Miracle-dz/UniFAR-FTUs huggingface dataset:
Blood pressure, blood pressure variability and the risk of poststroke dementia

Supplemental Digital Content is available in the text Objective: High blood pressure and blood pressure variability are potential, modifiable risk factors of poststroke dementia. We aimed to investigate the association between achieved blood pressure, blood pressure variability and poststroke dementia. Methods: We studied 17 064 patients with noncardioembolic ischemic stroke included in the Prevention Regimen for Effectively avoiding Second Strokes (PRoFESS) trial. We analysed the data as a single observational cohort. We studied mean achieved SBP and DBP and blood pressure variability defined as coefficient of variation (SD/mean∗100). The association between blood pressure and dementia was investigated with logistic regression analysis, correcting for sociodemographic factors and cardiovascular risk factors. Results: During 39 818 person-years of follow-up, 817 patients were diagnosed with dementia (2.1 per 100 person-years). We found a significant nonlinear association between mean SBP and the risk of dementia, implying a U-shaped association between mean SBP and dementia. Mean SBP of 120–129 mmHg was associated with a significantly higher risk of dementia than 130–139 mmHg [odds ratio (OR) 1.28; 95% confidence interval (95% CI) 1.03–1.58]. There was no indication of a U-shaped association between mean DBP and dementia, and no significant association between mean DBP categories and dementia. Higher blood pressure variability was associated with an increased risk of dementia (OR 1.06 per point increase, 95% CI 1.02–1.04), independent of mean SBP. Conclusion: Among patients with a recent noncardioembolic ischemic stroke, there appears to be a U-shaped association between achieved SBP and dementia. High blood pressure variability is associated with an increased risk of poststroke dementia.
Treatment of completely displaced distal radial fractures with a straight plaster or manipulation under anaesthesia.

AIMS The management of completely displaced fractures of the distal radius in children remains controversial. This study evaluates the outcomes of surgical and non-surgical management of 'off-ended' fractures in children with at least two years of potential growth remaining. METHODS A total of 34 boys and 22 girls aged 0 to ten with a closed, completely displaced metaphyseal distal radial fracture presented between 1 November 2015 and 1 January 2020. After 2018, children aged ten or under were offered treatment in a straight plaster or manipulation under anaesthesia with Kirschner (K-)wire stabilization. Case notes and radiographs were reviewed to evaluate outcomes. In all, 16 underwent treatment in a straight cast and 40 had manipulation under anaesthesia, including 37 stabilized with K-wires. RESULTS Of the children treated in a straight cast, all were discharged with good range of mo (ROM). Five children were discharged at six to 12 weeks with no functional limitations at six-month follow-up. A total of 11 children were discharged between 12 and 50 weeks with a normal ROM and radiological evidence of remodelling. One child had a subsequent diaphyseal fracture proximal to the original injury four years after the initial fracture. Re-displacement with angulation greater than 10° occurred for 17 children who had manipulation under anaesthesia. Four had a visible cosmetic deformity at discharge and nine had restriction of movement, with four requiring physiotherapy. One child developed over- granulation at the pin site and one wire became buried, resulting in a difficult retrieval in clinic. No children had pin site infections. CONCLUSION Nonoperative management of completely displaced distal radial fractures in appropriately selected cases results in excellent outcomes without exposing the child to the risks of surgery. This study suggests that nonoperative management of these injuries is a viable and potentially underused strategy.
Characteristics and long-term mortality of patients with ST-elevation or non-ST-elevation myocardial infarction after orthopaedic surgery

Objective To investigate the clinical characteristics and long-term mortality of patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) after orthopaedic surgery. Methods This retrospective, single-centre study enrolled patients that underwent inpatient orthopaedic surgery from 2009 to 2017 in Beijing Jishuitan Hospital. The patients were screened for a cardiac troponin I elevation and fulfilled the Fourth Universal Definition of Myocardial Infarction within 30 days of surgery. Results A total of 180 patients that developed perioperative myocardial infarction (MI) were included in the study. Among them, 14 patients (7.8%) were classified as STEMI, and 166 (92.2%) had NSTEMI. Compared with those with NSTEMI, STEMI patients had significantly higher 30-day and long-term mortality rates (50.0% versus 5.4%; 71.4% versus 22.3%; respectively). Multivariate Cox regression model analysis among the entire cohort demonstrated that STEMI (hazard ratio [HR] 5.78, 95% confidence interval [CI] 2.50, 13.38) and prior MI (HR 2.35, 95% CI 1.02, 5.38) were the most significant independent predictors of long-term mortality. Conclusion Perioperative MI after orthopaedic surgery was associated with a high mortality rate. STEMI was independently associated with a significant increase in short- and long-term mortality.
Risk Factors of Fistula Following Primary Palatoplasty

Supplemental Digital Content is available in the text Background: Oronasal fistula (ONF) is a common complication following cleft palate surgery. This study aims to determine the prevalence of ONF and the factors that influence development of ONF following primary palatoplasty. Materials and Methods: There were 234 patients undergoing primary palatoplasty during 2012 to 2016 included in this cross-sectional study. Patient demographics, surgeon's experience, age at the time of primary palatoplasty, cleft type by Veau classification, cleft width, and operative technique were recorded. The prevalence of fistulae was the primary outcome. Association of age at the time of repair, cleft type, cleft associated with syndromes, cleft width, and surgeon's experience with fistula rate were secondary outcomes. Results: There were 234 consecutive patients (128 boys [54.7%] and 106 girls [45.3%]). The mean age at primary palatoplasty was 13 months. Oronasal fistulae occurred in 61 (26.07%) patients. There was a statistically significant association between postoperative oronasal fistulae and the following independent variables: Veau classification (adjusted odds ratio 2.1; 95% confidence interval [CI] = 1.45–3.1, P < 0.01), cleft associated with syndromes (adjusted odds ratio 4.76; 95% CI = 1.48–15.2, P < 0.01) and cleft width more than 11.5 mm (adjusted odds ratio 1.96; 95% CI = 1.00–3.85, P = 0.04). Conclusion: The overall number of fistulae was moderate in patients who had undergone primary palatoplasty in our center. Cleft severity as defined by the Veau classification, cleft width, and cleft associated with syndromes were predictive factors for development of postoperative fistulae.
Pneumocystis jirovecii Disease: Basis for the Revised EORTC/MSGERC Invasive Fungal Disease Definitions in Individuals Without Human Immunodeficiency Virus.

BACKGROUND Pneumocystis jirovecii pneumonia (PCP) causes substantive morbidity in immunocompromised patients. The EORTC/MSGERC convened an expert group to elaborate consensus definitions for Pneumocystis disease for the purpose of interventional clinical trials and epidemiological studies and evaluation of diagnostic tests. METHODS Definitions were based on the triad of host factors, clinical-radiologic features, and mycologic tests with categorization into probable and proven Pneumocystis disease, and to be applicable to immunocompromised adults and children without human immunodeficiency virus (HIV). Definitions were formulated and their criteria debated and adjusted after public consultation. The definitions were published within the 2019 update of the EORTC/MSGERC Consensus Definitions of Invasive Fungal Disease. Here we detail the scientific rationale behind the disease definitions. RESULTS The diagnosis of proven PCP is based on clinical and radiologic criteria plus demonstration of P. jirovecii by microscopy using conventional or immunofluorescence staining in tissue or respiratory tract specimens. Probable PCP is defined by the presence of appropriate host factors and clinical-radiologic criteria, plus amplification of P. jirovecii DNA by quantitative real-time polymerase chain reaction (PCR) in respiratory specimens and/or detection of β-d-glucan in serum provided that another invasive fungal disease and a false-positive result can be ruled out. Extrapulmonary Pneumocystis disease requires demonstration of the organism in affected tissue by microscopy and, preferably, PCR. CONCLUSIONS These updated definitions of Pneumocystis diseases should prove applicable in clinical, diagnostic, and epidemiologic research in a broad range of immunocompromised patients without HIV.
Hearing Outcomes After Surgical Manipulation of the Membranous Labyrinth During Superior Semicircular Canal Dehiscence Plugging or Posterior Semicircular Canal Occlusion

Objective: To analyze audiometric data after surgical manipulation of the membranous labyrinth during plugging of superior semicircular canal dehiscence (SSCD) or posterior semicircular canal occlusion (PSCO) for benign paroxysmal positional vertigo. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Patients undergoing plugging of SSCD or PSCO between 2009 and 2019. Main Outcome Measures: Pre- and postoperative audiometric data were collected per AAO-HNS guidelines. Hearing outcomes at initial and last follow-up were compared. Subanalyses were performed for surgical approach and age. Results: Eighty-seven total procedures in 76 patients including 43 middle cranial fossa for SSCD, 29 transmastoid SSCD, and 15 PSCO. Mean preoperative air-conduction–pure-tone averages was 21.1±14.9 dB compared with 26.1 ± 19.6 dB at initial follow-up and 24.4 ± 18.6 dB at last follow-up (p = 0.006). Mean preoperative bone-conduction–pure-tone average was 14.3 ± 11.9 dB compared with 18.3 ± 15.6 dB at initial follow-up and 18.5 ± 16.9 dB at last follow-up (p < 0.001). There were five cases of hearing loss >20 dB including one case of profound sensorineural hearing loss >55 dB. PSCO resulted in the most hearing loss at initial follow-up but largely resolves with time. Transmastoid approaches for SSCD resulted in more hearing loss compared with middle cranial fossa. Hearing outcomes were generally stable for SSCD approaches but showed improvement over time for PSCO. Age >50 was associated with greater hearing loss of 5.2 ± 11.1 dB compared with 1.3 ± 10.5 dB but did not reach statistical significance (p = 0.110). Conclusions: Surgical manipulation of the membranous labyrinth results in statistically significant hearing loss in a pooled analysis. Transient hearing loss is observed in PSCO and TM SSCD plugging was associated with postoperative hearing loss. There was a trend toward increased hearing loss in patients >50 years old.
Experimental Determination of the Transfer Function of a Differential Mobility Analyzer (DMA) in the nanometer size range

This paper describes the evaluation of the transfer function for the TSI-short differential mobility analyzer (DMA) in the nanometer particle size range. The TSI-short DMA is identical with the TSI-long DMA (Model 3071) but has shortened inner and outer electrodes and the insulator material Teflon was replaced by black Delrin. The DMA transfer function was determined by operating two identical DMAs in series. The DMA was investigated at a sheath to aerosol flow rate ratio of between 10 and 1. Usually for particles above 50nm the parameters of the assumed triangular transfer function, i.e. height and half-width, approach the ideal values, which depend only on the flow ratio. For particle size below 50 nm the height decreases from 0.9 at 50nm to 0.18 at 5 nm. The half-width increases from the ideal value 0.1 to about 0.17. The observed changes of the transfer function are due to diffusional effects resulting in losses mainly in the inlet and outlet and also broadening of the aerosol stream inside the DMA. The determined transfer functions were also compared with transfer functions calculated using a theoretical model. The agreement proved to be satisfactory. The half-widths and the transmission efficiencies of the conventional TSI-DMA (Model 3071), TSI-short with Teflon and also black Delrin insulator as a function of particle size are compared to demonstrate the improvements in performance.
The Long-term Fate of Asymptomatic Proximal Junctional Kyphosis Following Long Instrumented Fusion in Elderly Patients with Sagittal Imbalance

The long-term clinical and radiographic outcomes were compared between PJK and non-PJK groups. Even if PJK was asymptomatic at initial development, PJK progressed radiographically with time and eventually gave a negative impact on the clinical outcomes in long-term follow-up in surgically treated elderly patients with sagittal imbalance. Study Design. Retrospective study. Objective. The aim of this study was to investigate the long-term fate of asymptomatic PJK focusing on the elderly patients with sagittal imbalance by comparing the patients with and without PJK. Summary of Background Data. Most of previous studies demonstrated that PJK does not negatively affect the clinical outcome compared to that of the patients without PJK. The question “will the asymptomatic PJK remain asymptomatic even in long-term follow-up? ” has not been answered yet because the previous results were based on the short follow-up duration. Methods. Patients >60 years who underwent four or more level fusions to the sacrum for sagittal imbalance were followed up for >5 years. The radiographic and clinical outcomes were compared between PJK (n = 30) and non-PJK groups (n = 43). PJK was defined by proximal junctional angle (PJA) >10°. Only patients with >3 years of follow-up duration after PJK development were included in PJK group. The clinical outcome measures included visual analog scale (VAS) for the back and leg, Oswestry disability index (ODI), and Scoliosis Research Society (SRS)-22 scores. Results. The mean age was 69.2 years. Total follow-up duration was 92.4 months. Time between PJK development and the last follow-up was 67.4 months in PJK group. Although there were no differences between the two groups in terms of pelvic incidence-lumbar lordosis mismatch, pelvic tilt, or sacral vertical axis, PJA significantly increased from 6.5° postoperatively to 21.2° at the final follow-up in the PJK group. The clinical outcomes were worse (such as VAS for the back, ODI, and SRS-22 scores) in the PJK group than in non-PJK group, except for the satisfaction domain. Three (10%) of 30 patients underwent a revision surgery for PJK progression. Conclusion. Even if PJK was asymptomatic at initial development, it progressed radiographically with time and eventually gave a negative impact on the clinical outcomes in long-term follow-up. Level of Evidence: 3
Super-resolution mapping of cellular double-strand break resection complexes during homologous recombination

Significance DNA resection is an initial, decisive step in the homologous recombination repair pathway of DNA double-strand breaks (DSBs). However, the individual roles and cross-talk of key proteins in this process remain unclear. To resolve the spatiotemporal dynamics of this intricate process, we applied multicolor single-molecule localization microscopy along with robust analytical approaches. Our data reveal the dynamic actions and interactions of MRE11, BRCA1, and CtIP both as a multimer and individually; the recruitment and spatial exclusion of 53BP1; the role of BLM helicase alongside EXO1 and DNA2 nucleases; and the inhibitory mechanisms of MRE11 exo-/endonuclease inhibition. Together, our findings describe important aspects of DNA DSB repair and highlight key differences between repair of clustered damage and sporadic endogenous breaks. Homologous recombination (HR) is a major pathway for repair of DNA double-strand breaks (DSBs). The initial step that drives the HR process is resection of DNA at the DSB, during which a multitude of nucleases, mediators, and signaling proteins accumulates at the damage foci in a manner that remains elusive. Using single-molecule localization super-resolution (SR) imaging assays, we specifically visualize the spatiotemporal behavior of key mediator and nuclease proteins as they resect DNA at single-ended double-strand breaks (seDSBs) formed at collapsed replication forks. By characterizing these associations, we reveal the in vivo dynamics of resection complexes involved in generating the long single-stranded DNA (ssDNA) overhang prior to homology search. We show that 53BP1, a protein known to antagonize HR, is recruited to seDSB foci during early resection but is spatially separated from repair activities. Contemporaneously, CtBP-interacting protein (CtIP) and MRN (MRE11-RAD51-NBS1) associate with seDSBs, interacting with each other and BRCA1. The HR nucleases EXO1 and DNA2 are also recruited and colocalize with each other and with the repair helicase Bloom syndrome protein (BLM), demonstrating multiple simultaneous resection events. Quantification of replication protein A (RPA) accumulation and ssDNA generation shows that resection is completed 2 to 4 h after break induction. However, both BRCA1 and BLM persist later into HR, demonstrating potential roles in homology search and repair resolution. Furthermore, we show that initial recruitment of BRCA1 and removal of Ku are largely independent of MRE11 exonuclease activity but dependent on MRE11 endonuclease activity. Combined, our observations provide a detailed description of resection during HR repair.
Efficacy and safety of greater occipital nerve block for the treatment of cervicogenic headache: a systematic review

ABSTRACT Introduction Cervicogenic headache (CGH) is a secondary headache disorder caused by cervical spine or neck soft tissue lesions. Despite few available evidence-based pharmacological treatments are available, greater occipital nerve blocks (GONBs) are considered as therapeutic option. Area covered In June 2020, we conducted a systematic review on Pubmed and Scopus, to summarize effectiveness and safety of GONBs in treating CGH. We included 5 observational studies and 3 nonrandomized trials reporting clinical outcomes of 140 CGH patients after GONBs. Authors performed unilateral GONBs during interictal phase (five studies) or during pain, injecting local anesthetic (four studies) or both local anesthetic and steroid (three studies) at variable timepoints. In 5 studies mean pain reduction ranged from −8.2 (at 2 weeks after the first block) to −0.1 (at 1 month after the third block); one study documented 66.6% reduction of pain intensity and another study documented a significant median reduction of pain intensity at 3 months (decreased from 5.5 to 2.3) and not at 9 months. Three studies reported minor adverse events. Expert opinion Few available studies suggest that GONBs are effective and safe in treating CGH. GONB is a high tolerable, low cost and repeatable procedure. Larger and randomized studies are needed.
Cognitive reserve and Alzheimer's biological continuum: clues for prediction and prevention of dementia.

Cognitive reserve is originally an epidemiological concept that encompasses individual abilities to cope with changes. It is considered the result of a balance between processes of cellular damage and repair, and its description raised much interest in predicting and preventing cognitive decline in aging and Alzheimer's disease (AD). Here we discuss the concept of cognitive reserve in light of the recent definition of AD as a biological continuum and suggest that the protection of cognitive reserve may result from efficient synaptic plasticity mechanisms. Despite pathological changes of AD appearing very early during life, long before the onset of cognitive symptoms, different variables act together to keep repair mechanisms effective guaranteeing successful aging as long as environmental enrichment is maintained.
An investigation of the factors that influence functional improvement in stroke rehabilitation

Background/aim The purpose of this study was to determine effect of age, sex, affected extremity, disability severity, treatment type, cerebrovascular accident (CVA) etiology, number of treatment sessions, and CVA duration on the functional improvement of the stroke patients who participated in a physical medicine and rehabilitation program. Materials and methods The research sample consisted of 322 stroke patients. Clinical and demographic features including age, sex, affected extremity, disability severity, treatment type, CVA etiology, number of treatment sessions, and CVA duration were recorded. Functional status was evaluated retrospectively by using the functional independence measure (FIM) at admission and discharge. Results It was detected that discharge FIM score of the patients exhibited an increase of significance level (p < 0.05). It was found that age, number of treatment sessions, CVA duration and FIM admission score were determinative parameters in FIM gain level (p < 0.05) while sex, affected extremity, and CVA etiology were not effective in FIM gain level (p > 0.05). Conclusion Results show that functional improvement after rehabilitation was better in the younger ages, shorter CVA durations and moderate functional disturbances. The findings obtained may be useful for stroke rehabilitation triage.
Water-splitting photoelectrodes consisting of heterojunctions of carbon nitride with a p-type low bandgap double perovskite oxide

Quinary and senary non-stoichiometric double perovskites such as Ba2Ca0.66Nb1. 34−x Fe x O6−δ (BCNF) have been utilized for gas sensing, solid oxide fuel cells and thermochemical CO2 reduction. Herein, we examined their potential as narrow bandgap semiconductors for use in solar energy harvesting. A cobalt co-doped BCNF, Ba2Ca0.66Nb0. 68Fe0.33Co0. 33O6−δ (BCNFCo), exhibited an optical absorption edge at ∼800 nm, p-type conduction and a distinct photoresponse up to 640 nm while demonstrating high thermochemical stability. A nanocomposite of BCNFCo and g-C3N4 (CN) was prepared via a facile solvent-assisted exfoliation/blending approach using dichlorobenzene and glycerol at a moderate temperature. The exfoliation of g-C3N4 followed by wrapping on perovskite established an effective heterojunction between the materials for charge separation. The conjugated 2D sheets of CN enabled better charge migration resulting in increased photoelectrochemical performance. A blend composed of 40 wt% perovskites and CN performed optimally, whilst achieving a photocurrent density as high as 1.5 mA cm−2 for sunlight-driven water-splitting with a Faradaic efficiency as high as ∼88%.
Nylon 6 structure in solid state as studied by high‐resolution 13C‐NMR spectroscopy

High resolution 13C-NMR spectra of nylon 6 samples crystallized under various conditions and of a drawn sample were measured at room temperature by the cross polarization/magic angle spinning (CP/MAS) and pulse saturation transfer/magic angle spinning techniques. Additionally, 13C-NMR spectra of the drawn sample were measured at temperatures from 20 to 100°C by the CP/MAS technique and at 20 and 100°C by the low-power decoupling/magic angle spinning technique. The nylon 6 structure in the solid-state is discussed on the basis of these results. The solid-state 13C chemical shift data are used for reference in a study of conformation in solution.