Miracle-dz/UniFAR-FTUs huggingface dataset:
Relative contribution of genetic and nongenetic modifiers to intestinal obstruction in cystic fibrosis.

BACKGROUND & AIMS Neonatal intestinal obstruction (meconium ileus [MI]) occurs in 15% of patients with cystic fibrosis (CF). Our aim was to determine the relative contribution of genetic and nongenetic modifiers to the development of this major complication of CF. METHODS A total of 65 monozygous twin pairs, 23 dizygous twin/triplet sets, and 349 sets of siblings with CF were analyzed for MI status, significant covariates, and genome-wide linkage. RESULTS Specific mutations in the CF transmembrane conductance regulator (CFTR), the gene responsible for CF, correlated with MI, indicating a role for CFTR genotype. Monozygous twins showed substantially greater concordance for MI than dizygous twins and siblings (P = 1 x 10(-5)), showing that modifier genes independent of CFTR contribute substantially to this trait. Regression analysis revealed that MI was correlated with distal intestinal obstruction syndrome (P = 8 x 10(-4)). Unlike MI, concordance analysis indicated that the risk for development of distal intestinal obstruction syndrome in CF patients is caused primarily by nongenetic factors. Regions of suggestive linkage (logarithm of the odds of linkage >2.0) for modifier genes that cause MI (chromosomes 4q35.1, 8p23.1, and 11q25) or protect from MI (chromosomes 20p11.22 and 21q22.3) were identified by genome-wide analyses. These analyses did not support the existence of a major modifier gene on chromosome 19 in a region previously linked to MI. CONCLUSIONS The CFTR gene along with 2 or more modifier genes are the major determinants of intestinal obstruction in newborn CF patients, whereas intestinal obstruction in older CF patients is caused primarily by nongenetic factors.
1064 nm long‐pulsed Nd:YAG laser treatment of basal cell carcinoma

Standard surgical and destructive treatments for basal cell carcinoma (BCC) can result in significant morbidity and scarring, stimulating the investigation of alternative non‐surgical options. The objective of this study was to determine the safety, clinical, and histological efficacy of pulsed, high‐fluence 1064 nm Nd:YAG laser therapy for the treatment of BCC on the trunk and extremities.
Association of Inter-arm Blood Pressure Difference with Atherosclerosis in Patients without Cardiovascular Diseases

Received: 2013.5. 14, Revised: 2013.9. 23, Accepted: 2013.9. 23 Correspondence to: Yun-Jin Kim, MD Address: Department of Family Medicine, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 602-739, Korea Tel: +82-51-240-7834, Fax: +82-51-242-8671 E-mail: yujkim@pusan.ac. kr Blood pressure (BP) measurement is the most common investigation performed in primary care. Precise monitor of BP is important for early detection, treatment, prevention of hypertension. However, patients are often encountered in the clinical setting with a different systolic BP (SBP) or diastolic BP (DBP) in each arm. The presence of difference between arm BP can result in a delayed di❙Original Article❙ Vol. 19, No. 3, September 2013 ISSN 2233-8136, eISSN 2233-8454, http://dx.doi. org/10.5646/jksh.2013. 19.3. 71 Copyright 2013. The Korean Society of Hypertension c Association of Inter-arm Blood Pressure Difference with Atherosclerosis in Patients without Cardiovascular Diseases
Factors Influencing Antibiotic-Prescribing Decisions Among Inpatient Physicians: A Qualitative Investigation

OBJECTIVE To understand the professional and psychosocial factors that influence physician antibiotic prescribing habits in the inpatient setting. DESIGN We conducted semi-structured interviews with 30 inpatient physicians. Interviews consisted of open-ended questions and flexible probes based on participant responses. Interviews were audio recorded, transcribed, de-identified, and reviewed for accuracy and completeness. Data were analyzed using emergent thematic analysis. SETTING Two teaching hospitals in Indianapolis, Indiana PARTICIPANTS A total of 30 inpatient physicians (10 physicians-in-training, 20 supervising staff) were enrolled in this study. RESULTS Participants recognized that antibiotics are overused, and many admitted to prescribing antibiotics even when the clinical evidence of infection was uncertain. Overprescription was largely driven by anxiety about missing an infection, whereas potential adverse effects of antibiotics did not strongly influence decision making. Participants did not routinely disclose potential adverse effects of antibiotics to inpatients. Physicians-in-training were strongly influenced by the antibiotic prescribing behavior of their supervising staff physicians. Participants sometimes questioned their colleagues’ antibiotic prescribing decisions, but they frequently avoided providing direct feedback or critique. These physicians cited obstacles of hierarchy, infrequent face-to-face encounters, and the awkwardness of these conversations. CONCLUSION A physician-based culture of prescribing antibiotics involves overusing antibiotics and not challenging the decisions of colleagues. The potential adverse effects of antibiotics did not strongly influence decision making in this sample. A better understanding of these factors could be leveraged in future efforts to improve antibiotic prescribing practices in the inpatient setting. Infect. Control Hosp. Epidemiol. 2015;36(9):1065–1072
Longitudinal Evaluation of Clinical and Colonization Methicillin-Resistant Staphylococcus aureus Isolates Among Veterans

Using the Veterans’ Health Administration MRSA Directive as a platform to collect methicillin-resistant Staphylococcus aureus (MRSA) colonization isolates and an active MRSA infection surveillance program, the genetic relatedness of colonization and infection isolates was evaluated. Infection and colonization strain concordance was found in 85.7% of patients. The USA 500 MRSA strain was identified in 31.8% of patients. Infect Control Hosp Epidemiol 2015;00(0): 1–3
Improvement in survival associated with adult-to-adult living donor liver transplantation.

BACKGROUND & AIMS More than 2000 adult-to-adult living donor liver transplantations (LDLT) have been performed in the United States, yet the potential benefit to liver transplant candidates of undergoing LDLT compared with waiting for deceased donor liver transplantation (DDLT) is unknown. The aim of this study was to determine whether there is a survival benefit of adult LDLT. METHODS Adults with chronic liver disease who had a potential living donor evaluated from January 1998 to February 2003 at 9 university-based hospitals were analyzed. Starting at the time of a potential donor's evaluation, we compared mortality after LDLT to mortality among those who remained on the waiting list or received DDLT. Median follow-up was 4.4 years. Comparisons were made by hazard ratios (HR) adjusted for LDLT candidate characteristics at the time of donor evaluation. RESULTS Among 807 potential living donor recipients, 389 underwent LDLT, 249 underwent DDLT, 99 died without transplantation, and 70 were awaiting transplantation at last follow-up. Receipt of LDLT was associated with an adjusted mortality HR of 0.56 (95% confidence interval [CI]: 0.42-0.74; P < .001) relative to candidates who did not undergo LDLT. As centers gained greater experience (>20 LDLT), LDLT benefit was magnified, with a mortality HR of 0.35 (95% CI: 0.23-0.53; P < .001). CONCLUSIONS Adult LDLT was associated with lower mortality than the alternative of waiting for DDLT. This reduction in mortality was magnified as centers gained experience with LDLT. This reduction in transplant candidate mortality must be balanced against the risks undertaken by the living donors themselves.
Identifying the essential components of cultural competence in a Chinese nursing context: A qualitative study

&NA; This qualitative study using semi‐structured interviews was conducted to identify the essential components of cultural competence from the perspective of Chinese nurses. A purposive sample of 20 nurse experts, including senior clinical nurses, nurse administrators, and educators in transcultural nursing, was recruited. Using thematic analysis, four themes: awareness, attitudes, knowledge, and skills, with two subthemes for each, were identified. Notably, culture in China was understood in a broad way. The participants' responses focused upon demographic attributes, individuality, and efforts to facilitate quality care rather than on the cultural differences of ethnicity and race and developing the capacity to change discrimination or health disparities. A greater understanding of cultural competence in the Chinese nursing context, in which a dominant cultural group exists, is essential to facilitate the provision of culturally competent care to diverse populations.
T cells redirected against hepatitis B virus surface proteins eliminate infected hepatocytes.

BACKGROUND & AIMS The final goal in hepatitis B therapy is eradication of the hepatitis B virus (HBV) replication template, the so-called covalently closed circular DNA (cccDNA). Current antiviral treatment of chronic hepatitis B depends on interferon alpha or nucleoside analogues inhibiting the viral reverse transcriptase. Despite treatment, cccDNA mostly persists in the host cell nucleus, continues to produce hepatitis B surface antigen (HBsAg), and causes relapsing disease. We therefore aimed at eliminating persistently infected hepatocytes carrying HBV cccDNA by redirecting cytolytic T cells toward HBsAg-producing cells. METHODS We designed chimeric T-cell receptors directed against HBV surface proteins present on HBV-infected cells and used them to graft primary human T cells with antibody-like specificity. The receptors were composed of a single chain antibody fragment directed against HBV S or L protein fused to intracellular signalling domains of CD3xi and the costimulatory CD28 molecule. RESULTS Our results show that these chimeric receptors, when retrovirally delivered and expressed on the cell surface, enable primary human T cells to recognize HBsAg-positive hepatocytes, release interferon gamma and interleukin 2, and, most importantly, lyse HBV replicating cells. When coincubated with HBV-infected primary human hepatocytes, these engineered, antigen-specific T cells selectively eliminated HBV-infected and thus cccDNA-positive target cells. CONCLUSIONS Elimination of HBV cccDNA-positive hepatocytes following antiviral therapy is a major therapeutic goal in chronic hepatitis B, and adoptive transfer of grafted T cells provides a promising novel therapeutic approach. However, T-cell therapy may also cause liver damage and therefore needs further preclinical evaluation.
Assessment of Clostridium difficile Burden in Patients Over Time With First Episode Infection Following Fidaxomicin or Vancomycin

In patients with first episode Clostridium difficile infection treated with vancomycin or fidaxomicin, more patients receiving fidaxomicin achieved at least 2 log10 colony-forming units/g reduction in spores at the follow-up visit (P=.02). Similar to published literature, a higher proportion of patients receiving fidaxomicin demonstrated sustained clinical response. Infect. Control Hosp. Epidemiol. 2016;37(2):215–218
The prevalence of breastfeeding in prematures with very low birth weight – a systematic review

Due to the difficulty in establishing breast feeding among mothers of premature babies, several studies have been carried out to find out the frequency of this practice. National and international indexes are little known, particularly those related to extremely underweight premature babies. The objective of this study was to do a systematic bibliographic review on the prevalence/ duration of breast feeding among mothers of very low birth weight infants. Six data bases were consulted to search for articles on the subject published from 1997 onwards. From the 78 articles related to the topic, 9 dealt with the prevalence and/or duration of breast feeding among mothers of premature babies born weighing less than 1500 grams. Data were summarized in a table containing detailed information on each research. Some issues came up as essential to the subject of breast feeding among mothers of premature babies such as the concept of breast feeding adopted, the sample, the place and year of the study, the design of the study and the time of data collection. As breast feeding is closely related to cultural and social values from each region and country and the mother’s decision, it is difficult to compare prevalence from different contexts/worlds. However, some interventions in the studied population were efficient, showing that breast feeding is necessary, difficult and highly demanding yet possible through simple and intentionally systematized actions.
A Pilot Feasibility Intervention to Increase Advance Care Planning among African Americans in the Deep South.

BACKGROUND Despite growing efforts to facilitate advance care planning (ACP) to decrease health disparities in palliative care, low completion rates of advance directives (AD) have been consistently found among African Americans. OBJECTIVE The objective was to examine the feasibility of a multicomponent ACP intervention program that integrates motivational interviewing, evidence-based ACP facilitation program (Respecting Choices(®)), and health-literacy adjusted AD. This pilot study aims to address the unique barriers to ACP engagement among African Americans in the Deep South. METHODS The design was a mixed-method randomized controlled trial design. Analysis of covariance (ANCOVA) and thematic content analysis (TCA) were conducted to identify barriers and facilitators for ACP engagement and to assess feasibility, knowledge, and intention to complete an AD. Thirty community-dwelling African Americans (mean age M = 55.43, SD = 6.71, range = 47-73) were recruited from the Deep South and randomly assigned to receive intervention (n = 15) or educational material (n = 15) at a local university medical center. RESULTS All participants (n = 30) reported high satisfaction (M = 4.81, SD = 0.44, max score = 5) and increased intent to complete an AD at postintervention. A significant increase in knowledge on AD from baseline to postintervention was observed in the intervention group-t(14) = -3.06, p = 0.01, d = 1.67); no significant change was found for control. Lack of information, mistrust of doctors, and avoidance of discussing death were primary barriers to ACP discussions. Facilitators include ACP education, decreased mistrust, and proactive initiation of ongoing ACP discussions. CONCLUSIONS Feasibility data revealed successful implementation of a brief intervention to increase ACP engagement and willingness to complete an AD among southern African Americans.
Kangaroo Mother Care for Low Birth Weight Babies: A prospective Observational Study

Introduction: Kangaroo Mother Care is the low cost, humane technique for caring low birth weight babies by direct skin to contact with the mother. Objective: The Prospective observational study was done to see the effect of KMC especially on weight gain on low birth weight babies weighing 2000 grams or less at Special Care Baby Unit of Paropakar Maternity and Women's hospital, Kathmandu. Method: The study was conducted in Special Care Baby Unit (SCBU) of Paropakar Maternity and Women's Hospital over 7 months period May 2007 to Nov. 2008 (from Baishakh 2064 to Kartik 2065). The method of care consisted of skin to skin contact between the mother and the infant. Result: It was observed that babies had good weight gain of average 30gms/day and had short duration of hospital stay of average 9 days. Babies had less morbidities like hypothermia, apnea, skin infections and oral thrush. 100% babies had exclusive breast feeding and KMC was acceptable to mothers. Conclusion: Kangaroo Mother Care shows early and good weight gain in low birth weight babies. It is simple, low cost technique and well acceptable by mother and family and can be continued at home. Key words: Kangaroo mother doi:10.3126/jnps.v29i1. 1593 J. Nepal Paediatr. Soc. Vol.29(1) p.6-9
The sensitivity of glioma cells to pyropheophorbide‐αmethyl ester‐mediated photodynamic therapy is enhanced by inhibiting ABCG2

To study the mechanisms of human glioblastoma cell resistance to methyl ester pyropheophorbide‐a‐mediated photodynamic therapy (MPPa‐PDT) and the relationship between the cells and adenosine triphosphate‐binding cassette superfamily G member 2 (ABCG2).
Potential relevance of cytoplasmic viral sensors and related regulators involving innate immunity in antiviral response.

BACKGROUND & AIMS Clinical significance of molecules involving innate immunity in treatment response remains unclear. The aim is to elucidate the mechanisms underlying resistance to antiviral therapy and predictive usefulness of gene quantification in chronic hepatitis C (CH-C). METHODS We conducted a human study in 74 CH-C patients treated with pegylated interferon alpha-2b and ribavirin and 5 nonviral control patients. Expression of viral sensors, adaptor molecule, related ubiquitin E3-ligase, and modulators were quantified. RESULTS Hepatic RIG-I, MDA5, LGP2, ISG15, and USP18 in CH-C patients were up-regulated at 2- to 8-fold compared with nonhepatitis C virus patients with a relatively constitutive Cardif. Hepatic RIG-I, MDA5, and LGP2 were significantly up-regulated in nonvirologic responders (NVR) compared with transient (TR) or sustained virologic responders (SVR). Cardif and RNF125 were negatively correlated with RIG-I and significantly suppressed in NVR. Differences among clinical responses in RIG-I/Cardif and RIG-I/RNF125 ratios were conspicuous (NVR/TR/SVR = 1.3:0.6:0.4 and 2.3:1.3:0.8, respectively). Like viral sensors, ISG15 and USP18 were significantly up-regulated in NVR (4-fold and 2.3-fold, respectively). Multivariate and receiver operator characteristic analyses revealed higher RIG-I/Cardif ratio, ISG15, and USP18 predicted NVR. Lower Cardif in NVR was confirmed by its protein level in Western blot. Also, transcriptional responses in peripheral blood mononuclear cells to the therapy were rapid and strong except for Cardif in not only a positive (RIG-I, ISG15, and USP18) but also in a negative regulatory manner (RNF125). CONCLUSIONS NVR may have adopted a different equilibrium in their innate immune response. High RIG-I/Cardif and RIG-I/RNF125 ratios and ISG15 and USP18 are useful in identifying NVR.
Emergence of Carbapenem-Resistant Acinetobacter baumannii in Nursing Homes With High Background Rates of MRSA Colonization

Carbapenem-resistant Acinetobacter baumannii (CRAB) with diverse multilocus sequence typing emerged among our nursing home residents (6.5%) with a high background rate of MRSA (32.2%). Rectal swabs yielded a higher rate of CRAB detection than axillary or nasal swabs. Bed-bound status, use of adult diapers, and nasogastric tube were risk factors for CRAB colonization. Infect Control Hosp Epidemiol 2016;37:983–986
Frusemide in pulmonary oedema: continuous versus intermittent

Objective: To analyse and compare the infusion of frusemide by different modes of administration. Design: Prospective clinical survey of patients suffering from acute respiratory failure due to cardiogenic pulmonary oedema. Setting: A seven-bed general intensive care unit. Patients: Group A comprised 10 patients treated with intravenous frusemide several times daily at a dose of 1 mg/kg. Group B comprised 10 patients treated with continuous infusion of frusemide for 24 hours at an initial dose of 1 mg/kg, and 0.1 mg/kg/hr thereafter, with an option of increasing the dose every 2 hours. Group C comprised 10 patients treated with albumin and frusemide combined in continuous infusion over 24 hours at a dose of 250 mg frusemide diluted in 12.5 g albumin at a rate of 0.1 mg frusemide/kg/hr. Measurements: i) Serum electrolytes, creatinine, blood urea nitrogen (BUN) and protein; ii) urinary electrolytes; iii) hourly urinary output during the first 24 hours after admission. Results: There were no differences in t.
Living donor liver transplantation for hepatitis C virus cirrhosis with a huge portal vein aneurysm

Received November 25, 2007; accepted January 20, 2008.A57-year-oldfemalewasdiagnosedwithhepatocellularcarcinoma associated with hepatitis C virus–related cir-rhosis. She underwent ablation therapy several times,including 4 repeated courses of percutaneous ethanolinjection, and was ﬁnally referred to our hospital forliver transplantation. During the preoperative evalua-tion, a huge extrahepatic portal vein aneurysm (PVA)and mural thrombosis were detected on computed to-mographic angiography and magnetic resonance imag-ing angiography (Fig. 1). Massive ascites and a recana-lized umbilical vein were also noted. She underwentliving donor liver transplantation using her daughter’sright lobe graft. During surgery, the conﬂuence of thesuperior mesenteric vein and splenic vein seemed to benormal and intact, so the whole PVA was resected, andthe mural thromboses were removed. Thereafter, directend-to-end anastomosis between the recipient portalvein and graft portal vein was successfully accom-plished without tension. The postoperative course wasuneventful until she developed portal vein thrombosisdue to anastomotic stenosis 1 year after the transplan-tation. The complication was successfully reversed bysystemic thrombolytic therapy using recombinant tis-sue plasminogen activator combined with subsequentpercutaneous transhepatic balloon dilatation. Sincethen, the patient has been doing well with normal liverfunction for the past 2 years.Abnormality of the portal vein is often observed inliver transplant candidates but mainly as stenosis orthrombosis in chronic diseases.
Long-term course of chronic hepatitis C in children: from viral clearance to end-stage liver disease.

BACKGROUND & AIMS The natural course of chronic hepatitis C (CHC) in children is not well understood. The aim of this study was to assess the long-term course of CHC in a large sample of otherwise healthy children. METHODS From 1990 to 2005, 504 consecutive antihepatitis C virus (HCV)-positive children were enrolled at 12 centers of a national observatory and were followed up retrospectively/prospectively. RESULTS Putative exposure was perinatal in 283 (56.2%) cases, parenteral in 158 (31.3%), and unknown in 63 (12.5%). At baseline, 477 (94.6%) cases were HCV RNA seropositive, 118 (24.7%) of which were treated with standard interferon alpha. Ten years after putative exposure, the outcome in 359 HCV RNA-positive, untreated patients was (1) undetectable viremia in 27 (7.5%) (by Cox regression analysis, spontaneous viral clearance was independently predicted by genotype 3 [hazard ratio 6.44; 95% confidence interval: 2.7-15.5]) and (2) persistent viremia in 332 (92%) cases. Six of these 332 cases (1.8%) progressed to decompensated cirrhosis (mean age, 9.6 years). This latter group included 5 Italian children perinatally infected with genotype 1a (4 of the mothers were drug users). Thirty-three (27.9%) treated patients achieved a sustained virologic response. CONCLUSIONS Over the course of a decade, few children with chronic HCV infection cleared viremia spontaneously, and those who did were more likely to have genotype 3. Persistent viral replication led to end-stage liver disease in a small subgroup characterized by perinatal exposure, maternal drug use, and infection with HCV genotype 1a. Children with such features should be considered for early treatment.