Miracle-dz/UniFAR-FTUs huggingface dataset:
Interventions in hospitalised patients with cancer: the importance of impending death awareness

Objectives Burdensome and futile interventions with the aim of prolonging life should be avoided in dying patients. However, current clinical practice has hardly been investigated. We examined the number and type of diagnostic and therapeutic medical interventions in hospitalised patients with cancer in their last days of life. In addition, we investigated if physician awareness of impending death affected the use of these interventions. Methods Questionnaire study and medical record study. Attending physicians of patients who died in a university hospital between January 2010 and June 2012 were asked whether they had been aware of the patient’s impending death. The use of diagnostic and therapeutic interventions and medications was assessed by studying patients’ charts. We included 131 patients. Results In the last 72 and 24 hours of life, 59% and 24% of the patients received one or more diagnostic interventions, respectively. Therapeutic interventions were provided to 47% and 31%. In the last 24 hours of life, patients received on average 5.8 types of medication. Awareness of a patient’s impending death was associated with a significant lower use of diagnostic interventions (48% vs 69% in the last 72 hours; 11% vs 37% in the last 24 hours) and several medications that potentially prolong life (eg, antibiotics and cardiovascular medication). Conclusions Many patients with cancer who die in hospital receive diagnostic and therapeutic interventions in the last days of life of which their advantages are questionable. To improve end-of-life care, medical care should be adapted.
A new cadinane sesquiterpenoid glucoside with cytotoxicity from Abelmoschus sagittifolius

Abstract A new cadinane sesquiterpenoid glucoside, 2β,7,3-trihydroxycalamenene 3-O-β-d-glucoside (1) together with six known compounds, N-(p-trans-coumaroyl)-N-methyl tyramine (2), Cleomiscosin A (3), 9,12,13-trihydroxy-10,15-heptadecadienoic acid (4), Cytochalasin B (5), Marmesinin (6) and N-(p-trans-coumaroyl) tyramine (7) were obtained from the stem bark of Abelmoschus sagittifolius. The new structure of compound 1 was elucidated by analysing its 1H and 13C-NMR, 1H-1H COSY, HSQC, HMBC, NOESY and HR-ESI-MS spectra. Compounds 1–7 showed moderate cytotoxicity against Hela and HepG-2 human cancer cell lines.
2-Hydroxyoleic acid-inserted liposomes as a multifunctional carrier of anticancer drugs

Abstract Studies have shown that insertion of oleic acid into lipid bilayers can modulate the membrane properties of liposomes so as to improve their function as drug carriers. Considering that 2-hydroxyoleic acid (2OHOA), a potential antitumor agent currently undergoing clinical trials, is a derivative of oleic acid, we explored the possibility of developing 2OHOA-inserted liposomes as a multifunctional carrier of antitumor drugs in the present study. The insertion of 2OHOA into lipid bilayers was confirmed by surface charge determination and differential scanning calorimetry. 2OHOA insertion greatly decreased the order of dimyristoylphosphatidylcholine packing, produced a nanosized (<100 nm) dispersion, and improved the colloidal stability of liposomes during storage. Moreover, 2OHOA-inserted liposome forms exhibited greater growth inhibitory activity against cancer cells compared with free 2OHOA, and the growth-inhibitory activity of liposomal 2OHOA was selective for tumor cells. 2OHOA insertion greatly increased the liposome-incorporated concentration of hydrophobic model drugs, including mitoxantrone, paclitaxel, and all-trans retinoic acid (ATRA). The in vitro anticancer activity of ATRA-incorporated/2OHOA-inserted liposomes was significantly higher than that of ATRA-incorporated conventional liposomes. In a B16-F10 melanoma syngeneic mouse model, the tumor growth rate was significantly delayed in mice treated with ATRA-incorporated/2OHOA-inserted liposomes compared with that in the control group. Immunohistochemical analyses revealed that the enhanced antitumor activity of ATRA-incorporated/2OHOA-inserted liposomes was due, at least in part, to increased induction of apoptosis. Collectively, our findings indicate that 2OHOA-inserted liposomes exhibit multiple advantages as antitumor drug carriers, including the ability to simultaneously deliver two anticancer drugs – 2OHOA and incorporated drug – to the tumor tissue.
African Americans and Hospice Care: A Culture-Centered Exploration of Enrollment Disparities

ABSTRACT Over the past decade, scholars and practitioners have called for efforts to reduce disparities in the cost and quality of end-of-life care; a key contributor to these disparities is the underuse of hospice care by African American patients. While previous studies have often relied on interviewing minority individuals who may or may not have been terminally ill and of whom few were using hospice care services, this essay draws upon the culture-centered approach to report the findings of a grounded theory analysis of 39 interviews with 26 African American hospice patients (n = 10) and lay caregivers (n = 16). Participants identified several barriers to hospice enrollment and reported how they were able to overcome these barriers by reframing/prioritizing cultural values and practices, creating alternative goals for hospice care, and relying on information obtained outside the formal health system. These findings have implications for understanding hospice experiences, promoting hospice access, and improving end-of-life care.
Multimycotoxin and fungal analysis of maize grains from south and southwestern Ethiopia

ABSTRACT The natural occurrence of fungi, mycotoxins and fungal metabolites was investigated in 100 samples of maize grains collected from south and southwestern Ethiopia in 2015. The maize samples were contaminated by Fusarium, Aspergillus and Penicillium species. Using liquid chromatography tandem mass spectrometry 127 secondary metabolites were analysed. Zearalenone was the most prevalent mycotoxin, occurring in about 96% of the samples. Zearalenone sulfate was the second most prevalent, present in 81% of the samples. Fumonisin B1 was detected in 70% of the samples with a mean level of 606 μg kg−1 in positive samples, while FB2, FB3 and FB4 were detected in 62%, 51% and 60% of the maize samples with mean levels of 202, 136 and 85 μg kg−1, respectively. Up to 8% of the samples were contaminated with aflatoxins, with a maximum level of aflatoxin B1 of 513 μg kg−1. Results were higher than earlier reports for maize from Ethiopia.
Urinary LRRK2 phosphorylation predicts parkinsonian phenotypes in G2019S LRRK2 carriers

Objective: To test whether phosphorylated Ser-1292 LRRK2 levels in urine exosomes predicts LRRK2 mutation carriers (LRRK2+) and noncarriers (LRRK2−) with Parkinson disease (PD+) and without Parkinson disease (PD−). Methods: LRRK2 protein was purified from urinary exosomes collected from participants in 2 independent cohorts. The first cohort included 14 men (LRRK2+/PD+, n = 7; LRRK2−/PD+, n = 4; LRRK2−/PD−, n = 3). The second cohort included 62 men (LRRK2−/PD−, n = 16; LRRK2+/PD−, n = 16; LRRK2+/PD+, n = 14; LRRK2−/PD+, n = 16). The ratio of Ser(P)-1292 LRRK2 to total LRRK2 was compared between LRRK2+/PD+ and LRRK2− in the first cohort and between LRRK2 G2019S carriers with and without PD in the second cohort. Results: LRRK2+/PD+ had higher ratios of Ser(P)-1292 LRRK2 to total LRRK2 than LRRK2−/PD− (4.8-fold, p < 0.001) and LRRK2−/PD+ (4.6-fold, p < 0.001). Among mutation carriers, those with PD had higher Ser(P)-1292 LRRK2 to total LRRK2 than those without PD (2.2-fold, p < 0.001). Ser(P)-1292 LRRK2 levels predicted symptomatic from asymptomatic carriers with an area under the receiver operating characteristic curve of 0.844. Conclusion: Elevated ratio of phosphorylated Ser-1292 LRRK2 to total LRRK2 in urine exosomes predicted LRRK2 mutation status and PD risk among LRRK2 mutation carriers. Future studies may explore whether interventions that reduce this ratio may also reduce PD risk.
Beta blocker use correlates with better overall survival in metastatic melanoma patients and improves the efficacy of immunotherapies in mice

ABSTRACT Immunotherapy has expanded treatment options for cancers with historically poor outcomes, yet a significant proportion of patients still fail to achieve durable clinical benefit. We defined the contribution of β-adrenergic receptor (βAR) signaling, a component of the stress response, on success of immunotherapy for melanoma since the use of antagonists (β-blockers) is associated with improved clinical outcomes in some cancers. We show that metastatic melanoma patients who received immunotherapy had improved overall survival if they also received pan β-blockers. This retrospective analysis is reinforced by results showing that βAR blockade enhances the control of murine melanoma growth by anti-(α)PD-1 checkpoint blockade. However, this effect was most significant when β-blocker was combined with dual αPD-1 + high dose interleukin-2 therapy and was reproduced by selective blockade of β2ARs. These results identify a novel strategy that can be quickly introduced to potentially increase the number of patients who benefit from immune-based therapies.
Endomorphins potentiate acid‐sensing ion channel currents and enhance the lactic acid‐mediated increase in arterial blood pressure: effects amplified in hindlimb ischaemia

Chronic limb ischaemia, characterized by inflammatory mediator release and a low extracellular pH, leads to acid‐sensing ion channel (ASIC) activation and reflexively increases mean arterial pressure; endomorphin release is also increased under inflammatory conditions. We examined the modulation of ASIC currents by endomorphins in sensory neurons from rats with freely perfused and ligated femoral arteries: peripheral artery disease (PAD) model. Endomorphins potentiated sustained ASIC currents in both groups of dorsal root ganglion neurons, independent of mu opioid receptor stimulation or G protein activation. Intra‐arterial administration of lactic acid (to simulate exercising muscle and evoke a pressor reflex), endomorphin‐2 and naloxone resulted in a significantly greater pressor response than lactic acid alone, while administration of APETx2 inhibited endomorphin's enhancing effect in both groups. These results suggest a novel role for endomorphins in modulating ASIC function to effect lactic acid‐mediated reflex increase in arterial pressure in patients with PAD.
Actuarial aging rate is not constant within the human life span.

It is often believed that the mortality intensity in the modern human population undergoes an exponential growth after 40 years, i.e. the actuarial aging rate is regarded to be constant after 40 years. To check this assumption we have calculated local aging rate values for 13 age ranges (within the interval of 30-92 years) for the male and female population of 48 states of the US (1969-1971). It was found that generally the male aging rate is not constant but lowers monotonically with time, while for females the aging rate has a pronounced approximately-shaped character with a minimum in the range of 45-60 years and a maximum within the range of 70-80 years. The results obtained are a warning to those who boldly use Gompertz or Gompertz-Makeham formulas when describing human aging on the population level.
Bottom-Up and Top-Down Factors Differentially Influence Stimulus Representations Across Large-Scale Attentional Networks

Visual attention is thought to be supported by three large-scale frontoparietal networks: the frontoparietal control network (FPCN), the dorsal attention network (DAN), and the ventral attention network (VAN). The traditional view is that these networks support visual attention by biasing and evaluating sensory representations in visual cortical regions. However, recent evidence suggests that frontoparietal regions actively represent perceptual stimuli. Here, we assessed how perceptual stimuli are represented across large-scale frontoparietal and visual networks. Specifically, we tested whether representations of stimulus features across these networks are differentially sensitive to bottom-up and top-down factors. In a pair of pattern-based fMRI studies, male and female human subjects made perceptual decisions about face images that varied along two independent dimensions: gender and affect. Across studies, we interrupted bottom-up visual input using backward masks. Within studies, we manipulated which stimulus features were goal relevant (i.e., whether gender or affect was relevant) and task switching (i.e., whether the goal on the current trial matched the goal on the prior trial). We found that stimulus features could be reliably decoded from all four networks and, importantly, that subregions within each attentional network maintained coherent representations. Critically, the different attentional manipulations (interruption, goal relevance, and task switching) differentially influenced feature representations across networks. Whereas visual interruption had a relatively greater influence on representations in visual regions, goal relevance and task switching had a relatively greater influence on representations in frontoparietal networks. Therefore, large-scale brain networks can be dissociated according to how attention influences the feature representations that they maintain. SIGNIFICANCE STATEMENT Visual attention is supported by multiple frontoparietal attentional networks. However, it remains unclear how stimulus features are represented within these networks and how they are influenced by attention. Here, we assessed feature representations in four large-scale networks using a perceptual decision-making paradigm in which we manipulated top-down and bottom-up factors. We found that top-down manipulations such as goal relevance and task switching modulated feature representations in attentional networks, whereas bottom-up manipulations such as interruption of visual processing had a relatively stronger influence on feature representations in visual regions. Together, these findings indicate that attentional networks actively represent stimulus features and that representations within different large-scale networks are influenced by different forms of attention.
Evaluation of voxel-based analysis in stroke using multiparametric MR imaging. (Évaluation d'une analyse voxel à voxel dans l'accident vasculaire cérébral à partir d'images IRM multiparamétriques)

Stroke is the leading cause of disability in adults. Beyond the narrow time window and possible risks of thrombolysis and mechanical thrombectomy, cell-therapies have strong potential. Reports showed that transplanted stem cells can enhance functional recovery after ischemic stroke in rodent models.To assess the mechanisms underlying the cell-therapy benefit after stroke, imaging is necessary. Multiparametric magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI), has become the gold standard to evaluate stroke characteristics. MRI also plays an important role in the monitoring of cerebral tissue following stroke from the acute to the chronic phase. However, the spatial heterogeneity of each stroke lesion and its dynamic reorganization over time, which may be related to the effect of a therapy, remain a challenge for traditional image analysis techniques. To evaluate the effect of new therapeutic strategies, spatial and temporal lesion heterogeneities need to be more accurately characterized and quantified.The current image analysis techniques, based on mean values obtained from regions of interest (ROIs), hide the intralesional heterogeneity. Histogram-based techniques provide an evaluation of lesion heterogeneity but fail to yield spatial information. The parametric response map (PRM) is an alternative, voxel-based analysis technique, which has been established in oncology as a promising tool to better investigate parametric changes over time at the voxel level which concern the therapeutic response or prognosis of disease.The PhD project was divided into two parts: a preclinical and a clinical study. The goal of the first study was to evaluate the PRM analysis using MRI data collected after the intravenous injection of human mesenchymal stem cells (hMSCs) in an experimental stroke model. The apparent diffusion coefficient (ADC), cerebral blood volume (CBV) and vessel size index (VSI) were mapped using 7T MRI. Two analytic procedures, the standard whole-lesion approach and the PRM, were performed on data collected at 4 time points in transient middle cerebral artery occlusion (MCAo) models treated with either hMSC or vehicle and in sham animals. During the second PhD project, 6 MR parametric maps (diffusion and perfusion maps) were collected in 30 stroke patients (the ISIS / HERMES clinical trial). MRI data, analyzed with both a classic mean value and a PRM approaches, were correlated with the evaluation of functional recovery after stroke measured with the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) at 4 time points.In both studies, PRM analysis of MR parametric maps reveals fine changes of the lesion induced by a cell therapy (preclincal study) and correlate with long-term prognosis (clinical study). In conclusion, the PRM analysis could be used as an imaging biomarker of therapeutic efficacy and of prognostic biomarker of stroke patients.
Vitamin D Suppression of Endoplasmic Reticulum Stress Promotes an Antiatherogenic Monocyte/Macrophage Phenotype in Type 2 Diabetic Patients*

Background: Interactions between environmental conditions and monocyte phenotype are critical for the development of vascular complications in diabetes. Results: Modulation of ER stress by vitamin D controls monocyte/macrophage phenotype and vascular adhesion. Conclusion: Vitamin D is a natural ER stress reliever that promotes an anti-inflammatory monocyte/macrophage phenotype. Significance: Vitamin D is a potential therapy to reduce vascular complications in diabetics. Cardiovascular disease is the leading cause of morbidity/mortality in patients with type 2 diabetes mellitus (T2DM), but there is a lack of knowledge about the mechanism(s) of increased atherosclerosis in these patients. In patients with T2DM, the prevalence of 25-hydroxy vitamin D (25(OH)D) deficiency is almost twice that for nondiabetics and doubles the relative risk of developing cardiovascular disease compared with diabetic patients with normal 25(OH)D. We tested the hypothesis that monocytes from vitamin D-deficient subjects will have a proatherogenic phenotype compared with vitamin D-sufficient subjects in 43 patients with T2DM. Serum 25(OH)D level inversely correlated with monocyte adhesion to endothelial cells even after adjustment for demographic and comorbidity characteristics. Vitamin D-sufficient patients (≥30 ng/ml 25(OH)D) had lower monocyte endoplasmic reticulum (ER) stress, a predominance of M1 over M2 macrophage membrane receptors, and decreased mRNA expression of monocyte adhesion molecules PSGL-1, β1-integrin, and β2-integrin compared with patients with 25(OH)D levels of <30 ng/ml. In vitamin D-deficient macrophages, activation of ER stress increased adhesion and adhesion molecule expression and induced an M2-predominant phenotype. Moreover, adding 1,25(OH)2D3 to vitamin D-deficient macrophages shifted their phenotype toward an M1-predominant phenotype with suppressed adhesion. Conversely, deletion of the vitamin D receptor in macrophages from diabetic patients activated ER stress, accelerated adhesion, and increased adhesion molecule expression. The absence of ER stress protein CCAAT enhancer-binding protein homologous protein suppressed monocyte adhesion, adhesion molecule expression, and the M2-predominant phenotype induced by vitamin D deficiency. Thus, vitamin D is a natural ER stress reliever that induced an antiatherogenic monocyte/macrophage phenotype.
Dimensions in the Perception of Fortis and Lenis Plosives

Abstract The analysis of the production of fortis and lenis plosives in German has shown the importance of the duration ratio vowel/ (vowel + closure) for the distinction. To complement these results a perception test was carried out in which 29 native speakers identified a randomised sequence of 220 stimuli from tape as one of the phrases ‘Diese Gruppe kann ich nicht leid(e)n (leit(e)n)’. The stimuli were obtained from the two naturally produced originals by changing the ratios and the length of voicing in the plosive through computer processing. The test results indicate very conclusively that judgment can be reversed simply by changing the ratio to the appropriate ones found in production. There is a hierarchy of perceptual dimensions: duration ratio > formant transition > voicing.
Hardness tests on sound enamel and artificially demineralized white spot lesions.

The accuracy and reproducability of hardness measurements have been investigated in this study. Sound and demineralized enamel were used as the main test materials. The reproducability of hardness measurements on artificial white spot lesions produced by a hydroxyethyl cellulose/lactic acid demineralizing solution was also investigated on embedded cross-sections. The operator error was found to be less than 5% when reading both steel and enamel indentations. The maximum hardness of the surface layer and the minimum hardness of the subsurface lesion were measured in three positions in each of 10 artificial white spot lesions. An analysis of the results showed that: (a) the hardness values at the same distance from the surface but in different areas of the same lesion were very similar; (b) hardness values between lesions were also very even; (c) the drop in hardness after demineralization was related to the initial hardness of the enamel.
Costs of Robotic-Assisted Versus Traditional Laparoscopy in Endometrial Cancer

Objectives The purpose of this study was to compare the costs of traditional laparoscopy and robotic-assisted laparoscopy in the treatment of endometrial cancer. Methods and Materials A total of 101 patients with endometrial cancer were randomized to the study and operated on starting from 2010 until 2013, at the Department of Obstetrics and Gynecology of Tampere University Hospital, Tampere, Finland. Costs were calculated based on internal accounting, hospital database, and purchase prices and were compared using intention-to-treat analysis. Main outcome measures were item costs and total costs related to the operation, including a 6-month postoperative follow-up. Results The total costs including late complications were 2160 &OV0556; higher in the robotic group (median for traditional 5823 &OV0556;, vs robot median 7983 &OV0556;, P < 0.001). The difference was due to higher costs for instruments and equipment as well as to more expensive operating room and postanesthesia care unit time. Traditional laparoscopy involved higher costs for operation personnel, general costs, medication used in the operation, and surgeon, although these costs were not substantial. There was no significant difference in in-patient stay, laboratory, radiology, blood products, or costs related to complications. Conclusions According to this study, robotic-assisted laparoscopy is 37% more expensive than traditional laparoscopy in the treatment of endometrial cancer. The cost difference is mainly explained by amortization of the robot and its instrumentation.