Miracle-dz/UniFAR-FTUs huggingface dataset:
Evaluation of preferable insertion routes for esophagogastroduodenoscopy using ultrathin endoscopes.

AIM To evaluate the discomfort associated with esophagogastroduodenoscopy (EGD) using an ultrathin endoscope through different insertion routes. METHODS This study (January 2012-March 2013) included 1971 consecutive patients [male/female (M/F), 1158/813, 57.5 ± 11.9 years] who visited a single institute for annual health checkups. Transnasal EGD was performed in 1394 patients and transoral EGD in 577. EGD-associated discomfort was assessed using a visual analog scale score (VAS score: 0-10). RESULTS Multivariate analysis revealed gender (M vs F: 4.02 ± 2.15 vs 5.06 ± 2.43) as the only independent predictor of the VAS score in 180 patients who underwent EGD for the first time; whereas it revealed gender (M vs F 3.60 ± 2.20 vs 4.84 ± 2.37), operator, age group (A: < 39 years; B: 40-49 years; C: 50-59 years; D: 60-69 years; E: > 70 years; A/B/C/D/E: 4.99 ± 2.32/4.34 ± 2.49/4.19 ± 2.31/3.99 ± 2.27/3.63 ± 2.31), and type of insertion as independent predictors in the remaining patients. Subanalysis for gender, age group, and insertion route revealed that the VAS score decreased with age regardless of gender and insertion route, was high in female patients regardless of age and insertion route, and was low in males aged over 60 years who underwent transoral insertion. CONCLUSION Although comprehensive analysis revealed that the insertion route may not be an independent predictor of the VAS score, transoral insertion may reduce EGD-associated discomfort in elderly patients.
Extreme Stress Hyperglycemia During Acute Illness in a Pediatric Emergency Department

Objectives: Although mild stress hyperglycemia in pediatric illness is common, severe hyperglycemic responses (≥300 mg/dL [16.7 mmol/L]) to stress are unusual. We sought to determine the incidence and course of extreme stress hyperglycemia (ESH) in acute pediatric illness, including whether it is a marker of increased mortality or associated with subsequent development of diabetes mellitus (DM). Methods: We retrospectively reviewed a cohort of 55,120 consecutive visits over 6 years to a pediatric emergency department at which blood glucose concentrations were measured and report on visits with laboratory glucose 300 mg/dL (16.7 mmol/L) or greater without DM. Results: There were 72 cases of ESH (incidence of 0.13%). Median age was 8.8 years; 63% were male. The most common diagnoses were respiratory illness (49%), trauma (15%), and seizure (8%), and 65% of patients had received glucose-influencing interventions before evaluation. Eighty-five percent were ill appearing, 60% were admitted to the intensive care unit, and half had acidemic pH values. The overall mortality rate was 22%. Despite treatment of hyperglycemia in only 8 patients, glucose concentrations decreased to 150 mg/dL (8.3 mmol/L) or less within 48 hours in 67% and before discharge or death in 85% of patients. Preceding symptoms and concurrent laboratory results were helpful to exclude diabetes, and none of the surviving patients with follow-up available went on to develop type 1 or 2 DM. Conclusions: Although rare, ESH (≥300 mg/dL [16.7 mmol/L]) does occur in acute pediatric illness, in most cases is at least partially iatrogenic, and is a marker of severe illness and high mortality. Normoglycemia is typically restored quickly with treatment of the primary illness. No association was found with a subsequent diagnosis of DM.
Eye-Movement Rhythmicity and Reading Comprehension

The purpose of these two studies was to examine the rhythmical patterns displayed by subjects with and without reading disabilities while they were reading (Study 1), and to vary rhythmicity through priming and observe the effects on parsing ability using eye-movement and comprehension measures (Study 2). Rhythmicity during silent reading was operationalized by tnanscribing eye-movement measures into pitch, rhythm, and rests. In Study 1, 17 subjects with reading disabilities and 15 control subjects (M age = 15, male = 60%) parsed 20 flawed and control sentences. In Study 2, 35 control subjects (M age = 21, male = 43%) parsed 9 phrases from familiar songs under one of three rhythm-priming conditions. Results (Study 1) indicated significant differences in rhythm patterns. Subjects with reading disabilities exhibited rhythm variability, unpredictability, and lethargic tempos. In Study 2, significant differences across priming conditions were found, with primed subjects exhibiting improved parsing and comprehension. Rhythm may be an organizational substrate for syntax.
Effect of age on the structure of Meissner corpuscles in murine digital pads

A light and electron microscopic study was performed to determine age changes in Meissner corpuscles. In forepaw digital pads of mice aged to their maximum life expectancy, corpuscles were found to increase in size and complexity until middle age, and then to become smaller, disorganized and lobulated with more advanced age. Nerve terminals at more advanced ages became attenuated with a loss of axonal processes, increased density of the axoplasm, and disordered arrangement of the organelles. Degeneration of axonal mitochondria accelerated with age. Lamellar cell processes investing the axons often become dense and attenuated with fewer plasmalemma‐associated vesicles. Basal laminae remained where lamellar processes had disintegrated. Lipofuscin was seen in the lamellar cells only at extremely old age. Extracellular material composed of fine basal lamina substance and collagen fibrils increased remarkably with age.
Fine Particulate Air Pollution and Hospital Admissions for Myocardial Infarction in a Subtropical City: Taipei, Taiwan

This study was undertaken to determine whether there was a correlation between fine particles (PM2.5) levels and hospital admissions for myocardial infarction (MI) in Taipei, Taiwan. Hospital admissions for MI and ambient air pollution data for Taipei were obtained for the period 2006–2010. The relative risk of hospital admissions for MI was estimated using a casecrossover approach, controlling for weather variables, day of the week, seasonality, and longterm time trends. For the single-pollutant model (without adjustment for other pollutants), increased numbers of MI admissions were significantly associated with higher PM2.5 levels both on warm days (>23°C) and on cool days (<23°C). This was accompanied by an interquartile range elevation correlated with a 10% (95% CI = 6–15%) and 5% (95% CI = 1–9%) rise in number of MI admissions, respectively. In the two-pollutant models, PM2.5 remained significant after inclusion of SO2 or O3 on both warm and cool days. This study provides evidence that higher levels of PM2.5 increase the risk of hospital admissions for MI.
Steers grazing endophyte-free tall fescue: seasonal changes in nutrient quality, forage intake, digesta kinetics, ruminal fermentation, and serum hormones and metabolites.

Six ruminally cannulated Holstein steers (average BW 514 kg) grazed a 33-ha, unirrigated, endophyte-free, tall fescue (Festuca arundinacea Schreb.) pasture from April 10 through December 7, 1989. Samples were collected in May, June, September, and November 1989. Total masticate N was relatively constant (P > .10) throughout the year. Masticate in vitro OM disappearance was less (P < .05) in September (48.4%) and November (50%) than in May (60.6%) and June (56%). Ruminal NH3N concentrations (milligrams/deciliter) were greater (P < .05) during May (20.5) and June (17.8) than during September (9.4) and November (5.9). Organic matter intake (grams/kilogram of BW) and particulate passage rate (percentage/hour) were least (P < .05) in November (15.3; 2.6) and not different (P > .10) during May (23.7; 3.1), June (20.7; 3.1), and September (21.0; 3.0). Extent and rate of NDF digestion and ruminal total VFA did not differ (P > .10) across sampling dates. Serum glucose concentrations were not affected (P > .10) by sampling date, but serum urea N was greater (P < .05) during May and November than during June and September. Nonesterified fatty acid concentrations increased (P < .05) with advancing plant maturity. Serum insulin concentrations were greater (P < .05) during May than during other sampling periods; however, growth hormone concentrations were not altered (P > .10) by advancing plant maturity. Unirrigated fescue pasture maintained a high nutrient level throughout the grazing season, and masticate samples did not display the decrease in nutrient content often noted with other types of pasture forage.
Student teachers can be as good as associate professors in teaching clinical skills

Aim: The aim of this study is to compare student teachers and clinical associate professors regarding the quality of procedural skills teaching in terms of participants’ technical skills, knowledge and satisfaction with the teaching. Methods: This is an experimental, randomized, controlled study comparing the teaching of student teachers and associate professors regarding participants’ learning outcome and satisfaction with the teaching. Two skills are chosen for the experiment, IV-access and bladder catheterization. Learning outcome is assessed by a pre- and post testing of the participants’ knowledge and skills. Participants evaluate satisfaction with teaching on nine statements immediately after the teaching. Results: In total 59 first year medical students are included as participants in the experiment. The students taught by student teachers perform just as well as the students taught by associate professors and in one skill–catheterization–they perform even better, mean post- minus pre-test scores 65.5 (SD 12.9) vs. 35.0 (SD 23.3), One-way ANOVA, p < 0.0001, effect size 1.62. Student teachers receive significantly more positive evaluations than associate professors on several statements. Conclusion: Trained student teachers can be as good as associate professors in teaching clinical skills.
Genetic variation in IL28B is associated with chronic hepatitis C and treatment failure: a genome-wide association study.

BACKGROUND & AIMS Hepatitis C virus (HCV) induces chronic infection in 50% to 80% of infected persons; approximately 50% of these do not respond to therapy. We performed a genome-wide association study to screen for host genetic determinants of HCV persistence and response to therapy. METHODS The analysis included 1362 individuals: 1015 with chronic hepatitis C and 347 who spontaneously cleared the virus (448 were coinfected with human immunodeficiency virus [HIV]). Responses to pegylated interferon alfa and ribavirin were assessed in 465 individuals. Associations between more than 500,000 single nucleotide polymorphisms (SNPs) and outcomes were assessed by multivariate logistic regression. RESULTS Chronic hepatitis C was associated with SNPs in the IL28B locus, which encodes the antiviral cytokine interferon lambda. The rs8099917 minor allele was associated with progression to chronic HCV infection (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.74-3.06; P = 6.07 x 10(-9)). The association was observed in HCV mono-infected (OR, 2.49; 95% CI, 1.64-3.79; P = 1.96 x 10(-5)) and HCV/HIV coinfected individuals (OR, 2.16; 95% CI, 1.47-3.18; P = 8.24 x 10(-5)). rs8099917 was also associated with failure to respond to therapy (OR, 5.19; 95% CI, 2.90-9.30; P = 3.11 x 10(-8)), with the strongest effects in patients with HCV genotype 1 or 4. This risk allele was identified in 24% of individuals with spontaneous HCV clearance, 32% of chronically infected patients who responded to therapy, and 58% who did not respond (P = 3.2 x 10(-10)). Resequencing of IL28B identified distinct haplotypes that were associated with the clinical phenotype. CONCLUSIONS The association of the IL28B locus with natural and treatment-associated control of HCV indicates the importance of innate immunity and interferon lambda in the pathogenesis of HCV infection.
The Influence of the M184V Mutation in HIV-1 Reverse Transcriptase on the Virological Outcome of Highly Active Antiretroviral Therapy Regimens with Or without Didanosine

Background In vitro phenotypic resistance studies suggest that the presence of the M184V mutation leads to a reduction in HIV-1 susceptibility to didanosine (ddI). The relevance of this to clinical outcomes remains unclear. In this study, we compared the virological response of ddI- and non-ddI-containing regimens in the presence or absence of the M184V mutation. Methods Data from an observational cohort study of all HIV-1 patients who had phenotypic resistance testing following the emergence of virological failure to an existing highly active antiretroviral therapy (HAART) regimen were analysed. A total of 586 patients entered the study and were followed-up over 48 weeks; 281 (48%) were switched to ddI-containing HAART, of whom 105 had the M184V mutation at baseline. Virological efficacy of combination therapy was studied by reference to average area under the curve of viral load (VL) response and the proportion of patients attaining an undetectable VL (<400 copies/ml). Baseline characteristics and univariate analysis of changes in VL were compared using the Wilcoxon rank sum test. Multivariate analyses were performed using the Van Elteren test. Additional variables included the number of baseline nucleoside reverse transcriptase inhibitor mutations and the number of active antiretroviral drugs given to each group as compared by ‘real phenotype’ resistance test results. Results Amongst patients on ddI-containing HAART, median fold changes in phenotypic susceptibility to ddI were greater in patients with the M184V mutation (fold changes of 2.2 vs 1.2, P<0.001). Nonetheless, the median change in VL and percentage of patients attaining an undetectable VL were similar in those taking ddI, irrespective of whether the M184V mutation was present at baseline. In the group of patients with the M184V mutation at baseline, the virological outcome was significantly better in those treated with ddI-containing HAART than in those on HAART without ddI (P<0.05). Conclusions While the M184V did increase the fold resistance of HIV to ddI, these changes appeared to be lower than the clinically relevant threshold for phenotypic resistance for this drug.
Flexible Capacitive Tactile Sensor Array With Truncated Pyramids as Dielectric Layer for Three-Axis Force Measurement

This paper presents a flexible capacitive tactile sensor array embedded with a truncated polydimethylsiloxane pyramid array as a dielectric layer. The proposed sensor array has been fabricated with 4 × 4 sensor units. The measurement ranges of forces in the x-axis, y-axis, and z-axis are 0-0.5, 0-0.5, and 0-4 N, respectively. In the range of 0-0.5 N, the sensitivities of the sensor unit are 58.3%/N, 57.4%/N, and 67.2%/N in the x-axis, y-axis, and z-axis, respectively. In the range of 0.5-4 N, the sensitivity in the z-axis is 7.7%/N. Three-axis force measurement has been conducted for all the sensor units. The average errors between the applied and calculated forces are 11.8% ± 6.4%. The sensor array has been mounted on a prosthetic hand. A paper cup and a cube are grasped by the prosthetic hand and the three-axis contact force is measured in real time by the sensor array. Results show that the sensor can capture the three-axis contact force image both in light and tight grasping. The proposed capacitive tactile sensor array can be utilized in robotics and prosthetic hand applications.
Serum angiotensin-converting enzyme and plasma atrial natriuretic peptide levels in hyperthyroid and hypothyroid rabbits.

BACKGROUND It is known that serum angiotensin-converting enzyme (ACE), and plasma atrial natriuretic peptide (p-ANP) levels increase in hyperthyroidism. However, the precise mechanism of the effects of thyroid hormone on ANP release remains to be clarified. No study investigating serum ACE together with p-ANP levels has been performed in experimental hyperthyroid and hypothyroid rabbits. The present study was designed in order to provide additional evidence of increased ANP production and secretion in hyperthyroidism and to investigate the relationships between ANP, ACE and thyroid hormones. METHODS Male New Zealand white rabbits (2.3-3.4 kg) were used throughout the study. Hyperthyroidism was induced by daily intraperitoneal administration of L-thyroxin (50 micrograms/100 g). Hypothyroidism was induced by daily intraperitoneal injection of propylthiouracil (2 mg/100 g body weight). Twelve days after the end of treatment, animals were sacrificed under anesthesia and blood samples were obtained from the aorta for serum ACE and thyroid hormone and p-ANP determinations. RESULTS Serum ACE, plasma renin activity (PRA) and p-ANP were higher in hyperthyroid rabbits and lower in hypothyroid rabbits than in euthyroid rabbits. ANP concentration in atria was lower in hyperthyroid rabbits and higher in hypothyroid rabbits than in euthyroid rabbits. p-ANP, PRA and serum ACE levels were positively correlated with serum thyroxin levels. Inverse correlation was found between serum thyroxin and ANP concentration in atria (a-ANP), and between p-ANP and a-ANP. CONCLUSIONS Our results indicate that not only p-ANP but also serum ACE activity was markedly increased in experimental hyperthyroid rabbits. It was thought that there were both direct and indirect effects of thyroxin on the release of ANP.
Perception of quality of maternal healthcare services among women utilising antenatal services in selected primary health facilities in Anambra State, Southeast Nigeria

Background: This is a cross-sectional descriptive study aimed at assessing antenatal care service attendees’ perception of quality of maternal healthcare (MHC) services in Anambra State, southeast Nigeria. Materials and Methods: A total of 310 pregnant women utilising antenatal care (ANC) services in three purposively selected primary health centres (PHCs) in rural communities in Anambra State were studied. Reponses were elicited from the participants selected consecutively over a 4-month period, using a pre-tested, semi-structured interviewer-administered questionnaire on socio-demographic characteristics, utilisation and perception of MHC services. Data collected were analysed using SPSS version 17. Results: Findings showed that utilisation of facility for both antenatal (97.0%; 95% CI, 94.4–98.4%) and natal services (92.7%; 95% CI 89.2–95.2%) were quite high. Generally, most of the women were satisfied with MHC services (89.7%). Most of them were satisfied with the staff attitude (85.1%), waiting time (84.1%) and cost of services (79.5%). Being ≥30 years (X2 = 4.61, P = 0.032), married (X2 = 9.70, P = 0.008) and multiparous (X2 = 9.14, P = 0.028), as well as utilisation of formal health facility for antenatal (X2 = 26.94, P = 0.000) and natal (X2 = 33.42, P = 0.000) services were associated with satisfaction with maternal health services. Conclusions: The study showed high level of satisfaction with quality of maternal health services among antenatal attendees and highlights the need to strengthen interventions that increase uptake of formal MHC services.
Monitoring adherence rates in glaucoma patients using the Travatan Dosing Aid. A 6-month study comparing patients on travoprost 0.004% and patients on travoprost 0.004%/timolol 0.5% fixed combination

Objective: To assess adherence in glaucoma patients using the Travatan Dosing Aid (TDA); to record differences in adherence by age, sex, therapy, systemic therapies, years from diagnosis, type of therapy and intraocular pressure (IOP). Research Design and Methods: Sixth-month cohort study; fifty-six Caucasian, primary open-angle glaucoma patients on travoprost (T) or travoprost/timolol fixed combination (TTFC) monotherapy were submitted to four visits: at baseline and months 1, 3 and 6 (M1, M3, M6). Adherence was recorded with TDA and classified as ‘high’ if greater than 90%. Self-reported and physician-presumed adherence data were collected. Kruskall-Wallis and Fisher's exact tests were applied. Results: Thirty-two patients (54.2%) were treated with T. Age, sex, level of schooling, presence of systemic comorbidities, duration of current therapy and IOP were similar between T and TTFC. Seventeen subjects (30.3%) recorded high adherence at every visit, 13 (23.2%) at two visits, 26 (46.4%) otherwise. Adherence was maintained over time with a slight decrease from month 1 to month 6 without statistical differences within and between groups. Adherence was statistically influenced by age (p = 0.007) and duration of therapy (p = 0.004). Conclusion: The typical nonadherent patient is elderly. TDA records indicate that only a minority of patients are really adherent: predictive models to screen for poor adherence are needed.
Omeprazole, Helicobacter pylori status, and alterations in the intragastric milieu facilitating bacterial N-nitrosation.

BACKGROUND & AIMS Omeprazole produces greater acid inhibition in Helicobacter pylori-positive than -negative subjects. We investigated whether this is accompanied by more profound changes in the intragastric milieu that facilitates bacterial synthesis of N-nitroso compounds. METHODS Gastric juice pH; nitrite, ascorbic acid, and total vitamin C concentrations; and colonization by other bacteria were examined before and during omeprazole treatment in subjects with and without H. pylori infection. Studies were performed in the fasting state and after consumption of 2 mmol nitrate (equivalent to a salad meal). RESULTS Before omeprazole, H. pylori-positive and -negative subjects were similar for all parameters. During omeprazole, H. pylori-positive subjects had a higher intragastric pH (7.8 vs. 3.0; P < 0.00001) and greater colonization with non-H. pylori species (5 x 10(7) vs. 5 x 10(5) CFU/mL; P < 0.05). These bacteria included nitrosating species. During omeprazole treatment, H. pylori-positive subjects had higher intragastric nitrite levels after the nitrate meal (median area under the concentration/time curve, 12,450 vs. 4708 micromol/L. min; P = 0.04). Omeprazole lowered intragastric vitamin C levels in H. pylori-positive but not -negative subjects (1.8 vs. 3.4 microg/mL, respectively; P = 0.02). CONCLUSIONS In H. pylori-positive subjects, omeprazole produces disturbances in intragastric nitrite, vitamin C, and bacterial colonization that facilitate bacterial N-nitrosation. This may place them at increased risk of mutagenesis and carcinogenesis.
Cybersecurity in the age of autonomous vehicles, intelligent traffic controls and pervasive transportation networks

Technologies for autonomous vehicles, “smart” roadways and ride-hailing services are advancing at a dizzying pace. They are also beginning to interconnect and interoperate to form complex systems-of-systems. The cyberattack surfaces of these systems-of-systems are expanding exponentially. Currently, many related systems are standalone, but when they are integrated, vulnerabilities of, and threats to, the resulting systems-of-systems could grow so much that they might well detract from the potential of these systems to improve safety and gain fuel use due to reduced travel times. Despite warnings, few are focusing on improving cybersecurity of the entire system-of-systems as the self-driving, ground-vehicle juggernaut ploughs ahead. Far too little attention is being paid to vulnerabilities throughout the systems-of-systems that will undoubtedly arise when the myriad of systems is interconnected and interoperate. In this paper, we discuss the cybersecurity consequences of the current uncoordinated evolution of these systems-of-systems and describe how such risks might be mitigated by, among other approaches, proactively introducing cybersecurity requirements early in the design, development and deployment process.