS; 1996–2008; 60–65 study facilities/phase). Adjusted linear and logistic regressions were used to identify associations of pruritus with treatment parameters and QoL outcomes. Adjusted Cox regressions examined the influence of pruritus severity on mortality. Moderate to extreme pruritus was experienced by 44% of prevalent patients undergoing HD in the Japanese Dialysis Outcomes and Practice Patterns Study. Many patient characteristics were significantly associated with pruritus, but this did not explain the large differences in pruritus among facilities (20–70%). Pruritus was slightly less common in patients starting HD than in patients on dialysis >1 year. Patients with moderate to extreme pruritus were more likely to feel drained (adjusted odds ratio = 2.2–5.8, P < 0.0001), have poor sleep quality (adjusted odds ratio = 1.9–3.7, P < 0.0001), and have QoL mental and physical composite scores 2.3–6.7 points lower (P < 0.0001) than patients with no/mild pruritus. Pruritus in patients undergoing HD was associated with a 23% higher mortality risk (P = 0.09). The many poor outcomes associated with pruritus underscore the need for better therapeutic agents to provide relief for the 40–50% of prevalent patients undergoing HD substantially affected by pruritus. Pruritus in new patients with end‐stage renal disease likely results from uremia or pre‐existing conditions (not HD per se), indicating the need to understand development of pruritus before end‐stage renal disease.
Multi-structure problems: Difficult model learning in discrete EDAs

Decomposition to smaller sub-problems is a general approach in problem solving. Many of the real-world problems can be decomposed into a number of sub-problems which may be solved easier. Appropriate decomposition is a significant issue specially for optimization problems where the optimal solution is usually obtained by combining the solutions of sub-problems. Estimation of distribution algorithms (EDAs) are a type of evolutionary algorithms that learn a model of problem from the population of candidate solutions. This model is intended to capture the interactions between problem variables, thus facilitating problem decomposition and is used to generate new solutions. In this paper, a novel type of problems is presented that is designed to challenge the model building process in discrete EDAs. The main idea is to propose a set of problems that their candidate solutions can be simultaneously decomposed into different sub-problems. This means that the candidate solution of a problem may be interpreted by two or more different structure where only one is true, resulting in the optimal solution to that problem. Some of these decompositions or structures may be more likely according to the low-order statistics collected from the population of candidate solutions, but may not necessarily lead to the optimal solution. Learning the correct structure/decomposition is a challenge for the model building process in EDA. The experimental results show that the proposed problems are indeed difficult for EDAs even when expressive models such as Bayesian networks are used to capture the interactions in the problem.
Peer victimization in early adolescence: Association between physical and relational victimization and drug use, aggression, and delinquent behaviors among urban middle school students

This study examined associations between two forms of peer victimization, physical and relational, and externalizing behaviors including drug use, aggression, and delinquent behaviors among a sample of 276 predominantly African American eighth graders attending middle school in an urban public school system. Regression analyses indicated that physical victimization was significantly related to cigarette and alcohol use but not to advanced alcohol and marijuana use; relational victimization contributed uniquely to all categories of drug use after controlling for physical victimization. Physical victimization was also significantly related to physical and relational aggression and delinquent behaviors, and relational victimization made a unique contribution in the concurrent prediction of these behaviors. Physical victimization was more strongly related to both categories of alcohol use, aggression, and to delinquent behaviors among boys than among girls. In contrast, relational victimization was more strongly related to physical aggression and marijuana use among girls than among boys, but more strongly related to relational aggression among boys than among girls. These findings provide information about the generalizability of prior research and have important implications for intervention efforts.This research was supported by Cooperative Agreement U81/CCU309966 from the Centers for Disease Control and Prevention (CDC). The research and interpretations reported herein are the sole responsibility of the authors and are not necessarily endorsed by the CDC or represent the views, opinions, or policies of the CDC or its staff.
Analysis of Hybrid ARQ in Ad Hoc Networks with Correlated Interference and Feedback Errors

In this paper, the performance of hybrid automatic repeat request (HARQ) technique in an ad hoc network is analyzed. Unlike most prior works on the analysis of HARQ, both time-correlated interference and feedback errors are taken into account in the analysis. Based on the theory of point processes, outage probability after the nth retransmission, delay limited throughput and mean transmission time are derived in closed forms. The analytical results are verified by simulations and the impacts of various parameters on the network performance are investigated in detail. It is found that the outage probability obeys the inverse-2/α power law over the number of retransmissions, where α is the path loss exponent. Furthermore, it is demonstrated that the feedback error significantly degrades the delay limited throughput when the ad hoc network becomes dense, while the increment of mean transmission time due to the feedback error is a concave function of the intensity of the network.
Prognostic factors in hodgkin's disease with special reference to age

A series of 182 patients with Hodgkin's disease, diagnosed between January 1973 and December 1978 was used to identify prognostic factors with special reference to age. There were 118 men and 64 women (mean age, 47 years; r = 15–92). During the same period 57 elderly patients who were never referred, were reported to the Local Cancer Registry. The diagnosis had been established shortly before death or at autopsy. The 182 patients under study were evenly distributed in Stages I‐IV. Nodular sclerosis (38%) and mixed cellularity (38%) were the most common histologic subtypes. The 5‐year survival probability estimate was 28% in patients above 50 years as compared to 74% in the remainder. Survival was significantly better in patients with Stage I‐II disease and lymphocyte predominance/nodular sclerosis histopathology. Age was the main prognostic factor in the whole series as well as in patients older than 50 years. However, in young patients advanced clinical stage and B‐symptoms were related to a poor prognosis. Biologic indicators such as ESR, hemoglobin and albumin were intimately linked to the extent of disease and did not add prognostic information besides that given by the clinical stage. It is concluded that the prognosis in elderly remains poor and appears to be partly unrelated to those factors which determine the prognosis in the young, assumingly reflecting a depressed host‐response and/or a decreased tolerance to intensive treatment. Cancer 53:1202‐1208, 1984.
CaMtw1, a member of the evolutionarily conserved Mis12 kinetochore protein family, is required for efficient inner kinetochore assembly in the pathogenic yeast Candida albicans

Proper assembly of the kinetochore, a multi‐protein complex that mediates attachment of centromere DNA to spindle microtubules on each chromosome, is required for faithful chromosome segregation. Each previously characterized member of the Mis12/Mtw1 protein family is part of an essential subcomplex in the kinetochore. In this work, we identify and characterize CaMTW1, which encodes the homologue of the human Mis12 protein in the pathogenic budding yeast Candida albicans. Subcellular localization and chromatin immunoprecipitation assays confirmed CaMtw1 is a kinetochore protein. CaMtw1 is essential for viability. CaMtw1‐depleted cells and cells in which CaMtw1 was inactivated with a temperature‐sensitive mutation had reduced viability, accumulated at the G2/M stage of the cell cycle, and exhibited increased chromosome missegregation. CaMtw1 depletion also affected spindle length and alignment. Interestingly, in C. albicans, CaMtw1 and the centromeric histone, CaCse4, influence each other for kinetochore localization. In addition, CaMtw1 is required for efficient kinetochore recruitment of another inner kinetochore protein, the CENP‐C homologue, CaMif2. Mis12/Mtw1 proteins have well‐established roles in the recruitment and maintenance of outer kinetochore proteins. We propose that Mis12/Mtw1 proteins also have important co‐dependent interactions with inner kinetochore proteins and that these interactions may increase the fidelity of kinetochore formation.
Accuracy of distraction based lifting criteria for the identification of insincere effort utilizing the under loading method.

BACKGROUND Distraction based material handling tests are used to measure effort during functional capacity evaluations. OBJECTIVE To identify validity of effort using the under loading method with the XRTS Lever Arm. Classification of effort between the two sessions (100% effort and estimated 50% effort) was compared with current validity criteria. METHODS Fifty healthy and asymptomatic subjects were tested under two conditions (100% effort and an estimated 50% effort). Comparisons were made between percent changes from crate lifts to lever arm lifts from three starting heights (0.25 m, 0.38 m and 0.051 m). RESULTS During the 100% effort sessions, no subject had a mean percent change >20%, a majority of lift comparison >25% or a single lift comparison >30%. The specificity of the current validity criteria is 100%. The under loading method of using the XRTS lever arm was 20% sensitive in identifying an equivocal or invalid test result when subjects gave an estimated 50% effort. CONCLUSIONS The results indicate the under loading method of distraction based testing is very specific but lacks sensitivity in identifying feigned weakness with asymptomatic, non-injured individuals. The high specificity of the test should eliminate concern of having a false positive for insincere effort during functional testing.
Recurrent Versus Persistent Diverticulitis: An Important Distinction.

To the Editor–on behalf of my coauthors, i would like to thank Drs Garfinkle and Boutros for their comments on our recently published study on the outcome of medically managed diverticular abscess. their main objection and concern comes from the discrepancy of our data versus their data (which unfortunately were not available for us to review yet). any results are unquestionably dependent on how a particular study cohort is defined. our study cohort did not exclude any patients. We reported the immediate treatment failures just as much as we reported the known failures occurring after the index hospitalization. from a patient management perspective, it makes sense to distinguish what happens during the initial hospitalization as opposed to the time after discharge. it is necessary to determine how to phrase clinical recommendations to the patients based on what they should expect or consider after leaving the hospital. in real life, there is no arbitrary warranty or grace period of 60 days. sure enough, one can define such an artificial time and give it a separate label, with the result that the worst players are eliminated, and not surprisingly the outcome of the remaining patients will be much better. a similar bias led Chapman et al to their often quoted but, because of the lack of convincing evidence, unsubstantiated statement that a history of diverticulitis would not predispose to and predict subsequent complications; their recommendation against a prophylactic resective surgery was really not supported by their own data, with a 98% resection rate that obviously resulted in a lack nonoperative follow-up data. the point of our all-inclusive cohort, however, was to raise the awareness that complicated diverticulitis, as defined by the presence of an abscess, has a higher than previously reported probability of failure after the index hospitalization. We do not claim to know at this point which 61% of abscess patients discharged without an operation are the ones who ultimately fail medical management and develop recurrent diverticulitis and what distinguishes them from the 39% of patients who do not experience a recurrent problem (at least not within our 2. Garfinkle R, Kugler a, Pelsser V, et al. Diverticular abscess managed with long-term definitive non-operative intent is safe. Dis Colon Rectum. 2016;59:648–655. 3. etzioni Da, Chiu VY, Cannom RR, Burchette RJ, haigh Pi, abbas ma. outpatient treatment of acute diverticulitis: rates and predictors of failure. Dis Colon Rectum. 2010;53:861–865.
Outcomes of surgical and transcatheter aortic valve replacement in the octogenarians-surgery still the gold standard?

BACKGROUND Contemporary options for aortic valve replacement (AVR) include transcatheter and surgical approaches (TAVR and SAVR). As evidence accrues for TAVR in high and intermediate risk patients, some clinicians advocate that all patients aged over 80 years should only receive TAVR. Our aim was to investigate the utility of SAVR and minimally invasive AVR (mAVR) among octogenarians in the current era of TAVR. METHODS From 2002 to 2015, 1,028 octogenarians underwent isolated AVR; 306 TAVR and 722 SAVR, of which 378 patients underwent mAVR. Logistic regression and Cox modeling were used to evaluate overall operative mortality and mid-term survival, respectively. Patients were stratified based on procedural approaches (mAVR or full sternotomy for SAVR, and transfemoral or alternate access for TAVR). Median follow-up was 35 [interquartile range (IQR) 14-65] months. RESULTS Compared to SAVR patients, TAVR patients were relatively older (86.2 versus 84.2 years) with co-morbidities such as chronic kidney disease (CKD), diabetes mellitus (DM), cerebrovascular disease (CVD), and prior myocardial infarction (MI), all P<0.05. The mean STS-PROM for the TAVR group was statistically higher, 6.81 versus 5.58 for the SAVR group (P<0.001). The median in-hospital LOS was statistically higher for the SAVR group (P<0.05). Cox proportional hazard modeling, adjusted for temporal differences in procedure and patient selection, identified age, New York Heart Association (NYHA) class III/IV, preoperative creatinine, severe chronic lung disease, prior cardiac surgery as significant predictors of decreased survival (all P<0.05), while type of intervention (approach) was non-contributory. Adjusted operative mortality stratified by procedure approaches was similar between full sternotomy SAVR and mAVR, and between alternative access and transfemoral TAVR. CONCLUSIONS After adjusting for confounders, TAVR (regardless of approach), SAVR, and mAVR had comparable operative mortality and mid-term survival. Treatment decisions should be individualized with consensus from a multi-disciplinary heart team, taking into account patient co morbidities, frailty, and quality of life. We believe certain patient groups will still benefit from SAVR even in this elderly population.