Miracle-dz/UniFAR-FTUs huggingface dataset:
Metastatic Breast Cancer Masquerading as Gastrointestinal Primary

Seven patients with metastatic breast cancer presenting as gastrointestinal primary are described. These included six gastric and one colonic lesions. None of the patients had known systemic metastases at the time of diagnosis. The mean age at presentation was 66.7 yr (range 55–78). Median interval between breast cancer and gastrointestinal metastasis diagnosis was 6 yr (range 0.25–12.5). Original breast cancer histology included infiltrating lobular cancer (n = 4), infiltrating ductal cancer (n = 1), and a mixed type (n = 2). All patients with gastric involvement presented with epigastric pain and early satiety; the patient with colonic involvement had heme-positive stool. In three cases of gastric tumor and the one case of colonic tumor presentation, a definitive diagnosis of metastatic breast cancer was only confirmed after surgical resection of a presumed primary gastric or colonic malignancy. In the other three cases, pathological diagnostic confirmation was obtained through endoscopic biopsies and comparison to breast biopsy material, and operative treatment was avoided in favor of systemic cytotoxic therapy. The diagnosis was confirmed through similarities between mammary and gastric histopathology with regard to growth pattern, hormone receptor status, or gross cystic disease fluid protein. A high level of suspicion for metastatic breast cancer and a detailed pathological analysis will help avoid unnecessary surgical treatment in patients with a history of mammary carcinoma presenting with a newly diagnosed gastrointestinal neoplasm.
Nonopsonic Binding of Type III Group B Streptococci to Human Neutrophils Induces Interleukin-8 Release Mediated by the p38 Mitogen-Activated Protein Kinase Pathway

ABSTRACT Nonopsonic interaction of host immune cells with pathogens is an important first line of defense. We hypothesized that nonopsonic recognition between type III group B streptococcus and human neutrophils would occur and that the interaction would be sufficient to trigger neutrophil activation. By using a serum-free system, it was found that heat-killed type III group B streptococci bound to neutrophils in a rapid, stable, and inoculum-dependent manner that did not result in ingestion. Transposon-derived type III strain COH1-13, which lacks capsular polysaccharide, and strain COH1-11 with capsular polysaccharide lacking terminal sialic acid demonstrated increased neutrophil binding, suggesting that capsular polysaccharide masks an underlying binding site. Experiments using monoclonal antibodies to complement receptor 1 and to the I domain or lectin site of complement receptor 3 did not inhibit binding, indicating that the complement receptors used for ingestion of opsonized group B streptococci were not required for nonopsonic binding. Nonopsonic binding resulted in rapid activation of cellular p38 and p44/42 mitogen-activated protein kinases. This interaction was not an effective trigger for superoxide production but did promote release of the proinflammatory cytokine interleukin-8. The release of interleukin-8 was markedly suppressed by the p38 mitogen-activated protein kinase inhibitor SB203580 but was only minimally suppressed by the mitogen-activated protein/extracellular signal-regulated kinase inhibitor PD98059. Thus, nonopsonic binding of type III group B streptococci to neutrophils is sufficient to initiate intracellular signaling pathways and could serve as an arm of innate immunity of particular importance to the immature host.
Patients' views: improving care for people with fibromyalgia.

AIM The purpose of this research is to provide healthcare professionals with patients' views on improving care for people with fibromyalgia. BACKGROUND Fibromyalgia is a chronic pain syndrome that often challenges patients and healthcare professionals. Current literature suggests that the people with fibromyalgia are disempowered by their interactions with physicians. Soliciting patients' suggestions for improving care can be helpful in identifying weaknesses and strengths in current physician-patient interactions, and in improving future care. METHODS Forty-two participants with fibromyalgia submitted written responses to open-ended questions about their experiences with physicians, and how care could be improved. RESULTS Positive interactions with physicians referenced care quality, feelings of respect and patient involvement. Negative interactions included receiving inadequate care, perceiving the physician to be uncaring and lacking knowledge of fibromyalgia. CONCLUSIONS Unlike most research suggests, the majority of patients with fibromyalgia report having positive interactions with physicians. However, suggestions for improving care are similar throughout the literature, reinforcing the need for supportive care, empathetic listening and increased knowledge of alternative treatments. RELEVANCE TO CLINICAL PRACTICE Patients' recommendations identified in this study can be implemented by nurses involved in providing supportive care and education to patients with fibromyalgia. Application of patients' recommendations may facilitate the creation of therapeutic alliances and improve patients' satisfaction with care.
Effects of a hospitalist care model on mortality of elderly patients with hip fractures.

BACKGROUND We previously demonstrated that a hospitalist service created to medically manage patients with hip fracture reduced time to surgery and length of hospital stay, with no difference in inpatient mortality, compared with patients who received standard care. Whether this improved efficiency affects long-term mortality is unknown. OBJECTIVE This study examined the effects of this hospitalist service versus standard care on mortality up to 1 year and identified predictors of mortality in patients with hip fracture. DESIGN Retrospective cohort study. SETTING Tertiary care center. PATIENTS Four hundred and sixty-six consecutive patients admitted for surgical repair of a hip fracture in 2000-2002 with 93% 1-year follow-up. RESULTS There was no significant difference in survival of the patients between those on the hospitalist care service and those on the standard care service (70.5% [CI: 64.8%, 76.7%] vs. 70.6% [CI: 64.9%, 76.8%]; P = .36), despite the shortened time to surgery and decreased length of stay in the hospitalist group. Predictors of mortality included: admission from a nursing home (hazard ratio [HR] 2.24, [CI: 1.73, 2.90]); age at admission (HR 1.17 [CI: 0.99, 1.38]); inpatient complications, including ICU admission, myocardial infarction, or acute renal failure (HR 1.85 [CI: 1.45, 2.35]); and ASA class III or IV compared with ASA class II (HR 4.20 [CI: 2.21, 7.99]). CONCLUSIONS The improved efficiency in reducing length of stay and time to surgery in the hospitalist group did not adversely affect long-term mortality of this patient population.
Non‐destructive monitoring of nitrate concentration in a laboratory flow experiment using time domain reflectometry (TDR)

Nitrates, when found in excess in the groundwater, are a health hazard. Nitrates can easily be transported by groundwater movement and may eventually reach aquifers located far away from the contamination location. Recent research has focused on developing innovative techniques to remediate nitrate‐contaminated soils. It is important to monitor the nitrate movement in the groundwater to predict the extent of nitrate contamination. Traditionally, nitrate movement is monitored by sampling soil pore water and analysing it in the laboratory. In this study a non‐destructive method, using time domain reflectometry (TDR) to monitor nitrate movement in laboratory flow experiments, is presented. Three flow cells (replicates) packed with a silty loam soil were subjected to a constant hydraulic gradient inducing saturated water flow through the flow cells. A source of potassium nitrate solution, containing 500 ppm NO3‐N, was connected at the inflow end, and the nitrate concentration change with time was monitored along the length of the flow cells by sampling the soil solution and analysing it in the laboratory for NO3‐N concentration. At the time of sampling, TDR wave forms were recorded using the TDR mini‐probes inserted at regular intervals along the length of the flow cells. The bulk soil electrical conductivity and the water content values extracted from the TDR wave forms were used to predict the nitrate concentrations at different locations. The nitrate concentration values predicted from the TDR‐measured bulk electrical conductivity and water content data correlated well with the nitrate concentrations obtained by soil solution sampling method.
The distribution of forces between the upper and lower back during load carriage.

INTRODUCTION/PURPOSE To determine the effects of backpack mass on the forces exerted by the backpack on the carrier and on the distribution of these forces between the upper back (including shoulders) and lower back (sacrum and iliac crest). METHODS Eleven male volunteers (mean age 22.7 SEM 1.1 yr) walked on a level treadmill at 1.34 m.s(-1) carrying a backpack loaded to three different masses (13.6, 27.2, and 40.8 kg). The backpack's hip belt was connected to force transducers that measured the forces exerted on the lower back. The total force between the subject and backpack was determined from the backpack's mass and acceleration. Forces on the upper back were calculated as total force minus the forces exerted on the lower back. RESULTS There was a significant effect of backpack mass on the vertical and anterior/posterior forces exerted on the upper and lower back, and on the total force exerted on the backpack center of mass. Regardless of mass, approximately 30% of the vertical force was borne by the lower back; the upper back and shoulders supported the remaining 70%; this is based on data averaged across the stride. Dimensionless analysis revealed peak forces on the upper and lower back increased proportionately to backpack mass whereas the peak forces exerted on the backpack COM increased disproportionately. CONCLUSIONS The backpack exerts consistent anterior force on the lower back, which likely contributes to the occurrence of low-back pain associated with load carriage. Approximately 30% of the vertical force generated by the backpack can be transferred to the lower back by using an external frame backpack with a hip belt.
Evaluation of a critical care simulation series for undergraduate nursing students

Abstract Simulation is increasingly being used to prepare and supplement clinical practice in critical care areas for undergraduate Bachelor of Nursing (BN) students, with some success. However, the effects of multiple, medium–high fidelity simulations for this purpose have not been previously assessed. The purpose of this study was to assess self-reported confidence and competence using scenario-based simulations. A pre-test post-test design was used to evaluate a series of simulations conducted over a semester. There were twenty seven scenarios, incorporating programmed mannequins, moulage and actors. The scenarios were embedded in a team-based process involving preparation and video-recordings used for debriefing. Third year BN students reported their confidence and competence before and after the simulation series and made comments on their perception of the experience. Multiple scenario simulations are effective in improving BN students’ confidence and competence related to critical care practice and are an enjoyable experience for students.
Preliminary Results: Prospective Clinical Study to Assess Image-Based Iterative Reconstruction for Abdominal Computed Tomography Acquired at 2 Radiation Dose Levels

Objective The objective of this study was to compare image quality for abdominal computed tomographic (CT) images acquired at 200 and 50 mA s and reconstructed with image-based iterative reconstruction. Materials and Methods In this institutional review board–approved prospective study, 22 patients (mean [SD] age, 64.3 [14.4] years; male-female ratio, 12:10) gave informed consent for acquisition of additional abdominal CT images on 64-slice multi-detector CT (MDCT) (Siemens Definition Flash). Standard-dose images were acquired at 200 quality reference mA s, whereas low-dose images were acquired at 50 mA s (all series: 120 kV; 5-mm section thickness; pitch, 0.9:1). The low-dose images were reconstructed with a nonlinear 3-dimensional iterative image reconstruction (3D-IIR) (SafeCT; MedicVision, Tirat Carmel, Israel) (4 settings, namely, A1, A2, A3, and A4) and were assessed by 3 abdominal radiologists for lesion detection, image noise, and visibility of small structures. CATPHAN 500 was scanned at the respective doses to obtain noise spectral density and modulation transfer function. Results Subjective image noise was unacceptable at 50-mA s filtered back projection and improved to average in 50-mA s A1 and minimal or no noise in 50-mA s A4. However, the visibility of small structures was similar to standard-dose filtered back projection images on 50-mA s A2. Objective image noise was reduced to 66% for the 50-mA s 3D-IIR images (9.08 [2.3]/26.75 [6.8]). The modulation transfer function curve demonstrated resolution improvement in the low-dose images with the 3D-IIR technique, whereas the noise spectral density curve confirmed noise suppression in the 50-mA s 3D-IIR images. Conclusions Three-dimensional iterative image reconstruction helps to lower image noise without affecting the visibility of small structures at “moderate” settings. Diagnostically acceptable abdominal CT examinations can be acquired at 75% lower-radiation dose with the help of the image-based iterative reconstruction technique.
Impact of Donor Age and Year of Transplantation on Graft and Patient Survival Following Liver Transplantation for Hepatitis C Virus

Background. Hepatitis C virus (HCV) infection has become the most common indication for liver transplantation (LT). Graft and patient survival are adversely affected by recurrent infection of the graft. Recent publications have described an inferior outcome for recently transplanted HCV patients and have highlighted the impact of advancing donor age on severity of recurrent HCV. The donor age at which a measurable impact on graft and patient outcome can be observed has not clearly been defined. In addition, the impact of donor age on graft and patient survival for non-HCV patients needs to be examined. Methods. We have examined a large European liver transplant database to define the impact of transplantation date and donor age on graft and patient survival for HCV patients (n=4,736) and the impact for a comparison group of transplanted alcoholic liver disease patients (ALD, n=5,406). Results. For the entire cohorts, graft and patient survival of HCV patients was inferior to ALD patients. Since 1987, there has been a steady and ongoing improvement in the outcome of transplanted ALD patients, an improvement not observed for HCV patients. Every year since 1989, there has been an increase in liver donor age. Graft and patient survival for both ALD and HCV cohorts was adversely affected by advancing donor age. Comparison of graft and patient survival for HCV and ALD cohorts was made according to donor age (donor age subgrouped <20, 20–30, 30–40, 40–50, 50–60 and >60 years of age). For donors younger than 40 years of age, HCV and ALD recipient graft and patient survival are not significantly different. For donors older than 40, HCV recipient graft survival is inferior to ALD graft survival, an inferiority that increases for each advancing decade of donor age. For donors older than 50 years, HCV recipient patient survival is inferior to ALD patient survival, an inferiority that increases when the donor age is greater than 60 years. Conclusion. The results of liver transplantation for European HCV patients is inferior to a comparison group of ALD patients, and have not improved during the past 15 years. Liver donor age has increased significantly during that period. Advancing donor age has an adverse influence on graft and patient survival for ALD and HCV patients, but a significantly greater impact is observed for HCV patients when the donor is older than 40 years.
The role of maternal factors in sibling relationship quality: a multilevel study of multiple dyads per family.

BACKGROUND Although many children grow up with more than one sibling, we do not yet know if sibling dyads within families show similarities to one another on sibling affection and hostility. In the present study the hypotheses were tested that (a) there will be significant between family variation in change in sibling affection and hostility and (b) this between family variation will be explained by maternal affective climate, operationalized as positive and negative ambient parenting, differential parenting and maternal malaise. METHODS A general population sample of families with single and multiple sibling dyads were visited twice, 2 years apart. Up to 2 children in a family acted as informants; 253 relationships were rated in 118 families. A cross-classified, multilevel model was fit to separate between-family and within-family variance in sibling relationships while simultaneously controlling for informant and partner influences. RESULTS Thirty-seven percent of the variance in change in sibling affection and 32% of the variance in change in sibling hostility was between family variance. The measured maternal affective climate including, maternal malaise and maternal ambient and differential hostility and affection explained between family differences. CONCLUSIONS Sibling relationship quality clusters in families and is partly explained by maternal affective climate.
Seasonal trends of viral respiratory tract infections in the tropics

To evaluate the seasonal trends of viral respiratory tract infections in a tropical environment, a retrospective survey of laboratory virus isolation, serology and immunofluorescence microscopy in two large general hospitals in Singapore between September 1990 and September 1994 was carried out. Respiratory tract viral outbreaks, particularly among infants who required hospitalization, were found to be associated mainly with respiratory syncytial (RSV) infections (72%), influenza (11%) and parainfluenza viruses (11%). Consistent seasonal variations in viral infections were observed only with RSV (March–August) and influenza A virus (peaks in June, December–January). The RSV trends were associated with higher environmental temperature, lower relative humidity and higher maximal day-to-day temperature variation. Although the influenza A outbreaks were not associated with meteorological factors, influenza B isolates were positively associated with rainfall. These data support the existence of seasonal trends of viral respiratory tract infections in the tropics.
Herpes Simplex Virus 2 Infection Impacts Stress Granule Accumulation

ABSTRACT Interference with stress granule (SG) accumulation is gaining increased appreciation as a common strategy used by diverse viruses to facilitate their replication and to cope with translational arrest. Here, we examined the impact of infection by herpes simplex virus 2 (HSV-2) on SG accumulation by monitoring the localization of the SG components T cell internal antigen 1 (TIA-1), Ras-GTPase-activating SH3-domain-binding protein (G3BP), and poly(A)-binding protein (PABP). Our results indicate that SGs do not accumulate in HSV-2-infected cells and that HSV-2 can interfere with arsenite-induced SG accumulation early after infection. Surprisingly, SG accumulation was inhibited despite increased phosphorylation of eukaryotic translation initiation factor 2α (eIF2α), implying that HSV-2 encodes previously unrecognized activities designed to maintain translation initiation downstream of eIF2α. SG accumulation was not inhibited in HSV-2-infected cells treated with pateamine A, an inducer that works independently of eIF2α phosphorylation. The SGs that accumulated following pateamine A treatment of infected cells contained G3BP and PABP but were largely devoid of TIA-1. We also identified novel nuclear structures containing TIA-1 that form late in infection. These structures contain the RNA binding protein 68-kDa Src-associated in mitosis (Sam68) and were noticeably absent in infected cells treated with inhibitors of viral DNA replication, suggesting that they arise as a result of late events in the virus replicative cycle.
The Role of Anemia in Congestive Heart Failure and Chronic Kidney Insufficiency: the cardio renal anemia syndrome

Anemia is a major problem in patients with chronic kidney insufficiency. The development of recombinant human erythropoietin has enabled physicians to correct this anemia. Although anemia has not been considered to be a common or important contributor to congestive heart failure, anemia of any cause can lead to cardiac damage and eventually congestive heart failure. Our joint renal-cardiac heart failure team found that anemia was indeed very common in congestive heart failure and was associated with severe, medication-resistant cardiac failure. Correction of the anemia with erythropoietin and intravenous iron led to a marked improvement in patients' functional status and their cardiac function, and to a marked fall in the need for hospitalization and for high-dose diuretics; renal function usually improved or at least stabilized. Subsequent investigations by others have confirmed many of our observations. We call this interrelationship between congestive heart failure, chronic kidney insufficiency, and anemia the Cardio-Renal Anemia syndrome. Treatment of the anemia in congestive heart failure may prove vital in preventing progression of both the heart failure and the associated renal disease.
Mechanical cues in orofacial tissue engineering and regenerative medicine

Cleft lip and palate patients suffer from functional, aesthetical, and psychosocial problems due to suboptimal regeneration of skin, mucosa, and skeletal muscle after restorative cleft surgery. The field of tissue engineering and regenerative medicine (TE/RM) aims to restore the normal physiology of tissues and organs in conditions such as birth defects or after injury. A crucial factor in cell differentiation, tissue formation, and tissue function is mechanical strain. Regardless of this, mechanical cues are not yet widely used in TE/RM. The effects of mechanical stimulation on cells are not straight‐forward in vitro as cellular responses may differ with cell type and loading regime, complicating the translation to a therapeutic protocol. We here give an overview of the different types of mechanical strain that act on cells and tissues and discuss the effects on muscle, and skin and mucosa. We conclude that presently, sufficient knowledge is lacking to reproducibly implement external mechanical loading in TE/RM approaches. Mechanical cues can be applied in TE/RM by fine‐tuning the stiffness and architecture of the constructs to guide the differentiation of the seeded cells or the invading surrounding cells. This may already improve the treatment of orofacial clefts and other disorders affecting soft tissues.
Hemorrhagic transformation of ischemic stroke in diabetics on sulfonylureas

Disability or death occurs more frequently in patients with hemorrhagic transformation (HT) after ischemic stroke. In rat models of stroke, sulfonylurea (SU) drugs such as glibenclamide (adopted US name, glyburide) confer protection against swelling and HT through actions on the novel SUR1‐regulated NCCa‐ATP channel. Here, we sought to determine whether the use of SU drugs in patients with diabetes mellitus (DM) presenting with acute ischemic stroke might influence the incidence of HT.