Miracle-dz/UniFAR-FTUs huggingface dataset:
Repeated Cross-sectional Surveys of Burnout, Distress, and Depression among Anesthesiology Residents and First-year Graduates.

WHAT WE ALREADY KNOW ABOUT THIS TOPIC Burnout has been identified in approximately 50% of residents and practicing physicians WHAT THIS ARTICLE TELLS US THAT IS NEW: Based on survey data from 2013 to 2016, the prevalence of burnout, distress, and depression in anesthesiology residents and first-year graduates was 51%, 32%, and 12%, respectivelyMore hours worked and student debt were associated with a higher risk of distress and depression, but not burnoutPerceived institutional and social support and work-life balance were associated with a lower risk of burnout, distress, and depression BACKGROUND:: This repeated cross-sectional survey study was conducted to determine the prevalence of, and factors associated with, burnout, distress, and depression among anesthesiology residents and first-year graduates. We hypothesized that heavy workload and student debt burden were associated with a higher risk of physician burnout, distress, and depression, and that perception of having adequate workplace resources, work-life balance, and social support were associated with a lower risk. METHODS Physicians beginning U.S. anesthesiology residency between 2013 and 2016 were invited to take online surveys annually from their clinical anesthesia year 1 to 1 yr after residency graduation. The Maslach Burnout Inventory, the Physician Well-Being Index, and the Harvard Department of Psychiatry/National Depression Screening Day Scale were used to measure burnout, distress, and depression, respectively. Logistic regression analyses were conducted to examine whether self-reported demographics, personal, and professional factors were associated with the risk of burnout, distress, and depression. RESULTS The response rate was 36% (5,295 of 14,529). The prevalence of burnout, distress, and depression was 51% (2,531 of 4,966), 32% (1,575 of 4,941), and 12% (565 of 4,840), respectively. Factors associated with a lower risk of all three outcomes included respondents' perceived workplace resource availability, (odds ratio = 0.51 [95% CI, 0.45 to 0.57] for burnout; 0.51 [95% CI, 0.45 to 0.56] for distress; 0.52 [95% CI, 0.45 to 0.60] for depression) and perceived ability to maintain work-life balance (0.61 [95% CI, 0.56 to 0.67] for burnout; 0.50 [95% CI, 0.46 to 0.55] for distress; 0.58 [95% CI, 0.51 to 0.65] for depression). A greater number of hours worked per week and a higher amount of student debt were associated with a higher risk of distress and depression, but not burnout. CONCLUSIONS Burnout, distress, and depression are notable among anesthesiology residents. Perceived institutional support, work-life balance, strength of social support, workload, and student debt impact physician well-being.
Plaque-Type Multinucleate Cell Angiohistiocytoma

Background: Multinucleate cell angiohistiocytoma (MCAH) is a rare cutaneous disorder that usually presents as papules or nodules. Objective: This article reports a case of MCAH that appeared clinically as a large cutaneous plaque. Methods and Results: A 74-year-old woman presented with a large painless, dusky red, indurated plaque measuring 12 × 6 cm on the trunk that was found on histopathologic examination to be a MCAH. Based on a literature review, this is the first reported case of MCAH presenting as a plaque rather than a papule or nodule. Conclusion: Multinucleate cell angiohistiocytoma may manifest clinically as a solitary cutaneous plaque.
Medical malpractice related to drug-induced anaphylaxis

Abstract Drug-induced anaphylaxis (DIA) is a highly paradoxical disorder involving a fatal response to medicines prescribed for therapeutic purposes. This study aimed to improve the awareness on DIA and to prevent errors through an analysis of lawsuit judgments. Sentenced judgments involving DIA from 1998 to 2017 using the database of the Korean Supreme Court Judgment System were collected. General characteristics, results, and recognized negligence of DIA litigation cases were analyzed. Of 27 lawsuit cases included, antibiotics (n = 6, 22.2%), radiocontrast media (n = 6, 22.2%), and non-steroidal anti-inflammatory drugs (n = 5, 18.5%) were the most common drugs that had caused DIA. Cardiac arrest was reported in 23 cases (85.2%). The median time interval from drug administration to diagnosis and from diagnosis to cardiac arrest were 7 (interquartile range, IQR = 0–35) and 5 minutes (IQR = 0–33), respectively, suggesting insufficient time to cope with anaphylaxis. Consequently, either death (n = 18, 66.7%) or ischemic brain injury (n = 9, 33.3%) occurred in all cases. Violation of duty of care was recognized in 19 cases (70.4%) with median awarded amount of $106,060 (IQR = $70,296–$168,363). The recognized negligence included inadequate observation after drug administration (n = 6), delayed or missed epinephrine administration (n = 6), ignoring a history of allergy or drug hypersensitivity (n = 6), and prescription error (n = 5). It is necessary to improve the awareness on DIA, because making a trivial error in any process of history taking, drug prescription and administration, observation, and/or emergency treatment may have fatal consequences that can lead to indemnity.
Chlamydia trachomatis samples testing falsely negative in the Aptima Combo 2 test in Finland, 2019

Since February 2019, over 160 Chlamydia trachomatis (CT) cases testing negative or equivocal by Aptima Combo 2 (AC2) but positive by Aptima CT test run with Panther instruments occurred in Finland. The AC2 test targets chlamydial 23S rRNA while the CT test targets 16S rRNA. Sequencing of 10 strains revealed a nucleotide substitution in 23S rRNA. The significance of this for the failure of the AC2 test to detect the variant is not yet known.
The stability of the circular hydraulic jump

We present the results of an experimental investigation of the striking flow structures that may arise when a vertical jet of fluid impinges on a thin fluid layer overlying a horizontal boundary. Ellegaard et al. (1998, 1999) demonstrated that the axial symmetry of the circular hydraulic jump may be broken, resulting in steady polygonal jumps. In addition to these polygonal forms, our experiments reveal a new class of steady asymmetric jump forms that include structures resembling cat’s eyes, threeand four-leaf clovers, bowties and butterflies. A parameter study reveals the dependence of the jump structure on the governing parameters. The symmetry-breaking responsible for the asymmetric jumps is demonstrated to result from a capillary instability of the circular jump. For all steady nonaxisymmetric forms observed, the wavelength of instability of the jump is related to the surface tension, σ, fluid density ρ and speed U of the radial outflow at the jump through λ = (68± 7) σ/(ρU).
MYC-Driven Small-Cell Lung Cancer is Metabolically Distinct and Vulnerable to Arginine Depletion

Purpose: Small-cell lung cancer (SCLC) has been treated clinically as a homogeneous disease, but recent discoveries suggest that SCLC is heterogeneous. Whether metabolic differences exist among SCLC subtypes is largely unexplored. In this study, we aimed to determine whether metabolic vulnerabilities exist between SCLC subtypes that can be therapeutically exploited. Experimental Design: We performed steady state metabolomics on tumors isolated from distinct genetically engineered mouse models (GEMM) representing the MYC- and MYCL-driven subtypes of SCLC. Using genetic and pharmacologic approaches, we validated our findings in chemo-naïve and -resistant human SCLC cell lines, multiple GEMMs, four human cell line xenografts, and four newly derived PDX models. Results: We discover that SCLC subtypes driven by different MYC family members have distinct metabolic profiles. MYC-driven SCLC preferentially depends on arginine-regulated pathways including polyamine biosynthesis and mTOR pathway activation. Chemo-resistant SCLC cells exhibit increased MYC expression and similar metabolic liabilities as chemo-naïve MYC-driven cells. Arginine depletion with pegylated arginine deiminase (ADI-PEG 20) dramatically suppresses tumor growth and promotes survival of mice specifically with MYC-driven tumors, including in GEMMs, human cell line xenografts, and a patient-derived xenograft from a relapsed patient. Finally, ADI-PEG 20 is significantly more effective than the standard-of-care chemotherapy. Conclusions: These data identify metabolic heterogeneity within SCLC and suggest arginine deprivation as a subtype-specific therapeutic vulnerability for MYC-driven SCLC.
Microbiota stratification identifies disease-specific alterations in neuro-Behçet's disease and multiple sclerosis.

OBJECTIVES Altered gut microbiota community dynamics are implicated in diverse human diseases including inflammatory disorders such as neuro-Behçet's disease (NBD) and multiple sclerosis (MS). Traditionally, microbiota communities are analysed uniformly across control and disease groups, but recent reports of subsample clustering indicate a potential need for analytical stratification. The objectives of this study are to analyse and compare faecal microbiota community signatures of ethno-geographical, age and gender matched adult healthy controls (HC), MS and NBD individuals. METHODS Faecal microbiota community compositions in adult HC (n=14), NBD patients (n=13) and MS (n=13) were analysed by 16S rRNA gene sequencing and standard bioinformatics pipelines. Bipartite networks were then used to identify and re-analyse dominant compositional clusters in respective groups. RESULTS We identified Prevotella and Bacteroides dominated subsample clusters in HC, MS, and NBD cohorts. Our study confirmed previous reports that Prevotella is a major dysbiotic target in these diseases. We demonstrate that subsample stratification is required to identify significant disease-associated microbiota community shifts with increased Clostridiales evident in Prevotella-stratified NBD and Bacteroides-stratified MS patients. CONCLUSIONS Patient cohort stratification may be needed to facilitate identification of common microbiota community shifts for causation testing in disease.
Objective measures of physical performance associated with depression and/or anxiety in midlife Singaporean women.

OBJECTIVES The aim of this study was to identify correlates of depression and anxiety in midlife Asian women, with a special focus on the potential role of objectively measured physical performance. METHODS Sociodemographic characteristics, reproductive health, menopause status, medical history, lifestyle choices, physical activity, and physical performance of healthy women aged 45 to 69 attending routine gynecologic care were collected. Depressive symptoms were assessed utilizing the Center for Epidemiologic Studies for Depression Scale (CES-D) and anxiety symptoms by the General Anxiety Disorder Scale (GAD-7). Upper body physical performance was assessed by handgrip strength, and lower body physical performance was assessed by the Short Physical Performance Battery. Chi-square tests and multivariable models were used to assess the crude and adjusted associations, respectively, between the studied risk factors and depression and/or anxiety. The main outcome measures were elevated depressive symptoms ≥16 on the CES-D, and/or elevated anxiety symptoms >10 on the GAD-7 score. RESULTS Of 1,159 women (mean age 56.3 ± 6.2), 181 (15.9%) were identified as having depressive and/or anxiety symptoms. Weak upper body (handgrip strength) and poor lower body strength (longer duration to complete the repeated chair stand test) were associated with elevated depressive and/or anxiety symptoms (adjusted odds ratio [aOR], 1.68; 95% CI, 1.18-2.40) and (aOR, 1.33; 95% CI, 1.09-1.63), respectively. CONCLUSIONS Weak upper and lower body physical performances were associated with depressive and anxiety symptoms in midlife Singaporean women. Future trials are required to determine whether strengthening exercises that improve physical performance could help reduce depressive and anxiety symptoms in midlife women. : Video Summary: Supplemental Digital Content 1, http://links.lww. com/MENO/A419.
Isoform-specific gene disruptions reveal a role for the V-ATPase subunit a4 isoform in the invasiveness of 4T1-12B breast cancer cells

The vacuolar H+-ATPase (V-ATPase) is an ATP-driven proton pump present in various intracellular membranes and at the plasma membrane of specialized cell types. Previous work has reported that plasma membrane V-ATPases are key players in breast cancer cell invasiveness. The two subunit a-isoforms known to target the V-ATPase to the plasma membrane are a3 and a4, and expression of a3 has been shown to correlate with plasma membrane localization of the V-ATPase in various invasive human breast cancer cell lines. Here we analyzed the role of subunit a-isoforms in the invasive mouse breast cancer cell line, 4T1-12B. Quantitation of mRNA levels for each isoform by quantitative RT-PCR revealed that a4 is the dominant isoform expressed in these cells. Using a CRISPR/Cas9-based approach to disrupt the genes encoding each of the four V-ATPase subunit a-isoforms, we found that ablation of only the a4-encoding gene significantly inhibits invasion and migration of 4T1-12B cells. Additionally, cells with disrupted a4 exhibited reduced V-ATPase expression at the leading edge, suggesting that the a4 isoform is primarily responsible for targeting the V-ATPase to the plasma membrane in 4T1-12B cells. These findings suggest that different subunit a-isoforms may direct V-ATPases to the plasma membrane of different invasive breast cancer cell lines. They further suggest that expression of V-ATPases at the cell surface is the primary factor that promotes an invasive cancer cell phenotype.
Development and Validation of a Parent-Based Program for Preventing Gaming Disorder: The Game Over Intervention

Since the inclusion of gaming disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition for further study, there has been an increasing consensus that problematic gaming can be detrimental to mental health, yet efforts in preventing such problems from emerging have been limited. To address this gap, we developed the Game Over Intervention (GOI), a parent-based program designed based on the frameworks of ecological systems theory and self-determination theory. This study aimed to test the efficacy of the new program using the method of a randomized controlled trial, with the control condition being a program for effective learning. Participants were the parents of upper primary school students, with 163 (77% women; Mage = 42.70) and 199 (83% women; Mage = 41.82) partaking in the intervention and the control conditions, respectively. Participants rated their children’s gaming time, exposure to violent video games, and symptoms of gaming disorder at three time points: baseline, one week after intervention, and three months after intervention. The results indicate a general reduction in these three criteria across the three-month period. Our study provides tentative evidence demonstrating the effectiveness of the GOI in mitigating some gaming-related problems.
Response of osteocalcin and insulin resistance after a hypocaloric diet in obese patients.

OBJECTIVE Osteocalcin is a hormone with a complex cross-talk between adipose tissue and the skeleton. The aim of the present study was to explore the change of osteocalcin, insulin resistance, and adipocytokines after hypocaloric diet in obese patients. PATIENTS AND METHODS A population of 178 obese patients was analyzed. At basal time and 2 months after the dietary intervention, weight, fat mass, body mass index, basal glucose, insulin, insulin resistance (HOMA), total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, leptin, adiponectin, IL-6, TNF alpha and osteocalcin levels were measured. RESULTS After dietary treatment, BMI, weight, fat mass, waist circumference, waist to hip ratio, systolic pressure, glucose, HOMA, triglycerides, total cholesterol, leptin and LDL cholesterol decreased significantly. Osteocalcin levels have a significant decrease after weight loss (Osteocalcin (ng/ml); 9.76 ± 5.3 vs 9.31 ± 4.1: p < 0.05). In correlation analysis, a negative association was detected among osteocalcin and age, BMI, fat mass, glucose, C reactive protein, interleukin-6. In the linear regression with age-, sex-, BMI, fat mass- and insulin- adjusted, only C reactive protein concentrations are related with osteocalcin levels -0.21 (CI 95%: -0.40 -0.009). CONCLUSIONS Osteocalcin decreased after a weight loss treatment. Moreover, osteocalcin levels, before and after treatment, were related in a negative way with CRP fat mass, body mass index, age and glucose levels.
Oral Health and Mortality Risk from Pneumonia in the Elderly

Although poor oral health influences the occurrence of pulmonary infection in elderly people, it is unclear how the degree of oral health is linked to mortality from pulmonary infection. Therefore, we evaluated the relationship between oral health and four-year mortality from pneumonia in an elderly Japanese population. The study population consisted of 697 (277 males, 420 females) of the 1282 individuals who were 80 years old in 1997. Data on oral and systemic health were obtained by means of questionnaires, physical examinations, and laboratory blood tests. One hundred eight of the study persons died between 1998 and 2002. Of these, 22 deaths were due to pneumonia. The adjusted mortality due to pneumonia was 3.9 times higher in persons with 10 or more teeth with a probing depth exceeding 4 mm (periodontal pocket) than in those without periodontal pockets. Therefore, the increase in teeth with periodontal pockets in the elderly may be associated with increased mortality from pneumonia.
ANNALS EXPRESS: Uninterpretable cerebrospinal fluid absorbance scan caused by doxycycline therapy.

The revised national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage (UK) provide a framework for analysis of cerebrospinal fluid samples for the purpose of investigation of subarachnoid haemorrhage. In principle, as long as samples are collected and analysed according to the guidelines, any absorbance scan thus obtained ought to be amenable to interpretation. The case presented involves a cerebrospinal fluid sample with an absorbance scan which could not be interpreted with the guidelines. An archive search for similar cases suggested interference from doxycycline therapy as the cause. Doxycycline was confirmed to be the cause through experimental in vitro reproduction of the interference. Difficulties arising from this interference are discussed. It is hoped that a future version of the guidelines may mention, and propose a means of dealing with, the issue of doxycycline interference.
Prevalence of impacted third molars among orthodontic patients in different malocclusions

Objectives: The aim of this retrospective study was to investigate the prevalence and pattern of third molar impaction and missing third molars in patients over 18 years in different anteroposterior skeletal patterns among central Indian populations. Materials and Methods: The study reviewed 357 orthopantomograms of patients attending the Government College of Dentistry, Indore, Madhya Pradesh. Patients were evaluated to determine the prevalence of third molar impaction, angulation, and level of eruption in Class I, Class II, and Class III patients using Winter's classification to determine angulation of third molars and Pell and Gregory classification for level of impaction. Results: Out of 357 patients, 187 (52.3%) were present with at least one impacted teeth. The third molar impaction was most commonly present in Class II malocclusion (60.65%). Overall, the most common angulation of impaction in both genders was the mesioangular (39%), and the most common level of impaction in both arches was Level B. In Class I, Class II and Class III malocclusion vertical angulation was the most common finding in the maxillary arch and mesioangular angulation in the mandibular arch. No significant association was observed between different types of malocclusion and third molar impaction (P > 0.4648). Conclusion: This study found that almost half of the adult patients above 18 years had at least one impacted third molar. The anteroposterior relationship does not have any significant role for the third molar impaction.
The mechanism of the suppressive action of bromocriptine on adrenocorticotropin secretion in patients with Cushing's disease and Nelson's syndrome.

The oral administration of 2.5 mg bromocriptine elicited a significant suppression of plasma ACTH and cortisol in 6 of 13 patients with untreated Cushing′s disease. In the responding patients, mean plasma ACTH levels were higher and pituitary tumor size was larger than in the nonresponders. In two patients with Nelson′s syndrome, plasma ACTH was diminished by 70% and 30%, respectively, from 4-6 h after 2.5 mg bromocriptine. In one patient with ectopic ACTH secretion from a bronchial carcinoid, plasma ACTH was suppressed by 32% from 3-5 h after 2.5 mg bromocriptine. The effects of bromocriptine and cyproheptadine on the secretion of ACTH from trypsin-dispersed tumor cells prepared from the ACTH-secreting rat pituitary tumor 7315a were investigated in vitro. Bromocriptine (1 µM) inhibited ACTH secretion by 40% (P < 0.01), while 1 JUM cyproheptadine inhibited ACTH secretion by 25% (P < 0.01). On the basis of 1) the direct effects of bromocriptine and cyproheptadine on ACTH secretion by rat pituitary tumor ce.
Stevens‐Johnson syndrome and toxic epidermal necrolysis: a retrospective descriptive study

Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and potentially life‐threatening mucocutaneous reactions. Given their rarity, limited cohort studies have been done. The aim of this study is to evaluate and compare the demographics, etiology, management, clinical and laboratory characteristics, complications, and outcome of SJS/TEN patients seen by the inpatient dermatology service at the University of Puerto Rico.
Real‐Time Observation of Superstructure‐Dependent DNA Origami Digestion by DNase I Using High‐Speed Atomic Force Microscopy

DNA nanostructures have emerged as intriguing tools for numerous biomedical applications. However, in many of those applications and most notably in drug delivery, their stability and function may be compromised by the biological media. A particularly important issue for medical applications is their interaction with proteins such as endonucleases, which may degrade the well‐defined nanoscale shapes. Herein, fundamental insights into this interaction are provided by monitoring DNase I digestion of four structurally distinct DNA origami nanostructures (DONs) in real time and at a single‐structure level by using high‐speed atomic force microscopy. The effect of the solid–liquid interface on DON digestion is also assessed by comparison with experiments in bulk solution. It is shown that DON digestion is strongly dependent on its superstructure and flexibility and on the local topology of the individual structure.
Lagrangian carotid strain imaging indices normalized to blood pressure for vulnerable plaque

Ultrasound Lagrangian carotid strain imaging (LCSI) utilizes physiological deformation caused by arterial pressure variations to generate strain tensor maps of the vessel walls and plaques. LCSI has been criticized for the lack of normalization of magnitude‐based strain indices to physiological stimuli, namely blood pressure. We evaluated the impact of normalization of magnitude‐based strain indices to blood pressure measured immediately after the acquisition of radiofrequency (RF) data loops for LCSI.