Miracle-dz/UniFAR-FTUs huggingface dataset:
Draping in Dermatology: A Physician’s Perspective

Background Patient dignity is a core component of medicine and health care, yet maintaining patient dignity can be challenging in clinical settings in dermatology, specifically during a total body skin examinations (TBSE) for appropriate assessment and diagnosis. A recent study evaluated patient perspectives in dermatology. The purpose of this study was to investigate current draping practices and perspectives from a physicians’ perspective. Methods A cross-sectional study was performed with the use of study-specific questionnaire distributed to staff dermatologists and dermatology residents across Canada. Results A total of 117 physicians were included (84 attending dermatologists and 33 dermatology residents). Nearly all staff and resident dermatologists (90.6%) indicated that draping was important. Specific practices differed between residents and staff (P = .03). Only 3.1% of residents indicated that they did not receive any form of teaching on draping during their training compared to 21.4% of attending physicians (P = .03). Discussion This study confirms that draping practices in dermatology are perceived as important by dermatologists, consistent with other reports emphasizing approaches to protect patient privacy and dignity. There is a shared value for draping and consistent integration of this within current practice of Canadian dermatologists. Formal and informal education incorporated in medical education and dermatology training is becoming more prominent. Major study limitations include sampling bias, convenience bias and nonresponse bias. Conclusion This is the first study to evaluate physician perspectives on draping in dermatology or other areas in medicine. Findings from this study support a focus on draping in medical education.
Definitive aetiology of unexplained syncope after cardiovascular autonomic tests in a tertiary syncope unit

Abstract Aims Syncope is a common condition with many possible causes, ranging from benign to life-threatening aetiologies. Establishing a diagnosis can be difficult, and specialized syncope units, using cardiovascular autonomic tests (CATs), including a head-up tilt test, can increase the diagnostic yield. However, up to one-fifth of examined patients have inconclusive CAT results. The aim of the present study was to investigate the predictive value of history, and clinical findings for unexplained syncope after CAT and characterize the group with negative results. Methods and results Consecutive syncope patients [n = 2663, 61% women, median age 52 (32–69) years] were evaluated and CAT explained aetiology of syncope in 79% of cases, whereas 21% remained unexplained. Predictors of negative CAT were older age at first syncope (+8% higher odds per 10-year increment, P = 0.042), higher supine heart rate (HR; +12% per 10 b.p.m.; P = 0.003), absence of prodromes (+48%; P < 0.001), hypertension (+45%; P = 0.003), diabetes (+82%; P < 0.001), heart failure (+98%; P = 0.014), and coronary artery disease (+51%; P = 0.027). Compared with vasovagal syncope, patients with negative CAT were older, reported more often the absence of prodromes, and had a higher burden of cardiovascular comorbidities. Conclusion A cardiovascular autonomic test established the cause of syncope in 79% of patients evaluated in a syncope unit. Syncope without prodromes and cardiovascular comorbidities were significant predictors of failure to reveal an aetiology from assessment by CAT. These are known risk factors for cardiac syncope and patients with inconclusive CAT warrant further investigation.
Orthostatic hypotension and its association with cerebral small vessel disease in a memory clinic population

Background: Orthostatic hypotension (OH), an impaired blood pressure (BP) response to postural change, has been associated with cognitive decline and dementia, possibly through cerebral small vessel disease (CSVD). We hypothesized that longer duration of BP drop and a larger BP drop is associated with increased risk of CSVD. Methods: This cross-sectional study included 3971 memory clinic patients (mean age 68 years, 45% female, 42% subjective cognitive complaints, 17% mild cognitive impairment, 41% dementia) from the Amsterdam Ageing Cohort and Amsterdam Dementia Cohort. Early OH (EOH) was defined as a drop in BP of ±20 mmHg systolic and/or 10 mmHg diastolic only at 1 min after standing, and delayed/prolonged OH (DPOH) at 1 and/or 3 min after standing. Presence of CSVD [white matter hyperintensities (WMH), lacunes, microbleeds] was assessed with MRI (n = 3584) or CT brain (n = 389). Results: The prevalence of early OH was 9% and of delayed/prolonged OH 18%. Age- and sex-adjusted logistic regression analyses showed that delayed/prolonged OH, but not early OH, was significantly associated with a higher burden of WMH (OR, 95%CI: 1.21, 1.00–1.46) and lacunes (OR, 95%CI 1.34, 1.06–1.69), but not microbleeds (OR, 95%CI 1.22, 0.89–1.67). When adjusting for supine SBP, these associations attenuated (ORs, 95%CI for WMH 1.04, 0.85–1.27; for lacunes 1.21, 0.91–1.62; for microbleeds 0.95, 0.68–1.31). A larger drop in SBP was associated with increased risk of WMH and microbleeds, however, when adjusted for supine SBP, this effect diminished. Conclusions: Among memory clinic patients, DPOH is more common than EOH. While longer duration and larger magnitude of BP drop coincided with a higher burden of CSVD, these associations were largely explained by high supine BP.
Pediatric attention deficit hyperactivity disorder (ADHD): 2022 updates on pharmacological management

ABSTRACT Introduction Pediatric attention-deficit disorder (ADHD) impacts a significant percentage of the population world-wide. Pharmacologic treatments have been shown to be safe and effective for managing symptoms. Various medication formulations exist, and new medication agents are continually approved each year. Areas covered This article offers an overview of ADHD, an overview of both stimulant and non-stimulant medication options as well as an overview of stimulant misuse. It explores the medication mechanisms of action and side effect profiles, as well as offering an in-depth summary of the novel agents recently approved and soon-to-be approved for use in youth. PubMed and Medline were utilized. Search terms included children, adolescents, ADHD, and medication. FDA package inserts were reviewed for all medications. Expert opinion New formulations of medications include an evening administered, extended, and delayed-release form of methylphenidate (DR/ER MPH), a methylphenidate pro-drug (serdexmethylphenidate) and an amphetamine patch. The availability of a new SNRI (selective norepinephrine reuptake inhibitor), viloxazine extended-release (VER), and the pending approval of a triple reuptake inhibitor (centanafadine) provides welcome additions to the prescriber’s toolbox. Plain Language Summary This article is a review of pharmacological treatment options for pediatric attention-deficit disorder (ADHD). It provides an overview of ADHD, an overview of the current stimulant and non-stimulant medication options as well as detailed information on the newer psychopharmacological options to assist in the education of the wide array of medication options for treatment. As ADHD is a heterogeneous illness, a wide array of medication options is helpful in the clinician’s toolbox. Learning the mechanisms of action along with the side effect profile for newer medication options is the focus of this review. There are new options for patches and new combinations for long-acting and delayed-release formulations as well as new non-stimulant options which target different receptors.
A TGF-β/KLF10 signaling axis regulates atrophy-associated genes to induce muscle wasting in pancreatic cancer

Significance Skeletal muscle wasting is a serious cancer comorbidity that directly impacts therapeutic response, surgical prognosis, quality of life, and overall survival. Effective treatments targeting cancer-associated muscle wasting are limited. TGF-β signaling is well established as a driver of cancer-associated muscle wasting, but precise mechanisms of action remain unclear. We present evidence that the TGF-β target gene KLF10 is a key mediator of pancreatic cancer–associated muscle wasting. We further demonstrate that KLF10 can be targeted to prevent muscle wasting. Ultimately, this work provides key evidence in support of targeting the TGF-β/KLF10 signaling axis in wasting cancer patients to improve clinical outcomes.
Stress appraisal and emotion regulation mediate the association between mindfulness and affect in cancer patients: Differential mechanisms for positive and negative affect

Cancer patients are at an increased risk for affective problems, including feelings of anxiety and depression. Mindfulness has been linked to an array of benefits for affective functioning in various populations including cancer patients, but the mechanisms underlying this relationship are still poorly understood. Based on emotion‐regulation and stress‐coping models, this study examined the potential mediating role of stress appraisal and coping strategies in the associations between mindfulness and cancer patients' positive and negative affect.
Off-host survival of Dermacentor variabilis (Acari: Ixodidae) adults near their northern distributional limit in Saskatchewan, Canada

Dermacentor variabilis (Say) is expanding its range northwards in Saskatchewan and Manitoba (Canada). Knowledge of the relative ability of different life cycle stages to survive off-host over winter is important for assessing the potential for further range expansion and risk of pathogen transmission. In the present study, the off-host survival of D. variabilis adults was determined in outdoor terraria within a field plot close to Lizard Lake Community Pasture (LLCP) situated near the northern distributional limit in Saskatchewan. Only a small proportion (7%) of adult ticks in this relatively recently established population survived from mid-summer to late winter. Off-host survival had declined further to <4% by mid-spring. A significantly greater proportion of female ticks (6%) survived from mid-summer to mid-spring than did male ticks (1%). The supercooling points (SCPs), the temperature below 0 °C when body fluids spontaneously freeze, of the 17 ticks that survived through to mid-spring did not differ significantly from the SCPs of questing ticks in the previous summer, suggesting adult D. variabilis do not undergo cold hardening during winter diapause. The off-host survival of D. variabilis adults near LLCP was also much lower than that previously reported for adults from Sandy Hook in Manitoba, a population that has been established for decades. This finding suggests that there is geographical variation in the ability of D. variabilis in southern Canada to survive from mid-summer to the subsequent spring. However, the ecological and genetic factors influencing the survival of northern populations of D. variabilis requires further investigation.
Association between postictal suppression and the therapeutic effects of electroconvulsive therapy: A systematic review

Electroconvulsive therapy (ECT) is an effective and safe medical treatment for patients with severe mood and neuropsychiatric disorders. Since the advent of ECT, extensive research has been performed to identify the predictive factors for response to ECT. In recent decades, postictal suppression on an electroencephalogram (EEG) has been considered a potential predictor of response to ECT. We aimed to investigate the direct association between postictal suppression and the therapeutic effects of ECT. In this systematic review, all articles in the field of the association between postictal suppression and the therapeutic effects of ECT published between 1990 and 2021 were identified. The full texts of these articles, which include clinical trials and retrospective and cross‐sectional studies, are available in scholarly research databases and search engines, including PubMed, Google Scholar, OVID, Web of Science, and Scopus. Of all retrieved articles, eight studies, including four retrospective cohort articles and four clinical trials, met the inclusion criteria for further analyses. The findings of this study showed a significant association between postictal suppression and the therapeutic efficacy of ECT. Factors such as electrode placement, tachycardia, type of anesthetic agent, and EEG amplitude were also directly related to postictal suppression and the efficacy of ECT. Postictal suppression on EEG can be considered a predictor of response to ECT. To increase the effectiveness of treatment with ECT and increase postictal suppression, factors including electrode placement, tachycardia, type of anesthesia, and EEG amplitude should be considered, which highlights the need for further research.
Defining Comprehensive Disease Control for Use as a Treatment Target for Ulcerative Colitis in Clinical Practice: International Delphi Consensus Recommendations

Abstract Background and Aims Treatment of ulcerative colitis [UC] requires a patient-centric definition of comprehensive disease control that considers improvements in aspects not typically captured by classical landmark trial endpoints. In an international initiative, we reviewed aspects of UC that affect patients and/or indicate mucosal inflammation, to achieve consensus on which aspects to combine in a definition of comprehensive disease control, using a modified Delphi process. Methods The Delphi panel comprised 12 gastroenterologists and one patient advocate. Two gastroenterologists were elected as chairs and did not vote. To inform statements, we asked 18 patients and the panel members about their experiences of remission and reviewed published literature. Panel members voted on statements anonymously in three rounds, with a live discussion before Round 3. Consensus was met if ≥67% of the panel agreed. Statements without consensus in Rounds 1 and 2 were revised or discarded after Round 3. Results The panel agreed to measure individual patient benefit using a definition of comprehensive disease control that combines aspects currently measured in trials [rectal bleeding, stool frequency, disease-related quality of life, endoscopy, histological inflammatory activity, inflammatory biomarkers, and corticosteroid use] with additional patient-reported symptoms [bowel urgency, abdominal pain, extraintestinal manifestations, fatigue, and sleep disturbance]. The panel agreed on scoring systems and thresholds for many aspects. Conclusions Using a robust methodology, we defined comprehensive disease control in UC. Next, we will combine the measurement and scoring of these aspects into a multicomponent tool and will adopt comprehensive disease control as a treatment target in clinical practice and trials.
Beyond skin-deep: targeting the plant surface for crop improvement

Abstract The above-ground plant surface is a well-adapted tissue layer that acts as an interface between the plant and its surrounding environment. As such, its primary role is to protect against desiccation and maintain the gaseous exchange required for photosynthesis. Further, this surface layer provides a barrier against pathogens and herbivory, while attracting pollinators and agents of seed dispersal. In the context of agriculture, the plant surface is strongly linked to post-harvest crop quality and yield. The epidermal layer contains several unique cell types adapted for these functions, while the non-lignified above-ground plant organs are covered by a hydrophobic cuticular membrane. This review aims to provide an overview of the latest understanding of the molecular mechanisms underlying crop cuticle and epidermal cell formation, with focus placed on genetic elements contributing towards quality, yield, drought tolerance, herbivory defence, pathogen resistance, pollinator attraction, and sterility, while highlighting the inter-relatedness of plant surface development and traits. Potential crop improvement strategies utilizing this knowledge are outlined in the context of the recent development of new breeding techniques.
Branch Union Morphology Affects Decay Following Pruning

Branch diameter relative to the trunk diameter (aspect ratio) affected the extent of discolored and decayed wood in the trunk of seedling-propagated red maple (Acer rubrum L.) after branch removal. More discoloration resulted from removing codominant stems than removing branches that were small compared to the trunk. Removing limbs that originated from lateral buds resulted in the same amount of discoloration and decay as removing suppressed limbs that were once the leader. This result provides indirect evidence that a small codominant stem suppressed by pruning techniques designed to slow its growth rate can result in a branch protection zone at the union. There was no relation between the presence of a bark inclusion and decay 4 years after making pruning cuts.
A Multicomponent Cognitive Intervention May Improve Self-Reported Daily Function of Adults With Subjective Cognitive Decline.

IMPORTANCE Limited evidence exists to support cognitive intervention improving the daily function of adults with subjective cognitive decline (SCD). OBJECTIVE To examine the preliminary efficacy of a group-based multicomponent cognitive intervention that integrates Lifestyle Redesign® (LR) techniques. DESIGN Single-arm two-period crossover trial; 16-wk waiting period, 16-wk intervention, and 16-wk follow-up. SETTING Memory clinic in a medical center, Taiwan. PARTICIPANTS Purposive sample of adults ages >55 yr with SCD. INTERVENTION Sixteen 1.5-hr weekly multicomponent sessions of cognitive training, cognitive rehabilitation, psychological intervention, and lifestyle intervention. OUTCOMES AND MEASURES Primary outcomes were (1) self-reported daily function, measured with the Activities of Daily Living Questionnaire (ADLQ) and Cognitive Failure Questionnaire; (2) performance-based daily function, measured with the Brief University of California San Diego Performance-Based Skills Assessment-Traditional Chinese Version; and (3) functional cognition, measured with the Contextual Memory Test (CMT) and Miami Prospective Memory Test. Secondary outcomes included cognitive functions, anxiety, and depression. RESULTS Seventeen participants completed the intervention; 4 missed the follow-up. The generalized estimating equations model showed significant changes from baseline to pretest (control) and pretest to posttest (intervention) on the ADLQ (p = .014) and CMT-delayed (p = .003). Effects remained at the 16-wk follow-up. After adjusting for the effects of covariates, the self-reported daily function of participants ages ≤ 63 yr improved more than that of other participants (p = .003). CONCLUSIONS AND RELEVANCE Multicomponent cognitive interventions integrating LR techniques may improve self-reported daily function and context-dependent memory function of adults with SCD, with efficacy sustained at follow-up. What This Article Adds: A group-based multicomponent cognitive intervention consisting of cognitive training, cognitive rehabilitation, psychoeducation, and lifestyle intervention may provide benefits for the daily function and cognitive function of adults with SCD.
Respiratory virus infections after allogeneic stem cell transplantation: Current understanding, knowledge gaps, and recent advances

Before the COVID‐19 pandemic, common community‐acquired seasonal respiratory viruses (CARVs) were a significant threat to the health and well‐being of allogeneic hematopoietic cell transplant (allo‐HCT) recipients, often resulting in severe illness and even death. The pandemic has further highlighted the significant risk that immunosuppressed patients, including allo‐HCT recipients, face when infected with SARS‐CoV‐2. As preventive transmission measures are relaxed and CARVs circulate again among the community, including in allo‐HSCT recipients, it is crucial to understand the current state of knowledge, gaps, and recent advances regarding CARV infection in allo‐HCT recipients. Urgent research is needed to identify seasonal respiratory viruses as potential drivers for future pandemics.
Selection and adaptation in human migration

This article reviews the ways migration shapes human biology. This includes the physiological and genetic, but also socio‐cultural aspects such as organization, behavior, and culture. Across disciplines I highlight the multiple levels of cultural and genetic selection whereby individuals and groups adapt to pressures along a migration timeline: the origin, transit, and destination. Generally, the evidence suggests that selective pressures and adaptations occur at the individual, family, and community levels. Consequently, across levels there are negotiations, interactions, and feedbacks that shape migration outcomes and the trajectory of evolutionary change. The rise and persistence of migration‐relevant adaptations emerges as a central question, including the maintenance of cumulative culture adaptations, the persistence of “cultures of migration,” as well as the individual‐level physiological and cognitive adaptations applied to successful transit and settlement in novel environments.
Obesity dominates early effects on cardiac structure and arterial stiffness in people with type 2 diabetes

Objective: Type 2 diabetes (T2D) and obesity are global epidemics leading to excess cardiovascular disease (CVD). This study investigates standard and novel cardiac MRI parameters to detect subclinical cardiac and central vascular dysfunction in inactive people with and without T2D. Methods: Physically inactive age and BMI-similar premenopausal women and men with (n = 22) and without [n = 34, controls with overweight/obesity (CWO)] uncomplicated T2D were compared to an age-similar and sex-similar reference control cohort (n = 20). Left ventricular (LV) structure, function, and aortic stiffness were assessed by MRI. Global arterial pulse wave velocity (PWV) was assessed using carotid-to-femoral applanation tonometry. Regional PWV was measured via 2D phase-contrast MRI and 4D flow MRI. Results: Global arterial PWV did not differ between CWO and T2D. 2D PC-MRI PWV in the ascending aorta was higher in people with T2D compared with CWOs (P < 0.01). 4D flow PWV in the thoracic aorta was higher in CWO (P < 0.01), and T2D (P < 0.001) compared with RC. End-diastolic volume, end-systolic volume, stroke volume, and cardiac output were lower in CWO and T2D groups compared with reference control. Conclusion: Subclinical changes in arterial stiffening and cardiac remodeling in inactive CWO and T2D compared with reference control support obesity and/or physical inactivity as determinants of incipient CVD complications in uncomplicated T2D. Future studies should determine the mechanistic causes of the CVD complications in greater detail in order to create therapeutic targets. Clinical Trial Registration: Cardiovascular Mechanisms of Exercise Intolerance in Diabetes and the Role of Sex (NCT03419195).
Reducing unnecessary premedication prior to parenteral iron therapy: A quality improvement project

Intravenous (IV) iron carries risks of mild, self‐limiting, tryptase‐negative Fishbane and complement activation‐related pseudo‐allergy reactions, with rare reports of anaphylaxis. Historically, high‐molecular‐weight iron dextran (HMWID) was associated with a higher incidence of anaphylaxis and empiric premedication with antihistamines/corticosteroids have been used to mitigate this risk. HMWID is no longer available and the risk of hypersensitivity reactions with newer IV iron formulations is low. Therefore, the use of routine prophylactic premedication in all patients is not justified but should be considered in high‐risk patients.