Miracle-dz/UniFAR-FTUs huggingface dataset:
Morbidity in 303 first-episode bipolar I disorder patients.

OBJECTIVES To test the hypotheses that: (i) depressive-dysthymic-dysphoric (D-type) morbidity is more prevalent than manic-hypomanic-psychotic (M-type) morbidity even from first episodes of bipolar I disorder (BPD-I) and despite treatment; (ii) initial presentations predict later morbidity; (iii) morbidity varies internationally; and (iv) early and later morbidity are similar. METHODS We followed SCID-based, DSM-IV BPD-I patients (n = 303) systematically and prospectively for two years to estimate the percent of weeks in specific morbid states from first lifetime major episodes. RESULTS Total morbidity accounted for 44% of the first two years, and D-type exceeded M-type illnesses by 2.1-fold (30%/14%) among morbidities ranking: mixed states (major + minor) >or= dysthymia >or= mania >or= major depression > hypomania > psychosis. In 164 cases, morbidities at 0.5-2.5 and 2.5-4.5 years were very similar. Depressive or mixed initial episodes predicted a 3.6-fold excess of D-type morbidity, and initial M-type episodes predicted a 7.1-fold excess of M-type morbidity over two years. Morbidity in European (EU) sites was nearly half that in the U.S., and 22% greater overall among men than women. In five comparable studies, illness accounted for 54% of follow-up time, and the ratio of D/M morbidity averaged 3.0. CONCLUSIONS In accord with four midcourse studies, morbidity from BPD-I onset, despite treatment by community standards, averaged 44%, was 68% D-type morbidity, and was strongly predicted by first-episode polarity. Lower morbidity in EU than U.S. sites may reflect differences in healthcare or social systems.
Immunosuppressants reduce venous thrombosis relapse in Behçet's disease.

OBJECTIVE To investigate and describe the long-term outcome of venous thrombosis in patients with Behçet's disease (BD). METHODS In a retrospective cohort of 807 BD patients, a reported 296 patients (36.7%) (73.3% male, median age 30 years [interquartile range 24-36 years]) met the international classification criteria for BD and had venous thrombosis. We assessed factors associated with thrombosis relapse and mortality. RESULTS There were a total of 586 venous thrombosis events, including 560 cases of deep thrombosis and 26 cases of superficial thrombosis. Deep venous thrombosis events included 323 cases of limb thrombosis (55.1%), 77 cases of cerebral venous thrombosis (13.1%), 57 cases of pulmonary embolism (9.7%), 63 cases of vena cava lesions (10.7%), 14 cases of Budd-Chiari syndrome (2.4%), and 13 cases of cervical vein thrombosis (2.2%). One hundred of 296 patients (33.8%) experienced at least 1 venous thrombosis relapse. The mortality rate was 6.4% (19 of 296 patients) after a median followup of 4.75 years (interquartile range 2-7 years). In univariate analysis, death was associated with cardiac involvement (P = 0.026) and Budd-Chiari syndrome (P = 0.004). In multivariate analysis, the use of immunosuppressive agents was found to prevent relapse of venous thrombosis (hazard ratio 0.27 [95% confidence interval 0.14-0.52], P = 0.00021), and there was a trend toward prevention of relapse with the use of glucocorticoids (hazard ratio 0.62 [95% confidence interval 0.40-0.97], P = 0.058). CONCLUSION Immunosuppressive agents significantly reduce venous thrombosis relapse in BD.
Cortical and subcortical white matter abnormalities in adults with remitted first-episode mania revealed by Tract-Based Spatial Statistics.

OBJECTIVES Abnormalities of brain white matter have been noted in structural magnetic resonance imaging and diffusion tensor imaging (DTI) studies of bipolar disorder, but there are fewer investigations specifically examining white matter integrity early in the course of illness. In this study, we employed DTI to elucidate white matter changes in adult patients with remitted first-episode mania and hypothesized that first-episode mania was associated with decreased fractional anisotropy in cortical (frontal) and subcortical (thalamus, striatum) white matter as well as white matter tracts (cingulum, corpus callosum). METHODS Diffusion tensor images were acquired from 16 patients with remitted first-episode mania and 16 healthy controls matched for age, gender, handedness, and years of education. Fractional anisotropy and radial and axial diffusivities were analyzed using Tract-Based Spatial Statistics. RESULTS Patients had lower fractional anisotropy and higher radial diffusivity in the left anterior frontal white matter, right posterior thalamic radiation, left cingulum, and bilateral sagittal striatum. In addition, increased radial diffusivity was found in the left corpus callosum. CONCLUSION Our findings highlighted that white matter abnormalities were present by the time of remission of first-episode mania. The widespread occurrence of these white matter abnormalities both in first-episode mania and chronic bipolar disorder suggested that disruption of white matter cortical-subcortical networks as well as projection, associative, and commissural tracts is a hallmark of the illness.
Chronic Hepatitis C in the Hispanic/Latino Population Living in the United States: A Literature Review

Advanced practice nurses are faced with the clinical challenge of recognizing risk factors for chronic hepatitis C, not only in the native-born population, but also in the immigrant populations in the United States. Hispanics/Latinos constitute 13% of the U.S. population and are the fastest growing minority in the United States. A greater understanding of chronic hepatitis C in this populace was accomplished by reviewing current literature in the areas of natural history, epidemiology of risk factors, screening practices, and therapy outcomes. This review serves as a foundation for the creation of a culturally competent assessment tool for the screening of chronic hepatitis C in this population. The information from the literature review suggests that Hispanics/Latinos have an overall prevalence rate for chronic hepatitis C of 2.6%; have faster liver fibrosis progression rates; are infected at an earlier age; are more likely to be HIV coinfected; and show significantly higher alanine transaminase, aspartate transaminase, and bilirubin levels. They also have more portal inflammation than do Caucasians and African Americans and a higher prevalence of cirrhosis than do African Americans—more so in Hispanic women than in Hispanic men. Transfusion, tattoos, and iatrogenic transfer are risk factors that need to be assessed.
Recommendations for the nomenclature of IgG4-related disease and its individual organ system manifestations.

John H. Stone, Arezou Khosroshahi, Vikram Deshpande, John K. C. Chan, J. Godfrey Heathcote, Rob Aalberse, Atsushi Azumi, Donald B. Bloch, William R. Brugge, Mollie N. Carruthers, Wah Cheuk, Lynn Cornell, Carlos Fernandez-Del Castillo, Judith A. Ferry, David Forcione, Gunter Kloppel, Daniel L. Hamilos, Terumi Kamisawa, Satomi Kasashima, Shigeyuki Kawa, Mitsuhiro Kawano, Yasufumi Masaki, Kenji Notohara, Kazuichi Okazaki, Ji Kon Ryu, Takako Saeki, Dushyant Sahani, Yasuharu Sato, Thomas Smyrk, James R. Stone, Masayuki Takahira, Hisanori Umehara, George Webster, Motohisa Yamamoto, Eunhee Yi, Tadashi Yoshino, Giuseppe Zamboni, Yoh Zen, and Suresh Chari
A preliminary study of sleep in adolescents with bipolar disorder, ADHD, and non-patient controls.

OBJECTIVES To compare the sleep of adolescents with bipolar disorder (BD) to groups of adolescents with attention-deficit hyperactivity disorder-combined type (ADHD-C) and those without psychopathology. METHODS A sample of 13 adolescents diagnosed with BD who were not in the midst of a mood episode, 14 adolescents with ADHD-C, and 21 healthy controls, all between the ages of 11 and 17 years served as participants. They were psychiatrically evaluated using a structured diagnostic interview and completed four nights of in-home sleep monitoring using actigraphy and sleep diaries. RESULTS Sleep diary estimates of sleep indicated that participants with BD experienced more awakenings than their peers with ADHD, whereas actigraphic estimates revealed that participants with BD slept longer and with less wakefulness than their peers. CONCLUSIONS In between mood episodes, adolescents with BD experience their sleep as more fragmented than that of their peers but do not exhibit more disturbed sleep as estimated by actigraphy. The possible influence of psychotropic medication is an important consideration when assessing sleep in the context of BD.
A systematic review and meta-analysis comparing complications following total joint arthroplasty for rheumatoid arthritis versus for osteoarthritis.

OBJECTIVE Most of the evidence regarding complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) is based on studies of patients with osteoarthritis (OA), with little being known about outcomes in patients with rheumatoid arthritis (RA). The objective of the present study was to review the current evidence regarding rates of THA/TKA complications in RA versus OA. METHODS Data sources used were Medline, EMBase, Cinahl, Web of Science, and reference lists of articles. We included reports published between 1990 and 2011 that described studies of primary total joint arthroplasty of the hip or knee and contained information on outcomes in ≥200 RA and OA joints. Outcomes of interest included revision, hip dislocation, infection, 90-day mortality, and venous thromboembolic events. Two reviewers independently assessed each study for quality and extracted data. Where appropriate, meta-analysis was performed; if this was not possible, the level of evidence was assessed qualitatively. RESULTS Forty studies were included in this review. The results indicated that patients with RA are at increased risk of dislocation following THA (adjusted odds ratio 2.16 [95% confidence interval 1.52-3.07]). There was fair evidence to support the notion that risk of infection and risk of early revision following TKA are increased in RA versus OA. There was no evidence of any differences in rates of revision at later time points, 90-day mortality, or rates of venous thromboembolic events following THA or TKA in patients with RA versus OA. RA was explicitly defined in only 3 studies (7.5%), and only 11 studies (27.5%) included adjustment for covariates (e.g., age, sex, and comorbidity). CONCLUSION The findings of this literature review and meta-analysis indicate that, compared to patients with OA, patients with RA are at higher risk of dislocation following THA and higher risk of infection following TKA.
Blocking of p38 and transforming growth factor β receptor pathways impairs the ability of tolerogenic dendritic cells to suppress murine arthritis.

OBJECTIVE Dendritic cells (DCs) modulated with lipopolysaccharide (LPS) are able to reduce inflammation when therapeutically administered into mice with collagen-induced arthritis (CIA). The aim of this study was to uncover the mechanisms that define the tolerogenic effect of short-term LPS-modulated DCs on CIA. METHODS Bone marrow-derived DCs were stimulated for 4 hours with LPS and characterized for their expression of maturation markers and their cytokine secretion profiles. Stimulated cells were treated with SB203580 or SB431542 to inhibit the p38 or transforming growth factor β (TGFβ) receptor pathway, respectively, or were left unmodified and, on day 35 after CIA induction, were used to inoculate mice. Disease severity was evaluated clinically. CD4+ T cell populations were counted in the spleen and lymph nodes from inoculated or untreated mice with CIA. CD4+ splenic T cells were transferred from mice with CIA treated with LPS-stimulated DCs or from untreated mice with CIA into other mice with CIA on day 35 of arthritis. RESULTS Treatment with LPS-stimulated DCs increased the numbers of interleukin-10 (IL-10)-secreting and TGFβ-secreting CD4+ T cells, but decreased the numbers of Th17 cells. Adoptive transfer of CD4+ T cells from treated mice with CIA reproduced the inhibition of active CIA accomplished with LPS-stimulated DCs. The therapeutic effect of LPS-stimulated DCs and their influence on T cell populations were abolished when the p38 and the TGFβ receptor pathways were inhibited. CONCLUSION DCs modulated short-term (4 hours) with LPS are able to confer a sustained cure in mice with established arthritis by re-educating the CD4+ T cell populations. This effect is dependent on the p38 and the TGFβ receptor signaling pathways, which suggests the participation of IL-10 and TGFβ in the recovery of tolerance.
Interference pattern in perineal muscles: I. A quantitative electromyographic study in normal subjects

The electromyographic pattern (EMG) in two perineal muscles, the external anal sphincter muscle and the puborectalis muscle, was examined in 30 normal subjects consisting of women aged 24–77 years, using a concentric needle electrode. The interference pattern in the two muscles was recorded at rest and at maximal voluntary activation and analyzed with a computerized technique. The number of turns and the mean amplitudes in the interference pattern were measured and the recorded differences between the two investigated muscles as well as the differences compared to other striated extremity muscles are discussed. This technique (T/A analysis) has been shown to differentiate between neurogenic and myopathic changes in a weak muscle, and it is proposed that the technique could be useful in characterizing disturbances in perineal muscles in patients with micturition or defaecation dysfunctions.
Mental disorders in offspring of parents with bipolar and major depressive disorders

Vandeleur C, Rothen S, Gholam‐Rezaee M, Castelao E, Vidal S, Favre S, Ferrero F, Halfon O, Fumeaux P, Merikangas KR, Aubry J‐M, Burstein M, Preisig M. Mental disorders in offspring of parents with bipolar and major depressive disorders. Bipolar Disord 2012: 14: 641–653. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S.
Educational inequalities in avoidable deaths in Norway: A population based study

Abstract The question we raise in this paper is whether the educational gradient in avoidable mortality differs from overall and non-avoidable mortality among men and women in Norway. By avoidable deaths we refer to deaths caused by diseases that are either treatable if given appropriate medical care, or preventable if available preventive measures were implemented. The data set is derived from official administrative registers and includes all Norwegian men (1,107,427) and women (1,087,842) aged 25–67 years with information about status alive/dead during the period 1994–1999. Adjusted for sociodemographic and socioeconomic factors, education forms a marked and independent gradient in overall and non-avoidable mortality and an even steeper gradient in avoidable mortality – in particular in ischemic heart disease and preventable deaths. The educational gradient is shallower for deaths considered treatable by health care, but is still present. These patterns apply to men and women alike. The findings of our study suggest that health care and health policies may play a role in reducing inequalities in deaths that are ‘avoidable, unnecessary and unjust’.
Sizing up portal hypertension: Better noninvasive methods are needed

The “congestion index” is used to mean the ratio between the cross‐sectional area (cm2) and the blood flow velocity (cm/sec) of the portal vein, as determined by a duplex Doppler system. The indices as determined in normal subjects and patients with liver disease were as follows: normal subjects (n = 85), 0.070 ± 0.029 cm × sec; acute hepatitis (n = 11), 0.071 ± 0.014 cm × sec; chronic active hepatitis (n = 42), 0.119 ± 0.084 cm × sec; cirrhosis (n = 72), 0.171 ± 0.075 cm × sec; and idiopathic portal hypertension (n = 11), 0.180 ± 0.107 cm × sec. There was a statistically significant difference between the congestion indices from the normal subject group and indices obtained from patients with chronic hepatitis, cirrhosis, and idiopathic portal hypertension. A weak positive correlation was obtained between the congestion index and the portal venous pressure, measured simultaneously through a percutaneously placed catheter (n = 64, r = 0.45, p < 0.01). It is suggested that the congestion index reflects the pathophysiological hemodynamics of the portal venous system in portal hypertension.
Expansion of autoreactive unresponsive CD21-/low B cells in Sjögren's syndrome-associated lymphoproliferation.

OBJECTIVE Primary Sjögren's syndrome (SS) is an autoimmune disease associated with a high risk of developing non-Hodgkin's lymphoma. This study was undertaken to determine the nature of B cells driving lymphoproliferation in primary SS. METHODS B cell subsets and function were analyzed in peripheral blood from 66 adult patients with primary SS (including 14 patients with B cell lymphoproliferative disease [LPD]) and 30 healthy donors, using flow cytometry, calcium mobilization, and gene array analysis. The reactivity of recombinant antibodies isolated from single B cells from patients with primary SS and LPD was tested using an enzyme-linked immunosorbent assay. RESULTS We observed an expansion of an unusual CD21-/low B cell population that correlated with lymphoproliferation in patients with primary SS. A majority of CD21-/low B cells from patients with primary SS expressed autoreactive antibodies, which recognized nuclear and cytoplasmic structures. These B cells belonged to the memory compartment, since their Ig genes were mutated. They were unable to induce calcium flux, become activated, or proliferate in response to B cell receptor and/or CD40 triggering, suggesting that these autoreactive B cells may be anergic. However, CD21-/low B cells from patients with primary SS remained responsive to Toll-like receptor (TLR) stimulation. Molecules specifically expressed in CD21-/low B cells that are likely to induce their unresponsive stage were detected in gene array analyses. CONCLUSION Patients with primary SS who display high frequencies of autoreactive and unresponsive CD21-/low B cells are susceptible to developing lymphoproliferation. These cells remain in peripheral blood controlled by functional anergy instead of being eliminated, and chronic antigenic stimulation through TLR stimulation may create a favorable environment for breaking tolerance and activating these cells.
Constitutive expression of major histocompatibility complex class ii antigens in pulmonary epithelium and endothelium varies among different species

We have observed high constitutive levels of class II antigen expression on porcine and human coronary endothelium, but not on the endothelium of rats and mice. This study examines whether a similar interspecies difference exists in the expression of class II molecules on pulmonary epithelium and endothelium. Lung tissues from naïve human, porcine, and rodent sources were stained with the monoclonal antibody ISCR3 and examined by light microscopy. Immunoperoxidase staining of class II molecules was observed on human and porcine pulmonary epithelium and endothelium, but was absent in rats and mice. By using an antibody with cross-species reactivity, we demonstrated that naïve swine pulmonary epithelium and endothelium, unlike those of rodent species, express basal levels of class II antigens in a manner similar to that observed in human lung tissue. These interspecies differences may explain experimental differences observed between murine and large-animal constructs.
Reduced Fibrin Deposition and Intravascular Thrombosis in hDAF Transgenic Pig Hearts Perfused With Tirofiban

Background. Solid organ xenograft rejection is associated with vascular injury resulting at least in part in platelet activation, and rejected xenografts invariably demonstrate intravascular thrombosis and interstitial hemorrhage. Complement activation plays a prominent role in platelet-endothelial interaction. We tested the effects of platelet GPIIb/IIIa inhibitor tirofiban during perfusion of hDAF pig hearts. Methods. Using a working-heart model, nontransgenic and hDAF pig hearts were perfused with tirofiban or human blood only. Myocardial damage was determined by hemodynamic parameters (cardiac output, stroke work index) and creatine phosphokinase. Further monitoring included the assessment of complement factors (C3, C4), platelets, fibrinogen, ATIII, and graft histology. Results. Tirofiban increased cardiac output (CO) and stroke work index (SWI) of nontransgenic pig hearts and improved superior CO and SWI of hDAF pig hearts. Although perfusion time of nontransgenic pig hearts was prolonged by tirofiban (196±65 min vs. 162±122 min), a similar effect in hDAF pig hearts (218±116 min vs. 222±30 min) could not be demonstrated. Tirofiban reduced consumption of C3 and C4 independently from hDAF. Depletion of fibrinogen was equally diminished by tirofiban and hDAF; the combination of both agents obtained no further reduction. ATIII consumption was most effectively inhibited by this combination. Intravascular fibrin deposition was reduced by tirofiban and hDAF, but particularly by the combination of the two agents. Conclusions. Improvement of heart performance and reduction of myocardial damage and intravascular thrombosis confirm a role of the GPIIb/IIIa inhibitor tirofiban for the prevention of hDAF pig heart rejection and xenograft function.
Divergent effects of endogenous and exogenous glucocorticoid-induced leucine zipper in animal models of inflammation and arthritis.

OBJECTIVE Glucocorticoid-induced leucine zipper (GILZ) has effects on inflammatory pathways that suggest it to be a key inhibitory regulator of the immune system, and its expression is exquisitely sensitive to induction by glucocorticoids. We undertook this study to test our hypothesis that GILZ deficiency would exacerbate experimental immune-mediated inflammation and impair the effects of glucocorticoids on inflammation and, correspondingly, that exogenous GILZ would inhibit these events. METHODS GILZ(-/-) mice were generated using the Cre/loxP system, and responses were studied in delayed-type hypersensitivity (DTH), antigen-induced arthritis (AIA), K/BxN serum-transfer arthritis, and lipopolysaccharide (LPS)-induced cytokinemia. Therapeutic expression of GILZ via administration of recombinant adeno-associated virus expressing the GILZ gene (GILZ-rAAV) was compared to the effects of glucocorticoid in collagen-induced arthritis (CIA). RESULTS Increased T cell proliferation and DTH were observed in GILZ(-/-) mice, but neither AIA nor K/BxN serum-transfer arthritis was affected, and GILZ deficiency did not affect LPS-induced cytokinemia. Deletion of GILZ did not impair the effects of exogenous glucocorticoids on CIA or cytokinemia. In contrast, overexpression of GILZ in joints significantly inhibited CIA, with an effect similar to that of dexamethasone. CONCLUSION Despite effects on T cell activation, GILZ deficiency had no effect on effector pathways of arthritis and was unexpectedly redundant with effects of glucocorticoids. These findings do not support the hypothesis that GILZ is central to the actions of glucocorticoids, but the efficacy of exogenous GILZ in CIA suggests that further evaluation of GILZ in inflammatory disease is required.
Service Users' Perceptions and Experiences of Goal Setting Theory and Practice in an Inpatient Neurorehabilitation Unit

Goal setting is a key component in the rehabilitation process and clinical guidelines recommend collaboration between health care professionals, service users and their families. This qualitative preliminary study (n = 6) used semi-structured interviews to explore the perceptions and experiences of the goal setting process with service users on a neurorehabilitation unit. Two overall themes emerged: the components of goal setting and the factors that helped to guide the process. The participants reported experiencing varying levels of collaboration and concluded that goals should be achievable, realistic and negotiated, yet challenging. Short-term goals were seen as particularly valuable.