Miracle-dz/UniFAR-FTUs huggingface dataset:
Assessment of acute changes in ventricular volumes, function, and strain after interventional edge-to-edge repair of mitral regurgitation using cardiac magnetic resonance imaging.

AIMS Whereas haemodynamic and echocardiographic studies suggest benefits for left ventricular (LV) function and cardiac output following reduction in LV preload by interventional edge-to-edge repair for mitral regurgitation (MR), there is limited data on volumetric and functional LV and right ventricular (RV) changes using cardiac magnetic resonance (CMR) imaging. METHODS AND RESULTS Patients with moderate to severe MR and high surgical risk underwent MitraClip-implantation and CMR imaging before and within 7 days after the procedure. In addition to volumetric and flow studies, myocardial feature tracking (FT) technology for quantification of myocardial strain was applied. Twenty patients (age: 76 ± 8 years) with functional (n = 15) or degenerative MR (n = 5) with a mean logistic Euroscore I of 33 ± 16 underwent both successful MitraClip implantation and CMR imaging. MR fraction (36 ± 10 vs. 19 ± 12%; P < 0.001) and LV end-diastolic volume (115 ± 36 vs. 105 ± 41 mL/m2; P = 0.002) decreased significantly, whereas LV ejection fraction (42 ± 15 vs. 41 ± 16%, P = 0.8) and cardiac index (1.7 ± 0.5 vs. 1.8 ± 0.4 L/min/m2, P = 0.4) remained unchanged. MitraClip implantation resulted in a significant impairment of circumferential (-12.8 ± 4.8 vs. -8.2 ± 3.3; P = 0.002) and radial strain (15.4 ± 7.7 vs. 9.6 ± 5.3; P = 0.02) on basal short-axis view. On RV level, there were no significant changes in end-diastolic volume (83 ± 19 vs. 84 ± 18 mL/m2, P = 0.8), ejection fraction (42 ± 9 vs. 43 ± 11%, P = 0.8), or tricuspid regurgitation fraction (24 ± 17 vs. 25 ± 19%, P = 0.7). MitraClip implantation led to a significant improvement in New York Heart Association functional class (patients in functional class III-IV pre 100% vs. post 45%; P < 0.001). CONCLUSION In severely compromised patients, marked reduction in MR by MitraClip implantation might not result in immediate improved cardiac output and effective biventricular forward flow.
Prognostic value of left ventricular global function index in patients after ST-segment elevation myocardial infarction.

AIMS The left ventricular global function index (LVGFI) is a novel indicator of left ventricular performance. Its prognostic value in patients after ST-segment elevation myocardial infarction (STEMI) is unknown. We sought to evaluate the prognostic significance of LVGFI measured by cardiovascular magnetic resonance (CMR) imaging after STEMI. METHODS AND RESULTS Two hundred eligible STEMI patients (56 ± 11 years, 16% female) revascularized by primary percutaneous coronary intervention were followed-up for 3.1 [2-4.1] years for major adverse cardiac events (MACE). MACE was defined as a composite of death, non-fatal myocardial re-infarction, and new congestive heart failure. All patients underwent CMR imaging within 2 [2-4] days after STEMI. Late enhancement and cine images were acquired to assess myocardial injury as well as myocardial function, including LVGFI. Patients suffering a MACE event (n = 20, 10%) had a significantly lower LVGFI (P = 0.001). In Kaplan-Meier analysis, a decreased LVGFI was associated with a reduced MACE-free survival (P < 0.001). Multivariate Cox regression analysis revealed a decreased LVGFI as a predictor for MACE [hazard ratio = 4.79, 95% confidence interval (CI) 1.46-15.67, P = 0.010] after adjusting for microvascular obstruction, left ventricular mass, and multivessel disease. In receiver operating characteristic analysis, LVGFI was a strong predictor for MACE (area under the curve = 0.73, CI 0.61-0.85). However, c-statistics revealed that LVGFI does not provide incremental prognostic information over left ventricular ejection fraction (LVEF) (P = 0.38). CONCLUSION LVGFI assessed by CMR is a strong predictor of MACE within 3 years after first STEMI. A superior predictive value as compared with LVEF was not found in this study.
ADULT CHILDREN CARING FOR THEIR ELDERLY PARENTS

Sri Lanka is the fastest ageing South Asian population. Using data from the Sri Lanka Aging Survey 2006, this paper documents the health of adult child caregivers and their elderly parents, nature of care provided, areas of caregiver concern, factors associated with caregiver stress, and caregiver attitudes towards elder care. Adult children (n=381), defining themselves as the elderly parent's primary caregiver, and their elderly parents (n=430), constitute the sample for this analysis. Relatively poor health among elderly parents combined with substantial time required for care-giving, and a relatively high level of stress among caregivers, is observed. Gender differences are observed in the type of elder care provided, and in the risk of being stressed/worried. Most caregivers have favourable attitudes towards home-based care, negative attitudes towards institutional care, and expect support from their children in old age. Caregiver burden will increasingly become a policy concern given Sri Lanka's ageing population and the predominant expectation that eldercare is the children's responsibility.
Improving parental adherence to a failed vision screening referral in the United States

Vision screening is an important function of the school nurse's role. Parental cooperation after a child's failed vision screening remains a problematic issue for school nurses, as research reveals inconsistent follow-up and a low rate of parental adherence to school nursing screening referral. Using a comparative descriptive design, the purpose of this investigation was to determine if there was an improvement in parental adherence after a failed vision screening referral in school-age children in an urban middle school setting when implementing an approach consisting of a comprehensive informative letter and telephone follow-up versus the use of a standard referral card commonly used in practice. Findings revealed a statistically significant increase in the number of school-age children who received professional eye care services with the use of the informative letter and telephone follow-up calls (P<0.001), as well as an increase in the number of eye care appointments made (P<0.001). Numerous barriers .
Reduction of hyaluronan-CD44-mediated growth, migration, and cisplatin resistance in head and neck cancer due to inhibition of Rho kinase and PI-3 kinase signaling.

OBJECTIVES To investigate whether hyaluronan (HA), a ligand for the transmembrane receptor CD44, and CD44, which acts through multiple signaling pathways to influence cellular behavior, promote Rho kinase- and phosphatidylinositol 3 (PI-3) kinase-mediated oncogenic signaling to alter cisplatin sensitivity and stimulate tumor cell proliferation, migration, and matrix metalloproteinase secretion in head and neck squamous cell carcinoma (HNSCC). DESIGN Laboratory investigation using the HNSCC cell line HSC-3. SETTING University laboratory. MAIN OUTCOME MEASURES Rho kinase and PI-3 kinase activity, myosin phosphatase and AKT phosphorylation, tumor cell growth, migration, and matrix metalloproteinase secretion were measured in the presence or absence of HA, cisplatin, and inhibitors of Rho kinase and PI-3 kinase. RESULTS The addition of HA, but not HA plus anti-CD44 antibody, resulted in increased Rho kinase and PI-3 kinase activity. Results of immunoblotting studies demonstrated that HA promotes Rho kinase-mediated myosin phosphatase phosphorylation and PI-3 kinase-mediated AKT phosphorylation. Hyaluronan was shown to promote migration and increased matrix metalloproteinase secretion through Rho kinase-mediated signaling. Hyaluronan treatment promoted increased tumor proliferation and resulted in a 12-fold reduced ability of cisplatin to cause HNSCC cell death. On the other hand, the presence of Y-27632, a Rho kinase inhibitor, and LY-294002, a PI-3 kinase inhibitor, blocked HA-mediated cisplatin resistance by HNSCC. CONCLUSIONS Our results suggest that HA and CD44 promote Rho kinase- and PI-3 kinase-mediated oncogenic signaling and cisplatin resistance. Perturbation of HA-CD44-mediated Rho kinase and PI-3 kinase signaling pathways may be a novel strategy to treat HNSCC.
Review of the association between retinal microvascular characteristics and eye disease

Computerized retinal imaging technologies enable the static and dynamic measurement of a range of retinal microvascular parameters. Large population‐based studies have reported associations between these microvascular indices and various ophthalmic diseases including diabetes, age‐related macular degeneration, retinal artery embolism, retinal vein occlusion, glaucoma and non‐glaucomatous optic neuropathies. Increasingly, sophisticated imaging and analysis techniques have the potential to provide relevant clinical information regarding disease risk and progression; however, further studies are required to verify associations and strengthen the predictive power of these techniques. We summarize the current state of knowledge regarding retinal microvascular characteristics and eye disease.
Applications of corneal topography and tomography: a review

Corneal imaging is essential for diagnosing and management of a wide variety of ocular diseases. Corneal topography is used to characterize the shape of the cornea, specifically, the anterior surface of the cornea. Most corneal topographical systems are based on Placido disc that analyse rings that are reflected off the corneal surface. The posterior corneal surface cannot be characterized using Placido disc technology. Imaging of the posterior corneal surface is useful for diagnosis of corneal ectasia. Unlike corneal topographers, tomographers generate a three‐dimensional recreation of the anterior segment and provide information about the corneal thickness. Scheimpflug imaging is one of the most commonly used techniques for corneal tomography. The cross‐sectional images generated by a rotating Scheimpflug camera are used to locate the anterior and posterior corneal surfaces. The clinical uses of corneal topography include, diagnosis of corneal ectasia, assessment of corneal astigmatism, and refractive surgery planning. This review will discuss the applications of corneal topography and tomography in clinical practice.
The otologic microbiome: a study of the bacterial microbiota in a pediatric patient with chronic serous otitis media using 16SrRNA gene-based pyrosequencing.

OBJECTIVE To characterize bacterial microbiota in middle ear, adenoid, and tonsil specimens using 16SrRNA gene-based pyrosequencing analysis. DESIGN Cross-sectional study of bacterial microbiota in middle ear, adenoid, and tonsil specimens from a pediatric patient with chronic serous otitis media. Middle ear, adenoid, and tonsil specimens from a pediatric patient were collected and underwent cell lysis and DNA isolation. Pyrosequencing was performed on the 454 Life Sciences GS FLX platform (Roche Diagnostics Corp, Branford, Connecticut). Pyrosequencing data were processed, quality-checked, and taxonomically classified to generate an abundance-based matrix. Ecological analyses were performed. SETTING Academic, tertiary referral center. MAIN OUTCOME MEASURES Comparative microbiome analysis. RESULTS We detected a total of 17 unique bacterial families, with 9, 9, and 12 bacterial families from the middle ear, tonsil, and adenoid specimens, respectively. Pseudomonadaceae dominated the middle ear microbiota at 82.7% relative abundance, whereas Streptococcaceae dominated the tonsil microbiota at 69.2%. Multiple bacteria, including Pseudomonadaceae, Streptococcaceae, Fusobacteriaceae, and Pasteurellaceae, dominated the adenoid microbiota. Overlap between the middle ear and the tonsil microbiota was minimal. In contrast, the adenoid microbiota encompassed bacteria detected from middle ear and tonsil. CONCLUSIONS Bacterial community analysis using pyrosequencing analysis revealed diverse, previously unknown bacterial communities in a set of pediatric middle ear, tonsil, and adenoid specimens. Our findings suggest that the adenoid may be a source site for both the middle ear and tonsil microbiota. An ecological framework is appropriate in comparative analysis of microbiota from nonsterile body sites.
Diagnosis of peripheral arterial disease based on distal limb pressures

Description: Atherosclerosis is the leading cause of death in the Western world. In the lower limbs, this condition can manifest itself as peripheral arterial disease (PAD), with a clinical presentation ranging from asymptomatic disease to critical limb ischaemia. The presence of PAD indicates a severe degree of systemic atherosclerosis. Due to the generalised nature, diagnosis of the condition is concurrently a strong predictor of risk of cardiovascular morbidity and mortality. PAD can be diagnosed non-invasively by measuring the blood pressure at the ankle or toe level and calculating a ratio with the arm pressure. Reliable measurements are pivotal for both detection of the disease and selection of the optimal treatment. This book targets various methodological issues regarding the diagnostic accuracy of automated non-laboratory as well as laboratory methods including signal interpretation and diagnostic agreement.
Arbeits- und Weiterbildungsbedingungen deutscher Assistenzärztinnen und -ärzte in internistischer Weiterbildung

Zusammenfassung Hintergrund | Die Arbeits- und Weiterbildungsbedingungen in Deutschland tätiger internistischer Assistenzärzte haben sich im Zuge weitreichender Veränderungen im Gesundheitssystem (u. a. diagnosebezogene Fallgruppen, Ökonomisierung / Kommerzialisierung, demografischer Wandel) geändert und zu Unzufriedenheit sowie Systemkritik geführt. Bislang existieren jedoch wenig publizierte Daten, welche diese Kritik quantitativ, im nationalen Kontext und mit Fokus auf die Teilaspekte Ökonomisierung und psychosoziale Arbeitsbelastung beschreiben. Methoden | Die Jungen Internisten der Deutschen Gesellschaft für Innere Medizin und das Junge Forum des Berufsverbands Deutscher Internisten haben eine online-basierte Befragung aller dort organisierter internistischer Weiterbildungsassistenten vorgenommen. Der Fragebogen deckt fünf wesentliche Konfliktfelder internistischer Arbeits- und Weiterbildungsbedingungen ab. Zusätzlich wurde das Modell beruflicher Gratifikationskrisen zur Beurteilung psychosozialer Arbeitsbelastung eingesetzt. Ergebnisse | 1696 Ärzte haben an der Befragung teilgenommen. Im stark verdichteten Arbeitsalltag kommen ihnen Fort- und Weiterbildung, sowie Familien- und Forschungsfreundlichkeit zu kurz. Ein Teil der Ärzte zieht hieraus persönliche Konsequenzen. Der Einfluss ökonomischer Erwägungen ist deutlich spürbar. Die psychosoziale Belastung der befragten Ärzte ist sehr hoch und stellt ein Risiko für die Gesundheit der Ärzte selbst und die Behandlungsqualität der Patienten dar. Schlussfolgerungen | Anpassungen der Arbeits- und Weiterbildungsbedingungen in der Inneren Medizin erscheinen auf Grundlage der erhobenen Daten erforderlich, um die Gesundheit der betroffenen Ärzte, die Qualität der Patientenversorgung und die Attraktivität des Berufsbildes für die Zukunft zu gewährleisten.
Statistical Analyses and Methods in the Published Literature: The SAMPL Guidelines*

Despite calls for guidelines on reporting statistical aspects of studies, most journals have still not included in their instructions for authors more than a paragraph or two about reporting statist ical methods and results. However, given that many statistical errors concern basic statistics, a comprehensive – and comp rehensible – set of reporting guidelines might improve how statistical analyses are documented. The SAMPL guidelines are designed to be included in a journal’s Instructions for Authors. These guide lines tell authors, journal editors, and reviewers how to report basic statistical methods and results. Although these guidelines are limited to the most common statistical analyses, they are nevertheless sufficient to prevent most of the reporting deficiencies routinely found in scientific articles.
Evaluation of the Knowledge of Physical Education Teachers from the City of Caruaru/PE of Tooth Avulsion-Replantation

Objetivo: Avaliar o conhecimento dos professores de educacao fisica do municipio de Caruaru-PE sobre avulsao-reimplante. Metodo: Foram entrevistados 79 profissionais por meio de formulario padronizado contendo 11 perguntas relativas a avulsao dentaria e aos procedimentos a serem realizados diante de tais casos. Resultados: Apenas 20,3% dos professores sabiam o que era traumatismo dentario, entretanto nenhum teve a oportunidade de estudar sobre o assunto durante a sua formacao. Os entrevistados receberam informacoes sobre avulsao dentaria e 44,3% dos participantes responderam ter presenciado este tipo de traumatismo em suas aulas. Todos os profissionais responderam que dariam um lenco ou toalha para o aluno morder e controlar o sangramento. Dos entrevistados, 19% nao saberiam o que fazer e 81% enxaguariam o dente em agua corrente. A maioria (86,1%) considerou que a procura do tratamento deveria ser imediata e todos relataram que envolveriam o elemento dentario em guardanapo de papel ate que a crianca fosse atendida e 26,6%, responderam que aconselharia o uso de analgesico em caso de dor. Conclusoes: Os professores nao demonstraram conhecimento dos procedimentos de urgencia a serem realizados em casos de avulsao dentaria. A inclusao destes procedimentos no curriculo dos profissionais e a realizacao de programas educativo-preventivos se faz necessario, aumentando-se desta forma as chances de sucesso do reimplante dentario.
Extracranial outflow of particles solved in cerebrospinal fluid: Fluorescein injection study

Cerebrospinal fluid is thought to be mainly absorbed into arachnoid granules in the subarachnoid space and drained into the sagittal sinus. However, some observations such as late outbreak of arachnoid granules in fetus brain and recent cerebrospinal fluid movements study by magnetic resonance images, conflict with this hypothesis. In this study, we investigated the movement of cerebrospinal fluid in fetuses. Several kinds of fluorescent probes with different molecular weights were injected into the lateral ventricle or subarachnoid space in mouse fetuses at a gestational age of 13 days. The movements of the probes were monitored by live imaging under fluorescent microscope. Following intraventricular injection, the probes dispersed into the 3rd ventricle and aqueduct immediately, but did not move into the 4th ventricle and spinal canal. After injection of low and high molecular weight conjugated probes, both probes dispersed into the brain but only the low molecular weight probe dispersed into the whole body. Following intra‐subarachnoid injection, both probes diffused into the spinal canal gradually. Neither probe dispersed into the brain and body. The probe injected into the lateral ventricle moved into the spinal central canal by the fetus head compression, and returned into the aqueduct by its release. We conclude this study as follows: (i) The movement of metabolites in cerebrospinal fluid in the ventricles will be restricted by molecular weight; (ii) Cerebrospinal fluid in the ventricle and in the subarachnoid space move differently; and (iii) Cerebrospinal fluid may not appear to circulate. In the event of high intracranial pressure, the fluid may move into the spinal canal.
Mutational analysis of the CYP1B1 gene in Pakistani primary congenital glaucoma patients: Identification of four known and a novel causative variant at the 3′ splice acceptor site of intron 2

Primary congenital glaucoma (PCG) causes blindness in early age. It has an autosomal recessive pattern of inheritance, hence is more prevalent in populations with frequent consanguineous marriages that occur in the Pakistani population. Mutations in the CYP1B1 gene are commonly associated with PCG. The aim of the present study was to identify genetic mutations in the CYP1B1 gene in PCG cases belonging to 38 Pakistani families. DNA was extracted using blood samples collected from all enrolled patients, their available unaffected family members and controls. Direct sequencing of the CYP1B1 gene revealed a novel 3' splice acceptor site causative variant segregating in an autosomal recessive manner in a large consanguineous family with four PCG‐affected individuals. The novel variant was not detected in 93 ethnically matched controls. Furthermore, four already reported mutations, including p.G61E, p.R355X, p.R368H, and p.R390H were also detected in patients belonging to nine different families. All identified causative variants were evaluated by computational programs, that is, SIFT, PolyPhen‐2, and MutationTaster. Pathogenicity of the novel splice site variant identified in this study was analyzed by Human Splicing Finder and MaxEntScan. Ten out of 38 families with PCG had the disease due to CYP1B1 mutations, suggesting CYP1B1 was contributing to PCG in these Pakistani patients. Identification of this novel 3' splice acceptor site variant in intron 2 is the first report for the CYP1B1 gene contributing to genetic heterogeneity of disease.
Synergistic prognostic implications of left ventricular mechanical dyssynchrony and impaired cardiac sympathetic nerve activity in heart failure patients with reduced left ventricular ejection fraction

Aims Impairment of cardiac sympathetic innervation is a potent prognostic marker in heart failure, while left ventricular mechanical dyssynchrony (LVMD) has recently been noted as a novel prognosis determinant in heart failure patients with reduced LV ejection fraction (HFrEF). This study was designed to determine the correlation between cardiac sympathetic innervation quantified by metaiodobenzylguanidine (MIBG) activity and LVMD measured by electrocardiogram-gated myocardial perfusion imaging and to evaluate their incremental prognostic values in HFrEF patients. Methods and results A total of 570 consecutive HFrEF patients were followed up for 19.6 months with a primary endpoint of lethal cardiac events (CE) such as sudden cardiac death, death due to pump failure and appropriate ICD shock against life-threatening ventricular tachyarrhythmias. Cardiac sympathetic function and innervation were quantified as heart-to-mediastinum ratio (HMR) and washout kinetics of cardiac MIBG activity. LVMD was assessed by a standard deviation (SD) of systolic phase angle in gated myocardial perfusion imaging. Patients with CE (n = 166, 29%) had a significantly lower HMR and a significantly greater phase SD than did non-CE patients: 1.46 ± 0.28 vs. 1.63 ± 0.29, P < 0.0001 and 39.1 ± 11.6 vs. 33.1 ± 10.1, P < 0.0001, respectively. Compared to the single use of optimal cut-offs of late HMR (1.54) and phase SD (38), their combination more precisely discriminated high-risk or low-risk patients from others with log rank values from 7.78 to 65.2 (P = 0.0053 to P ≤ 0.0001). Among significant univariate variables, multivariate Cox proportional hazards model identified NYHA functional class, estimated glomerular filtration rate (eGFR), HMR 1.54 and phase SD 60 as significant determinants of CE with hazard ratios of 3.108 (95% CI, 2.472-3.910; P < 0.0001), 0.988 (95% CI, 0.981-0.996; P = 0.0021), 0.257 (95% CI, 0.128-0.498; P < 0.0001) and 1.019 (95% CI, 1.019-1.037; P = 0.0228), respectively. By combining the four independent determinants, the prognostic powers synergistically (P < 0.0001) increased maximally to 263.8. Conclusions Left ventricular mechanical dyssynchrony and impairment of cardiac sympathetic innervation are synergistically related to lethal cardiac events, contributing to better stratification of lethal cardiac event-risks and probably to optimization of therapeutic strategy in patients with HFrEF.