Miracle-dz/UniFAR-FTUs huggingface dataset:
Dexmedetomidine and propofol for cerebral angiography in non-intubated patients: A comparative study

Abstract Context: Patients posted for cerebral angiography may be restless and drowsy with high chance of inadvertent movements. Aims: The primary objective was to compare the incidence of inadvertent movements between propofol and dexmedetomidine groups. The secondary objectives include comparison of recovery time and characteristics, Steward’s score, and haemodynamic and respiratory parameters between the two groups. Settings and Design: Prospective, randomised, double-blind, pilot study. Materials and Methods: In all, 20 adult uncooperative, drowsy patients were randomised to dexmedetomidine (1 μg/kg bolus over 10 minutes followed by 0.3-0.7 μg/kg/hour infusion) or propofol (100 μg/kg/min for 10 minutes followed by 25-75 μg/kg/min infusion). Rate of movement, success of sedation, haemodynamics, respiratory parameters, Steward’s recovery score and recovery time were recorded. Statistical analysis used: Repeated measures of analysis of variance, Mann-Whitney test, independent and paired t-tests, and Fisher test. Results: The median rate of movement was similar (1, P = 0.206) with success of sedation achieved in 7 (70%) patients in Group D and 9 (90%) patients in Group P, which was comparable (P = 0.582). The median recovery time in patients in Group D was 150 (37–764) seconds and in Group P was 128 (54–174) seconds (P = 0.519) with similar Steward’s scores (P = 0.363). Haemodynamics and respiratory variables were well-maintained during loading and maintenance dose infusions in both the groups. Conclusions: Dexmedetomidine is a safe alternative for diagnostic cerebral angiography. Its success of sedation, median rate of movement during the imaging procedure, haemodynamics, respiratory parameters, recovery time and Steward’s recovery score were similar to propofol in our study.
Neural Crest–Derived Pericytes Promote Egress of Mature Thymocytes at the Corticomedullary Junction

Thymocyte Egress A critical step during the development of the immune system is the egress of developing T lymphocytes, or thymocytes, from the thymus to peripheral organs, where they can defend against infectious microorganisms. Egress requires detection of the lipid mediator, sphingosine-1-phosphate (S1P), by thymocytes, but whether S1P detection is sufficient for egress, the source of S1P and the location where T lymphocytes exit the thymus are unknown. Zachariah and Cyster (p. 1129, published online 22 April) found that selective expression of a transgene for the S1P receptor-1 in mouse thymocytes was sufficient for thymocyte egress. Thymocyte egress occurred at corticomedullary junctions via blood vessels, rather than via lymphatics. Pericytes, neural crest-derived cells, which ensheath blood vessels, provided the S1P for exiting thymocytes. Cells that ensheath blood vessels promote exit of the developing T lymphocytes from the thymus. T cell egress from the thymus is essential for adaptive immunity, yet the requirements for and sites of egress are incompletely understood. We have shown that transgenic expression of sphingosine-1-phosphate receptor-1 (S1P1) in immature thymocytes leads to their perivascular accumulation and premature release into circulation. Using an intravascular procedure to label emigrating cells, we found that mature thymocytes exit via blood vessels at the corticomedullary junction. By deleting sphingosine kinases in neural crest–derived pericytes, we provide evidence that these specialized vessel-ensheathing cells contribute to the S1P that promotes thymic egress. Lymphatic endothelial cell–derived S1P was not required. These studies identify the major thymic egress route and suggest a role for pericytes in promoting reverse transmigration of cells across blood vessel endothelium.
Sfrp5 Is an Anti-Inflammatory Adipokine That Modulates Metabolic Dysfunction in Obesity

Fat's Mixed Messages Certain metabolic disorders, such as type 2 diabetes, are more prone to arise in obese individuals, a link that has been attributed, in part, to the detrimental activities of adipokines—proteins secreted by fat cells. Most adipokines disrupt glucose homeostasis by promoting inflammation and insulin resistance. Ouchi et al. (p. 454, published online 17 June; see the Perspective by Oh and Olefsky) identify a new adipokine, secreted frizzled-related protein 5 (Sfrp5), which has the opposite effect: It is anti-inflammatory and appears to promote metabolic health. In obese mice, Sfrp5 suppresses the activation of key inflammatory cells (macrophages) residing within adipose tissue by inhibiting the c-Jun N-terminal kinase (JNK) signaling pathway. Further study of this Sfrp5-JNK1 regulatory axis in fat may offer therapeutic opportunities for obesity-linked metabolic disorders. Fat cells secrete an anti-inflammatory factor that has beneficial effects on metabolic health. Adipose tissue secretes proteins referred to as adipokines, many of which promote inflammation and disrupt glucose homeostasis. Here we show that secreted frizzled-related protein 5 (Sfrp5), a protein previously linked to the Wnt signaling pathway, is an anti-inflammatory adipokine whose expression is perturbed in models of obesity and type 2 diabetes. Sfrp5-deficient mice fed a high-calorie diet developed severe glucose intolerance and hepatic steatosis, and their adipose tissue showed an accumulation of activated macrophages that was associated with activation of the c-Jun N-terminal kinase signaling pathway. Adenovirus-mediated delivery of Sfrp5 to mouse models of obesity ameliorated glucose intolerance and hepatic steatosis. Thus, in the setting of obesity, Sfrp5 secretion by adipocytes exerts salutary effects on metabolic dysfunction by controlling inflammatory cells within adipose tissue.
Results of Arthroscopic Repair of Type II Superior Labral Anterior Posterior Lesions in Overhead Athletes

Background: The majority of the literature on surgical outcomes of superior labral anterior posterior (SLAP) repairs has focused on short-term follow-up of 1 to 2 years, not allowing adequate time for full rehabilitation and return to maximum level of competition for all types of athletes. Also, previous studies have concentrated on using questionnaires that primarily evaluate patients’ activities of daily living, which do not focus on sport-specific performance. Purpose: To determine the midterm results of type II SLAP repairs in overhead athletes, focusing primarily on athletic performance as well as activities of daily living. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of 30 overhead athletes, who underwent an arthroscopic superior labral repair for a symptomatic type II SLAP tear between 2002 and 2007, was performed. Our study population included 22 male and 8 female patients with a mean age at the time of surgery of 24 years. Twenty-one patients participated in baseball or softball, and the remainder of patients were involved in javelin throwing or tennis. The average follow-up was 3.5 years. The outcome of treatment was evaluated using the American Shoulder and Elbow Society (ASES) scoring system, assessing activities of daily living, and the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC) score, assessing sport-specific performance. In addition, the length of time to return to sport and the degree of successful performance were evaluated. Results: Repairs resulted in ASES scores comparable with those from prior published studies (average ASES score, 87.9). The KJOC score averaged 73.6. The athletes’ perception was that they returned to approximately 84.1% of their preinjury level of function with a mean time to return to play of 11.7 months. There was a significant drop in the ASES to KJOC score for the baseball/softball players (87.9 ± 14.94 and 72 ± 19.24, respectively; P = .006). Patients reported an overall satisfaction rate of 93.3% with the procedure, with the majority being very satisfied. Conclusion: Arthroscopic SLAP repairs show excellent results and a high rate of overall satisfaction; however, the outcomes are less reliable in throwers. The KJOC score provides a more stringent assessment of overhead athletes’ function after SLAP repair than the ASES score. Our findings also indicate that SLAP repairs lead to improved shoulder function during routine daily activities but that consistent return to elite throwing sports may still remain somewhat problematic.
Utility of Gram Stain and Sputum Culture in the Management of Community-Acquired Pneumonia

The clinical value of diagnostic testing in community-acquired pneumonia is still controversial, mainly because of the lack of prospective, controlled studies that specifically address this issue. This article reviews the utility of sputum Gram stain and culture in the management of these patients. Although with limited sensitivity, Gram stain is the most cost-effective diagnostic test available before initiation of antibiotic therapy in pneumonia. When the test is interpreted by skilled personnel, it provides reliable information on the etiology of bacterial pneumonia. It is highly specific for the diagnosis of pneumococcal and Haemophilus influenzae pneumonia and permits initial pathogen-oriented therapy. The sputum culture should be interpreted in the light of Gram stain results, except for specific pathogens such as Legionella. It provides etiologic diagnosis and allows susceptibility testing for resistant bacteria.
A Molecular Clock for Malaria Parasites

Relative rates of nucleotide substitution between host and parasite cytochrome b set the molecular clock for malaria. The evolutionary origins of new lineages of pathogens are fundamental to understanding emerging diseases. Phylogenetic reconstruction based on DNA sequences has revealed the sister taxa of human pathogens, but the timing of host-switching events, including the human malaria pathogen Plasmodium falciparum, remains controversial. Here, we establish a rate for cytochrome b evolution in avian malaria parasites relative to its rate in birds. We found that the parasite cytochrome b gene evolves about 60% as rapidly as that of host cytochrome b, corresponding to ~1.2% sequence divergence per million years. This calibration puts the origin of P. falciparum at 2.5 million years ago (Ma), the initial radiation of mammalian Plasmodium at 12.8 Ma, and the contemporary global diversity of the Haemosporida across terrestrial vertebrates at 16.2 Ma.
Avaliação fitoterápica da Jatropha gossypiifolia L. na cicatrização de suturas na parede abdominal ventral de ratos

INTRODUCTION: The Jatropha gossypiifolia L. , which is used in popular medicine is considered to have good diuretic effect in hypertension and is also used as a laxative drug. It seems to have a healing effect, although not proved till now. PURPOSE: To evaluate the influence of intraperitoneum administration of Jatropha Gossypiifolia L. , in suture healing of ventral abdominal wall of rats, through tensiometric measurement, macro and microscopic aspect of post-operative period. METHODS: Forty wistar male rates were allocated in two groups of 20 animals . After the incision and exposure of abdominal cavity 1 ml/kg/weight of 0,9% sodium chloride solution was injected in control group, and in the other one the injection was of 1 ml/kg/weight of a gross ethanol extract of Jatropha gossypiifolia L. The suture of the abdominal wall was than performed with polypropylene separated stitches. The animals were followed-up and killed in the third and seventh days. The ventral abdominal wall was macroscopically analyzed, the resistance strength to strain was measured and it was also studied the histological aspects. RESULTS: On macroscopic examination more intense adhesion was found on the group of Jatropha in both third and seventh post-operative days. The strain evaluation was meanly greater on Jatropha group also in third and seventh days. CONCLUSION: The histological comparative analysis between the different groups showed that the acute inflammatory process was meanly greater for the Jatropha group in third and seventh post-operative days. The vascular neoformation was significantly greater in third pos-operative day of Jathopha group; the other histological parameters were just alike. The intraperitoneum injection of Jatropha extract did not have any significant improvement for the wound healing on ventral abdominal wall on the evaluated animals in this study, no matter if analyzed at the third or seventh pos-operative days.
Psychosocial impact of testing (by linkage) for the BRCA1 breast cancer gene: An investigation of two families in the research setting

Data are reported on an investigation of the impact of genetic testing in two families with a >95% probability of linkage to the BRCA1 Breast/Ovarian cancer predispostion gene. Levels of psychological morbidity and cancer specific concerns in this highly selected group were not unusually high. At least half of the sample had no specific prior expectation regarding their gene carrier status. However, there was an indication that an unanticipated unfavourable genetic test result can cause subsequent psychological distress. Uptake of testing in this research sample was 41% overall and was higher (59%) in females. This is likely to have important resource implications if this level of uptake is found when genetic testing is extended outside such research cohorts.
MicroRNA-33 and the SREBP Host Genes Cooperate to Control Cholesterol Homeostasis

miR-33 in Cholesterol Control With the well-established link between serum cholesterol levels and cardiovascular disease and the availability of effective cholesterol-lowering drugs, cholesterol screening has rapidly become a routine part of health care. Yet, much remains to be learned about how cholesterol levels are regulated at the cellular level (see the Perspective by Brown et al.). Now, Najafi-Shoushtari et al. (p. 1566, published online 13 May) and Rayner et al. (p. 1570, published online 13 May) have discovered a new molecular player in cholesterol control—a small noncoding RNA that, intriguingly, is embedded within the genes coding for sterol regulatory element-binding proteins (SREBPs), transcription factors already known to regulate cholesterol levels. This microRNA, called miR-33, represses expression of the adenosine triphosphate–binding cassette transporter A1, a protein that regulates synthesis of high-density lipoprotein (HDL, or “good” cholesterol) and that helps to remove “bad” cholesterol from the blood. Reducing the levels of miR-33 in mice boosted serum HDL levels, suggesting that manipulation of this regulatory circuit might be therapeutically useful. A small noncoding RNA helps regulate cholesterol levels in mice. Proper coordination of cholesterol biosynthesis and trafficking is essential to human health. The sterol regulatory element–binding proteins (SREBPs) are key transcription regulators of genes involved in cholesterol biosynthesis and uptake. We show here that microRNAs (miR-33a/b) embedded within introns of the SREBP genes target the adenosine triphosphate–binding cassette transporter A1 (ABCA1), an important regulator of high-density lipoprotein (HDL) synthesis and reverse cholesterol transport, for posttranscriptional repression. Antisense inhibition of miR-33 in mouse and human cell lines causes up-regulation of ABCA1 expression and increased cholesterol efflux, and injection of mice on a western-type diet with locked nucleic acid–antisense oligonucleotides results in elevated plasma HDL. Our findings indicate that miR-33 acts in concert with the SREBP host genes to control cholesterol homeostasis and suggest that miR-33 may represent a therapeutic target for ameliorating cardiometabolic diseases.
Decrease in the CO2 Uptake Capacity in an Ice-Free Arctic Ocean Basin

Sinking in Slowly As the Arctic warms and its sea ice continues to melt, more of the ocean surface will be exposed, creating the potential for greater uptake of carbon dioxide from the atmosphere. Cai et al. (p. 556, published online 22 July) present results from a series of Arctic Ocean transects that show that the amount of CO2 in the surface waters has increased greatly recently. This will act as a barrier to future CO2 uptake and suggests that the Arctic Ocean will not become the large CO2 sink that some have predicted. The current carbon dioxide levels in the Arctic Ocean basin will limit further uptake under ice-free conditions. It has been predicted that the Arctic Ocean will sequester much greater amounts of carbon dioxide (CO2) from the atmosphere as a result of sea ice melt and increasing primary productivity. However, this prediction was made on the basis of observations from either highly productive ocean margins or ice-covered basins before the recent major ice retreat. We report here a high-resolution survey of sea-surface CO2 concentration across the Canada Basin, showing a great increase relative to earlier observations. Rapid CO2 invasion from the atmosphere and low biological CO2 drawdown are the main causes for the higher CO2, which also acts as a barrier to further CO2 invasion. Contrary to the current view, we predict that the Arctic Ocean basin will not become a large atmospheric CO2 sink under ice-free conditions.
What Strains the Anterior Cruciate Ligament During a Pivot Landing?

Background: The relative contributions of an axial tibial torque and frontal plane moment to anterior cruciate ligament (ACL) strain during pivot landings are unknown. Hypothesis: The peak normalized relative strain in the anteromedial (AM) bundle of the ACL is affected by the direction of the axial tibial torque but not by the direction of the frontal plane moment applied concurrently during a simulated jump landing. Study Design: Controlled and descriptive laboratory studies. Methods: Fifteen adult male knees with pretensioned knee muscle-tendon unit forces were loaded under a simulated pivot landing test. Compression, flexion moment, internal or external tibial torque, and knee varus or valgus moment were simultaneously applied to the distal tibia while recording the 3D knee loads and tibiofemoral kinematics. The AM-ACL relative strain was measured using a 3-mm differential variable reluctance transducer. The results were analyzed using nonparametric Wilcoxon signed–rank tests. A 3D dynamic biomechanical knee model was developed using ADAMS and validated to help interpret the experimental results. Results: The mean (SD) peak AM-ACL relative strain was 192% greater (P < .001) under the internal tibial torque combined with a knee varus or valgus moment (7.0% [3.9%] and 7.0% [4.1%], respectively) than under external tibial torque with the same moments (2.4% [2.5%] and 2.4% [3.2%], respectively). The knee valgus moment augmented the AM-ACL strain due to the slope of the tibial plateau inducing mechanical coupling (ie, internal tibial rotation and knee valgus moment); this augmentation occurred before medial knee joint space opening. Conclusion: An internal tibial torque combined with a knee valgus moment is the worst-case ACL loading condition. However, it is the internal tibial torque that primarily causes large ACL strain. Clinical Relevance: Limiting the maximum coefficient of friction between the shoe and playing surface should limit the peak internal tibial torque that can be applied to the knee during jump landings, thereby reducing peak ACL strain and the risk for noncontact injury.
Video Incident Analysis of Head Injuries in High School Girls’ Lacrosse

Background: Knowledge of injury mechanisms and game situations associated with head injuries in girls’ high school lacrosse is necessary to target prevention efforts. Purpose: To use video analysis and injury data to provide an objective and comprehensive visual record to identify mechanisms of injury, game characteristics, and penalties associated with head injury in girls’ high school lacrosse. Study Design: Descriptive epidemiology study. Methods: In the 25 public high schools of 1 school system, 529 varsity and junior varsity girls’ lacrosse games were videotaped by trained videographers during the 2008 and 2009 seasons. Video of head injury incidents was examined to identify associated mechanisms and game characteristics using a lacrosse-specific coding instrument. Results: Of the 25 head injuries (21 concussions and 4 contusions) recorded as game-related incidents by athletic trainers during the 2 seasons, 20 head injuries were captured on video, and 14 incidents had sufficient image quality for analysis. All 14 incidents of head injury (11 concussions, 3 contusions) involved varsity-level athletes. Most head injuries resulted from stick-to-head contact (n = 8), followed by body-to-head contact (n = 4). The most frequent player activities were defending a shot (n = 4) and competing for a loose ball (n = 4). Ten of the 14 head injuries occurred inside the 12-m arc and in front of the goal, and no penalty was called in 12 injury incidents. All injuries involved 2 players, and most resulted from unintentional actions. Turf versus grass did not appear to influence number of head injuries. Conclusion: Comprehensive video analysis suggests that play near the goal at the varsity high school level is associated with head injuries. Absence of penalty calls on most of these plays suggests an area for exploration, such as the extent to which current rules are enforced and the effectiveness of existing rules for the prevention of head injury.
The Effect of Dynamic Femoroacetabular Impingement on Pubic Symphysis Motion

Background: A link between femoroacetabular impingement and athletic pubalgia has been reported clinically. One proposed origin of athletic pubalgia is secondary to repetitive loading of the pubic symphysis, leading to instability and parasymphyseal tendon and ligament injury. Hypothesis/Purpose: The purpose of this study was to investigate the effect of simulated femoral-based femoroacetabular impingement on rotational motion at the pubic symphysis. The authors hypothesize that the presence of a cam lesion leads to increased relative symphyseal motion. Study Design: Controlled laboratory study. Methods: Twelve hips from 6 fresh-frozen human cadaveric pelvises were used to simulate cam-type femoroacetabular impingement. The hips were held in a custom jig and maximally internally rotated at 90° of flexion and neutral adduction. Three-dimensional motion of the pubic symphysis was measured by a motion-tracking system for 2 states: native and simulated cam. Load-displacement plots were generated between the internal rotational torque applied to the hip and the responding motion in 3 anatomic planes of the pubic symphysis. Results: As the hip was internally rotated, the motion at the pubic symphysis increased proportionally with the degrees of the rotation as well as the applied torque measured at the distal femur for both states. The primary rotation of the symphysis was in the transverse plane and on average accounted for more than 60% of the total rotation. This primary motion caused the anterior aspect of the symphyseal joint to open or widen, whereas the posterior aspect narrowed. At the torque level of 18.0 N·m, the mean transverse rotation in degrees was 0.89° ± 0.35° for the native state and 1.20° ± 0.41° for cam state. The difference between cam and the native groups was statistically significant (P < .03). Conclusion: Dynamic femoroacetabular impingement as caused by the presence of a cam lesion causes increased rotational motion at the pubic symphysis. Clinical Relevance: Repetitive loading of the symphysis by cam impingement is thought to lead to increased symphyseal motion, which is one possible precursor to athletic pubalgia.