Miracle-dz/UniFAR-FTUs huggingface dataset:
Optimizing in-hospital triage for large vessel occlusion using a novel clinical scale (GAI2AA)

Objective To identify a proximal anterior circulation occlusion for effectively administering immediate mechanical thrombectomy by developing a novel, simple diagnostic scale to predict the occlusion, to compare its validity with available scales, and to assess its utility. Methods To develop a novel clinical scale, we retrospectively analyzed a cohort of 429 patients with acute ischemic stroke from a single center. The novel scale GAI2AA was applied to a prospective cohort of 259 patients from 3 stroke centers for external validation. The utility of the scale as an in-hospital triage was compared for the temporal factors of 158 patients with the occlusion. Results In a scale-developmental phase, those with a proximal anterior circulation occlusion had significantly more frequent signs of hemispheric symptoms, including gaze palsy, aphasia, inattention, arm paresis, and atrial fibrillation. The GAI2AA scale was developed using consolidated hemispheric symptoms and was scored as follows: score = 2, arm paresis score = 1, and atrial fibrillation score = 1. A cutoff value ≥3 was optimal for the correlation between sensitivity (88%) and specificity (81%), with a C statistic of 0.90 (95% confidence interval 0.87–0.93). External validation indicated that discrimination was significantly better than or not different from that of available complex scales. Door-to-puncture time was significantly reduced (91 [82–111] vs 52 [32–75] minutes, p < 0.001). Conclusion The GAI2AA scale showed high sensitivity and specificity when an optimal cutoff score was used and was useful as an in-hospital triage tool.
Attitude towards Mental illness and Psychiatry among the Medical students and Interns in a University Medical College

Introduction: Medical students tend to have a neutral or negative attitude to Psychiatry as a discipline. This study was initiated to explore the attitude towards Mental illness and Psychiatry among the Medical students and Interns in Kathmandu University School of Medical Sciences (KUSMS). Method: A cross-sectional Questionnaire based study was conducted among the Medical students and Interns at Dhulikhel Hospital (Kathmandu University Hospital). Two self-rating scales; Attitudes towards psychiatry (ATP-30) and Attitudes to mental illness (AMI) were used to assess attitudes towards mental illness and Psychiatry among the total 159 subjects. Descriptive statistics and independent sample t-test applied using SPSS-16 for analysis. Results: Among the total 159 subjects, 56.6% were males and 27.7% were Interns. Comparison of means of each item in ATP-30 and AMI was done between Males and Females, Medical students and Interns, First semester and Ninth semester students. Most of the subjects showed neutral attitude towards all the scoring items; though there were a few significant differences in mean scores of some items in group wise comparison. Conclusions: Overall attitudes towards Mental illness and Psychiatry among the Medical students and Interns in our Medical School were positive or neutral. A further study with medical students from different institutions is needed to get a detail nationwide picture. Key words: Attitude, Interns, Medical Students, Mental illness, Psychiatry.
Comprehensive management of obstructive sleep apnea by telemedicine: Clinical improvement and cost-effectiveness of a Virtual Sleep Unit. A randomized controlled trial

Introduction Obstructive sleep apnea (OSA) is a prevalent disease associated with significant morbidity and high healthcare costs. Information and communication technology could offer cost-effective management options. Objectives To evaluate an out-of-hospital Virtual Sleep Unit (VSU) based on telemedicine to manage all patients with suspected OSA, including those with and without continuous positive airway pressure (CPAP) therapy. Methods This was an open randomized controlled trial. Patients with suspected OSA were randomized to hospital routine (HR) or VSU groups to compare the clinical improvement and cost-effectiveness in a non-inferiority analysis. Improvement was assessed by changes in the Quebec Sleep Questionnaire (QSQ), EuroQol (EQ-5D and EQ-VAS), and Epworth Sleepiness Scale (ESS). The follow-up was 3 months. Cost-effectiveness was assessed by a Bayesian analysis based on quality-adjusted life-years (QALYs). Results The HR group (n: 92; 78% OSA, 57% CPAP) compared with the VSU group (n: 94; 83% OSA, 43% CPAP) showed: CPAP compliance was similar in both groups, the QSQ social interactions domain improved significantly more in the HR group whereas the EQ-VAS improved more in the VSU group. Total and OSA-related costs were lower in the VSU group than the HR. The Bayesian cost-effectiveness analysis showed that VSU was cost-effective for a wide range of willingness to pay for QALYs. Conclusions The VSU offered a cost-effective means of improving QALYs than HR. However, the assessment of its clinical improvement was influenced by the choice of the questionnaire; hence, additional measurements of clinical improvement are needed. Our findings indicate that VSU could help with the management of many patients, irrespective of CPAP use.
Psoralen and narrowband UVB combination provides higher efficacy in treating vitiligo compared with narrowband UVB alone: A randomised clinical trial

Side effects of current treatments and the need for a safe treatment with higher efficiency necessitate seeking new treatment options for vitiligo. Few studies have investigated the combination of psoralen with narrowband ultraviolet B (NBUVB). In this study, we compared the efficacy and safety of psoralen and NBUVB combination (P‐NBUVB) with NBUVB alone in treatment of vitiligo.
Impacts of pseudo amino acid components and 5-steps rule to proteomics and proteome analysis.

Stimulated by the 5-steps rule during the last decade or so, the computational proteomics has achieved remarkable progresses in the following three areas: (1) protein structural class prediction; (2) protein subcellular location prediction; (3) post-translational modification (PTM) site prediction. The results obtained by these predictions are very useful not only for in-depth studying the functions of proteins and their biological processes in a cell, but also for developing novel drugs against major diseases such as cancers, Alzheimer's, and Parkinson's. Moreover, since the targets to be predicted may have the multi-label feature, two sets of metrics are introduced: one is for inspecting the global prediction quality, while the other for the local prediction quality. All the predictors covered in this review each have a user-friendly web-server, by which the majority of experimental scientists can easily get their desired data without the need to go through the complicated mathematics involved.
Mental fatigue after allogeneic hematopoietic stem cell transplantation is associated with cognitive dysfunction, but not central nervous system inflammation

For long-term survivors of allogeneic hematopoietic stem cell transplantation (aHSCT), persisting fatigue remains a significant problem 5 years after treatment. Fatigue is a subjective feeling of exhaustion with physical, mental and emotional manifestations, not relieved by rest. In addition to fatigue, a large proportion of cancer patients suffer from cognitive dysfunction (CD), affecting processing speed, memory and executive function which limit work capacity and everyday life. Elevated peripheral inflammatory cytokine levels correlate with fatigue after solid tumor treatment. Likewise, increased interleukin (IL)-6 and soluble tumor necrosis factor α have been reported in the peripheral blood of aHSCT survivors with fatigue. However, mechanistic studies as to the contribution of central nervous system (CNS) inflammation in the pathophysiology of fatigue remain largely absent. Current treatment for persistent fatigue and CD after cancer therapy is cognitive behavioral therapy, physical activity and education programs, aiming to reduce symptom burden. In order to detect patients that would benefit from such interventions, systematic measurement of fatigue and CD during follow-up after cancer therapy and aHSCT is necessary. The aim of this study was to correlate quantitatively assessed mental fatigue and CD to CNS inflammation. The impact of the symptoms was evaluated through measurement of quality of life and degree of employment. Importantly, we applied instruments that can be used without previous neuropsychological training. The study was conducted at Karolinska University Hospital (KUS), Huddinge, Sweden, with patients classified as 1) self-reported symptoms of mental fatigue and a men-
Cross-sectional survey of orthotic service provision in the UK: does where you live affect the service you receive?

Objective To investigate the quantity and quality of orthotic service provision within the UK. Design Cross-sectional survey obtained through freedom of information request in 2017. Setting National Health Service (NHS) Trusts/Health Boards (HBs) across the UK. Main outcome measures Descriptive statistics of survey results, including information related to finance, volume of appointments, patients and orthotic products, waiting times, staffing, complaints, outcome measures and key performance indicators. Results Responses were received from 61% (119/196) of contacted Trusts/HBs; 86% response rate from Scotland (12/14) and Wales (6/7), 60% (3/5) from Northern Ireland and 58% (98/170) from England. An inhouse service was provided by 32% (35/110) of responses and 68% (74/110) were funded by a block contract. Long waiting times for appointments and lead times for footwear/orthoses, and large variations in patient entitlements for orthotic products across Trusts/HBs were evident. Variations in the length of appointment times were also evident between regions of the UK and between contracted and inhouse services, with all appointment times relatively short. There was evidence of improvements in service provision; ability for direct general practitioner referral and orthotic services included within multidisciplinary clinics. However, this was not found in all Trusts/HBs. Conclusions The aim to provide a complete UK picture of orthotic service provision was hindered by the low response rate and limited information provided in some responses, with greater ability of Trusts/HBs to answer questions related to quantity of service than those that reflect quality. However, results highlight the large discrepancies in service provision between Trusts/HBs, the gaps in data capture and the need for the UK NHS to establish appropriate processes to record the quantity and quality of orthotic service provision. In addition to standardising appointment times across the NHS, guidelines on product entitlements for patients and their lead times should be prescribed to promote equity.
BitClust: Fast Geometrical Clustering of Long Molecular Dynamics Simulations

The growing computational capacity allows the investigation of large biomolecular systems by increasingly extensive molecular dynamics simulations. The resulting huge trajectories demand efficient partition methods to discern relevant structural dissimilarity. Clustering algorithms are available to address this task, but their implementations still need to be improved to gain in computational speed and to reduce the consumption of random access memory. We propose the BitClust code which, based on a combination of Python and C programming languages, performs fast structural clustering of long molecular trajectories. BitClust takes advantage of bitwise operations applied to a bit-encoded pairwise similarity matrix. Our approach allowed us to process a half-million frames trajectory in 6 hours using less than 35 GB, a task that is not affordable with any of the similar alternatives.
Antibiotic resistance patterns of Escherichia coli in migrants versus non-migrants: a study of 14,561 urine samples.

BACKGROUND To investigate differences in distribution of urine isolates and antibiotic resistance patterns in Escherichia coli (E. coli), the predominant uropathogen, in migrants and non-migrant individuals. METHODS We linked a cohort consisting of all migrants obtaining residence as refugees or family-reunited migrants in Denmark between January 1993 and December 2015 to hospital urine samples examined from January 2000 to December 2015 at the Department of Microbiology, University Hospital Hvidovre, Denmark. Samples from non-migrant individuals, Danish-born from Danish parents, were included as comparison. Analysis was carried out using multivariate logistic regression. RESULTS 14,561 first time urine samples were included, with E. coli being the most prevalent bacterial pathogen. Of the identified isolates 4,686/11,737 were E. coli among non-migrants and 1,032/2,824 among migrants.Sulfamethoxazol-Trimethoprim resistance was found in 34.3% (350/1020) of E. coli isolates among migrants and 23.2% (1070/4619) among non-migrant patients (Odds ratio (OR) 1.73, 95%CI: 1.47-2.03). Ciprofloxacin resistance was found in 5.8% (36/618) of isolates among migrants and 2.2% (67/3092) among non-migrants (OR 2.20, 95%CI:1.37-3.53). Gentamicin resistance was seen in 10.8% (61/565) and 4.7% (110/2328) of isolates (OR 2.33, 95%CI:1.63-3.34), Cefuroxime resistance in 8.5% (87/1019) and 3.4% (158/4618) (OR 2.40, 95%CI:1.77-3.24), Ampicillin resistance in 51.4% and 40.8% (OR 1.65, 95%CI: 1.42-1.92), and Piperacillin-Tazobactam resistance in 6.9 % (30/432) and 4.2% (65/1532) for migrant and non-migrant patients respectively. When stratifying according to migrant status, family-reunited had higher odds of resistance than refugees for Sulfamethoxazol-Trimethoprim, Gentamicin, and Ampicillin. CONCLUSIONS Prevalence of antibiotic resistance was significantly higher in E. coli isolates among migrants, both refugees and family reunited, than non-migrant patients. Differences could not be explained by comorbidity or income. The results emphasise the importance of urine sample testing in both local-born and migrants before antibiotic start-up and points to the benefit of considering migration to secure individual treatment and equal health outcomes.
The spectrum of involuntary vocalizations in humans: A video atlas

In clinical practice, involuntary vocalizing behaviors are typically associated with Tourette syndrome and other tic disorders. However, they may also be encountered throughout the entire tenor of neuropsychiatry, movement disorders, and neurodevelopmental syndromes. Importantly, involuntary vocalizing behaviors may often constitute a predominant clinical sign, and, therefore, their early recognition and appropriate classification are necessary to guide diagnosis and treatment. Clinical literature and video‐documented cases on the topic are surprisingly scarce. Here, we pooled data from 5 expert centers of movement disorders, with instructive video material to cover the entire range of involuntary vocalizations in humans. Medical literature was also reviewed to document the range of possible etiologies associated with the different types of vocalizing behaviors and to explore treatment options. We propose a phenomenological classification of involuntary vocalizations within different categorical domains, including (1) tics and tic‐like vocalizations, (2) vocalizations as part of stereotypies, (3) vocalizations as part of dystonia or chorea, (4) continuous vocalizing behaviors such as groaning or grunting, (5) pathological laughter and crying, (6) vocalizations resembling physiological reflexes, and (7) other vocalizations, for example, those associated with exaggerated startle responses, as part of epilepsy and sleep‐related phenomena. We provide comprehensive lists of their associated etiologies, including neurodevelopmental, neurodegenerative, neuroimmunological, and structural causes and clinical clues. We then expand on the pathophysiology of the different vocalizing behaviors and comment on available treatment options. Finally, we present an algorithmic approach that covers the wide range of involuntary vocalizations in humans, with the ultimate goal of improving diagnostic accuracy and guiding appropriate treatment. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
Proteasome activation by insulin‐like growth factor‐1/nuclear factor erythroid 2‐related factor 2 signaling promotes exercise‐induced neurogenesis

Physical exercise‐induced enhancement of learning and memory and alleviation of age‐related cognitive decline in humans have been widely acknowledged. However, the mechanistic relationship between exercise and cognitive improvement remains largely unknown. In this study, we found that exercise‐elicited cognitive benefits were accompanied by adaptive hippocampal proteasome activation. Voluntary wheel running increased hippocampal proteasome activity in adult and middle‐aged mice, contributing to an acceleration of neurogenesis that could be reversed by intrahippocampal injection of the proteasome inhibitor MG132. We further found that increased levels of insulin‐like growth factor‐1 (IGF‐1) in both serum and hippocampus may be essential for exercise‐induced proteasome activation. Our in vitro study demonstrated that IGF‐1 stimulated proteasome activity in cultured adult neural progenitor cells (NPCs) by promoting nuclear translocation of nuclear factor erythroid 2‐related factor 2 (Nrf2), followed by elevated expressions of proteasome subunits such as PSMB5. In contrast, pretreating adult mice with the selective IGF‐1R inhibitor picropodophyllin diminished exercise‐induced neurogenesis, concurrent with reduced Nrf2 nuclear translocation and proteasome activity. Likewise, lowering Nrf2 expression by RNA interference with bilateral intrahippocampal injections of recombinant adeno‐associated viral particles significantly suppressed exercise‐induced proteasome activation and attenuated cognitive function. Collectively, our work demonstrates that proteasome activation in hippocampus through IGF‐1/Nrf2 signaling is a key adaptive mechanism underlying exercise‐related neurogenesis, which may serve as a potential targetable pathway in neurodegeneration.
A Review of the Food and Drug Administration Adverse Event Reporting System for Tramadol-Related Hypoglycemia

Background: Hypoglycemia is a rare adverse effect of tramadol that is described in the medical literature and package insert. Objective: The purpose of this study was to review reports of tramadol and hypoglycemia in the Food and Drug Administration Adverse Event Reporting System (FAERS) database to determine a potential association. Methods: Disproportionality analysis with Bayesian correction was used to compare tramadol and hypoglycemia with other medications in FAERS. The results were considered significant if the fifth percentile of the Empirical Bayesian geometric mean distribution (EB05) >2. Logistic regression odds ratios was used to determine if age, diabetes medications, and renal insufficiency masked the disproportionality of hypoglycemia, with the fifth percentile of the logistic regression odds ratio (LR05) >2 indicating a potential signal. The Interaction Signal Score (INTSS) was computed to determine the influence of predisposing risk factors on the signal. Results: A total of 605 cases of tramadol-associated hypoglycemia were reported, but our results were not significant (EB05: 1.590). Tramadol-associated hypoglycemia was significant in patients who did not take diabetes medications (EB05: 2.256; LR05: 2.2104). Renal insufficiency was not found to increase the risk of tramadol-associated hypoglycemia (INTSS: 0.865). There was a significant signal for tramadol-associated hypoglycemia in patients aged 0 to 1 year (LR05: 3.0240) and 2 to 4 years (LR05: 2.6853). Conclusion and Relevance: Results of our analysis suggest a potential signal between hypoglycemia and tramadol use in patients not taking diabetes medications. Our results do not support a predisposition for tramadol-associated hypoglycemia in patients with renal insufficiency, increasing age, and/or diabetes as noted in the tramadol package insert.
Family needs at one and two years after severe traumatic brain injury: a prospective study of changes and predictors

ABSTRACT Objective: To assess changes in family needs between the first and second years after severe traumatic brain injury (sTBI) and to identify factors predicting unmet family needs. Design: Prospective Norwegian multicenter cohort study. Participants: The family members of 110 patients with sTBI were followed up at one year, and family members of 70 patients also at two years after trauma. Main measure: The Family Needs Questionnaire-Revised (FNQ-R). Results: Mean ratings of met family needs changed with a small decline between one year and two years post-injury on the FNQ-R subscales of Health Information and of Community Support Network. Proportions of needs met at one and two years ranged between 28% and 55%. Family needs most often met were from the Health Information subscale, and needs most often unmet were from the Emotional Support subscale. Caring for older patients, patients with more functional disabilities, female patients and being a spouse of a patient were associated with statistically significantly greater unmet family needs. Conclusion: Family members of survivors of traumatic brain injuries experience high levels of unmet needs, and rating of met needs tends to decline from one to two years post-injury. The identified predictors of unmet needs can contribute to guiding services following sTBI.
Relevance of sleep, pain cognition, and psychological distress with regard to pain in patients with burning mouth syndrome

ABSTRACT Objective: To clarify the influence of sleep, psychological distress, and pain catastrophizing on the pain experience in patients with burning mouth syndrome (BMS). Methods: Ninety-three patients with BMS were investigated by reviewing medical records and questionnaires using the Brief Pain Inventory (BPI), Pittsburgh Sleep Quality Index (PSQI), Symptom Checklist-90 revised (SCL-90R), and pain catastrophizing scale (PCS). Results: Of the 65 patients included in the study, 81.5% and 66% showed high PSQI and PCS scores, respectively. The PSQI, PCS, and SCL-90R scores correlated positively with pain interference. The result of multiple regression analysis demonstrated that helplessness and rumination of PCS significantly add to the prediction of pain interference. Discussion: Pain catastrophizing rather than psychological distress and sleep quality seems to be associated with pain experience in patients with BMS. Therefore, targeting pain catastrophizing, specifically rumination and helplessness, might lead to reduction of pain-related disability in BMS patients.