Miracle-dz/UniFAR-FTUs huggingface dataset:
A Case of Rapidly Progressive Primary Sclerosing Cholangitis Requiring Liver Transplantation

Primary sclerosing cholangitis (PSC) is a slowly progressive cholestatic liver disease. In cases of PSC, liver transplantation is the only effective treatment that can delay the disease's natural course. We report a case of rapidly progressive PSC requiring liver transplantation. A 52-year-old woman visited our hospital with abdominal pain. There was no evidence of PSC, as there was no elevation in cholestatic liver enzymes at her first visit. Although her total bilirubin was in a normal range at the initial visit, liver dysfunction progressed rapidly. Despite endoscopic procedures and ursodeoxycholic acid intake, total bilirubin levels rose to 18.9 mg/dL, and liver transplantation was performed 17 months after her first visit. PSC was pathologically confirmed after liver transplantation.
Chiral alkynylcarbinols from marine sponges: asymmetric synthesis and biological relevance.

Covering: up to March 2014. Previous review on the topic: B. W. Gung, C. R. Chim. , 2009, 12, 489-505. Chiral α-functional lipidic propargylic alcohols extracted from marine sponges, in particular of the pacific genus Petrosia, constitute a class of acetylenic natural products exhibiting remarkable in vitro biological activities, especially anti-tumoral cytotoxicity. These properties, associated to functionalities that are uncommon among natural products, have prompted recent projects on asymmetric total synthesis. On the basis of a three-sector structural typology, three main sub-types of secondary alkynylcarbinols (with either alkyl, alkenyl, or alkynyl as the second substituent) can be identified as the minimal pharmacophoric units. Selected natural products containing these functionalities have been targeted using previously known or on purpose-designed procedures, where the stereo-determining step can be: (i) a C-C bond forming reaction (e.g. the Zn-mediated addition of alkynyl nucleophiles to aldehydes in the presence of chiral aminoalcohols), (ii) a functional layout (e.g. the asymmetric organo- or metallo-catalytic reduction of ynones), or (iii) an enantiomeric resolution (e.g. a lipase-mediated kinetic resolution via acetylation). The promising medicinal importance of these targets is finally surveyed, and future investigation prospects are proposed, such as: (i) further total synthesis of known or future extraction products; (ii) the synthesis of non-natural analogues, with simpler lipophilic environments of the alkynylcarbinol-based pharmacophoric units; (iii) the variation and optimization of both the pharmacophoric units and their lipophilic environment; and (iv) investigations into the biological mode of action of these unique structures.
Survival and morbidity following congenital heart surgery in a population-based cohort of children--up to 12 years of follow-up.

OBJECTIVES The Risk Adjusted Classification for Congenital Heart Surgery can predict early mortality. However, the relation to long-term outcome in terms of mortality and morbidity is unknown. DESIGN We did a population-based follow-up study of 801 children undergoing congenital heart surgery between 1996 and 2002. All patients were followed from surgery until death or January 1, 2008. Operations were classified according to the Risk Adjusted Classification for Congenital Heart Surgery. Each patient was matched by age and sex with 10 population controls. Cox regression analysis, area under the receiver operator curve and competing risk analysis were used for the analyses. RESULTS Overall follow-up was 99.6%. The distribution of the Risk Adjusted Classification for Congenital Heart Surgery was: Category one 20%, category two 37%, category three 27%, category four 8%, category five 0% and category six 2%. Overall survival after a median follow-up of 8.2 years was 86% (95% confidence interval: 83-88%), with 54 early deaths occurring within 30 days after surgery and 57 late deaths. Long-term survival in those who were alive 30 days after surgery was 92% (90-94%); ranging from 98% (93-100%) in risk category one to 33% (5-68%) in category six. Survival overall and beyond 30 days was lower in each risk category than in controls (P < .001). During follow-up, 124 (15%) patients had new operations and 106 (13%) catheter-based interventions. These events were more frequent in category three, four, and six compared with category one, with no difference between category one and two. The area under the receiver operator curve for long-term mortality was 0.81 (95% confidence interval 0.75-0.87). CONCLUSIONS Children operated for congenital heart disease have impaired survival and often undergo new operations or catheter-based interventions. The risk of these events is related to the surgical complexity according to the Risk Adjusted Classification for Congenital Heart Surgery.
In vitro study of the efficacy of acrylic bone cement loaded with supplementary amounts of gentamicin: Effect on mechanical properties, antibiotic release, and biofilm formation

Background Infection remains a severe complication following a total hip replacement. If infection is suspected when revision surgery is being performed, additional gentamicin is often added to the cement on an ad hoc basis in an attempt to reduce the risk of recurrent infection. Methods and results In this in vitro study, we determined the effect of incorporating additional gentamicin on the mechanical properties of cement. We also determined the degree of gentamicin release from cement, and also the extent to which biofilms of clinical Staphylococcus spp. isolates form on cement in vitro. When gentamicin was added to unloaded cement (1–4 g), there was a significant reduction in the mechanical performance of the loaded cements compared to unloaded cement. A significant increase in gentamicin release from the cement over 72 h was apparent, with the amount of gentamicin released increasing significantly with each additional 1 g of gentamicin added. When overt infection was modeled, the incorporation of additional gentamicin did result in an initial reduction in bacterial colonization, but this beneficial effect was no longer apparent by 72 h, with the clinical strains forming biofilms on the cements despite the release of high levels of gentamicin. Interpretation Our findings indicate that the addition of large amounts of gentamicin to cement is unlikely to eradicate bacteria present as a result of an overt infection of an existing implant, and could result in failure of the prosthetic joint because of a reduction in mechanical performance of the bone cement.
Strategies for Distinguishing Low-grade Endometrioid and Serous Carcinomas of Endometrium

Distinction between endometrioid and serous carcinomas of the endometrium has important prognostic and therapeutic implications. Misdiagnosing a serous carcinoma as endometrioid can have significant consequences for the patient and pathologist. Although many cases are straightforward and easy to classify, there are occasional problematic cases. This review focuses on strategies that help differentiate between low-grade endometrioid carcinoma and serous carcinoma of the endometrium. We will discuss clinical, morphologic, and immunohistochemical differences between the 2 entities and provide practical tips for practicing pathologists when confronted with this differential diagnosis.
Relationship between response rates and median progression‐free survival in non‐Hodgkin's lymphoma: A meta‐analysis of published clinical trials

Demonstration of clinical effectiveness of a non‐Hodgkin's lymphoma (NHL) treatment generally involves determination of progression‐free survival (PFS). However, the long evaluation time of PFS limits its utility to make timely decisions in drug development. Therefore, the objective of this analysis was to determine the relationship between response rates and median PFS in NHL. A database was systematically developed from 513 identified NHL trials reported from 1996 to 2015. Potential predictors of the relationship between response rates and PFS were evaluated, including age, sex, treatment, percentage of treatment‐naïve patients, and subtype of NHL. Seventy‐three trials involving 86 cohorts were included in the meta‐analysis. Linear regression analysis using logit of response rates and logarithm of median PFS indicated that the correlation between overall response rate (ORR) and median PFS was higher (R2 = 0.70) when compared to that of complete response (CR) rate and median PFS (R2 = 0.57). Furthermore, the correlation was improved with the addition of percentage of treatment‐naïve patients and percentage of patients with follicular lymphoma (FL) (P < .005) between ORR and median PFS (R2 = 0.78), and between CR rate and median PFS relationship (R2 = 0.74). Treatment was not found to alter this relationship. In summary, ORR is as good as CR rate in predicting median PFS. Moreover, longer median PFS is expected in the trials including treatment‐naïve and/or FL patients at a given ORR/CR rate. The determined relationship can be used to project the median PFS based on ORR or CR rate.
Epstein‐Barr virus lytic cycle involvement in diffuse large B cell lymphoma

Epstein‐Barr virus (EBV)‐mediated B cell transformation is achieved predominantly through the action of latent proteins, but recent evidence suggests that lytic EBV replication has also a certain pathogenic role in lymphomagenesis, at least in the early phases of cell transformation. Particularly, in diffuse large B cell lymphoma (DLBCL), the EBV lytic cycle is by and large unexplored, so to disclose lytic cell contribution to lymphomagenesis, our aim was to evaluate viral early and late lytic gene expression in relation to several immune response markers in a series of EBV+ DLBCL from Argentina. An unexpected number of cells expressed lytic transcripts, being transcribed at the BZLF1, BHRF1, and BLLF1 locus, by real‐time quantitative polymerase chain reaction. This lytic antigen expression was confirmed by immunohistochemical staining for BMRF1 early lytic protein, and a positive correlation between lytic and latent genes was confirmed, revealing a close link between their expressions in EBV+ DLBCL pathogenesis. Remarkably, BZLF1 displayed a negative correlation with CD4 cell counts, and this could be in part justified by the restriction of antigen presentation previously reported. The direct correlation for the late lytic gene BLLF1 and IFNγ in this series could represent a specific response directed towards this antigen. Interleukin 10 transcripts also displayed a positive correlation with lytic expression, indicating that regulatory mechanisms could be also involved on EBV‐associated DLBCL pathogenesis in our series. Complete lytic reactivation in EBV‐positive tumours could potentially kill EBV‐positive malignant cells, providing a tool to promote tumour cell killing mediated by EBV as a complementary treatment strategy.
Analysis of the Bethesda System for Reporting Thyroid Cytopathology and Similar Precursor Thyroid Cytopathology Reporting Schemes

The Bethesda System for Reporting Thyroid Cytopathology is a standardized reporting system for classifying thyroid fine-needle aspiration results comprising of 6 diagnostic categories with unique risks of malignancy and recommendations for clinical management. The majority of thyroid nodules are benign; however, up to 30% of fine-needle aspiration of thyroid nodule results are equivocal. Until 2007, various diagnostic terms were used to classify such cases, including “atypical,” “indeterminate,” and rule-out or cannot exclude malignancy. A literature review of 13 original studies was conducted to evaluate whether utilization of the Bethesda System for Reporting Thyroid Cytopathology nomenclature represent an improvement over thyroid cytopathology reporting schemes used before 2007 in diagnosing thyroid malignancy. The sensitivity and specificity of thyroid fine-needle aspiration was high in the studies that assessed the measures. However, a selection bias exists and most studies do not include indeterminate diagnosis in their calculations. Although the Bethesda System for Reporting Thyroid Cytopathology recommends a repeat fine-needle aspiration to follow-up nondiagnostic specimens, in the majority of studies, an appreciable number of cases underwent follow-up surgical biopsy or thyroidectomy. The diagnostic category of atypia/follicular lesion of undetermined significance remains heterogenous in terms of usage and clinical outcome. The majority of the studies that utilize the Bethesda System for Reporting Thyroid Cytopathology in this literature review retrospectively reclassified thyroid fine-needle aspiration into the Bethesda System for Reporting Thyroid Cytopathology nomenclature with reported malignancy rates that are similar between cases reclassified as atypia/follicular lesion of undetermined significance and follicular neoplasm/suspicious for follicular neoplasm.
Higher risk of revision for infection using systemic clindamycin prophylaxis than with cloxacillin

Background and purpose — Clindamycin has not been compared with other antibiotics for prophylaxis in arthroplasty. Since 2009, the Swedish Knee Arthroplasty Register (SKAR) has been collecting information on the prophylactic antibiotic regime used at every individual operation. In Sweden, when there is allergy to penicillin, clindamycin has been the recommended alternative. We examined whether there were differences in the rate of revision due to infection depending on which antibiotic was used as systemic prophylaxis. Patients and methods — Patients who had a total knee arthroplasty (TKA) performed due to osteoarthritis (OA) during the years 2009–2015 were included in the study. Information on which antibiotic was used was available for 80,018 operations (55,530 patients). Survival statistics were used to calculate the rate of revision due to infection until the end of 2015, comparing the group of patients who received cloxacillin with those who received clindamycin as systemic prophylaxis. Results — Cloxacillin was used in 90% of the cases, clindamycin in 7%, and cephalosporins in 2%. The risk of being revised due to infection was higher when clindamycin was used than when cloxacillin was used (RR =1.5, 95% CI: 1.2–2.0; p = 0.001). There was no significant difference in the revision rate for other causes (p = 0.2). Interpretation — We advise that patients reporting allergic reaction to penicillin should have their allergic history explored. In the absence of a clear history of type-I allergic reaction (e.g. urticaria, anaphylaxis, or bronchospasm), we suggest the use of a third-generation cephalosporin instead of clindamycin as perioperative prophylaxis when undergoing a TKR. No recommendation can be given regarding patients with type-1 allergy.
Fatigue in People Undergoing Hemodialysis

BACKGROUND Fatigue, a common symptom reported by people with end-stage renal disease (ESRD), is a nonspecific and invisible symptom and is a phenomenon that is poorly understood by healthcare professionals. There is limited understanding of the level of fatigue experienced by people with ESRD, with research currently limited to people treated with hemodialysis. AIM Levels of fatigue as experienced by people undergoing hemodialysis (HD) were assessed using the Visual Analog Scale for Fatigue (VAS-F). METHOD The VAS-F was completed by 138 people with ESRD who were patients of HD units in Sivas, Turkey. Demographic and renal health history data were also collected with a structured questionnaire. The statistical analyses used in order to evaluate the data include: student's t-test, Kruskal-Wallis test, Pearson correlation test, and logistic regression analysis. RESULTS The level of fatigue experienced by people with HD in our study was high, and their energy level was low. Univariate analysis showed that levels of fatigue differed by gender, age, education, employment, and presence of anemia. However, logistic regression analysis, age, and duration of dialysis were found to be the independent predictors of fatigue. CONCLUSIONS The results of the study indicated that high levels of fatigue are experienced. In order to improve patient care and promote patient's quality of life, nephrology professionals should understand the comprehensive assessment of fatigue and work with patients to initiate a range of strategies and interventions to address it.
PS-090 Hereditary Spherocytosis And Red Cell Indices Mchc, Mcv, Rdw

Background Hereditary spherocytosis (HS) is a common inherited disorder that is characterised by anaemia, jaundice, and splenomegaly. Clinical severity is variable with most patients having a well-compensated hemolytic anaemia. The primary lesion in HS is loss of membrane surface area, leading to reduced deformability due to defects in the membrane proteins ankyrin, band 3, beta spectrin, alpha spectrin, or protein 4.2. Many isolated mutations have been identified in the genes encoding these membrane proteins; common hereditary spherocytosis-associated mutations have not been identified. The classic laboratory features of HS include minimal or no anaemia, reticulocytosis, an increased mean corpuscular haemoglobin concentration (MCHC), spherocytes on the peripheral blood smear, hyperbilirubinemia, and abnormal results on the osmotic fragility test. Aim Of the study is to evaluate the role of MCV, MCHC as a screen test to diagnose spherocytosis Methods In our study are included 60 subjects, 30 children with HS and 30 children-control groups. Our patients with anaemia, jaundice, and splenomegaly are diagnose with HS by incubated osmotic fragility test, performed after incubating RBCs for 18–24 h under sterile conditions at 37°C. Results We found that 25% of pts. have mild HS, 20% moderate HS, 30% moderate to severe HS and 25% severe HS. In peripheral blood smear 7% of pts. had 0–5 spherocites for field, 30% had 5–10 spherocites for field and 63% had 10–15 spherocites for field. 70% of pts. With HS have MCHC > 38%. There are a positive correlation between MCHC and spherocites in peripheral blood smear (r = 0,898, p < 0,001) and RDW (r = 0,647, p < 0.001), negative correlation between MCHC and MCV (r = -0,437 p < 0,001) Conclusion The dedication of hiperdense erythrociyte today is used as a new tool in diagnosing HS. The determination of MCHC constantly growing with other red cell index, MCV < 80 fl, RDW > 15 obtained from an electronic cell counter usually is enough to suggest for HS. Key Words Spherocytosis, MCHC, anaemia, children.
Using measurements of neutralizing antibodies: the challenge of IFN‐β therapy

Although the occurrence of neutralizing antibodies (NAbs) to interferon (IFN)‐β has been acknowledged since the pivotal trials of IFN‐β in multiple sclerosis (MS), the effect of these antibodies has for several reasons been debated. The main reason for the controversies has been insufficient knowledge of the fact that clinically relevant NAbs do not appear until 12–18 months after initiation of IFN‐β therapy which make studies of 2 years or less unsuited to assess the clinical relevance of NAbs. Further, changes in NAb affinity occur and contribute to increase NAb effects by time.
A field assessment of floor slipperiness in a student cafeteria

Investigation of floor slipperiness is critical in studying the risk of slips and falls. This research conducted friction measurements and employee survey on floor slipperiness in a student cafeteria in a university in China in order to study the correlation between the two types of floor slipperiness measure. It was found that the fryer area in kitchen 1 and the meat defrost sink in kitchen 2 had significantly the lowest coefficient of friction (COF) values among all areas in the same kitchen. The results showed that the levels of friction on the floors in different areas in each kitchen were significantly different. Employee perceptions of floor slipperiness among areas were also significantly different. The level of friction and employee perception of floor slipperiness was highly correlated (ρ = 0.87). This implies a good agreement between the two measures. A linear regression model was established to describe the relationship between the perceived floor slipperiness and the measured COF. The model was significant at p < 0.0001 with an R 2 of 0.59.
Prostate cancer in Port Harcourt, Nigeria: features and outcome

Background: To present the clinical features and outcome of management of patients with prostate cancer in Port Harcourt, Nigeria. Methods: A retrospective study of patients with prostate cancer managed in 14 years at the University of Port Harcourt Teaching Hospital. Results: Of 154,594 men above 40 years old who attended the hospital, 177 were treated for prostate cancer, giving a hospital incidence of 114/100,000. Of these, the records of 47 had sufficient data to be included for analysis. Record keeping was poor. The ages ranged from 45 to 88 years with an average of 71.6 years. Forty-three patients (91.5%) presented late with features of advanced disease such as anaemia, spinal cord compression and urinary retention. The diagnosis was made from tissue biopsies, x-rays and biochemical results with clinical findings. The treatment was bilateral subcapsular orchidectomy with or without diethylstilbestrol. The response to treatment in most patients was satisfactory initially but relapse was common and fatal. Conclusions: Record keeping requires urgent attention. Prostate cancer screening should be adopted in line with trends in industrialised countries. Mortality in our patients was mainly from direct complications of prostate cancer. Keywords: Prostate cancer, Features, Port Harcourt, Nigeria. Nig. J. of Surgical Research 4(1-2) 2002: 34-44
Avaliação clínica da relação entre postura, respiração e deglutição em paciente pós-acidente vascular cerebral na fase crônica: relato de caso

O Acidente Vascular Cerebral (AVC) e a doenca neurologica que mais incapacita os adultos. A respiracao, a postura e a degluticao possuem uma relacao direta nesta doenca, necessitando assim de uma intervencao multidisciplinar. O objetivo do presente estudo foi realizar uma avaliacao clinica integrada para analisar a relacao entres estas disfuncoes. Trata-se de uma paciente do sexo feminino com 37 anos, com seis anos de diagnostico de AVC isquemico com hemiparesia completa a direita de predominio crural, hipertensao arterial sistemica, disfagia e disartrofonia. Na anamnese, relatou sintomas referentes a dispneia, dores na coluna lombar, presenca de tosse e engasgos a alimentacao e escape anterior de saliva, principalmente durante a fala. A paciente apresenta escoliose, hipercifose toracica e fraqueza dos musculos abdominais. A avaliacao respiratoria evidenciou uma forca expiratoria abaixo do limite esperado. O pico de fluxo da tosse esta abaixo do esperado, demonstrando nao possuir forca para tossir. A investigacao fonoaudiologica evidenciou alteracoes no tempo aumentado para se alimentar, necessidade de ingerir liquidos para ajudar na degluticao de solidos, eventuais escapes anteriores de alimento, necessidade de degluticoes multiplas devido a sensacao de estase em cavidade laringo-faringea e diminuicao do paladar, bem como saliva grossa e viscosa. Utilizando-se das avaliacoes fisioterapicas e fonoaudiologicas, foi possivel concluir que uma paciente com AVC na fase cronica apresenta alteracoes respiratorias que podem impedi-la de proteger com eficiencia as vias aereas inferiores, o que, somado as alteracoes posturais e na degluticao demonstram a importância da avaliacao integrada para futuras intervencoes terapeuticas mais eficazes.