Miracle-dz/UniFAR-FTUs huggingface dataset:
Testosterone deficiency in men with Type 2 diabetes: pathophysiology and treatment

Epidemiological studies consistently demonstrate that lowered serum testosterone is not only common in men with established Type 2 diabetes, but also predicts future diabetic risks and increased mortality. Preclinical studies report plausible mechanisms by which low testosterone could mediate dysglycaemia. Exogenous testosterone treatment consistently reduces fat mass, increases muscle mass and improves insulin resistance in some studies, but the majority of currently available randomized controlled trials (RCTs) do not report a consistent glycaemic benefit. In men with diabetes, testosterone treatment effects on androgen deficiency‐like clinical features are inconsistent, and effects on sexual dysfunction may be attenuated compared with men without diabetes. The long‐term risks of testosterone treatment in older men without medical disease of the hypothalamic–pituitary–testicular axis are not known. Current RCTs are not definitive, owing to their small size, short duration and enrolment of men with mostly relatively good baseline glycaemic control not specifically selected for the presence of androgen deficiency symptoms. Although large, well‐designed clinical trials are needed, given the benefit–risk ratio of testosterone treatment is not well understood, routine serum testosterone testing or testosterone treatment of asymptomatic men with Type 2 diabetes is currently not recommended. Carefully selected, symptomatic men with low testosterone who are informed of the lack of high‐level evidence regarding the long‐term benefits and risks of this approach may be offered a trial of testosterone treatment in combination with lifestyle measures, weight loss and optimization of comorbidities.
Effect of enamel matrix derivative liquid in combination with a natural bone mineral on new bone formation in a rabbit GBR model.

OBJECTIVES Recently, a new liquid carrier system for enamel matrix derivate (EMD-liquid) was developed with better physico-chemical properties for improved adsorption of EMD to biomaterial surfaces. The aim of the present study was to investigate the bone regenerative potential of EMD-liquid in combination with a natural bone mineral (NBM) in vivo. METHODS Four 6-mm defects were created in the calvaria of six New Zealand white rabbits. Defects were filled with either (1) control (empty), (2) 20 mg of NBM, or (3) 20 mg of NBM + 20 µl of EMD-liquid (n = 8). All defects were covered with collagen barrier membranes. The bone regenerative potential was investigated by micro-CT and histomorphological analyses at 8 weeks postsurgery. RESULTS The mineralized tissue volume was significantly higher in the NBM + EMD-liquid group when compared to control, whereas no difference was observed between the NBM alone and control groups. While no significant difference was observed for horizontal bone defect closure between the NBM + EMD-liquid and the NBM alone groups, NBM + EMD-liquid significantly increased the total mineralized area and reduced the percentage of soft/connective tissue infiltration. No statistically significant difference was observed between the NBM + EMD-liquid group and NBM alone group for amount of mineralized bone. CONCLUSION The addition of EMD-liquid did not lead to statistically significant bone formation when compared to NBM alone. The combination of NBM + EMD-liquid but not NBM alone did however induce superior mineralized tissues when compared to control (empty). Further research investigating the adsorption potential of EMD-liquid to bone-grafting particles with/without collagen may provide valuable insights into future regenerative strategies with enamel matrix proteins.
Biplanar ultrasound investigation of in vivo Achilles tendon displacement non‐uniformity

The Achilles tendon is a common tendon for the medial and lateral gastrocnemius and soleus muscles. Non‐uniform Achilles tendon regional displacements have been observed in vivo which may result from non‐uniform muscle loading and intratendinous shearing. However, prior observations are limited to the sagittal plane. This study investigated Achilles tendon tissue displacement patterns during isometric plantarflexor contractions in the coronal and sagittal planes. Fourteen subjects (5 female, 9 male, 26 ± 3 year) performed maximal isometric plantarflexor contractions with the knee in full extension and flexed to 110°. An ultrasound transducer positioned over the free Achilles tendon collected beam formed radio frequency (RF) data at 70 frames/s. Localized tissue displacements were analyzed using a speckle tracking algorithm. We observed non‐uniform Achilles tendon tissue displacements in both imaging planes. Knee joint posture had no significant effect on tissue displacement patterns in either imaging plane. The non‐uniform Achilles tendon tissue displacements during loading may arise from the anatomical organization of the sub‐tendons associated with the three heads of the triceps surae. The biplanar investigation suggests that greatest displacements are localized to tissue likely to belong to soleus subtendon. This study adds novel information with possible implications for muscle coordination, function, and muscle‐tendon injury mechanisms.
Nutrition in transition: historical cohort analysis summarising trends in under- and over-nutrition among pregnant women in a marginalised population along the Thailand–Myanmar border from 1986 to 2016

Abstract The objective of the present study is to summarise trends in under- and over-nutrition in pregnant women on the Thailand–Myanmar border. Refugees contributed data from 1986 to 2016 and migrants from 1999 to 2016 for weight at first antenatal consultation. BMI and gestational weight gain (GWG) data were available during 2004–2016 when height was routinely measured. Risk factors for low and high BMI were analysed for <18·5 kg/m2 or ≥23 kg/m2, respectively. A total of 48 062 pregnancies over 30 years were available for weight analysis and 14 646 pregnancies over 13 years (2004–2016) had BMI measured in first trimester (<14 weeks’ gestational age). Mean weight at first antenatal consultation in any trimester increased over the 30-year period by 2·0 to 5·2 kg for all women. First trimester BMI has been increasing on average by 0·5 kg/m2 for refugees and 0·6 kg/m2 for migrants, every 5 years. The proportion of women with low BMI in the first trimester decreased from 16·7 to 12·7 % for refugees and 23·1 to 20·2 % for migrants, whereas high BMI increased markedly from 16·9 to 33·2 % for refugees and 12·3 to 28·4 % for migrants. Multivariate analysis demonstrated low BMI as positively associated with being Burman, Muslim, primigravid, having malaria during pregnancy and smoking, and negatively associated with refugee as opposed to migrant status. High BMI was positively associated with being Muslim and literate, and negatively associated with age, primigravida, malaria, anaemia and smoking. Mean GWG was 10·0 (sd 3·4), 9·5 (sd 3·6) and 8·3 (sd 4·3) kg, for low, normal and high WHO BMI categories for Asians, respectively.
A meta-analysis

Background: The optimal anesthetic technique remains debated in patients undergoing total-hip arthroplasty (THA). The purpose of this meta-analysis was to test the efficacy of general and spinal anesthesia for patients undergoing THA. Methods: In January 2018, we searched PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and the Google database. Data from randomized controlled trials (RCTs) that compared the use of general and spinal anesthesia for patients undergoing THA were retrieved. The primary outcome was to compare the total blood loss. The secondary outcomes were the occurrence of deep venous thrombosis (DVT), the occurrence of nausea, and the length of hospital stay. Software Stata 12.0 was used for meta-analysis. Results: Five RCTs with 487 THAs were finally included for meta-analysis. There was no significant difference between the general anesthesia and spinal anesthesia in terms of the total blood loss (weighted mean difference [WMD]= 20.72, 95% confidence interval [CI] 84.50 to 43.05, P= .524; I=87.8%) and the occurrence of DVT (risk ratio (RR)=0.85, 95%CI 0.24–3.01, P= . 805; I= 70.5%). Compared with general anesthesia, spinal anesthesia was a significant reduction in the occurrence of nausea (RR=3.04, 95% CI 1.69–5.50, P= .000; I=0.0%) and the length of hospital stay (WMD=1.00, 95% CI 0.59–1.41, P= .000; I=94.7%). Conclusion: Spinal anesthesia was superior than general anesthesia in terms of the occurrence of nausea and shorten the length of hospital stay. The quality and number of included studies was limited; thus, a greater number of high-quality RCTs is still needed to further identify the effects of spinal anesthesia on reducing the blood loss after THA. Abbreviations: CENTRAL = Cochrane Central Register of Controlled Trials, CI = confidence interval, DVT = deep venous thrombosis, GRADE = Grading of Recommendations, Assessment, Development and Evaluation, PRISMA = preferred reporting items for systematic reviews and meta-analyses, RCTs = randomized controlled trials, RR = risk ratio, SD = standard deviation, THA = total-hip arthroplasty, WMD = weighted mean differences.
On the Validity of Forced Choice Scores Derived From the Thurstonian Item Response Theory Model

Forced choice (FC) measures may be a desirable alternative to single stimulus (SS) Likert items, which are easier to fake and can have associated response biases. However, classical methods of scoring FC measures lead to ipsative data, which have a number of psychometric problems. A Thurstonian item response theory (TIRT) model has been introduced as a way to overcome these issues, but few empirical validity studies have been conducted to ensure its effectiveness. This was the goal of the current three studies, which used FC measures of domains from popular personality frameworks including the Big Five and HEXACO, and both statement and adjective item stems. We computed TIRT and ipsative scores and compared their validity estimates. Convergent and discriminant validity of the scores were evaluated by correlating them with SS scores, and test-criterion validity evidence was evaluated by examining their relationships with meaningful outcomes. In all three studies, there was evidence for the convergent and test-criterion validity of the TIRT scores, though at times this was on par with the validity of the ipsative scores. The discriminant validity of the TIRT scores was problematic and was often worse than the ipsative scores.
Elevated plasma cystathionine is associated with increased risk of mortality among patients with suspected or established coronary heart disease.

BACKGROUND Elevated circulating cystathionine levels are related to atherosclerotic cardiovascular disease, a leading cause of death globally. OBJECTIVE We investigated whether plasma cystathionine was associated with mortality in patients with suspected or established coronary heart disease (CHD). METHODS Data from 2 independent cohorts of patients with suspected stable angina pectoris (SAP) (3033 patients; median 10.7 y follow-up; 648 deaths) or acute myocardial infarction (AMI) (3670 patients; median 7.0 y follow-up; 758 deaths) were included. Hazard ratios with 95% CIs per SD increment of log-transformed cystathionine were calculated using Cox regression modeling. Endpoint data was obtained from a national health registry. RESULTS Among patients with SAP, there was a positive association between plasma cystathionine and death (age- and sex-adjusted HRs [95% CI] per SD: 1.23 [1.14, 1.32], 1.29 [1.16, 1.44], and 1.17 [1.05, 1.29] for total, cardiovascular, and noncardiovascular mortality, respectively). Corresponding risk estimates were 1.28 (1.19, 1.37) for all-cause, 1.33 (1.22, 1.45) for cardiovascular, and 1.19 (1.06, 1.34) for noncardiovascular death among AMI patients. In both cohorts, estimates were slightly attenuated after multivariate adjustments for established CHD risk factors. Subgroup analyses showed that the relation between cystathionine and all-cause mortality in SAP patients was stronger among nonsmokers and those with lower plasma concentration of pyridoxal-5'-phosphate (P-interaction ≤ 0.01 for both). CONCLUSIONS Elevated plasma cystathionine is associated with both cardiovascular and noncardiovascular mortality among patients with suspected or established CHD. The joint risk associations of high plasma cystathionine with lifestyle factors and impaired vitamin B-6 status on mortality need further investigation. This trial was registered at clinicaltrials.gov as NCT00354081 and NCT00266487.
Plasma NT-proBNP levels associated with cardiac structural abnormalities in asymptomatic health examinees with preserved ejection fraction: a retrospective cross-sectional study

Objectives Stage B heart failure (HF) is defined as an asymptomatic abnormality of the heart structure or function. The circulating level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) is elevated in symptomatic patients with left ventricular (LV) dysfunction caused by a structural or functional abnormality. This study investigated the association of the NT-proBNP level with echocardiography-detected cardiac structural or diastolic abnormalities in asymptomatic subjects with preserved LV systolic function (ejection fraction >50%). Methods We retrospectively studied 652 health examinees who underwent echocardiography and an NT-proBNP test at a health-promotion centre in Seoul, between January 2016 and September 2018. The left ventricular mass index (LVMI) and the left atrial dimension (LAD) were used as markers for structural abnormalities, and the mean e’ velocity and mitral early flow velocity/early diastolic tissue velocity (E/e’) ratio were used as markers for diastolic dysfunction. The plasma NT-proBNP level was measured using electrochemiluminescence immunoassay (DPC Immulite 2000 XPi, Siemens Healthcare Diagnostics, Tarrytown, New York, USA). Results Subjects with preclinical structural abnormalities were older and had a higher body mass index (BMI), higher blood pressure, lower high-density lipoprotein cholesterol level, higher NT-proBNP level, and higher E/e’ (p<0.05). Multivariate regression analysis indicated that the factors associated with a higher NT-proBNP level were older age, female sex, lower BMI, higher creatinine level, higher LVMI and higher LAD (p<0.01). Conclusion Diastolic dysfunction is not associated with higher NT-proBNP levels, whereas preclinical cardiac structural abnormalities, as well as older age, female sex, lower BMI, and higher creatinine level, are associated with higher NT-proBNP levels.
Effect of remifentanil and midazolam on ED95 of propofol for loss of consciousness in elderly patients

Background: Older people are more vulnerable to hemodynamic instability caused by propofol due to their decreased initial distribution volume and increased sensitivity to propofol. Midazolam or remifentanil can often be coadministered because of their synergistic or additive effects with propofol as well as amnesic properties and the blockade of sympathetic stimulation. However, no study has confirmed the appropriate dose of propofol for loss of consciousness in aged patients when administered with other drugs, including opioids or benzodiazepines. Methods: Patients >65 years scheduled for general anesthesia were enrolled. The patients were randomized into 3 groups using a computer-generated randomization table. Patients in group P (propofol) received only propofol for loss of consciousness, those in group PR (propofol–remifentanil) received remifentanil before propofol, and those in group PMR (propofol–midazolam–remifentanil) received remifentanil and midazolam before propofol. After propofol administration, loss of both eyelash reflex and verbal response represented success. The 95% effective dose of propofol for loss of consciousness in each group, which was the primary outcome, was determined using a modified biased coin up-and-down method. Results: In total, 120 patients were randomized into the 3 groups (n = 40). The 95% effective dose of propofol for loss of consciousness was 1.13, 0.87, and 0.72 mg/kg in groups P, PR, and PMR, respectively. The mean blood pressure (MBP) in group PMR was more significantly decreased before propofol injection (P = .041) as well as 2 minutes (P = .005) and 3 minutes after propofol administration (P<.001), compared with group P, but there were no intergroup differences at other time points. Conclusions: The effective dose of propofol for loss of consciousness in elderly patients could be decreased by 23% and 36% when remifentanil pretreatment was used without and with midazolam, respectively. However, the decrease in MBP was greater with remifentanil and midazolam pretreatment than with propofol alone. These findings suggest that pretreatment with midazolam for propofol infusions with remifentanil in elderly patients should be cautiously used, due to hemodynamic instability during induction.
Spearman’s hypothesis tested comparing Korean young adults with various other groups of young adults on the items of the Advanced Progressive Matrices

Abstract Spearman’s hypothesis tested at the subtest level of an IQ battery states that differences between races on the subtests of an IQ battery are a function of the g loadings of these subtests, such that there are small differences between races on subtests with low g loadings and large differences between races on subtests with high g loadings. Jensen (1998) stated that Spearman’s hypothesis is a law-like phenomenon. It has also been confirmed many times at the level of items of the Raven’s Progressive Matrices. This study hypothesizes that with concern to Spearman’s hypothesis, subtests and items function in fundamentally the same way, and tested whether Spearman’s hypothesis is confirmed at the item level for White–East Asian comparisons. A group of Korean young adults (N=205) was compared with other groups of young adults from Canada, the US, Russia, Peru and South Africa (total N=4770) who took the Advanced Progressive Matrices. Spearman’s hypothesis was strongly confirmed with a sample-size-weighted r with a value of 0.63. Computing the g loadings of the items of the Raven with either the Raven-g or the Wechsler-g led to the same conclusions. Tests of Spearman’s hypothesis yielded less-strong outcomes when the 36-item Advanced Progressive Matrices were used than when the 60-item Standard Progressive Matrices were used. There is a substantial correlation between sample size and the outcome of Spearman’s hypothesis. So, all four hypotheses were confirmed, showing that a part of the subtest-level nomological net replicates at the item level, strengthening the position that, with concern to Spearman’s hypothesis, subtests and items function fundamentally the same. It is concluded that Spearman’s hypothesis is still a law-like phenomenon. Detailed suggestions for follow-up research are made.
Commentary: Normative orbital measurement in Indian population

The manuscript titled “CT imaging‐based normative orbital measurement in Indian population” by Gupta et al. attempts to provide normative measures for bone and soft tissues in 200 orbits drawn from an Indian population. [1] Normative measurements of the orbit were reported by Dhanwate and Gaikwad from dry ossified intact adult skulls in an Indian population. [2] Orbital height, breadth, and index measured by the current study are higher than those reported by Dhanwate and Gaikwad. [1,2] This difference may be attributed largely to methodological variance than actual differences related to gender (males predominated both study groups) and age. [1,2] Gupta et al. acknowledge this methodological difference. [1] While Dhanwate and Gaikwad used simple instruments like Vernier caliper, scale, and marker to measure the horizontal and vertical dimensions along predetermined points on the orbital rim in a human skull, Gupta et al. relied on the computed tomography (CT) to measure the maximum distance between superior and inferior walls on coronal section and the medial and lateral walls on axial section as vertical and horizontal diameters, respectively. [1,2] Anatomically, the largest horizontal and vertical dimensions in the orbit are posterior to the orbital rim and this explains why Gupta et al. have higher values for orbital height and breadth. [1] The orbital indices of 103 and 97 for the right and left orbits, respectively, reported by Gupta et al. would classify Indians (North Indians) as megaseme. [2] This is in contrast to two other studies from North India where orbital indices were classified as microseme. [3,4]
Symptom Clusters in Patients With Brain Tumors Undergoing Proton Beam Therapy.

OBJECTIVES To explore symptom clusters during proton beam therapy in patients with primary brain tumors and investigate associations among symptom clusters, demographic variables, and comorbidity in this patient population. SAMPLE & SETTING Data were collected from 187 adult patients with primary brain tumors during their treatment periods in the Skandion Clinic in Uppsala, Sweden. Symptoms were assessed with the Radiotherapy-Related Symptoms Assessment Scale, and comorbidity was evaluated with the Self-Administered Comorbidity Questionnaire. METHODS & VARIABLES The study used a quantitative and longitudinal design. Exploratory factor analysis was used to determine the underlying structure of symptom clusters. RESULTS Three clusters were identified. IMPLICATIONS FOR NURSING Building knowledge about how these symptoms interact and are clustered will support healthcare professionals to more efficiently relieve symptom clusters during proton beam therapy.
Microparticles and cardiovascular diseases

Abstract Microparticles are a distinctive group of small vesicles, without nucleus, which are involved as significant modulators in several physiological and pathophysiological mechanisms. Plasma microparticles from various cellular lines have been subject of research. Data suggest that they are key players in development and manifestation of cardiovascular diseases and their presence, in high levels, is associated with chronic inflammation, endothelial damage and thrombosis. The strong correlation of microparticle levels with several outcomes in cardiovascular diseases has led to their utilization as biomarkers. Despite the limited clinical application at present, their significance emerges, mainly because their detection and enumeration methods are improving. This review article summarizes the evidence derived from research, related with the genesis and the function of microparticles in the presence of various cardiovascular risk factors and conditions. The current data provide a substrate for several theories of how microparticles influence various cellular mechanisms by transferring biological information.
A Theory of Fairness in Labour Markets

I study a gift-exchange game, in which a profit-maximizing firm offers a wage to a fair-minded worker, who then chooses how much effort to exert. The worker judges a transaction fairer to the extent that his own gain is more nearly equal to the firm's gain. The worker calculates both players' gains relative to what they would have gained from the "reference transaction," which is the transaction that the worker most recently personally experienced. The model explains several empirical regularities: rent sharing, persistence of a worker's entry wage at a firm, insensitivity of an incumbent worker's wage to market conditions, and-if the worker is loss averse and the reference wage is nominal-downward nominal wage rigidity. The model also makes a number of novel predictions. Whether the equilibrium is efficient depends on which notion of efficiency is used in the presence of the worker's fairness concern, and which is appropriate to use partly depends on whether loss aversion is treated as legitimate for normative purposes.