Miracle-dz/UniFAR-FTUs huggingface dataset:
A Revised Scoring System for Preoperative Evaluation of Metastatic Spine Tumor Prognosis

Study Design. A semi-prospective clinical study was conducted. Objectives. To evaluate the accuracy of a revised scoring system predicting metastatic spinal tumor prognosis and the suitability of the subsequent treatment strategy. Summary of the Background Data. We used a scoring system for the preoperative evaluation of the prognosis of metastatic spinal tumors and selected treatment methods for the predicted prognosis. In the previous version of our scoring system, the reliability of the predicting prognosis was 63.3% in 128 patients with metastatic spinal tumors. Methods. The study participants were 164 patients who died after surgery and 82 who died after conservative treatment. Six parameters were used in the revised scoring system. Each parameter ranged from 0 to 5 points, and the total score was 15 points. In principle, conservative treatment or palliative procedures were indicated in patients with a total score of 8 or less (predicted survival period, less than 6 months) or those with multiple vertebral metastases, while excisional procedures were performed in patients with a total score of 12 or more (predicted survival period, 1 year or more) or those with a total score of 9 to 11 (predicted survival period, 6 months or more) and with metastasis in a single vertebra. The selection of treatment modality was followed faithfully according to the criteria of the revised scoring system after 1998. The prognosis predicted by the revised scoring system and the actual survival period after treatment were compared, and the reliability of the prognostic criteria was analyzed for the group subjected to it prospectively after 1998 (n = 118) and for all 246 patients it was applied to retrospectively. Results. The total score for each patient could be correlated with the survival period. This correlation was also observed in each treatment group. The consistency rate between the predicted prognosis from the criteria of the total scores and the actual survival period was high in patients within each score range (0–8, 9–11, or 12–15), 86.4% in the 118 patients evaluated prospectively after 1998, and 82.5% in the 246 patients evaluated retrospectively. Furthermore, a similar result was also observed in both the surgical procedure group and conservative treatmentgroup. The rate of consistency between the predictedprognosis and the actual survival period in each local extension of the lesion was 75% or more in all types, excluding Type 6 in the surgical classification of Tomita et al. Conclusion. The prognostic criteria using the total scores from our revised scoring system were useful for the pretreatment evaluation of metastatic spinal tumor prognosis irrespective of treatment modality or local extension of the lesion.
Perceptions and Attitudes Toward NANDA‐I Nursing Diagnoses: A Cross‐Sectional Study of Jordanian Nursing Students

PURPOSE To assess the perceptions and attitudes of undergraduate nursing students toward NANDA-I nursing diagnosis. METHODS A descriptive cross-sectional design was used. A convenient sample was recruited from nursing students at Zarqa University/Jordan. Perceptions toward NANDA-I Nursing Diagnosis scale and Positions on Nursing Diagnosis scale were used. FINDINGS A total of 101 nursing students were included. A correct perception toward NANDA-I nursing diagnosis was evident. Attitudes toward NANDA appeared positive. However, insufficient distinction between nursing diagnosis and medical diagnosis and feeling less comfort while using NANDA-I were reported. CONCLUSIONS Nursing students showed correct perceptions and positive attitudes toward the application of NANDA-I. PRACTICE IMPLICATIONS Proper implementation of NANDA-I is a prerequisite to the better understanding of nursing language.
Prevalence of Low Back Pain (LBP) and its affect on Everyday Life among Female Caregivers of Children with Cerebral Palsy (CP)

Aim: To find out the prevalence of low back pain among female caregivers of children with cerebral palsy and how it affects the ability of female caregivers to manage in everyday life. Methods: Cross sectional design was selected to conduct this research. In this study, one question was used to estimate the prevalence of low back pain (LBP) among female caregivers of children with cerebral palsy.
Clenil Modulite, a CFC‐free MDI with no adjustment on switching

Clenil Modulite is the first CFC‐free metered‐dose inhaler directly interchangeable with existing CFC‐containing inhalers. In our New products review, Steve Chaplin presents the clinical data relating to its bioequivalence and Dr Steve Head comments on its place in treatment. Copyright © 2007 Wiley Interface Ltd
Toll-like receptor-4 mediates obesity-induced non-alcoholic steatohepatitis through activation of X-box binding protein-1 in mice

Background Non-alcoholic fatty liver disease is an obesity-related chronic liver disorder ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), which may progress to liver fibrosis and cirrhosis. Objective Tto investigate the role of Toll-like receptor (TLR) 4 in mediating the transition from steatosis to inflammation. Methods ApoE−/−/TLR4mut mice and ApoE−/−/TLR4 wild-type mice (ApoE−/−/TLR4-WT) were generated by cross-breeding an ApoE-deficient (ApoE−/−) strain with TLR4-mutant (TLR4mut) mice, which were fed with high-fat, high-cholesterol (HFHC) diet to induce obesity. Results ApoE−/−/TLR4-WT mice fed with an HFHC diet for 12 weeks developed typical pathological features of NASH, which is associated with obesity and the metabolic syndrome. By contrast, ApoE−/−/TLR4mut mice lacking functional TLR4 were resistant to HFHC diet-induced liver inflammation and injury and were less susceptible to the diet-induced production of reactive oxygen species (ROS) and proinflammatory cytokines. In ApoE−/−/TLR4-WT mice, X-box binding protein-1 (XBP-1), a transcription factor involved in the unfolded protein responses, was activated in the liver by an HFHC diet, whereas XBP-1 activation was abrogated in ApoE−/−/TLR4mut mice. In primary rat Kupffer cells, endotoxin induced XBP-1 activation through ROS production, whereas siRNA-mediated knockdown of XBP-1 expression resulted in a marked attenuation in endotoxin-evoked NF-κB activation and cytokine production. Furthermore, adenovirus-mediated expression of dominant negative XBP-1 led to a significant attenuation in HFHC diet-induced liver inflammation and injury in mice. Conclusions These findings support the key role of TLR4 in Kupffer cells in mediating the progression of simple steatosis to NASH, by inducing ROS-dependent activation of XBP-1.
Gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS): a new autosomal dominant syndrome

Objective The purpose of this study was the clinical and pathological characterisation of a new autosomal dominant gastric polyposis syndrome, gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS). Methods Case series were examined, documenting GAPPS in three families from Australia, the USA and Canada. The affected families were identified through referral to centralised clinical genetics centres. Results The report identifies the clinical and pathological features of this syndrome, including the predominant dysplastic fundic gland polyp histology, the exclusive involvement of the gastric body and fundus, the apparent inverse association with current Helicobacter pylori infection and the autosomal dominant mode of inheritance. Conclusions GAPPS is a unique gastric polyposis syndrome with a significant risk of gastric adenocarcinoma. It is characterised by the autosomal dominant transmission of fundic gland polyposis, including areas of dysplasia or intestinal-type gastric adenocarcinoma, restricted to the proximal stomach, and with no evidence of colorectal or duodenal polyposis or other heritable gastrointestinal cancer syndromes.
Double-blind comparative trial of mianserin versus clomipramine

SummaryA double-blind, randomized trial was carried out in 62 female hospitalized patients with affective psychoses to compare the effectiveness and tolerance of mianserin with that of clomipramine. Patients were treated with median doses of 60 mg mianserin (30 to 80 mg) or 150 mg clomipramine (75 to 200 mg) daily for 3 weeks. There were no significant differences between drug treatments as measured by the Hamilton Rating Scale for Depression, the Clinical Global Impressions and the Syndrome Specific Self-Rating Scales. Both drugs produced significant but indistinguishable improvement in depressive symptomatology. The overall incidence of side-effects was low, but clomipramine produced significantly more anticholinergic effects.
Helicobacter pylori CagL dependent induction of gastrin expression via a novel αvβ5-integrin–integrin linked kinase signalling complex

Objective One of the most important hormones in the human stomach is the peptide gastrin. It is mainly required for the regulation of gastric pH but is also involved in growth and differentiation of gastric epithelial cells. In Helicobacter pylori infected patients, gastrin secretion can be upregulated by the pathogen, resulting in hypergastrinaemia. H pylori induced hypergastrinaemia is described as being a major risk factor for the development of gastric adenocarcinoma. Design In this study, the upstream receptor complex and bacterial factors involved in H pylori induced gastrin gene expression were investigated, utilising gastric epithelial cells which were stably transfected with a human gastrin promoter luciferase reporter construct. Results Integrin linked kinase (ILK) and integrin β5, but not integrin β1, played an important role in gastrin promoter activation. Interestingly, a novel CagL/integrin β5/ILK signalling complex was characterised as being important for H pylori induced gastrin expression. On interaction of H pylori with αvβ5-integrin and ILK, the epidermal growth factor receptor (EGFR) →Raf→mitogen activated protein kinase kinase (MEK)→extracellular signal regulated kinase (Erk) downstream signalling cascade was identified which plays a central role in H pylori gastrin induction. Conclusion The newly discovered recognition receptor complex could be a useful target in treating precancerous conditions triggered by H pylori induced hypergastrinaemia.
NUT midline carcinoma with leukemic presentation mimicking CD34-positive acute leukemia.

[Figure][1] A 17-year-old boy presented with cough, chest pain for 3 weeks, and weight loss for several months. He was treated with multiple rounds of antibiotics with no improvement. A right lower lobe lung lesion with extension into the mediastinum and innumerable bone metastases were
Post-Anastomotic Enterocutaneous Fistulas: Associated Factors and Spontaneous Closure at a Tertiary Centre in Western Kenya

Objective To determine the factors associated with the occurrence and spontaneous closure of enterocutaneous fistulas. Design A retrospective, hospital-based study of patients who developed enterocutaneous fistulas after resection and anastomosis. Setting The general and paediatric surgical wards of Moi Teaching and Referral Hospital (MTRH), a 550 bed tertiary teaching and referral hospital in the Western region of Kenya. Subjects Two hundred and twenty patients of all ages who underwent gut resection and anastomosis for varied reasons between 2002 and 2006. Main outcome measures The primary outcome measures were variables associated with development and spontaneous closure of fistulas while the secondary outcome measures were morbidity and mortality associated with enterocutaneous fistulas. Results Enterocutaneous fistulas formed in 22 of 220 patients and constituted 44% of all the complications after gut resection and anastomosis. Age younger than 20 years (p=0.04), female gender (p=0.032), duration of symptoms greater than one day prior to presentation to hospital (0.032), deranged electrolytes (p=0.042), delay in surgery after admission (p=0.043) and the use of ileal segment in the anastomosis (p=0.018) were significantly associated with occurrence of fistulas on univariate analysis. The use of ileal segment in the anastomosis (p=0.033), deranged electrolytes (p=0.045) and duration prior to surgery (p=0.045) were also found to be predictive of fistula formation on multivariate analysis. The spontaneous closure rate was 45.5%. Factors significantly associated with spontaneous closure were age greater than 20 years (p= 0.027) and occurrence of the fistula in an ileal segment (p=0.031). Enterocutaneous fistulas had a case specific mortality rate of 50%. The factor most significantly associated with mortality was re-operation (P<0.001) and this was also predictive of both mortality and prolonged hospital stay. Conclusion Renal dysfunction, delay before surgery and the use of ileal segments were significantly associated with the occurrence of enterocutaneous fistulas while age greater than 20 years and occurrence of fistulas in ileal segments had significant association with spontaneous closure of the fistulas. Re-operation is a strong predictor of mortality in interocutaneous fistula patients.
Role of biological therapy for inflammatory bowel disease in developing countries

Inflammatory bowel disease (IBD) has become a global disease. Its incidence in developing countries is rising. In Asia, this has been attributed to the rapid modernisation and westernisation of the population. As IBD emerges in developing nations, there is a need to reconcile the most appropriate treatment for these patient populations from the perspectives of both disease presentation and cost. In the West, biological agents are the fastest-growing segment of the prescription drug market. They typically cost several thousand to several tens of thousands of dollars per patient per year. The healthcare systems in developing countries will struggle to afford such expensive treatments. Developing countries cover two-thirds of the earth's surface and are home to 3–5 billion inhabitants, constituting three-quarters of all humanity. If IBD emerges to the same extent in those countries as it has in the West, the need for biological therapy will increase dramatically, and the pharmaceutical industry, healthcare providers, patient advocate groups, governments and non-governmental organisations will have to discuss how to handle this. The authors propose that this dialogue should begin now with regard to (1) the major needs of patients with complicated IBD in developing countries, (2) the potential need for biological therapy in developing countries to treat IBD, (3) the necessary infrastructure for selecting patients with IBD who need biological therapy, and (4) medical/ethical issues limiting the use of biological therapy.
Insulin resistance and response to telaprevir plus peginterferon α and ribavirin in treatment-naïve patients infected with HCV genotype 1

Objective Insulin resistance is a predictor of poor response to peginterferon/ribavirin in patients infected with the chronic hepatitis C virus (HCV). There are no data on direct-acting antivirals. This exploratory analysis assessed the effect of metabolic factors and insulin resistance, measured by homoeostatic model assessment (HOMA), on virological response to telaprevir in Study C208. Design Overall, 161 HCV genotype 1-infected, treatment-naïve patients received 12 weeks of telaprevir plus peginterferon/ribavirin, then 12/36 weeks of peginterferon/ribavirin depending on on-treatment response criteria. The prognostic significance of several factors, including HOMA-insulin resistance (HOMA-IR), on virological response at weeks 4 and 12, end of treatment and 24 weeks after treatment was explored by multiple regression analysis. Results Baseline HOMA-IR data were available for 147 patients; baseline characteristics were consistent with the overall population. Baseline HOMA-IR <2, 2–4 and >4 was seen in 54%, 30% and 16% of patients, respectively. Neither response rates (any time point) nor week 4 viral load decline were significantly influenced by baseline HOMA-IR. In multivariate analyses, fibrosis stage and low-density lipoprotein cholesterol level were predictive of sustained virological response (OR 0.47 and 1.02, respectively). After the end of treatment, HOMA-IR was significantly lower in patients with sustained virological response than in those without (0.61 vs 1.34 for relapsers and 1.15 for non-responders; p<0.05). Conclusion In this study, baseline HOMA-IR was not predictive of virological response to telaprevir in HCV genotype 1-infected, treatment-naïve patients, while sustained virological response was associated with improved HOMA-IR. These results suggest that metabolic factors and insulin resistance do not have a significant effect on telaprevir-based treatment efficacy.
Transitions from functionalization to fragmentation reactions of laboratory secondary organic aerosol (SOA) generated from the OH oxidation of alkane precursors.

Functionalization (oxygen addition) and fragmentation (carbon loss) reactions governing secondary organic aerosol (SOA) formation from the OH oxidation of alkane precursors were studied in a flow reactor in the absence of NO(x). SOA precursors were n-decane (n-C10), n-pentadecane (n-C15), n-heptadecane (n-C17), tricyclo[5.2. 1.0(2,6)]decane (JP-10), and vapors of diesel fuel and Southern Louisiana crude oil. Aerosol mass spectra were measured with a high-resolution time-of-flight aerosol mass spectrometer, from which normalized SOA yields, hydrogen-to-carbon (H/C) and oxygen-to-carbon (O/C) ratios, and C(x)H(y)+, C(x)H(y)O+, and C(x)H(y)O(2)+ ion abundances were extracted as a function of OH exposure. Normalized SOA yield curves exhibited an increase followed by a decrease as a function of OH exposure, with maximum yields at O/C ratios ranging from 0.29 to 0.74. The decrease in SOA yield correlates with an increase in oxygen content and decrease in carbon content, consistent with transitions from functionalization to fragmentation. For a subset of alkane precursors (n-C10, n-C15, and JP-10), maximum SOA yields were estimated to be 0.39, 0.69, and 1.1. In addition, maximum SOA yields correspond with a maximum in the C(x)H(y)O+ relative abundance. Measured correlations between OH exposure, O/C ratio, and H/C ratio may enable identification of alkane precursor contributions to ambient SOA.
Lymphoma "benchmark" or "bench-smudge"?

In this issue of Blood , Crump et al provide data on 636 refractory diffuse large B-cell lymphoma (DLBCL) patients. 1 In a retrospective analysis of a subset of subjects extracted from 2 observational cohorts and 2 randomized clinical trials, the authors describe outcomes in this patient population. 2-6 The authors report a pooled response rate of 26% to the subsequent line of therapy. Although we acknowledge the useful findings of this study, we are cautious in considering this retrospectively defined cohort as a “benchmark” for prospective trials in refractory DLBCL.
Understanding lymphoma molecular complexity.

In this issue of Blood , Bouska et al give an excellent example of an integrated molecular approach applied to high-grade B-cell lymphoma with the molecular Burkitt lymphoma (BL) signature. 1 This study has several practical implications regarding (1) the concept of the pathological entity, (2) the understanding of the different mechanisms at work in patients who apparently have the same disease, and (3) the impact that a comprehensive molecular approach can have on the identification of novel therapeutic targets.
Increased risk of acute pancreatitis among tetracycline users in a Swedish population-based case–control study

Objective To evaluate the suggested association between tetracycline and acute pancreatitis in a large pharmacoepidemiological study. Design The use of tetracycline in relation to the risk of acute pancreatitis was examined in a nationwide case–control study of people aged 40–84 years between 2006 and 2008 in Sweden. The Swedish Patient Register was used to identify 6161 cases of first-episode acute pancreatitis. The Register of the Total Population was used to randomly select 61 637 control subjects from the general population using frequency-based density sampling, matched for age, sex, and calendar year. Tetracycline use was defined as ‘current’, ‘recent’, ‘past’ or ‘former’ if the drug had been dispensed 0–30 days, 31–180 days, 181–365 days or 1–3½ years before the index date, respectively. The risk of acute pancreatitis was estimated by unconditional logistic regression, providing ORs with 95% CIs, adjusted for potential confounding factors. Results There was a 60% increased risk of acute pancreatitis among current users of tetracycline after adjustment for potential confounders (OR=1.6, 95% CI 1.2 to 2.1). There was no increased OR for any category of previous use. Conclusion Current use of tetracycline is associated with an increased risk of acute pancreatitis, verifying previous case reports.
Analytic derivation of the performance degradation in recursive implementation of sliding-DFT with the twiddle factors of finite-bit precision

This paper presents an analytic derivation of the erroneous effect when the sliding-DFT is implemented in a recursive way with the finite-bit approximation of the twiddle factors. The analysis result is obtained in a closed form equation of the noise-to-signal power ratio (NSR) employing the zero-mean white Gaussian signal as the target input of the DFT. The analytically derived results are verified through the comparison with the data actually measured from the computer simulation experiment.
CT colonography for detection and characterisation of synchronous proximal colonic lesions in patients with stenosing colorectal cancer

Objective To investigate CT colonography (CTC) performance for detecting and characterising synchronous lesions proximal to a stenosing colorectal cancer and to suggest patient management strategies according to the CTC findings. Methods 411 consecutive patients underwent CTC for proximal colonic evaluation after failed colonoscopy past a newly diagnosed stenosing colorectal cancer. Pathological examination of colectomy specimen and/or postsurgical colonoscopy with pathological confirmation of the proximal synchronous lesions to serve as reference standards existed in 284 patients. Per-patient and per-lesion diagnostic performance measures of CTC for diagnosing proximal synchronous lesions ≥6 mm analysed by histopathological categories were obtained for the 284 patients. Per-lesion sensitivity and positive predictive value (PPV) of various CTC lesion size criteria and lesion size combined with other CTC findings for diagnosing cancer in the proximal colon were determined. Results Both per-patient and per-lesion CTC detection sensitivities for proximal synchronous cancers were 100% (6/6 patients and 8/8 lesions; 95% CI 64.3% to 100% and 70.7% to 100%, respectively) with the corresponding per-patient negative predictive value (NPV) of a negative CTC of 100% (194/194 patients; 95% CI 98.3% to 100%). Per-patient NPV of a negative CTC for advanced neoplasia (ie, advanced adenomas and colorectal cancers) was 97.4% (189/194 patients; 95% CI 93.9% to 99.1%). A lesion size ≥15 mm on CTC as the criterion to specifically diagnose proximal cancer yielded 87.5% (7/8 lesions; 95% CI 50.8% to 99.9%) per-lesion sensitivity, rendering one 8-mm submucosal cancer mischaracterised as a non-cancerous lesion, and 70% (7/10 lesions; 95% CI 39.2% to 89.7%) per-lesion PPV. Additional CTC findings did not improve the sensitivity. Conclusion CTC is highly sensitive in detecting synchronous cancers proximal to a stenosing colorectal cancer. CTC has limited capability in differentiating advanced adenomas from colorectal cancer and this compromises the PPV of CTC for the presence of proximal cancer.
Incidence of transient hypoxia during pre‐hospital rapid sequence intubation by anaesthesiologists

Pre‐hospital tracheal intubation (TI) is an important but difficult procedure with the potential to produce hypoxaemia. The aim of this study was to determine the incidence of desaturation episodes during out‐of‐hospital rapid sequence induction (RSI) and TI by the medical team of a German Helicopter Emergency Medical Service (HEMS).