Miracle-dz/UniFAR-FTUs huggingface dataset:
Restricted Infraclavicular Distribution of the Local Anesthetic Solution After Infraclavicular Brachial Plexus Block

Background and Objectives The distribution of local anesthetic after different approaches for brachial plexus anesthesia could be responsible for the varying rates of side effects, such as phrenic block, hoarseness, and Horner’s syndrome associated with each approach. We compared the distribution of local anesthetic within the neurovascular space in infraclavicular block with that of interscalene and supraclavicular block. Methods In a prospective analysis using fluoroscopy, we studied the distribution of a solution of local anesthetic containing radiologic contrast medium in 18 patients. Six patients received an interscalene block, another 6 patients received a perpendicular supraclavicular block, and another 6 patients, a perpendicular coracoid block. Results Distribution of the anesthetic solution in the interscalene and supraclavicular groups extended to both supraclavicular and infraclavicular spaces in all patients. This distribution was significantly different (P < .05) compared with that of the infraclavicular group. In this group, the solution remained below the clavicle in every patient. Conclusions Spread of the local anesthetic from the infraclavicular space after infraclavicular coracoid block appears to be limited to below the level of the clavicle. Conversely, local anesthetic solution passes below the clavicle in all patients given interscalene or supraclavicular blocks. Reg Anesth Pain Med 2003;28:33-36.
Population Estimation of the Effects of Cytochrome P450 2C9 and 2C19 Polymorphisms on Phenobarbital Clearance in Japanese

Abstract: A nonlinear mixed-effect modeling (NONMEM) program was used to evaluate the effects of cytochrome P450 (CYP) 2C9 and CYP2C19 polymorphisms on the phenobarbital (PB) population clearance for Japanese epileptics. The pharmacokinetics of the 260 PB concentrations at a steady-state obtained from 79 patients was described with a one-compartment open pharmacokinetic model with first-order elimination. The covariates screened included the total body weight (BW), age, gender, PB daily dose, CYP2C9 and CYP2C19 genotypes, the coadministered antiepileptic drugs (AEDs), and complications. The final model of PB apparent clearance was as follows: where CL = the clearance of PB; CYP2C9*1/*3 = 1, otherwise 0; VPA = 1 if valproic acid is coadministered, otherwise 0; PHT = 1 if phenytoin is coadministered, otherwise 0; SMID = 1 if complications of severe or profound mental retardation with a significant behavior impairment are presented, otherwise 0; and &eegr;CL = the independent random error distributed normally with the mean zero and variance equal to ωP2. The total clearance of PB decreased by 48% in patients with CYP2C9*1/*3 genotype in comparison with those with CYP2C9*1/*1 genotype (P < 0.001). An effect of CYP2C19 polymorphisms was not detected. To our knowledge, this is the first report to demonstrate that the CYP2C9 genotype affects the PB metabolism in routine care, but the results should be further verified in other ethnic populations.
Regulated Delayed Expression of rfaH in an Attenuated Salmonellaenterica Serovar Typhimurium Vaccine Enhances Immunogenicity of Outer Membrane Proteins and a Heterologous Antigen

ABSTRACT RfaH is a transcriptional antiterminator that reduces the polarity of long operons encoding secreted and surface-associated cell components of Salmonella enterica serovar Typhimurium, including O antigen and lipopolysaccharide core sugars. A ΔrfaH mutant strain is attenuated in mice (50% lethal dose [LD50], >108 CFU). To examine the potential for using rfaH in conjunction with other attenuating mutations, we designed a series of strains in which we replaced the native rfaH promoter with the tightly regulated arabinose-dependent araC PBAD promoter so that rfaH expression was dependent on exogenously supplied arabinose provided during in vitro growth. Following colonization of host lymphoid tissues, where arabinose was not available, the PBAD promoter was no longer active and rfaH was not expressed. In the absence of RfaH, O antigen and core sugars were not synthesized. We constructed three mutant strains that expressed different levels of RfaH by altering the ribosome-binding sequence and start codon. One mutation, ΔPrfaH178, was introduced into the attenuated vaccine strain χ9241 (ΔpabA ΔpabB ΔasdA) expressing the pneumococcal surface protein PspA from an Asd+ balanced-lethal plasmid. Mice immunized with this strain and boosted 4 weeks later induced higher levels of serum immunoglobulin G specific for PspA and for outer membrane proteins from other enteric bacteria than either an isogenic ΔrfaH derivative or the isogenic RfaH+ parent. Eight weeks after primary oral immunization, mice were challenged with 200 LD50 of virulent Streptococcuspneumoniae WU2. Immunization with ΔPrfaH178 mutant strains led to increased levels of protection compared to that of the parent χ9241 and of a ΔrfaH derivative of χ9241.
Musculoskeletal Function Assessment Instrument: Criterion and Construct Validity.

The Musculoskeletal function assessment (MFA) instrument is a 100-item, self-reported, health status measure designed for use in a clinical setting on a broad range of patients with musculoskeletal disorders of the extremities. This study sought to test both its criterion and construct validity, an important aspect of creating a health status instrument. The criterion validity was tested against physicians’ ratings of patient function and against various clinical measures. Construct validity was evaluated using medical records, demographic data, other standard health instruments, and by comparing patients based on their various health issues. Both types of validity were affirmed by significant correlations between the MFA scores and the criteria evaluated.
Expression of SOCS1, SOCS2, and SOCS3 in growth hormone-stimulated skin fibroblasts from children with idiopathic short stature

Abstract Background/aim: Possible etiologies of idiopathic short stature (ISS) include a range of conditions, some of which may be caused by defects in the modulation of the growth hormone (GH)-signaling pathway. The Janus kinase/signal transducer and activator of transcription pathway is regulated by several mechanisms, including negative feedback regulation by the suppressors of cytokine signaling (SOCS). However, the specific induction of SOCS transcript levels in fibroblasts from ISS patients has not been studied. Methods: We determined the transcript levels of the SOCS1–3 genes under basal conditions, and in the presence or absence of stimulation with rhGH for 24 h in skin fibroblast cultures obtained from patients with ISS and children with normal height. Results: Under basal conditions, ISS patients express higher SOCS2–3 transcript levels than control children. After incubation with recombinant human GH (rhGH), the transcript levels of SOCS2 increased significantly in ISS patients compared to controls (0.79±0.06 vs. 0.55±0.07; p=0.03), a pattern which did not achieve statistical significance for SOCS3 transcript levels (0.55±0.08 vs. 0.40±0.07). Conclusion: The higher baseline transcript levels of the SOCS genes, and the increase observed for SOCS2 after rhGH treatment in ISS patients, suggest that growth retardation in some of these children may be mediated, at least in part, by intracellular overexpression of the SOCS genes.
Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?

OBJECTIVES The value of ventilation monitoring with end-tidal carbon dioxide (ETCO2) to anticipate acute respiratory events during emergency department (ED) procedural sedation and analgesia (PSA) is unclear. The authors sought to determine if ETCO2 monitoring would reveal findings indicating an acute respiratory event earlier than indicated by current monitoring practices. METHODS The study included a prospective convenience sample of ED patients undergoing PSA. Clinicians performed ED PSA procedures with generally accepted patient monitoring, including oxygen saturation (SpO2), and clinical ventilation assessment. A study investigator recorded ETCO2 levels and respiratory events during each PSA procedure, with clinical providers blinded to ETCO(2) levels. Acute respiratory events were defined as SpO2 < or =92%, increases in the amount of supplemental oxygen provided, use of bag-valve mask or oral/nasal airway for ventilatory assistance, repositioning or airway alignment maneuvers, and use of physical or verbal means to stimulate patients with depressed ventilation or apnea, and reversal agent administration. RESULTS Enrollment was stopped after independent review of 20 acute respiratory events in 60 patient sedation encounters (33%). Abnormal ETCO2 findings were documented in 36 patients (60%). Seventeen patients (85%) with acute respiratory events demonstrated ETCO2 findings indicative of hypoventilation or apnea during PSA. Abnormal ETCO2 findings were documented before changes in SpO2 or clinically observed hypoventilation in 14 patients (70%) with acute respiratory events. CONCLUSIONS Abnormal ETCO2 findings were observed with many acute respiratory events. A majority of patients with acute respiratory events had ETCO2 abnormalities that occurred before oxygen desaturation or observed hypoventilation.
Toward a Hepatitis C Virus Vaccine: the Structural Basis of Hepatitis C Virus Neutralization by AP33, a Broadly Neutralizing Antibody

ABSTRACT The E2 envelope glycoprotein of hepatitis C virus (HCV) binds to the host entry factor CD81 and is the principal target for neutralizing antibodies (NAbs). Most NAbs recognize hypervariable region 1 on E2, which undergoes frequent mutation, thereby allowing the virus to evade neutralization. Consequently, there is great interest in NAbs that target conserved epitopes. One such NAb is AP33, a mouse monoclonal antibody that recognizes a conserved, linear epitope on E2 and potently neutralizes a broad range of HCV genotypes. In this study, the X-ray structure of AP33 Fab in complex with an epitope peptide spanning residues 412 to 423 of HCV E2 was determined to 1.8 Å. In the complex, the peptide adopts a β-hairpin conformation and docks into a deep binding pocket on the antibody. The major determinants of antibody recognition are E2 residues L413, N415, G418, and W420. The structure is compared to the recently described HCV1 Fab in complex with the same epitope. Interestingly, the antigen-binding sites of HCV1 and AP33 are completely different, whereas the peptide conformation is very similar in the two structures. Mutagenesis of the peptide-binding residues on AP33 confirmed that these residues are also critical for AP33 recognition of whole E2, confirming that the peptide-bound structure truly represents AP33 interaction with the intact glycoprotein. The slightly conformation-sensitive character of the AP33-E2 interaction was explored by cross-competition analysis and alanine-scanning mutagenesis. The structural details of this neutralizing epitope provide a starting point for the design of an immunogen capable of eliciting AP33-like antibodies.
Assessment of vulnerable plaque composition by matching the deformation of a parametric plaque model to measured plaque deformation

Intravascular ultrasound (IVUS) elastography visualizes local radial strain of arteries in so-called elastograms to detect rupture-prone plaques. However, due to the unknown arterial stress distribution these elastograms cannot be directly interpreted as a morphology and material composition image. To overcome this limitation we have developed a method that reconstructs a Young's modulus image from an elastogram. This method is especially suited for thin-cap fibroatheromas (TCFAs), i.e., plaques with a media region containing a lipid pool covered by a cap. Reconstruction is done by a minimization algorithm that matches the strain image output, calculated with a parametric finite element model (PFEM) representation of a TCFA, to an elastogram by iteratively updating the PFEM geometry and material parameters. These geometry parameters delineate the TCFA media, lipid pool and cap regions by circles. The material parameter for each region is a Young's modulus, E/sub M/, E/sub L/, and E/sub C/, respectively. The method was successfully tested on computer-simulated TCFAs (n=2), one defined by circles, the other by tracing TCFA histology, and additionally on a physical phantom (n=1) having a stiff wall (measured E/sub M/=16.8 kPa) with an eccentric soft region (measured E/sub L/=4.2 kPa). Finally, it was applied on human coronary plaques in vitro (n=1) and in vivo (n=1). The corresponding simulated and measured elastograms of these plaques showed radial strain values from 0% up to 2% at a pressure differential of 20, 20, 1, 20, and 1 mmHg respectively. The used/reconstructed Young's moduli [kPa] were for the circular plaque E/sub L/=50/66, E/sub M/=1500/1484, E/sub C/=2000/2047, for the traced plaque E/sub L/=25/1, E/sub M/=1000/1148, E/sub C/=1500/1491, for the phantom E/sub L/=4.2/4 kPa, E/sub M/=16.8/16, for the in vitro plaque E/sub L/=n.a. /29, E/sub M/=n.a. /647, E/sub C/=n.a. /1784 kPa and for the in vivo plaque E/sub L/=n.a. /2, E/sub M/=n.a. /188, E/sub C/=n.a. /188 kPa.
Organochlorine pesticides in Western Australian nursing mothers

To measure the concentrations of organochlorine (OC) pesticides in nursing mothers in Western Australia and to evaluate the safety of these concentrations for breastfed infants; to evaluate the need for future monitoring of OC pesticide concentrations and to determine whether breast milk is an accurate substitute for adipose tissue in future monitoring programs. Design: Two cohorts of nursing mothers were recruited during the period October 1990 to March 1991. Levels of OC pesticides were measured in 128 samples of breast milk and 31 samples each of adipose tissue, maternal blood and cord blood. Laboratory analysis was by gas chromatography with electron capture. Health Department studies since 1974 were collated and levels of OC pesticides compared over time. Results: DDT (dichlorodiphenyltrichloroethane), HCB (hexachlorobenzene) and dieldrin were found in all samples of breast milk and adipose tissue. A significant fall in the levels of OCs was noted since the 1974 survey, with the current concentrations of the cyclodienes (heptachlor, chlordane and dieldrin) being close to the limit of detection of the assay. The acceptable daily intake for dieldrin was exceeded in 90% of infants and for heptachlor in 2% of infants. The daily intakes of the other OCs were below the respective acceptable levels. HCB was detected at a median level of 0.1 mg/kg in both breast milk and adipose tissue despite being deregistered in 1972. As there is no current acceptable daily intake for HCB, the safety of this level could not be assessed by this method. A low correlation was found between levels of the cyclodiene pesticides in breast milk and adipose tissue, but levels of DDT and HCB were closely correlated. Conclusions: Restrictions on the use of the OC insecticides (DDT, aldrin, dieldrin, heptachlor and chlordane) have resulted in reduced concentrations of these chemicals in breast milk and adipose tissue as compared with previous studies. The dieldrin intake of breast‐fed infants consistently exceeded the acceptable daily intake; the heptachlor intake exceeded the acceptable daily intake in some infants, but the low concentrations of heptachlor in breast milk made accurate measurement difficult. The concentrations of DDT and chlordane in breast milk did not pose a hazard to breast‐fed infants. The significance of the levels of the fungicide HCB in breast milk cannot be determined. The widespread distribution of HCB, its marked persistence in the environment and its potential for human toxicity indicate a need for continued monitoring, for which breast milk is a suitable medium. The poor correlation between concentrations of dieldrin, heptachlor and chlordane in breast milk and adipose tissue may reflect the technical difficulty of measuring chemical concentrations close to the limit of detection. As aldrin is a registered pesticide and the dieldrin intake of breast‐fed infants is consistently above the acceptable daily intake, monitoring of dieldrin should continue. Further population monitoring of DDT, heptachlor and chlordane is unlikely to be of value.
Clearance of funguria with short-course antifungal regimens: a prospective, randomized, controlled study.

The effects of short-course antifungal regimens on funguria were studied in 180 hospitalized adults who did not have ascending urinary or deep fungal infections but did have > 1,000 cfu of yeast/mL in two consecutive urine cultures. Before treatment, efforts were made to eliminate factors conducive to funguria. No additional interventions were implemented in the management of the control group (group A), whereas five experimental groups received short-course therapy as follows: oral administration of fluconazole (group B); single-dose intravenous administration of amphotericin B (group C); and intermittent bladder irrigation with amphotericin B at low, medium, and high concentrations (groups D, E, and F, respectively). Urine was cultured on days 1 and 7 after antifungal treatment. The rate of spontaneous clearance of funguria in the control group was 40.0%. Rates of clearance in experimental groups B through F were 58.6%, 55.2%, 82.1% (P < .01), 86.7% (P < .001), and 83.3% (P < .001), respectively, on day 1 and 77.3% (P < .01), 72.0% (P < .05), 42.9%, 68.4%, and 68.2% (P < .05), respectively, on day 7. The decrement in yeast count was 60.8% for the control group. Decrements for experimental groups B through F were 80.5%, 74.2%, 94.2% (P < .01), 86.7% (P < .05), and 95.3% (P < .001), respectively, on day 1 and 85.5% (P < .05), 80.7%, 75.7%, 87.9% (P < .05), and 76.4%, respectively, on day 7. (ABSTRACT TRUNCATED AT 250 WORDS)
Ultrasonographic Findings of Masseter Muscle in Females With Temporomandibular Disorders

ObjectivesThe aim of this study was to evaluate of ultrasonographic findings of masseter muscle in females with temporomandibular disorders. Sonographic features were compared in those with myofacial pain disorder (MPD) and temporomandibular click, as well as healthy women. MethodsSixty-three females referred to the Prosthetic Department of Dental Faculty of Mashhad University of Medical Sciences (22 with MPD, 21 with click, and 20 control subjects) aged from 20 to 40 years were evaluated. The masseter muscle thickness in each group was measured bilaterally at rest and maximum contraction by a real-time ultrasound imaging technique. The type of the internal pattern of the masseter muscle in sonography was classified to 3 types (I, II, and III) according to the visibility, widths, and echogenicity of internal echogenic bands. ResultsIn the right-side masseter, thickness in the control group was greater than that in the MPD group (P = 0.033). There was no significant difference about the thickness of the masseter at rest and at maximum contraction between both sides in control and MPD groups; however, in the click group, the difference was significant. Also, the muscle thickness of either right or left side at rest and at maximum contraction was significant. There was a significant difference between control and MPD groups (P < 0.001) as well as MPD and click groups (P < 0.001) in the type of the internal pattern. ConclusionsThere were obvious ultrasonographic changes of the masseter muscle in females with MPD, which might be related to the muscle inflammation.
Congenital eye diseases at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.

BACKGROUND Congenital eye disorders, though rare are important causes of childhood blindness. It can occur in isolation or in combination, or as part of a syndrome. This retrospective study was aimed at documenting the causes of congenital eye diseases at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria. METHOD A review of the case notes of patients presenting at the eye clinic with congenital eye diseases between January 1994 and December 2004 was carried out. RESULT The most common congenital disorders are cataract 50 (47.6%), congenital glaucoma 15 (14.3%), Dacryostenosis 11 (10.5%), and corneal opacity 6 (5.7%) which are causes of preventable blindness. Less common congenital disorders are microcornea (1%), aniridia (1%), retinal atrophy (1%), and congenital anomaly of the optic disc (1%), which are congenital causes of irreversible childhood blindness. CONCLUSION We conclude that screening programmes should be instituted at the maternity centers before babies are discharged for early detection of congenital eye diseases and treatment of those that can cause preventable blindness. Also we recommend that Government should strengthen our welfare system by providing adequate measures for rehabilitation and care of those with irreversible blindness.
Comparison of two methods of assessing total body water at sea level and increasing high altitude

Fluid retention is a recognized feature of acute mountain sickness. However, accurate assessment of hydration, including the quantification of body water, has traditionally relied on expensive and non‐portable equipment limiting its utility in the field setting. We compared the assessment of total body water (TBW) and their relationship to total body weight using two non‐invasive methods using the NICas single‐frequency bioimpedance analysis (SF‐BIA) system and the BodyStat QuadScan 4000 multifrequency BIA system (MF‐BIA). TBW measurements were performed at rest at sea level and at high altitude (HA) at 3833 m postexercise and at rest and thereafter at rest at 4450 m and 5129 m on 47 subjects. The average age was 34·5 ± 9·3 years with an age range of 21–54 years (70·2% male). There were strong correlations between TBW assessment with both methods at sea level (r = 0·90; 95% CI 0·78–0·95: P<0·0001) and at HA (r = 0·92; 0·89–0·94: P<0·0001), however, TBW readings were 0·2 l and 1·91 l lower, respectively, with the NICaS. There was a stronger correlation between TBW and body weight with the QuadScan (r = 0·91; P<0·0001) than with the NICaS (r = 0·83; P<0·0001). The overall agreement between the two TBW methods was good, but the 95% confidence intervals around these agreements were relatively wide. We conclude that there was reasonable agreement between the two methods of BIA for TBW, but this agreement was lower at HA.