Miracle-dz/UniFAR-FTUs huggingface dataset:
Intrauterine Repair of Cleft Lip‐Like Defects in Lambs with a Novel Microclip

Potential for scarless wound healing in fetal surgeries has aroused interest in fetal repair of malformations such as cleft lip. However, current protocols for fetal surgery have entailed fetal externalization, imparting significant risks for mother and fetus. We have developed a unique silver microclip that rapidly approximates tissue, is nonpenetrating, and is well suited for endoscopie use. Using standardized intrauterine surgical techniques, we compared suture versus microclip in the repair of surgically created cleft lip-like defects in fetal lambs at 124 days' gestation (term, 145 days). Nine fetal lambs were analyzed with bilateral cleft lips; the right cleft was repaired by microclip, seven of the left clefts were repaired by suture, and the remaining two left clefts were not approximated (controls). Results demonstrated excellent wound healing and smooth lip continuity with minimal scar formation after repair by either microclip or suture. The most striking result, however, was in the comparison of intraoperative repair time; the total time for cleft lip repair by microclip averaged 2.5 minutes in contrast to 9.8 minutes for suture. These data suggest a distinct advantage of the microclip in reduction of operative time. Furthermore, its endoscopie application has the potential for making endoscopie fetal surgery a more viable option.
Serum levels of leukocyte functional antigen‐3 in pregnancy and preeclampsia

BACKGROUND Adhesion molecules have been demonstrated to be involved in placental growth and development in normal pregnancy. Experimental evidence indicates that adhesion molecules are key factors of endothelial activation in preeclampsia. The aim of our study was to evaluate serum levels of the adhesion molecule Leukocyte Functional Antigen (LFA)-3 in healthy, non pregnant, female controls, healthy pregnant women, and preeclamptic women. METHODS In our study we included 45 healthy, non pregnant, female controls, 45 healthy pregnant women, and 45 preeclamptic women. An enzyme-linked immunosorbent assay was used to determine serum levels of LFA-3. Results were correlated to clinical data. RESULTS The median LFA-3 serum level in healthy, non pregnant, female controls was 0.2 (range 0 to 8.6) ng/mL. LFA-3 serum levels in healthy pregnant women were 4.8 (range 0 to 18) ng/mL and were significantly elevated compared to healthy, non pregnant, female controls (Mann-Whitney U-test, p=0.004). A cut-off level of 4.8 ng/mL was selected according to the 75th quantile of serum levels measured in the panel of healthy, non pregnant, female controls. In preeclamptic women, whose pregnancies had to be terminated due to exacerbation of preeclamptic symptoms, LFA-3 serum levels above the cut-off level were seen in 14/27 (52%) cases. In contrast, preeclamptic women, who went into spontaneous labor showed elevated LFA-3 serum levels in 17/18 (95%) cases (chi-square test, p=0.002). LFA-3 serum levels revealed a statistically significant influence on the odds of termination of pregnancy due to exacerbation of preeclamptic symptoms (unconditional logistic regression, p=0.02) with an odds ratio of 0.1 (95% CI, 0.006 to 0.7) by every doubling of LFA-3 values. CONCLUSIONS Our results suggest that LFA-3 expression is upregulated in healthy pregnant women compared to healthy, non pregnant, female controls. Failure of LFA-3 upregulation in preeclampsia is associated with an increased risk for termination of pregnancy due to exacerbation of preeclamptic symptoms.
Management of Difficult Airways Using a Hospital-Wide “Alpha Team” Approach

Airway management is germane to safe patient care. Keys to management of difficult airways (DAs) are the “Right People, Right Parts, and Right Place” (R3P3). Successful management of DA requires clinicians who have adequate training, experience, and equipment. Policies were implemented to optimize the management of DAs. One identified inpatients with potential DAs, whereas the other addressed creation and deployment of “Alpha Teams” (ATs). In the event of impending respiratory compromise, an AT was called in the same manner as a code blue. Health care providers were educated about these process changes, and ATs were tested using computerized patient simulators and self-paced observations. Testing assessed performance before, immediately after, and 30 days after the seminar. Changes in, and retention of, knowledge about DAs was analyzed. The goal of the R3P3 was to identify DAs and then to bring a well-trained hospital-wide AT to the bedside to decrease response time, rapidly establish a definitive airway, and improve survivability in an airway emergency.
Comparative effects of University of Wisconsin and Euro-Collins solutions on pulmonary mitochondrial function after ischemia and reperfusion.

BACKGROUND The aim of this study was to compare the effects of Euro-Collins and University of Wisconsin solutions on pulmonary mitochondrial function after cold ischemia and subsequent warm reperfusion. METHODS Seventeen pigs underwent lung harvesting after classical lung flush with either University of Wisconsin or Euro-Collins solutions. The mitochondria were isolated from fresh swine lungs, from swine lungs subjected to 24 hr of cold ischemia, and from swine lungs subjected to 24 hr of ischemia followed by 30 min of subsequent ex vivo reperfusion at 37 degrees C with Krebs-Henseleit buffer solution and air ventilation. Mitochondrial oxidative phosphorylation parameters were determined in isolated mitochondria by in vitro measurement of oxygen consumption rates. During reperfusion, the lung function was assessed by the pulmonary aerodynamic parameters and the pulmonary vascular resistance. RESULTS Relative to controls, mitochondria submitted to cold ischemia showed an alteration in the oxidoreductase activities of the respiratory chain. However, the yield of oxidative phosphorylation was conserved. After reperfusion, pulmonary mitochondria underwent a significant worsening in the oxidoreductase activities of the respiratory chain, and a decrease in the respiratory control and the efficiency of oxidative phosphorylation. Meanwhile, the reperfused lungs showed evidence of early dysfunction, assessed by the aerodynamic parameters and pulmonary vascular resistance. In this model, there was no advantage of University of Wisconsin solution over Euro-Collins solution. CONCLUSIONS The mild mitochondrial alterations after cold ischemia were not sufficient to explain the limited tolerance of lung to ischemia. After reperfusion, the mitochondrial damage was more severe and could be involved in the posttransplant lung dysfunction.
EVALUATION OF MEDETOMIDINE–KETAMINE ANESTHESIA WITH ATIPAMEZOLE REVERSAL IN AMERICAN ALLIGATORS (ALLIGATOR MISSISSIPPIENSIS)

Abstract Sixteen captive and wild-caught American alligators (Alligator mississippiensis), seven juveniles (≤1 m total length [TL]; 6.75 ± 1.02 kg), and nine adults (≥2 m TL; 36.65 ± 38.85 kg), were successfully anesthetized multiple times (n = 33) with an intramuscular (i.m.) medetomidine–ketamine (MK) combination administered in either the triceps or masseter muscle. The juvenile animals required significantly larger doses of medetomidine (x̄ = 220.1 ± 76.9 μg/kg i.m.) and atipamezole (x̄ = 1,188.5 ± 328.1 μg/kg i.m.) compared with the adults (medetomidine, x̄ = 131.1 ± 19.5 μg/kg i.m.; atipamezole, x̄ = 694.0 ± 101.0 μg/kg i.m.). Juvenile alligators also required higher (statistically insignificant) doses of ketamine (x̄ = 10.0 ± 4.9 mg/kg i.m.) compared with the adult animals (x̄ = 7.5 ± 4.2 mg/kg i.m.). The differences in anesthesia induction times (juveniles, x̄ = 19.6 ± 8.5 min; adults, x̄ = 26.6 ± 17.4 min) and recovery times (juveniles, x̄ = 35.4 ± 22.1 min; adults, x̄ = 37.9 ± 20.2 min) were also not statistically significant. Anesthesia depth was judged by the loss of the righting, biting, corneal and blink, and front or rear toe-pinch withdrawal reflexes. Recovery in the animals was measured by the return of reflexes, open-mouthed hissing, and attempts to high-walk to the opposite end of the pen. Baseline heart rates (HRs) were significantly higher in the juvenile animals (x̄ = 37 ± 4 beats/min) compared with the adults (x̄ = 24 ± 5 bpm). However, RRs (juveniles, x̄ = 8 ± 2 breaths/min; adults, x̄ = 8 ± 2 breaths/min) and body temperatures (juveniles, x̄ = 24.1 ± 1.1°C; adults, x̄ = 25.2 ± 1.2°C) did not differ between the age groups. In both groups, significant HR decreases were recorded within 30–60 min after MK administration. Cardiac arrhythmias (second degree atrio-ventricular block and premature ventricular contractions) were seen in two animals but were not considered life-threatening. Total anesthesia times ranged from 61–250 min after i.m. injection. Although dosages were significantly different between the age groups, MK and atipamezole provided safe, effective, completely reversible anesthesia in alligators. Drug-dosage differences appear to be related to metabolic differences between the two size-classes, requiring more research into metabolic scaling as a method of calculating anesthetic dosages.
Evolution of the Cutaneous Immune Response to Experimental Haemophilus ducreyi Infection and Its Relevance to HIV-1 Acquisition1 2

Haemophilus ducreyi causes the sexually transmitted disease chancroid, which facilitates HIV-1 transmission. Skin biopsies were obtained from subjects experimentally infected with H. ducreyi to study the evolution of the immune response and immunophenotypes relevant to transmission of HIV-1. Compared with peripheral blood, there was an enrichment of T cells and macrophages after 48 h of infection in the skin. Neutrophils became the predominant cell type by 7–9 days. By immunohistochemistry, macrophage-inflammatory protein-1α was not present early in infection, but was abundant at later stages. RANTES was present throughout the papular and pustular stages of experimental infection, but not present in uninfected control skin. Stromal cell-derived factor-1 was present at low levels in all samples examined. Macrophages in lesions had significantly increased expression of CCR5 and CXCR4 compared with peripheral blood cells, and CD4 T cells had significant up-regulation of CCR5. The magnitude of increased expression of these receptors was not replicated when PBMCs were incubated with H. ducreyi or H. ducreyi lipooligosaccharide in vitro. Together with the disruption of mucosal and skin barriers, the presence of cells with up-regulated HIV-1 coreceptors in H. ducreyi-infected lesions may provide an environment that facilitates the acquisition of R5 (CCR5), X4 (CXCR4), and dual-tropic HIV-1 strains.
Implicit and explicit memory after focal thalamic lesions

Background: Lesions of the thalamus interfere with cognitive functions mainly in the area of declarative learning and memory. Little is known about the role the thalamus plays in implicit learning. Objective: To study explicit and implicit learning and memory in subjects with thalamic lesions and to analyze the influence of lesion characteristics on cognitive performance. Methods: The authors studied the performance of 15 subjects with focal thalamic infarction or hemorrhage on a comprehensive neuropsychological test battery focusing on tests of explicit memory and learning of a nondeclarative motor skill. Subjects with thalamic lesions were compared to 15 healthy matched control subjects and to a clinical control group of 22 subjects who had sustained basal ganglia lesions. Results: Subjects with thalamic lesions showed well-preserved intellectual and executive functions but demonstrated deficits on measures of attention and psychomotor speed, explicit memory, and implicit visuomotor sequence learning. Lesion size in the thalamus was clearly related to subjects’ long-term explicit memory performance. However, few of the neuropsychological deficits found seemed specific to the long-term neuropsychological outcome of focal thalamic infarctions. Subjects with lesions in the basal ganglia demonstrated similar deficits. Conclusions: Focal subcortical lesions in the thalamus and the basal ganglia lead to a similar profile of neuropsychological deficits. Lesions in the thalamus not only affect declarative memory but also interfere with nondeclarative motor skill learning.
Distortion product emission features and the prediction of pure tone thresholds

Distortion product emission (DPE) growth functions, demographic data, and pure tone thresholds (PTTs) were recorded in 229 normal‐hearing and hearing‐impaired ears. Half of the data set (115 ears) was used by a discriminant analysis routine to classify DPE and demographic features into either a normal PTT group or an impaired PTT group (PTT greater than 30 dB SPL [sound pressure level]) at six frequencies in the audiometric range. The six discriminant functions developed from this classification process were then used to predict PTT group membership in the remaining 114‐ear data set. Frequency‐specific prediction accuracy was approximately 85% overall.
Long-term prospective follow-up study of cardiac function after cardiotoxic therapy for malignancy in children.

PURPOSE To evaluate cardiac function by means of conventional and three-dimensional echocardiography (3DE) and measurement of natriuretic peptides in children and adolescents previously treated for childhood malignancy using individual follow-up data and matched control children as reference criteria. PATIENTS AND METHODS Thirty-nine survivors of childhood malignancy were examined in 1994 and 1998. The mean time from the diagnosis was 8.6 (3.9 to 16.8) years and between cardiac evaluations was 4.1 (3.3 to 5.1) years. Patients were divided into two groups according to therapies given (group I (n = 30): no cardiac irradiation, median cumulative anthracycline dose 210 mg/m2; group II (n = 9): irradiation in the cardiac region, median cumulative anthracycline dose 180 mg/m2). RESULTS Fractional shortening (FS) in 1994 was higher than in 1998 (32.5 +/- 4.3 vs. 30.3% +/- 3.3%, P =.009). 33% of patients in group I and 56% in group II in 1994 and 30% of patients in group I and 67% in group II in 1998 had N-terminal of the propeptide-atrial natriuretic peptide (NT-proANP) levels exceeding the 90th percentile of controls. In 1998, both groups (I and II) had lower ejection fraction (EF) measured by 3DE than their matched controls (52.9 +/- 5.2 vs. 58.8% +/- 3.1%, P <.001 and 50.0 +/- 6.6 vs. 60.8% +/- 3.2%, P =.024, respectively). Left atrial maximum volumes/body surface area were smaller in the patients than in controls. B-Type natriuretic peptide values did not differ significantly in either group. CONCLUSION Left ventricular contractility decreases slowly even years after cardiotoxic cancer therapy in children. 3DE and NT-proANP measurements are effective methods to evaluate the cardiac function in these patients.
Both Cycloclasticus spp. and Pseudomonas spp. as PAH-degrading bacteria in the Seine estuary (France).

Like other highly urbanized and industrialized estuaries, the Seine estuary (France) has, for decades, received high inputs of polycyclic aromatic hydrocarbons (PAHs). In order to estimate the bioremediation potentials and to identify the bacterial species involved in hydrocarbon degradation, we used microcosms containing seawater from the Seine estuary supplemented with either naphthalene, phenanthrene, fluorene or pyrene. In the microcosms enriched with naphthalene or phenanthrene, hydrocarbon biodegradation was significant within 9 weeks (43% or 46%, respectively), as shown by analyses in GC-MS. In similar microcosms incubated also with naphthalene or phenanthrene, analysis of the 16S rRNA gene sequences (DNA and cDNA) with denaturing gradient gel electrophoresis and clone libraries indicated that the PAH-degrading communities were dominated by Cycloclasticus spp. , confirming their universal key role in degradation of low-molecular-weight PAHs in marine environments. However, in contrast to previous studies, we found that Pseudomonas spp. also degraded naphthalene and phenanthrene in seawater; this occurred only after 21 days, as was confirmed by real-time PCR. Although this genus has been abundantly described in the literature as a good PAH-degrading bacterial group in soil or in sediment, to our knowledge, this is the first evidence of a significant fitness in PAH degradation in seawater.
Role of laparoscopy in management of renal stones: single-center experience and review of literature.

BACKGROUND AND PURPOSE Laparoscopy can be an alternative modality in the management of renal stones. We present our experience with laparoscopic renal stone surgery. PATIENTS AND METHODS Eighteen patients (4 males, 14 females) with mean age of 51 years (range 18-86 years) underwent 19 laparoscopic procedures. The mean stone number and size, excluding five patients who had nephrectomy/heminephrectomy, were 1.9 (range 1-5) and 1.3 cm (range 0.5-4.5 cm), respectively. Three patients with ureteropelvic junction obstruction underwent pyeloplasty and concomitant pyelolithotomy. Three patients with upper-pole caliceal-diverticular stones had nephrolithotomy and fulguration of the diverticular mucosa. Three patients with stones and hydrocalix with scarred cortex had partial nephrectomy, two under cold and one under warm ischemia. Five patients, including one with a horseshoe kidney (who had one procedure on each kidney), had pyelolithotomy as an alternative to percutaneous nephrolithotomy. Patients with stones in a nonfunctioning kidney underwent nephrectomy (three patients) or heminephrectomy (one patient). RESULTS All procedures were completed laparoscopically. The operative time was variable depending on the complexity of the procedures, from 115 minutes for Fengerplasty to 315 minutes for partial nephrectomy under cold ischemia (mean 178 minutes). The estimated blood loss was 53.2 mL (range 20-120 ml), and none of the patients received a blood transfusion. Complete stone clearance was achieved in 93% of the procedures. The mean hospital stay was 10.5 days (range 5-35 days). Three patients needed temporary pigtail-catheter drainage for obstruction after pyelolithotomy. One patient with a solitary kidney and infected staghorn calculus had prolonged urinary leak, which stopped with conservative management. One nephrectomy for nephrocutaneous fistula was complicated by a late colonic perforation necessitating colostomy. CONCLUSION Laparoscopic surgery is effective for complex renal stones and allows for adjunctive procedures. It can also be an alternative to percutaneous nephrolithotomy. It complements other minimally invasive procedures, and a need for open stone surgery should be rare in the future.
Effect of extravascular plasma protein on pressure‐flow relations across synovium in anaesthetized rabbits.

1. The effect of extravascular plasma protein on fluid flux through interstitial matrix was investigated in vivo by studying the pressure‐flow relation across synovium during intra‐articular infusions of protein solutions (usually bovine serum albumin). Synovium is a sheet of non‐epithelial cells separated by interstitium‐filled gaps, beneath which are fenestrated capillaries: synovium regulates synovial fluid volume and composition. 2. Albumin solutions (10‐150 g l‐1) of measured oncotic pressure and viscosity were infused at known pressure into the synovial cavity of knees of anaesthetized rabbits. Flow across the synovial lining in the steady state (absorption rate Qs) was recorded at a series of joint pressures (Pj) to define the pressure‐flow relation. Krebs solution was infused into the opposite knee as a control (26 animals). 3. Infusion of a low albumin concentration (10 g l‐1, bovine or rabbit) or diluted rabbit serum revealed no specific effect of plasma protein on interstitial matrix permeability (cf. specific protein effect on capillary glycocalyx permeability). Physiological (22.5 g l‐1) and higher concentrations reduced trans‐synovial absorption rate. The slope of the pressure‐flow relation was reduced and the pressure intercept displaced to the right (i.e. Pj at zero flow was raised). 4. Slope dQs/dPj correlated negatively with intra‐articular viscosity (P = 0.001‐0.04), in keeping with viscous interstitial flow. The reduction in normalized slope, however, did not equal the reduction in fluidity (1/viscosity) quantitatively. It is proposed that apparent fluidity within the interstitial matrix is higher than in the bulk phase due to steric exclusion of albumin (radius 3.55 nm) by the interstitial glycosaminoglycans. The latter form spaces of estimated mean hydraulic radius 14‐18 nm in synovium. 5. The joint‐pressure intercept at zero net trans‐synovial flow was displaced 0.015 cmH2O per cmH2O intra‐articular oncotic pressure (pi j; S.E.M. +/‐ 0.006). Thus large trans‐synovial osmotic gradients were not maintained at physiological flow velocities. The 1.5% displacement of the Pj intercept by pi j was attributed principally to interstitial albumin exerting pericapillary oncotic pressure and enhancing net Starling filtration pressure. Indeed, net trans‐synovial flow at low joint pressure sometimes reversed from absorption to filtration into the joint cavity at high intra‐articular oncotic pressures. 6. The displacement of the trans‐synovial flow intercept per unit change in intra‐articular oncotic pressure, (dQs/d pi j)Pj = 0, was 18 +/‐ 3 nl min‐1 cmH2O‐1. (ABSTRACT TRUNCATED AT 400 WORDS)