Miracle-dz/UniFAR-FTUs huggingface dataset:
Early versus late surgical management for complicated appendicitis in adults: a multicenter propensity score matching study

Purpose Surgeons may be uncertain about the optimal timing of appendectomy to decrease complications, especially for complicated appendicitis. The aim of the study was to compare clinical outcomes between early and late surgery for complicated appendicitis. Methods A prospectively maintained database of complicated appendicitis was queried. Elective interval surgery (EIS) group and early surgery (ES) were matched with propensity score and marked with a prefix ‘p.’ Patient characteristics and surgical outcomes were compared. Results The propensity score-matched EIS group had a lower chance to underwent ileo-cecectomy or right hemicolectomy (1.5% vs. 6.9%, P = 0.031), a tendency of lower rate of postoperative complication (6.9% vs. 13.7%, P = 0.067), a lower rate of wound infection (1.5% vs. 8.4%, P = 0.010), and shorter postoperative hospital stay (3.72 days vs. 5.82 days, P < 0.001) than the propensity score-matched ES group. Multivariate analysis showed that delayed surgery for more than 48 hours or urgent surgery due to failure of EIS and open conversion were independent risk factors for postoperative complications (P = 0.001 and P = 0.025, respectively). In subgroup analysis, high American Society of Anesthesiologists physical status classification and distant abscess or generalized ascites in initial CT increased the risk of failure of EIS. Conclusion EIS can be a useful option for selected adult patients with complicated appendicitis.
Predictor of Death in Diarrheal Children Under 5 Years of Age Having Severe Sepsis in an Urban Critical Care Ward in Bangladesh

We aimed to identify clinical predictors of fatal outcome in children under 5 years of age having diarrhea and severe sepsis and treated in the Intensive Care Unit of the Dhaka Hospital of icddr,b from October 2010 through September 2011. Among 191 enrolled children, 70 (37%) died and were considered to be cases, while the remaining 121 (63%) who survived constituted the controls. The cases more often had shortness of breath (SOB), septic shock, dehydrating diarrhea compared with the controls (for all, P < .05). After adjusting for potential confounders using logistic regression analysis, the likelihood of death was higher in children who had septic shock and SOB and lower in children having dehydrating diarrhea (for all, P < .05). Thus, SOB can trigger an early alarm for sepsis recognition; otherwise, these children can end up with fatality from septic shock. In resource-poor settings, early identification of these predictors can alleviate death.
Variability in Hospital Admission Rates for Neonates With Fever in North Carolina

Background. Despite multiple guidelines recommending admission, there is significant variation among emergency departments (EDs) regarding disposition of neonates presenting with fever. We performed a statewide epidemiologic analysis to identify characteristics that may influence patient disposition in such cases within North Carolina. Methods. This study is a retrospective cohort study of infants 1 to 28 days old with a diagnosis of fever presenting to North Carolina EDs from October 1, 2010, to September 30, 2015, using data from the NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool) database. We analyzed various patient epidemiology characteristics and their associations with patients being admitted or discharged from the emergency room setting. Results. Of 2745 unique patient visits for neonatal fever, 1173 (42.7%) were discharged from the ED, while 1572 (57.3%) were either admitted or transferred for presumed admission. Age, sex, region within North Carolina, and the presence of a pediatric service did not significantly influence disposition. An abnormal documented ED temperature was associated with higher likelihood of admission (P < .01). The size of the hospital was also found to be significant when comparing large with small hospitals (P < .01). Government-funded insurance was associated with lower likelihood of admission (P < .01). Conclusions. A high number of neonates diagnosed with fever were discharged home, inconsistent with current recommendations. An association with a government-funded insurance represents a possible health care disparity. Further studies are warranted to further understand these variations in practice.
Neuroendocrine Tumors in Pediatrics

Neuroendocrine cells are dispersed diffusely throughout many organ systems in the body and hence neuroendocrine tumors (NETs) can arise from almost anywhere in the body. NETs are considered rare tumors, and the current incidence is reported to be about 6 cases in 100 000 in adults and about 2.8 cases per million in the pediatric age group. Despite the indolent nature of these tumors, they have the potential for metastasis and significant morbidity. NETs can be asymptomatic at the time of diagnosis or can present with flushing, diarrhea, wheezing, weight loss, and fatigue among other symptoms. Due to the ambiguity of presenting symptoms, it is not uncommon for NETs to be diagnosed late in the disease course. Despite low incidence, the prevalence of the disease is high since patients live for many years and sometimes decades. Early detection of well-differentiated NETs has excellent outcomes with the majority of early-stage diseases being cured with surgical resection alone. There have been recent advancements in the management of metastatic progressive NETs with approval of peptide receptor radionuclide therapy, telotristat, and everolimus. Awareness of these rare tumors and its management is crucial for optimal management. This article will focus on pediatric NETs and current advances in its management.
Bifurcation Configuration Is an Independent Risk Factor for Aneurysm Rupture Irrespective of Location

Background: Bifurcation and sidewall aneurysms have different rupture risks, but whether this difference comes from the location of the aneurysm is not clear. The objective of this study is to illustrate the rationality of ranking bifurcation configuration as an independent risk factor for aneurysm rupture. Methods: Morphological features of 719 aneurysms (216 ruptured) were automatically extracted from a consecutive cohort of patients via PyRadiomics. Rupture risks and morphological features were compared between bifurcation and sidewall aneurysms, and lasso regression was applied to explore the morphological determinants for rupture in bifurcation and sidewall aneurysms. Rupture risks and morphological features of bifurcation aneurysms in different locations were analyzed. Multivariate regression was performed to explore the risk factors for aneurysm rupture. Results: Twelve morphological features were automatically extracted from PyRadiomics implemented in Python. The rupture risks were higher in bifurcation aneurysms (P < 0.01), and morphological features Elongation and Flatness were much lower in ruptured bifurcation than sidewall aneurysms (P = 0.036, 0.011, respectively). Elongation and Flatness were the morphological determinants for rupture in bifurcation aneurysms, whereas Elongation and SphericalDisproportion were determinants for sidewall aneurysms. Different rupture risks and morphological features were found between sidewall and bifurcation aneurysms of the same location, and among bifurcation aneurysms of different locations. In multivariate regression, bifurcation configuration was an independent risk factor for aneurysm rupture (OR 3.007, 95% CI 1.752–5.248, P < 0.001). Conclusions: Sidewall and bifurcation aneurysms and bifurcation aneurysms of different locations have different rupture risks and morphological features. Bifurcation configuration is an independent risk factor for aneurysm rupture irrespective of location.
Diversity, Distribution and Co-occurrence Patterns of Bacterial Communities in a Karst Cave System

Caves are typified by their permanent darkness and a shortage of nutrients. Consequently, bacteria play an important role in sustaining such subsurface ecosystems by dominating primary production and fueling biogeochemical cycles. China has one of the world’s largest areas of karst topography in the Yunnan-Guizhou Plateau, yet the bacteriomes in these karst caves remain unexplored. In this study, bacteriomes of eight karst caves in southwest China were examined, and co-occurrence networks of cave bacterial communities were constructed. Results revealed abundant and diversified bacterial communities in karst caves, with Proteobacteria, Actinobacteria, and Firmicutes being the most abundant phyla. Statistical analysis revealed no significant difference in bacteriomes among the eight caves. However, a PCoA plot did show that the bacterial communities of 128 cave samples clustered into groups corresponding to sampling types (air, water, rock, and sediment). These results suggest that the distribution of bacterial communities is driven more by sample types than the separate caves from which samples were collected. Further community-level composition analysis indicated that Proteobacteria were most dominant in water and air samples, while Actinobacteria dominated the sediment and rock samples. Co-occurrence analysis revealed highly modularized assembly patterns of the cave bacterial community, with Nitrosococcaceae wb1-P19, an uncultured group in Rokubacteriales, and an uncultured group in Gaiellales, being the top-three keystone members. These results not only expand our understanding of cave bacteriomes but also inspires functional exploration of bacterial strains in karst caves.
Does statin increase the risk of intracerebral hemorrhage in stroke survivors? A meta-analysis and trial sequential analysis

Background: It remains debatable whether statin increases the risk of intracerebral hemorrhage (ICH) in poststroke patients. Methods: We systematically searched PubMed, EMBASE, and CENTRAL for randomized controlled trials. Trial sequential analysis (TSA) was conducted to assess the reliability and conclusiveness of the available evidence in the meta-analysis. To evaluate the overall effectiveness, the net composite endpoints were derived by totaling ischemic stroke, hemorrhagic stroke, transient ischemic attack (TIA), myocardial infarction, and cardiovascular mortality. Results: A total of 17 trials with 11,576 subjects with previous ischemic stroke, TIA, or ICH were included, in which statin therapy increased the risk of hemorrhagic stroke (risk ratio [RR], 1.42; 95% confidence interval [CI], 1.07–1.87), but reduced the risk of ischemic stroke (RR, 0.85; 95% CI, 0.75–0.95). For the net composite endpoints, statin therapy was associated with a 17% risk reduction (95% CI, 12–21%; number needed to treat = 6). With a control event rate 2% and RR increase 40%, the TSA suggested a conclusive signal of an increased risk of hemorrhagic stroke in stroke survivors taking statin. However, with the sensitivity analysis by changing assumptions, the conclusions about hemorrhagic stroke risk were less robust. Conclusions: Statin therapy in poststroke patients increased the risk of hemorrhagic stroke but effectively reduced ischemic stroke risk. Weighing the benefits and potential harms, statin has an overall beneficial effect in patients with previous stroke or TIA. However, more studies are required to investigate the conclusiveness of the increased hemorrhagic stroke risk revealed in our study.
The Impact of Versatile Macrophage Functions on Acute Kidney Injury and Its Outcomes

Acute kidney injury (AKI) is a common and devastating clinical condition with a high morbidity and mortality rate and is associated with a rapid decline of kidney function mostly resulting from the injury of proximal tubules. AKI is typically accompanied by inflammation and immune activation and involves macrophages (Mϕ) from the beginning: The inflamed kidney recruits “classically” activated (M1) Mϕ, which are initially poised to destroy potential pathogens, exacerbating inflammation. Of note, they soon turn into “alternatively” activated (M2) Mϕ and promote immunosuppression and tissue regeneration. Based on their roles in kidney recovery, there is a growing interest to use M2 Mϕ and Mϕ-modulating agents therapeutically against AKI. However, it is pertinent to note that the clinical translation of Mϕ-based therapies needs to be critically reviewed and questioned since Mϕ are functionally plastic with versatile roles in AKI and some Mϕ functions are detrimental to the kidney during AKI. In this review, we discuss the current state of knowledge on the biology of different Mϕ subtypes during AKI and, especially, on their role in AKI and assess the impact of versatile Mϕ functions on AKI based on the findings from translational AKI studies.
Adiponectin Decreases Gastric Smooth Muscle Cell Excitability in Mice

Some adipokines known to regulate food intake at a central level can also affect gastrointestinal motor responses. These are recognized to be peripheral signals able to influence feeding behavior as well. In this view, it has been recently observed that adiponectin (ADPN), which seems to have a role in sending satiety signals at the central nervous system level, actually affects the mechanical responses in gastric strips from mice. However, at present, there are no data in the literature about the electrophysiological effects of ADPN on gastric smooth muscle. To this aim, we achieved experiments on smooth muscle cells (SMCs) of gastric fundus to find out a possible action on SMC excitability and on membrane phenomena leading to the mechanical response. Experiments were made inserting a microelectrode in a single cell of a muscle strip of the gastric fundus excised from adult female mice. We found that ADPN was able to hyperpolarize the resting membrane potential, to enhance the delayed rectifier K+ currents and to reduce the voltage-dependent Ca2+ currents. Our overall results suggest an inhibitory action of ADPN on gastric SMC excitation–contraction coupling. In conclusion, the depressant action of ADPN on the gastric SMC excitability, here reported for the first time, together with its well-known involvement in metabolism, might lead us to consider a possible contribution of ADPN also as a peripheral signal in the hunger–satiety cycle and thus in feeding behavior.
Virus-Specific Secondary Plasma Cells Produce Elevated Levels of High-Avidity Antibodies but Are Functionally Short Lived

Most vaccines aim at inducing durable antibody responses and are designed to elicit strong B cell activation and plasma cell (PC) formation. Here we report characteristics of a recently described secondary PC population that rapidly originates from memory B cells (MBCs) upon challenge with virus-like particles (VLPs). Upon secondary antigen challenge, all VLP-specific MBCs proliferated and terminally differentiated to secondary PCs or died, as they could not undergo multiple rounds of re-stimulation. Secondary PCs lived in bone marrow and secondary lymphoid organs and exhibited increased production of antibodies with much higher avidity compared to primary PCs, supplying a swift wave of high avidity antibodies early after antigen recall. Unexpectedly, however, secondary PCs were functionally short-lived and most of them could not be retrieved in lymphoid organs and ceased to produce antibodies. Nevertheless, secondary PCs are an early source of high avidity antibodies and induction of long-lived MBCs with the capacity to rapidly differentiate to secondary PCs may therefore be an underestimated possibility to induce durable protection by vaccination.
The Endless Saga of Monocyte Diversity

Cancer immunotherapy relies on either restoring or activating the function of adaptive immune cells, mainly CD8+ T lymphocytes. Despite impressive clinical success, cancer immunotherapy remains ineffective in many patients due to the establishment of tumor resistance, largely dependent on the nature of tumor microenvironment. There are several cellular and molecular mechanisms at play, and the goal is to identify those that are clinically significant. Among the hematopoietic-derived cells, monocytes are endowed with high plasticity, responsible for their pro- and anti-tumoral function. Indeed, monocytes are involved in several cancer-associated processes such as immune-tolerance, metastatic spread, neoangiogenesis, and chemotherapy resistance; on the other hand, by presenting cancer-associated antigens, they can also promote and sustain anti-tumoral T cell response. Recently, by high throughput technologies, new findings have revealed previously underappreciated, profound transcriptional, epigenetic, and metabolic differences among monocyte subsets, which complement and expand our knowledge on the monocyte ontogeny, recruitment during steady state, and emergency hematopoiesis, as seen in cancer. The subdivision into discrete monocytes subsets, both in mice and humans, appears an oversimplification, whereas continuum subsets development is best for depicting the real condition. In this review, we examine the evidences sustaining the existence of a monocyte heterogeneity along with functional activities, at the primary tumor and at the metastatic niche. In particular, we describe how tumor-derived soluble factors and cell-cell contact reprogram monocyte function. Finally, we point out the role of monocytes in preparing and shaping the metastatic niche and describe relevant targetable molecules altering monocyte activities. We think that exploiting monocyte complexity can help identifying key pathways important for the treatment of cancer and several conditions where these cells are involved.
Physical Growth and Body Adiposity Curves in Students of the Maule Region (Chile)

Objectives: Physical growth and body adiposity patterns provide relevant information to infer the nutritional and health status of students. Our objectives were (a) to compare the variables of body adiposity and physical growth of Chilean children and adolescents with data from the CDC-2012 and international studies, and (b) to develop regional reference curves to evaluate growth and body adiposity. Methods: 8,261 children and adolescents were studied. We evaluated the weight, height, and waist circumference (WC). The Body Mass Index (BMI) was calculated. Their physical growth and body adiposity were compared with the CDC-2012 references as well as with other international references. Percentile curves for weight, height, BMI, and WC were constructed with the LMS method. Results: The Chilean students showed reduced weight and height during adolescence when compared with the CDC-2012 reference. During early ages, the BMI for the Chilean sample was lower while at advanced ages, the WC values were greater in comparison to the CDC-2012 reference. Graphic comparisons with international studies indicated that Chilean students weighed more at all ages. However, height was slightly greater until age 14 for males and age 11 for females. Body adiposity (BMI and WC) for the Chilean students was slightly higher at early ages while at later ages, adiposity values were relatively similar for both sexes. Conclusions: Discrepancies were observed between the physical growth and body adiposity trajectories and the American CDC-2012 references and the international studies. The proposed percentiles for weight, height, BMI, and WC for each age and sex may be useful for health sciences professionals and researchers.
Impacts of Experimental Flooding on Microbial Communities and Methane Fluxes in an Urban Meadow, Baton Rouge, Louisiana

The impacts of flooding on microbial communities and their activities in rice paddy soils have been well documented. However, little is known about the responses of urban soil microbial communities. To assess resistance and resilience to short-term flooding, surface soil samples and intact soil cores were collected from an urban meadow bisected by Dawson Creek in Baton Rouge, LA. All samples were collected subsequent to the unprecedented flood of south central Louisiana during August, 2016, which ensued after deposition of some 27 trillion liters of water. During the flood, an area (lower meadow) adjacent to Dawson Creek was inundated for an unknown period lasting at least several days, while an elevated area (upper meadow) was not flooded. Microbial community composition and diversity at each site were assessed for soils collected from core sections at intervals over a 10-cm depth before and after 3 days of experimental flooding ex situ. Cores from both lower and upper meadow sites were also used to assess methane fluxes before and after the experimental flooding. The results indicated that methane fluxes differed between lower and upper meadow sites, and that they were not resistant to flooding. Lower meadow cores emitted methane prior to flooding and rates increased substantially post-flooding; upper meadow cores consumed methane to levels below ambient atmospheric concentrations prior to flooding, but emitted methane post-flooding. In contrast both lower and upper meadow microbial communities were resistant to short-term flooding, with no significant changes observed at either site, or at any depth interval from the surface to 10 cm. However, lower and upper meadow soil communities differed significantly, with distinct distributions of Acidobacteria, Nitrospirae, and Thaumarchaeota among others. Based on responses of soil cores to experimental flooding, the differences between sites in microbial communities do not appear to be residual effects of the August, 2016 flood, but rather appear to arise from physical, chemical, and biological variables that change along a 4-m elevation gradient. Collectively, the results suggest that the composition and diversity for some urban soils might be insensitive to short-term flooding, but that important biogeochemical processes, e.g., methane fluxes, might respond rapidly.
Injection of α-syn-98 Aggregates Into the Brain Triggers α-Synuclein Pathology and an Inflammatory Response

Pathological aggregation of α-synuclein (α-syn) is a major component of Lewy bodies (LB), which play a central role in pathogenesis of Parkinson’s disease (PD). Differential expression of α-syn isoforms has been shown in PD. Isoform α-syn-98 is generated by excision of exon-3 and exon-5 of the α-syn gene. In contrast to the canonical full-length α-syn isoform (α-syn140), little is known about the function of the α-syn-98 isoform. In the present study, to identify the potential role of α-syn-98 protein in PD, we examined the effects of exogenous recombinant insoluble α-syn-98 aggregates on α-syn pathology and inflammatory responses in the midbrain. After injection of α-syn-98 aggregates into the substantia nigra (SN), mice exhibited motor dysfunction accompanied by nigral dopaminergic neuron loss. In addition, α-syn-98 aggregates injection resulted in a significant increase in phosphorylation of endogenous α-syn. Accumulations of α-syn were co-localized with p62 and ubiquitin, which suggests α-syn-98 aggregates-induced pathology exhibits properties similar to human LB. Many glial cells were activated after α-syn-98 aggregates injection. In addition, expression of NF-κB, interleukin 6 (IL6), and tumor necrosis factor-α (TNF-α) and levels of oxidative stress increased after α-syn-98 aggregates injection. Our results suggest that α-syn-98 may play a crucial role in the pathogenesis of PD.