Miracle-dz/UniFAR-FTUs huggingface dataset:
A need for otolaryngology education among primary care providers

Objective : Otolaryngic disorders are very common in primary care, comprising 20–50% of presenting complaints to a primary care provider. There is limited otolaryngology training in undergraduate and postgraduate medical education for primary care. Presented at the American Academy of Otolaryngology – Head & Neck Surgery 2011 Annual Meeting, San Francisco, USA, on Tuesday, September 13, 2011. Continuing medical education may be the next opportunity to train our primary care providers (PCPs). The objective of this study was to assess the otolaryngology knowledge of a group of PCPs attending an otolaryngology update course. Methods : PCPs enrolled in an otolaryngology update course completed a web-based anonymous survey on demographics and a pre-course knowledge test. This test was composed of 12 multiple choice questions with five options each. At the end of the course, they were asked to evaluate the usefulness of the course for their clinical practice. Results : Thirty seven (74%) PCPs completed the survey. Mean knowledge test score out of a maximum score of 12 was 4.0±1.7 (33.3±14.0%). Sorted by area of specialty, the mean scores out of a maximum score of 12 were: family medicine 4.6±2.1 (38.3±17.3%), pediatric medicine 4.2±0.8 (35.0±7.0%), other (e.g., dentistry, emergency medicine) 4.2±2.0 (34.6±17.0%), and adult medicine 3.9±2.1 (32.3±17.5%). Ninety one percent of respondents would attend the course again. Conclusion : There is a low level of otolaryngology knowledge among PCPs attending an otolaryngology update course. There is a need for otolaryngology education among PCPs.
Transcriptional repression of plasma cell differentiation is orchestrated by aberrant over‐expression of the ETS factor SPIB in Waldenström macroglobulinaemia

In Waldenström macroglobulinaemia (WM), the mechanism(s) responsible for repression of B‐cell differentiation remains unknown. We found that expression of SPIB and ID2 were significantly increased and decreased, respectively, in WM lymphoplasmacytic cells (LPC). Ectopic expression of SPIB in healthy donor CD19+ cells inhibited plasmacytic differentiation in conjunction with decreased transcription of IRF4 and XBP1 spliced form. In primary WM LPC, knock‐down of SPIB induced plasmacytic differentiation in conjunction with increased transcription of PRDM1, XBP1 spliced form, IRF4 and ID2. Knock‐down of SPIB also led to decreased BCL2 expression. Given that SPIB is a direct target of POU2AF1 (OBF1) in complex with POU2F2 or POU2F1, we next examined their expression in WM LPC. POU2F2 transcription, as well as POU2F2 and POU2AF1 protein expression was higher in WM LPC. Ectopic expression of POU2F2 in healthy donor CD19+ cells induced transcription of SPIB and suppressed transcription of PRDM1 and IRF4. Chromatin immunoprecipitation analysis in BCWM.1 WM cells confirmed binding of POU2F2 and POU2AF1 in SPIB and ID2 promoters. These findings establish a molecular hierarchy among POU2F2, SPIB and ID2 during B‐cell differentiation, and suggest that aberrant expression of these transcription factors plays an important role in arresting plasmacytic differentiation in WM.
Genetic parameters among weight, prolificacy, and wool traits of Columbia, Polypay, Rambouillet, and Targhee sheep.

Genetic parameters for Columbia, Polypay, Rambouillet, and Targhee sheep were estimated using REML with animal models for prolificacy, weight, and wool traits. All bivariate analyses included a covariance between additive genetic effects for the two traits plus appropriate additional covariances. Number of observations by breed ranged from 5,140 to 7,095 for prolificacy traits, from 7,750 to 9,530 for weight traits, and from 4,603 to 34,746 for wool traits. Heritability estimates ranged from . 03 to . 11 for prolificacy traits (litter size at birth and litter size at weaning), from . 09 to . 26 for weight traits (birth weight and average daily gain), and from . 25 to . 53 for wool traits (fleece weight, fleece grade and staple length). Estimates of direct genetic correlations among prolificacy and among weight traits were positive and ranged from . 58 to 1.00 and . 18 to 1.00, respectively. Estimates of direct genetic correlation between fleece weight and staple length were positive (.50 to .70) but were negative between fleece weight and fleece grade (-.60 to -.34) and between staple length and fleece grade (-.72 and -.40). Prolificacy and wool traits were essentially uncorrelated. Weight and prolificacy traits were slightly positively correlated. Weight traits had a moderate positive direct genetic correlation with fleece weight and staple length, but were uncorrelated with fleece grade. These estimates of genetic parameters between prolificacy, weight, and wool traits can be used to construct multiple-trait selection indexes for dual-purpose sheep.
Assessment of the biomechanical properties of the cornea with the ocular response analyzer in normal and keratoconic eyes.

PURPOSE To compare hysteresis, a novel measure of ocular rigidity (viscoelasticity) in normal and keratoconic eyes. METHODS The study consisted of 207 normal and 93 keratoconic eyes. Eyes were diagnosed as keratoconic based on clinical examination and corneal topography. The hysteresis was measured by the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments, Buffalo, NY). The data were recorded by Generation 3 software for the ORA. Central corneal thickness (CCT) was measured with a handheld ultrasonic pachymeter in the midpupillary axis. RESULTS The mean hysteresis was 10.7 +/- 2.0 (SD) mm Hg (range, 6.1-17.6) in normal eyes compared with 9.6 +/- 2.2 mm Hg (range, 4.7-16.7) in keratoconic eyes. The difference was statistically significant (P < 0.0001, unpaired t-test). Mean CCT in the normal and keratoconic eyes was 545.0 +/- 36.4 microm (range, 471-650) and 491.8 +/- 54.7 microm (range, 341-611), respectively; the difference was significant (P < 0.0001, unpaired t-test). CONCLUSIONS Hysteresis was significantly higher in normal than in keratoconic eyes. It may be a useful measurement in addition to CCT, when assessing ocular rigidity, and may be of particular importance when trying to correct intraocular measurements for increased or decreased ocular rigidity. Long-term studies of change in hysteresis may provide information on the progression of keratoconus.
The therapeutic efficacy of endoscopic optic nerve decompression and its effects on the prognoses of 96 cases of traumatic optic neuropathy

BACKGROUND: Traumatic optic neuropathy (TON) is an important cause of severe loss of vision due to blunt or penetrating head trauma. The pathogenesis of TON remains unclear, and there are several potential causes for the observed loss in vision. Endoscopic optic nerve decompression (EOND) has been reported to improve the visual prognosis in TON cases, but its efficacy remains controversial. It is important to investigate the therapeutic efficacy of EOND in the treatment of TON and to evaluate the relevant prognostic factors. METHODS: A retrospective study was conducted to analyze the clinical characteristics and prognoses of 96 TON cases. The &khgr;2 test and multiple logistic regression analyses were used to evaluate potential prognostic factors. RESULTS: The overall rate of EOND effectiveness was 40.6% (39 of 96). A significantly higher effective rate (83.3%) was observed for patients with light perception compared with those without light perception (26.4%, p < 0.05). Univariate and multiple logistic regression analyses identified three variables (no light perception, undergoing EOND 3 days after trauma, and hemorrhage within the ethmoid and/or sphenoid sinus) that were significantly associated with unrecovered visual acuity. Age, loss of consciousness, optic canal fracture, preoperative steroid megadose treatment, and optic nerve sheath incision were all factors that showed no significant correlation with therapeutic efficacy. However, patients with fractures in a single medial wall of the optic canal appeared to have better prognoses than patients with multiple fractures or those with a single fracture in a lateral wall. CONCLUSIONS: The overall therapeutic efficacy of EOND for the treatment of TON is far from satisfactory, especially for patients without light perception. The factors that impact TON prognoses are complex and may be interrelated. The indication for EOND must be individualized. LEVEL OF EVIDENCE: III, epidemiological study.
Cognitive evolution in natalizumab-treated multiple sclerosis patients

Background Cognitive dysfunction affects up to 65% of multiple sclerosis (MS) patients and progresses over time. Natalizumab has been shown to be superior to placebo in preserving cognition for the first two years of therapy. Objectives The objectives of this study are to understand the impact of natalizumab on cognition beyond two years of therapy and to investigate whether baseline characteristics are predictive of clinical response. Methods This is a single-center, 24-month, observational study. Sixty-three patients treated with natalizumab were assessed prior to monthly infusions using a Cogstate battery and the Symbol Digit Modalities Test (SDMT). Patient demographics were collected at baseline. A linear mixed model was conducted with duration of natalizumab therapy as a between-subjects factor (≤2 or >2 years), assessment as a within-subjects factor, and Multiple Sclerosis Severity Score (MSSS) as a covariate. Results Aside from the MSSS (p = 0.0074), the two groups were identical. No patient showed evidence of sustained cognitive deterioration over the 24-month period. Baseline parameters including impaired cognition did not influence the trajectory of cognitive change over 24 months. Conclusions Our results suggest that natalizumab preserves cognition following four to seven years of continuous therapy. This occurs irrespective of baseline characteristics, including impaired cognition.
The role of 68Ga-DOTA-TATE PET/CT scanning in the evaluation of patients with multiple myeloma: preliminary results

Objective In this observational pilot study, we aimed to evaluate the role of gallium-68-labelled DOTA-TATE (68Ga-TATE) PET/computed tomography (CT) scanning in patients with multiple myeloma (MM), considering previous promising results obtained from conventional somatostatin receptor scintigraphy with 111In pentetreotide. Materials and methods Twenty-one patients with a diagnosis of MM were prospectively included in this study: eight patients were referred for initial staging and 13 patients for restaging purpose. Both fluorine-18 fluorodeoxyglucose (18F-FDG) and TATE PET/CT scanning were performed in all patients. Results All patients had one or more PET-positive lesion on either 18F-FDG or TATE scans. Six patients had an additional diffusely increased bone marrow activity on 18F-FDG scans, five of whom also had a concordant bone marrow appearance on TATE scans. Each PET set (either 18F-FDG or TATE) was positive in 19 patients. There was a discordant result in four (19%) patients between 18F-FDG and TATE scans. 18F-FDG scans showed 112 lesions (86 TATE-positive; 26 TATE-negative) in 19 patients, whereas TATE scans showed 108 lesions (86 18F-FDG-positive; 22 18F-FDG-negative) in 19 patients. No significant difference was found between the two modalities in terms of lesion numbers detected (P=0.67). However, the presence of diffuse bone marrow uptake of TATE seems to be a predicting factor for the overall survival (P=0.033, hazard ratio: 15.2 and 95% confidence interval: 1.2–185.5). Conclusion TATE PET/CT seems to be an alternative imaging modality and may play a complementary role in MM management, at least by providing a different pathobiological insight into the disease.
INTERACTION OF MYCOPHENOLATE MOFETIL AND HLA MATCHING ON RENAL ALLOGRAFT SURVIVAL

Introduction. The importance of HLA matching for renal transplantation outcomes has been appreciated for several decades. It has been hypothesized that as pharmacologic immunosuppression becomes stronger and more specific, the impact of HLA matching may be vanishing. Mycophenolate Mofetil (MMF) has been demonstrated to both decrease acute rejection and improve three-year graft survival. It is possible that with new immunosuppressive regimens containing MMF the relative effect of HLA matching may be altered. To determine the relative impact of HLA matching in patients on MMF we undertook an analysis of the United States Renal Transplant Data Registry (USRDS). Methods. All primary, solitary renal transplants registered at the USRDS between January 1995 and June 1997, on initial immunosuppression that included either MMF or AZA were followed until June 1998. Primary study end points were graft and patient survival. Kaplan-Meier analysis was performed to compare AZA vs. MMF treated patients by HLA mismatch. Cox proportional hazard models were used to investigate the interaction between HLA mismatch and AZA versus MMF therapy on the study endpoints. All multivariate analyses were corrected for 13 potential confounding pretransplant variables including intention to treat immunosuppression. Results. A total of 19,675 patients were analyzed (8,459 on MMF and 11,216 on AZA). Overall three year graft survival was higher in the MMF group when compared to the AZA group (87% vs. 84% respectively P <0.001). For both AZA and MMF three-year graft survival improved with fewer HLA donor-recipient mis-matches. Comparing zero antigen mismatches to six antigen mismatches, the relative improvement was comparable for both patients on AZA (92.4% vs. 80.6%) and MMF (95.2% vs. 82.9%). By Cox proportional hazard model the relative risk for graft loss decreased significantly in both the AZA and MMF treated patients with increased HLA matching. Conclusion. The use of MMF does not obviate the benefits of HLA matching, while HLA matching does not minimize the benefits of MMF on long term graft survival. Our study would suggest that HLA matching and MMF therapy are additive factors in decreasing the risk for renal allograft loss.
Mega‐Analysis of Meta‐Analysis: An Examination of Meta‐Analysis with an Emphasis on Once‐Daily Aminoglycoside Comparative Trials

Meta‐analysis is increasingly performed to try and answer clinical questions around which controversy exists. We performed meta‐analyses using three different methods as examples to illustrate problems and points to consider when doing such work. The questions of interest were comparing frequency of nephrotoxicity and clinical effectiveness with once‐daily aminoglycoside regimens versus multiple‐daily dose aminoglycoside regimens. Inclusion and exclusion criteria were established. Studies were obtained from literature searches, and included published studies and abstracts. The overall odds ratio (95% confidence interval) for nephrotoxicity and clinical effectiveness metaanalyses of these studies using the Mantel‐Haenszel‐Peto method were 0.70 (0.51–0.94, p = 0.042) and 0.79 (0.59–1.07, p = 0.09), respectively. Analyzing the data by Fisher's combined test and the Mean‐P method showed agreement with the other methods' conclusions for nephrotoxicity but not for clinical effectiveness. Meta‐analysis is not an exact procedure and contains various problems and inconsistencies. Combining studies of poor quality is not ideal for answering unresolved clinical questions.
The effects and after effects of the α2-adrenoceptor antagonist idazoxan on mood, memory and attention in normal volunteers

Idazoxan, an α 2-adrenoceptor antagonist, is an effective antidepressant with a mode of action different from that of conventional antidepressants. As it is used as an antidepressant it is important to know whether there are any unwanted CNS side effects. Study of its effects will also provide information on the relationship between noradrenergic function and mood and performance. Twelve normal male volunteers who were given the drug (40 mg orally three times daily for 21 days) were compared with 12 matched controls. A computerized test battery was used to assess mood and various aspects of memory and attention. Many of the tests of memory and attention in the battery have been widely used over the last 20 years, and in addition two new selective attention tasks were included. The subjects were tested 3 days before starting the drug, on days 3 and 17 while on the drug, and after they had stopped taking the drug (4 days after and 24 days after). Control subjects followed a similar testing schedule. The results showed that the drug had no effect on mood, logical reasoning, retrieval from semantic memory or sustained attention. However, the drug did improve one aspect of selective attention (the place repetition effect), although this effect was only observed on the third day on the drug. Overall, the results suggest that idazoxan produces selective performance improvements, and that the measures of selective attention used here may be more sensitive indicators of drug effects than some of the traditional tasks currently in use.
Modeling the Dark Current Non-Uniformity of Image Sensors With GEANT4

The 3D Monte Carlo transport code GEANT 4 was used to simulate the Dark Current Non Uniformity of image sensors. The method includes three different physical processes: the Coulombic scattering, the nuclear elastic interaction and the nuclear inelastic interaction. The dark current distribution is directly deduced from the damage distribution according to the Universal Damage Factor of Srour (UDF). Comparisons have been performed with experimental measurements made on two CMOS Image Sensors (JADE from E2 V and HAS2 from ON SEMICONDUCTOR) irradiated with protons of various energies ranging from 30 MeV to 185 MeV. Despite the simplifying assumptions of the model, the calculations are demonstrated to be in quite good agreement with experimental data.
National and ethnic mutation databases: recording populations' genography

Genetic databases are gradually assuming an increasing importance in all areas of health care. The national and ethnic mutation databases (NEMDBs) are continuously updated mutation depositories, recording extensive information over the described genetic heterogeneity of an ethnic group or population. Together with the central and locus‐specific databases, those resources not only enhance awareness of the various genetic disorders but also facilitate the provision of genetic services and provide useful insights into the genographic history of human populations. Fifteen independent NEMDBs devoted to the documentation of the extant genetic heterogeneity in various population groups within 57 different countries were assessed; 13 of the NEMDBs were fully functional. The contents of the 13 fully functional NEMDBs were thoroughly analyzed for the presence or absence of 39 criteria, pertaining database general information, operating platform, data source and submission, and querying capacity. This study provides a strong case for uniformity of data to make the NEMDBs content maximally useful. In this direction, a hypothetical content for the ideal NEMDB is derived, which is currently being incorporated in an upgraded version of the ETHNOS NEMDB development and curation software, as well as a community structure that would enhance the chances of mutation frequency capture and documentation in human populations. The ultimate goal is that interested parties and granting bodies will assist in achieving the vision of a comprehensive resource that collects and displays all population‐specific genetic information discovered. Hum Mutat 27(9), 879–887, 2006. © 2006 Wiley‐Liss, Inc.
Prevalence, pathogenic capability, virulence genes, biofilm formation, and antibiotic resistance of Listeria in goat and sheep milk confirms need of hygienic milking conditions

Abstract Goat and sheep milk is consumed by human populations throughout the world; as a result, it has been proposed as an alternative, nutrient-rich milk to feed infants allergic to cow’s milk. Unfortunately, potentially harmful bacteria have not been thoroughly tested in goat or sheep milk. Listeria monocytogenes is a harmful bacterium that causes adverse health effects if ingested by humans. The purpose of this study was to estimate the prevalence and characterize the phenotype, genotype, virulence factors, biofilm formation, and antibiopotential of Listeria isolated from the milk of goat and sheep. Udder milk samples were collected from 107 goats and 102 sheep and screened for mastitis using the California mastitis test (CMT). Samples were then examined for the presence of pathogenic Listeria spp; if detected, the isolation of pathogenic Listeria (L. monocytogenes and Listeria ivanovii) was completed using isolation and identification techniques recommended by the International Organization for Standards (ISO 11290-1, 1996), in addition to serological, in vitro and in vivo pathogenicity tests. The isolates were subjected to PCR assay for virulence associated genes (hlyA, plcA, actA, and iap). Pathogenic Listeria spp. were isolated from 5·6% of goat and 3·9% sheep milk samples, with 33·3 and 25% of these selected samples respectively containing L. monocytogenes. The results of this study provide evidence of the low-likelihood of contamination leading to the presence of L. monocytogenes in raw goat and sheep milk; however, this study also confirmed a strong in vitro ability for biofilm formation and pathogenic capability of L. monocytogenes if discovered in the milk. L. monocytogenes may be present in goat and sheep milk and in order to reduce the exposure, hygienic milking conditions must be employed for the milk to be considered a safe alternative for human consumption.
Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: experience with Rifaximin.

AIM To estimate the prevalence of small intestinal bacterial overgrowth (SIBO) in our geographical area (Western Sicily, Italy) by means of an observational study, and to gather information on the use of locally active, non-absorbable antibiotics for treatment of SIBO. METHODS Our survey included 115 patients fulfilling the Rome II criteria for diagnosis of irritable bowel syndrome (IBS); a total of 97 patients accepted to perform a breath test with lactulose (BTLact), and those who had a positive test, received Rifaximin (Normix, Alfa Wassermann) 1200 mg/d for 7 d; 3 wk after the end of treatment, the BTLact was repeated. RESULTS Based on the BTLact results, SIBO was present in about 56% of IBS patients, and it was responsible for some IBS-related symptoms, such as abdominal bloating and discomfort, and diarrhoea. 1-wk treatment with Rifaximin turned the BTLact to negative in about 50% of patients and significantly reduced the symptoms, especially in those patients with an alternated constipation/diarrhoea-variant IBS. CONCLUSION SIBO should be always suspected in patients with IBS, and a differential diagnosis is done by means of a "breath test". Rifaximin may represent a valid approach to the treatment of SIBO.