Miracle-dz/UniFAR-FTUs huggingface dataset:
Pitfalls in Communication That Lead to Nonbeneficial Emergency Surgery in Elderly Patients With Serious Illness: Description of the Problem and Elements of a Solution

Objective:To provide a description of communication breakdowns and to identify interventions to improve surgical decision making for elderly patients with serious illness and acute, life-threatening surgical conditions. Background:Communication between surgeons, patients, and surrogates about goals of treatment plays an important and understudied role in determining the surgical interventions elderly patients with serious illness receive. Communication breakdowns may lead to nonbeneficial procedures in acute events near the end of life. Methods:We review the available literature on factors that lead to communication challenges and nonbeneficial surgery at the end of life. We use this review to identify solutions for navigating surgical decision making for seriously ill elderly patients with acute surgical conditions. Results:Surgeon, patient, surrogate, and systemic factors—including time constraints, inadequate provider communication skills and training, uncertainty about prognosis, patient and surrogate anxiety and fear of inaction, and limitations in advance care planning—contribute to communication challenges and nonbeneficial surgery at the end of life. Surgeons could accomplish more effective communication with seriously ill elderly patients if they had a structured, standardized approach to exploring patients' preferences and to integrating those preferences into surgical decisions in the acute setting. Conclusions:Improved communication among surgeons, patients, and surrogates is necessary to ensure that patients receive the care that they want and to avoid nonbeneficial treatment. Further research is needed to learn how to best structure these conversations in the emergency surgical setting.
Late relapse of testicular cancer.

PURPOSE This study analyzed a large group of patients with testicular germ cell cancer in complete remission, who relapsed more than 2 years after completion of treatment. PATIENTS AND METHODS A review of all patients treated at Indiana University Medical Center from 1979 through 1992 for late relapse was conducted. Eighty-one patients were treated for late relapse of testicular cancer. Forty-seven patients relapsed more than 5 years after successful management of their initial disease. RESULTS At initial diagnosis, 35 patients had clinical stage I, 18 stage II, and 28 stage III disease. Twenty-three of 35 stage I, all 18 stage II, and all 28 stage III patients were treated by chemotherapy before their late relapse. The median follow-up duration of patients post-management of late relapse was 4.8 years. Twenty-one patients (25.9%) are continuously disease-free. Nineteen of these 21 patients had surgical resection of carcinoma or teratoma as a component of their therapy. Of sixty-five patients treated for late relapse by chemotherapy, 17 (26.2%) had a complete response, but only two have been continuously disease-free with chemotherapy alone. These two never received prior chemotherapy. CONCLUSION Late relapse of testis cancer is more common than previously thought. Surgery is the preferred mode of therapy. Chemotherapy has only modest success in this entity, in contrast to the excellent results in de novo germ cell tumors. Patients treated for testicular germ cell cancer need annual follow-up evaluations throughout their life due to the possibility of late relapse.
Õpetaja professionaalse rolli internaliseerimise hindamine õpetajakoolituse esmaõppe üliõpilaste hulgas

Artiklis tutvustatakse opetaja professionaalse rolli internaliseerimise uurimiseks loodud testi. Opetaja professionaalse identiteedi kujunemist voib kasitleda vastava sotsiaalse rolli internaliseerimisena, mis voib leida aset ainult sotsiokultuurilises kontekstis, pakkudes personaalse kultuuri loomiseks semiootiliselt vahendatud teavet (Valsiner & Rosa, 2007). Semiootilise materjali vahendamist isiku ja keskkonna vahel saab kirjeldada internaliseerimise ja eksternaliseerimisena (Valsiner, 2001). Kirjeldatava testi puhul kasutati isiku ja keskkonna dialoogi motestamiseks intrapsuuhilisel tasandil dialoogilise mina teooriat (Hermans & Hermans-Konopka, 2010), mis voimaldab jalgida isiku aktuaalseid rolle, nende seoseid ja muutumist. Tutvustatava testi koostamisel tugineti Kullasepa (2008) ning Leijeni ja Kullasepa (2013a) loodud mootevahenditele. Test koosneb uheksast ulesandest, kus vastajal tuleb opetajatooga seotud dilemma kirjelduse pohjal nimetada ja seletada vastavas olukorras tekkivaid tundeid. Uuringus osales 109 opetajakoolituse uliopilast. Eeldati, et opetajakoolituses kaugemale joudnud ja suurema pedagoogilise too kogemusega isikute vastused valjendavad enam professionaalse rolli omaksvotmist. Tulemused kinnitasid nimetatud seost tookogemuse ja professionaalse rolli omaksvotmise vahel. Suurema tookogemusega uliopilaste vastused kajastasid teistega vorreldes sagedamini internaliseeritud professionaalset mina-positsiooni. Summary
Functional Analysis of the Matricellular Protein SPARC with Novel Monoclonal Antibodies

SPARC (osteonectin, BM-40) is a matricellular glycoprotein that is expressed in many embryogenic and adult tissues undergoing remodeling or repair. SPARC modulates cellular interaction with the extracellular matrix (ECM), inhibits cell adhesion and proliferation, and regulates growth factor activity. To explore further the function and activity of this protein in tissue homeostasis, we have developed several monoclonal antibodies (MAbs) that recognize distinct epitopes on SPARC. The MAbs bind to SPARC with high affinity and identify SPARC by ELISA, Western blotting, immunoprecipitation, immunocytochemistry, and/or immunohistochemistry. The MAbs were also characterized in functional assays for potential alteration of SPARC activity. SPARC binds to collagen I and laminin-1 through an epitope defined by MAb 293; this epitope is not involved in the binding of SPARC to collagen III. The other MAbs did not interfere with the binding of SPARC to collagen I or III or laminin-1. Inhibition of the anti-adhesive effect of SPARC on endothelial cells by MAb 236 was also observed. Functional analysis of SPARC in the presence of these novel MAbs now confirms that the activities ascribed to this matricellular protein can be assigned to discrete subdomains.
Myotendinous plasticity to ageing and resistance exercise in humans

The age‐related loss of muscle mass known as senile sarcopenia is one of the main determinants of frailty in old age. Molecular, cellular, nutritional and hormonal mechanisms are at the basis of sarcopenia and are responsible for a progressive deterioration in skeletal muscle size and function. Both at single‐fibre and at whole‐muscle level, the loss of force exceeds that predicted by the decrease in muscle size. For single fibres, the loss of intrinsic force is mostly due to a loss in myofibrillar protein content. For whole muscle, in addition to changes in neural drive, alterations in muscle architecture and in tendon mechanical properties, exemplified by a reduction in tendon stiffness, have recently been shown to contribute to this phenomenon. Resistance training can, however, cause substantial gains in muscle mass and strength and provides a protective effect against several of the cellular and molecular changes associated with muscle wasting and weakness. In old age, not only muscles but also tendons are highly responsive to training, since an increase in tendon stiffness has been observed after a period of increased loading. Many of the myotendinous factors characterizing ageing can be at least partly reversed by resistance training.
Relation of Plasma Thyroid-Stimulating Hormone Levels to Vascular Lesions and Atrophy of the Brain in the Elderly

Context: Recent studies suggest that thyroid disease is associated with cardiovascular and peripheral vascular disease. However, little is known about the underlying pathophysiology and the relation with cerebrovascular disease or brain atrophy in the elderly. Objective: To determine if plasma thyroid-stimulating hormone (TSH) levels are associated with vascular brain changes and cortical atrophy in the elderly. Design: Community based, cross-sectional study. Participants and Setting: 268 participants of the Memory and Morbidity in Augsburg Elderly Study, 65–83 years of age and without contraindications for magnetic resonance imaging (MRI) of the brain. Main Outcome Measures: The presence of brain lesions and atrophy was determined using a standardized MRI protocol, an established rating scale and a single rater. Plasma TSH levels were assessed using standard laboratory methods. The association between plasma TSH levels and MRI findings was analyzed using logistic and linear regression models. Results: Higher TSH levels within the normal clinical range were significantly associated with severer cortical atrophy (p = 0.04) and a higher proportion of infarct-like vascular lesions (p = 0.005) in men. These associations were independent of potential confounders, including thyroid hormone therapy, in multivariable regression analysis. No association between plasma TSH levels and both MRI outcomes were observed in women. In addition, neither in men nor in women was an association between TSH levels and white-matter lesions found. Conclusions: Increasing TSH levels even within the normal clinical range are associated with severer brain atrophy and infarct-like vascular lesions in elderly men.
Analysis and design of cutoff frequency for power calculation low-pass filters in droop control

Droop control method has been widely applied to achieve equal power sharing among distributed generations in microgrids. In practice, low-pass filters are usually required to mitigate the harmonics and noises in the calculated instantaneous power and obtain the average power used for the generation of frequency and voltage references. Unfortunately, the design of low-pass filters has not been studied systematically in the existing research. This paper, by proposing a small-signal model of the droop controlled system, analyzes the effects of the low-pass filters on system stability and provides a design method for an optimal cutoff frequency. The effectiveness of the proposed design method is verified by simulations.
RPGR ORF15 genotype and clinical variability of retinal degeneration in an Australian population

Background: Mutations in the retinitis pigmentosa GTPase regulator gene (RPGR) are estimated to cause up to 20% of all Caucasian retinitis pigmentosa and up to 75% of cases of X-Linked RP (XLRP). Exon open reading frame 15 (ORF15) is a purine-rich mutation hotspot. Mutations in RPGR ORF15 have also been documented to cause X linked cone–rod dystrophy (XLCORD) and atrophic macular degeneration at an unknown frequency. Methods: From a hospital clinic population, probands with probable XLRP and XLCORD were screened for RPGR ORF15 mutations and fully phenotyped. Results: Four different RPGR ORF15 mutations were found in four probands. All mutations in the ORF15 exon resulted in premature truncation of the RPGR protein. Three were nonsense mutations: c.507G>T (p.E169stop), c.867G>T (p.G289stop), c.897G>T (p.E299stop) and the fourth a single nucleotide insertion c.1558–1559insA (p.S522fs 525stop). One family exhibited typical XLRP, two XLCORD and one a combination of the phenotypes. Conclusion: RPGR ORF15 mutations produce intrafamilial and interfamilial clinical variability with varying degrees of cone degeneration. In an Australian clinic population RPGR ORF15 mutations cause XLCORD in addition to XLRP.
Amisyn Regulates Exocytosis and Fusion Pore Stability by Both Syntaxin-dependent and Syntaxin-independent Mechanisms*

Amisyn and tomosyn are related by the possession of a C-terminal vesicle-associated membrane protein-like domain that allows them to bind to syntaxin 1 and assemble into SNARE complexes. The formation of inactive complexes may sequester syntaxin and allow tomosyn and amisyn to act as inhibitors of exocytosis. We aimed to use adrenal chromaffin and PC12 cells to probe this possible mode of action of amisyn and tomosyn in dense core granule exocytosis. Although tomosyn is expressed by adrenal chromaffin and PC12 cells, amisyn expression could not be detected allowing examination of the effect of introduction of amisyn expression onto a neuronal-like background. Overexpression of m-tomosyn1 and expression of amisyn both inhibited Ca2+-induced exocytosis in transfected PC12 cells. Surprisingly, this inhibition was not removed when amisyn and tomosyn constructs were used in which key residues required for efficient binding to syntaxin1 were mutated. The effect of amisyn was further characterized using carbon fiber amperometry in chromaffin cells. Expression of amisyn had no effect on the basic characteristics of the amperometric spikes but reduced the number of spikes elicited. This inhibitory action on the extent of exocytosis was also seen with the amisyn mutant deficient in syntaxin1 binding. In addition, expression of amisyn resulted in an increase in the lifetime of the prespike foot, and this effect was abolished by the mutations. These results show that tomosyn and amisyn can negatively regulate exocytosis independently of syntaxin and also that amisyn can regulate the stability of the fusion pore.
Track and field injuries.

OBJECTIVE A review of the existing literature on injuries to youth (< or =18 years old) in track and field or athletics. DATA SOURCES Searches of the Medline and SPORT Discus databases for English language articles through the end of 2003, using the search terms (adolescent or youth) and (track or field or running) and injuries. MAIN RESULTS Only nine prospective or retrospective studies were found dealing with track and field injuries in children and that stated injury rates or provided enough information to allow the estimation of injury rates. Differences in study design and inconsistencies in the definition of a reportable injury provided major hindrances to making comparisons or combining data across studies. Among the few conclusions that can be drawn are that the lower extremities account for the majority of injuries, and muscle strains and ligament sprains are the predominant types of injury. While a majority of injuries may occur during training, since there is much more exposure during training than during competitions, the risk of injury is about four times higher during competitions. CONCLUSIONS Informed decisions with regard to preventing injuries in youth track and field are dependent upon the quality of the basic epidemiological data available, and at this time such data are, for the most part, nonexistent. Because of the large numbers of participants and the large number and variety of activities involved in track and field, adequately designed epidemiological research is difficult, but opportunities for research in this sport are available for anyone willing to take on the challenge.
Primed CTLs specific for HLA class I may still be present in sensitized patients when anti-HLA antibodies have disappeared: relevance for donor selection1

Background. The presence of donor-specific HLA antibodies is generally considered to be a contraindication for transplantation, even when these antibodies are only present in historical sera. Previous studies showed that donor-specific antibodies in current sera were associated with the presence of primed cytotoxic T cells (CTLs) with a high avidity for donor HLA class I antigens. The presence of these CTLs is considered to be a reflection of an activated immune system and a contraindication for transplantation with a donor sharing these particular HLA antigens. Methods. In the present study we compared the incidence of primed CTLs in patients with anti-HLA antibodies in current sera and in patients with anti-HLA antibodies in historical sera only. Cytotoxic T lymphocyte precursor (CTLp) frequencies and the incidence of primed CTLs directed against HLA class I antigens to which the patient had formed antibodies were studied in 37 sensitized renal patients. As controls, antigens to which a patient has never formed antibodies were tested. Results. In patients with antibodies in current sera mainly primed CTLs were detected, whereas in patients where the antibodies had disappeared mainly naive CTLs were detected. However, in four patients primed CTLs persisted despite the fact that the HLA antibodies had disappeared. Conclusion. Considering the previously described association between primed CTLs and graft rejection, these findings may be relevant for the selection of patients who can be transplanted across a positive historical crossmatch. If the antibodies have disappeared and only naive CTLs are present, a successful transplantation should be feasible. A prospective study will reveal whether this is indeed the case.
Depression: What We can Learn from Postmortem Studies

The existence of depression has been recognized for decades, but its precise neurobiological basis remains unknown. Whereas neuroimaging studies unravel the gross morphological localization of dysfunctional brain regions in depression, postmortem studies provide further insights into the cellular and neurochemical substrates of depression. Recent cell-counting studies have established that major depressive disorder and bipolar illness are characterized by alterations in the density and size of neuronal and glial cells in frontolimbic brain regions. It remains to be fully elucidated to what extent these findings represent neurodevelopmental abnormalities or disease progression and whether the cellular changes observed in depression can be reversed by antidepressant and mood-stabilizing medications. Efforts to unravel specific groups of genes that are compromised in depression have recently been undertaken by investigators in the postmortem research field. Future studies will determine whether these genes may be novel targets of therapeutic medications.
Effect of high temperature and feeding level on energy utilization in piglets.

The effect of temperature (23 or 33 degrees C) and feeding level on components of energy balance was studied in seven groups of individually reared Piétrain x (Landrace x Large White) littermate piglets. Within each litter, one pig was reared at 23 degrees C and given a predefined feeding level close to ad libitum (23AL pigs), one was reared at 33 degrees C and also fed close to ad libitum (33AL), and one was reared at 23 degrees C and pair-fed to the 33AL pig (23PF). Piglets of one litter were acclimated during 2 to 4 wk to their experimental temperature in temperature-controlled rooms before being transferred (one per week) to a respiration chamber for measurement of nitrogen and energy balances. The average initial BW was 22.4 kg. The data on O2 consumption, CO2 production, and physical activity were collected over seven consecutive days and used to calculate total heat production (HPtot) and its components: fasting heat production (FHP), heat production due to physical activity (HPact), and thermic effect of feed (TEF). A preliminary trial was conducted in which heat production was measured in three piglets according to a Latin square design at 23, 25, and 27 degrees C. Total heat production was, but activity-free heat production was not, affected by temperature, and no firm conclusions could be drawn as to whether 23 degrees C was within the thermoneutral zone of fed piglets. In Trial 2, the combination of increased temperature and reduced feed intake resulted in a 20% lesser heat production in 33AL than in 23AL pigs. This was due to a reduction in both TEF (-39%) and FHP (0.642 vs 0.808 MJ x d(-1) x kg BW-0.60). Despite the shorter duration of standing activity, HPact was slightly higher at 33 degrees C, probably due to hyperventilation at this temperature. With similar feeding levels (23PF vs 33AL), HPtot and activity-free heat production were less at 33 degrees C and energy retention as protein (+6%) and fat (+31%) was increased. Because HPact was similar for both treatments, the greater energy retention for 33AL seemed to be due to a greater utilization of feed energy or to a reduced maintenance requirement (i.e., reduced FHP). However, the type of stress imposed on 23PF and 33AL pigs was different and may have affected energy metabolism. The results suggest that the reduction in heat production of piglets at high ambient temperatures is caused by a reduction in voluntary feed intake and differences in energetic efficiency. The mechanisms for the lesser efficiency at 23 degrees C compared to 33 degrees C (at the same level of feed intake) remain unclear.
Infectivity and distribution of infectious bursal disease virus in the chicken. Persistence of the virus and lesions.

SUMMARY Chickens susceptible to infectious bursal disease (IBD) became viremic for only a transient period when inoculated with two different strains of infectious bursal disease virus (IBDV). The virus was not isolated from tissues beyond 10 days postinoculation. There was no apparent spread of IBDV to susceptible contact chickens placed with infected groups 16, 30, 42, and 52 days postinoculation. At three days postinoculation, the virus was consistently isolated in the highest concentration from the bursa of Fabricius and spleen whereas the brain and blood were low in yield. In contrast, 1-day-old chicks from IBD-immune parent stock were resistant to infection when inoculated with embryo-adapted IBD vaccine virus. This observation may explain failures to obtain an active immune response when chickens possessing high levels of parentally conferred immunity are vaccinated at an early age. Bursae of chickens were markedly atrophied upon gross examination 33, 51, and 71 days after infection. The lymphoid follicles were severely depleted at 33 and 51 days; at 71 days, repopulation of lymphocytes was commencing. Uninoculated control chickens possessed normal-appearing bursae throughout the experiments. The diagnostic implications of the findings are given.
In vitro susceptibilities of rapidly growing mycobacteria to newer antimicrobial agents

The in vitro antimicrobial susceptibilities of 42 isolates of rapidly growing mycobacteria (Mycobacterium fortuitum, M. chelonae, and Mycobacterium species [other than M. fortuitum and M. chelonae]) to nine quinolones, including newer agents, two new aminoglycosides, and an aminocyclitol (trospectomycin) were determined by a broth microdilution method. The new quinolones, PD 117596, PD 127391, and PD 117558, showed excellent in vitro activities against M. fortuitum (MICs for 90% of isolates [MIC90s], 0.06, 0.06, and 0.12 microgram/ml, respectively). The MIC90 of ciprofloxacin for M. fortuitum was 0.5 microgram/ml. Only 14 to 28% of isolates of M. chelonae were susceptible to various quinolones. Most isolates of all three species were susceptible to the new aminoglycosides SCH 21420 and SCH 22591. The MIC90s of trospectomycin were 8 micrograms/ml for M. chelonae, 32 micrograms/ml for Mycobacterium species, and > 64 micrograms/ml for M. fortuitum.
Comparison of biliary complications in adult living‐donor liver transplants performed at two busy transplant centers

Melcher ML, Pomposelli JJ, Verbesey JE, McTaggart RA, Freise CE, Ascher NL, Roberts JP, Pomfret EA. Comparison of biliary complications in adult living‐donor liver transplants performed at two busy transplant centers. Clin Transplant 2009 DOI: 10.1111/j.1399‐0012.2009. 01189.x. © 2009 John Wiley & Sons A/S.