Miracle-dz/UniFAR-FTUs huggingface dataset:
Adverse Events of Cervical Arthroplasty

Rates of adverse events after cervical arthroplasty mirror those of arthrodesis. Different patterns of adverse events occur including those related to any prosthetic devices such as subsidence, heterotrophic ossification, dislodgement, malposition, and infection. The use of proper indications, preoperative planning, and meticulous techniques can avoid the majority of these complications. Sizing and exact placement in the correct mechanical axis is essential and requires accurate biplanar fluoroscopic imaging. Further, spinal related events include clinical failure related to inadequate foramenal decompression and spinal cord injury. Compared with arthrodesis where residual foramenal stenosis may be tolerated, maintenance of motion by arthroplasty may cause loading in the uncus with further hypertrophy and persistent or recurrent symptoms. This is best prevented by assuring wide foramenal decompression at the time of arthroplasty. Spinal cord injury during implantation has not been reported. Wear of the bearing surfaces and formation of debris particles can cause loosening and prosthetic failure. This has not been reported as yet after cervical arthroplasty due to the relatively short time of follow-up for most devices. Two notable cases of apparent metal hypersensitivity causing formation of a pseudotumor have been seen after placement of a metal on metal cobalt-chrome prosthesis. The treatment of malpositioned or hardware-related events is by removal and arthrodesis usually not requiring corpectomy and fusion of other levels. Radiculopathy from foramenal stenosis at the index level site can be resolved with posterior microforamenotomy.
Complications and mortality in hereditary hemorrhagic telangiectasia

Objectives: Studies report that the risks of significant neurologic complications (including stroke, cerebral abscess, and migraine) and hemorrhagic sequelae are high in patients with hereditary hemorrhagic telangiectasia (HHT), and that life expectancy in this cohort is reduced. However, most published cohorts derive from specialist centers, which may be susceptible to bias. Methods: We used a population-based approach to estimate the risks of developing neurologic and hemorrhagic complications of HHT, the association of a diagnosis of HHT with common cardiovascular and malignant comorbidities, and also long-term survival of those with the disease. Results: From a UK primary care database of 3.5 million patients (The Health Improvement Network), we identified 675 cases with a diagnosis of HHT and compared them with 6,696 controls matched by age, sex, and primary care practice. Risks of stroke (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.2–2.6), cerebral abscess (OR 30.0, CI 3.1–288), and migraine (OR 1.7, CI 1.3–2.2) were elevated over controls. Bleeding complications including epistaxis (OR 11.6, CI 9.1–14.7) and gastrointestinal hemorrhage (OR 6.1, CI 2.8–13.4) were more common in cases with HHT. Survival of cases with HHT was poorer than controls with a hazard ratio for death of 2.0 (CI 1.6–2.6) and a median age at death 3 years younger. Conclusions: Patients with HHT are at substantially increased risk of serious neurologic and hemorrhagic complications of the disease. Because a diagnosis of HHT is associated with a significantly poorer survival compared with those who have no disease, evaluation of new strategies to improve clinical management is required.
The surgically remediable syndrome of epilepsy associated with bottom-of-sulcus dysplasia

Objective: To determine clinical and EEG features that might help identify patients with epilepsy harboring small, intrinsically epileptogenic, surgically treatable, bottom-of-sulcus dysplasias (BOSDs). Methods: Retrospective review of clinical records, EEG, MRI, and histopathology in 32 patients with drug-resistant epilepsy and MRI-positive (72% 3.0 tesla), pathologically proven (type 2B cortical dysplasia) BOSDs operated at our centers during 2005–2013. Results: Localization of BOSDs was frontal in 19, insula in 5, parietal in 5, and temporal in 3, on the convexity or interhemispheric surfaces. BOSDs were missed on initial MRI at our centers in 22% of patients. Patients presented with focal seizures during infancy in 9, preschool years in 15, and school years in 8 (median age 5 years). Seizures were stereotyped, predominantly nocturnal, and typically nonconvulsive, with semiology referable to the fronto-central or perisylvian regions. Seizures occurred at high frequency during active periods, but often went into prolonged remission with carbamazepine or phenytoin. Intellect was normal or borderline, except in patients with seizure onset during infancy. Scalp EEG frequently revealed localized interictal epileptiform discharges and ictal rhythms. Patients underwent lesionectomy (median age 14 years) guided by electrocorticography and MRI, with prior intracranial EEG monitoring in only one patient. Twenty-eight patients (88%) became seizure-free, and 20 discontinued antiepileptic medication (median follow-up 4.1 years). Conclusions: In patients with cryptogenic focal epilepsy, this clinical presentation and course should prompt review of or repeat MRI, looking for a BOSD in the frontal, parietal, or insula cortex. If a BOSD is identified, the patient might be considered for single-stage lesionectomy.
Knowledge, attitudes, and behaviours of healthcare professionals regarding child maltreatment in China

BACKGROUND A new, recently issued national law and regulation in China conferred the responsibility of healthcare professionals in child maltreatment intervention. However, few studies have reported on the recognition and reporting of child maltreatment by healthcare professionals in China. The aim of this study was to assess healthcare professionals' knowledge, attitudes, and self-perceived behaviour in terms of identifying, assessing, and reporting child maltreatment cases in China. METHODS A cross-sectional survey of 877 healthcare professionals from four provinces was conducted using a structured questionnaire. RESULTS The respondents demonstrated insufficient knowledge on identifying potential child maltreatment cases. Over 30% of them were less than confident in the medical examination, evaluation, and treatment of child maltreatment cases, especially with regard to cases involving sexual abuse. Only 3.19% of respondents had ever received training on child maltreatment intervention, and as a result, lack of knowledge with regard to dealing with child maltreatment cases, referral procedures, and regulations was indicated to be the main cause of underreporting. CONCLUSIONS Healthcare professionals in China have insufficient knowledge, skills, and confidence when it comes to dealing with all aspects of child maltreatment. Although participants reported a positive attitude towards their role in detecting and reporting child maltreatment cases, there are obstacles that hinder them from doing so. Appropriate training courses should be developed to empower professionals with knowledge and skills, as well as increase their confidence in dealing with suspected child maltreatment cases.
The internet as a source of support for youth with chronic conditions: A qualitative study

BACKGROUND Adolescents living with chronic conditions often portray themselves as "healthy" online, yet use the Internet as one of their top sources of health information and social communication. There is a need to develop online support programs specific to adolescents with chronic conditions in order to provide a private space to discuss concerns. This paper endeavors to increase our understanding of the online support needs and wants of these adolescents and their interest in and preferences for an online support program. METHODS A qualitative descriptive study using semistructured interviews was completed. Stratified purposive sampling was utilized to ensure a representative sample based on age and diagnosis. English speaking adolescents (aged 12-18 years) diagnosed with a chronic condition were recruited from clinic and inpatient areas across 3 paediatric hospitals in Canada. RESULTS Thirty-three participants aged 15.3 ± 1.8 years (64% female) completed the study. The main topics identified were (a) the purpose of current online activity, (b) the benefits and challenges of existing online supports, and (c) a description of ideal online resources. The purpose of online activity was social networking, information, online gaming, and social support. When accessing health information online, participants prioritized websites that were easy to access and understand despite the trustworthiness of the site. The reported benefits and challenges varied across participants with many areas perceived as both a benefit and a challenge. The majority of participants were interested in participating in an online support program that included both accurate disease-related information and a community of other adolescents to provide social support. CONCLUSIONS Adolescents with chronic conditions are interested in online support that encompasses health information and social support that is flexible and easy to navigate. Findings can be used to develop or adapt existing online support programs for adolescents with chronic conditions to help increase engagement and utilization.
Salmonella spp., importante agente patogênico veiculado em alimentos

A ocorrencia de doencas transmitidas por alimentos (DTAs) tem sido foco de discussoes nos ultimos anos, devido a preocupacao mundial com estrategias que permitam seu controle e, consequentemente, garantam a colocacao de produtos seguros no mercado consumidor. A Salmonella spp. e um dos microrganismos mais amplamente distribuidos na natureza, sendo o homem e os animais seus principais reservatorios naturais, com ocorrencia de sorotipos regionais, reconhecidos como salmoneloses, e considerado como um dos principais agentes envolvidos em surtos de origem alimentar em paises desenvolvidos. O aumento da incidencia da salmonelose provocada por alimentos contaminados demonstra que, na atualidade, apesar dos avancos tecnologicos alcancados, este problema ainda ocorre mundialmente. As aves e bovinos sao responsaveis pela maior disseminacao desse agente patogenico. A ampla distribuicao da Salmonella spp. entre os animais, a existencia de portadores assintomaticos e sua permanencia no ambiente e nos alimentos contribuem para que este microrganismo assuma um papel de grande relevância na saude publica mundial e, portanto, programas permanentes de controle e erradicacao devem ser adotados.
068-ICLINICAL AND HAEMODYNAMIC OUTCOMES IN 804 PATIENTS RECEIVING THE FREEDOM SOLO STENTLESS AORTIC VALVE: RESULTS FROM AN INTERNATIONAL PROSPECTIVE MULTICENTRE STUDY

OBJECTIVES: The Freedom SOLO™ valve (Sorin Group, Italy) is a stentless aortic bioprosthesis designed for simplified implantation. The present multicentre study is the largest prospective evaluation of this prosthesis. Herein, we report on outcomes at 3-year follow-up. METHODS: From March 2009 to February 2013, a total of 804 consecutive patients (mean age 74.9 ± 6.3 years; 45.1% females) underwent aortic valve replacement with the Freedom SOLO™ valve at 33 centres. Concomitant procedures (70.2% coronary artery bypass grafting) were performed in 376 patients. The cumulative follow-up included 1100 patient-years (mean 16.5 ± 10.8 months; range: 0–40.5 months). RESULTS: Sixty-four patients died (14 early, 50 late); 12 deaths (1 early, 11 late) were valve-related. Operative mortality (30 days) was 1.7%. At 3 years, overall survival was 82.6% [95% confidence interval (CI) 75.5–87.8%] and freedom from valve-related death was 95.5% (95% CI 89.2–98.2%). Linearized late event rates were 0.82%/patient-years for non-structural valve dysfunction, 0.55%/patient-years for structural valve deterioration, 1.55%/patient-years for endocarditis, 3.64%/patient-years for thromboembolism and 3.18%/patient-years for bleeding. In total, there were 22 reinterventions [19 valve explants, 2 refixations, 1 transcatheter aortic valve intervention (TAVI)] for endocarditis (11), non-structural dysfunction (9) and structural valve deterioration (2). Freedom from reintervention was 95.2% (95% CI 91.2–97.4%) at 3 years. There were no instances of valve thrombosis or haemolysis. At 1, 2 and 3 years, 97.0, 95.5 and 91.4% of patients were in NYHA class I or II. Between discharge and 3 years after surgery, mean transvalvular gradients exhibited a non-significant increase (6.5 ± 4.3 vs 8.7 ± 6.5 mmHg), whereas effective orifice area index remained stable (0.9 ± 0.2 vs 0.8 ± 0.3 cm 2 /m 2 ). At 3 years, no patient presented with more than mild aortic regurgitation. Left ventricular mass index decreased significantly between discharge and 1 year after surgery (139.4 ± 40.9 vs 122.4 ± 35.3 g/m 2 , P< 0.001) and remained unchanged thereafter. Left ventricular size and function did not change over time. CONCLUSIONS: The Freedom SOLO™ valve is a unique stentless pericardial bioprosthesis whose design favours haemodynamic performance and thus facilitates left ventricular reverse remodelling. In terms of survival, morbidity and functional status, it is associated with beneficial outcomes up to 3 years after surgery. Ongoing follow-up will assess the valve at the long-term course.
Subjective cognitive concerns, amyloid-β, and neurodegeneration in clinically normal elderly

Objective: To determine whether neuroimaging biomarkers of amyloid-β (Aβ) and neurodegeneration (ND) are associated with greater self-reported subjective cognitive concerns (SCC) in clinically normal older individuals. Methods: A total of 257 participants underwent Pittsburgh compound B PET, PET with fluorodeoxyglucose 18F, and structural MRI, as well as a battery of neuropsychological measures including several questionnaires regarding SCC. Individuals were classified into 4 biomarker groups: biomarker negative (Aβ−/ND−), amyloidosis alone (Aβ+/ND−), amyloidosis plus ND (Aβ+/ND+), and ND alone (Aβ−/ND+). Results: Both Aβ and ND were independently associated with greater SCC controlling for objective memory performance. By contrast, neither Aβ nor ND was associated with objective memory performance controlling for SCC. Further examination revealed greater SCC in individuals with Aβ or ND positivity compared to biomarker-negative individuals. In addition, greater SCC predicted Aβ positivity when controlling for ND status. Conclusions: When individuals were grouped by biomarker status, those who were positive on Aβ or ND had the highest report of SCC compared to biomarker-negative individuals. Findings were consistent when SCC was used to predict Aβ positivity. Taken together, results suggest that both Aβ and ND are associated with SCC, independent of objective memory performance. Enrichment of individuals with SCC may increase likelihood of Aβ and ND markers in potential participants for secondary prevention trials.
Cerebral amyloidosis associated with cognitive decline in autosomal dominant Alzheimer disease

Objective: To investigate the associations of cerebral amyloidosis with concurrent cognitive performance and with longitudinal cognitive decline in asymptomatic and symptomatic stages of autosomal dominant Alzheimer disease (ADAD). Methods: Two hundred sixty-three participants enrolled in the Dominantly Inherited Alzheimer Network observational study underwent neuropsychological evaluation as well as PET scans with Pittsburgh compound B. One hundred twenty-one participants completed at least 1 follow-up neuropsychological evaluation. Four composite cognitive measures representing global cognition, episodic memory, language, and working memory were generated using z scores from a battery of 13 standard neuropsychological tests. General linear mixed-effects models were used to investigate the relationship between baseline cerebral amyloidosis and baseline cognitive performance and whether baseline cerebral amyloidosis predicts cognitive change over time (mean follow-up 2.32 years ± 0.92, range 0.89–4.19) after controlling for estimated years from expected symptom onset, APOE ε4 allelic status, and education. Results: In asymptomatic mutation carriers, amyloid burden was not associated with baseline cognitive functioning but was significantly predictive of longitudinal decline in episodic memory. In symptomatic mutation carriers, cerebral amyloidosis was correlated with worse baseline performance in multiple cognitive composites and predicted greater decline over time in global cognition, working memory, and Mini-Mental State Examination. Conclusions: Cerebral amyloidosis predicts longitudinal episodic memory decline in presymptomatic ADAD and multidomain cognitive decline in symptomatic ADAD. These findings imply that amyloidosis in the brain is an indicator of early cognitive decline and provides a useful outcome measure for early assessment and prevention treatment trials.
Effect of transfer with younger and older adults on control solution testing using two blood glucometers

As of 2005, 5.5% of the American population had some form of diabetes, with an increasing rate of diagnosis. Adults 65 years of age and over are at an increased risk for developing diabetes. Sixty-four participants completed 10 trials of control solution testing. MANOVA results indicated main effects of participant age and order of glucometer use on dependent variables. Follow-up ANOVAs revealed a main effect of age on task time, errors during training, and near transfer errors, and a main effect of glucometer use on rate of near and far transfer errors committed. Results and avenues of further investigation are discussed.
Helping the One You Hurt: Toddlers' Rudimentary Guilt, Shame, and Prosocial Behavior After Harming Another.

This study explored the role of guilt and shame in early prosocial behavior by extending previous findings that guilt- and shame-like responses can be distinguished in toddlers and, for the first time, examining their associations with helping. Toddlers (n = 32; Mage = 28.9 months) were led to believe they broke an adult's toy, after which they exhibited either a guilt-like response that included frequently confessing their behavior and trying to repair the toy; or a shame-like response that included frequently avoiding the adult and seldom confessing or attempting to repair the toy. In subsequent prosocial tasks, children showing a guilt-like response helped an adult in emotional distress significantly faster and more frequently than did children showing a shame-like response.
Infant Attention Is Dynamically Modulated With Changing Arousal Levels.

Traditional accounts of developing attention and cognition emphasize static individual differences in information encoding; however, work from Aston-Jones et al. suggests that looking behavior may be dynamically influenced by autonomic arousal. To test this model, a 20-min testing battery constituting mixed photos and cartoon clips was shown to 53 typical 12-month-olds. Look duration was recorded to index attention, and continuous changes in arousal were tracked by measuring heart rate, electrodermal activity, and movement levels. Across three analyses, we found that continuous changes in arousal tracked simultaneous changes in attention measures, as predicted by the Aston-Jones model. It was also found that changes in arousal tended to precede (occur before) subsequent changes in attention. Implications of these findings are discussed.
Is electrocorticography-based language mapping ready to replace stimulation?

Worldwide experts consider presurgical electrocorticography (ECoG) or intracerebral electrode monitoring a necessary evaluation tool for a selected population of patients with focal epilepsy. The goal of chronic ECoG monitoring at bedside generally includes localizing the seizure onset zone presumably responsible for generation of habitual seizures and localizing the eloquent areas to be preserved for avoiding major functional deficits following cortical resection. Language function directly determines the quality of life in patients following epilepsy surgery; thus, each surgical team makes the best effort to localize the language areas before performing resective surgery.
Statins and poststroke intracerebral hemorrhage

Post hoc analyses of data from randomized controlled trials can generate useful hypotheses, but need to be considered exploratory. When conducted, such evaluations should adhere to specified criteria and test for a treatment by subgroup interaction for the trial's primary endpoint.1 The best way to proceed if unexpected but potentially important outcomes occur is less clear. Concern that treatment with HMG-CoA reductase inhibitors (i.e., statins) might increase the risk of poststroke intracerebral hemorrhage (ICH) arose from an unanticipated observation in the Stroke Prevention with Aggressive Reduction in Cholesterol Levels (SPARCL) trial.2 In SPARCL, patients who had a noncardioembolic ischemic stroke (67%) or TIA (31%) or hemorrhagic stroke (2%) within the prior 1 to 6 months were randomized to high-dose atorvastatin or placebo. SPARCL found an overall reduction in the risk of the primary outcome (fatal or nonfatal stroke; adjusted hazard ratio [HR] 0.84; 95% confidence interval [CI] 0.71–0.99) despite an increase in hemorrhagic stroke (HR 1.66, 95% CI 1.08–2.55) in the atorvastatin group with statistical heterogeneity based on the type of stroke occurring during the trial (ischemic, hemorrhagic, or unclassified stroke). In addition to atorvastatin treatment, subsequent exploratory analyses using multivariable regression revealed higher hemorrhagic stroke risk in those having a hemorrhagic stroke as the entry event (HR 5.65, 95% CI 2.82–11.30), in men (HR 1.79, 95% CI 1.13–2.84), and with increased age (10-year increments, HR 1.42, 95% CI 1.16–1.74). There were no statistical interactions between these factors and treatment.3 Concern about a statin-related increase in ICH after stroke also arose after a post hoc analysis of the Heart Protection Study showed a nonsignificant increase in hemorrhagic stroke rate in those with a history of cerebrovascular disease (n = 3,280) treated with simvastatin vs placebo (1.3% vs 0.7%; p for heterogeneity = 0.03). 4 Among those treated with atorvastatin in SPARCL, patients with lower low-density lipoprotein (LDL) cholesterol levels had no increased risk of brain hemorrhage.3 Nonetheless, the fact that at least some observational studies (largely Asian populations) suggested an inverse relationship between cholesterol levels and bleeding risk caused further concern.5,6