Miracle-dz/UniFAR-FTUs huggingface dataset:
Prophylactic fenoldopam for renal protection in sepsis: A randomized, double-blind, placebo-controlled pilot trial*

Objective:Acute renal failure is common in septic patients. Fenoldopam, a dopamine-1 receptor agonist, increases renal blood flow and may, therefore, reduce the risk of acute renal failure in such patients. Accordingly, we sought to determine the safety and efficacy of fenoldopam for the prevention of acute renal failure in septic patients. Design:Prospective, double-blind, placebo-controlled trial. Setting:Three multidisciplinary intensive care units at a university hospital. Patients:Three hundred septic patients with baseline serum creatinine concentrations <150 &mgr;mol/L. Interventions:We randomized patients to a continuous infusion of either fenoldopam (n = 150) at 0.09 &mgr;g·kg−1·min−1 or placebo (n = 150) while in the intensive care unit. The primary outcome measure was the incidence of acute renal failure, defined as a serum creatinine concentration increase to >150 &mgr;mol/L, during study drug infusion. Measurements and main results:The incidence of acute renal failure was significantly lower in the fenoldopam group compared with the control group (29 vs. 51 patients; p = .006). The odds ratio of developing acute renal failure for patients treated with fenoldopam was estimated to be 0.47 (p = .005). The difference in the incidence of severe acute renal failure (creatinine >300 &mgr;mol/L), however, failed to achieve statistical significance (10 vs. 21; p = .056). The length of intensive care unit stay in surviving patients was significantly lower in the fenoldopam group compared with the control group (10.64 ± 9.3 vs. 13.4 ± 14.0; p < .001). There were no complications of fenoldopam infusion. A direct effect of treatment on the probability of death, beyond its effect on acute renal failure, was not significant (odds ratio = 0.68, p = .1). Conclusions:Compared with placebo, low-dose fenoldopam resulted in a smaller increase in serum creatinine in septic patients. The clinical significance of this finding is uncertain. A large multiple-center trial is now needed to confirm these findings.
Autologous hematopoietic stem cell transplantation for autoimmune diseases: an observational study on 12 years’ experience from the European Group for Blood and Marrow Transplantation Working Party on Autoimmune Diseases

Background Autologous hematopoietic stem cell transplantation has been used since 1996 for the treatment of severe autoimmune diseases refractory to approved therapies. We evaluated the long-term outcomes of these transplants and aimed to identify potential prognostic factors. Design and Methods In this observational study we analyzed all first autologous hematopoietic stem cell transplants for autoimmune diseases reported to the European Group for Blood and Marrow Transplantation (EBMT) registry between 1996–2007. The primary end-points for analysis were overall survival, progression-free survival and transplant-related mortality at 100 days. Results Nine hundred patients with autoimmune diseases (64% female; median age, 35 years) who underwent a first autologous hematopoietic stem cell transplant were included. The main diseases were multiple sclerosis (n=345), systemic sclerosis (n=175), systemic lupus erythematosus (n=85), rheumatoid arthritis (n=89), juvenile arthritis (n=65), and hematologic immune cytopenia (n=37). Among all patients, the 5-year survival was 85% and the progression-free survival 43%, although the rates varied widely according to the type of autoimmune disease. By multivariate analysis, the 100-day transplant-related mortality was associated with the transplant centers’ experience (P=0.003) and type of autoimmune disease (P=0.03). No significant influence of transplant technique was identified. Age less than 35 years (P=0.004), transplantation after 2000 (P=0.0015) and diagnosis (P=0.0007) were associated with progression-free survival. Conclusions This largest cohort studied worldwide shows that autologous hematopoietic stem cell transplantation can induce sustained remissions for more than 5 years in patients with severe autoimmune diseases refractory to conventional therapy. The type of autoimmune disease, rather than transplant technique, was the most relevant determinant of outcome. Results improved with time and were associated with the transplant centers’ experience. These data support ongoing and planned phase III trials to evaluate the place of autologous hematopoietic stem cell transplantation in the treatment strategy for severe autoimmune diseases.
Beyond Listening: The Distinct Effects of Proactive Versus Responsive Customer Orientation on the Reduction of Uncertainties at the Fuzzy Front End of Innovation

The extent to which the intensity of R&D employees' interaction with market-oriented employees, proactive customer orientation, and responsive customer orientation affect the ability to reduce product-related uncertainties at the fuzzy front end of innovation was analyzed. They investigated 160 product innovation projects in various high-tech industries and identified proactive customer orientation as an important moderator of the link between R&D employees' interaction with market-oriented employees and the reduction of product-related uncertainties at the fuzzy front end. They also found that responsive customer orientation diminishes the ability to reduce product-related uncertainties at the fuzzy front end. The theoretical and managerial implications of the results are discussed.
Nursing Students’ Attitudes Toward Lesbian, Gay, Bisexual, and Transgender Persons: An Integrative Review

AIMThe aim of this study was to critically appraise and synthesize findings from studies on the attitudes of nursing students toward lesbian, gay, bisexual, and transgender (LGBT) persons. BACKGROUNDThere is paucity of research to assess the attitudes of nursing students toward LGBT persons. METHODAn electronic search was conducted using PubMed, Medline, Web of Science, EbscoHost, PsycInfo, and the Cumulative Index to Nursing and Allied Health Literature using medical subject headings terminologies. Search terms used included gay, lesbian, transgender, bisexual, LGBT, nursing students, baccalaureate nursing, undergraduate nursing, homophobia, homosexuality, sexual minority, attitudes, discrimination, and prejudice RESULTSLess than 50 percent of the studies (5 out of 12) suggested positively leaning attitudes of nursing students toward LGBT persons; six studies reported negative attitudes, and one study reported neutral attitudes. CONCLUSIONThere are some indications that student attitudes may be moving toward positively leaning. Studies published before 2000 reported a preponderance of negative attitudes.
Glycogen content of preimplantation mouse embryos

Preimplantation mouse embryos of various stages of development, from single‐cell zygotes to late blastocysts, were fixed on microscope slides and were stained using the periodic acid‐Schiff method. Half of the slides were treated with diastase before staining to determine whether the positive material was glycogen.
Electrocardiographic Findings in Systemic Lupus Erythematosus: Data From an International Inception Cohort

To estimate the early prevalence of various electrocardiographic (EKG) abnormalities in patients with systemic lupus erythematosus (SLE) and to evaluate possible associations between repolarization changes (increased corrected QT [QTc] and QT dispersion [QTd]) and clinical and laboratory variables, including the anti‐Ro/SSA level and specificity (52 or 60 kd).
Profound decrease of mesolimbic dopaminergic neuronal activity in morphine withdrawn rats.

The spontaneous neuronal activity of meso-accumbens dopaminergic neurons was recorded in unanesthetized rats withdrawn from chronic morphine administration (15 days) by means of single cell extracellular recording techniques coupled with antidromic identification from the nucleus accumbens. Twenty-four h after last morphine administration, firing rate and burst firing were found to be drastically reduced and the relative refractory periods of the same neurons were prolonged in morphine-dependent rats as compared with chronic saline-treated controls. The number of spontaneously active dopaminergic neurons, however, did not differ between the two groups. Administration of morphine restored electrophysiological parameters. When rats were tested 2 h after last morphine administration, i.v. challenge with the opiate antagonist naloxone caused an abrupt and virtually complete reduction of dopaminergic firing rate, burst rate and a prolongation of the relative refractory period. These effects were not observed in control rats. The results indicate that the mesolimbic dopaminergic system is tonically reduced in its activity during morphine withdrawal syndrome and considering its role in the reinforcing properties of opioids, its depressed activity during the morphine withdrawal syndrome may bear relevance for the dysphoric state associated to morphine withdrawal in humans.
Phase Noise Effects on High Spectral Efficiency Coherent Optical OFDM Transmission

There are three major advantages for coherent optical orthogonal frequency-division multiplexing (CO-OFDM) transmission using digital signal processing. First, coherent detection is realized by digital phase estimation without the need for optical phase-locked loop. Second, OFDM modulation and demodulation are realized by the well-established computation-efficient fast Fourier transform (FFT) and inverse FFT. Third, adaptive data rates can be supported as different quadrature amplitude modulation (QAM) constellations are software-defined, without any hardware change in transmitter and receiver. However, it is well-known that coherent detection, OFDM, and QAM are all susceptible to phase noise. In this paper, theoretical, numerical, and experimental investigations are carried out for phase noise effects on high spectral efficiency CO-OFDM transmission. A transmission model in the presence of phase noise is presented. By using simulation, the bit error rate floors from finite laser linewidth are presented for CO-OFDM systems with high-order QAM constellations. In the experiments, the phase noise effects from both laser linewidth and nonlinear fiber transmission are investigated. The fiber nonlinearity mitigation based on receiver digital signal processing is also discussed.
Review Article: Steroid Hormones and Uterine Vascular Adaptation to Pregnancy

Pregnancy is a physiological state that involves a significant decrease in uterine vascular tone and an increase in uterine blood flow, which is mediated in part by steroid hormones, including estrogen, progesterone, and cortisol. Previous studies have demonstrated the involvement of these hormones in the regulation of uterine artery contractility through signaling pathways specific to the endothelium and the vascular smooth muscle. Alterations in endothelial nitric oxide synthase expression and activity, nitric oxide production, and expression of enzymes involved in PGI2 production contribute to the uterine artery endothelium—specific responses. Steroid hormones also have an effect on calcium-activated potassium channel activity, PKC signaling pathway and myogenic tone, and alterations in pharmacomechanical coupling in the uterine artery smooth muscle. This review addresses current understanding of the molecular mechanisms by which steroid hormones including estrogen, progesterone, and cortisol modulate uterine artery contractility to alter uterine blood flow during pregnancy with an emphasis on the pregnant ewe model.
IL-10-Deficient Mice Demonstrate Multiple Organ Failure and Increased Mortality During Escherichia coli Peritonitis Despite an Accelerated Bacterial Clearance1

To determine the role of endogenous IL-10 in local antibacterial host defense and in the development of a systemic inflammatory response syndrome during abdominal sepsis, IL-10 gene-deficient (IL-10−/−) and wild-type (IL-10+/+) mice received an i.p. injection with Escherichia coli. Peritonitis was associated with a bacterial dose-dependent increase in IL-10 concentrations in peritoneal fluid and plasma. The recovery of E. coli from the peritoneal fluid, blood, and lungs was diminished in IL-10−/− mice, indicating that endogenous IL-10 impaired bacterial clearance. Despite a lower bacterial load, IL-10−/− mice had higher concentrations of TNF, macrophage inflammatory protein-2 and keratinocyte in peritoneal fluid and plasma, and demonstrated more severe multiple organ damage as indicated by clinical chemistry and histopathology. Furthermore, IL-10−/− mice showed an increased neutrophil recruitment to the peritoneal cavity. To examine the role of elevated TNF levels in the altered host response in IL-10−/− mice, the effect of a neutralizing anti-TNF mAb was determined. Anti-TNF did not influence the clearance of E. coli in either IL-10+/+ or IL-10−/− mice. Furthermore, anti-TNF did not affect leukocyte influx in the peritoneal fluid, multiple organ damage, or survival in IL-10+/+ mice. In IL-10−/− mice, anti-TNF partially attenuated neutrophil recruitment and multiple organ damage, and prevented the increased lethality. These data suggest that although endogenous IL-10 facilitates the outgrowth and dissemination of bacteria during E. coli peritonitis, it protects mice from lethality by attenuating the development of a systemic inflammatory response syndrome by a mechanism that involves inhibition of TNF release.
Electoral Margins and American Foreign Policy 1

Conventional wisdom holds that large margins of electoral victory contribute to presidential power. How does this variation in power impact U.S. foreign policy? I argue here that presidents who win elections by a substantial margin authorize the use of substantial military force more regularly, but do so at the expense of personal diplomacy and low-level crisis engagement. This distinction stems from the variation in the external constraint that other political actors place on these policies. New presidents who are empowered by a decisive election have more leverage and are therefore better able to pursue otherwise constrained foreign policies such as the use of major force. In contrast, those who win by smaller margins have less political capital and are forced disproportionately to the less constrained arenas of diplomacy and crisis intervention.
P REHOSPITAL C ARE AND O UTCOME OF P EDIATRIC O UT - OF - HOSPITAL C ARDIAC A RREST

Cardiac arrest in children outside the hospital is associated with high mortality rates. Recent investigations have suggested that the use of advanced life support (ALS) measures by emergency medical services (EMS) personnel may decrease survival. These studies have used the pediatric Utstein style of defining ALS and basic life support (BLS) measures. The pediatric Utstein style defines BLS as “an attempt to restore effective ventilation and circulation” using noninvasive means to open the airway but specifically excludes the use of bag-valve-mask devices. Advanced life support is defined as the “addition of invasive maneuvers to restore effective ventilation and circulation. ” The authors of the study described below believe that using this definition would categorize some patients into an ALS group who would otherwise be categorized as having received BLS (i.E., “bag-valve-mask only”). Objective: To compare survival rates among children receiving BLS or ALS following out-of-hospital cardiac arrest using amended definitions of prehospital life support measures. Specifically, the definition of BLS was expanded to include the use of bag-valve-mask devices only. Methods: This was a retrospective chart review in an urban, pediatric emergency department. Patients included all children presenting to the emergency department between January 1, 1986, and December 31, 1999, following out-of-hospital cardiac arrest. The main outcome measure was survival to hospital discharge. Results: Two hundred ten children were identified. Twenty-one patients were excluded from further analysis because of absent or incomplete medical records. One hundred eighty-nine patients were studied. Five children (2.6%) survived to discharge from the hospital. Of 189 children, 39 (20.6%) were provided BLS measures by prehospital personnel; 150 (79.4%) received ALS. There was no significant difference between groups in survival to hospital discharge. Patients who survived to hospital discharge were more likely to be in sinus rhythm upon arrival in the emergency department (p < 0.001) and to have received fewer doses of standard-dose epinephrine in the emergency department (p < 0.001). Conclusion: The use of ALS by prehospital personnel for children with out-of-hospital cardiac arrest did not improve survival to discharge from the hospital when compared with the use of BLS.
Delayed thalamic astrocytosis and disrupted sleep–wake patterns in a preclinical model of traumatic brain injury

Traumatic brain injury (TBI) involves diffuse axonal injury and induces subtle but persistent changes in brain tissue and function and poses challenges for early detection of neurological injury. The present study uses an automated behavioral analysis system to assess alterations in rodent behavior in the subacute phase in a preclinical mouse model of TBI, controlled cortical impact (CCI) injury. In the first few weeks following CCI, mice demonstrated normal exploratory behaviors and other typical home‐cage behaviors. However, beginning 4 weeks post‐injury, CCI mice developed disruptions in sleep–wake patterns, including an increased number of awakenings from sleep. Such impaired sleep maintenance was accompanied by an increased latency to reach peak sleep in CCI mice. These sleep disruptions implicate involvement of the thalamocortical network, the activity of which must be tightly regulated to control sleep maintenance. After injury, there was an increase in reactive microglia in thalamic regions as well as delayed reactive astrocytosis that was evident in the thalamic reticular nucleus, which preceded the development of sleep disruptions. These data suggest that cortical injury may trigger inflammatory responses in deeper neuroanatomical structures, including the thalamic reticular nucleus. Such engagement of the thalamus may perturb the thalamocortical network that regulates sleep/awake patterns and contribute to sleep disruptions observed in this model as well as those documented in patients with TBI. © 2014 Wiley Periodicals, Inc.
Long‐term maintenance therapy with prazosin in congestive heart failure

We evaluated the effects of long‐term maintenance therapy with oral prazosin (6‐20 mg, mean 14±2 mg/d) in 14 patients with congestive heart failure. The patients were followed for 6±1 months. Eleven of the fourteen patients reported subjective improvement. Two patients required increased diuretics because of gain in body weight. Systolic blood pressure showed a slight but sustained decrease suggesting persistent vasodilator effect. Reductions in echocardiographic left ventricular end‐diastolic (6.35±0.25‐5.88±0.25 cm, p<0.05) and end‐systolic (5.16±0.35‐4.73 ±0.28 cm, p<0.05) diameters were observed at 2 months. However, the cardiothoracic ratio on chest x ray was unaltered. Maximum exercise tolerance time increased in eight patients (57%) during prazosin therapy. Improvement in exercise tolerance time was observed in patients with most marked clinical improvement, suggesting presence of cardiac reserve. Two patients died suddenly after reporting subjective improvement. This study shows sustained clinical improvement in most patients with heart failure treated with oral prazosin.
Bacterial entropathogens and antimicrobial susceptibility in children with acute diarrhea in Babol, Iran.

BACKGROUND Infectious diarrhea is one of common cause of children diarrhea causing mortality and morbidity worldwide. This study was performed to identify the common bacteria and their antimicrobial susceptibility in children with diarrhea. METHODS Children under 14 years old with acute diarrhea who referred to Amirkola Children's Hospital, Mazandaran, North of Iran, were enrolled during the summer and fall of 2009. From each patient, two fecal specimens were collected. Samples were cultured and bacterial isolation was done by conventional methods. Antimicrobial susceptibility was identified by disk diffusion and micro dilution methods. RESULTS One hundred-seventy two patients with the mean age of 41.8±37.6 months were evaluated. The bacteria were isolated in 48 (27.9%) cases. The most common isolated bacteria was E.coli and then shigella in both bloody and nonbloody diarrheal patients. There was a significant difference between bacteria positive specimens and WBC in stool smear (p=0.003). All isolated shigella were susceptible to Ceftizoxime and ciprofloxacin and were resistant to Cefixime. Resistant to Nalidixic acid was seen in 14% of them. CONCLUSION The results show that E.coli was the most frequently isolated pathogen in children with bloody and nonbloody diarrhea. Ceftizoxime is a good antibiotic for shigellosis in children in our area but Cefixime is not appropriate.
Emergence of HIV-1 drug resistance in previously untreated patients initiating combination antiretroviral treatment: a comparison of different regimen types.

BACKGROUND Standard first-line combination antiretroviral treatment (cART) against human immunodeficiency virus 1 (HIV-1) contains either a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI/r). Differences between these regimen types in the extent of the emergence of drug resistance on virological failure and the implications for further treatment options have rarely been assessed. METHODS We investigated virological outcomes in patients from the Swiss HIV Cohort Study initiating cART between January 1, 1999, and December 31, 2005, with an unboosted PI, a PI/r, or an NNRTI and compared genotypic drug resistance patterns among these groups at treatment failure. RESULTS A total of 489 patients started cART with a PI, 518 with a PI/r, and 805 with an NNRTI. A total of 177 virological failures were observed (108 [22%] PI failures, 24 [5%] PI/r failures, and 45 [6%] NNRTI failures). The failure rate was highest in the PI group (10.3 per 100 person-years; 95% confidence interval [CI], 8.5-12.4). No difference was seen between patients taking a PI/r (2.7; 95% CI, 1.8-4.0) and those taking an NNRTI (2.4; 95% CI, 1.8-3.3). Genotypic test results were available for 142 (80%) of the patients with a virological treatment failure. Resistance mutations were found in 84% (95% CI, 75%-92%) of patients taking a PI, 30% (95% CI, 12%-54%) of patients taking a PI/r, and 66% (95% CI, 49%-80%) of patients taking an NNRTI (P < .001). Multidrug resistance occurred almost exclusively as resistance against lamivudine-emtricitabine and the group-specific third drug and was observed in 17% (95% CI, 9%-26%) of patients taking a PI, 10% (95% CI, 0.1%-32%) of patients taking a PI/r, and 50% (95% CI, 33%-67%) of patients taking an NNRTI (P < .001). CONCLUSIONS Regimens that contained a PI/r or an NNRTI exhibited similar potency as first-line regimens. However, the use of a PI/r led to less resistance in case of virological failure, preserving more drug options for the future.