Miracle-dz/UniFAR-FTUs huggingface dataset:
The factors affecting end-of-life decision-making by physicians of patients with intellectual disabilities in the Netherlands: a qualitative study.

BACKGROUND The aim of this study was to investigate the process of end-of-life decision-making regarding people with intellectual disabilities (ID) in the Netherlands, from the perspective of physicians. METHODS This qualitative study involved nine semi-structured interviews with ID physicians in the Netherlands after the deaths of patients with ID that involved end-of-life decisions. The interviews were transcribed verbatim and analysed using Grounded Theory procedures. RESULTS Four main contributory factors to the physicians decision-making process were identified, three of which are related to the importance of relatives' wishes and opinions: (1) Involving relatives in decision-making. As they had assessed their patients as lacking capacity, the physicians gave very great weight to the opinions and wishes of the relatives and tended to follow these wishes. (2) Delegating quality of life assessments to relatives. Physicians justified their end-of-life decisions based on their medical assessment, but left the assessment of the patients' quality of life to relatives, despite having their own implicit opinion about quality of life. (3) Good working relationships. Physicians sought consensus with relatives and paid care staff, often giving greater weight to the importance of good working relationships than to their own assessment of the patient's best interest. (4) Knowledge of the patient's vulnerabilities. Physicians used their intimate, long-standing knowledge of the patient's fragile health. CONCLUSIONS In order to take a more balanced decision, physicians should seek possibilities to involve patients with ID themselves and other stakeholders which are important for the patients. Physicians who have known the patient over time should rely more on their own knowledge of the patient's needs and preferences, seek the input of others, and openly take the lead in the decision-making process.
Disclosure of belief-dependent preferences in the trust game

We adopt a psychological games perspective to analyze behavior and beliefs in a Trust Game experiment. Subjects are randomly assigned to the role of "truster", A player, and "trustee", B player. Assuming that B subjects may be affected by guilt aversion and reciprocity, we try to elicit their belief dependent motivations with a set of hypothetical questions. We design the experiment so that subjects have no incentives to manipulate and we check that answers are reliable. We have two main treatments. In the No-Transmission (control) treatment, B's (belief dependent) preferences cannot be common knowledge, hence the game has incomplete information. In the Transmission treatment, B's answers to the hypothetical questions are transmitted and made common knowledge between the two matched subjects. In so far as such answers reveal the "psychological type" of B, this treatment approximates a psychological game with complete information. In this case, assuming that players coordinate their expectations on the efficient equilibrium, we should observe trust/cooperation when the revealed type of B is guilt averse (or reciprocal) and no-trust/defection when he is selfish. We also provide qualitative predictions for the incomplete information case, based on a simplified Bayesian psychological game. The main insight is that average behavior is intermediate. We analyze the set of answers of each B subject with a grid estimation algorithm. Most B subjects are not selfish and we observe a dominance of guilt aversion over reciprocity. Coherently with our theoretical insights, our experimental results show that in the Transmission treatment inducing a psychological game with (approximately) complete information behavior is more extreme: in the subpopulation of matched pairs where B is highly guilt averse there is more trust and cooperation than in the corresponding incomplete information setting without transmission; whereas in the subpopulation of matched pairs where B has low guilt aversion there is less trust and cooperation than in the corresponding incomplete information setting. In both information settings, we find that the B subjects' cooperation rate is positively related to guilt aversion.
Analysis of the Proliferative T Cell Response to Human Cytomegalovirus Major Immediate‐Early Protein (IEl): Phenotype, Frequeney and Variability *

Cellular immune responses are important in the recovery from human cytomegalovirus (HCMV) infection. However, little is known about the CD4+ T cell response and the target antigens (Ag) recognized. In this paper, we have analysed the proliferative T cell response of healthy HCMV seropositive (HCMV+) blood donors to recombinant immediate‐early proteins expressed in trans‐fected astrocytoma cells and to total HCMV Ags expressed in infected astrocytoma cells. We found that CD4+ T cells were the major cell population that proliferated in the presence of IE or total HCMV Ags. Among healthy HCMV seropositive blood donors with anti‐HCMV specific proliferative response, 33–44% also responded to IE Ags. Moreover, in high responders, the precursor frequencies of cells which proliferated in the presence of total HCMV, IE, or IEl Ags were high (1/103 to 1/255, 1/2785 to 1/7744 and 1/5190 to 1/13531, respectively). In some donors, the anti‐IE response was variable over time, whereas the anti‐total HCMV Ags response remained constant, which suggests regulation of the anti‐IE response in immunocompetent subjects. Our results suggest that the CD4+ anti‐IEl response represents a significant part of the anti‐HCMV proliferative response, both at the population level, and within individual immune systems.
Geographical Distribution of the Herpes Simplex Virus Type 1 BgKL Variant in Japan Suggests Gradual Dispersion of the Virus from Shikoku Island to the Other Islands

ABSTRACT Restriction endonuclease fragment length polymorphism (RFLP) is useful for the epidemiological study of herpes simplex virus type 1 (HSV-1). We report here the identification of a major BglII RFLP variant of HSV-1, designated BgKL, found in 27.0% of 636 HSV-1 clinical isolates. We have also established its geographic distribution in Japan. BgKL has an unusually large BglII K fragment. SalI cleavage analyses showed that 97% of BgKL variant isolates lack both the SalI C-J and the F-J cleavage sites and have an unusually large SalI D or E fragment, and 91% of the BgKL variants lack both SalI G and H fragments. Furthermore, 96% of BgKL isolates have an unusually small KpnI M fragment. Therefore, BgKL is a marker for these five mutations in most HSV-1 isolates and is a useful HSV-1 RFLP marker. The BgKL variant was found in 59% of HSV-1 isolates from Shikoku Island, 44% of HSV-1 isolates from the Chugoku region of Honshu Island, 31% of HSV-1 isolates from Kyushu Island, 0% of HSV-1 isolates from Okinawa Island, 49% of HSV-1 isolates from Osaka, 27% of HSV-1 isolates from Shiga, 13% of HSV-1 isolates from the Chubu Region, and 9% of HSV-1 isolates from the Tohoku Region of Honshu Island. Differences in the frequency of BgKL between the Shikoku-Chugoku-Osaka area (49%) and Kyushu, between Kyushu and Okinawa, between the Shikoku-Chugoku-Osaka area and Shiga, and between Shiga and Tohoku are all statistically significant. The BgKL frequency decreases in a geographical gradient suggest that this HSV-1 variant was dispersed from Shikoku to the surrounding regions and then to more distant regions. The BgKL frequency in Tokyo was similar to the nationwide average. These are the first data to suggest a geographic and demographic dispersion pattern of HSV-1. Implications for the epidemiology and diversification of HSV-1 are discussed.
Epigallocatechin gallate protects U937 cells against nitric oxide‐induced cell cycle arrest and apoptosis

Ingesting phenolic phytochemicals in many plant products may promote health, but the effects of phenolic phytochemicals at the cellular level have not been fully examined. Thus, it was determined if the tea phenolic phytochemical, epigallocatechin gallate (EGCG), protects U937 human pro‐monocytic cells against the nitrogen free radical, nitric oxide (•NO). Cells were incubated for 4–6 h with 500 μM S‐nitrosoglutathione (GSNO), which generates •NO, but this did not induce single‐strand breaks in DNA. Nevertheless, 82 ± 4% of GSNO‐treated cells, compared to only 39 ± 1% of untreated cells, were arrested in the G1‐phase of the cell cycle. However, dosing the GSNO‐treated cells with 9, 14, or 18 μg/ml of EGCG resulted in only 74 ± 8%, 66 ± 1%, and 43 ± 3% of the cells, respectively, in the G1‐phase. Exposing cells to GSNO also resulted in the emergence of a sub‐G1 apoptotic cell population numbering 14 ± 3%, but only 5 ± 2%, 5 ± 1%, and 2 ± 0% upon dosing of the GSNO‐treated cells with 9, 14, and 18 μg/ml of EGCG, respectively. Furthermore, exposing cells to GSNO resulted in greater cell surface binding of annexin V‐FITC, but binding was 41–89% lower in GSNO‐treated cells dosed with EGCG. Collectively, these data suggest that •NO or downstream products induced cell cycle arrest and apoptosis that was not due to single‐strand breaks in DNA, and that EGCG scavenged cytotoxic •NO or downstream products, thus reducing the number of cells in a state of cell cycle arrest or apoptosis. J. Cell. Biochem. 81: 647–658, 2001. © 2001 Wiley‐Liss, Inc.
Blood Culture and Bacteremia Predictors in Infants Less Than Three Months of Age With Fever Without Source

Objectives: (1) To assess the rate of bacteremia in febrile infants less than 3 months of age admitted to a pediatric emergency department at a tertiary hospital; (2) to describe the bacteria isolated; and (3) to analyze factors related to increased probability of having a positive blood culture. Methods: A retrospective, cross-sectional, 5-year descriptive study that includes all infants less than 3 months of age who presented with fever without source (FWS) and had a blood culture performed. Results: A blood culture was performed in 1018 (91.5%) of 1125 infants admitted, and a bacterial pathogen was grown in 23 (2.2%) of these; 8 were associated with a positive urine culture. The most frequently isolated pathogen was Escherichia coli (9), followed by Streptococcus pneumoniae (4). The risk factors detected by multivariate analysis were: (a) being classified as “not well-appearing” (12.5% vs. 1.8%; odds ratio: 8.37) and (b) leukocyturia and/or nitrituria in a urine dipstick test (5.6% vs. 1.6%; odds ratio: 3.73). C-reactive protein value was higher than white blood cell count and absolute neutrophil count in detecting bacteremia; a 70 g/L cut-off had a specificity of 93.8%, but sensitivity of only 69.6%. Conclusions: A positive blood culture rate of 2.2% was found in infants less than 3 months of age with FWS. C-reactive protein, white blood cell count, and absolute neutrophil count were not good bacteremia predictors. We recommend obtaining a blood culture in infants less than 3 months of age with FWS, particularly those patients considered “not well-appearing” and those with leukocyturia and/or nitrituria.
Complete genome sequence of a KI polyomavirus isolated from an otherwise healthy child with severe lower respiratory tract infection

Unbiased, deep sequencing of a nasal specimen from an otherwise healthy 13‐month‐old boy hospitalized in intensive care revealed high gene expression and the complete genome of a novel isolate of KI polyomavirus (KIPyV). Further investigation detected minimal gene expression of additional viruses, suggesting that KIPyV was potentially the causal agent. Analysis of the complete genome of isolate NMKI001 revealed it is different from all previously reported genomes and contains two amino acid differences as compared to the closest virus isolate, Stockholm 380 (EF127908). J. Med. Virol. 89:926–930, 2017. © 2016 Wiley Periodicals, Inc.
Aberrant methylation of the Ras-related associated with diabetes gene in human primary esophageal cancer.

BACKGROUND/AIM Ras-related associated with diabetes (RRAD), a member of the Ras-related GTPase superfamily, is frequently methylated in several human cancers, though its methylation profile remains unclear in esophageal cancer. MATERIALS AND METHODS We examined RRAD promoter hypermethylation using real-time quantitative methylation-specific PCR in 229 primary human esophageal tissues of contrasting histological types. RESULTS RRAD hypermethylation showed highly discriminative receiver-operator characteristic curve profiles, clearly distinguishing esophageal squamous cell carcinoma (ESCC) from esophageal adenocarcinoma (EAC) or normal esophagus (NE) (p<0.01 and p<0.01, respectively). RRAD normalized methylation values were significantly higher in ESCC (0.0242) than in NE (0.0057, p<0.05) or EAC (0.0139, p<0.01). RRAD hypermethylation frequency was also significantly higher in ESCC (23.1%) than in NE (0%, p<0.05) or EAC (5.4%, p<0.05). CONCLUSION Promoter hypermethylation of RRAD is a frequent, tissue-specific event in ESCC, and is uncommon in EAC. The aberrant methylation of RRAD may be involved in the pathogenesis of a subset of ESCC, but not in EAC.
The Characteristics of Medial Septal Neurons Antidromically Identified as Projecting to the Median Eminence and their Response to Gonadal Steroids

We have obtained extracellular single unit recordings from 129 neurons in the medial septum of the male rat that projected to the median eminence. These cells were identified on the basis of their antidromic responses to electrical stimulation in the median eminence. The antidromically‐evoked spike was always followed by a period of inhibition (−100 ms) which often (80%) persisted at stimulus intensities below threshold for antidromic activation. The identified neurons displayed one of three patterns of activity, the relative proportions of which were dependent upon the anesthetic. In rats anesthetized with urethane, 15% of the antidromically identified septal neurons displayed an oscillating, 25% a continuous, and 61% a low irregular pattern of spontaneous activity or no activity. In contrast, in barbiturate‐anesthetized animals only 6% exhibited an oscillating and 3% a continuous pattern of activity. The remaining neurons (91%) displayed either a low firing rate or were silent. We then assessed the responses of these identified neurons to systemic administration of gonadal steroids. Systemic administration of 17β‐estradiol elicited a rapid decrease in the firing rate of 9 of 29 neurons tested. The inhibitory response was specific to those cells displaying an oscillating (6/9) or continuous (3/6) firing pattern of which 60% were inhibited. In contrast, systemic administration of testosterone failed to elicit such changes in the activity of the identified septal neurons (n = 12) including one neuron which was subsequently shown to be inhibited by estradiol. As such identified septal neurons may contain gonadotropin‐releasing hormone, these results suggest a role for estradiol but not testosterone in the short‐term regulation of the secretion of this releasing hormone in the male rat.
Analyse du fonctionnement des performances des associations blé dur-pois d'hiver et blé dur-féverole d'hiver pour la conception d'itinéraires techniques adaptés à différents objectifs de production en systèmes bas-intrants

Les associations d'especes sont definies comme la culture simultanee d'au moins deux especes sur la meme parcelle pendant une periode significative de leur croissance. Ce systeme permettrait d'ameliorer l'utilisation des ressources du milieu (eau, azote, lumiere…) et ainsi d'augmenter le rendement et la qualite des grains par rapport aux cultures monospecifiques. L'objectif de notre travail etait d'analyser le fonctionnement et d'evaluer la performance des associations ble dur - pois d'hiver et ble dur - feverole d'hiver pour aider a la conception d'itineraires techniques adaptes a differents objectifs de production. Pour cela nous avons teste, au cours de trois annees d'experimentations, differentes combinaisons de varietes de ble dur, disponibilites en azote, structures de couverts et densites de plantes. Nos resultats ont confirme l'interet de ces systemes pour ameliorer le rendement et la teneur en proteines du ble dur comparativement aux cultures monospecifiques mais egalement pour la reduction des ravageurs, maladies et de l'enherbement dans certaines conditions. Ces systemes sont ainsi particulierement bien adaptes aux situations a faible disponibilite en azote en raison de la complementarite entre cereale et legumineuse pour l'utilisation de l'azote (mineral du sol et fixation symbiotique) mais aussi pour la captation de l'energie lumineuse. In fine, ce travail a permis de proposer des prototypes d'itineraires techniques d'associations adaptes a differents objectifs de production, grâce notamment a l'analyse dynamique des competitions et complementarites entre especes au sein du couvert et en particulier de l'elaboration du rendement du ble dur en association.
Effects of alcohol on brain‐derived neurotrophic factor mRNA expression in discrete regions of the rat hippocampus and hypothalamus

Chronic alcohol consumption has adverse effects on the central nervous system, affecting some hippocampal and hypothalamic functions. In this study we tempted to demonstrate that some of these modifications could involve impairment of neurotrophic factors. Three experimental groups of male Sprague Dawley rats were studied: one control group, one chronically treated with alcohol vapor according to a well‐established model that induces behavioral dependence, and a third group treated similarly but killed 12 hr after alcohol withdrawal. In all groups, changes in brain‐derived neurotrophic factor mRNA expression occurring in the hippocampus and supraoptic nucleus were first analyzed by reverse transcription‐polymerase chain reaction and then by in situ hybridization. In parallel, we used ribonuclease protection assay to measure mRNA levels encoding trkB in the two central nervous system regions. We showed that chronic alcohol intoxication decreases brain‐derived neurotrophic factor mRNA expression in discrete regions of the rat hippocampus (CA1 region and dentate gyrus) and in the supraoptic nucleus of the hypothalamus. We also showed a global up‐regulation of trkB mRNA expression encoding the high‐affinity brain‐derived neurotrophic factor receptor (TrkB), after applying the same treatment. Following 12 hr of alcohol withdrawal, a significant increase in BDNF mRNA expression was observed in the dentate gyrus and CA3 region of hippocampus and in the hypothalamic supraoptic nucleus. These findings suggest that chronic alcohol intake may modify hippocampal and hypothalamic neuronal functions through modifications in growth factors and its receptors. J. Neurosci. Res. 63:200–208, 2001. © 2001 Wiley‐Liss, Inc.
Hyperuricemia, gout and the metabolic syndrome

Purpose of reviewThe metabolic syndrome is defined by the clustering of a number of cardiovascular risk factors and entails an increased risk for cardiovascular disease and mortality from both cardiovascular disease and all causes. In the present paper, we review the most recent evidence on the association between hyperuricemia, metabolic syndrome, and cardiovascular disease. Recent findingsSerum urate is frequently elevated in patients with the metabolic syndrome and increases with the number of components of this condition. Hyperuricemia has been related to decreased renal uric acid excretion, which may be mediated by enhanced proximal tubular sodium reabsorption and hyperinsulinemia. Recent epidemiologic studies have shed some light on the prognosis of hyperuricemia. While hyperuricemia appears to show a benign significance in low cardiovascular risk individuals, it clearly increases cardiovascular mortality in patients at high cardiovascular disease risk. SummaryClinicians should be aware of the presence of metabolic syndrome in patients with hyperuricemia or gout in order to control its components (high blood pressure, obesity, etc.) and hence reduce the risk for cardiovascular disease. Long-term, randomized interventional clinical trials are needed to test the hypothesis that urate-lowering therapy can reduce cardiovascular risk in these patients.
A retrospective study of 192 horses affected with septic arthritis/tenosynovitis.

The medical records of 192 horses with septic arthritis/tenosynovitis 1979-1989 were reviewed. Forty-three horses developed infection after an intra-articular injection, 46 following a penetrating wound, 25 following surgery, 66 were foals less than 6 months old, and 12 were adult horses without a known aetiology. Haematogenous infection of a joint occurs in adult horses and should be considered as a differential diagnosis in horses with an acute onset of severe lameness. The aetiology of the infection had a significant effect on the type of bacteria identified by culture. Staphylococcus was cultured from most of the horses that developed infection following a joint injection or surgery, 69% of the horses from which an organism was identified. Horses that developed infection secondary to a penetrating wound frequently provided cultures of more than one organism; Enterobacteriaceae and anaerobes were more frequently isolated in this group. The most common organisms isolated from foals were Enterobacteriaceae; E. coli was identified in more than 27% of the foals. The hock was the most frequently involved joint. Multiple treatments were used over the 10-year period of study. Survival rates were lowest in foals; only 45% survived to be released from the hospital. Survival was greater in adult horses; 85% of the horses that were treated were released from the hospital. Survival was significantly greater in horses with septic tenosynovitis; all 14 of the horses that were treated survived. Survival was not significantly affected by the joint involved or by the type of bacteria cultured from the synovial fluid. (ABSTRACT TRUNCATED AT 250 WORDS)
Comparing Dexmedetomidine Prescribing Patterns and Safety in the Naturalistic Setting Versus Published Data

BACKGROUND: In clinical practice, new drugs may be used differently than the product labeling recommends. Furthermore, it often takes several years of use before adverse drug reactions (ADRs) are reported. OBJECTIVE: To compare prescribing patterns and safety of the newly released drug dexmedetomidine as observed in clinical practice with published data on the drug. METHODS: Information from a convenience sample of adults receiving dexmedetomidine as part of routine patient care at 10 institutions was retrospectively collected from June 27, 2001, to May 31, 2002. Investigators reviewed medical records daily and entered dosing information, patient demographics, and predefined categories of ADR severity and probability anonymously via the Internet on a secure server. RESULTS: Only 33% of the total sample (n = 136) of patients received a loading infusion of dexmedetomidine; however, maintenance dosing was usually within product labeling guidelines. Of note, 27.2% of patients received dexmedetomidine above the maximum dose and 33.8% received the drug beyond 24 hours. Some patients (15.4%) were never mechanically ventilated, while 59.5% received dexmedetomidine following extubation for an average of 11.3 hours. ADRs were reported in 30% of patients: 20% of the reactions required treatment or increased length of stay. Hypotension was the most common ADR, occurring in 22.7% of patients. Bradycardia was reported in 4.4% of patients. The rate and type of ADRs were similar in patients receiving dexmedetomidine >24 hours compared with the total population. CONCLUSIONS: Dexmedetomidine is prescribed within product labeling guidelines except for low use of a loading dose, some patients received the drug at doses above the maximum, and others received it for longer than 24 hours. Since ADR rates are similar to those of other published reports, dexmedetomidine maintained its expected safety profile in our patients.