Miracle-dz/UniFAR-FTUs huggingface dataset:
Dynamic Evaluation of Pivot-Shift Kinematics in Physeal-Sparing Pediatric Anterior Cruciate Ligament Reconstruction Techniques

Background: Conventional transphyseal anterior cruciate ligament (ACL) reconstruction techniques in skeletally immature patients have been questioned because of potential physeal injuries. Consequently, multiple alternative reconstruction options have been described to restore stability while sparing the physes in the skeletally immature patient. Hypothesis: All pediatric reconstruction techniques will restore knee stability to intact levels, and the knee stability index (KSI) will discriminate stability patterns between reconstruction techniques. Study Design: Controlled laboratory study. Methods: A novel mechanical pivot-shift device (MPSD) that consistently applies dynamic loads to cadaveric knees was used to study the effect of different physeal-sparing ACL reconstruction techniques on knee stability. Six adult cadaveric fresh-frozen knees were used. All knees were tested with 3 physeal-sparing reconstruction techniques: all epiphyseal (AE), transtibial over the top (TT), and iliotibial band (ITB). The MPSD was used to consistently perform a simulated pivot-shift maneuver. Tibial anterior displacement (AD), internal rotation (IR), posterior translational velocity (PTV), and external rotational velocity (ERV) were recorded using an Optotrak navigation system. The KSI (score range, 0-100; 0 = intact knee) was quantified using a regression analysis of AD, IR, PTV, and ERV. Repeated-measures analysis of variance and logistic regression were used for comparison of kinematics and derivation of KSI coefficients, respectively. Results: ACL deficiency resulted in an increase of 20% to 115% in all primary stability measures tested compared with the ACL-intact state. All reconstructions resulted in a decrease in ADmax and IRmax as well as PTVmax and ERVmax to within intact ranges, indicating that all reconstructions do improve stability compared with the ACL-deficient state. The ITB reconstruction overconstrained AD and IR by 38% and 52%, respectively. The mean (±SD) KSI for the ACL-deficient state was 61.7 ± 22.2 (range, 47-100), while the ITB reconstruction had a mean KSI of 0.82 ± 24.0 (range, −24 to 35), the TT reconstruction had a mean KSI of 13.3 ± 8.9 (range, 0.3-23), and the AE reconstruction had a mean KSI of −4.0 ± 15.2 (range, −24 to 14). The KSI was not significantly different between reconstructions, and all were significantly lower than the ACL-deficient state (P < .0001). Conclusion: Although all reconstruction techniques tested were able to partially stabilize an ACL-deficient knee, the AE reconstruction was most effective in restoring native knee kinematics under dynamic loading conditions that mimic the pivot-shift test. Clinical Relevance: This study provides orthopaedic surgeons with objective dynamic rotational data on the ability of physeal-sparing ACL reconstructions to better determine the ideal technique for ACL construction in skeletally immature patients.
Achilles tendinopathy has an aberrant strain response to eccentric exercise.

PURPOSE Eccentric exercise has become the treatment of choice for Achilles tendinopathy. However, little is known about the acute response of tendons to eccentric exercise or the mechanisms underlying its clinical benefit. This research evaluated the sonographic characteristics and acute anteroposterior (AP) strain response of control (healthy), asymptomatic, and symptomatic Achilles tendons to eccentric exercise. METHODS Eleven male adults with unilateral midportion Achilles tendinopathy and nine control male adults without tendinopathy participated in the research. Sagittal sonograms of the Achilles tendon were acquired immediately before and after completion of a common eccentric rehabilitation exercise protocol and again 24 h later. Tendon thickness, echogenicity, and AP strain were determined 40 mm proximal to the calcaneal insertion. RESULTS Compared with the control tendon, both the asymptomatic and symptomatic tendons were thicker (P < 0.05) and hypoechoic (P < 0.05) at baseline. All tendons decreased in thickness immediately after eccentric exercise (P < 0.05). The symptomatic tendon was characterized by a significantly lower AP strain response to eccentric exercise compared with both the asymptomatic and control tendons (P < 0.05). AP strains did not differ in the control and asymptomatic tendons. For all tendons, preexercise thickness was restored 24 h after exercise completion. CONCLUSIONS These observations support the concept that Achilles tendinopathy is a bilateral or systemic process and structural changes associated with symptomatic tendinopathy alter fluid movement within the tendon matrix. Altered fluid movement may disrupt remodeling and homeostatic processes and represents a plausible mechanism underlying the progression of tendinopathy.
Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm

In this controlled before-after study the effect of improvements, derived from Lean Six Sigma strategy, on parenteral medication administration errors and the potential risk of harm was determined. During baseline measurement, on control versus intervention ward, at least one administration error occurred in 14 (74%) and 6 (46%) administrations with potential risk of harm in 6 (32%) and 1 (8%) administrations. Most administration errors with high potential risk of harm occurred in bolus injections: 8 (57%) versus 2 (67%) bolus injections were injected too fast with a potential risk of harm in 6 (43%) and 1 (33%) bolus injections on control and intervention ward. Implemented improvement strategies, based on major causes of too fast administration of bolus injections, were: Substitution of bolus injections by infusions, education, availability of administration information and drug round tabards. Post intervention, on the control ward in 76 (76%) administrations at least one error was made (RR 1.03; CI95:0.77-1.38), with a potential risk of harm in 14 (14%) administrations (RR 0.45; CI95:0.20-1.02). In 40 (68%) administrations on the intervention ward at least one error occurred (RR 1.47; CI95:0.80-2.71) but no administrations were associated with a potential risk of harm. A shift in wrong duration administration errors from bolus injections to infusions, with a reduction of potential risk of harm, seems to have occurred on the intervention ward. Although data are insufficient to prove an effect, Lean Six Sigma was experienced as a suitable strategy to select tailored improvements. Further studies are required to prove the effect of the strategy on parenteral medication administration errors.
Has U.S. Investment Abroad Become More Sensitive to Tax Rates?

We use data from the U.S. Treasury corporate tax files for 1984 and 1992 to address two related questions concerning the investment decisions of U.S. multinational corporations. How sensitive are investment location decisions to tax rate differences across countries, and have investment location choices become more sensitive to differences in host country tax rates? We regress a measure of the real capital held in the manufacturing affiliates of U.S. manufacturing firms in each of the 58 countries in our sample on tax rate variables and measures of non-tax characteristics of countries. The availability of two years of data allows us to control for unmeasured country fixed effects. We find large estimated tax elasticities for investment abroad. Our basic estimates yield an elasticity of real capital to after-tax rates of return of close to three in 1992 and about 1.5 in 1984; both the elasticities and the difference between them are significant at standard levels. The increase of more than one in the estimated elasticities from 1984 to 1992 suggests that the allocation of real capital abroad may have become more sensitive to differences in host country taxes in recent years. These results are consistent with increasing international mobility of capital and globalization of production.
Mental Models of Cause and Inheritance for Type 2 Diabetes Among Unaffected Individuals Who Have a Positive Family History

Using the familial risk perception (FRP) model as a framework, we elicited causal and inheritance explanations for type 2 diabetes (T2D) from people who do not have T2D but have a family history for it. We identified four composite mental models for cause of T2D: (a) purely genetic; (b) purely behavioral/environmental; (c) direct multifactorial, in which risk factors interact and over time directly lead to T2D; and (d) indirect multifactorial, in which risk factors interact and over time cause a precursor health condition (such as obesity or metabolic syndrome) that leads to T2D. Interestingly, participants described specific risk factors such as genetics, food habits, lifestyle, weight, and culture as “running in the family. ” Our findings provide insight into lay beliefs about T2D that can be used by clinicians to anticipate or make sense of responses to questions they pose to patients about mental models for T2D.
Examining Postconcussion Symptoms of Dizziness and Imbalance on Neurocognitive Performance in Collegiate Football Players

Objective This study examined the effects of symptom reports of dizziness and imbalance on cognitive function in concussed collegiate football players. Design Retrospective, descriptive. Setting University athletic medicine facility. Subjects Twenty-seven collegiate football players were included in the final analysis: 16 with symptoms of dizziness/imbalance resulting from concussion and 11 without dizziness/imbalance resulting from concussion. Main Outcome Measures Participants completed the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) at baseline, at 1 to 2 days postconcussion and 5 to 7 days postconcussion. The ImPACT neurocognitive assessment consists of 6 modules, yielding 4 composite scores: verbal memory, visual memory, visual-motor processing speed, and reaction time. In addition, it includes a postconcussion symptom scale total score. Results Results revealed that participants with reports of dizziness and imbalance had significantly lower scores on the ImPACT composite scores; however, these individuals also had an overall higher symptom inventory. When accounting for the additional postconcussion symptoms, time was the only significant effect. Conclusion Dizziness and imbalance are common symptoms postconcussion; however, these symptoms did not predict performance on acute ImPACT scores. Further research is needed to understand the mechanisms causing postconcussion symptoms, including symptoms of dizziness and imbalance, and influence on outcomes postconcussion.
Dynamics of prebiotic RNA reproduction illuminated by chemical game theory

Significance The origins of life required a means for information-containing molecules to compete with one another for survival and reproduction. Using an analysis based on game theory, we can predict the situations in which cooperation, selfishness, or a mixture of the two is beneficial to the future evolutionary success of RNAs. Many origins-of-life scenarios depict a situation in which there are common and potentially scarce resources needed by molecules that compete for survival and reproduction. The dynamics of RNA assembly in a complex mixture of sequences is a frequency-dependent process and mimics such scenarios. By synthesizing Azoarcus ribozyme genotypes that differ in their single-nucleotide interactions with other genotypes, we can create molecules that interact among each other to reproduce. Pairwise interplays between RNAs involve both cooperation and selfishness, quantifiable in a 2 × 2 payoff matrix. We show that a simple model of differential equations based on chemical kinetics accurately predicts the outcomes of these molecular competitions using simple rate inputs into these matrices. In some cases, we find that mixtures of different RNAs reproduce much better than each RNA type alone, reflecting a molecular form of reciprocal cooperation. We also demonstrate that three RNA genotypes can stably coexist in a rock–paper–scissors analog. Our experiments suggest a new type of evolutionary game dynamics, called prelife game dynamics or chemical game dynamics. These operate without template-directed replication, illustrating how small networks of RNAs could have developed and evolved in an RNA world.
Evaluation of the AutoDimer D-dimer assay for the exclusion of pulmonary embolism

Marieke J. H. A. Kruip1, Huub H. D. M. vanVliet1, Peter M. T. Pattynama2, Alice Kars3, Anton H. van den Meiracker4, Kon-Siong G. Jie1,5, Frank W. G. Leebeek1 1Department of Hematology, 2Department of Radiology, 3Department of Pulmonology, 4Department of Internal Medicine of the Erasmus University Medical Center, Rotterdam, The Netherlands; 5*Department of Internal Medicine, Atrium Medical Center, Heerlen, The Netherlands
Interleukin-12 and -10 and gamma interferon regulate polyclonal and ligand-specific expansion of murine B-1 cells

B-1 cells (CD5+ B220+) are a self-replenishing lineage of B cells which are autoreactive and capable of producing large amounts of interleukin-10 (IL-10). In mice experimentally infected with the human helminth parasite Schistosoma mansoni, expansion of B-1 cells is seen in the peritoneal cavity just prior to egg laying. In naive mice, B-1 cell expansion can be elicited by intraperitoneal injection of saline soluble egg antigens (SEA) or the polylactosamine sugar lacto-N-fucopentaose III (LNFPIII), which contains the Lewis-X trisaccharide. In this study, we demonstrate that LNFPIII is the major stimulus in SEA responsible for expansion of B-1 cells, since SEA-induced B-1 outgrowth is blocked by multiple injections of non-cross-linked free LNFPIII. IL-10 is an autocrine growth factor for B-1 cells, and we show that B-1 outgrowth after SEA and LNFPIII administration is inhibited by injection of anti-IL-10 antibodies. Furthermore, SEA- and LNFPIII-induced expansion of B-1 cells is inhibited by in vivo administration of recombinant murine IL-12 or recombinant gamma interferon. These data suggest that activation and expansion of IL-10-producing B-1 cells are governed via cross-regulatory cytokines.
Pattern of skin diseases in a hospital in southwestern Saudi Arabia.

OBJECTIVE To ascertain the type of skin diseases in Najran General Hospital as a rough pattern of skin diseases in Najran region and to compare this with other similar regional studies in the Kingdom of Saudi Arabia (KSA). METHODS A retrospective 12 months study of the common skin dermatoses, which were recorded in Najran General Hospital, Najran, KSA, within the period December 2000 to December 2001. RESULTS We recorded 1192 new patients within the study period, 37% had one of the dermatitis or eczema group of diseases, 12.75% had acne, 7% had vitiligo, 5.9% had viral infections 5.6% had superficial mycoses, 5% had bacterial infections, 1.51% had psoriasis and only 1.1% had lichen planus. By comparison, the incidence of dermatitis or eczema, acne and vitiligo was slightly higher in Najran compared to other regions such as Asir, Hail, Al-Jouf and Jeddah, KSA owing, probably, to the genetic predilection of Najran community to these disorders. Najran was lower than others in psoriasis and in lichen planus, but in minimal deviations. However, Najran was comparable to others in infective diseases including viral warts, superficial mycoses and bacterial infections. CONCLUSION This comparison indicates that there were no large differences between Najran and other compared regions of KSA and this region is present in the heart of health development.
Oxidation of alloys in steam environments - a review.

Traditionally materials designed for use at high temperature have been developed primarily for their mechanical properties but there is now a growing realisation that oxidation may limit lifetime. The purpose of this report is to review existing information regarding oxidation of alloys, which are intended for use at high temperatures, under atmospheres containing steam or high water vapour content and to identify areas where more understanding is required.
Acute Postpartum Headache

PRESENTATION OF CASE – ROBERT L. GLOVER, MD, ADULT NEUROLOGY RESIDENT, MONTEFIORE MEDICAL CENTER, ALBERT EINSTEIN COLLEGE OF MEDICINE, BRONX, NY A 22-year-old woman 6 days postpartum originally presented to the emergency room in 2007 with headache.The patient underwent an elective cesarean section 6 days prior to presentation with use of epidural anesthesia after an uncomplicated pregnancy. Vaginal delivery was deferred because of her history of multiple previous cesarean sections. She began experiencing a bilateral frontal headache the day prior to arrival in the emergency room. She described the headache as 9/10 in intensity,of sudden onset,and with associated photophobia but no nausea or vomiting. Review of systems was otherwise negative.The patient reported no significant medical history and no history of headaches. She had undergone uncomplicated cesarean section deliveries in 2001,2003,and 2005.She could not recall any family history of neurological symptoms or conditions, and denied the use of any alcohol, tobacco, or any illicit drugs. Query by discussant Matthew S. Robbins, MD, Montefiore Headache Center,Albert Einstein College of Medicine, Bronx, NY: Were there any additional details offered regarding exacerbating or alleviating factors? Response by Dr. Glover: Yes, the headache did not change with position or straining. Additionally, the patient did not feel nauseous or have any episodes of vomiting. Her blood pressure and pulse were normal, and she was afebrile. Neurological examination was notable for diffuse hyperreflexia, including bilateral Hoffman’s reflexes but no Babinski signs and otherwise demonstrated no neurological focality. Query by discussant Matthew S. Robbins, MD: It was mentioned that the headache was sudden onset, were there any meningeal signs on examination? Response by Dr. Glover: No, on examination the neck was supple. She underwent computerized tomography (CT) scan of the head without intravenous contrast (Fig. 1). Multiple hypodensities in the frontal white matter were visualized. Based on imaging results, the patient was admitted to the neurology inpatient service. Results from human immunodeficiency virus testing, copper levels, antinuclear antibody, antineutrophil cytoplasmic antibody, as well as antibodies to Ro, La, and DNA, and were all negative or within normal limits. A comprehensive antiphospholipid battery was unremarkable. Rheumatoid factor was measured at 22.3 IU/mL (normal 0.0-20.0 IU/mL). Plasma From the Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (R.L. Glover, S. Vollbracht, M.S. Robbins); Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA (S. Vollbracht, M.S. Robbins).
Evaluation of insulin sensitivity with a new lipid-based index in non-diabetic postmenopausal overweight and obese women before and after a weight loss intervention.

OBJECTIVE To evaluate the validity of a new lipid-based index (Disse index) in assessing insulin sensitivity (IS) compared with the hyperinsulinemic-euglycemic (HIEG) clamp in overweight and obese, non-diabetic, postmenopausal women, before and after a weight loss intervention. RESEARCH DESIGN AND METHODS Association between Disse index and the HIEG clamp was evaluated in 86 non-diabetic postmenopausal overweight and obese women before and after weight loss. Percentage changes (%Delta) were calculated for several fasting indices and compared with %Delta of HIEG clamp. RESULTS We observed a strong correlation between Disse index and HIEG clamp (r=0.69, P<0.001). This association was higher than those of homeostasis model assessment (HOMA), quantitative insulin sensitivity check index (QUICKI), and McAuley indices while no significant difference was observed with Revised-QUICKI. Percent change of Disse index (pre- versus post-weight loss program) was significantly correlated with %Delta of HIEG clamp (r=0.34, P<0.01). This correlation was similar to those observed for the other indices tested. CONCLUSIONS We validated the reliability of Disse index in assessing IS in non-diabetic post-menopausal overweight and obese women, before and after weight loss intervention. Disse index may be useful not only for insulin resistant diagnostics in this type of population, but also for the IS follow-up after a weight-loss program and weight stabilization. The presence of lipid elements in this fasting index improves the estimation of IS in overweight and obese non-diabetic post-menopausal women and could add more information about peripheral IS.
“It Doesn't All Just Stop at 18”: Psychological Adjustment and Support Needs of Adults Born with Cleft Lip and/or Palate

Background Cleft in the lip and/or the palate (CL/P) is considered to be a lifelong condition, yet relatively little is known about the long-term outcomes for patients. Existing literature is largely outdated and conflicted, with an almost exclusive focus on medical aspects and deficits. Objective To explore the psychological adjustment and possible support needs of a large number of adults born with CL/P from their own perspective. Design Fifty-two individual telephone interviews eliciting qualitative data. Results Qualitative analysis identified five themes. Participants reported a range of challenges in relation to discharge from the service, additional surgery as an adult, social and romantic relationships, higher education, vocational achievement, and access to psychological support. The findings imply that most adults with a cleft adjust well to these challenges and report many positive outcomes. For a minority of patients, issues attributed to the cleft may continue to cause distress in adulthood. Conclusions Adults with CL/P may require psychological support, information about the heritability of cleft, signposting and referrals from nonspecialists, support regarding further treatment, and opportunities to take part in research and activities. New issues arising in adulthood, such as entering the workplace, forming long-term relationships, and starting a family, may warrant both further investigation and additional support. Further work is needed to identify the factors that contribute to psychological distress and resilience, as well as the timing of particular points of risk and opportunity for personal growth.
Estrogen Synthetase (Aromatase) Immunohistochemistry Reveals Concordance Between Avian and Rodent Limbic Systems and Hypothalami

During amniote evolution, an early divergence occurred about 300 million years ago between the reptilian lines leading to the appearance of birds (anapsids) and mammals (synapsids). The different functional requirements of these vertebrate groups have involved divergent evolution of their brains. Even superficial examination reveals major anatomical differences between mammalian and avian brains, such as extensive development of the optic lobes and cerebellum in birds and a highly developed cortex in mammals. It has been nearly impossible to identify avian homologs of some mammalian brain regions by standard morphological criteria. This has long frustrated efforts at clarifying hypotheses regarding the anatomical location, field size, and regulation of brain functions shared between these two classes, despite the certainty that the principles of neurobiology apply equally at the cellular level in both groups. In an effort to remove this barrier, we have sought markers of common function that despite apparent anatomical dissimilarity, can allow recognition of homologous brain structures. We illustrate here how comparative analysis of the distribution of the steroid-metabolizing enzyme estrogen synthetase (aromatase) may help to understand the differences and similarities in the limbic system and hypothalamus of birds and mammals.