Miracle-dz/UniFAR-FTUs huggingface dataset:
Hormonal Changes after Roux-en Y Gastric Bypass for Morbid Obesity and the Control of Type-II Diabetes Mellitus

Morbid obesity (MO) is associated with diabetes mellitus-type II (DM-II). Roux-en Y gastric bypass (RNY) has been shown to normalize glucose intolerance in these patients through an incompletely understood mechanism. Gastrointestinal hormonal changes have been suggested as an explanation for resolution of DM II. Preoperatively, 20 MO patients with DM-II were evaluated for demographics and fasting levels of the following: glucose, insulin, C-peptide, glucagon, Cortisol, gastric inhibitory polypeptide (GIP), and glucagon-like peptide-1 (GLP-1). Each patient underwent RNY with a 15-cc gastric pouch and 150-cm Roux limb. Postoperatively, each of the variables was measured at 2 weeks, 6 weeks, and 12 weeks and compared with the preoperative result using Student t test with significance, P = 0.05. Results are expressed as mean ± SD. Twenty patients (5 male and 15 female), age 40.3 ± 7.9 years, weight 146.3 ± 34.0 kg, height 158.7 ± 18.7 cm, and BMI 52.7 ± 8.8, were enrolled in this IRB-approved protocol. Weight and BMI decreased progressively (117.5 ± 26.9 kg and 47.0 ± 7.4, P = 0.01, respectively) during the study but reached significance only at 12 weeks. Fasting plasma glucose decreased significantly within 2 weeks after RNY. Insulin and Cortisol both approached, but never achieved, significant changes over 12 weeks. GLP-1 increased initially, but not significantly. GIP and C-peptide both decreased significantly. Glucagon remained essentially unchanged over 12 weeks. RNY rapidly normalizes fasting plasma glucose in morbidly obese patients with DM-II. GIP, a gactor in the enteroinsulin axis, decreases and may play a role in the correction of DM-II after gastric bypass.
Safety of the blood supply.

BACKGROUND The transfusion of blood components plays a significant role as supportive therapy in the treatment of patients with cancer. Although blood transfusions help manage complications arising from either the patient's primary condition or associated with therapeutic intervention, their use introduces a new set of risks; therefore, health care professionals must be aware of the potential morbidity introduced by using blood components and endeavor to optimize outcomes by ordering transfusions only when the benefits outweigh the inherent risks. METHODS This article sought to review the published literature, including the epidemiology of diseases transmissible via transfusion, performance characteristics for assays used for blood donor screening, surveillance activities to detect newly emergent pathogens, and biovigilance activities reported by public health authorities. RESULTS Effective measures have been implemented to significantly decrease the risk of transmissible diseases associated with transfusion. Reports of viral disease transmitted via transfusion have been nearly eliminated, particularly since the introduction of molecular-based detection technology. The transmission of bacteria and parasites still represents a threat to the use of cellular blood components. Transfusion-associated human prion disease has not been reported in the United States. Immune-mediated reactions due to donor-recipient incompatibility remain a challenge. CONCLUSIONS Transmissible agents most commonly associated with risks due to transfusion are no longer a major threat; however, a significant challenge remains with regard to addressing the need for quick response mechanisms to manage emerging pathogens with the potential for rapid spread, either unintentionally (eg, globalization) or intentionally (eg, bioterrorism). The use of technology to reduce pathogens holds promise for further increasing the safety profile of blood transfusion.
APOE epsilon variation in multiple sclerosis susceptibility and disease severity

Background: Previous studies have examined the role of APOE variation in multiple sclerosis (MS), but have lacked the statistical power to detect modest genetic influences on risk and disease severity. The meta- and pooled analyses presented here utilize the largest collection, to date, of MS cases, controls, and families genotyped for the APOE epsilon polymorphism. Methods: Studies of MS and APOE were identified by searches of PubMed, Biosis, Web of Science, Cochrane Review, and Embase. When possible, authors were contacted for individual genotype data. Meta-analyses of MS case-control data and family-based analyses were performed to assess the association of APOE epsilon genotype with disease risk. Pooled analyses of MS cases were also performed to assess the influence of APOE epsilon genotype on disease severity. Results: A total of 22 studies (3,299 MS cases and 2,532 controls) were available for meta-analysis. No effect of ε2 or ε4 status on MS risk was observed (summary OR 1.14, 95% CI 0.96–1.34 and OR 0.89, 95% CI 0.78–1.01). Results obtained from analyses of APOE genotypes in 1,279 MS families were also negative (p = 0.61). Finally, results from pooled analyses of 4,048 MS cases also argue strongly that APOE epsilon status does not distinguish a relapsing-remitting from primary progressive disease course, or influence disease severity, as measured by the Expanded Disability Status Scale and disease duration. Conclusion: Overall, these findings do not support a role for APOE in multiple sclerosis, and underscore the importance of using large sample sizes to detect modest genetic effects, particularly in studies of genotype-phenotype relationships.
Susceptibility profile of Gram-negative bacteremic isolates to beta lactam-beta lactamase inhibitor agents in comparison to other antibiotics.

BACKGROUND Comprehensive understanding about the local antibiogram is an essential requirement for preparation of hospital or unit based antibiotic policy. Bacteremic isolates are the most useful ones for this purpose, representing invasive disease. OBJECTIVE To analyze susceptibility pattern of bacteremic Gram-negative isolates in our center, to various antibiotics, including beta lactam-beta lactamase inhibitor (BL-BLI) agents and carbapenem. MATERIALS AND METHODS This is a retrospective study done in Apollo Specialty Hospital, a tertiary care oncology center in South India. The susceptibility of Escherichia coli, Klebsiella, Acinetobacter and Pseudomonas blood culture isolates, identified between January 2013 and June 2014 to various antibiotics were analyzed. RESULTS A total of 231-Gram-negative bacteremic isolates were analyzed. ESBL rate among E. coli isolates was 82.7% (67 out of 81) and 74.3% (58 out of 78) in Klebsiella. Carbapenem (imipenem) susceptibility rate in E. coli was 76.5%, Klebsiella 58.9%, Acinetobacter 32% and Pseudomonas 77.2%. Colistin susceptibility in E. coli was 96.2%, Klebsiella 93.5%, Acinetobacter 92.8% and Pseudomonas 97.7%. Difference in the susceptibility of Enterobacteriaceae to BL-BLI agents (especially cefepime-tazobactam) and carbapenem were minimal. In nonfermenters, BL-BLI susceptibility was better than that of carbapenem. CONCLUSION Findings of the study make a strong argument for using BL-BLI agents and sparing carbapenem to curtail the spiraling scenario of carbapenem resistance.
Circulating memory B-cell subpopulations are affected differently by HIV infection and antiretroviral therapy

Objective:To determine if the depletion of IgM memory B cells might contribute to the increased susceptibility of HIV patients to pneumococcal infection, memory B-cell subpopulations were investigated in HIV patients, including patients receiving antiretroviral therapy (ART). Methods:Blood B cells with the phenotype of IgM memory B cells (CD27+, IgM+) and switched memory B cells (CD27+, IgM−) were measured in antiretroviral-treated (n = 32) and untreated (n = 24) HIV patients and non-HIV controls (n = 35). Serum levels of IgG and IgG2 antibodies to pneumococcal polysaccharides, IgG, IgG subclasses, IgM and IgA were also assayed in HIV patients. Results:Switched memory B-cell counts were lower than controls in HIV patients (P < 0.01) irrespective of antiretroviral status and correlated with CD4 T-cell counts (r = 0.56, P = 0.001) in treated patients. In untreated patients, IgM memory B-cell counts correlated with CD4 T-cell counts (r = 0.73, P < 0.0001) reflecting higher values than controls in patients with CD4 T-cell counts greater than 300 cells/μl (P = 0.004) and lower values than controls in patients with CD4 T-cell counts below 300 cells/μl (P = 0.0001). There was no relationship between serum levels of pneumococcal antibodies and IgM or switched memory B cells. Conclusion:The depletion of IgM memory B cells in untreated HIV patients with a CD4 T-cell count below 300 cells/μl might be a risk factor for pneumococcal infection. The depletion of switched memory B cells is a complication of HIV infection irrespective of ART and might contribute to impaired IgG antibody responses. Memory B-cell subpopulations might predict the risk of pneumococcal sepsis more accurately than the CD4 T-cell count or pneumococcal antibody levels.
Demographic Analysis of Sex Ratio on Population Growth of Bactrocera dorsalis (Diptera: Tephritidae) With Discussion of Control Efficacy Using Male Annihilation.

The life table data for the oriental fruit fly, Bactrocera dorsalis (Hendel), at different adult sex ratios (1♀: 1♂, 1♀: 50♂, 50♀: 1♂ free-choice mating, and 50♀: 1♂ no-choice mating) were collected to determine the effects of sex-ratio manipulation on current pest control procedures. At 1♀: 1♂, females mated, on average, 2.3 times during their lifetime with a mean fecundity (F) of 1,122 eggs. The net reproductive rate (R0), intrinsic rate of increase (r), finite rate (λ), and mean generation time (T) were 561.0 offspring, 0.1693 d- 1, 1.1844 d- 1, and 37.4 d, respectively. At 50♀: 1♂ free-choice mating, males mated 46.7 times during their lifetime, while at 50♀: 1♂ no-choice mating, males mated on average 50 times during their lifetime, and all females mating only once in both treatments. The values for F, r, and λ were significantly lower for both 50♀: 1♂ treatments than those in the 1♀: 1♂ group; the R0 values, however, were either equal to or even higher than those in the 1♀: 1♂ treatment. In the male-biased sex ratio (1♀: 50♂), fecundity was the highest (1,610 eggs) and female average life span the longest (166 d), while the R0 was the lowest (31.6 offspring) among all treatments. Population projections showed that even at a sex ratio of 50♀: 1♂, B. dorsalis could still produce a large number of offspring. These findings demonstrate that management strategies for controlling B. dorsalis could be properly evaluated by using demographic methods. Because female annihilation appears to be a more effective control strategy, it should be considered as a viable alternative.
RNASEL Arg462Gln polymorphism and prostate cancer in PLCO

The Gln allele of the Arg462Gln polymorphism in RNASEL results in a threefold decrease in enzymatic activity, a reported deficiency in apoptotic response, and has been associated with prostate cancer in some high‐risk family studies. The relationship of this variant to sporadic prostate cancer remains uncertain.
Effects of alfalfa root saponins on digestive function in sheep.

The effects of alfalfa saponins on ruminal pH and VFA concentrations, protozoal numbers, forestomach motility, and digesta flow from the rumen were examined in this experiment. In a preliminary study, either 800 or 1600 mg/kg of saponins per kg BW were administered intraruminally in a single dose to one of two 60-kg wethers. Ruminal contractions were suppressed within 15 min. The study was terminated when one wether didn't recover. Saponins were then administered intraruminally in two equal doses daily into four ruminally and duodenally cannulated wethers (60 +/- 1 kg) in amounts equivalent to 0, 200, 400, and 800 mg/kg BW daily in a 4 x 4 Latin Square arrangement. Saponins increased VFA concentrations (P = .001) and lowered ruminal pH (P = .001) after 2 d of administration. On d 2 and d 14, saponins decreased (P < .01) protozoal populations. On d 11, pressure changes during ruminal contractions increased by 79% during resting (P = .06), 202% during feeding (P = .05), and 53% during an 8-h period (P = .08) as the level of saponins increased from 0 to 800 mg/kg BW. Administered saponins increased duodenal flows of OM and total N by 19 and 26%, respectively (P = .04 and .01). Apparent total tract N digestibility was reduced (P = .02) by 5% at the highest saponin dosage. We conclude that alfalfa may contain enough saponins to adversely impact ruminoreticular motility. Saponins also caused decreased ruminal protozoal populations, increased flow of total duodenal N, and reduced ruminal and total tract apparent digestibilities.
Differences in Humoral Immunity between a Nonrejection Group and a Rejection Group after ABO-Incompatible Renal Transplantation

Background. Renal transplantation across the blood barrier is a unique model for investigating the humoral response to different carbohydrate antigens. However, in such a renal transplantation, the characteristics of B cells as well as of the antibodies produced by B cells are less well defined. Methods. In the present study we investigated B cell subsets (i.e., the CD5+ B-1 and CD5– B-2 subsets) by flow cytometric analysis, and their subclasses of antibody, by ELISA, in patients who had undergone renal transplantation across the blood barrier. The subjects consisted of five recipients with good function (group 1) and five recipients with graft loss (group 2) accompanied by antibody-titer elevation after ABO-incompatible renal transplantation. Results. The B-cell population analysis revealed that CD5+ B-1 cells temporarily increased in all patients in both groups soon after transplantation, and that CD5– B-2 cells significantly increased 1 month after transplantation only in group 2. The antibody subclasses analysis showed mild elevation of immunoglobulin (Ig) G2 and IgM in group 1 as opposed to remarked elevation of IgG2, IgM and IgG1 in group 2. Conclusions. The results of this study suggested that CD5+ B-1 cell T-independent activation usually occurs soon after ABO-incompatible renal transplantation, but that CD5– B-2 cell T-dependent activation occurs only in patients who experience graft rejection.
Influence of Sevoflurane on the Metabolism and Renal Effects of Compound A in Rats

Background:The sevoflurane degradation product compound A is nephrotoxic in rats. In contrast, patient exposure to compound A during sevoflurane anesthesia has no clinically significant renal effects. The mechanism for this difference is incompletely understood. One possibility is that the metabolism and toxicity of compound A in humans is prevented by sevoflurane. However, the effect of sevoflurane on compound A metabolism and nephrotoxicity is unknown. Thus, the purpose of this investigation was to determine the effect of sevoflurane on the metabolism and renal toxicity of compound A in rats. Methods:Male rats received 0.25 mmol/kg intraperitoneal compound A, alone and during sevoflurane anesthesia (3%, 1.3 minimum alveolar concentration, for 3 h). Compound A metabolites in urine were quantified, and renal function was evaluated by serum creatinine and urea nitrogen, urine volume, osmolality, protein excretion, and renal tubular histology. Results:Sevoflurane coadministration with compound A inhibited compound A defluorination while increasing relative metabolism through pathways of sulfoxidation and β-lyase–catalyzed metabolism, which mediate toxicity. Sevoflurane coadministration with compound A increased some (serum creatinine and urea nitrogen, and necrosis) but not other (urine volume, osmolality, and protein excretion) indices of renal toxicity. Conclusions:Sevoflurane does not suppress compound A nephrotoxicity in rats in vivo. These results do not suggest that lack of nephrotoxicity in surgical patients exposed to compound A during sevoflurane anesthesia results from an inhibitory effect of sevoflurane on compound A metabolism and toxicity. Rather, these results are consistent with differences between rats and humans in compound A exposure and inherent susceptibility to compound A nephrotoxicity.
A Cost-Benefit Analysis of the ENIGMA Trial

Background:The ENIGMA trial was a prospective, randomized, multicenter study that evaluated the clinical consequences of including N2O in general anesthesia. Patients who were given a N2O-free anesthetic when undergoing major surgery for which the expected hospital stay was at least 3 days had lower rates of some postoperative complications. This suggests that, despite a higher consumption of potent inhalational agent, there could be a financial benefit when N2O is avoided in such settings. Methods:A retrospective cost analysis of the 2,050 patients recruited to the ENIGMA trial was performed. We measured costs from the perspective of an implementing hospital. Direct health care costs include the costs for maintaining anesthesia, daily medications, hospitalization, and complications. The primary outcome was the net financial savings from avoiding N2O in major noncardiac surgery. Comparisons between groups were analyzed using Student t test and bootstrap methods. Sensitivity analyses were also performed. Results:Rates of some serious complications were higher in the N2O group. Total costs in the N2O group were $16,203 and in the N2O-free group $13,837, mean difference of $2,366 (95% CI: 841–3,891); P = 0.002. All sensitivity analyses retained a significant difference in favor of the N2O-free group (all P ≤ 0.005). Conclusions:Despite N2O reducing the consumption of more expensive potent inhalational agent, there were marked additional costs associated with its use in adult patients undergoing major surgery because of an increased rate of complications. There is no cogent argument to continue using N2O on the basis that it is an inexpensive drug.
Training experiences immediately after medical school

Trainees in all teaching hospitals in New South Wales were surveyed using a self‐completion, postal questionnaire to assess perceptions of the quality and extent of training received for interactional and technical skills. The response rate was 67.1%. Mean age was 25.4 years and 38.8% were female. Overall, training was found to be generally poor in terms of time and educational strategies used. Interactional skills were found to receive lower levels of training than technical skills both prior to and during the intern year with significantly fewer (P < 0.000) educational strategies reported for training received in interactional skills than for technical skills. Trainees' perceptions of the adequacy of training was significantly more negative for interactional than technical skills (P < 0.001). Assessment of competence was also significantly lower for interactional than technical skills (P < 0.001). On average, fewer than one in three trainees considered themselves to be competent in interactional skills compared to two‐thirds who reported themselves as competent for technical skills. The findings of this study highlight the need for improved efforts with regard to both the quality and quantity of training provided during the intern year. Considerable scope exists for improved educational experiences for both interactional and technical skill areas, but particularly for interactional skills. Overall, greater use of a range of basic educational strategies such as the provision of ‘observation’ and ‘critical feedback’ is indicated. Efforts also need to be directed toward the training of clinical educators to optimize the potential of the preregistration period.
The responsible genes in Japanese deafness patients and clinical application using Invader assay

Discovery of deafness genes has progressed but clinical application lags because of the genetic heterogeneity. To establish clinical application strategy, we reviewed the frequency and spectrum of mutations found in Japanese hearing loss patients and compared them to those in populations of European ancestry. Screening revealed that in Japanese, mutations in GJB2, SLC26A4, and CDH23, and the mitochondrial 12S rRNA are the major causes of hearing loss. Also, mutations in KCNQ4, TECTA, COCH, WFS1, CRYM, COL9A3, and KIAA1199 were found in independent autosomal dominant families. Interestingly, spectrums of GJB2, SLC26A4, and CDH23 mutations in Japanese were quite different from those in Europeans. Simultaneous screening of multiple deafness mutations based on the mutation spectrum of a corresponding population using an Invader panel revealed that approximately 30% of subjects could be diagnosed. This assay will enable us to detect deafness mutations in an efficient and practical manner in the clinical platform. We conclude that specific racial populations may have unique deafness gene epidemiologies; therefore, ethnic background should be considered when genetic testing is performed. Simultaneous examination of multiple mutations based on a population's spectrum may be appropriate and effective for detecting deafness genes, facilitating precise clinical diagnosis, appropriate counseling, and proper management.
Body protein in prepubertal children with phenylketonuria.

OBJECTIVE To assess body protein and protein deposition in prepubertal children with phenylketonuria (PKU). DESIGN Cross-sectional study with nested longitudinal cohort. SETTING A tertiary referral paediatric hospital. SUBJECTS 37 PKU patients (3.9-11.0 years) and 27 unselected healthy controls (4.0-11.5 years) of whom 29 PKU patients and 17 controls were followed longitudinally. INTERVENTIONS All had measurements of height, weight, body fat and total body nitrogen (TBN) by neutron capture analysis; PKU patients and their unaffected siblings (n = 16) also had measurements of four day weighed food record and plasma amino acids by HPLC. RESULTS The children with PKU compared with the controls were significantly shorter (height SD score -0.42 +/- 0.89 vs 0.17 +/- 0.94, respectively, P < 0.02) and had a lower TBN (575 +/- 200 vs 710 +/- 215g, respectively, P < 0.02). TBN in the controls was significantly correlated with lean body mass (LBM), weight, height and age (r = 0.97, 0.95, 0.95, 0.88, respectively, P < 0.001). The children with PKU had significantly lower TBN when predicted from LBM, weight and age (93%, 92%, 92% of predicted, respectively), but normal TBN predicted from height (102% of expected). The annual accretion of nitrogen was similar for the PKU and controls (86 +/- 45 and 77 +/- 58 g/y, respectively). There was no difference between the two groups in protein intake or plasma amino acids except for phenylalanine. CONCLUSION The children with PKU had a deficit in height and body protein despite a normal to higher accretion of protein. If the deficit occurs early in life, amino acid supplementation and other nutritional practices used at this time need to be reviewed.