Miracle-dz/UniFAR-FTUs huggingface dataset:
Are clinical symptoms more predictive than laboratory parameters for adverse maternal outcome in HELLP syndrome?

Background. To determine the risk factors for adverse maternal outcome among women with HELLP syndrome. Methods. Sixty‐one pregnancies with hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome diagnosed antenatally were reviewed between 2003 and 2005. Maternal outcomes analyzed included eclampsia, abruptio placentae, disseminated intravascular coagulopathy (DIC), acute renal failure, need for transfusion of blood products, cesarean delivery and maternal death. Risk factors included maternal age, parity, gestational age at diagnosis, mean arterial blood pressure, headache, visual changes, nausea‐vomiting, epigastric pain, blood platelet count (≤50,000 versus>50,000 cells/mm3), and peak serum levels of aspartate aminotransferase. Results. Eclampsia was present in 52%, abruptio placentae in 11%, and DIC in 8% of 61 women with HELLP syndrome. 23% women required transfusion of blood products, 15% had acute renal failure, and 73% had cesarean section. Women with eclampsia had significantly more headache, nausea‐vomiting, visual changes and epigastric pain (p<0.05). Transfusion was significantly more frequent among women with blood platelet counts≤50,000 cells/mm3 (33 versus 21%; p<0.05). Women with a platelet count≤50,000 cells/mm3 had a higher rate of DIC compared to women with a platelet count>50,000 cells/mm3 (33.3 versus 3.8%; p<0.05). In women with acute renal failure and abruptio placentae, there were no significant differences in all the variables studied between those with and without these complications. Conclusions. Clinical symptoms, such as headache, visual changes, epigastric pain and nausea‐vomiting, are more predictive than laboratory parameters for adverse maternal outcomes.
Genotyping of clinical isolates of Acanthamoeba genus in Venezuela

Free-living amoebae of Acanthamoeba genus are opportunistic pathogens distributed worldwide. Strains included in this genus are causative agents of a fatal encephalitis and a sight-threating keratitis in humans and other animals. In this study, 550 clinical samples which were collected between 1984 and 2014 from different patients with suspected infections due to Acanthamoeba were initially screened for the presence of this amoebic genus at the Laboratorio de Amibiasis-Escuela de Bioanálisis at the Universidad Central de Venezuela. Samples were cultured in 2% Non-Nutrient agar plates seeded with a layer of heat killed Escherichia coli. From the 550 clinical samples included in this study, 18 of them were positive for Acanthamoeba genus after culture identification. Moreover, positive samples were confirmed after amplification of the Diagnostic Fragment 3 (DF3) of the Acanthamoeba 18S rDNA genus and sequencing was carried out in order to genotype the isolated strains of Acanthamoeba. Furthermore, the pathogenic potential of the strains was checked by performing thermotolerance and osmotolerance assays. Sequencing of the DF3 region resulted in the identification of genotype T4 in all the isolated strains. Moreover, most isolates were thermotolerant or both thermotolerant and osmotolerant and thus were classified as potentially pathogenic strains. To the best of our knowledge, this is the first report on the molecular characterization at the genotype level of Acanthamoeba strains in Venezuela.
Differences in vasculature between pilocytic and anaplastic astrocytomas of childhood.

BACKGROUND The clinical manifestations of childhood pilocytic astrocytoma (PA) and anaplastic astrocytoma (AA) markedly differ, especially in the time to progression and prognosis. Because of the aggressive course and poor survival rate of AA, one would expect it to be associated with a high angiogenic index. Counterintuitively, we often find higher microvessel density counts in PA than in AA. PROCEDURE We examined the differences in type or density of microvasculature between the two neoplasms. To differentiate established, mature vessels from immature growing ones, we used antibodies to Factor VIII (FVIII) to stain endothelial cells (ECs) of blood vessels and alpha-smooth muscle actin (alpha-SMA) antibodies to stain vessels supported by adventitia. RESULTS We found that large, mature, alpha-SMA-positive vessels predominated in PA, and small, immature, alpha-SMA-negative vessels in AA. The vessel maturation index was 54.5% for PA, and 6.1% for AA. Immunostaining with vascular endothelial growth factor (VEGF) and anti-flt-1/VEGF receptor-1 antibodies showed distinct tissue patterns. VEGF immunoreactivity occurred mainly in the processes of the tumor astrocytes in PA; the opposite was observed in AA. flt-1/VEGFR-1 was detected in the tumor cells of AA but not in those of PA. CONCLUSIONS We propose that the predominance of small, alpha-SMA-negative vessels in AA represents immature, unstable vasculature with a potentially greater susceptibility to anti-angiogenic therapy. The expression of both flt-1 and VEGF by AA tumor cells also suggests a possible autocrine growth-promoting function for VEGF in addition to its role as paracrine pro-angiogenic growth factor for activated ECs, thus making anti-angiogenesis an attractive therapeutic target in the treatment of AA.
Percutaneous closure of ventricular septal defects

Isolated ventricular septal defect is the most common form of congenital heart disease. Surgery has been performed for many years and is considered the gold standard for the treatment of ventricular septal defects. However, it is associated with morbidity and mortality. Less invasive techniques have been developed and currently percutaneous closure of muscular and perimembranous ventricular septal defects has to be considered a possible alternative to the standard surgical approach.
The oral health status of patients on oral bisphosphonates for osteoporosis.

BACKGROUND The oral health status of patients on bisphosphonates is the key to the patient's ongoing health and well-being. If they are orally healthy, invasive bone procedures, particularly extractions can be avoided, then the risk of osteonecrosis of the jaws (ONJ) is low. METHODS The records of 49 consecutive patients on oral bisphosphonates, referred to the Oral and Maxillofacial Surgery Unit (OMSU) for an oral health check and probable extractions, were retrospectively reviewed. The DMFT, periodontal and pathologic state were calculated from the OPG radiographs. An age and gender matched control group, from patients referred to the OMSU but who were not on oral bisphosphonates, were similarly assessed. Community data were also obtained. RESULTS The DMFT score for the oral bisphosphonate group was 29: Decayed 3, Missing 10, Filled 16. The control group DMFT score was 24: Decayed 5, Missing 11, Filled 8. Both groups had advanced periodontal disease (over 95 per cent) and were medically compromised (over 90 per cent). The DMFT for general community data for age matched government pensioners was 19.1: Decayed 0.8, Missing 10.4, Filled 7.9. With severe periodontal disease 23 per cent. Thus, the oral health of the oral bisphosphonate group was similar to the control group and both had more decayed teeth and periodontal disease than community values. CONCLUSIONS This study confirms that one cannot assume that a patient on an oral bisphosphonate for osteoporosis has a healthy mouth. It supports the view that all patients on bisphosphonates need to be seen by a dentist either before or soon after commencement of bisphosphonate therapy.
Narrowing the options: the process of deciding on prostate cancer treatment.

Prostate cancer is a pressing health concern in the United States and one surrounded by continual controversy. Currently there is no consensus regarding the efficacy of routine screening, nor has one treatment modality been demonstrated as superior. Patients and spouses are asked to choose from several options: radical prostatectomy, radiation therapy, or the "watch and wait" approach. A grounded theory design was used to examine the actual treatment decision-making process as it occurred over time among 18 newly diagnosed prostate cancer patients and their wives in western North Carolina. Couples were interviewed conjointly and individually to explore their perceptions of the decision process. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis techniques. Couples negotiated decisions through their common and unique personal and family histories, biases, and individual coping styles. They narrowed the options based on these factors. Most couples received their counseling regarding treatment options exclusively from the surgeon who narrowed the options based on age and physiologic status. Most couples chose surgery believing it to be the only treatment promising cure. Distinct misconceptions about radiation therapy were noted. Concern about potential side effects did not deter men from selecting surgery, although men and their wives differed in their willingness to accept treatment "at any cost. " Information regarding potential for cure and risk of recurrence were highly important factors in the decision process. The decision was incomparable with any other life decisions the couples had faced.
Density of the cerebral cortex in computed tomography angiography source images and clinical outcomes in Grade V subarachnoid hemorrhage

Abstract Objective: Among patients diagnosed with Grade V subarachnoid hemorrhage (SAH) according to the World Federation of Neurosurgical Societies (WFNS), the identification of those with the possibility of recovery is not feasible, although approximately one-fifth of these patients have favorable outcomes according to a recently published series of surgical papers. We hypothesized that computed tomography angiography (CTA) source images (SIs), which have applied to the detection of acute ischemia, might be useful for selecting Grade V patients with possibilities for favorable outcomes. Methods: We retrospectively assessed 170 SAH patients who underwent surgery between January 2009 and February 2012 and quantitatively measured their mean cerebral cortical densities from the initial CTA-SIs. Results: The cortical densities of 123 patients of Grades I–IV were strongly affected by the following two CTA-SI findings that were revealed by multivariate analysis: the density of the internal carotid artery (ICA) just proximal to the petrous portion and the ratio of the subarachnoid (SA) space to intracranial volume (P < 0·05). Favorable outcomes were obtained in 9 of the 47 Grade V patients (19·1%), and the predictors of the favorable outcomes according to multivariate analysis were increased cortical densities on the CTA-SIs and female patients (P < 0·05). Conclusion: The outcomes of Grade V patients could be partly predicted based on the estimates of cortical density from the CTA-SIs, and this measure might be useful for the selection of Grade V patients for surgery, provided that both ICA density and SA space ratio are confirmed before the evaluation of cortical density.
Lateral hypothalamus: Early developmental expression and response to hypocretin (orexin)

Hypocretin is a recently discovered peptide that is synthesized by neurons in the lateral hypothalamic area (LH) and is believed to play a role in sleep regulation, arousal, endocrine control, and food intake. These functions are critical for the development of independent survival. We investigated the developmental profile of the hypocretin system in rats. Northern blot analysis showed that the expression of hypocretin mRNA increased from postnatal day 1 to adulthood. Both of the identified hypocretin receptor mRNAs were strongly expressed very early in hypothalamic development, and expression subsequently decreased in the mature brain. Immunocytochemistry revealed hypocretin‐2 peptide expression in the cell bodies of LH neurons and in axons in the brain and spinal cord as early as embryonic day 19. Whole‐cell patch clamp recordings from postnatal P1‐P14 LH slices demonstrated a robust increase in synaptic activity in all LH neurons tested (n = 20) with a 383% increase in the frequency of spontaneous activity upon hypocretin‐2 (1.5 μM) application. A similar increase in activity was found with hypocretin‐1 application to LH slices. Hypocretin‐2 evoked a robust increase in synaptic activity even on the earliest day tested, the day of birth. Furthermore, voltage‐clamp recordings and calcium digital imaging experiments using cultured LH cells revealed that both hypocretin‐1 and ‐2 induced enhancement of neuronal activity occurred as early as synaptic activity was detected. Thus, as in the adult central nervous system, hypocretin exerts a profound excitatory influence on neuronal activity early in development, which might contribute to the development of arousal, sleep regulation, feeding, and endocrine control. J. Comp. Neurol. 433:349–363, 2001. © 2001 Wiley‐Liss, Inc.
[Accuracy of MR perfusion weighted imaging for cerebral glioma grading: a meta-analysis].

OBJECTIVE To evaluate values of MR perfusion weighted imaging(PWI) in the grading of intracranial gliomas by a meta-analysis. METHODS All English and Chinese literatures published before November 2009 in PUBMED and CNKI (China National Knowledge Infrastructure) were searched. Literature searching requirements: (1) MR PWI with region of interest (ROI) must have been applied in the grading of gliomas; (2) histopathological results must have been used as the reference standards. In addition, after data extraction, a bivariate random-effect model and hierarchical weighted symmetric summary receiver-operating curve must have been utilized to pool the data. Furthermore, a meta regression method must have been applied to detect and analyze the factors that affected the diagnostic accuracy. RESULTS Overall, fourteen studies were included with a total amount of 1021 patients. The pooled sensitivity, specificity and diagnostic odds ratio with 95% of CI were 93% (89% - 96%), 81% (73% - 87%) and 55 (28 - 107), respectively. The factors that affected the diagnostic accuracy were the sample size, the ratio of malignant glioma, the injection rate of contrast agents, the repetition time and the cutoff value. Heterogeneity did exist among the results obtained from different studies. CONCLUSION the relative cerebral blood volume (rCBV) of MR PWI can be referred to differentiate malignant cerebral gliomas from benign ones with sound sensitivity and specificity. However, there is not a unified threshold applied in the researches that have been conducted so far, and techniques used differ among the studies. In summary, clinical application values of rCBV of MR PWI are to be corroborated by further studies with a larger sample size.
Integration of mental health care into primary care

Background Targeting resources on cost-effective care strategies is important for the global mental health burden. Aims To demonstrate cost–outcome methods in the evaluation of mental health care programmes in low-income countries. Method Four rural populations were screened for psychiatric morbidity. Individuals with a diagnosed common mental disorder were invited to seek treatment, and assessed prospectively on symptoms, disability, quality of life and resource use. Results Between 12% and 39% of the four screened populations had a diagnosable common mental disorder. In three of the four localities there were improvements over time in symptoms, disability and quality of life, while total economic costs were reduced. Conclusion Economic analysis of mental health care in low-income countries is feasible and practicable. Our assessment of the cost-effectiveness of integrating mental health into primary care was confounded by the naturalistic study design and the low proportion of subjects using government primary health care services.
Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures.

STUDY DESIGN Cadaveric study on the biomechanics of osteoporotic vertebral bodies augmented and not augmented with polymethylmethacrylate cement. OBJECTIVES To determine the strength and stiffness of osteoporotic vertebral bodies subjected to compression fractures and 1) not augmented, 2) augmented with unipedicular injection of cement, or 3) augmented with bipedicular injection of cement. SUMMARY OF BACKGROUND DATA Percutaneous vertebroplasty is a relatively new method of managing osteoporotic compression fractures, but it lacks biomechanical confirmation. METHODS Fresh vertebral bodies (L2-L5) were harvested from 10 osteoporotic spines (T scores range, -3.7 to -8.8) and compressed in a materials testing machine to determine intact strength and stiffness. They were then repaired using a transpedicular injection of cement (unipedicular or bipedicular), or they were unaugmented and recrushed. RESULTS Results suggest that unipedicular and bipedicular cement injection restored vertebral body stiffness to intact values, whereas unaugmented vertebral bodies were significantly more compliant than either injected or intact vertebral bodies. Vertebral bodies injected with cement (both bipedicular and unipedicular) were significantly stronger than the intact vertebral bodies, whereas unaugmented vertebral bodies were significantly weaker. There was no significant difference in loss in vertebral body height between any of the augmentation groups. CONCLUSIONS This study suggests that unipedicular and bipedicular injection of cement, as used during percutaneous vertebroplasty, increases acute strength and restores stiffness of vertebral bodies with compression fractures.
Indomethacin protects permeability barrier from focal segmental glomerulosclerosis serum.

BACKGROUND Eicosanoids are believed to play a role in the pathophysiology of several models of glomerular disease. The cyclooxygenase inhibitor indomethacin reduces proteinuria in patients with focal segmental glomerulosclerosis (FSGS) or other glomerular diseases. We have shown that sera of some patients with FSGS significantly increase glomerular albumin permeability (Palb) in an in vitro assay. METHODS To determine the role of eicosanoids in the increased Palb caused by the FSGS factor, glomeruli were isolated from normal rats, preincubated with indomethacin, then incubated with FSGS serum or normal serum and Palb was calculated. To study the direct effect of individual eicosanoids on Palb, glomeruli were incubated with prostaglandin E2, prostaglandin F2alpha or a thromboxane A2 mimetic, and Palb was calculated. In the final set of experiments, normal glomeruli were preincubated with the thromboxane synthase inhibitor furegrelate, incubated with FSGS serum, and Palb was calculated. RESULTS Preincubation of isolated glomeruli with either the cyclooxygenase inhibitor indomethacin or the thromboxane synthase inhibitor furegrelate protected glomeruli from the increase in Palb caused by FSGS serum. Each of the three principal glomerular eicosanoids significantly increased Palb of isolated glomeruli. CONCLUSIONS These studies implicate a product of the cyclooxygenase pathway of arachidonic acid metabolism as mediating the increased Palb caused by FSGS serum in our in vitro assay and possibly the proteinuria seen in patients with FSGS.
Recurrent plot analysis of leakage current for monitoring outdoor insulator performance

Outdoor insulators are widely accepted in power industry to maintain electrical insulation ranging from distribution to transmission lines. Such increasing development leads to a lack of appropriate diagnostic tools for assessing the performance of insulator in service, particularly in contaminated conditions. In order to monitor operating performance of contaminated outdoor insulators, a recurrent plot technique is proposed to analyze the leakage current passing through the insulator surface. Contamination tests were conducted in a laboratory by employing heavy salt fog with the deposition of non-soluble contamination. The leakage current was decomposed into different frequency components by using a wavelet transform technique. The temporal sequence of the extracted component was extended to m-dimensional phase space by using a phase-space reconstructed method. The recurrent plot is obtained to show that the topological structure of the high-frequency components is prominent to identify non-linear properties of discharge activities. Based on the analysis of the high-frequency components, the quantitative indicators of recurrent plot are obtained to reflect the underlying mechanism of flashover process. The results obtained indicate that the recurrent plot technique gives visual recurrent patterns of discharge activities for monitoring outdoor insulator performance. The dynamic behaviors on the insulator surface are graphically illustrated on the rectangular block structures with higher density of points. The structure changes indicate the switches of discharge states during the flashover process.
CMV DNA is rarely detected in healthy blood donors using validated PCR assays

BACKGROUND : Although serologic screening or WBC reduction of blood components can reduce the incidence of transfusion‐transmitted CMV (TT‐CMV) infection, ‘breakthrough’ cases of TT‐CMV still occur and may produce serious sequelae. NAT of blood components for CMV DNA has been proposed to further reduce the risks of TT‐CMV. However, large‐scale studies to determine the utility of validated CMV NAT assays for donor screening have not been reported.
B cell lymphoma progression promotes the accumulation of circulating Ly6Clo monocytes with immunosuppressive activity

ABSTRACT Monocytosis is considered a poor prognostic factor for many cancers, including B cell lymphomas. The mechanisms by which different monocyte subsets support the growth of lymphoma is poorly understood. Using a pre-clinical mouse model of B cell non-Hodgkin's lymphoma (B-NHL), we investigated the impact of tumor progression on circulating monocyte levels, subset distribution and their activity, with a focus on immune suppression. B-NHL development corresponded with significant expansion initially of classical (Ly6Chi) and non-classical (Ly6Clo) monocytes, with accumulation and eventual predominance of Ly6Clo cells. The lymphoma environment promoted the conversion, preferential survival and immune suppressive activity of Ly6Clo monocytes. Ly6Clo monocytes expressed higher levels of immunosuppressive genes including PD-L1/2, Arg1, IDO1 and CD163, compared to Ly6Chi monocytes. Both monocyte subsets suppressed CD8 T cell proliferation and IFN-γ production in vitro, but via different mechanisms. Ly6Chi monocyte suppression was contact dependent, while Ly6Clo monocytes suppressed via soluble mediators, including IDO and arginase. Ly6Clo monocytes could be selectively depleted in tumor-bearing hosts by liposomal doxorubicin treatment, further enhanced by co-administration of anti-4-1BB monoclonal antibody. This treatment led to a reduction in tumor growth, but failed to improve overall survival. Analogous immunosuppressive monocytes were observed in peripheral blood of diffuse large B cell lymphoma patients and actively suppressed human CD8 T cell proliferation. This study highlights a potential immune evasion strategy deployed by B cell lymphoma involving accumulation of circulating non-classical monocytes with immunosuppressive activity.