Miracle-dz/UniFAR-FTUs huggingface dataset:
A Five-Year Institutional Study of the Effectiveness of Fourth-Year Clinical Anatomy in Promoting Musculoskeletal Education

Despite the increasing prevalence of musculoskeletal disease in the population, studies continue to show deficiencies in the duration and extent of musculoskeletal education. From 2009-2013, senior medical students enrolled in a clinical anatomy elective at our institution’s medical school completed pre- and post-course examinations related to musculoskeletal education with associated radiographic interpretation and physical examination correlates. A control group of fourth-year students who did not participate in a clinical anatomy elective completed a comparable exam. Student pre-course and control group test scores averaged 54%. The control group scored at the same level for the radiographic (pre-course average 65%, control-group average 61%, p = 0.21) and physical exam sections (pre-course average 56%, control-group average 53%, p = 0.28), and lower in the musculoskeletal portion (pre-course average 50%, control-group average 39%, p p < 0.001) and scored higher than their classmates in the control group, with mean test scores of 84% for the combined sections, representing a 28% improvement. Senior medical students demonstrated deficits in knowledge related to musculoskeletal medicine. Following a focused fourth-year anatomy elective providing students with the opportunity to focus their learning of anatomy in a clinical context, students’ knowledge in musculoskeletal medicine increased substantially.
Mini Review: Changes in the Incidence of and Progression to Proliferative and Sight-Threatening Diabetic Retinopathy Over the Last 30 Years

ABSTRACT Purpose: Diabetic retinopathy is a leading cause of blindness worldwide. The last 3 decades have seen major improvements in glycemic and blood pressure control as well as the introduction of national screening programs, and we sought to determine if rates of proliferative diabetic retinopathy have changed as a result. Methods: We conducted a systematic review to determine whether the incidence and progression rates of proliferative diabetic retinopathy and sight-threatening retinopathy have changed, focusing on large population-based studies with objective assessment of diabetic retinopathy. Results: Comparisons across different studies is problematic due to different baseline retinopathy severity, different reported outcomes and different follow-up periods, but within these constraints certain trends could be identified. This review provides evidence that the incidence and progression of these conditions has reduced by approximately 2–3 fold over the last 3 decades. Conclusion: These results have implications for current diabetic retinopathy screening guidelines and has identified future areas where research could be improved.
CLINICAL MANAGEMENT OF BINOCULAR VISION: HETEROPHORIC, ACCOMMODATIVE AND EYE MOVEMENT DISORDERS

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Incidence and Progression of Diabetic Retinopathy in Urban India: Sankara Nethralaya-Diabetic Retinopathy Epidemiology and Molecular Genetics Study (SN-DREAMS II), Report 1

ABSTRACT Purpose: To evaluate the 4-year incidence and progression of and risk factors for diabetic retinopathy (DR) in an Indian population. Methods: From a cross-sectional study of 1425 subjects with diabetes, 911 (63.9%) returned for 4-year follow-up. After excluding 21 with ungradable retinal images, data from 890 subjects were analyzed. Participants underwent examinations based on a standard protocol, which included grading of retinal photographs. Results: The incidences of DR, diabetic macular edema (DME), and sight-threatening diabetic retinopathy (STDR) were 9.2%, 2.6%, and 5.0%, respectively. In subjects with DR at baseline, the incidence of DME and STDR had increased (11.5% and 22.7%, respectively). 1-step and 2-step progressions of DR were seen in 30.2% and 12.6% of participants, respectively, and 1-step and 2-step regressions were seen in 12.0% and 1.8%, respectively. Incident DR, DME, and STDR were associated with higher systolic blood pressure (odds ratio, OR, 1.21, 2.11 and 1.72, respectively, for every 10 mmHg increase). Incident DR and DME were associated with increasing duration of diabetes (OR 2.29 and 4.77, respectively, for every 10-year increase) and presence of anemia (OR 1.96 and 10.14, respectively). Incident DR was also associated with higher hemoglobin A1c (OR 1.16 for every 1% increase). Variables associated with 1-step progression were every 10 mg/dL increase in serum total cholesterol (OR 15.65) as a risk factor, and 10 mg/dL increase in serum triglyceride (OR 0.52) as a protective factor. Conclusions: The incidences of STDR and DME were higher in people with pre-existing DR than in those without DR at baseline.
Myopigenic Activity Change and Its Risk Factors in Urban Students in Beijing: Three-Year Report of Beijing Myopia Progression Study

ABSTRACT Purpose: To investigate the myopigenic activity change and its risk factors in urban students in Beijing. Methods: A total of 241 primary or secondary students aged 6–17 years from the Beijing Myopia Progression Study (BMPS) were re-examined 3 years after their baseline enrollment. A detailed questionnaire was administered to assess myopigenic activities at both baseline and at the 3-year follow-up. Altogether, 217 students (90.0%) with completed data were included in the analysis. Results: Compared to baseline, primary students (n = 123) had significant increases in outdoor sports time (mean ± standard deviation: 3.5 ± 4.3 vs. 2.4 ± 3.0 hours/week, p = 0.02), near work time (32.1 ± 13.4 vs. 24.8 ± 9.2 hours/week, p < 0.001), diopter hours (128.8 ± 53.3 vs. 97.5 ± 35.9 diopter hours/week, p < 0.001), and indoor time (53.8 ± 22.8 vs. 41.4 ± 16.9 hours/week, p < 0.001) at the 3-year follow-up. At both baseline and follow-up, females spent less time than males on outdoor sports (baseline: 2.4 ± 2.8 vs. 4.0 ± 5.2 hours/week, p = 0.006; follow-up: 2.3 ± 3.1 vs. 5.1 ± 5.0 hours/week, p < 0.001), and total outdoors (baseline: 11.9 ± 7.9 vs. 14.4 ± 9.5 hours/week, p = 0.03; follow-up: 10.5 ± 8.2 vs. 13.9 ± 9.6 hours/week, p = 0.005). In the multivariate regression analysis after adjustment by student’s gender, younger students had more increase in both near work time (slope = −0.99 hours/week for age, p = 0.009) and indoor time (slope = −2.04 hours/week for age, p = 0.001). Conclusions: During the 3-year follow-up, primary students had more myopigenic activities. Female students had more myopigenic activities than males at both baseline and follow-up. Children’s age was a significant risk factor for this myopigenic activity change.
Interferon γ in acute and subacute encephalitis

Intrathecal synthesis of interferon γ was shown in 14 out of 16 samples of cerebrospinal fluid collected in the first days of disease in adults, children, and newborn infants with herpes encephalitis. This synthesis was concomitant with that of interferon α and was switched off when the specific antibodies in the central nervous system increased. No endogenous interferon γ was detected in 11 serum samples or 13 samples of cerebrospinal fluid collected early in the course of the disease from patients with measles encephalitis and rubella encephalitis, or in serum and cerebrospinal fluid samples from seven patients with subacute sclerosing panencephalitis. In serum collected after the 10th day after the onset of neurological symptoms interferon γ was present at low concentrations in only three out of 11 serum specimens from patients with measles encephalitis or rubella encephalitis. Interferon γ was present in patients with acute herpes encephalitis and there was active virus replication, but it was not present in postinfectious encephalitis. Possibly the local production of specific antibodies masks the viral antigens and switches off the induction of interferons.
Vascular neuroprotection via TrkB‐ and Akt‐dependent cell survival signaling

The cerebral endothelium can be a vital source of signaling factors such as brain‐derived neurotrophic factor that defends the neuronal parenchyma against stress and injury. But the underlying mechanisms remain to be fully defined. Here, we use cell models to ask how vascular neuroprotection is sustained. Human brain endothelial cells were grown in culture, and conditioned media were transferred to primary rat cortical neurons. Brain endothelial cell‐conditioned media activated neuronal Akt signaling and protected neurons against hypoxia and oxygen‐glucose deprivation. Blockade of Akt phosphorylation with the PI3‐kinase inhibitor LY294002 negated this vascular neuroprotective effect. Upstream of Akt signaling, the brain‐derived neurotrophic factor receptor TrkB (neurotrophic tyrosine kinase receptor, type 2) was involved because depletion with TrkB/Fc eliminated the ability of endothelial‐conditioned media to protect neurons against hypoxia. Downstream of Akt signaling, activation of GSK‐3β (glycogen synthase kinase 3 beta), caspase 9, caspase 3 and Bad pathways were detected. Taken together, these findings suggest that the molecular basis for vascular neuroprotection involves TrkB‐Akt signaling that ameliorates neuronal apoptosis. Further investigation of these mechanisms may reveal new approaches for augmenting endogenous vascular neuroprotection in stroke, brain injury, and neurodegeneration.
Blood pressure variability and the development of early neurological deterioration following acute ischemic stroke

Objectives: Early neurological deterioration (END) is a common condition associated with poor outcome after acute ischemic stroke. We studied association between blood pressure (BP) variability and development of END. Methods: In this retrospective observational study, we studied a consecutive series of patients hospitalized for acute ischemic stroke within 24 h of onset. The primary outcome of interest was the development of END according to predefined criteria within the first 72 h of stroke onset. During this period, the mean, maximum (max), and minimum (min) values for the SBP and DBP were measured. The following parameters of BP variability were calculated for the SBP and DBP: the difference between the maximum and minimum (max−min), the SD, and the coefficient of variation. Results: Of the 1161 patients enrolled in the study (mean age, 67.5 ± 13.3 years; 59.6% men), 210 (18.1%) developed END. All of the BP variability parameters were linearly associated with END independent of mean BP and potential clinical variables (P values < 0.05 on likelihood ratio tests for trend), except for SBPmax−min. Among the other BP parameters, SBPmean, SBPmax, DBPmax, and DBPmin were independently associated with END. After adjustments for potential confounders, the odds for END increased 14–21% with each increase of one standard deviation in the BP variability parameter. Conclusion: BP variability is independently and linearly associated with the development of neurologic deterioration in acute stage of ischemic stroke.
A genetic association study of 5‐HTT LPR and GNβ3 C825T polymorphisms with irritable bowel syndrome

Abstract A pharmacogenetic study suggests the 5‐HTT LPR polymorphism predicts response to alosetron, and another study describes a possible association of the GNβ3 C825T polymorphism with IBS in patients with dyspepsia. We performed a case–control association study to determine whether these polymorphisms are associated with irritable bowel syndrome (IBS). The study aim was to compare allele and genotype frequencies between cases and controls for the 5‐HTT LPR and the GNβ3 C825T polymorphism. Cases were 50 GI outpatients; controls were 53 General Medicine outpatients matched to cases for age, gender and race at a major medical centre. Participants completed a questionnaire and donated blood. DNA was genotyped using polymerase chain reaction based assays. Eighty‐two per cent of cases met Rome II criteria for IBS: 12% constipation‐, 46% diarrhoea‐, and 42% mixed‐IBS. Genotype and allele frequencies for both polymorphisms did not differ between cases and controls. However, the allele frequency of the short (S) allele of the 5‐HTT LPR polymorphism was greater in those with mixed‐IBS compared with controls (68%vs 45%, P < 0.05). This study suggests that the 5‐HTT LPR polymorphism may be associated with mixed‐IBS, but not IBS overall. No association was observed for the GNβ3 C825T polymorphism with IBS overall or subtypes.
Heritability of ambulatory and office blood pressure in the Swiss population

Background: Blood pressure (BP) is known to aggregate in families. Yet, heritability estimates are population-specific and no Swiss data have been published so far. We estimated the heritability of ambulatory and office BP in a Swiss population-based sample. Methods: The Swiss Kidney Project on Genes in Hypertension is a population-based family study focusing on BP genetics. Office and ambulatory BP were measured in 1009 individuals from 271 nuclear families. Heritability was estimated for SBP, DBP, and pulse pressure using a maximum likelihood method implanted in the Statistical Analysis in Genetic Epidemiology software. Results: The 518 women and 491 men included in this analysis had a mean (±SD) age of 48.3 (±17.4) and 47.3 (±17.7) years, and a mean BMI of 23.8 (±4.2) and 25.9 (±4.1) kg/m2, respectively. Narrow-sense heritability estimates (±standard error) for ambulatory SBP, DBP, and pulse pressure were 0.37 ± 0.07, 0.26 ± 0.07, and 0.29 ± 0.07 for 24-h BP; 0.39 ± 0.07, 0.28 ± 0.07, and 0.27 ± 0.07 for day BP; and 0.25 ± 0.07, 0.20 ± 0.07, and 0.30 ± 0.07 for night BP, respectively (all P < 0.001). Heritability estimates for office SBP, DBP, and pulse pressure were 0.21 ± 0.08, 0.25 ± 0.08, and 0.18 ± 0.07 (all P < 0.01). Conclusions: We found significant heritability estimates for both ambulatory and office BP in this Swiss population-based study. Our findings justify the ongoing search for the genetic determinants of BP.
Ischemic Cerebral Edema

Ischemic cerebral edema should be characterized by the anatomy and pathophysiology of the problem before instituting any treatment regimen. Cerebral edema is best described by a 2 compartment model, defined by an intracellular compartment and an extracellular compartment. Both compartments are involved in stroke, and the amount that each contributes varies according to the time course from the original insult. The ideal treatment modality is patient specific and can involve a combination of chemical and mechanical decompression. Decisions pertaining to the treatment modality used should attempt to maximize the physiologic needs of the brain at any given point throughout the course of the edema. Careful planning and a thorough understanding of the anatomy and physiology of both the healthy and abnormal cerebral parenchyma is imperative in the treatment of the broad scope of this problem.
The managerial and development issues of nurses and midwives in new roles.

RATIONALE The number of innovative roles in nursing and midwifery has expanded considerably; however, the evidence base for the introduction of these roles is limited. AIM This study aimed to identify the managerial and developmental issues affecting those in innovative roles. METHODOLOGICAL DESIGN A self-completion postal questionnaire was distributed to all innovative role holders in Northern Ireland, 450 responses were analysed. This survey was the second phase of a larger investigation into innovative roles in nursing and midwifery. INSTRUMENT The questionnaire that had been developed for the 'Exploring New Roles in Practice' project was adapted for use in this study. ETHICAL ISSUES The explanatory letter sent to potential participants clearly detailed that informed consent was assumed on receipt of a completed questionnaire and gave contact details for the research team. The confidentiality and anonymity of responses were assured. RESULTS Most participants (65%) stated that their innovative role had commenced since the year 2000. There was evidence of preparation for these roles including the development of job descriptions and protocols. Nevertheless, there were issues noted relating to resource allocation and replacement when the role holder was absent. The importance of role evaluation was highlighted, with some participants noting their role had not been assessed since its inception. Support provided by managers and colleagues was key to ensuring role effectiveness. Participants reported high levels of job satisfaction. LIMITATIONS Innovative role holders were identified by managers in their employing organization: therefore the research team could not verify that all existing innovative roles were included in the study. Innovative roles in private and voluntary sectors were not included. CONCLUSIONS The evolution of innovative nursing and midwifery roles has been considerable worldwide and they engender job satisfaction to those occupants them. Results support international literature showing that adequate support, especially from administrators, is significant to ensuring the success of new roles. Furthermore, the careful planning for innovative role development and evaluation are important in ensuring the role is effective.
Brachial artery diameter, but not flow-mediated dilation, is associated with sleep apnoea in the Multiethnic Study of Atherosclerosis

Background: The percentage flow-mediated dilation (FMD%) of the brachial artery is purported to be an early indicator of atherosclerosis and has been reported to be reduced in people with obstructive sleep apnoea. Nevertheless, FMD% scales poorly for, and is concomitantly dependent on, initial artery diameter, which may, itself, be higher in obstructive sleep apnoea patients. Therefore, for the first time, we aimed to quantify the differences in initial diameter and properly scaled flow-mediated dilation between people with and without sleep apnoea. Method: The prevalence of physician-diagnosed sleep apnoea, as well as initial and peak diameters of the brachial artery were recorded for 3354 participants in the Multiethnic Study of Atherosclerosis (MESA). Arterial data were analysed using FMD% and an allometric approach, which scales the flow-mediated response properly for initial diameter. Results: In the sex, race and age-adjusted model, initial diameter was 0.19 mm larger in sleep apnoea patients [95% confidence interval (CI): 0.07 to 0.32 mm, P = 0.003] and correlated negatively with FMD% (r = −0.43, 95% CI: −0.57 to −0.26, P < 0.0005). Using this same adjusted model, FMD% was 3.8 ± 2.7% for sleep apnoea patients (n = 104) versus 4.4 ± 2.7% for undiagnosed people (95% CI for difference: −1.12 to −0.07%, P = 0.028). Allometric scaling halved this FMD%-indicated sample difference in flow-mediated dilation (95% CI: −0.7 to 0.1%, P = 0.19). Conclusion: The initial diameter of the brachial artery is larger in MESA participants diagnosed with sleep apnoea compared with undiagnosed people. However, the difference in flow-mediated dilation between these two cohorts is trivial, when the flow-mediated response is scaled properly for resting diameter.
Muscle Activation Patterns of the Forearm: High-Density Electromyography Data of Normally Limbed and Transradial Amputee Subjects

For many years, myoelectric prostheses have been accepted by upper limb amputees. Multifunction pattern recognition has been used successfully to develop myoelectric-controlled limbs; however, much of this research has used normally limbed subjects as they are capable of producing distinguishable muscle activation patterns for different movements. Surprisingly, there has been limited research using clinical populations to test advanced devices and control systems. One reason for the lack of studies with amputees is the limited data regarding their ability to produce repeatable muscle activation patterns. Although it would be expected that these patterns would differ between amputees and normally limbed individuals, it is worthwhile to determine whether amputees can produce repeatable muscle patterns. Therefore, the purpose of this study was to look for distinct and repeatable muscle activation patterns (required for pattern recognition myoelectric control) using amputee subjects. A high-density electromyography system was used to investigate muscle activation patterns during wrist and hand motions. Subjects performed repetitions of different movements, so that intertrial and intermovement electromyography activity comparison could be completed within subject. Topographical (energy maps), classification accuracies, and a separability index were used to determine the discriminate power of the movements performed. It was found that amputee subjects are able to elicit distinct and repeatable patterns for at least a subset of the movements, suggesting promise for amputee control of multifunction myoelectric prostheses.
A Practice Patterns of Child and Adolescent Psychiatrists in South Korea

Methods:A survey on demographic data, work environment, opinion on fellowship training program, and current practice patterns was conducted in 76/223 (34.0%) of all child and adolescent psychiatrists (N=223) were from 1980 to 2008. The survey data from the responders were analyzed. Results:More than half of those surveyed were women. The mean age of survey participants was 40.8 years; most were mar- ried, and lived in the Seoul National Capital Area. In general, the responders were very satisfied with their work. They worked in private practice, public sector, group practice, and as consultants. Up to 87% of the patients treated were children and adolescents. The most common treatment modalities were medication and parent psychoeducation. Social skills training and play therapy were applied mainly for children aged 4 to 12 years old. Cognitive behavioral therapy and counseling were preferred in adolescents. Conclusion:The current study used a database approach in order to define current practice patterns. These data may be help- ful in consideration of future training programs, workforce issues in child and adolescent psychiatry in South Korea, and also in collaboration with other mental health providers.