Miracle-dz/UniFAR-FTUs huggingface dataset:
Cost analysis of intraoperative frozen section examinations in thyroid surgery in a Canadian tertiary center.

OBJECTIVE To perform a cost analysis of the routine intraoperative frozen section (FS) examinations in the management of patients undergoing thyroid surgery for unilateral thyroid nodules with benign or indeterminate cytology on preoperative fine-needle aspiration biopsies (FNABs). METHOD A retrospective chart review of 190 consecutive patients with unilateral thyroid nodules undergoing thyroid surgery was undertaken between March 2006 and March 2008. The results of FNAB, FS, and final histology were obtained from the pathology report. A cost analysis was performed to compare the cost of routine FS examinations to determine malignancy with the cost of performing a second surgical procedure. RESULTS Of the 169 patients evaluated, there were 53 cases of malignant nodules. Malignancy was diagnosed by FS in 16 of these 53 cases, resulting in a total thyroidectomy and thereby avoiding the need for a completion thyroidectomy. The sensitivity and specificity of FS examination were 30.2% and 100.0%, respectively. The routine use of intraoperative FS examination in cases of benign or indeterminate nodules afforded a total cost savings of $3719.27, or a cost savings of $22.01 per patient. CONCLUSION FS examination was useful in guiding our intraoperative management for patients with unilateral thyroid nodules with benign or indeterminate preoperative FNAB. The routine use of FS was cost-effective in our Canadian health care system, even without considering the intangible costs, such as patients' anxiety, emotional stress, and the loss of productivity owing to a second surgical procedure.
Subcellular Localization and Membrane Topology of the Melon Ethylene Receptor CmERS11

Ethylene receptors are multispanning membrane proteins that negatively regulate ethylene responses via the formation of a signaling complex with downstream elements. To better understand their biochemical functions, we investigated the membrane topology and subcellular localization of CmERS1, a melon (Cucumis melo) ethylene receptor that has three putative transmembrane domains at the N terminus. Analyses using membrane fractionation and green fluorescent protein imaging approaches indicate that CmERS1 is predominantly associated with the endoplasmic reticulum (ER) membrane. Detergent treatments of melon microsomes showed that the receptor protein is integrally bound to the ER membrane. A protease protection assay and N-glycosylation analysis were used to determine membrane topology. The results indicate that CmERS1 spans the membrane three times, with its N terminus facing the luminal space and the large C-terminal portion lying on the cytosolic side of the ER membrane. This orientation provides a platform for interaction with the cytosolic signaling elements. The three N-terminal transmembrane segments were found to function as topogenic sequences to determine the final topology. High conservation of these topogenic sequences in all ethylene receptor homologs identified thus far suggests that these proteins may share the same membrane topology.
Serum IF1 concentration is independently associated to HDL levels and to coronary heart disease: the GENES study[S]

HDL is strongly inversely related to cardiovascular risk. Hepatic HDL uptake is controlled by ecto-F1-ATPase activity, and potentially inhibited by mitochondrial inhibitor factor 1 (IF1). We recently found that IF1 is present in serum and correlates with HDL-cholesterol (HDL-C). Here, we have evaluated the relationship between circulating IF1 and plasma lipoproteins, and we determined whether IF1 concentration is associated with the risk of coronary heart disease (CHD). Serum IF1 was measured in 648 coronary patients ages 45–74 and in 669 matched male controls, in the context of a cross-sectional study on CHD. Cardiovascular risk factors were documented for each participant, including life-style habits and biological and clinical markers. In controls, multivariate analysis demonstrated that IF1 was independently positively associated with HDL-C and apoA-I (r = 0.27 and 0.28, respectively, P < 0.001) and negatively with triglycerides (r = −0.23, P < 0.001). Mean IF1 concentration was lower in CHD patients than in controls (0.43 mg/l and 0.53 mg/l, respectively, P < 0.001). In multivariate analyses, following adjustments on cardiovascular risk factors or markers, IF1 was negatively related to CHD (P < 0.001). This relationship was maintained after adjustment for HDL-C or apoA-I. This study identifies IF1 as a new determinant of HDL-C that is inversely associated with CHD.
Upper limits on X-ray emission from two rotating radio transients

X-ray emission from the enigmatic rotating radio transients (RRATs) offers a vital clue to understanding these objects and how they relate to the greater neutron star population. An X-ray counterpart to RRAT J1819−1458 is known, and its properties are similar to those of other middle-aged (0.1 Myr) neutron stars. We have searched for X-ray emission with Chandra/Advanced CCD Imaging Spectrometer at the positions of two RRATs with arcsecond (or better) localization, J0847−4316 and J1846−0257. Despite deep searches (especially for RRAT J1846−0257) we did not detect any emission with 0.3–8 keV count-rate limits of 1 and 0.068 counts ks −1 , respectively, at 3σ confidence. Assuming thermal emission similar to that seen from RRAT J1819−1458 (a blackbody with radius ≈20 km), we derive effective temperature limits of 77 and 91 eV for the nominal values of the distances and column densities to both sources, although both of those quantities are highly uncertain and correlated. If we instead fix the temperature of the emission (a blackbody with kT = 0.14 keV), we derive unabsorbed luminosity limits in the 0.3–8 keV range of 1 × 10 32 and 3 × 10 32 erg s −1 . These limits are considerably below the luminosity of RRAT J1819−1458 (4 × 10 33 erg s −1 ), suggesting that RRATs J0847−4316 and J1846−0257 have cooled beyond the point of visibility (plausible given the differences in characteristic age). However, as we have not detected X-ray emission, it may also be that the emission from RRATs J0847−4316 and J1846−0257 has a different character from that of RRAT J1819−1458. The two non-detections may prove a counterpoint to RRAT J1819−1458, but more detections are certainly needed before we can begin to derive general X-ray emission properties for the RRAT populations.
Physiological and performance responses to the “FIFA 11+” (part 1): is it an appropriate warm-up?

Abstract The aim of the study was to examine the post-exercise effects of the “FIFA 11+” on various physical performance and physiological variables, to understand whether this programme is an appropriate warm-up for football players. Results were compared with the literature using a meta-analytical approach. Twenty amateur male football players [mean age 25.5 (s ± 5.1) years, body mass 75(8) kg, height 181(6) cm] participated in the study. They were tested twice before (control period) and once after the “FIFA 11+” for: 20-m sprints, agility, vertical jump, stiffness, isometric maximal voluntary contraction (MVC), rate of force development (RFD), and star excursion balance test. Oxygen uptake, lactate and core temperature were also measured. Pre-post warm-up differences were found for all the performance variables (from 1.0 to 6.2%; 0.015 < P < 0.001) with the exclusion of MVC (−13%; P = 0.426) and RFD (−10%; P = 0.205). After the warm-up there was an increase (0.004 <P < 0.001) in resting oxygen uptake from 325(87) to 379(142) mL · min−1, in core temperature from 37.3(0.3) to 37.7(0.3) °C, and in lactate from 1.0(0.2) to 2.6(1.1) mmol · L−1. In conclusion, the “FIFA 11+” prevention programme can be considered an appropriate warm-up, inducing improvements in football players comparable with those obtained with other warm-up routines reported in the literature.
Distribution and ZAP-70 Expression of WHO Lymphoma Categories in Shanxi, China: A Review of 447 Cases Using a Tissue Microarray Technique

This study aims to assess the distribution of lymphoma subtypes in Shanxi, China, according to the World Health Organization (WHO) classification, and to compare the relative distribution with other areas of the world. H&E-stained tissue sections from the archives of the Shanxi Tumor Hospital, China, were reviewed and 447 cases with sufficient materials were selected for detailed study. A panel of antibodies and probes was assembled, including antibodies to ALK1, bcl-6, CDs 1α, 3, 4, 5, 7, 8, 10, 15, 20, 23, 30, 43, 56, 68, 79α, and 99, cyclin D1, EMA, kappa, lambda, LMP1, PAX5, TdT, Vs38C and ZAP70, plus EBER RNA probe by in situ hybridization. The 447 lymphoma cases, subtyped according to the WHO classification, were assembled in triplicate into 11 tissue microarrays and examined with the panel of markers described. Among the 447 cases, 385 (82.6%) were confirmed to be non-Hodgkin lymphomas (NHL) and 62 (13.9%) were Hodgkin lymphomas of classic type (CHL). Of the NHL cases, 68.6% were B-cell lymphomas and 30.6% T/NK-cell lymphomas. Histiocytic neoplasms accounted for only three cases (0.8%). Diffuse large B-cell lymphomas (DLBCL) were the most common subtype (35.1%), followed by peripheral T-cell lymphomas unspecified (PTun, 12.0%), extranodal marginal zone B-cell lymphomas (MALT lymphomas, 11.7%), follicular lymphomas (FL, 8.6%), T-lymphoblastic lymphomas (T-LBL, 7.0%), anaplastic large cell lymphomas (ALCL, 4.2%), B small lymphocytic lymphomas (B SLL, 3.6%), and mantle cell lymphomas (MCL, 2.6%). Of 263 B-cell neoplasms, 105 (39.9%) expressed immunoglobulin light chain, including 52 kappa and 53 lambda, detectable in paraffin sections. The incidence of DLBCL was similar to many Western countries and Asia. The frequency of FL was, however, much lower than the usual pattern in Western countries, although NK/T-cell lymphomas were more common (30.6%), similar to other countries in Asia, including Japan and Korea. With regard to markers of EBV infection, 8 of 385 (2.1%) NHL cases gave positive findings by both in situ hybridization (EBER RNA) and immunohistochemistry (LMP-1), whereas 24 (6.2%) expressed only the EBER and 12 (3.1%) expressed only LMP-1. EBV positivity was found in 24 of 119 (20.2%) T and NK cell lymphomas, in 20 of 263 (7.6%) B cell neoplasms, and in 37 of 62 (59.7%) CHLs. In CHLs there was complete concordance of results by both in situ hybridization (EBER RNA) and immunohistochemistry (LMP-1) procedures. ZAP70 was detected in most T cell-lineage disorders (61.4%) and also in a subset of B small lymphocytic lymphomas (50%). However, ZAP-70 was expressed in a minority of other types of B-cell lymphomas, including precursor B-cell acute lymphoblastic leukemia (25%), diffuse large B-cell lymphoma (26.7%), follicular lymphoma (15.2%), and lymphoplasmacytic lymphoma (9.1%). Immunohistochemical analysis represents an effective method for assessing ZAP-70 expression and reveals that a variety of B-cell malignant neoplasms express ZAP-70, albeit at low frequency.
Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the U.S. Population, 2012.

IMPORTANCE Understanding skin cancer incidence is critical for planning prevention and treatment strategies and allocating medical resources. However, owing to lack of national reporting and previously nonspecific diagnosis classification, accurate measurement of the US incidence of nonmelanoma skin cancer (NMSC) has been difficult. OBJECTIVE To estimate the incidence of NMSC (keratinocyte carcinomas) in the US population in 2012 and the incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in the 2012 Medicare fee-for-service population. DESIGN, SETTING, AND PARTICIPANTS This study analyzes US government administrative data including the Centers for Medicare & Medicaid Services Physicians Claims databases to calculate totals of skin cancer procedures performed for Medicare beneficiaries from 2006 through 2012 and related parameters. The population-based National Ambulatory Medical Care Survey database was used to estimate NMSC-related office visits for 2012. We combined these analyses to estimate totals of new skin cancer diagnoses and affected individuals in the overall US population. MAIN OUTCOMES AND MEASURES Incidence of NMSC in the US population in 2012 and BCC and SCC in the 2012 Medicare fee-for-service population. RESULTS The total number of procedures for skin cancer in the Medicare fee-for-service population increased by 13% from 2,048,517 in 2006 to 2,321,058 in 2012. The age-adjusted skin cancer procedure rate per 100,000 beneficiaries increased from 6075 in 2006 to 7320 in 2012. The number of procedures in Medicare beneficiaries specific for NMSC increased by 14% from 1,918,340 in 2006 to 2,191,100 in 2012. The number of persons with at least 1 procedure for NMSC increased by 14% (from 1,177,618 to 1,336,800) from 2006 through 2012. In the 2012 Medicare fee-for-service population, the age-adjusted procedure rate for BCC and SCC were 3280 and 3278 per 100,000 beneficiaries, respectively. The ratio of BCC to SCC treated in Medicare beneficiaries was 1.0. We estimate the total number of NMSCs in the US population in 2012 at 5,434,193 and the total number of persons in the United States treated for NMSC at 3,315,554. CONCLUSIONS AND RELEVANCE This study is a thorough nationwide estimate of the incidence of NMSC and provides evidence of continued increases in numbers of skin cancer diagnoses and affected patients in the United States. This study also demonstrates equal incidence rates for BCC and SCC in the Medicare population.
Experimental testing of the dual-layer Woven EndoBridge device using an elastase-induced aneurysm model in rabbits

The dual-layer Woven EndoBridge (WEB) device (WEB II) is designed to improve the performance of the first-generation WEB device. This study was performed to evaluate the acute and chronic performance of WEB II for aneurysm occlusion in an elastase-induced aneurysm model in rabbits. We implanted WEB II devices in 36 elastase-induced aneurysms and followed up for one, three, six, and 12 months. Degree of aneurysm occlusion at follow-up was graded on the Web Occlusion Scale (WOS): Grade A, complete aneurysm occlusion; Grade B, complete occlusion with recess filling; Grade C, residual neck filling; and Grade D, residual aneurysm filling. Hematoxylin and eosin staining was performed for histological assessment of aneurysm healing. Grades A, B, C, and D aneurysm occlusion at one-month follow-up were noted in three (17%), three (17%), eight (44%), and four (22%) of 18 cases, respectively. At the three-month time point Grades A, B, C, and D were shown in two (33%), two (33%), one (17%), and one (17%) aneurysms. Six months after treatment, one (17%), two (33%), two (33%), and one (17%) cases demonstrated Grades A, B, C, and D occlusion. At the 12-month time point, Grades B, C, and D were shown in three (50%), two (33%), and one (17%) aneurysms. Histologic evaluation showed progressive thrombus organization within aneurysm lumen from one to 12 months. These results indicated that the WEB II device can achieve high rates of aneurysm occlusion over time in experimental aneurysms.
Percutaneous cholecystostomy: A valuable technique in high‐risk patients with presumed acute cholecystitis

the variation in findings is presumably surgeon-related and some due to the difference in protocols used in assessing the surgical specimens. It is our view that the definition of the CRM (also at times referred to as the lateral resection margin), used by some authors’. ’ to refer to a zone of tissue 1 mm in width around the circumference of the specimen, differs from the usual meaning of a resection margin and could also account for some of the differences between series. To most pathologists and surgeons a resection margin is literally the line along which the scalpel or diathermy point has passed when tissue is excised. As Quirke et have indicated, circumferential clearance in rectal cancer is often very limited. It follows that some cases will be found to have invaded the 1 mm marginal zone yet not have involved a line of resection, These patients retain the possibility of bcing cured of their tumour, assuming there are no known distant metastases. We have found from survival studies in colorcctal cancer that when tumour is present in a line of resection, there is justification for classifying the case as clinicopathological stage D (i.e. known residual tumour)’. In this study we demonstrated tumour in a circumferential line of resection in 54 of 706 consecutive patients with rectal cancer (7.6 per cent). This figure is similar to the incidence of 6.5 per cent recorded by Cawthorne cf ul. ’ for CRM involvement. As these authors did not define their resection margin as having thickness and their patients had a very poor survival, it seems likely that they were also referring to a line of resection. In comparing the results of these two series, it is noteworthy that in both the patients were from only one institution, the method of specimen dissection was similar and only one pathologist was involved. To avoid confusion in the future, we would advocate use of the term circumferential marginal zone (CMZ), preceded by a statement of the width, in order to make a clear distinction from the terms ‘resection margin’ and ‘line of surgical resection’ which we regard as synonymous. It would be informative if authors were to record data on both the involvement of the CMZ as well as the Circumferential line of resection. R. C. Newland P. H. Chapuis 0. F. Dent E. L. Bokey Cblorectul unit Concord Repatriation General Hospital Concord New South Wales 2039 Australia
Pathologic gambling in Parkinson's disease: A behavioral manifestation of pharmacologic treatment?

We describe 12 patients with Parkinson's disease and pathologic gambling. This association has apparently never been reported. The patients were selected from a Parkinson's disease unit of 250 patients. They met Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for pathologic gambling. All patients underwent a neurologic, psychiatric, and psychologic examination, specifically noting the presence or absence of psychopathology in the spectrum of impulse control disorder and the nature of the gambling. Ten patients started gambling after the onset of Parkinson's disease and treatment with levodopa. The pathologic behavior was exclusively present or was markedly increased in “on” periods in 11 patients. All patients had motor fluctuations at the time of the study. Slot machines were the preferred source of gambling for 10 patients, similar to the Spanish gambling population. That the gambling behavior appears more often in the “on” periods of motor fluctuations and that it begins after the onset of Parkinson's disease in most patients and worsens with levodopa therapy suggest that it could be related to the dopaminergic tone in patients with Parkinson's disease and motor fluctuations (that is, it could represent a behavioral manifestation of pharmacologic treatment).
Predictors of appropriate therapy in patients with implantable cardioverter-defibrillator for primary prevention of sudden cardiac death

The purpose of this study was to evaluate predictors of appropriate therapy in patients with implantable cardioverter-defibrillators (ICD) for primary prevention of sudden cardiac death. A retrospective cohort of 321 patients with systolic heart failure undergoing ICD placement for primary prevention of sudden cardiac death was queried with a mean follow-up period of 2.6 years. Appropriate ICD therapy was defined as therapy delivered for termination of a ventricular tachyarrhythmia. Appropriate ICD therapy was delivered in 142 (44%) of the patients. In a multivariate model, body mass index ≥28.8 kg/m2, chronic kidney disease, left ventricular ejection fraction ≤20% and metabolic syndrome were found to be independent predictors of appropriate ICD therapy. Appropriate ICD therapy was associated with higher cardiovascular mortality. These findings show the importance of identification of risk factors, especially metabolic syndrome, in patients following ICD implantation as aggressive treatment of these co-morbidities may decrease appropriate ICD therapy and cardiovascular mortality.
Persistence with medication and overactive bladder: an ongoing challenge

ABSTRACT Introduction: For optimum results from pharmacological management of overactive bladder, adherence to prescribed medication is required. Overactive bladder treatment has been compromised by low adherence and persistence to medications, losing many people who might benefit from treatment and exposing them to unnecessary consequences of their disease. Areas covered: This narrative review examines what is known about adherence and persistence with treatment and, drawing evidence from other disease areas suggests factors which might be modifiable to improve the situation. A structured search of PubMed using the terms persistence, adherence, overactive bladder, urgency incontinence, and chronic conditions, was performed and added to as themes from exiting data emerged. Expert commentary: Adherence has traditionally been poor in this disease area with limited understanding of the modifiable factors underlying the observation. Increased understanding of the nature of the underlying disease should allow adoption of strategies tested in other disease areas.
Assessment of Chemotherapy-Induced Emesis and Evaluation of a Reduced-Dose Intravenous Ondansetron Regimen in Pediatric Outpatients with Leukemia

Objective: To measure the severity of nausea and vomiting in pediatric patients receiving intravenous or intrathecal chemotherapy for acute lymphoblastic leukemia and to evaluate the effectiveness of 2 intravenous doses of ondansetron for this condition. Design: Patients were surveyed during repeated treatments of maintenance chemotherapy, given with or without ondansetron, using a repeated measures pretest/posttest design. Setting: Outpatient pediatric oncology clinic. Patient population: Sixteen pediatric patients (aged 2–15 years, mean 6.2) with acute lymphoblastic leukemia. Methods: Surveys to assess nausea and vomiting and the extent of interference with daily activities were administered following emetogenic chemotherapy with or without ondansetron. Results: A total of 255 surveys following emetogenic chemotherapy with daunorubicin, cyclophosphamide, carmustine, and etoposide and cytarabine combined, as well as intrathecal therapy with methotrexate, hydrocortisone, and cytarabine, were analyzed. Analysis was performed on surveys of 149 courses without antiemetic therapy and 106 courses after 2 doses of ondansetron 0.15 mg/kg iv. The most emetogenic chemotherapy treatment was the etoposide/cytarabine combination (p<0.05). Ondansetron completely protected patients (defined as no nausea or no vomiting) during most (>50%) of the chemotherapy treatments, except for those in which cyclophosphamide was used. Ondansetron provided greater control of nausea and vomiting, a higher percentage of complete protection, and decreased the daily activity interference rating for carmustine and etoposide/cytarabine compared with courses of chemotherapy without antiemetics (p<0.05). Two intravenous doses of ondansetron also provided durable antiemetic efficacy over time for the most emetogenic chemotherapy treatment (etoposide/cytarabine). Conclusions: Etoposide/cytarabine proved to be the most emetogenic of the chemotherapy treatments studied. A reduced-dose regimen of intravenous ondansetron was shown to be an effective antiemetic for the outpatient treatments with etoposide/cytarabine and carmustine, but not with cyclophosphamide.