Miracle-dz/UniFAR-FTUs huggingface dataset:
Epigallocatechin Gallate in Relapsing-Remitting Multiple Sclerosis

Objective To assess the safety and efficacy of epigallocatechin-3-gallate (EGCG) add-on to glatiramer acetate (GA) in patients with relapsing-remitting multiple sclerosis (RRMS). Methods We enrolled patients with RRMS (aged 18–60 years, Expanded Disability Status Scale [EDSS] score 0–6.5), receiving stable GA treatment in a multicenter, prospective, double-blind, phase II, randomized controlled trial. Participants received up to 800 mg oral EGCG daily over a period of 18 months. The primary outcome was the proportion of patients without new hyperintense lesions on T2-weighted (T2w) brain MRI within 18 months. Secondary end points included additional MRI and clinical parameters. Immunologic effects of EGCG were investigated in exploratory experiments. Results A total of 122 patients on GA were randomly assigned to EGCG treatment (n = 62) or placebo (n = 60). We could not demonstrate a difference between groups after 18 months for the primary outcome or other radiologic (T2w lesion volume, T1w hypointense lesion number or volume, number of cumulative contrast-enhancing lesions, percent brain volume change), or clinical (EDSS, MS functional composite, and annualized relapse rate) parameter. EGCG treatment did not affect immune response to GA. Pharmacologic analysis revealed wide ranging EGCG plasma levels. The treatment was well tolerated with a similar incidence of mostly mild adverse events similar in both groups. Conclusion In RRMS, oral EGCG add-on to GA was not superior to placebo in influencing MRI and clinical disease activity over 18 months. The treatment was safe at a daily dosage up to 800 mg EGCG. It did not influence immune parameters, despite indication of EGCG being bioavailable in patients. Classification of Evidence This study provides Class II evidence that for patients with RRMS, EGCG added to GA did not significantly affect the development of new hyperintense lesions on T2-weighted brain MRI. Trial Registration Information Clinical trial registration number: NCT00525668.
Clinical characteristics and outcomes of children with cochlear implants who had preoperative residual hearing

Abstract Objective Cochlear implants (CI) candidacy criteria have expanded to include children with more residual hearing. This study explored the clinical profiles and outcomes of children with CIs who had preoperative residual hearing in at least one ear. Design A retrospective chart review was conducted to collect clinical characteristics and speech perception data. Pre- and post-CI auditory and speech perception data were analysed using a modified version of the Pediatric Ranked Order Speech Perception (PROSPER) score. Study sample This study included all children with residual hearing who received CIs in one Canadian paediatric centre from 1992 to 2018. Results A total of 100 of 389 (25.7%) children with CIs had residual hearing (median 77.6 dB HL, better ear). The proportion of children with residual hearing increased from 1992 to 2018. Children who had auditory behaviour and speech perception tests (n = 83) showed higher modified PROSPER scores post-CI compared to pre-CI. Phonologically Balanced Kindergarten (PBK) test scores were available for 71 children post-CI; 81.7% (58/71) of children achieved > 80% on the PBK. Conclusions One in four children who received CIs had residual hearing, and most of them had severe hearing loss at pre-CI. These children showed a high level of speech perception with CIs.
Effect of computer literacy on the working time of the dental CAD software program.

PURPOSE The purpose of this study was to compare the correlation between the learning effect of dental computer-aided design (CAD) software and computer literacy in the clinical and preclinical experience groups of computer-aided design and computer-aided manufacturing (CAD/CAM). METHODS A total of 28 participants were recruited, including 14 dental students and 14 dental technicians. Their working time was evaluated using a custom abutment design with two dental CAD software program (exocad GmbH and Deltanine). The working time of custom abutment design was measured 3 times. A survey was conducted to evaluate the computer literacy. For statistical analysis, Mann-Whitney U test was used to analyze the difference between the clinical and preclinical experience groups and the correlation between computer literacy and reduction in working time was confirmed by Spearman's Rank correlation analysis (α=.05). RESULTS The median working time showed the clinical experience group had faster than the preclinical experience group (P<.001). On the other hand, the reduction in working time was higher in the preclinical experience group (P=.002). Only preclinical experience group had a significant positive correlation between the computer literacy and reduction in working time (P<.001). CONCLUSIONS Basic computer skills are required for first-time users to achie ve an excellent learning effect of dental CAD software program.
Analysis of endotracheal intubation-related judicial precedents in South Korea

Background Medical malpractice during endotracheal intubation can result in catastrophic complications. However, there are no reports on these severe complications in South Korea. We aimed to investigate the severe complications associated with endotracheal intubation occurring in South Korea, via medicolegal analysis. Methods We retrospectively analyzed the closed judicial precedents regarding complications related to endotracheal intubation lodged between January 1994 and June 2020, using the database of the Supreme Court of Korea. We collected clinical and judicial characteristics from the judgments and analyzed the medical malpractices related to endotracheal intubation. Results Of 220 potential cases, 63 were included in the final analysis. The most common event location was the operating room (n = 20, 31.7%). All but 3 cases were associated with significant permanent or more severe injury, including 31 deaths. The most common problems were failed or delayed intubation (n = 56, 88.9%). Supraglottic airway device was used in 5.2% (n = 3) cases of delayed or failed intubation. Fifty-one (81%) cases were ruled in favor of the plaintiff in the claims for damages, with a median payment of Korean Won 133,897,845 (38,000,000, 308,538,274). The most common malpractice recognized by the court was that of not attempting an alternative airway technique (n = 32, 50.8%), followed by violation of the duty of explanation (n = 10, 15.9%). Conclusions Our results could increase physicians’ awareness of the major complications related to endotracheal intubation and help ensure patient safety.
Balancing risks: Qualitative study of attitudes, motivations and intentions about attending for mammography during the COVID-19 pandemic

Aims: To explore attitudes, motivations and intentions about attending for mammography among women who cancelled or postponed breast cancer screening, which had remained open in Denmark during the COVID-19 pandemic. Methods: A telephone interview study was conducted at the end of April 2020. A qualitative, phenomenological approach was chosen to identify themes and concepts and a semi-structured interview guide was developed. The analysis was structured according to constructs from the theory of planned behaviour, including attitudes to breast cancer screening, norms and motivations to comply with breast cancer screening, perceived control and anticipated regret. Results: Interviews were carried out with 33 women aged 50–69 (mean 62) years. The women felt that screening was of secondary importance during the height of the pandemic and they felt low perceived control over transportation to the screening clinic and over the screening situation itself, where social distancing was impossible. They perceived messages from the authorities as conflicting regarding the request for social distancing and a lack of recommendations about using face masks at the screening clinic. Conclusions: Women who postponed or cancelled breast cancer screening during the COVID-19 pandemic felt that public recommendations appeared contradictory. Uncertainty about the ‘new norm(al)’ of COVID-19 made them stay at home, although the screening clinics remained open. The findings point to the importance of addressing perceived inconsistency between recommendations from the World Health Organization and the national management of these recommendations, and to secure univocal information from the authorities about the recommended use of healthcare services in a time of crisis.
Inter-specialty variation of the Press Ganey Outpatient Medical Practice Survey

Abstract Measuring patient satisfaction scores and interpreting factors that impact their variation is of importance as scores influence various aspects of health care administration. Our objective was to evaluate if Press Ganey scores differ between medical specialties. New patient visits between January 2014 and December 2016 at a single tertiary academic center were included in this study. Press Ganey scores were compared between specialties using a multivariable logistic mixed effects model. Secondary outcomes included a comparison between surgical versus non-surgical specialties, and pediatric versus adult specialties. Due to the survey's high ceiling effect, satisfaction was defined as a perfect total score. Forty four thousand four hundred ninety six patients met inclusion criteria. Compared to internal medicine, plastic surgery, general surgery, dermatology, and family medicine were more likely to achieve a perfect overall score, as, with odds ratios of 1.46 (P = .02), 1.29 (P = .002), 1.22 (P = .004), and 1.16 (P = .02) respectively. Orthopaedics, pediatric medicine, pediatric neurology, neurology, and pain management were less likely to achieve satisfaction with odds ratios of 0.85 (P = .047), 0.71 (P < .001), 0.63 (P = .005), 0.57 (P < .001), and 0.51 (P = .006), respectively. Compared to pediatric specialties, adult specialties were more likely to achieve satisfaction (OR 1.73; P < .001). There were no significant differences between surgical versus non-surgical specialties. Press Ganey scores systematically differ between specialties within the studied institution. These differences should be considered by healthcare systems that use patient satisfaction data to modify provider reimbursement.
Isotretinoin for the treatment of nonobstructive azoospermia: a pilot study

Retinoic acid plays essential roles in spermatogonial differentiation, spermatid adhesion to Sertoli cells, and spermiation.5 Given the importance of retinoic acid in spermatogenesis, it seems possible that some men with infertility might have intratesticular concentrations of retinoic acid below those necessary for spermatogenesis. Indeed, infertile men have significantly lower concentrations of aldehyde dehydrogenase-1A2, the enzyme responsible for retinoic acid biosynthesis in germ cells.6 Recently, we performed a pilot study of isotretinoin in 20 men with infertility due to oligoasthenoteratozoospermia.7 In this study, roughly half of the men had significant improvements in their sperm production during treatment and several pregnancies occurred. In this study, we sought to examine isotretinoin therapy in men with infertility due to azoospermia in a single-arm pilot study using baseline sperm values as controls. We hypothesized that some men treated with isotretinoin would manifest detectable sperm in their ejaculates, suitable for use in ICSI. Alternatively, we hypothesized that isotretinoin therapy might allow men with a previously negative TESE to undergo successful repeat TESE, allowing for fertility.
Highly parallelized droplet cultivation and prioritization of antibiotic producers from natural microbial communities

Antibiotics from few culturable microorganisms have saved millions of lives since the 20th century. But with resistance formation, these compounds become increasingly ineffective, while the majority of microbial and with that chemical compound diversity remains inaccessible for cultivation and exploration. Culturing recalcitrant bacteria is a stochastic process. But conventional methods are limited to low throughput. By increasing (i) throughput and (ii) sensitivity by miniaturization, we innovate microbiological cultivation to comply with biological stochasticity. Here, we introduce a droplet-based microscale cultivation system, which is directly coupled to a high-throughput screening for antimicrobial activity prior to strain isolation. We demonstrate that highly parallelized in-droplet cultivation starting from single cells results in the cultivation of yet uncultured species and a significantly higher bacterial diversity than standard agar plate cultivation. Strains able to inhibit intact reporter strains were isolated from the system. A variety of antimicrobial compounds were detected for a selected potent antibiotic producer.
On the role of solar EUV, photoelectrons, and auroral electrons in the chemistry of C(1D) and the production of C I 1931 Å in the cometary coma: A case for comet 1P/Halley

The observations of C I 1931 A emission in the ultraviolet spectra of comets show that a large fraction of carbon atoms in the cometary coma are produced in the metastable 1D excited state. A coupled-chemistry transport model is employed to examine in detail the various processes of production and loss of the C(1D) atoms in the coma of comet 1P/Halley. Different mechanisms forming CI 1931 A line are subsequently studied. The impacts of solar UV-EUV photons, photoelectrons, and auroral electrons of solar wind origin, on the chemistry of C(1D) and the C I 1931 A emission are evaluated. Dissociation of CO by solar photon and electron impact are the dominant mechanisms of the production of C(1D). Contrary to the findings of the earlier works, the dissociative e-CO+ recombination is not a significant source of C(1D) in the inner (<104 km) coma. Quenching of C(1D) by H2O is the main loss mechanism of C(1D) in the inner most coma (<103 km), while radiative deexcitation dominates at larger radial distances. The density of C(1D) in the inner coma is found to be controlled predominantly by the CO and H2O density distribution. Deep in the coma (<300 km) the photodissociative excitation of CO is the major source of 1931 A emission, while beyond 500 km the resonant scattering of solar radiation by C(1D) atoms dominates. The contribution of the solar resonance fluorescence to the 1931 A IUE slit-averaged intensity is about 80% in the normal and auroral conditions. Results of the model case studies performed to assess the impact of changing C(1D) + H2O quenching rate coefficient, C(1D) to C(3P) production ratio, neutral and electron temperatures, and extended CO source are discussed. The modeled intensity of carbon 1931 A emission is found to be a factor of 3–6 smaller compared to the IUE-observed intensity.
Symptoms and symptom clusters associated with SARS-CoV-2 infection in community-based populations: Results from a statewide epidemiological study

Background Prior studies examining symptoms of COVID-19 are primarily descriptive and measured among hospitalized individuals. Understanding symptoms of SARS-CoV-2 infection in pre-clinical, community-based populations may improve clinical screening, particularly during flu season. We sought to identify key symptoms and symptom combinations in a community-based population using robust methods. Methods We pooled community-based cohorts of individuals aged 12 and older screened for SARS-CoV-2 infection in April and June 2020 for a statewide prevalence study. Main outcome was SARS-CoV-2 positivity. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for individual symptoms as well as symptom combinations. We further employed multivariable logistic regression and exploratory factor analysis (EFA) to examine symptoms and combinations associated with SARS-CoV-2 infection. Results Among 8214 individuals screened, 368 individuals (4.5%) were RT-PCR positive for SARS-CoV-2. Although two-thirds of symptoms were highly specific (>90.0%), most symptoms individually possessed a PPV <50.0%. The individual symptoms most greatly associated with SARS-CoV-2 positivity were fever (OR = 5.34, p<0.001), anosmia (OR = 4.08, p<0.001), ageusia (OR = 2.38, p = 0.006), and cough (OR = 2.86, p<0.001). Results from EFA identified two primary symptom clusters most associated with SARS-CoV-2 infection: (1) ageusia, anosmia, and fever; and (2) shortness of breath, cough, and chest pain. Moreover, being non-white (13.6% vs. 2.3%, p<0.001), Hispanic (27.9% vs. 2.5%, p<0.001), or living in an Urban area (5.4% vs. 3.8%, p<0.001) was associated with infection. Conclusions Symptoms can help distinguish SARS-CoV-2 infection from other respiratory viruses, especially in community or urgent care settings where rapid testing may be limited. Symptoms should further be structured in clinical documentation to support identification of new cases and mitigation of disease spread by public health. These symptoms, derived from asymptomatic as well as mildly infected individuals, can also inform vaccine and therapeutic clinical trials.
Measurement of Charge Transfer due to Single Particle Impact

In the processing of particulate solids, interparticle and particle‐wall collisions can generate electrostatic charges. This can lead to a variety of problems ranging from fire and explosion hazards to segregation, caking and blocking. For a fundamental understanding of the particle charging, it is essential to study the charge transfer due to single particle impacts on a target. A new experimental rig that can measure charge generation due to a single impact between a particle and a target plane has been designed and constructed. In this study, pharmaceutical particles were tested by impacting against a stainless steel target. The amount of charge transfer due to impact can be described as a function of impact velocity and impact angle as well as initial charge. It is noted that for a given material, initial particle charge for which no charge transfer occurs, is independent of impact velocity and impact angle.
An Assessment of Siderophore Production, Mucoviscosity, and Mouse Infection Models for Defining the Virulence Spectrum of Hypervirulent Klebsiella pneumoniae

The pathogenic potential of hvKp strains is primarily mediated by a large virulence plasmid. The minimal set of genes required for the full expression of the hypervirulent phenotype is undefined. ABSTRACT Hypervirulent Klebsiella pneumoniae (hvKp) bacteria are more virulent than classical K. pneumoniae (cKp) with resultant differences in clinical manifestations and management. It is unclear whether all hvKp isolates share a similar pathogenic potential. This report assessed the utility of siderophore production, mucoviscosity, and murine infection for defining the virulence spectrum of hvKp. Three strain cohorts were identified and defined based on the CD1 mouse subcutaneous (SQ) challenge model: (i) fully virulent hvKp strains (fvhvKp), lethal at a challenge inoculum (CI) of ≤103 CFU; (ii) partially virulent hvKp strains (pvhvKp), lethal at a CI of >103 to 107 CFU; (iii) classical K. pneumoniae, not lethal at a CI of 107 CFU. Quantitative siderophore and mucoviscosity assays differentiated fvhvKp and pvhvKp strains from cKp strains but were unable to differentiate between the fvhvKP and pvhvKP strain cohorts. However, SQ challenge of CD1 mice and intraperitoneal (IP) challenge of CD1 and BALB/c mice, but not C57BL/6 mice, were able to discriminate between an fvhvKp and a pvhvKp strain; SQ challenge of CD1 mice may have the greatest sensitivity. cKp was differentiated from hvKp both by SQ challenge of CD1 mice and IP challenge of all three mouse strains. These data identify a means to define the relative virulence of hvKP strains. It remains unclear whether the observed differences of hvKp virulence in mice translates to human infection. However, these data can be used to sort random collections of K. pneumoniae strains into fvhvKp and pvhvKp strain cohorts and assess for differences in clinical manifestations and outcomes. IMPORTANCE The pathogenic potential of hvKp strains is primarily mediated by a large virulence plasmid. The minimal set of genes required for the full expression of the hypervirulent phenotype is undefined. A number of reports describe hvKp strains possessing only a portion of the virulence plasmid; the clinical consequences of this are unclear. Therefore, the goal of this report was to determine whether virulence among hvKp strains varied and, if so, how to best identify the relative virulence of hvKp isolates. Data demonstrate hvKp pathogenic potential varies in CD1 and BALB/c murine infection models. In contrast, measurements of siderophore production and mucoviscosity were unable to discriminate the differences in hvKp isolate virulence observed in mice. This information can be used in future studies to determine the mechanisms responsible for differences between fully virulent hvKp and partially virulent hvKp and whether the differences observed in mice translate to disease in humans.
COVID-19–Associated Mold Infection in Critically Ill Patients, Chile

Patients with severe coronavirus disease (COVID-19) may have COVID-19–associated invasive mold infection (CAIMI) develop. We report 16 cases of CAIMI among 146 nonimmunocompromised patients with severe COVID-19 at an academic hospital in Santiago, Chile. These rates correspond to a CAIMI incidence of 11%; the mortality rate for these patients was 31.2%.
Numerical investigation of soot reduction potentials with diesel homogeneous charge compression ignition combustion by an improved phenomenological soot model

Abstract An improved phenomenological soot model coupled with a reduced n-heptane chemical mechanism was implemented into KIVA-3V code to describe soot formation and oxidation processes in diesel homogeneous charge compression ignition (HCCI) combustion. This model was first validated by the shock tube experiments with a rich n-heptane mixture over wide temperature and pressure ranges. The computational results demonstrate that the phenomenological soot model is capable of predicting the soot yield, particle diameter, and number density with satisfactory accuracy. Then the model was applied to investigate the influence of the orifice diameter and injection pressure on soot emissions in a constant-volume combustion vessel under typical diesel combustion conditions. The predictions showed qualitative agreement with the measurements on the soot volume fraction distribution. The results also indicate that the soot formation can almost be suppressed as the local equivalence ratio is kept lower than 2.0. Finally, the model was used to explore the potentials of soot reduction with HCCI combustion for diesel engines. The overall trend of soot with the variations in the start of injection timing was well reproduced by the model. With the help of an equivalence ratio—temperature map, it was found that nitrogen oxide emissions could be markedly reduced by applying a high exhaust gas recirculation rate and relative low compression ratio for diesel HCCI engines. However, the mixture preparation by using a multi-hole injector with early injection strategy remains a limitation for further reduction in soot emissions.