Miracle-dz/UniFAR-FTUs huggingface dataset:
Reversible Paraneoplastic Encephalomyelitis Associated with a Benign Ovarian Teratoma

Background: Paraneoplastic encephalomyelitis (PEM) is a well characterized, and typically irreversible, paraneoplastic syndrome, usually associated with small cell lung cancer or other malignancy. We describe a case of a young woman with a benign ovarian teratoma who presented with a reversible PEM. Case report: A 24-year-old woman presented with a three week history of memory impairment, unusual behavior, personality changes, auditory hallucinations, hypersomnolence and binocular diplopia. On admission she was disoriented and inattentive with impaired short term memory. Small doses of lorazepam (1 mg), given for episodic agitation, repeatedly induced multidirectional bilateral nystagmus and a skew deviation, but her neurological examination was otherwise normal. A left-sided pelvic mass was palpable. Brain MRI pre- and post-gadolinium was normal. There was a mild CSF pleocytosis and an EEG showed minimal bilateral background activity irregularities. There were no other laboratory abnormalities. Two weeks after admission, she clinically deteriorated developing central respiratory failure and a flaccid paraplegia. Repeat MRI showed an area of increased T2 weighted signal in the medulla and three similar areas in the spinal cord. Following removal of her tumor, treatment with high dose corticosteroids and intravenous immunoglobulin, she ultimately made a full recovery. Pathology revealed the tumor to be a benign ovarian cystic teratoma. Conclusion: This is the first report of a reversible PEM seen in association with a benign tumor, in this case a mature ovarian teratoma. Presumably, an immune response directed against neural elements of the teratoma cross-reacted with normal brain, brainstem and spinal cord antigens to cause neurologic symptoms. Tumor removal was followed by neurologic recovery.
Interventions to reduce haemorrhage during myomectomy for fibroids.

BACKGROUND Uterine myomas (fibroids) are benign tumours of the uterus. Myomectomy, the surgical removal of myomas, can be associated with life-threatening bleeding and prolonged postoperative stay. Knowledge of the effectiveness of the interventions to reduce bleeding during myomectomy is essential to enable evidence-based clinical decisions. This is an update of the review published in The Cochrane Library Issue 3, 2009. OBJECTIVES To assess the effectiveness, safety, tolerability, and costs of interventions to reduce blood loss during myomectomy. SEARCH STRATEGY Electronic searches were undertaken in the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3), MEDLINE (1950 to February 2011), EMBASE (1980 to February 2011), CINAHL (1982 to February 2011), and PsycINFO (1801 to February 2011). SELECTION CRITERIA Only randomised controlled trials (RCTs) that compared the use of interventions to reduce blood loss during myomectomy to placebo or no treatment were included. DATA COLLECTION AND ANALYSIS The two authors independently selected RCTs for inclusion, assessed the methodological quality of trials, and extracted data. We expressed study results as mean differences (MD) for continuous data and odds ratios for dichotomous data, with 95% confidence intervals (CI). MAIN RESULTS Twelve RCTs with 674 participants met our inclusion criteria. The interventions were intramyometrial vasopressin (two RCTs), intravenous oxytocin (two RCTs), peri-cervical tourniquet (two RCTs), and one RCT each for vaginal misoprostol, gelatin thrombin matrix, chemical dissection with sodium-2-mercaptoethane sulfonate (mesna), intramyometrial bupivacaine plus epinephrine, tranexamic acid, and myoma enucleation by morcellation. We found significant reductions in blood loss with misoprostol (MD -149.00 ml, 95% CI -229.24 to -68.76), vasopressin (MD -298.72 ml, 95% CI -593.10 to -4.34; I(2) = 99%), bupivacaine plus epinephrine (MD -68.60 ml, 95% CI -93.69 to - 43.51), tranexamic acid (MD -243 ml, 95% CI -460 to -25.98), peri-cervical tourniquet (MD -289.44, 95% CI -406.55 to -172.32; I(2) = 95%), and gelatin-thrombin matrix (MD -545.00 ml, 95% CI -593.26 to -496.74). There was no evidence of an effect on blood loss with oxytocin or morcellation. None of the interventions significantly increased myomectomy-related complications. The trials did not assess the costs of the different interventions. AUTHORS' CONCLUSIONS There is limited evidence that misoprostol, vasopressin, bupivacaine plus epinephrine, tranexamic acid, gelatin thrombin matrix, peri-cervical tourniquet, and mesna may reduce bleeding during myomectomy. Bupivacaine plus epinephrine has limited clinical importance compared with other interventions as the clinical impact was small. There is no evidence that oxytocin and morcellation reduce blood loss. Further well designed studies are required to establish effectiveness, safety and the costs of different interventions for reducing blood loss during myomectomy.
Sedimentary Tectonics and Stratigraphy: The Early Mesozoic Record in Central to Northeastern Mexico

The stratigraphy has traditionally been conceived as a geological science based on the description and subdivision of rock successions in some kind of units, following the International Stratigraphic Guide or the North American Stratigraphic Code and accord to lithostratigraphic criteria. Diversification or development of modern analytical techniques and emerged new concepts and models of sedimentary, volcanic, plutonic or metamorphic settings, associated to specific geotectonic regimes, offers new possible approaches for stratigraphic subdivision. Accord to these new criteria, revision of numerous sequences is required in order to establish a direct relationship between subdivision and events or environments in space and time, prevailing genetic or provenance criteria over the simple lithological or chronological criteria. Tectonic events are typically recorded in sediments being deposited at the same time, in such a way; each stratigraphic unit can be related to an specific geologic process or tectonic setting.
Hair Shaft Videodermoscopy in Netherton Syndrome

Abstract: Netherton syndrome is an autosomal recessive disorder, characterized by ichthyosis, atopic manifestations, and hair shaft abnormalities (trichorrhexis invaginata). The diagnosis of Netherton syndrome may be established on the basis of just one abnormal hair, but it is often difficult to find a hair with pathognomonic features on light microscopic examination. Every attempt requires pulling new hairs. We present the case of an 11‐year‐old female patient with Netherton syndrome in whom hair and scalp videodermoscopy (trichoscopy) was used to visualize typical bamboo hairs and hairs with golf tee type endings in the scalp hairs and eyebrows. Trichoscopy is a method, which allows noninvasive viewing of hair shafts in many‐fold magnification without the need of pulling hair for diagnostic purposes. This case shows that trichoscopy may be employed to significantly improve the chance of establishing the diagnosis of Netherton syndrome in patients.
Transfectant Influenza A Viruses with Long Deletions in the NS1 Protein Grow Efficiently in Vero Cells

ABSTRACT We established a reverse genetics system for the nonstructural (NS) gene segment of influenza A virus. This system is based on the use of the temperature-sensitive (ts) reassortant virus 25A-1. The 25A-1 virus contains the NS gene from influenza A/Leningrad/134/57 virus and the remaining gene segments from A/Puerto Rico (PR)/8/34 virus. This particular gene constellation was found to be responsible for the ts phenotype. For reverse genetics of the NS gene, a plasmid-derived NS gene from influenza A/PR/8/34 virus was ribonucleoprotein transfected into cells that were previously infected with the 25A-1 virus. Two subsequent passages of the transfection supernatant at 40°C selected viruses containing the transfected NS gene derived from A/PR/8/34 virus. The high efficiency of the selection process permitted the rescue of transfectant viruses with large deletions of the C-terminal part of the NS1 protein. Viable transfectant viruses containing the N-terminal 124, 80, or 38 amino acids of the NS1 protein were obtained. Whereas all deletion mutants grew to high titers in Vero cells, growth on Madin-Darby canine kidney (MDCK) cells and replication in mice decreased with increasing length of the deletions. In Vero cells expression levels of viral proteins of the deletion mutants were similar to those of the wild type. In contrast, in MDCK cells the level of the M1 protein was significantly reduced for the deletion mutants.
Obesity in Pregnancy: Risks and Outcome

Obesity has been associated in the literature with other pregnancy risks such as hypertension and diabetes mellitus, but disagreement persists about the expected course and complications of labor. Also, the effects of obesity on intrauterine growth and gestational duration have not been well defined. This study of 2746 consecutive deliveries used a computer-based uniform perinatal record to compare 300 pregnancy risk and outcome factors for obese and nonobese patients. The 279 obese women (more than 90 kg at some time during the pregnancy) were found to be older and of higher parity than the 2467 who were not obese. Those in the obese group were at increased antepartum risk and had increased frequencies of chronic hypertension, inadequate pregnancy weight gain, twin gestation, and diabetes mellitus. Oxytocin induction and repeat cesarean sections were performed more frequently for the obese patients, with no increase in complications during the current labor. The frequency of labor abnormalities, oxytocin augmentation, and primary cesarean section was similar to that of the comparison group. Examination of infant outcome revealed similar Apgar scores and perinatal mortality in the 2 groups, but fewer low-birth-weight infants (under 2500 g) and more macrosomic babies (over 4000 g) occurred in the obese population. This increase in birth weight was accounted for not only by an increase in the birth weight percentile, but also by a significant lengthening of the period of gestation. (Obstet Gynecol 56:446, 1980)
Ex Vivo Assessment of Coronary Atherosclerotic Plaque by Grating-Based Phase-Contrast Computed Tomography: Correlation With Optical Coherence Tomography

Objectives The aim of this study was to determine the diagnostic accuracy of grating-based phase-contrast computed tomography (gb-PCCT) to classify and quantify coronary vessel characteristics in comparison with optical coherence tomography (OCT) and histopathology in an ex vivo setting. Materials and Methods After excision from 5 heart specimens, 15 human coronary arteries underwent gb-PCCT examination using an experimental imaging setup consisting of a rotating molybdenum anode x-ray tube, a Talbot-Lau grating interferometer, and a single photon counting detector. Subsequently, all vessels were imaged by OCT and histopathologically processed. Optical coherence tomography, gb-PCCT, and histopathology images were manually matched using anatomical landmarks. Optical coherence tomography and gb-PCCT were reviewed by 2 independent observers blinded to histopathology. Vessel, lumen, and plaque area were measured, and plaque characteristics (lipid rich, calcified, and fibrous) were determined for each section. Measures of diagnostic accuracy were derived, applying histopathology as the standard of reference. Results Of a total of 286 assessed cross sections, 241 corresponding sections were included in the statistical analysis. Quantitative measures derived from gb-PCCT were significantly higher than from OCT (P < 0.001) and were strongly correlated with histopathology (Pearson r ≥0.85 for gb-PCCT and ≥0.61 for OCT, respectively). Results of Bland-Altman analysis demonstrated smaller mean differences between OCT and histopathology than for gb-PCCT and histopathology. Limits of agreement were narrower for gb-PCCT with regard to lumen area, for OCT with regard to plaque area, and were comparable with regard to vessel area. Based on histopathology, 228/241 (94.6%) sections were classified as fibrous, calcified, or lipid rich. The diagnostic accuracy of gb-PCCT was excellent for the detection of all plaque components (sensitivity, ≥0.95; specificity, ≥0.94), whereas the results for OCT showed sensitivities of ≥0.73 and specificities of ≥0.66. Conclusions In this ex vivo setting, gb-PCCT provides excellent results in the assessment of coronary atherosclerotic plaque characteristics and vessel dimensions in comparison to OCT and histopathology. Thus, the technique may serve as adjunct nondestructive modality for advanced plaque characterization in an experimental setting.
Memory enhancement and deep-brain stimulation of the entorhinal area.

n engl j med 366;20 nejm.org may 17, 2012 1945 To the Editor: The study by Suthana and coworkers (Feb. 9 issue)1 involved patients with pharmacoresistant epilepsy who underwent implantation of intracranial depth electrodes before possible surgical resection. The authors found that stimulation of the entorhinal cortex, but not of the hippocampus proper, during the learning phase of a spatial-navigation task resulted in more efficient performance. This finding may serve as a starting point for future neuromodulatory interventions aimed at treating disorders with medial temporal-lobe dysfunction and associated cognitive dysfunction. In the context of identification of therapeutic targets, a more precise description of electrode localization, especially along the anterior-posterior axis, would considerably strengthen the findings. Spatial navigation, as tested in the current study, is functionally associated with the posterior hippocampus, as shown by long-standing evidence obtained from studies involving various species, including monkeys2 and humans.3 Electrical conduction could have affected structures that were not directly targeted by the electrodes of interest; this further underscores the importance of clarifying electrode positions in three-dimensional space for every patient.
Pattern of acute abdomen and variables associated with adverse outcome in a rural primary hospital setting.

OBJECTIVE To analyze the clinical presentation, causes, outcomes of surgical intervention (as measured by postoperative morbidity and mortality), and variables associated with adverse outcomes of patients with surgically important acute abdominal pain. DESIGN A cross sectional hospital based longitudinal case series analysis. SETTING Glen C Olsen Memorial Primary General Hospital. Butajira, Ethiopia. SUBJECT All patients admitted and operated for acute abdominal pain over a period of two years. (Oct. 10, 2004 -Nov. 20, 2006) OUTCOME MEASURES Being referred from other centers, duration of symptoms, types of symptoms and physical findings, relevant investigations, diagnosis and procedure done, hospital stay, mortality, morbidity, and variables associated with adverse out comes. RESULTS A total of 143 patients were operated and of them 55.2% were referred from other health care facilities. Male to female ratio was 2.5:1 and mean age of presentation was 26.6 +/- 16.6 years. Patients presented after an average of 88.4 +/- 87.9 hours of symptom onset. Intestinal obstruction 50 (34.9%), acute appendicitis 35 (24.5%), Intussusceptions 23 (16.1%) and bowel perforation 16 (11.2%) were the leading causes of admission. Clinical variables found to have statistical significant association (P < 0.05) with adverse outcomes were referred patients, those with abdominal distension, absolute constipation, deranged vital signs, abdominal mass, guarding, positive vaginal/rectal examination and/or leukocytosis. The average hospital stay was 8.74 +/- 4.66 days and 28.7% of patients develop one or more of acute complications. Forty two (29.4%) patients presented with deranged vital signs from either septic or hypovolemic shock and of them 7 (4.9%) died with subsequent multiple organ failure. CONCLUSION Patients who presented early and immediate corrective measures were instituted had better outcome while those seen late developed unfavorable out-come with significantly higher complications. Therefore early detection and treatment of acute abdomen is essential.
Streptococcal pharyngitis therapy. Comparison of cephalexin, phenoxymethyl penicillin, and ampicillin.

Results of cephalexin monohydrate and potassium phenoxymethyl penicillin were compared in children with pharyngitis and group A streptococci in two consecutive studies, 1968 to 1969 and 1969 to 1970. Ampicillin anhydrous was included in the first study. The patients were assigned randomly to one of the antibiotics, 0.5 gm daily for ten days. Recurrences, detected by routine weekly cultures, of the original group A streptococcal types within three weeks after end of treatment were classified as failures. The failure rates in the first study were 11% (4/38) for cephalexin, 26% (10/39) for phenoxymethyl penicillin, and 27% (10/27) for ampicillin. The failure rates in the second study were 9% (4/46) for cephalexin and 20% (10/50) for potassium phenoxymethyl penicillin. In the combined studies cephalexin was more effective than potassium phenoxymethyl penicillin ( P
Ach‐induced endothelial NO synthase translocation, NO release and vasodilatation in the hamster microcirculation in vivo

Studies in cultured cells show that activation of endothelial nitric oxide (NO) synthase (eNOS) requires the dissociation of this enzyme from its inhibitory association with caveolin‐1 (Cav‐1), and perhaps its translocation from plasma membrane caveolae to other cellular compartments. We investigated the hypothesis that in vivo NO‐dependent vasodilatation is associated with the translocation of eNOS from the cell membrane. To this end, we applied ACh topically (10‐100 μm for 10 min) to the hamster cheek pouch microcirculation and measured NO production, blood flow and vessel diameter, and assessed subcellular eNOS distribution by Western blotting. Baseline NO production was 54.4 ± 5.2 pmol min−1 (n= 16). ACh increased NO release, caused arteriolar and venular dilatation and elevated microvascular flow. These responses were inhibited by NG‐nitro‐L‐arginine (30 μm). The maximal increase in NO production induced by 10 μm and 100 μm ACh was 45 ± 20 % and 111 ± 33 %, respectively; the corresponding blood flow increases were 50 ± 10 % and 130 ± 24 %, respectively (n= 4‐6). Both responses followed a similar time course, although increases in NO preceded flow changes. In non‐stimulated tissues, eNOS was distributed mainly in the microsomal fraction. ACh‐induced vasodilatation was associated with eNOS translocation to the cytosolic and Golgi‐enriched fractions. After 1.5, 3.0 or 6.0 min of application, 10 μm ACh decreased the level of membrane‐bound eNOS by ‐13 ± 4 %, ‐60 ± 4 % and ‐19 ± 17 %, respectively; at the same time points, 100 μm ACh reduced microsomal eNOS content by ‐38 ± 9 %, ‐61 ± 16 % and ‐40 ± 18 %, respectively (n= 4‐5). In all cases, microsomal Cav‐1 content did not change. The close ACh concentration dependence and the concomitance between eNOS subcellular redistribution and NO release support the concept that eNOS translocation from the plasma membrane is part of an activation mechanism that induces NO‐dependent vasodilatation in vivo.
Dominance of texture over shape in facial identity processing is modulated by individual abilities

For face recognition, observers utilize both shape and texture information. Here, we investigated the relative diagnosticity of shape and texture for delayed matching of familiar and unfamiliar faces (Experiment 1) and identifying familiar and newly learned faces (Experiment 2). Within each familiarity condition, pairs of 3D-captured faces were morphed selectively in either shape or texture in 20% steps, holding the respective other dimension constant. We also assessed participants' individual face-processing skills via the Bielefelder Famous Faces Test (BFFT), the Glasgow Face Matching Test, and the Cambridge Face Memory Test (CFMT). Using multilevel model analyses, we examined probabilities of same versus different responses (Experiment 1) and of original identity versus other/unknown identity responses (Experiment 2). Overall, texture was more diagnostic than shape for both delayed matching and identification, particularly so for familiar faces. On top of these overall effects, above-average BFFT performance was associated with enhanced utilization of texture in both experiments. Furthermore, above-average CFMT performance coincided with slightly reduced texture dominance in the delayed matching task (Experiment 1) and stronger sensitivity to morph-based changes overall, that is irrespective of morph type, in the face identification task (Experiment 2). Our findings (1) show the disproportionate importance of texture information for processing familiar face identity and (2) provide further evidence that familiar and unfamiliar face identity perception are mediated by different underlying processes.
Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia.

BACKGROUND A five-year prospective study was conducted in North Iraq and Cambodia to test a model for rural prehospital trauma systems in low-income countries. RESULTS From 1997 to 2001, 135 local paramedics and 5,200 lay First Responders were trained to provide in-field trauma care. The study population comprised 1,061 trauma victims with mean evacuation time 5.7 hours. The trauma mortality rate was reduced from pre-intervention level at 40% to 14.9% over the study period (95% CI for difference 17.2-33.0%). There was a reduction in trauma deaths from 23.9% in 1997 to 8.8% in 2001 (95% CI for difference 7.8-22.4%), and a corresponding significant improvement of treatment effect by year. The rate of infectious complications remained at 21.5 percent throughout the study period. CONCLUSION Low-cost rural trauma systems have a significant impact on trauma mortality in low-income countries.