Miracle-dz/UniFAR-FTUs huggingface dataset:
Long-Term Evaluation of the Roux-Elmslie-Trillat Procedure for Patellar Instability

Background Few published articles exist reporting the long-term evaluation of the Roux-Elmslie-Trillat procedure. Purpose To assess the long-term effect of the Roux-Elmslie-Trillat procedure in preventing recurrent subluxation and dislocation of the patella. Study Design Case series; Level of evidence, 4. Methods Eighteen patients who underwent the Roux-Elmslie-Trillat procedure for dislocation or subluxation of the patella were identified from a group previously evaluated at a mean follow-up of 3 years. The prevalence of recurrent subluxation or dislocation at a mean follow-up of 26 years was compared with the prevalence reported at the mean follow-up of 3 years. Although not the focus of this study, Cox functional scores were obtained from the smaller group and compared with the results at the 3-year follow-up. Results Seven percent (95% confidence interval, 0.00-0.32) of the patients had recurrent subluxation at 26 years compared with 7% (95% confidence interval, 0.03-0.13) of the study population reported at 3 years (P = 1.00). Fifty-four percent (95% confidence interval, 0.27-0.79) rated their affected knee as good or excellent at 26 years compared with 73% (95% confidence interval, 0.64-0.81) of the larger study population reported at 3 years (P = .14). Conclusion The prevalence of recurrent subluxation and dislocation in patients with patellofemoral malalignment who underwent the Roux-Elmslie-Trillat procedure for dislocation or subluxation of the patella is similar at 3 and 26 years after the procedure. The long-term functional status of the affected knee in patients who underwent the Roux-Elmslie-Trillat procedure declined.
Anthropometric Measurements of the Human Knee: Correlation to the Sizing of Current Knee Arthroplasty Systems

Background: There is a paucity of data concerning the morphological dimensions of the distal part of the femur, the proximal part of the tibia, and the patella. The objective of this study was to analyze the exact anatomic data collected from a large group of patients undergoing total knee arthroplasty and to correlate the measurements to the dimensions of current prosthetic systems. Methods: Eight different centers collected morphologic data from the distal part of the femur, the proximal part of the tibia, and the patella from 337 knees during total knee arthroplasty. Microcaliper measurements from templates and measuring guides were used to decrease intraobserver variation. The study included 188 women (209 knees) and 107 men (128 knees) who had a mean age of sixty-nine years. A characterization of the aspect ratio (the medial-lateral to anterior-posterior dimensions) was made for the proximal aspect of the tibia and the distal part of the femur. Known dimensions from six prosthetic knee systems were compared with the morphologic data. Results: A wide variation in the aspect ratio for the femoral component was seen among the six different prosthetic systems. For women, there was a significant association between the component size and the amount of medial-lateral overhang, with larger sizes having more overhang (p < 0.0001). Although the femoral aspect ratio for the morphologic data showed higher ratios for smaller knees and proportionally lower ratios for larger knees, the designs showed little change in the aspect ratio. The tibial aspect ratio from the morphologic data showed a higher ratio for smaller knees and a proportionally lower ratio for larger knees. The Duracon component tracked the decline in aspect ratio fairly well, whereas the other brands either did not change with anterior-posterior dimension or actually increased (NexGen). Gender differences in the morphologic data were shown by the variable tibial aspect ratios. A comparison of the bone dimensions from the study data and the dimensions of the implants indicated that the smaller sizes were too small while the larger sizes tended to be too large. The average overall unresected patellar thickness was 23.7 mm. Conclusion: The results of this study will allow manufacturers to make more appropriate determinations of the sizes and aspect ratios of components for use in total knee arthroplasty.
Key Molecular Factors in Hemagglutinin and PB2 Contribute to Efficient Transmission of the 2009 H1N1 Pandemic Influenza Virus

ABSTRACT Animal influenza viruses pose a clear threat to public health. Transmissibility among humans is a prerequisite for a novel influenza virus to cause a human pandemic. A novel reassortant swine influenza virus acquired sustained human-to-human transmissibility and caused the 2009 influenza pandemic. However, the molecular aspects of influenza virus transmission remain poorly understood. Here, we show that an amino acid in hemagglutinin (HA) is important for the 2009 H1N1 influenza pandemic virus (2009/H1N1) to bind to human virus receptors and confer respiratory droplet transmissibility in mammals. We found that the change from glutamine (Q) to arginine (R) at position 226 of HA, which causes a switch in receptor-binding preference from human α-2,6 to avian α-2,3 sialic acid, resulted in a virus incapable of respiratory droplet transmission in guinea pigs and reduced the virus's ability to replicate in the lungs of ferrets. The change from alanine (A) to threonine (T) at position 271 of PB2 also abolished the virus's respiratory droplet transmission in guinea pigs, and this mutation, together with the HA Q226R mutation, abolished the virus's respiratory droplet transmission in ferrets. Furthermore, we found that amino acid 271A of PB2 plays a key role in virus acquisition of the mutation at position 226 of HA that confers human receptor recognition. Our results highlight the importance of both the PB2 and HA genes on the adaptation and transmission of influenza viruses in humans and provide important insights for monitoring and evaluating the pandemic potential of field influenza viruses.
β1 integrin–dependent Rac/group I PAK signaling mediates YAP activation of Yes-associated protein 1 (YAP1) via NF2/merlin

Cell adhesion to the extracellular matrix or to surrounding cells plays a key role in cell proliferation and differentiation and is critical for proper tissue homeostasis. An important pathway in adhesion-dependent cell proliferation is the Hippo signaling cascade, which is coregulated by the transcription factors Yes-associated protein 1 (YAP1) and transcriptional coactivator with PDZ-binding motif (TAZ). However, how cells integrate extracellular information at the molecular level to regulate YAP1's nuclear localization is still puzzling. Herein, we investigated the role of β1 integrins in regulating this process. We found that β1 integrin–dependent cell adhesion is critical for supporting cell proliferation in mesenchymal cells both in vivo and in vitro. β1 integrin–dependent cell adhesion relied on the relocation of YAP1 to the nucleus after the down-regulation of its phosphorylated state mediated by large tumor suppressor gene 1 and 2 (LATS1/2). We also found that this phenotype relies on β1 integrin–dependent local activation of the small GTPase RAC1 at the plasma membrane to control the activity of P21 (RAC1)-activated kinase (PAK) of group 1. We further report that the regulatory protein merlin (neurofibromin 2, NF2) interacts with both YAP1 and LATS1/2 via its C-terminal moiety and FERM domain, respectively. PAK1-mediated merlin phosphorylation on Ser-518 reduced merlin's interactions with both LATS1/2 and YAP1, resulting in YAP1 dephosphorylation and nuclear shuttling. Our results highlight RAC/PAK1 as major players in YAP1 regulation triggered by cell adhesion.
Japanese Multicenter Outcomes With the HeartMate II Left Ventricular Assist Device in Patients With Small Body Surface Area.

BACKGROUND The HeartMate II (HMII) continuous-flow LVAD was approved for Japanese health insurance coverage in April 2013 as a bridge to transplantation (BTT). We report on post-approval Japanese multicenter outcomes, and a comparison between patients with low and high body surface area (BSA). METHODSANDRESULTS HMII LVAD was implanted in 104 consecutive patients at 15 Japanese centers between April 2013 and July 2014. Perioperative data were submitted to the Japanese Registry for Mechanically Assisted Circulatory Support. Patients were divided into 2 groups on the basis of BSA less or greater than 1.5 m(2). Survival outcomes, New York Heart Association functional class, and adverse event rates were compared between the 2 groups. Preoperative hemodynamics and INTERMACS profiles were similar between groups. There were more females and younger patients in the low BSA group. The respective 6-month and 1-year death- or pump exchange-free survival rates were excellent: 90% and 90% in the BSA <1.5 group vs. 90% and 85% in the BSA ≥1.5 group. In the BSA <1.5 group, occurrence of hemorrhagic stroke was 10% and occurrence of embolic stroke was 0%, vs. 12% and 8% in BSA ≥1.5 group. Driveline infection was encountered more frequently in the BSA <1.5 group. CONCLUSIONS Results for HMII LVAD as BTT in the post-approval era showed excellent survival and functional capacity improvement. Of particular interest to the Japanese patient population are the excellent results in patients with small BSA. (Circ J 2016; 80: 1931-1936).
Glucosamine Supplementation Demonstrates a Negative Effect on Intervertebral Disc Matrix in an Animal Model of Disc Degeneration

Study Design. Laboratory based controlled in vivo study. Objective. To determine the in vivo effects of oral glucosamine sulfate on intervertebral disc degeneration. Summary of Background Data. Although glucosamine has demonstrated beneficial effect in articular cartilage, clinical benefit is uncertain. A Centers for Disease Control report from 2009 reported that many patients are using glucosamine supplementation for low back pain, without significant evidence to support its use. Because disc degeneration is a major contributor of low back pain, we explored the effects of glucosamine on disc matrix homeostasis in an animal model of disc degeneration. Methods. Eighteen skeletally mature New Zealand White rabbits were divided into 4 groups: control, annular puncture, glucosamine, and annular puncture + glucosamine. Glucosamine treated rabbits received daily oral supplementation with 107 mg/d (weight based equivalent to human 1500 mg/d). Annular puncture surgery involved puncturing the annulus fibrosus of 3 lumbar discs with a 16-gauge needle to induce degeneration. Serial magnetic resonance images were obtained at 0, 4, 8, 12, and 20 weeks. Discs were harvested at 20 weeks for determination of glycosaminoglycan content, relative gene expression measured by real time polymerase chain reaction, and histological analyses. Results. The magnetic resonance imaging index and nucleus pulposus area of injured discs of glucosamine treated animals with annular puncture was found to be lower than that of degenerated discs from rabbits not supplemented with glucosamine. Consistent with this, decreased glycosaminoglycan was demonstrated in glucosamine fed animals, as determined by both histological and glycosaminoglycan content. Gene expression was consistent with a detrimental effect on matrix. Conclusion. These data demonstrate that the net effect on matrix in an animal model in vivo, as measured by gene expression, magnetic resonance imaging, histology, and total proteoglycan is antianabolic. This raises concern about this commonly used supplement, and future research is needed to establish the clinical relevance of these findings.
Bacterial vaginosis – a laboratory and clinical diagnostics enigma

Diagnosing bacterial vaginosis (BV) has long been based on the clinical criteria of Amsel et al., whereby three of four defined criteria must be satisfied. Though there are other criteria and scoring methods which function well in comparison (i.e. Nugent scoring), it is not certain that they will always identify the same category of patients. Point‐of‐care methods based on various combinations of microbial products, presence of RNA, or more complex laboratory instrumentations such as sensor arrays, have also been introduced for the diagnosis of BV. No method for diagnosing BV can at present be regarded as the best. It could be that – based partly on tacit knowledge on the part of the clinical investigators scoring in the clinic – various scoring systems have been chosen to fit a particular BV‐related problem in a particular population. In this review we critically examine these pertinent issues influencing clinical scoring and laboratory diagnostics of BV.
Maternal satisfaction with services provided in the neonatal step-down ward in a public sector hospital in North India

Background: Early transfer of baby to mother in step down ward is an approach that can improve maternal satisfaction among parents of neonates admitted in NICU. Objective: To assess the satisfaction of mothers of neonates admitted in the neonatal step down ward of a public sector hospital. Methods: This cross sectional study was conducted in neonatal step down ward of a public sector hospital in North India. One hundred mothers of neonates (< 34 weeks gestation and/or <1800 g birth weight) admitted to the step down ward were included in the study. Mothers of neonates born with major congenital malformations, mothers who were HIV or Hepatitis B positive or had any other chronic illness were excluded. The mothers were interviewed on the day of discharge using a semi-structured questionnaire. It comprised of 35 questions, categorized into 8 domains, namely interpersonal relationships with staff, personal requirements of mother, health services provided by hospital, caregiver proficiency, education and guidance, kangaroo mother care, food provision, and environment of the ward. Maternal satisfaction was marked on a three-point Likert scale. Results: Among the mothers interviewed, a vast majority expressed the utmost satisfaction with the interpersonal relationships with the staff (97.5%). Deficit in satisfaction was observed with the health services (79.57%), and education and guidance by the hospital (78.87%). Conclusion: Neonatal step down set up with early involvement of mother in care of neonates makes mother-baby duo ready for discharge and offers new possibilities for neonatal management in resource-poor countries. Multicentric studies with objectivized outcomes and larger sample size are required for implementing this setup.
Phosphate regulon in members of the family Enterobacteriaceae: comparison of the phoB-phoR operons of Escherichia coli, Shigella dysenteriae, and Klebsiella pneumoniae

The structure and function of the phoB and phoR genes of Shigella dysenteriae strains and Klebsiella pneumoniae, which are involved in regulation of the phosphate regulon, were analyzed. Complementation tests among the genes of Escherichia coli, S. dysenteriae strains, and K. pneumoniae for production of alkaline phosphatase indicate that S. dysenteriae serotype 2 and serotype 3 strains and K. pneumoniae are phoA+ phoB+ phoR+ but S. dysenteriae Sh and serotype 1 strains are phoA phoB+ phoR. Nucleotide sequences of phoB and phoR of S. dysenteriae Sh and K. pneumoniae are highly homologous to those of E. coli, except for a single base insertion found in phoR of S. dysenteriae Sh.
Factors associated with use of bone morphogenetic protein during pediatric spinal fusion surgery: an analysis of 4817 patients.

BACKGROUND Our goal was to investigate whether the use of recombinant human bone morphogenetic protein (rhBMP, or BMP) during pediatric spinal fusion surgery has been increasing and how patient, surgical, and hospital characteristics influence BMP use. METHODS Using the Nationwide Inpatient Sample database, we identified 4817 children eighteen years old or younger who had undergone spinal fusion surgery with the use of BMP from 2003 through 2009. A multivariate logistic regression model, the Z-test of proportions, and simple linear regression were used for statistical analysis (significance, p < 0.05). RESULTS There was a 3.4-fold increase in BMP use, from 2.7% in 2003 to 9.3% in 2009-an average 16% per year increase (p < 0.01). For each additional year of age, BMP use increased 1.09-fold (odds ratio [OR]: 1.05 to 1.13, p < 0.01). Compared with BMP use for adolescent idiopathic scoliosis, the adjusted odds of BMP use were increased 1.3-fold for congenital scoliosis (OR: 1.02 to 1.76, p = 0.04), 2.8-fold for thoracolumbar fractures (OR: 2.1 to 3.8, p < 0.01), and 5.0-fold for spondylolisthesis (OR: 3.9 to 6.3, p < 0.01). Patients with private insurance were 1.5-fold more likely to receive BMP (OR: 1.2 to 1.9, p < 0.01). Patients in whom autograft bone was used intraoperatively were 0.63-fold less likely to receive BMP (OR: 0.52 to 0.77, p < 0.01). The rate of BMP use was 0.38-fold lower in teaching hospitals (OR: 0.31 to 0.48, p < 0.01) and 1.7-fold higher in hospitals with a large bed capacity (OR: 1.3 to 2.2, p < 0.01). Compared with hospitals located in the Northeast, those in the West had a 1.7-fold increase (OR: 1.3 to 2.4, p < 0.01) and those in the South had a 2.0-fold increase (OR: 1.5 to 2.7, p < 0.01) in the odds of BMP use. CONCLUSIONS Use of BMP during pediatric spinal fusion has increased significantly. Patient factors (age, diagnosis, and insurance), surgical factors (autograft use), and hospital factors (teaching status, bed capacity, and location) influenced the variation in BMP use.
Chronic disease, functional health status, and demographics: a multi-dimensional approach to risk adjustment.

OBJECTIVE The goal of this study was to develop unbiased risk-assessment models to be used for paying health plans on the basis of enrollee health status and use propensity. We explored the risk structure of adult employed HMO members using self-reported morbidities, functional status, perceived health status, and demographic characteristics. DATA SOURCES/STUDY SETTING Data were collected on a random sample of members of a large, federally qualified, prepaid group practice, hospital-based HMO located in the Pacific Northwest. STUDY DESIGN Multivariate linear nonparametric techniques were used to estimate risk weights on demographic, morbidity, and health status factors at the individual level. The dependent variable was annual real total health plan expense for covered services for the year following the survey. Repeated random split-sample validation techniques minimized outlier influences and avoided inappropriate distributional assumptions required by parametric techniques. DATA COLLECTION/EXTRACTION METHODS A mail questionnaire containing an abbreviated medical history and the RAND-36 Health Survey was administered to a 5 percent sample of adult subscribers and their spouses in 1990 and 1991, with an overall 44 percent response rate. Utilization data were extracted from HMO automated information systems. Annual expenses were computed by weighting all utilization elements by standard unit costs for the HMO. PRINCIPAL FINDINGS Prevalence of such major chronic diseases as heart disease, diabetes, depression, and asthma improve prediction of future medical expense; functional health status and morbidities are each better than simple demographic factors alone; functional and perceived health status as well as demographic characteristics and diagnoses together yield the best prediction performance and reduce opportunities for selection bias. We also found evidence of important interaction effects between functional/perceived health status scales and disease classes. CONCLUSIONS Self-reported morbidities and functional health status are useful risk measures for adults. Risk-assessment research should focus on combining clinical information with social survey techniques to capitalize on the strengths of both approaches. Disease-specific functional health status scales should be developed and tested to capture the most information for prediction.
Concurrent criterion validity of the safe driving behavior measure: a predictor of on-road driving outcomes.

We determined the concurrent criterion validity of the Safe Driving Behavior Measure (SDBM) for on-road outcomes (passing or failing the on-road test as determined by a certified driving rehabilitation specialist) among older drivers and their family members-caregivers. On the basis of ratings from 168 older drivers and 168 family members-caregivers, we calculated receiver operating characteristic curves. The drivers' area under the curve (AUC) was . 620 (95% confidence interval [CI] = .514-.725, p = .043). The family members-caregivers' AUC was . 726 (95% CI = .622-.829, p ≤ .01). Older drivers' ratings showed statistically significant yet poor concurrent criterion validity, but family members-caregivers' ratings showed good concurrent criterion validity for the criterion on-road driving test. Continuing research with a more representative sample is being pursued to confirm the SDBM's concurrent criterion validity. This screening tool may be useful for generalist practitioners to use in making decisions regarding driving.
Water balance throughout the adult life span in a German population

Mild dehydration, defined as a 1–2 % loss in body mass caused by fluid deficit, is associated with risks of functional impairments and chronic diseases. Whether water requirements change with increasing age remains unclear. Therefore, the aim of the present investigation is to quantify hydration status and its complex determining factors from young to old adulthood to analyse age-related alterations and to provide a reliable database for the derivation of dietary recommendations. Urine samples collected over a 24 h period and dietary records from 1528 German adults (18–88 years; sub-sample of the first National Food Consumption Survey) were used to calculate water intake (beverages, food and metabolic water) and water excretion parameters (non-renal water losses (NRWL), urine volume, obligatory urine volume) and to estimate hydration status (free-water-reserve) and ‘adequate intake (AI)’. Median total water intake (2483 and 2054 ml/d, for men and women, respectively (P < 0·0001)), decreased with increasing age only in males (P = 0·001). Obligatory urine volume increased in both sexes (P < 0·0001) due to decreased renal concentration capacity. The latter was balanced by a decrease of NRWL (P < 0·05), leaving the free-water-reserve and therefore hydration status almost unchanged. Calculated ‘AI’ of total water was the same for young (18–24 years) and elderly ( ≥ 65 years) adults (2910 and 2265 ml/d, for men and women, respectively). The present study is the first population-based examination showing that total water requirements do not change with age although ageing affects several parameters of water metabolism. Reduced sweat loss with increasing age appears to be primarily responsible for this observation.