Miracle-dz/UniFAR-FTUs huggingface dataset:
Emergence of Multiple Cytomegalovirus Strains in Blood and Lung of Lung Transplant Recipients

Background. Cytomegalovirus (CMV) is a major pathogen in lung transplant recipients (LTRs). The emergence of different CMV strains in lung and blood after transplantation has not yet been analyzed. Methods. In total, 75 serum and 91 broncheoalveolar lavage (BAL) samples obtained from 25 LTRs in the follow-up after transplantation were tested for the presence of different CMV strains. The gB, gN, and gO genes of the CMV isolates were analyzed by subtype-specific PCR, restriction fragment length polymorphism (RFLP), sequencing, and phylogenetic analysis. Results. Mixed CMV-strain populations were detected after cessation of antiviral prophylaxis in up to 80% and 90% of the patients’ BAL and serum, respectively, and this was independent of the CMV serostatus of donor and recipient. In five patients, the same single CMV strain was consistently detectable over at least 1 year in lung and blood, although in two of these cases donor and recipient had both been CMV-seropositive. Most CMV strains were distributed in the lung and blood compartment. Symptomatic CMV infection within the first year after transplantation was observed only in patients with mixed CMV-strain populations (P<0.05). Conclusion. Most LTRs harbor more than one CMV strain in their lung and blood compartment after cessation of prophylaxis, but the CMV strain distribution within and between the compartments varies between individuals and is not associated with the donor/recipient serostatus. The data further show that compartmentalization of CMV strains in lung versus blood seems to be a rare event and that the presence of mixed CMV-strain infections within the first year after transplantation may be disadvantageous for LTRs.
Switching to anastrozole versus continued tamoxifen treatment of early breast cancer. Updated results of the Italian tamoxifen anastrozole (ITA) trial.

BACKGROUND Tamoxifen, for many years the 'gold standard' in the adjuvant setting for the management of endocrine sensitive early breast cancer, is associated with an increased risk of endometrial cancer and other life-threatening events. Moreover, many women relapse during or after tamoxifen therapy due to the development of resistance. This provided the rationale for a switching trial with anastrozole, the updated results of which are reported here. PATIENTS AND METHODS This trial investigated the efficacy of switching to anastrozole for women already receiving tamoxifen. After 2-3 years of tamoxifen treatment, postmenopausal, node-positive, ER-positive patients were randomized to receive either anastrozole 1 mg/day or to continue tamoxifen, 20 mg/day, giving a total duration of 5-years treatment. The primary end point was disease-free survival and secondary endpoints were event-free survival, overall survival and safety. RESULTS A total of 448 patients were enrolled. At a median follow-up time of 64 months (range 12-93), 63 events had been reported in the tamoxifen group compared with 39 in the anastrozole group [HR 0.57 (95% CI 0.38-0.85) P = 0.005]. Relapse-free and overall survival were also longer in the anastrozole group [HR 0.56 (95% CI 0.35-0.89) P = 0.01 and 0.56 (95% CI 0.28-1.15) P = 0.1]. However, the latter difference was not statistically significant. Overall more patients in the anastrozole group experienced at least one adverse event (209 versus 151: P = 0.000). However, numbers of patients experiencing serious adverse events were comparable (37 versus 40, respectively: P = 0.7). CONCLUSIONS Switching to anastrozole after the first 2-3 years of treatment was confirmed to improve event-free and relapse-free survival of postmenopausal, node-positive, ER-positive early breast cancer patients already receiving adjuvant tamoxifen.
Delayed diagnosis of incident type 2 diabetes mellitus in the ARIC study.

OBJECTIVES To estimate delays to physician diagnosis of incident cases of type 2 diabetes mellitus (DM) and to identify predictors of delayed diagnosis. STUDY DESIGN The Atherosclerosis Risk in Communities (ARIC) study, an ongoing population-based prospective study of 15 792 middle-aged adults. METHODS The study population comprised 298 adults with incident DM. Exposures were demographic, socioeconomic, health behavior, and clinical risk factors before the onset of type 2 DM. The main outcome was the delay from onset of DM to physician diagnosis. RESULTS Among 298 ARIC participants with incident type 2 DM at visit 2 of the study, the median delay from onset of DM to physician diagnosis was 2.4 years. More than 7% of incident cases remained undiagnosed for at least 7.5 years after the onset of disease. Compared with individuals with promptly diagnosed incident DM, those with delayed diagnosis were more likely to be obese before the onset of DM (P = .003), less likely to have heart disease at baseline (P = .02 for trend), less likely to have seen their physician in the past year (P = .005 for trend), and had a slower rise in fasting hyperglycemia (P = .04). Neither demographic characteristics nor study site predicted delayed diagnosis. CONCLUSIONS Even with a de facto screening program, diagnosis of incident type 2 DM in the community is typically delayed for 2 years and sometimes as long as 7 years or more. The associated risk factors suggest deficiencies in organizational processes, physician actions, and patient access or acceptance of the diagnosis.
An epidemiological study of tuberculosis and HIV infection in Tanzania, 1991–1993

ObjectiveIn Tanzania during the past 6 years reported tuberculosis (TB) cases have nearly doubled, with proportionately much greater increases in smear-negative and extrapulmonary cases compared with smear-positive cases. At the same time, HIV infection has become widespread throughout the country. This survey was undertaken in order to study the association of TB and HIV and to determine the impact of HIV on present and future TB cases in Tanzania. MethodsThe survey design provided for HIV testing of a representative country-wide sample of approximately one-sixth of all new and relapse cases registered between January 1991 and December 1993, with linkage to demographic, clinical and bacteriological data for these cases. HIV surveillance data were used for comparison purposes. ResultsA total of 6928 TB cases from all of the country's 20 mainland regions were tested. The overall HIV seroprevalence was 32%. Both crude and adjusted odds ratios (OR) for HIV infection were higher in women, those aged 25–44 years, urban residents, cases of smear-negative and extrapulmonary disease, and persons with a bacille Calmette-Guérin (BCG) vaccination scar. The age-and sex-adjusted relative risk for HIV infection in TB patients compared to blood donors in the same regions was 7.1 (95% confidence interval, 6.6–7.5), and was significantly higher among those aged 25–34 years. Of 3360 patients with bacteriological culture results 46% were culture-positive for Mycobacterium tuberculosis. Drug susceptibility tests were performed on 1164 isolates with the overall rate of drug resistance of 6.2%. Rates of initial resistance were low in both HIV-positive (4%) and HIV-negative (5.8%) patients. Rates of acquired resistance were higher (19% overall) and did not vary significantly by HIV serostatus. Initial combined resistance to both isoniazid and rifampicin was uncommon (0.4%) as was monoresistance to rifampicin (0.3%). ConclusionsThe higher OR for women and young adults reflect the higher rates of HIV infection in those populations. The finding that smear-positive relapse cases were no more likely to have HIV infection than new smear-positive cases suggests that the treatment regimen for new cases is effective in HIV-associated TB. The low rates of both initial and acquired drug resistance in HIV-positive patients is further evidence of adequacy of treatment. The higher relative risk for HIV infection among patients aged 25–34 years suggests increased HIV-related TB transmission. Finally, it is estimated that approximately two-thirds of the increase in the rate of smear-positive tuberculosis in the country can be directly attributed to HIV infection.
Effects of aerobic exercise performed in fasted v. fed state on fat and carbohydrate metabolism in adults: a systematic review and meta-analysis

Abstract This study aimed to verify the effect of aerobic exercise performed in the fasted v. fed states on fat and carbohydrate metabolism in adults. Searches were conducted in March 2015, and updated in July 2016, using PubMed®, Scopus and Cochrane databases (terms: ‘fasting’, ‘exercise’, ‘aerobic exercise’, ‘substrate’, ‘energy metabolism’, ‘fat’, ‘glucose’, ‘insulin’ and ‘adult’) and references from selected studies. Trials that compared the metabolic effects of aerobic exercise (duration ≤120 min) performed in the fasted v. fed states in adults were accepted. The outcomes evaluated were fat oxidation during exercise and the plasma concentrations of insulin, glucose and NEFA before and immediately after exercise; two independent reviewers extracted the data (A. F. V. and L. C.). The results were presented as weighted mean differences between treatments, with 95 % CI. Of 10 405 articles identified, twenty-seven studies – with a total of 273 participants – were included. There was a significant increase in fat oxidation during exercise performed in the fasted, compared with fed, state (−3·08 g; 95 % CI −5·38, −0·79; I 2 39·1 %). The weighted mean difference of NEFA concentrations was not significantly different between states (0·00 mmol/l; 95 % CI −0·07, 0·08; I 2 72·7 %). However, the weighted mean differences of glucose (0·78 mmol/l; 95 % CI 0·43, 1·14; I 2 90·8 %) and insulin concentrations (104·5 pmol/l; 95 % CI 70·8, 138·2; I 2 94·5 %) were significantly higher for exercise performed in the fed state. We conclude that aerobic exercise performed in the fasted state induces higher fat oxidation than exercise performed in the fed state.
Subtypes of borderline personality disorder, associated clinical disorders and stressful life-events: a latent class analysis based on the British Psychiatric Morbidity Survey.

OBJECTIVES The current study examined the types of borderline personality profiles, associated psychological disorders and stressful life-events. DESIGN Data from the British Psychiatric Morbidity Survey were used to examine homogeneous subtypes of participants based on their responses to nine borderline personality disorder (BPD) criteria. METHODS Latent class analysis (LCA) was used to identify homogeneous groups, or classes, of individuals. A multinomial logistic regression model was used to estimate the association between classes and associated psychological disorders and stressful life-events. RESULTS A 4-class solution provided the best fit, ranging from a class with a low probability of showing any BPD symptoms to a class whose members had a relatively high probability of endorsing all criteria. Severity of BPD was associated with higher co-morbidity and higher stressful life-events. CONCLUSIONS Results suggest that four discrete classes make up the borderline continuum.
FoxP3+ CD25+ CD8+ T-Cell Induction during Primary Simian Immunodeficiency Virus Infection in Cynomolgus Macaques Correlates with Low CD4+ T-Cell Activation and High Viral Load

ABSTRACT The early immune response fails to prevent the establishment of chronic human immunodeficiency virus (HIV) infection but may influence viremia during primary infection, thereby possibly affecting long-term disease progression. CD25+ FoxP3+ regulatory T cells may contribute to HIV/simian immunodeficiency virus (SIV) pathogenesis by suppressing efficient antiviral responses during primary infection, favoring high levels of viral replication and the establishment of chronic infection. In contrast, they may decrease immune activation during chronic infection. CD4+ regulatory T cells have been studied in the most detail, but CD8+ CD25+ FoxP3+ T cells also have regulatory properties. We monitored the dynamics of CD25+ FoxP3+ T cells during primary and chronic SIVmac251 infection in cynomolgus macaques. The number of peripheral CD4+ CD25+ FoxP3+ T cells paralleled that of memory CD4+ T cells, with a rapid decline during primary infection followed by a rebound to levels just below baseline and gradual depletion during the course of infection. No change in the proportion of CD25+ FoxP3+ T cells was observed in peripheral lymph nodes. A small number of CD4+ CD25+ FoxP3+ T cells at set point was associated with a high plasma viral load. In contrast, peripheral CD8+ CD25+ FoxP3+ T cells were induced a few days after peak plasma viral load during primary infection. The number of these cells was positively correlated with viral load and negatively correlated with CD4+ T-cell activation, SIV antigen-specific proliferative responses during primary infection, and plasma viral load at set point, with large numbers of CD8+ CD25+ FoxP3+ T cells being indicative of a poor prognosis.
Intracranial extra-axial cavernous (HEM) angiomas: tumors or vascular malformations?

INTRODUCTION Extra-axial cavernous hemangiomas or angiomas [(hem)angiomas] are relatively rare lesions. They usually arise in relation to the dura mater intracranially or at the spinal level. Most of these lesions have been described in the middle cranial fossa at level of the cavernous sinus. Controversy still exists regarding the exact nature of these extra-axial cavernous angiomas: vascular tumor versus vascular malformation similar to intra-axial cavernomas. It has been suggested that they could represent an adult form of the hemangioma of infancy. Extra-axial cavernous (hem)angiomas often mimic meningiomas and their clinical behavior and imaging appearance are quite different than those of intra-axial cavernous angiomas. SUBJECTS AND METHODS Five patients ranging in age from 24 to 63 years with a histologically proven dural cavernous angioma were retrospectively included. The lesions were located at level of the cavernous sinus (4 cases) and falx. CT and MR scans were performed in all cases and angiography in three patients. Four patients underwent surgery and a biopsy was performed in one case. One lesion was embolized before biopsy. Histology was available in all patients. RESULTS In the operated patients, the lesion was totally resected in 2 cases and partially in the other 2. No postsurgical complication was noted. Histology revealed a vascular malformation composed of large vascular channels lined by flat endothelium and separated by fibroconnective tissue stroma. The pathological diagnosis was cavernous angioma. CONCLUSION On the basis of the analysis of the literature and of our cases, intra-cranial extra-cerebral so-called cavernous (hem)angiomas present findings suggesting that they are vascular malformative lesions, analogous to the intra-axial cavernous angioma. A relationship with the hemangiomas of infancy seems unlikely. Correct terms for extra-cerebral cavernous (hem)angiomas are cavernoma, cavernous angioma, or venous vascular malformation of cavernous type . The term hemangioma should be avoided and reserved for the common vascular tumor of infancy.
Financial market

- A financial market is a market in which people and entities can trade financial securities, commodities, and other fungible items of value at low transaction costs and at prices that reflect supply and demand. Securities include stocks and bonds, and commodities include precious metals or agricultural goods. In economics, typically, the term market means the aggregate of possible buyers and sellers of a certain good or service and the transactions between them.
Pharmacokinetics and Biodistribution of a pGT2-VEGF Plasmid DNA After Administration in Rats

Intramyocardial administration of gene therapy vectors expressing angiogenic factors have been attempted as an alternative to conventional surgical methods for the management of myocardial ischemia. In this study, we have developed the pGT2-VEGF, a plasmid DNA vector expressing human VEGF165, for the management of ischemic cardiovascular disease and investigated in vivo pharmacokinetics and tissue distribution of pGT2-VEGF after intramyocardial and intravenous administration in rats. A high concentration of pGT2-VEGF was observed in the heart after intramyocardial injection of 300 μg, which is in line with the assumption that direct intramyocardial delivery enables extended localization at the administration site. Leakage of the pGT2-VEGF to the blood circulation was observed after intramyocardial injection, with an area under the curve (AUC) of 3.8 μg min/mL, as compared with 37.3 μg min/mL after intravenous injection of the same dose. The pGT2-VEGF concentration in blood peaked at 5 minutes after intramyocardial administration and declined rapidly to undetectable levels by 2 hours post-administration. In tissue distribution studies, pGT2-VEGF peaked at 5 minutes post-administration in various organs but was undetectable at 2 hours in all organs except heart, lung, and liver. Taken together, the results suggest that intramyocardial-delivered pGT2-VEGF was degraded rapidly in vivo and mainly persisted in target tissues, the heart. In addition, intramyocardial-administered pGT2-VEGF was expressed for longer periods than the persistence of the pGT2-VEGF plasmid DNA in a target tissue. Therefore, a direct myocardial injection of pGT2-VEGF might be useful for local therapeutic angiogenesis.
Use of nicotine replacement therapy in adolescent smokers and nonsmokers.

BACKGROUND Assessing whether and how adolescents use nicotine replacement therapy (NRT) will be important given recent recommendations to make NRT more accessible by lowering its price, increasing its distribution, and advising health care professionals to suggest its use for smoking cessation. OBJECTIVES To report the prevalence, ease of access, and reasons for NRT use and describe inappropriate use in adolescent smokers and nonsmokers. DESIGN Cross-sectional survey of 4078 high school students during the school term of 1998. SETTING City schools in Memphis, Tenn. MAIN OUTCOME MEASURES Community-based self-reported prevalence of NRT use and characteristics of those using NRT. RESULTS Approximately 5% of adolescents reported trying or using nicotine gum or patches. Females were less likely than males and African Americans were less likely than others to use NRT. For African American smokers, NRT use was highest at lower smoking levels, while other smokers showed the opposite pattern. Almost 40% of former smokers reported using NRT to try to quit smoking; however, 75% of current smokers endorsed using NRT for reasons other than trying to quit smoking. Other inappropriate use of NRT was reported; 18% of NRT users reported themselves as never smokers. More than 50% of students reported that it would be easy for them to get NRT. CONCLUSIONS Nicotine replacement therapy is used by adolescent smokers and nonsmokers, is easily accessible, and is used for reasons other than trying to quit smoking. Efforts are needed to discourage NRT use in nonsmoking youth and to encourage appropriate use of NRT in young smokers to maximize its potential for successful cessation.
Exogenous reinfection with multidrug-resistant Mycobacterium tuberculosis in patients with advanced HIV infection.

BACKGROUND In the United States there have been recent outbreaks of multidrug-resistant tuberculosis. These outbreaks have primarily involved persons infected with the human immunodeficiency virus (HIV). METHODS We collected clinical information on 17 patients seen at a New York City hospital who had repeatedly positive cultures for Mycobacterium tuberculosis. Analysis of restriction-fragment--length polymorphisms (RFLPs) was performed on serial isolates of M. tuberculosis obtained from these patients. RESULTS Six patients had isolates that remained drug-susceptible, and the RFLP patterns of these isolates did not change over time. Eleven patients had isolates that became resistant to antimicrobial agents. The RFLP patterns of the isolates from six of these patients remained essentially unchanged (two strains showed one additional band) despite the development of drug resistance. In five other patients, however, the RFLP patterns of the isolates changed dramatically at the time that drug resistance was detected. The change in the RFLP pattern of the isolate from one patient appeared to be the result of contamination during processing in the laboratory. In the remaining four patients, all of whom had advanced HIV disease, the clinical and microbiologic evidence was consistent with the presence of active tuberculosis caused by a new strain of M. tuberculosis. CONCLUSIONS Resistance to antituberculous drugs can develop not only in the strain that caused the initial disease, but also as a result of reinfection with a new strain of M. tuberculosis that is drug-resistant. Exogenous reinfection with multidrug-resistant M. tuberculosis can occur either during therapy for the original infection or after therapy has been completed.
Prevalence of hyperhomocysteinaemia and its major determinants in rural Chinese hypertensive patients aged 45–75 years

We aimed to investigate the prevalence of hyperhomocysteinaemia (total plasma homocysteine (tHcy) ≥ 10 μmol/l) and its major determinants in rural Chinese hypertensive patients. A cross-sectional investigation was carried out in Lianyungang of Jiangsu province, China. This analysis included 13 946 hypertensive adults. The prevalence of hyperhomocysteinaemia was 51·6 % (42·7 % in women and 65·6 % in men). The OR of hyperhomocysteinaemia were 1·52 (95 % CI 1·39, 1·67) and 2·32 (95 % CI 2·07, 2·61) for participants aged 55–65 and 65–75 v. 45–55 years; 1·27 (95 % CI 1·18, 1·37) for participants with a BMI ≥ 25 v. < 25 kg/m2; 1·14 (95 % CI 1·06, 1·23) for participants with v. without antihypertensive treatment; 1·09 (95 % CI 1·00, 1·18) for residents inland v. coastal; 0·89 (95 % CI 0·82, 0·97) and 0·83 (95 % CI 0·74, 0·92) for participants with moderate and high v. low physical activity levels; 1·54 (95 % CI 1·41, 1·68) and 2·47 (95 % CI 2·17, 2·81) for participants with a glomerular filtration rate 60–90 and < 60 v. ≥ 90 ml/min per 1·73 m2; and 1·20 (95 % CI 1·07, 1·35) and 3·81 (95 % CI 3·33, 4·36) for participants with CT and TT v. CC genotype at methylenetetrahydrofolate reductase 677C>T polymorphism, respectively. Furthermore, higher tHcy concentrations were observed in smokers of both sexes (men: geometric mean 12·1 (interquartile range (IQR) 9·2–14·5) v. 11·9 (IQR 9·3–14·0) μmol/l, P= 0·005; women: geometric mean 10·3 (IQR 8·3–13·0) v. 9·6 (IQR 7·8–11·6) μmol/l, P= 0·010), and only in males with hypertension grade 3 (v. grade 1 or controlled blood pressure) (geometric mean 12·1 (IQR 9·2–14·4) v. 11·7 (IQR 9·2–14·0), P= 0·016) and in male non-drinkers (yes v. no) (geometric mean 12·3 (IQR 9·4–14·8) v. 11·7 (IQR 9·1–13·9), P= 0·014). In conclusion, there was a high prevalence of hyperhomocysteinaemia in Chinese hypertensive adults, particularly in the inlanders, who may benefit greatly from tHcy-lowering strategies, such as folic acid supplementation and lifestyle change.