Miracle-dz/UniFAR-FTUs huggingface dataset:
Ending the Culture of Culture-Negative Sepsis in the Neonatal ICU

* Abbreviations: CFU — : colony-forming unit IAP — : intrapartum antibiotic prophylaxis Sepsis is a major cause of morbidity and mortality among infants in the NICU. Because septic infants present with nonspecific clinical findings, providers are justifiably concerned about missing sepsis. Blood cultures are the gold standard for diagnosis of sepsis, and when adequate volumes are obtained, cultures have excellent sensitivity even when the infant has very low levels of bacteremia.1 However, many providers view sterile culture results with skepticism, especially when the infant appears ill or received antibiotics before cultures were obtained. Therefore, we have developed a culture (no pun intended) of acceptance in treating “culture-negative” sepsis. Recent reports suggest that up to 10 times as much antibiotic is used for culture-negative sepsis as for culture-proven sepsis.2,3 This practice must stop. The evidence for unintended harm caused by prolonged or unnecessary antibiotic exposure continues to mount and includes increased risk for obesity, atopy, and, for preterm infants, necrotizing enterocolitis, sepsis, bronchopulmonary dysplasia, and death.4 Why then do providers view sterile cultures with such skepticism? The first reason is that providers have all-too-frequent experiences with cultures that are obtained incorrectly. Blood cultures collected inappropriately cannot be trusted, but such cultures, unfortunately, are a common problem. The recommendation is that a minimum of 1 mL of blood, either in 1 culture or divided into 2 0.5 mL cultures, be obtained from infants … Address correspondence to Joseph B. Cantey, MD, Department of Pediatrics, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229. E-mail: cantey{at}uthscsa.edu
EFFICACY AND SAFETY OF CASPOFUNGIN THERAPY IN CHILDREN WITH INVASIVE FUNGAL INFECTIONS

Twenty children with proven (n = 12) or probable (n = 8) invasive fungal infections received caspofungin treatment either as first-line (n = 7) or as salvage (n = 13) therapy and as monotherapy (n = 5) or in combination (n = 15). Eleven had aspergillosis, 7 had candidiasis, and 2 had Rhodotorula infections. Caspofungin was well tolerated. Nine patients experienced 11 drug-related adverse events, none were severe, and none led to drug discontinuation. Caspofungin as a first-line treatment was successful in 5 of the 7 children (these 5 patients survived the infectious episode, with a follow-up of 147 days), and salvage therapy rescued 8 of 13 children, but only 5 of them survived.
Barrett's esophagus with high-grade dysplasia. An indication for prophylactic esophagectomy.

OBJECTIVE The authors review the results and outcomes of esophagectomy (prophylactic esophagectomy) for patients with Barrett's esophagus and high-grade epithelial dysplasia (HGD). SUMMARY BACKGROUND DATA The role of prophylactic esophagectomy for Barrett's esophagus with HGD is controversial, with some authors recommending surgery and others favoring endoscopic surveillance until biopsy diagnosis of carcinoma is made. METHODS Between 1982 and 1994, 30 consecutive patients with HGD underwent esophagectomy and had the pre- and postoperative pathology reviewed at our institution. The medical records were reviewed to determine patient characteristics, preoperative endoscopic data, surgical approach, operative morbidity and mortality, length of hospitalization, and treatment outcome. Patients were divided into two groups based on whether invasive adenocarcinoma was found in the resection specimen (group 1) or not (group 2). RESULTS The duration of reflux symptoms was 22 +/- 14 years for group 1 and 9 +/- 11 years for group 2 (p = 0.05). There was one operative death (3.3%) and six complications (20%). In 13 patients (43%, group 1), invasive adenocarcinoma was found in the resected esophagus. The American Joint Committee on Cancer stage for these patients was stage I (8 patients), stage II (2 patients), and stage III (3 patients). One stage I patient died of adenocarcinoma (72 months) in an incompletely excised HGD segment. Other stage I and II patients are alive without adenocarcinoma with an 18-and 63-month mean follow-up, respectively. Outcome for stage III patients was one operative death, one noncancer death (6 months), and one patient with metastatic adenocarcinoma (26 months). For group 2 (57%), there were no adenocarcinoma deaths (40 months). CONCLUSIONS High-grade epithelial dysplasia is an indication for esophagectomy because of the prevalence of occult adenocarcinoma (43%). Esophagectomy can be performed safely, and survival in patients with completely resected Barrett's esophagus and early-stage adenocarcinoma is excellent.
Clenbuterol and the Horse

Clenbuterol is a b2-agonist bronchodilator and mucokinetic drug. When administered at the recommended dose of 0.8 mg/kg q 12 h, it reaches plasma levels that should relax airway smooth muscle. However, the measurable degree of bronchodilation achieved may not always be clinically obvious even in horses with heaves. After a ten-day treatment (0.8 mg/kg q 12 h), the half-life of elimination from plasma is about ten hours and plasma levels are below the pharmacological threshold within three days. Urinary elimination is prolonged and irregular so that control of clenbuterol usage in racehorses should be based on blood rather than urine levels. Author’s address: Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI 48824-1314. © 2000 AAEP.
Our experience with epidural steroid injections in management of low backpain and sciatica.

BACKGROUND Low back pain and sciatica is a common clinical condition. It is a most common orthopaedic complaint in the Kaski region of Nepal. The reason for its increased incidence may be hilly terrain, difficult working and living environment of the region. The initial treatment of Low back pain is conservative. Epidural steroid injection is being slowly established as are liable mode of conservative management in many orthopaedic centres of the world. This is a preliminary report of on-going study of the use of epidural steroid in the management of low back pain cases coming to the orthopaedic department of Manipal Teaching Hospital. METHODS Prospective clinical trial was carried out on the patients reporting with low back pain and sciatica not responding to other modes of conservative treatment. Pre and post injection evaluation was done clinically. The level of pain, improvement in physical signs and ability to do activities of daily living were noted. RESULTS Fifty two patients were observed for the average duration of 2.87 months. Average duration of symptoms was for 10 months. After first epidural steroid injection 83% of patients reported relief on day one. In some cases the onset of analgesia was delayed. Four patients reported no relief after first injection. Fifteen patients were given two injections and four received three injections. The average duration between two injections was three weeks. Average duration of pain relief was 20 days. At the end of 3 months, good results were seen in 39%, fair in 33% and bad results in 27%. Overall 59% of patients were able to do activities of daily living. Three patients (5.76%)required operation for disc prolapse. Postoperatively two patients reported back with back pain. Most common complaint of patients after injection was pain at the injection site. No major complications were encountered. CONCLUSION Epidural Steroid Injection is a safe and effective mode of treatment of Low Back Pain. It provides painfree period to enable the patient for physiotherapy which helps in early recovery.
Chromosomal imbalances in wood dust‐related adenocarcinomas of the inner nose and their associations with pathological parameters

Comparative genomic hybridization (CGH) was used to screen 42 wood dust‐related sinonasal adenocarcinomas for chromosomal alterations. The tumour collection comprised 39 papillary‐tubular cylinder cell adenocarcinomas (PTCCs; six cases G1, 23 G2, and ten G3), two alveolar goblet cell adenocarcinomas (AGCs), and one signet ring cell adenocarcinoma (SRC), according to the Kleinsasser and Schroeder classification. Copy number changes were detected in 41 tumours (97.6%). The one carcinoma without imbalances was a PTCC‐G1. DNA gains were most frequently seen on chromosomes 12p (83%), 7q (74%), 8q (71%), and 20q (71%), 11q (61%), 22 (59%), and 1q (52%). Pronounced overrepresentations suggestive of high copy amplifications were detected on 8q (15 cases, 36%), 7q (six cases, 14%), 20q (five cases, 12%), 13q14 (three cases, 7%), 1q22, 5p, 12p and 20 (two cases, 5% each), and 2q24, 3q13, 3q22, 7p, 14q12, and 16q13 (one case, each 2%). Frequent chromosomal losses occurred at 5q (81%), 18q (76%), 4 (74%), 8p (61%), 9p (60%), 6q and 17p (52% each), and 3p, 13q, and 21 (50% each). There was a quantitative as well as a qualitative increase of alterations from PTCC‐G1 to PTCC‐G2 and finally PTCC‐G3, confirming the usefulness of histopathological grading. While PTCC‐G1 carried only a few alterations, namely gains on chromosomes 17 and 7 as well as losses of 4q and 13q, PTCC‐G2 already carried many of the above‐mentioned alterations, while PTCC‐G3 showed significantly more gains of 7q, 8q, and 12p, and losses of 8p and 17p. Additionally, the latter subgroup was particularly prone to carry pronounced DNA gains. These data provide further evidence for a recurrent pattern of chromosomal imbalances in sinonasal adenocarcinomas and highlight distinct aberrations that are associated with tumour differentiation and progression. Copyright © 2005 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
Diagnosis of Parathyroid Adenoma Using Intraoperative Squash Cytology and Frozen Sections-A Rare Case Report

The identification of parathyroid gland tissue and its distinction from surrounding structures such as thyroidgland, lymphoid, fibroadipose, and, rarely, thymic tissues on frozen section (FS) may be challenging owingto freezing artifact and small biopsy sent for FS. Intraoperative cytology (IC) provides valuable complementary morphologic details. We evaluated a case by IC alone, followed by interpretation with FS to reach a final interpretation using IC and FS together. IC is a valuable adjunct to FS during intraoperative consultation for evaluation of tissue in a parathyroid location. We present a rare case of parathyroid adenoma which was evaluated by relatively faster procedure of squash cytology first and then confirmed on FS for effective diagnosis. The present study infers that a combined approach of IC and FS is preferable to using FS or IC alone.
Complaints from emergency department patients largely result from treatment and communication problems.

OBJECTIVE Emergency department patient complaints are often justified and may lead to apology, remedial action or compensation. The aim of the present study was to analyse emergency department patient complaints in order to identify procedures or practices that require change and to make recommendations for intervention strategies aimed at decreasing complaint rates. METHODS We undertook a retrospective analysis of patient complaints from 36 Victorian emergency departments during a 61 month period. Data were obtained from the Health Complaint Information Program (Health Services Commissioner). RESULTS In all, 2,419 emergency department patients complained about a total of 3,418 separate issues (15.4% of all issues from all hospital departments). Of these, 1,157 complaints (47.80%) were received by telephone and 829 (34.3%) were received by letter; 1,526 (63.1 %) complaints were made by a person other than the patient. Highest complaint rates were received from patients who were female, born in non-English-speaking countries and very young or very old. One thousand one hundred and forty-one issues (33.4%) related to patient treatment, including inadequate treatment (329 issues) and inadequate diagnosis (249 issues); 1079 (31.6%) issues related to communication, including poor staff attitude, discourtesy and rudeness (444 issues); 407 (11.9%) issues related to delay in treatment. Overall, 2516 issues (73.6%) were resolved satisfactorily, usually by explanation or apology. Only 59 issues (1.7%) resulted in a procedure or policy change. Remedial action was taken in 109 issues (3.2%) and compensation was paid to eight patients. CONCLUSIONS Communication remains a significant factor in emergency department patient dissatisfaction. While patient complaints have resulted in major changes to policy and procedure, research and intervention strategies into communication problems are indicated. In the short term, focused staff training is recommended.
IL‐6 receptor blockage inhibits the onset of autoimmune kidney disease in NZB/W F1 mice

In the present study, we examined the preventive effect of anti‐mouse IL‐6 receptor (IL‐6R) antibody, MR16‐1, on the development of autoimmune kidney disease in female NZB/W F1 (BWF1) mice. Immunological tolerance to MR16‐1 or isotype‐matched control antibody, KH‐5, was induced by the simultaneous administration of anti‐CD4 MoAb in mice. Thereafter, mice were intraperitoneally given 0.5 mg of MR16‐1, 0.5 mg of KH‐5 or saline once a week from 13 to 64 weeks of age. MR16‐1 treatment dramatically suppressed proteinuria and prolonged the survival time of BWF1 mice. Only one out of 10 mice died with high levels of proteinuria throughout the experiment. MR16‐1 almost completely suppressed the production of IgG forms of anti‐DNA and anti‐TNP antibodies, but not the IgM forms of these antibodies. In particular, all IgG subclasses (IgG1, IgG2a, IgG2b and IgG3) of anti‐DNA antibody production were significantly suppressed. Moreover, serum IgG1, IgG2a and IgG3 levels in MR16‐1‐treated mice were lower than those in saline‐ and KH‐5‐treated mice, whereas serum IgM and IgA levels were not influenced. In conclusion, MR16‐1 potently suppressed the development of autoimmune disease in BWF1 mice, and this was attributed to its effect of specific suppression of IgG class antibody production.
Characterization of Aspergillus nidulans α‐glucan synthesis: roles for two synthases and two amylases

Cell walls are essential for fungal survival and growth. Fungal walls are ∼ 90% carbohydrate, mostly types not found in humans, making them promising targets for anti‐fungal drug development. Echinocandins, which inhibit the essential β‐glucan synthase, are already clinically available. In contrast, α‐glucan, another abundant fungal cell wall component has attracted relatively little research attention because it is not essential for most fungi. Aspergillus nidulans has two α‐glucan synthases (AgsA and AgsB) and two α‐amylases (AmyD and AmyG), all of which affect α‐glucan synthesis. Gene deletion showed that AgsB was the major synthase. In addition, AmyG promoted α‐glucan synthesis whereas AmyD had a repressive effect. The lack of α‐glucan had no phenotypic impact on solid medium, but reduced conidial adhesion during germination in shaken liquid. Moreover, α‐glucan level correlated with resistance to Calcofluor White. Intriguingly, overexpression of agsA could compensate for the loss of agsB at the α‐glucan level, but not for phenotypic defects. Thus, products of AgsA and AgsB have different roles in the cell wall, consistent with agsA being mainly expressed at conidiation. These results suggest that α‐glucan contributes to drug sensitivity and conidia adhesion in A. nidulans, and is differentially regulated by two synthases and two amylases.
[Shang Ring circumcision versus conventional surgical procedures: comparison of clinical effectiveness].

OBJECTIVE To compare the efficacy and complications of the Shang Ring circumcision with those of conventional surgical procedures. METHODS A total of 724 patients, 521 with redundant prepuce and 203 with phimosis, were randomly assigned to receive the Shang Ring circumcision (n = 402) and conventional surgical procedures (n = 322). Comparisons were made between the two groups in the surgical duration, blood loss, pain score, as well as postoperative complications, satisfaction with the penile appearance, and the quality of sexual life. RESULTS The surgical duration, blood loss, postoperative satisfaction and IIRF-5 score were (4.70 +/- 1.30) min, (2.60 +/- 1.80) ml, 99.50% (400/402) and 23.45 +/- 3.43, respectively, in the Shang Ring group as compared with (25.6 +/- 8.3) min, (11.20 +/- 3.50) ml, 69.57% (224/322) and 23.12 +/- 3.26 in the conventional surgery group, with statistically significant differences in the first three parameters (P < 0.01), but not in IIRF-5 score (P > 0.05). CONCLUSION Compared with the conventional surgical procedures, the Shang Ring circumcision has the advantages of shorter operation time, less blood loss, mild pain, fewer complications, better penile appearance, lower expenses, and higher satisfaction and acceptance of the patients.
Phase II trial of single-agent sorafenib in patients with advanced non-small cell lung carcinoma.

7002 Background: Sorafenib, an oral multi-kinase inhibitor, targets the Raf/MEK/ERK pathway at the level of Raf kinase and receptor tyrosine kinases, and has shown efficacy against several tumor types in phase I/II trials. Non-small-cell lung cancer (NSCLC) is associated with mutations in k-ras, upstream of Raf/MEK/ERK. METHODS This multi-center, uncontrolled, phase II trial evaluated efficacy (every 8 weeks using RECIST) and safety of sorafenib (400 mg bid, continuous) in patients with relapsed or refractory advanced NSCLC. Plasma for proteomic biomarker analysis (ELISA [n=44]; mass-spectrometry [n=43]) was taken at screening, Day 21 of Cycle 1, and Day 1 of Cycle 3. RESULTS Fifty-two of 54 patients enrolled received sorafenib. Most (49/52) patients who received sorafenib had stage IV NSCLC. Thirty patients (59%) out of 51 evaluable for efficacy had SD. Although there were no confirmed PRs, tumor shrinkage was observed in 15 (29%) patients (four had ≥30% shrinkage). Patients with SD had a median progression-free survival (PFS) of 23.7 weeks, while all evaluable patients (n=51) had a median PFS of 11.9 weeks and median overall survival of 29.3 weeks. The most frequent drug-related adverse events observed in 52 patients were diarrhea (21 [40%] patients), hand-foot skin reaction (HFS; 19 [37%]), fatigue (14 [27%]), and nausea (13 [25%]). Frequent drug-related adverse events ≥ grade 3 included HFS (n=5 [10%]) and hypertension (n=2 [4%]). Three patients discontinued due to adverse events (HFS, elevated lipase, and myocardial infarction). There were nine deaths within 30 days of discontinuation of sorafenib (n=5 PD; n=2 cardiopulmonary arrest; n=1 hemoptysis; and n=1 unknown cause). The levels of five proteins measured by ELISA, either at screening or change over treatment duration, correlated significantly with time to progression (TTP) or maximum tumor shrinkage. Levels of five additional proteins, identified by mass-spectrometry, also correlated with TTP. CONCLUSIONS Identified biomarkers may help assess efficacy of sorafenib in NSCLC patients. Sorafenib 400 mg bid is generally well tolerated and shows promising efficacy in patients with advanced, progressive NSCLC, with approximately 60% of pts achieving disease stabilization. [Table: see text].
Biotransformations of Explosives

During the past century, explosives have been produced in lame quantities for both military and industrial purposes. Many explosives have been found to be highly resistant to biodegradation in the environment, and considerable areas of land have become contaminated with residues resulting from their manufacture, storage, use, and disposal. Such contamination is thought to affect at least 75,000 sites in the U.S. (Rosenblatt et al., 1991). An estimated 0.82 million cubic metres of soil at former ordinance sites and military proving grounds in the U.S. arecontaminated with TNT and its metabolites (USATHAMA, 1989). Increased awareness of environmental problems has resulted in a considerable volume of research into the fate of explosives in the environment and into means for the cost-effective removal of explosive residues from soil and water. The cleanup costs are enormous; estimated costs for incineration are $400 to $600/yd3 of soil (Griest etal. 1998). Bioremediation, and most particularly in situ bioremediation, could potentially offer a relatively low cost method for decontamination. This review summarizes recent developments in research concerning transformations of important secondary high explosives in living systems.
Phenotype and HFE genotype in a population with abnormal iron markers recruited from an Endocrinology Department.

OBJECTIVE The aim of this study was to describe HFE genotype in a population of patients with altered iron markers recruited in an Endocrinology Department and to define the possible phenotype-genotype relationships. METHODS A total of 156 patients with high serum ferritin concentrations (>300 ng/ml) or transferrin saturation (>45%) (I group), and a control group of 106 healthy subjects (C group) underwent HFE genotyping (classical C282Y and H63D mutations). We also examined the main genetic features of subgroups in I according to the presence (D) or the absence (ND) of diabetes. RESULTS (1) The genotypes were significantly different in the I and C groups (P<0.001), with an increased frequency of major 282Y allele in the I group (35% vs 7.5%), but not of minor 63D allele (17 vs 18.5%). (2) The genotype of D and ND groups also differed (P<0.0001), with a lower frequency of C282 heterozygosity (P<0.0001) in the D group, and a higher prevalence of H63D heterozygosity in the D vs ND groups (P<0.01). (3) The phenotypic comparison of D and ND groups also showed a higher mean body mass index, age, and serum ferritin concentration, as well as an increased proportion of males with increased liver enzymes in the D group. CONCLUSION This population harboring abnormal iron markers had a different HFE genotype and a higher 282Y allele frequency than the control population. This suggests that blood iron markers could be checked in etiological investigations of metabolic disturbances to identify patients who should undergo genotyping, since approximately 20% were diagnosed with C282Y homozygosity.
Clinical presentation and outcome of tuberculosis patients infected by M. africanum versus M. tuberculosis.

SETTING A tuberculosis (TB) case contact study in the Gambia. OBJECTIVE To test whether Mycobacterium africanum, which has lost around 68 kb compared with M. tuberculosis sensu stricto, causes less severe TB disease. DESIGN We genotyped mycobacterial isolates and compared clinical and radiological characteristics as well as outcome data of M. africanum-infected TB patients with those infected with M. tuberculosis. RESULTS Of 317 index cases, 301 had a mycobacterial isolate available, 290 of which had an interpretable spoligotype pattern. Of these, 110 isolates (38%) were M. africanum and 180 (62%) were M. tuberculosis. M. africanum cases had lower body mass indices (17 vs. 17.45 for M. tuberculosis-infected patients, P = 0.029) and their radiographic disease was more extensive (96% vs. 89% had at least moderately severe radiographic changes, P = 0.031). Outcome on treatment was similar (2.8% of human immunodeficiency virus [HIV] negative M. africanum patients died on treatment vs. 3.0% of M. tuberculosis patients, P = 0.95). CONCLUSION M. africanum causes sputum smear-positive tuberculosis disease that is at least as severe as that caused by M. tuberculosis sensu stricto. Further clinical comparisons may be helpful in smear-negative patients and HIV-TB co-infected patients, and to identify whether there is any difference in time to develop disease.