Miracle-dz/UniFAR-FTUs huggingface dataset:
Is it necessary to focus on morphologically normal acrosome of sperm during intracytoplasmic sperm injection?

Background & objectives: The detailed assessment of sperm morphology is important in the semen of infertile men because there is a low proportion of normal spermatozoa. One of the parameters of such sperm morphology is the acrosome, and its effect on assisted reproductive outcomes is controversial. This study was undertaken to evaluate the association between different forms of acrosome on the chromatin status and the assisted reproductive outcomes. Methods: A total of 1587 unstained sperms from 514 infertile men were captured and analyzed for different acrosome forms (normal, large, small, skew, amorphous acrosome and without acrosome) in real time during intracytoplasmic sperm injection into oocytes. The association between the percentage of sperms with atypical acrosome and head shapes and the sperm chromatin status was studied. Fertilization, zygote and embryo quality and clinical pregnancy rates were calculated for different groups of sperms. Results: The highest frequency of irregular shapes of acrosomes, such as small, large and amorphous, was observed in abnormal ellipticity, anteroposterior symmetry and angularity parameters, respectively (P <0.05). The fertilization rate of injected sperms with large (P <0.01) and small (P=0.001) acrosomes and without acrosome (P=0.001) was significantly lower in comparison with normal acrosomes. The quality of zygotes (Z3, P=0.05), embryos (grade C, P <0.05) and the pregnancy rate (P=0.001) from injected sperms with large acrosomes were significantly lower compared with normal acrosomes. Interpretation & conclusions: Our findings showed that the different sperm acrosome morphologies (e.g., large, small, and without acrosome) might negatively relate with chromatin integrity and decrease the sperm's fertility potential and pregnancy rate during intracytoplasmic sperm injection (ICSI) cycles.
Performance in 6-min walk test in prediction of post-operative pulmonary complication in major oncosurgeries: A prospective observational study

Background and Aims: Post-operative pulmonary complications (PPC) contribute to increased morbidity and mortality, necessitating pre-operative functional assessment. Six-minute walk test (6MWT) is a simple option for functional assessment. Methods: This is a prospective observational study conducted in 75 patients who underwent elective abdominal or thoracic oncosurgery under general anaesthesia with either age above 60 years or with cardiopulmonary diseases or obstructive sleep apnoea or low serum albumin or smoking. Patients with history of acute coronary syndrome in past 6 months, dyspnoea at rest, severe pain, inability to walk or interpret instructions and haemodynamic instability were excluded. Preoperatively 6MWT was conducted according to the American Thoracic Society guidelines and patients were observed for PPC. Patients were divided into two groups: group 1–no PPC and group 2–developed PPC. Statistical analysis was done using SPSS software (version 11.0.1). Categorical variables were assessed using Chi-square/Fisher's exact test and continuous variables using student's t-test/Mann-Whitney U test. Association was tested using logistic regression. Results: Out of the 75 patients, 40 patients had no PPC (group 1) and 35 patients had PPC (group 2) including a death. The 6MWD of group with PPCs was significantly less (344 ± 61.927 m) compared to the group without PPCs (442.28 ± 83.194 m, P value = 0.001). The cut-off 6MWD obtained was 390 m, which correlated with longer duration of hospital stay and ICU stay (P = 0.001). Conclusion: Six-minute walk test is a reliable predictor of post-operative pulmonary complications with a cut-off 6MWD of 390 m in the studied oncosurgery patients.
Metabolic syndrome in patients with psoriasis: A hospital-based case–control study

I read with interest the outstanding study by Gangaiah et al.[1] on the metabolic syndrome (MS) in Indian patients with psoriasis. On employing the updated National Cholesterol Education Program–Adult Treatment Panel III (ATPIII) with Asian modification for waist circumference (WC) (ATPIII criteria), the authors found that MS was significantly more common in psoriatic patients than in controls (38% vs. 22%, P = 0.043). Psoriatic patients had higher prevalence of increased fasting blood sugar (FBS) (32% vs. 16%, P = 0.0334), high serum triglyceride (TG) (34% vs. 18%, P = 0.037), low serum high‐density lipoprotein cholesterol (HDLC) (50% vs. 20%, P = 0.00093), and hypertension (38% vs. 20%, P = 0.025). Although not statistically significant (P = 0.08), increased values of WC were estimated higher in psoriatic patients than in controls. [1] I presume that these results ought to be interpreted cautiously. This is based on the presence of the following methodological limitation related to the MS definition criteria employed in the study. The impact of this limitation could be explained in dual aspects. On one hand, there are many definition criteria for MS in the clinical field. These include the following: The National Cholesterol Education Program–ATPIII, the American Heart Association (AHA), and the International Diabetes Federation (IDF). Evaluation of these three criteria showed that the prevalence of MS was significantly estimated greater on employing the AHA and IDF as compared to the ATPIII definition and that AHA and IDF definitions were found more sensitive than that of ATPIII in diagnosing MS.[2] On the other hand, the updated ATPIII criteria employed in Gangaiah et al’s study[1] is old and it is no more worthy as it was set nearly a decade ago. [3] To my knowledge, the new diagnostic MS criteria in the Indian population have been set to be employed in the clinical setting and researches. These include the following: WC >35” in men and >31” in women; serum TG ≥150 mg/dl; serum HDLC <40 mg/dl for men and <50 mg/dl for women; blood pressure ≥130/85 mmHg; and FBS >100 mg/dl (prediabetes). [4] I wonder why Gangaiah et al.[1] did not refer to the Indian‐specific MS criteria in their study. I presume that if they employed these criteria, different results might be obtained. Despite the aforementioned limitation, the increased susceptibility of psoriatic patients to have MS compared with the general population necessitates strict actions to minimize the future risk of diabetes mellitus and cardiovascular sequelae.
A Retrospective Comparison of Preoperative Estimated Glomerular Filtration Rate as a Predictor of Postoperative Cardiac Surgery Associated Acute Kidney Injury

Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) remains common with distressingly high mortality. Over time, risk scorings systems have been developed to predict it and preoperative low estimated glomerular filtration rate (eGFR) has been regarded as one of the predicting risk factors. Objectives: The present study is aimed at assessing the relation of different ranges of preoperative eGFR with an incidence of CSA-AKI defined by the AKI network (AKIN) criteria. Materials and Methods: Files of 134 patients with eGFR of >40 cc/min/1.73 m2 body surface area (BSA) who underwent cardiac surgeries on cardiopulmonary bypass were screened for data collection. Occurrences of CSA-AKI were evaluated as per the AKIN criteria over the course of 3 postoperative days. The relationships of different ranges of preoperative eGFR with CSA-AKI were analyzed by appropriate statistical tests using Instat software and P < 0.05 was considered statistically significant. Results: A total of 60 males and 74 females with a mean + standard deviation (SD) age of 37.98 ± 12.50 years and mean + SD preoperative eGFR of 70.20 ± 20.89 cc/min/1.73 m2 were analyzed in this study. About 49.25% of patients suffered from CSA-AKI by the 3rd postoperative day. The crude risk of CSA-AKI in patients with eGFR 40–60 cc/min/1.73 m2 was not higher (odds ratio 0.29) as compared to patients in patients with eGFR >100 cc/min/1.73 m2. The CSA-AKI trend with different eGFR was also statistically insignificant (P > 0.05). Conclusion: In patients with preoperative eGFR >40 cc/min/1.73 m2 BSA, a lower preoperative eGFR (40–60 cc/min/1.73 m2) does not predict higher incidence of CSA-AKI as defined by AKIN criteria as compared to higher preoperative eGFR (>100 cc/min/1.73 m2). Lower height is independently associated with higher incidence of CSA-AKI in such patients.
Do Asian Patients Require Only Half of the Clozapine Dose Prescribed for Caucasians? A Critical Overview

Since 1997, studies have found that Asians need lower clozapine doses than Caucasians. Caucasians with average clozapine metabolism may need from 300 to 600 mg/day to reach the therapeutic range (350 ng/ml). Thus, serum clozapine concentration-to-dose (C/D) ratios typically range between 0.60 (male smokers) and 1.20 (female non-smokers). A 2019 systematic review of clozapine levels demonstrated weighted mean C/D ratios of 1.57 in 876 East Asians and 1.07 in 1147 Caucasians (P < .001). In Asian countries, average clozapine doses are lower than 300 mg/day. After sex and smoking stratification in 5 Asian samples with clozapine concentrations, the clozapine dose required to reach 350 ng/ml in female non-smokers ranged from 145 to 189 mg/day and in male smokers, from 259 to 294 mg/day. Thus, in Asian patients with average metabolism (with no inducers other than smoking, with no inhibitors, and in the absence of extreme obesity), the dose needed for clinical response may range between 150 mg/day for female non-smokers to 300 mg/day for male smokers. Clozapine levels may help personalize dosing in clozapine poor metabolizers (PMs) and ultrarapid metabolizers (UMs). Asian PMs may need very low doses (50-150 mg/day) to obtain therapeutic concentrations. About 10% (range 2-13%) of Asians are genetic PM cases. Other PMs are patients taking CYP1A2 inhibitors such as fluvoxamine, oral contraceptives, and valproate. Temporary clozapine PM status may occur during severe systemic infections/inflammations with fever and C-reactive protein (CRP) elevations. Asian UMs include patients taking potent inducers such as phenytoin, and rarely, valproate.
Adductor canal blockade versus continuous epidural analgesia after total knee joint replacement: A retrospective cohort study

Background: Total knee arthroplasty is associated with intense pain postoperatively. Thus, adequate pain relief is essential in the immediate postoperative period to enable ambulation, initiation of physiotherapy, and prevention of postoperative complications. The objective of this study was to compare the effectiveness and early outcomes of adductor canal blockade (ACB) and continuous epidural analgesia (CEA) in patients who underwent a unilateral total knee replacement (TKR). Materials and Methods: This is a retrospective cohort study that was conducted in Riyadh with 80 patients receiving a unilateral total knee arthroplasty from August 2017 to July 2018. Forty patients received ACB, and 40 received CEA exclusively. The primary outcomes measured were the degree of knee flexion and extension in physiotherapy sessions on postoperative day 1 and discharge, how soon patients walked after surgery, length of hospital stay (LOS), local anesthetic and total opioid consumption, postoperative blood drainage output, incidence of nausea and vomiting, and pain scores. Results: Significantly more patients receiving ACB could flex their knee in the first 24 h postoperatively (P <0.05), and the total drain output was also significantly less (P <0.05). Pain in the first 8, 24, and 48 h was less in the ACB group using a Visual Analog Scale (P <0.05). In addition, LOS, total opioid consumption, postoperative blood drain output, incidence of nausea and vomiting, and pain scores were significantly decreased after using ACB compared with epidural analgesia. Conclusion: This study provided evidence that ACB as postoperative analgesia after TKR is associated with better outcomes in terms of facilitating early functional recovery and mobility, and consequently prevents major postoperative complications.
Can Shorter Fluoroscopic Time Obviates the Need of Routine Heparin Use in Coronary Angiography via Femoral Route? A Prospective Study

Background: The use of heparin in coronary angiography (CAG) through radial route is a well-known practice. However, the prophylactic use of heparin following the femoral arterial sheath insertion is still controversial, so we aimed to assess the safety of CAG without the use of heparin through femoral approach by minimizing fluoroscopy time. Methods: All patients undergoing diagnostic CAG through femoral approach were enrolled in our study. Heparin was not given after femoral sheath insertion contrary to the usual practice. Depending on the fluoroscopy time, patients were divided into three groups: (a) group with fluoroscopy time <2 min, (b) group with fluoroscopy time 2–5 min, and (c) group with fluoroscopy time 5–10 min. The study patients were prospectively assessed for any thrombus formation or embolic event. Femoral puncture site and other complications were also studied simultaneously. Patients with primary/elective angioplasty and longer fluoroscopy time (>10 min) were excluded from the study as well as those who received heparin. Results: Altogether, 1550 patients were enrolled in the study over a period of 3 years. The mean age of the study population was 57.0 ± 12.5 years; 71% of the patients were male. Fluoroscopy time was <2 min in 63% of the patients, 2–5 min in 33% of the patients, and 4% of the patients had fluoroscopy time of 5–10 min. No thromboembolic clinical events were recorded in the entire population during the study. Femoral sheath thrombus was seen in only 2.9% of the patients, and all of these cases had a fluoroscopy time of 𕟷 min. Conclusion: CAG can be safely performed through femoral route without the use of heparin and without any associated thromboembolic complications if fluoroscopy time is <10 min.
Depression Outcome Expectancy in Primary Care in Singapore: Symptom Severity as a Mediating Determinant

Background: Depression has been identified as the most common mental illness in Singapore. To address this growing concern, the current study focused on the population within the primary care setting since depression has been demonstrated to be highly prevalent in these patients. This study examined the possible predictors of outcome expectancy based on illness perception and depression severity. Methods: One hundred and one adult patients with depressive symptoms in primary care were recruited for a cross-sectional study. Positive outcome expectancy was measured using the Depression Change Expectancy Scale, and illness perception was measured using the Illness Perception Questionnaire Mental Health. Depression severity was derived from the Patient Health Questionnaire-9 scores extracted from the participants' medical records. Regression and mediation analyses were applied to explore possible predictors of positive outcome expectancy. Results: Regression analysis demonstrated that symptom severity, and specific dimensions under illness perception (i.e., perception of chronicity, perception of personal control, and perception of treatment control) were the most significant predictors of positive outcome expectancy. Mediation analysis found that symptom severity partially mediated the relationship between perception of chronicity and positive outcome expectancy. Conclusions: Pharmacotherapy, interventions from allied health professionals, and psychotherapeutic interventions (e.g., strategies from positive psychology, solution-focused therapy, and strengths-based cognitive behavioral therapy) that aim to directly alleviate depressive symptoms as well as improve the perceptions of chronicity, personal control, and treatment control could potentially enhance treatment benefits in primary care patients with depression.
A Functional MRI Paradigm Suitable for Language and Memory Mapping in Pediatric Temporal Lobe Epilepsy

Functional Magnetic Resonance Imaging (fMRI) is a technique frequently used to determine the territories of eloquent tissue that serve critical functions, such as language. This can be particularly useful as part of the pre-surgical assessment for temporal lobe epilepsy (TLE) in order to predict cognitive outcome and guide surgical decision-making. Whereas language fMRI is widely used, memory fMRI is less frequently employed in adult TLE, and lacking in childhood TLE. We have developed a combined language/memory fMRI paradigm that is suitable for children, to provide clinically useful information for surgical planning in pediatric TLE. We evaluated this paradigm in 28 healthy children, aged 8 to 18 years. The advantages of this paradigm are: (a) it examines the functional mapping of language and memory networks within one scanning session, (b) provides assessment of both memory encoding- and retrieval-related neural networks, (c) examines recall-based retrieval to engage hippocampal involvement compared to recognition-based retrieval, and (d) provides overt verbal responses to monitor in-scanner memory performance. This novel fMRI paradigm was designed for language and memory mapping in pediatric TLE and could provide clinically useful information for surgical planning. Finally, parallel versions of the paradigm allow the comparison of brain activations pre- and post-surgical intervention.
The Potential of Arable Weeds to Reverse Invertebrate Declines and Associated Ecosystem Services in Cereal Crops

There is global concern that invertebrate populations are declining rapidly, particularly in agricultural habitats. Declines have been attributed to the intensification of farming systems, with many studies focussing on a lack of semi-natural habitat in the landscape and the use of insecticides. However, within-field arable weeds are also an important driver of invertebrate abundance and the ecosystem services to which they contribute. This study focuses on the role of arable weeds in supporting invertebrate populations and selected ecosystem services they deliver. , using winter wheat as a case study. Weed-invertebrate relationships were investigated across seven studies of winter-sown wheat spanning 18 years. Both phytophagous and predatory invertebrates responded to weed cover but to different degrees. Phytophages showed a stronger positive relationship with weed cover than the predators, because they rely on the resources provided by the weeds whereas predatory species response is likely to be mediated by their prey. Farmland bird chick-food indices were positively related to both broadleaf and grass cover in cropped fields, indicating that increased weed cover can provide increased invertebrate food for birds in winter wheat. Despite this potential, there were insufficient invertebrate food resources for birds in the majority of wheat fields sampled. Weed diversity did not play a significant role in moderating the relationships between weeds and invertebrate abundance, however this may be a function of the low weed diversity in modern winter wheat fields. In this study the weed species most frequently shown to predict the invertebrate community were: Poa annua, Stellaria media, Fumaria officinalis, Sinapis arvensis, Senecio vulgaris, Persicaria lapathifolia, Sonchus spp. , Matricaria discoidea, Persicaria maculosa, Agrostis spp. , Lamium purpureum, Lamium album, Veronica spp. , Atriplex spp. , Myosotis spp. and Anagallis arvensis. We conclude that even in an intensively grown cereal, arable weeds can play an important role in maintaining and restoring invertebrate populations, that 10% weed cover is needed to fulfill the potential and that a successful outcome will be driven by the presence of weed species that support invertebrates that provide ecosystem services.
Genomic Characterization of a Novel Gut Symbiont From the Hadal Snailfish

Hadal trenches are characterized by not only high hydrostatic pressure but also scarcity of nutrients and high diversity of viruses. Snailfishes, as the dominant vertebrates, play an important role in hadal ecology. Although studies have suggested possible reasons for the tolerance of hadal snailfish to high hydrostatic pressure, little is known about the strategies employed by hadal snailfish to cope with low-nutrient and virus-rich conditions. In this study, the gut microbiota of hadal snailfish was investigated. A novel bacterium named “Candidatus Mycoplasma liparidae” was dominant in the guts of three snailfish individuals from both the Mariana and Yap trenches. A draft genome of “Ca. Mycoplasma liparidae” was successfully assembled with 97.8% completeness by hybrid sequencing. A set of genes encoding riboflavin biosynthesis proteins and a clustered regularly interspaced short palindromic repeats (CRISPR) system was present in the genome of “Ca. Mycoplasma liparidae,” which was unusual for Mycoplasma. The functional repertoire of the “Ca. Mycoplasma liparidae” genome is likely set to help the host in riboflavin supplementation and to provide protection against viruses via a super CRISPR system. Remarkably, genes encoding common virulence factors usually exist in Tenericutes pathogens but were lacking in the genome of “Ca. Mycoplasma liparidae. ” All of these characteristics supported an essential role of “Ca. Mycoplasma liparidae” in snailfish living in the hadal zone. Our findings provide further insights into symbiotic associations in the hadal biosphere.
Convergence of Scaffold-Guided Bone Reconstruction and Surgical Vascularization Strategies—A Quest for Regenerative Matching Axial Vascularization

The prevalent challenge facing tissue engineering today is the lack of adequate vascularization to support the growth, function, and viability of tissue engineered constructs (TECs) that require blood vessel supply. The research and clinical community rely on the increasing knowledge of angiogenic and vasculogenic processes to stimulate a clinically-relevant vascular network formation within TECs. The regenerative matching axial vascularization approach presented in this manuscript incorporates the advantages of flap-based techniques for neo-vascularization yet also harnesses the in vivo bioreactor principle in a more directed “like for like” approach to further assist regeneration of the specific tissue type that is lost, such as a corticoperiosteal flap in critical sized bone defect reconstruction.
Inflammatory Role of TLR-MyD88 Signaling in Multiple Sclerosis

Multiple sclerosis (MS) is a neuro-autoimmune and neurodegenerative disorder leading to chronic inflammation, demyelination, axonal, and neuronal loss in the central nervous system (CNS). Despite intense research efforts, the pathogenesis of MS still remains unclear. Toll-like receptors (TLRs) are a family of type I transmembrane receptors that play a crucial role in the innate immune response. Myeloid differentiation factor 88 (MyD88) is the adaptor of major TLRs. It has been widely considered that the TLR-MyD88 signaling pathway plays an important role in the occurrence and development of autoimmune disease. Data have revealed that the TLR-MyD88 signaling may be involved in the pathogenesis of MS and experimental autoimmune encephalomyelitis (EAE), an animal model for MS, by regulating the antigen presentation of dendritic cells, the integrity of blood-brain barrier (BBB), and the activation of T cells and B cells. Here, we summarize the role of TLRs and MyD88 in MS and discuss the possible therapies that are based on these molecules.