Miracle-dz/UniFAR-FTUs huggingface dataset:
Scleroderma: health services utilization from patients' perspective.

OBJECTIVE To evaluate utilization of the health care system by patients with scleroderma by determining which physicians are diagnosing and following patients, what tests are being used, and what is the time to diagnosis, as measured over the past 3 decades. METHODS A self-administered questionnaire (available in English and French) was mailed up to twice to 1,437 members of 12 provincial chapters of the Scleroderma Society of Canada. RESULTS The overall response rate was 63%. Eighty-nine percent of respondents were female. Sixty percent were between the ages of 30 and 59 years. Forty-three percent were diagnosed by a rheumatologist. Among patients with diffuse disease, 90% have been followed by a rheumatologist; however just over half of patients have seen a gastroenterologist (54%), cardiologist (51%), respirologist (67%), and less than half have seen a dermatologist (42%), nephrologist (13%), physiotherapist (46%), or occupational therapist (34%). The mean time to diagnosis over the last 3 decades is 2.4 years. At diagnosis less than 50% of patients had an electrocardiogram, echocardiogram, gastroscopy, thorax CT, or skin thickness measurements, whereas over 50% of patients had a chest radiograph and pulmonary function testing. CONCLUSION Less than half of patients were diagnosed by a rheumatologist, and time to diagnosis from onset of symptoms has remained unchanged over the last 3 decades. Despite their complex, multisystemic disease, less than 50% of patients see sub-specialists or had baseline screening tests for organ involvement of their systemic sclerosis. Further research is needed on health services utilization and on determinants of access to care by patients with scleroderma.
A link between chronic asthma and chronic infection.

BACKGROUND Asthma is a prevalent disease with marked effects on quality of life and economic societal burden. However, the cause of asthma and its pathophysiology are not completely defined. Recently, the possibility that chronic infection may play a role has been suggested. OBJECTIVE We sought to define the association between Mycoplasma and Chlamydia species and chronic asthma. METHODS We performed a comparison study of asthmatic patients and normal control subjects. Fifty-five patients with chronic stable asthma were compared with 11 normal control subjects by using PCR, culture, and serology for Mycoplasma species, Chlamydia species, and viruses from the nasopharynx, lung, and blood. Bronchoalveolar lavage cell count and differential, as well as tissue morphometry, were also evaluated. Computer-generated scoring for the degree of chronic sinusitis in asthmatic patients was additionally evaluated. RESULTS Thirty-one of 55 asthmatic patients had positive PCR results for Mycoplasma (n = 25) or Chlamydia species (n = 6), which were mainly found on lung biopsy specimens or in lavage fluid. Only 1 of 11 normal control subjects had positive PCR results for Mycoplasma species. The distinguishing phenotype between asthmatic patients with positive and negative PCR results was the significantly greater number of tissue mast cells in the group with positive results. CONCLUSION A significant number of patients with chronic stable asthma demonstrate the presence of Mycoplasma species, Chlamydia species, or both in their airways, with the distinguishing feature of increased mast cell number. These findings need further delineation but may help us to understand the pathophysiology of asthma and new treatment options.
On local search based heuristics for optimization problems

When comparing various metaheuristics, even asking a fair and formally consistent question is often difficult. Having this in mind, we provide some further evidence that simple local search heuristics may be at least very competitive choice. On a dataset from an industrial application, i.e. construction of an optical system, we compare local search and genetic algorithms. In our case, the best performance is obtained by a combination of both heuristics.
Controlled evaluation of intravenous drugs in the specific desensitization of phobias.

Introduction The technique of specific desensitization was first described by Wolpe (17) who postulated that if a patient could be made to feel non-anxious while thinking about and visualizing himself in a feared situation he could not at the same time feel anxious — anxiety and non-anxiety being mutually exclusive. According to Wolpe, if this procedure is repeated a sufficient number of times the patient will come to learn that he no longer feels frightened when thinking about his phobic stimulus, and by generalization he will come to feel equally calm and relaxed when facing it in reality. The manner in which Wolpe induced the required state of non-anxiety was to teach the patient how to relax his musculature by the use of Jacobsen's method ( 9 ) . This was done in the belief that if an individual is fully relaxed in the muscular sense he must also necessarily be relaxed mentally. Unfortunately this is not always the case (14,16). Direct measurements of autonomic accompaniments of anxiety have revealed that muscular relaxation is not necessarily directly related to a reduction in central arousal and anxiety (12). Patients can feel quite calm even though muscularly tense and, conversely, they can feel psychologi-
Cerebrocortical microdysgenesis in neurologically normal subjects

Previous studies showed that few foci of cerebro-cortical microdysgenesis (molecular layer neuronal ectopias and focal laminar dysplasia) are present in up to 26% of variably processed normal brains; they are more common in the right inferior frontal region. Brains of male developmental dyslexics processed in serial histologic sections showed 30 to 140 foci of these types of anomalies, predominantly in left perisylvian cortex. Here, we present the results of a detailed analysis of ten normal brains also processed in serial sections. The ages ranged from 3.5 to 87 years, all male. Three brains showed abnormalities similar in type to those of the dyslexic, but in far smaller numbers and in different locations: two showed a single cingulate focus—one right, one left; the third brain snowed two right supratemporal foci. We conclude that the present form of developmental anomaly is rare in normal brains, and that the findings in the dyslexic brains may be significant.
Comparative study for the efficacy and safety of percutaneous nefhrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for the treatment of 2-3,5 cm kidney stones.

OBJECTIVES Retrograde intrarenal surgery (RIRS) has become an important alternative for the treatment of kidney stones due to its increased safety and efficiency. The purpose of this study is to compare efficacy and safety features of RIRS against percutaneous nephrolithotomy (PCNL) for the treatment of 2 - 3.5 cm kidney stones. METHODS 142 cases (106 RIRS and 36 PCNL) encompassing 2 - 3.5 cm kidney stones that have been treated in our center between December 2009 and December 2011 have been considered. Demographic variables, stone characteristics, surgical stay and surgical time have been evaluated. Additionally, the complication prerate and success rate after one and two procedures (retreatment) have also been assessed. Student's T, Mann-Whitney U y Chi² - V Cramer (p=0.05) tests were used for statistical analysis. RESULTS There are not statistically significant differences in demographic or stone variables. The calculated mean surgical time was lower for PCNL (85 min) than for RIRS (112 min). Mean hospital stay was statistically significantly shorter in RIRS (16 h vs. 98 h in RIRS, p=0.001). PCNL exhibited a higher global complication rate of 19.4% vs. 6.6% for RIRS (p=0.001). PCNL also showed a higher successful rate (80.6% vs. 73.6% for RIRS), although this difference was not statistically significant (p=0.40). When comparing the success rate after a second procedure, PCNL results in 94.3% vs. 93.5% for RIRS (p=0.88). CONCLUSION RIRS was found to be a safe and efficient procedure with a short hospital stay. Overall, RIRS can be considered as an alternative to PCNL for the treatment of renal stones smaller than 3.5 cm.
A simple Bayesian approach to quantifying confidence level of adverse event incidence proportion in small samples

ABSTRACT In both clinical development and post-marketing of a new therapy or a new treatment, incidence of an adverse event (AE) is always a concern. When sample sizes are small, large sample-based inferential approaches on an AE incidence proportion in a certain time period no longer apply. In this brief discussion, we introduce a simple Bayesian framework to quantify, in small sample studies and the rare AE case, (1) the confidence level that the incidence proportion of a particular AE p is over or below a threshold, (2) the lower or upper bounds on p with a certain level of confidence, and (3) the minimum required number of patients with an AE before we can be certain that p surpasses a specific threshold, or the maximum allowable number of patients with an AE after which we can no longer be certain that p is below a certain threshold, given a certain confidence level. The method is easy to understand and implement; the interpretation of the results is intuitive. This article also demonstrates the usefulness of simple Bayesian concepts when it comes to answering practical questions.
Discrimination of Tropical Mangroves at the Species Level with EO-1 Hyperion Data

Understanding the dynamics of mangroves at the species level is the key for securing sustainable conservation of mangrove forests around the globe. This study demonstrates the capability of the hyper-dimensional remote sensing data for discriminating diversely-populated tropical mangrove species. It was found that five different tropical mangrove species of Southern Thailand, including Avicennia alba, Avicennia marina, Bruguiera parviflora, Rhizophora apiculata, and Rhizophora mucronata, were correctly classified. The selected data treatment (a well-established spectral band selector) helped improve the overall accuracy from 86% to 92%, despite the remaining confusion between the two members of the Rhizophoraceae family and the pioneer species. It is therefore anticipated that the methodology presented in this study can be used as a practical guideline for detailed mangrove species mapping in other study areas. The next stage of this work will be to exploit the differences between the leaf textures of the two Rhizophoraceae mangroves in order to refine the classification outcome.
Safety and efficacy of insulin detemir in clinical practice: 14‐week follow‐up data from type 1 and type 2 diabetes patients in the PREDICTIVETM European cohort

PREDICTIVETM (Predictable Results and Experience in Diabetes through Intensification and Control to Target: An International Variability Evaluation) is a large, multi‐national, open‐label, prospective, observational study assessing the safety and efficacy of insulin detemir in clinical practice. A total of 20,531 patients with type 1 or 2 diabetes from 11 countries were prescribed insulin detemir and followed up after a mean of 14.4 weeks. The primary endpoint was incidence of serious adverse drug reactions (SADRs), including major hypoglycaemia. Secondary endpoints were: haemoglobin A1c (HbA1c), mean self‐monitored fasting glucose, within‐patient fasting glucose variability and body weight change. Two hundred and fourteen patients (1%) reported SADRs, including major hypoglycaemia. The incidence of major hypoglycaemic episodes was reduced from 3.0/patient‐year at baseline to 0.7/patient‐year at follow‐up in type 1 patients (p < 0.0001), and from 0.8 to 0.1/patient‐year in type 2 patients (p < 0.0001). Insulin detemir improved glycaemic control in type 1 and type 2 patients, with reductions in mean HbA1c (0.5% and 0.9%, respectively, p < 0.0001 for both), fasting glucose (1.7 and 2.6 mmol/l, p < 0.0001 for both) and within‐patient fasting glucose variability (0.7 and 0.5 mmol/l, p < 0.0001 for both). There was a small decrease in mean body weight in both type 1 and 2 patients (−0.1 kg, p < 0.01 and −0.4 kg, p < 0.0001 respectively). Insulin detemir was used once‐ or twice‐daily in 49% and 50% of type 1 patients, and 77% and 23% of type 2 diabetes patients, respectively. The 14‐week observations from PREDICTIVE support clinical trial data showing that insulin detemir improves glycaemic control, with a lowered risk of hypoglycaemia and no weight gain.
The Role of Therapeutic Plasma Exchange in Poisonings and Intoxications

Poisonings, intoxications, and drug overdoses are common occurrences and rapid lowering of the toxin level is a cornerstone of all effective therapies. Therapeutic plasma exchange (TPE) has several unique characteristics that allow it to be a potentially effective therapy in rapidly achieving this goal. Specifically, TPE allows for the removal of large molecular weight, protein‐bound molecules that have a small volume of distribution. Due to the nature of poisonings, intoxications, and drug overdoses, no randomized controlled trials studying the efficacy of TPE in these situations exist. Thus, careful interpretation and analysis of case reports and series are required to assess the potential efficacy of this therapy. Recent data suggest that TPE may also be effective in the therapy of patients receiving biologic treatments who develop life‐threatening complications due to therapy.
Melanopsin retinal ganglion cells and the maintenance of circadian and pupillary responses to light in aged rodless/coneless (rd/rd cl) mice

Melanopsin‐expressing ganglion cells have been proposed as the photoreceptors mediating non‐rod, non‐cone ocular responses to light. Here we use the aged (approximately 2 years) rodless and coneless (rd/rd cl) mouse to assess the impact of progressive inner retinal cell loss on melanopsin expression, circadian entrainment and pupillary constriction. Aged rd/rd cl mice show substantial transneuronal retinal degeneration leaving only the ganglion cell layer and little of the inner nuclear layer. Despite this loss, quantitative reverse transcriptase‐polymerase chain reaction showed normal levels of melanopsin expression, and immunocytochemistry demonstrated both the presence and normal cellular appearance of these cells. Furthermore, the optic nerves of the two genotypes (rd/rd cl and +/+) were not obviously different in animals older than 2 years. However, this massive level of retinal degeneration left both pupillary and circadian responses to light intact, even in rd/rd cl mice older than 2 years. Our data provide the first positive correlation between the persistence of melanopsin‐expressing cells and the maintenance of both circadian and pupillary responses to light in the absence of rods and cones. These findings, together with recent studies on melanopsin knockout mice, are consistent with the hypothesis that melanopsin‐expressing ganglion cells are photosensitive and mediate a range of irradiance‐detection tasks.
Sphingomyelinase pathway activation in septic myocardial depression--another brick in the wall?

cholestasis. J Am Coll Surg 2002; 194: 731–739 10. Hamada E, Nishida T, Uchiyama Y, et al: Activation of Kupffer cells and caspase-3 involved in rat hepatocyte apoptosis induced by endotoxin. J Hepatol 1999; 30:807–818 11. Hotchkiss RS, Swanson PE, Cobb JP, et al: Apoptosis in lymphoid and parenchymal cells during sepsis: Findings in normal and Tand B-cell-deficient mice. Crit Care Med 1997; 25:1298–1307 12. Weiss YG, Bellin L, Kim PK, et al: Compensatory hepatic regeneration after mild, but not fulminant, intraperitoneal sepsis in rats. Am J Physiol Gastrointest Liver Physiol 2001; 280:G968–G973 13. Coopersmith CM, Chang KC, Swanson PE, et al: Overexpression of Bcl-2 in the intestinal epithelium improves survival in septic mice. Crit Care Med 2002; 30:195–201 14. Han J, Kim N, Joo H, et al: Ketamine abolishes ischemic preconditioning through inhibition of K(ATP) channels in rabbit hearts. Am J Physiol Heart Circ Physiol 2002; 283: H13–H21
Common interneurones in reflex pathways from group 1a and 1b afferents of ankle extensors in the cat.

1. Input from group I afferents of ankle and toe extensors, other muscles, skin nerves and descending tracts to interneurones of Rexed's laminae V‐VI in the cat spinal cord was analysed using intracellular recording from these interneurones. Adequate stimuli (muscle stretches) were used to activate selectively group Ia muscle spindle afferents of triceps surae and plantaris while other fibre systems were excited electrically. 2. Ia and Ib afferents of ankle and toe extensors were found to co‐excite, co‐inhibit or exert opposite synaptic actions in 41, 33, and 50% of the analysed interneurones, respectively. Taking into account both excitatory and inhibitory input from these two groups of afferents, 64% of the interneurones appeared to be used in common in reflex pathways from muscle spindles and tendon organs of ankle and toe extensors. 3. Selective input from Ib afferents of triceps surae and plantaris (excitation and/or inhibition) was found in 36% of the interneurones; there was evidence for a similarly selective input from Ia afferents. 4. A great majority (over 90%) of the interneurones excited by group I afferents were also inhibited by group I afferents, from either the same or other muscles. 5. Both monosynaptic and disynaptic e.p.s.p.s from Ia and/or Ib afferents from other muscles and from fibres in the ipsilateral funiculi were found in a great proportion of the same interneurones, together with disynaptic e.p.s.p.s from low threshold cutaneous afferents. 6. Intracellular staining with horseradish peroxidase revealed four different patterns of axonal projections of the analysed interneurones: (i) projections to motor nuclei and the intermediate region, (ii and III) projections only to the intermediate region, locally or combined with projections to different rostro‐caudal levels, and (iv) projections to the opposite side of the spinal cord. 7. A large proportion of interneurones projecting to motor nuclei displayed input from both Ia and Ib afferents although such an input was a feature of interneurones with other projections as well. No systematic differences in the input from group I afferents were found for interneurones with different axonal projections. In contrast disynaptic e.p.s.p.s of cutaneous origin and monosynaptic e.p.s.p.s upon stimulation of ipsilateral spinal tracts appeared predominantly in interneurones projecting to motor nuclei.
Activity of clarithromycin against Mycobacterium avium infection in patients with the acquired immune deficiency syndrome. A controlled clinical trial.

Disseminated Mycobacterium avium infection is common in patients with acquired immune deficiency syndrome (AIDS), but no drug studies have been reported establishing antimicrobial activity against this organism in a controlled, randomized trial. Clarithromycin, a new macrolide, has activity against M. avium in vitro and in animals, but it has not been studied in humans. In this randomized, double-blind, placebo-controlled trial, we measured the ability of clarithromycin to reduce M. avium bacteremia in patients with AIDS and disseminated infection. Of 23 patients initially enrolled, 15 men with late-stage AIDS qualified for the study. One group received clarithromycin alone for 6 wk, then placebo plus rifampin, isoniazid, ethambutol, and clofazimine for 6 wk. The other group received placebo alone, then clarithromycin plus the other four drugs. Colony-forming units (CFU) of M. avium per milliliter of blood were determined by quantitative cultures taken at baseline and every 2 wk thereafter. Minimum inhibitory concentration of clarithromycin for 90% of the strains isolated from patients at baseline, as measured on 7H11 agar at pH 6.6, was 8 micrograms/ml. Eight eligible patients with initial positive cultures who were initially receiving clarithromycin alone had marked declines in blood M. avium CFU; in six cases, CFU decreased to zero. When seven patients were switched to placebo plus the other four drugs, CFU rose in four patients and remained undetectable in three. The five eligible patients initially treated with placebo had progressive CFU increases; when three were switched to clarithromycin plus the four drugs, their CFU declined. (ABSTRACT TRUNCATED AT 250 WORDS)
Effects of excess post-exercise oxygen consumption and resting metabolic rate in energetic cost

The constant growth of obesity and overweight only goes to show the need of intervention to reverse those figures. In this context, physical activity can contribute with a double effect, through acute and chronic physiological changes: in the first condition one can find the energetic cost from exercising and recovery (EPOC – excess post-exercise oxygen consumption), and in the second, the resting metabolic rate (RMR). Thus, this revision’s goal was to investigate the effect of EPOC and RMR as supporting factors in weight-control programs, willing to discuss the different results found in literature, concerning both magnitude and length of EPOC, as well as discussing the effects of exercising in RMR. Research shows, in general terms, that the most intense exercises are able to promote a bigger EPOC when compared to exercises of lower intensity, while a bigger EPOC was found in resistive exercises when compared to aerobic ones. Concerning RMR changes, the acute results show significant increase at it; however, long-term results are more discrepant, due to the difficulty in measuring this variable without overestimating it. In summary, literature points that periodicity of a training that can maximize both EPOC and RMR may be an important factor to weight-losing and, although energetic cost of these variables in a therapy session seem rather small, it can be significant in a long-term relation. However, new studies are important to confirm these evidences.
Restorative treatment decisions on occlusal caries in Scandinavia

In order to map variations in the operative treatment threshold for occlusal caries, a pre-coded questionnaire was sent to a random sample of 759 dentists in Norway, 923 in Sweden, and 173 in the Danish Public Dental Health Service inquiring about caries and treatment strategies. A further intention was to explore the type of operative treatment and filling material dentists in Scandinavia would use given an occlusal lesion in the lower 2nd molar in a 20-year-old. It is found that close to 70% of dentists in the 3 countries would put off carrying out operative treatment of occlusal caries until they registered a moderately sized cavity and/or any radiolucency in dentin. In Sweden, 26.7% of dentists and in Denmark 24.3% would postpone operative treatment until the lesion had a large cavity and/or until radiolucency could be observed in the middle third of the dentin; in Norway, only 11.5% of dentists indicated this. The majority of dentists in all 3 countries preferred to drill only the carious part of the fissure, though in Norway more dentists (30.9%) would tend to drill the whole fissure compared to their Swedish (23.4%) and Danish (9.5%) colleagues. The majority of Danish dentists (52.4%) suggested amalgam for restoring the occlusal surface, while 19.9% of Norwegian and 2.9% of Swedish dentists would use amalgam. Composite was the first material of choice for 71.5% of the Swedish dentists, the remaining 25.6% suggesting conventional glass ionomer cement, light-cured 'glass ionomer cement', or a combination of glass ionomer cement and composite. The corresponding values for the Norwegian dentists were 39.1% and 41.0%, respectively, and for the Danish dentists 29.2% and 18.4%. In Scandinavia, the leading strategy for occlusal caries seems to be to postpone operative treatment until a definite cavity or radiolucency in the outer third of dentin can be observed, and to carry out operative treatment only of the part of the fissure that is carious. Composite resin is the predominant material of choice in Sweden, while in Denmark the majority of dentists preferred amalgam. Composite, or composite in combination with glass ionomer cement material, was the choice of almost 80% of Norwegian dentists.