Miracle-dz/UniFAR-FTUs huggingface dataset:
Nonmotor Disturbances in Parkinson’s Disease

Nonmotor disturbances (NMDs) affect most patients with Parkinson’s disease (PD) and often have a profound impact on their quality of life. NMDs such as depression, anxiety, fatigue, REM sleep behavior disorder, constipation, delayed gastric emptying, altered olfaction and pain can precede the onset of motor symptoms. Other NMDs, including hallucinations, dementia, excessive daytime sleepiness, insomnia, orthostatic hypotension and bladder disturbances, typically appear later in the course of PD. For most NMDs of PD, nondopaminergic and non-nigrostriatal mechanisms (e.g. neurodegeneration of other transmitter systems in the cortex and brainstem, side effects of medications, genetic and psychosocial factors) are considered more relevant than the ‘classical’ dopaminergic-nigrostriatal dysfunction. The recognition of NMDs requires a high degree of clinical suspicion, the use of specific questionnaires and ancillary tests. Pharmacological and nonpharmacological approaches can be effective, but for most forms of treatment of NMDs, the scientific evidence is limited.
Main characteristics of type 1 and type 2 diabetic patients interested in the use of a telemonitoring platform

buysse h, de moor g, coorevits p, van maele g, kaufman j & ruige j (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 456–468 Main characteristics of type 1 and type 2 diabetic patients interested in the use of a telemonitoring platform Aims and objectives. The main question addressed in this work, and to the best of our knowledge the first study focusing on this aspect, is whether diabetic patients – before they ever used a telemonitoring platform – are interested in using such a platform. In case they are interested, it is investigated whether characteristics of interested users could be distinguished. From a clinical perspective, special attention was drawn to metabolic control and to empowerment. Background. Diabetes is one of the most challenging health problems in the 21st century. The use of a telemonitoring platform could be an opportunity for persons with diabetes. However, until now, it has never been investigated if those persons are interested in using such a platform. Results. Of the 172 patients signing the informed consent, 137 (79·7%) patients filled in the questionnaires. Depending on the type of treatment, about 40–60% is interested in using a telemonitoring platform. Patients can easily be identified by the use of a computer or Internet, and interested patients log their treatment data. Most patients showing interest are on insulin treatment without having adequate metabolic control, or are on insulin and oral treatment with low empowerment scores, suggesting that implementation of a telemonitoring platform in these patients makes sense and can be used to improve metabolic control, e.g., by increasing empowerment. Conclusions. There is substantial interest in the use of a telemonitoring platform in insulin using (type 1/type 2) patients, and there is also a potential for improvement of metabolic control or empowerment in these patients. Implications for practice. Implementation of telemonitoring projects is potentially cost-effective in insulin using (type 1/type 2) patients already using a computer or the Internet.
Dexamethasone but not tadalafil improves exercise capacity in adults prone to high-altitude pulmonary edema.

RATIONALE Whether pulmonary hypertension at high altitude limits exercise capacity remains uncertain. OBJECTIVES To gain further insight into the pathophysiology of hypoxia induced pulmonary hypertension and the resulting reduction in exercise capacity, we investigated if the reduction in hypoxic pulmonary vasoconstrictive response with corticosteroids or phosphodiesterase-5 inhibition improves exercise capacity. METHODS A cardiopulmonary exercise test and echocardiography to estimate systolic pulmonary artery pressure were performed in 23 subjects with previous history of high altitude pulmonary edema, known to be associated with enhanced hypoxic vasoconstriction. Subjects were randomized to dexamethasone 8 mg twice a day, tadalafil 10 mg twice a day, or placebo (double-blinded), starting the day before ascent. MEASUREMENTS AND MAIN RESULTS Measurements were performed at low and high (i.e., 4,559 m) altitude. Altitude exposure decreased maximum oxygen uptake and oxygen saturation, increased pulmonary artery pressure, and altered oxygen uptake kinetics. Compared with placebo, dexamethasone improved maximum oxygen uptake (% predicted 74 +/- 13%; tadalafil 63 +/- 13%, placebo 61 +/- 11%; P < 0.05), oxygen kinetics (mean response time 41 +/- 13 s; tadalafil 46 +/- 6 s, placebo 45 +/- 10 s; P < 0.05), and reduced the ventilatory equivalent for CO(2) (42 +/- 4; tadalafil 49 +/- 4, placebo 50 +/- 5; P < 0.01). Peak oxygen saturation did not differ significantly between the three groups (dexamethasone 66 +/- 7%, placebo 62 +/- 7%, tadalafil 69 +/- 5%; P = 0.08). During echocardiography at low-intensity exercise (40% of peak power), dexamethasone compared with placebo resulted in lower pulmonary artery pressure (47 +/- 9 mm Hg; tadalafil 57 +/- 11 mm Hg, placebo 68 +/- 23 mm Hg; P = 0.05) and higher oxygen saturation (74 +/- 7%; tadalafil 67 +/- 3%, placebo 61 +/- 20; P < 0.02). CONCLUSIONS Corticosteroids, but not phosphodiesterase-5 inhibition, partially prevented the limitation of exercise capacity in subjects with intense hypoxic pulmonary vasoconstriction at high altitude.
Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis.

OBJECT The object of this study was to evaluate an alternative surgical approach to degenerative thoracolumbar deformity in adults. The authors present their early experience with the minimally invasive, lateral retroperitoneal transpsoas approach for placing interbody grafts and providing anterior column support for adult degenerative deformity. METHODS The authors retrospectively reviewed a prospectively acquired database of all patients with adult thoracolumbar degenerative deformity treated with the minimally invasive, lateral retroperitoneal transpsoas approach at our institution. All patient data were recorded including demographics, preoperative evaluation, procedure used, postoperative follow-up, operative time, blood loss, length of hospital stay, and complications. The Oswestry Disability Index and visual analog scale (for pain) were also administered pre- and postoperatively as early outcome measures. All patients were scheduled for follow-up postoperatively at weeks 2, 6, 12, and 24, and at 1 year. RESULTS The authors identified 25 patients with adult degenerative deformity who were treated using the minimally invasive, lateral retroperitoneal transpsoas approach. All patients underwent discectomy and lateral interbody graft placement for anterior column support and interbody fusion. The mean total blood loss was 53 ml per level. The average length of stay in the hospital was 6.2 days. Mean follow-up was 11 months (range 3-20 months). A mean improvement of 5.7 points on visual analog scale scores and 23.7% on the Oswestry Disability Index was observed. Perioperative complications include 1 patient with rhabdomyolysis requiring temporary hemodialysis, 1 patient with subsidence, and 1 patient with hardware failure. Three patients (12%) experienced transient postoperative anterior thigh numbness, ipsilateral to the side of approach. In this series, 20 patients (80%) were identified who had more than 6 months of follow-up and radiographic evidence of fusion. The minimally invasive, lateral retroperitoneal transpsoas approach, without the use of osteotomies, did not correct the sagittal balance in approximately one-third of the patients. CONCLUSIONS Degenerative scoliosis of the adult spine is secondary to asymmetrical degeneration of the discs. Surgical decompression and correction of the deformity can be performed from an anterior, posterior, or combined approach. These procedures are often associated with long operative times and a high incidence of complications. The authors' experience with the minimally invasive, lateral retroperitoneal transpsoas approach for placement of a large interbody graft for anterior column support, restoration of disc height, arthrodesis, and realignment is a feasible alternative to these procedures.
AN EXPERIMENTAL STUDY OF RECIPROCATING RHYTHM

As evolution proceeded, the muscular connection between auricles and ventricles gradually diminished. In the piscine heart, junctional fibers are present and conduct equally well in either direction at the whole circumference of the auriculoventricular border. In the amphibian heart, some parts of the junctional tissue conduct better than others; in some sections, reversed, or ventriculoauricular, conduction is even more rapid than normal, or auriculoventricular, conduction. Differences in conductivity are even more pronounced in the reptilian heart, and a reduction in the amount of conduction tissue has occurred. 1 Differentiation and specialization are still more evident in the avian heart, and in the mammalian heart the relatively small auriculoventricular conduction system furnishes the only morphologic connection between auricles and ventricles. Thus, functional differentiation may be assumed to have preceded anatomic alteration and reduction. A second communication between auricles and ventricles in man has been suggested as an atavistic, inherited anomaly occurring
Trends in Modifiable Risk Factors Are Associated With Declining Incidence of Hospitalized and Nonhospitalized Acute Coronary Heart Disease in a Population

Background— Few studies have used individual person data to study whether contemporary trends in the incidence of coronary heart disease are associated with changes in modifiable coronary risk factors. Methods and Results— We identified 29 582 healthy men and women ≥25 years of age who participated in 3 population surveys conducted between 1994 and 2008 in Tromsø, Norway. Age- and sex-adjusted incidence rates were calculated for coronary heart disease overall, out-of-hospital sudden death, and hospitalized ST-segment–elevation and non–ST-segment–elevation myocardial infarction. We measured coronary risk factors at each survey and estimated the relationship between changes in risk factors and changes in incidence trends. A total of 1845 participants had an incident acute coronary heart disease event during 375 064 person-years of follow-up from 1994 to 2010. The age- and sex-adjusted incidence of total coronary heart disease decreased by 3% (95% confidence interval, 2.0–4.0; P<0.001) each year. This decline was driven by decreases in out-of-hospital sudden death and hospitalized ST-segment–elevation myocardial infarction. Changes in coronary risk factors accounted for 66% (95% confidence interval, 48–97; P<0.001) of the decline in total coronary heart disease. Favorable changes in cholesterol contributed 32% to the decline, whereas blood pressure, smoking, and physical activity each contributed 14%, 13%, and 9%, respectively. Conclusions— We observed a substantial decline in the incidence of coronary heart disease that was driven by reductions in out-of-hospital sudden death and hospitalized ST-segment–elevation myocardial infarction. Changes in modifiable coronary risk factors accounted for 66% of the decline in coronary heart disease events.
Fluticasone propionate/formoterol fumarate improves asthma control and reduces exacerbations compared with fluticasone

Introduction: The combination of fluticasone (FLUT) and formoterol (FORM) in a single inhaler (FLUT/FORM; flutiform ®) is approved for the maintenance treatment of asthma. This analysis assessed the efficacy of FLUT/FORM versus FLUT in patients who had previously received ICS therapy. Methods: Data were pooled from 5 randomized studies in patients with asthma (aged ≥12 years) treated for 8 or 12 weeks with FLUT/FORM (100/10, 250/10 or 500/20 μg b.i.d.; N=528) or FLUT alone (100, 250 or 500 μg b.i.d.; N=527). Results: FLUT/FORM significantly ( p Conclusions: FLUT/FORM significantly improves lung function and asthma control measures, and is associated with a lower incidence of exacerbations compared with FLUT.
Tracking of 25-hydroxyvitamin D status during pregnancy: the importance of vitamin D supplementation.

BACKGROUND The role of maternal 25-hydroxyvitamin D [25(OH)D] in fetal development is uncertain, and findings of observational studies have been inconsistent. Most studies have assessed 25(OH)D only one time during pregnancy, but to our knowledge, the tracking of an individual's 25(OH)D during pregnancy has not been assessed previously. OBJECTIVE We determined the tracking of serum 25(OH)D from early to late pregnancy and factors that influence this. DESIGN The Southampton Women's Survey is a prospective mother-offspring birth-cohort study. Lifestyle, diet, and 25(OH)D status were assessed at 11 and 34 wk of gestation. A Fourier transformation was used to model the seasonal variation in 25(OH)D for early and late pregnancy separately, and the difference between the measured and seasonally modeled 25(OH)D was calculated to generate a season-corrected 25(OH)D. Tracking was assessed with the use of the Pearson correlation coefficient, and multivariate linear regression was used to determine factors associated with the change in season-corrected 25(OH)D. RESULTS A total of 1753 women had 25(OH)D measured in both early and late pregnancy. There was a moderate correlation between season-corrected 25(OH)D measurements at 11 and 34 wk of gestation (r = 0.53, P < 0.0001; n = 1753). Vitamin D supplementation was the strongest predictor of tracking; in comparison with women who never used supplements, the discontinuation of supplementation after 11 wk was associated with a reduction in season-corrected 25(OH)D (β = -7.3 nmol/L; P < 0.001), whereas the commencement (β = 12.6 nmol/L; P < 0.001) or continuation (β = 6.6 nmol/L; P < 0.001) of supplementation was associated with increases in season-corrected 25(OH)D. Higher pregnancy weight gain was associated with a reduction in season-corrected 25(OH)D (β = -0.4 nmol · L(-1) · kg(-1); P = 0.015), whereas greater physical activity (β = 0.4 nmol/L per h/wk; P = 0.011) was associated with increases. CONCLUSIONS There is a moderate tracking of 25(OH)D status through pregnancy; factors such as vitamin D supplementation, weight gain, and physical activity are associated with changes in season-corrected 25(OH)D from early to late gestation. These findings have implications for study designs and analyses and approaches to intervention studies and clinical care.
The Triple Test Markers Profile Among Fetuses and Children Diagnosed With Umbilical Vein Varix

Umbilical vein varix (UVV) is defined as a focal enlargement of the umbilical vein and represents approximately 4% of fetal umbilical cord malformations. The reported neonatal outcome of fetuses with UVV varies widely due to its rarity, hence the small sample sizes of the case series in the literature. Earlier studies reported high fetal mortality, but more recent reports have demonstrated no association between UVV and intrauterine fetal death. A recent study has described a possible association between UVV diagnosed prenatally and child developmental delay. The present study of fetuses with UVV was done to evaluate and compare the levels of triple test serum biomarkers used for Down syndrome screening (human chorionic gonadotropin, α-fetoprotein, and unconjugated estriol) between a group of fetuses with uneventful obstetric outcome versus a subgroup of children with developmental delay.
Five-Year Clinical and Angiographic Outcomes of a Randomized Comparison of Sirolimus-Eluting and Paclitaxel-Eluting Stents: Results of the Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization LATE Trial

Background— Long-term comparative data of first-generation drug-eluting stents are scarce. We investigated clinical and angiographic outcomes of sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) at 5 years as part of the Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization (SIRTAX) LATE study. Methods and Results— A total of 1012 patients were randomly assigned to SES or PES. Repeat angiography was completed in 444 of 1012 patients (43.8%) at 5 years. Major adverse cardiac events occurred in 19.7% of SES- and 21.4% of PES-treated patients (hazard ratio, 0.89; 95% confidence interval, 0.68 to 1.17; P=0.39) at 5 years. There were no differences between SES and PES in terms of cardiac death (5.8% versus 5.7%; P=0.35), myocardial infarction (6.6% versus 6.9%; P=0.51), and target lesion revascularization (13.1% versus 15.1%; P=0.29). Between 1 and 5 years, the annual rate of target lesion revascularization was 2.0% (95% confidence interval, 1.4% to 2.6%) for SES and 1.4% (95% confidence interval, 0.9% to 2.0%) for PES. Among patients undergoing paired angiography at 8 months and 5 years, delayed lumen loss amounted to 0.37±0.73 mm for SES and 0.29±0.59 mm for PES (P=0.32). The overall rate of definite stent thrombosis was 4.6% for SES and 4.1% for PES (P=0.74), and very late definite stent thrombosis occurred at an annual rate of 0.65% (95% confidence interval, 0.40% to 0.90%). Conclusions— Long-term follow-up of first-generation drug-eluting stents shows no significant differences in clinical and angiographic outcomes between SES and PES. The continuous increase in late lumen loss in conjunction with the ongoing risk of very late stent thrombosis suggests that vascular healing remains incomplete up to 5 years after implantation of first-generation drug-eluting stents. Clinical Trial Registration— http://www.clinicaltrials. gov. Unique identifier: NCT00297661.
A Need for True GSTM1 and GSTT1 Genotyping

To the Editor: I read with interest the recent publication by Reding et al. on “Genetic polymorphisms in the catechol estrogen metabolism pathway and breast cancer risk” (CEBP 2009; 18:1461–7), which examined polymorphisms in five genes including GSTM1 and GSTT1 and found no association with
Predictive factors of ICU bedsores using Braden scale

Background: Bed sore is a major problem for inpatients in the hospital. This study was aimed to determine the predictive factors of bedsore in Intensive Care Unit (ICU). Methods: A descriptive – analytical study was conducted on 673 Intensive Care Unit (ICU) inpatients of 6 selected hospitals in a period of 6 months in Guilan. The participants were selected via simple random sampling. Data were collected by the Braden Scale whose reliability and validity had breen confirmed in previous studies. Data were fed into SPSS software and analyzed using t-test, chi-square and Logistic regression. Results: The mean age of the subjects was 45.35±16.7. Incidence of bedsore was 3.6%. Dietary patterns, wear and tension were identified as predictors of bed sore after adjustment of odds ratio. Conclusion: We can properly manage the bed sore and its complications, in addition to predicting the parameters of the given model, through attention to proper nutrition, stretching the muscles and tissues of the patients in ICU. Retraining the personnel of the intensive care unit and training the patients are recommended.
Effects of physical exercise on human circadian rhythms

Bright light is the principal zeitgeber for the biological clock in mammals, including humans. But there is a line of evidence that non-photic stimuli such as physical activity play an important role in entrainment. Scheduled physical activity, such as wheel and forced treadmill running, has been reported to phase-shift and entrain the circadian rhythm in rodent species. In humans, several studies have reported the phase-shifting effects of physical exercise. A single bout of physical exercise at night was demonstrated to phase-delay the circadian rhythm in plasma melatonin. However, for the entrainment of human circadian rhythm, a phase-advance shift is needed. Previously, we demonstrated that scheduled physical exercise in the waking period facilitated the entrainment of plasma melatonin rhythm to the sleep/wake schedule of 23 h 40 min. This result suggested that timed physical exercise produced phase-advance shifts. A regular physical exercise also facilitated entrainment of the circadian rhythms associated with acute phase-delay shifts of the sleep/wake and light/dark schedule. These findings suggest that physical exercise is useful to adjust the circadian rhythm to external time cues, especially for totally blind people and elderly people.
Conocimientos, habilidades y características del acceso a internet en estudiantes de medicina de una Universidad Peruana

OBJECTIVES: To study the knowledge abilities and access characteristics to the Internet in undergraduate medical students from a Peruvian University. METHODS: Development and application of a questionnaire to medical students, report of the results and nested case-control analysis of data to identify variables related to the ability to surf the Internet. RESULTS: The students enter the Internet mainly from home. The most visited websites were those from web mail services and entertainment sites. The quality of the medical information available on the net was overrated, even though there was a poor knowledge of the online tools related to health, as well as a deficient ability with basic tools of navigation and e-mail. Being skillful on the Internet was significantly related to a long experience on the net, the presence of access to the Internet from home and the frequent use of e-mail and the WWW. CONCLUSIONS: The population studied does not have the ability and knowledge required to make the Internet a useful tool for its academic formation.
Effect of Biologic Treatments on Growth in Children with Juvenile Idiopathic Arthritis

Objective. Growth retardation is a frequent complication of severe juvenile idiopathic arthritis (JIA). Biologic treatments may improve growth velocity by controlling systemic inflammation and reducing corticosteroids. Our goals were to compare growth velocity before and after the onset of biologic therapy and to determine whether the JIA subtype, the use of steroids, the requirement of one or several biologic agents, or the disease activity influenced growth velocity. Methods. We retrospectively analyzed the growth of children with JIA who never received growth hormone treatment, who started biologic treatment before puberty, and who were followed for at least 6 months afterward. Results. We included 100 children (33 boys). Median patient age was 7.1 years (range: 1.6–15.7) at the onset of biologic treatment and 11.0 years (range: 2.3–19.5) at the latest followup. Forty-six patients had received corticosteroid and 34 had received more than 1 biologic agent. Patient median height expressed as SD score (SDS) was 0.31 (range: −2.47 to 5.46) at disease onset, −0.24 (−3.63 to 2.90) at biologic therapy onset (p < 0.0001), and −0.15 (−4.95 to 3.52) at the latest followup (p = 0.171 compared to biologic treatment onset). Patients who required several biologics and systemic patients had a significantly lower growth velocity after the onset of biologic treatment. At the latest followup, 18% of our study group had low growth velocities and 19% were below −2SD or shorter than genetically programmed. Conclusion. In a subset of patients, particularly systemic JIA patients and patients who required more than 1 biologic, biologic therapy may be insufficient to restore normal growth velocity.