Miracle-dz/UniFAR-FTUs huggingface dataset:
Maturing into Gerotranscendence

According to the empirically based theory of gerotranscendence, the individual moving toward gerotranscendence may experience a series of gerotranscendental changes or developments. These include a redefinition of the self and of relationships to others, as well as a new understanding of fundamental existential questions. It is not farfetched to associate this with a kind of transpersonal development. Gerotranscendence, however, does not imply any state of withdrawal or disengagement, as is sometimes believed. It is not the old disengagement theory in a new disguise. Rather, it is a theory describing a developmental pattern that goes beyond the old dualism of activity and disengagement. Research in various parts of the world confirms the existence of gerotranscendence, and lately a promising new type of counseling based on the theory has been created in countries as widely dispersed as Sweden and Taiwan. Author Note: The theory of gerotranscendence was born, almost 25 years ago, to address what I saw as a mismatch between present theories in social gerontology and some existing empirical data. Based on intellectual input from scholars such as Jung and Erikson, together with qualitative as well as quantitative data, I have been able to capture a certain kind of positive aging in a grounded-theory-like concept I have called gerotranscendence. The theory suggests that human aging includes a potential to mature into a new outlook on and understanding of life. Gerotranscendence implies a shift in meta-perspective, from a materialistic and rational view of the world to a more cosmic and transcendent one, normally accompanied by an increase in life satisfaction.
Dual SP/ALDH Functionalities Refine the Human Hematopoietic Lin−CD34+CD38− Stem/Progenitor Cell Compartment

Identification of prevalent specific markers is crucial to stem/progenitor cell purification. Determinants such as the surface antigens CD34 and CD38 are traditionally used to analyze and purify hematopoietic stem/progenitor cells (HSCs/HPCs). However, the variable expression of these membrane antigens poses some limitations to their use in HSC/HPC purification. Techniques based on drug/stain efflux through the ATP‐binding cassette (ABC)G2 pump (side population [SP] phenotype) or on detection of aldehyde dehydrogenase (ALDH) activity have been independently developed and distinguish the SP and ALDHBright (ALDHBr) cell subsets for their phenotype and proliferative capability. In this study, we developed a multiparametric flow cytometric method associating both SP and ALDH activities on human lineage negative (Lin−) bone marrow cells and sorted different cell fractions according to their SP/ALDH activity level. We find that Lin−CD34+CD38Low/− cells are found throughout the spectrum of ALDH expression and are enriched especially in ALDHBr cells when associated with SP functionality (SP/ALDHBr fraction). Furthermore, the SP marker identified G0 cells in all ALDH fractions, allowing us to sort quiescent cells regardless of ALDH activity. Moreover, we show that, within the Lin−CD34+CD38−ALDHBr population, the SP marker identifies cells with higher primitive characteristics, in terms of stemness‐related gene expression and in vitro and in vivo proliferative potential, than the Lin−CD34+ CD38−ALDHBr main population cells. In conclusion, our study shows that the coexpression of SP and ALDH markers refines the Lin−CD34+CD38− hematopoietic compartment and identifies an SP/ALDHBr cell subset enriched in quiescent primitive HSCs/HPCs. STEM CELLS 2009;27:2552–2562
An emotional Stroop functional MRI study of euthymic bipolar disorder.

OBJECTIVE To identify the brain regions associated with emotional processing in euthymic bipolar patients. METHODS The study examined 12 euthymic bipolar patients using functional magnetic resonance imaging (fMRI) while performing an emotional Stroop (eStroop) task. The task comprised emotionally valent and neutral words presented in alternating blocks that was designed to implicitly induce affect. In conjunction with fMRI, galvanic skin responses (GSR) were measured to monitor arousal. RESULTS Euthymic bipolar patients had diminished activation in response to the affective stimuli in both cortical and subcortical brain regions when compared with healthy subjects. In particular, patients had less activation in the left ventral prefrontal cortex suggesting a potential trait deficit. Patients were slower to react than healthy controls, but did not differ with respect to accuracy. CONCLUSIONS Euthymic bipolar patients are perhaps constrained in their ability to engage affective processing. Diminished ventral prefrontal cortex activation corroborates previous reports of a potential trait deficit, suggesting that 'all is not well in euthymia', although the effects of medication cannot be overlooked.
Impact of pay for performance on behavior of primary care physicians and patient outcomes

Pay‐for‐performance is a financial incentive which links physicians’ income to the quality of their services. Although pay‐for‐performance is suggested to be an effective payment method in many pilot countries (ie the UK) and enjoys a wide application in primary health care, researches on it are yet to reach an agreement. Thus, a systematic review was conducted on the evidence of impact of pay‐for‐performance on behavior of primary care physicians and patient outcomes aiming to provide a comprehensive and objective evaluation of pay‐for‐performance for decision‐makers.
Learning Curve to Lymph Node Resection in Minimally Invasive Esophagectomy for Cancer

Objective Minimally invasive esophagectomy (MIE) is a safe alternative to open approaches, yet the impact of the minimally invasive approach on oncologic efficacy is unclear. The objectives of the current study were to compare lymph node yields and surgical margins during a single-surgeon series to examine the learning curve to oncologic aspects of MIE. Methods A retrospective review of a prospectively maintained institutional database was performed. The sequential MIE experience for esophageal cancer was subcategorized into terciles (first 25 MIEs as early, next 24 as middle, and most recent 24 as later). Results Seventy-three patients underwent MIE for cancer between 2008 and 2013. Complete resections (R0) were performed in 71 cases (93%), and there were no significant differences in the number of complete resections with negative margins during the MIE experience (P = 0.54). The number of lymph nodes harvested during MIE increased significantly with progressive experience, with a mean of 22, 29, and 28 nodes recovered in the early, middle, and late subgroups, respectively (P = 0.038). On multivariate analysis, only increasing surgeon experience (1.4-fold increase in nodal yield for the latter two thirds relative to the first third, P = 0.0011) and histology of high-grade dysplasia (0.54-fold decrease in nodal yield relative to adenocarcinoma or squamous cell carcinoma, P = 0.025) were significant predictors of lymph node yield. Conclusions The ability to execute a complete lymphadenectomy during MIE is affected by surgeon experience and improves over time, plateauing after the first 25 cases.
Influenza A Virus Infection Predisposes Hosts to Secondary Infection with Different Streptococcus pneumoniae Serotypes with Similar Outcome but Serotype-Specific Manifestation

ABSTRACT Influenza A virus (IAV) and Streptococcus pneumoniae are major causes of respiratory tract infections, particularly during coinfection. The synergism between these two pathogens is characterized by a complex network of dysregulated immune responses, some of which last until recovery following IAV infection. Despite the high serotype diversity of S. pneumoniae and the serotype replacement observed since the introduction of conjugate vaccines, little is known about pneumococcal strain dependency in the enhanced susceptibility to severe secondary S. pneumoniae infection following IAV infection. Thus, we studied how preinfection with IAV alters host susceptibility to different S. pneumoniae strains with various degrees of invasiveness using a highly invasive serotype 4 strain, an invasive serotype 7F strain, and a carrier serotype 19F strain. A murine model of pneumococcal coinfection during the acute phase of IAV infection showed a significantly increased degree of pneumonia and mortality for all tested pneumococcal strains at otherwise sublethal doses. The incidence and kinetics of systemic dissemination, however, remained bacterial strain dependent. Furthermore, we observed strain-specific alterations in the pulmonary levels of alveolar macrophages, neutrophils, and inflammatory mediators ultimately affecting immunopathology. During the recovery phase following IAV infection, bacterial growth in the lungs and systemic dissemination were enhanced in a strain-dependent manner. Altogether, this study shows that acute IAV infection predisposes the host to lethal S. pneumoniae infection irrespective of the pneumococcal serotype, while the long-lasting synergism between IAV and S. pneumoniae is bacterial strain dependent. These results hold implications for developing tailored therapeutic treatment regimens for dual infections during future IAV outbreaks.
Association between Elevated Serum Ferritin and HBA1C in Type 2 Diabetes Mellitus

Background and objectives : Diabetes is a disease of metabolic dysregulation. Recent studies have emphasized the role of serum ferritin in insulin resistance and the incidence of diabetes mellitus. However, the role of ferritin as a marker of iron overload in pancreatic damage and peripheral insulin resistance or its role as an inflammatory marker is not clear. The aim of this study is to establish an association between serum ferritin, FBS and HbA1c in type 2 diabetes mellitus and to evaluate the role of serum ferritin on glycemic status. Methods : A case control study was done with 90 type 2 DM patients. FBS,PLBS, Hb%, HbA1c% and serum ferritin were measured. Results : Significant hyperglycemia was observed in the cases compared to the controls. Mean ±SD of FBS, PLBS, HbA1c and serum ferritin were highest in group with poor glycemic control. Interpretations and conclusion : Higher positive correlation of serum ferritin with HbA1c shows that dysglycemia affects ferritin levels possibly due to inflammation or oxidative stress or a combination of two. Iron may negatively impact on glycemic control. Also in the presence of hyperglycemia and inflammation, iron may contribute to the development and progression of oxidative injury.
No association between XRCC1 polymorphisms and survival in non-small-cell lung cancer patients treated with platinum-based chemotherapy

Purpose: Genetic polymorphisms in DNA repair genes are thought to represent important determinants of platinum drug efficacy. The current study investigated whether single nucleotide polymorphisms (SNPs) in the X-ray repair cross complementing protein 1 (XRCC1) gene are associated with survival in non-small-cell lung cancer (NSCLC) patients treated with platinum-based chemotherapy. Experimental design: A total of 199 platinum-treated patients with stage III-IV NSCLC were recruited. Overall survival (OS) and progression-free survival (PFS) according to genotypes and haplotypes were analyzed using Kaplan-Meier method and assessed by log-rank test. Hazard ratios (HRs) were calculated using Cox proportional hazards models by adjusting for clinical factors. Results: During the median 26.5 months of follow-up, 159 deaths occurred. Regarding XRCC1 Arg194Trp, Arg280His, and Arg399Gln genotypes, no significant effects on survival were observed, although the 280Arg/His genotype was associated with a borderline-significant higher median survival time (20.0 months for Arg/His versus 16.0 months for Arg/Arg; P = 0.131). Moreover, no significant association of haplotypes with survival was found. Conclusions: This study showed no influence of the XRCC1 Arg194Trp, Arg280His, and Arg399Gln polymorphisms on survival in advanced NSCLC patients with platinum-based chemotherapy.
Cerebral Vasoreactivity in Children and Adolescents with Type 1 Diabetes Mellitus

It is well established in clinical and experimental settings that diabetes mellitus, especially if long lasting, impairs autoregulation of cerebral blood flow (CBF). However, the onset and the course of development of this dysfunction remain unknown. We hypothesized that assessment of autoregulatory functions of cerebral arteries in children with relatively short duration of type 1 diabetes mellitus may provide an insight into the pathophysiology of the development of impaired autoregulation of CBF. Such a dysfunction of vasodilation of cerebral arteries can be assessed by transcranial Doppler. Therefore, to examine whether and when autoregulation of CBF becomes affected by diabetes, we used transcranial Doppler and a pCO2 challenge in 17 males between the ages of 12–20 years with type 1 diabetes mellitus of 0.2–16 years duration and with varying degrees of glucose control. The results were compared with age‐matched, healthy, nondiabetic controls. The CO2 challenge increased cerebral blood‐flow velocities and decreased the pulsatility index. These changes were not influenced by the presence or duration of diabetes, insulin dose, or degree of diabetic control.
Response Strategies in Problematic Alliances: An Experimental Study

Building on Hirschman’s (1970) seminal work, we proposed and tested a circular model of seven response strategies in problematic alliances: exit propensity, opportunism, aggressive voice, creative voice, considerate voice, patience, and neglect. Previous alliance studies failed to theorize on the relationship between response strategies and examined responses to problematic situations in isolation. In contrast, in this study we focus on the interdependence between responses strategies and their antecedents. The response strategies studied are conceptually different, empirical distinct and can be represented as a circular system.Furthermore, the effect of four exchange variables: economic satisfaction, social satisfaction, transaction specific investments, and availability of alternatives are investigated. Using an experimental design empirical results support the hypotheses relating exchange variables and response strategies in problematic strategic alliances.
[Influence of impaired glucose tolerance on long-term survival after acute myocardial infarction].

BACKGROUND AND OBJECTIVE An impaired glucose tolerance as well as type 2 diabetes are associated with an increased cardiovascular mortality. This study was undertaken to determine whether this is also true for impaired glucose tolerance in immediate temporal relation with an acute myocardial infarction (AMI). PATIENTS AND METHODS The survival of 562 patients (232 females, 330 males; age 68 +/- 13 years) consecutively admitted to the intensive care unit of a medical department with the diagnosis of AMI, were prospectively evaluated over a span of more than 3 years. Type 2 diabetes had been previously known in 152, while it was newly diagnosed in 83 patients. Oral glucose tolerance tests (OGTT) were performed in 129, but the test was not performed in 222 patients. Survival was analysed with the Kaplan-Meier test. RESULTS Among the 129 patients who had had an OGTT, it was normal in 60 (47%), 45 (35%) had impaired glucose tolerance and 24 (19%) were found to have previously undiagnosed diabetes (WHO criteria). Survival of all patients with type 2-diabetes was significantly worse than in the remainder of patients (p < 0.0001). In patients with impaired glucose tolerance the survival time was significantly shorter than in those with normal glucose tolerance (p = 0.029). Even after excluding those patients who had died in the acute post-infarction phase, the difference between patients with normal and with impaired glucose tolerance remained significant (p = 0.034). CONCLUSION Patients with impaired glucose tolerance have a significantly shorter survival after AMI than those with a normal glucose tolerance. Blood glucose concentration 2 hours after oral glucose intake thus seems to be an important predictor of death after AMI.
Determinants of head injury mortality: importance of the low risk patient.

Data were obtained prospectively for 7,912 head-injured patients admitted from 1980 to 1981 to 41 hospitals in 3 U.S. metropolitan areas. Highly significant independent predictors of mortality were motor score, number of reactive eyes, systolic blood pressure, abdominal injury, chest injury, age, and hospital unit (hospital or group of hospitals). The difference between the number of deaths observed and the number expected, by hospital unit, ranged from 43% below expectation to 52% above expectation. The 2 hospital units with the lowest mortality had only 1 death, where 9.4 would be expected, in patients whose risk of death was estimated to be less than 10%. In the single hospital with clearly excess mortality, however, the standardized mortality ratios were 208, 135, and 144% for the risk groups whose probabilities of death were 0 to 50, 50 to 80, and 80 to 100%, respectively. The lack of deaths in those hospitals with the best mortality experience and the excess mortality in the hospital with the worst mortality experience appear to be explained largely by differences in patients who, by clinical criteria, seem to be at low risk for death, and not by severely injured patients.
A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome.

RATIONALE Ventilation in the prone position for about 7 h/d in patients with acute respiratory distress syndrome (ARDS), acute lung injury, or acute respiratory failure does not decrease mortality. Whether it is beneficial to administer prone ventilation early, and for longer periods of time, is unknown. METHODS We enrolled 136 patients within 48 h of tracheal intubation for severe ARDS, 60 randomized to supine and 76 to prone ventilation. Guidelines were established for ventilator settings and weaning. The prone group was targeted to receive continuous prone ventilation treatment for 20 h/d. RESULTS The intensive care unit mortality was 58% (35/60) in the patients ventilated supine and 43% (33/76) in the patients ventilated prone (p = 0.12). The latter had a higher simplified acute physiology score II at inclusion. Multivariate analysis showed that simplified acute physiology score II at inclusion (odds ratio [OR], 1.07; p < 0.001), number of days elapsed between ARDS diagnosis and inclusion (OR, 2.83; p < 0.001), and randomization to supine position (OR, 2.53; p = 0.03) were independent risk factors for mortality. A total of 718 turning procedures were done, and prone position was applied for a mean of 17 h/d for a mean of 10 d. A total of 28 complications were reported, and most were rapidly reversible. CONCLUSION Prone ventilation is feasible and safe, and may reduce mortality in patients with severe ARDS when it is initiated early and applied for most of the day.
Questioning the Methodologic Superiority of ‘Placebo’ Over ‘Active’ Controlled Trials

A resilient issue in research ethics is whether and when a placebo-controlled trial (PCT) is justified if it deprives research subjects of a recognized treatment. The clinicians' moral duty to provide the best available care seems to require the use of ‘active’ controlled trials (ACTs) that use an established treatment as a control whenever such a therapy is available. In another regard, ACTs are supposedly methodologically inferior to PCTs. Hence, the moral duty of the clinical researcher to use the best methods will favor PCTs. In this target article, I analyze the three reasons for believing that ACTs are inferior to PCTs namely: 1) ACTs lack ‘assay sensitivity’; 2) ACTs do not measure absolute effect size; and 3) ACTs require more participants; and I contend that none are acceptable. Consequently the tension between clinical and research ethics dissolves: the moral duty of the clinician to avoid PCTs is unopposed by methodological considerations.
The biochemical characterization of E2, a T cell surface molecule involved in rosettes

We have previously identified a molecule on the T cell surface, which, in addition to CD2 is involved in the rosette phenomenon. This is a 32‐kDa single polypeptide chain which we have termed E2. The studies reported here show striking patterns on the glycosylation status of E2. It is a heavily sialylated and glycosylated molecule, the sugar moieties accounting for almost half of its relative molecular mass (Mr). It carries no N‐linked sugar residues, only O‐linked oligosaccharides. Despite heavy glycosylation, the molecule appears to behave homogeneously on gel electrophoresis, both in terms of Mr and pI. Neuraminidase treatment of E2 lowered its Mr to 28 kDa; this was further decreased to 18 kDa after removal of O‐linked sugar residues by treatment with O‐glycanase. An identical reduction in size was observed after treatment with trifluoromethane sulfonic acid, showing that the molecule carries no detectable N‐linked sugar residues. Moreover, endoglycosidase F and endoglycosidase H treatment of either the immunoprecipitates from 125I surface‐labeled thymocytes, or of a purified preparation of E2, did not reduce the Mr of E2, nor did tunicamycin treatment of T cells. Two‐dimensional gel electrophoresis revealed two discrete spots of acidic pI (4.4 and 4.6) that were still seen after neuraminidase treatment, though they had moderately shifted. Pulse‐chase experiments revealed a single 28‐kDa precursor form that could have been the unsialylated molecule. Finally, sequencing 14 amino acid residues of the N‐terminal side revealed no homology with known proteins. Since the sugar moieties of adhesion protein could play an important role, the results obtained in this study will prove valuable to our understanding of the role exerted by the E2 molecule.
A new low-cost and non-intrusive feet tracker

Capturing gait is useful for many applications, including video-surveillance and medical purposes. The most common sensors used to capture gait suffer from significant drawbacks. We have therefore designed a new low-cost and nonintrusive system to capture gait. Our system is able to track the feet on the horizontal plane in both the stance and the swing phases by combining measures of several range laser scanners. The number of sensors can be adjusted according to the target application specifications. The first issue addressed in this work is the calibration: we have to know the precise location of the sensors in a plane, and their orientations. The second issue addressed is how to calculate feet coordinates from the distance profiles given by the sensors. Our method has proven to be robust and precise to measure gait abnormalities in various medical conditions, especially neurological diseases (with a focus on multiple sclerosis).