Miracle-dz/UniFAR-FTUs huggingface dataset:
Anterior decompression combined with corpectomies and discectomies in the management of multilevel cervical myelopathy: a hybrid decompression and fixation technique.

OBJECT The authors retrospectively evaluated the safety and efficacy of a decompression and fixation technique in the treatment of patients with multilevel cervical spondylotic myelopathy (CSM). METHODS The authors describe the "hybrid decompression fixation" technique, a procedure involving a combination of corpectomies and discectomies to preserve a vertebra intact within the area of the decompression, thus augmenting mechanical stability. The authors retrospectively reviewed outcomes in 25 patients with multilevel CSM in whom the hybrid technique was performed between 1999 and 2003. Twelve patients underwent a single-level corpectomy and three-level discectomies. In 13 patients a two-level corpectomy and adjacent four-level discectomies were conducted, leaving a vertebral bridge the middle. All patients underwent fusion involving placement of disc and vertebral body cages filled with autogenous local bone and supplemental anterior dynamic plate fixation. The mean preoperative Nurick grade was 3 and improvement in status was reflected by a postoperative decrease to 2.6 (p < 0.05). In one patient neurological deterioration was demonstrated. At the end of the follow-up period (mean 29 months) radiography revealed evidence of osseous fusion in 24 patients; fusion status could not be determined in one patient. No evidence of late-onset instrumentation-related failure was observed in any of the 25 patients. CONCLUSIONS The authors found the hybrid technique to be safe and efficient for anterior decompression in patients with multilevel CSM. The use of this technique obviates the need for staged circumferential procedures.
Initial clinical presentation and spectrum of pheochromocytoma: a study of 94 cases from a single center

Background With the increasing access to imaging more pheochromocytomas are diagnosed in the workup of adrenal incidentalomas. This may have changed the occurrence of the classic presentation with hypertension and the classic triad (headaches, sweating and palpitation). Methods We reviewed 94 consecutive cases of pheochromocytomas. Two cases of ectopic ACTH-syndrome were subsequently excluded. Results Of the 92 cases included 64% had presented as an incidentaloma, 32% as a suspected pheochromocytoma and 4% had been screened because of previously diagnosed MEN2A. Those screened were youngest while those with incidentalomas were oldest. The females were more common in the incidentaloma and the screening groups, and males in the suspected pheochromocytoma group. Measurements of noradrenaline/normetanephrine levels were highest in the suspected pheocromocytoma group and lowest in the screening group. Hypertension was present in 63% of the incidentalomas, 79% of suspected pheochromocytomas and in none of the screening group. Paroxysmal symptoms were present in almost all with suspected pheochromocytoma while only in half of the other groups. The suspected pheocromocytoma group had most symptoms and the screening group least. The classic triad was present in 14% of the incidentalomas, in 28% of the suspected and in none of the screening group, while no symptoms at all was present in 12%, 0% and 25%, respectively. Pheochromocytoma crisis occurred in 5%. There was a positive correlation between tumor size vs hormone levels, and catecholamine levels vs blood pressure. Conclusion Clinicians need to be aware of the modern presentation of pheochromocytomas since early identification can be life-saving.
Initial multicenter experience with a novel distal protection filter during carotid artery stent implantation

Atheroembolization resulting in transient or permanent neurologic impairment is the most common complication of catheter‐based percutaneous carotid artery intervention. Protection of the distal cerebral vasculature during carotid stent implantation may enhance procedural safety. Carotid stent implantation with distal cerebral protection using the FilterWire EX was performed in 35 consecutive patients undergoing 36 procedures at six centers. The FilterWire was delivered and deployed successfully in all 36 cases, and embolic material was retrieved from 74% of procedures. The 30‐day rate of major adverse events (death, major or minor stroke) was 0%. Transient ipsilateral periprocedural neurologic ischemia developed in two patients (5.7%), both resolving within 30 min. Distal cerebral protection with the FilterWire during carotid stenting is feasible and safe, results in capture and extraction of atheroembolic debris in the majority of patients while affording uninterrupted cerebral perfusion, and in this initial multicenter experience was associated with a high rate of procedural success without major complications. Cathet Cardiovasc Intervent 2003;58:139–146. © 2003 Wiley‐Liss, Inc
Surgeon-performed ultrasound in the critical care setting: its use as an extension of the physical examination to detect pleural effusion.

BACKGROUND Critically ill surgical patients are often difficult to assess for complications because of their altered sensorium, multiple monitoring devices, and immobility. Surgeon-performed ultrasound may enhance the physical examination of these patients and provide for an early detection of select complications. We hypothesized that a focused thoracic ultrasound examination could reliably detect a pleural effusion and the results could be used in the decision matrix for patient care. METHODS Serial focused thoracic ultrasound examinations were performed by a surgeon and a medical student on critically ill patients. The medical student learned select facets of the physical examination and then demonstrated how ultrasound imaging could enhance these findings. Ultrasound images were recorded on hard copy and videotape, with the results available to the surgical intensive care unit and surgery teams. The images were reviewed and compared with the chest radiograph readings. RESULTS Forty-seven patients underwent 140 ultrasound examinations. There were 85 true-negative, 46 true-positive, 9 false-negative, and zero false-positive examination results, yielding an 83.6% sensitivity, 100% specificity, and 94% accuracy. Of the 46 true-positive results, thoracentesis was performed or a thoracostomy tube was placed in 5 patients. Nine false-negative ultrasound examinations occurred in six patients, five of whom had their effusions detected on computed tomographic scans. CONCLUSION A focused thoracic ultrasound examination reliably detects pleural effusions in critically ill patients, and the results can be used successfully in the decision matrix for patient care.
Long-term survival advantage and prognostic factors associated with intraperitoneal chemotherapy treatment in advanced ovarian cancer: a gynecologic oncology group study.

PURPOSE To determine long-term survival and associated prognostic factors after intraperitoneal (IP) chemotherapy in patients with advanced ovarian cancer. PATIENTS AND METHODS Data from Gynecologic Oncology Group protocols 114 and 172 were retrospectively analyzed. Cox proportional hazards regression models were used for statistical analyses. RESULTS In 876 patients, median follow-up was 10.7 years. Median survival with IP therapy was 61.8 months (95% CI, 55.5 to 69.5), compared with 51.4 months (95% CI, 46.0 to 58.2) for intravenous therapy. IP therapy was associated with a 23% decreased risk of death (adjusted hazard ratio [AHR], 0.77; 95% CI, 0.65 to 0.90; P = .002). IP therapy improved survival of those with gross residual (≤ 1 cm) disease (AHR, 0.75; 95% CI, 0.62 to 0.92; P = .006). Risk of death decreased by 12% for each cycle of IP chemotherapy completed (AHR, 0.88; 95% CI, 0.83 to 0.94; P < .001). Factors associated with poorer survival included: clear/mucinous versus serous histology (AHR, 2.79; 95% CI, 1.83 to 4.24; P < .001), gross residual versus no visible disease (AHR, 1.89; 95% CI, 1.48 to 2.43; P < .001), and fewer versus more cycles of IP chemotherapy (AHR, 0.88; 95% CI, 0.83 to 0.94; P < .001). Younger patients were more likely to complete the IP regimen, with a 5% decrease in probability of completion with each year of age (odds ratio, 0.95; 95% CI, 0.93 to 0.96; P < .001). CONCLUSION The advantage of IP over intravenous chemotherapy extends beyond 10 years. IP therapy enhanced survival of those with gross residual disease. Survival improved with increasing number of IP cycles.
Combined D‐dimer and clinical probability are useful for exclusion of recurrent deep venous thrombosis

It is estimated that up to one‐third of patients with a history of deep venous thrombosis (DVT) present with symptoms of recurrent DVT. Our objective was to investigate both the diagnostic value of D‐dimer (DD) and safety of a standard diagnostic algorithm including clinical assessment, plasma DD levels, and compression venous ultrasound as diagnostic tools in outpatients presenting with clinically suspected acute recurrent DVT of the lower limbs. We have enrolled 105 outpatients with a previous history of confirmed DVT and clinically suspected recurrent DVT. A 3‐month follow‐up period was carried out for patients in whom DVT was initially excluded. Prevalence of DVT in our study population was 44.8% (47/105). DD was negative in 17.1% of cases (18/105) and DVT could be ruled out in 15.2% of patients evaluated (16/105) on the basis of an unlikely clinical probability and a negative DD result. Only one false negative DD result in a patient scored as likely for DVT was found. Sensitivity, specificity, positive and negative predictive value of DD for the diagnosis of DVT were 97.9% (95% CI 88.9–99.6%), 29.3% (95% CI 19.2–42.0%), 52.9% (95% CI 42.5–63.0) and 94.4% (95% CI 74.2%–99.0), respectively. Sensitivity was 100% (95% CI 75.7–100) in the group of patients in whom DVT was considered unlikely. A diagnostic strategy combining clinical evaluation and DD has proved to be useful for the exclusion of DVT in subjects with clinically suspected recurrent DVT, especially in patients included in the lower clinical pretest probability group. Am. J. Hematol. , 2006. © 2006 Wiley‐Liss, Inc.
The role of urological surgery in male infertility

In 50% of involuntarily childless couples a male infertility associated factor is found together with abnormal semen parameters. Surgical management of male infertility has advanced significantly over the last decade. This improvement in operative intervention is due in part to advancements in assisted reproductive technologies and associated new sperm retrieval techniques, an increased awareness among vasectomised men that they may still have their own biological offspring after a vasectomy reversal, and a more scientific understanding of the effects of varicoceles on spermatogenesis as well as the introduction of innovative techniques in their surgical repair. We describe various investigations to determine the underlying aetiology for male infertility and surgical techniques to improve semen parameters and sperm delivery, including microsurgical procedures which are technically challenging and demand specialised skills and andrological expertise.
The Influence of Neuromusculoskeletal Model Calibration Method on Predicted Knee Contact Forces during Walking

Neuromusculoskeletal models used to predict muscle and joint contact forces for a specific individual require specification of muscle-tendon, skeletal geometry, and neural control model parameter values. Though these parameter values should ideally be calibrated using in vivo data collected from the subject, they are often taken from generic models. This study explored the influence of three model calibration methods on predicted lower limb muscle and knee contact forces during walking. The calibrated model from each approach was used in a static optimization that predicted knee contact forces for six walking trials. The predictions were evaluated using knee contact forces measured in vivo from a subject implanted with a force-measuring knee replacement. The first calibration approach used muscle-tendon model parameter values (i.e., optimal muscle fiber lengths and tendon slack lengths) taken directly from the literature. The second approach calibrated muscle-tendon model parameter values such that each muscle operated within a physiological range on the ascending region of its normalized force-length curve. The third approach used a novel two-level optimization that exploited knowledge of the knee contact force measurements to calibrate muscle-tendon, moment arm, and neural control model parameter values such that the calibrated model would predict the in vivo contact forces as closely as possible. For the third approach, three walking trials were used to calibrate the model and the remaining three to test the calibrated model. Overall, calibration method had a large affect on predicted knee contact forces. The first method produced highly inaccurate contact force predictions and infeasible solutions for most time frames. The second approach produced accurate medial contact force predictions (average R2 = 0.89, average RMS error = 107 N) but inaccurate lateral predictions (average R2 = -1.77, average RMS error = 297 N). The third approach produced accurate testing predictions for both medial (average R2 = 0.91, average RMS error = 96 N) and lateral (average R2 = 0.76, average RMS error = 84 N) contact force. These results reveal that when knee contact force data are available, a single set of model parameter values can be successfully calibrated to predict medial and lateral knee contact force accurately over multiple walking cycles. They also reveal that when knee contact force data are not available (the most common situation), a simple calibration method based on muscle operating ranges on their normalized force-length curves may be sufficient to produce accurate medial but not lateral knee contact force predictions.
Mutual interactions between an invasive bark beetle and its associated fungi

Abstract Interactions between invasive insects and their fungal associates have important effects on the behavior, reproductive success, population dynamics and evolution of the organisms involved. The red turpentine beetle (RTB), Dendroctonus valens LeConte (Coleoptera: Scolytinae), an invasive forest pest in China, is closely associated with fungi. By carrying fungi on specialized structures in the exoskeleton, RTB inoculates fungi in the phloem of pines (when females dig galleries for egg laying and when males join them for mating). After eggs hatch, larvae gregariously feed on the phloem colonized by the fungi. We examined the effects of five isolates of RTB associated fungi (two from North America, Leptographium terebrantis and L. procerum, and three from China, Ophiostoma minus, L. sinoprocerum and L. procerum) on larval feeding activity, development and mortality. We also studied the effects of volatile chemicals produced in the beetle hindgut on fungal growth. Ophiostoma minus impaired feeding activity and reduced weight in RTB larvae. Leptographium sinoprocerum, L. terebrantis and L. procerum did not dramatically influence larval feeding and development compared to fungi-free controls. Larval mortality was not influenced by any of the tested fungi. Hindgut volatiles of RTB larvae, verbenol, myrtenol and myrtenal, inhibited growth rate of all the fungi. Our results not only show that D. valens associated fungus, O. minus, can be detrimental to its larvae; but, most importantly, they also show that these notorious beetles have an outstanding adaptive response evidenced by the ability to produce volatiles that inhibit growth of harmful fungus.
A Prospective Case Control Study of the Association of Gianotti–Crosti Syndrome with Human Herpesvirus 6 and Human Herpesvirus 7 Infections

Abstract: Gianotti–Crosti syndrome (GCS) is known to be associated with hepatitis B and Epstein–Barr virus (EBV) infections. Apart from a single case report based on serology alone, there are no published data on an association between GCS and human herpesvirus 6 (HHV‐6) and human herpesvirus 7 (HHV‐7) primary infections or reactivations. Our aim was to investigate the association between GCS and HHV‐6 and HHV‐7 infections. Ten patients diagnosed with GCS at a primary care practice over an 18‐month period were recruited. Controls were age‐ and sex‐matched patients with unrelated symptoms requiring venepuncture for other indications. Blood specimens were collected from patients and controls at presentation, and from patients 4 weeks later. Virologic evidence of HHV‐6 and HHV‐7 infection was sought in peripheral blood leukocytes and plasma using polymerase chain reaction (PCR) for viral DNA, reverse transcriptase polymerase chain reaction (RT‐PCR) for HHV‐6 U91 mRNA transcripts, and serology. Serology for EBV and hepatitis B virus was done. In contrast to the 10 controls, 2 patients (both infants) with clinically diagnosed GCS had evidence of active HHV‐6 infection. This was demonstrated by detection of viral DNA in the absence of antibody in the acute plasma specimens and HHV‐6 DNA viral loads of more than 5.3 log10 genome copies/5 μl in the whole blood specimens, a profile previously shown to be diagnostic of recent primary HHV‐6 infection. None of the patients had evidence of recent EBV or hepatitis B infection. We conclude that primary HHV‐6 infection may be associated with GCS in some infants.
Early prediction of the long term evolution of multiple sclerosis: the Bayesian Risk Estimate for Multiple Sclerosis (BREMS) score

Aim: To propose a simple tool for early prediction of unfavourable long term evolution of multiple sclerosis (MS). Methods: A Bayesian model allowed us to calculate, within the first year of disease and for each patient, the Bayesian Risk Estimate for MS (BREMS) score that represents the risk of reaching secondary progression (SP). Results: The median BREMS scores were higher in 158 patients who reached SP within 10 years compared with 1087 progression free patients (0.69 vs 0.30; p<0.0001). The BREMS value was related to SP risk in the whole cohort (p<0.0001) and in the subgroup of 535 patients who had never been treated with immune therapies, thus reasonably representing the natural history of the disease (p<0.000001). Conclusions: The BREMS score may be useful both to identify patients who are candidates for early or for more aggressive therapies and to improve the design and analysis of clinical therapeutic trials and of observational studies.
Reactive Impedance Surface TM Mode Slow Wave for Patch Antenna Miniaturization [AMTA Corner]

This paper presents a two-layer mushroom-like reactive impedance surface (RIS) and its application to patch-antenna miniaturization. A reactive impedance surface, known as a meta-substrate, has been shown to present the ability to miniaturize printed antennas when serving as the substrate for the antenna. However, the area of conventional reactiveimpedance- surface substrates is usually much larger than that of the miniaturized antenna. Here, a reactive impedance surface with very small unit-cell dimensions (a cell area reduction of 95.6%, compared to a traditional reactive impedance surface) is proposed, and utilized to design a miniaturized antenna over a reactive-impedance-surface substrate with the same size as the antenna itself. The two-layer mushroom-like reactive impedance surface is analyzed theoretically and numerically. The reflection phase diagram of the reactive-impedance-surface substrate and the reactive impedance surface/PEC parallel plate waveguide are studied to verify the analytic model. It is shown to have a high propagation constant near the resonant frequency of the reactive impedance surface. The effect of vias in the mushroom-like reactive impedance surface is also discussed. Applying the two-layer reactive-impedance-surface substrate and an optimized miniaturized patch antenna topology, several UHF-band patch antennas, working around 400 MHz, were designed and fabricated. Using this approach, a miniaturized antenna with dimensions λ0/11.4×λ0/11.4×λ0/74, including the reactive-impedance-surface substrate, was developed.
An Essential Role for Rac/Cdc42 GTPases in Cerebellar Granule Neuron Survival*

Rho family GTPases are critical molecular switches that regulate the actin cytoskeleton and cell function. In the current study, we investigated the involvement of Rho GTPases in regulating neuronal survival using primary cerebellar granule neurons. Clostridium difficile toxin B, a specific inhibitor of Rho, Rac, and Cdc42, induced apoptosis of granule neurons characterized by c-Jun phosphorylation, caspase-3 activation, and nuclear condensation. Serum and depolarization-dependent survival signals could not compensate for the loss of GTPase function. Unlike trophic factor withdrawal, toxin B did not affect the antiapoptotic kinase Akt or its target glycogen synthase kinase-3β. The proapoptotic effects of toxin B were mimicked by Clostridium sordellii lethal toxin, a selective inhibitor of Rac/Cdc42. Although Rac/Cdc42 GTPase inhibition led to F-actin disruption, direct cytoskeletal disassembly withClostridium botulinum C2 toxin was insufficient to induce c-Jun phosphorylation or apoptosis. Granule neurons expressed high basal JNK and low p38 mitogen-activated protein kinase activities that were unaffected by toxin B. However, pyridyl imidazole inhibitors of JNK/p38 attenuated c-Jun phosphorylation. Moreover, both pyridyl imidazoles and adenoviral dominant-negative c-Jun attenuated apoptosis, suggesting that JNK/c-Jun signaling was required for cell death. The results indicate that Rac/Cdc42 GTPases, in addition to trophic factors, are critical for survival of cerebellar granule neurons.