Miracle-dz/UniFAR-FTUs huggingface dataset:
Efficacy of Preoperative Autologous Blood Donation in Free TRAM Flap Breast Reconstruction

Background: The authors critically evaluated the use of autologous blood donation in patients who had surgical breast reconstruction using the free transverse rectus abdominis musculocutaneous (fTRAM) flap technique following mastectomy. Methods: A retrospective chart review of 201 patients was performed. Patients were operated on at one community hospital and one university hospital. Cohorts of 101 blood donors and 100 control nondonors were established. Demographic and premorbid factors and primary outcome variables were evaluated. Results: The autologous donor and nondonor groups were not statistically different in any demographic categories, and there were no significant differences in premorbid factors between the two groups. Total surgical complications were more common in the autologous donor group (48 percent versus 28 percent; p < 0.004). The autologous donor group was also more likely to receive a transfusion intraoperatively (13 percent versus 0 percent, p < 0.001) or postoperatively (28 percent versus 5 percent, p < 0.001) compared with the nondonor group. Conclusions: Few patients in the nondonor group required perioperative transfusion, and fewer than half of the donors received their blood back. There was a statistically significant higher rate of surgical complications associated with autologous blood donation, most likely due to relative preoperative anemia.Autologous donation was associated with a significantly higher rate of transfusion intraoperatively and postoperatively. The authors do not recommend autologous blood donation before free TRAM flap autogenous breast reconstruction.
Demographic Externalities from Poverty Programs in Developing Countries: Experimental Evidence from Latin America

Conditional cash transfer programs have been shown to be effective development strategies for raising human capital investments in children in many LDCs. In this paper, we use experimental data from cash transfer programs in three Latin America countries to assess the potential, unintended impact of conditional cash transfers programs on childbearing. Because cash transfer programs both affect household resource levels as well as possibly shape parental preferences for quality versus quantity of children, they may prove to have unintended demographic externalities. Our findings show that the program in Honduras, which may have inadvertently been designed to create incentives to have children, may have in fact raised fertility by somewhere between 2-4 percentage points – a non-negligible impact in a country where fertility is relatively high. In the two other countries where the programs did not include the same unintentional incentives, Mexico and Nicaragua, we found no net impact of the programs on fertility. Our analysis also explored the potential mechanisms through which fertility in Honduras may have risen and we find that marriage rates may have increased. Furthermore, there is some indication in the other two countries that contraceptive use rose but this might be simply to counteract the impact of reduced spousal separation – another possible unintentional impact of the poverty programs.
Role of Metabolism in the Immunobiology of Regulatory T Cells

Intracellular metabolism is central to cell activity and function. CD4+CD25+ regulatory T cells (Tregs) that express the transcription factor FOXP3 play a pivotal role in the maintenance of immune tolerance to self. Recent studies showed that the metabolism and function of Tregs are influenced significantly by local environmental conditions and the availability of certain metabolites. It also was reported that defined metabolic programs associate with Treg differentiation, expression of FOXP3, and phenotype stabilization. This article reviews how metabolism modulates FOXP3 expression and Treg function, what environmental factors are involved, and how metabolic manipulation could alter Treg frequency and function in physiopathologic conditions.
Ethnic Influence on Disease Manifestations and Autoantibodies in Chinese-Descent Patients with Systemic Sclerosis

Objective. To investigate ethnic influence on disease manifestations and autoantibody profile in patients of Chinese descent with systemic sclerosis (SSc). Methods. In a retrospective study of a multiethnic SSc cohort followed over a 17-year period, disease manifestations and autoantibody profile of patients of European and Chinese descent were compared. Results. There were 300 patients of European descent and 36 of Chinese descent, with similar proportions of women (81% and 72%, respectively) and patients with diffuse SSc (50% and 56%). Patients of Chinese descent [mean age ± standard deviation (SD) 52 ± 16 yrs; p = 0.05] were diagnosed at an older age compared to patients of European descent (mean ± SD 46 ± 12 yrs). Patients of Chinese descent compared to those of European descent had less frequent joint (69% vs 86%; p = 0.01) and gastrointestinal involvement (78% vs 94%; p = 0.004), but increased prevalence of myositis (17% vs 5%; p = 0.01). Patients of Chinese descent had less frequent digital ulceration (36% vs 55%; p = 0.04), and an absence of renal crisis. The frequency of cardiac and pulmonary involvement was similar in both groups. More patients of Chinese than of European descent were positive for anti-topoisomerase-I (47% vs 27%; p = 0.02), anti-Ro (36% vs 10%; p = 0.001), and anti-U1RNP (17% vs 5%; p = 0.03) antibodies. The observed differences for anti-topoisomerase-I, anti-Ro, and joint and gastrointestinal manifestations persisted in the subgroup analysis of patients matched for sex, disease subtype, and age at diagnosis. Conclusion. Patients of Chinese descent have milder SSc disease with less frequent joint and gastrointestinal manifestations, less severe vasculopathy, but increased prevalence of myositis and certain autoantibodies. Research is needed to identify determinants (genetic, environmental, and cultural factors) of the relationship between ethnicity and disease.
EXPERIMENTAL OBSERVATIONS ON THE INFLUENCE OF TEMPERATURE, LIGHT, AND SALINITY ON CELL DIVISION OF THE MARINE DIATOM, DETONULA CONFERVACEA (CLEVE) GRAN 2

The influence of 116 combinations of temperature (2, 7, 12, 16 C), salinity (5–35‰ at 5‰ intervals) and light (5 levels) on the mean daily cell division rate (K) of the Narragansett Bay clone of Detonula confervacea was examined following appropriate preconditioning. Growth did not occur at 16 C, but was excellent (K = 1.2–1.5) under certain combinations of light and salinity at 2, 7, and 12 C, being somewhat better at the 2 highest temperature levels. At 32%, and 1100–1200 ft‐c, K increased approximately 2.5 fold from 0.6 to 1.5 between 2 and 12 C.
Elemental sulfur-based electrodeposition of indium sulfide films

We report research on electrodeposition of indium sulfide films, with In2S3 a less hazardous alternative to CdS buffer layers in solar cells. Numerous organic and aqueous/organic electrolytes of InCl3, NaCl, and elemental sulfur were investigated, including several glycols and amides. Temperatures ranged from 80–170 °C, and deposition voltages from −0.6 to −1.2 V (Ag/AgCl with organic filling solution). Substrates included indium tin oxide-on-glass, molybdenum, and titanium, with indium or graphite anodes. Rapid stirring was used. Deposition was sluggish in all baths. Uniformity and adherence were only moderate, with irregular coverage and cracking-and-flaking sometimes evident. The best baths were ethylene glycol or 1, 2-propanediol-based, with golden-yellow films, nominally In2S3−xOx, depositing typically heavier around the substrate edges. With low temperatures and/or large currents, brown films more rich in indium sometimes formed. Cyclic voltammetry elucidated onset potentials, secondary reactions, and photoactivity, with the greatest anodic photocurrents arising from In2S3's n-type conductivity occurring with mixed ethylene glycol/propionic acid/water baths. Scanning electron microscope photographs indicated a compact small grain microstructure for yellow films. Energy dispersive X-ray analysis and photoelectron spectroscopy data indicate up
Targeted radionuclide therapy with 90Y-DOTATOC in patients with neuroendocrine tumors.

BACKGROUND The aim of this study was to assess the efficacy and safety of targeted radionuclide therapy with [90Y-DOTA0, Tyr3]-octreotide (90Y-DOTATOC) in patients with metastatic neuroendocrine tumors. PATIENTS AND METHODS One hundred and sixteen patients with metastatic neuroendocrine tumors were included. All patients were pre-therapeutically staged with morphological imaging procedures and with somatostatin receptor scintigraphy. The scintigraphy was positive in all cases. The patients were treated with 162-200 mCi/m2 body surface. In 57 patients, the quality of life was assessed with the National Cancer Institute grading criteria (NCI-CTC). Restaging was performed 8-12 weeks after the last treatment cycle. Blood samples were drawn every 2 weeks after the treatment to evaluate toxicity. RESULTS Complete remissions were found in 4%, partial remissions in 23%, stabilization in 62% and progressive disease in 11%. A significant reduction of symptoms was found in 83%. No serious adverse event occurred and the toxicity was acceptable. CONCLUSION 90Y-DOTATOC is a safe and effective treatment for patients with metastatic neuroendocrine tumors.
Regulating health professionals: a review of the empirical literature.

to health care cost-containment, existing systems for regulating health professionals are being scrutinized. The federalized system of control mechanisms for credentialing, together with the procedures of accreditation, institutional rationing of practice privileges, peer review, malpractice actions, and the like, supplies a complex and often redundant array of regulations. These devices are manipulated by several federal agencies, each of the 50 states, professional groups, and several private organizations. These regulations are perceived by many to be a significant barrier to ongoing efforts to encourage costcontainment through more widespread use of competitive incentives in the health care industry. Health manpower regulations govern the locations and settings within which professionals can work and the activities of professionals in the course of their practice. The justification for these controls is the belief that the public interest will best be served if poorly trained, incompetent, and unethical people are kept from practicing. If these regulations are effective, they will ensure the patients' safe treatment by prohibiting some people from pursuing careers and will appropriately modify the behavior of practicing professionals. An unfortunate by-
Failure to Eradicate Vancomycin-Resistant Enterococci in a University Hospital and the Cost of Barrier Precautions

Abstract Objective: To describe the effect of infection control interventions on the incidence of vancomycin-resistant enterococci (VRE), the utility of pharyngeal cultures for surveillance for VRE colonization, and the cost of barrier precautions. Design: Evaluation of the occurrence of VRE infection or colonization, rates of vancomycin use, results of surveillance cultures before and after interventions, and the cost of increased barrier precautions. Setting: University of Massachusetts Medical Center, a 347-bed tertiary-care teaching hospital with eight intensive-care units, one burn unit, and one bone marrow transplant unit. Participants: Patients in the intensive-care units and staff who were involved with patients colonized or infected with VRE. Methods: Infection control interventions included placement of patients with VRE in private rooms, strict contact isolation, cohorting of patient and nursing staff, prohibiting of equipment sharing, and monitoring of compliance with the vancomycin restriction policy, with hand washing, and of the adequacy of environmental cleaning. Both rectal and pharyngeal cultures were obtained from patients at the beginning of the outbreak, and the utility of pharyngeal cultures was evaluated. The cost of barrier precautions was estimated by comparing the cost of glove and gown use before and after the outbreak began. Results: The interventions decreased the number of new cases of VRE, but total eradication of VRE was not achieved. Compliance with the room-cleaning protocol was 91% (141/155 observations). Hand washing following interaction with patients who were not in isolation was 51%, vs 100% for patients in isolation. Overall, handwashing compliance was 71% (319/449): 56% (130/231) for physicians and 86% (187/218) for nurses (P<.0001). The mean number of doses of vancomycin dispensed per 1,000 patient days decreased from 145 to 114 per 1,000 patient days (P<.001). Compliance with vancomycin-use guidelines was 85%. Forty-six (77%) of 60 surveillance rectal swabs yielded enterococci, as compared to only 4 (11%) of 36 pharyngeal cultures (P<.0001). Expenses on glove and gowns alone increased by over $11,000 per year since the epidemic began. Conclusions: Implementation of the various infection control measures did not eradicate VRE cases from the hospital. Rectal cultures were more useful than pharyngeal cultures for surveillance of VRE. Controlling VRE epidemics can be costly.
Exposure to oxidized low-density lipoprotein reduces activable ras protein in vascular endothelial cells

SummaryOxidized low-density lipoprotein (ox-LDL) has been shown to alter the migratory and proliferative activities of the vascular endothelial cells (EC) in response to serum and growth factors. The mechanism underlying the antiproliferative effect of ox-LDL on vascular EC has not been fully elucidated. In this report, we show that exposure of vascular EC to ox-LDL results in a marked reduction of the membrane-associated Ras protein. Further study shows that in ox-LDL-treated EC, reduction of the membrane-associated Ras protein is correlated with a reduced amount of active Ras (Ras-guanosine triphosphate), indicating that the Ras signaling pathway is attenuated. The attenuation of the Ras signaling pathway in ox-LDL-treated EC may thus be responsible for the retarded response to the mitogenic stimulation of serum and growth factors.
Predictive Value of Age, Angle, and Refraction on Rate of Reoperation and Rate of Spontaneous Resolution in Infantile Esotropia

In the Early vs. Late Infantile Strabismus Surgery Study (ELISSS), 13.5% of children operated at 20 months vs. 3.9% of those operated at age 4 had gross binocular vision (Titmus Housefly). Reoperation rates were 28.7% in the former vs. 24.6% in the latter group and, although all were eligible for surgery at baseline at 11 SD 3.7 months, 8% in the early group vs. 20% in the late group were never operated, mostly because their angle decreased spontaneously. We assessed the predictive value of age, angle, and refraction in these matters. Methods: The ELISSS reoperation rates were first compared with those found in nine series of consecutive cases in nine university clinics operated during one particular year, between 6 and 23 years previously. Logistic regression was used to estimate the effect of postoperative angle and clinic on the chance of reoperation. Secondly, a meta-regression analysis was done of these and other reported reoperation rates. The mean age at operation and the mean duration of follow-up were regressed on the logistically transformed reported reoperation rates. Finally, to estimate the chance of spontaneous decrease of the angle without surgery, a random-effects model was fitted on the 6-monthly orthoptic measurements of angle and refraction in the ELISSS that antedated surgery, loss to follow-up, or final examination. In the random-effects model (see online-only supplement link or visit, www.simonsz.net), for ELISSS patients the random effect was defined as the deviation of the average angle, the fixed effect. A vector was defined based on age and spherical equivalent of the patient. The variance around the prediction consisted of uncertainty in the estimations, random effects, and residuals. Results: In the retrospective study, 204 patients who had been first operated between 6 and 23 years previously were eligible. A reoperation had been performed in 32 (19.3%) of the remaining 166 children who were 4.33 SD 1.35 years old at first surgery. The reoperation rate was 7.3% for those with a postoperative angle of −4° to +4° (N = 82), 25% for postoperative divergence > 5°, and 29% for postoperative convergence 10° to 14°. Strabismologists overestimated the reoperation rates at double. In the meta-regression analysis, 12 studies were included. Reoperation rates were between 60% and 80% for children first operated around age 1 and approximately 25% for children operated around age 4 (best fit: −0.221 Ln [age in months] + 1.1069; R2 = 0.5725). Finally, in the predictions of random-effects model, a small angle at age 1 and hyperopia of approximately +4 increased the chance of spontaneous decrease of the angle into a microstrabismus. Discussion: The benefit of early surgery for gross binocular vision is balanced by a higher reoperation rate and an occasional child being operated that would have had a spontaneous decrease into a microstrabismus without surgery. The fact that, in the ELISSS, hyperopia was associated with a decrease of the angle underscores the benefit of early refractive correction.
Low‐Level Light Therapy for Androgenetic Alopecia: A 24‐Week, Randomized, Double‐Blind, Sham Device–Controlled Multicenter Trial

Background Androgenetic alopecia (AGA) is a common disorder affecting men and women. Finasteride and minoxidil are well‐known, effective treatment methods, but patients who exhibit a poor response to these methods have no additional adequate treatment modalities. Objective To evaluate the efficacy and safety of a low‐level light therapy (LLLT) device for the treatment of AGA. Methods This study was designed as a 24‐week, randomized, double‐blind, sham device–controlled trial. Forty subjects with AGA were enrolled and scheduled to receive treatment with a helmet‐type, home‐use LLLT device emitting wavelengths of 630, 650, and 660 nm or a sham device for 18 minutes daily. Investigator and subject performed phototrichogram assessment (hair density and thickness) and global assessment of hair regrowth for evaluation. Results After 24 weeks of treatment, the LLLT group showed significantly greater hair density than the sham device group. Mean hair diameter improved statistically significantly more in the LLLT group than in the sham device group. Investigator global assessment showed a significant difference between the two groups, but that of the subject did not. No serious adverse reactions were detected. Conclusion LLLT could be an effective treatment for AGA.
Liver disease in the pregnant patient

Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. Given the wide range of choices in any health care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its practice parameters committee. These guidelines are also approved by the governing boards of the American Gastroenterological Association, the American Society for Gastrointestinal Endoscopy, and the American Association for the Study of Liver Diseases. Expert opinion is solicited from the outset for the document. Guidelines are reviewed in depth by the committee, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.
The Q‐switched Neodymium (Nd):YAG Laser with Quadruple Frequency.: TClinical Histological Evaluation of Facial Resurfacing Using Different Wavelengths

background. The Q‐switched neodymium (Nd):YAG laser with quadruple frequency is very effective for the treatment of tattoos, pigmented lesions, and vascular, benign lesions. It is also an option for treating rhytides, scars, and facial pigmentations. objectives. This paper is based on a series of patients with periocular and perioral rhytides, postacne scars, and melanic and vascular eyelid pigmentation who were treated with the Q‐switched Nd:YAG laser with quadruple frequency. methods. The patients were divided in three separate groups: facial wrinkles, postacne scars, and eyelid pigmentation. All were biopsied before and after the laser treatment. Different wavelengths (1064, 650, 585, and 532 nm) were used in order to study the clinical improvement and the histological changes that occurred several weeks following the laser treatment. Additionally, these biopsies aided in observing specific histological characteristics related to applying the different wavelengths by evaluating them along with the clinical results. results. Very good results were achieved in the 22 facial wrinkle cases with two treatments. Excellent results were achieved in the 28 postacne patients, and the outcome of the 16 patients with pigmentation of the eyelids were considered good. conclusion. The Q‐switched Nd:YAG laser with quadruple frequency can be classified as a valid alternative for facial resurfacing. The results obtained are comparable to those with the pulsed carbon dioxide lasers, plus it has the advantage of being effective on vascular lesions.
The role of coinfections in HIV epidemic trajectory and positive prevention: a systematic review and meta-analysis

Objectives:Recurrent or persistent coinfections may increase HIV viral load and, consequently, risk of HIV transmission, thus increasing HIV incidence. We evaluated the association between malaria, herpes simplex virus type 2 (HSV-2) and tuberculosis (TB) coinfections and their treatment on HIV viral load. Design:Systematic review and meta-analysis of the association of malaria, HSV-2 and TB coinfections and their treatment with HIV viral load. Methods:PubMed and Embase databases were searched to 10 February 2010 for studies in adults that reported HIV plasma and/or genital viral load by coinfection status or treatment. Meta-analyses were conducted using random-effects models. Results:Forty-five eligible articles were identified (six malaria, 20 HSV-2 and 19 TB). There was strong evidence of increased HIV viral load with acute malaria [0.67 log10 copies/ml, 95% confidence interval (CI) 0.15–1.19] and decreased viral load following treatment (−0.37 log10 copies/ml, 95% CI −0.70 to −0.04). Similarly, HSV-2 infection was associated with increased HIV viral load (0.18 log10 copies/ml, 95% CI 0.01–0.34), which decreased with HSV suppressive therapy (−0.28 log10 copies/ml, 95% CI −0.36 to −0.19). Active TB was associated with increased HIV viral load (0.40 log10 copies/ml, 95% CI 0.13–0.67), but there was no association between TB treatment and viral load reduction (log10 copies/ml −0.02, 95% CI −0.19 to 0.15). Conclusion:Coinfections may increase HIV viral load in populations where they are prevalent, thereby facilitating HIV transmission. These effects may be reversed with treatment. However, to limit HIV trajectory and optimize positive prevention for HIV-infected individuals pre-antiretroviral therapy, we must better understand the mechanisms responsible for augmented viral load and the magnitude of viral load reduction required, and retune treatment regimens accordingly.