Miracle-dz/UniFAR-FTUs huggingface dataset:
Redo aortic valve surgery versus transcatheter valve-in-valve implantation for failing surgical bioprosthetic valves: consecutive patients in a single-center setting.

BACKGROUND Due to a considerable rise in bioprosthetic as opposed to mechanical valve implantations, an increase of patients presenting with failing bioprosthetic surgical valves in need of a reoperation is to be expected. Redo surgery may pose a high-risk procedure. Transcatheter aortic valve-in-valve implantation is an innovative, less-invasive treatment alternative for these patients. However, a comprehensive evaluation of the outcome of consecutive patients after a valve-in-valve TAVI [transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV)] as compared to a standard reoperation [surgical aortic valve redo-operation (SAV-in-SAV)] has not yet been performed. The goal of this study was to compare postoperative outcomes after TAV-in-SAV and SAV-in-SAV in a single center setting. METHODS All SAV-in-SAV and TAV-in-SAV patients from January 2001 to October 2014 were retrospectively reviewed. Patients with previous mechanical or transcatheter valves, active endocarditis and concomitant cardiac procedures were excluded. Patient characteristics, preoperative data, post-procedural complications, and 30-day mortality were collected from a designated database. Mean values ± SD were calculated for all continuous variables. Counts and percentages were calculated for categorical variables. The Chi-square and Fisher exact tests were used to compare categorical variables. Continuous variables were compared using the t-test for independent samples. A 2-sided P value <0.05 was considered statistically significant. RESULTS A total of 102 patients fulfilled the inclusion criteria, 50 patients (49%) underwent a transcatheter valve-in-valve procedure, while 52 patients (51%) underwent redo-surgery. Patients in the TAV-in-SAV group were significantly older, had a higher mean logistic EuroSCORE and exhibited a lower mean left ventricular ejection fraction than patients in the SAV-in-SAV group (78.1±6.7 vs. 66.2±13.1, P<0.001; 27.4±18.7 vs. 14.4±10, P<0.001; and 49.8±13.1 vs. 56.7±15.8, P=0.019 respectively). Postoperative pacemaker implantation and chest tube output were higher in the SAV-in-SAV group compared to the TAV-in-SAV group [11 (21%) vs. 3 (6%), P=0.042 and 0.9±1.0 vs. 0.6±0.9, P=0.047, respectively]. There was no significant difference in myocardial infarction, stroke or dialysis postoperatively. Thirty-day mortality was not significantly different between the two groups [TAV-in-SAV2 (4%) vs. SAV-in-SAV0, P=0.238]. Kaplan-Meier (KM) 1-year survival was significantly lower in the TAV-in-SAV group than in the SAV-in-SAV group (83% vs. 96%, P<0.001). CONCLUSIONS The present investigation shows that both groups, irrespective of different baseline comorbidities, show very good early clinical outcomes. While redo surgery is still the standard of care, a subgroup of patients may profit from the transcatheter valve-in-valve procedure.
Shutdown Decision of Firms Based on Variable Costs and Demand

The forest products industry in Alabama, the second largest manufacturing sector of the state, has been experiencing a recession in production, number of establishments and employees since the mid-1990s. This study investigates the determinants of this decline in the industry, using a county-level panel dataset that spans the period between 1996 and 2012. Four sub-sectors were analyzed separately, including the logging, wood, paper, and furniture manufacturing sectors. Results suggest that increases in average variable cost, rather than decreases in demand, were more strongly associated with the recession as measured by the number of operating establishments. Decomposition analysis indicates that the cost of materials, rather than labor, contributes more to the decline in the number of forest sector establishments in the state. This could be because increases in labor costs, such as wage increases, are accompanied by increases in labor productivity.
Brain structures involved in interoceptive awareness and cardioafferent signal processing: A dipole source localization study

Afferent signals from the body play an important role for emotional and motivational aspects of behavior. Nevertheless, little is known about the cortical and subcortical structures involved in interoceptive processes. Recently, a functional MRI study demonstrated that insula, somatomotor, and cingulated cortices are activated when subjects focus attention on their heartbeats. Aside from the use of imaging data, cardiac awareness has frequently been studied by using the heartbeat‐evoked potential (HEP), a brain wave that appears contingent on the heartbeat. The present study aimed at localizing sources of the HEP. Multichannel EEG was recorded in 44 subjects while they performed a heartbeat perception task. This task was used to quantify interoceptive awareness and to subdivide the subjects into good and poor heartbeat perceivers. Analyses showed highest HEP amplitudes over frontal and frontocentral electrode locations in the time range of later than 200 ms after R‐wave onset. By means of a BESA dipole‐source‐analysis, four sources of the HEP were identified which were located in the anterior cingulate, the right insula, the prefrontal cortex, and the left secondary somatosensory cortex. Good heartbeat perceivers showed both significantly higher HEP amplitudes and higher dipole strength than poor heartbeat perceivers in all four cortical sources. We conclude that the identified structures are involved in the processing of cardiac signals, whereby anterior cingulate and right insula seem to serve as interoceptive centers for cardioception. Hum Brain Mapping, 2005. © 2005 Wiley‐Liss, Inc.
The Deubiquitinase A20 Mediates Feedback Inhibition of Interleukin-17 Receptor Signaling

Inhibition of an inflammatory cytokine signaling pathway by A20 at the receptor may play a role in preventing autoimmunity. A20 Targets a Cytokine Receptor to Limit Inflammation The cytokine interleukin-17 (IL-17) mediates immunity against various microorganisms; however, it also causes inflammatory tissue damage in autoimmune disorders, such as rheumatoid arthritis (RA). Garg et al. found that IL-17 stimulated the production of the deubiquitinase A20, an inhibitor of nuclear factor κB (NF-κB) activation downstream of the tumor necrosis factor receptor and Toll-like receptors. Mutations in the gene encoding A20 are associated with RA in some patients. Knockdown of A20 in human fibroblast-like synoviocytes resulted in enhanced IL-17–dependent production of the inflammatory cytokine IL-6. IL-17 stimulated an association between A20, the IL-17R, and the E3 ubiquitin ligase TRAF6 (tumor necrosis factor receptor–associated factor 6) to inhibit IL-17–dependent signaling. In addition to demonstrating the direct recruitment of A20 to a cytokine receptor, these results may partly explain the association of mutations in A20 with susceptibility to RA. The proinflammatory cytokine interleukin-17 (IL-17) is the signature cytokine of the T helper 17 (TH17) subset of CD4+ T cells, and antibodies targeting IL-17 or the IL-17 receptor (IL-17R) show clinical efficacy in several autoimmune diseases. Although important for protective immunity against microorganisms, IL-17 causes collateral damage in inflammatory settings. TNFAIP3 encodes the deubiquitinase A20 and is genetically linked to numerous autoimmune syndromes. A20, a potent inhibitor of tumor necrosis factor–α signaling, removes ubiquitin from signaling intermediates upstream of nuclear factor κB (NF-κB), thereby dampening NF-κB–mediated inflammation. We demonstrated that IL-17 stimulates TNFAIP3 expression. Enhanced IL-17–mediated induction of genes encoding proinflammatory factors, including IL-6 and various chemokines, occurred upon knockdown of A20 with short inhibitory RNA or in A20−/− cells. A20 associated with the E3 ubiquitin ligase TRAF6 (tumor necrosis factor receptor–associated factor 6) in an IL-17–dependent manner and restricted the IL-17–dependent activation of NF-κB and mitogen-activated protein kinases. A20 interacted directly with the distal domain of IL-17RA, a previously defined inhibitory domain. Together, these data describe a mechanism of restraining IL-17 signaling and reveal an aspect of A20 activity that may help to explain its role in autoimmunity in humans.
Interacting at a Distance: Creating Engagement in Online Learning Environments

Effective online instruction requires understanding not only interaction but also how to facilitate interaction through technology (Moore & Kearsley, 2012). Specifically, Moore and Kearsley (2012) categorize these types of interactions as “learner with content, interaction with instruction [or] interaction with other learners” (p. 132). This chapter examines each of these interaction types and suggests ways to incorporate them into online learning environments (OLEs). The chapter provides techniques and approaches that will be beneficial to both instructional design practitioners and online instructors. It seeks to assuage some of the concerns that faculty have about OLEs and provides ideas and activities that can be implemented by course designers or instructors in OLE projects.
Identifying Irrationality and Fear-Driven Reactions to Financial Market Shocks & Terrorism

Economic research on post 9-11 terrorism lacks a distinction between fear-based reactions and rational financial market behavior in its analysis surrounding terror strikes. The purpose of this paper is to expose and interpret the fear triggered by terrorism in financial markets, and to separate rational market responses from irrational, fear-driven investor reactions. A rational market response follows the efficient market theory (Wang 1993) in which investors alter their behavior based on changes in fundamental values. Becker and Rubinstein (2011) define terrortriggered fear as the magnitude with which subjective beliefs about danger hinder objective risk assessment. I apply this definition to the De Long et al (1990) discussion of noise trading to define irrational investor reactions as a response to subjective beliefs about danger and disregard for fundamental risk that causes volatility and a divergence from fundamental valuations. I observe the Volatility Index (VIX) and change in 10-year Treasury yield surrounding terror events to identify irrationality, and differentiate from rational market behavior through a comparison to the two gauges surrounding foreign and domestic central bank action. I analyze market behavior surrounding 9-11 and recent 2013 and 2015 terror events and find consistently heightened post-event volatility. I observe responses in the 10-year Treasury yield, and find that response duration is dependent on the implications for Federal Reserve policy and expectations of demand for safe-haven assets (Krishnamurthy & Vissing-Jorgensen 2012). I also find a decrease in magnitude of financial market response from 2001 to 2015, which could be due to prior experience with terrorism (Becker & Rubinstein 2011) or the Federal Reserve’s recent consideration of global instability in domestic monetary policy.
[The promise of statins].

Statins, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, are a class of drugs with a potent lipid-lowering effect that have been shown to reduce LDL cholesterol by 35-45% at therapeutic doses. Recent trials have demonstrated that in subjects with coronary artery disease, an aggressive treatment with high doses of statins, which lowers LDL cholesterol below 100 mg/dl, can obtain better results in terms of reduction of cardiovascular events, compared to the currently used dosage of statins. The pharmacologic effect of statins is far beyond the mere reduction of LDL cholesterol, in that it has been demonstrated that they are able to inhibit the proliferation of smooth muscle cells and macrophages, to restore the endothelial activity, and to inhibit the inflammatory response of macrophages. These effects have been called "pleiotropic effects" of statins. These metabolic activities of statins play an important role in contrasting the inflammatory elements of the atherosclerotic plaque. The atherosclerotic plaque is formed by a lipid core and a fibrous cap. Smooth muscle cells, macrophages and T lymphocytes are present in the plaque, particularly in the fibrous cap. In stable plaques, smooth muscle cells produce extracellular matrix, i.e. collagen and elastin, which strengthens the fibrous cap. In the presence of inflammatory stimuli, primarily oxidized LDL, T lymphocytes activate macrophage and smooth muscle cells to secrete cytokines and proteolytic enzymes, the collagenolytic metalloproteases, that can weaken the extracellular matrix and rupture the fibrous cap. A local thrombotic mechanism starts in the ruptured plaque, promoted by the tissue factor released by macrophages in the lipid core of the plaque, which can propagate to the coronary lumen with total occlusion. Statins have been demonstrated to contrast the inflammatory activity of macrophages and smooth muscle cells, inducing smooth muscle cells to secrete extracellular matrix which strengthens the fibrous cap and prevents rupture. At present, the primary target of statins is LDL cholesterol reduction, but with additional effects on the inflammatory cell of the plaque with a reduction in macrophages and secretion of collagenolytic metalloproteases and reinforcing the fibrous skeleton of the plaque by increasing the content of interstitial collagen.
Execution of Activities of Daily Living in Persons with Parkinson Disease.

INTRODUCTION Muscular weakness and the motor difficulties associated with Parkinson disease (PD) often impair the performance of activities of daily living (ADL). However, little is known about the magnitude and distribution of relative muscular effort of persons with PD during ADL. The purpose of this investigation was to determine the relative magnitude of lower extremity moment production that persons with PD use to perform common ADL. METHODS Fifteen participants with mild-to-moderate PD and 14 age/sex-matched controls volunteered. Participants performed a series of ADL tasks, as follows: gait initiation (GI), gait, and stair ascending tasks. Participants were then asked to perform maximal-effort isokinetic tests of hip and knee extension and ankle plantarflexion at speeds of 90° per second and 120° per second. Relative effort was quantified as a percentage of the maximal isokinetic value produced by a joint during performance of the ADL. Relative effort and peak isokinetic joint moments were analyzed using a mixed-model ANOVA with repeated measures. All other comparisons were evaluated using independent t-tests. RESULTS Persons with PD produced smaller ankle plantarflexion moment at both 90° per second and 120° per second (P < 0.05). Relative effort during GI (271% vs 189%, P < 0.05) and gait (270% vs 161%, P < 0.05) was significantly greater at the ankle in persons with PD. Contribution of the ankle to the support moment was lower in PD during stair ascending (24% vs 34%) and GI (63% vs 57%) compared with that in controls. CONCLUSIONS The reduced ankle moments during ADL are indicative of deficits in muscular capabilities in those with PD. Moreover, PD caused a redistribution of joint torques, such that PD participants used their hip extensors more and ankle plantarflexors less.
Spatiotemporal activation of caspase‐dependent and ‐independent pathways in staurosporine‐induced apoptosis of p53wt and p53mt human cervical carcinoma cells

Background information. Caspase‐dependent and ‐independent death mechanisms are involved in apoptosis in a variety of human carcinoma cells treated with antineoplastic compounds. Our laboratory has reported that p53 is a key contributor of mitochondrial apoptosis in cervical carcinoma cells after staurosporine exposure. However, higher mitochondrial membrane potential dissipation and greater DNA fragmentation were observed in p53wt (wild‐type p53) HeLa cells compared with p53mt (mutated p53) C‐33A cells. Here, we have studied events linked to the mitochondrial apoptotic pathway.
Congenital toxoplasmosis in the United Kingdom: to screen or not to screen?

The United Kingdom National Screening Committee recently reviewed the evidence for prenatal and neonatal screening for toxoplasma infection1 and concluded that there was insufficient evidence to recommend screening in the United Kingdom. This issue will need to be revisited as new information or treatments become available. In this paper, the extent to which the research evidence on toxoplasma infection meets the criteria that need to be fulfilled for the introduction of screening in the United Kingdom is reviewed.
Attenuation of working memory and spatial acquisition deficits after a delayed and chronic bromocriptine treatment regimen in rats subjected to traumatic brain injury by controlled cortical impact.

Cognitive impairments are pervasive and persistent sequelae of human traumatic brain injury (TBI). In vivo models of TBI, such as the controlled cortical impact (CCI) and fluid percussion (FP), are utilized extensively to produce deficits reminiscent of those seen clinically with the hope that empirical study will lead to viable therapeutic interventions. Both CCI and FP produce spatial learning acquisition deficits, but only the latter has been reported to impair working memory in rats tested in the Morris water maze (MWM). We hypothesized that a CCI injury would impair working memory similarly to that produced by FP, and that delayed and chronic treatment with the D2 receptor agonist bromocriptine would attenuate both working memory and spatial learning acquisition deficits. To test these hypotheses, isoflurane-anesthetized adult male rats received either a CCI (2.7 mm deformation, 4 m/sec) or sham injury, and 24 h later were administered bromocriptine (5 mg/kg, i.p.) or vehicle, with continued daily injections until all behavioral assessments were completed. Motor function was assessed on beam balance and beam walking tasks on postoperative days 1-5 and cognitive function was evaluated in the MWM on days 11-15 for working memory (experiment 1) and on days 14-18 for spatial learning acquisition (experiment 2). Histological examination (hippocampal CA1 and CA3 cell loss/survival and cortical lesion volume) was conducted 4 weeks after surgery. All injured groups exhibited initial impairments in motor function, working memory, and spatial learning acquisition. Bromocriptine did not affect motor function, but did ameliorate working memory and significantly attenuated spatial acquisition deficits relative to the injured vehicle-treated controls. Additionally, the injured bromocriptine-treated group exhibited significantly more morphologically intact CA3 neurons than the injured vehicle-treated group (55.60 +/- 3.10% vs. 38.34 +/- 7.78% [p = 0.03]). No significant differences were observed among TBI groups in CA1 cell survival (bromocriptine, 40.26 +/- 4.74% vs. vehicle, 29.13 +/- 6.63% [p = 0.14]) or cortical lesion volume (bromocriptine, 17.78 +/- 0.62 mm3 vs. vehicle, 19.01 +/- 1.49 mm3 [p > 0.05]). These data reveal that CCI produces working memory deficits in rats that are similar to those observed following FP, and that the delayed and chronic bromocriptine treatment regimen conferred cognitive and neural protection after TBI.
18F-FDG PET/CT of thymic epithelial tumors: usefulness for distinguishing and staging tumor subgroups.

UNLABELLED The purpose of our study was to assess the usefulness of integrated PET/CT using 18F-FDG for distinguishing thymic epithelial tumors according to the World Health Organization (WHO) classification. METHODS Thirty-three patients (age range, 34-68 y; mean age, 54.6 y) with thymic epithelial tumors, who underwent both integrated PET/CT and enhanced CT, were included. The clinicopathologic stages, maximum standardized uptake values (SUVs), and uptake patterns of tumors on integrated PET/CT images, and various enhanced CT findings, are described according to the simplified (low-risk [types A, AB, and B1] and high-risk [types B2 and B3] thymomas and thymic carcinomas) subgroups of the WHO classification. Discriminant analysis was performed to determine the relative capabilities of integrated PET/CT and enhanced CT findings to differentiate tumor subgroups. RESULTS Tumors included 8 low-risk thymomas, 9 high-risk thymomas, and 16 thymic carcinomas. The maximum SUVs of high-risk thymomas (P < 0.001) and low-risk thymomas (P < 0.001) were found to be significantly lower than those of thymic carcinomas. Homogeneous 18F-FDG uptake within tumors was more frequently seen in thymic carcinomas than in high-risk thymomas (P = 0.027) or low-risk thymomas (P = 0.001). The uptake pattern (homogeneous vs. heterogeneous) on integrated PET/CT images and the presence of mediastinal fat invasion on enhanced CT images were found to be useful for differentiating tumor subgroups. In addition, integrated PET/CT helped detect lymph node metastases, which were not identified on enhanced CT in 2 patients. CONCLUSION Integrated PET/CT was found to be useful for differentiating subgroups of thymic epithelial tumors and for staging the extent of the disease.
Effects of female genital cutting on the sexual function of Egyptian women. A cross-sectional study.

INTRODUCTION The existing literature is conflicting regarding effects of female genital cutting (FGC) on sexual functions. Several studies from Africa over the past 20 years have challenged the negative effect of genital cutting on sexual function as defined by performance on the following domains: desire, arousal, lubrication, orgasm, satisfaction, and sexual pain. Other studies however indicated that sexual function of genitally cut women is adversely altered. AIM The aim of the study was to investigate the effects of FGC on the female sexual function of Egyptian women. METHODS This is a cross-sectional study conducted between February and May 2011 at the outpatient clinic of Cairo University Hospitals. The study included 650 Egyptian females between 16 and 55 years of age (333 genitally cut women and 317 uncut women). Participants were requested to complete the Arabic Female Sexual Function Index (ArFSFI) and were then subjected to clinical examination where the cutting status was confirmed. MAIN OUTCOME MEASURES The total score of the ArFSFI and its individual domains. RESULTS The mean age of cutting was 8.59 (±1.07) years. Of the cut participants, 84.98% showed signs of type I genital cutting, while 15.02% showed signs of type II genital cutting. After adjusting for age, residential area, and education level, uncut participants had significantly higher ArFSFI total score (23.99±2.21) compared with cut participants (26.81±2.26). The desire, arousal, lubrication, orgasm, and satisfaction domains were significantly higher in the uncut participants (4.02±0.78, 4.86±0.72, 4.86±0.75, 4.86±0.68, 5.04±0.71, respectively) compared with those of the cut participants (3.37±0.89, 4.13±0.71, 4.16±0.84, 4.50±0.79, 4.69±0.92, respectively). No significant difference between the two groups was found regarding the sexual pain domain. CONCLUSION In Egyptian women, FGC is associated with reduced scores of ArFSFI on all domain scores except the sexual pain domain.