Miracle-dz/UniFAR-FTUs huggingface dataset:
Effect of Obesity on Flap and Donor-Site Complications in Pedicled TRAM Flap Breast Reconstruction

Background: The detrimental effects of obesity on pedicled and free transverse rectus abdominis myocutaneous (TRAM) flap reconstructions, including flap loss, hematoma, and donor-site hernia, are well documented. This study examined the effect of obesity on complications in patients undergoing pedicled TRAM flap breast reconstruction. Methods: A retrospective review of 224 pedicled TRAM flaps in 200 patients over a 10-year period was carried out. Patients were divided into three groups: normal weight (body mass index < 25; 47 percent of patients), overweight (body mass index 25 to 29.9; 38 percent), and obese (body mass index ≥ 30; 15 percent). There were no statistically significant differences in age, smoking history, radiation/chemotherapy history, distribution of flap pedicle types, timing of reconstruction, percentage of delay procedures performed, or expanders implanted among the three subgroups. Donor-site, flap, and other miscellaneous complications were compared among subgroups, and logistic regression analysis was used to identify risk factors for flap and donor-site complications. Results: Compared with normal weight and overweight patients, obese patients had a statistically significantly higher incidence of multiple flap complications (36.7 percent versus 10.6 percent and 36.7 percent versus 10.5 percent, respectively; p = 0.0036) and partial flap necrosis (21.6 percent versus 5.8 percent and 21.6 percent versus 7.1 percent; p = 0.01 and p = 0.03, respectively). Lastly, obese patients had a significantly higher incidence of overall (one or more) donor-site complications when compared with normal weight patients (53.3 percent versus 31.9 percent; p = 0.0499). Conclusion: Obese patients, in contrast to normal weight and overweight patients, have a statistically significantly higher risk for developing overall (one or more) and multiple flap complications, overall donor-site complications, TRAM flap delayed wound healing, and minor flap necrosis.
Event- and interval-based measurement of stuttering: a review.

BACKGROUND Event- and interval-based measurements are two different ways of computing frequency of stuttering. Interval-based methodology emerged as an alternative measure to overcome problems associated with reproducibility in the event-based methodology. No review has been made to study the effect of methodological factors in interval-based absolute reliability data or to compute the agreement between the two methodologies in terms of inter-judge, intra-judge and accuracy (i.e., correspondence between raters' scores and an established criterion). AIMS To provide a review related to reproducibility of event-based and time-interval measurement, and to verify the effect of methodological factors (training, experience, interval duration, sample presentation order and judgment conditions) on agreement of time-interval measurement; in addition, to determine if it is possible to quantify the agreement between the two methodologies METHODS & PROCEDURES The first two authors searched for articles on ERIC, MEDLINE, PubMed, B-on, CENTRAL and Dissertation Abstracts during January-February 2013 and retrieved 495 articles. Forty-eight articles were selected for review. Content tables were constructed with the main findings. MAIN CONTRIBUTION Articles related to event-based measurements revealed values of inter- and intra-judge greater than 0.70 and agreement percentages beyond 80%. The articles related to time-interval measures revealed that, in general, judges with more experience with stuttering presented significantly higher levels of intra- and inter-judge agreement. Inter- and intra-judge values were beyond the references for high reproducibility values for both methodologies. Accuracy (regarding the closeness of raters' judgements with an established criterion), intra- and inter-judge agreement were higher for trained groups when compared with non-trained groups. Sample presentation order and audio/video conditions did not result in differences in inter- or intra-judge results. A duration of 5 s for an interval appears to be an acceptable agreement. Explanation for high reproducibility values as well as parameter choice to report those data are discussed. CONCLUSIONS & IMPLICATIONS Both interval- and event-based methodologies used trained or experienced judges for inter- and intra-judge determination and data were beyond the references for good reproducibility values. Inter- and intra-judge values were reported in different metric scales among event- and interval-based methods studies, making it unfeasible to quantify the agreement between the two methods.
Fluoroscopic guided lumbar interlaminar epidural injections: a prospective evaluation of epidurography contrast patterns and anatomical review of the epidural space.

OBJECTIVE To evaluate the pattern and flow of epidural contrast in fluoroscopically guided lumbar interlaminar steroid injections. DESIGN AND METHODS A prospective case series of 25 (twenty-five) consecutive patients receiving 25 (twenty-five) injections. Patients had either lumbar spinal stenosis (LSS) or herniated nucleus pulposus (HNP). All patients received their injection using a loss of resistance technique. Once the epidural space was felt localized 0.5 mL of Isovue contrast was injected to confirm accurate needle placement. If in the epidural space, another 4.5 mL was injected for a total of 5 mL contrast media. Both AP and lateral radiographs were obtained and reviewed by a physician trained in fluoroscopic injections for review of the contrast pattern. Patterns recorded were Unilateral, Bilateral, Ventral or Dorsal. The dorsal flow was also characterized as being cephalad or caudad and the number of lumbar intervertebral levels of flow were recorded as well. RESULTS Dorsal contrast flow occurred in all 25 injections. Thirty-six percent (9 out of 25) resulted in ventral spread of contrast. Eighty-four percent (21 out of 25) of the injections had flow of contrast unilaterally and 16% (4 out of 25) was bilateral. The mean number of levels of flow of contrast cephalad from the injection site was 1.28 and caudally 0.88. There was a significant difference in more cephalad than caudal contrast flow (P = 0.004) CONCLUSION Thirty six percent of the injections observed in the study revealed ventral contrast flow. Bilateral contrast flow occurred in 16% of the injections. Caudad contrast flow is less than cephalad. The observed contrast flows need to be studied clinically to determine if this can affect clinical outcome.
Sizing and Allocation of Operating Reserves following Wind Power Integration (Dimensioneren en toewijzen van operationele reserves met het oog op de integratie van windenergie)

As part of the European policy goals aiming towards a sustainable energy supply, the share of renewable energy sources in the electricity system is increasing. The two technologies driving this development in Europe, i.e. wind and PV, are characterised by a variable energy output, facing a limited predictability. These unexpected output variations challenge the real-time balance between electricity demand and supply and require appropriate operating reserve capacity. In the absence of large-scale storage or price responsive demand, the balancing of the power system is the main bottleneck for a large-scale deployment of renewable electricity generation in the power system. This dissertation deals with the management of operating reserves for balancing the power system with high shares of wind power. Firstly, a numerical model is developed to generate realistic time series of wind power generation and predictions over a region. This data is used to determine the short-term variations and prediction errors impacting the system balance. These are assessed by means of a flexibility assessment tool quantifying the operational thermal flexibility which is available for covering real-time system imbalances. Results show that without additional reserve requirements, this flexibility is insufficient to ensure a reliable integration of wind power. Particularly the upward fast-response flexibility is found to be scarce. Secondly, a statistical methodology is used to size and allocate additional reserve capacity to maintain stable reliability standards while integrating wind power. A strategy which minimises total capacity while maximising the allocation of reserve capacity towards slow-response reserves is put forward as a cost-efficient strategy. This is verified by means of a model simulating the day-ahead scheduling of power plants to meet the demand for power and reserve capacity. It is found that reserve requirements, and in particular the fast-response upward reserves, impact electricity generation cost. This cost increase is minimised when deploying slow-response reserve strategies. Results indicate the importance of peak power plants and base load flexibility to obtain a cost-efficient procurement of thermal reserve capacity. Finally, two reserve strategies are presented based on probabilistic wind power forecasting tools. Information concerning the uncertainty of the wind power forecast is used to obtain time-varying reserve requirements and enables the active participation of wind power in reserves. It is shown that both strategies achieve substantial cost savings without impacting system security. In particular the dynamic reserve strategy is particularly useful for reducing upward reserve capacity. In contrast, wind power participation remains a last-resort measure when facing low downward flexibility and elevated reserve requirements.
Clonotype Selection and Composition of Human CD8 T Cells Specific for Persistent Herpes Viruses Varies with Differentiation but Is Stable Over Time1

Protection from reactivation of persistent herpes virus infection is mediated by Ag-specific CD8 T cell responses, which are highly regulated by still poorly understood mechanisms. In this study, we analyzed differentiation and clonotypic dynamics of EBV- and CMV-specific T cells from healthy adults. Although these T lymphocytes included all subsets, from early-differentiated (EM/CD28pos) to late-differentiated (EMRA/CD28neg) stages, they varied in the sizes/proportions of these subsets. In-depth clonal composition analyses revealed TCR repertoires, which were highly restricted for CMV- and relatively diverse for EBV-specific cells. Virtually all virus-specific clonotypes identified in the EMRA/CD28neg subset were also found within the pool of less differentiated “memory” cells. However, striking differences in the patterns of dominance were observed among these subsets, because some clonotypes were selected with differentiation while others were not. Late-differentiated CMV-specific clonotypes were mostly characterized by TCR with lower dependency on CD8 coreceptor interaction. Yet all clonotypes displayed similar functional avidities, suggesting a compensatory role of CD8 in the clonotypes of lower TCR avidity. Importantly, clonotype selection and composition of each virus-specific subset upon differentiation was highly preserved over time, with the presence of the same dominant clonotypes at specific differentiation stages within a period of 4 years. Remarkably, clonotypic distribution was stable not only in late-differentiated but also in less-differentiated T cell subsets. Thus, T cell clonotypes segregate with differentiation, but the clonal composition once established is kept constant for at least several years. These findings reveal novel features of the highly sophisticated control of steady state protective T cell activity in healthy adults.
Mifepristone and Misoprostol Compared With Misoprostol Alone for Second-Trimester Abortion: A Randomized Controlled Trial

OBJECTIVE: To estimate the clinical benefit of pretreatment with mifepristone followed by misoprostol compared with misoprostol alone for second-trimester abortion. METHODS: Two hundred sixty women with live fetuses of gestational ages 14–21 weeks were enrolled in a randomized, placebo-controlled, double-blind trial in Vietnam. Eligible consenting women received either mifepristone or placebo to take on their own at home and were scheduled to return to the hospital the next day. At the hospital, women were given 400 micrograms buccal misoprostol every 3 hours, up to five doses, until both the fetus and placenta were expelled. Efficacy was evaluated 15 hours after misoprostol dosing began and the procedure was considered complete if uterine evacuation was achieved without recourse to surgical evacuation. RESULTS: Pretreatment with mifepristone resulted in more than twice the chance of complete uterine evacuation in 15 hours (79.8% compared with 36.9%, relative risk 2.16, 95% confidence interval 1.70–2.75). The mean induction-to-abortion interval for complete uterine evacuations was statistically significantly shorter among participants pretreated with mifepristone compared with those given misoprostol alone (8.1, standard deviation 2.8, range 2.5–14.8; and 10.6, standard deviation 2.5, range 6.5–15.5 hours, respectively; P<.001). The side-effect profiles for the two regimens did not differ significantly and acceptability of the treatments was high. CONCLUSION: Mifepristone–misoprostol is more efficacious and faster than misoprostol alone. Services offering home administration of mifepristone as pretreatment could optimize efficacy and acceptability of medical abortions for women with gestations 14–21 weeks since the last menstrual period. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials. gov, NCT00784186. LEVEL OF EVIDENCE: I
Active smoking and COPD phenotype: distribution and impact on prognostic factors

Purpose Smoking can affect both the phenotypic expression of COPD and factors such as disease severity, quality of life, and comorbidities. Our objective was to evaluate if the impact of active smoking on these factors varies according to the disease phenotype. Patients and methods This was a Spanish, observational, cross-sectional, multicenter study of patients with a diagnosis of COPD. Smoking rates were described among four different phenotypes (non-exacerbators, asthma-COPD overlap syndrome [ACOS], exacerbators with emphysema, and exacerbators with chronic bronchitis), and correlated with disease severity (body mass index, obstruction, dyspnea and exacerbations [BODEx] index and dyspnea grade), quality of life according to the COPD assessment test (CAT), and presence of comorbidities, according to phenotypic expression. Results In total, 1,610 patients were recruited, of whom 46.70% were classified as non-exacerbators, 14.53% as ACOS, 16.37% as exacerbators with emphysema, and 22.40% as exacerbators with chronic bronchitis. Smokers were predominant in the latter 2 groups (58.91% and 57.67%, respectively, P=0.03). Active smoking was significantly associated with better quality of life and a higher dyspnea grade, although differences were observed depending on clinical phenotype. Conclusion Active smoking is more common among exacerbator phenotypes and appears to affect quality of life and dyspnea grade differently, depending on the clinical expression of the disease.
Relationship between age and site of colorectal cancer based on colonoscopy findings.

BACKGROUND Colorectal cancer occurs more frequently in older people. Because the population of aged persons is increasing, a better understanding of the characteristics of colorectal cancer with respect to age would be useful. The purpose of this study was to determine whether there is any relationship between the site of colorectal adenoma and adenocarcinoma in the colon and age. METHODS Colonoscopy was performed (September 1995 to December 1998) on 2942 consecutive patients (1907 men, 1035 women; mean age 61 years, range 11 to 95 years) with no history of colorectal adenoma, adenocarcinoma, or inflammatory bowel disease. The occurrence of colorectal neoplasia, histologically proven as adenoma or adenocarcinoma, was analyzed for a possible association between site in the colon and patient age. RESULTS Adenocarcinoma was found in 191 patients (196 lesions). The proportion of patients with right-sided colonic adenocarcinoma increased with patient age: < 50 years, 15% (2/13); 50 to 59 years, 21% (8/39); 60 to 69 years, 32% (18/57); 70 to 79 years, 42% (25/49); > or =80 years, 57% (16/28). The proportion of patients with right-sided adenoma did not significantly differ among age groups: < 50 years, 40% (98/246); 50 to 59 years, 41% (280/678); 60 to 69 years, 46% (459/1001); 70 to 79 years, 53% (270/508); and > or =80 years, 57% (87/152). CONCLUSION The frequency of right-sided colon cancer increases with patient age. Hence, colonoscopy may be indicated in the elderly for colorectal cancer screening. Over half of colon carcinomas may be missed if sigmoidoscopy alone is used for screening.
Dissociation of perceptual and motor inhibitory processes in young and elderly participants using the Simon task

Abstract Deficits in inhibitory abilities are frequently observed in normal aging. However, few studies have explored the generality of these deficits in a single group of participants. Here, we used an adaptation of the Simon task to differentially assess perceptual and motor inhibition using the same stimuli and task design and to determine whether these processes use separate or shared cognitive resources. We were interested in determining whether (1) normal aging is associated with the use of separate (as previously evidenced in young participants) or similar cognitive resources to perform perceptual and motor inhibition tasks; (2) older participants present a specific impairment in one of these two processes. Analyses of reaction times indicated that motor and perceptual inhibitory processes share some cognitive resources and both are impaired in normal aging. These results can be interpreted by considering that a dedifferentiation process is responsible for the inhibitory deficits presented by older participants. (JINS, 2008, 14, 1014–1021.)
Citrus leaf blotch virus invades meristematic regions in Nicotiana benthamiana and citrus.

To invade systemically host plants, viruses need to replicate in the infected cells, spread to neighbouring cells through plasmodesmata and move to distal parts of the plant via sieve tubes to start new infection foci. To monitor the infection of Nicotiana benthamiana plants by Citrus leaf blotch virus (CLBV), leaves were agroinoculated with an infectious cDNA clone of the CLBV genomic RNA expressing green fluorescent protein (GFP) under the transcriptional control of a duplicate promoter of the coat protein subgenomic RNA. Fluorescent spots first appeared in agroinfiltrated leaves 11-12 days after infiltration, indicating CLBV replication. Then, after entering the phloem vascular system, CLBV was unloaded in the upper parts of the plant and invaded all tissues, including flower organs and meristems. GFP fluorescence was not visible in citrus plants infected with CLBV-GFP. Therefore, to detect CLBV in meristematic regions, Mexican lime (Citrus aurantifolia) plants were graft inoculated with CLBV, with Citrus tristeza virus (CTV), a virus readily eliminated by shoot-tip grafting in vitro, or with both simultaneously. Although CLBV was detected by hybridization and real-time reverse transcription-polymerase chain reaction (RT-PCR) in 0.2-mm shoot tips in all CLBV-inoculated plants, CTV was not detected. These results explain the difficulty in eliminating CLBV by shoot-tip grafting in vitro.
Engraftment assessment in human and mouse liver tissue after sex‐mismatched liver cell transplantation by real‐time quantitative PCR for Y chromosome sequences

Transplanted hepatocytes can engraft, proliferate, and function permanently in host animals. After one cell infusion, however, engrafted hepatocytes constitute only between 1 in 200 to 1 in 3000 host liver cells. Although transplanted cells can be identified using biochemical and molecular techniques, more accurate methods are needed to evaluate interventions that could improve cell engraftment rates. Real‐time polymerase chain reaction (PCR) was done using primers and probes complementary to human testis determining gene (SRY) and mouse testis‐specific Y‐encoded protein (TSPY) pseudogene. Tissue samples from human or mouse recipients of liver cell transplantation were used to determine the test ability to detect transplanted cell DNA. Real‐time PCR for the human SRY and mouse TSPY were species‐ and sex‐specific. These two tests were sensitive in the detection of male DNA. Test sensitivity was consistently found at minimum 1:10,000 of male and female DNA mixing curve in both human SRY and mouse TSPY assays. The optimal amount of sample DNA per reaction to produce the highest sensitivity was 300 ng to 1 μg. Real‐time PCR gave similar results whether standard male‐female mixtures were prepared from liver cells or mononuclear cells. Engraftment of male liver cells in female liver tissues in mice and humans ranging from 0.125% to 0.257% was successfully measured using this method. Real‐time PCR for SRY and TSPY affords a specific, sensitive, and reproducible tool for chimerism analysis in transplanted human and mouse liver tissues. This method could be used to optimize current models of cell transplantation.
Merkel cell carcinoma: is this a true carcinoma?

Recent years have brought an enhanced understanding of Merkel cell carcinoma (MCC) biology, especially with regard to the Merkel cell polyoma virus as a causative agent. Differences between Merkel cell polyomavirus‐positive and Merkel cell polyomavirus‐negative MCC in morphology,, gene expression, miRNA profiles and prognosis have been reported. Origin of MCC is controversial. Presence of neurosecretory granules has suggested that these carcinomas originate from one of the neurocrest derivatives, most probably Merkel cells; the name Merkel cell carcinoma is now widely accepted. Expression of PGP 9.5, chromogranin A and several neuropeptides, initially regarded as specific markers for neural and neuroendocrine cells, has recently been shown in a subset of lymphomas. MCC commonly expresses terminal deoxynucleotidyl transferase and PAX5. Their co‐expression under physiologic circumstances is restricted to pro/pre‐B cells and pre‐B cells. These findings lead to the hypothesis by zur Hausen et al. that MCC originates from early B cells. This review was intended to critically appraise zur Hausen's hypothesis and discuss the possibility that MCC is a heterogenous entity with distinct subtypes.