Miracle-dz/UniFAR-FTUs huggingface dataset:
Cancerous glucose metabolism in lung cancer—evidence from exhaled breath analysis

Cancer cells prefer hyperglycolysis versus oxidative phosphorylation, even in the presence of oxygen. This phenomenon is used through the FDG-PET scans, and may affect the exhaled volatile signature. This study investigates the volatile signature in lung cancer (LC) before and after an oral glucose tolerance test (OGTT) to determine if tumor cells’ hyperglycolysis would affect the volatile signature. Blood glucose levels and exhaled breath samples were analyzed before the OGTT, and 90 min after, in both LC patients and controls. The volatile signature was measured by proton transfer reaction mass spectrometry (PTR-MS). Twenty-two LC patients (age 66.6 ± 12.7) with adenocarcinoma (n = 14), squamous (n = 6), small cell carcinoma (n = 2), and twenty-one controls (age 54.4 ± 13.7; 10 non-smokers and 11 smokers) were included. All LC patients showed a hyperglycolytic state in their FDG-PET scans. Both baseline and post OGTT volatile signatures discriminate between the groups. The OGTT has a minimal effect in LC (a decrease in m/z 54 by 39%, pv = 0.0499); whereas in the control group, five masses (m/z 64, 87,88, 142 and 161) changed by −13%, −49%, −40% and −29% and 46% respectively. To conclude, OGTT has a minimal effect on the VOC signature in LC patients, where a hyperglycolytic state already exists. In contrast, in the control group the OGTT has a profound effect in which induced hyperglycolysis significantly changed the VOC pattern. We hypothesized that a ceiling effect in cancerous patients is responsible for this discrepancy.
Renal Outcomes of Liver Transplant Recipients Who Had Pretransplant Kidney Biopsy

Background Kidney biopsy has been recommended to guide kidney allocation in selected liver transplant (LT) candidates with renal dysfunction. However, post–LT-alone renal outcomes in recipients who showed evidence of reversible renal injury and limited chronicity on pre-LT kidney biopsy are unclear. Methods Renal outcomes of 41 LT recipients who had pre-LT kidney biopsy for unexplained renal dysfunction, proteinuria, and hematuria were retrospectively reviewed. All biopsies showed less than 30% interstitial fibrosis and less than 30% to 40% glomerulosclerosis. Study endpoints were renal replacement therapy (RRT) at 1 month and the need for kidney transplantation at 1 year from LT. Results Six patients were on RRT at time of biopsy. Median (range) iothalamate glomerular filtration rate and 24-hr urinary protein excretion for the remaining 35 patients were 29 (6–88) mL/min per 1.73 m2 and 65 (0–4,338) mg/day, respectively. Glomerulonephritis and acute tubular necrosis were present in 28 (68%) and 16 (39%) of the cases. Six patients (15%) did not recover kidney function at 1 month and RRT at time of LT was the only factor associated with this endpoint (P=0.04). Seven of the 31 (22%) patients with 1-year data met criteria for kidney transplantation within the first post-LT year. Surgical re-exploration was the only factor associated with the need for kidney transplantation at 1 year (P=0.05). Conclusions The most LT recipients with minimal chronic changes on pre-LT kidney biopsy recovered kidney function within 1 month from LT. A small but significant percentage met criteria for kidney transplantation at 1 year because of the development of unforeseen post-LT complications.
Therapeutic Effects of a Non–&bgr; Cell Bioartificial Pancreas in Diabetic Mice

Background Cell-based insulin therapies can potentially improve glycemic regulation in insulin-dependent diabetic patients. Enteroendocrine cells engineered to secrete recombinant insulin have exhibited glycemic efficacy, but have been primarily studied as uncontrollable growth systems in immune incompetent mice. Furthermore, reports suggest that suboptimal insulin secretion remains a barrier to expanded application. Methods Genetic and tissue engineering strategies were applied to improve recombinant insulin secretion from intestinal L-cells on both a per-cell and per-graft basis. Transduction of insulin-expressing GLUTag L-cells with lentivirus carrying an additional human insulin gene–enhanced secretion twofold. We infected cells with lentivirus expressing a luciferase reporter gene to track cell survival in vivo. To provide a growth-controlled and immune protective environment without affecting secretory capacity, cells were microencapsulated in barium alginate. Approximately 9×107 microencapsulated cells were injected intraperitoneally in immune competent streptozotocin-induced diabetic mice for therapeutic efficacy evaluation. Results Graft insulin secretion was increased to 16 to 24 mU insulin per day. Transient normoglycemia was achieved in treated mice two days after transplantation, and endogenous insulin was sufficient to sustain body weights of treated mice receiving minimal supplementation. Conclusion Glycemic efficacy of a bioartificial pancreas based on insulin-secreting enteroendocrine cells is insufficient as a standalone therapy, despite enhancement of graft insulin secretion capacity. Supplemental strategies to alleviate secretion limitations should be pursued.
Quality of nursing documentation: Paper‐based health records versus electronic‐based health records

AIMS AND OBJECTIVES To assess and compare the quality of paper-based and electronic-based health records. The comparison examined three criteria: content, documentation process and structure. BACKGROUND Nursing documentation is a significant indicator of the quality of patient care delivery. It can be either paper-based or organised within the system known as the electronic health records. Nursing documentation must be completed at the highest standards, to ensure the safety and quality of healthcare services. However, the evidence is not clear on which one of the two forms of documentation (paper-based versus electronic health records is more qualified. METHODS A retrospective, descriptive, comparative design was used to address the study's purposes. A convenient number of patients' records, from two public hospitals, were audited using the Cat-ch-Ing audit instrument. The sample size consisted of 434 records for both paper-based health records and electronic health records from medical and surgical wards. RESULTS Electronic health records were better than paper-based health records in terms of process and structure. In terms of quantity and quality content, paper-based records were better than electronic health records. The study affirmed the poor quality of nursing documentation and lack of nurses' knowledge and skills in the nursing process and its application in both paper-based and electronic-based systems. CONCLUSION Both forms of documentation revealed drawbacks in terms of content, process and structure. This study provided important information, which can guide policymakers and administrators in identifying effective strategies aimed at enhancing the quality of nursing documentation. RELEVANCE TO CLINICAL PRACTICE Policies and actions to ensure quality nursing documentation at the national level should focus on improving nursing knowledge, competencies, practice in nursing process, enhancing the work environment and nursing workload, as well as strengthening the capacity building of nursing practice to improve the quality of nursing care and patients' outcomes.
Development and psychometric testing the Health of Body, Mind and Spirit Scale for assessing individuals who have drug abuse histories

AIMS AND OBJECTIVES To develop the Health of Body, Mind and Spirit Scale (HBMSS), which was designed to assess drug abusers' health condition. BACKGROUND Helping drug abusers to become healthy is important to healthcare professionals. However, no instrument exists to assess drug abusers' state of health. DESIGN A cross-sectional questionnaire survey was implemented to examine the validity of the HBMSS. METHODS Data were collected from 2015-2016 at one drug abuse prevention centre in Taiwan. Participants (N = 320) who had abused drugs were invited to complete a preliminary 64-item version of the HBMSS. An item analysis, criterion-related validity analysis (using the Relapse Prediction Scale [RPS] score), split-half reliability testing and confirmatory factor analysis (CFA) were conducted to examine the psychometric properties of the HBMSS. RESULTS The final version of the HBMSS contained 15 items that were divided into three subscales: the health of the body, mind and spirit. Cronbach's α and split-half reliability coefficients were all above . 85. The factor loading of each item was between . 74-. 95. The HBMSS had satisfactory criterion-related validity with the RPS score (r = -.50, p < .001). A second-order CFA was conducted on the HBMSS. The fit indexes were good, χ2 = 184.060, df = 94, χ2 /df = 1.958 (p = .000). CONCLUSIONS The entire HBMSS and the subscales had satisfactory reliability and validity. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals could use the HBMSS to evaluate the condition of the health of individuals with a drug abuse history.
Impact of Expanded Criteria Variables on Outcomes of Kidney Transplantation from Donors After Cardiac Death

Introduction To expand the donor pool, kidney transplants are being performed using donors who were previously considered unacceptable. We applied the United Network for Organ Sharing criteria to define expanded criteria donors (ECD) within the donation after cardiac death (DCD) and donation after brain stem death (DBD) cohorts. We compared outcomes of DCD and DBD transplants with and without (standard criteria donor [SCD]) the ECD criteria. Methods This was a single-center retrospective study of all deceased donor transplants from 2004 to 2010 (n=359). Four groups were identified—DBD-SCD (n=154), DBD-ECD (n=93), DCD-SCD (n=78), and DCD-ECD (n=34). Kaplan-Meier analysis of graft and patient survival and multiple regression analysis of 1-year graft function were performed. Results One-year and two-year uncensored graft survivals were similar between DCD-ECD and DCD-SCD cohorts (1 year, 90% and 93%; 2 years, 81% and 93% respectively; log-rank test P=0.2). Median estimated glomerular filtration rate (eGFR) was lower in DCD-ECD recipients at 12 months (41 vs. 53 mL/min, P=0.003) and 24 months (33 vs. 54 mL/min, P<0.001) compared with DCD-SCD recipients. Compared with DBD-ECD recipients also at 24 months, DCD-ECD recipients showed a lower graft function (median, eGFR 33 vs. 47 mL/min; P=0.007) but similar graft survival. Expanded criteria donor status (B=−9.7, P=0.01) was associated with a lower 1-year eGFR within the DCD cohort, with donor age (B=−0.42, P=0.002) being the only significant ECD variable. Conclusion Short-term graft survival in DCD-ECD transplants was comparable to DCD-SCD and DBD-ECD transplants albeit with poorer allograft function at 2 years. Quality-of-life studies are needed to determine the true value of these transplants, particularly when performed to older recipients.
Medicina complementar e alternativa na rede básica de serviços de saúde: uma aproximação qualitativa

This article focuses on the social representations of health professionals about the introduction of complementary and alternative medical practices in the public health service network in Campinas city (SP, Brazil). Based in an essentially qualitative methodological perspective, the article analyses the general conditions, the problems and the obstacles related to the implementation of such practices. The success of this inclusion was found in four main reasons: the clientele disposition which gives support and demands this kind of service; the health vision of the sanitarian doctors, which is open to such project; the wide support given by the non-medical health professions, which intend to add value and amplify their practice and, finally, the own perspective of the alternative and complementary medicines, which agree with the Unified Health System (SUS) proposals. Despite the success in the implementation of such practices in the health basic system, two negative aspects were detected: the insufficient planning and the simplified vision which converts such rationalities in mere techniques, which follow the same mechanistic principles of the allophatic medicine and the same reified understanding of disease.
Clinical and pathological features of a parkinsonian syndrome in a family with an Ala53Thr α‐synuclein mutation

We describe an Australian family of Greek origin with a parkinsonian syndrome and an Ala53Thr α‐synuclein gene mutation. Five of 9 siblings were affected, the average age of onset was 45 years, and the initial symptoms were variable, including resting tremor, bradykinesia, and gait disturbance, as previously described in families with the same point mutation. Affected family members responded well to levodopa, developed progressive cognitive impairment, and had a disease duration of 5 to 16 years. Pathologic features typical of idiopathic Parkinson's disease were found at autopsy. However, there were several additional features not previously reported in families with this gene mutation. These features included severe central hypoventilation, orthostatic hypotension, prominent myoclonus, and urinary incontinence. An abundance of α‐synuclein–immunoreactive Lewy neurites were found in the brainstem pigmented nuclei, hippocampus, and temporal neocortex. The Lewy neurites were associated with temporal lobe vacuolation. Subcortical basal ganglia cell loss and gliosis were seen. These additional clinical and pathological features suggest that the Ala53Thr α‐synuclein mutation can produce a more widespread disorder than found in typical idiopathic Parkinson's disease. Ann Neurol 2001;49:313–319
Ethical dilemmas in nursing: An integrative review

AIMS To identify themes and gaps in the literature to stimulate researchers to develop strategies to guide decision-making among clinical nurses faced with ethical dilemmas. BACKGROUND The concept of ethical dilemmas has been well explored in nursing because of the frequency of ethical dilemmas in practice and the toll these dilemmas can take on nurses. Although ethical dilemmas are prevalent in nursing practice, frequently leading to moral distress, there is little guidance in the literature to help nurses resolve them. DESIGN This study is an integrative review of published research from 2000 to 2017. METHODS The keywords ethics, ethical dilemmas and nurs* were searched in CINAHL, PubMed, OVID and SCOPUS. Exclusion criteria were sources not available in English, not in acute care, and without an available abstract. Seventy-two studies were screened; 35 were retained. Garrard's matrix was utilised to analyse and synthesise the studies. RESULTS Ethical dilemmas arose from end-of-life issues, conflict with physicians or families, patient privacy concerns and organisational constraints. Differences were found in study location, and yet international research confirms that ethical dilemmas are universally prevalent and must be addressed globally to protect patients and nurses. CONCLUSIONS This review offers an analysis of the available evidence regarding ethical dilemmas in acute care, identifying themes, limitations and gaps in the literature. The gaps in quantitative intervention work, US paucity of research, and lack of comparisons across practice settings/nursing roles must be addressed. Further exploration is warranted in the relationship between ethical dilemmas and moral distress, the significance patient physical appearance plays on nurse determination of futility, and strategies for pain management and honesty. RELEVANCE TO NURSING PRACTICE Understanding and addressing gaps in research is essential to develop strategies to help nurses resolve ethical dilemmas and to avoid moral distress and burnout.
Dental and oral health status in drug abusers in Chennai, India: A cross-sectional study

Aim: To ascertain the oral health status and dental health status of drug abusers (DA) and compare them with those of non-drug-abusing dental patients. Design: Hospital-based cross-sectional study. Setting and Participants: Hundred consecutive male DA attending rehabilitation center for drug abuse and age-matched 100 non-drug abusers attending the outpatient department of a dental college hospital. Measurements: Detailed history and clinical findings were recorded in a predetermined format by trained physician and dental surgeons. Data entry and statistical analysis were done using SPSS 10.0. 5® Variables: Oral mucosal lesions (OML), dental lesions (DL), 'decay, missing, filling teeth' index (DMFT), brushing material (toothpaste/others), mode (toothbrush/others), and frequency per day (once/twice). Results: The occurrence of at least one oral mucosal lesion was 49% in drug abusers and 6% in controls, the difference being statistically significant ( P = 0.00). In brushing habits, DL were significantly associated with brushing material ( P = 0.005) and frequency ( P = 0.001) when a comparison was made between DA and controls. The difference of ≤7 in the DMFT score between DA and controls in relation to material used for brushing ( P = 0.04) and frequency of brushing ( P = 0.001) was statistically significant. For any oral mucosal lesion, odds ratio (OR) was 15.1 (95% CI, 6-37.5); for any potentially malignant states, OR was 54.4 (95% CI, 3.2-911.3); for dental caries, the OR was 3.3 (95% CI, 1.8-5.9); and the OR for extrinsic stains was 8 (95% CI, 2.7-24). Conclusion: A large gap exists with respect to dental and oral health status between DA and the general population. DA are at 54.4 times higher risk for having a potentially malignant state. These factors highlight the need for regular oral examination and dental treatment in DA.
Detection of volatile biomarkers of therapeutic radiation in breath

Breath testing could provide a rational tool for radiation biodosimetry because radiation causes distinct stress-producing molecular damage, notably an increased production of reactive oxygen species. The resulting oxidative stress accelerates lipid peroxidation of polyunsaturated fatty acids, liberating alkanes and alkane metabolites that are excreted in the breath as volatile organic compounds (VOCs). Breath tests were performed before and after radiation therapy over five days in 31 subjects receiving daily fractionated doses: 180–400 cGy d–1 standard radiotherapy (n = 26), or 700–1200 cGy d–1 high-dose stereotactic body radiotherapy (n = 5). Breath VOCs were assayed using comprehensive two-dimensional gas chromatography time-of-flight mass spectrometry. Multiple Monte Carlo simulations identified approximately 50 VOCs as greater-than-chance biomarkers of radiation on all five days of the study. A consistent subset of 15 VOCs was observed at all time points. A radiation response function was built by combining these biomarkers and the resulting dose-effect curve was significantly elevated at all exposures ⩾1.8 Gy. Cross-validated binary algorithms identified radiation exposures ⩾1.8 Gy with 99% accuracy, and ⩾5 Gy with 78% accuracy. In this proof of principal study of breath VOCs, we built a preliminary radiation response function based on 15 VOCs that appears to identify exposure to localized doses of 1.8 Gy and higher. VOC breath testing could provide a new tool for rapid and non-invasive radiation biodosimetry.
Off-line breath acetone analysis in critical illness

Analysis of breath acetone could be useful in the Intensive Care Unit (ICU) setting to monitor evidence of starvation and metabolic stress. The aims of this study were to examine the relationship between acetone concentrations in breath and blood in critical illness, to explore any changes in breath acetone concentration over time and correlate these with clinical features. Consecutive patients, ventilated on controlled modes in a mixed ICU, with stress hyperglycaemia requiring insulin therapy and/or new pulmonary infiltrates on chest radiograph were recruited. Once daily, triplicate end-tidal breath samples were collected and analysed off-line by selected ion flow tube mass spectrometry (SIFT-MS). Thirty-two patients were recruited (20 males), median age 61.5 years (range 26–85 years). The median breath acetone concentration of all samples was 853 ppb (range 162–11 375 ppb) collected over a median of 3 days (range 1–8). There was a trend towards a reduction in breath acetone concentration over time. Relationships were seen between breath acetone and arterial acetone (rs = 0.64, p < 0.0001) and arterial beta-hydroxybutyrate (rs = 0.52, p < 0.0001) concentrations. Changes in breath acetone concentration over time corresponded to changes in arterial acetone concentration. Some patients remained ketotic despite insulin therapy and normal arterial glucose concentrations. This is the first study to look at breath acetone concentration in ICU patients for up to 8 days. Breath acetone concentration may be used as a surrogate for arterial acetone concentration, which may in future have a role in the modulation of insulin and feeding in critical illness.
Postexertional hypotension: A brief review

A statistically and clinically significant reduction in arterial pressure occurs following a single bout of low intensity, short duration aerobic exercise in individuals with hypertension. The reduction in arterial pressure is most often associated with a decrease in total peripheral resistance, peripheral sympathetic nerve activity, and plasma norepinephrine concentration; however, cardiac output is often elevated without a change in heart rate. The purpose of this article is to review the literature and propose a model that analyzes the components contributing to the postexercise reduction in arterial pressure. The model implicates an attenuated vascular response to catecholamine stimulation and an enhanced inhibitory cardiopulmonary reflex response. Recent evidence has shown that a single bout of dynamic exercise significantly attenuated the vasoconstrictor response to phenylephrine in an isolated aortic ring preparation and in the intact conscious rabbit and rat. This suggests that the ability of the .
The challenge in diagnosing de novo minimal change disease after transplantation.

A man with end-stage kidney disease (ESKD) secondary to renal coloboma syndrome received an en bloc kidney transplant from a 5-month-old donor. He was induced with thymoglobulin and discharged on tacrolimus, mycophenolate mofetil, and prednisone. Three months later, he was without complaint, had a creatinine of 1.4 mg/dL, and urine protein creatinine ratio (UPCR) of 5.7. He tested negative for hepatitis B, hepatitis C, and human immunodeficiency viruses. A kidney biopsy revealed immature-appearing glomeruli with moderate mesangial matrix expansion and focal mesangial hypercellularity. There was no interstitial inflammation and minimal interstitial fibrosis or tubular atrophy. Immunofluorescence examination was negative for immunoglobulins or complement deposits. Ultrastructural evaluation showed diffuse epithelial foot process effacement and podocyte injury. There were no electron dense deposits. Tubuloreticular inclusions were noted (Figure 1), because of which he underwent polymerase chain reaction testing for cytomegalovirus, BK virus and Epstein-Barr virus, all of which were negative. He was diagnosed to have de novo minimal change disease (MCD) and treated with prednisone 1 mg/kg daily and lisinopril 5 mg daily. Eight weeks later, his UPCR was 0.5, and prednisone was tapered over the next 2 months. His UPCR further decreased to 0.1. Twenty months after the diagnosis his UPCR is 0.1 and creatinine 0.9 mg/dL. Minimal change disease is characterized by the clinical picture of nephrotic syndrome without a reduction in glomerular filtration rate where a kidney biopsy shows normal glomeruli on light microscopy (or only minimal mesangial prominence), negative or low-level staining for C3, immunoglobulin M staining on immunofluorescence microscopy, and diffuse foot process effacement on electron microscopy. It was hypothesized to be caused by a secreted factor resulting from systemic T-cell dysfunction that damages the glomerular basement membrane. Some recent studies have suggested that podocyte expression of B7-1(CD-80)