Miracle-dz/UniFAR-FTUs huggingface dataset:
Downstaging and survival benefits of neoadjuvant radiotherapy before cystectomy for patients with invasive bladder carcinoma

Objective. To compare the long-term outcomes of a series of patients treated with neoadjuvant radiotherapy combined with cystectomy against a later series of patients treated with immediate cystectomy. Material and methods. A total of 187 consecutive patients, surgically treated with cystectomy due to cT1–3 transitional cell bladder carcinoma with (n=90) or without (n=97) neoadjuvant radiotherapy, was included in a retrospective analysis. The clinical stage at the primary bladder resection and the pathological reports after the cystectomy were re-evaluated and progression-free, disease-specific and overall survival were calculated. Results. Seven of 97 (7%) patients treated without any neoadjuvant therapy had pT0 in the bladder specimen. In contrast, 51 of 90 patients (57%) treated with neoadjuvant radiotherapy downstaged to pT0. Among cT3 tumours none of 16 patients (0%) treated without radiotherapy downstaged to pT0, while 19 (56%) of 34 patients treated with radiotherapy did so. The progression-free survival was significantly longer for patients with pT0 than for those with a remaining tumour (pT1–4) in the cystectomy specimen (p<0.001). A high T stage correlated with adverse overall survival. Patients with cT3 tumours treated with neoadjuvant radiotherapy followed by cystectomy had significantly longer disease-specific survival time (p=0.007) than those undergoing cystectomy only. In a Cox regression analysis, cT stage as well as pT stage and occurrence of carcinoma in situ in the cystectomy specimens remained as independent prognostic factors. Conclusions. In this retrospective study neoadjuvant radiotherapy before the cystectomy resulted in significant downstaging of invasive bladder transitional cell carcinoma. This downstaging was most significant for patients with cT3 tumours leading to prolonged survival.
Relative frequency function models for species distribution modeling

A new approach to habitat distribution modeling is presented and tested with data on North American plants. The relative frequency function (RFF) algorithm compares the relative frequencies of a species’ sample points to that of random points or absence points on the landscape to compute a frequency ratio. The relative frequency ratio r is smoothed across the range of values using moving, overlapping windows. The ratio of frequencies at a sample point for each variable is used to compute the geometric mean score for all data with non-missing values. Variables are added using a forward stepwise method. Confidence intervals are computed with bootstrap resampling. The method was tested with artificial and species habitat and geographic range data. The RFF method in all cases gave results comparable to other methods tested. For the species with good geographic range maps, the results were consistent with known biogeography. The RFF method is particularly well-suited to irregularly shaped distributions and can classify sample points even when the data contain missing values. The method is extremely simple to use and comes with a free software tool, does not require a large sample size, does not require absence data, and is more interpretable and portable than certain other methods.
Tracking Rates of Patient Safety Indicators Over Time: Lessons From the Veterans Administration

Background:The Patient Safety Indicators (PSIs), developed by the Agency for Healthcare Research and Quality, are useful screening tools for highlighting areas in which quality should be further investigated and providing useful benchmarks for tracking progress. Objectives:Our objectives were to: 1) provide a descriptive analysis of the incidence of PSI events from 2001 to 2004 in the Veterans Health Administration (VA); 2) examine trends in national PSI rates at the hospital discharge level over time; and 3) assess whether hospital characteristics (eg, teaching status, number of beds, and degree of quality improvement implementation) and baseline safety-related hospital performance predict future hospital safety-related performance. Methods:We examined changes in risk-adjusted PSI rates at the discharge level, calculated the correlation between hospitals’ risk-adjusted PSI rates in 2001 with subsequent years, and developed generalized linear models to examine predictors of hospitals’ 2004 risk-adjusted PSI rates. Results:Risk-adjusted rates of 2 of the 15 PSIs demonstrated significant trends over time. Rates of iatrogenic pneumothorax increased over time, whereas rates of failure to rescue decreased. Most PSIs demonstrated consistent rates over time. After accounting for patient and hospital characteristics, hospitals’ baseline risk-adjusted PSI rates were the most important predictors of their 2004 risk-adjusted rates for 8 PSIs. Conclusions:The PSIs are useful tools for tracking and monitoring patient safety events in the VA. Future research should investigate whether trends reflect better or worse care or increased attention to documenting patient safety events.
[Femoral ultrasound in the assessment of preclinical atherosclerosis. Distribution of intima-media thickness and frequency of atheroma plaques in a Spanish community cohort].

BACKGROUND AND OBJECTIVE High-resolution B-mode ultrasound measurements of intima-media thickness (IMT) and plaque presence are useful to assess preclinical atherosclerosis. Normal carotid IMT values, but not normal femoral IMT values, have been reported in Spanish subjects. Our aim was to define the normality data of femoral ultrasound by sex and age. SUBJECTS AND METHOD We studied 192 healthy subjects from a community cohort, 85 men and 107 women (mean age: 49 years; range: 20-81 years). We sonographically determined mean and maximum IMT in the far wall of the common femoral artery, plaque occurrence, and maximum plaque height. RESULTS Reference values for femoral IMT, expressed as 25th, 50th, and 75th percentiles by sex and 5 age groups, were obtained. The 50th percentiles of mean IMT ranged from 0.50 to 1.04 mm in men in the age groups < or = 35 years and > or = 65 years, respectively. For women, corresponding IMT values ranged from 0.40 to 0.53 mm. IMT was positively related to age in both men (r = 0.44; p < 0.001) and women (r = 0.23; p = 0.019). From the regression equations of IMT versus age, the estimated yearly increase in IMT was 0.016 mm in men and 0.008 mm in women. More than 50% of men aged > or = 55 years and women aged > or = 65 years had plaques. CONCLUSIONS Both IMT and plaque frequency are associated with age in men and women. Femoral IMT values in a Spanish community cohort are lower than those reported for geographical areas with higher cardiovascular risk, such as the Northern European countries and the US.
Increased absenteeism from work among aware and treated hypertensive and hypercholesterolaemic patients

Aim The ‘labelling hypothesis’ was introduced on the basis of the observation that labelling subjects with blood pressure elevation as hypertensive was associated with an increase in sickness absence. In the Belstress I study this hypothesis was analysed in the same way for the possible influence on sick leave of labelling persons with elevated cholesterol as hypercholesterolaemic. Methods and results The Belstress I cohort concerns a sample of more than 16000 men and 5000 women at work in 24 Belgian industries in various sectors. Baseline data were collected by questionnaire and clinical examination. Awareness was defined as answering positively to the question ‘did a physician ever tell you that your blood pressure/serum cholesterol was too high? ’ Sick leave data were independently and objectively recorded during 1 year following the screening. Sick leave was treated in a dichotomous way whereby the event was defined as being in the highest quartile of the annual number of days of sick leave (10 days or more for men and 15 days or more for women) or as being in the highest quartile of the annual number of spells of sick leave (two spells or more for both sexes). Gender-specific logistic regression analyses were performed, with adjustment for a large set of covariates. A positive association was observed between both awareness of hypertension and awareness of hypercholesterolaemia and the various definitions of sick leave, in both sexes and after adjustment for different covariates. When dividing up aware subjects into treated versus untreated, we observed in men the highest sick leave incidence in aware and treated hypertensive patients as well as in aware and treated hypercholesterolaemic patients. In women findings were less consistent, probably due to the smaller sample size. When looking at cumulative effects by examining participants with both hypertension and hypercholesterolaemia and their level of awareness for one or both risk factors, a statistically significant gradient was noticed in men, with the highest sick leave incidence, whatever the definition, in men aware for both risk factors, followed by men aware for one. In women the same trends were observed, but no level of statistical significance was reached. Conclusion Without being able to test the effect of ‘labelling’ as such, our study provides support for the association between awareness of two different coronary risk factors and incidence of sick leave. Probably a common mechanism is at the base of these findings. Further research is needed, in order to reduce potential negative effects of screening on human wellbeing as well as on productivity.
[Study of immunomodulatory function of exosomes derived from human umbilical cord mesenchymal stem cells].

OBJECTIVE To investigate the immumodulation ability of exosomes secreted from human umbilical cord-derived mesenchymal stem cells (hUC-MSCs). METHODS hUC-MSCs were isolated and cultured.Exosomes were isolated from the culture media of the third-generation hUC-MSCs. The expression of specific surface marker CD9 and CD81 were detected by Western blot, and the concentration of hUC-MSCs exosomes(hUC-MSCs-ex) was evaluated by BCA assay. CD3/CD28-stimulated peripheral blood mononuclear cells(PBMCs) from healthy donor were co-cultured with different concentration of hUC-MSCs-ex for 72 h. The percentage of Th17 and Treg cells and the proliferation of CD4⁺ and CD8⁺ T cells were detected by flow cytometry. ELISA was used to test the level of IFN-γ, IL-6, TNF-α and TGF-β1. RESULTS hUC-MSCs-ex inhibited the proliferation of CD4⁺ and CD8⁺ cells obviously,and increased the proportion of CD4⁺ CD25⁺ FoxP3⁺ Treg cells, with high expression of CD81 and CD9. After CD3/CD28 monoclonal antibody stimulated, the percentage of CD45⁺ CD4⁺ Ki67⁺ and CD45⁺ CD8⁺ Ki67⁺ cells were 85.3% ± 5.6% and 72.6% ± 6.3%, respectively. Meanwhile, the level of TGF-β1 were elevated and the level of IFN-γ, IL-6 and TNF-α were decreased (P<0.05). CONCLUSION hUC-MSCs-ex has the immunomodulatory functionin vitro, which could be a new therapeutic agent for the treatment of immune disorders.
Stimulated Intrauterine Insemination: Efficient, cost-effective, safe?

A retrospective report of pregnancy and birth rates achieved in 1010 cycles of stimulated intrauterine insemination (SIUI). Over the years there has been an increasing emphasis on safety, particularly towards reducing the number of high order multiple pregnancies. SIUI is a complex form of assisted conception and requires a high level of clinical judgement to maintain an optimal balance between maximising pregnancy and birth rates and minimising complications, of which the most serious is multiple pregnancy. Extrapolating from these results, it is concluded that a well managed SIUI programme that selects patients appropriately, monitors them intensively and has in place effective strategies to manage over-responders safely, should be able to deliver at least a 15% live birth rate per cycle started with only a 5% cycle cancellation rate. Although SIUI birth rates are lower than IVF rates, the much lower cost of SIUI means that this treatment can be more cost-effective than IVF. However SIUI remains more risky than IVF and, despite careful management, high order multiple pregnancy rates will occasionally occur. It is estimated that the rate of unavoidable high order multiple pregnancies (triplets and above) is 4 per 1000 cycles started.
Awareness and Attitudes of Community-Dwelling Individuals in Singapore towards Participating in Advance Care Planning.

INTRODUCTION Advance care planning (ACP) is an important aspect of end-of-life care that has been shown to improve patient autonomy in decision-making and reduce stress for surviving family members. Given the rapidly ageing population in Singapore, a greater emphasis on end-of-life care planning is needed. This study therefore sought to examine the awareness and attitudes of the general Singaporean community towards participating in ACP, which are not known hitherto. MATERIALS AND METHODS A 24-item interviewer-administered questionnaire was constructed and administered via door-to-door survey amongst community-dwelling residents living in Housing and Development Board (HDB) flats across Singapore, selected via a two-stage stratified random sampling. RESULTS Of the 406 completed surveys, 14.4% of respondents had heard of ACP (n = 58), mostly through the media (67.9%), from family and friends (21.4%) and healthcare providers (21.4%). Only 26.8% of those who had previously heard of ACP knew how to begin an ACP discussion and 12.5% of them had a prior ACP discussion. After education, the majority of respondents were willing to begin an ACP discussion (n = 236, 60.1%). Being of an older age, having a life threatening illness, and having more knowledge about ACP were significant factors associated with willingness to have an ACP discussion. Barriers included perceiving oneself as still healthy and preferring the family to make decisions instead. CONCLUSION There is a low awareness but high expressed willingness to engage in an ACP discussion amongst the Singaporean community. More efforts are needed to educate the public about ACP, engage the family unit and correct the present misconceptions.
Outcomes of rehabilitation in older people--functioning and cognition are the most important predictors: an inception cohort study.

OBJECTIVE To explore the influence of level of functioning and cognitive status on outcome after rehabilitation for older people with different types of impairment. DESIGN An inception cohort study. SUBJECTS A total of 560 older people, mean age 80.0 years, participating in rehabilitation programmes in the Sydney area. METHODS Level of functioning using the Functional Independence Measure (FIMTM), the Barthel Index, cognitive status using the Mini Mental State Examination (MMSE), and type of impairment were assessed on admission. Level of functioning and length of hospital stay were assessed on discharge and after 6 months. RESULTS Disability on admission was the strongest independent predictor for functioning at discharge (B=0.35, R2=0.49 p<0.001) and follow-up (B=0.22, R2=0.27, p<0.001), and for length of hospital stay (B= -0.63, R2=0.12, p<0.001). Cognitive status at admission (mean MMSE 25 (standard deviation 5.3)) was also a significant predictor of functioning at discharge and at follow-up (B=0.30, R2=0.42, p<0.01). Functional status prior to injury, joint replacement impairment category, and type of hospital had marginal, but statistically significant, impacts on functioning after discharge. CONCLUSION Functional status on admission to a rehabilitation facility has stronger predictive value than type of impairment for rehabilitation outcome for older people. Cognitive impairment may have a small adverse effect on rehabilitation outcome.
Long-term treatment of 12 children with chronic hypoparathyroidism: a randomized trial comparing synthetic human parathyroid hormone 1-34 versus calcitriol and calcium.

CONTEXT Hypoparathyroidism is among the few hormonal insufficiency states not treated with replacement of the missing hormone. This is the first randomized controlled study in children comparing treatment with synthetic human PTH 1-34 and calcitriol. OBJECTIVE The primary objective was to assess the efficacy and safety of long-term PTH 1-34 vs. calcitriol treatment in the maintenance of normal serum calcium values and renal calcium excretion in children with hypoparathyroidism. SETTING The study was conducted at a clinical research center. SUBJECTS Subjects included 12 children aged 5-14 yr with chronic hypoparathyroidism and without severe renal or hepatic insufficiency. STUDY DESIGN The study was a 3-yr randomized parallel trial comparing twice-daily calcitriol (plus calcium and cholecalciferol in four daily doses) vs. s.c. PTH 1-34 treatment, with weekly or biweekly monitoring of serum and urine calcium. RESULTS Mean predose serum calcium levels were maintained at, or just below, the normal range, and urine calcium levels remained in the normal range throughout the 3-yr study, with no significant differences between treatment groups. Creatinine clearance, corrected for body surface area, did not differ between groups and remained normal throughout the study. Markers of bone turnover were mildly elevated during PTH 1-34 therapy and remained within the normal range during calcitriol therapy. Mean bone mineral density Z-scores at the anterior-posterior lumbar spine, femoral neck, distal radius, and whole body remained within the normal range and did not differ between groups throughout the study. Similarly, height and weight percentiles did not differ between treatment groups and remained normal throughout the 3-yr follow-up. CONCLUSION We conclude that PTH 1-34 therapy is safe and effective in maintaining stable calcium homeostasis in children with hypoparathyroidism. Additionally, PTH 1-34 treatment allowed normal skeletal development because there were no differences in bone mineral accrual, linear growth, or weight gain between the two treatment arms over the 3-yr study period.
The Immune Injury Effects and Clinical Significance of Eosinophils in Auto-Immune-Related Hematocytopenia

Eosinophils (EOS) quantity, active state, peroxidase activity (POX), and HLA-DR expression in bone marrow of 176 Auto-Immune-Related Hematocytopenia (AIRH) patients were analyzed. Immunofluorescent staining (IF) is performed to observe the expression of immunizing molecules on EOS. In serum of AIRH patients the levels of IL-4, IL-5, IL-6, IL-12, IL-17, and IFN-γ were increased but there was no significance on IL-2 level. In marrow of AIRH, activated EOS expressed POX, and other molecules, it played various cell-mediated immunity injury roles to hemocyte. EOS might be possessed with multiple immunological fuctions, it playes an important immune effect in AIRH autoimmune pathological processes.
Effects of methanolic root extract of ledebouria ovaltifolia (hyacithaneae) on isolated smooth muscle preparation in rats

This study investigated the receptor effects of methanolic root extract of ledebouria ovaltifolia on Acetylcholine and Potassium (K + ) induced contractions in Rat stomach strip (RSS), Adrenaline and K + (induce contractions) in rat vas deferens (RVD), and carbachol and K + induced contractions in rat uterus (RUT). Effects of the root extract (1.27mg/mL) on acetylcholine (6.8x10 -9 to 10.4x10 -8 M) adrenaline 2x10 -7 M, carbachol (2x10 8 M-1.6x10 -7 M), and K + contractions were non competitive. Results of muscle contractility in zero-Ca 2+ containing 0.5mM EGTA varies in these tissues in this order RSS>RVD>RUT. It is concluded in this study, the inhibitory effect of the extract was non specific on muscarinic, adreneceptors nor depolarised membrane site. The effect of the extract was more marked on potassium (K + ) than receptor mediated contractions.
Membrane association induces a conformational change in the Ebola virus matrix protein

The matrix protein VP40 from Ebola virus is targeted to the plasma membrane, where it is thought to induce assembly and budding of virions through its association with the lipid bilayer. Ebola virus VP40 is expressed as a monomeric molecule in solution, consisting of two loosely associated domains. Here we show that a C‐terminal truncation of seven residues destabilizes the monomeric closed conformation and induces spontaneous hexamerization in solution, as indicated by chemical cross‐linking and electron microscopy. Three‐dimensional reconstruction of electron microscopy images shows ring‐like structures consisting of the N‐terminal domain along with evidence for flexibly attached C‐terminal domains. In vitro destabilization of the monomer by urea treatment results in similar hexameric molecules in solution. In addition, we demonstrate that membrane association of wild‐type VP40 also induces the conformational switch from monomeric to hexameric molecules that may form the building blocks for initiation of virus assembly and budding. Such a conformational change induced by bilayer targeting may be a common feature of many viral matrix proteins and its potential inhibition may result in new anti‐viral therapies.
Refining the Management of Low-Grade Cervical Abnormalities in the UK National Health Service and Defining the Potential for Human Papillomavirus Testing: A Commentary on Emerging Evidence

The Trial of Management of Borderline and Other Low-Grade Abnormal Smears (TOMBOLA) Group: Elaine Bentley, PhD, Seonaidh C. Cotton, MLitt, Margaret E. Cruickshank, MBChB, FRCOG, MD, Ian Duncan, MBChB, FRCOG, ILTM, Nicola M. Gray, BA, David Jenkins, MD, Julian Little, PhD, Keith Neal, MD, Zoë Philips, PhD, Ian Russell, PhD, Rashmi Seth, PhD, Linda Sharp, MSc, and Norman Waugh, FRCP (Edin, Glas) University of Nottingham Medical School at Derby, Derby City General Hospital, Derby, United Kingdom; Department of Public Health, University of Aberdeen, Foresterhill, Aberdeen, United Kingdom; Department of Obstetrics & Gynaecology, University of Aberdeen, Foresterhill, Aberdeen, United Kingdom; Maternal & Child Health Sciences, University of Dundee, Ninewells Hospital, Dundee, United Kingdom; STD Team, GlaxoSmithKline Biologicals, Rixensart, Belgium; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of