Miracle-dz/UniFAR-FTUs huggingface dataset:
Antibiotics for the Prevention and Treatment of Postsurgical Obstetric Infections.

Importance: Infectious complications contribute significantly to maternal morbidity and mortality. Antibiotics are a cornerstone of prevention and management of postsurgical infections in obstetrics. However, antibiotic resistance from inappropriate use of antibiotics is an emerging global health threat. Objective: The aim of this study was to review the evidence and provide recommendations for antibiotic selection for prevention and treatment of postsurgical infections in obstetrics. Evidence Acquisition: Published literature was retrieved through a search of PubMed. Relevant original research articles, systematic reviews, review articles, and practice guidelines were identified and included. Results: Available evidence supports the use of a first-generation cephalosporin for an unlabored cesarean delivery, with the addition of adjunctive azithromycin for women undergoing labored cesarean delivery. Limited data also support the use of a second-generation cephalosporin at the time of obstetric anal sphincter injury repair. Limited retrospective studies suggest against the use of prophylactic antibiotics for manual removal of the placenta. Data are insufficient to recommend prophylactic antibiotics for postpartum dilation and curettage. Evidence from a systematic review supports clindamycin and gentamicin as the optimal regimen for the treatment of postpartumendometritis. Original obstetric research for the treatment of other postsurgical obstetric infections is limited, and recommendations provided are based on expert opinion. Conclusions andRelevance:Obstetric providers should be familiar with available evidence and guidelines regarding antibiotic selection for the prevention and treatment of obstetric infections. Widespread selection of the narrowest effective antibiotic regimen has the potential to combat the rising threat of antibiotic resistance while ensuring appropriate prevention and treatment of postsurgical infections in obstetrics. Target Audience: Obstetricians and gynecologists, family physicians. LearningObjectives: After completing this activity, the learner should be better able to (1) categorize themost common bacterial isolates responsible for obstetric postsurgical infections; (2) determine which obstetric operative interventions warrant antibiotic prophylaxis based on evidence-based guidelines; and (3) select appropriate, effective, and targeted antibiotics for the treatment of postsurgical infections in obstetrics patients.
Identification of the role of Rh protein in ammonia excretion of the swimming crab Portunus trituberculatus

ABSTRACT In Portunus trituberculatus, a full-length cDNA of Rhesus-like glycoprotein (Rh protein), encoding the entire 478 amino acid protein, has been identified in gills, and plays an essential role in ammonia (NH3/NH4+) excretion. Phylogenetic analysis of Rh-like proteins from crabs was clustered, showing high conservation of the ammonium transporter domain and transmembrane segments essential to the function of Rh protein. Rh protein of P. trituberculatus (PtRh) was detected in all tested tissues, and showed the highest expression in the gills. To further characterize the role of PtRh in ammonia metabolism and excretion, double-stranded RNA-mediated RNA interference of PtRh was employed. Knockdown of PtRh upregulated mRNA expression of ammonia excretion-related genes encoding aquaporin (AQP), K+ channels and vesicle-associated membrane protein (VAMP), increased the activity of Na+/K+-ATPase (NKA) and V-type H+-ATPase (V-ATPase), and initially reduced then elevated the expression of the Na+/H+-exchanger (NHE). dsRNA-mediated reduction in PtRh significantly reduced ammonia excretion rate and increased ammonia and glutamine (Gln) levels in the hemolymph, together with an increase of glutamate dehydrogenase (GDH) and glutamine synthetase (GS) activity, indicating a central role for PtRh in ammonia excretion and detoxification mechanisms. Taken together, we conclude that Rh protein is a primary contributor to ammonia excretion of P. trituberculatus, which may be the basis of their ability to inhabit benthic water with high ammonia levels. Highlighted Article: Evidence for Rh protein as a new paradigm for ammonia excretion, with Rh protein-mediated NH3 movement as the core of ammonia excretion.
Do Intracerebral Cytokine Responses Explain the Harmful Effects of Dexamethasone in Human Immunodeficiency Virus–associated Cryptococcal Meningitis?

Abstract Background The CryptoDex trial showed that dexamethasone caused poorer clinical outcomes and slowed fungal clearance in human immunodeficiency virus–associated cryptococcal meningitis. We analyzed cerebrospinal fluid (CSF) cytokine concentrations from participants over the first week of treatment to investigate mechanisms of harm and test 2 hypotheses: (1) dexamethasone reduced proinflammatory cytokine concentrations, leading to poorer outcomes and (2) leukotriene A4 hydrolase (LTA4H) genotype influenced the clinical impact of dexamethasone, as observed in tuberculous meningitis. Methods We included participants from Vietnam, Thailand, and Uganda. Using the Luminex system, we measured CSF concentrations of the following: interferon γ, tumor necrosis factor (TNF) α, granulocyte-macrophage colony-stimulating factor, monocyte chemoattractant 1, macrophage inflammatory protein 1α, and interleukin 6, 12p70, 8, 4, 10, and 17. We determined the LTA4H genotype based on the promoter region single-nucleotide polymorphism rs17525495. We assessed the impact of dexamethasone on cytokine concentration dynamics and the association between cytokine concentration dynamics and fungal clearance with mixed effect models. We measured the influence of LTA4H genotype on outcomes with Cox regression models. Results Dexamethasone increased the rate TNF-α concentration’s decline in (−0.13 log2pg/mL/d (95% confidence interval, −.22 to −.06 log2pg/mL/d; P = .03), which was associated with slower fungal clearance (correlation, −0.62; 95% confidence interval, −.83 to −.26). LTA4H genotype had no statistically significant impact on outcome or response to dexamethasone therapy. Better clinical outcomes were associated with higher baseline concentrations of interferon γ. Conclusions Dexamethasone may slow fungal clearance and worsen outcomes by increasing TNF-α concentration’s rate of decline.
Impact of an Intimate Partner Violence Training on Home Visitors’ Perceived Knowledge, Skills, and Abilities to Address Intimate Partner Violence Experienced by Their Clients

Aims. The aims of this study were to (1) evaluate the effects of a statewide intimate partner violence (IPV) training on home visitors’ perceived knowledge, skills, and abilities to address IPV experienced by their clients and (2) examine home visitors’ perceived barriers to addressing IPV during client home visits. Methods. In 2015, five equivalent, daylong IPV trainings were held throughout West Virginia. Attendance was mandatory for all home visitors in the state. Pre- and posttraining surveys were administered to every attendee (N = 125). The surveys assessed home visitors’ perceived knowledge, skills, and abilities to address IPV experienced by their clients and perceived barriers to addressing IPV during a client home visit. Results. The results showed (1) home visitors’ knowledge, skills, and abilities significantly improved from pre- to posttraining (all p < .05) and (2) the most commonly reported barriers to addressing IPV were “the partner is present for the visit” (86.2%), “worried that asking may risk my relationship with my client” (30.2%), “not sure how to ask questions without seeming too intrusive” (25.9%), and “worried about upsetting the client” (21.6%). Conclusions. Our findings highlight the immediate positive effects of an IPV training on home visitors’ professional capabilities to address IPV experienced by clients and the most prevalent barriers home visitors face when addressing IPV that should be targeted in future health education interventions.
Selecting immuno-oncology–based drug combinations – what should we be considering?

ABSTRACT Introduction: Checkpoint inhibitor immunotherapy has revolutionized the treatment of many advanced stage cancers. Preexisting immunity is necessary for a response to these agents, which are most effective in inflamed tumors since they principally act by reinforcing preexisting antitumor T-cell responses. An important goal of therapy is to convert the tumor environment from non-inflamed to inflamed in order to facilitate subsequent response to checkpoint inhibitors. Clinical trials are underway to identify checkpoint inhibitor-based combination approaches, which may help to achieve this goal. Areas covered: Anti-PD-1 agents are being assessed in combination with different treatments (e.g. TLR9 agonists, oncolytic peptides, oncolytic vaccines, LAG-3, HDAC inhibitors, GITR, recombinant human interleukin-2) with promising results. PD-1 agents are also being assessed in combination with other locoregional or systemic treatment modalities, including ECT, radiotherapy, chemotherapy, and targeted therapy, with promising results being achieved. Expert commentary: Emerging approaches based on combinations with anti-PD-1 agents seem to offer increased efficacy compared to anti-PD-1 monotherapy. Such combinations also appear to be well tolerated, with safety profiles often comparable to those seen with anti-PD-1 monotherapy. These combination approaches are likely to become an increasing focus of research. There is also the potential for triplet anti-PD-1 combinations.
Ablation of Ezh2 in neural crest cells leads to aberrant enteric nervous system development in mice

In the current study, we examined the role of Ezh2 as an epigenetic modifier for the enteric neural crest cell development through H3K27me3. Ezh2 conditional null mice were viable up to birth, but died within the first hour of life. In addition to craniofacial defects, Ezh2 conditional null mice displayed reduced number of ganglion cells in the enteric nervous system. RT-PCR and ChIP assays indicated aberrant up-regulation of Zic1, Pax3, and Sox10 and loss of H3K27me3 marks in the promoter regions of these genes in the myenteric plexus. Overall, these results suggest that Ezh2 is an important epigenetic modifier for the enteric neural crest cell development through repression of Zic1, Pax3, and Sox10.
Palliative care is effective: but hospital symptom outcomes superior

Objectives To explore differences in severe symptom outcomes for palliative care patients receiving hospital care compared with those receiving care at home. Methods Change in symptom distress from the start of an episode of palliative care to just prior to death was measured for 25 679 patients who died under the care of a hospital or home-based palliative care team between January 2015 and December 2016. Logistic regression models controlled for differences between hospital and home and enabled a comparison of the number of severe symptoms just prior to death. Results All symptoms improved and over 85% of all patients had no severe symptoms prior to death. Pain control illustrates this with 7.4% of patients reporting severe pain distress at episode start and 2.5% just prior to death. When comparing all symptom outcomes by place of death, hospital patients are 3.7 times more likely than home patients to have no severe symptoms. Conclusion Symptom outcomes are better for hospital patients. Patients at home have less improvement overall and some symptoms get worse. Reasons for the difference in outcomes by hospital and home are multifactorial and must be considered in relation to the patient’s right to choose their place of care.
[Independent external verification of the nomograms for predicting lymph node metastasis in penile cancer].

Objective To evaluate the two newly established nomograms for predicting lymph node metastasis in penile cancer based on the clinical data on a large cohort of patients. METHODS We retrospectively studied the clinical data on 93 patients with penile cancer treated in the Center for Tumor Prevention and Treatment. Using the two recently established nomograms (Bhagat nomogram and Zhu nomogram), we predicted lymph node metastasis in the patients, analyzed the differences between prediction and the results of postoperative pathology, and compared the accuracy of prediction between the two nomograms with the receiver operating characteristic (ROC) curve and the area under the curve (AUC). RESULTS The median age of the patients was 55 (27－82) years. Positive lymph nodes were found in 31 cases (33.3%) postoperatively and in 9 (21.9%) of the 41 clinically negative cases. The AUC of the Bhagat nomogram was 0.739 and that of Zhu nomogram was 0.808, both of which were similar to the prediction accuracy of internal verification and manifested a medium predictive ability. CONCLUSIONS The newly established Bhagat and Zhu nomograms can be used for predicting lymph node metastasis in penile cancer, but with a low precision, and therefore cannot be relied exclusively for the option of inguinal lymphadenectomy.
Chemical Differentiation of Genetically Identified Atractylodes japonica, A. macrocephala, and A. chinensis Rhizomes Using High-Performance Liquid Chromatography with Chemometric Analysis

The rhizome of Atractylodes japonica, which is a herbal medicine used for gastrointestinal therapeutics, has been categorized with A. macrocephala rhizome or A. chinensis rhizome based on different therapeutic criteria in Korea, China, and Japan. In the present study, 61 A. japonica, A. macrocephala, and A. chinensis rhizomes were collected from Korea and China and were genetically identified by internal transcribed spacer sequencing analysis. Chromatographic profiles were obtained from high-performance liquid chromatography analysis of the methanol and hot-water extracts of Atractylodes rhizomes and chemical differentiation of the rhizomes was carried out using chemometric statistical analyses such as principal component analysis, hierarchical clustering analysis, and Pearson's correlation coefficient analysis. The results from chromatographic profiles and chemometric analyses demonstrate that A. japonica rhizomes showed apparent chemical differences from A. macrocephala and A. chinensis rhizomes in the methanol extracts. In contrast, no clear distinction was apparent for the hot-water extracts of Atractylodes rhizomes, especially A. chinensis rhizomes. These results indicate that there is a clear chemical difference between A. japonica and A. macrocephala rhizomes; however, the chemical diversity of A. chinensis rhizome shows different chemical relationships with A. japonica or A. macrocephala rhizome, dependent on the chemical features.
Determining the Joint Effect of Obesity and Diabetes on All-Cause Mortality and Cardiovascular-Related Mortality following an Ischemic Stroke

Although obesity and diabetes mellitus, or diabetes, are independently associated with mortality-related events (e.g., all-cause mortality and cardiovascular-related mortality) following an ischemic stroke, little is known about the joint effect of obesity and diabetes on mortality-related events following an ischemic stroke. The aim of this study is to evaluate the joint effect of obesity and diabetes on mortality-related events in subjects with a recent ischemic stroke. Data from the multicenter Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial was analyzed for this study. The joint effect of obesity and diabetes on mortality-related events was estimated via Cox proportional hazards regression models. No difference in the hazard of all-cause mortality following an ischemic stroke was observed between obese subjects with diabetes and underweight/normal-weight subjects without diabetes. In contrast, obese subjects with diabetes had an increased hazard of cardiovascular-related mortality following an ischemic stroke compared with underweight/normal-weight subjects without diabetes. Additionally, there was evidence of an attributable proportion due to interaction as well as evidence of a highly statistically significant interaction on the multiplicative scale for cardiovascular-related mortality. In this clinical trial cohort of ischemic stroke survivors, obesity and diabetes synergistically interacted to increase the hazard of cardiovascular-related mortality.
Preemptive Analgesia in Total Knee Arthroplasty: Comparing the Effects of Single Dose Combining Celecoxib with Pregabalin and Repetition Dose Combining Celecoxib with Pregabalin: Double-Blind Controlled Clinical Trial

Acute pain is the most common early complication after total knee arthroplasty causing delayed mobilization and increased demands of morphine, leading to higher operative cost. Several studies have assessed the effectiveness, side-effects, and ease of use of various analgesics. Preemptive analgesia with combined celecoxib and pregabalin has been reported to yield positive outcomes. In this randomized, double-blind controlled clinical trial, 30 subjects underwent surgery for total knee arthroplasty using 15-20mg bupivacaine 5% epidural anesthesia. All subjects were divided into three groups. Group 1 was given celecoxib 400mg and pregabalin 150mg 1 hour before the operation, Group 2 was given celecoxib 200mg and pregabalin 75mg twice daily starting from 3 days before the operation, and Group 3 was given a placebo. The outcome was measured with Visual Analog Scale, knee range of motion, and postoperative mobilization. There was a significant difference in postoperative morphine usage between the groups that were administered with preemptive analgesia and the placebo group, but no significant difference was found between Group 1 and Group 2 that were given preemptive analgesia at different doses. ROM and postoperative mobilization were not significantly different among the three groups. Two patients in the first group, one patient in the second group, and one patient in the third group developed nausea. Preemptive analgesia is proven to reduce postoperative usage of morphine independent of the dosage. We recommend the use of combined celecoxib and pregabalin as preemptive analgesia after the total knee arthroplasty procedure. This trial is registered with NCT03523832 (ClinicalTrials.gov).
Direct Electrophysiological Mapping of Shape-Induced Affective Perception

Visual information may convey different affective valences and induce our brain into different affective perceptions. Many studies have found that unpleasant stimuli could produce stronger emotional effects than pleasant stimuli could. Although there has been a notion that triangle is perceived as negative and circle as positive, there has been no systematic study to map the degrees of valence of shapes with different affective perceptions. Here, we employed four shapes (ellipse, triangle, and line-drawn happy and angry faces) to investigate the behavior and electrophysiological responses, in order to systematically study shape-induced affective perception. The reaction time delay and the event-related potential (ERP), particularly the early ERP component, were applied to find the associations with different affective perceptions. Our behavioral results showed that reaction time for angry face was significantly shorter than those for the other three types of stimuli (p < 0.05). In the ERP results, P1, N1, P2, and N2 amplitudes for angry face were significantly larger than those for happy face. Similarly, P1, N1, P2, and N2 amplitudes for triangle were significantly larger than those for ellipse. Particularly, P1 amplitude in the parietal lobe for angry face was the strongest, followed by happy face, triangle, and ellipse. Hence, this work found distinct electrophysiological evidence to map the shape-induced affective perception. It supports the hypothesis that affective strain would induce larger amplitude than affective ease does and strong affective stimuli induce larger amplitude than mild affective stimuli do.
Efficacy and Safety of Single-Session Endoscopic Stone Removal for Acute Cholangitis Associated with Choledocholithiasis

Background/Aims In early endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis due to choledocholithiasis, it is unclear that single-session stone removal can be safely performed. We examined the efficacy and safety of early single-session stone removal for mild-to-moderate acute cholangitis associated with choledocholithiasis. Methods Among patients with mild-to-moderate acute cholangitis associated with choledocholithiasis who underwent early ERCP (n = 167), we retrospectively compared the removal group (patients who underwent single-session stone removal; n = 78) with the drainage group (patients who underwent biliary drainage alone; n = 89) and examined the effectiveness and safety of single-session stone removal by early ERCP. Results The patients in the removal group had significantly fewer and smaller stones compared with those in the drainage group. The single-session complete stone removal rate was 85.9% in the removal group. The complication rate in early ERCP was 11.5% in the removal group and 10.1% in the drainage group, with no significant difference (P = 0.963). On comparing patients who underwent early endoscopic sphincterotomy (EST) with those who underwent elective EST after cholangitis had improved, the post-EST bleeding rates were 6.8% and 2.7%, respectively, with no significant difference (P = 0.600). The mean duration of hospitalization was 11.9 days for the removal group and 19.9 days for the drainage group, indicating a shorter stay for the removal group (P < 0.001). In multiple linear regression analysis, stone removal in early ERCP, number of stones, and C-reactive protein level were significant predictors of hospitalization period. Conclusions Single-session stone removal for mild-to-moderate acute cholangitis can be safely performed. It is useful from the perspective of shorter hospital stay.
Bayesian Network Meta-Analysis of the Effectiveness of Various Interventions for Nontraumatic Osteonecrosis of the Femoral Head

Objective To assess the effectiveness of various therapeutic hip preservation strategies on patients with nontraumatic osteonecrosis of the femoral head (ONFH). Design This is a systematic review of previous literature and in-depth Bayesian network meta-analysis of randomized controlled trials (RCTs) to compare the clinical effect of various operation methods and one physical intervention (extracorporeal shockwave). Data Sources Electronic literature, for studies published up to December 2017, was collected from PubMed, Medline, and the Cochrane Library. Study Selection We selected RCTs on patients with ONFH. Treatment methods included extracorporeal shockwave (ESW), core decompression (CD), multiple drilling decompression (DD), vascularized fibular grafting (VFG), free-vascularized fibular grafting (FVFG), inverted femoral head grafting (IFHG), vascular iliac pedicle bone grafting (VIPBG), osteotomy, and tantalum implantation (TI). Outcome The primary outcome was Harris score; the secondary outcome was Harris hip score (HHS), including total hip arthroplasty requirement (THA) and progression to collapse. Results A total of 14 randomized controlled trials were investigated. ESW had the highest improvement on Harris score (probability best 52%), followed by VFG (probability was 38%). In the meanwhile, VFG also proved to be superior in reducing the failure rates of treatment (probability lowest 59%), followed by ESW (probability lowest 24%). In femoral necrosis stage-II, VFG achieved the highest probability in preventing treatment failures (52%) and showed better performance in reducing treatment failure rates than CD. Conclusion ESW therapy (ESWT) is the most effective intervention to improve HHS, and VFG shows superior effect on reducing treatment failure rates.