Miracle-dz/UniFAR-FTUs huggingface dataset:
Kawasaki Disease Presenting as Febrile Seizure: A Clinical Oddity.

FIGURE. Two-dimensional echocardiography. Parasternal short-axis view shows dilated left coronary artery ostium (10 mm; Z score >10) (arrow). A n 18-month-old boy presented with history of 1 episode of generalized tonic-clonic seizure and loss of consciousness lasting for 5 minutes, 2 hours prior to the presentation. He also had highgrade fever, up to 102°F for the past 2 days. At presentation, he was playful, active, and without any postictal drowsiness, meningeal signs, or focal deficit. Systemic examination was unremarkable. Investigation revealed normocytic, normochromic anemia (hemoglobin 8.7 g/dL), thrombocytosis (platelet count 684,000/μL), normal leukocyte count (6700/μL), and normal blood sugar and electrolytes. Even after 48 hours, high-grade fever persisted without any definite clinical focus, except faint erythematous macular rash on trunk and extremities. He had elevated erythrocyte sedimentation rate (55 mm in the first hour) and C-reactive protein (190 mg/dL). His serum procalcitonin, urine examination, blood culture, cerebrospinal fluid examination, and cranial imaging were normal.Workup for other etiologies of fever including malaria, rickettsia, and enteric fever were noncontributory. He was started on intravenous ceftriaxone. He continued to have fever on day 10 of the illness. Kawasaki disease (KD) was suspected in view of fever with rash and thrombocytosis and lasting more than 5 days and nonresponsiveness to intravenous antibiotics. His serum triglyceride level was high (284mg/dL) and 2-dimensional echocardiography showed dilated left coronary artery ostium with normal ejection fraction (Fig.). He was started on intravenous immunoglobulin (2 g/kg over 48 hours) along with oral aspirin. He became afebrile after 2 days of intravenous immunoglobulin. Neurological complications in KD are rare, and aseptic meningoencephalitis is the most commonly reported complication. However, febrile seizurewithout any evidence of meningoencephalitis as presenting symptom inKD is extremely rare. In a large series, neurological complications were found in only 6 (1.1%) of 540 cases. Of these 6 children, 4 had lower motor neuron facial palsy, and 2 had aseptic meningoencephalitis. Of 217 KD patients at Nishi-Kobe Medical Centre in Japan, studied between 1994 and 2004, only 1 child (0.46%) had febrile seizure. Three other clinical studies in Japan included 155, 540, and 177 children, and only 1 study found a single case of febrile seizure in a 5-year-old boy. Meta-analysis of all these studies estimated a very low incidence (0.18%) of febrile seizure in KD. This incidence is unexpectedly low, compared with incidence of febrile seizure in general population of children younger than 5 years. On the other hand, Yoshikawa and Abe found that 2 of 177 children with KD had seizures, but both of them had aseptic meningitis. Similar findings were demonstrated in another clinical study, which reviewed seizure characteristics of 7 children with KD. Five of 7 patients had seizure clustering, 4 had
Peroxisomal fission is modulated by the mitochondrial Rho‐GTPases, Miro1 and Miro2

Peroxisomes are essential for a number of cellular functions, including reactive oxygen species metabolism, fatty acid β‐oxidation and lipid synthesis. To ensure optimal functionality, peroxisomal size, shape and number must be dynamically maintained; however, many aspects of how this is regulated remain poorly characterised. Here, we show that the localisation of Miro1 and Miro2—outer mitochondrial membrane proteins essential for mitochondrial trafficking—to peroxisomes is not required for basal peroxisomal distribution and long‐range trafficking, but rather for the maintenance of peroxisomal size and morphology through peroxisomal fission. Mechanistically, this is achieved by Miro negatively regulating Drp1‐dependent fission, a function that is shared with the mitochondria. We further find that the peroxisomal localisation of Miro is regulated by its first GTPase domain and is mediated by an interaction through its transmembrane domain with the peroxisomal‐membrane protein chaperone, Pex19. Our work highlights a shared regulatory role of Miro in maintaining the morphology of both peroxisomes and mitochondria, supporting a crosstalk between peroxisomal and mitochondrial biology.
Lipoprotein(a) Reduction in Persons with Cardiovascular Disease.

BACKGROUND Lipoprotein(a) levels are genetically determined and, when elevated, are a risk factor for cardiovascular disease and aortic stenosis. There are no approved pharmacologic therapies to lower lipoprotein(a) levels. METHODS We conducted a randomized, double-blind, placebo-controlled, dose-ranging trial involving 286 patients with established cardiovascular disease and screening lipoprotein(a) levels of at least 60 mg per deciliter (150 nmol per liter). Patients received the hepatocyte-directed antisense oligonucleotide AKCEA-APO(a)-LRx, referred to here as APO(a)-LRx (20, 40, or 60 mg every 4 weeks; 20 mg every 2 weeks; or 20 mg every week), or saline placebo subcutaneously for 6 to 12 months. The lipoprotein(a) level was measured with an isoform-independent assay. The primary end point was the percent change in lipoprotein(a) level from baseline to month 6 of exposure (week 25 in the groups that received monthly doses and week 27 in the groups that received more frequent doses). RESULTS The median baseline lipoprotein(a) levels in the six groups ranged from 204.5 to 246.6 nmol per liter. Administration of APO(a)-LRx resulted in dose-dependent decreases in lipoprotein(a) levels, with mean percent decreases of 35% at a dose of 20 mg every 4 weeks, 56% at 40 mg every 4 weeks, 58% at 20 mg every 2 weeks, 72% at 60 mg every 4 weeks, and 80% at 20 mg every week, as compared with 6% with placebo (P values for the comparison with placebo ranged from 0.003 to <0.001). There were no significant differences between any APO(a)-LRx dose and placebo with respect to platelet counts, liver and renal measures, or influenza-like symptoms. The most common adverse events were injection-site reactions. CONCLUSIONS APO(a)-LRx reduced lipoprotein(a) levels in a dose-dependent manner in patients who had elevated lipoprotein(a) levels and established cardiovascular disease. (Funded by Akcea Therapeutics; ClinicalTrials.gov number, NCT03070782.).
The MitraClip Procedure in Patients With Moderate Resting but Severe Exercise-Induced Mitral Regurgitation.

BACKGROUND Optimal timing for percutaneous mitral regurgitation (MR) treatment using MitraClip (Abbott Vascular) remains unclear. We evaluated the outcome after MitraClip in patients with moderate resting MR, progressing to severe exercise- induced MR (MR2+) compared to patients with severe resting MR (MR3). METHODS We retrospectively investigated 221 patients undergoing MitraClip. All-cause deaths and heart failure (HF) hospitalizations were assessed as the combined primary endpoint. RESULTS We identified 55 MR2+ and 166 MR3 patients. At baseline, MR3 patients showed higher STS scores (6.7 ± 7.3 vs 4.4 ± 5.5; P<.01), more HF hospitalizations in the 2 years prior to the procedure (51% vs 29%; P<.01), worse left ventricular ejection fraction (44.9 ± 16.5% vs 52.5 ± 14.3%; P<.01), larger left ventricular end-diastolic diameter (LVEDd; 57.0 ± 9.3 mm vs 51.7 ± 8.2 mm; P<.001), and larger left atrial volumes (118.3 ± 55.8 mL vs 98.6 ± 35.2 mL; P=.02). Long-term outcome according to the combined endpoint was significantly worse in MR3 patients (P=.01). HF hospitalizations significantly declined in both groups 2 years after MitraClip (P<.001 in MR3 patients, P=.03 in MR2+ patients). Multivariate Cox regression analysis revealed LVEDd (hazard ratio, 1.035; 95% confidence interval, 1.005-1.066; P=.02) and previous HF hospitalizations (hazard ratio, 1.813; 95% confidence interval, 1.016-3.234; P=.04) as strong outcome predictors. CONCLUSIONS Symptomatic patients with moderate resting and severe exercise-induced MR during handgrip echocardiography may represent an MR cohort at an earlier disease stage with improved treatment response following MitraClip implantation compared to individuals with severe resting MR. Larger left ventricular diameters and preprocedural HF hospitalizations were identified as independent adverse outcome predictors.
eIF4E-related miR-320a and miR-340-5p inhibit endometrial carcinoma cell metastatic capability by preventing TGF-β1-induced epithelial-mesenchymal transition

Endometrial cancer (EC) is a common form of cancer in women. Metastasis is the main cause of EC treatment failure. Eukaryotic translation initiation factor 4E (eIF4E) is an oncogene that is overexpressed in a variety of malignancies and their distant metastases. The present study analyzed microarray data from the Oncomine database and revealed that high eIF4E expression was associated with poor prognosis and high pathological grade of EC. The expression of eIF4E was higher in EC tissues compared with in adjacent normal tissues. In addition, microRNA (miR)-320a and miR-340-5p expression levels were downregulated in EC tissues compared with those in adjacent normal tissues, which suggested that these microRNAs may serve as EC tumor suppressor genes. miR-320a and miR-340-5p could bind to the 3′-UTR of eIF4E mRNA, thus downregulating the expression of eIF4E and phosphorylated (p)-eIF4E in EC cells. Overexpression of miR-320a or miR-340-5p effectively suppressed HEC-1A cell migration and invasion. The downregulation of eIF4E and p-eIF4E following miR-320a or miR-340-5p transfection reduced the invasiveness and metastatic capability of EC cells in a manner associated with decreased expression of matrix metallopeptidase (MMP)-3 and MMP-9. In addition, one of the effects of transforming growth factor β1 (TGF-β1), which is to induce the phosphorylation of eIF4E, was suppressed by miR-320a and miR-340-5p overexpression. These two microRNAs also attenuated the features of TGF-β1-induced epithelial-mesenchymal transition (EMT). In conclusion, the results of the present study demonstrated that eIF4E was upregulated in EC, whereas miR-320a and miR-340-5p were downregulated in EC compared with adjacent normal tissues. In vitro, miR-320a and miR-340-5p inhibited the migratory capability of EC cells by downregulating MMP-3 and MMP-9 and prevented TGF-β1-induced EMT through p-eIF4E.
Neuromuscular Fatigue Induced by a Mixed Martial Art Training Protocol

Abstract Giboin, L-S and Gruber, M. Neuromuscular fatigue induced by a mixed martial art training protocol. J Strength Cond Res 36(2): 469–477, 2022—Mixed martial arts (MMA) is a full-contact sport whose popularity and professionalism are rapidly growing. However, the specific physiological demands of this sport have been only scarcely studied so far, and especially the amount or type of neuromuscular fatigue induced by an MMA bout remains completely unknown. We estimated neuromuscular fatigue of knee extensors muscles during and after an MMA training protocol designed to simulate the physiological demands of MMA competition in competitive practitioners (n = 9) with isometric maximal voluntary force (MVF), potentiated muscle twitch at rest (Ptw), and voluntary activation (VA). Bayesian linear mixed models showed that the training protocol induced a reduction of MVF, Ptw, and VA. Although the largest reduction across time of VA was smaller than the largest reduction of Ptw, an effect of VA, but not of Ptw, was found on MVF variation. The training protocol induced neuromuscular fatigue, with a larger peripheral (Ptw) than central component (VA). However, despite the large decrease in Ptw, force production capacity was related only to VA, indicating that central control might play an important role in the compensation of the peripheral fatigue components estimated with Ptw. This central compensation can most probably prevent a too large loss of muscle force during the training protocol.
Prognostic value of 18F-FDG-PET in patients with mantle cell lymphoma: results from the LyMa-PET Project

Mantle cell lymphoma (MCL) is an incurable aggressive non-Hodgkin lymphoma (NHL), which accounts for approximately 5% of all NHL. Novel agents and rituximab maintenance therapy (RM) have greatly improved patient outcomes,[1][1],[2][2] but most patients still experience recurrent relapses. This
Intramuscular innervation patterns of the splenius capitis and splenius cervicis and their clinical implications for botulinum toxin injections

The purpose of this study was to clearly characterize the intramuscular nerve distributions of the splenius capitis and splenius cervicis muscles that are both responsible for the onset of a chronic tension type headache and to use this information to identify the effective botulinum toxin (BoNT) injection sites.
Seasonal Variations and Global Wave Distributions in the Mars Thermosphere From MAVEN and Multisatellites Accelerometer‐Derived Mass Densities

Martian lower thermospheric variations are complex due to internal surface dust storms and external solar activities. However, limited Martian measurement data are restricted to observe and understand its variations in the past. In this paper, multisatellite accelerometer‐derived densities and the Mars Climate Database are used to investigate seasonal variations, gravity waves, and coupling effects with the internal and external inputs, including Mars Global Surveyor, Mars Reconnaissance Orbiter, Mars Odyssey, and Mars Atmosphere and Volatile EvolutioN Mission. The diurnal and seasonal structures are reconstructed by the data, and the phase of the cycles is formed by solar heating/ionizing processes. Both amplitude and phase are impacted by surface dust activities during autumn and winter, for which density increases about 1.5–3.5 times compared to spring and summer seasons. A parameterized model that includes a newly introduced dust index is proposed to well fit and reinterpret the seasonal cycles. Furthermore, the coupling process between internal atmospheric gravity waves (IAGWs) and dust activities are investigated and explained. During dust storm times/seasons, the IAGWs exhibit both narrower amplitude peaks and deposit their energy at higher altitudes relative to “clear sky” times. The IAGWs could extend their energies into higher layers beyond exobase due to a thermospheric layer expansion(i.e., density increase) during dust seasons.
PAX-MAC: A Low Latency Anycast Protocol with Advanced Preamble †

Wireless sensor networks employ duty-cycles to save energy, with the cost of enlargement of end-to-end latency. Cross-layer protocols that use anycast medium access control achieve latency reduction in asynchronous duty-cycled wireless sensor networks (WSNs). A series of strobed preambles is sent in order to achieve rendezvous with the next relay, selected from a forwarding candidate set (FCS). This paper proposes PAX-MAC: Pramble Ahead Cross-layer Medium Access Control. It is a novel anycast protocol for low latency packet propagation in duty-cycled WSNs. In PAX-MAC, preambles propagate ahead of data packet, prospecting the route towards sink node, while the message is sent some hops later. Simultaneous propagation of preambles and data packets provides latency reduction. The cardinality of FCS determines the average preamble propagation speed, which is lower bounded by data packet propagation speed. Differently from other approaches, our protocol takes the data packet size into account in order to maintain an optimal distance between preamble and data to minimize latency. For determining this distance, a detailed mathematical model is introduced. The performance of several state-of-the-art asynchronous protocols was appraised and compared with PAX-MAC. Our protocol outperforms in latency all other protocols for the simulated scenarios. Its energy expenditure was compatible with the best result among the other protocols. In the worst case, PAX-MAC spent 6% more energy than the best one for a gain of 20% in latency.
Feasibility of Linear-Shaped Gastroduodenostomy during the Performance of Totally Robotic Distal Gastrectomy

Purpose Although linear-shaped gastroduodenostomy (LSGD) was reported to be a feasible and reliable method of Billroth I anastomosis in patients undergoing totally laparoscopic distal gastrectomy (TLDG), the feasibility of LSGD for patients undergoing totally robotic distal gastrectomy (TRDG) has not been determined. This study compared the feasibility of LSGD in patients undergoing TRDG and TLDG. Materials and Methods: All c onsecutive patients who underwent LSGD after distal gastrectomy for gastric cancer between January 2009 and December 2017 were analyzed retrospectively. Propensity score matching (PSM) analysis was performed to reduce the selection bias between TRDG and TLDG. Short-term outcomes, functional outcomes, learning curve, and risk factors for postoperative complications were analyzed. Results This analysis included 414 patients, of whom 275 underwent laparoscopy and 139 underwent robotic surgery. PSM analysis showed that operation time was significantly longer (163.5 vs. 132.1 minutes, P<0.001) and postoperative hospital stay significantly shorter (6.2 vs. 7.5 days, P<0.003) in patients who underwent TRDG than in patients who underwent TLDG. Operation time was the independent risk factor for LSGD after intracorporeal gastroduodenostomy. Cumulative sum analysis showed no definitive turning point in the TRDG learning curve. Long-term endoscopic findings revealed similar results in the two groups, but bile reflux at 5 years showed significantly better improvement in the TLDG group than in the TRDG group (P=0.016). Conclusions LSGD is feasible in TRDG, with short-term and long-term outcomes comparable to that in TLDG. LSGD may be a good option for intracorporeal Billroth I anastomosis in patients undergoing TRDG.
Nursing Students' Satisfaction with Their Clinical Placement

Introduction: Exposure to positive clinical learning experience influences the nursing students' knowledge, skills, attitudes, and interest in continuing the nursing profession. It is widely acknowledged that clinical placement evaluations while students are on placement is very useful for better understanding of what constitutes quality clinical education from the students’ perspective to provide better educational experiences. Aim: The aim of the study was to assess the nursing students’ satisfaction with their clinical placement experiences and the degree to which their experiences are regarded as positive. Methodology: A descriptive design was used for the purpose of the study at college of Nursing in the eastern region of Saudi Arabia. Students enrolled in clinical courses during 2010-2012 were included. Clinical placement evaluation form was used for data collection and students were asked to respond to three open ended questions asking them for the advantages and the disadvantages of each clinical placement and their suggestions for improvement. Results: The majority of the students (75.6%) agreed or strongly agreed with statements rating their satisfaction with the clinical placement. However, students were dissatisfied with short clinical exposures, staff nurses role and evaluation process from the clinical instructors.
Soil Respiration Dynamics in Bromus erectus-Dominated Grasslands under Different Management Intensities

Reduction of soil greenhouse gas emissions is crucial to control increases in atmospheric CO2 concentrations. Permanent grasslands are of considerable importance in climate change mitigation strategies as they cover about 13% of the global agricultural area. However, uncertainties remain for the effects of management practices on soil respiration, especially over the short term. This study investigated the influence of different mowing intensities on soil respiration over the short term for Bromus erectus-dominated grasslands in the central Apennines. From 2016 to 2018, soil respiration, temperature, and moisture were measured under three different management systems: customary management, intensive use, and abandonment. Both soil water content and temperature changed over time, however mowing did not affect soil water content while occasionally altered soil temperature. The intensive use promoted higher seasonal mean soil respiration compared to the abandonment only during the 2016 growing season. Soil temperature was the main driver of soil respiration above a soil water content threshold that varied little among treatments (18.23–22.71%). Below the thresholds, soil moisture was the main driver of soil respiration. These data suggest that different mowing regimes have little influence on soil respiration over the short term in Bromus erectus-dominated grasslands. Thus, more intensive use would not have significative impacts on soil respiration, at least over the short term. Future studies need to clarify the role of root mycorrhizal and microbial respiration in the light of climate change, considering the seasonal redistribution of the rainfall.
Mycophenolate Mofetil Induced Remission in Steroid-Refractory Autoimmune Hemolytic Anemia

Meandros Med Dent J 2018;19:82-5 ORCID ID: orcid.org/0000-0002-0111-1672 Ad­dress­for­Cor­ res­pon­den­ce/Ya­zış­ma­Ad­re­si: Emine Özdemir MD, Pamukkale University Faculty of Medicine, Department of Child Health and Diseases, Division of Pediatrics, Denizli, Turkey Phone : +90 532 590 22 27 E-mail : dremineozdemir@hotmail.com Received/Geliş­Ta­rihi : 12.01. 2015 Accepted/Ka­bul­Ta­ri­ hi : 16.03. 2015 Anah­tar­Ke­li­me­ler Steroid, otoimmün hemolitik anemi, mikofenolat mofetil
OTOGENIC BRAIN ABSCESS: OUR EXPERIENCE

OBJECTIVE: To share our experience about otogenic brain abscess and to provide information about diagnosis and treatment of otogenic brain abscess (OBA). MATERIALS & METHODS: Eight patients with an average age of 20.62years (range of 8 to 51 years) were diagnosed with OBA. All patients had cholesteatoma except one. Six had cerebral and 2 had cerebellar abscess. All underwent medical & surgical treatment. No mortality was reported in our study with the mean follow up period of 11 months. CONCLUSION: OBA is a life threatening condition, which requires early diagnosis and aggressive treatment. Combined approach by ENT surgeon and neurosurgeon reduces morbidity and mortality to a great extent.
Simulating a Watershed-Scale Strategy to Mitigate Drought, Flooding, and Sediment Transport in Drylands

Drylands today are facing a landscape-scale water storage problem. Throughout the increasingly arid Southwest of the United States, vegetation loss in upland watersheds is leading to floods that scour soils and transport sediment that clogs downstream riparian areas and agricultural infrastructure. The resulting higher flow energies and diminished capacity to infiltrate flood flows are depleting soil water storage across the landscape, negatively impacting agriculture and ecosystems. Land and water managers face challenges to reverse the trends due to the complex interacting social and biogeophysical root causes. Presented here is an integrative system dynamics model that simulates innovative and transformative management scenarios. These scenarios include the natural and hydro-social processes and feedback dynamics critical for achieving long-term mitigation of droughts, flooding, and sediment transport. This model is a component of the Flood Flow Connectivity to the Landscape framework, which integrates spatial and hydrologic process models. Scenarios of support and collaboration for land management innovations are simulated to connect flood flow to the floodplains throughout the watershed to replenish soil storage and shallow groundwater aquifers across regional scales. The results reveal the management policy levers and trade-off balances critical for restoring management and water storage capacity to the system for long-term resilience.