Miracle-dz/UniFAR-FTUs huggingface dataset:
MisoREST: surgical versus expectant management in women with an incomplete evacuation of the uterus after misoprostol treatment for miscarriage: a randomized controlled trial.

STUDY QUESTION Is curettage more effective than expectant management in case of an incomplete evacuation after misoprostol treatment for first trimester miscarriage? SUMMARY ANSWER Curettage leads to a higher chance of complete evacuation but expectant management is successful in at least 76% of women with an incomplete evacuation of the uterus after misoprostol treatment for first trimester miscarriage. WHAT IS KNOWN ALREADY In 5-50% of the women treated with misoprostol, there is a suspicion of incomplete evacuation of the uterus on sonography. Although these women generally have minor symptoms, such a finding often leads to additional curettage. STUDY DESIGN, SIZE, DURATION From June 2012 until July 2014, we conducted a nationwide multicenter randomized controlled trial (RCT). Women who had had primary misoprostol treatment for miscarriage with sonographic evidence of incomplete evacuation of the uterus were randomly allocated to either curettage or expectant management (1:1), using a web-based application. PARTICIPANTS/MATERIALS, SETTING, METHODS We included 59 women in 27 hospitals; 30 were allocated to curettage and 29 were allocated to expectant management. A successful outcome was defined as sonographic finding of an empty uterus 6 weeks after randomization. MAIN RESULTS AND THE ROLE OF CHANCE Baseline characteristics of both groups were comparable. Empty uterus on sonography or uneventful clinical follow-up was seen in 29/30 women (97%) allocated to curettage compared with 22/29 women (76%) allocated to expectant management (RR 1.3, 95% CI 1.03-1.6) with complication rates of 10% versus 10%, respectively (RR 0.97, 95% CI 0.21-4.4). In the group allocated to curettage, no woman required re-curettage, while two women (6.7%) underwent hysteroscopy (for other or unknown reasons). In the women allocated to expectant management, curettage was performed in four women (13.8%) and three women (10.3%) underwent hysteroscopy. LIMITATIONS, REASONS FOR CAUTION Due to a strong patient preference, mainly for expectant management, the targeted sample size could not be included and the trial was stopped prematurely. WIDER IMPLICATIONS OF THE FINDINGS In women suspected of incomplete evacuation of the uterus after misoprostol, curettage is more effective than expectant management. However, expectant management is equally safe and prevents curettage for most of the women. This finding could further restrain the use of curettage in the treatment of first trimester miscarriage. STUDY FUNDING/COMPETING INTERESTS This study was funded by ZonMw, a Dutch organization for Health Research and Development, project number 80-82310-97-12066. There were no conflicts of interests. TRIAL REGISTRATION NUMBER Dutch Trial Register NTR3310, http://www.trialregister. nl TRIAL REGISTRATION DATE: 27 February 2012. DATE OF FIRST PATIENT'S ENROLMENT 12 June 2012.
Total Antioxidant Capacity and C-Reactive Protein Levels in Patients with Community-Acquired Pneumonia

Results: In the whole study population, the TAC level was inversely correlated with CRP levels and WBC counts (r=-0.648, P=0.0001; r=-0.626, P=0.0001, respectively). Lower TAC and higher MDA levels were found in CAP patients compared with those of controls (P = 0.0001, P = 0.029). Although the mean serum MDA and TAC levels were similar between the groups of PSI class I-III (n=45) and PSI class IV-V (n=22), the radiological scores (2.36±1.23 vs 3.19±1.17) and CRP levels (138.67 ± 63.86 vs 177.14 ± 56.43) were significantly higher in the latter group (P = 0.010 and P=0.005, respectively). Conclusions: Single measurement of serum MDA or TAC levels in CAP patients, in contrast to CRP level measurement, does not seem to predict the severity of disease.
Intracranial aneurysms: detection with gadolinium-enhanced dynamic three-dimensional MR angiography-initial results.

PURPOSE To assess the clinical utility and accuracy of contrast material-enhanced dynamic three-dimensional (3D) T1-weighted magnetic resonance (MR) angiography in the detection of unruptured intracranial aneurysms. MATERIALS AND METHODS A prospective blinded comparison of 3D contrast-enhanced T1-weighted MR angiography with 3D inflow magnetization transfer and tilted optimized nonsaturating excitation (MT TONE) imaging, phase-contrast MR angiography, and conventional digital subtraction angiography (DSA) was performed in 32 consecutive patients. The first dynamic 3D contrast-enhanced T1-weighted acquisition was individually timed after injection of a bolus of gadolinium-based contrast agent to obtain an arterial phase image followed by two sequential venous phase images (three 18-second acquisitions). Two readers independently interpreted and graded the MR images for diagnostic confidence and depiction of aneurysms and subsequently compared them with DSA images. RESULTS Three-dimensional contrast-enhanced T1-weighted MR angiograms depicted all 23 aneurysms detected in 17 patients at DSA (mean size, 6 mm; range, 2-21 mm) with one false-positive result by one reader (sensitivity, 100%; specificity, 94%). MT TONE and phase-contrast images failed to depict one and seven aneurysms, respectively (MT TONE sensitivity of 96% and specificity of 100%, phase-contrast sensitivity of 70% and specificity of 100%). Aneurysm depiction at 3D contrast-enhanced T1-weighted MR angiography was significantly better than that at MT TONE imaging (P <.012), and that with both was significantly superior to that of phase-contrast imaging (P <. 001). Differences in diagnostic confidence in the presence of an aneurysm were not significant between 3D contrast-enhanced T1-weighted and MT TONE imaging (P =.076). CONCLUSION Dynamic 3D contrast-enhanced T1-weighted MR angiography is a fast, efficient, and minimally invasive imaging method with which to diagnose intracranial aneurysms.
Heme oxygenase‐1 modulates the allo‐immune response by promoting activation‐induced cell death of T cells

Heme oxygenase‐1 (HO‐1), which degrades heme into three products (carbon monoxide, free iron, and biliverdin), plays a protective role in many models of disease via its anti‐inflammatory, anti‐apoptotic, and anti‐proliferative actions. Overexpression of HO‐1 has been shown to suppress immune responses and prolong the survival of allografts; however, the underlying mechanism is not clear. We demonstrate two “new” properties of HO‐1 that mediate activation induced cell death (AICD) of allo‐antigen‐responsive murine CD4+ T cells, resulting in immunomodulation. First, it functions in vivo and in vitro to “boost” the proliferative response of CD4+ T cells to allo‐antigens in the early phase of allo‐antigen‐driven immune responses. This “boosting” effect is accompanied with a significant increase of activation markers and IL‐2 production. Second, it exerts a pro‐apoptotic effect in those activated T cells after the initial burst of proliferation. We further show that the AICD effect is mediated through the Fas/CD95‐FasL signal transduction pathway. Correlating with the above‐mentioned findings is the observed prolongation of mouse heart graft survival when HO‐1 is expressed in vivo in both donor and recipient. In conclusion, induction of HO‐1 expression accelerates clonal deletion of peripheral alloreactive CD4+ T cells by promoting AICD, which is presumably a key mechanism for its immunomodulatory effects such as in prolonging the survival of transplanted organs.
An empirical model of global climate – Part 1: A critical evaluation of volcanic cooling

Abstract. Observed reductions in Earth's surface temperature following explosive volcanic eruptions have been used as a proxy for geoengineering of climate by the artificial enhancement of stratospheric sulfate. Earth cools following major eruptions due to an increase in the reflection of sunlight caused by a dramatic enhancement of the stratospheric sulfate aerosol burden. Significant global cooling has been observed following the four major eruptions since 1900: Santa Maria, Mount Agung, El Chichon and Mt. Pinatubo, leading IPCC (2007) to state "major volcanic eruptions can, thus, cause a drop in global mean surface temperature of about half a degree Celsius that can last for months and even years". We use a multiple linear regression model applied to the global surface temperature anomaly to suggest that exchange of heat between the atmosphere and ocean, driven by variations in the strength of the Atlantic Meridional Overturning Circulation (AMOC), has been a factor in the decline of global temperature following these eruptions. The veracity of this suggestion depends on whether sea surface temperature (SST) in the North Atlantic, sometimes called the Atlantic Multidecadal Oscillation, but here referred to as Atlantic Multidecadal Variability (AMV), truly represents a proxy for the strength of the AMOC. Also, precise quantification of global cooling due to volcanoes depends on how the AMV index is detrended. If the AMV index is detrended using anthropogenic radiative forcing of climate, we find that surface cooling attributed to Mt. Pinatubo, using the Hadley Centre/University of East Anglia surface temperature record, maximises at 0.14 °C globally and 0.32 °C over land. These values are about a factor of 2 less than found when the AMV index is neglected in the model and quite a bit lower than the canonical 0.5 °C cooling usually attributed to Pinatubo. This result is driven by the high amplitude, low frequency component of the AMV index, demonstrating that reduced impact of volcanic cooling upon consideration of the AMV index is driven by variations in North Atlantic SST that occur over time periods much longer than those commonly associated with major volcanic eruptions. The satellite record of atmospheric temperature from 1978 to present and other century-long surface temperature records are also consistent with the suggestion that volcanic cooling may have been over estimated by about a factor of 2 due to prior neglect of ocean circulation. Our study suggests a recalibration may be needed for the proper use of Mt. Pinatubo as a proxy for geoengineering of climate. Finally, we highlight possible shortcomings in simulations of volcanic cooling by general circulation models, which are also being used to assess the impact of geoengineering of climate via stratospheric sulfate injection.
Lifetime enhancement routing algorithm for mobile ad hoc networks

In this study, the author investigates the problem of lifetime enhancement of mobile nodes in mobile ad hoc networks. Here, the author uses two metrics namely, residual battery capacity of the node and non-critical node to route the data packets from the source to the destination. The proposed model uses the non-critical node if all the nodes contain residual battery capacity above the threshold value. The proposed model has been simulated using Qualnet Simulator-4.5. The proposed model has compared against the existing algorithms such as minimum total transmission power routing, conditional max–min battery capacity routing and lifetime prediction routing. From the results, the author concludes that the proposed model has reached at the top position in terms of the number of survived nodes, energy saving and number of nodes with zero remaining energy.
Tuberculosis in UK prisoners: a challenge for control

Aims Prisoners include a disproportionate number of those with social and clinical risk factors for tuberculosis and pose a challenge for control. The aim of this study was to investigate the characteristics of prisoners with tuberculosis in order to inform clinical management and control policy. Methods Between 2004 and 2007, 205 patients newly diagnosed as having tuberculosis in prison in the UK identified in national surveillance reports were studied. Isolates from prisoners were tested for susceptibility to first-line antituberculosis drugs and strain typed where possible. Results Prisoners were significantly more likely to be UK-born (47 vs 25%), to be white (33 vs 22%) and to have pulmonary disease (75 vs 56%) than other tuberculosis patients. Pulmonary cases were also more likely to be sputum-smear-positive (69 vs 57%). Over one-third of culture confirmed cases among prisoners were resistant to isoniazid. Less than half (48%) of patients diagnosed as having tuberculosis in prison completed treatment, with a fifth lost to follow-up. Discussion In the UK, imprisonment is an important risk factor for tuberculosis, especially drug-resistant and infectious forms of the disease. The management of tuberculosis among UK prisoners is further complicated by high rates of loss to follow-up care and poor treatment outcomes.
Nonsustained effect of short-term bisphosphonate therapy on bone turnover three years after renal transplantation.

BACKGROUND We recently showed that two doses of 4 mg of zoledronic acid (ZOL) ameliorated the bone loss and improved bone histology within the first six months after kidney transplantation. The aim of the present study was to evaluate whether this early short-term intervention exhibited a sustained bone-sparing effect. METHODS A homogenous group of 20 de novo renal transplant recipients were equally randomized to two infusions of 4 mg of ZOL or placebo at two weeks and three months after engraftment. Patients were followed up for three years by sequential determination of bone densitometry and specific biochemical markers. RESULTS From month six to three years after transplantation, both treatment groups exhibited an improvement of bone mineralization. Femoral neck bone mineral density z-scores increased statistically significantly from -1.3 (2.6) to -0.2 (3.6) in the placebo group and from -1.6 (2.9) to -1.2 (1.9) in the ZOL group (median, range). Biochemical parameters of osteoblast activity such as osteocalcin and bone-specific alkaline phosphatase did not increase significantly in both groups. Osteoprotegerin, a marker of osteoclast inhibition, was significantly elevated over the first six months in the ZOL group, but decreased to similar levels, as in the placebo group, over the next two and a half years. Other markers of osteoclast activity such as c-telopeptide of type 1 collagen, calcitonin, and intact parathyroid hormone were not different between six months and three years in either group. CONCLUSION The early bone-sparing effect of short-term ZOL therapy confers no sustained benefit versus placebo at three year post-transplantation.
A Comparison of PCR and In Vitro Culture for Detection of Tritrichomonas foetus in Bovine Preputial Scrapings

Tritrichomonas foetus is a flagellated anaerobic protozoan responsible for abortions and reproductive failure in cattle worldwide. Bovine trichomoniasis is venereally transmitted from bull to cow. Although testing of breeding animals and use of artificial insemination has helped to control its distribution worldwide, infection rates in beef herds within the USA still range from 5–50% [9]. Cows are infected at conception and will often maintain a pregnancy for 35–150 days before abortion. Infected bulls are asymptomatic and are infected for life [1]. There is no known curative treatment licensed for T. foetus infections for use in cattle in the USA. Typically, infected bulls are culled, and diagnosis made on an individual animal basis by observing motile trophozoites in washes from the prepuce of the bull or from short-term cultures of preputial scrapings. Current diagnostic recommendations include triplicate samples from bulls resulting in a 95–99% sensitivity using the commercially available InPouch TF culture system (Biomed Diagnostics, San Jose, CA) [1]. False positives may however occur, by contamination of samples with intestinal (coprophilic) trichomonad protozoa, which may be mistaken for T. foetus [10,13]. In previous reports, intestinal trichomonads instead of T. foetus have occasionally been found in virgin bull samples submitted for culture [3,4]. Without additional microscopic or molecular confirmation for T. foetus, some bulls are probably culled unnecessarily. Comparatively little is known about the bovine intestinal trichomonads and it is unclear what infection rates exist in bulls within the USA. In an attempt to decrease the time spent on diagnostic culturing of T. foetus, and to confirm parasite identification, efforts have been made to establish DNA-based diagnostic methods. Several primer sets have been designed based on PCR amplification of a portion of the ribosomal RNA gene, specifically the 5.8S ribosomal RNA and flanking internal transcribed spacer regions ITS1 and ITS2 [7,8,11]. The purpose of this study was to compare a single PCR assay detecting T. foetus to the standard culture from preputial collections using the InPouch TF culture system.
Maternal serum screening for Down syndrome in pregnancies conceived by intra‐uterine insemination

The purpose of our study was to assess the influence of intra‐uterine insemination (IUI) on the results of maternal serum Down syndrome screening. 43 women with IUI pregnancies and 4507 healthy women who conceived were studied. Ovulation in IUI pregnancies was induced by clomiphene and/or human menopausal gonadotrophin (hMG). Maternal serum levels of free β‐human chorionic gonadotrophin (hCG) and alpha‐fetoprotein (AFP) were measured for Down syndrome screening. It was considered screen‐positive when the risk of Down syndrome was 1 in 270 or greater in the second trimester. The value of maternal serum AFP was significantly lower in the IUI group (median=0.760 MoM) than in the control group (median=1.050 MoM). However, the value of free β‐hCG was not significantly different between the two groups. The positive rate of maternal serum Down syndrome in IUI pregnancies was similar to that of the control group. Our results indicate that IUI pregnancy may be associated with a lower level of AFP, although the mechanism for this difference remains unknown. Copyright © 1999 John Wiley & Sons, Ltd.
Gradual development of a genome‐wide H3‐K9 trimethylation pattern in paternally derived pig pronucleus

The cytoplasm of a mature oocyte contains many protein complexes that are programmed to restructure incoming sperm chromatins on fertilization. Of the complicated biochemical events that these functional machineries control, the most impressive and important is epigenetic reprogramming. Despite its importance in epigenetic resetting, or “de‐differentiation,” of gamete genomes back to an incipient status, the mechanisms of epigenetic reprogramming do not seem to be conserved among mammals. Here, we report that, unlike in the mouse, the pig sperm‐derived pronucleus is markedly trimethylated at lysine 9 of histone H3 (H3‐m3K9), which might be associated with preservation of paternally derived cytosine methylation in pig zygotes. The male H3‐m3K9 pattern is gradually established during pronucleus development, and this process occurs independently of DNA replication. Considering these unique epigenetic features, the pig zygote is, we believe, suited to serve as another model of epigenetic reprogramming that is antithetical to the well‐characterized mouse model. Developmental Dynamics 236:1509–1516, 2007. © 2007 Wiley‐Liss, Inc.
Comparison of inflammatory responses to genetically engineered hypoallergenic derivatives of the major birch pollen allergen bet v 1 and to recombinant bet v 1 wild type in skin chamber fluids collected from birch pollen-allergic patients.

BACKGROUND Nearly 60% of birch pollen-allergic patients react exclusively to Bet v 1. With use of the skin blister model, previously only established for installation of crude allergens, we have for the first time characterized the inflammatory response in vivo to recombinant birch pollen allergen, rBet v 1, molecules (rBet v 1 wild type, fragments and trimer). OBJECTIVE Our purpose was to examine whether challenge with rBet v 1 derivatives (fragments and trimer) compared with rBet v 1 wild type differs with respect to influx of activated eosinophils and detectable levels of cytokines/chemokines related to allergic inflammation in skin chambers applied to birch pollen-allergic patients. METHODS The skin blister chambers were filled for 2 hours with rBet v 1, the derivatives or PBS and heparin (negative control). The fluids were analyzed after 2 and 8 hours. The number of eosinophils was determined and EG2 and CD69 expression measured by flow cytometry. Cytokines and mediators were analyzed by ELISA and RIA techniques. RESULTS Comparable numbers of eosinophils were recruited to the chambers challenged with rBet v 1 molecules, but the eosinophils from the rBet v 1 wild-type challenged chambers showed a significantly higher expression of CD69. The levels of eotaxin were similar in all 4 chambers, whereas rBet v 1 wild type induced significantly higher levels of histamine, eosinophil cationic protein, and GM-CSF than the derivatives did. Recombinant Bet v 1 trimer elicited significantly lower levels of IL-4 compared with rBet v1 wild type. CONCLUSION Genetically engineered hypoallergenic rBet v 1 derivatives recruited eosinophils analogously with rBet v 1 wild type. However, the derivatives exhibited a lower capacity to activate eosinophils and to release proinflammatory mediators and T helper type 2-derived cytokines. The derivatives may therefore be candidate molecules for specific immunotherapy of birch pollen allergy with reduced risk of inducing allergenic or inflammatory side effects.