Miracle-dz/UniFAR-FTUs huggingface dataset:
Continuous Preperitoneal Infusion of Ropivacaine Provides Effective Analgesia and Accelerates Recovery after Colorectal Surgery: A Randomized, Double-blind, Placebo-controlled Study

Background:Blockade of parietal nociceptive afferents by the use of continuous wound infiltration with local anesthetics may be beneficial in a multimodal approach to postoperative pain management after major surgery. The role of continuous preperitoneal infusion of ropivacaine for pain relief and postoperative recovery after open colorectal resections was evaluated in a randomized, double-blinded, placebo-controlled trial. Methods:After obtaining written informed consents, a multiholed wound catheter was placed by the surgeon in the preperitoneal space at the end of surgery in patients scheduled to undergo elective open colorectal resection by midline incision. They were thereafter randomly assigned to receive through the catheter either 0.2% ropivacaine (10-ml bolus followed by an infusion of 10 ml/h during 48 h) or the same protocol with 0.9% NaCl. In addition, all patients received patient-controlled intravenous morphine analgesia. Results:Twenty-one patients were evaluated in each group. Compared with preperitoneal saline, ropivacaine infusion reduced morphine consumption during the first 72 h and improved pain relief at rest during 12 h and while coughing during 48 h. Sleep quality was also better during the first two postoperative nights. Time to recovery of bowel function (74 ± 19 vs. 105 ± 54 h; P = 0.02) and duration of hospital stay (115 ± 25 vs. 147 ± 53 h; P = 0.02) were significantly reduced in the ropivacaine group. Ropivacaine plasma concentrations remained below the level of toxicity. No side effects were observed. Conclusions:Continuous preperitoneal administration of 0.2% ropivacaine at 10 ml/h during 48 h after open colorectal resection reduced morphine consumption, improved pain relief, and accelerated postoperative recovery.
Small inverter-interfaced distributed energy resources for reactive power support

The use of small inverter-interfaced distributed energy resources for reactive power support is discussed. While the primary function of these resources is to deliver active power, they can also be used to provide reactive power, often identified as an ancillary service by a utility. Given the large and increasing number of small grid-connected inverters, the total reactive power that can be collectively provided under proper control is substantial. The paper discusses inverter configurations for reactive power production, and presents distributed control strategies that enable these resources to provide reactive power support.
Overexpression of Focal Adhesion Kinase in Head and Neck Squamous Cell Carcinoma Is Independent of fak Gene Copy Number

The development of human malignancies can involve the aberrant regulation of intracellular signal transduction pathways that regulate cell-extracellular matrix interactions. Purpose: In the current study, we aimed to evaluate focal adhesion kinase (FAK) at both genetic and protein expression levels in head and neck squamous cell carcinomas (HNSCC) and to explore the prognostic significance of FAK. Experimental Design: A total of 211 tissue specimens, including 147 primary tumors, 56 lymph node metastases, 3 benign hyperplasias, and 5 dysplasias, were analyzed using immunohistochemistry. The fak gene dosage was determined in 33 tumors. Correlations among DNA, protein, and clinicopathologic variables were analyzed. Results: FAK protein was overexpressed in HNSCCs compared with corresponding normal mucosa. High expression levels were found in 62% of the samples. Positive immunostaining was also detected in benign hyperplasias and preinvasive dysplastic lesions. All lymph node metastases examined showed FAK overexpression, with significant correlation with the expression in matched primary tumor. DNA copy number ratios for fak were higher in 39% of the tumors compared with normal mucosa. However, elevated FAK expression did not correlate with gains on DNA level, and not all cases with an amplification of the fak gene displayed protein overexpression. Similar data were obtained in five HNSCC-derived cell lines, in which FAK mRNA levels were precisely correlated with FAK protein levels. FAK protein overexpression in tumors correlated with nodal metastases. Conclusions: These findings suggest an involvement of FAK in the onset and progression of HNSCC and provide an insight into a mechanism of FAK activation alternative to gene amplification.
Concurrent treatment for adolescent and parent depressed mood and suicidality: feasibility, acceptability, and preliminary findings.

OBJECTIVE The purpose of this study was to conduct a treatment development study to examine the feasibility, acceptability, and preliminary efficacy of treating depressed, suicidal adolescents and their depressed parent concurrently in a cognitive behavioral therapy (CBT) protocol (Parent-Adolescent-CBT [PA-CBT]). METHODS A randomized, controlled, repeated measures design was used to test the hypothesis that PA-CBT would lead to greater reductions in suicidality and depression compared with Adolescent Only CBT (AO-CBT). Participants included 24 adolescent and parent dyads in which the adolescent met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for current major depressive episode (MDE) and the parent met DSM-IV criteria for current or past MDE. RESULTS The concurrent protocol was found to be feasible to implement with most depressed adolescents and parents. Adolescent ratings of program satisfaction were somewhat lower in PA-CBT, suggesting that some teens view treatment negatively when they are required to participate with a parent. The concurrent treatment protocol was more effective in reducing depressed mood in the parent-adolescent dyad at the end of maintenance treatment (24 weeks) than treating an adolescent alone for depression; the largest effect was on parental depressed mood. This difference between dyads was no longer significant, however, at the 48 week follow-up. Adolescent and parent suicidal ideation improved equally in both groups during active and maintenance treatment, and remained low at follow-up in both groups. CONCLUSIONS The PA-CBT protocol is feasible to conduct and acceptable to most but not all adolescents. The strongest effect was on parental depressed mood. A larger study that has sufficient power to test efficacy and moderators of treatment outcome is necessary to better understand which adolescents would benefit most from concurrent treatment with a parent.
Comorbidity and Outcomes of Coronary Artery Bypass Graft Surgery at Cardiac Specialty Hospitals Versus General Hospitals

Background:Cardiac specialty hospitals assert better patient outcomes and efficiency, whereas general hospitals contend they attract healthier patients. Objectives:To ascertain whether increased cardiac specialization of a hospital's services is associated with improved outcomes for coronary artery bypass graft (CABG) surgery and whether patients with and without comorbid disease have equivalent outcomes to their counterparts at general hospitals. Methods:We conducted a retrospective cohort study of a 5% sample of Medicare beneficiaries undergoing CABG procedures from 2001 to 2003. Using multivariate analyses, we assessed the hospital degree of cardiac specialization on mortality, length of stay, hospital readmissions, and emergency room visits leading to rehospitalization for all patients and those with more comorbidities. Results:Patients at cardiac specialty hospitals had less comorbid disease (29.7% with Charlson scores ≥2) than those at moderately (37.2%) and least specialized hospitals (36.6%, P = 0.001). Overall, CABG outcomes in all 3 groups were similar for inpatient mortality (P = 0.78), 30-day postdischarge mortality (P = 0.69), emergency room visit leading to rehospitalization (P = 0.35), and hospital readmission within 30 days postdischarge (P = 0.70). However, for patients with greater comorbidity, 30-day postdischarge mortality was worse at cardiac specialty hospitals compared with least specialized hospitals from across the United States (adjusted odds ratio, 1.71; 95% confidence interval, 1.26–2.32; P = 0.001). Results were robust when hospitals were compared within metropolitan statistical areas. Conclusions:Favorable patient selection may occur at cardiac specialty hospitals. Although healthier patients fare comparably across types of hospitals, patients with greater comorbid disease seem to experience worse 30-day postdischarge mortality at specialty hospitals.
Skin tuberculosis as seen at Ga‐Rankuwa Hospital

The experience with cutaneous tuberculosis at Ga‐Rankuwa Hospital is reviewed. A total of 92 cases of skin tuberculosis was seen over the past 12 years. All recognized forms of cutaneous tuberculosis were encountered, plus some forms which were difficult to classify. Lupus vulgaris was the most common true infection and papulonecrotic tuberculid the most common tuberculid. The classification and pathogenetic mechanisms are briefly discussed.
Extraversion, Impulsivity, and Online Group Membership as Predictors of Problematic Internet Use

The present study investigated predictors of problematic Internet use. Undergraduate students (N = 272) completed a self-report questionnaire measuring extraversion, impulsivity, online group membership, frequency of use, and gender as predictors of problematic Internet use. Males and females differed significantly in their use of the Internet, with males significantly more likely to be Gamers than were females, and females significantly more likely to be Workers. Professional users reported significantly less problematic Internet use than nonprofessional users. Hierarchical regression analysis indicated that higher frequency of use, lack of perseverance (an aspect of impulsivity), and online group membership significantly predicted problematic Internet use. Given recent concerns about the growth of Internet addiction, this study extends our knowledge of the role played by personality, usage profile, and gender in this developing field of study.
Knockdown of prolyl‐4‐hydroxylase domain 2 inhibits tumor growth of human breast cancer MDA‐MB‐231 cells by affecting TGF‐β1 processing

The prolyl‐4‐hydroxylase domain 1–3 (PHD1–3) enzymes are regulating the protein stability of the α‐subunit of the hypoxia‐inducible factor‐1 (HIF‐1), which mediates oxygen‐dependent gene expression. PHD2 is the main isoform regulating HIF‐1α hydroxylation and thus stability in normoxia. In human cancers, HIF‐1α is overexpressed as a result of intratumoral hypoxia which in turn promotes tumor progression. The role of PHD2 for tumor progression is in contrast far from being thoroughly understood. Therefore, we established PHD2 knockdown clones of MDA‐MB‐231 breast cancer cells and analyzed their tumor‐forming potential in a SCID mouse model. Tumor progression was significantly impaired in the PHD2 knockdown MDA‐MB‐231 cells, which could be partially rescued by re‐establishing PHD2 expression. In a RNA profile screen, we identified the secreted phosphoprotein 1 (SPP1) as one target, which is differentially regulated as a consequence of the PHD2 knockdown. Knockdown of PHD2 drastically reduced the SPP1 expression in MDA‐MB‐231 cells. A correlation of SPP1 and PHD2 expression was additionally verified in 294 invasive breast cancer biopsies. In subsequent analyses, we identified that PHD2 alters the processing of transforming growth factor (TGF)‐β1, which is highly involved in SPP1 expression. The altered processing capacity was associated with a dislocation of the pro‐protein convertase furin. Thus, our data demonstrate that in MDA‐MB‐231 cells PHD2 might affect tumor‐relevant TGF‐β1 target gene expression by altering the TGF‐β1 processing capacity.
Regarding the Announcement to Halt the Intensive Glucose Lowering Arm of the Action to Control Cardiovascular Risk in Diabetes

An announcement to halt the intensive glucose lowering arm of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial has received tremendous press recently. The basis for stopping the trial was that more deaths from cardiovascular events were noted in the treatment group.1 No specific cause has been identified as yet. Past studies that aimed for “tight” control such as the Diabetes Control and Complications Trial (DCCT)2 have concluded that lower hemoglobin A1c levels were associated with improved cardiovascular health. The new findings appear to contradict this conclusion. One important difference in the ACCORD trial is the study population. In the DCCT trial, exclusion criteria eliminated concurrent hypertension and hyperlipidemia, whereas in the ACCORD study, one of the objectives was to examine the effect of intensive glycemic lowering in subjects who had concurrent hyperlipidemia and hypertension. A known mathematically described principle in control engineering (conservation of uncertainty) states that every connected system has a conserved or constant amount of uncertainty and that attempts to rein in more certainty in one area automatically create uncertainty in another area. When applying this principle to physiology, and in particular the ACCORD study, it is conceivable that attempts to constrain or increase certainty in glycemic control, blood pressure, and hyperlipidemia all at the same time, may be inducing uncertainty or vulnerability in other physiological functions, potentially resulting in a catastrophic event. For a review of this principle, refer to the Journal of Diabetes Science and Technology commentary article.3 In light of recent ACCORD findings, it will be important to consider a range of potential mechanisms and explanations that may be at play. The conservation of the uncertainty principle, in fact, predicts the consequences resulting from restricting the system's range of physiological responses. These consequences might include increased fragility in the microvasculature, leading to myocardial infarction, stroke, or unwanted adverse effects, such as increased risk of hypoglycemia or other neuroendocrine problems. A precise event cannot be specified without a detailed model of the system's complete physiology. Moving forward, when dealing with the complexity of several interconnected physiological functions, careful consideration should be given to studying the system biology along with the specific molecular and cellular mechanisms.
Home Literacy Experiences and Their Relationship to Bilingual Preschoolers' Developing English Literacy Abilities: An Initial Investigation.

PURPOSE This study investigated the relationship between home literacy experiences and bilingual preschoolers' early literacy outcomes. METHOD Forty-three Puerto Rican mother-child dyads recruited from Head Start programs in central Pennsylvania participated in this study of home literacy experiences and emerging English literacy abilities. The dyads were grouped according to whether the children had learned Spanish and English from birth (simultaneously; n=28) or Spanish from birth and English in Head Start (sequentially; n=15). Mothers of simultaneous and sequential learners were compared on the value they placed on literacy, press for achievement, the number of reading materials that were available in the home, and how often they read to their child. The children were compared on their scores on the Test of Early Reading Ability-2 (Reid, Hresko, & Hammill, 1991), which was given during the first and second years of their Head Start program. RESULTS Mothers of simultaneous and sequential learners differed with regard to mothers' press for achievement. No differences were found between the two groups with respect to the other measures. When the early literacy abilities of the two groups of children were assessed, all learners had comparable mean emergent reading scores. The mean literacy scores of the entire group of children were significantly lower at Year 2 as compared to Year 1. CLINICAL IMPLICATIONS Although the children experienced literacy activities at home and in Head Start, it appears that children's literacy development would benefit from increased exposure to literacy materials and literacy events during the preschool years.
Detection of Inflammation- and Neoplasia-Associated Alterations in Human Large Intestine Using Plant/Invertebrate Lectins, Galectin-1 and Neoglycoproteins

Commonly, plant and invertebrate lectins are accepted glycohistochemical tools for the analysis of normal and altered structures of glycans in histology and pathology. Mammalian lectins and neoglycoproteins are recent additions to this panel for the detection of lectin-reactive carbohydrate epitopes and glycoligand-binding sites. The binding profiles of these three types of probes were comparatively analyzed in normal, inflamed and neoplastic large intestine. In normal colonic mucosa the intracellular distribution of glycoconjugates and carbohydrate ligand-binding sites in enterocytes reveals a differential binding of lectins with different specificity and of neoglycoproteins to the Golgi apparatus, the rough and smooth endoplasmic reticulum and the apical cell surface. The accessible glycoligand-binding sites and the lectin-reactive carbohydrate epitopes detected by galectin-1 show the same pattern of intracellular location excluding the apical cell surface. Lectin-reactive carbohydrate epitopes detected by plant lectins of identical monosaccharide specificity as the endogenous lectin [Ricinus communis agglutinin-I (RCA-I), Viscum album agglutinin (VAA)], however, clearly differ with respect to their intracellular distribution. Maturation-associated differences and heterogeneity in glycohistochemical properties of epithelial cells and non-epithelial cells (macrophages, dendritic cells, lymphocytes) are found. Dissimilarities in the fine structural ligand recognition of lectins with nominal specificity to the same monosaccharide have been demonstrated for the galactoside-specific lectins RCA-I, VAA and galectin-1 as well as the N-acetylgalactosamine (GalNAc)-specific lectins Dolichos biflorus agglutinin (DBA), soybean agglutinin (SBA) and Helix pomatia agglutinin in normal mucosa and in acute appendicitis. Acute inflammation of the intestinal mucosa found in acute phlegmonous appendicitis is associated with selective changes of glycosylation of mucin in goblet cells mainly of lower and middle crypt segments resulting in an increase of DBA- and SBA-binding sites in the goblet cell population. Appendicitis causes no detectable alteration of neoglycoprotein binding. In contrast, tumorigenesis of colonic adenoma is characterized by increases in lectin-reactive galactose (Gal; Gal-β1, 3-GalNAc), fucose and N-acetylglucosamine moieties and by enhanced presentation of respective carbohydrate ligand-binding capacity. This work reveals that endogenous lectins and neoglycoproteins are valuable glycohistochemical tools supplementing the well-known analytic capacities of plant lectins in the fields of gastrointestinal anatomy and gastroenteropathology.
Residents’ scholarly activity: a cost analysis with regard to its effects on departments

Purpose of review Current financial strain on training departments may have a significantly negative impact on continuing support for residents’ scholarly activity. A cost analysis with regard to residents’ scholarly activity effects on anesthesiology training departments is performed. Recent findings The Accreditation Council for Graduate Medical Education has issued a new outcome-focused scholarly activity requirement. Low scholarly achievement by anesthesiology faculty in the USA has been documented and needs transformation. It is evident that a structured scholarly activity support system is effective. To support such a system, training departments need to support anesthesiology residents’ nonclinical time, which would cost an average of $13 500 per month per resident using nonresident hands-on care providers in operating rooms, resident's meeting attendance in average $1424 per resident per meeting, and faculty mentorship and other infrastructure. It must also be taken into account that missed clinical opportunities by an anesthesiology resident during nonclinical time are an estimated average of 60 cases per month. Summary The importance of resident scholarly activity has never been so or as critical as in the present. Anesthesiology leadership must continue to invest to support resident scholarly activity for the future of the specialty while being mindful of costs incurred.
VALVULAR AND STRUCTURAL HEART DISEASES Original Studies Repeat Percutaneous Mitral Balloon Valvuloplasty for Patients with Mitral Valve Restenosis

Objectives: To determine immediate and long-term clinical outcome, as well prognostic factors in patients who underwent repeat percutaneous mitral balloon valvuloplasty (PMBV). Background: Repeat PMBV may be a method of treatment for symptomatic patients with restenosis after successful initial PMBV, but data regarding its long term safety and efficacy are scarce. Methods: The study group consisted of 67 patients (mean age 52.1 6 10.5 years). All PMBV procedures were performed using the Inoue balloon system. Results: Repeat PMBV resulted in significant increase in MVA from 1.17 6 0.16 cm to 1.63 6 0.22 cm (P < 0.001). Good immediate result (MVA ‡1.5 cm, mitral regurgitation £2) was obtained in 52 (77.6%) patients and was not predicted by any analyzed factors. During follow-up (mean time 4.9 6 2.9 years) six patients died, nine underwent mitral valve replacement, four—third PMBV, and four developed heart failure. The 3-, 5-, and 8-year good functional results (survival free of mitral valve replacement, third PMBV or heart failure ‡ NYHA III) by Kaplan–Meier estimates were 89.3, 75.6, and 52.6%, respectively. These results were significantly superior in patients with good immediate results and echo score <7. In the entire population multivariate Cox regression analysis identified echo score <7 and absence of prior surgical commissurotomy as the independent predictors of event-free survival. Conclusions: Repeat PMBV is safe and provides good immediate results in patients with restenosis after successful first procedure. Long-term results of repeat PMBV are satisfactory and related mainly to the echo score and quality of the procedure. VC 2010 Wiley-Liss, Inc.
Nutritional status and quality of life in current patients with liver cirrhosis as assessed in 2007–2011

Current guidelines recommended adequate nutritional support for patients with liver cirrhosis to improve clinical outcome and quality of life (QOL). However, these evidences were obtained more than 10 years ago when malnutrition prevailed. In recent years, the impact of obesity on liver damage and carcinogenesis has grown. We attempted to elucidate the nutritional state and QOL in present cirrhotics.
Ovarian Endometrioid Adenocarcinoma Coexistent with Benign and Borderline Endometrioid Adenofibroma: A Case Report

A well‐differentiated endometrioid adenocarcinoma coexistent with benign and borderline‐malignant endometrioid adenofibroma was found in the ovary of a 64‐year‐old woman. She had vaginal bleeding caused by simple hyperplasia of the endo‐metrium due to high levels of sex steroid hormones. A FIGO stage la solid ovarian tumor was identified. It was composed of irregularly shaped endometriotic glands with benign and borderline malignant cytologic features embedded in abundant fibromatous stroma. Well‐differentiated malignant epithelium was adjacent to these areas, but fibromatous stroma was not predominant. She was treated by surgery and three cycles of chemotherapy. This paper describes this unusual tumor and reviews the literature.