Miracle-dz/UniFAR-FTUs huggingface dataset:
State-level and system-level opioid prescribing policies: The impact on provider practices and overdose deaths, a systematic review.

OBJECTIVE In response to persistent public health concerns regarding prescription opioids, many states and healthcare systems have implemented legislation and policies intended to regulate or guide opioid prescribing. The overall impact of these policies is still uncertain. The aim of this systematic review was to examine the existing evidence of provider-level and patient-level outcomes preimplementation and postimplementation of policies and legislation constructed to impact provider prescribing practices around opioid analgesics. DESIGN A systematic search of MEDLINE, EMBASE, the Web of Science, and the Cochrane Database of Systematic Reviews was conducted to identify studies evaluating the impact of opioid prescribing policies on provider-level and patient-level outcomes. The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Eleven studies were included in the review. A meta-analysis was not possible due to between-study heterogeneity. Six of the studies assessed state-level policies, and five were at the level of the healthcare system or hospital. Studies showed temporal associations between policy implementation and reductions in opioid prescribing, as well as opioid-related overdoses. Results were mixed regarding the impact of policies on misuse. The majority of the studies were judged to be of low quality based on the GRADE criteria. CONCLUSIONS There is low to moderate quality evidence suggesting that the presence of opioid prescribing policy will reduce the amount and strength of opioid prescribed. The presence of these policies may impact the number of overdoses, but there is no clear evidence to suggest that it reduces opioid misuse.
A double-blind non-inferiority clinical study of montelukast, a cysteinyl leukotriene receptor 1 antagonist, compared with pranlukast in patients with seasonal allergic rhinitis.

BACKGROUND During the course of development of montelukast, a cysteinyl leukotriene receptor 1 antagonist, for treatment of seasonal allergic rhinitis, a double-blind, non-inferiority study was carried out to evaluate the efficacy and safety of montelukast 5mg and 10mg compared with pranlukast 450mg, which has a similar mechanism of action. METHODS Montelukast 5mg, 10mg or pranlukast 450mg and the corresponding placebo were orally administered to patients with seasonal allergic rhinitis three times a day for 2 weeks. Non-inferior efficacy of montelukast 5mg and 10mg to pranlukast 450mg was investigated by the change from the baseline in the composite nasal symptoms scores over the 2-week treatment period. RESULTS Montelukast 5mg, 10mg once daily and the pranlukast 450mg/day showed significant improvements in the change from the baseline in the composite, daytime and nighttime nasal symptom scores, and the improvement lasted for 2 weeks. Montelukast 5mg and 10mg were non-inferior to pranlukast 450mg in the change from the baseline in the composite nasal symptoms scores. The incidence rates of adverse experiences and drug-related adverse experiences were not significantly different among the three treatment groups. CONCLUSIONS The results indicate that administration of montelukast 5mg and 10mg once daily are potent alternatives for the treatment of seasonal allergic rhinitis and demonstrated that the efficacy and the safety profiles are comparable with pranlukast 450mg/day.
Anatomical organization of primary visual cortex (area 17) in the ferret

The present report describes the intrinsic and extrinsic cortical connectivity of striate cortex (area 17) in the ferret. Injections of horseradish peroxidase demonstrate periodic intrinsic connections over an extent of 2.5–3.0 mm, mainly in the supragranular layers but also occurring secondarily in layer 5. These connections have a stripelike configuration, with a centerto‐center spacing of 0.5–0.7 mm. Their laminar distribution and stripelike configuration resemble the pattern in the cat (Gilbert and Wiesel,′83), another member of the carnivore family, but not that in monkeys. In both macaque and squirrel monkeys, these connections have a bilaminar distribution in layers 2–3 and 4B, and a more complicated latticelike geometry (Rockland and Lund,'83). Their interperiod spacing, of about 0.5 mm, however, is relatively constant across species. Extrinsic connections in the ferret link striate cortex with territories probably homologous to feline areas 18 and 19, and to the suprasylvian region. Callosal connections extend on the lateral surface about 1.5 mm into area 17 and 4.0 mm into area 18 beyond their common border. There are homotopical connections between striate cortices and heterotopical connections from at least areas 18 and 19 to contralateral area 17. In addition to gray matter connections, intracortical injections also result in labeled interstitial neurons in the subgriseal white matter. These occur both subjacent to an injection site in area 17, and below labeled foci in area 18 projecting back to area 17, as if interstitial neurons shared the connectivity of overlying layer 6.
Abnormal Magnetic Resonance Signal in the Internal Capsule Predicts Poor Neurodevelopmental Outcome in Infants With Hypoxic-Ischemic Encephalopathy

Objective. The aim of this study was to establish whether abnormal signal intensity in the posterior limb of the internal capsule (PLIC) on magnetic resonance imaging is an accurate predictor of neurodevelopmental outcome at 1 year of age in infants with hypoxic-ischemic encephalopathy (HIE). Methods. We have examined 73 term neonates with HIE between 1 and 17 days after birth with cranial magnetic resonance imaging and related the magnetic resonance imaging findings to neurodevelopmental outcome at 1 year of age. Results. All infants with an abnormal signal intensity in the PLIC developed neurodevelopmental impairment although in 4 infants with very early scans the abnormal signal was not apparent until up to 4 days after birth. A normal signal intensity was associated with a normal outcome in all but 4 cases; 3 of these infants had minor impairments and all had persistent imaging changes within the white matter. The 4th infant with a normal signal intensity on day 2 died before a further image could be obtained. The absence of normal signal predicted abnormal outcome in term infants with HIE with a sensitivity of 0.90, a specificity of 1.0, a positive predictive value of 1.0, and a negative predictive value of 0.87. The test correctly predicted outcome in 93% of infants with grade II HIE, according to the Sarnat system. Applying a Bayesian approach, the predictive probability of the test (the probability that the test would predict an outcome correctly) was distributed with a mean of 0.94 and 95% confidence limits of 0.89 to 1.0. Conclusion. Abnormal signal intensity in the PLIC is an accurate predictor of neurodevelopmental outcome in term infants suffering HIE.
Is macitentan not a treatment option for digital ulcers in systemic sclerosis?

Systemic sclerosis (SSc) is a chronic autoimmune and vascular disease resulting in extensive tissue fibrosis of the skin and various internal organs with unknown etiology. Although the entire pathogenesis of SSc still remains elusive, the canonical wisdom is that a complex network of cytokines, growth factors, chemokines, and cell adhesion molecules drives the three pathological components of this disease, including autoimmunity/inflammation, vasculopathy, and fibrosis, which co-operatively promote disease progression. The emergence of molecular targeting therapy has disclosed a hierarchical structure of complex molecular network in various diseases, including SSc (1-3). As a part of recent advances in the treatment of SSc, a dual endothelin receptor antagonist, bosentan, has provided strict evidence indicating a vital role of endothelins in the pathogenesis of SSc, especially its vascular aspect (4,5).
INFLUENCE OF TYPE OF MECHANICAL LOADING, MENSTRUAL STATUS, AND TRAINING SEASON ON BONE DENSITY IN YOUNG WOMEN ATHLETES

Bone mineral density (BMD) variables were compared in 2 groups of women Division I collegiate athletes—gymnasts (GYM) and cross-country runners (CC)—during the preseason and during the competitive season. An osteogenic advantage may exist in women athletes involved in impact loading (gymnastics) over those women in active loading sports like long-distance running. The effects of menstrual status and the time of the training season on BMD also were examined. Dietary intake, menstrual status, BMD, and serum estradiol levels were measured during the preseason and during the competitive season in 26 women athletes (18–22 years of age). GYM had significantly higher BMD (p < 0.05) at all sites for both the pre- and posttests compared to CC. Neither group experienced a significant change (p ≤ 0.05) in BMD between trials for any site; however, CC showed slight decreases at all BMD sites from baseline to the posttest. GYM had a higher prevalence of self-reported menstrual cycle disturbances than CC. No significant difference (p ≤ 0.05) in BMD was found between the eumenorrheic and menstrual dysfunction groups (oligo/amenorrheic). In conclusion, the gymnasts had significantly higher (p < 0.05) BMD than the runners, suggesting BMD is influenced by the type of mechanical loading. Menstrual status did not significantly affect BMD in these women athletes. Cross-country runners were determined to be at greater risk than the gymnasts for low bone mass; thus, it is recommended that these athletes include more high-impact activities in their training regimen to optimize their bone health.
Cytomegalovirus prophylaxis with valganciclovir in kidney, pancreas–kidney, and pancreas transplantation

Abstract: Cytomegalovirus, seen in more than 50% of solid organ transplant recipients, is responsible for numerous direct and indirect consequences, including infection with opportunistic pathogens and allograft rejection. Prophylaxis with intravenous ganciclovir has been the gold standard for prevention; however, intravenous treatment is expensive and carries risks of its own. Oral ganciclovir, to be effective, must be given in large, divided doses. Valganciclovir, the valine ester of ganciclovir, at 900 mg/day, provides oral bioavailability equivalent to that of intravenous ganciclovir and superior to that of oral ganciclovir. This retrospective study assessed the efficacy of 3 months prophylaxis with valganciclovir in kidney, simultaneous pancreas–kidney, and pancreas transplantation. Of 161 patients, all of whom received potent immunosuppressive regimens and were followed for a mean of 440 days, only one developed cytomegalovirus infection, at 120 days post‐transplantation. Two patients died, and two others lost their grafts. There were seven incidents of acute rejection. Only seven patients discontinued treatment early, five because of leukopenia. These results suggest that prophylaxis with 900 mg/day of valganciclovir for at least 3 months safely and effectively prevents cytomegalovirus infection in kidney, simultaneous pancreas–kidney and pancreas transplant recipients on highly potent immunosuppression.
Influence of annealing on the pasting properties of starches from varying botanical sources.

Pea, potato, wheat, and rice starches were annealed for 24 hr. Differential scanning calorimetry data were collected ; pasting characteristics were determined using the Brabender Viscoamylograph and the Newport Scientific Rapid Visco-Analyser (RVA) ; and amylose leaching during heating in the viscoamylograph was examined. Differential scanning calorimetry data showed an increased gelatinization temperature and enthalpy, and a narrower gelatinization temperature range for all starches. Viscoamylograph viscosity curves showed that annealing resulted in an increased peak viscosity (except for potato starch), and an increased viscosity upon cooling. The amount of amylose leached from the granules was not linked to viscosity changes. Less amylose was leached from the granules of annealed pea and potato starches. The amount of solubilized amylose was practically unchanged (slightly decreased) after the annealing treatment for rice starch, whereas annealed wheat starch showed a slightly increased leaching of amylose. Except for pea starch, RVA results were comparable to the results from the viscoamylograph. In a dimethyl sulfoxide (DMSO) and water mixture (92.5 :7.5, w/w), viscosity changes were not consistent for all annealed starches. For annealed pea, wheat, and rice starches, the onset of solubilization occurred at lower temperatures. The increased peak viscosity was attributed to a higher rigidity and resistance to shear of the starch granules. For annealed potato starch, the viscosity was decreased. A higher rigidity and increased resistance to heat and shear of the starch granules are probably the main causes of the viscosity changes due to annealing, both in water and in a DMSO-water mixture.
Melatonin reduces stress‐activated/mitogen‐activated protein kinases in spinal cord injury

Abstract: Permanent functional deficits following spinal cord injury (SCI) arise from both mechanical injury and from secondary tissue reactions involving inflammation. The mitogen‐activated protein kinases (MAPKs) play a critical role in cell signaling and gene expression. MAPK family includes three major members: extracellular signal regulated kinase (ERK), p38, and c‐Jun N‐terminal kinase (JNK), representing three different signaling cascades. Moreover, various studies have clearly shown that high‐mobility group box 1 (HMGB1) protein is implicated as a putative danger signal involved in the pathogenesis of a variety of inflammatory conditions including autoimmunity, cancer, trauma and hemorrhagic shock, and ischemia‐reperfusion injury. Recently, we have reported that the pineal secretory product melatonin exerts important anti‐inflammatory effects in an experimental model of SCI induced by the application of vascular clips (force of 24 g) to the dura after a four‐level T5–T8 laminectomy. However, no reports are available on the effect of melatonin on MAPK signaling pathways and HMGB1 expression in SCI. The aim of the present study was to evaluate whether the melatonin protective effect observed in SCI is related to the regulation of MAPK signaling pathways and HMGB1 in mice. In this study we demonstrate the efficacy of treatment with the melatonin in SCI in mice in reducing (a) motor recovery, (b) activation of MAPKs p38, JNK and ERK1/2, (c) tumor necrosis factor‐α expression, and (d) expression of HMGB1. We propose that melatonin’s ability to reduce SCI in mice is also related to a reduction in MAPK signaling pathways and HMGB1 expression.
Circadian Variation in Cortisol Reactivity to an Acute Stressor

To investigate the role of the circadian pacemaker in cortisol reactivity to a cold pressor challenge, 26 diurnally subjects participated in a constant‐routine protocol and were divided into two groups. Group 1 started immediately after a monitored sleep period at 09:00 h, while group 2 started 12 h later. After 2 h of adaptation, a cold pressor test was presented every 3 h. The cortisol response was assessed by means of saliva samples that were taken before and after the test. The pretest samples were considered to be base‐rate measures and base‐rate values as subtracted from post‐test values were considered as reactivity measures. Both measures showed distinct Time‐of‐Day variations (respectively: F7,168 = 16.92, p < 0.001, ε = 0.383; and F7,175 = 8.01, p < 0.001, ε = 0.523). These findings are interpreted as evidence for the existence of an endogenous circadian periodicity underlying the sensitivity of the hypothalamus–pituitary–adrenal (HPA)‐axis to acute stress.
Simulation of an Epidural Test Dose with Intravenous Epinephrine in Sevoflurane-Anesthetized Children

An epidural test dose containing small doses of epinephrine does not produce a reliable increase in heart rate (HR) in children under halothane anesthesia.Because sevoflurane is increasingly used in clinical practice, we designed the present study to determine the hemodynamic responses to, and efficacy of, a simulated IV test dose containing a small dose of epinephrine in sevoflurane-anesthetized children. Sixty ASA physical status I infants and children (4.1 +/- 2.5 yr) undergoing elective minor surgeries were studied during 1.0 minimum alveolar anesthetic concentration of sevoflurane and 60% nitrous oxide in oxygen. The patients were randomly assigned to receive either saline (n = 15), a test dose consisting of 1% lidocaine (0.1 mL/kg) with 1:200,000 epinephrine (0.5 [micro sign]g/kg, n = 15), atropine 0.01 mg/kg followed 5 min later by saline (n = 15), or atropine followed by the test dose (n = 15) via a peripheral vein to simulate intravascular injection of the epidural test dose. HR and systolic blood pressure were recorded every 15 and 30 s, respectively. The test dose increased the HR from 15 to 60 s and from 15 to 90 s without and with atropine, respectively. Mean maximum increases in HR were similar with and without atropine (21 +/- 8 and 22 +/- 6 bpm, respectively). Of 15 children, 7 and 5 developed HR changes <20 bpm after the test dose with and without atropine, respectively, whereas all children who received saline had an increase in HR <20 bpm. No dysrhythmia occurred during the study. Our results indicate that an epidural test dose containing epinephrine is unreliable based on the conventional HR criterion (positive if >or=to20 bpm increase), but reliable on the modified HR criterion (positive if >or=to10 bpm increase) in children anesthetized with sevoflurane. IV atropine before the test dose injection did not improve the efficacy based on the conventional HR criterion. Because test doses of epinephrine-containing solution are used to determine whether an epidural catheter is intravascular, it is important to define the optimal test dose under sevoflurane anesthesia. Implications: We found that during sevoflurane anesthesia in children, a heart rate increase >or=to10 bpm and a systolic blood pressure increase >or=to15 mm Hg, when preceded by atropine, may be reliable indicators for detecting intravascular injection. (Anesth Analg 1998;86:952-7)
3-Axis MEMS accelerometer-based implantable heart monitoring system with novel fixation method

Existing heart monitoring methods have certain drawbacks such as lack of specificity or inability to perform continuous monitoring. An accelerometer attached to the heart wall can provide a very direct measurement of the heart function. This system could provide monitoring during the surgery and for the period after it. Miniaturization of modern commercial off-the-shelf accelerometers makes it possible to repackage these sensors to serve as an implantable heart monitoring system. The compact size also allows implanting the sensor directly into the heart muscle, which was not possible before. This system was fabricated using a 3-axis accelerometer (CMA3000A01 from Murata Electronics Oy, Finland), a custom designed flexible substrate-cable and silicone encapsulation. In this paper the prototype fabrication process is described, early reports from the ongoing trials as well as some conclusion based on those reports are presented.
GABAergic neurons that pioneer hippocampal area CA1 of the mouse: Morphologic features and multiple fates

Dramatic changes occur in the expression of glutamic acid decarboxylase (GAD67) immunoreactivity in mouse hippocampus during postnatal development. Most striking is the presence of a dense population of immunopositive cells in stratum radiatum and stratum oriens in area CA1 during the first postnatal week. Between days 5 and 10, these cells disappear and the GAD67 immunoreactivity begins to resemble that of adulthood. These neurons are considered pioneer cells, and studies were undertaken to determine their fate. Between days 5 and 50, area CA1 doubles in size; however, the loss of cells expressing GAD67 mRNA cannot be explained solely by dilution resulting from hippocampal growth. In stratum radiatum, cell loss is particularly dramatic. Although between days 5 and 15, many cells seem to migrate from stratum radiatum to its border with stratum lacunosum‐moleculare, both fate maps of pioneer cells labeled with bromodeoxyuridine (BrdU) on embryonic day 13 (E13) and in situ DNA end‐labeling studies suggest that some cells die by means of programmed cell death. However, not all pioneer cells die, because many cells labeled with BrdU on E13 are present in adulthood and express markers for and have anatomic features of hippocampal interneurons. In conclusion, events that underlie the age‐dependent disappearance of γ‐aminobutyric acid (GABA) ‐ergic pioneer cells are complex and cannot be completely explained by dilution in an expanding neuropile. Although some GABAergic pioneer cells likely undergo programmed cell death during the first postnatal weeks, others relocate within hippocampal laminae and terminally differentiate into the interneurons of adulthood. J. Comp. Neurol. 439:176–192, 2001. © 2001 Wiley‐Liss, Inc.
Pneumonia in Pregnancy

Pneumonia complicating pregnancy requires a prompt diagnosis and the institution of adequate supportive and antimicrobial therapy. In a patient with a classic presentation of pneumonia, the most likely pathogens are Streptococcus pneumoniae and Haemophilus influenzae. In a patient with an atypical presentation of pneumonia, Mycoplasma pneumoniae and Chlamydia pneumoniae are frequently encountered. In a patient suffering from acquired immunodeficiency syndrome (AIDS), Pneumocystis carinii is the most frequent pathogen. The antimicrobial therapy, therefore, has to be tailored to the sensitivity patterns of these pathogens in the community. Hospitalization is recommended for the pregnant patient diagnosed with pneumonia to ensure effective supportive care and minimize the risk of preterm labor and delivery.
Adaptive Fuzzy Tracking Control of Nonlinear Systems With Asymmetric Actuator Backlash Based on a New Smooth Inverse

This paper is concentrated on the problem of adaptive fuzzy tracking control for an uncertain nonlinear system whose actuator is encountered by the asymmetric backlash behavior. First, we propose a new smooth inverse model which can approximate the asymmetric actuator backlash arbitrarily. By applying it, two adaptive fuzzy control scenarios, namely, the compensation-based control scheme and nonlinear decomposition-based control scheme, are then developed successively. It is worth noticing that the first fuzzy controller exhibits a better tracking control performance, although it recourses to a known slope ratio of backlash nonlinearity. The second one further removes the restriction, and also gets a desirable control performance. By the strict Lyapunov argument, both adaptive fuzzy controllers guarantee that the output tracking error is convergent to an adjustable region of zero asymptotically, while all the signals remain semiglobally uniformly ultimately bounded. Lastly, two comparative simulations are conducted to verify the effectiveness of the proposed fuzzy controllers.