Miracle-dz/UniFAR-FTUs huggingface dataset:
The effect of increased number of cesarean on maternal and fetal outcomes.

OBJECTIVES The aim of this study was to evaluate the effects of multiple cesarean deliveries (CDs) on maternal-fetal mor-bidity and mortality rates. MATERIAL AND METHODS This retrospective study included a total of 1,506 patients who underwent multiple CDs between January 2006 and May 2014. The patients were divided into two groups. One group consisted of patients with four or more CDs (n = 444) and a control group of patients with three CDs (n=1,062). Both groups were analyzed for demographics, complications from multiple cesarean deliveries and perinatal outcomes. RESULTS The mean age was higher in the study group (p < 0.001). Dense adhesion (p < 0.001), demand for tubal ligation (p < 0.001), the requirement of pelvic drainage (p < 0.001), duration of hospitalization (p < 0.001) and the requirement for blood transfusion (p=0.03) was also significantly higher in the study group. Hemoglobin levels (p = 0.002) were signifi-cantly higher in the control group on the second postoperative day. Regarding perinatal morbidity; umbilical artery pH results (p = 0.003) were significantly lower in the study group. There was no significant difference in the maternal and fetal mortality rates between both groups. CONCLUSIONS According to our study results, an increase in the number of cesarean sections increases maternal and fetal morbidity rates significantly. Therefore, we recommend decreasing the rate of primary cesarean deliveries by encouraging vaginal birth after CD. We also advocate the use of permanent contraceptive methods in patients with a high number of CD's. Further large-scale prospective results are required to establish a definitive conclusion.
Towards the free energy landscape for catalysis in mammalian nitric oxide synthases

The general requirement for conformational sampling in biological electron transfer reactions catalysed by multi‐domain redox systems has been emphasized in recent years. Crucially, we lack insight into the extent of the conformational space explored and the nature of the energy landscapes associated with these reactions. The nitric oxide synthases (NOS) produce the signalling molecule NO through a series of complex electron transfer reactions. There is accumulating evidence that protein domain dynamics and calmodulin binding are implicated in regulating electron flow from NADPH, through the FAD and FMN cofactors, to the haem oxygenase domain, where NO is generated. Simple models based on static crystal structures of the isolated reductase domain have suggested a role for large‐scale motions of the FMN‐binding domain in shuttling electrons from the reductase domain to the oxygenase domain. However, detailed insight into the higher‐order domain architecture and dynamic structural transitions in NOS enzymes during enzyme turnover is lacking. In this review, we discuss the recent advances made towards mapping the catalytic free energy landscapes of NOS enzymes through integration of both structural techniques (e.g. cryo‐electron microscopy) and biophysical techniques (e.g. pulsed‐electron paramagnetic resonance). The general picture that emerges from these experiments is that NOS enzymes exist in an equilibrium of conformations, comprising a ‘rugged’ or ‘frustrated’ energy landscape, with a key regulatory role for calmodulin in driving vectorial electron transfer by altering the conformational equilibrium. A detailed understanding of these landscapes may provide new opportunities for discovery of isoform‐specific inhibitors that bind at the dynamic interfaces of these multi‐dimensional energy landscapes.
Trends, Costs, and Benefits of Green Certification of Office Buildings: A Polish Perspective

Green buildings may become the solution to the problem of high energy consumption, including those that are subject to verification by the relevant institutions issuing green certificates. The aim of the paper is an analysis and a brief discussion of trends related to the certification of office buildings in Poland. At the end of 2017, almost 9.7 million m2 of modern office space was available in Poland, of which 62% was a certified area. This constitutes a five percent increase in the share of certified office space in relation to the total modern office space available during 2017. In order to compare the costs and benefits of certified buildings, the costs of an office building and a certified building were simulated. The comparison was made using the idea of costs in the life cycle and calculating the Life Cycle Cost. The difference between the base building and the green one was mainly based on obtaining higher Net Present Value with lower investment expenditures for the green building. There was also a clear difference between the beginning of investment profitability for the different levels of rent.
Default Risk and Option Returns

This paper studies the effects of default risk on expected equity option returns. In the cross-section, expected delta-hedged equity option returns have a negative relation with default risk measured by credit ratings or default probability. In the time series, credit rating downgrades (upgrades) lead to a decrease (increase) in the firm’s delta-hedged option return. Our results are consistent with a stylized capital structure model in which the negative relation between option returns and default risk is driven by firm leverage and asset volatility. This paper was accepted by Lukas Schmid, finance. Funding: A. Vasquez thanks the Asociación Mexicana de Cultura A.C. for financial support. Supplemental Material: The online appendix and data are available at https://doi.org/10.1287/mnsc.2023. 4796 .
How much guidewire is too much? Direct measurement of the distance from subclavian and internal jugular vein access sites to the superior vena cava‐atrial junction during central venous catheter placement

Objective: The introduction of excessive lengths of guidewire during placement of central venous catheters from the internal jugular vein (IJV) or the subclavian vein (SCV) can result in rare but significant complications. To identify a “safe” guidewire insertion length, the authors performed direct intravascular measurement of the distance from these venous access sites to the superior vena cava‐atrial junction (CAJ), and evaluated these distances relative to the patients' height, weight, sex, and chest radiographs. Design: Prospective, nonrandomized observation. Setting: The Interventional Radiology Department of a tertiary care referral hospital. Patients: 100 adults (45 women, 55 men) evaluated during fluoroscopically directed central venous catheter placement. Interventions: None. Measurements and Main Results: The distance from the IJV or SCV access site was directly measured using fluoroscopy and an intravascular guidewire. 40 right IJVs, 31 right SCVs, 16 left SCVs, and 13 left IJVs were studied. Comparative measurements from the postprocedure radiograph were made in 20 of these cases. All measurements were correlated with patient sex, height, and weight. The mean distance from all access sites to the superior vena cava‐atrial junction was 18.0 cm. The right IJV distance was the shortest, averaging 16 cm. The left SCV distance was the longest, averaging 21.2 cm. Right SCV and left IJV distances were 18.4 and 19.1 cm, respectively, but this difference was not statistically significant. Weight and radiographic measurements did not correlate with the measured vascular distance, although there was a trend toward longer distances in taller patients and males. Conclusions: Patient height, weight, and measurements from previous chest radiographs are less reliable in predicting a safe wire length than is the access site selected. In most cases, 18 cm should be considered the upper limit of guidewire introduced during central catheter placement in adults. The guidewires supplied in catheter kits should have lengths correlated to those of the catheters, and should have distance markings printed upon them.
Characteristic Pattern of Chromosomal Imbalances in Posttransplantation Lymphoproliferative Disorders: Correlation with Histopathological Subcategories and EBV Status

Background. Posttransplantation lymphoproliferative disorders (PTLDs) are a spectrum of lymphoid proliferations, occurring in immunosuppressed organ transplant recipients. They comprise early lesions, polymorphic (P-PTLD), monomorphic (M-PTLD), and Hodgkin/Hodgkin-like lymphoma PTLD (HL-PTLD) lesions. Most of them are associated with Epstein-Barr virus (EBV). Little is known about their genetic changes. Materials and Methods. We have studied 35 PTLDs[7 P-PTLDs (3/7 polyclonal IgH), 26 M-PTLDs (22 B-cell PTLD, 4 T-cell PTLD), 2 HL-PTLDs], using comparative genomic hybridization (CGH), a DNA-based technique allowing a screening of chromosomal imbalances without needing cultured cells. Results. Overall incidence of chromosomal imbalances: 51.5 %. The most frequent gains involved 8q24, 3q27 [4 cases each]; 2p24p25, 5p, 9q22q34, 11, 12q22q24, 14q32, 17q, 18q21 [2 cases each]. Nonrandom losses were 17p13 [4 cases]; 1p36, 4q [3 cases each]; 17q23q25, Xp [2 cases each]. Three high-level amplifications were detected: 4p16, 9p22p24, 18q21q23. In this latter imbalance, involvement of Bcl2 has been confirmed by FISH. The nonrandom CGH imbalances occurring in M-PTLD are usually described in lymphomas of immunocompetent patients and contain genes known to be involved in lymphomagenesis, while genomic abnormalities detected in half cases of EBV positive P-PTLD are mostly unknown. Conclusion. This study reported nonrandom chromosomal imbalances in PTLD and also identified early genomic alterations in EBV positive P-PTLD. These results raise two questions: the role of such lesions in the development and progression of those EBV induced-lymphoproliferations and their clinical significance especially in P-PTLD.
Diabetes mellitus Worsens Intrarenal Hemodynamic Abnormalities in Nondialyzed Patients with Chronic Renal Failure

Duplex Doppler sonography has been reported to be useful in examining the intrarenal hemodynamic abnormalities in various renal diseases. We investigated the impact of diabetes on intrarenal hemodynamics in patients with chronic renal failure (CRF). The resistive index and pulsatility index of the renal interlobar arteries were measured using duplex Doppler sonography in 90 CRF patients (serum creatinine >130 and <800 mmol/l, mean age 59 ± 11 years). Forty-eight patients had type 2 diabetes and 42 did not. Twenty-nine age-matched, healthy subjects served as controls. Both resistive index and pulsatility index were greater in CRF patients than in the controls (p < 0.0001). No significant differences existed in age, sex, body mass index, total serum cholesterol, serum creatinine, estimated creatinine clearance, or mean blood pressure between the diabetic CRF and nondiabetic CRF groups. Resistive index and pulsatility index were significantly increased in the diabetic CRF patients compared to the nondiabetic CRF patients (p < 0.0001). Multiple regression analysis of all CRF patients revealed that resistive index was independently affected by the presence of type 2 diabetes (F = 44.535), as well as decreased creatinine clearance (F = 18.157) and age (F = 15.160) (R2 = 0.559, p < 0.0001). These results clearly demonstrated that intrarenal arterial resistance is significantly increased in CRF patients with type 2 diabetes compared to similar patients without diabetes. The impact of diabetes mellitus and advanced age on intrarenal hemodynamics may be due to intrarenal arteriosclerosis and interstitital lesions. Measurements of RI values in addition to conventional ultrasound imaging may add further information on such renal lesions.
CXCL14 Displays Antimicrobial Activity against Respiratory Tract Bacteria and Contributes to Clearance of Streptococcus pneumoniae Pulmonary Infection

CXCL14 is a chemokine with an atypical, yet highly conserved, primary structure characterized by a short N terminus and high sequence identity between human and mouse. Although it induces chemotaxis of monocytic cells at high concentrations, its physiological role in leukocyte trafficking remains elusive. In contrast, several studies have demonstrated that CXCL14 is a broad-spectrum antimicrobial peptide that is expressed abundantly and constitutively in epithelial tissues. In this study, we further explored the antimicrobial properties of CXCL14 against respiratory pathogens in vitro and in vivo. We found that CXCL14 potently killed Pseudomonas aeruginosa, Streptococcus mitis, and Streptococcus pneumoniae in a dose-dependent manner in part through membrane depolarization and rupture. By performing structure-activity studies, we found that the activity against Gram-negative bacteria was largely associated with the N-terminal peptide CXCL141–13. Interestingly, the central part of the molecule representing the β-sheet also maintained ∼62% killing activity and was sufficient to induce chemotaxis of THP-1 cells. The C-terminal α-helix of CXCL14 had neither antimicrobial nor chemotactic effect. To investigate a physiological function for CXCL14 in innate immunity in vivo, we infected CXCL14-deficient mice with lung pathogens and we found that CXCL14 contributed to enhanced clearance of Streptococcus pneumoniae, but not Pseudomonas aeruginosa. Our comprehensive studies reflect the complex bactericidal mechanisms of CXCL14, and we propose that different structural features are relevant for the killing of Gram-negative and Gram-positive bacteria. Taken together, our studies show that evolutionary-conserved features of CXCL14 are important for constitutive antimicrobial defenses against pneumonia.
The Fate of Organic Sources of Carbon in Moss‐rich Tundra Soil Microbial Communities: A Laboratory Experimental Study

Effects of glucose‐carbon supplementation on soil respiration and bacterial and protist biomass were investigated in laboratory studies of three soil samples from Alaskan tundra: spring tussock sample 1 (thin surface moss), spring tussock sample 2 (thick surface moss), and a summer tundra open field sample. Addition of 1% (w/v) glucose solution produced an immediate, pronounced two to three fold increase in respiration above basal rate, which declined over 4 h to baseline levels. Less than 1% (w/w) of glucose‐C supplement was respired during the respiratory spike, relative to the 89 μg/g added. A more substantial amount of the glucose‐C became incorporated in microbial biomass. The total difference in microbial carbon (μg/g) between the experimental treatments and controls without glucose after 1 wk was as follows: spring sample 1 (8), spring sample 2 (31), and summer sample (70). The percent (w/w) of glucose‐C incorporated was: spring sample 1 (5%), spring sample 2 (17%), and summer sample (39%), most attributed to biomass of bacteria and heterotrophic nanoflagellates. Although respiratory response to pulsed glucose‐C was minimal, the overall mean basal rate after 1 wk ranged between 4 and 6 nmol/min/g soil, indicating a significant assimilation and respiration of constituent soil organic carbon.
Epidemiology and Outcomes of Infectious Spondylodiscitis in Hemodialysis Patients

Study Design. A retrospective study of patients who were hospitalized for infectious spondylodiscitis over a 13-year period. Objective. To elucidate the epidemiology and prognostic factors of infectious spondylodiscitis in hemodialysis (HD) patients and to identify the impact of HD on infectious spondylodiscitis. Summary of Background Data. Only a few case studies of infectious spondylodiscitis in HD patients can be found in the literature. Reports of prognostic factors are limited and patients’ outcomes have not been well described. Methods. The cases of 1402 patients who were hospitalized for infectious spondylodiscitis over a 13-year period were retrospectively reviewed. Of these, 102 patients on maintenance HD were enrolled in this study. Cox proportional hazard model was used to evaluate the risk factors of mortality and recurrence. Results. The 102 enrolled patients had an average age 63.3 ± 11.2 years old and male-to-female ratio of 1:1.04. Back pain was present in 75.5% of patients and the most commonly infected site was the lumbosacral spine. Infection associated with vascular access was identified in 31.4% of patients. The prevalence of dialysis via central venous catheters was higher than prevalent HD patients. Methicillin-resistant Staphylococcus aureus was the most common pathogen, followed coagulase-negative staphylococci. The patients’ in-hospital survival rate was 82.4%; their vascular access survival rate was 75.5%; their 1-year survival rate was 78.4%, and their 1-year recurrence rate was 20.2%. Congestive heart failure was associated with an increased 1-year mortality. Other variables exhibited no significant relationship with patients’ in-hospital mortality, 1-year mortality or recurrence. Conclusion. The characteristics and outcomes of infectious spondylodiscitis in HD patients were elucidated. Most of the demographic and clinical variables, evaluated upon admission, did not predict mortality or recurrence. Level of Evidence: 3
Self-Measurement of Blood Glucose: Accuracy of Self-Reported Data and Adherence to Recommended Regimen

Reflectance meters containing memory chips were used in a study that addressed several questions concerning routine use of self-monitoring of blood glucose (SMBG), including accuracy of patient blood glucose (BG) diaries, reliability of self-reported frequency of SMBG, and adherence to recommended SMBG regimen. Thirty adults with insulin-dependent diabetes used memory meters and recorded test results in diaries for 2 wk while performing their normal SMBG regimen. Analysis of glucose diaries showed that only 23% of the subjects had no diary errors and 47% had clinically accurate diaries (>10% error rate). The most common types of errors were omissions of values contained in meter memory and additions of values not contained in meter memory, with significantly more omissions than additions. Alterations of test values (e.g., changing a 300-mg/dl reading to 200 mg/dl) were extremely rare. There was no difference in the rate of errors that resulted in a more positive clinical profile (omitting unacceptable values and adding acceptable values) or a more negative clinical profile (omitting acceptable values and adding unacceptable values). Examination of the actual frequency of SMBG showed that most subjects (56.6%) measured their BG an average of two to three times each day. Self-report of SMBG frequency correlated with both actual frequency and HbA1. Although actual frequency of SMBG was not related to physicians' recommendations, the majority (64%) of subjects were self-testing as often or more often than they had been instructed.
Development and initial validation of the comprehensive early childhood parenting questionnaire (CECPAQ) for parents of 1–4 year-olds

Abstract Parenting is a multifaceted task and the way in which parents fulfill this task plays an important role in children’s growth and development, especially in early childhood. Conceptualization and assessment of parenting behavior is elementary for research on child and family development and would fill a gap in clinical work, as there is a lack of questionnaires simultaneously assessing multiple parenting behaviors specific for early childhood. Therefore the Comprehensive Early Childhood Parenting Questionnaire (CECPAQ) was designed; a parent report measure of commonly occurring behaviors in five domains of parenting (i.e., support, stimulation, structure, harsh discipline, and positive discipline) central to early childhood. Data were collected from 1139 mothers and 526 fathers of 1–4 year-old children. Confirmatory factor analysis confirmed a five-factor structure (composed of 54 items). The five parenting domains were found to have good internal consistency and temporal stability. Preliminary evidence of validity of the CECPAQ was demonstrated by moderate relationships with measures of parental stress and child problem behavior. It is concluded that the CECPAQ is a promising measure of self-perceived parenting behavior for parents of 1–4 year-old children.
Nonbloody, Red Stools from Coadministration of Cefdinir and Iron‐Supplemented Infant Formulas

Cefdinir is an extended‐spectrum, third‐generation cephalosporin that may be used for treatment of acute otitis media in patients allergic to penicillin. When administered with iron‐containing products, including infant formulas, cefdinir or one of its metabolites may bind to ferric ions, forming a nonabsorbable complex that imparts a reddish color to the stool. We describe a 9‐month‐old infant with failure to thrive and acute otitis media who developed an erythematous maculopapular rash during treatment with amoxicillin‐clavulanate. His antibiotic therapy was changed to cefdinir. Five days into a 10‐day course of therapy, the infant's mother brought him to the pediatric clinic and reported the appearance of red stools. He had no associated gastrointestinal symptoms (vomiting, abdominal pain, or diarrhea). His hematocrit and hemoglobin level were normal, and Clostridium difficile antigen studies and tests for species of Shigella, Salmonella, and Camphylobacter as well as ova and parasites were all negative. Cefdinir was discontinued, and his stools returned to normal within 48 hours. Three weeks later, he again received cefdinir for recurrent otitis media. Red stools reappeared 48 hours later, were determined to be guaiac negative, and resolved within hours of drug discontinuation. During both occurrences of red stools, the infant had been breastfed and was receiving supplemental feedings with an iron‐containing infant formula. In the product labeling of cefdinir, this adverse event is described as a consequence of the drug‐drug interaction; however, it is not listed in the adverse drug reaction section of the labeling. As such, one may miss the association between cefdinir and reddish stools when investigating this event as a potential adverse reaction to cefdinir. When using the Naranjo adverse drug reaction probability scale to assess causality in our patient's case, this adverse drug reaction was determined as highly probable. As this infant had been breastfed, the use of a supplemental iron‐containing infant formula was not identified as a potential contributing factor until the second occurrence of red stools. Health care professionals should review the entire product labeling, including the drug‐drug interaction section, when investigating a potential adverse drug reaction. With the recent approval of generic formulations of cefdinir, clinicians should be aware of this drug‐drug interaction with iron‐containing products to prevent unnecessary alarm by parents and caregivers, as well as costly medical evaluations for gastrointestinal bleeding.