Miracle-dz/UniFAR-FTUs huggingface dataset:
Sequential nephron blockade versus sequential renin–angiotensin system blockade in resistant hypertension: a prospective, randomized, open blinded endpoint study

Objective: To compare two drug regimens to treat resistant hypertension. Methods: In a prospective, randomized, open blinded endpoint study, 167 patients with mean baseline daytime ambulatory blood pressure 135 mmHg or more and/or 85 mmHg or more, despite 4 weeks’ treatment with irbesartan 300 mg/day, hydrochlorothiazide 12.5 mg/day and amlodipine 5 mg/day, were randomized to sequential nephron blockade (group 1, n = 85) or sequential renin–angiotensin system blockade (group 2, n = 82). First, spironolactone 25 mg/day in group 1 or ramipril 5 mg/day in group 2 were added for 4 weeks. Treatment was increased at weeks 4, 8 or 10 if home blood pressure was 135 mmHg or more and/or 85 mmHg or more by sequentially administering furosemide 20 mg/day, furosemide 40 mg/day and amiloride 5 mg/day in group 1, or ramipril 10 mg/day, bisoprolol 5 mg/day and bisoprolol 10 mg/day in group 2. The primary endpoint was change in systolic daytime ambulatory blood pressure at week 12. Results: At week 12, the mean between-group difference in daytime ambulatory blood pressure was 10/4 mmHg (95% confidence interval: 7–14/2–7; P < 0.001/P = 0.0014) in favour of the group 1. The blood pressure goal (daytime ambulatory blood pressure <135/85 mmHg) was achieved in 58% in the group 1 and 20% in the group 2 (P < 0.0001). Discontinuation for drug-related adverse events was low (group 1, n = 7; group 2, n = 6). Conclusion: In patients with resistant hypertension, sequential nephron blockade induces a large and well tolerated reduction in blood pressure via a progressive increase in sodium depletion, and is more effective than sequential renin–angiotensin system blockade.
Functional hypothalamic amenorrhea: Current view on neuroendocrine aberrations

Functional hypothalamic amenorrhea (FHA) is defined as a non-organic and reversible disorder in which the impairment of gonadotropin-releasing hormone (GnRH) pulsatile secretion plays a key role. There are main three types of FHA: stress-related amenorrhea, weight loss-related amenorrhea and exercise-related amenorrhea. The spectrum of GnRH–luteinizing hormone (LH) disturbances in FHA is very broad and includes lower mean frequency of LH pulses, complete absence of LH pulsatility, normal-appearing secretion pattern and higher mean frequency of LH pulses. Precise mechanisms underlying the pathophysiology of FHA are very complex and unclear. Numerous neuropeptides, neurotransmitters and neurosteroids play important roles in the physiological regulation of GnRH pulsatile secretion and there is evidence that different neuropeptides may be involved in the pathophysiology of FHA. Particular attention is paid to such substances as allopregnanolone, neuropeptide Y, corticotropin-releasing hormone, leptin, ghrelin and β-endorphin. Some studies reveal significant changes in these mentioned substances in patients with FHA. There are also speculations about use some of these substances or their antagonists in the treatment of FHA.
Effect of Aerodiol administration on ocular arteries in postmenopausal women

Objective. The aim of the present study was to evaluate the alteration of ocular blood hemodynamics after intranasal administration of 17β-estradiol, through measurement of the ophthalmic artery (OA) and the central retinal artery (CRA) using color duplex sonography. Methods. Thirty healthy women who had been naturally postmenopausal for at least 1 year were enrolled in the study. A randomized, placebo-controlled, crossover, double-blinded study was conducted of the acute effect of 17β-estradiol (Aerodiol®; Servier, Chambrayles-Tours, France) on OA and CRA blood flow using color duplex sonography. Results. The peak systolic and end diastolic velocities of the CRA were increased significantly after 17β-estradiol administration compared with placebo. A significant decrease was also found in the pulsatility and resistive indices of the CRA. However, there were no statistically significant differences in OA flow velocities or pulsatility and resistive indices. Conclusions. Nasal 17β-estradiol administration in postmenopausal women causes an improvement in the ocular vascular Doppler indices. These results suggest that there could be a positive effect of Aerodiol® on middle-sized arteries and arterioles.
Printing Unrealistic Expectations: A Closer Look at Newspaper Representations of Noninvasive Prenatal Testing

Background: Informed consent is one of the major ethical issues raised in conversations about prenatal genetic testing, and understanding of the risks and benefits is a key component of informed consent. Because newspapers help translate complex scientific developments into understandable, practical insights, they can influence understanding of prenatal genetic testing outside of the clinical encounter. We assess the extent to which newspaper articles address concerns about accurately portraying cell-free fetal DNA testing and discuss how they create what we consider to be unrealistic expectations about this methodology. Methods: LexisNexis Academic was searched for United States-based newspapers to identify articles including discussion about cell-free fetal DNA testing for Down syndrome. This broad search yielded 447 articles. Two independent coders reviewed these articles for adherence to a specific set of inclusion criteria, and discrepancies were reconciled through consensus. Articles meeting the inclusion criteria (n = 23) were analyzed in terms of how they portrayed noninvasive prenatal testing. Results: Newspaper articles more often described the benefits of testing than the harms, suggesting to the reader that the benefits outweigh the risks. Many articles poorly explained costs and financial implications of testing as well as numerical evidence about accuracy, Down syndrome birth prevalence, and termination rates following prenatal diagnosis. While most articles included discussion or quotes where scientists and clinicians serve as experts, they sometimes insufficiently disclosed these experts’ relevant conflicts of interest. None of the articles included parents of adults with Down syndrome or those who choose to terminate pregnancies following prenatal diagnosis as external sources. Conclusions: We contend that newspaper framing of noninvasive prenatal testing is problematic, especially for the average health care consumer who may consider its clinical application. Ultimately, these representations may leave consumers with unrealistic expectations about such emerging technologies. Because of media influence on public understanding about noninvasive prenatal testing, readers must be critical of the information that media present, and clinicians should assess patient understanding at decision-making points in prenatal care.
Prevalence and predictors of abnormal glucose metabolism in Mediterranean women with polycystic ovary syndrome

Impaired glucose tolerance (IGT) and Type 2 diabetes mellitus (DM) are common in women with polycystic ovary syndrome (PCOS) in American studies. However, whether rates are similar in other countries with a lower frequency of insulin resistance is not clear. Our purpose was to investigate the prevalence of abnormal glucose metabolism (AGM) in women with PCOS and asses the ability of clinical data and biochemical tests to predict these abnormalities within our population. One hundred and three PCOS women undergo a 75-g oral glucose tolerance test. Glucose tolerance was categorised according to World Health Organisation criteria. Glucose tolerance was abnormal in 18.5% of women: 10.7% had IGT and 7.7% had DM. Women with DM were older than those with IGT or normal glucose tolerance. Women with AGM were more obese, had a higher waist/hip ratio and free testosterone levels than normal glucose metabolism patients. QUICKI was the best predictor of AGM. Receiver operating characteristics analysis suggested a threshold value of 0.31 in quantitative insulin-sensitivity check index (QUICKI) (94.1% sensitivity, 86% specificity, 57.1 positive predictive value and 98.6 negative predictive value) for the prediction of AGM. In conclusion, Mediterranean women with PCOS are at lower risk of AGM than that published from other countries; however, the incidence is still high compared with populations of women without PCOS. We recommend that PCOS patients undergo periodic metabolic screening for AGM using QUICKI.
Evaluation of insulin resistance and metabolic syndrome in patients with polycystic ovary syndrome

Aim. Polycystic ovary syndrome (PCOS) is associated with the clustering of states including insulin resistance (IR), obesity, elevated blood pressure, and dyslipidemia that are termed as metabolic syndrome (MBS). This study was designed to assess the differences between homeostatic model assessment (HOMA) values in PCOS and healthy women. Methods. In a case–control study, 55 women with PCOS and 59 women with normal cycles (control group) aged 15–40 years old were evaluated. In all the subjects (after obtaining written informed consent), blood pressure, body weight, height, body mass index (BMI), waist /hip ratio(WHR) and fasting blood glucose (FBG), triglycerides (TG), HDL, C-peptide, insulin, HOMA Index, and FGIR (fasting glucose to insulin ratio) were measured. Results. In this study, the prevalence of MBS was significantly higher in PCOS group compared with the control group (p = 0.028). There were no significant differences in age, waist/hip ratio, fasting glucose, insulin, and C-peptide levels between patients with PCOS and control group. Furthermore, the prevalence of impaired fasting glucose (IFG) and the mean of HOMA and FGIR did not differ significantly between PCOS and control group. Conclusion. Criteria of MBS are frequently present in young women with PCOS and may be more useful as a prognostic factor than IR indexes in this age group. We suggest evaluation of IR in older age women with PCOS.
The Effectiveness of Simultaneous Thermotherapy with Ultrasound and Electrotherapy with Combined AC and DC Current on the Immediate Pain Relief of Myofascial Trigger Points

Objectives: This study is designed to investigate the immediate effectiveness of combining ultrasound [deep heat] therapy and modified electrotherapy for the treatment of myofascial trigger points [TrPs] of upper trapezius [UT] muscle.Methods: Twenty-six patients [12 males and 14 females, average age 42.1 ± 16.4 years] were studied. All patients had myofascial TrPs in one or two sides of the UT muscles. Fifty skeletal muscles were studied. The involved UT muscles were treated with different methods according to random assignment: Group A muscles were given placebo treatment [Control group]; Group B muscles were treated with only ultrasound [USD]; Group C muscles were given only electrotherapy [ET]; and Group D muscles were given a combination of ultrasound therapy and electrotherapy [USD + ET]. The effectiveness of treatment was assessed by conducting three measurements on each patient before and immediately after treatment: subjective pain intensity [PI], pain threshold [PT], and range of motion [ROM] of.
Interleukin-4 deficiency induces mild preeclampsia in mice

Objective: Inflammation is necessary for successful pregnancy; however, excessive inflammation plays a central role in the development of the pregnancy-specific hypertensive disorder preeclampsia. Numerous anti-inflammatory cytokines are decreased in women with preeclampsia but the role of individual cytokines in blood pressure regulation during pregnancy is unknown. Therefore, we examined whether the lack of the potent anti-inflammatory cytokine interleukin-4 (IL-4) would be sufficient to elicit a preeclampsia-like syndrome in mice, and when coupled with immune system activation that these symptoms would be further augmented. Methods: Measures of splenic immune cells, placental inflammation, blood pressure, endothelial function, and urinary protein excretion were performed in pregnant IL-4-deficient mice as well as in pregnant IL-4-deficient mice treated with the Toll-like receptor 3 agonist polyinosinic:polycytidylic (poly I:C). Results: Pregnant IL-4-deficient mice exhibited altered splenic immune cell subsets, increased levels of pro-inflammatory cytokines, placental inflammation, mild hypertension, endothelial dysfunction, and proteinuria compared to pregnant control mice. Compared to pregnant control mice treated with poly I:C which exhibit preeclampsia-like symptoms, poly I:C-treated pregnant IL-4-deficient mice exhibited a further increase in pro-inflammatory cytokine levels, which was associated with augmented SBP and endothelial dysfunction. Conclusion: Collectively, these data show that the absence of IL-4 is sufficient to induce mild preeclampsia-like symptoms in mice due to excessive inflammation. Thus, the anti-inflammatory effects of IL-4 are important in preventing hypertension during pregnancy.
Current Situation of Taeniasis and Cysticercosis in Indonesia

Three human taeniid species, Taenia solium, Taenia saginata and Taenia asiatica are distributed in Indonesia. A field survey conducted in Bali from 2002 to 2006 showed that the prevalence of taeniasis was highly variable among four districts (1.1-27.5%), and only two cysticercosis cases due to T. solium infection were detected. All tapeworms (n = 66) expelled from 66 tapeworm carriers were confirmed to be T. saginata by mitochondrial DNA analysis. A total prevalence of 13.0% (19⁄146) for T. solium taeniasis was found in Jayawijaya District, Papua (Irian Jaya). It included 14 of 88 (15.9%) in 1999 and 5 of 58 (8.6%) in 2001, while the seroprevalence of cysticercosis in humans by sub-district in Papua ranged from 0.0% in a non-endemic area to 48.5% in an endemic area from 1996 to 2005. The seroprevalence of cysticercosis in pigs and dogs in Jayawijaya ranged from 8.5% to 70.4% (1998-1999) and 4.9% to 33.3% (2000-2002), respectively. A 2003-2006 survey of 371 local people in Samosir island, north Sumatra revealed 6 of 240 (2.5%) to be infected with T. asiatica; 2 of 58 (3.4%) and 4 of 182 (2.2%) cases were detected in 2003 and 2005, respectively. This brief review summarizes the present situation of taeniasis and cysticercosis, the distribution of three human taeniid species, and the risk factors⁄transmission aspects of these tapeworm infections in Bali, Papua, and north Sumatra regions of Indonesia.
Vascular and parenchymal lesions along with enhanced neurogenesis characterize the brain of asymptomatic stroke-prone spontaneous hypertensive rats

Background and objectives: Spontaneously hypertensive stroke-prone rats (SHRSPs) develop hypertension, cerebrovascular abnormalities and a stroke phenotype in association with higher levels of proteinuria. Here, we focus on cerebral abnormalities preceding lesions detectable by MRI. Methods: Longitudinal assessment of brain histology was performed in salt-loaded male SHRSPs (n = 26) and Wistar–Kyoto (WKY) normotensive control animals (n = 27). Groups of rats were sacrificed at different time points: Time 0, before the salt diet administration; Time 1, when proteinuria achieved 40 mg/day; Time 2, when proteinuria exceeded 100 mg/day. Results: At Time 0, no brain lesions were observed. At Time 1, changes of the cortical penetrating arteries, vasogenic oedema, lacunae and focal cell loss appeared in SHRSPs and worsened at Time 2, although no lesions were yet detected by MRI. Staining for proliferation markers revealed a significant boost of cellular mitosis in the subventricular zone (SVZ) of SHRSPs. Moreover, we observed higher immunopositivity for nestin, glial fibrillary acidic protein and doublecortin (markers for neural stem cells, astrocytes and immature neurons, respectively). At Time 2, apoptotic caspase-3 as well as 4-hydroxynonenal-positive neurons were associated to decreased nestin and doublecortin staining. High expression levels of glial fibrillary acidic protein were maintained in the SVZ. No comparative alterations and SVZ activation were recorded in WKYs. Conclusion: Appearance of vascular changes in SHRSPs, before any MRI-detectable brain lesion, is coupled to active neural proliferation in the SVZ. With disease progression, only newborn astrocytes can survive, likely because of the neurotoxicity triggered by brain oedema and oxidative stress.
Progression of coronary artery calcification is associated with long-term cadiovascular events in hypertensive adults

Objectives: Coronary artery calcification (CAC) is an independent predictor of cardiovascular (CV) events in hypertensive adults. However, the additive value of serial CAC measurements for risk stratification is unclear. The aim of the present study was to find whether CAC progression predicts long-term CV events in hypertensive patients. Methods: The study group included 210 patients (mean age 64 ± 5.6 years, 54% men), a subgroup of 544 participants in the calcification side arm of the INSIGHT (International Nifedipine Study Intervention as Goal for Hypertension Therapy). All were free of symptoms or known CV disease, had at least two CT scans 1 year apart, and had available long-term follow-up. Progression of CAC was defined as the absolute change in CAC score between maximal score during follow-up and baseline score. The endpoint was the first CV event after the last CT scan. Three categories of CAC progression were defined. Zero progression was defined as ‘nonprogressors’, and progression below and above the median of maximal progression were defined as ‘slow progressors’ and ‘rapid progressors’, respectively. Results: During 15 years of follow-up (mean 11.4 ± 4.4), 83 patients experienced a first CV event. The rate of events was higher in rapid (29/59, 49%), and slow (36/78 46%) than in nonprogressors (18/73 25%); (P = 0.005). Compared with nonprogressors, the adjusted hazard ratio for CV events was 1.91 [95% confidence interval (95% CI); 1.05–3.47] in the slow, and 2.13 (95% CI; 1.12–4.03) in the rapid progressors. Conclusion: In hypertensive patients, progression of CAC is associated with long-term CV events.
Working together: lessons for collaboration between health and social services

The recent community care reforms have placed a high premium on interagency collaboration between health and social care agencies to ensure the delivery of high quality services to users. An examination of the historical record reveals the problematic nature of such activity. This paper provides a review of this record and then illustrates contemporary inter-agency issues through an analysis of a local experiment in joint service delivery in Leeds (UK). The paper's examination of the literature on joint working provides some clues as to why the experiment's original aims and objectives remained largely unrealized. The difficulties encountered by the key actors were a mix of cultural, professional and organizational factors.
Cellular senescence in pretransplant renal biopsies predicts postoperative organ function

Older and marginal donors have been used to meet the shortfall in available organs for renal transplantation. Post‐transplant renal function and outcome from these donors are often poorer than chronologically younger donors. Some organs, however, function adequately for many years. We have hypothesized that such organs are biologically younger than poorer performing counterparts. We have tested this hypothesis in a cohort of pre‐implantation human renal allograft biopsies (n = 75) that have been assayed by real‐time polymerase chain reaction for the expression of known markers of cellular damage and biological aging, including CDKN2A, CDKN1A, SIRT2 and POT1. These have been investigated for any associations with traditional factors affecting transplant outcome (donor age, cold ischaemic time) and organ function post‐transplant (serum creatinine levels). Linear regression analyses indicated a strong association for serum creatinine with pre‐transplant CDKN2A levels (p = 0.001) and donor age (p = 0.004) at 6 months post‐transplant. Both these markers correlated significantly with urinary protein to creatinine ratios (p = 0.002 and p = 0.005 respectively), an informative marker for subsequent graft dysfunction. POT1 expression also showed a significant association with this parameter (p = 0.05). Multiple linear regression analyses for CDKN2A and donor age accounted for 24.6% (p = 0.001) of observed variability in serum creatinine levels at 6 months and 23.7% (p = 0.001) at 1 year post‐transplant. Thus, these data indicate that allograft biological age is an important novel prognostic determinant for renal transplant outcome.
The World We Share: Four Challenges Worthy of Art Therapists’ Attention

Nine years ago, I began my tenure as Editor of Art Therapy by calling upon Janus, the Greek god of beginnings who looked in two directions, past and present. In transitional times we pay attention to what is coming into our world and what is departing. Now, as outgoing Editor, I will soon be the one taking leave. Before doing so, I’d like to share the Editor’s unique vantage of seeing, Janus-like, what is trending in the profession’s scholarly writings as compared to where things were when I began.
Behavior change stages related to physical activity in adolescents

Studies related to behavior in relation to the practice of physical exercises have attracted the attention of many researchers. However, there is still a lack of investigations on this topic especially among adolescents. The objective of this descriptive-analytical type research was to classify the practice of physical exercise according to the Behavior Change Stages (BCS) theory, according to gender, grade and socioeconomic level. The subjects were high-school adolescents from the city of Recife-PE with average age of 16.2 ± 1.1 (14 to 19 years of age) selected by conglomerate sampling totalizing 2,271 students (1,022 boys and 1,249 girls) from 29 private schools. Social-demographic and BCS characteristics were surveyed by means of the application of a self-report questionnaire. The analysis of data were conducted using the descriptive statistics, the chi-squared test, the Spearman correlation and the MannWhitney U test (p < 0.05). The students presented the following characteristics: 66.3% belonged to economical classes A1 and A2, what evidenced the high purchasing power of the sample. In the group studied, 61.6% of the adolescents were classified as inactive or irregularly active and 26.2% were classified as inactive (precontemplative and contemplative), and in the analysis by gender, boys were physically more active than girls according to grouped BCS. A decline on the practice of physical activities with the grade advance was also verified. The creation of interventions in schools of the region with the objective of encouraging the practice of physical activities is suggested, especially among girls, that contemplate the option selected by the students, and structural reformulations to suit schedule/activity as effective ways to change the behavior in relation to physical activities.
People are not computers: (most) thought processes are not computational procedures

The computational conception of the mind that dominates cognitive science assumes that thought processes involve the computation of algorithms or the execution of functions. Human minds turn out to be automatic formal systems or physical syntax-processing systems. The objection has often been posed that systems of this kind do not possess sufficient conditions for mentality, because the syntax they process may be meaningless for those systems. That problem concerns their semantic content. Here an additional objection is posed that systems of this kind, as normatively-directed, problem-solving causal systems, impose conditions that are not necessary for mentality, because many if not most human thought processes violate them. This problem concerns their causal character. The computational conception reflects an overgeneralization about human thought processes based on special kinds of thinking and thus seems to be trivial or false.