Miracle-dz/UniFAR-FTUs huggingface dataset:
Five-Year Effectiveness of the Multidisciplinary Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM) on Diabetes-Related Complications and Health Service Uses—A Population-Based and Propensity-Matched Cohort Study

OBJECTIVE To evaluate the 5-year effectiveness of a multidisciplinary Risk Assessment and Management Programme–Diabetes Mellitus (RAMP-DM) in primary care patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A 5-year prospective cohort study was conducted with 121,584 Chinese primary care patients with type 2 DM who were recruited between August 2009 and June 2011. Missing data were dealt with multiple imputations. After excluding patients with prior diabetes mellitus (DM)-related complications and one-to-one propensity score matching on all patient characteristics, 26,718 RAMP-DM participants and 26,718 matched usual care patients were followed up for a median time of 4.5 years. The effect of RAMP-DM on nine DM-related complications and all-cause mortality were evaluated using Cox regressions. The first incidence for each event was used for all models. Health service use was analyzed using negative binomial regressions. Subgroup analyses on different patient characteristics were performed. RESULTS The cumulative incidence of all events (DM-related complications and all-cause mortality) was 23.2% in the RAMP-DM group and 43.6% in the usual care group. RAMP-DM led to significantly greater reductions in cardiovascular disease (CVD) risk by 56.6% (95% CI 54.5, 58.6), microvascular complications by 11.9% (95% CI 7.0, 16.6), mortality by 66.1% (95% CI 64.3, 67.9), specialist attendance by 35.0% (95% CI 33.6, 36.4), emergency attendance by 41.2% (95% CI 39.8, 42.5), and hospitalizations by 58.5% (95% CI 57.2, 59.7). Patients with low baseline CVD risks benefitted the most from RAMP-DM, which decreased CVD and mortality risk by 60.4% (95% CI 51.8, 67.5) and 83.6% (95% CI 79.3, 87.0), respectively. CONCLUSIONS This naturalistic study highlighted the importance of early optimal DM control and risk factor management by risk stratification and multidisciplinary, protocol-driven, chronic disease model care to delay disease progression and prevent complications.
MALIGNANT HYPERTENSION: THE HISTOLOGIC CHANGES IN THE KIDNEYS

The relationship of arterial disease to disease of the kidneys is far from accurately settled. 1 As a contribution to the subject I determined, in twenty-seven cases, the size and the weight of the kidneys and the ratio of the wall to the lumen of the renal arterioles in relation to histologic renal changes. So far as I know, this is the largest series of cases in which both a clinical diagnosis of malignant hypertension and a histologic study of the tissue obtained at necropsy have been made. Consciously, or without elaborately detailed distinction, most physicians have considered various grades of severity in cases of arterial hypertension. Perhaps Volhard and Fahr, 2 in 1914, were most definite in this regard. For them there was a bosartige type distinct from a milder one. Later Fahr 3 used the term malignant nephrosclerosis to indicate the picture presented by the kidneys in a
The Change of Practice Patterns of the Hereditary Breast Cancer Management in Korea after the Korean Hereditary Breast Cancer Study

change in the practice patterns for managing hereditary breast and ovarian cancer (HBOC) among Korean physicians after the Korean Hereditary Breast Cancer (KOHBRA) study. Methods: The first survey was performed from July to August 2007, at the initiation of the KOHBRA study, and the followup survey was conducted from July to December 2009. Members of the Korean Breast Cancer Society were invited to participate in the study by e-mail. The 2009 survey was conducted with a self-administered questionnaire concerning HBOC management and was identical to the previous questionnaire. Results: According to the 2009 survey, most physicians (60.0%) tended to draw a pedigree (48.0% in 2007 survey). The rate of genetic test recommendations for patients at risk for HBOC was higher in the 2009 survey (84.0%) than that in the 2007 survey (64.0%). Physicians tended to select a BRCA genetic testing candidate more appropriately than in the previous survey (42.4% answered right in 2007 survey; 74.4% in 2009 survey). Fifteen of 25 participants (60.0%) provided genetic counseling before their patients underwent a genetic test, which was higher than that (40.0%) in the 2007 survey. According to the 2009 survey, half of the genetic counseling was being conducted by KOHBRA study research nurses; whereas most of the genetic counseling was conducted by physicians in 2007. Conclusion: The KOHBRA study The Change of Practice Patterns of the Hereditary Breast Cancer Management in Korea after the Korean Hereditary Breast Cancer Study
Viewpoints of pedestrians with and without cognitive impairment on shared zones and zebra crossings

Background Shared zones are characterised by an absence of traditional markers that segregate the road and footpath. Negotiation of a shared zone relies on an individual’s ability to perceive, assess and respond to environmental cues. This ability may be impacted by impairments in cognitive processing, which may lead to individuals experiencing increased anxiety when negotiating a shared zone. Method Q method was used in order to identify and explore the viewpoints of pedestrians, with and without cognitive impairments as they pertain to shared zones. Results Two viewpoints were revealed. Viewpoint one was defined by “confident users” while viewpoint two was defined by users who “know what [they] are doing but drivers might not”. Discussion Overall, participants in the study would not avoid shared zones. Pedestrians with intellectual disability were, however, not well represented by either viewpoint, suggesting that shared zones may pose a potential barrier to participation for this group.
Non-TH1 cytokines are augmented systematically early in Guillain–Barré syndrome

Abstract—The TH1 vs non-TH1 cytokine balance in Guillain–Barré syndrome (GBS) is unknown. Using enzyme-linked immunospot (ELISPOT) assays, we observed elevated numbers of interleukin (IL)-6 and IL-10–secreting blood mononuclear cells (BMNC) during the acute phase in untreated patients, and low levels of tumor necrosis factor &agr;–secreting BMNC in the recovery phase of GBS. Numbers of IL-12p70–secreting BMNC were not affected over the course of GBS. The non-TH1 cytokine profile observed early in GBS may explain the self-limited clinical course associated with GBS.
Post-operative immune suppression is mediated via reversible, Interleukin-10 dependent pathways in circulating monocytes following major abdominal surgery

Introduction Post-operative infections occur frequently following major surgery. The magnitude of the post-operative immune response is associated with an increased risk of post-operative infections, although the mechanisms driving post-operative immune-dysfunction and the potential reversibility of this response with immune stimulants are not well understood. This study aims to describe the immediate immune response to major surgery and establish links to both post-operative infection and functional aspects of immune dysregulation. We also investigate the potential of clinically available immune stimulants to reverse features of post-operative immune-dysfunction. Methods Patients over 45 years old undergoing elective gastro-intestinal surgery with planned post-operative surgical ICU admission were recruited. The expression of selected genes was determined pre-operatively and at 2, 24 and 48 hours post-operatively using qRT-PCR. Circulating levels of Interleukin-10 protein were determined by ELISA. Peri-operative cell surface monocyte HLA-DR (mHLA-DR) expression was determined using flow cytometry. Gene expression and mHLA-DR levels were determined in healthy monocytes cultured in peri-operative serum with and without neutralising antibodies and immune stimulants. Results 119 patients were recruited; 44 developed a post-operative infection. Interleukin-10 mRNA and protein increased 4-fold post-operatively (P<0.0001), peaking within 2 hours of the procedure. Higher post-operative Interleukin-10 mRNA (P = 0.007) and protein (P = 0.001) levels were associated with an increased risk of infection. Cell surface mHLA-DR expression fell post-operatively (P<0.0001). Reduced production, rather than intracellular sequestration, accounted for the post-operative decline in cell surface mHLA-DR expression. Interleukin-10 antibody prevented the decrease in mHLA-DR expression observed when post-operative serum was added to healthy monocytes. GM-CSF and IFN-γ prevented the decline in mHLA-DR production through distinct pathways. Conclusions Monocyte dysfunction and features of immune suppression occur frequently after major surgery. Greater post-operative Interleukin-10 production is associated with later infection. Interleukin-10 is an important mediator of post-operative reductions in mHLA-DR expression, while clinically available immune stimulants can restore mHLA-DR levels.
Presence of Metabolic Syndrome is not an Independent Predictor of In-hospital Adverse Events in Patients with ST Elevation Myocardial Infarction that Underwent Primary Percutaneous Coronary Intervention

Background: Presence of Metabolic Syndrome (MetS) has been shown to predict higher risk for cardiovascular diseases. However, in patients with ST Segment Elevation Myocardial Infarction (STEMI), prognostic importance of MetS has not been widely studied. Methods: We prospectively recruited 611 STEMI patients (521 male, 90 female) who were treated by primary angioplasty. Metabolic syndrome was diagnosed according to the International Diabetes Federation metabolic syndrome worldwide definition. Coronary angiographic data and in-hospital events of individuals were recorded. Major Adverse Cardiac Events (MACE) included cardiac death, recurrent myocardial infarction and target lesion revascularization. Results: Metabolic syndrome group included 276 (45.1% of the study cohort; mean age 56.8 ± 12.2; 210 male) and control group included 335 subjects (54.9% of the study cohort; mean age 55.6 ± 12.9; 311 male). The frequency of female gender, hypertension, Diabetes Mellitus (DM), hyperlipidemia and positive history for coronary artery disease were higher in MetS group, whereas, the ratio of smokers was higher in the control group. The incidence of in-hospital death and MACE was not statistically different in MetS and control groups. Presence of MetS was not correlated with in-hospital death and MACE in univariate analysis. In multivariate analysis using model adjusted for age, gender, DM/ fasting glucose >100 mg/dL, left ventricular ejection fraction, post-PCI TIMI flow grade <3 and high creatinine and peak CK-MB levels age, peak CK-MB and creatinine levels remained the independent predictors of in-hospital mortality. Peak CK-MB and creatinine levels were also independent predictors of in-hospital MACE. Conclusion: Presence of MetS was not a predictor of in-hospital adverse events in patients with STEMI treated with primary percutaneous intervention. Peak CK-MB and creatinine levels may indicate higher risk for in-hospital adverse events.
Non-parametric estimation of survival in age-dependent genetic disease and application to the transthyretin-related hereditary amyloidosis

In genetic diseases with variable age of onset, survival function estimation for the mutation carriers as well as estimation of the modifying factors effects are essential to provide individual risk assessment, both for mutation carriers management and prevention strategies. In practice, this survival function is classically estimated from pedigrees data where most genotypes are unobserved. In this article, we present a unifying Expectation-Maximization (EM) framework combining probabilistic computations in Bayesian networks with standard statistical survival procedures in order to provide mutation carrier survival estimates. The proposed approach allows to obtain previously published parametric estimates (e.g. Weibull survival) as particular cases as well as more general Kaplan-Meier non-parametric estimates, which is the main contribution. Note that covariates can also be taken into account using a proportional hazard model. The whole methodology is both validated on simulated data and applied to family samples with transthyretin-related hereditary amyloidosis (a rare autosomal dominant disease with highly variable age of onset), showing very promising results.
Drug abuse among patients of Tanta university hospital outpatient clinic, Gharbia governorate, Egypt

The aim of this study was to assess the frequency of drug abuse among patients who attended Tanta university outpatient clinic for medical consultations, as well as to determine its sociodemographic predictors. A cross-sectional study was carried out on 218 patients who attended Tanta university outpatient clinic over a period of 3 months using the Drug Abuse Screen Test (DAST-10) to determine the frequency of drug abuse and its grades. The results revealed that 15.14% of this study group comprised drug abusers and most of the drug abusers used more than one drug. The majority of drug abusers in this study population could not discontinue drugs and suffered from withdrawal symptoms. Drug abuse was significantly higher in the male population than in the female population, among individuals with low educational qualifications than among university graduates and those with secondary education, in those between 18 and 25 years of age than in other age categories, in urban residents than in rural ones, in single than in married individuals, in cigarette smokers and alcohol users than in nonsmokers and nonalcohol users. Thus, I recommend (according to DAST-10 recommendations) the monitoring and reassessment of mild drug abusers, further investigation of moderate and substantial drug abusers, and intensive assessment of severe cases.
Infundibuloneurohypophysitis in Children

Two children with diabetes insipidus secondary to a chronic inflammatory infiltrate of the infundibulum – infundibuloneurohypophysitis – are presented. Features unique to these cases are contrasted with prior case reports. The differential diagnoses of diabetes insipidus and inflammatory pituitary disorders are discussed. Recommendations for diagnosis and treatment are proposed.
Severity and properties of cardiac damage caused by Streptococcus pneumoniae are strain dependent

Streptococcus pneumoniae is an opportunistic Gram-positive pathogen that can cause invasive disease. Recent studies have shown that S. pneumoniae is able to invade the myocardium and kill cardiomyocytes, with one-in-five adults hospitalized for pneumococcal pneumonia having a pneumonia-associated adverse cardiac event. Furthermore, clinical reports have shown up to a 10-year increased risk of adverse cardiac events in patients formerly hospitalized for pneumococcal bacteremia. In this study, we investigated the ability of nine S. pneumoniae clinical isolates, representing eight unique serotypes, to cause cardiac damage in a mouse model of invasive disease. Following intraperitoneal challenge of C57BL/6 mice, four of these strains (D39, WU2, TIGR4, and 6A-10) caused high-grade bacteremia, while CDC7F:2617–97 and AMQ16 caused mid- and low-grade bacteremia, respectively. Three strains did not cause any discernible disease. Of note, only the strains capable of high-grade bacteremia caused cardiac damage, as inferred by serum levels of cardiac troponin-I. This link between bacteremia and heart damage was further corroborated by Hematoxylin & Eosin and Trichrome staining which showed cardiac cytotoxicity only in D39, WU2, TIGR4, and 6A-10 infected mice. Finally, hearts infected with these strains showed varying histopathological characteristics, such as differential lesion formation and myocytolysis, suggesting that the mechanism of heart damage varied between strains.
Association of Hemoglobin A1c and Wound Healing in Diabetic Foot Ulcers

OBJECTIVE This study evaluated the association between hemoglobin A1c (A1C) and wound outcomes in patients with diabetic foot ulcers (DFUs). RESEARCH DESIGN AND METHODS We conducted a retrospective analysis of an ongoing prospective, clinic-based study of patients with DFUs treated at an academic institution during a 4.7-year period. Data from 270 participants and 584 wounds were included in the analysis. Cox proportional hazards regression was used to assess the incidence of wound healing at any follow-up time in relation to categories of baseline A1C and the incidence of long-term (≥90 days) wound healing in relation to tertiles of nadir A1C change and mean A1C change from baseline, adjusted for potential confounders. RESULTS Baseline A1C was not associated with wound healing in univariate or fully adjusted models. Compared with a nadir A1C change from baseline of −0.29 to 0.0 (tertile 2), a nadir A1C change of 0.09 to 2.4 (tertile 3) was positively associated with long-term wound healing in the subset of participants with baseline A1C <7.5% (hazard ratio [HR] 2.07; 95% CI 1.08–4.00), but no association with wound healing was seen with the mean A1C change from baseline in this group. Neither nadir A1C change nor mean A1C change were associated with long-term wound healing in participants with baseline A1C ≥7.5%. CONCLUSIONS There does not appear to be a clinically meaningful association between baseline or prospective A1C and wound healing in patients with DFUs. The paradoxical finding of accelerated wound healing and increase in A1C in participants with better baseline glycemic control requires confirmation in further studies.
Positive perception of aging is a key predictor of quality-of-life in aging people

Objective We conducted a cross-sectional survey in France in a cohort over 55 years of age to characterize the impact of psychological dimensions on quality-of-life (QoL). Methods The predictors of QoL in relation with aging were studied using an adapted quality-of-life model, based on emotional, cognitive and physical symptoms, functional status, and general health perception. Adding psychological dimensions such as self-esteem, psychological distress, perceptions of ageing and coping, was hypothesized to improve the QoL model. Responses were analyzed using structural equation modeling and path analysis. Results The study involved 258 participants, mean age 66.9±7.9 years. Psychological distress and positive perception of aging exhibited the strongest direct impact on QoL (p<0.0001). Psychological distress also appeared to be mediator on QoL for perceived health status, self-esteem and negative perception of aging. Coping centred on emotion exhibited direct impact on self-esteem and so, indirect impact on QoL (p = 0.0002). Perception of personal financial situation (p = 0.0007) and coping centred on social support (p = 0.02) appeared as direct mediators influencing QoL. Conclusions Psychological dimensions are predictors of QOL and have to be taken into account to maximize the resources with a view to successful aging. Further interventions targeting successful aging should focus on positive perception aging.
Using farmers' local knowledge of tree provision of ecosystem services to strengthen the emergence of coffee-agroforestry landscapes in southwest China

Intensive monoculture coffee farms quickly expanded in Yunnan Province in the 1990’s and 2000’s. In 2012, local authorities in Pu’er and Xishuangbanna Prefectures, the main coffee producing centre in the province, initiated a large-scale conversion program of these farms towards coffee-agroforestry systems to promote “ecologically-friendly coffee”. Shade tree inventories and household interviews were conducted in these two prefectures to characterize coffee farms and the Local Ecological Knowledge (LEK) of farmers on the provision of ecosystem services by associated tree species. This study on newly emerging coffee farming systems revealed a high level of tree species diversity at both farm and landscape levels despite the previous dominance of intensive coffee monoculture and the large-scale distribution of a limited number of shade tree species by the government. 162 tree species were encountered during farm inventories, out of which the community of coffee farmers was able to rank 30 against 9 ecosystem services and disservices. This study reveals that this LEK is a type of hybrid knowledge that still relies mostly on traditional knowledge of tree species combined with experience acquired from newly-implemented coffee-agroforestry practices. This study also pointed out knowledge gaps regarding the impact of mature trees on coffee yield, coffee quality and pest control. The participatory approach resulted in the identification of non-promoted species with a high potential to provide locally relevant ecosystem services in coffee-agroforestry systems. These results lead to the upgrade of an online tool (www.shadetreeadvice.org) which allows extension services generating lists of recommended shade tree species tailored to the local ecological context and individual farmers’ needs. This tool will benefit farmers’ livelihood, support landscape health and contribute to the sustainability of the emerging Yunnan coffee agriculture sector.
Association of Vitamin D Receptor Gene G>T and T>C Polymorphisms in Young Onset Diabetes Mellitus in a Bangladeshi Population -

Background: Vitamin D has an important immunomodulatory property and Vitamin D receptor (VDR) gene polymorphism has also been found to be associated with insulin secretory capacity and glucose intolerance. The present study was undertaken to determine genotype of VDR gene common variants in young onset diabetic subjects of Bangladesh to explore its association with diabetes and B cell secretory capacity. Methods: A total number of 94 young diabetic subjects and 92 healthy controls were recruited. Blood parameters were estimated by standard methods and DNA was extracted using QIAGEN Kit. VDR gene variants [G>T and T>C] were determined by PCR-RFLP using restriction endonuclease Apa1 and Taq1 respectively. Data were managed using Statistical Program for Social Science (SPSS). Results: C-peptide level was found to be significantly lower 3.297 (pT and T>C genome frequencies (wild, heterozygous and homozygous variants) were in the control (0.183, 0.516, 0.316 and 0.370, 0.522, 0.109 respectively) and (0.198, 0.484, 0.319 and 0.484, 0.418, 0.090 respectively) in YDM which did not show significant association with YDM (p=0.906 and 0.288 respectively). Genotype frequency of the marker allele did not show significant association with glucose, C-peptide, HOMA%S and IR either in Controls or YDM subjects except the HOMA%B shown to have relatively lower. Conclusions: VDR gene G>T and T>C polymorphic marker are not associated with diabetes mellitus in the young Bangladeshi diabetic patients, Insulin secretory dysfunction is main feature of pathogenesis of diabetes in the young. VDR gene G>T genotype is associated with higher secretary capacity.