Miracle-dz/UniFAR-FTUs huggingface dataset:
An outbreak of multidrug-resistant, quinolone-resistant Salmonella enterica serotype typhimurium DT104.

BACKGROUND Food-borne salmonella infections have become a major problem in industrialized countries. The strain of Salmonella enterica serotype typhimurium known as definitive phage type 104 (DT104) is usually resistant to five drugs: ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline. An increasing proportion of DT104 isolates also have reduced susceptibility to fluoroquinolones. METHODS The Danish salmonella surveillance program determines the phage types of all typhimurium strains from the food chain, and in the case of suspected outbreaks, five-drug-resistant strains are characterized by molecular methods. All patients infected with five-drug-resistant typhimurium are interviewed to obtain clinical and epidemiologic data. In 1998, an outbreak of salmonella occurred, in which the strain of typhimurium DT104 was new to Denmark. We investigated this outbreak and report here our findings. RESULTS Until 1997, DT104 infections made up less than 1 percent of all human salmonella infections. The strain isolated from patients in the first community outbreak of DT104 in Denmark, in 1998 was resistant to nalidixic acid and had reduced susceptibility to fluoroquinolones. The outbreak included 25 culture-confirmed cases. Eleven patients were hospitalized, and two died. The molecular epidemiology and data from patients indicated that the primary source was a Danish swine herd. Furthermore, the investigation suggested reduced clinical effectiveness of treatment with fluoroquinolones. CONCLUSIONS Our investigation of an outbreak of DT104 documented the spread of quinolone-resistant bacteria from food animals to humans; this spread was associated with infections that were difficult to treat. Because of the increase in quinolone resistance in salmonella, the use of fluoroquinolones in food animals should be restricted.
Incisional Hernia After Liver Transplant.

OBJECTIVES An incisional hernia seriously burdens the quality of life after liver transplant. The incidence of incisional hernia after liver transplant is reported to be 4% to 20%. Here, we evaluated incisional hernias that occurred after adult liver transplant and incisional hernias intentionally made in infant liver transplant procedures. MATERIALS AND METHODS Between December 1988 and May 2016, we performed 536 liver transplant procedures in 515 patients. Demographic features, surgical outcomes, and predisposing factors were evaluated. RESULTS Of 452 liver transplant patients included, incisional hernias were diagnosed in 29 patients (6.4%; 7 pediatric, 22 adult). Most were males (77%) with Child-Pugh score C cirrhosis (62%), moderate/severe ascites (81%), and serum albumin levels <3.5 g/L (86%). Incisional hernia developed in 16 of 51 patients (31%) with wound infection. Twelve incisional hernias were seen in 40 recipients (30%) with body mass index ≥30 kg/m2. Eight of 45 patients (18%) with repeated surgery had incisional hernias. Five of 22 adult incisional hernias (23%) had primary fascia repair, and 17 (77%) were repaired with Prolene mesh graft (3 sublay, 14 onlay). No other complications and no hernia recurrence were shown during follow-up (range, 8-138 mo). Of 7 pediatric liver transplant patients with intentionally made incisional hernias during liver transplant, 5 patients had primary fascia repair and 2 patients had onlay mesh repair. No complications or recurrence were shown during follow-up (range, 12-60 mo). CONCLUSIONS Repeated surgery, postoperative wound infection, and obesity were found to be predisposing risk factors for incisional hernia development after liver transplant in adults. Abdomen closure in infant liver transplant with large-for-size grafts is a different area of discussion. Here, we suggest that an intentionally made incisional hernia with staged closure of the abdomen is safe and effective for graft and patient survival.
Risk-taking attitudes of people who seek health care: an exploratory approach through lottery games using generalized estimating equations

RESUMEN Fundamento: La caracterizacion de la actitud ante el riesgo puede ser util en la planificacion de las intervenciones sanitarias. El objetivo fue estudiar la actitud ante el riesgo de una poblacion que demanda cuidados de salud y evaluar la capacidad de un juego de loterias para evidenciar dicha actitud. Metodos: Estudio multicentrico transversal. Se recogieron caracteristicas demograficas, socioeconomicas, de calidad de vida y conductas de riesgo en salud de 662 personas usuarias de 23 centros de salud seleccionadas mediante muestreo aleatorio. La actitud ante el riesgo se evaluo mediante una escala subjetiva y mediante dos juegos de azar (L1 y L2; L2 incluia la posibilidad de perdidas economicas). Se realizaron modelos explicativos para valorar la variabilidad de la propension al riesgo utilizando Generalized Estimating Equations (GEE). Resultados: El 19,1% (IC95%:15,6-22,6%) de los sujetos expresaron una propension al riesgo alta, el 10,0% (IC95%:7,0-13,0) fueron clasificados como propensos al riesgo con L2. Se encontro asociacion entre una mayor propension al riesgo y tener mejor percepcion del estado de salud (0,110; IC95%:0,007-0,212) o mayor renta (0,010; IC95%: 0,017-0,123) o ser fumador (0,059; IC95%: 0,004-0,114). Ser espanol se relacionaba con menor propension al riesgo (-0,105; IC95%: -0,205- -0,005), al igual que ser mayor de 65 anos (-0,031; IC95%:-0,061--0,001) o ser mujer (-0,038, IC95%:-0,064--0,012). El coeficiente de correlacion intraclase para la escala subjetiva fue 0,511 (IC95%:0,372-0,629), 0,571 (IC95%:0,441-0,678) para L1 y 0,349 (IC95%:0,186-0,493) para L2. Conclusiones: Las personas que demandan cuidados de salud presentan con frecuencia propension al riesgo, la cual se atenua cuando se caracteriza mediante metodologias que implican perdidas. La propension al riesgo parece mayor en personas jovenes, varones, con mejor estado de salud, con mayor renta y en inmigrantes.
Acute Copper and Cupric Ion Toxicity in an Estuarine Microbial Community

Copper was acutely toxic to the estuarine microbial community of Middle Marshes, N.C. Under ambient water quality conditions, 10 μg of added total copper [Cu(II)] liter−1 reduced the CFU bacterial abundance by up to 60% and inhibited the amino acid turnover rate (AATR) by as much as 30%. Copper toxicity, however, was a quantitative function of free cupric ion (Cu2+) activity that was not directly related to Cu(II) or ligand-bound copper. By using a nitrilotriacetic acid-cupric ion buffer to control pCu (−log Cu2+ activity), it was found that an in situ pCu of 10.1 was bactericidal, reducing the CFU by 60%, but inhibited the AATR by only about 10%. A bacterial bioassay that was used to estimate the pCu in Cu(II)-treated Middle Marshes samples indicated that less than 0.5% of added Cu(II) was in the free cupric ion form. CFU was a more sensitive indicator of low-level copper stress than was AATR. When tested at different times, native microbial community responses to acute cupric ion stress were quantitatively quite similar even when there were large differences in bacterial abundances and in situ metabolic rates. Variations were observed in response to Cu(II) treatments at different times, but these were likely due to differences in water quality, which would quantitatively influence the distribution of copper complexes that were present. Asymptotic response curves suggest that some degree of copper resistance exists in this community. At a pCu of 8, more than 2 orders of magnitude above the minimum inhibitory level, the CFU was still 5 to 10% and the AATR was about 3% of the control values.
Protection of Neonatal Chicks Against a Lethal Challenge of Escherichia coli Using DNA Containing Cytosine-Phosphodiester-Guanine Motifs

Oligodeoxynucleotides (ODN) containing cytosine-phosphodiester-guanine (CpG) motifs have been shown to be effective immunoprotective agents in murine models for a variety of viral, intracellular bacterial, and protozoan infections. We recently have shown that CpG ODN protects against extracellular bacterial infections in mature chickens. The objective of this study was to investigate the effect of CpG ODN on Escherichia coli septicemia in neonatal broiler chicks. Two-day-old chicks, or embryonated eggs that had been incubated for 18 or 19 days, received 50 microg CpG ODN. Three days after exposure to CpG ODN, a virulent isolate of E. coli was inoculated subcutaneously in the neck of each bird. Birds were examined for 7 days post-E. coli challenge and dinical, pathologic, and bacteriologic assessments were conducted. The control group of birds that received no CpG ODN had a survival rate of 0% to 20%. In contrast, groups that received CpG ODN, either by intramuscular or in ovo routes, had significantly higher survival rates (P < 0.0001). Bacterial counts in air sacs were significantly lower when birds or embryos were treated with CpG ODN as compared with controls. A dose as low as 10 microg of CpG ODN, administered intramuscularly, was able to protect birds significantly against E. coli challenge. Formulation of CpG ODN with 30% Emulsigen did not enhance the protection. This study demonstrates that CpG ODN has systemic protective effects in broiler chicks against E. coli infections. This is the first time that CpG ODN has been demonstrated to have an immunoprotective effect against a bacterial infection in chicks following in ovo delivery.
Transmission protocols for challenging networks: LTP and LTP-T

Challenging networks require transmission protocols able to deal with the specificities of the environment. These adverse conditions include very long delays (delays in hours are normal), episodic connectivity, asymmetric data rates, higher bit error rate (The raw BERs are in the order of 10-2), very high free space losses (around 250-300 dB) and power constraints that may severely compromise the effectiveness of standard transport protocols. Transmissions protocols must also relieve applications and other upper-layer protocols (like the bundle protocol from the Delay Tolerant Network architecture) from the need to deal with the characteristics of intervening communications networks and services. In this paper we analyse the impacts of parameters such as loss probability and propagation delay on Licklider Transmission Protocol (LTP) [1], [2] and the newly proposed Licklider Transmission Protocol-(LTP-T) [3] following a comparative study of both the protocols.
Novel glomerular lipoprotein deposits associated with apolipoprotein E2 homozygosity.

BACKGROUND Hyperlipoproteinemia is occasionally associated with severe glomerular injury caused by abnormal accumulation of lipid in glomeruli, which occurs in conditions such as lipoprotein glomerulopathy (LPG). This study investigates the cases of two siblings with homozygous apolipoprotein (apo) E2 who show unique histologic features, massive proteinuria, and dysbetalipoproteinemia. METHODS Histologic studies were performed using renal biopsy specimens. Plasma lipoproteins were extensively characterized. The exons of the apo E genes were sequenced to avoid missing any mutations. RESULTS Histologically, the siblings' condition resembled LPG by light microscopy studies. Electron microscopy studies revealed large lipoid deposits in the paramesangium, subendothelium, and subepithelium of the glomeruli, which were different from LPG in terms of not forming the layered structure resembling a fingerprint even in large lipoprotein thrombi, and mesangial foam cells. Immunohistochemically, the lipoid deposits contained apo E and apo B. These patients did not have either diabetic nephropathy or other known forms of glomerulonephritis. The sequence of exons of the apo E genes revealed homozygosity for apo E2 in both cases. CONCLUSION The extensive lipoprotein deposition in glomeruli, which resembles LPG, can also occur in apo E2 homozygous individuals, but in a distinct fashion. Because the two cases were siblings, they may have other shared alleles, in addition to the apo E2 allele, that negatively affect processing of lipoproteins and lead to abnormal accumulation of lipoprotein deposits in glomeruli.
The role of diffusion magnetic resonance imaging in Parkinson's disease and in the differential diagnosis with atypical parkinsonism

Parkinson's disease is one of the most common neurodegenerative diseases. Clinically, it is characterized by motor symptoms. Parkinson's disease should be differentiated from atypical parkinsonism conditions. Conventional magnetic resonance imaging is the primary imaging method employed in order to facilitate the differential diagnosis, and its role has grown after the development of advanced techniques such as diffusion-weighted imaging. The purpose of this article was to review the role of magnetic resonance imaging in Parkinson's disease and in the differential diagnosis with atypical parkinsonism, emphasizing the diffusion technique.
Utilization of patient classification systems in Swedish hospitals and the degree of satisfaction among nursing staff.

BACKGROUND Although patient classification tools have been used in Sweden since the 1980s, few studies have examined how they are utilized and monitored. AIM This paper investigates the patient classification systems implemented in hospitals in the country as well as the level of satisfaction of nurses with the implemented instrument. METHOD A postal survey method was used in which a total of 128 questionnaires were sent to nurse managers. Twenty-three hospitals were identified with patient classification systems currently in operation. RESULTS AND CONCLUSION The Zebra and Beakta systems are the most commonly used instruments. Nurse managers appear to be satisfied with the patient classification systems in use on their wards as a whole except for their inability to measure the quality of care provided, the time spent to use the instruments and the fact that the administration do not estimate nursing staff requirements using the system.
Lithium: An American Perspective

American psychiatry (like the country itself) seems to be branded by those outside my country with the adjectives associated with children or superficial, easily distracted adults. ”enamored by whatever is new and shiny” [1]. With regard to lithium, we are accused of being out of step with the rest of the psychiatric world, prescribing lithium less frequently, distracted by pharmaceutical marketing of proprietary medications or unduly swayed by the direct to consumer (DTC) marketing, unable to resist our patients’ requests to be prescribed whatever medication they saw advertised on late night television.
Wideband RF power amplifier predistortion using real-valued time-delay neural networks

this paper suggests the application of Real-Valued Time-Delay Neural Networks (RVTDNN) for Power Amplifier (PA) behavioral modeling and linearization. The Weights of the RVTDNN model and linearizer are identified using the Back Propagation Learning Algorithm (BPLA), which is applied to the measured input and output signals of the PA. The RVTDNN scheme is first successfully used to accurately predict the dynamic nonlinear behavior of a 250W LDMOS Doherty amplifier driven with 4 Carrier (4C) WCDMA signal. The RVTDNN is then applied for the construction of a digital predistortion to improve the linearity of the same Doherty amplifier. The ACPR of the linearized Doherty amplifier revealed an adjacent channel power ratio (ACPR) of better then 50dBc at the three offset frequency (5MHz, 10MHz, 15MHz).
The clinical, psychosocial, and socioeconomic concerns of urban youth living with diabetes.

OBJECTIVE Young people with chronic diseases face the challenge of moving from the pediatric to the adult health care environment, in addition to the normal hurdles of young adulthood. To most effectively help them through this process, we must first understand their perspective. DESIGN Qualitative study of the social and emotional impact of having diabetes. SAMPLE Young adults (n=23), aged 19-26, who had been living with diabetes for a median of 12 years (range 4-19) were contacted; all but one were from underserved ethnic minorities. MEASUREMENTS Semistructured telephone interviews were conducted, transcribed, and coded. RESULTS Having diabetes profoundly affected the life choices and expectations of these young people; their feelings and attitudes evolved over time. Financial and insurance concerns were key, because managing diabetes care on one's own as an adult was a major challenge. Most young people reported that family, friends, and coworkers were sources of support, but that disclosure of their diabetes was problematic. CONCLUSIONS Offering emotional and practical support to young adults coping with diabetes is key to ensuring adequate medical management as they move into the adult system and assume full responsibility for their health.
UK Monitoring of Problem Drug Users: The Drug Misuse Database – A System Based on Regional Centres

UK drug treatment policy aims to reduce the harm to individuals and communities resulting from drug misuse through multidisciplinary community services, prescribing, detoxification and rehabilitation facilities. Drug Misuse Databases (DMD) were set up in England, Wales and Scotland in 1990 to monitor treatment demand; that in Northern Ireland is under development. The regional base of these DMDs provides good local context and data specificity, while periodic collation of regional data by the Department of Health provides national analyses. DMD will be able to deliver the TDI dataset with only minor adjustments, following harmonisation between the constituent UK countries.
Systemic inflammatory response is a predictor of outcome in patients undergoing preoperative chemoradiation for locally advanced rectal cancer

Aim Current management of locally advanced rectal cancer includes neoadjuvant chemoradiation in selected patients to increase the chance of a tumour‐free circumferential resection margin. There is uncertainty over the role of and selection criteria for additional systemic therapy in this group of patients. In this retrospective study we investigate the association between markers of systemic inflammatory response (SIR) and outcome from treatment.
Fewer REBOA complications with smaller devices and partial occlusion: evidence from a multicentre registry in Japan

Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) performed by emergency physicians has been gaining acceptance as a less invasive technique than resuscitative thoracotomy. Objective To evaluate access-related complications and duration of occlusions during REBOA. Methods Patients with haemorrhagic shock requiring REBOA, from 18 hospitals in Japan, included in the DIRECT-IABO Registry were studied. REBOA-related characteristics were compared between non-survivors and survivors at 24 hours. 24-Hour survivors were categorised into groups with small (≤8 Fr), large (≥9 Fr) or unusual sheaths (oversized or multiple) to assess the relationship between the sheath size and complications. Haemodynamic response, occlusion duration and outcomes were compared between groups with partial and complete REBOA. Results Between August 2011 and December 2015, 142 adults undergoing REBOA were analysed. REBOA procedures were predominantly (94%) performed by emergency medicine (EM) physicians. The median duration of the small sheath (n=53) was 19 hours compared with 7.5 hours for the larger sheaths (P=0.025). Smaller sheaths were more likely to be removed using external manual compression (96% vs 45%, P<0.001). One case of a common femoral artery thrombus (large group) and two cases of amputation (unusual group) were identified. Partial REBOA was carried out in more cases (n=78) and resulted in a better haemodynamic response than complete REBOA (improvement in haemodynamics, 92% vs 70%, P=0.004; achievement of stability, 78% vs 51%, P=0.007) and allowed longer occlusion duration (median 58 vs 33 min, P=0.041). No statistically significant difference in 24-hour or 30-day survival was found between partial and complete REBOA. Conclusion In Japan, EM physicians undertake the majority of REBOA procedures. Smaller sheaths appear to have fewer complications despite relatively prolonged placement and require external compression on removal. Although REBOA is a rarely performed procedure, partial REBOA, which may extend the occlusion duration without a reduction in survival, is used more commonly in Japan.
Parathyroid Hormone Uses Multiple Mechanisms to Arrest the Cell Cycle Progression of Osteoblastic Cells from G1 to S Phase*

Parathyroid hormone (PTH) plays a major role in bone remodeling and has the ability to increase bone mass if administered daily. In vitro, PTH inhibits the growth of osteoblastic cell lines, arresting them in G1 phase. Here, we demonstrate that PTH regulates the expression of at least three genes to achieve the following: inducing expression of MAPK phosphatase 1 (MKP-1) and p21Cip1 and decreasing expression of cyclin D1 at both mRNA and protein levels. The induction of MKP-1 causes the dephosphorylation of extracellular signal-regulated kinase and therefore the decrease in cyclin D1. Overexpression of MKP-1 arrests UMR cells in G1 phase. The mechanisms involved in PTH regulation of these genes were studied. Most importantly, PTH administration produces similar effects on expression of these genes in rat femoral metaphyseal primary spongiosa. Analyses of p21Cip1 expression levels in bone indicate that repeated daily PTH injections make the osteoblast more sensitive to successive PTH treatments, and this might be an important feature for the anabolic functions of PTH. In summary, our data suggest that one mechanism for PTH to exert its anabolic effect is to arrest the cell cycle progression of the osteoblast and hence increase its differentiation.
Primary follicular lymphoma of the gastrointestinal tract: a retrospective case series

Little is known about the clinicopathologic char− acteristics of primary follicular lymphoma of the gastrointestinal tract (PFLGI). We report our ex− perience with double−balloon enteroscopy (DBE) in patients with PFLGI. Between January 2001 and December 2006, thirteen patients with PFLGI (nine men and four women; mean age, 53.4 years) visited Hiroshima University Hospital. We performed DBE in 11 PFLGI patients to examine the entire small bowel. DBE showed new lesions in the third portion of the duodenum, jejunum, or ileum in nine of these 11 patients (81.8%). The en− doscopic finding was nodularity of the involved mucosal surface (small whitish polyps or whitish granules). Seven patients were treated with ri− tuximab plus CHOP chemotherapy (R−CHOP). A complete response was obtained in all patients who received R−CHOP, and no recurrence was seen (mean follow−up period, 22.5 months).