Miracle-dz/UniFAR-FTUs huggingface dataset:
Penetration force and cannula sliding profiles of different pen needles: the PICASSO study

Purpose Pen needles used for insulin injections can have different characteristics that affect a patient’s injection experience. The aim of the study was to investigate in a standardized laboratory setting the penetration force and sliding force of different 31/32/33/34 gauge pen needles available in 3.5/4/5/8 mm length and 3/5 bevel tips for subcutaneous injection through pen needles and injection pens. Methods Eight different commercially available pen needles were tested in this experimental study. The needle was inserted into a polyurethane substrate at a specific constant speed and the force for insertion was recorded as a function of penetration depth. A load cell was utilized to measure force during the different stages of insertion. Results Maximum load was lower with the PiC G32×4 when compared with the G32×4 5-bevel needle (p<0.0001), while it was not significantly lower with the PiC G32×4 when compared to the G32×4 3-bevel needle (p=0.064). The comparison of G33×4 PiC and G34×3.5 PiC needles with G32 needles demonstrated significantly lower maximum loads with G33 and G34 (p<0.0001). No difference between needles emerged for sliding results. Conclusion Newer pen needles represent a significant improvement in insulin delivery, reducing the amount of force required to penetrate tissues. Needle tip sharpness and other factors that can reduce the force of insertion such as lubrication are important parameters that can be optimized to increase patient acceptance.
Cost-effectiveness of the implementation of a transitional discharge model for community integration of psychiatric clients: Practice insights and policy implications

Abstract Transitions in care are vulnerable periods for individuals with mental health illness. A network of therapeutic relationships during transitional period assists in discharge planning and recovery. This study evaluated the cost-effectiveness of the implementation of the transitional discharge model (TDM), an intervention for community integration of clients with mental health illness. This study used a participatory action research design to evaluate TDM implementation in nine hospitals across Ontario, Canada. The study enrolled 370 participants from participating hospitals. The analyses compared data on readmissions, length of stay, and hospitals spending that were collected at three points in time: prior and after four and eight months of TDM implementation. Corresponding results indicated no statistically significant differences in pre and post-intervention readmission means. The average length of stay, in eight months following the implementation, decreased by 9.8 days; however, results showed no statistically significant difference between pre and post-intervention median length of stay (mean rank = 6.63 vs. 5.64), Z = −0.585, p = 0.592). Additionally, comparisons of implementation cost to hospital spending found a total savings of $3,392,810. In addition to cost-savings to the health care system as demonstrated by reduced length of stay, TDM implementation provides cost-effective supports to help keep clients in the community and out of the hospital. As such, TDM implementation provides mental health practice and policy one of the unique opportunities for effective discharge of clients from hospital to community mental health services, through early discharge planning and connecting clients to community peer support system.
Role of novel cardiac biomarkers for the diagnosis, risk stratification, and prognostication among patients with heart failure

Heart failure (HF) is a leading cause of hospitalizations among adults and the elderly in the US, with estimated medical costs expected to increase from $20.9 billion in 2012 to $53.1 billion by 2030 [1]. The mean per-patient cost of an HF-related hospitalization in the US was $10,775 in 2011, and the prevalence of HF is estimated to be 5.7 million with an incidence of 870,000 new cases diagnosed every year. Approximately ifty percent of patients with HF are expected to die within ive years of diagnosis [2]. HF thus confers not only a substantial burden on patients, but the hospitalization rates are at epidemic proportions and strategies are needed that can direct prevention, early detection and successful, tailored therapy. The current ACC/AHA guidelines for the management of HF de ine the condition as a “complex clinical syndrome that results from any structural or functional impairment of ventricular illing or ejection of blood” and that practically there is a lack of a “single diagnostic test for HF because it is largely a clinical diagnosis based on a careful history and physical examination” [3]. Furthermore, studies have identi ied the limited reliability and decreased speci icity Abstract
Teasing Apart the Impact of Illness and IQ on Functional Neuroimaging Findings in Schizophrenia

Schizophrenia is a major psychiatric disorder associated with cognitive impairment. Functional brain imaging (fMRI) studies of schizophrenia patients reveal a complex pattern of brain differences in the prefrontal cortex. Both decreased (hypofrontality) and increased (hyperfrontality) activity have been reported in patients – inconsistencies that this paper argues could be explained by differences in IQ between patients and healthy controls. This study demonstrates a novel method to tease apart IQ and schizophrenia effects on brain activity. Twelve schizophrenia patients were matched to twelve healthy controls matched to patients’ estimated (premorbid) IQ before their illness, and twelve healthy controls matched to patients’ measured current IQ. All participants performed an executive function event-related fMRI task. Schizophrenia patients’ mean behavioral scores fell numerically between those of both control groups, and did not differ significantly from either group. Two distinct patterns of brain activity were found that were consistent with an effect due to either IQ impairment or schizophrenia diagnosis. Schizophrenia patients’ relatively reduced activity in middle/superior frontal (BA6/BA8) regions was related to their schizophrenia diagnosis, whereas their relatively increased activity in inferior frontal (BA44/45) and left middle frontal (BA8/9) regionsrelated instead to their current IQ impairment. These findings indicate that some fMRI differences reported in schizophrenia patients are artefacts of IQ matching. After removing the IQ confounds, schizophrenia was associated with lateral frontal hypoactivations and medial frontal failure of deactivation. This paper proposes a method to address IQ matching-related issues when studying populations where their illness involves cognitive deterioration.
Determinants of dysphagia following stroke

Background: Swallowing is affected following stroke. Many studies focus on various aspects of swallowing difficulties (dysphagia) following stroke. However, there are not many studies on the determinants of dysphagia following stroke. The aim of the present study is to establish the association between various factors with the severity of dysphagia. Methods: After screening for Mann Assessment of Swallowing Ability (MASA),110 patients, post-stroke were selected using consecutive sampling to assess the common risk factors, namely the presence of diabetes mellitus, dyslipidemia, hypertension, alcohol usage and smoking habits. Additionally, other variables such as age, gender, type of lesion, side of lesion, tobacco chewing, speech disorders, arterial dysfunction, lobe involvement and Brunnstrom’s stages, were also evaluated using a structured interview method. c2 (chi-squared) analysis was carried out to find out the association between the selected determinants and severity of dysphagia following stroke. Results: It was found that age and Brunnstrom’s stages are the determinants of dysphagia, as analysis showed a strong association with a p value < 0.001. A marginal association between post-stroke dysphagia and type of lesion with a p value of 0.056 was also observed. Conclusions: Among 15 factors evaluated, age, type of lesion and Brunnstrom’s stages showed a significant association with the severity of dysphagia following stroke. This study advocates early dysphagia management for elderly patients with high Brunnstrom’s grading, for those who are not expected to spontaneously recover following stroke, and for earlier and better community rehabilitation. [ Ethiop.J. Health Dev. 2019; 33(3):147-152] Key words: Post-stroke dysphagia, Brunnstrom’s stages, dysphagia risk factors.
Phenotype of mesenchymal stem cells from patients with myelodyplastic syndrome maybe partly modulated by decitabine

Mesenchymal stem cells (MSCs) derived from myelodysplastic syndromes (MDSs) have been demonstrated to accelerate the progression of MDS. However, whether the phenotype of MSCs derived from MDS (MDS-MSCs) may be reversed and serve as a potential target for the treatment of MDS remains unclear. The present study investigated the functional alternations of MDS-MSCs following in vitro decitabine-treatment. Primary MSCs were cultured from the bone marrow aspirates of 28 patients with MDS. The impact on the growth of MDS-MSCs treated with decitabine was analyzed using the MTT assay. Changes in the gene expression levels of runt related transcription factor 2 (RUNX2), Sp7 transcription factor (SP7), cyclin dependent kinase inhibitor 1A (CDKN1A) and CD274 in MDS-MSCs following treatment with decitabine were analyzed by reverse transcription-quantitative polymerase chain reaction. The effects of decitabine on apoptosis and the cell cycle were examined using flow cytometry. The effect of decitabine on the immune regulation of MDS-MSCs was tested by the co-culture of MSCs with activated T cells in vitro. The results revealed that proliferation, apoptosis and the mRNA expression levels of RUNX2 and SP7 in MDS-MSCs did not significantly change following treatment with decitabine compared with control MDS-MSCs. However, treatment with decitabine resulted in a smaller population of cells in the G1 phase and an increase in the number of cells in the G2/M phase compared with control MDS-MSCs. This change was associated with decreased expression of CDKN1A in cells treated with decitabine compared with control cells. Notably, the ability of MDS-MSCs treated with decitabine to induce the differentiation of T cells into regulatory T cells was significantly reduced compared with control MDS-MSCs. This was associated with a decreased expression of CD274 in MDS-MSCs treated with decitabine compared with control MDS-MSCs. In conclusion, the phenotype of MSCs derived from patients with MDS was partially reversed by treatment with decitabine, presenting a potential therapeutic intervention.
Artesunate and sorafenib: Combinatorial inhibition of liver cancer cell growth

An antimalarial medication, artesunate (Art), has exhibited promising anticancer effects with excellent tolerability in various types of cancer, suggesting that it has the potential to be used in combination with sorafenib (Sora) in hepatocellular carcinoma (HCC) treatment. To determine the potency of this combination, the present study attempted to quantitatively measure the dose-effect relationship of each drug alone and in combination in liver cancer cells in vitro using Calcusyn software. Cell growth inhibition was determined using the CyQUANT proliferation assay in two liver cancer cell lines, HepG2 and Huh7. Drug combination and reduction indices and isobologram plots were used to assess drug interactions. Cell apoptosis was evaluated by measurements of the proportion of cells in the sub G0/G1 phase of the cell cycle, and determination of protein expression levels of cleaved poly ADP ribose polymerase and caspase-9. Additionally, a cell migration assay was conducted using Essen ImageLock plates with an IncuCyte Zoom imaging system. The results of the present study revealed that the inhibitory effect of Sora on cell growth was synergistically enhanced by the combination with Art in HepG2 and Huh7 cells. The combination index and dose reduction index were specific to each cell line. Furthermore, combination at a fixed ratio presented mutual enhancement with respect to apoptosis induction and suppression of in vitro liver cancer cell migration. Therefore, considering the low toxicity and well-defined clinical characteristics of Art, combination of Sora and Art may present an attractive therapeutic option in the development of clinical trials for HCC treatment.
Changes in Helicobacter pylori Immunoglobulin G Levels and Gastric Mucosal Atrophy after Successful Eradication of Helicobacter pylori

The Korean Journal of Helicobacter and Upper Gastrointestinal Research is an Open-Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ORIGINAL ARTICLE ISSN 1738-3331 eISSN 2671-826X, https://doi.org/10.7704/kjhugr.2019. 19.3. 174 The Korean Journal of Helicobacter and Upper Gastrointestinal Research, 2019;19(3):174-183
Tissue Factor and Platelet Microparticles in Acute Myocardial Infarction

Aim of the work: This study aimed to assess the presence of tissue factor and platelet microparticles in cases of acute myocardial infarction in relation to clinical outcome. Patients and methods: This study included 42 patients with acute ST elevation Myocardial infarction. The counting of platelet microparticles carrying CD42b&CD42b (MFI and tissue factor microparticles carrying CD142&CD142 (MFI) was done by flow cytometry. Systemic blood samples of 40 healthy individuals (control) were obtained to assay the studied parameters. A comparison was done between the patients according to their clinical picture and mode of treatment used, and also between patients and control cases. Results: There was high statistical significant elevation of platelet microparticles (count and MFI) and tissue factor microparticles (count and MFI) in patients group in comparison with the control group. There was no statistically significant difference between patients on medical treatment and patients receiving no treatment as regard platelet microparticles and tissue factor microparticles. The study shows highly statistically significant difference between patients without and with primary PCI as regard platelet microparticles and tissue factor microparticles. The study also shows high significant positive correlation between platelet microparticles CD42b (MFI) and tissue factor microparticles CD142 (MFI), and shows non-significant correlation between platelet microparticles CD42b (MFI) and other parameters in control group.
Cardioprotective effect of transcutaneous electrical acupuncture point stimulation on perioperative elderly patients with coronary heart disease: a prospective, randomized, controlled clinical trial

Purpose The purpose of this study was to evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) on postoperative autonomic nervous system function and serum biomarkers in the elderly. Patients and methods A total of 122 American Society of Anesthesiologists class II or III patients with coronary heart disease undergoing spinal surgery were randomly divided into two groups: TEAS (received TEAS at Neiguan [PC6] and Ximen [PC4] for 30 minutes before anesthesia induction until the end of surgery) and control (received electrode plate at the same acupuncture points without any electrical stimulation). Serum was isolated for the measurement of concentration of high-sensitive troponin T (hs-cTnT), CRP, and CK. Heart rate (HR) and heart rate variability (HRV) including: total power (TP), low-frequency (LF) power, high-frequency (HF) power, and LF/HF ratio were used to assess autonomic nervous system function. The primary outcome was to evaluate whether TEAS changed the postoperative serum hs-cTnT. The secondary outcomes were to observe the effects of TEAS on HRV, circulating CK and CRP after surgery. Results Hs-cTnT, CRP, and CK concentrations were significantly higher on first, third and fifth day after surgery than those before anesthesia induction in both groups. Hs-cTnT concentration was significantly lower on the first and third day after surgery in TEAS group than in control group. Compared with 1 day before surgery, TP, LF, and HF decreased significantly and HR, LF/HF increased significantly on first, third, and fifth day after surgery in control group. Compared with control group, HR was significantly lower on the first, third, and fifth day after surgery, LF/HF decreased and TP, LF, HF were significantly higher on the first day after surgery in TEAS group. Conclusion TEAS at PC6 and PC4 could reduce postoperative serum hs-cTnT concentration and change HRV index to improve autonomic nervous system activity.
Pregnancy, childbirth and puerperium health problems in women after 35 year of age: A systematic literature review

Advancing medical knowledge, improving quality of life and increasing life expectancy have resulted in increased numbers of women deciding to deliver a child over 35 years of age. Infertility in delayed motherhood is associated not only with medical but also with psychological problems. The question of delayed motherhood concerns the whole world, and is of interest not only to obstetricians, but also economists and demographers. The purpose of our study was to identify and review studies into the health problems of women over 35 years of age in pregnancy (Advanced Maternal Age), delivery and the puerperium. Original papers investigating health problems in women over 35 years of age related to pregnancy, childbirth and the puerperium published between August 2017, and January 2018 were identified. Databases including PubMed, Scopus, ProQuest Central, and Elsevier Clinical Key Journals were utilised. After removing duplicates and those not meeting inclusion criteria, 15 studies were reviewed. Findings are discussed according to three time periods; before pregnancy, during pregnancy, and during childbirth and the puerperium. AMA mothers, especially primiparous women, were more likely to suffer with underlying chronic diseases and were more likely to have been treated for infertility. Increased use ART (Assisted Reproduction Techniques) can explain an increased rate of multiple pregnancies and the resultant rise in both caesarean section deliveries and premature births. Study groups subclassified according to maternal age allowed outcomes which are progressive with age to be identified. All the studies we reviewed have reported similar health problems in women over 35 years of age. The most common health problems in pregnancy, during childbirth and the puerperium in women over 35 years of age are diabetes mellitus type one and two, hypertension, preeclampsia, and cholestasis
Static magnetic field effect on cardiovascular regulation: a review.

Mounting evidence suggests that environmental and occupational magnetic fields affect cardiovascular system. In this review, supported by original hemodynamic recordings direct experimental evidence of the effect static magnetic field (SMF) effects on arterial baroreflex cardiovascular control mechanism have been summarized. Local exposure of 120 350 mT SMF to sinocarotid baroreceptors in rabbits and healthy volunteers exerted a stimulatory effect on arterial baroreflex normalized arterial blood pressure in hypertensive and hypotensive conditions, significantly increased microcirculation, heart rate variability, arterial baroreflex sensitivity and sodium nitroprusside (spontaneous nitric oxide donor) microcirculatory vasodilatory effect. The improvement of the vasodilator responsiveness to nitric oxide by baroreceptor stimulation suggested to be a new mechanism in baroreflex physiology with potential implementation in a spectrum of cardiovascular diseases where endothelial dysfunction and sympathovagal imbalance that results from a loss of baroreflex control over autonomic activity increases the risk of morbidity and mortality substantially. The modulation of the baroreflex-mediated autonomic cardiovascular control is a new concept for understanding environmental magnetic fields effect on cardiovascular system and an effective strategy to prevent their potential public health hazards.
Influence of Vitamin B12 Deficiency on Autonomic Nervous System Activity in Children

: Vitamin B12 has an important role in neuronal development of children. Autonomic nervous dysfunction which can be hidden by compensating mechanisms also accompanies vitamin B12 deficiency. However, in children, there is still limited data about this effect of vitamin B12 deficiency. The aim of this study was to evaluate the autonomic activity in vitamin B12 deficient children by analyzing the heart rate variability (HRV) with Holter monitoring. HRV parameters of 37 children who were diagnosed with vitamin B12 deficiency were compared those of 25 age and sex matched healthy controls. All of the heart rate variability parameters (time-domain and frequency-domain) were reduced in the vitamin B12 deficient group compared with controls. The search for factors modifying heart rate variability yielded that serum vitamin B12 level was significantly effective on both time-domain and frequency-domain HRV parameters. A positive correlation was also found between vitamin B12 levels and the mean of the 5 minute RR interval standard deviations (SDNNi), the square root of the mean of the squared differences of two consecutive RR intervals (RMSSD), low-frequency power (LF) parameters (P < 0.05, r: 0.285, 0.262, 0.246, respectively). In conclusion, vitamin B12 deficiency can cause autonomic dysfunction in children.
Effect of Hearing Ability and Mild Behavioural Impairment on MoCA and Memory Index Scores

Background The life-course model of modifiable risk factors for dementia now recognizes managing hearing loss and addressing social isolation. Objective To investigate the contribution and inter-relationship of hearing ability and behaviour change on cognitive ability. Methods We present the preliminary findings from a prospective longitudinal study of 35 non-demented participants ages 60–93, recruited from community rehabilitation and acute-care programs of Geriatric Medicine, who underwent baseline hearing, behavioural, and cognitive testing. Results After controlling for age and hearing impairment, the left ear Dichotic Digit Test (DDT) score accounted uniquely for 20% of the variance in MoCA Memory Index (p = .016 with β = .598). Mild Behavioural Impairment (MBI) was highly prevalent, with 80% of older adults reporting at least one MBI symptom. People with hearing impairment had greater global MBI burden than people with normal hearing, especially in the domains of apathy and impulse dyscontrol; however, greater severity of hearing impairment was not associated with a higher number of neuropsychiatric symptoms (NPS). Conclusions Low left DDT contributed to lower memory index and greater MBI burden is associated with hearing impairment. Our findings demonstrate the value of early non-invasive hearing and behavioural assessments as part of dementia risk assessment in older adults.