Miracle-dz/UniFAR-FTUs huggingface dataset:
The relative importance of traditional Chinese medicine diagnosis & treatment individualisation as seen through a study on irritable bowel syndrome

Background: The past forty years have seen an increase in the number of people with chronic illness and a struggle for biomedicine to provide effective treatments. The lack of effective biomedical treatments for conditions such as IBS creates opportunities for Chinese medicine; however, in its growing popularity, Chinese medicine has had to adapt to biomedicine’s dominant influence on research and practice. Purpose: The purpose of this thesis is to explore Chinese medicine’s adaptations to biomedicine regarding diagnosis differentiation and treatment individualisation through a study that places Chinese medicine in the context of IBS. Methods: Methods were selected based on a pragmatic mixed methodological underpinning that allowed for the research questions to dictate appropriateness. As such, a mixture of qualitative and quantitative methods were used to assess acupuncturists’ contextualisation and treatment of IBS; patient’ experiences with acupuncture and perceptions of outcome; and patients’, GPs’, and acupuncturists’ understanding of how acupuncture works and the impact of that understanding on outcome and acceptance of acupuncture. Findings: Acupuncturists contextualise IBS according to symptoms they perceive to be relevant, and do not perceive IBS to be a useful diagnosis. Acupuncture treatment of IBS incorporated three over-lapping approaches including: disease-specific, pragmatic, and individualised. The proportional influences of the approaches were different for different treatment aspects. Regarding how acupuncture works, patients, acupuncturists, and GPs used a variety of traditional, scientific, and physical explanations. Patients and acupuncturists perceived that the explanation may affect treatment outcome. Conclusions: Collective interpretation of the findings suggest that TCM diagnosis differentiation is fundamental to TCM treatment and plays a role similar to biomedical diagnoses in that it may validate patients’ symptoms and identify conditions that are treated effectively. Additionally, the use of combined treatment approaches notes an over-emphasis on individualisation that may be a by-product of TCM’s adaptation to biomedicine.
Impact of Statistical Approaches for Handling Missing Data on Trauma Center Quality

Objective:To determine whether imputed data can be used to produce unbiased hospital quality measures. Background:Different methods for handling missing data may influence which hospitals are designated as quality outliers. Methods:Monte-Carlo simulation study based on 63,020 patients with no missing data in 68 hospitals using the National Trauma Data Bank (NTDB, version 6.1). Patients were assigned missing data for the motor component of the Glasgow coma scale (GCS) conditional on their observed clinical risk factors. Multiple imputation was then used to “fill in” the missing data. Hospital risk-adjusted quality measures (observed-to-expected mortality ratio) based either on (1) imputed data, (2) excluding patients with missing data (complete case analysis), or (3) excluding the predictor with missing data were compared with hospital quality based on the true data (no missing data). Pair-wise comparisons of hospital quality were performed using the intraclass correlation coefficient (ICC) and the &kgr; statistic. Results:With 10% of the data missing, the level of agreement between multiple imputation and the true data (ICC = 0.99 and &kgr; = 0.87) was better compared with the level of agreement between complete case analysis and the true data (ICC = 0.93 and &kgr; = 0.62). Excluding the predictor (motor GCS) with missing data from the risk adjustment model resulted in the least amount of agreement with quality assessment based on the true data (ICC = 0.88 and &kgr; = 0.46). Conclusion:Multiple imputation can be used to impute missing data and yields hospital quality measures that are nearly identical to those based on the true data. Simply excluding patients with missing data or excluding risk factors with missing data from hospital quality assessment yields substantially inferior quality measures.
Secondary Conditions Experienced by Adults with Injury-Related Disabilities in Montana

Secondary conditions have recently emerged as a major issue affecting the health and independence of people with disabilities, but little is known about their prevalence or severity. The rates and severity of secondary conditions experienced by adults living in Montana (the second-most rural state) with disabilities related to injuries were assessed and were compared to rates of secondary conditions observed through state-wide surveillance of adults with disabilities related to other physical impairments. Survey techniques were used to collect self-reported experience with secondary conditions. Adult consumers of three centers for independent living, residents of three reservations, and a random selection of 1,000 from the state's handicapped parking registry were surveyed. Participants rated the severity of their experience with 40 secondary conditions. Data were analyzed using simple statistical procedures. Respondents reported experiencing an average of 15 secondary conditions annually. These data show.
Truncated peptides from melittin and its analog with high lytic activity at endosomal pH enhance branched polyethylenimine‐mediated gene transfection

Melittin is a commonly used cell‐penetrating peptide (CPP) for improving branched polyethylenimine (BPEI)‐mediated gene transfection. However, its application is limited owing to the cytotoxicity generated by the lytic activity at neutral pH. In the present study, we report two truncated peptides from melittin and florae with improved transfection efficiency.
Investigating relationship between transfection and permeabilization by the electric field and/or the Pluronic® L64 in vitro and in vivo

Electrotransfer can be obtained by the successive delivery of a high voltage short duration pulse (HV) inducing membrane destabilization and then a low voltage long duration pulse (LV), allowing DNA electrophoresis (HVLV mode). Pluronic® L64 (L64) (Fluka, Sigma‐Aldrich, L'Isle‐d'Abeau Chesnes, Saint‐Quentin Fallavier, France) has permeabilizing properties and amplifies the expression of DNA. We aimed to determine whether L64 could have an adjuvant effect on transfection by electrotransfer and whether the sequence L64 injection and then application of a LV pulse could induce transfection comparable to that observed with the HVLV mode.
Long-Term Outcome of Initially Unresectable Metastatic Colorectal Cancer Patients Treated with 5-Fluorouracil/Leucovorin, Oxaliplatin, and Irinotecan (FOLFOXIRI) Followed by Radical Surgery of Metastases

Objective/Background:The GONO-FOLFOXIRI regimen improved the rate of R0 secondary resection of metastases in initially unresectable metastatic colorectal cancer. The objective of this study was to evaluate the long-term outcome of resected patients and the impact of FOLFOXIRI on perioperative morbidities, mortality, and chemotherapy induced hepatotoxicity. Patients and Methods:Overall, 196 patients with initially unresectable metastatic colorectal cancer were treated with FOLFOXIRI in 2 phase II and 1 phase III trial. This regimen was associated with an elevated response rate (70.4%) and 37 patients (19%) could undergo a secondary R0 surgery on metastases. This study was registered with the Australian New Zealand Clinical Trials Registry Database at http://www.anzctr. org.au/Statistics.aspx and has ID number ACTRN12608000615381. Results:Main characteristics of the 37 radically resected patients were: median age 64 years (45–73), Eastern Cooperative Oncology Group Performance Status (ECOG) PS ≥1 in 30%, synchronous metastases in 65%, multiple sites of disease in 22%, and metastases confined to the liver in 68%. Preoperative FOLFOXIRI was administered for a median of 5.5 months. There was no perioperative mortality and all morbidities (27% of patients) resolved without sequelae. After a median follow up of 67 months, 5-year and 8-year survival are 42% and 33% respectively. At 5 years, 29% of patients are free of disease. The analysis of treatment-induced liver injury showed neither G3 vascular toxicity nor G4 steatosis, and steato-hepatitis in only 5% of patients. Conclusions:The GONO-FOLFOXIRI regimen allow an R0 surgery in approximately 1 out of 5 unselected patients with initially unresectable metastatic colorectal cancer, and the long-term survival of resected patients is considerable. Neoadjuvant FOLFOXIRI for 3-6 months is safe and not associated with severe liver injury.
Assessment of Inhaled Corticosteroid Therapy for Asthma Treatment during Pregnancy

ABSTRACT Background Inhaled corticosteroids (ICSs) have become widely used in asthma management during pregnancy since the publication of the NIH report Management of Asthma during Pregnancy in 1993. In the current study, the usefulness and safety of ICSs in the treatment of pregnant women with asthma were investigated. Methods Of 11,358 women who delivered in our hospital between January 1987 and December 2003, 592 women had asthma. Their midwifery records, delivery records, and clinical charts retained in the outpatient clinic of the internal medicine department were reviewed to identify treatments provided, pregnancy/delivery course, and possible perinatal abnormalities. On the basis of these data, the usefulness and safety of ICSs were retrospectively investigated. Results The percentage of pregnant women with asthma receiving asthma treatment was 17.5% from 1987 to 1989, 32.7% from 1990 to 1994, 43.8% from 1995 to 1999, and 40.7% from 2000 to 2003. Among those treated, the proportion treated with ICSs showed an increase (0% from 1987 to 1989, 10.0% from 1990 to 1994, 55.3% from 1995 to 1999, and 83.3% from 2000 to 2003). Intrapartum asthma attacks occurred in 1.38% of the asthma patients from 1995 to 1999, while there was no such occurrence in 2000 or later. In the untreated patients, the incidence of perinatal abnormalities remained unchanged with the guideline publication (31.6% before and 31.3% after). In contrast, the incidence of perinatal abnormalities in the treated patients decreased from 59.6% to 26.2% with the guideline publication. The incidence of perinatal abnormality among the treated was compared between the ICS therapy and non-ICS therapy groups. No difference was observed between the two groups from 1987 to 1994, but from 1995 to 2003, the total incidence of perinatal abnormalities was significantly higher in the non-ICS group. Conclusions ICSs can be considered to be safe and useful for the prevention of asthma attacks during pregnancy and for decreasing perinatal abnormalities.
Operative Experience of Residents in US General Surgery Programs: A Gap Between Expectation and Experience

Objective:The purpose of the study was to identify a group of operations which general surgery residency program directors believed residents should be competent to perform by the end of 5 years of training and then ascertain actual resident experience with these procedures during their training. Summary Background Data:There is concern about the adequacy of training of general surgeons in the United States. The American Board of Surgery and the Association of Program Directors in Surgery undertook a study to determine what operative procedures residency program directors consider to be essential to the practice of general surgery and then we measured the actual operative experience of graduating residents in those procedures, as reported to the Residency Review Committee for Surgery (RRC). Methods:An electronic survey was sent to residency program directors at the 254 general surgery programs in the US accredited by the RRC as of spring 2006. The program directors were presented with a list of 300 types of operations. Program directors graded the 300 procedures “A,” “B,” or “C” using the following criteria: A—graduating general surgery residents should be competent to perform the procedure independently; B—graduating residents should be familiar with the procedure, but not necessarily competent to perform it; and C—graduating residents neither need to be familiar with nor competent to perform the procedure. After ballots were tallied, the actual resident operative experience reported to the RRC by all residents finishing general surgery training in June 2005 was reviewed. Results:One hundred twenty-one of the 300 operations were considered A level procedures by a majority of program directors (PDs). Graduating 2005 US residents (n = 1022) performed only 18 of the 121 A procedures, an average of more than 10 times during residency; 83 of 121 procedures were performed on an average less than 5 times and 31 procedures less than once. For 63 of the 121 procedures, the mode (most commonly reported) experience was 0. In addition, there was significant variation between residents in operative experience for specific procedures. In virtually all cases, the mean reported experience exceeded the mode, suggesting that the mean is a poor measure of typical experience. Conclusions:These data pose important problems for surgical educators. Methods will have to be developed to allow surgeons to reach a basic level of competence in procedures which they are likely to experience only rarely during residency. Even for more commonly performed procedures, the numbers of repetitions are not very robust, stressing the need to determine objectively whether residents are actually achieving basic competency in these operations. Finally, the large variations in experience between individuals in our residency system need to be explored, understood, and remedied.
A Case of Toxic Epidermal Necrolysis due to Acetaminophen

43歳, 女性。 発熱と咽頭痛に対してフロモックス®, PL®顆粒を内服。 内服5時間後より下口唇の腫脹, 前胸部に紅斑が出現した。 翌日には全身の皮膚, 粘膜に紅斑・水疱が出現し, ニコルスキー現象が陽性であった。 眼症状として充血と眼脂を認めた。 病理組織学的には, 表皮の基底層を中心に液状変性を, 表皮全層に多数のコロイド小体を認め, 表皮下水疱を伴っていた。 真皮内には血管周囲にわずかのリンパ球浸潤を認めた。 ステロイドパルス療法後ステロイド内服漸減にて皮疹は比較的速やかに消失した。 フロモックス®, PL®顆粒と, その構成成分であるサリチルアミド, メチレンジサリチル酸プロメタジン, アセトアミノフェン, 無水カフェインのパッチテストとスクラッチパッチテストをステロイド内服中止後に行い, 48時間後にアセトアミノフェン, 72時間後にPL®顆粒とアセトアミノフェンに陽性反応を認めた。 ステロイド内服中に施行したDLSTは陰性であった。 以上の所見より, 本疾患をPL®顆粒中のアセトアミノフェンによる中毒性表皮壊死融解症 (TEN) 型薬疹と診断した。
Community Program Improves Quality of Life and Self‐Management in Older Adults with Diabetes Mellitus and Comorbidity

To compare the effect of a 6‐month community‐based intervention with that of usual care on quality of life, depressive symptoms, anxiety, self‐efficacy, self‐management, and healthcare costs in older adults with type 2 diabetes mellitus (T2DM) and 2 or more comorbidities.
Targeted elimination of activated hepatic stellate cells by an anti‐epidermal growth factor‐receptor single chain fragment variable antibody‐tumor necrosis factor‐related apoptosis‐inducing ligand (scFv425‐sTRAIL)

Progressive liver fibrosis is the result of chronic liver injury and is characterized by the excessive accumulation of extracellular matrix that may result in liver failure. Activated hepatic stellate cells are known to play a central role in this process and their elimination is a crucial step towards the resolution and reversion of liver fibrosis. In the present study, we investigated the potential application of an anti‐epidermal growth factor receptor single chain fragment variable antibody‐tumor necrosis factor‐related apoptosis‐inducing ligand (scFv425‐sTRAIL) fusion protein in the targeted elimination of activated hepatic stellate cells.
Adeno‐associated virus mediated delivery of an engineered protein that combines the complement inhibitory properties of CD46, CD55 and CD59

A variety of disorders are associated with the activation of complement. CD46, CD55 and CD59 are the major membrane associated regulators of complement on human cells. Previously, we have found that independent expression of CD55, CD46 or CD59 through gene transfer protects murine tissues against human complement mediated attack. In the present study, we investigated the potential of combining the complement regulatory properties of CD46, CD55 and CD59 into single gene products expressed from an adeno‐associated virus (AAV) vector in a soluble non‐membrane anchored form.
Genetic retargeting of adenovirus vectors: functionality of targeting ligands and their influence on virus viability

We studied the ability of adenovirus type 5 (Ad5) to encapsidate new cellular ligands carried by their fibers to yield functional retargeted vectors for gene therapy. Recombinant Ad5 fibers containing shaft repeats 1 to 7 and an extrinsic trimerization motif, and terminated by its native knob or amino acid motifs containing RGD, have been rescued into infectious virions.
Health-Related Quality of Life of Older Native American Primary Care Patients

The Dartmouth Primary Care COOP Charts are used to characterize the health-related quality of life of patients in five clinics operated by the Cherokee Nation of Oklahoma. A profile of COOP scores for older Native American patients is presented, as well as the relationships of COOP scores with selected health-related and sociodemographic variables, a partial assessment of construct validity. Data are from a nonprobability sample of adult patients surveyed in 1995 and 1997. This article reports on 157 patients age 55 to 87. More limitations were reported in relation to physical function, bodily pain, and health perceptions. Fewer limitations were reported in social activities and social support. Correlations among COOP dimensions were similar to other studies of chronic disease patients. There was substantial, although partial, agreement between expected and observed relationships, particularly for the health variables. The easily administered COOP charts can improve communication across barriers of class, race, and generation to encourage better quality of care and quality of life for older Native American patients.
Adaptive singular value cancelation of ventricular activity in single-lead atrial fibrillation electrocardiograms

The proper analysis and characterization of atrial fibrillation (AF) from surface electrocardiographic (ECG) recordings requires to cancel out the ventricular activity (VA), which is composed of the QRS complex and the T wave. Historically, for single-lead ECGs, the averaged beat subtraction (ABS) has been the most widely used technique. However, this method is very sensitive to QRST wave variations and, moreover, high-quality cancelation templates may be difficult to obtain when only short length and single-lead recordings are available. In order to overcome these limitations, a new QRST cancelation method based on adaptive singular value cancelation (ASVC) applied to each single beat is proposed. In addition, an exhaustive study about the optimal set of complexes for better cancelation of every beat is also presented for the first time. The whole study has been carried out with both simulated and real AF signals. For simulated AF, the cancelation performance was evaluated making use of a cross-correlation index and the normalized mean square error (nmse) between the estimated and the original atrial activity (AA). For real AF signals, two additional new parameters were proposed. First, the ventricular residue (VR) index estimated the presence of ventricular activity in the extracted AA. Second, the similarity (S) evaluated how the algorithm preserved the AA segments out of the QRST interval. Results indicated that for simulated AF signals, mean correlation, nmse, VR and S values were 0.945 ± 0.024, 0.332 ± 0.073, 1.552 ± 0.386 and 0.986 ± 0.012, respectively, for the ASVC method and 0.866 ± 0.042, 0.424 ± 0.120, 2.161 ± 0.564 and 0.922 ± 0.051 for ABS. In the case of real signals, the mean VR and S values were 1.725 ± 0.826 and 0.983 ± 0.038, respectively, for ASVC and 3.159 ± 1.097 and 0.951 ± 0.049 for ABS. Thus, ASVC provides a more accurate beat-to-beat ventricular QRST representation than traditional techniques. As a consequence, VA cancelation is optimized and the AA can be extracted more precisely. Finally, the study has proven that optimal VA cancelation is achieved when a number between 20 and 30 complexes is selected following a correlation-based strategy.
Immediate Postoperative Low Platelet Count is Associated With Delayed Liver Function Recovery After Partial Liver Resection

Objective:To evaluate whether a low postoperative platelet count is associated with a poor recovery of liver function in patients after partial liver resection. Background:Experimental studies in rodents have recently suggested that blood platelets play a critical role in the initiation of liver regeneration. It remains unclear whether platelets are also involved in liver regeneration in humans. Methods:In a series of 216 consecutive patients who underwent partial liver resection for colorectal liver metastases, we studied postoperative mortality and liver dysfunction in relation to the immediate postoperative platelet count. All patients had normal preoperative liver function and none of them had liver fibrosis or cirrhosis. Delayed postoperative recovery of liver function was defined as serum bilirubin >50 &mgr;mol/L or prothrombin time >20 seconds at any time point between postoperative day 1 and 5. Results:Patients with a low (<100 ×109/L) immediate postoperative platelet count had worse postoperative liver function, higher serum markers of liver injury, and increased mortality compared with patients with normal platelet counts (>1009/L). A low immediate postoperative platelet count was identified as an independent risk factor of delayed postoperative recovery of liver function (OR, 11.5; 95% CI, 1.1–122.4; P = 0.04 in multivariate analysis). Conclusion:After partial liver resection, a low platelet count is an independent predictor of delayed postoperative liver function recovery and is associated with increased risk of postoperative mortality. These clinical findings are in accordance with the accumulating evidence from experimental studies, indicating that platelets play a critical role in liver regeneration.
Reduced short-term complexity of heart rate and blood pressure dynamics in patients with diabetes mellitus type 1: multiscale entropy analysis

Multiscale entropy (MSE) analysis provides information about complexity on various time scales. The aim of this study was to test whether MSE is able to detect autonomic dysregulation in young patients with diabetes mellitus (DM). We analyzed heart rate (HR) oscillations, systolic (SBP) and diastolic blood pressure (DBP) signals in 14 patients with DM type 1 and 14 age- and sex-matched healthy controls. SampEn values (scales 1–10) and linear measures were computed. HR: among the linear measures of heart rate variability significant differences between groups were only found for RMSSD (p = 0.043). MSE was significantly reduced on scales 2 and 3 in DM (p = 0.023 and 0.010, respectively). SBP and DBP: no significant differences were detected with linear measures. In contrast, MSE analysis revealed significantly lower SampEn values in DM on scale 3 (p = 0.039 for SBP; p = 0.015 for DBP). No significant correlations were found between MSE and linear measures. In conclusion, MSE analysis of HR, SBP and DBP oscillations is able to detect subtle abnormalities in cardiovascular control in young patients with DM and is independent of standard linear measures.