Miracle-dz/UniFAR-FTUs huggingface dataset:
Duodenal injuries in the very young: Child abuse?

BACKGROUND Duodenal injuries in children are uncommon but have been specifically linked with child abuse in case reports. Owing to the rarity of the diagnosis, few studies to date have looked at the association between duodenal injuries and mechanism in younger child. We hypothesize that duodenal injuries in the very young are significantly associated with child abuse. METHODS This investigation is a retrospective cohort study of patients admitted with duodenal injuries at one of six Level I pediatric trauma centers. All institutions had institutional review board approval. The trauma registries were used to identify children aged 0 year to 5 years from 1991 to 2011. Multiple variables were collected and included age, mechanism of injury, type of duodenal injury, additional injuries, mortality, and results of abuse investigation if available. Relationships were analyzed using Fischer’s exact test. RESULTS We identified 32 patients with duodenal injuries with a mean age of 3 years. Duodenal injuries included duodenal hematomas (44%) and perforations/transections (56%). Of all duodenal injuries, 53% resulted in operation, 53% had additional injuries, and 12.5% resulted in death. Of the 32 children presenting with duodenal injuries, 20 were child abuse patients (62.5%). All duodenal injuries in children younger than 2 years were caused by child abuse (6 of 6, p = 0.06) and more than half of the duodenal injuries in children older than 2 years were caused by child abuse (14 of 26). Child abuse–related duodenal injuries were associated with delayed presentation (p = 0.004). There was a significant increase in child abuse–related duodenal injuries during the time frame of the study (p = 0.002). CONCLUSION Duodenal injuries are extremely rare in the pediatric population. This multi-institutional investigation found that child abuse consistently associated with duodenal injuries in children younger than 2 years. The evidence supports a child abuse investigation on children younger than 2 years with duodenal injury. LEVEL OF EVIDENCE Epidemiological study, level III.
Outbreak of Chikungunya virus in the north Caribbean area of Colombia: clinical presentation and phylogenetic analysis.

INTRODUCTION The Caribbean area of Colombia has been severely affected by a Chikungunya virus (CHIKV) outbreak since 2014. METHODOLOGY The study was carried out on 100 patients during a fever outbreak from August to September 2014 in two small rural villages in the northern Caribbean area of Colombia. The molecular assays performed by reverse transcription polymerase chain reaction (RT-PCR) on acute patient sera were collected within one to five days of the appearance of symptoms. Sequence analyses were carried out based on phylogenetic analyses of genes NS1 and E2. For serological assays, 49 (49%) patients at ≥ 6 days of disease onset were tested with NovaLisa Chikungunya IgG/IgM µ-capture enzyme-linked immunosorbent assay (ELISA). RESULTS The main signs or symptoms associated with Chikungunya infection were arthralgia of the lower limbs (96%), fever (91%), arthralgia of the upper limbs (85%), rash (64%), and headache (57%). Ninety-four percent (46/49) of patients were positive for either IgM or IgG; the remaining three (6%) patients were seronegative. Viral loads were detected in 25 patients. Based on phylogenetic analysis of NS1 and E2, the characterization of the Colombian CHIKV indicated that it was a strain closely related to the British Virgin Islands strain and to the Asian genotype. CONCLUSIONS This study shows the phylogenetic and clinical description of CHIKV in Colombia. The main symptoms shown were: arthralgia, fever, and rash. CHIKV sequences detected in Colombian patients were within the Asian genotype and closely related to the British Virgin Islands strain.
Differential effects of sustained inflation recruitment maneuvers on alveolar epithelial and lung endothelial injury*

Objective:The role of recruitment maneuvers in mechanical ventilation for patients with the acute respiratory distress syndrome and acute lung injury remains uncertain in part due to a lack of data on the effects of specific recruitment maneuvers on lung injury severity. The primary objective of this study was to determine the effect of one type of recruitment maneuver—sustained inflation—on alveolar epithelial and lung endothelial injury in experimental acute lung injury. Design:Randomized experimental study. Setting:Academic research laboratory. Subjects:Forty-nine Sprague-Dawley rats. Interventions:Lung injury was induced in anesthetized, ventilated rats by instillation of acid (pH 1.5) into the airspaces. Rats were ventilated with a tidal volume of 6 mL/kg and a positive end-expiratory pressure of 5 cm H2O with or without a sustained inflation recruitment maneuver repeated every 30 mins. Each recruitment maneuver consisted of two 30-sec inflations to total lung capacity (30 cm H2O) 1 min apart. Measurements and Main Results:The use of recruitment maneuvers significantly improved oxygenation, compliance, end-expiratory lung volume, functional residual capacity, and deadspace fraction. Recruitment maneuvers reduced extravascular lung water and lung endothelial injury as measured by protein permeability (217 ± 28 vs. 314 ± 70 extravascular plasma equivalents [&mgr;L], p < .05). However, recruitment maneuvers did not prevent alveolar epithelial injury. Epithelial permeability and bronchoalveolar lavage RTI40 levels, a marker of type I cell injury, were similar with or without recruitment maneuvers. Recruitment maneuvers decreased epithelial fluid transport, a functional marker of epithelial injury. Recruitment maneuvers did not reduce markers of airspace inflammation. Conclusions:Sustained inflation recruitment maneuvers improve respiratory mechanics and oxygenation and may protect the lung endothelium but do not reduce alveolar epithelial injury. Because of the differential effects of recruitment maneuvers on the lung endothelium and alveolar epithelium, the net effect in clinical acute lung injury may not be beneficial. Additional clinical studies will be needed to assess the net impact of recruitment maneuvers in patients with acute lung injury.
The Patient-Centered Medical Home

BACKGROUND The patient-centered medical home (PCMH) describes mechanisms for organizing primary care to provide high quality care across the full range of individuals' health care needs.It is being widely implemented by provider organizations and third party payers. PURPOSE To describe approaches for PCMH implementation and summarize evidence for effects on patient and staff experiences,process of care, and clinical and economic outcomes. DATA SOURCES PubMed (through 6 December 2011), Cumulative Index to Nursing & Allied Health Literature, and the Cochrane Database of Systematic Reviews (through 29 June 2012). STUDY SELECTION English-language trials and longitudinal observational studies that met criteria for the PCMH, as defined by the Agency for Healthcare Research and Quality, and included populations with multiple conditions. DATA EXTRACTION Information on study design, populations, interventions,comparators, financial models, implementation methods,outcomes, and risk of bias were abstracted by 1 investigator and verified by another. DATA SYNTHESIS In 19 comparative studies, PCMH interventions had a small positive effect on patient experiences and small to moderate positive effects on the delivery of preventive care services(moderate strength of evidence). Staff experiences were also improved by a small to moderate degree (low strength of evidence). Evidence suggested a reduction in emergency department visits(risk ratio [RR], 0.81 [95% CI, 0.67 to 0.98]) but not in hospital admissions (RR, 0.96 [CI, 0.84 to 1.10]) in older adults (low strength of evidence). There was no evidence for overall cost savings. LIMITATION Systematic review is challenging because of a lack of consistent definitions and nomenclature for PCMH. CONCLUSION The PCMH holds promise for improving the experiences of patients and staff and potentially for improving care processes,but current evidence is insufficient to determine effects on clinical and most economic outcomes
EFFECTS OF DIETARY SUPPLEMENTAL L-CARNITINE AND ASCORBIC ACID ON PERFORMANCE, CARCASS COMPOSITION AND PLASMA L-CARNITINE CONCENTRATION OF BROILER CHICKS REARED UNDER DIFFERENT TEMPERATURE

The present study was initiated to determine whether dietary supplemental L-carnitine and ascorbic acid affect growth performance, carcass yield and composition, abdominal fat and plasma L-carnitine concentration of broiler chicks reared under normal and high temperature. During the experiment, two temperature regimes were employed in two experimental rooms, which were identical but different in environmental temperature. The regimes were thermoneutral (20-22°C for 24 h) or recycling hot (34-36°C for 8 h and 20-22°C for 16 h). One-day-old broiler chicks (ROSS) were used in the experiment. A 2 x 2 x 2 factorial arrangement was employed with two levels (0 and 50 mg/kg) of supplemental L-carnitine and two levels (0 or 500 mg/kg) of supplemental ascorbic acid in drinking water under thermoneutral or high temperature regimes. Body weight gain was affected by high temperature. However, body weight gain was significantly improved in animals receiving supplemental L-carnitine, ascorbic acid or L-carnitine + ascorbic acid compared to animals receiving unsupplemented diet under high temperature. On the other hand, supplemental L-carnitine or L-carnitine + ascorbic acid reduced body weight gain under thermoneutral condition. Supplemental ascorbic acid significantly improved feed conversion efficiency, the improvement was relatively greater under high temperature. The L-carnitine content in the plasma was higher in the groups receiving supplemental L-carnitine and ascorbic acid under high temperature, while broilers fed supplemental L-carnitine and ascorbic acid had a decreased level of plasma L-carnitine concentration under normal temperature. It is concluded that dietary supplemental L-carnitine or L-carnitine + ascorbic acid may have positive effects on body weight gain, carcass weight under high temperature conditions.
Elevated risk of human papillomavirus‐related second cancers in survivors of anal canal cancer

Over the last decade, the causal link between human papillomavirus (HPV) infection and squamous cell carcinoma of the anus (SCCA) has been well described. Because HPV infection in one site is often associated with other sites of infection, it then follows that patients with SCCA may have an increased risk of additional HPV‐related cancers. Identifying and targeting at‐risk sites through cancer screening and surveillance may help to guide best practices. The current study sought to ascertain sites and risk of HPV‐related second primary malignancies (SPMs) in survivors of SCCA.
Actual flip‐angle imaging in the pulsed steady state: A method for rapid three‐dimensional mapping of the transmitted radiofrequency field

A new method has been developed for fast image‐based measurements of the transmitted radiofrequency (RF) field. The method employs an actual flip‐angle imaging (AFI) pulse sequence that consists of two identical RF pulses followed by two delays of different duration (TR1 < TR2). After each pulse, a gradient‐echo (GRE) signal is acquired. It has been shown theoretically and experimentally that if delays TR1 and TR2 are sufficiently short and the transverse magnetization is completely spoiled, the ratio r = S2/S1 of signal intensities S1 and S2, acquired at the beginning of the time intervals TR1 and TR2, depends on the flip angle (FA) of applied pulses as r = (1 + n * cos(FA))/(n + cos(FA)), where n = TR2/TR1. The method allows fast 3D implementation and provides accurate B1 measurements that are highly insensitive to T1. The unique feature of the AFI method is that it uses a pulsed steady‐state signal acquisition. This overcomes the limitation of previous methods that required long relaxation delays between sequence repetitions. The method has been shown to be useful for time‐efficient whole‐body B1 mapping and correction of T1 maps obtained using a variable FA technique in the presence of nonuniform RF excitation. Magn Reson Med 57:192–200, 2007. © 2006 Wiley‐Liss, Inc.
The 2007 San Diego Wildfire Impact on the Emergency Department of the University of California, San Diego Hospital System

Abstract Introduction: In October 2007, San Diego County experienced a severe firestorm resulting in the burning of more than 368,000 acres, the destruction of more than 1,700 homes, and the evacuation of more than 500,000 people. Hypothesis: The goal of this study was to assess the impact of the 2007 San Diego Wildfires, and the acute change in air quality that followed, on the patient volume and types of complaints in the emergency department. Method: A retrospective review was performed of a database of all patients presenting to the Emergency Departments of University of California, San Diego (UCSD) hospitals for a six-day period both before (14–19 October 2007) and after (21–26 October 2007) the start of the 2007 firestorm. Charts were abstracted for data, including demographics, chief complaints, past medical history, fire-related injuries and disposition status. As a measure of pollution, levels of 2.5 micron Particulate Matter (PM 2.5) also were calculated from data provided by the San Diego Air Pollution Control District. Results: Emergency department volume decreased by 5.8% for the period following the fire. A rapid rise in PM2.5 levels coincided with the onset of the fires. The admission rate was higher in the period following the fires (19.8% vs. 15.2%) from the baseline period. Additionally, the Left Without Being Seen (LWBS) rate doubled to 4.6% from 2.3%. There was a statistically significant increase in patients presenting with a chief complaint of shortness of breath (6.5% vs. 4.2% p = 0.028) and smoke exposure (1.1% vs. 0% p = 0.001) following the fires. Patients with significant cardiac or pulmonary histories were no more likely to present to the emergency department during the fires. Conclusions: Despite the decreased volume, the admission and LWBS rate did increase following the onset of the firestorm. The cause of this increase is unclear. Despite a sudden decline in air quality, patients with significant cardiac and pulmonary morbidity did not vary their emergency department utilization rate. Based on the experience at UCSD, it appears that significant wildfires like that seen in 2007, only may marginally affect emergency department operations, and may not require significant changes to normal staffing levels.
Evidence for an Essential Catalytic Role of the F10 Protein Kinase in Vaccinia Virus Morphogenesis

ABSTRACT Temperature-sensitive mutants of vaccinia virus, with genetic changes that map to the open reading frame encoding the F10 protein kinase, exhibit a defect at an early stage of viral morphogenesis. To further study the role of the enzyme, we constructed recombinant vaccinia virus vF10V5i, which expresses inducible V5 epitope-tagged F10 and is dependent on a chemical inducer for plaque formation and replication. In the absence of inducer, viral membrane formation was delayed and crescents and occasional immature forms were detected only late in infection. When the temperature was raised from 37 to 39°C, the block in membrane formation persisted throughout the infection. The increased stringency may be explained by a mild temperature sensitivity of the wild-type F10 kinase, which reduced the activity of the very small amount expressed in the absence of inducer, or by the thermolability of an unphosphorylated kinase substrate or uncomplexed F10-interacting protein. Further analyses demonstrated that tyrosine and threonine phosphorylation of the A17 membrane component was inhibited in the absence of inducer. The phosphorylation defect could be overcome by transfection of plasmids that express wild-type F10, but not by plasmids that express F10 with single amino acid substitutions that abolished catalytic activity. Although the mutated forms of F10 were stable and concentrated in viral factories, only the wild-type protein complemented the assembly and replication defects of vF10V5i in the absence of inducer. These studies provide evidence for an essential catalytic role of the F10 kinase in vaccinia virus morphogenesis.
Differential bulbar and extrabulbar projections of diverse olfactory receptor neuron populations in the adult zebrafish (Danio rerio)

Immunohistochemical methods were used to characterize the expression of two calcium‐binding proteins, calretinin (CR) and S100, in the olfactory rosette of the adult zebrafish. These proteins are expressed in different sets of sensory neurons, and together represent a large proportion of these cells. Double immunofluorescence for CR and Gαolf protein, and CR immunoelectron microscopy, indicated that most CR‐immunoreactive (ir) cells were ciliary neurons. Differential S100‐ and CR‐ir projections to glomerular fields of the olfactory bulb were also observed, although these projections overlap in some glomeruli. Application of the carbocyanine dye DiI to either S100‐ir or CR‐ir glomerular regions led to labeling of cells mostly similar to S100‐ir and CR‐ir neurons, respectively. Instead, these bulbar regions project to similar telencephalic targets. On the other hand, antibodies against keyhole limpet hemocyanin (KLH)‐stained numerous sensory cells in the olfactory rosette, including cells that were CR‐ and S100‐negative. This antiserum also stained most primary bulbar projections and revealed extrabulbar olfactory primary projections coursing to the ventral area of the telencephalon through the medial olfactory tract. This extrabulbar projection was confirmed by tract‐tracing with DiI. A loose association of this extrabulbar primary olfactory projection and the catecholaminergic populations of the ventral area was also observed with double tyrosine hydroxylase/KLH‐like immunohistochemistry. Comparison between KLH‐like‐ir pathways and the structures revealed by FMRFamide immunohistochemistry (a marker of terminal ganglion cells and fibers) indicated that the KLH‐like‐ir extrabulbar projection was different from the terminal nerve system. The significance of the extrabulbar olfactory projection of zebrafish is discussed. J. Comp. Neurol. 519:247‐276, 2011. © 2010 Wiley‐Liss, Inc.
ObfusMem: A low-overhead access obfuscation for trusted memories

Trustworthy software requires strong privacy and security guarantees from a secure trust base in hardware. While chipmakers provide hardware support for basic security and privacy primitives such as enclaves and memory encryption. these primitives do not address hiding of the memory access pattern, information about which may enable attacks on the system or reveal characteristics of sensitive user data. State-of-the-art approaches to protecting the access pattern are largely based on Oblivious RAM (ORAM). Unfortunately, current ORAM implementations suffer from very significant practicality and overhead concerns, including roughly an order of magnitude slowdown, more than 100% memory capacity overheads, and the potential for system deadlock. Memory technology trends are moving towards 3D and 2.5D integration, enabling significant logic capabilities and sophisticated memory interfaces. Leveraging the trends, we propose a new approach to access pattern obfuscation, called ObfusMem. ObfusMem adds the memory to the trusted computing base and incorporates cryptographic engines within the memory. ObfusMem encrypts commands and addresses on the memory bus, hence the access pattern is cryptographically obfuscated from external observers. Our evaluation shows that ObfusMem incurs an overhead of 10.9% on average, which is about an order of magnitude faster than ORAM implementations. Furthermore, ObfusMem does not incur capacity overheads and does not amplify writes. We analyze and compare the security protections provided by ObfusMem and ORAM, and highlight their differences.
Behavioral and psychiatric disorders in adult male carriers of fragile X.

OBJECTIVE In the present study we examined the incidence of psychiatric and behavioral problems among male carriers of the fragile X gene. METHOD Retrospective data on carrier males were gathered using the family informant method. Each of 56 fragile X carrier women was interviewed about her father by an examiner blind to the father's carrier status. The interviewer administered measures of (1) behaviors related to DSM-III-R Axis I disorders, (2) adult attention-deficit hyperactivity disorder (ADHD) behaviors, (3) parental bonding skills, and (4) abusive behaviors. The endorsements from 24 women with fragile X fathers were compared with endorsements from 32 women with nonfragile X fathers. RESULTS The results show a higher incidence of psychopathology among the fragile X males (relative to nonfragile X fathers) for behaviors related to adult ADHD, parental bonding, abuse; and particularly for alcohol abuse/dependence and obsessive-compulsive disorder behaviors. CONCLUSIONS These findings support the hypotheses that some "nonpenetrant" males may indeed be mildly affected carriers and that there is a broad spectrum of involvement among carrier males.
Overtightening of the Ankle Syndesmosis: Is It Really Possible?

Background: Many surgeons and orthopaedic references recommend that fixation of a disrupted distal tibiofibular syndesmosis be performed with the ankle in dorsiflexion to avoid overtightening and subsequent restriction of ankle dorsiflexion. This recommendation is based in large part on one cadaveric study without clinical correlation. The purpose of the present study was to examine whether overtightening of the syndesmosis limits maximal ankle dorsiflexion. Methods: Nineteen cadaveric ankles were used for the study. Each ankle was tested for the initial range of motion after release of the Achilles tendon proximal to the ankle joint. All capsular and ligamentous structures remained intact. Kirschner wires were placed in the tibia and talus. The angle between the wires with the ankle maximally dorsiflexed was measured before and after syndesmotic compression. Syndesmotic compression was achieved with a 4.5-mm lag screw with the ankle in plantar flexion. Results: There was no difference between the values for maximal dorsiflexion before and after syndesmotic compression. Conclusions: Syndesmotic compression in and of itself does not diminish ankle dorsiflexion in a cadaveric model. Clinical Relevance: Maximal dorsiflexion of the ankle during syndesmotic fixation is not required in order to avoid loss of dorsiflexion. It is likely that the most important aspect of syndesmotic fixation is anatomic reduction of the syndesmosis and that the degree of ankle dorsiflexion during fixation is not important.