Miracle-dz/UniFAR-FTUs huggingface dataset:
Risk factors of sepsis following pancreaticoduodenectomy based on inflammation markers and clinical characteristics.

BACKGROUND Sepsis is a common complication following pancreaticoduodenectomy (PD). The aim of this study was to evaluate the risk factors of sepsis based on serum inflammatory markers and clinical characteristics in patients who underwent PD. METHODS A total of 138 patients were enrolled in this study and all patients underwent curative PD. Logistic regression analysis was performed to identify risk factors for post-operative sepsis. The patients' basic clinical features and inflammatory biomarkers including cytokines (IL-1, IL-2, IL-6, IL-8, IL-10 and tumour necrosis factor-α), procalcitonin, C-reactive protein and peripheral neutrophil to lymphocyte ratio were analysed. RESULTS Of 138 patients, 31 developed sepsis during hospitalization. Univariate logistic regression analysis showed that body mass index, blood transfusion, operative time, American Society of Anesthesiologists score and diabetes were significant predictors of sepsis among all clinical characteristic variables. IL-2, IL-6, IL-10, procalcitonin and C-reactive protein were significant predictors among all inflammation biomarkers. By including different variables, three different regression models were obtained. The full model including all predictors mentioned above showed a C-index of 0.831 and blood transfusion showed no statistically significance in this model. The reduced model 1 including blood transfusion showed a C-index of 0.809. Another reduced model which included pre-operative and intra-operative variables showed a C-index of 0.814 and this model could be used for early sepsis risk estimation. CONCLUSION Pre-operative IL-6 was an independent risk factor for sepsis following PD. The three different predictive models could help early sepsis estimation for patients underwent PD.
Self Medication of Abortion Pill: Women’s Health in Jeopardy

Background: Federation of Obstetrics and Gynaecological Societies of India (FOGSI) recommends close monitoring of distribution of drugs that are used for medical abortion and that the medical profession and pharmaceutical industry should exercise due diligence in the promotion and usage of drugs that are used for medical abortion. Despite this, it has been perceived by the society that, medical abortions are extremely safe option even in hands of untrained personnel, leading to its over the counter dispensing and possibly increase in unsupervised terminations and life threatening complications. Objective: To study consequences of self medication of Abortion pill on women’s health Study Design: Retrospective Observational Study Duration of Study: One Year: August 2012 to July 2013 Material and Methods: After due permission from authority, data was collected from patients who had come for follow-up and treatment after self medication (purchased over the counter by self/family member without medical guidance/supervision) for Medical method of Medical Termination of Pregnancy (MTP). Results: Data was collected in 37 patients, who had history of self medication of abortion pill. More than half, 20 (54%) women were in age group of 20-29 years and married women were 35 (94.5%). Uneducated women were 12 (32.4%). Majority 33(89.1%) of women had complaint of bleeding per vaginum. On Ultrasonography (USG), 26(70.2%) women had incomplete abortion, 4 (10.8%) women had intrauterine gestational sac with cardiac activity, 2(5.4%) women had complete abortion and 1(2.7%) woman had missed abortion. Surgical curettage was performed in 28(75.6%) women. In 2(5.4%) women, there was complete abortion after oxytocin and misoprostol. One woman (2.7%) wanted to continue the pregnancy. Laparotomy was performed in 2 (5.4%) women having ectopic pregnancy and in 1(2.7%) woman who had perforation of uterus while undergoing surgical curettage at private hospital. Moderate and severe anaemia was found in 21(56.7%) and 5(13.5%) women respectively. Blood and blood products were required in 6(16.2 %) women. Septicemia was present in 3(8.1%) women and 2(5.4%) women were presented with shock on admission. Maternal death occurred in one (2.7) woman. Conclusion: Health care and health protection is every woman’s reproductive right. Every woman must be counseled regarding advantages, drawbacks, risks and limitations of different methods of abortion. Awareness on contraceptives is must for all. The chemist also needs to be aware about the MTP Act and consequence of medicines that are taken without medical supervision. The Government must stop the over the counter sell of drugs that are used for medical abortion and provision should be made to make these drugs available directly from hospital/ practitioner who are qualified under the MTP Act. Training on various regimes and advancement is also required for the medical practitioners.
The Relationship Between Corvis ST Tonometry Parameters and Ocular Response Analyzer Corneal Hysteresis

Precis: Corvis ST Tonometry and Ocular Response Analyzer (ORA) measurements were conducted in primary open-angle glaucoma and normative subjects. Many parameters were significantly correlated, however, the strengths were weak to moderate. Purpose: Reichert ORA parameters are derived from pressure information following the application of air-jet, whereas detailed structural observation can be made using the Corneal Visualization Scheimpflug Technology instrument (CST). The purpose of the study was to investigate the association between CST measurements and ORA measured corneal hysteresis (CH). Methods: Measurements of CST, ORA, axial length, average corneal curvature, central corneal thickness (CCT) and intraocular pressure with Goldmann applanation tonometry were carried out in 104 eyes of 104 patients with primary open-angle glaucoma and 35 eyes from normative subjects. The association between CST and ORA parameters was assessed using linear regression analysis, with model selection based on the second order bias corrected Akaike Information Criterion index. Results: Deformation amplitude ratio (corneal softness, R=−0.51), SP A1 (corneal stiffness, R=0.41), and Inverse Radius (integrated area under the curve of the inverse concave radius, R=−0.44) were significantly correlated with CH (P <0.05). The optimal model to explain CH using CST measurements was given by: CH=−76.3+4.6×A1 time (applanation time in the corneal inward movement)+1.9×A2 time (second applanation time in the corneal outward movement) + 3.1 × highest concavity deformation amplitude (magnitude of movement of the corneal apex from before deformation to its highest concavity) + 0.016×CCT (R2=0.67; P<0.001). Conclusions: CST parameters are significant, but weakly or moderately, related to ORA measured CH.
The authors reply.

302 www.pccmjournal. org March 2020 • Volume 21 • Number 3 The authors reply: We are grateful for the thoughtful letter to the editor from Shime and MacLaren (1) submitted in response to our recently published article (2) in Pediatric Critical Care Medicine. Shime and MacLaren (1) raised several important points. First, as Shime and and MacLaren (1) pointed out, perioperative prophylactic antibiotics are intended to reduce surgical site infection (SSI) rather than for bloodstream infection (BSI), pneumonia, or urinary tract infection. They argue that the composite outcome of SSI and BSI may not be appropriate. However, BSI is the most common infection that develops after pediatric cardiac surgery, which is associated with mortality along with SSI (3) and frequently coexists with SSI (4). In clinical practice, it is sometimes difficult to distinguish BSI with insidious SSI from one without SSI, without reopening the surgical site or without radiologic evidence. Thus, excluding BSI might lead to overlooking insidious SSI and misunderstanding the efficacy of prophylactic antibiotics. Therefore, we assessed the composite outcome comprising SSI and BSI. Second, we agree with Shime and MacLaren (1) that the liberal use of broad-spectrum antibiotics induces the emergence of resistant microorganisms, which also leads to morbidity and mortality in present and future patients. Therefore, further investigations are needed to elucidate whether the benefit of improving the composite outcome of SSI and BSI with broad-spectrum antibiotics outweighs the potential risk of inducing resistant microorganisms. In this regard, when SSI was chosen for an outcome in the reanalysis of our data, the broad-spectrum antibiotic regimen (meropenem plus vancomycin compared with cefazolin) failed to decrease SSI in multivariable analysis with adjustments for potential risk Nobuaki Shime, MD, PhD, Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Graeme MacLaren, MBBS, MSc, Cardiothoracic ICU, National University Hospital, Singapore, and Paediatric ICU, Royal Children’s Hospital, Melbourne, VIC, Australia
Maternal and Infant Outcomes Among Pregnant Women Treated for Multidrug/Rifampicin-Resistant Tuberculosis in South Africa

Abstract Background Data on safety and efficacy of second-line tuberculosis drugs in pregnant women and their infants are severely limited due to exclusion from clinical trials and expanded access programs. Methods Pregnant women starting treatment for multidrug/rifampicin-resistant (MDR/RR)-tuberculosis at King Dinuzulu Hospital in KwaZulu-Natal, South Africa, from 1 January 2013 to 31 December 2017, were included. We conducted a record review to describe maternal treatment and pregnancy outcomes, and a clinical assessment to describe infant outcomes. Results Of 108 pregnant women treated for MDR/RR-tuberculosis, 88 (81%) were living with human immunodeficiency virus. Favorable MDR/RR-tuberculosis treatment outcomes were reported in 72 (67%) women. Ninety-nine (91%) of the 109 babies were born alive, but overall, 52 (48%) women had unfavorable pregnancy outcomes. Fifty-eight (54%) women received bedaquiline, and 49 (45%) babies were exposed to bedaquiline in utero. Low birth weight was reported in more babies exposed to bedaquiline compared to babies not exposed (45% vs 26%; P = .034). In multivariate analyses, bedaquiline and levofloxacin, drugs often used in combination, were both independently associated with increased risk of low birth weight. Of the 86 children evaluated at 12 months, 72 (84%) had favorable outcomes; 88% of babies exposed to bedaquiline were thriving and developing normally compared to 82% of the babies not exposed. Conclusions MDR/RR-tuberculosis treatment outcomes among pregnant women were comparable to nonpregnant women. Although more babies exposed to bedaquiline were of low birth weight, over 80% had gained weight and were developing normally at 1 year.
Reasons For Seeking Orthodontic Treatment A Pilot Study

This pilot survey was conducted to determine the main reason and the motivating factors which, influence patients in seeking orthodontic treatment. 115 patients aged 11-30 years old were taken from the orthodontic waiting list at the Dental Faculty, University Malaya dated December 1999 - May 2000. A structured questionnaire was designed and the survey of patients was carried out using the telephone. The desire to have a better dental appearance was the main reason (65 %) given by patients who were seeking orthodontic treatment. The most important motivating factor that influences patients in seeking orthodontic treatment was to attain straight teeth (48 %). In conclusion, patients seek orthodontic treatment mainly due to psychological reason, which is to improve dental appearance and aesthetic. Perceived needs of an orthodontic patient should also be taken into consideration before commencing orthodontic treatment to increase chances of mutually satisfying result for both the orthoqontist and patient.
Job Resources and Burnout: Work Motivation as a Moderator.

This longitudinal study (T1 n = 399; T2 n = 279) investigated the moderating role of work motivation in the relationship between job resources (control and recognition) and burnout. Overall, job recognition and control resulted in more burnout for employees with poor-quality work motivation (high controlled or low autonomous motivation). These results suggest that poor-quality motivation renders employees more vulnerable to certain resources in their work environment, as these job characteristics stimulate compensatory behaviours (e.g., overinvesting in one's job to boost one's sense of self-worth or to obtain others' approval), leading to energy depletion over time. This article is protected by copyright. All rights reserved.
Melanotic neuroectodermal tumour of infancy - a case report of a rapidly enlarging maxillary mass.

Introduction : The melanotic neuroectodermal tumor of infancy (MNTI) is a rare benign neoplasm that primarily affects the maxilla of infants during their first year of life. It is a rapidly growing lesion, clinically aggressive and surgery is the mainstay of treatment with proven efficacy. Case Presentation : A case of maxillary MNTI in a 5-month-old male infant treated by radical surgery is reported here. Both extraoral and intraoral findings showed a massive swelling with multiple ulcerations of the overlying mucoas. Radiographs showed an ill defined mixed radiolucent radiopaque lesion. Histopathological examination showed biphasic microscopical presentation consisting of aggregates of small neuroblastic cells surrounded by the larger pigmented cells. Conclusions : MNTI is a rare, rapidly progressive pigmented lesion that commonly affects the anterior maxilla. Other differentials should be carefully considered in arriving at a diagnosis. Wide surgical excision with margin of normal tissue is the mainstay of treatment.
PPE51 Is Involved in the Uptake of Disaccharides by Mycobacterium tuberculosis

We have recently found that selected thio-disaccharides possess bactericidal effects against Mycobacterium tuberculosis but not against Escherichia coli or Staphylococcus aureus. Here, we selected spontaneous mutants displaying resistance against the investigated thio-glycoside. According to next-generation sequencing, four of six analyzed mutants which were resistant to high concentrations of the tested chemical carried nonsynonymous mutations in the gene encoding the PPE51 protein. The complementation of these mutants with an intact ppe51 gene returned their sensitivity to the wild-type level. The uptake of tritiated thio-glycoside was significantly more abundant in wild-type Mycobacterium tuberculosis compared to the strain carrying the mutated ppe51 gene. The ppe51 mutations or CRISPR-Cas9-mediated downregulation of PPE51 expression affected the growth of mutant strains on minimal media supplemented with disaccharides (maltose or lactose) but not with glycerol or glucose as the sole carbon and energy source. Taking the above into account, we postulate that PPE51 participates in the uptake of disaccharides by tubercle bacilli.
Ocular Phenotype of Relaxin Gene Knockout (Rln-/-) Mice

ABSTRACT Purpose: To test if relaxin deficiency affects ocular structure and function we investigated expression of relaxin (Rln) and RXFP receptors (Rxfp1, Rxfp2), and compared ocular phenotypes in relaxin gene knockout (Rln−/−) and wild type (Rln+/+) mice. Materials and Methods: Rln, Rxfp1 and Rxfp2 mRNA expression was detected in ocular tissues of Rln+/+ mice using RT-PCR. The eyes of 11 Rln−/− and 5 Rln+/+ male mice were investigated. Corneal and retinal thickness was assessed using optical coherence tomography. Intraocular pressure was measured using a rebound tonometer. Retinal, choroidal and sclera morphology and thickness were evaluated histologically. Eyes were collected and fixed for immunofluorescence staining or used for RNA extraction to evaluate mRNA expression using real-time PCR. Results: Rln mRNA was expressed only in the retina, whereas Rxfp1 transcripts were detected in the retina, cornea and sclera/choroid. Rxfp2 was only present in the cornea. None of these genes were expressed in the lacrimal gland, eyelid or lens. Intraocular pressure was higher and central cornea of Rln−/− mice was significantly thicker and had significantly larger endothelial cells and a lower endothelial cell density than Rln+/+ mice. Immunohistochemistry demonstrated no significant difference in AQP3 and AQP5 staining in the cornea or other regions between wildtype and Rln−/− mice. mRNA expression of Aqp4 was significantly higher in Rln−/− than in Rln+/+ corneas, whereas Col1a2, Mmp9, Timp1 and Timp2 were significantly decreased. Expression of Aqp1, Aqp4, Aqp5, Vim and Tjp1 was significantly decreased in Rln−/− compared to Rln+/+ uvea. No significant differences in these genes were detected in the retina. Retinal, choroidal and scleral thicknesses were not different and morphology appeared normal. Conclusion: The findings indicate that loss of Rln affects expression of several genes in the uvea and cornea and results in thicker corneas with altered endothelial cells. Many of the gene changes suggest alterations in extracellular matrix and fluid transport between cells.
Dysregulated TFR and TFH cells correlate with B‐cell differentiation and antibody production in autoimmune hepatitis

Follicular helper T (TFH) cell provides germinal centre (GC) B cell with critical signals for autoantibody production in the immunopathogenesis and progression of autoimmune hepatitis (AIH). However, the immunoregulatory functions of follicular regulatory T (TFR) cell in AIH are still unclear. The numbers of circulating TFR/TFH cells were measured in AIH patients. Moreover, we established experimental autoimmune hepatitis (EAH) model to examine the function of TFR cells on B‐cell differentiation and autoantibody production in vivo and vitro. AIH patients had significantly increased numbers of TFH cells and decreased numbers of TFR cells as well as imbalanced TFR/TFH‐type cytokines (IL‐10, TGF‐β1 and IL‐21) compared with healthy controls (HCs). In addition, TFR cell numbers negatively correlated with TFH cell numbers. Also, serum hypergammaglobulinaemia (IgG and IgM) concentration negatively correlated the levels of serum IL‐21, but positively correlated with the levels of serum IL‐10 in AIH patients. Furthermore, in comparison with control group, significantly higher frequencies of spleen TFR cells but lower frequencies of spleen TFH cells were detected in the EAH group. Further analysis found that TFR cells simultaneously express the phenotypic characteristics of Treg and TFH cells, but exercise as negative regulators of autoantibody production in vitro culture. Our findings demonstrated that dysregulated between TFR and TFH cells might cause excessive production of autoantibodies and destruction of the immune homeostasis, leading to the immunopathological process in AIH.
Developing an FHIR-Based Computational Pipeline for Automatic Population of Case Report Forms for Colorectal Cancer Clinical Trials Using Electronic Health Records

PURPOSE The Fast Healthcare Interoperability Resources (FHIR) is emerging as a next-generation standards framework developed by HL7 for exchanging electronic health care data. The modeling capability of FHIR in standardizing cancer data has been gaining increasing attention by the cancer research informatics community. However, few studies have been conducted to examine the capability of FHIR in electronic data capture (EDC) applications for effective cancer clinical trials. The objective of this study was to design, develop, and evaluate an FHIR-based method that enables the automation of the case report forms (CRFs) population for cancer clinical trials using real-world electronic health records (EHRs). MATERIALS AND METHODS We developed an FHIR-based computational pipeline of EDC with a case study for modeling colorectal cancer trials. We first leveraged an existing FHIR-based cancer profile to represent EHR data of patients with colorectal cancer, and then we used the FHIR Questionnaire and QuestionnaireResponse resources to represent the CRFs and their data population. To test the accuracy of and overall quality of the computational pipeline, we used synoptic reports of 287 Mayo Clinic patients with colorectal cancer from 2013 to 2019 with standard measures of precision, recall, and F1 score. RESULTS Using the computational pipeline, a total of 1,037 synoptic reports were successfully converted as the instances of the FHIR-based cancer profile. The average accuracy for converting all data elements (excluding tumor perforation) of the cancer profile was 0.99, using 200 randomly selected records. The average F1 score for populating nine questions of the CRFs in a real-world colorectal cancer trial was 0.95, using 100 randomly selected records. CONCLUSION We demonstrated that it is feasible to populate CRFs with EHR data in an automated manner with satisfactory performance. The outcome of the study provides helpful insight into future directions in implementing FHIR-based EDC applications for modern cancer clinical trials.
Woodlands and woody debris: Understanding structure and composition to inform restoration

Simplification of stand structure of forests and woodlands through human-induced modification is a serious threat to biodiversity. Restoring lost habitat complexity and heterogeneity, such as woody debris, requires an understanding of the relationships between different elements that contribute to stand structure. In this study, we examine the structure and composition of a critically endangered box-gum grassy woodland in south-eastern Australia and relationships with woody debris loads. We found that: (1) despite modification by humans and differing susceptibility to dieback, the two dominant tree species, Blakeley’s red gum, Eucalyptus blakelyi and yellow box, E. melliodora, occurred in similar proportions irrespective of vegetation density; (2) E. blakelyi had the largest number of stems and basal area, but while E. melliodora had fewer stems, it had a similar basal area to E. blakelyi. E. melliodora also showed fewer signs of dieback than E. blakelyi with between 40–50% trees in good condition compared to 2% for the latter species; (3) woody debris loads were low compared to other studies in woodland, but there were levels of heterogeneity indicating ‘natural’ accumulation was occurring; (4) tree basal area and woody debris loads had a 1:1 relationship across all sites and vegetation densities. Overall, our study indicated that ecosystem recovery was taking place (i.e. with many young trees), but there were fewer large trees that are known to supply most woody debris. Our findings highlight the slow accumulation of this critical resource because the volumes were lower than expected. Based on our results, we recommend: (1) aiming for approximately a 50:50 ratio of yellow box to Blakely's red gum basal area in woodland restoration projects; (2) to accelerate the recovery of woodland structure, addition of woody debris should be added at a minimum ratio of 1:1 to standing basal area (i.e. a basal area of 5.99 m2 requires a minimum volume of 3.11 m3) (3) managing for both volume and heterogeneity of woody debris loads; (4) preserving large diameter trees to harness proportionally higher woody debris and litter inputs.