Miracle-dz/UniFAR-FTUs huggingface dataset:
Visceral adiposity index and DHEAS are useful markers of diabetes risk in women with polycystic ovary syndrome.

OBJECTIVE On the basis of the known diabetes risk in polycystic ovary syndrome (PCOS), recent guidelines of the Endocrine Society recommend the use of an oral glucose tolerance test (OGTT) to screen for impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) in all women with PCOS. However, given the high prevalence of PCOS, OGTT would have a high cost-benefit ratio. In this study, we identified, through a receiver operating characteristic analysis, simple predictive markers of the composite endpoint (impaired fasting glucose (IFG) or IGT or IFG+IGT or T2DM) in women with PCOS according to the Rotterdam criteria. DESIGN We conducted a cross-sectional study of 241 women with PCOS in a university hospital setting. METHODS Clinical, anthropometric, and metabolic (including OGTT) parameters were evaluated. The homeostasis model assessment of insulin resistance (HOMA2-IR), the Matsuda index of insulin sensitivity, and the oral dispositional index and visceral adiposity index (VAI) were determined. RESULTS Out of 241 women included in this study, 28 (11.6%) had an IFG, 13 (5.4%) had IGT, four (1.7%) had IFG+IGT, and four (1.7%) had T2DM. Among the anthropometric variables examined, the VAI had a significantly higher C-statistic compared with BMI (0.760 (95% CI: 0.70-0.81) vs 0.613 (95% CI: 0.54-0.67); P=0.014) and waist circumference (0.760 (95% CI: 0.70-0.81) vs 0.619 (95% CI: 0.55-0.68); P=0.028). Among all the hormonal and metabolic serum variables examined, DHEAS showed the highest C-statistic (0.720 (95% CI: 0.65-0.77); P<0.001). CONCLUSIONS In addition to fasting glucose, the VAI and DHEAS may be considered useful tools for prescreening in all women with PCOS without the classical risk factors for diabetes.
The role of external fixation in trauma

External fixation is a method of immobilization that uses percutaneous pins placed in bone and linked with external connectors to maintain the fracture segments in a desired spatial relationship. It is a valuable clinical treatment option, providing surgeons with the ability to affect the spatial relationship of tissues, both statically and dynamically, via minimally invasive techniques. The ease and speed of application, adjustability of the frame, and minimization of blood loss with preservation of blood supply at the cutaneous and osseous levels are advantages of the external fixation technique. Care of the trauma patient remains one of the major applications for external fixation. Open fractures with severe soft tissue injuries and/or massive contamination are ideally suited to this technique. External fixation is also a versatile salvage technique for the complications arising from extremity trauma. The management of residual fracture deformity, bone loss, infections, and complex post-traumatic arthritis are often facilitated by external fixation.
Evaluation of a screening program on reduction of gastric cancer mortality in Japan: preliminary results from a cohort study.

Abstract Background. Systematic population-based screening for gastric cancer is widely spread in Japan. However, the case–control study method has been the main method used to evaluate the effectiveness of the screen ing to reduce gastric cancer mortality in Japan. Methods. This article presents a population-based co hort study. A questionnaire about lifestyles and dietary habits was distributed to 36,990 residents in a city of Japan. The response rate to the questionnaire was 92.0%. After ineligible responders had been excluded, 24,134 subjects were classified into screened and un screened groups according to their self-reports of par ticipation in the screening the previous year. We fol lowed them up for 40 months and linked resident death records in the city. We compared mortality from gastric cancer and all other causes between the groups by us ing the Cox proportional hazard model. Results. The follow-up period was 78,156.6 person-years from September 1992 to December 1995. The mul tivariate relative risks for gastric cancer death of the screened group in comparison with the unscreened group were 0.72 (95% CI 0.31–1.66) among males and 1.46 (95% CI 0.43–4.90) among females. Conclusion. Although our data are preliminary, we were unable to demonstrate a large contribution of the present screening program to decreasing gastric cancer mortality. Further follow-up is needed to in crease the precision.
The Preliminary Study on the Coincidence between Sasang Constitutional Analysis Tool β-version and Expert of Sasang Constitution

Abstract The Preliminary Study on the Coincidence between Sasang Constit utional Analysis Tool β-version and Expert of Sasang Constitution Eun-Su Jang, Hee-Jeong Jin, Jun-Hyung Do, Si-Woo Lee, Jong-Yeol Kim. Korea Institute of Oriental Medicine 1. Objectives In Sasang constitutional medicine, it has been known that diagnosing Sasang constitution correctly is mostly important. We had developed an Integrated Sasang Constitutional Analysis Tool (SCAT) β-version using face, voice, body shape and questionnaire before. The purpose of this study is to suggest whether SCAT β-version is reliable or not. 2. Methods We collected 371 subjects from 6 oriental medical clinics. We analyzed the Sasang constitutional diagnostic results using Kappa and coincidence rates between experts in Sasang constitution and SCAT β-version which was developed on the basis of face, body shape, voice and characteristics and symptom questionnaire data. 3. Results The agreement rates between SCAT β-version and experts was 69.3% in total, and 73.2%, in Taeeumin, 70.8% in Soeumin, and 56.9% in Soyangin in detailed. The Kappa was 0.510 (p value<.000). There was an increasing trend of agreement rates and kappa value corresponded to increasing constitutional probability. When The constitutional probabilities were changed from below 40%, to over 40%, 50%, 60%, the agreement rates corresponded from 50.8% to 79.5%, 91.4%, 95.7% respectively.
Platelet Transfusion During Liver Transplantation Is Associated with Increased Postoperative Mortality Due to Acute Lung Injury

BACKGROUND: Platelet transfusions have been identified as an independent risk factor for survival after orthotopic liver transplantation (OLT). In this study, we analyzed the specific causes of mortality and graft loss in relation to platelet transfusions during OLT. METHODS: In a series of 449 consecutive adult patients undergoing a first OLT, the causes of patient death and graft failure were studied in patients who did or did not receive perioperative platelet transfusions. RESULTS: Patient and graft survival were significantly reduced in patients who received platelet transfusions, compared with those who did not (74% vs 92%, and 69% vs 85%, respectively at 1 yr; P < 0.001). Lower survival rates in patients who received platelets were attributed to a significantly higher rate of early mortality because of acute lung injury (4.4% vs 0.4%; P = 0.004). There were no significant differences in other causes of mortality between the two groups. The main cause of graft loss in patients receiving platelets was patient death with a functioning graft. CONCLUSIONS: These findings suggest that platelet transfusions are an important risk factor for mortality after OLT. The current study extends previous observations by identifying acute lung injury as the main determinant of increased mortality. The higher rate of graft loss in patients receiving platelets is related to the higher overall mortality rate and does not result from specific adverse effects of transfused platelets on the grafted liver.
Growth Differentiation Factor 5 (GDF5) Core Promoter Polymorphism Is Not Associated with Susceptibility to Osteoarthritis of the Knee in the Korean Population

Background : Osteoarthritis (OA) is a common disease characterized by degenerating joint cartilage in the knee, hip, and hand. A functional single nucleotide polymorphism (SNP) +104T/C; rs143383 in the 5′untranslated region of the growth differentiation factor 5 (GDF5) gene was recently associated with susceptibility to OA in the Japanese and Chinese populations. Methods : To investigate whether this association is present in the Korean population, the frequency of the polymorphism was investigated in 276 patients with knee OA and 298 healthy subjects as controls. Polymorphism analysis was performed by amplifying the core promoter region of the GDF5 gene and digesting it with the BsiEI restriction enzyme. Results : The frequency of the TT, CT, and CC genotypes was 54.3% (150/276), 41.7% (115/276), and 4.0% (11/276), respectively, in patients with OA, and 53.4% (159/298), 37.9% (113/298), and 8.7% (26/298), respectively, in healthy controls. No significant differences in genotypic or allelic frequencies of the +104T/C SNP of the GDF5 gene were observed between patients with OA and controls. Also, no significant differences in allelic and genotypic frequencies were found when the individuals were stratified by age and gender. Conclusions : The results suggest that the +104T/C; rs143383 GDF5 core promoter polymorphism is not a risk factor for OA in the Korean population.
Use of statins is associated with lower serum total and non-sex hormone-binding globulin-bound testosterone levels in male participants of the Rotterdam Study.

OBJECTIVE Statins, or HMG-CoA reductase inhibitors, decrease cholesterol production. Because cholesterol is a precursor of the testosterone biosynthesis pathway, there is some concern that statins might lower serum testosterone levels. The objective of the present study was to investigate the association between the use of statins and serum testosterone levels in men. DESIGN Cross-sectional study within the prospective population-based Rotterdam Study. SUBJECTS AND METHODS We included 4166 men with available data on total testosterone, non-sex hormone-binding globulin (SHBG)-bound testosterone, and medication use. Multivariable linear regression analysis was used to compare the differences in serum testosterone levels (nmol/l) between current, past, and never statin users. We considered dose and duration of use. Analyses were adjusted for age, BMI, cardiovascular disease, diabetes mellitus, hypertension, and estradiol levels. RESULTS We identified 577 current (mean age 64.1 years), 148 past (mean age 64.6 years), and 3441 never (mean age 64.6 years) statin users. Adjusted for all covariables, current statin use of 1-≤ 6 months or >6 months was significantly associated with lower total testosterone levels as compared to non-users (β -1.24, 95% CI -2.17, -0.31, and β -1.14, 95% CI -2.07, -0.20 respectively). Current use of 1-≤ 6 months was also associated with significantly lower non-SHBG-bound testosterone levels (β -0.42, 95% CI -0.82, -0.02). There was a trend toward lower testosterone levels at higher statin doses both for total (P(trend) 2.9 × 10(-5)) and non-SHBG-bound (P(trend) 2.0 × 10(-4)) testosterone. No association between past statin use and testosterone levels was found. CONCLUSION We showed that current use of statins was associated with significantly lower serum total and non-SHBG-bound testosterone levels. The clinical relevance of this association should be further investigated.
Early endocrine alterations reflect prolonged stress and relate to 1-year functional outcome in patients with severe brain injury.

OBJECTIVE Severe brain injury may increase the risk of developing acute and chronic hypopituitarism. Pituitary hormone alterations developed in the early recovery phase after brain injury may have implications for long-term functional recovery. The objective of the present study was to assess the pattern and prevalence of pituitary hormone alterations 3 months after a severe brain injury with relation to functional outcome at a 1-year follow-up. DESIGN Prospective study at a tertiary university referral centre. METHODS A total of 163 patients admitted to neurorehabilitation after severe traumatic brain injury (TBI, n=111) or non-TBI (n=52) were included. The main outcome measures were endocrine alterations 3.3 months (median) after the brain injury and their relationship to the functioning and ability of the patients at a 1-year follow-up, as measured by the Functional Independence Measure and the Glasgow Outcome Scale-Extended. RESULTS Three months after the injury, elevated stress hormones (i.e. 30 min stimulated cortisol, prolactin and/or IGF1) and/or suppressed gonadal or thyroid hormones were recorded in 68 and 32% of the patients respectively. At 1 year after the injury, lower functioning level (Functional Independence Measure) and lower capability of performing normal life activities (Glasgow Outcome Scale-Extended) were related to both the elevated stress hormones (P≤0.01) and the reduced gonadal and/or thyroid hormones (P≤0.01) measured at 3 months. CONCLUSION The present study suggests that brain injury-related endocrine alterations that mimic secondary hypogonadism and hypothyroidism and that occur with elevated stress hormones most probably reflect a prolonged stress response 2-5 months after severe brain injury, rather than pituitary insufficiency per se. These endocrine alterations thus seem to reflect a more severe disease state and relate to 1-year functional outcome.
Caring and Compassion in Clinical Practice

In this thought-provoking volume, Seymour B. Sarason (psychological researcher, educator, and concerned clinician of more than 40 years' experience) examines salient issues underlying the public's perception that care and compassion are lacking among human services clinicians. Rather than criticizing the intentions of individual practitioners, Sarason instead probes the social systems that elicit and maintain the view of the compassionless and uncaring behavior of many clinicians. Ultimately, Sarason concludes that the processes whereby clinicians are selected, trained, and professionally socialized may discourage caring and compassionate persons from entering the helping professions and may inhibit the expression of caring and compassion among practitioners. Beginning with an incisive analysis of Abraham Flexner's 1910 report on medical education in the United States and Canada, Sarason sketches the historical development of exaggerated emphasis on technical expertise and concomitant neglect of interpersonal sensitivity during the selection and training of physicians. His definition of clinician , which includes
A Historical Perspective on Resident Evaluation, the Accreditation Council for Graduate Medical Education Outcome Project and Accreditation Council for Graduate Medical Education Duty Hour Requirement

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project, endorsed at the 1999 ACGME annual meeting, was intended to shift the focus of residency program requirements and accreditation from process-oriented assessment to an assessment of outcomes. The Outcome Project established six general competencies, each of which is supported by more specific competencies. METHODS: We compared contemporary resident evaluation based on the Outcome Project to faculty evaluation of a surgical resident at Mayo Clinic that was completed in 1917. RESULTS: The contemporary faculty assessment of resident performance was remarkably similar to the evaluation form and criteria used in 1917. All six general competencies, and nearly all of the more specific items listed under each general competency, were included in the 1917 evaluation. Duty hour data as a component of the 1917 resident evaluation included the number of hours per week spent in “practical work,” “medical library,” and “research work. ” CONCLUSIONS: The remarkable similarities between the qualities assessed in the 1917 evaluation and the assessment of contemporary ACGME competencies suggest that a common set of desirable physician characteristics and behaviors can be identified and measured.
Auditory Event-Related Potentials, Bispectral Index, and Entropy for the Discrimination of Different Levels of Sedation in Intensive Care Unit Patients

BACKGROUND:Sedation protocols, including the use of sedation scales and regular sedation stops, help to reduce the length of mechanical ventilation and intensive care unit stay. Because clinical assessment of depth of sedation is labor-intensive, performed only intermittently, and interferes with sedation and sleep, processed electrophysiological signals from the brain have gained interest as surrogates. We hypothesized that auditory event-related potentials (ERPs), Bispectral Index® (BIS), and Entropy® can discriminate among clinically relevant sedation levels. METHODS:We studied 10 patients after elective thoracic or abdominal surgery with general anesthesia. Electroencephalogram, BIS, state entropy (SE), response entropy (RE), and ERPs were recorded immediately after surgery in the intensive care unit at Richmond Agitation-Sedation Scale (RASS) scores of −5 (very deep sedation), −4 (deep sedation), −3 to −1 (moderate sedation), and 0 (awake) during decreasing target-controlled sedation with propofol and remifentanil. Reference measurements for baseline levels were performed before or several days after the operation. RESULTS:At baseline, RASS −5, RASS −4, RASS −3 to −1, and RASS 0, BIS was 94 [4] (median, IQR), 47 [15], 68 [9], 75 [10], and 88 [6]; SE was 87 [3], 46 [10], 60 [22], 74 [21], and 87 [5]; and RE was 97 [4], 48 [9], 71 [25], 81 [18], and 96 [3], respectively (all P < 0.05, Friedman Test). Both BIS and Entropy had high variabilities. When ERP N100 amplitudes were considered alone, ERPs did not differ significantly among sedation levels. Nevertheless, discriminant ERP analysis including two parameters of principal component analysis revealed a prediction probability PK value of 0.89 for differentiating deep sedation, moderate sedation, and awake state. The corresponding PK for RE, SE, and BIS was 0.88, 0.89, and 0.85, respectively. CONCLUSIONS:Neither ERPs nor BIS or Entropy can replace clinical sedation assessment with standard scoring systems. Discrimination among very deep, deep to moderate, and no sedation after general anesthesia can be provided by ERPs and processed electroencephalograms, with similar PKs. The high inter- and intraindividual variability of Entropy and BIS precludes defining a target range of values to predict the sedation level in critically ill patients using these parameters. The variability of ERPs is unknown.
Automatic Mining of Quantitative Association Rules with Gravitational Search Algorithm

The classical optimization algorithms are not efficient in solving complex search and optimization problems. Thus, some heuristic optimization algorithms have been proposed. In this paper, exploration of association rules within numerical databases with Gravitational Search Algorithm (GSA) has been firstly performed. GSA has been designed as search method for quantitative association rules from the databases which can be regarded as search space. Furthermore, determining the minimum values of confidence and support for every database which is a hard job has been eliminated by GSA. Apart from this, the fitness function used for GSA is very flexible. According to the interested problem, some parameters can be removed from or added to the fitness function. The range values of the attributes have been automatically adjusted during the time of mining of the rules. That is why there is not any requirements for the pre-processing of the data. Attributes interaction problem has also been eliminated with the designed GSA. GSA has been tested with four real databases and promising results have been obtained. GSA seems an effective search method for complex numerical sequential patterns mining, numerical classification rules mining, and clustering rules mining tasks of data mining.
A family support service for homeless children and parents: user and staff perspectives

Children and their parents who become homeless constitute a group of families with a complex range of social care and health needs, including mental health difficulties. In response to this, a local authority housing department established a family support team (FST) that provides assessment and detection of a range of problems, support to parents and children, parenting interventions for child behavioural problems, liaison with other agencies, and referral to specialist services when appropriate. The aim of this study was to establish the perceptions of parents and staff on their experience of the service, and ways of improving it in the future. The study adopted a developmental evaluation approach and used multiple methods, including in-depth interviews with families; diaries; reflective activities; participatory learning and action; and observation of the FST. The study mapped the innovative service and captured the range of skills in the team and the complexity of agencies the team interacted with. It also identified areas for further development in terms of the mental health needs of children and parents who have become homeless.
Mass spectrometry methods measured androgen and estrogen concentrations during pregnancy and in newborns of mothers with polycystic ovary syndrome.

OBJECTIVE Little is known about the aetiology of polycystic ovary syndrome (PCOS). Some suggest that elevated maternal androgens during gestation play a causative role. This implies placental passage of androgens during pregnancy. The aim of this study is to compare androgen and estrogen concentrations in maternal serum during pregnancy and in umbilical cord blood, between mothers with PCOS and their offspring compared to controls. DESIGN Prospective case-control study. METHODS Maternal blood samples were collected around 20 weeks of gestation and at delivery. Umbilical cord blood was also taken at delivery. Androgens (testosterone (T), androstenedione (ADION), dehydroepiandrostenedione (DHEA)) and estrogens (estrone (E1), estradiol (E2), estriol (E3)) were measured using the liquid chromatography tandem mass spectrometry (LC-MS/MS) methods. RESULTS At 20 weeks of gestation: T (P=0.019) and ADION (P=0.034) were higher in the PCOS mothers (pregnant with a girl), whereas DHEA, E1, E2, and E3 were not different. Maternal concentration at birth: T (P=0.004) and ADION (P=0.009) were also higher in the subgroup of PCOS mothers that were pregnant with a girl compared to the girl pregnancy controls. DHEA, E1, E2 and E3 were not different. In umbilical cord blood, no differences were found for T, ADION, DHEA, E2, E3, and AMH between the PCOS mothers and the controls respectively. E1 was lower in girls from PCOS mothers (P=0.007). CONCLUSIONS Despite elevated maternal androgen concentrations during pregnancy in PCOS mothers, offspring showed no signs of elevated androgen concentrations in cord blood at birth using the latest highly specific LC-MS/MS methods.
Visible-near infrared absorbing dithienylcyclopentadienone-thiophene copolymers for organic thin-film transistors.

Structural design, synthesis, and characterization of a series of organic semiconductors consisting exclusively of dithienylcyclopentadienone subunits within a polythiophene backbone are described as the first example for organic electronic devices. The donor (thiophene)-alt-acceptor (cyclopentadienone) copolymers exhibit a substantial p-carrier mobility in OFET but an unexpected noncorrelation between absorption and photoconductivity.
The loneliness of the left handed surgeon

Left handed surgeons lack access to left handed instruments while training, receive little mentoring about their left handedness, and are more prone to needle stick injuries than their right handed colleagues. They also have considerable difficulty handling some instruments. One in 10 left handed surgeons was also uncomfortable with the idea of being operated on by a left handed surgeon, says a report in Current Surgery (2004:61:587-91). Six per cent also reported concerns by patients about their laterality. The perils and pitfalls of being left handed emerge from a survey of surgeons in New York city, Manhattan, and …