Miracle-dz/UniFAR-FTUs huggingface dataset:
Spontaneous intracranial hypotension presenting to the ENT surgeon: case report

Abstract Objective: To highlight a case of spontaneous intracranial hypotension presenting to the ENT surgeon. Method: We present a case report and a review of the literature concerning spontaneous intracranial hypotension. Results: Spontaneous intracranial hypotension is a rare diagnosis, particularly to the ENT surgeon. We report a patient with tinnitus, hearing loss and headache, symptoms suggestive of an ENT diagnosis such as Ménière's disease or vestibular schwannoma. However, magnetic resonance imaging revealed the characteristic findings of spontaneous intracranial hypotension. The patient's symptoms resolved, except for a mild residual tinnitus, with conservative management alone. Conclusion: This case highlights the importance of considering spontaneous intracranial hypotension as a differential diagnosis of certain ENT symptoms.
Establishing Links Between Health and Productivity in the New Zealand Workforce

Objective: To provide the first investigation of individual health behaviors and measures of work performance in New Zealand. Methods: Health risk assessments were completed by 747 adults aged 18 to 65 years. Associations between measures of productivity and health risk factors were assessed using multiple stepwise regression. Results: Participants with low to moderate psychological distress levels and who were physically active reported a work performance 6.5% (P < 0.001) and 3.5% (P < 0.001) higher, respectively. Furthermore, high psychological distress and smoking accounted for 16.8 (P < 0.001) and 11.6 (P = 0.038) additional absentee hours over the previous 4 weeks. Conclusions: The impact that psychological distress, physical inactivity, and smoking have on productivity suggests that employers may benefit from contributing to health promotion within the workplace.
Q-onset and T-end delineation: assessment of the performance of an automated method with the use of a reference database

The aim of the study is to assess the performance of an automated method for Q-onset and T-end delineation, as well as QT measurement with the use of a ‘gold standard’ of a manually created reference database. The data to be used comprise 548 recordings of the PTB Diagnostic ECG Database. The ECG signals are preprocessed, suppressing power-line interference, electromyographic noise and baseline drift according to our previously published investigations, guaranteeing accurate Q-onset and T-end locality preservation. Our method for automatic detection of Q-onset and T-end is based on the minimum value of the angle between two segments having a common mid point and equal lengths of 10 ms. The minimum of the angle is searched in defined time intervals delimited separately for the Q-onset and T-end. All measurements are performed on lead II only. Mean ± standard deviations are obtained for 95% of the recordings: −0.08 ± 2.71 for Q-onset, 5.10 ± 9.22 for T-end and 4.40 ± 9.93 for QT interval, as well as for 100% of the recordings: 0.46 ± 4.84 for Q-onset, 1.28 ± 16.75 for T-end and 0.83 ± 16.67 for QT interval.
Elevated pulse pressure is associated with age-related decline in language ability

Abstract Recent research suggests that pulse pressure (PP), a putative marker of vascular integrity, may be associated with brain microvascular damage and age-related cognitive decline. Thus, the present study examined the relationship between PP and cognition in a sample of healthy nondemented older adults. One hundred nine participants were administered neurological and neuropsychological evaluations and determined to be nondemented. Regression analyses were used to examine the relationships among pulse pressure (PP) [systolic blood pressure (SBP) – diastolic blood pressure (DBP)], age, and cognition. PP and related measures were inversely correlated with global cognitive functioning and scores on a composite measure of language function, even after adjusting for age, education, and relevant vascular risk factors. Results indicate that increases in the pulsatile component of blood pressure may convey added risk of global cognitive decline and specific impairment in language abilities. (JINS, 2010, 16, 933–938.)
Aberrant signalling and transcription factor activation as an explanation for the defective growth control and differentiation of keratinocytes in psoriasis: a hypothesis

Abstract: Psoriasis is a chronic inflammatory skin disease characterized by the accumulation of red, scaly plaques on the skin. The plaques result from hyperproliferation and incomplete differentiation of keratinocytes (KC) in a process that seems to be driven, in part by skin‐infiltrating leucocytes. We believe that the KC have inherent defects in intracellular signalling which could be usefully targeted to allow the development of more effective therapies. We suggest that there are defects in the regulation of the transcription factors: signal transducer and activator of transcription (STAT‐1α), interferon regulated factor‐1 (IRF‐1) and NFκB which lead to loss of growth and differentiation control when the cells are subjected to physico‐chemical and immunological stress. We also highlight recent studies that suggest that peroxisome proliferator‐activated receptors, the notch receptor and defects in calcium and other ion transporting proteins may contribute to impairment in the ability of psoriatic KC to differentiate. The role of these systems in the development of the psoriatic phenotype and tests of these hypotheses are proposed.
Prolonged ventilatory support after open‐heart surgery

ObjectivesTo characterize the course of open-heart surgery patients who require prolonged (>72 hrs) mechanical ventilation and to define the role and timing of tracheostomy. DesignRetrospective review. SettingCardiac surgery ICU and surgery wards at a university hospital. PatientsAll open-heart surgery patients during an 18-month period from January 1988 to July 1989 (n = 581). From this group, 58 patients (9.9%) required prolonged mechanical ventilation. InterventionsStudy patients (n = 58) were followed through the course of intubation and/or tracheostomy until they were extubated, left the hospital on ventilation, or died. Measurements and Main ResultsEnd-points for mortality and complications were determined. Overall mortality rate was 43% in the patients who required prolonged mechanical ventilation. Twenty-eight percent of the 58 patients died within the first 14 days. Of those patients who survived, 55% required an endotracheal tube only and were extubated in <14 days; 45% of the patients required tracheostomy. Of those patients who required tracheostomy, five (26%) were eventually extubated, seven (37%) remained mechanically ventilated, and seven (37%) died. The complication rate for endotracheal tubes was 65%; the complication rate for tracheostomy was 37%. ConclusionsOpen-heart surgery patients requiring prolonged mechanical ventilation are a desperately ill subset of cardiac surgery patients. Those patients who survive are either extubated in <14 days or require prolonged mechanical ventilation beyond that point. In our opinion, patients should be given 1 wk to recover and one trial of weaning from the ventilator. If this approach fails, then they should undergo elective tracheostomy.
Invasive Pneumococcal Disease Among Immunocompromised Persons: Implications for Vaccination Programs.

BACKGROUND In 2012/2013, a single dose of 13-valent pneumococcal conjugate vaccine (PCV13) was recommended for immunocompromised adults in the United States and Canada. To assess the potential benefits of this recommendation, we assessed the serotype-specific burden of invasive pneumococcal disease (IPD) among immunocompromised individuals. METHODS From 1995 to 2012, population-based surveillance for IPD was conducted in Metropolitan Toronto and Peel Region, Canada. Disease incidence and case fatality were measured in immunocompromised populations over time, and the contribution of different serotypes determined. RESULTS Overall, 2115/7604 (28%) episodes of IPD occurred in immunocompromised persons. IPD incidence was 12-fold higher (95% confidence interval [CI], 8.7-15) in immunocompromised compared to immunocompetent persons; the case fatality rate was elevated in both younger (odds ratio [OR] 1.8) and older (OR 1.3) adults. Use of immunosuppressive medications was associated with a 2.1-2.7 fold increase in the risk of IPD. Five years after PPV23 program implementation, IPD incidence had declined significantly in immunocompromised adults (IRR 0.57, 95% CI, .40-.82). Ten years after pediatric PCV7 authorization, IPD due to PCV7 serotypes had decreased by 90% (95% CI, 77%-96%) in immunocompromised persons of all ages. In 2011/2012, 37% of isolates causing IPD in immunocompromised persons were PCV13 serotypes and 27% were PPV23/not PCV13 serotypes. CONCLUSIONS Immunocompromised individuals comprised 28% of IPD. Both PPV23 and herd immunity from pediatric PCV7 were associated with reductions in IPD in immunocompromised populations. PCV13 vaccination of immunocompromised adults may substantially reduce the residual burden until herd immunity from pediatric PCV13 is fully established.
Guidelines and Requirements for the Evaluation of Contraceptive Steroids

Since their introduction in the early 1960s, the oral contraceptive (OCs) steroids have been subjected to preclinical and clinical investigations unprecedented in medical history. As a result of such extensive studies, it is now possible to make a comprehensive review of preclinical and clinical data on oral contraceptives. The OCs were introduced at a time when the Food and Drug Administration (FDA) was undergoing drastic changes as a result of the thalidomide tragedy, the introduction of the Kefauver-Harris Amendment, and, the desire for greater control over the pharmaceutical industry. The initial requirements for the safety evaluation of OCs were identical to those of other drugs. There were no explicit requirements for OCs although it was generally felt that the requirements should be more stringent because the OCs were being used in otherwise healthy women for long periods of time and with minimal medical supervision. In the 1960s when it became apparent from ongoing studies that there was an increased incidence of mammary tumors in dogs treated with some progestins, the FDA made the decision to terminate clinical studies and established the requirement for 7- and 10-yr studies in dogs and monkeys, respectively. The primary purpose of this paper is to present an historical perspective of the evolution of the preclinical requirements for the evaluation of the safety of OCs prior to their use in the various phases (I, II, III) of clinical trials. Some proposed changes in the requirements are discussed. This information will form the basis for other presentations dealing with the safety assessment of OCs in rats, dogs, and monkeys.
Synergy between anti‐endoglin (CD105) monoclonal antibodies and TGF‐β in suppression of growth of human endothelial cells

Endoglin (CD105) is a proliferation‐associated cell membrane antigen of endothelial cells and strongly expressed in the angiogenic vasculature of solid tumors. Endoglin is essential for angiogenesis/vascular development and an ancillary transforming growth factor β (TGF‐β) receptor. Certain anti‐endoglin monoclonal antibodies (mAbs), termed SN6 series mAbs, inhibited angiogenesis, tumor growth and metastasis in mice. We investigated the mechanisms by which anti‐endoglin mAbs suppress growth of proliferating endothelial cells. We found that 4 SN6 series mAbs suppressed growth of human umbilical vein endothelial cells (HUVECs) in a dose‐dependent manner in the absence of any effector cells or complement. Significant differences in the growth suppression between the 4 anti‐endoglin mAbs defining different epitopes were observed. These differences were not determined by antigen‐binding avidities of the mAbs. Combination of TGF‐β1 and each of the 4 anti‐endoglin mAbs exerted synergistic growth suppression of HUVECs. Binding of anti‐endoglin mAbs to endoglin‐expressing cells did not block the subsequent binding of TGF‐β1. Conversely, preincubation of HUVECs with TGF‐β1 did not change cell surface expression of endoglin. The present results suggest that direct suppression of the endothelial cell growth by SN6 series mAbs is one of the underlying mechanisms by which anti‐endoglin mAbs exert antiangiogenic and tumor‐suppressive activity in vivo. The results further suggest that TGF‐β1 plays an important role in the in vivo antiangiogenic efficacy of anti‐endoglin mAbs by synergistically enhancing the activity of these mAbs. Further studies of the present novel findings may provide valuable information about the functional roles of endoglin and anti‐endoglin mAbs in the TGF‐β‐mediated cell regulation. © 2003 Wiley‐Liss, Inc.
Genetics of spontaneous, high-frequency loss of b capsule expression in Haemophilus influenzae

We determined that the frequency of spontaneous capsule loss in Haemophilus influenzae type b is 0.1 to 0.3%. All of 10 independent capsule-deficient variants (derived from four different type b strains) were found to be missing an identical 9-kilobase EcoRI restriction fragment when probed with a cloned piece of DNA containing sequences known to be necessary for type b capsule expression. These results suggest the existence of a specific mechanism for shutting off type b capsule synthesis at a high frequency. Intranasal infection of infant rats showed that capsule loss occurred in vivo at frequencies comparable to those observed in vitro.
Chronic manganese poisoning in the dry battery industry

Emara, A. M. , El-Ghawabi, S. H. , Madkour, O. I. , and El-Samra, G. H. (1971). Brit. J. industr. Med., 28, 78-82. Chronic manganese poisoning in the dry battery industry. A survey was carried out on 36 workers in the dry battery industry exposed to dust containing 65 to 70% manganese oxide. Eight (22·2%) were found to have neuropsychiatric manifestations, six (16·6%) had chronic manganese psychosis, one had left hemi-parkinsonism, and one had left choreoathetosis. An environmental study revealed a high concentration of manganese dust at the main working areas, far exceeding the accepted MAC. The manganese level in blood was almost within the normal range. Coproporphyrin in urine was normal. The electroencephalogram was abnormal in only two of the affected workers (25%) but there was no association between this and the clinical manifestations or duration of exposure. The concentration of manganese dust in air showed some association with the prevalence and rapidity of effect on workers according to their occupation. However, individual susceptibility was apparent. The shortest latent period was one year.
Aberrant methylation of breast and ovarian cancer susceptibility gene 1 in chemosensitive human ovarian cancer cells does not involve the phosphatidylinositol 3′‐kinase–Akt pathway

Methylation is an important silencing mechanism of breast and ovarian cancer susceptibility gene 1 (BRCA1) expression in sporadic ovarian cancer. However, the role of BRCA1 methylation in chemotherapy in sporadic ovarian cancer and the related pathways have not been understood completely. This study has determined the roles of BRCA1 hypermethylation in chemotherapy of sporadic ovarian cancer and its related signaling pathways. We used bisulfite sequencing, real‐time polymerase chain reaction, and western blotting to check the methylation state and expression levels of BRCA1 of the following cell lines: platinum‐sensitive human ovarian cancer cell line COC1, platinum‐resistant cell line COC1/DDP, SKOV‐3, and 5‐Aza‐dC treated COC1. The cisplatin sensitivity of ovarian cancer cells was examined by MTS (methyl‐thiazol tetrazolium) assay. Tumorigenicity in vivo and DDP‐based chemosensitivity were compared among the above cells. Phosphatidylinositol 3′‐kinase (PI3K)–Akt pathway activation in ovarian cancer cells was studied by western blotting. The frequency of BRCA1 methylation in the COC1 cell line was higher than in COC1/DDP and SKOV‐3 cell lines, whereas the mRNA and protein expression of BRCA1 were lower than in the COC1/DDP and SKOV‐3 cell lines. DNA demethylation decreased the chemosensitivity of COC1 cells and partially increased the expression levels of BRCA1. The activation of the PI3K‐Akt pathway was low in ovarian cancer cells. Our results indicate that hypermethylation of BRCA1 might play an important role in the chemosensitivity of ovarian cancer, and that the PI3K–Akt pathway is not involved in this response. (Cancer Sci 2010)
Pattern Of Leukaemia Patients Admitted In Ayub Teaching Hospital Abbottabad.

BACKGROUND Any tissue of the body can give rise to cancer. However, those tissues which multiply rapidly are at high risk of developing cancer and haematopoietic system is one of them. Neoplasms of this system are known as leukaemia and lymphoma, according to the types of white cells involved. Study of cancer patterns in different societies, however can contribute a substantial knowledge about the aetiology of cancer. The present Study was designed and aimed to estimate the frequency of different types of leukaemia in patients admitted in Ayub Teaching hospital Abbottabad. METHODS Data from the patients admitted at oncology Department of Ayub Teaching Hospital Abbottabad from 2010 to 2015 was collected and analysed to calculate cumulative and year-wise frequency of leukaemia and its major types. Frequency distribution with reference to gender and age was also calculated. RESULTS In our analysis about 16% patients had acute myelocytic leukaemia and 32% patients had acute lymphocytic leukaemia; while chronic myeloid leukaemia outnumbered chronic lymphocytic leukaemia (11% and 3%); Hodgkin lymphoma was seen in 18% cases while Non Hodgkin lymphoma (NHL) was present in 20% cases. Out of the total, 150 cases (75%) belonged to mountainous areas of Hazara, i.e., 40 cases belonged to Kohistan, another 40 cases were residents of Battagram, 45 cases belonged to hilly areas of Mansehra and 25 cases to Kaghan valley, while only 50 (25%) cases were from the plain areas of Abbottabad and Haripur districts, i.e., 20 and 30 cases respectively. CONCLUSIONS Leukaemia is more common in hilly areas of Hazara, since majority of the cases belonged to well-known mountainous regions of Kohistan, Battagram, Kaghan or Mansehra and only few cases belonged to the plain areas of Abbottabad and Haripur districts.
Automatic grunt detector and recognizer for Atlantic cod (Gadus morhua).

Northwest Atlantic cod (Gadus morhua) have been heavily overfished in recent years and have not yet recovered. Passive acoustic technology offers a new approach to identify the spatial location of spawning fish, as well as their seasonal and long term persistence in an area. To date, the lack of a species-specific detector has made searching for Atlantic cod grunts in large amounts of passive acoustic data cumbersome. To address this problem, an automatic grunt detection and recognition algorithm that processes yearlong passive acoustic data recordings was designed. The proposed technique is a two-stage hypothesis testing algorithm that includes detecting and recognizing all grunt-like sounds. Test results demonstrated that the algorithm provided a detection probability of 0.93 for grunts with a signal-to-noise ratio (SNR) higher than 10 dB, and a detection probability of 0.8 for grunts with the SNR ranging from 3 to 10 dB. This detector is being used to identify cod in current and historical data from U.S. waters. Its use has significantly reduced the time required to find and validate the presence of cod grunts.
Joint effects of smoking and gene variants involved in sex steroid metabolism on hot flashes in late reproductive-age women.

BACKGROUND Although smoking has a known association with hot flashes, the factors distinguishing smokers at greatest risk for menopausal symptoms have not been well delineated. Recent evidence supports a relationship between menopausal symptoms and variants in several genes encoding enzymes that metabolize substrates such as sex steriods, xenobiotics, and catechols. It is currently not known whether the impact of smoking on hot flashes is modified by the presence of such variants. OBJECTIVE The objective of the study was to investigate the relationship between smoking and hot flash occurrence as a function of genetic variation in sex steroid-metabolizing enzymes. METHODS A cross-sectional analysis of data from the Penn Ovarian Aging study, an ongoing population-based cohort of late reproductive-aged women, was performed. Smoking behavior was characterized. Single-nucleotide polymorphisms in five genes were investigated: COMT Val158Met (rs4680), CYP1A2*1F (rs762551), CYP1B1*4 (Asn452Ser, rs1800440), CYP1B1*3 (Leu432Val, rs1056836), and CYP3A4*1B (rs2740574). RESULTS Compared with nonsmokers, European-American COMT Val158Met double-variant carriers who smoked had increased odds of hot flashes [adjusted odds ratio (AOR) 6.15, 95% confidence interval (CI) 1.32-28.78)]; European-American COMT Val158Met double-variant carriers who smoked heavily had more frequent moderate or severe hot flashes than nonsmokers (AOR 13.7, 95% CI 1.2-154.9). European-American CYP 1B1*3 double-variant carriers who smoked described more frequent moderate or severe hot flashes than nonsmoking (AOR 20.6, 95% CI 1.64-257.93) and never-smoking (AOR 20.59, 95% CI 1.39-304.68) carriers, respectively. African-American single-variant CYP 1A2 carriers who smoked were more likely to report hot flashes than the nonsmoking carriers (AOR 6.16, 95% CI 1.11-33.91). CONCLUSION This is the first report demonstrating the effects of smoking within the strata of gene variants involved in sex steroid metabolism on hot flashes in late reproductive-age women. The identification of individuals with a genetic susceptibility to smoking-related menopausal symptoms could contribute to interventions targeted at reducing reproductive morbidity both in the menopause and across the reproductive life course.
Chemonucleolysis Versus Laminectomy: A Cohort Comparison of Effectiveness and Charges

Study Design A prospective cohort study was done comparing 100 consecutive chemonucleolysis patients with 100 consecutive laminectomy patients. Objectives The effectiveness and cost of chymopapain chemonucleolysis was compared with that of laminectomy to manage herniated lumbar discs. Summary of Background Data Although the efficacy of chemonucleolysis has been established, controversy regarding the relative benefits of chemonucleolysis and laminectomy continues to arise. The relative cost-effectiveness of the two procedures has not been evaluated previously in a cohort study. Methods Patients in both treatment groups were of comparable age, height and weight, and worker's compensation status. Patients with migrated disc were not considered for chemonucleolysis. Improvement in pain, paresthesia, straight-leg raising, reflexes, motor loss, and sensory function, self-reported overall improvement, ability to maintain employment, and charge of treatment were used to measure treatment success. Results Clinical assessment after 6 weeks showed 92% of laminectomy patients compared with 82% of chemonuclealysis patients had successful results (P=0.058). Chemonucleolysis patients had greater improvement in numbness (P=0.014) and sensory and motor functions (P=0.002). After 6 months, 88% of chemonucleolysis patients and 85% of laminectomy patients had successful results, with a greater improvement in sensory status of chemonucleolysis patients (P<0.001). After 1 year, 87% of chemonucleolysis patients and 82% of laminectomy patients had successful results, and more chemonucleolysis patients than laminectomy patients were employed. Based on similar therapeutic results, the average charge savings for chemonucleolysis patients was $5365 when chemonucleolysis was performed instead of laminectomy. Conclusion This study shows that chemonucleolysis is as effective as laminectomy in appropriately selected patients but at lower charge and can contribute substantially to reducing short- and long-term health costs.