Miracle-dz/UniFAR-FTUs huggingface dataset:
Residency Training: A failed lumbar puncture is more about obesity than lack of ability

Objective: To identify factors influencing the success of lumbar puncture (LP) performed by neurology residents in an outpatient clinic. Background: There is a need to understand the specific influence of patient or operator characteristics in LP performance in order to identify situations at high risk for failure that could benefit from compensatory interventions. Methods: We performed a retrospective analysis of all consecutive patients who underwent elective LP in the Neurology Clinic at the University of Iowa between 2009 and 2012. We recorded demographic, anthropometric, and clinical information, and the level of training of the resident performing the procedure. Outcomes measure was unsuccessful LP, defined as no quantifiable CSF. This study was previously approved by the University of Iowa institutional review board. Results: A total of 328 patients (59% women) were included. Men were significantly older than women, and the indication of the procedure differed by sex. Headache or possible multiple sclerosis were more common indications in women than in men. Nineteen percent of the LPs were unsuccessful. We found a strong correlation between patient body mass index (BMI) and unsuccessful outcome (p < 0.0001). Age of the patient and level of training of the operator did not predict unsuccessful LP. Conclusions: Patient BMI is the key factor that determines an unsuccessful LP by neurology residents in an outpatient setting, an association that might be applicable to different clinical settings. The high failure rate in patients with BMI >35 suggests that implementing compensatory interventions such as the use of imaging guidance might be cost-effective and better tolerated by these patients.
The decline in dental caries among Belgian children between 1983 and 1998.

OBJECTIVES to investigate cross-sectionally a probable dental caries decline in Belgian 12-yr-olds and to analyse some factors that may be associated with dental caries during the study period. METHODS In the region of Brussels, children in the 7th grade at the same schools were sampled in 1983 (n=533) and 1998 (n= 496). DMFT, DMFS and dental fluorosis were clinically recorded. Data on children's home-based and professional dental health care habits were registered. RESULTS Caries-free children increased from 4% to 50%. A reduction of the mean number of teeth attacked by dental caries from 7.5 to 1.6 and of tooth surfaces from 11.5 to 2.5 (P<0.001) was observed. Early signs of dental fluorosis were identified in 5% in 1983 and 30% of the subjects in 1998. Multiple linear regression analyses revealed that tooth brushing with fluoridated toothpaste, dental appointments and dental fluorosis were significantly related to dental caries reduction. CONCLUSIONS A remarkable decline in dental caries was observed during the 15-yr period. The factors related to the children's home-based and professional dental health care were associated with the observed decline.
Clinical use of circulating nucleosomes

Nucleosomes, complexes of DNA and histone proteins, are released from dying and stressed cells into the blood circulation. Concentrations of circulating nucleosomes in plasma and serum are frequently found to be elevated in various cancers, and also in such acute conditions as stroke, trauma, and sepsis as well as in autoimmune diseases. The first part of this review focuses on the structural and functional properties of nucleosomes, the potential sources of nucleosome release into the circulation, the metabolism of circulating nucleosomes, and their pathophysiological role in disease. It goes on to describe the relevance of circulating nucleosomes in the diagnosis and prognosis of non-malignant conditions such as sepsis, stroke, and autoimmune disease. Finally, it describes the clinical value of nucleosomes in the diagnosis, staging, prognosis, and monitoring of therapy in cancer; in particular, their potential as a new diagnostic tool for the early estimation of response to cytotoxic cancer therapy is emphasized.
The effect of smoking on osseointegrated dental implants. Part I: implant survival.

PURPOSE Recent studies implicate smoking as a significant factor in the failure of dental implants. The purpose of this long-term retrospective study was to evaluate the survival of Brånemark endosseous dental implants in relation to cigarette smoking. MATERIALS AND METHODS The sample consisted of 464 consecutively treated completely and partially edentulous patients who had a total of 1852 implants placed between 1979 and 1999, and who were part of a surgical/prosthodontic prospective treatment outcomes study. The effect of cigarette smoking on implant survival in relation to the time of implant failure, gender, age, surgeon, date and site of implant placement, implant length and diameter, prosthesis design, and occlusal loading considerations was assessed in bivariate and multivariate survival analyses. RESULTS The overall implant failure rate was 7.72%. Patients who were smokers at the time of implant surgery had a significantly higher implant failure rate (23.08%) than nonsmokers (13.33%). Multivariate survival analysis showed early implant failure to be significantly associated with smoking at the time of stage 1 surgery and late implant failure to be significantly associated with a positive smoking history. Short implants and implant placement in the maxilla were additional independent risk factors for implant failure. CONCLUSION Cigarette smoking should not be an absolute contraindication for implant therapy; however, patients should be informed that they are at a slightly greater risk of implant failure if they smoke during the initial healing phase following implant insertion or if they have a significant smoking history.
Correction: An Emperor Penguin Population Estimate: The First Global, Synoptic Survey of a Species from Space

There was an error in the Author Contributions designations. The correct Author Contributions are: Conceived and designed the experiments: PF PT GK CP AHF. Performed the experiments: PF ML CP. Analyzed the data: PF ML GK AJF NR. Contributed reagents/materials/analysis tools: PF ML PM CP NR. Wrote the paper: PF PT GK BW ML PM. Provided data: PM AHF GK BW.
Virtual classroom helps medical education for both Chinese and foreign students.

AIMS The rapid development of computer and internet technology has a strong influence over one's quality of education within different fields of study. To determine the potential benefits of introducing internet into medical school classes, a pilot study was conducted in three different Chinese medical schools. MATERIALS AND METHODS Seven hundred and eight medical school undergraduates, 385 dental school students and 366 foreign students were randomly recruited to complete a self-administered questionnaire. The contents included personal information, current usage of computer and internet, and attitudes towards the computerised teaching methods. Two forum groups were created using instant message software and were randomly assigned to two classes, allowing students to freely ask or discuss questions with the help of their teachers in these two virtual classrooms. RESULTS All 1539 questionnaires were accepted and analysed. Although there were some differences between Chinese and foreign undergraduates, both group of students were highly proficient in internet usage and navigation. Overwhelmingly, 88.37% of the students owned a computer and frequently logged onto the internet. Most of them believed that the internet is a helpful adjunct to their studies and held positive attitudes towards computerised teaching. Compared to the classes that were not assigned internet forums, the two experimental classes performed significantly better on the examination. CONCLUSIONS Our results suggest that computerised teaching methods have significant potential to assist in learning for both Chinese and foreign medical undergraduates.
Depersonalization Phenomena in Psychiatric Patients

The complaints, ‘I am a stranger to myself; I am unreal’, are manifestations of depersonalization which have been noted frequently by clinicians. Depersonalization has been reported in epilepsy, after drug ingestion, encephalitis, hysteria, manic depression, and schizophrenia, as well as in various neurotic patients. It has also been noted in normals, but usually after emotional shock or physical exhaustion. Most recently, persistent feelings of depersonalization have been elevated to the status of a diagnostic entity in itself.
Modulation of murine herpes simplex virus type 1 retinitis in the uninoculated eye by CD4+ T lymphocytes.

PURPOSE To investigate the contribution of CD4+ and CD8+ T lymphocytes to retinitis in the contralateral eye after anterior chamber inoculation of herpes simplex virus type 1 (KOS strain). METHODS T-cell-depleted BALB/c mice were prepared by adult thymectomy and treatment with anti-L3T4 (anti-CD4) monoclonal antibody and/or anti-Lyt2.2 (anti-CD8) monoclonal antibody. On days 9 and 14 after inoculation of herpes simplex virus type 1 (KOS strain) via the anterior chamber, the titer of virus in the uninoculated eye was determined by plaque assay. The eyes were examined microscopically, and the severity of retinitis was evaluated using a histopathologic scoring system. RESULTS At day 14 postinoculation, significantly less severe destruction of the parenchyma and less inflammatory cell infiltration were observed in the retina of the uninoculated eye of CD4+ T-cell-depleted mice and of mice depleted of both T-cell subsets. The titer of virus in the uninjected eye of CD4+ T-cell-depleted mice and of mice depleted of both CD4+ and CD8+ T cells was also significantly higher at day 14 postinoculation. CONCLUSIONS The results of the studies suggest three ways CD4+ T cells might contribute to the pathogenesis of herpes simplex virus type 1 retinitis in the uninoculated contralateral eye: (1) accumulation of massive inflammatory cell infiltrates in the retina, (2) induction of retinal destruction, and (3) clearance of herpes simplex virus type 1 from the contralateral eye. In infection of the contralateral retina of nondepleted mice after uniocular anterior chamber inoculation of KOS, CD4+ T cells are required to induce fulminant retinitis and to mediate clearance of virus from the uninoculated eye by day 14 postinoculation. The exact mechanism by which CD4+ T cells contribute to contralateral retinitis remains to be identified.
Toward a multidimensional assessment of picture archiving and communication system success

Objectives: Based on a prevalent framework in the information systems field, this study proposes and describes an integrated model for evaluating picture archiving and communication system (PACS) success from multiple users' perspectives. Methods: Our study details the validation process of the proposed model at a large tertiary-care teaching hospital in Canada. Both qualitative and quantitative data were collected to assess the psychometric properties of the measurement instrument and test the research hypotheses. Results: Our findings clearly reveal that radiologists, technologists, and clinicians have different views regarding the factors influencing PACS success. For instance, the results for radiologists show that their concern with efficiency and productivity is best guaranteed by a system that is reliable and easy to use. Furthermore, that only perceived system usefulness influenced clinicians' satisfaction with PACS is a reflection of the primary impact that technology has on their work, namely, the ability to have instant access to images from any point in the hospital. Even though, overall, all three groups view the adoption of PACS positively, the mean scores indicate that radiologists and technologists seem to be more satisfied and their expectations to be met at a higher level than clinicians. Conclusions: We believe the measurement instruments developed in this study can be used as a diagnostic tool by project managers interested in better understanding the extent to which different groups of stakeholders perceive the deployment of PACS as being successful and how factors influencing perceptions of PACS success vary across user types.
Use of computed tomography in anterior abdominal stab wounds: results of a prospective study.

HYPOTHESIS Computed tomography (CT) can be used to evaluate patients with anterior abdominal stab wounds (AASWs). DESIGN Prospective observational study. SETTING Academic level I trauma center. PATIENTS AND METHODS All of the patients sustaining AASWs, excluding those with hemodynamic instability, peritonitis, or omental evisceration, were admitted for serial abdominal examinations with or without CT depending on attending preference. Patients with associated left thoracoabdominal stab wounds underwent diagnostic laparoscopy. MAIN OUTCOME MEASURES Change in patient management as a direct result of the CT scan findings, as well as sensitivity, specificity, positive predictive value, and negative predictive value of CT scanning calculated against clinical outcome (the need for laparotomy, uneventful discharge without laparotomy, or return to the hospital for adverse events). RESULTS One hundred fifty-six consecutive patients with AASWs were included over 24 months. Computed tomography was performed for 67 patients (CT group) whereas 89 patients were admitted for serial examination only (no-CT group). Nineteen of the 67 patients in the CT group had positive CT results, leading to laparotomy in 10 patients. Of the 48 patients with negative CT results, 3 underwent diagnostic laparoscopy for an associated thoracoabdominal stab wound and 2 eventually underwent laparotomy for clinical deterioration with negative results. Excluding patients with associated thoracoabdominal stab wounds, the negative predictive value of CT was 100%. CONCLUSIONS In patients with AASWs, CT can be used to identify visceral injuries. It is a promising tool that may identify patients who can be discharged after a shorter period of observation. Further evaluation of its use in patients with AASWs is warranted.
Analysis of questions asked by family doctors regarding patient care

Abstract Objectives: To characterise the information needs of family doctors by collecting the questions they asked about patient care during consultations and to classify these in ways that would be useful to developers of knowledge bases. Design: Observational study in which investigators visited doctors for two half days and collected their questions. Taxonomies were developed to characterise the clinical topic and generic type of information sought for each question. Setting: Eastern Iowa. Participants: Random sample of 103 family doctors. Main outcome measures: Number of questions posed, pursued, and answered; topic and generic type of information sought for each question; time spent pursuing answers; information resources used. Results: Participants asked a total of 1101 questions. Questions about drug prescribing, obstetrics and gynaecology, and adult infectious disease were most common and comprised 36% of all questions. The taxonomy of generic questions included 69 categories; the three most common types, comprising 24% of all questions, were “What is the cause of symptom X? ” “What is the dose of drug X? ” and “How should I manage disease or finding X? ” Answers to most questions (702, 64%) were not immediately pursued, but, of those pursued, most (318, 80%) were answered Doctors spent an average of less than 2 minutes pursuing an answer, and they used readily available print and human resources Only two questions led to a formal literature search. Conclusions: Family doctors in this study did not pursue answers to most of their questions. Questions about patient care can be organised into a limited number of generic types, which could help guide the efforts of knowledge base developers. Key messages Questions that doctors have about the care of their patients could help guide the content of medical information sources and medical training In this study of US family doctors, participants frequently had questions about patient care but did not pursue answers to most questions (64%) On average, participants spent less than 2 minutes seeking an answer to a question The most common resources used to answer questions included textbooks and colleagues; formal literature searches were rarely performed The most common generic questions were “What is the cause of symptom X? ” “What is the dose of drug X? ” and “How should I manage disease or finding X? ”
Use of ranibizumab for the treatment of subretinal neovascularization in pathologic myopia: a prospective study

E-mail: laserfilatova@gmail.com Purpose: To determine the efficacy of ranibizumab as a treatment for subretinal neovascularization (SRNV) in pathologic myopia. Materials and Methods: This was an uncontrolled, prospective cohort study, involving 66 pathologic myopic eyes (65 patients) with SRNV. Patients were treated with 0.05-mL (0.5 mg) intravitreal ranibizumab and followed up over 12 months. The best-corrected visual acuity (BCVA) at 12 months was used as a primary end point. Safety, OCT retinal thickness at the fovea, activity of SRNV as assessed by fluorescein angiography, and the number of ranibizumab injections were secondary end points. Results: Compared with baseline, the visual acuity improved significantly at all follow-up points (р = 0.001). The mean BCVA was 0.2 (SD 0.13) at baseline and improved to 0.4 (SD 0.21) at month 12. The mean CRT was 313 μm (SD 82) at baseline and decreased to 244 μm (SD 31) at the end point (р = 0.0001). Conclusions: Intravitreal ranibizumab was found to be a safe and efficacious treatment for SRNV in pathologic myopia at the follow-up of 12 months. In routine clinical practice, the use of ranibizumab for the treatment of SRNV in pathologic myopia results in a statistically significant improvement in visual acuity and a regression in retinal edema.
Retinopathy and Nephropathy in Insulin‐dependent Diabetics: An Inconsistent Relationship?

The association between retinopathy and nephropathy was investigated in a retrospective study of 52 insulin‐dependent diabetics with preproliferative or proliferate retinopathy and in 48 patients without or with background retinopathy. The duration of diabetes was 23.2 ± 1.0 years (mean ± SEM) and 22.0 ± 1.2 years in the two groups. Patients in the retinopathy group showed a higher frequency of detectable nephropathy and were more often treated with antihypertensive drugs. However, a high proportion (35%) of patients with proliferative retinopathy did not show any detectable signs of nephropathy. Furthermore, nephropathy did not seem to develop in patients with retinopathy during an observation period of up to 9 years. The data suggest that the factors underlying the development of retinal and renal microangiopathy might be of different origin.
"Sweet Talk": text messaging support for intensive insulin therapy for young people with diabetes.

Optimal diabetes management involves considerable behavioural modification, while nonadherence contributes significantly to poor glycaemia. Extensive research on psychological interventions aiming to improve glycaemia suggests that current strategies are costly and time-consuming and in our experience do not appeal to young people with Type 1 diabetes. Text messaging has rapidly become a socially popular form of communication. It is personal, highly transportable, and widely used, particularly in the adolescent population. However, text messaging coupled with specific behavioural health strategies has yet to be utilised effectively. We have developed a novel support network ("Sweet Talk"), based on a unique text-messaging system designed to deliver individually targeted messages and general diabetes information. Individualised motivation strategies--based on social cognition theory, the health belief model, and goal setting--form the theoretical basis of the message content. Intensifying insulin therapy and increasing contact with the diabetes team can improve control, but are difficult to provide within existing resources. Our support system offers a means of contact and support between clinic visits and aims to increase adherence with intensive insulin regimens and to improve clinical outcome.
Thrombosis of the cerebral veins and sinuses.

Thrombosis of the cerebral veins and sinuses affects mainly young adults and children. This potentially disabling or fatal condition is usually not diagnosed until a week after the onset of symptoms. This review article describes the clinical presentations of the disorder such as those that occur after a head injury or lumbar puncture. Therapeutic options include anticoagulation, thrombolysis, and measures to control intracranial hypertension.
Two cases of subintimal angioplasty with proximal stent implantation for long superficial femoral artery occlusions

Subintimal angioplasty is a simple and safe alternative to conventional intraluminal angioplasty for the recanalization of diffuse long femoropopliteal occlusions. However, long‐term patency rates are unsatisfactory despite the high initial technical success rates. Two cases of occluded left superficial femoral arteries are presented in which subintimal angioplasty with proximal stent implantation was successfully performed. Self‐expanding nitinol stents were placed at the proximal part of subintimal plane to maintain good inflow. In both cases, follow‐up angiogram at 6 months demonstrated patent stents with good antegrade flow. © 2005 Wiley‐Liss, Inc.
Mechanisms and consequences of sexual conflict in garter snakes (Thamnophis sirtalis, Colubridae)

Red-sided garter snakes (Thamnophis sirtalis parietalis) court and mate in early spring around large communal overwintering dens in central Manitoba. Emerging females are immediately covered by dozens or hundreds of vigorously-courting males, potentially imposing significant costs to the female. By manipulating numbers of courting males (both directly and by applying anticourtship pheromones), we quantified the degree to which female dispersal from the den is hindered by courtship. Courted females dispersed only about half as fast as did solitary females. Blood lactate levels were higher in mating than in courting or noncourting snakes of both sexes; the high levels of lactate in mating females support the idea that courtship is physiologically stressful to these animals, perhaps via constraints to female respiration. In arena trials, females that were exercised to exhaustion before courtship mated with smaller males than did control females. The spatial distribution of snakes around the den exhibits substantial heterogeneity, with densities often varying markedly between adjacent areas. Arena trials mimicking this heterogeneity showed that unmated females avoided parts of the enclosure containing scent cues from males. Our data support the hypothesis that courtship in T. s. parietalis confers significant costs to females, and that female behaviors have evolved to reduce those costs. Copyright 2004.