Miracle-dz/UniFAR-FTUs huggingface dataset:
Anterior cruciate ligament reconstruction: principles of treatment

Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures in sports medicine. Several areas of controversy exist in ACL tear management which have engaged surgeons and researchers in debates towards identifying an ideal approach for these patients. This instructional review discusses the principles of ACL reconstruction in an attempt to provide guidelines and initiate a critical thinking approach on the most common areas of controversy regarding ACL reconstruction. Using high-level evidence from the literature, as presented in randomised controlled trials, systematic reviews, and meta-analyses, operative versus conservative treatment, timing of surgery, and rehabilitation are discussed. Also, the advantages and disadvantages of the most common types of autografts, such as patellar tendon and hamstrings as well as allografts are presented. Key considerations for the anatomical, histological, biomechanical and clinical data (‘IDEAL’) graft positioning are reviewed. Cite this article: Paschos NK, Howell SM. Anterior cruciate ligament reconstruction: principles of treatment. EFORT Open Rev 2016;398-408. DOI: 10.1302/2058-5241.1. 160032.
Effect of air flow rate and C/N ratio on biological nitrogen removal through the CANON process treating reject water

ABSTRACT The CANON process is a promising method for nitrogen removal in wastewaters with low organic carbon content like reject water. This study investigated the effect of important factors for optimization of the CANON process through inhibition of nitrite-oxidizing bacteria (NOB). In the acclimation period, complete ammonium removal and 43.3% total N removal were obtained at hydraulic retention time of 12 h, temperature of 30°C ± 0.5°C and DO equal to 7–9 mg/L. The effects of air flow rate (AFR) (representative of DO), SRT and C/N were evaluated. Air flow rate was the most important factor for controlling the process, but the effect of SRT was negligible. When AFR was increased from 100 to 500 mL/min, both ammonium removal efficiency (33–43% to 81–83%) and nitrite accumulation (nitritation, 40 mgN/L to 100–120 mgN/L) were increased, but with increasing AFR to 1000 mL/min only ammonium removal efficiency was increased and because of better condition (high DO) for NOBs, nitritation was decreased. C/N had an effect like AFR of 1000 and only increased ammonium removal efficiency and total N removal. With increasing AFR and C/N, both OUR and AUR were increased, but SVI was decreased.
Leg and joint stiffness in human hopping

The present study investigated the regulation of leg and joint stiffness in hopping at different intensity levels. Eight male subjects performed bilateral hopping at various intensity levels that were determined by peak vertical ground reaction force (GRF). In addition to the GRF, the measurements included hopping kinematics and electromyography (EMG) of selected leg muscles. While the leg and ankle joint stiffness remained invariant, the knee joint stiffness increased significantly (P<0.01) with the hopping intensity. EMG analysis revealed a significant increase in averaged EMG for all the measured muscles before and during the early phase of ground contact (P<0.05–0.001) with increasing hopping intensity. However, only the vastus lateralis muscle showed significant increase in stretch reflex EMG with increasing hopping intensity (P<0.01). The present study indicates that in hopping with short contact time the leg stiffness modulation is sensitive to changes in ankle joint stiffness and the role of knee joint stiffness is to regulate the jumping performance (height). Furthermore, our results suggest that leg and joint stiffness in hopping is mainly adjusted by centrally programmed motor commands and the contribution of stretch reflexes to muscle force output is muscle‐dependent.
Acute papilledema and visual loss in a patient with pseudotumor cerebri.

To the Editor. —Patients with papilledema usually retain normal visual acuity. I recently evaluated and treated a patient with pseudotumor cerebri in whom marked loss of central vision developed in the acute stage of papilledema. Report of a Case. —A 33-year-old male professional trumpet player weighing 184.5 kg complained of blurred vision of recent onset in both eyes. On examination, visual acuity was 20/200 OU. Visual fields demonstrated that both blind spots were greatly enlarged and that each extended centrally to involve fixation. Peripheral isopters showed very slight constriction. The patient could slowly identify 24 of 24 Ishihara color test plates with each eye. Pupillary responses were normal. Fundus examination revealed massive disc swelling with extensive retinal and preretinal hemorrhage in both eyes (Figure). In addition, bilateral serous detachments of the macula were noted. A computed tomographic scan of the head was normal. A lumbar puncture was performed and revealed
Immediate resection in emergency large bowel surgery: a 7 year audit

In a consecutive series of 153 emergency admissions with large bowel disease during a 7 year period, 49 per cent were for colonic obstruction, 46 per cent for peritonitis and 5 per cent for miscellaneous conditions. Urgent operation was performed on 104 (68 per cent) patients. Of those operated upon, 82 (79 per cent) had a primary resection with a mortality rate of 12·2 per cent, intraperitoneal sepsis rate of 2·4 per cent and wound sepsis rate of 7·3 per cent. The median postoperative hospital stay was 21 days. An immediate anastomosis was performed in 46 (56 per cent) patients with a mortality rate of 8·7 per cent, anastomotic leak rate of 2·2 per cent, and wound sepsis rate of 8·7 per cent. The median postoperative hospital stay was 19 days.
Using ICT to increase professional connectedness for teachers in remote Australia

Connecting with other education professionals is important in supporting teacher learning. Teachers in remote locations in Australia experience a professional isolation due to geographic isolation that makes it difficult to engage in sustained collaborations with other teachers. In a national project ICT was used to assist these teachers by connecting them for the purposes of having reciprocal interactions and developing a sense of community, both of which facilitate professional connectedness. A five-phase Transformative Professional Learning Model supported by the use of ICT, in particular videoconferencing was implemented for teachers in remote locations across five different states of Australian. These teachers reported a sense of an expanded professional connection despite technical issues during the videoconferencing sessions used to support some phases of the model. To improve the sustainability of the connection of remotely-located teachers in the future it is recommended that the model be modified to include videoconference-based connection in each phase rather than just focusing on synchronous inter-teacher communication at the introductory and concluding phases of the professional learning.
Characterization of E-cadherin Endocytosis in Isolated MCF-7 and Chinese Hamster Ovary Cells

The endocytosis of E-cadherin has recently emerged as an important determinant of cadherin function with the potential to participate in remodeling adhesive contacts. In this study we focused on the initial fate of E-cadherin when it predominantly exists free on the cell surface prior to adhesive binding or incorporation into junctions. Surface-labeling techniques were used to define the endocytic itinerary of E-cadherin in MCF-7 cells and in Chinese hamster ovary cells stably expressing human E-cadherin. We found that in this experimental system E-cadherin entered a transferrin-negative compartment before transport to the early endosomal compartment, where it merged with classical clathrin-mediated uptake pathways. E-cadherin endocytosis was inhibited by mutant dynamin, but not by an Eps15 mutant that effectively blocked transferrin internalization. Furthermore, sustained signaling by the ARF6 GTPase appeared to trap endocytosed E-cadherin in large peripheral structures. We conclude that in isolated cells unbound E-cadherin on the cell surface is predominantly endocytosed by a clathrin-independent pathway resembling macropinocytotic internalization, which then fuses with the early endosomal system. Taken with earlier reports, this suggests the possibility that multiple pathways exist for E-cadherin entry into cells that are likely to reflect cell context and regulation.
A short peptide at the C terminus is responsible for the nuclear localization of RAG2

The RAG1 and RAG2 proteins are the lymphoid‐specific factors essential for V(D)J recombination, the process that leads to the diversification of antigen receptors on B and T lymphocytes. Nucleolar/nuclear localization of RAG1 is mediated by four basic domains, which are the binding sites for the nuclear transport proteins SRP1 and RCH1, and by a nuclear localization signal (NLS) in the fifth basic domain. The C‐terminal region of RAG2 from amino acids (aa) 417 to 484 shows a homology with the PHD domain of other proteins involved in chromatin‐mediated gene regulation by protein‐protein interactions. Mutations in this domain were shown to be responsible for several diseases and in some case lead to altered subcellular localization of proteins. We found that the C‐terminal PHD domain of RAG2 is not responsible for the nuclear localization of the protein. We report here the characterization of a region (aa 491–527) in the C‐terminal domain of RAG2, downstream of the putative PHD domain, which directs the nuclear localization of the protein.
Association of prostate stem cell antigen gene polymorphisms with the risk of stomach cancer in Japanese

A recent whole‐genome association study identified a strong association between polymorphisms in the prostate stem cell antigen (PSCA) gene and stomach cancer risk. In this case‐control study, we aimed to validate this association, and further to explore environmental factors possibly interacting with PSCA polymorphisms in 708 incident stomach cancer cases and 708 age–sex matched controls. The association between PSCA polymorphisms and Helicobacter pylori infection was also examined. We found that rs2294008 and rs2976392, which were strongly linked to each other (D′ = 1.00), were significantly associated with stomach cancer risk. Per allele odds ratio for rs2994008 was 1.40 (95% confidence interval: 1.19–1.65; p = 3.7 × 10−5). We found significant interaction with a family history of stomach cancer in first‐degree relatives (p‐heterogeneity = 0.009). Similar to originally reported association, we found significant heterogeneity between diffuse and intestinal type (p‐heterogeneity = 0.007). No association was seen between PSCA polymorphisms and H. pylori infection. In conclusion, PSCA polymorphisms are associated with stomach cancer risk in Japanese. A possible interaction with family history warrants further evaluation. © 2009 UICC
Initial low frequency vibrations of the first heart sound.

The low frequency, earliest component of the first heart sound 'M' was studied in 53 subjects. It is present in normal subjects and in patients in whom prosthetic replacement of one or both atrioventricular valves have been undertaken whether they are in sinus rhythm or in atrialfibrillation. After prosthetic valve replacement 'M' is often accentuated. 'M' is not caused by atrial activity, tricuspid valve closure, or valve cusp coaption. It corresponds to the initial movement of the apical ventricular impulse and is produced by resonance of ventricular blood, myocardium, and the atrioventricular valve ring.
Hes6 Promotes Cortical Neurogenesis and Inhibits Hes1 Transcription Repression Activity by Multiple Mechanisms

ABSTRACT Hes1 is a mammalian basic helix-loop-helix transcriptional repressor that inhibits neuronal differentiation together with corepressors of the Groucho (Gro)/Transducin-like Enhancer of split (TLE) family. The interaction of Hes1 with Gro/TLE is mediated by a WRPW tetrapeptide present in all Hairy/Enhancer of split (Hes) family members. In contrast to Hes1, the related protein Hes6 promotes neuronal differentiation. Little is known about the molecular mechanisms that underlie the neurogenic activity of Hes6. It is shown here that Hes6 antagonizes Hes1 function by two mechanisms. Hes6 inhibits the interaction of Hes1 with its transcriptional corepressor Gro/TLE. Moreover, it promotes proteolytic degradation of Hes1. This effect is maximal when both Hes1 and Hes6 contain the WRPW motif and is reduced when Hes6 is mutated to eliminate a conserved site (Ser183) that can be phosphorylated by protein kinase CK2. Consistent with these findings, Hes6 inhibits Hes1-mediated transcriptional repression in cortical neural progenitor cells and promotes the differentiation of cortical neurons, a process that is normally inhibited by Hes1. Mutation of Ser183 impairs the neurogenic ability of Hes6. Taken together, these findings clarify the molecular events underlying the neurogenic function of Hes6 and suggest that this factor can antagonize Hes1 activity by multiple mechanisms.
Clinical and pharmacologic evaluation of cefazolin in children.

Children between six months and 15 years of age with pneumonia, osteomyelitis, gastroenteritis, or infections of soft tissue were treated with cefazolin parenterally. Prior to initiation of therapy, blood and other appropriate material from the site of infection were obtained for smear and bacterial culture. The first 12 patients received cefazolin im in a dose of 25-50 mg/kg per day. An additional 19 patients participated in a randomized protocol, in which the majority of patients received either cefazolin (50 mg/kg per day) or cephalothin (100 mg/kg per day). When organisms susceptible to cefazolin had been isolated, the clinical response to cefazolin was satisfactory in every case. Significant adverse effects of therapy were not encountered. Concentrations of drug in serum after im administration of 6.25 mg/kg doses of cefazolin exceeded the serum concentrations after im administration of 25 mg/kg of cephalothin. Following iv therapy, higher con
Carcinoma of the uterine cervix associated with pregnancy.

1. A group of 66 cases of carcinoma of the cervix associated with pregnancy seen at the I. Gonzalez Martinez Oncologic Hospital in a 23 year period has been reviewed2. Irradiation is considered the treatment of choice. The results obtained are comparable to those obtained with lesions of similar stage not associated with pregnancy.3. First and second trimester cases should be submitted to pelvic irradiation without consideration of the fetus. Third trimester patients should be promptly delivered by cesarean section and then irradiated.4. Thirty-four patients with carcinoma of the cervix gave birth vaginally and 12 (35 per cent) survived 5 years or longer, showing that a significant number can overcome the risk involved.
Relationship of the body mass index and childhood psoriasis in a Chinese Han population: A hospital‐based study

for antinuclear antibody and anti-Jo-1 antibody were negative. The serum C-reactive protein level was within normal limits (0.11 mg ⁄ dL, normal 0.0–0.3 mg ⁄ dL), and the result for serum matrix metalloproteinase-3 was transiently positive (82.8 ng ⁄ mL, normal 17.3–59.7 ng ⁄ mL) at the initial examination. Skin biopsy was performed from a lesion on the left cheek. Histological examination revealed giant cells in the upper to the middle dermis, containing eosinophilic and fine granular cytoplasm (Fig. 2a). Immunohistochemical examination revealed positive staining for CD68 and periodic acid-Schiff (Fig. 2b), and negative staining for S-100 protein, CD1a and Factor XIIIa. Plain X-rays of the hands revealed bony erosions of the distal interphalangeal joint of the second, third and fifth fingers of both sides. Bony erosions and narrowing of the central lumen of the fifth PIP joints of both sides were also seen. The interphalangeal joint of the left thumb was in a state of subluxation. Based on these findings, we made the diagnosis of multicentric reticulohistiocytosis (MR). The patient was started on treatment with oral prednisolone, 5 mg daily. Marked improvement of the eruptions was noted after 3 months of therapy with prednisolone; however, the joint deformities persisted. Multicentric reticulohistiocytosis is classified as a non-Langerhans cell-type of histiocytosis of unknown etiology. The eruptions are usually pink in color, with firm or hard papules measuring a few millimeters in size. The common sites of the lesions in MR are the dorsal aspects of the lower arms, hands and fingers. The ‘‘coral beads’’ sign around a nail is a characteristic clinical feature. The female-to-male ratio is 1.85:1. Arthritis is a common initial presenting feature of MR, and is seen at presentation in approximately 60% of the patients. The mean age at onset is usually in the 50s. Because 20–31% of the patients have an associated internal malignancy, screening for the presence of malignancies is essential when a diagnosis of MR is made. The skin manifestations in our case preceded the arthritis, and screening revealed no malignant tumors. The eruptions were characteristically distributed on the sun-exposed areas of the skin in our case. MR sometimes presents with skin manifestations mimicking those of dermatomyositis. According to MuñozSantos et al., five cases of MR with lesions closely mimicking those of dermatomyositis have been reported in the published work. The eruptions were distributed on the photo-exposed areas of the skin in three of these five cases. Characteristically, none of the three patients of MR with skin lesions mimicking those of dermatomyositis had any internal malignancy. We could not determine the reason for the eruptions mainly affecting the sunexposed areas. Because mild photosensitivity to ultraviolet A was observed (minimal response dose 37.5 mJ ⁄ cm) in our case, and Koebner’s phenomenon has been reported in MR, we suggest that the photo-Koebner’s phenomenon may have given rise to the eruption prior to sun-exposed areas.
Risk Factors of Venous Thromboembolism in Indian Patients with Pelvic-Acetabular Trauma

Purpose. To determine risk factors of venous thromboembolism (VTE) in Indian patients undergoing surgery for pelvic-acetabular fractures. Methods. 48 men and 8 women aged 17 to 61 (mean, 36) years who underwent open reduction and internal fixation for pelvic-acetabular fractures were evaluated for VTE in the postoperative period. Pulmonary angiography and indirect computed tomographic venography were used in the hospital, whereas colour Doppler ultrasonography was used in an outpatient setting until postoperative week 6. Patients with evidence of VTE were treated according to the American College of Chest Physician guidelines. Correlations between VTE and putative variable were assessed, and risk factors determined. Results. 16 patients developed VTE. Six patients with proximal DVT had associated pulmonary embolism (PE). There were 12 cases of proximal deep vein thrombosis (DVT), 2 cases of distal DVT, and 10 cases of PE. The rate of VTE was significantly higher in patients who had predominantly posterior injury (as opposed to anterior injury) [13/27 vs. 3/29, p=0.003], who were operated on in the lateral position (as opposed to the supine position) [13/30 vs. 3/26, p=0.016], or via the Kocher-Langenbeck or combined approach (as opposed to others) [13/30 vs. 3/26, p=0.016]. Patients were more likely to develop VTE when they had predominantly posterior injuries (7.8 fold) or were operated on in a lateral position (2.96 fold) or via the Kocher-Langenbeck approach (2.27 fold). Conclusion. Pelvic-acetabular trauma is a significant risk factor for VTE, even in Indians. Patients who have posterior injuries or are operated on in the lateral position, or via the Kocher-Langenbeck approach have a significantly higher risk of VTE.
Osteoarthritis guidelines: a progressive role for topical nonsteroidal anti-inflammatory drugs

Current treatment guidelines for the treatment of chronic pain associated with osteoarthritis reflect the collective clinical knowledge of international experts in weighing the benefits of pharmacologic therapy options while striving to minimize the negative effects associated with them. Consideration of disease progression, pattern of flares, level of functional impairment or disability, response to treatment, coexisting conditions such as cardiovascular disease or gastrointestinal disorders, and concomitant prescription medication use should be considered when creating a therapeutic plan for a patient with osteoarthritis. Although topical nonsteroidal anti-inflammatory drugs historically have not been prevalent in many of the guidelines for osteoarthritis treatment, recent evidence-based medicine and new guidelines now support their use as a viable option for the clinician seeking alternatives to typical oral formulations. This article provides a qualitative review of these treatment guidelines and the emerging role of topical nonsteroidal anti-inflammatory drugs as a therapy option for patients with localized symptoms of osteoarthritis who may be at risk for oral nonsteroidal anti-inflammatory drug-related serious adverse events.
Predicting the Risk of Clostridium difficile Infection upon Admission: A Score to Identify Patients for Antimicrobial Stewardship Efforts.

INTRODUCTION Increasing morbidity and health care costs related to Clostridium difficile infection (CDI) have heightened interest in methods to identify patients who would most benefit from interventions to mitigate the likelihood of CDI. OBJECTIVE To develop a risk score that can be calculated upon hospital admission and used by antimicrobial stewards, including pharmacists and clinicians, to identify patients at risk for CDI who would benefit from enhanced antibiotic review and patient education. METHODS We assembled a cohort of Kaiser Permanente Northwest patients with a hospital admission from July 1, 2005, through December 30, 2012, and identified CDI in the six months following hospital admission. Using Cox regression, we constructed a score to identify patients at high risk for CDI on the basis of preadmission characteristics. We calculated and plotted the observed six-month CDI risk for each decile of predicted risk. RESULTS We identified 721 CDIs following 54,186 hospital admissions-a 6-month incidence of 13.3 CDIs/1000 patient admissions. Patients with the highest predicted risk of CDI had an observed incidence of 53 CDIs/1000 patient admissions. The score differentiated between patients who do and do not develop CDI, with values for the extended C-statistic of 0.75. Predicted risk for CDI agreed closely with observed risk. CONCLUSION Our risk score accurately predicted six-month risk for CDI using preadmission characteristics. Accurate predictions among the highest-risk patient subgroups allow for the identification of patients who could be targeted for and who would likely benefit from review of inpatient antibiotic use or enhanced educational efforts at the time of discharge planning.