Miracle-dz/UniFAR-FTUs huggingface dataset:
Tai Chi versus routine exercise in patients with early- or mild-stage Parkinson's disease: a retrospective cohort analysis

Parkinson's disease cannot be cured but symptoms can be improved by making use of physical therapy. The objective of the study was to compare the effect of routine exercises and Tai Chi on physical and clinical performance in elderly people suffering from Parkinson's disease. Data from interviews, physical and clinical performance, and levodopa consumption of 500 patients with confirmed Parkinson's disease (severity level I to III) were collected and analyzed. Participants who received 80 min/day Tai Chi 3 times/week for 2 months were included in the Tai Chi (TC) group (n=250) and those who received 90 min/day routine exercise 3 times/week for 2 months were included in routine exercise (RE) group (n=250). Timed up-and-go, 50-foot speed walk, and functional reach were improved by Tai Chi and routine exercise (P<0.05 for all) but intensities of Tai Chi for improvement of such parameters was higher than routine exercise. Incidence of falls was decreased by both physical therapies (P<0.05 for all) but more for the TC group (P<0.0001, q=38.512). In the TC group, at the end of follow-up, 22 (9%) patients were successful in withdrawal of levodopa treatment. Also, the dose of levodopa was decreased in patients of the TC group who had to continue levodopa. Tai Chi had the potential to slow down the progression of symptoms of Parkinson's disease and delayed the introduction of levodopa (level of evidence: III).
Association of Tuberculosis With Household Catastrophic Expenditure in South India.

Importance The high household costs associated with tuberculosis (TB) diagnosis and treatment can create barriers to access and adherence, highlighting the urgency of achieving the World Health Organization's End TB Strategy target that no TB-affected households should face catastrophic costs by 2020. Objective To estimate the occurrence of catastrophic costs associated with TB diagnosis and treatment and to identify socioeconomic indicators associated with catastrophic costs in a setting where TB control strategies have been implemented effectively. Design, Setting, and Participants In this cross-sectional study, 455 patients with TB in the Chennai metropolitan area of South India who were treated under the TB control program between February 2017 and March 2018 were interviewed. Patients were interviewed by trained field investigators at 3 time points: at the initiation of treatment, at the end of the intensive phase of treatment, and at the end of the continuation phase of treatment. A precoded interview schedule was used to collect information on demographic, socioeconomic, and clinical characteristics and direct medical, direct nonmedical, and indirect costs. Data analysis was performed from August 2018 to November 2019. Main Outcomes and Measures Direct, indirect, and total costs to patients with TB. Catastrophic costs associated with TB were defined as costs exceeding 20% of the household's annual income. A binary response model was used to determine the factors that were significantly associated with catastrophic costs. Results Of 455 patients with TB interviewed, 205 (53%) were aged 19 to 45 years (mean [SD] age, 38.4 [16.0] years), 128 (33%) were female, 72 (19%) were illiterate, 126 (33%) were employed, and 186 (48%) had a single earning member in the family (percentages are based on the 384 patients who were interviewed through the end of the continuation phase of treatment). Sixty-one percent of patients (234 patients) had pulmonary smear positive TB. The proportion of patients with catastrophic costs was 31%. Indirect costs contributed more toward catastrophic cost than did direct costs. Multivariate logistic regression analysis found that unemployment (adjusted odds ratio, 0.2; 95% CI, 0.1-0.5; P < .001) and higher annual household income (Rs 1-200 000, adjusted odds ratio, 0.4; 95% CI, 0.2-0.7; P = .004; Rs >200 000, adjusted odds ratio, 0.2; 95% CI, 0.1-0.5; P < .001) were associated with a decreased likelihood of experiencing catastrophic costs. Conclusions and Relevance Despite the implementation of free diagnostic and treatment services under a national TB control program, TB-affected households had a high risk of catastrophic costs and further impoverishment. There is an urgent demand to provide additional financial protection for patients with TB.
The idealization of dying at home : the social context of home-based palliative caregiving

THE IDEALIZATION OF DYING AT HOME: THE SOCIAL CONTEXT OF HOME-BASED PALLIATIVE CAREGIVING The impetus to provide home-based palliative care is growing in an effort to curtail health care costs and to provide a more therapeutic milieu for dying and death to occur. Despite an expanding body of research focusing on the provision of palliative care at home, there has been little attention given to the historical, social, economic, political, and ideological structures and processes that play a role in shaping family caregivers' experiences with providing home-based palliative care. This ethnographic study approached this problem by examining the social context of home-based palliative caregiving, with the overall purpose of uncovering how larger structures and processes influence family caregiver experiences with providing home-based palliative care. The investigator conducted 130 hours of field work in the homes of 13 palliative caregivers (and 12 patients), and interviewed 13 active caregivers, 47 previous caregivers, 28 health care providers, nine health care administrators, and one publicly known lobbyist for the assisted suicide movement. Through this research, home-based palliative caregiving was revealed as more complicated than typically represented. Under ideal conditions, home-based palliative caregiving would result in life-enriching experiences, marked by negotiated decision making, careful consideration of caregivers' needs, respectful interactions with health care providers, and equitable access to health care. However, a number of factors stemming from idealized assumptions about dying at home and the contexts of health care provision resulted in some caregivers feeling "pressured" to provide home care, and consequently, left some of them feeling that their obligations to care were exploited by the health care system. Recent shifts toward moving the provision of health care closer to home not only changed some of the caregivers in profound ways but also transformed the home setting into one that was infused with the influences of biomedicine. Long-standing philosophical divisions between mainstream medical practice and the ideals upheld by palliative care have inhibited the development of coordinated and consistent systems of palliative care that could ultimately benefit both patients at the end-of-life and their caregivers. The findings of this study demonstrate a need to re-think the ways in which home care for the dying is conceptualized, pointing to a need to foster critical consciousness in order to explore how taken-for-granted assumptions influence and sometimes dominate the provision of health care at home. Such awareness will ultimately pave the way toward a health care system and society that genuinely respects and honours the obligations, choices, and needs of family members who provide palliative care at home.
Biodegradable magnesium alloy (WE43) in bone‐fixation plate and screw

Abstract The purpose of the present study was to evaluate the mechanical strength and the absorption rate of WE43 material and to develop an absorbable metallic plate and screw for craniofacial application. The extruded WE43 plate and screw were evaluated using a LeFort I osteotomy canine model of 10 beagle dogs. Animals were divided into two groups: five dogs in the experimental group and five dogs in the control group. μCT was acquired at 4, 12, and 24 weeks. At 24 weeks after the operation, all animals were sacrificed, and histologic evaluation was performed. Swelling and gas formation were observed in three dogs in the experimental groups at 8 weeks. From 12 weeks, infraorbital fistula and inflammation were observed in three dogs in the experimental group, which gradually decreased and disappeared at 24 weeks. Other two dogs showed less gas formation at 12 weeks. The plates were completely absorbed, and gas formation was not observed at 24 weeks in these two dogs. New bone was well formed around the plates and screws in both groups. Histologic examination showed no specific differences between two groups. The mechanical strength of extruded WE43 was sufficient for mid‐facial application. Plates and screws made with appropriately treated WE43 have the potential to be useful clinically.
The Countervailing Effects of Weight Stigma on Weight-Loss Motivation and Perceived Capacity for Weight Control

We hypothesized that exposure to weight stigma simultaneously increases motivation to lose or avoid gaining weight to avoid future stigma and decreases perceived capacity to do so, by heightening concerns about experiencing stigma and negative affect. Study 1 showed that more frequently experiencing weight-based discrimination was associated with greater concerns about being a victim of weight stigma, which predicted increased motivation to lose weight but decreased perceived capacity for weight control. Study 2 showed that participants randomly assigned to view a weight-stigmatizing (vs. control) message showed increased concerns about being a target of weight stigma, which indirectly increased motivation to lose weight and decreased state self-control. These, in turn, predicted increased willingness to engage in unhealthy weight-loss behaviors and decreased perceived capacity for weight control, respectively. Study 3 showed that increased motivation to avoid stigma and increased negative affect mediate these effects of exposure to weight stigma.
Cost savings to hospital of rituximab use in severe autoimmune acquired thrombotic thrombocytopenic purpura.

Patients with severe autoimmune thrombotic thrombocytopenic purpura (TTP) experience acute hematologic emergencies during disease flares and a lifelong threat for relapse. Rituximab, in addition to steroids and therapeutic plasma exchange (TPE), has been shown to mitigate relapse risk. A barrier to care in initiating rituximab in the inpatient setting has been the presumed excessive cost of medication to the hospital. Retrospectively reviewing TTP admissions from 2004 to 2018 at our academic center, we calculated the actual inpatient cost of care. We then calculated the theoretical cost to the hospital of initiating rituximab in the inpatient setting for both initial TTP and relapse TTP cohorts, with the hypothesis that preventing sufficient future TTP admissions offsets the cost of initiating rituximab in all patients with TTP. At a median follow-up of 55 months in the initial TTP cohort, rituximab use produced a projected cost savings of $905 906 and would have prevented 185 inpatient admission days and saved 137 TPE procedures. In the relapse TTP setting, rituximab use produced a projected cost savings of $425 736 and would have prevented 86 inpatient admission days and saved 64 TPE procedures. From a hospital cost standpoint, cost of rituximab should no longer be a barrier to initiating inpatient rituximab in both initial and relapse TTP settings.
The Clinical Impact of Flow Titration on Epoprostenol Delivery via High Flow Nasal Cannula for ICU Patients with Pulmonary Hypertension or Right Ventricular Dysfunction: A Retrospective Cohort Comparison Study

(1) Background: inhaled epoprostenol (iEPO) delivered via high-flow nasal cannula (HFNC) has been reported to be effective for pulmonary hypertension and right ventricular dysfunction. In vitro studies have identified HFNC gas flow as a key factor in trans-nasal aerosol delivery efficiency; however, little evidence is available on the clinical impact of flow titration on trans-nasal aerosol delivery. At our institution, iEPO via HFNC was initiated in 2015 and the concept of flow titration during iEPO via HFNC has been gradually accepted and carried out by clinicians in the recent years. (2) Methods: a retrospective review of the electronic medical records for all adult patients who received iEPO via HFNC in a tertiary teaching hospital. Pre- and post- iEPO responses were reported for patients whose HFNC flow was titrated or maintained constant during iEPO delivery. Positive response to iEPO was defined as the reduction of mean pulmonary arterial pressure (mPAP) > 10% for pulmonary hypertension patients or the improvement of oxygenation [pulse oximetry (SpO2)/fraction of inhaled oxygen (FIO2)] > 20%. The number of responders to iEPO was compared between groups with titrated vs constant flow. (3) Results: 51 patients who used iEPO to treat pulmonary hypertension and/or right ventricular dysfunction were reviewed. Following iEPO administration via HFNC, mPAP decreased (43.6 ± 11.7 vs. 36.3 ± 9.7 mmHg, p < 0.001). Among the 51 patients, 24 had concomitant refractory hypoxemia, their oxygenation (SpO2/FIO2) improved after iEPO delivery (127.8 ± 45.7 vs. 157.6 ± 62.2, p < 0.001). During iEPO initiation, gas flow was titrated in 25 patients and the remaining 26 patients used constant flow. The percentage of patients in the flow titration group who met the criteria for a positive response was higher compared to the group with constant flow (85.7% vs. 50%, p = 0.035). Pre- vs post-iEPO responses were significant in the flow titration group included improvement in cardiac output (p = 0.050), cardiac index (p = 0.021) and FIO2 reduction (p = 0.016). These improvements in hemodynamics and FIO2 were not observed in the constant flow group. (4) Conclusion: in patients with pulmonary hypertension and/or right ventricular dysfunction, trans-nasal iEPO decreased pulmonary arterial pressure. It also improved oxygenation in patients with combined refractory hypoxemia. These improvements were more evident in patients whose gas flow was titrated during iEPO initiation than those patients using constant flow.
ITTREAT (Integrated Community Test ‐ Stage ‐ TREAT) Hepatitis C service for people who use drugs: Real‐world outcomes

Direct‐acting antivirals (DAAs) provide an unprecedented opportunity for a “find‐and‐treat strategy. ” We aimed to report real‐world clinical, patient reported and health economic outcomes of community‐based hepatitis C virus (HCV) screening/treatment in people who use drugs (PWUDs).
Infection of Hexametra angusticaecoides Chabaud & Brygoo, 1960 (Nematoda: Ascarididae) in a population of captive crested geckoes, Correlophus ciliatus Guichenot (Reptilia: Diplodactylidae)

Abstract Here we report on the infection of captive crested geckos Correlophus ciliatus Guichenot (Reptilia: Diplodactylidae), with adults of the ascaridoid nematode, Hexametra angusticaecoides Chabaud & Brygoo, 1960 (Ascarididae). A population of captive crested geckoes became ill and died within a short period of time. Nematodes were recovered from the crested geckoes examined from within the coelomic cavity, penetrating various organs and migrating through subcutaneous tissues, as well as emerging through the geckos' skin. One gecko was treated with levamisole following surgical excision of nematodes from under the skin; this gecko survived. The potential source of the nematode infection in the captive geckoes is discussed. It is most likely that wild-caught Madagascan mossy geckoes, Uroplatus sikorae Boettger (Reptilia: Gekkonidae), introduced the infection to the colony. Molecular sequences of the nematodes are the first produced for the members of this genus. A redescription of the species and its genetic characterization based on the internal transcribed spacer sequence data is provided, suggesting some of the morphological criteria that have been used in the past to distinguish between Hexametra spp. may have been intraspecific morphological variations.
Prognostic value of epithelial‐mesenchymal transition‐inducing transcription factors in head and neck squamous cell carcinoma: A meta‐analysis

Epithelial‐mesenchymal transition (EMT) plays a critical role in cancer progression and is primarily regulated by several EMT‐inducing transcription factors (EMT‐TFs), including TWIST1, TWIST2, SNAI1, SNAI2, ZEB1, and ZEB2. However, the prognostic value of EMT‐TFs remains controversial in head and neck squamous cell carcinoma (HNSCC). Studies on the prognostic role of EMT‐TFs in HNSCC were searched for in the Web of Science, Science Direct, Proquest, EMBASE, PubMed, and Cochrane Library. Meta‐analysis was performed by using Revman 5.2 software. The pooled analysis showed that overexpression of EMT‐TFs indicated a poor overall survival (OS) (HR = 1.93, 95% CI = 1.67‐2.23) of HNSCC. Subgroup analysis for individual EMT‐TFs revealed that overexpression of TWIST1 (HR = 1.61, 95% CI = 1.29‐2.02), SNAI1 (HR = 2.17, 95% CI = 1.63‐2.88), SNAI2 (HR = 1.90, 95% CI = 1.38‐2.62), and ZEB1 (HR = 2.70, 95% CI = 1.61‐4.53) were significantly associated with poor OS of HNSCC. These findings support the hypothesis that overexpression of EMT‐TFs indicates a poor prognosis for HNSCC patients.
Sagittal spinopelvic alignment after spinal fusion in degenerative lumbar scoliosis: a meta-analysis

Abstract Objective: This meta-analysis aimed to investigate the changes in sagittal spinopelvic alignment in degenerative lumbar scoliosis (DLS) from the preoperative state to the last follow-up. Methods: The MEDLINE via PubMed, Cochrane, Scopus, and Embase databases were searched for studies published between January 2010 and January 2019 evaluating radiological parameters including the coronal Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) in DLS. Two authors performed data extraction independently. All discrepancies were resolved by consensus. Results: The 34 studies identified showed significant decreases in overall and subgroup Cobb angles from the preoperative state to the last follow-up. Both overall TK and LL were significantly increased from the preoperative state to the last follow-up. In subgroup analysis, LLs in the long fusion, combined approach, and posterior approach group were significantly increased at the final follow-up, but the LL increase in the short fusion group was not significant at the last follow-up. However, there was no significant change in SVA, PI, SS, and PT from the preoperative state to the last follow-up. Conclusions: A literature review identified 34 studies reporting preoperative and last follow-up data on spinal fusion in DLS. Despite heterogeneity, a limited meta-analysis showed significant improvement in the coronal Cobb angle, TK, and LL after spinal fusion in DLS. A large, randomized clinical trial would be necessary to validate our results.
In vitro models of the small intestine: engineering challenges, engineering solutions.

Pathologies affecting the small intestine contribute significantly to the disease burden of both the developing and the developed world, which has motivated investigation into the disease mechanisms through in vitro models. Although existing in vitro models recapitulate selected features of the intestine, various important aspects have often been isolated or omitted due to the anatomical and physiological complexity. The small intestine's intricate microanatomy, heterogeneous cell populations, steep oxygen gradients, microbiota, and intestinal wall contractions are often not included in in vitro experimental models of the small intestine, despite their importance in both intestinal biology and pathology. Known and unknown interdependencies between various physiological aspects necessitate more complex in vitro models. Microfluidic technology has made it possible to mimic the dynamic mechanical environment, signaling gradients, and other important aspects of small intestinal biology. This review presents an overview of the complexity of small intestinal anatomy and bioengineered models that recapitulate some of these physiological aspects.
MicroRNA 322 Aggravates Dexamethasone-Induced Muscle Atrophy by Targeting IGF1R and INSR

Dexamethasone (Dex) has been widely used as a potent anti-inflammatory, antishock, and immunosuppressive agent. However, high dose or long-term use of Dex is accompanied by side effects including skeletal muscle atrophy, whose underlying mechanisms remain incompletely understood. A number of microRNAs (miRNAs) have been shown to play key roles in skeletal muscle atrophy. Previous studies showed significantly increased miR-322 expression in Dex-treated C2C12 myotubes. In our study, the glucocorticoid receptor (GR) was required for Dex to increase miR-322 expression in C2C12 myotubes. miR-322 mimic or miR-322 inhibitor was used for regulating the expression of miR-322. Insulin-like growth factor 1 receptor (IGF1R) and insulin receptor (INSR) were identified as target genes of miR-322 using luciferase reporter assays and played key roles in Dex-induced muscle atrophy. miR-322 overexpression promoted atrophy in Dex-treated C2C12 myotubes and the gastrocnemius muscles of mice. Conversely, miR-322 inhibition showed the opposite effects. These data suggested that miR-322 contributes to Dex-induced muscle atrophy via targeting of IGF1R and INSR. Furthermore, miR-322 might be a potential target to counter Dex-induced muscle atrophy. miR-322 inhibition might also represent a therapeutic approach for Dex-induced muscle atrophy.
Differential decay of intact and defective proviral DNA in HIV-1-infected individuals on suppressive antiretroviral therapy.

BACKGROUND The relative stabilities of the intact and defective HIV genomes over time during effective antiretroviral therapy (ART) have not been fully characterized. METHODS We used the intact proviral DNA assay (IPDA) to estimate the rate of change of intact and defective proviruses in HIV-infected adults on ART over several years. We used linear spline models with a knot at seven years; these included a random intercept and slope up to the knot. We also estimated the influence of covariates on starting levels and rates of change. RESULTS We studied 81 individuals for a median of 7.3 (IQR 5.9-9.6) years. In a model allowing for a change in the rate of decline, we found evidence for a more rapid rate of decline in intact genomes from initial suppression through seven years (15.7% per year decline; CI -22.8%, -8.0%) followed by a slower rate of decline after seven years (3.6% per year; CI -8.1%, +1.1%). The estimated half-life of the reservoir was 4.0 years (CI 2.7-8.3) until year seven and 18.7 years (CI 8.2-infinite) thereafter. There was substantial variability between individuals in the rate of decline until year seven. Intact provirus declined at a faster rate than defective provirus (P < 0.001). Individuals with higher CD4+ T cell nadir values had a faster rate of decline in intact provirus. CONCLUSIONS These findings provide evidence that the biology of the replication-competent (intact) reservoir differs from that of the replication-incompetent (non-intact) pool of proviruses. The IPDA will likely be informative when investigating the impact of interventions targeting the reservoir. FUNDING This work was supported the Delaney AIDS Research Enterprise (DARE; AI096109, A127966). The SCOPE cohort receives additional support from the UCSF/Gladstone Institute of Virology & Immunology CFAR (P30 AI027763), the CFAR Network of Integrated Systems (R24 AI067039) and the amfAR Institute for HIV Cure Research (amfAR 109301). Additional support was provided by the I4C and Beat-HIV Collaboratories, the Howard Hughes Medical Institute, Gilead, and the Bill and Melinda Gates Foundation.