Miracle-dz/UniFAR-FTUs huggingface dataset:
Accessory Belly of the Piriformis Muscle as a Cause of Piriformis Syndrome: a Case Report with Magnetic Resonance Imaging and Magnetic Resonance Neurography Imaging Findings

Piriformis syndrome is a rare entrapment neuropathy in which the sciatic nerve is compromised by an abnormal piriformis muscle (1). It is usually caused by an abnormal condition of the piriformis muscle such as hypertrophy, spasm, contracture, inflammation, or anatomic variation (1, 2). An accessory piriformis muscle is one such anatomic variation. Although possible anatomical relationships between sciatic nerve and piriformis muscle were classified by Beaton and Anson in 1937 into six types (3), only a few cases have been reported regarding the accessory piriformis muscle. Most of previous studies describing the accessory piriformis muscle (1, 4-6) reported one of the six types described by Beaton and Anson (3). Ravindranath et al. (7) and Natsis et al. (8) have reported a few cases not classified by Beaton and Anson (3). Here, we report a very rare case of an accessory piriformis muscle not described in the Beaton and Anson classification as a cause of piriformis syndrome. Its magnetic resonance imaging (MRI) and magnetic resonance neurography (MRN) imaging findings are also described. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received: February 18, 2019 Revised: April 8, 2019 Accepted: May 9, 2019
Pathophysiology of severe traumatic brain injury and management of intracranial hypertension

It is well recognized that severe traumatic brain injury causes major health and socioeconomic burdens for patients their families and society itself. Over the past decade, understanding of secondary brain injury processes has increased tremendously, permitting implementation of new neurocritical methods of care that substantially contribute to improved outcomes of such patients. The main objective of current treatment protocols is to optimize different physiological measurements that prevent secondary insults and reinforce the ability of the brain to heal. The aim of this literature review is to uncover the pathophysiological mechanisms of severe traumatic brain injury and their interrelationship, including cerebral metabolic crisis, disturbances of blood flow to the brain and development of edema, putting emphasis on intracranial hypertension and its current management options.
Ocular toxoplasmosis with surprisingly good retinal function

Ocular toxoplasmosis is an infection in the eye caused by the parasite Toxoplasma Gondii. A common retinal finding in its inactive stages are pigmented retinochoroidal scarring. The retinal function in the affected area assumingly reflects the amount of retinal involvement. This case report presents a 48-year-old woman who has a long-standing large retinochoroidal scar in the temporal posterior pole of her left eye. She had not experienced any visual symptoms, and no recurrent infections had occurred as far as she knew. She has a scotoma in her nasal visual field that her optometrist detected by a coincidence when she was in her twenties. The corresponding visual field defect is smaller and less deep than what may be expected from the structural appearance of the scar. The reported case demonstrates, that the visual function may be well preserved in the visual field corresponding to a retinochoroidal scarred area due to toxoplasmosis, in spite of loss of structures in the outer retinal layers as seen with OCT.
Segmentation of Breast Cancer Ultrasound Images

Breast cancer is the most common cancer occurring in women. Breast-conserving surgery is a desirable choice for an early-stage breast cancer. An intra-operative margin assessment of excised breast lesion tissue can help avoid additional surgeries. An essential problem in intra-operative margin assessment is how to extract an accurate boundary of the excised lesion automatically and quickly. To solve this problem, we segment breast cancer ultrasound (US) images and then generate boundaries based on the segmentation results. In this research, we propose a new convolutional neural network model, named IU-Net, to segment breast cancer US images. IU-Net combines inception blocks and the well-known U-Net model. We train IU-Net with US images and corresponding manually segmented images provided by Dr. Jeffery Carson and his research group of the Lawson Health Research Institute, London, Ontario, Canada. We also apply an autoencoder in training IU-Net. The experimental results show that IU-Net achieves slightly more accurate results than U-Net and uses 3.8x fewer parameters than U-Net.
Identification and Validation of Tumor Stromal Immunotype in Patients With Hepatocellular Carcinoma

Background: The immune landscape of hepatocellular carcinoma (HCC) is heterogeneous. This study aims to develop the immune type which could improve predictive value of HCC survival. Methods: A total of 208 HCC patients in the testing cohort, 112 patients in the validation cohort and 365 HCC patients in the TCGA database were included in this study. Immune features were assessed by immunohistochemical staining or CIBERSORT method. We constructed prognostic classifiers by LASSO COX analyses in the TCGA cohort, which identified five features out of the 22 types of immune cells. Results: The formulas based on the immunohistochemical staining are as follows: ISOS = 0.648* Macrophagestromal + 0.444*Neutrophilsstromal + 0.218*Tregsstromal – 0.703*Memory T cellsstromal; ISDFS = 0.285*B cellsstromal + 0.494*Neutrophilsstromal + 0.431*Tregsstromal – 0.736*Memory T cellsstromal. We classified HCC patients into immune type A subgroup (IS-A) and type B subgroup (IS-B) based on immune scores. The immune type was an independent prognostic indicator for disease-free survival (DFS) and overall survival (OS) in both testing and validation cohorts. Two nomograms (for OS and DFS) that integrated the immune type and clinicopathologic risk factors also showed good predictive accuracy and discriminatory power. IS-A group was correlated with higher immune checkpoint molecule expression. In addition, patients with IS-A and IS-B had distinct mutation signature. Conclusion: The immune types could predict survival and recurrence of HCC effectively. In addition, the immunosuppressive pathways and mutation signature are distinct between two immune types.
Maternal and Fetal Risks in Higher Multiple Cesarean Deliveries

The professionalization of women has shifted family planning to increased maternal ages. This has increased the use of assisted reproduction. Therefore, the tolerance toward suboptimal outcome of pregnancy decreases, and self-determined decision-making is on the rise. Once women have made the decision for elective cesarean section in their first pregnancy, subsequent pregnancies may result in multiple cesarean deliveries. This chapter analyzes the risks associated with higher multiple cesarean deliveries, such as bleeding and transfusion, adhesions, bowel and urinary tract injury, and uterus rupture. It also discussed the risks for vaginal birth following cesarean (VBAC) following multiple cesareans. Also there are neonatal risks involved, and women may require specific obstetric anesthesia. The chapter will analyze the risks for the offspring and the mother depending on the number of previous cesarean sections. This may enable detailed counseling of parents before a higher multiple repeat cesarean section is performed.
Malaria in pregnancy in the Ndop health district (North West Region, Cameroon): results from retrospective and prospective surveys

Malaria is a life-threatening parasitic disease that is entirely preventable and curable. Pregnant women are among the most vulnerable groups to this deadly disease. Increased efforts towards prevention and control of the disease have led in drastic reduction in mortality rates by 54% in the world health organisation (WHO) African Region. However, the widespread implementation of WHO policies remains highly challenging and the disease still persists despite the efforts of control programmes and stakeholders. The objective of the present study was to capture the situation of malaria during pregnancy in the Ndop health district (North West Region, Cameroon), and assess the knowledge, attitudes and practices of pregnant women regarding this killer disease. Retrospective data was then collected between April and November, 2013 in all public and private health facilities’ registers of the Ndop health district, and pregnant women attending the Ndop district hospital interviewed about their knowledge, attitudes and practices regarding malaria. A total of 1,080 pregnant women, aged 14 to 46 years old attended the seven health facilities of the Ndop health district. The prevalence of Plasmodium falciparum infection in pregnant women was 19.3% (95% CI: 17.0 to 21.7%), with similar trends between age groups and periods (month) of health facility attendance, indicating a stable transmission throughout the period of performance of the survey. Also, different patterns in malaria transmission were observed between rural and urban areas, with huge infection rates in rural settings. Pregnant women were aware of the malaria prevention methods, the persistence of the infection suggesting that the WHO policy to defeat malaria is not fully applied. Key words: Malaria, Plasmodium falciparum, pregnant women, KAP, Ndop, North West, Cameroon.
Renal impact of high-loading-dose statin pre-cardiac catheterization in patients with chronic kidney disease and long-term statin use

Previous studies have reported that short-term statin loading effectively protects statin-naive patients with mild renal insufficiency from contrast-induced acute kidney injury (CI-AKI). The aim of the present study was to determine whether patients with more advanced chronic kidney disease (CKD) and long-term statin therapy also benefit from high-loading statin pretreatment. A total of 256 consecutive patients with moderate-to-severe CKD receiving long-term statin therapy and undergoing percutaneous coronary intervention (PCI) or coronary artery angiography (CAG) were divided into the statin-loading group (n=34) and the no statin-loading group (n=222), depending on whether the respective patient received high-dose statin within 24 h prior to the intervention. The primary endpoint was the percent change in serum creatinine (SCr) levels. Additional endpoints included absolute change in SCr levels, estimated glomerular filtration rate (eGFR) at 48–72 h after contrast exposure, incidence rate of CI-AKI and composite in-hospital adverse events. The mean SCr decreased from baseline in either of the two groups, and the differences in the percent (P=0.930) and absolute change (P=0.990) in SCr levels were not significant between the two groups. Furthermore, no significant difference in the post-procedural eGFR was observed between the two groups. The incidence rates of CI-AKI (2.9 vs. 4.1%, P>0.999) and in-hospital adverse events (0.0 vs. 3.6%, P=0.602) were also similar between the two groups. Stratified analyses were then performed, which yielded results consistent with the above. Multiple linear regression indicated that the baseline eGFR value and current smoking status were independent factors affecting the post-procedural eGFR value, while high-dose statin loading was not. Therefore, statin reloading prior to intervention may not provide any further renal protection or decrease the occurrence of in-hospital adverse events in patients with moderate-to-severe CKD receiving long-term statin therapy, which warrants validation in prospective trials.
Using Visual Scaffolding Strategy for Teaching Reading in Junior High School

This research was aimed to investigate the effectiveness of using visualscaffolding strategy in teaching reading comprehension at the eighth grade of juniorhigh school. The design of this study was a quasi experimental study. The subjectswere the students of state junior high schools in Cirebon, Indonesia. The data wereobtained by administering reading test and from observation as a supporting dataanalysis. The data of the test were analyzed by using t-test formula to know thedifference of the students’ comprehension in reading narrative text between twogroups. Meanwhile the result of the observation was analyzed descriptively. Theresults indicate that there was a significant difference on students’ learning resultbefore and after Visual Scaffolding applied.
Physical fitness and executive functions in adolescents: cross-sectional associations with academic achievement

[Purpose] This study analyzed the relationship between fitness and executive functions in adolescents and its influence on academic achievement. [Participants and Methods] The design was cross-sectional. The sample included 713 adolescents (14.2 ± 1.5 years old). Physical fitness was evaluated using flexibility test, strength test, balance test and aerobic test. Executive function was evaluated with the tests (Stroop, Symbol digit, Trail making, Wechsler memory, and MESSY scale). Academic performance was evaluated through the school records. A partial correlational analysis of physical fitness and executive functions with respect to academic achievement was carried out. A multivariate linear regression was performed to identify the physical component model that best defined each of the executive functions. [Results] The analysis showed how academic achievement is significantly influenced, from a physical point of view, by resistance strength (r=0.21), aerobic endurance (r=0.188), and flexibility (r=0.17), whereas from a cognitive point of view it is significantly influenced by inhibition/interference (r=0.25), working memory (r=0.10) and processing speed (r=0.18). [Conclusion] The results indicate that the physical fitness and executive function are closely related and both have a significant influence on academic achievement.
Comparison between Circulating Endothelial Cells and Platelet Microparticles Levels in Egyptians Rheumatic Mitral Diseases with and without Atrial Fibrillation

Background: Atrial fibrillation (AF) is a continued cardiac arrhythmia, which is linked to a high risk thromboembolism. The association of AF and valvular heart disease results in a substantial stroke and thromboembolic risk. AF is interrelated with a hypercoagulable state and abnormalities of plasma indices of endothelial damage/dysfunction such as circulating endothelial cells (CECs) and platelet microparticles (PMPs), the levels of which are elevated in patients with coronary artery disease (CAD), diabetes mellitus `and stroke, all of which are conditions that lead to (AF). Thus, we hypothesized that the levels of CECs and PMPs would be raised in rheumatic atrial fibrillation diseases. Methods: 60 patients with rheumatic valvular diseases [(30 patients (35±12 years; 10 male and 20 females)] with rheumatic mitral valve disease [(Mitral stenosis MS and Mitral regurgitation MR)] and with normal sinus (RNAF) compared to [(30 patients (31±11 years; 11 male and 19 females)] with rheumatic valvular diseases with AF (RAF) and 20 healthy controls HC (31±10 years; 17 male and 3 females). CECs were calculated using flow cytometry after staining with mouse anti-human CD45 antibody (pan-leukocyte marker), mouse anti-human CD 146 antibody (endothelial cell marker). PMPs were distinguished from non-platelet events by their fluorescence from Fluorescein 6isothiocyanate (FITC) conjugated anti-CD41a bound to the particle surfaces. Results: RAF patients had significantly elevated numbers of CECs and PMPs compared to healthy controls HC (P<0.0001). CECs levels were significantly higher in RAF diseases compared to patients with RNAF (P<0.05). RAF patients had significantly higher levels of PMPs (p <0.001) compared to HC. Conclusion: Severe endothelial damage, as assessed by increased numbers of CECs, not to be a prominent trait of rheumatic valvular lesions in sinus rhythm patients, however levels are definitely high in rheumatic valvular diseases with AF. There is evidence of platelet activation in rheumatic AF patients, owing to original cardiovascular diseases rather than the arrhythmia as such.
Recent Update of Advanced Imaging for Diagnosis of Cardiac Sarcoidosis: Based on the Findings of Cardiac Magnetic Resonance Imaging and Positron Emission Tomography

Sarcoidosis is a multisystem disease characterized by noncaseating granulomas. Cardiac involvement is known to have poor prognosis because it can manifest as a serious condition such as the conduction abnormality, heart failure, ventricular arrhythmia, or sudden cardiac death. Although early diagnosis and early treatment is critical to improve patient prognosis, the diagnosis of CS is challenging in most cases. Diagnosis usually relies on endomyocardial biopsy (EMB), but its diagnostic yield is low due to the incidence of patchy myocardial involvement. Guidelines for the diagnosis of CS recommend a combination of clinical, electrocardiographic, and imaging findings from various modalities, if EMB cannot confirm the diagnosis. Especially, the role of advanced imaging such as cardiac magnetic resonance (CMR) imaging and positron emission tomography (PET), has shown to be important not only for the diagnosis, but also for monitoring treatment response and prognostication. CMR can evaluate cardiac function and fibrotic scar with good specificity. Late gadolinium enhancement (LGE) in CMR shows a distinctive enhancement pattern for each disease, which may be useful for differential diagnosis of CS from other similar diseases. Effectively, T1 or T2 mapping techniques can be also used for early recognition of CS. In the meantime, PET can detect and quantify metabolic activity and can be used to monitor treatment response. Recently, the use of a hybrid CMR-PET has introduced to allow identify patients with active CS with excellent co-localization and better diagnostic accuracy than CMR or PET alone. However, CS may show various findings with a wide spectrum, therefore, radiologists should consider the possible differential diagnosis of CS including myocarditis, dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy, amyloidosis, and arrhythmogenic right ventricular cardiomyopathy. Radiologists should recognize the differences in various diseases that show the characteristics of mimicking CS, and try to get an accurate diagnosis of CS.
Role of Copper, Magnesium, and Zinc in Pathogenesis of Hepatocellular Carcinoma and Cirrhosis

The present study aimed to estimate the level of copper, magnesium and zinc in patients of cirrhosis and hepatocellular carcinoma (HCC) to determine their correlation to pathogenesis of these diseases. A case-control study was conducted on thirty subjects that were included as control (group) I obtained from blood transfusion donors healthy subjects. All patients whose coming to the specialized medical hospital Mansoura University from January 2016 till January 2017 were clinically evaluated and investigated to select 70 subjects; twenty-five patients with cirrhosis (group II), and forty-five patients with HCC (group III). The levels of copper, magnesium and zinc were assessed in all participants. Copper level showed significantly increased values while magnesium and zinc were significantly decreased comparing to control group in both cirrhosis and HCC groups. There were significant increase in zinc level and significant decrease in magnesium and copper levels in comparison to HCC and cirrhotic groups. Also, a significant negative correlation between zinc and magnesium levels and the advances in liver condition, advances in spleen condition and presence of ascites was observed, while there is non-significant negative correlation between Child-Pugh classification and the levels of zinc and magnesium in cirrhosis and HCC groups. There was a significant positive correlation between the copper level and the advances in liver condition, advances in spleen condition presence of ascites and Child-Pugh classification. In conclusion, there is association between copper, magnesium and zinc and the severity of the cirrhosis and HCC.
Improper Communication Makes for Squat: A Qualitative Study of the Health-Care Processes Experienced By Older Adults in a Clinical Trial for Back Pain

Background: The study focused on perceptions of older adults toward the healthcare processes they experienced during a clinical trial for back pain that involved family medicine residents and licensed chiropractors. Methods: Individual semi-structured interviews were conducted with 115 older adults after a 12-week, 3-arm, randomized controlled trial. Two researchers conducted thematic analysis with inductive coding using qualitative software to identify participants’ salient experiences of the doctor–patient relationship, healthcare process, and collaboration between study providers. Investigators categorized thematic codes within an existing framework of clinical excellence in primary care. Results: Participants emphasized provider communication and interpersonal relationships, professionalism and passion for patient care, clinical and diagnostic acumen, and skillful negotiation of the health-care system. Older adults also described the importance of interdisciplinary collaboration and their preferences for receiving hands-on treatments for musculoskeletal conditions. Conclusion: These older adults valued doctors who communicated clearly and spent time listening to their concerns. Many participants appreciated clinicians who supported an active role for patients in their health-care and who provided touch-based care for musculoskeletal conditions.
Role of Serum Interleukin–10 as a Marker of T-helper 2 Activity in Egyptian Chronic Hepatitis C Patients

The present study included 45 subjects classified into three groups: Group I (control group) which comprised 15 healthy individuals, group II which comprised 15 patients with positive ELISA test for hepatitis C, but negative PCR test for HCV RNA and Group III which included 15 patients with positive ELISA test for hepatitis C and positive PCR test for HCV RNA. As regards IL-10 level the present study showed that there was highly significant increase in the level of IL – 10 in group II and III when compared with control group (p< 0.001) as positive ELISA test for hepatitis C and positive PCR test for HCV RNA was an indication to the activity of HCV. It just indicated that the patient was carrier of HCV infection. The study revealed a positive significant correlation between IL 10 and ALT, AST, GGT and ALP. In conclusion, from the present study, it could be concluded that IL -10 as a marker of Thelper 2 activity increases with chronic hepatitis C and that increase is related to the increased chronicity of the disease so it may be a useful marker in diagnosis of hepatitis C patients.