Miracle-dz/UniFAR-FTUs huggingface dataset:
3D Morphological Study of the Indian Arthritic Knee: Comparison with Other Ethnic Groups and Conformity of Current TKA Implant*

Background: Studies have shown that there are striking variations in knee morphology between Asian and Western population. However, most of the existing total knee arthroplasty (TKA) implants are designed to suit the anatomy of Western population. Our study investigated anthropometry of Indian arthritic knees and compared them to international ethnic groups. Methods: Computed tomography was used to create 3D knee models and obtain anthropometric data of distal femur and proximal tibia of Indian arthritic knees. Femoral measurements included mediolateral length, medial and lateral anteroposterior length, medial and lateral condylar width and aspect ratio. Tibial measurements included mediolateral length, medial, lateral and central anteroposterior length and aspect ratio. A preoperative virtual implantation using Western TKAimplants was carried out to visualize anatomical conformity. Results: Statistical analysis results showed that Indian males had significantly larger femoral and tibial mediolateral and anteroposterior width than Indian females; however, femoral and tibial aspect ratio was similar for both. In case of females, significant difference was observed between medial and lateral condylar widths. When compared to knee anthropometry of other ethnic groups, femoral and tibial aspect ratio of Indian knees was found to be similar to the Asian population and different from the Western population. The virtual implantation showed overhang of the femoral component in both lateral and medial regions. Conclusion: Morphological mismatch between Western and Indian knees established the fact that Western implants have drawbacks when implanted in Indian patients. The study also provided a basis for designing gender-specific TKA implants for the Indian population.
Otorhinolaryngeal foreign bodies in children presenting to the emergency department.

INTRODUCTION Accidents with foreign bodies are common in the paediatric population. It is impossible to mandate that all foreign bodies (FB) in the ear, nose and throat (ENT) of children should be removed by the specialty-trained physicians. This study evaluates the management of ENT FB removal in children achieved by emergency physicians not trained in otolaryngology in an urban tertiary care paediatric emergency department. METHODS A retrospective study was conducted on consecutive paediatric patients presenting with suspected foreign body in the ear, nose or throat to the children's emergency department (ED) of KK Women's and Children's Hospital over a 10-month period. Removal methods, foreign body types, rates of successful removal and associated complications were evaluated. RESULTS There were 353 patients, most of whom presented after office hours. An attempt at removal of FB by the emergency physician was made in 76.8 percent of the cases. ENT specialist referral in the ED was made in 1.7 percent of the cases. 50.1 percent of cases were discharged after successful removal of FB in the ED. 4.2 percent of cases were admitted for removal of FB and 44.8 percent of cases were referred to the ENT specialist clinic for further assessment. CONCLUSION The emergency physician managed most cases in the ED and urgent referral to ENT specialists was not required. Complications and morbidity often occur from repeated attempts at removal of the FB. ENT opinion should be sought whenever there is doubt. The ED physician should be skilled in techniques of FB removal, especially throat FB, which had the lowest rate of success in our study.
Time course of onset and decay of humoral natriuretic activity in the rat.

The natriuretic mechanism.tic activity shown in earlier cross-circulation experiments to develop in the blood of rats undergoing sustained vascular expansion has been further characterized. Following whole blood infusion and urine reinfusion of the donor rat, a cross-circulated isovolaemic partner exhibits a natriuresis of gradual onset, requiring 60-80 min to reach a peak (0.04-3.24 muequiv./min per gram kidney weight). The gradual feature of recipient natriuresis was unchanged by infusing the donor rat 1 h prior to cross-circulation. Once developed, the recipient natriuresis was sustained when fluid depletion by the renal response was prevented, but was reversible with a half-life of about 30 min on interruption of the cross-circulation; reconnection of cross-circulation promptly restored recipient natriuresis. No significant natriuresis (0.04-0.16 muequiv/min per gram kidney weight) occurred in the recipients if the donors in comparable cross-circulations were not infused. These findings confirm that a natriuretic activity develops in the blood as a consequence of vascular expansion, and reveal that the activity has a slowly developing and reversible action on the renal natriure
Review of Cases with Cystic Hydatid Lung Disease in a Tertiary Referral Hospital Located in an Endemic Region: A 10 Years’ Experience

Background: Echinococcus disease is endemic in sheep-and cattle-raising areas world wide. Its prevalence is also high in the Mediterranean region including Turkey. Objective: To determine the presentation, approach to surgical treatment and outcome of hydatid disease in an endemic region. Methods: From January 1989 to December 1998 288 patients, aged between 1 and 71 years with a mean age of 31 years (134 female, 154 male), were operated on for pulmonary hydatidosis. Clinical charts of the patients were reviewed retrospectively in a tertiary referral hospital. Results: Of 288 patients, 30 patients were asymptomatic, the rest (89%) were symptomatic, cough and chest pain being the most common symptoms. Fifty-three patients (18%) had associated liver hydatid cysts. Bilateral lung hydatid cysts were present in 18 patients (6%). Recurrent hydatid cysts were observed in 33 patients (11%). Seventy-seven patients (27%) presented with complicated hydatid cysts. Postoperative morbidity was observed in 3 patients [bronchopleural fistula (2), infection of the cyst space (1)] and postoperative mortality in 1 patient who presented with hydatid lung disease associated with liver and brain cysts. In the remaining 98.6%, no complications were noted. Conclusions: In conclusion, hydatidosis is still an important public health problem in Turkey and in an endemic country such as Turkey hydatid lung disease should be considered initially in a patient presenting with a corresponding chest roentgenogram and a compatible epidemiologic history. Surgery is indicated in all symptomatic and/or enlarging or infected cysts. When necessary lobectomy or wedge resection can be the procedure of choice. Single-stage combined resection is preferred in hydatid lung disease with associated liver hydatid cysts. Total postoperative complication and mortality rate is low and we recommend a close follow-up of the operated cases to diagnose postoperative recurrence early in its course.
THE DURATION AND AMPLITUDE CHARACTERISTICS OF EARTHQUAKE GROUND MOTIONS WITH EMPHASIS ON LOCAL SITE EFFECTS

Among various indices of earthquake ground motions, the maximum amplitude value and frequency content have been regarded as the most important indices for earthquake engineering. These indices are strongly affected by local site conditions. Also the fact that the duration of earthquake ground motion differs from site to site even during the same earthquake has been noticed by many researchers. This paper dealt with the duration and its related parameters were adopted as representative parameter of the duration characteristics of earthquake ground motions. We investigated how they are influenced by the earthquake magnitude, hypocentral distance and the focal depth. The average and overall trends of the duration and its related parameters were presented. Also the correlation of the duration and its related parameters with the Japan Meteorological Agency (JMA) instrumental seismic intensity was shown. A simple statistical technique was performed by using the earthquake ground motion records obtained in the Sendai region, Japan. This paper discusses the variability for the duration and its related parameters with emphasis on the site-dependency and the event-dependency to reveal the duration and amplitude characteristics of earthquake ground motions. The difference of these ground motion parameters is not only site-dependent but also event-dependent. For the total power and rms amplitude, the difference at each site exceeds the variability at each event, and strong site-dependency was found. The variability for the total power, rms amplitude and peak ground acceleration (PGA) indicated essentially the same trends. On the other hand, it is quantitatively revealed that the event-dependency for the duration is greater than the site-dependency. Among various ground motion parameters, these parameters would be divided into two groups regarding the site-dependency and the event-dependency. One is the ground motion parameter based on “amplitude”, and the other based on “duration”. In addition, this paper suggested that the duration and amplitude characteristics of earthquake ground motions suffer a reciprocal effect due to the earthquake magnitude, hypocentral distance, the focal depth and the local site conditions. In view of the results, the duration is not less important than the maximum amplitude and frequency content in earthquake engineering. Furthermore, this paper provided meaningful information of input motion available to earthquake-resistant design.
Gluten sensitivity in Japanese patients with adult-onset cerebellar ataxia.

OBJECTIVE Gluten sensitivity is associated with multiple neurological abnormalities including gluten ataxia, motor neuron disease-like neuropathy, small fiber type neuropathy, cognitive impairment, and even parkinsonism. We investigated whether or not gluten sensitivity is involved in Japanese patients with idiopathic cerebellar ataxia with extracerebellar presentation. PATIENTS OR MATERIALS Fourteen patients with idiopathic cerebellar ataxia with extracerebellar presentation (autonomic instability, parkinsonism, or pyramidal dysfunction in varying combinations) were screened for anti-gliadin antibodies (AGA) to analyze for the presence or absence of gluten sensitivity. Patients with typical MR findings of multiple system atrophy of the cerebellar type were excluded. As disease controls without cerebellar ataxia, 9 patients with Parkinson's disease and 18 patients with amyotrophic lateral sclerosis were screened for AGA. Forty-seven normal controls were also screened for AGA. RESULTS We found a high prevalence of AGA in 5 (36%) of 14 cerebellar ataxia patients, but in only 1 (4%) of 27 disease controls without cerebellar ataxia (odds ratio, 14.4; 95% CI, 1.41147; p<0.05) and in only 1 (2%) of 47 normal controls (odds ratio, 25.6; 95% CI, 2.66246; p<0.001). Among the cerebellar ataxia patients, atypical features such as sensorimotor neuropathy and/or mild cognitive impairment were more prevalent in the AGA-positive group (60%) than in the AGA-negative group (0%). In one of the ataxic patients with AGA, a gluten-free diet had positive effects on neurological symptoms and nutritional status. CONCLUSION Gluten sensitivity is involved in at least some of the unexplained neurological symptoms of Japanese patients with adult-onset, sporadic cerebellar ataxia.
Extraction, Purification and Characterization of Fish Chymotrypsin: A Review

Problem statement: Solid fish waste is generated from the unwanted parts of fish including heads, tails, fins, frames, offal (guts, kidney and liver) and skin. It accounts for up to 80% of material from production of surimi, 66% from production of fillet and 27% from production of headed and gutted fish. Currently, fish wastes are disposed off in land-based waste disposal systems or at sea generating toxic by-products during the decomposition process. However, fish processing waste can be used to produce commercially valuable by-products, such as chymotrypsin. Approach: A comperehensive review of the literature on the extraction, purification and characeterization of fish chymotrypsin was performed. Results: Chymotrypsin is an endopeptidase secreted by the pancreatic tissues of vertebrates and invertebrates. It has 3 different structures (chymotrypsin A, B and C) varying slightly in solubility, electrophoretic mobility, isoelectric point and cleavage specificity. Only chymotrypsin A and B are found in fish. Compared with mammal chymotrypsin, fish chymotrypsins have similar amino acid composition and molecular weights. Fish chymotrypsins have higher specific activity, especially those from cold-water fish, and low pH and temperature tolerance. The factors affecting the concentration and activity of chymotrypsin in fish are water temperature, fish species, fish age, fish weight and starvation. Chymotrypsin has application in various industries including the food industry, leather production industry chemical industry and medical industry. Conclusion: Extraction techniques for chymotrypsin include: ultra-filtration, ammonium sulphate fractionation precipitation or water-in-oil microemulsions. Purification can be carried out using re-crystallization and gel-filtration, ion-exchange and hydrophobic interaction chromatography. Further studies should focus on the optimization of purifiying chymotrypsin from fish processing wastes.
Diagnosis and management of the acute retinal necrosis syndrome.

The acute retinal necrosis (ARN) syndrome is an increasingly occurring entity characterized by the triad of acute confluent peripheral retinitis with papillitis and anterior-chamber uveitis. We present case reports on four patients (age, 12-65 years) with an ARN syndrome caused by herpes simplex or varicella zoster virus and discuss diagnostic and therapeutic modalities. Immediate antiviral therapy in three patients exhibiting the typical clinical features reduced the intraocular inflammation. However, due to proliferative vitreoretinopathy with peripheral retinal necrosis, vitrectomy with encircling band and silicone oil instillation was necessary in all patients. The suspected diagnosis of an ARN syndrome induced by herpes simplex virus (HSV) was confirmed in one case during the early stage of the disease by the detection of increased levels of HSV-IgA in the vitreous and in another case by the measurement of increased titers of HSV-IgG in the vitreous. For the first time, we found intraocular HSV DNA sequences using the polymerase chain reaction (PCR) in one of these patients. In a fourth patient intraocular varicella zoster virus (VZV) infection was confirmed by the detection of elevated VZV-IgA levels and by positive PCR in the intraocular fluids. Two patients who were diagnosed and treated early retained a visual acuity of 0.4 and 0.5, respectively, whereas in the other two patients, whose diagnosis and therapy were delayed (> 6 weeks), visual acuity was reduced to light perception. We conclude that use of the PCR in the intraocular fluids together with detection of autochthonous antibodies in the vitreous seem to be the most important diagnostic laboratory tools. (ABSTRACT TRUNCATED AT 250 WORDS)
Adipokines in Peritoneal Dialysis: Relevant Clinical Impact According to Body Composition

Adipokines impact on clinical outcomes is not adequately addressed in peritoneal dialysis (PD). We investigated the impact of leptin/adiponectin ratio (L/A) as a predictor of cardiovascular events (CVE) in PD, taking into consideration patient's body composition and the potential role of glucose load. We prospectively followed 66 prevalent PD patients for 47.0 ± 28.2 months. New CVE were evaluated. Lean tissue index (LTI), relative fat mass (relFM) and relative overhydration (relOH) using multifrequency bioimpedance (BCM) were assessed; serum lipids, interleukin‐6 (IL‐6), leptin and adiponectin were measured. We established the determinants of L/A using multiple linear regression and the impact of L/A on CVE. Obesity was present in 47 (73.4%) patients according to relFM, and in seven (10.6%) according to body mass index (BMI). Leptin and L/A exhibited a stronger correlation with relFM (both r = 0.62, P < 0.0001) than with BMI (r = 0.46 and r = 0.51, respectively, both P < 0.0001). L/A showed a significant correlation with triglycerides (r = 0.41, P = 0.001) and HDL‐cholesterol (r = −0.358, P = 0.003), better than isolated leptin or adiponectin. RelFM (RR = 0.130, 95%confidence interval [CI]:0.086–0.174, P < 0.0001) and LTI (RR = 0.194, 95%CI:0.037–0.351, P = 0.016) were independent predictors of L/A (R2 = 0.67). Patients who suffered new CVE were older (59.12 ± 12.41 vs. 47.52 ± 13.84years, P = 0.003) and had a higher relOH (11.28 ± 7.29 vs. 6.60 ± 8.16%, P = 0.028). L/A was significantly higher in patients with CVE[2.29 (1.79) vs. 0.65 (1.73), P = 0.028] but this association was only put on evidence after excluding patients with wasting. BMI is an inaccurate method to classify obesity in PD since it underestimates its prevalence compared with body composition assessment using BCM. High adiponectin and low leptin are associated with a more favorable metabolic risk profile in peritoneal dialysis. The L/A is determined by relFM and by LTI. A higher L/A is associated with CVE in PD patients without wasting.
Erythrocyte Volume Distribution Analysis and Hematologic Changes in Dogs with Iron Deficiency Anemia

Hematologic features were characterized in 12 dogs with iron deficiency anemia attributable to chronic external blood loss. Consistent abnormalities in hemograms included moderate to marked reticulocytosis, decreased mean corpuscular volume, and decreased mean corpuscular hemoglobin concentration. Hypoproteinemia occurred in only four of 12 dogs. Consistent blood film findings included hypochromic cells, leptocytosis, and erythrocyte fragmentation. These dogs had significantly decreased serum iron values (p < 0.001) and percent transferrin saturation values (p < 0.001) compared with 33 clinically healthy adult dogs. The total iron binding capacity values of these dogs were not significantly different (p > 0.5) than those of the healthy dogs. Using erythrocyte volume distribution curves, the percentages of microcytic cells (≤ 45 fl) were determined to range from 20% to 82%. Sequential changes in erythrocyte subpopulations were evaluated in four dogs which received iron therapy. The hematologic response consisted of fairly rapid restoration of packed cell volume by production of normocytes followed by a more gradual replacement of residual microcytes by new normocytes.
Accumulation and Phytotoxicity of Engineered Nanoparticles to Cucurbita Pepo

The effect of bulk and engineered nanoparticle (NP) Ag, Au, Cu, Si, and C at 250 and 750 mg/L on zucchini biomass, transpiration, and element content was determined. The pH of bulk and NP solutions prior to plant growth frequently differed. Nanoparticle Cu solution pH was significantly higher than bulk Cu, whereas for Ag and C, the NPs had significantly lower pH. Plants were unaffected by Au, regardless of particle size or concentration. NP Ag reduced plant biomass and transpiration by 49–91% compared to equivalent bulk Ag. NP Si at 750 mg/L reduced plant growth and transpiration by 30–51% relative to bulk Si. Bulk and NP Cu were phytotoxic but much of the effect was alleviated by humic acid. The shoot Ag and Cu content did not differ based on particle size or concentration. The accumulation of bulk Au was greater than the NP, but humic acid increased the accumulation of NP and bulk Au by 5.6-fold and 80%, respectively. The uptake of NP Si was 5.6–6.5-fold greater than observed with the bulk element. These findings show that the NPs may have unique phytotoxicity or accumulation patterns and that solution properties can significantly impact particle fate and effects.
Evaluating and improving multiple choice papers: true–false questions in public health medicine

Summary. The quality of a multiple true–false (MTF) examination paper in public health medicine for 149 clinical medical students was evaluated using predefined performance criteria to offer guidelines for improvement of such a paper. There were 35 questions, each with five true‐false branches, and the performance of the overall best 25% of candidates was compared for individual items with that of the overall worst 25%. To improve discrimination between best and worst candidates, 60% of items needed changes, and several indicators were used to identify how, usually because the branch was too easy (26%), unpopular (16%) or too hard (10%). A number of guidelines for writing good MTF questions and for improving them are suggested. The inequity is illustrated of marking systems which do not allocate a negative mark for incorrect answers equal in size to the positive mark for correct ones, with zero for unanswered questions or ‘don't know’ answers.
Dissection of genomewide-scan data in extended families reveals a major locus and oligogenic susceptibility for age-related macular degeneration.

To examine the genetic basis of age-related macular degeneration (ARMD), a degenerative disease of the retinal pigment epithelium and neurosensory retina, we conducted a genomewide scan in 34 extended families (297 individuals, 349 sib pairs) ascertained through index cases with neovascular disease or geographic atrophy. Family and medical history was obtained from index cases and family members. Fundus photographs were taken of all participating family members, and these were graded for severity by use of a quantitative scale. Model-free linkage analysis was performed, and tests of heterogeneity and epistasis were conducted. We have evidence of a major locus on chromosome 15q (GATA50C03 multipoint P=1.98x10-7; empirical P< or =1.0x10-5; single-point P=3.6x10-7). This locus was present as a weak linkage signal in our previous genome scan for ARMD, in the Beaver Dam Eye Study sample (D15S659, multipoint P=.047), but is otherwise novel. In this genome scan, we observed a total of 13 regions on 11 chromosomes (1q31, 2p21, 4p16, 5q34, 9p24, 9q31, 10q26, 12q13, 12q23, 15q21, 16p12, 18p11, and 20q13), with a nominal multipoint significance level of P< or =. 01 or LOD > or =1.18. Family-by-family analysis of the data, performed using model-free linkage methods, suggests that there is evidence of heterogeneity in these families. For example, a single family (family 460) individually shows linkage evidence at 8 loci, at the level of P<. 0001. We conducted tests for heterogeneity, which suggest that ARMD susceptibility loci on chromosomes 9p24, 10q26, and 15q21 are not present in all families. We tested for mutations in linked families and examined SNPs in two candidate genes, hemicentin-1 and EFEMP1, in subsamples (145 and 189 sib pairs, respectively) of the data. Mutations were not observed in any of the 11 exons of EFEMP1 nor in exon 104 of hemicentin-1. The SNP analysis for hemicentin-1 on 1q31 suggests that variants within or in very close proximity to this gene cause ARMD pathogenesis. In summary, we have evidence for a major ARMD locus on 15q21, which, coupled with numerous other loci segregating in these families, suggests complex oligogenic patterns of inheritance for ARMD.