Miracle-dz/UniFAR-FTUs huggingface dataset:
Subclasses of Breast Carcinoma and Their Clinical Significance

Human breast cancer represents a heterogeneous group of tumors with a diverse biologic behavior, prognosis, and response to therapy. Traditionally, histologic subtypes recognized by the morphology, histologic grade, stage, nodal metastasis, and expression of hormone receptors provide us information regarding the biology of disease, prognosis, and response to the treatment to certain extent. Recent cDNA microarray profiling studies on breast tumors have identified distinct subtypes of breast carcinomas that are associated with different clinical outcomes. On the basis of the expression pattern of 534 genes of 115 tumors, a group of investigators from Norway and United States have shown that breast carcinoma can be divided into 5 subtypes: basal-like, ERBB2-overexpressing, 2 luminal-like (luminal A and B), and 1 normal breast tissue-like groups. These results strongly support the notion that different tumor subtypes originate from different cell types, ie, luminal epithelial cells and basal myoepithelial cells. Furthermore, luminal and basal subtypes seem to be distinct biologic entities and have significant different biologic behavior. Breast cancer treatment has evolved around the expression of hormone receptors and Her2/neu oncogene in the last decade. Therapy may not be effective if the tumor express neither of these targets (triple negative tumors; ER, PR, and Her2/neu all negative). The characterization of these subtypes will lead to more focused investigation on putative therapeutic targets and treatment regimen. Incorporation of these findings into diagnostic pathology and treatment decision has become paramount in the management of breast cancer. Using tissue microarrays and immunohistochemistry, Matos et al have studied the expression of ER, Her2/ neu, P-cadherin, p63, cytokeratin 5, and Ki-67 of 168 invasive breast carcinomas. On the basis of the expression of ER and Her2, these cancers can be classified into 4 subtypes: basal-type expressed neither ER nor Her2 and represented 7.6% of their series; Basal-like (ER ) Her2-expressing tumor represented 17.7%; Luminal A (ER+/Her2 ) represent 56.3% and luminal B (ER+/Her2+) represented 16.5%. Furthermore, they have shown that most of the basal types are predominantly high grades, frequently positive for P-cadherin, p63, and CK5, and had a higher proliferation rate. Conversely, luminal type was often low grade, and have low proliferation rate. Therefore, basal cell markers, such as P-cadherin, p63, and CK5 can be used to distinguish a basal subtype from other subtypes of breast carcinoma.
Epidemiology, clinical features, and laboratory detection of Mycoplasma pneumoniae infection in East Azerbaijan, Iran

Results: M. pneumoniae infection was detected in 9 (6.15%), 8 (5.3%), and 3 (2.01%) of patients by PCR, ELISA, and culture methods, respectively. M. pneumoniae infection was mostly prevalent in patients 21–80 years old. Most infections (92%) were communityacquired and coughs, fever, dyspnea, and malaise were among the most common symptoms. Conclusion: Pneumonia due to the M. pneumoniae infection is infrequent in Tabriz and the clinical symptoms of the patients were determined to be mild. The PCR method also proved to be more sensitive and reliable than ELISA and culture assays in the detection of M. pneumoniae.
Humanização da assistência de fisioterapia: estudo com pacientes no período pós-internação em unidade de terapia intensiva

OBJETIVOS: As unidades de terapia intensiva surgiram a partir da necessidade de aperfeicoamento e concentracao de recursos materiais e humanos para o atendimento a pacientes graves, e da necessidade de observacao constante e assistencia continua. Entretanto, o paciente internado na unidade de terapia intensiva necessita de cuidados de excelencia, dirigidos nao apenas aos problemas fisiopatologicos, mas tambem para as questoes psicossociais, que se tornam intimamente interligadas a doenca fisica. Neste local tao exigente quanto a competencia da equipe multiprofissional, a presenca do fisioterapeuta tem sido cada vez mais frequente. Este estudo teve por objetivo constatar se a conduta profissional do fisioterapeuta experimentada na unidade de terapia intensiva e humanizada. METODO: Foi elaborado um questionario para avaliacao da humanizacao da assistencia de fisioterapia e incluidos pacientes maiores de 18 anos, lucidos e que estiveram internados em unidade de terapia intensiva por periodo igual ou superior a 24 horas. RESULTADOS: Foram entrevistados 44 pacientes e 95.5% destes avaliaram a assistencia de fisioterapia como humanizada. Observou-se associacao positiva entre insatisfacao com os itens dignidade, comunicacao, garantia e empatia, e uma assistencia de fisioterapia desumanizada. Pacientes que avaliaram a garantia como negativa apresentaram uma chance 2.0 (0.7 - 5.3) vezes maior de perceberem a assistencia como desumanizada. Pacientes que avaliaram a empatia como negativa apresentaram uma chance 1,6 (0,8 - 3,4) vezes maior de perceberem essa assistencia como desumanizada. CONCLUSOES: A assistencia de fisioterapia prestada na unidade de terapia intensiva foi marcada pelo bom atendimento, pela atencao dada ao paciente e pelo tratamento de qualidade, caracterizando uma assistencia humanizada.
PHARMACISTS’ PERCEPTION OF THEIR ROLE AND ASSESSMENT OF CLINICAL PHARMACY EDUCATION TO IMPROVE CLINICAL PHARMACY SERVICES IN INDONESIAN HOSPITALS

Objectives: To identify the pharmacists’ perception on their role, barriers to implement clinical pharmacy services (CPSs), and importance of clinical pharmacy education (CPE) to improve CPSs in Indonesian hospitals. Methods: A predetermined questionnaire was distributed to pharmacists (n=49) in Haji Adam Malik, Pirngadi, Haji, and Columbia Hospitals and staffs of Faculty of Pharmacy, University of Sumatera Utara, Indonesia for the two-month period in 2012. The participants were asked to choose answering yes or no for the importance of CPSs, poor to excellent for the current CPSs, not agree to strongly agree for the usefulness and target of CPE, way and whom to deliver it, rank priority-based topic of CPE, and choose the appropriate size, frequency, and duration of the CPE. The participants’ responses were analyzed using Statistical Package for the Social Sciences (SPSS, version 19, Chicago, IL, USA). Results: Mean age of the participants was 48.38 ± 10.66 (years) with working experience of 17.50±9.06 (years). Most of them (82%) were female. The majority of them (79.2%) graduated pharmacy degree. Pharmacists (44.9%) argued that their understanding on clinical pharmacy (CP) was still fair. Nearly half of the participants (44.9%) revealed that CPSs in these hospitals were poor. Most of them declared that CPE was important to improve their knowledge and healthcare. Conclusions: This study confirms that knowledge of pharmacists on CP as well as CPSs in Indonesian hospitals still need improvement through CPE to optimize health services.
High-Resolution Magnetic Recording Structures

Design concepts are established for several high-resolution magnetic recording structures, and their application demonstrated. The conventional ring head is treated and two new devices are described. A probe-type unit is discussed which shows promise in high-density vertical magnetic recording. A wire-grid array is also advanced to outline a unique conceptual approach to the achievement of higher resolution.
Mental Health Services for Older Adults in Rural Areas: An Ecological Systems Approach

Groups of North Dakota professionals from health and aging services participated in a focus group study of mental health needs and barriers to service among older adults. Data were collected from 13 focus groups that included human service providers, public health nurses, out-reach workers, and advisory groups who discuss mental health and aging issues in a number of ecological systems contexts. Lack of knowledgeable care providers, funding cutbacks, accessibility of services, and ageism were frequently cited barriers to mental health services for older adults in rural areas. Focus groups also discussed the needs of older adults including information on services, how to access services, the need for service providers in rural areas, and routine assessments by physicians. Participants suggested that the main needs of providers were education, more services, and changes or flexibility in the types of services.
Impairment of cardiac autonomic control in patients with amyotrophic lateral sclerosis

Abstract The aim of this study was to investigate autonomic cardiac control in patients with amyotrophic lateral sclerosis (ALS). Fifty-five patients with sporadic ALS (28 female and 27 male; average age 56.00 ± 10.34 years) were compared to 30 healthy controls (17 female and 13 male; average age 42.87 ± 11.91 years). Patients with previous history of cardiac disease, diabetes mellitus, and impaired respiratory function were excluded from the study. Cardiovascular autonomic tests according to Ewing, power spectrum analysis of RR variability (low- and high-frequency bands – LF and HF, LF/HF index), real-time beat-to-beat ECG signal monitoring with heart rate variability analysis and baroreflex function analysis were carried out in all patients. Time-domain parameters of heart rate variability (mean RR interval, SDNN, SDANN, SDNN index, rMSSD and pNN50%) were obtained from 24-h ECG monitoring. ALS patients had a significantly higher score of sympathetic (p <0.01) and parasympathetic (p <0.001) dysfunction, as well as of the overall score of autonomic dysfunction (p <0.001). LF/HF index was significantly increased; baroreflex sensitivity and time-domain parameters of heart rate variability were highly significantly decreased in ALS patients (p <0.001). Our results demonstrated impaired cardiac autonomic control in ALS with marked parasympathetic dysfunction and sympathetic predominance.
The Effect of Age on Maintenance of Functional Gains Following Stroke Rehabilitation

In order to study the effect of age on the stability of functional improvement following stroke rehabilitation, seventy-one randomly selected patients with ischemic stroke without functionally limiting co-morbid medical problems were folloived for two years. Patients were divided into two groups: age ≤ 69 (n = 32, X = 60 ± 6.5 years) and age ≥ 70 (N = 39, X = 77 ± 6 years). Barthel Index (BI) scores were generated for patients on admission and discharge from the inpatient rehabilitation unit and at six, twelve, and twenty-four months thereafter. Intercurrent medical and neurologic illnesses and changes in discharge placement were recorded. There was no difference in sex ratio, interval since stroke, hemisphere involved, or mean rehabilitation hospital admission and discharge BI scores for the younger vs. older patient groups. Life Table Analysis showed no significant difference in BI scores for the two groups over the twenty-four-month follow-up interval. This was true for both groups as a whole and for subgroups matched for extent of neurologic impairment. The frequency of new or progressive disease affecting function was the same for younger (16/32) as for older (20/39) patient groups. Death and skilled nursing facility (SNF) placement during the follow-up interval were more frequent for older vs. younger patients. These data indicate that in the absence of functionally limiting co-morbid medical problems, age is related to death and SNF placement but has no clinically significant effect on maintenance of rehabilitation gains following ischemic stroke.
Interdisciplinary Team Care for Diabetic Patients by Primary Care Physicians, Advanced Practice Nurses, and Clinical Pharmacists

IN BRIEF Most diabetic patients are managed by primary care physicians, but clinical inertia and limited time with patients hamper efforts to meet treatment goals. Successfully caring for the medical and psychosocial needs of the expanding diabetic population seen in primary care will require new strategies. This article reviews interdisciplinary efforts by primary care physicians, advanced practice nurses, and clinical pharmacists that can achieve improvements in clinical processes and outcomes at reasonable costs.
Ischemic Preconditioning in Cardiac Surgery


Murry and colleagues in 1986 described a paradoxical phenomenon that exposure of the heart to repeated brief ischemic episodes delayed the severity of myocardial infarction of a following prolonged myocardial ischemia and termed it myocardial ischemic preconditioning (IP). From then on, IP had been extensively studied in various kinds of experimental models as well as in humans. Besides delaying myocardial infarction, IP has been proved to be a potent endogenous factor in preserving high energy phosphates, suppressing arrhythmias and improving postischemic functional recovery. Delaying myocardial ultrastructure damage, reducing lactate, reducing the utilization of myocardial glycogen and protecting coronary endothelium after IP has also been found. Different experimental models and conditions resembling cardiac surgery have also been investigated. The mechanism of IP is not yet clear, however. The conclusions derived from animal studies could not totally stand for the situation in open heart surgery. IP was found effective in preserving high energy phosphate, improving heart performance and decreasing cardiac troponin T release during open heart surgery. Controversial exists because in same reports there were no effects of IP. The difference in IP protocol, myocardial protective method and study object might be the reason of the controversial results. Several clinical factors may affect IP effects during clinical practice. The purpose of the present study was to review the recent literature on IP, especially the IP mechanism, IP phenomenon in cardiac surgery and the possible influential factors, to summarize whether IP might prefer additional protection of current protective strategy in cardiac surgery.
Comparison of Percutaneous Nephrolithotomy, Shock Wave Lithotripsy, and Retrograde Intrarenal Surgery for Lower Pole Renal Calculi 10-20 mm

Objective: To compare the results of percutaneous nephrolithotomy (PCNL), shock wave lithotripsy (SWL), and retrograde intrarenal surgery (RIRS) for 1- to 2-cm lower pole kidney stones. Patients and Methods: This retrospective study was based on data collected from the files of patients between January 2007 and May 2012. The files of 383 patients (221 SWL, 144 PCNL, 38 RIRS) were evaluated. The groups were compared for stone size, success rate, and complication rate using the modified Clavien grading system. Results: The stone burdens of the groups were similar (p = 0.36). The success rates were 76, 94, and 73%, respectively, in SWL, PCNL, and RIRS. The highest stone-free rate was in the PNL group (p < 0.05). When the complication rates were evaluated using the Clavien grading system, they were determined to be 13% in PCNL, 3% in SWL, and 5% in RIRS. Especially GII and GIII complications were more common in the PCNL group (p < 0.05). Conclusion: PCNL seems to be the most successful but most invasive method. However, with relatively low complication rates, SWL and RIRS are other techniques to keep in mind. To determine the first-line treatment, prospective randomized studies with larger series are needed.
Pixel distribution analysis: can it be used to distinguish clear cell carcinomas from angiomyolipomas with minimal fat?

PURPOSE To retrospectively determine if pixel histogram analysis of unenhanced computed tomographic (CT) images can be used to distinguish angiomyolipomas (AMLs) with minimal fat from clear cell renal cell carcinomas (CCRCCs). MATERIALS AND METHODS The human studies committee approved this HIPAA-complaint study, with waiver of informed consent. Patients with pathologically proved AMLs lacking visible macroscopic fat at CT and patients with pathologically proved CCRCCs were included. Lesions were measured, and a histogram (number of pixels with each attenuation) was calculated electronically within a central region of interest. The percentage of pixels below the attenuation thresholds -20 HU and 10 HU was calculated in both cohorts. The unpaired Student t test was used to compare the average percentage of subthreshold pixels at each threshold. P < . 05 indicated a significant difference. The number of lesions with more than the selected percentage of subthreshold pixels was calculated in both groups, and the chi(2) test was used to test the significance of differences between cohorts. The area under the receiver operating characteristic (ROC) curve was used to determine if any percentage of subthreshold pixels could be used to differentiate between the two cohorts. RESULTS There were 22 patients with pathologically proved AMLs lacking visible macroscopic fat on CT images. Tuberous sclerosis affected three of these patients. Mean maximal transverse lesion diameter was 20 mm (range, 11-38 mm). There were 28 patients in the CCRCC comparison group. Mean maximal transverse lesion diameter was 26 mm (range, 15-36 mm). Neither the Student t test (P > .2 for all thresholds <0 HU) nor the chi(2) test (P > .15 for all thresholds <0 HU) revealed a significant difference between cohorts. A lesion with more low-attenuation pixels was significantly more likely to be characterized as CCRCC than as AML with ROC curve analysis. CONCLUSION Once AMLs with visible fat on CT images are excluded, pixel histogram analysis cannot be used to distinguish between AMLs and CCRCCs.
Randomised Prospective Trial of Contact Laser Prostatectomy (CLAP) versus Visual Laser Coagulation of the Prostate (VLAP) for the Treatment of Benign Prostatic Hyperplasia

Objective: To determine the long–term efficacy and complications of visual laser coagulation/ ablation, VLAP (side–firing fibre) and direct contact laser ablation, CLAP (sapphire–tipped fibre) of the prostate in the treatment of benign prostatic hyperplasia (BPH). Patients and Methods: Patients with clinical BPH, obstructed at voiding cystometry, were recruited and randomised to undergo either CLAP (21 patients) or VLAP (17 patients). At baseline, 1, 6, 12 and 24 months, patients underwent clinical evaluation, International Prostate Symptom Score (IPSS), uroflowmetry, post–void residual urine volume, and pressure/flow urodynamics. Results: The mean operating time for CLAP was 37.7 min and 24.5 min for VLAP. There was minimal morbidity with only 5 men requiring bladder irrigation after CLAP, 1 of whom had a blood transfusion. No patient required irrigation after VLAP. The mean catheterisation time after CLAP was 4.5 days (range 1–31 days) and 13.2 days (range 7–70 days) after VLAP. IPSS and Qmax improved significantly and maintained at 2 years. After CLAP, the IPSS decreased from 20.9 to 13.5 at 2 years while Qmax rose from 10 to 15.5 ml/s at 2 years. After VLAP, the IPSS decreased from 21.8 to 13.3 at 2 years while Qmax rose from 10 to 15.9 ml/s. There was no difference between CLAP and VLAP. Pressure/flow urodynamics at 6 months showed reduced bladder outflow obstruction.Conclusions: CLAP and VLAP offer the same improvement in flow rates and symptoms at 2years. Both procedures lead to minimal morbidity, but the excellent haemostasis that is achieved at VLAP makes it of more use in treating patients at high risk of haemorrhage after surgery.
Benefits of developing a whole-school approach to health promotion

This chapter examines the school experience as a determinant of future health, including discussion of how broad dimensions such as physical health, emotional wellbeing, cultural identity and psychosocial development, may be developed and enhanced within a whole-school health-promoting context. Healthy behaviours can be established in young people, and these behaviours tend to translate into healthy habits in adulthood, which are subsequently modelled and passed on to the following generations. In this chapter, the salience of health promotion in schools is presented in terms of preventing obesity and type 2 diabetes by promoting a healthy body image, establishing positive food habits and encouraging involvement in sport and physical activity. The potential ‘ripple effect’ that school health promotion can have via families and communities is also addressed as an additional avenue which can be utilised and embraced by teachers, health professionals and communities. Links between health and education outcomes One way to promote health in schools is to highlight the important links between a child’s health status and their academic achievement. As recently as 2010, the United Nations’ 2010 Human Development Report clearly reiterated the predictive nature of health and education variables by stating that ‘education, health, nutrition and sanitation complement each other, with investments in any one contributing to better outcomes in the others’ [39]. Other researchers agree and demonstrate how literacy and numeracy are inextricably interwoven with education, and education is concurrently a key predictor of life opportunities, including economic development, psychological wellbeing, health status and social spheres [4, 33]. It is recognised that healthy students are more able and ready to learn [25], and that improving the health of students and the school environment has positive outcomes for learning and academic results. An example of this important association is given in some recent studies which clearly demonstrate the predictive relationships between physical activity and educational performance and achievement, and show that physical activity is positively related to
Pulmonary alveolar proteinosis in a child from an informal settlement: 12 litres of fluid drained from the lungs and successful use of ECMO

Pulmonary alveolar proteinosis (PAP) is a rare cause of chronic interstitial lung disease, characterised by accumulation of pulmonary surfactant, respiratory insufficiency and an increased incidence of infections. The current standard therapy is whole-lung lavage to remove the accumulated surfactant. We report on a cachexic 12-year-old boy from an informal settlement in South Africa, presenting for the first time with PAP. Twelve litres of broncho-alveolar lavage fluid were drained under extracorporeal membrane oxygenation, and the patient gained 10 kg during his 2-month admission.
Second-line rituximab, lenalidomide, and bendamustine in mantle cell lymphoma: a phase II clinical trial of the Fondazione Italiana Linfomi

In this past decade, new therapeutic approaches based on the use of rituximab, high-dose cytosine-arabinoside, and autologous stem cell transplantation (ASCT) have changed the paradigm of mantle cell lymphoma (MCL) treatment, significantly improving the quality and duration of response and