Miracle-dz/UniFAR-FTUs huggingface dataset:
Comparison of Initial Vasopressors Used for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage

Background: The main reason for morbidity after aneurysmal subarachnoid hemorrhage (aSAH) is delayed cerebral ischemia (DCI). The mainstay of medical therapy for treating DCI is induced hypertension with vasopressors to restore cerebral perfusion. Both phenylephrine (PE) and norepinephrine (NE) are commonly used for induced hypertension, but the impact of the initial choice of vasopressor on the efficacy, adverse effects, or outcome after hemodynamic therapy for DCI is unknown. Methods: Sixty-three patients with aSAH between January 2012 and October 2014, who developed DCI (defined as new focal deficit or decline in Glasgow Coma Score) and in which PE (n = 45) or NE (n = 18) treatment was initiated were evaluated in this retrospective study. Baseline characteristics, adverse effects, the need to change or add vasopressors, the response to therapy, the need for endovascular therapy, new infarct development, discharge disposition, and 3 months modified Rankin score were all compared between pressor groups. Results: Baseline characteristics (e.g., Hunt Hess and Fisher grades) were similar. There were no differences in the overall rate of complications including arrhythmia, pulmonary edema, or kidney injury. However, those initiated on PE were more likely to be changed to an alternate vasopressor (64 vs. 33%, p = 0.016), mostly for bradycardia or failure to reach therapeutic targets. Patients initially treated with PE were less likely to respond neurologically (71 vs. 94%, p = 0.01) or to be discharged to home or acute rehabilitation facilities (73 vs. 94%, p = 0.02) and were more likely to have a delayed infarct on imaging (62 vs. 33%, p = 0.04). Conclusions: Our study suggests that patients with DCI after aSAH initiated on PE are more likely to require treatment change to another vasopressor and are at greater risk for poor clinical outcomes compared to patients started on NE. Larger comparative studies are warranted.
Surveillance for Antibodies to Leishmania spp. in Dogs from Sri Lanka

Abstract The global distribution of leishmaniasis is rapidly expanding into new geographic regions. Dogs are the primary reservoir hosts for human visceral leishmaniasis caused by infection with Leishmania infantum. Natural infections with other Leishmania spp. can occur in dogs, but their role as reservoir hosts for other species of Leishmania is uncertain. Leishmania donovani is traditionally considered a visceralizing anthroponotic species; however, cutaneous leishmaniasis caused by L. donovani has been reported in Sri Lanka. In the present study, sera from 114 dogs in Sri Lanka were examined for antibodies to visceralizing Leishmania spp. Sera were tested by the canine immunochromatographic strip assays based on recombinant K39 antigen. Anti-Leishmania spp. antibodies were detectable in 1 of 114 (0.9%) dogs from Sri Lanka. Nonetheless, serological evidence suggests that leishmaniasis may be an emerging zoonosis in Sri Lanka.
Diagnostic Reproducibility of Hydatidiform Moles: Ancillary Techniques (p57 Immunohistochemistry and Molecular Genotyping) Improve Morphologic Diagnosis

Distinction of hydatidiform moles (HMs) from nonmolar specimens (NMs) and subclassification of HMs as complete hydatidiform moles (CHMs) and partial hydatidiform moles (PHMs) are important for clinical practice and investigational studies; yet, diagnosis based solely on morphology is affected by interobserver variability. Molecular genotyping can distinguish these entities by discerning androgenetic diploidy, diandric triploidy, and biparental diploidy to diagnose CHMs, PHMs, and NMs, respectively. Eighty genotyped cases (27 CHMs, 27 PHMs, and 26 NMs) were selected from a series of 200 potentially molar specimens previously diagnosed using p57 immunostaining and genotyping. Cases were classified by 3 gynecologic pathologists on the basis of H&E slides (masked to p57 immunostaining and genotyping results) into 1 of 3 categories (CHM, PHM, or NM) during 2 diagnostic rounds; a third round incorporating p57 immunostaining results was also conducted. Consensus diagnoses (those rendered by 2 of 3 pathologists) were determined. Genotyping results were used as the gold standard for assessing diagnostic performance. Sensitivity of a diagnosis of CHM ranged from 59% to 100% for individual pathologists and from 70% to 81% by consensus; specificity ranged from 91% to 96% for individuals and from 94% to 98% by consensus. Sensitivity of a diagnosis of PHM ranged from 56% to 93% for individual pathologists and from 70% to 78% by consensus; specificity ranged from 58% to 92% for individuals and from 74% to 85% by consensus. The percentage of correct classification of all cases by morphology ranged from 55% to 75% for individual pathologists and from 70% to 75% by consensus. The &kgr; values for interobserver agreement ranged from 0.59 to 0.73 (moderate to good) for a diagnosis of CHM, from 0.15 to 0.43 (poor to moderate) for PHM, and from 0.13 to 0.42 (poor to moderate) for NM. The &kgr; values for intraobserver agreement ranged from 0.44 to 0.67 (moderate to good). Addition of the p57 immunostain improved sensitivity of a diagnosis of CHM to a range of 93% to 96% for individual pathologists and 96% by consensus; specificity was improved from a range of 96% to 98% for individual pathologists and 96% by consensus; there was no substantial impact on diagnosis of PHMs and NMs. Interobserver agreement for interpretation of the p57 immunostain was 0.96 (almost perfect). Even with morphologic assessment by gynecologic pathologists and p57 immunohistochemistry, 20% to 30% of cases will be misclassified, and, in particular, distinction of PHMs and NMs will remain problematic.
Consumer credit in the Czech Republic: What does its current growth imply for financial stability?

This article analyses structural changes in the evolution of consumer credit with regard to loan type, maturity category and extent of refinancing. We also examine changes in the interest rate distribution of consumer loans, which is multimodal. We go on to explore the determinants of consumer credit rates and identify growing competition and partially also easy monetary policy as the main determinants of the shift of the distribution of consumer credit rates towards lower client rates.
Diagnosis of Vaginal Discharge by Wet Mount Microscopy: A Simple and Underrated Method

Vaginal discharge is highly variable in quality and quantity among different individuals, and even in the same individual during different periods of life. Vaginal discharge is most commonly caused by infection with sexually transmitted organisms or increased colonization by different facultative pathogenic microorganisms (i.e., Gardnerella vaginalis). Noninfectious causes of vaginal discharge are quite rare (10% noninfectious as compared to 90% infectious causes). Most common in women with a vaginal infection is bacterial vaginosis (40%–50% of cases), followed by vulvovaginal candidosis (20%–25%), and then trichomoniasis (15%–20%). If infection is suspected as the primary cause, a sample of the vaginal discharge should be taken and examined microscopically. When evaluating vaginal secretions by phase-contrast wet mount microscopy, knowledge of what is normal versus abnormal is very important. Knowledge of the sensitivity and specificity of wet mount microscopy in different clinical settings is also important. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completing this CME activity, physicians should be better able to evaluate lifetime changes in vaginal secretions, characterize the physiological and pathological appearance of vaginal discharge, assess the clinical practicality and usefulness of wet mount microscopy and use wet mount microscopy to diagnose bacterial vaginosis and other common vaginal infections.
High-Intensity Interval Training to Maximize Cardiac Benefits of Exercise Training?

We hypothesized that high-intensity aerobic interval training results in a greater beneficial adaptation of the heart compared with that observed after low-to-moderate exercise intensity. This is supported by recent epidemiological, experimental, and clinical studies. Cellular and molecular mechanisms of myocardial adaptation to exercise training are discussed in this review.
The New Civic Leadership: Place and the co-creation of public innovation

ABSTRACT This paper discusses the role of place-based leadership in stimulating the co-creation of inclusive public services and outcomes. A conceptual framework, designed to illuminate the forces shaping the power of place, and to provide a fresh way of envisaging the changing nature of modern local leadership and public management, is presented. This New Civic Leadership (NCL) framework, one that can be contrasted with the outdated idea of New Public Management (NPM), is being used to guide the development of the One City Approach to urban governance in Bristol, UK. This effort to unite public purpose in a city is discussed, and emerging themes relating to the role of place-based leadership in spurring new ways of co-creating public service futures are explored. IMPACT This paper on New Civic Leadership (NCL) presents specific ideas on how to improve the leadership of collaborative governance in cities and localities. It explains how the power of place—the strong feelings of commitment people have to ‘their’ city or locality—has been seriously neglected in public management theory and practice. The NCL conceptual model is being used by the mayor of Bristol, and other civic leaders to develop a One City Approach to meeting the complex challenges facing the city. This paper provides practical steps that civic leaders can take to improve collaborative governance.
Relationships between C-kit expression and mean platelet volume in benign, preneoplastic and neoplastic endometrium.

BACKGROUND c-Kit is a proto-oncogene that encodes a tyrosine kinase receptor (CD117). Mean platelet volume (MPV) is a useful marker for demonstrating thrombocyte function. We aimed to investigate whether c-kit is expressed in benign, preneoplastic and neoplastic endometrial tissues and whether MPV has a relation with c-kit expression and its intensity. MATERIALS AND METHODS c-Kit expression was investigated immunohistochemically in 10 samples of normal endometrium (n=10), simple endometrial hyperplasia (5 cases with atypia and 10 cases without atypia), complex endometrial hyperplasia (10 cases with atypia and 10 cases without atypia) and endometrial cancer (EC) (10 cases grade I and 10 cases grade II) and MPV of all cases was checked. RESULTS c-Kit expression was observed at very low rates in cases with normal endometrial tissues (NE) and in hyperplasia without atypia. c-Kit expression and immunostaining were strong in endometrial atypia and EC. MPV levels of complex atypical endometrial hyperplasia (CAEH) (p:0.002), EC grade I (ECG I) (p<0.001) and EC grade II (ECG II) (p<0.001) were significantly elevated when compared with the NE group. Both c-kit expression and intensity of immunostaining had a positive correlation with MPV level. CONCLUSIONS While c-kit expression and intensity of immunostaining were mildly positive in NE and hyperplasia without atypia, they were clearly observed in EC and hyperplasia with atypia. As c-kit expression is related to the mutagenesis a long-term follow- up may be needed in these cases. A high MPV level may be a good test for demonstrating c-kit expression and intensity of immunostaining.
Factors Associated With Undergoing Bilateral Salpingo-oophorectomy at the Time of Hysterectomy for Benign Conditions

OBJECTIVE: To identify possible factors associated with undergoing bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy among women with benign conditions. METHODS: This was a cross-sectional analysis using the 2005 Nationwide Inpatient Sample. Women aged 18 years or older who underwent hysterectomy with BSO or hysterectomy only for a benign condition were included. We examined a broad range of factors associated with undergoing BSO in multivariable analyses. RESULTS: Fifty-two percent of 461,321 hysterectomies included BSO, with a mean age of 49 years compared with 43 years in the hysterectomy-only group (P<.001). The odds of BSO were two times higher in the Midwest and South and 1.67 times higher in the West as compared with the Northeast (P<.001). Women who were uninsured or had Medicaid were more likely to undergo BSO compared with those with private insurance (odds ratio 1.86, 95% confidence interval 1.14–3.04 for “no charge/charity,” odds ratio 1.21, 95% confidence interval 1.08–1.35 for Medicaid) Although BSO was more common among white women than African-American, Latina, and Asian women (P<.001), lower income was associated with BSO among African-American and white women only, not among Asian and Latina women (P=.007 for test for interaction). BSO was eight times as likely with a laparoscopic hysterectomy and 12 times as likely with an abdominal hysterectomy compared with a vaginal approach (P<.001). Women who had endometriosis, pelvic infection, or an ovarian cyst were more likely to undergo BSO (P<.001) compared with women who did not have these diagnoses. CONCLUSION: There is significant nationwide variation in the practice of BSO. Age, route of hysterectomy, and diagnosis at surgery affect BSO rates. Nonclinical factors such as race or ethnicity, insurance status, income, and geographic location are also associated with BSO practice. LEVEL OF EVIDENCE: II
Seasonal variation in blood pressure and its relationship with outdoor temperature in 10 diverse regions of China: the China Kadoorie Biobank

Objectives: Mean blood pressure varies moderately with outdoor air temperature in many western populations. Substantial uncertainty exists, however, about the strength of the relationship in other populations and its relevance to age, adiposity, medical treatment, climate and housing conditions. Methods: To investigate the relationship of blood pressure with season and outdoor temperature, we analysed cross-sectional data from the China Kadoorie Biobank study of 506 673 adults aged 30–79 years recruited from 10 diverse urban and rural regions in China. Analyses related mean blood pressure – overall and in various subgroups – to mean local outdoor temperature. Results: The mean difference in SBP between summer (June–August) and winter (December–February) was 10 mmHg overall, and was more extreme, on average, in rural than in urban areas (12 vs. 8 mmHg; P for interaction <0.0001). Above 5°C, SBP was strongly inversely associated with outdoor temperature in all 10 areas studied, with 5.7 (SE 0.04) mmHg higher SBP per 10°C lower outdoor temperature. The association was stronger in older people and in those with lower BMI. At lower temperatures, there was no evidence of an association among participants who reported having central heating in their homes. Conclusion: Blood pressure was strongly inversely associated with outdoor temperature in Chinese adults across a range of climatic conditions, although access to home central heating appeared to remove much of the association during the winter months. Seasonal variation in blood pressure should be considered in the clinical management of hypertension.
Effect of adenoid hypertrophy and pulmonary function tests in children with mild asthma.

OBJECTIVES This study aims to assess the effect of adenoid hypertrophy on asthma in children with mild asthma. PATIENTS AND METHODS Between September 2010 and September 2012, 63 children (42 males, 21 females; median age 10.5 years; range 6 to 14 years) admitted to our clinic with asthma complaint were included in this study. These children were evaluated for adenoid hypertrophy, symptoms of asthma, medical treatment, pulmonary function tests at the beginning of the study and at the end of second month. RESULTS There was no correlation between initial pulmonary function tests and adenoid hypertrophy. But we observed significantly lower forced vital capacity values in children with prominent adenoid hypertrophy (p=0.033). While there was no significant difference in pulmonary function tests in terms of inhaled steroid usage (p>0.05), final forced mid-expiratory flow rate (FEF25-75) values were statistically higher in patients who were using nasal steroids (p=0.015). CONCLUSION Consequently, significantly higher values of FEF25-75 in the group that used nasal steroid suggest that adenoid hypertrophy affects the airway obstruction. Moreover, absence of airway obstruction symptoms in patients with mild adenoid hypertrophy suggests pulmonary function tests may help to decide performing adenoidectomy.
Applications of Transcranial Magnetic Stimulation in Movement Disorders

Summary The author reviews the applications of transcranial magnetic stimulation (TMS) in a series of movement disorders—namely, Parkinson’s disease, corticobasal degeneration, multiple system atrophy, progressive supranuclear palsy, essential tremor, dystonia, Huntington’s chorea, myoclonus, the ataxias, Tourette’s syndrome, restless legs syndrome, Wilson’s disease, Rett syndrome, and stiff-person syndrome. Single- and paired-pulse TMS studies have been done mainly for pathophysiologic purposes. Repetitive TMS has been used largely for therapy. Many TMS abnormalities are seen in the different diseases. They concur to show that motor cortical areas and their projections are the main target of the basal ganglia dysfunction typical of movement disorders. Interpretation has not always been clear, and sometimes there were discrepancies and contradictions. Largely, this may be the result of the extreme heterogeneity of the methods used and of the patients studied. It is premature to give repetitive TMS a role in treatment. Overall, however, TMS gives rise to a new, outstanding enthusiasm in the neurophysiology of movement disorders. There is reason to predict that TMS, with its continuous technical refinement, will prove even more helpful in the near future. Then, research achievements are reasonably expected to spill over into clinical practice.
Vertebroplasty and Kyphoplasty – Inefficient Treatments for Degenerative Spine Disease

Osteoporotic vertebral fractures and pathological vertebral lesions are frequent clinical situations causing severe back pain. The pharmacological treatment of the underlying disease and the analgetic treatment of the associated back pain usually do not rid the patient's back pain completely and are insufficient to prevent the fracture-weakened vertebral body from further fracturing with long term consequences for the biomechanical competence of the entire spine. In the last 10 years the minimal invasive treatment options vertebroplasty (VP) and balloon kyphoplasty (BK) have spread quickly because these procedures appeared to be promising treatments to stop the fracture and vertebral lesion associated back pain and to internally stabilize a fractured vertebral body. Numerous published reports on VP and BK appeared to support the notion of an immediate and lasting pain reduction after VP and BK in additon to a prevention of further fracturing of the treated vertebrae. The first three randomized controlled and partly blinded trials have been published this year. Two of these trials demonstrate that VP does not result in a better pain control than a sham operation whereas BK was shown to reduce back pain due to verterbal fractures for at least 12 months. Considering that more than 1.5 million people world-wide have been treated with VP and BK until now this work discusses the recent trials and suggests clinical and academic consequences on the basis of the most recent evidence.
A cross-population analysis of the growth of long bones and the os coxae of three Early Medieval Austrian populations

Long-bone and pelvic-bone growth patterns of three Early Medieval Austrian populations from the sites of Gars, Thunau, Zwentendorf and Zwölfaxing are assessed and compared with an Anglo-Saxon population from Raunds, England and with several comparative reference populations. Bone measurements are analysed against dental age estimates in order to assess inter-population differences in growth rates and dimensions. The three Austrian populations are from geographically close locations and share relatively similar archaeological contexts and ecological conditions. The expectation was that the greatest differences in growth patterns would be found between the Anglo-Saxon and the Austrian samples, reflecting variability in their genetic and biocultural background. Analysis of covariance (ANCOVA) and post-hoc tests were performed for each bone dimension, with dental age as a covariate. Subsequently, Gompertz growth curves were iteratively estimated for each sample in order to inspect variability in growth rates. The results point to a contrast between inter-popuation similarities in diaphyseal long bones growth and variability in the distal diaphyseal dimensions of the femur and humerus and the length and breadth dimensions of the ilium. Varying growth patterns are therefore associated with specific morphological structures implying that there is a need to address variation in the growth of each specific morphological structure. The most consistent differences in bone growth and related dimensions are between Gars-Thunau and Zwölfaxing. No significant differences in growth were detected between the Anglo-Saxon and the Austrian populations.
Value chain restructuring in Europe in a global economy

Project number: CIT3-CT-2005-006193 The material in this report draws on the collective work of the WORKS consortium, funded by the European Commission under its 6th Framework Programme, and the copyright is held by the WORKS project. However the views expressed in this report are those of the named authors and do not necessarily reflect the European Commission’s official view on the subject nor that of the consortium as a whole. The Community is not responsible for any use that might be made of data/information appearing therein.
Effect of Stress on Pregnancy Outcome among Women Undergoing Assisted Reproduction Procedures

Background This study was performed to examine the effect of stress on pregnancy outcome in women who underwent assisted reproductive technology (ART) procedures. Methods In a controlled clinical study of healthy volunteers in an academic research environment, stress was measured subjectively by administering patient questionnaires and biochemically by examining urinary excretion of cortisol and 6-sulfatoxy-melatonin (6-SM), the primary metabolite of melatonin and a marker of peripheral stress response. A total of 42 women who underwent ART procedures during an 18-month period agreed to participate in the study and were enrolled consecutively. The women collected 24-hour urine specimens on the day after human chorionic gonadotropin administration and concurrently completed the State-Trait Anxiety Inventory questionnaire. We measured the cortisol and 6-SM levels in the urine collection for each of the 42 women and for 10 oocyte donors who served as controls. Pregnancy tests were performed 14 days after embryo transfer. Analysis of covariance was used to compare the relationship of stress ratings to urinary cortisol and 6-SM levels among the women who became pregnant, the women who did not, and the women who served as controls. Other variables were explored by performing &khgr;2 analysis and Fisher's exact test. Results Neither self-ratings of acute anxiety, nor total daily 6-SM value, nor cortisol levels were associated with pregnancy outcome in the ART procedures. Conclusion Biochemical markers of stress failed to support a deleterious effect of stress on pregnancy outcome in women who underwent ART procedures. Subjective measurement of stress levels did not differ between women who became pregnant and those who did not.