Miracle-dz/UniFAR-FTUs huggingface dataset:
Management of polytrauma patients in emergency department: An experience of a tertiary care health institution of northern India.

BACKGROUND In a tertiary care institute of northern India, the emergency department receives an average of 6-7 patients with poly trauma every day. Of these patients, some come directly and many are referred from other hospitals from the region. Various problems are faced in the management of patients with poly trauma. This study aimed to elicit various complaints, suggestions and possible solutions in the management of patients with poly trauma. METHODS A retrospective cross sectional study was done on 210 patients in the emergency OPD for a period of 2 months. All the records of the patients with poly trauma were studied and the problems during their management were measured against 6 predetermined steps (step I to step VI). RESULTS In the younger generation, males were predominantly the primary victims of poly trauma injury, and road traffic accident was the major etiological factor. Injuries involving more than 2 specialties induced many problems during the management of patients with poly trauma. Of 210 patients we studied, 32 patients had problems at various steps and maximum problems in step III, i.e. co-ordination between various specialties in the management of patients with poly trauma. CONCLUSION A proper poly trauma management team and a well defined standard operative procedure are the keys to effective management of patients with poly trauma by minimizing the problems encountered.
Natural Autoreactive B Cells in Transgenic Mice Reproduce an Apparent Paradox to the Clonal Tolerance Theory1

Naturally occurring autoreactive B cells are thought to be physically eliminated or rendered functionally silent through different mechanisms of tolerance. However, multireactive low affinity natural autoantibody-producing B cells seem to escape these mechanisms in normal adults and could constitute the B cell pool from which pathological autoantibodies can emerge. To analyze this apparent paradox to the clonal tolerance theory, we have made two transgenic mouse lines (μk, μ∂k) producing a natural low affinity multireactive human autoantibody. These models enable us to test both the central tolerance mechanisms (reactivity with single-stranded DNA) and the peripheral tolerance mechanisms after Ag administration. Not only are the multireactive B cells not deleted in the bone marrow, they circulate and remain in the periphery even after the prolonged administration of Ag, the presence of membrane IgD increasing the number of mature autoreactive B cells. Self-reactive B cells are shown to be autoantigen ignorant both in vivo and in vitro, but they are not anergic because they can be easily activated through both B cell receptor-dependent and -independent pathways. Thus, these mouse lines reproduce an apparent paradox to the clonal tolerance theory meriting further investigation of the biological significance of this phenomenon.
Glia-independent chains of neuroblasts through the subcortical parenchyma of the adult rabbit brain

In the brains of adult mammals long-distance cell migration of neuronal precursors is known to occur in the rostral migratory stream, involving chains of cells sliding into astrocytic glial tubes. By combining immunocytochemistry for polysialylated neural cell adhesion molecule (PSA-NCAM), neuronal and glial antigens, endogenous and exogenously administered cell-proliferation markers, and light and electron microscopy 3D reconstructions, we show that chains of newly generated neuroblasts exist both inside and outside the subventricular zone of adult rabbits. Two groups of chains were detectable within the mature brain parenchyma: anterior chains, into the anterior forceps of the corpus callosum, and posterior chains, close to the external capsule. Parenchymal chains were not associated with any special glial structures, thus coming widely in contact with the mature nervous tissue, including unmyelinated/myelinated fibers, astrocytes, neurons, and oligodendrocytes. These chains of cells, unlike those in the subventricular zone, do not display cell proliferation, but they contain BrdUrd administered several weeks before. Telencephalic areas, such as the putamen, amygdala, claustrum, and cortex, adjacent to the chains harbor numerous PSA-NCAM-positive cells. The counting of newly generated cells in these areas shows small differences in comparison with others, and a few cells double-labeled for BrdUrd/PSA-NCAM (after 1-month survival) and for BrdUrd/NeuN (after 2 months) were detectable. These results demonstrate the occurrence of glial-independent chains of migrating neuroblasts, which directly contact the mature brain parenchyma of adult mammals. These chains could provide a possible link between the adult germinative layers and a very low-rate/long-term process of cell addition in the telencephalon.
Mothering an Extremely Low Birth‐Weight Infant: A Phenomenological Study

Mothers of preterm infants are reported to experience heightened levels of psychological stress, greater than mothers of full-term infants during the neonatal period. The purpose of this study is to describe the lived experience of what it is like to be a mother of an extremely low birth-weight infant during their stay with their infants in the NICU. Interpretive phenomenology articulated by Benner and Diekelmann is the method of qualitative research employed. Thematic analysis is the method of narrative analysis that is used to capture and describe the lived experience with emerging themes, patterns, and meanings. Participants were chosen by purposive sampling. Sample size was 9 participants. Repeated interviews of the participants were done to obtain “redundancy, clarity, and confidence” in the interpreted text. Understanding the themes offers guidance for future research and future programs to aid in the development of meaningful healthy mother—infant relationships and helpful relationships of and with NICU structure and staff.
Low-dose radiation therapy and reduced chemotherapy in childhood Hodgkin's disease: the experience of the French Society of Pediatric Oncology.

PURPOSE With the aim of decreasing undesirable side effects of therapy, we investigated the reduction of both chemotherapy and radiation therapy (RT) in children with Hodgkin's disease, and compared Adriamycin (doxorubicin; Farmitalia Carlo Erba, Rueil-Malmaison, France), bleomycin, vinblastine, and dacarbazine (ABVD) alone to mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) and ABVD in favorable cases and assessed the effectiveness of low-dose RT (20 Gy) after good response to chemotherapy. PATIENTS AND METHODS A French national study began in 1982 that included 238 pediatric patients with Hodgkin's disease. Initial staging was clinical and without laparotomy. In patients with localized disease (IA-IIA), an equivalence trial compared the effectiveness of four cycles of ABVD with two cycles of ABVD that were alternated with two cycles of MOPP. Patients with more advanced disease (IB-IIB-III-IV) received three courses of MOPP that was alternated with three courses of ABVD. All of the patients who achieved a good remission after chemotherapy were administered 20 Gy RT, which was limited to the initially involved areas for localized disease, and encompassed the paraaortic nodes and the spleen as well for more advanced stages. When a good remission was not obtained, 40 Gy RT was administered. RESULTS At the completion of chemotherapy, 227 patients (97%) were considered good responders, whereas 11 did not achieve a good remission. With a median follow-up of 6 years, the 6-year actuarial survival was 92% and the disease-free survival was 86%. The relapse-free survival in favorable stages was 90% in the ABVD arm and was 87% in the MOPP and ABVD arm. In June 1987, inclusion of stage IV patients was discontinued because of poor results. CONCLUSIONS Present findings indicate that (1) in favorable stages, ABVD alone and alternating MOPP and ABVD are equivalent, and (2) chemotherapy followed by 20 Gy RT represents a valid therapeutic approach in the vast majority of children with Hodgkin's disease.
Predictors of mortality and morbidity in acute obstructive jaundice: implication of preventive measures.

BACKGROUND/AIMS The afferent events in acute obstructive jaundice (AOJ) are characterized by endotoxemia-induced decrease in systemic vascular resistance and bile salt mediated natriuresis and diuresis leading to diminished effective plasma volume. METHODOLOGY A prospective protocol aimed at preventing those alterations was carried out in 104 consecutive patients with AOJ. The preoperative risk factors that predict postoperative mortality and morbidity were reevaluated and correctable factors were identified. RESULTS The average duration between the initiation of jaundice and surgery was 9.3 days. The perioperative mortality was 0%. The essentials of the treatment protocol were lactulose and cefazolin administration respectively for the prevention of portal endotoxemia and biliary sepsis and maintenance of body weight with adequately replaced fluid and electrolytes. Clinically relevant nutritional deficit was not observed in any of the patients during the perioperative period. The unique factor that predicted late mortality was the preoperative alanine transaminase value. Renal hemodynamics and hematologic parameters were completely correctable before the operation and patients with malignant or benign biliary strictures benefited and responded to the treatment similarly. CONCLUSIONS Measures taken to prevent the activation and progression of the afferent events in AOJ, have resulted in excellent clinical outcomes.
Moral Hazard and Capital Structure Dynamics

We base a contracting theory for a start-up firm on an agency model with observable but nonverifiable effort, and renegotiable contracts. Two essential restrictions on simple contracts are imposed: the entrepreneur must be given limited liability, and the investor’s earnings must not decrease in the realized profi to f thefirm. All message game contracts with pure strategy equilibria (and no third parties) are considered. Within this class of contracts/equilibria, and regardless of who has the renegotiating bargaining power, debt and convertible debt maximize the entrepreneur’s incentives to exert effort. These contracts are optimal if the entrepreneur has the bargaining power in renegotiation. If the investor has the bargaining power, the same is true unless debt induces excessive effort. In the latter case, a non-debt simple contract achieves efficiency — the non-contractibility of effort does not lower welfare. Thus, when the non-contractibility of effort matters, our results mirror typical capital structure dynamics: an early use of debt claims, followed by a switch to equity-like claims.
MicroRNA‐183 suppresses retinoblastoma cell growth, invasion and migration by targeting LRP6

Our study demonstrates the downregulation of microRNA‐183 (miR‐183) in retinoblastoma (RB) tissues and RB cell lines compared with normal retinal tissues. The ectopic expression of miR‐183 in the RB cell lines Y79, SO‐RB50 and WERI‐RB1 suppresses cell viability, migration and invasion. Furthermore, the Wnt co‐receptor low‐density lipoprotein receptor‐related protein 6 (LRP6) was identified as a new target of miR‐183, and restoration of the expression of LRP6 rescues the effects induced by miR‐183 in RB cells. These results indicate that miR‐183 targets and downregulates LRP6 in the growth, migration and invasion of RB cells.
Conflicting patterns of DNA barcoding and taxonomy in the cicada genus Tettigettalna from southern Europe (Hemiptera: Cicadidae)

DNA barcodes have great potential to assist in species identification, especially when high taxonomical expertise is required. We investigated the utility of the 5′ mitochondrial cytochrome c oxidase I (COI) region to discriminate between 13 European cicada species. These included all nine species currently recognized under the genus Tettigettalna, from which seven are endemic to the southern Iberian Peninsula. These cicadas have species‐specific male calling songs but are morphologically very similar. Mean COI divergence between congeners ranged from 0.4% to 10.6%, but this gene was proven insufficient to determine species limits within genus Tettigettalna because a barcoding gap was absent for several of its species, that is, the highest intraspecific distance exceeded the lowest interspecific distance. The genetic data conflicted with current taxonomic classification for T. argentata and T. mariae. Neighbour‐joining and Bayesian analyses revealed that T. argentata is geographically structured (clades North and South) and might constitute a species complex together with T. aneabi and T. mariae. The latter diverges very little from the southern clade of T. argentata and shares with it its most common haplotype. T. mariae is often in sympatry with T. argentata but it remains unclear whether introgression or incomplete lineage sorting may be responsible for the sharing of haplotypes. T. helianthemi and T. defauti also show high intraspecific variation that might signal hidden cryptic diversity. These taxonomic conflicts must be re‐evaluated with further studies using additional genes and extensive morphological and acoustic analyses.
Optimizing Symptom Relief and Preventing Complications in Adults with Gastro-Oesophageal Reflux Disease

Gastro-oesophageal reflux disease (GORD) is a chronic illness causing recurrent typical and atypical symptoms. Possible complications include oesophagitis, ulcer, stricture and Barrett’s oesophagus. Evidence suggests that the intraoesophageal pH correlates directly with the degree of mucosal injury. Proton pump inhibitors (PPIs) are the first choice of therapy because they are significantly more effective than histamine-2-receptor antagonists (H2RAs) in achieving and sustaining an intragastric pH above 4.0. Numerous trials have shown that PPIs provide superior and faster relief of heartburn compared with H2RAs. PPIs have also been shown to be superior to H2RAs in healing oesophageal ulcers and improving the clinical outcome of patients with stricture formation. Unfortunately, even higher-than-standard doses of PPIs do not provide a complete regression in the length of Barrett’s oesophagus, which is the most serious complication of GORD. Although the majority of patients with oesophagitis relapse within 6 months of stopping PPI therapy, maintenance PPI therapy prevents this in more than 80% of cases. Surgical and endoscopic procedures are alternative approaches to managing GORD. Surgery is successful but is not without risk. Endoscopic procedures are promising, but comparative and longer-term efficacy and safety data are needed.
Identification of glial cell proliferation in early multiple sclerosis lesions

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system which leads to destruction of myelin sheaths. The patterns of cell proliferation in the early course of the disease are largely unknown. The present study used immunohistochemical identification of proliferating glial cells in stereotactic brain biopsy material of eight patients with early chronic MS. Double‐labelling with the proliferation marker MIB‐1 detected proliferating oligodendrocytes (MOG), astrocytes (GFAP) and microglia/macrophages (Ki‐M1P). The majority of proliferating cells were macrophages/microglia when compared with oligodendrocytes (P>0.005) or astrocytes (P>0.0005); only a minor proportion of microglia/macrophages, however, proliferated in situ. Astrocytic and oligodendroglial proliferation was sparse to absent and showed significant variations between different patients. There were statistically significant differences when comparing the amount of proliferation between lesions of different demyelinating activity: highest numbers of proliferating cells were found in early active lesions compared with demyelinated and early remyelinated lesions (P>0.05) or the periplaque white matter (P>0.01). MOG‐positive oligodendrocytes proliferated occasionally in the early stages of lesion formation; this proliferation occurred in four cases but was independent of the stage of the disease. Since MOG is expressed by mature oligodendrocytes, and not by immature precursors, this might suggest a potential role for the proliferation of mature surviving oligodendrocytes with subsequent remyelination.
Immunoblotting and serology for diagnosis of Helicobacter pylori infection in children

Background. The easiest way to identify the presence of current or past Helicobacter pylori infection is to test for antibodies. The aim of this study was to compare an enzyme‐linked immunosorbent assay (ELISA) technique based on the detection of IgG antibodies directed against a global antigenic preparation with immunoblotting based on the analysis of IgG antibody reactivity to separate proteins. Methods. Sera were collected from 80 children (mean age, 9.9 ± 4.3 years). The reference tests were microbiologic and histologic examination of gastric biopsies obtained at upper endoscopy. Results. The immunoblotting was more sensitive (100%) and specific (88%) than ELISA (96 and 79%, respectively) in the evaluation of H. pylori infection in children. Its positive predictive value was 92%, and its negative predictive value was 100%. The best performance index of immunoreactive bands to detect antibodies was obtained with the 26‐kDa (88.7%), 30‐kDa (77.5%) and 19.5‐kDa (70%) antigens. Antibodies by immunoblot technique against the CagA antigen were present in 43.1% of children. Conclusion. Immunoblotting is highly sensitive and more specific than ELISA in children and provides additional information about the full serologic profile. Immunoblotting may therefore be a useful complement to serology, particularly in cases with doubtful ELISA results.
Tuberculosis - an under-appreciated disease.

Tuberculosis Worldwide Tuberculosis (TB, as usually abbreviated) is a major cause of morbidity and mortality in many countries, and a signifi cant public health problem worldwide. The World Health Organization (WHO) estimates that there are about 8.8 million new cases of TB and 1.6 million deaths from TB every year.1 Non-compliance with anti-TB drug treatment, or inappropriate treatment, or both, has led to one of the greatest challenge facing TB control programmes worldwide, i.e. drug-resistant tuberculosis. Drug-resistant TB is much more diffi cult and costly to treat than fully drug-susceptible TB. An estimated 490,000 cases of multi-drug resistant TB (MDR-TB), causing about 110,000 deaths, occur each year among both new and previously treated cases. These cases are resistant to rifampicin and isoniazid, the 2 most effective fi rst-line anti-TB drugs. The 2008 WHO Report on Anti-TB Drug Resistance stated that the world was experiencing the highest ever recorded rates of MDR-TB, with an average proportion among all TB cases of 5.3%. There were 14 geographic areas showing MDR-TB rates greater than 6% among new TB cases. These areas were mainly in countries of the former Soviet Union and in China. The highest rate of MDR-TB was reported in Baku City, the capital of Azerbaijan, where nearly a quarter of new TB cases were reported to be MDR-TB.2 The same 2008 WHO Report also indicated that cases of extensively drug-resistant TB (XDR-TB) have been reported in 45 countries, and emphasised that this phenomenon threatens to derail 10 years of progress in TB control. XDR-TB is TB that is resistant not just to rifampicin and isoniazid, but also to a fl uoroquinolone and to 1 of 3 injectable second-line anti-TB drugs (kanamycin, amikacin or capreomycin). XDR-TB is thus very diffi cult to treat, and the success rate of treatment is only 30% at best, in contrast to 50% to 70% for MDR-TB and over 95% success for pan-sensitive tuberculosis. Another major challenge has been the impact of the pandemic of human immunodefi ciency virus (HIV). HIV
Co-expression tools for plant biology: opportunities for hypothesis generation and caveats.

Gene co-expression analysis has emerged in the past 5 years as a powerful tool for gene function prediction. In essence, co-expression analysis asks the question 'what are the genes that are co-expressed, that is, those that show similar expression profiles across many experiments, with my gene of interest? '. Genes that are highly co-expressed may be involved in the biological process or processes of the query gene. This review describes the tools that are available for performing such analyses, how each of these perform, and also discusses statistical issues including how normalization of gene expression data can influence co-expression results, calculation of co-expression scores and P values, and the influence of data sets used for co-expression analysis. Finally, examples from the literature will be presented, wherein co-expression has been used to corroborate and discover various aspects of plant biology.
Self-administered psychotherapy for depression using a telephone-accessed computer system plus booklets: an open U.S.-U.K. study.

OBJECTIVE To evaluate the efficacy and acceptability of a self-help program for mild-to-moderate depression that combined treatment booklets and telephone calls to a computer-aided Interactive Voice Response (IVR) system. METHOD In an open trial, 41 patients from Boston, Massachusetts; Madison, Wisconsin; and London, England, used COPE, a 12-week self-help system for depression. COPE consisted of an introductory videotape and 9 booklets accompanied by 11 telephone calls to an IVR system that made self-help recommendations to patients based on information they entered. RESULTS All 41 patients successfully completed the self-assessment in the booklets and telephone calls; 28 (68%) also completed the 12-week self-help program. Hamilton Rating Scale for Depression (HAM-D) and Work and Social Adjustment scores improved significantly (41% and 42% mean reduction in the intent-to-treat sample, respectively, p < .001). Eighteen (64%) of the 28 completers were considered responders on the basis of > or = 50% reduction in their HAM-D scores. There was a higher percentage of completers in the pooled U.S. sites (82% vs. 43%), and U.S. completers improved more than those in the United Kingdom (73% vs. 43% were responders). Most (68%) of the calls were made outside usual office hours, Monday-Friday, 9:00 a.m. to 5:00 p.m. Expectation of effectiveness and time spent making COPE calls (more treatment modules) correlated positively with improvement over 12 weeks. Mean call length for completers was 14 minutes. CONCLUSION A self-help system comprised of a computer-aided telephone system and a series of booklets was used successfully by people with mild-to-moderate depression. These preliminary results are encouraging for people who cannot otherwise access ongoing, in-person therapy.
Les Campagnes de la Syrie du Nord du IIe au VIIe Siecle. Un Exemple d'Expansion Demographique et Economique a la fin d'Antiquite

reference work for students of both disciplines. The blending of classical texts with inscriptions and their associated locations also puts new life into Roman Crete. The references to inscription texts highlights how many names of individuals have survived, some of which themselves portray evidence of the scale of Roman influence, and a tradition of having memorial records set in stone. The bibliography adds to that given in Roman Crete, though it does highlight the gaps in unpublished sites. In terms of presentation The Romans and Crete has a style more akin to the first draft of a thesis as opposed to a finished book. This is also reflected in the illustrations, where the full impact has been lost with the use of what can only be described as simple sketches. None the less, for the true student The Romans and Crete is worthy of a place on the bookshelf. Like Roman Crete it will also serve as a foundation for further research and discussion.