Miracle-dz/UniFAR-FTUs huggingface dataset:
Sevoflurane inside and outside the operating room

Background: Sevoflurane is often presented as a near-perfect anaesthetic. After 10 years in the operating room, new uses are emerging outside. Objective: To remind readers of the principal characteristics of sevoflurane, to affirm its usefulness for day-case anaesthesia and to consider the recent new uses. Methods: The discussion of the physical properties, pharmacokinetics, metabolism, mechanisms of action and clinical effects is based on classic, essential papers. Recent literature concerning emerging utilizations of sevoflurane was analysed. Results: Sevoflurane presents many benefits with minimum inconvenience. It allows rapid inhalation induction, maintenance and rapid recovery. It has little toxicity and its haemodynamic and respiratory depressive effects are moderate and well tolerated. It is already widely use for sedation for magnetic resonance imaging in children. Its use in paediatric or adult intensive care could improve the management of pain and sedation.
Novel flow‐cytometric analysis based on BCD5+ subpopulations for the evaluation of minimal residual disease in chronic lymphocytic leukaemia

Summary. We describe a new flow‐cytometric analysis using quadruple labelling with anti‐CD19, CD20, CD5, CD79b monoclonal antibodies and sequential gating. We determined a novel criteria defined by BCD5+CD79b–/low/total BCD5+ cells ratio (BCD5+R), and compared it with the previous definition of phenotypic remission, based on CD19+CD5+ coexpression, and with complementarity‐determining region 3 polymerase chain reaction (CDR3 PCR) and clonotypic PCR (cPCR). A series of 54 peripheral blood samples from 21 chronic lymphocytic leukaemia (CLL) patients in complete haematological remission and a series of 16 from normal volunteers were analysed. In normal controls, the BCD5+R was always < 0·2. The sensitivity of the BCD5+R was 1 × 10−4vs 5 × 10−2 for CDR3 PCR and 1 × 10−5 for cPCR. Among the 54 CLL samples, 35 had a BCD5+R < 0·2 and showed polyclonal CDR3 PCR, whereas the cPCR was positive in 12 out of 20 tested. In the remaining 19 samples, BCD5+R was > 0·2, CDR3 PCR was monoclonal in 16 out of 19 and cPCR positive in 14 out 14 tested, including one out of three samples with polyclonal CDR3 amplification. Even though cPCR remains the most sensitive method to evaluate MRD, this new, sensitive and specific flow cytometric parameter, the BCD5+R, is more suitable than CDR3 PCR for routine clinical MRD assessment in CLL.
Effect of Placement of a Supraglottic Airway Device vs Endotracheal Intubation on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest in Taipei, Taiwan

Key Points Question What is the effect of placement of a supraglottic airway device compared with endotracheal intubation among adults with out-of-hospital cardiac arrest? Findings In this cluster randomized clinical trial, a total of 968 patients who experienced out-of-hospital cardiac arrest were enrolled. There was no significant difference between the 2 groups, in which the proportion of sustained return of spontaneous circulations was 26.9% in the endotracheal intubation group and 25.8% in the supraglottic airway group. Meaning This clinical trial showed no difference in the rates of sustained return of spontaneous circulation in initial prehospital airway management with the placement of a supraglottic airway vs endotracheal intubation.
Randomized open trial for comparison of proton pump inhibitors in triple therapy for Helicobacter pylori infection in relation to CYP2C19 genotype

Abstract Background and aims : Genetic polymorphism of cytochrome P450 (CYP) 2C19 influences the efficacy of Helicobacter pylori eradication therapy with a proton pump inhibitor (PPI) and amoxicillin. However, in triple therapy (PPI plus amoxicillin and clarithromycin), little is known about the impact of CYP2C19 polymorphism, or the use of rabeprazole, which is not well metabolized by CYP2C19. The efficacy of three PPI (omeprazole, lansoprazole, and rabeprazole) in a 1‐week triple regimen were compared in relation to CYP2C19 polymorphism.
Effects of garlic oil on rat hepatic P4502E1 expression.

1. The effects of garlic oil (GO) on the expression of P4502E1, glutathione S-transferase (GST) and microsomal epoxide hydrolase (mEH) were assessed by metabolic activities, immunoblot and RNA blot analyses in the rat. 2. p-Nitrophenol (PNP) hydroxylase activity decreased in the hepatic microsomes isolated from rats treated with GO at 200 mg/kg b.w. by 10-30% as compared with control. Pyrazine-inducible P4502E1 expression was decreased by approximately 40% following concomitant treatment of animals with GO at the dose of 200 mg/kg from day 1 to 3 post-treatment, as evidenced by PNP hydroxylase activity. The rates of aniline hydroxylase and NDMA demethylase activities in GO-treated animals were consistent with those of PNP hydroxylase activity. Treatment of animals with 500 mg/kg GO resulted in suppression of P4502E1-mediated catalytic activities, as monitored by both PNP and aniline hydroxylase activities, whereas the effects at the dose of 1000 mg/kg were identical with those at 500 mg/kg b.w. 3. Immunoblot analyses of hepatic microsomes, using an anti-P4502E1 antibody, showed that GO minimally suppressed constitutive P4502E1 expression at 24, 48 and 72 h post-treatment at the daily doses from 200 to 1000 mg/kg b.w. , as compared with vehicle-treated animals. Time-dependent pyrazine induction of P4502E1, however, was substantially blocked by concomitant treatment of animals with 200 mg/kg GO to the levels of control. Treatment at the dose of 1000 mg/kg failed to further suppress P4502E1 levels. GO treatment caused no changes in the levels of P4502E1 mRNA, as assessed by slot blot analyses. 4. Cytosol produced from the GO-treated rat showed approximately 40% increases in GST conjugating activity toward 1-chloro-2,4-dinitrobenzene, whereas mEH protein levels were 1.5-2.0-fold greater than control with similar increases in the mRNA levels noted. 5. These results demonstrate that GO suppresses inducible P4502E1 expression more significantly than constitutive expression, and that GO induces GST and mEH expression to a certain extent.
Non‐invasive subcutaneous fat reduction: a review

The risks, financial costs and lengthy downtime associated with surgical procedures for fat reduction have led to the development of a number of non‐invasive techniques. Non‐invasive body contouring now represents the fastest growing area of aesthetic medicine. There are currently four leading non‐invasive techniques for reducing localized subcutaneous adipose tissue: low‐level laser therapy (LLLT), cryolipolysis, radio frequency (RF) and high‐intensity focused ultrasound (HIFU). To review and compare leading techniques and clinical outcomes of non‐invasive subcutaneous fat reduction. The terms ‘non‐invasive’, ‘low‐level laser’, ‘cryolipolysis’, ‘ultrasound’ and ‘radio frequency’ were combined with ‘lipolysis’, ‘fat reduction’ or ‘body contour’ during separate searches in the PubMed database. We identified 31 studies (27 prospective clinical studies and four retrospective chart reviews) with a total of 2937 patients that had been treated with LLLT (n = 1114), cryolipolysis (n = 706), HIFU (n = 843) or RF (n = 116) or other techniques (n = 158) for fat reduction or body contouring. A majority of these patients experienced significant and satisfying results without any serious adverse effects. The studies investigating these devices have all varied in treatment regimen, body locations, follow‐up times or outcome operationalization. Each technique differs in offered advantages and severity of adverse effects. However, multiple non‐invasive devices are safe and effective for circumferential reduction in local fat tissue by 2 cm or more across the abdomen, hips and thighs. Results are consistent and reproducible for each device and none are associated with any serious or permanent adverse effects.
Prediction of thrombolytic efficacy in acute ischemic stroke using thin-section noncontrast CT

Thin-section noncontrast CT (NCT) can detect thrombi in large arteries and can provide a measure of thrombus composition based on Hounsfield Units (HU). A study using polyethylene tubes as a model of intracranial arteries concluded that the HUs of platelet-rich thrombi are lower than those of erythrocyte-rich thrombi. Thrombus HUs were measured by NCT in 34 patients with acute ischemic stroke before thrombolysis. Thrombi with lower HU counts were resistant to thrombolytics.
Who should assess medical students' communication skills: their academic teachers or their patients?

The objective of this study was to compare the assessment of medical students communication skills made by their academic teachers, with the assessment made by their role‐playing `patients'. It was a cross‐sectional study, conducted at the Department of General Practice, University of Sydney, Australia, and consisted of 519 undergraduate medical students. Teachers rated students' communication skills using ten specific criteria, each marked on a five‐point Likert scale. Teachers then rated students' overall performance using a 10‐point scale. Patients rated students' overall performance on the same 10‐point Likert scale. Only two of the 10 criteria, as rated by the academic teachers, correlated with the role‐playing patients' overall score, and all 10 criteria accounted for only 10·1% of the variance in that score. The academic assessors' overall score accounted for only 9·7% of the variance of the patients' overall score. The communications skills emphasized by academic teachers do not reflect the skills considered to be important by role‐playing patients.
The epidemiology of severe sepsis syndrome and its treatment with recombinant human activated protein C

Severe sepsis syndrome has important consequences to healthcare systems as the incidence is increasing, there is significant attributed morbidity and mortality and there is a substantial cost for in-hospital and post-discharge care. Current treatment includes the use of antimicrobials, local source control and aggressive physiological support, usually in an intensive care unit setting. Drotrecogin-alpha (activated) or recombinant human activated protein C (rhAPC) is the only biological agent approved for use in severe sepsis syndrome that has demonstrated efficacy in reducing 28-day all-cause mortality and new data suggests a trend towards longer term survival. However, given the evidence of a variable effect on survival rates in patient subgroups and its acquisition cost, controversy has arisen concerning its appropriate use. This review discusses the epidemiology of sepsis, preclinical and clinical evidence supporting the use of rhAPC use, controversies about the evidence of efficacy in severe sepsis syndrome and cost-effectiveness data.
Keeping the body in mind: Insula functional organization and functional connectivity integrate interoceptive, exteroceptive, and emotional awareness

Relatively discrete experimental literatures have grown to support the insula's role in the domains of interoception, focal exteroceptive attention and cognitive control, and the experience of anxiety, even as theoretical accounts have asserted that the insula is a critical zone for integrating across these domains. Here we provide the first experimental demonstration that there exists a functional topography across the insula, with distinct regions in the same participants responding in a highly selective fashion for interoceptive, exteroceptive, and affective processing. Although each insular region is associated with areas of differential resting state functional connectivity relative to the other regions, overall their functional connectivity profiles are quite similar, thereby providing a map of how interoceptive, exteroceptive, and emotional awareness are integrated within the insular cortex. Hum Brain Mapp 34:2944–2958, 2013. © 2012 Wiley Periodicals, Inc.
Factors influencing compliance with continuous positive airway pressure ventilation in obstructive sleep apnea syndrome.

INTRODUCTION Positive pressure ventilation is considered first line therapy in obstructive sleep apnea syndrome however compliance is limited by various factors. We aimed to investigate possible factors influencing compliance. MATERIALS AND METHODS One hundred and forty patients were prescribed positive pressure ventilation for obstructive sleep apnea during June 2006-June 2008. Of these patients, 77% (n= 108) were reached by telephone and a questionnaire was administered regarding factors influencing treatment compliance. Airway passage was measured with C2 vertebrae level and narrowest airway passage on lateral skull radiographs. RESULTS The mean age was 52.2 ± 12.3 years. Seventy one percent (n= 77) of subjects obtained the prescribed device. There was no difference in sex, age, marital status, educational level, symptoms, co-morbid conditions, and social security coverage between the subjects who have received the prescribed devices and who have not (p> 0.05). No difference was detected between these two groups of patients in view of Epworth sleepiness scale (ESS) and apnea hypopnea index (AHI). Mean duration of device usage was 6.3 ± 2.3 hours. The device use compliance was not affected by any of the following factors: age, gender, level of education, co-morbid diseases, ESS score, AHI, airway passage measurements, application of humidification and education concerning the device (p> 0.05). Patient (p= 0.057) and bed partners (p= 0.001) satisfaction about the device yielded higher compliance rates. CONCLUSION Factors influencing compliance rates in obstructive sleep apnea syndrome seems to be related to satisfaction about the device use however upper airway morphology measured with C2 vertebrae level and narrowest airway passage has no impact on treatment compliance.
Effect of domestic violence on pregnancy outcome.

OBJECTIVE To determine the causes and type of domestic violence endured by pregnant women and their effect on pregnancy, in terms of maternal and neonatal outcome. STUDY DESIGN Cohort study. PLACE AND DURATION OF STUDY The study was conducted in Sir Syed Trust Hospital, Karachi, from March 2007 to February 2008. METHODOLOGY All the antenatal patients were screened for domestic violence, using a self-made questionnaire and abuse assessment screen. All the pregnant patients, who had language barrier or those who declined to be interviewed were excluded. All the pregnant patients with positive response, according to the abuse assessment screen were included in the group A, while every 4th patient with negative response was taken as control. SPSS 10 was used for statistical analysis. Logistic regression analysis was performed to determine the effect of domestic violence on delivery outcome. Relative risk was also calculated. Statistical significance was taken at p (2) 0.05. RESULTS Four hundred and ten (n=410) antenatal patients were interviewed. The factors associated with domestic violence included addiction in 32 (39%), allegedly aggressive nature of husband in 21 (25.6%) and unemployment of husband in 6 (7.31%) cases (p=0.001). Fifty two per cent women had been victims to more than one form of violence. Antenatal complications were not observed in a statistically significant number in either group. Depression was identified in 25.60% of group A and in 3.65% of group B (p=0.001; RR=2.01; 95%CI=1.58-2.56). CONCLUSION Various factors leading to domestic violence were identified among the husbands of women subjected to violence during pregnancy. The differences between the two groups, with regard to neonatal outcome (except depression), did not reach statistical significance. However, depression was significantly higher in the women enduring violence.
Transcranial direct current stimulation (tDCS) and robotic practice in chronic stroke: the dimension of timing.

BACKGROUND Combining tDCS with robotic therapy is a new and promising form of neurorehabilitation after stroke, however the effectiveness of this approach is likely to be influenced by the relative timing of the brain stimulation and the therapy. OBJECTIVE To measure the kinematic and neurophysiological effects of delivering tDCS before, during and after a single session of robotic motor practice (wrist extension). METHODS We used a within-subjects repeated-measurement design in 12 chronic (>6 months) stroke survivors. Twenty minutes of anodal tDCS was delivered to the affected hemisphere before, during, or after a 20-minute session of robotic practice. Sham tDCS was also applied during motor practice. Robotic motor performance and corticomotor excitability, assessed through transcranial magnetic stimulation (TMS), were evaluated pre- and post-intervention. RESULTS Movement speed was increased after motor training (sham tDCS) by ∼20%. Movement smoothness was improved when tDCS was delivered before motor practice (∼15%). TDCS delivered during practice did not offer any benefit, whereas it reduced speed when delivered after practice (∼10%). MEPs were present in ∼50% of patients at baseline; in these subjects motor practice increased corticomotor excitability to the trained muscle. CONCLUSIONS In a cohort of stroke survivors, motor performance kinematics improved when tDCS was delivered prior to robotic training, but not when delivered during or after training. The temporal relationship between non-invasive brain stimulation and neurorehabilitation is important in determining the efficacy and outcome of this combined therapy.
Abnormalities of fuel utilization as predisposing to the development of obesity in humans.

A number of recent investigations in man have demonstrated that a low ratio of fat to carbohydrate oxidation (i.e., a high respiratory quotient or RQ) was associated with actual and/or subsequent body weight gain in obese non-diabetic Pima Indians, in American men of various ages and in post-obese European women investigated shortly after the cessation of a hypocaloric diet. It is well known that numerous exogenous and endogenous factors influence the RQ at rest such as: the level of feeding (positive vs. negative energy balance), the composition of food eaten (high vs. low carbohydrate), the size of the glycogen stores, the amount of adipose tissue as well as genetic factors. It should be stressed that some nutritional situations can co-exist during which a low ratio of fat to carbohydrate is observed (i.e., a high RQ) despite weight loss. Furthermore, in most studies mentioned above, the low fat to carbohydrate oxidation ratio explains less than 10% of the variance in weight gain, suggesting that numerous additional factors also play a substantial role in the onset of weight gain. It is concluded that: 1) a low fat to carbohydrate oxidation ratio or an abnormal fat oxidation is difficult to define quantitatively since it is largely influenced by the energy level and the composition of the diet. (ABSTRACT TRUNCATED AT 250 WORDS)
Mechanical dissociation of bronchi from parenchyma in the immature piglet lung.

Previous studies of isolated piglet lungs suggested that local distending forces around bronchi might be relatively weak before postnatal growth and maturation. The present study used tantalum bronchograms to compare pressure-diameter relationships of bronchi in situ and after excision from the parenchyma in immature (3- to 7-day-old) and mature (3-mo-old) piglets. The mature group reproduced behavior that is well established in mature lungs from other species; i.e., bronchial diameters maintained a constant relationship to the parenchyma as the lungs were deflated from maximum to minimum volume. In sharp contrast, diameters failed to change until the immature lungs were deflated to <5 cmH(2)O transpulmonary pressure. Total percent change in bronchial diameter was then only 24% in the immature lungs compared with 47% in the mature lungs (P < 0.002). Total elastances of mature generation 3-8 bronchi did not change when they were excised from the parenchyma. However, in the same generations of immature bronchi, total elastances were lower after than before (1.06 vs. 1.60 cmH(2)O/%, P < 0.05) excision from the parenchyma. Elastances of the excised immature and mature bronchi were then the same (1.06 vs. 1.03 cmH(2)O/%, not significant). Because elastic moduli of the lung parenchyma are also similar in the two age groups, it was concluded that local features of airway-parenchyma coupling limited the generation of local parenchymal recoil around bronchi in the immature lungs.
The Regression Effect as a Neglected Source of Bias in Nonrandomized Intervention Trials and Systematic Reviews of Observational Studies

Health care providers depend on the findings of observational intervention studies and systematic reviews of those studies to make evidence-based decisions about their clients' care. The nonrandom methods of group formation in observational studies necessitate carefully assessing threats to the validity of conclusions. Regression to the mean is a source of change in clinical outcome measures that has escaped widespread notice as a potential threat to the accuracy of conclusions from observational studies and systematic reviews thereof. Failure to assess the degree to which regression confounds study results elevates the risk of making clinical decisions using biased estimates of intervention effectiveness. Because the change in average outcome scores due to regression can be quantified, it is a type of bias whose direct influence can be known. Yet determining and reporting change due to regression is uncommon in observational studies or systematic reviews thereof. The means to quantify change due to regression in average outcome scores is illustrated by example in this article.
Tensile Strength of Mineralized/Demineralized Human Normal and Carious Dentin

The bond strengths of resins to caries-affected dentin are low. This could be due to weakened organic matrix. The purpose of this work was to determine if the ultimate tensile strength (UTS) of excavated carious dentin is weaker than that of normal dentin. Soft caries was excavated from extracted human molars, and the tooth was vertically sectioned into slabs. Each slab was trimmed to an hourglass shape, parallel or perpendicular to the tubule direction. Half of the specimens were mineralized, while the other half were completely demineralized in EDTA. ANOVA on ranks showed that the three-factor interactions (mineralization, caries, tubule direction) were all significant (p < 0.0001), indicating that mineralization and tubule direction gave different UTS results in normal and caries-affected dentin. No significant differences were seen between the UTS of normal and and that of caries-affected demineralized dentin in the parallel or perpendicular group. The matrix of demineralized caries-affected dentin was as strong as that of normal demineralized dentin when tested in the same direction.
Determination of Steroidal Saponins and Fixed Oil Content in Fenugreek (Trigonella foenum-graecum) Genotypes

Trigonella foenum-graecum, commonly called fenugreek, is a leguminous plant native to many Asian, Middle Eastern and European countries. Fenugreek oil is very effective in digestion. Identification of fenugreek genotype rich in saponins and fixed oil will be useful for pharmaceutical industries. In the present study, steroidal saponin and fixed oil content was analysed in 46 diverse fenugreek genotypes on dry weight basis. Significant differences were observed in the total saponin and fixed oil content among the genotypes. Saponin and fixed oil content ranged from 0.92 g to 1.68 g and 3.25 to 6.88 g with corresponding mean value of 1.34 g and 5.19 g/100 g dw, respectively.