Miracle-dz/UniFAR-FTUs huggingface dataset:
Elective induction versus spontaneous labor: a case-control analysis of safety and efficacy.

The recent article by Prysak and Castronova (Obstet Gynecol 1998;92:47–52) concludes “cesarean delivery is increased significantly by nulliparity and/or an unfavorable cervix . but not by elective induction itself. ” These conclusions cannot be drawn from this study. The logistic regression model used draws from a population of 461 electively induced and 461 spontaneous labors. This artificial population does not represent all women at risk for cesarean, but only those choosing induction and equal numbers of matched age and parity controls. The study was not designed to identify factors predicting cesarean and should not be used for that purpose. Further, several variables included simultaneously in the logistic regression model are correlated (induction, oxytocin, cervical priming, epidurals, and possibly nulliparity). Their Table 1 shows that cervical priming, oxytocin, and epidurals were more common in the group that had induced delivery. Including these variables in the model simultaneously induces collinearity, which confuses the issue. Induction was not significant after adjusting for cervical priming and oxytocin. Does this mean that induction is not related to cesarean after you take away the effects of induction starting with a gel and induction with oxytocin? What is the induction variable actually measuring after you already measure the ways it is commonly done? The authors cannot conclude from their study that unfavorable cervix is associated with cesarean. While relating cervical priming to unfavorable cervix, they did not measure cervix favorability on all patients. The authors laud the benefits of induction and mention its disadvantages. Two considerable disadvantages in our hospital system, which delivers more than 5000 babies annually, are prolonged labor and increased cost. Elective inductions in our system cost an average of $218 more and take 3.5 hours more of in-hospital predelivery time than spontaneous labors (unpublished findings). Despite increased costs to the hospital, reimbursement for induced deliveries is no different than for spontaneous labors. The authors are to be commended for reviewing the charts of more than 900 patients. Their study provides valuable information comparing induced to spontaneous labors in low-risk patients. However, their conclusions related to induction and risk of cesarean are not based on sound methodology.
Effects of Co-occurring Genomic Alterations on Outcomes in Patients with KRAS-Mutant Non–Small Cell Lung Cancer

Purpose: KRAS mutations occur in approximately 25% of patients with non–small cell lung cancer (NSCLC). Despite the uniform presence of KRAS mutations, patients with KRAS-mutant NSCLC can have a heterogeneous clinical course. As the pattern of co-occurring mutations may describe different biological subsets of patients with KRAS-mutant lung adenocarcinoma, we explored the effects of co-occurring mutations on patient outcomes and response to therapy. Experimental Design: We identified patients with advanced KRAS-mutant NSCLC and evaluated the most common co-occurring genomic alterations. Multivariate analyses were performed incorporating the most frequent co-mutations and clinical characteristics to evaluate association with overall survival as well as response to platinum–pemetrexed chemotherapy and immune checkpoint inhibitors. Results: Among 330 patients with advanced KRAS-mutant lung cancers, the most frequent co-mutations were found in TP53 (42%), STK11 (29%), and KEAP1/NFE2L2 (27%). In a multivariate analysis, there was a significantly shorter survival in patients with co-mutations in KEAP1/NFE2L2 [HR, 1.96; 95% confidence interval (CI), 1.33–2.92; P ≤ 0.001]. STK11 (HR, 1.3; P = 0.22) and TP53 (HR 1.11, P = 0.58) co-mutation statuses were not associated with survival. Co-mutation in KEAP1/NFE2L2 was also associated with shorter duration of initial chemotherapy (HR, 1.64; 95% CI, 1.04–2.59; P = 0.03) and shorter overall survival from initiation of immune therapy (HR, 3.54; 95% CI, 1.55–8.11; P = 0.003). Conclusions: Among people with KRAS-mutant advanced NSCLC, TP53, STK11, and KEAP1/NFE2L2 are the most commonly co-occurring somatic genomic alterations. Co-mutation of KRAS and KEAP1/ NFE2L2 is an independent prognostic factor, predicting shorter survival, duration of response to initial platinum-based chemotherapy, and survival from the start of immune therapy. Clin Cancer Res; 24(2); 334–40. ©2017 AACR.
D(+)-Glyceric Aciduria: Etiology and Clinical Consequences

ABSTRACT: A family comprising mother, father, and five children is described. Four of the children were found to excrete massive amounts of D(+)-glyceric acid in their urine. This was verified by gas chromatography-mass spectrometry and the configuration determined by capillary gas chromatography of O-acetylated menthyl esters. The excretion ranged from 10.8 to 19.9 mmol/24 h. The remaining child and the parents showed no evidence of this unusual metabolite. The virtual absence of clinical manifestations in this family was particularly interesting. Only two of the children showed any clinical abnormality and this was limited to mild microcephaly and speech delay; the other two children found to excrete large amounts of D(+)- glycerate were healthy and developmentally normal at 7 y and 9 y of age. There was a marked increase in the excretion rate of D(+)-glycerate in response to both oral fructose and serine loading. These results are consistent with a deficiency of D(+)-glycerate kinase and indicate the potentially benign nature of this disorder.
Alteration textures in terrestrial volcanic glass and the associated bacterial community

Alteration textures were examined in subglacial (hyaloclastite) deposits at Valafell, Southern Iceland. Pitted and ‘elongate’ alteration features are observed in the glass similar to granular and tubular features reported previously in deep‐ocean basaltic glasses, but elongate features generally did not have a length to width ratio greater than five. Elongate features were found in only 7% of surfaces. Crystalline basalt clasts, which are incorporated into the hyaloclastite, did not display elongate structures. Pitted alteration features were poorly defined in crystalline basalt, comprising only 4% of the surface compared to 47% in the case of basaltic glass. Examination of silica‐rich glass (obsidian) and rhyolite similarly showed poorly defined pitted textures that comprised less than 15% of the surface and no elongate features were observed. These data highlight the differences in alteration textures between terrestrial basaltic glass and previously studied deep‐ocean and subsurface basaltic glass, and the important role of mineralogy in controlling the type and abundance of alteration features. The hyaloclastite contains a diverse and abundant bacterial population, as determined by 16S rDNA analysis, which could be involved in weathering the glass. Despite the presence of phototrophs, we show that they were not involved in the production of most alteration textures in the basaltic glass materials we examined.
Peripheral arterial disease in community-based patients with diabetes in Singapore: Results from a Primary Healthcare Study.

INTRODUCTION Peripheral arterial disease (PAD) is an important complication of diabetes mellitus (DM), significantly associated with increased morbidity and mortality secondary to amputations, strokes and coronary artery disease. Information on DM patients with PAD is limited in our ethnically diverse population in Singapore. We aimed to determine the prevalence, risk factors and co-morbidities of PAD in patients managed for DM in the primary care setting. MATERIALS AND METHODS A cross-sectional study was conducted among 521 diabetics in 9 of the 18 government-aided clinics in the community. Data including demographics, presence of co-morbidities and vascular risk factors were collected using an interviewer-administered questionnaire, and Ankle-Brachial Index (ABI) was calculated from systolic ankle and brachial pressure measurements. RESULTS The prevalence of PAD, defi ned as resting ABI of <0.9 on either leg and/or a history of gangrene or non-traumatic amputation was 15.2% [95% confidence interval (CI), 12.3-18.5]. This prevalence of PAD was higher in patients with pre-existing microvascular and other macrovascular complications. In multivariate analysis, prevalence of PAD was positively associated with increasing age (OR, 1.08; 95% CI, 1.05-1.12), Malay versus Chinese ethnicity (OR, 2.27; 95% CI, 1.09-4.70), low HDL-cholesterol (OR, 1.87; 95% CI, 1.04- 3.37), and insulin treatment (OR, 2.98; 95%CI, 1.39-6.36). CONCLUSION PAD is an important cause of concern among patients with diabetes, with a high prevalence which further increases with increasing age and duration of DM, and exhibits ethnic variation. Risk factors identified in this study may improve early identification of PAD, allowing for prompt interventions, with a potential to reduce long-term morbidity and mortality.
Treatment with 1,25‐dihydroxyvitamin D3 reduces impairment of human osteoblast functions during cellular aging in culture

Adequate responses to various hormones, such as 1,25‐dihydroxyvitamin D3 (calcitriol) are a prerequisite for optimal osteoblast functions. We have previously characterized several human diploid osteoblastic cell lines that exhibit typical in vitro aging characteristics during long‐term subculturing. In order to study in vitro age‐related changes in osteoblast functions, we compared constitutive mRNA levels of osteoblast‐specific genes in early‐passage (< 50% lifespan completed) with those of late‐passage cells (> 90% lifespan completed). We found a significant reduction in mRNA levels of alkaline phosphatase (AP: 68%), osteocalcin (OC: 67%), and collagen type I (ColI: 76%) in in vitro senescent late‐passage cells compared to early‐passage cells, suggesting an in vitro age‐related impairment of osteoblast functions. We hypothesized that decreased osteoblast functions with in vitro aging is due to impaired responsiveness to calcitriol known to be important for the regulation of biological activities of the osteoblasts. Thus, we examined changes in vitamin D receptor (VDR) system and the osteoblastic responses to calcitriol treatment during in vitro osteoblast aging. We found no change in the amount of VDR at either steady state mRNA level or protein level with increasing in vitro osteoblast age and examination of VDR localization, nuclear translocation and DNA binding activity revealed no in vitro age‐related changes. Furthermore, calcitriol (10−8M) treatment of early‐passage osteoblastic cells inhibited their proliferation by 57 ± 1% and stimulated steady state mRNA levels of AP (1.7 ± 0.1‐fold) and OC (1.8 ± 0.2‐fold). Similarly, calcitriol treatment increased mRNA levels of AP (1.7 ± 0.2‐fold) and OC (3.0 ± 0.3‐fold) in late‐passage osteoblastic cells. Thus, in vitro senescent osteoblastic cells maintain their responsiveness to calcitriol and some of the observed in vitro age‐related decreases in biological markers of osteoblast functions can be reverted by calcitriol treatment. J. Cell. Physiol. 186:298–306, 2001. © 2001 Wiley‐Liss, Inc.
Phenytoin and carbamazepine, alone and in combination

Comedication with phenytoin and carbamazepine is frequently used in patients with refractory seizures, although the benefit of this strategy has not been established. To assess whether the combination is a rational anticonvulsant treatment, we determined the therapeutic index (toxicity:efficacy ratio) for the drugs, alone and together, in mice. The individual agents were virtually identical in anticonvulsant and neurotoxic activity, and combined use had no additional therapeutic advantage. Analysis of drug concentrations in brain showed an additive pharmacodynamic interaction for phenytoin and carbamazepine, indicating that the combination is unlikely to be superior to either drug alone. Thus, we find no experimental justification for the simultaneous use of phenytoin and carbamazepine in the treatment of epilepsy.
"Knowing What You Don't Know": Language Insight in Semantic Dementia.

BACKGROUND Reduced insight commonly occurs in dementia and can be specific to one area of functioning. Despite recent models identifying a role for semantic memory, little investigation of insight has been conducted in semantic dementia (SD), with patients often described as being aware of their language problems. OBJECTIVE This study aims to investigate language insight in SD. METHOD Twenty-two SD (n = 11 severe, n = 11 mild-moderate) and 9 nonfluent primary progressive aphasic patients completed three experimental language tasks to assess knowledge and awareness of certain words. Skills in evaluating language were tested by comparing performance ratings on the Cookie Theft task with objective scoring. Awareness regarding the existence and previous use of certain words was tested using two additional tasks. RESULTS While SD patients were as accurate as nonfluent patients in rating their own performance on the Cookie Theft immediately following the task, they were significantly poorer at evaluating the same content re-recorded, or other examples of poor language. Compared to nonfluent patients, severe SD patients also made more errors identifying previously known low frequency words. Lastly, when tested on labels for specific aspects of an object, only SD patients made errors regarding the existence, or their past knowledge, of certain words. CONCLUSION SD patients show a general awareness of their language impairments, but have difficulty evaluating language content. These difficulties adversely affect the ability to reflect upon current and past language skills producing an under-awareness of language deficits. This mild, secondary form of anosognosia appears to increase with greater levels of semantic impairment.
Adjustment disorders: the state of the art

Adjustment disorders are common, yet under-researched mental disorders. The present classifications fail to provide specific diagnostic criteria and relegate them to sub-syndromal status. They also fail to provide guidance on distinguishing them from normal adaptive reactions to stress or from recognized mental disorders such as depressive episode or post-traumatic stress disorder. These gaps run the risk of pathologizing normal emotional reactions to stressful events on the one hand and on the other of overdiagnosing depressive disorder with the consequent unnecessary prescription of antidepressant treatments. Few of the structured interview schedules used in epidemiological studies incorporate adjustment disorders. They are generally regarded as mild, notwithstanding their prominence as a diagnosis in those dying by suicide and their poor prognosis when diagnosed in adolescents. There are very few intervention studies.
MIS success: why does it vary among users?

Organizations have been developing and implementing computer-based management information systems (MIS) at an increasing rate for the last 35 years. However, evidence indicates that many computer-based MIS are not as successful as they should be and many may be considered failures.There has been much research to investigate organizational factors, individual differences, user involvement and their relationship to MIS success, and in particular, one indicator of MIS success, user information satisfaction (UIS). Little attention, however, has been paid to whether UIS for any particular MIS varies for users from different organization functions and different management levels within an organization.This paper reports the results of a field study of MIS in different organizations in Australia which investigates the relationship between type of user, user involvement and user information satisfaction. The results show that MIS success (UIS) varies between users of the same MIS based on their organizational function and that user involvement in the systems development life cycle (SDLC) has a significant positive effect on UIS. The significance of the effect of user involvement varies for users based on their organizational function. Technical users are less satisfied with MIS than administrative users. The relationship between user involvement and user control of the systems development process and UIS is significantly different for administrative and technical users.
Empreendedorismo jovem e a influência da família: a história de vida de uma empreendedora de sucesso

As caracteristicas pessoais dos empreendedores e os fatores que influenciam suas escolhas, acoes e comportamentos sao temas relevantes para a compreensao do processo de criacao de negocios. O objetivo deste estudo e analisar os fatores que influenciaram ou determinaram a trajetoria de uma jovem que iniciou seu negocio aos treze anos de idade. Mais especificamente, pretendeu-se analisar a influencia da familia nessa trajetoria e identificar as caracteristicas mais marcantes que contribuiram para seu sucesso. Essa jovem empreendedora foi escolhida para este estudo de caso, pois sua experiencia singular - de iniciar um empreendimento em idade tao precoce - permite explorar novos insights sobre as caracteristicas mais marcantes que influenciaram o sucesso de seu negocio. Adotou-se a estrategia de estudo de caso e utilizou-se a historia de vida como tecnica de coleta de dados, com a realizacao de entrevista em profundidade. Observou-se que a influencia dos pais foi decisiva para a criacao e desenvolvimento do negocio e que algumas caracteristicas de empreendedores encontradas em outros estudos foram facilmente identificadas na jovem empreendedora, a exemplo de determinacao, criatividade, desejo de independencia, aprendizagem continua e utilizacao de redes de relacionamentos
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.

BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors--elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle--are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. METHODS We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups. RESULTS The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin. CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.
Disregarding RBE variation in treatment plan comparison may lead to bias in favor of proton plans.

PURPOSE Currently in proton radiation therapy, a constant relative biological effectiveness (RBE) equal to 1.1 is assumed. The purpose of this study is to evaluate the impact of disregarding variations in RBE on the comparison of proton and photon treatment plans. METHODS Intensity modulated treatment plans using photons and protons were created for three brain tumor cases with the target situated close to organs at risk. The proton plans were optimized assuming a standard RBE equal to 1.1, and the resulting linear energy transfer (LET) distribution for the plans was calculated. In the plan evaluation, the effect of a variable RBE was studied. The RBE model used considers the RBE variation with dose, LET, and the tissue specific parameter α/β of photons. The plan comparison was based on dose distributions, DVHs and normal tissue complication probabilities (NTCPs). RESULTS Under the assumption of RBE=1.1, higher doses to the tumor and lower doses to the normal tissues were obtained for the proton plans compared to the photon plans. In contrast, when accounting for RBE variations, the comparison showed lower doses to the tumor and hot spots in organs at risk in the proton plans. These hot spots resulted in higher estimated NTCPs in the proton plans compared to the photon plans. CONCLUSIONS Disregarding RBE variations might lead to suboptimal proton plans giving lower effect in the tumor and higher effect in normal tissues than expected. For cases where the target is situated close to structures sensitive to hot spot doses, this trend may lead to bias in favor of proton plans in treatment plan comparisons.
Vascular endothelial growth factor promotes fibrosis resolution and repair in mice.

BACKGROUND & AIMS Vascular endothelial growth factor (VEGF)-induced angiogenesis is implicated in fibrogenesis and portal hypertension. However, the function of VEGF in fibrosis resolution has not been explored. METHODS We developed a cholecystojejunostomy procedure to reconstruct biliary flow after bile duct ligation in C57BL/6 mice to generate a model of fibrosis resolution. These mice were then given injections of VEGF-neutralizing (mcr84) or control antibodies, and other mice received an adenovirus that expressed mouse VEGF or a control vector. The procedure was also performed on macrophage fas-induced apoptosis mice, in which macrophages can be selectively depleted. Liver and blood samples were collected and analyzed in immunohistochemical, morphometric, vascular permeability, real-time polymerase chain reaction, and flow cytometry assays. RESULTS VEGF-neutralizing antibodies prevented development of fibrosis but also disrupted hepatic tissue repair and fibrosis resolution. During fibrosis resolution, VEGF inhibition impaired liver sinusoidal permeability, which was associated with reduced monocyte migration, adhesion, and infiltration of fibrotic liver. Scar-associated macrophages contributed to this process by producing the chemokine (C-X-C motif) ligand 9 (CXCL9) and matrix metalloproteinase 13. Resolution of fibrosis was impaired in macrophage fas-induced apoptosis mice but increased after overexpression of CXCL9. CONCLUSIONS In a mouse model of liver fibrosis resolution, VEGF promoted fibrogenesis, but was also required for hepatic tissue repair and fibrosis resolution. We observed that VEGF regulates vascular permeability, monocyte infiltration, and scar-associated macrophages function.