Miracle-dz/UniFAR-FTUs huggingface dataset:
Early recurrence detected by 18F-FDG PET/CT in patients with resected pancreatic ductal adenocarcinoma

Abstract 18F-fluoro-2-deoxy-D-glucose positron emission tomography integrated with computed tomography (18F-FDG PET/CT) has been proved to be practical in detecting occult malignant lesions. However, the evidence of its utility in detecting early recurrence after resection of pancreatic ductal adenocarcinoma (PDAC) is lacking. Therefore, the primary aim of the present study is to evaluate the diagnostic value of 18F-FDG PET/CT in the early postoperative period after radical resection of PDAC. This retrospective study included 32 patients who had 18F-FDG PET/CT scan within 6 months after radical resection of PDAC between January 2010 and December 2018. In total, 10 positive PET results were found at surgical margins of remnant pancreas, 12 at locoregional lymph nodes, 5 at distant areas, with the corresponding mean maximum standard uptake value (SUVmax) of 5.8 ± 1.1, 5.9 ± 0.9, and 6.4 ± 0.7, respectively. The median follow-up time was 23.5 months (range: 8–75 months), and the median survival time was 39.5 months (95% confidence interval: 14.6–64.4 months) for the entire cohort. Patients with positive PET findings at either locoregional lymph nodes or distant areas obtained significantly poorer overall survival (OS) than those without increased FDG uptake at the corresponding areas (P = .003 and P < .001, respectively). Whereas comparisons of OS between patients with or without increased FDG uptake at the surgical margin of remnant pancreas presented no statistically difference (P = .742). The early application of 18F-FDG PET/CT after radical resection of PDAC could stratify the prognosis of patients well by detecting occult early recurrence at locoregional lymph nodes and distant areas efficiently.
Over 2 Decades of Transplanting Hepatitis C Virus–Positive Liver Allografts: Almost Full Circle With Encouraging Early Results

Concern about aggressive disease recurrence in the absence of effective antiviral therapy restricted the use of HCV positive allografts to patients listed as status 1. However it soon became clear that transplantation of HCV positive allografts into HCV positive recipients was associated with excellent short and long term outcomes , ] and the use of HCV positive liver allografts became routine.
Computed Tomographic Findings in COVID-19

Dear Editor, We read the publication on “Novel Coronavirus Pneumonia Outbreak in 2019: Computed Tomographic Findings in Two Cases” with great interest (1). Lin et al. (1) described “chest computed tomography findings of multiple regions of patchy consolidation and ground-glass opacities in both lungs” and mentioned that “these findings were characteristically located along the bronchial bundle or subpleural lungs. ” We would like to share ideas and observations from other countries where coronavirus disease 2019 (COVID-19) is also endemic. The computed tomography (CT) findings of COVID-19 are variable. In our setting, some patients have no initial abnormal lung findings and can be misdiagnosed with other common diseases. A recent publication showed that the detection rate of disease is 98% (2). Also, there are different clinical findings in different stages of the disease (3). Use of CT imaging might be useful for assessing the severity of COVID-19, but disease confirmation is still based on molecular diagnosis of the pathogen.
A Systematic Review of Drug-associated Bullous Pemphigoid

Bullous pemphigoid is an autoimmune subepithelial disease characterised by pruritus followed by urticarial plaques and finally bullae on the skin and mucosa. Drug-associated bullous pemphigoid (DABP) is a term used to describe instances of bullous pemphigoid demonstrating clinical, histological, or immunopathological features identical or similar to those of the idiopathic form of bullous pemphigoid, associated with the systemic ingestion, or topical application of particular drugs. In this study, we conducted a comprehensive search of the literature according to PRISMA guidelines and a total of 170 publications were included in the final qualitative analysis. In conclusion, 89 drugs were implicated in DABP. The strongest evidence for DABP is seen with gliptins, PD-1/PD-L1 inhibitors, loop diuretics, penicillin and derivatives. An appreciation of the medications associated with bullous pemphigoid enables clinicians to identify potential cases of DABP earlier and cease the offending medication.
Risks and Associations of Third- and Fourth-Degree Lacerations: An Urban Single Center Experience

Our study examined the incidence of and risk factors for obstetric anal sphincter injuries within a racially and ethnically diverse academic institution. Objective Obstetric anal sphincter injuries (OASIs) are severe tears involving the external and internal anal sphincters. We aimed to document the incidence of OASIs within a racially and ethnically diverse institution to elucidate which maternal, fetal, and parturition factors may be associated with OASIs in minority subgroups. Methods This was a retrospective unmatched case-control study of reproductive aged women who delivered between January 1, 2014, and December 31, 2017, at our institution. Data for maternal, fetal, and parturition factors were gathered through chart review. We also investigated the expertise level of the surgeon performing repairs and complications that developed in the postpartum period. Logistic regression analysis was used to compare women with third- and fourth-degree lacerations against the control group of women with first-degree, second-degree, or no lacerations. Results Of the 23,362 deliveries between January 1, 2014, and December 31, 2017, the incidence of OASIs was 1%. Of our patients, 38% self-identified as Hispanic, 32% as Black, 13% as White, and 3.5% as Asian. Risk for OASIs was significantly increased in nulliparity, Pitocin use, operative deliveries, episiotomy, and prolonged second stage of labor. Black race and obesity were protective for OASIs. There was no significant difference in complication rates based on type of repair nor the provider level of training. Conclusions The incidence of OASIs at our institution is similar to current published literature. Our study population is unique in its overrepresentation of minority groups, offering insight into potentially distinctive risk and protective factors associated with OASIs.
Biochemical and mesophyll diffusional limits to photosynthesis are determined by prey and root nutrient uptake in the carnivorous pitcher plant Nepenthes x ventrata.

BACKGROUND AND AIMS Carnivorous plants can enhance photosynthetic efficiency in response to prey nutrient uptake but the underlying mechanisms of increased photosynthesis are largely unknown. Here we investigated photosynthesis in the pitcher plant Nepenthes x ventrata in response to different prey-derived and root mineral nutrition to reveal photosynthetic constrains. METHODS Nutrient-stressed plants were irrigated with full inorganic solution or fed with four different insects: wasps, ants, beetles and flies. Full dissection of photosynthetic traits was achieved by means of gas exchange, chlorophyll fluorescence and immunodetection of photosynthesis-related proteins. Leaf biochemical and anatomical parameters together with mineral composition, N and C isotopic discrimination of leaves and insects were also analysed. KEY RESULTS Mesophyll diffusion was the major photosynthetic limitation for nutrient-stressed Nepenthes x ventrata, while biochemistry was the major photosynthetic constriction after nutrient application. The better nutrient status of insect-fed and root-fertilized treatments increased chlorophyll, pigment-protein complexes and Rubisco content. As a result, both photochemical and carboxylation potential were enhanced, increasing carbon assimilation. Different nutrient application affected growth development, and root-fertilized treatment invested more biomass in leaves instead of pitchers. CONCLUSIONS The study resolved a 35 year old hypothesis proposed by Givnish et al. (1984) that carnivorous plants increase photosynthetic assimilation via the investment of prey-derived nitrogen to photosynthetic apparatus. The equilibrium between biochemical and mesophyll limitations of photosynthesis is strongly affected by the nutrition treatment.
Real-Time Automatic Ejection Fraction and Foreshortening Detection Using Deep Learning

Volume and ejection fraction (EF) measurements of the left ventricle (LV) in 2-D echocardiography are associated with a high uncertainty not only due to interobserver variability of the manual measurement, but also due to ultrasound acquisition errors such as apical foreshortening. In this work, a real-time and fully automated EF measurement and foreshortening detection method is proposed. The method uses several deep learning components, such as view classification, cardiac cycle timing, segmentation and landmark extraction, to measure the amount of foreshortening, LV volume, and EF. A data set of 500 patients from an outpatient clinic was used to train the deep neural networks, while a separate data set of 100 patients from another clinic was used for evaluation, where LV volume and EF were measured by an expert using clinical protocols and software. A quantitative analysis using 3-D ultrasound showed that EF is considerably affected by apical foreshortening, and that the proposed method can detect and quantify the amount of apical foreshortening. The bias and standard deviation of the automatic EF measurements were −3.6 ± 8.1%, while the mean absolute difference was measured at 7.2% which are all within the interobserver variability and comparable with related studies. The proposed real-time pipeline allows for a continuous acquisition and measurement workflow without user interaction, and has the potential to significantly reduce the time spent on the analysis and measurement error due to foreshortening, while providing quantitative volume measurements in the everyday echo lab.
A Decade of Dementia Care Training: Learning Needs of Primary Care Clinicians.

INTRODUCTION Limited knowledge of dementia among health professionals is a well-documented barrier to optimal care. This study examined the self-perceived challenges with dementia care and learning needs among primary care clinicians and assessed whether these were associated with years of practice and perceived preparedness for dementia care. METHODS Participants were multi-disciplinary clinicians attending a 5-day team-based dementia education program and physicians attending a similar condensed continuing medical education workshop. Pre-education, they completed an online survey in which they rated (5-point scales): interest in learning about various dementia-related topics, perceived challenges with various dementia-related practice activities and preparedness for dementia care, provided additional dementia-related topics of interest, number of years in clinical practice, and discipline. RESULTS Thirteen hundred surveys were completed across both education programs. Mean ratings of preparedness for dementia care across all respondents reflected that they felt somewhat prepared for dementia care. Challenge ratings varied from low to very challenging and mean ratings reflected a high level of interest in learning more about all of the dementia-related topics; significant differences between disciplines in these ratings were identified. In most cases, perceived challenges and learning needs were not correlated with number of years in clinical practice, but in some cases lower ratings of preparedness for dementia care were associated with higher ratings of the challenges of dementia care. DISCUSSION Clinicians perceived that their formal education had not prepared them well for managing dementia and desired more knowledge in all topic areas, regardless of years in practice. Implications for education are discussed.
Animal agriculture exposures among Minnesota residents with zoonotic enteric infections, 2012–2016

Abstract Prospective, population-based surveillance to systematically ascertain exposures to food production animals or their environments among Minnesota residents with sporadic, domestically acquired, laboratory-confirmed enteric zoonotic pathogen infections was conducted from 2012 through 2016. Twenty-three percent (n = 1708) of the 7560 enteric disease cases in the study reported an animal agriculture exposure in their incubation period, including 60% (344/571) of Cryptosporidium parvum cases, 28% (934/3391) of Campylobacter cases, 22% (85/383) of Shiga toxin-producing Escherichia coli (STEC) O157 cases, 16% (83/521) of non-O157 STEC cases, 10% (253/2575) of non-typhoidal Salmonella enterica cases and 8% (9/119) of Yersinia enterocolitica cases. Living and/or working on a farm accounted for 61% of cases with an agricultural exposure, followed by visiting a private farm (29% of cases) and visiting a public animal agriculture venue (10% of cases). Cattle were the most common animal type in agricultural exposures, reported by 72% of cases. The estimated cumulative incidence of zoonotic enteric infections for people who live and/or work on farms with food production animals in Minnesota during 2012–2016 was 147 per 10 000 population, vs. 18.5 per 10 000 for other Minnesotans. The burden of enteric zoonoses among people with animal agriculture exposures appears to be far greater than previously appreciated.
The Challenge of Very Early Systemic Sclerosis: A Combination of Mild and Early Disease?

Objective. To address the hypothesis that very early patients with systemic sclerosis (SSc) are a heterogeneous group with mild or early disease, we analyzed the extent of heterogeneity in clinical, epidemiological, and immunological characteristics of these patients. Methods. We performed an analysis of very early SSc patients from the Zurich cohort, who fulfilled neither the 2013 American College of Rheumatology (ACR)/European League Against Rheumatism nor the 1980 ACR classification criteria, but had a clinical expert diagnosis of SSc with Raynaud phenomenon (RP) and additional features of SSc (puffy fingers, SSc-specific antibodies, SSc pattern on nailfold capillaroscopy, or any organ involvement characteristic for SSc). Disease duration was defined from first RP symptom. Results. One hundred and two patients fulfilled the inclusion criteria and were analyzed. Their clinical presentation was heterogeneous with the large majority presenting with RP, antinuclear antibodies, and nailfold capillaroscopy changes, but with varying presentations of other features such as SSc-specific antibodies and early signs of organ involvement. While 54.1% (52/96) of patients had a disease duration of < 5 years, as many as 29.1% (28/96) of patients had a disease duration of > 10 years, indicating long-standing mild disease. Patients with very early, potentially progressive disease did not differ from patients with long-standing mild disease in terms of their clinical features at first presentation. Conclusion. This study showed that patients with very early SSc are a mixture with mild or early disease. This needs to be considered in clinical practice for risk stratification and for the study design of patients considered as early SSc.
Traditional Chinese medicine Shenqi compound to improve lower extremity atherosclerosis of patients with type 2 diabetes by affecting blood glucose fluctuation

Abstract Background: Clinical and basic research supports that blood glucose fluctuation is an important predictor of diabetic vascular disease and an etiology of lower extremity atherosclerosis, which is an important pathological basis for lower extremity vascular diseases. Previous Chinese National Natural Science Foundation trials (No. 81503566) have reported that the traditional Chinese medicine Shenqi compound can reduce blood glucose fluctuation and low-grade inflammation, and protect blood vessels; however, there are no high-quality clinical evidences available to support the same. This multicenter randomized controlled trial aims to obtain more clinical evidence to confirm the efficacy and safety of Shenqi compound in type 2 diabetes with lower extremity atherosclerosis. Methods: A multicenter RCT will be implemented in this study for a 32-week study period (8 weeks for intervention and 24 weeks for follow-up). Participants will be recruited from the Teaching Hospital of Chengdu University of TCM, Mianyang Hospital of TCM, and Shuangliu Hospital of TCM. Sixty participants will be randomly divided into a treatment group (basic treatment combined with traditional Chinese medicine Shenqi Compound) or a control group (basic treatment combined with Chinese medicine placebo) with 30 participants in each group. Patients will be selected considering the following inclusion criteria: age between 35 and 65 years, and a positive diagnosis for type 2 diabetes with lower extremity atherosclerosis and TCM syndromes. Primary outcome indicator is an arterial color Doppler ultrasound. Secondary outcome indicators include: blood glucose fluctuation indicators (MBG, SDBG, LAGE), islet β-cell function evaluation indicators (Homa-IR, Homa-islet, SG, SCP), inflammation indicators (NLR, CRP, IL-6), blood lipids, and HbA1c. Safety index includes vital signs (T, P, R, BP), blood, urine, stool routine, liver and renal function, electrocardiogram, and adverse event records. The endpoint event is defined as the presence of gangrene in the lower limbs. Discussion: Explore the clinical effect of traditional Chinese medicine “Shenqi Compound” to reduce blood glucose fluctuation and use HOMA-IR, the area under the glucose curve, and the area under the C-peptide curve to evaluate the effect of protecting islet β cell function. Trial registration : Chinese clinical trial registry (ChiCTR-1900027693). Registered on November 23, 2019. http://www.chictr. org.cn
Sirolimus-based immunosuppression improves outcomes in liver transplantation recipients with hepatocellular carcinoma beyond the Hangzhou criteria.

Background The administration of calcineurin inhibitors (CNIs) posttransplant has been implicated as an independent risk factor for the recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT). The new immunosuppressive agent sirolimus (SRL) acts as a primary immunosuppressant or antitumor agent. In this study we investigated the effect of sirolimus-based immunosuppression compared to CNIs (non-SRL) on the outcomes of LT candidates with HCC. Methods We retrospectively analyzed 204 HCC patients who underwent LT in our hospital between January 2, 2014 and December 10, 2017. The median of the follow-up duration of patients was 24.5 months. The patients were divided into a sirolimus (SRL) group (76 patients) and a non-sirolimus (non-SRL) group (128 patients). Patients exceeding the LT criteria were analyzed as subgroups. Disease-free survival (DFS) and overall survival (OS) after tumor recurrence were compared using the Kaplan-Meier method. Univariate and multivariate Cox analyses were used to compare OS between the SRL and non-SRL groups. Results The SRL group achieved better OS compared to the non-SRL group, while there was no significant difference in DFS. Subgroup (Milan criteria-based or Hangzhou criteria-based) analyses revealed that patients exceeding, rather than meeting, the Milan or Hangzhou criteria benefited from SRL (exceeding the Milan criteria: P=0.002; exceeding the Hangzhou criteria: P<0.001). There was no significant difference in OS between the SRL group and the non-SRL group that met the Milan or Hangzhou criteria. Conclusions SRL can improve survival outcomes in LT patients with HCC exceeding the Hangzhou criteria.
No Acoustic Correlates of Grammatical Class: A Critical Re-Examination of Sereno and Jongman (1995)

Abstract The present article describes an extended replication of a reading study by Sereno and Jongman (1995) that reported acoustic differences between noun and verb pronunciations of English disyllabic, non-stress-shifting homophone pairs, for example, answer (v) versus answer (n). The original findings point to a gradual influence of the typical stress patterns of both grammatical categories, with noun readings exhibiting a tendency toward trochaic and verb readings toward iambic pronunciation. However, the effects found by Sereno and Jongman (1995) did not consistently reach statistical significance and were based on a very small sample size. Employing a considerably larger group of speakers, the current replication fails to find the reported effects of the grammatical category. The null result obtained can be accounted for within speech production models that assume identical metrical templates for the homophone pairs tested and no direct influence of the grammatical category on the phonetics of stress assignment.
Haemato-chemical, histopathological and immunological studies on chicks infected with low pathogenic avian influenza virus (H5N2)

The haematochemical, histopathological and immunological studies were carried out on chicks experimentally infected with the low pathogenic avian influenza virus (LPAIV) (A/Turkey/CA/209092/02) H5N2. Eighty SPF one day old chicks were serologically negative for specific antibodies against avian influenza virus. The birds were devided into 2 groups, birds in the 1 group were inoculated with the virus via the intraocular and intranasal routs, while the other group was kept as non-infected control. Five birds were sacrificed from both groups at 5, 7, 10, 15, and 21 days post inoculation. Sera and heparinized blood as well as tissue specimens from lung, liver, spleen, trachea, small intestine and bursa of Fabricius were collected. Estimation of haemagglutination inhibition antibodies response against AI, liver and kidney function tests, rate of proliferation of T-lymphocyte were conducted. The experimentally infected birds showed general signs of illness with 80% morbidity and 6 % mortality. There was an increase in aniline aminotransferase (ALT) and asparate aminotransferase (AST) enzymes which reflected liver damage. High urea and creatinine values were also detected in sera of infected birds which proved kidney dysfunction. There was no significant proliferation of T-lymphocyte among examined groups. Very low haemagglutinating inhibiting (HI) antibodies was detected in infected birds. Histopathological examination displayed conspicuous depletion and necrosis of the lymphocytic aggregation in the organs of the haemobiotic system (Bursa of Fabricius, spleen and thymus). Such finding may decipher the low sero-conversion as well as the unproliferation of T-lymphocyte. The necrobiotic changes in liver and kidney sections in addition to congestion and edema elucidate the increased parameters in their functions. Also, the epithelial hyperplasia of the tracheal mucosa and the sloughing in the lining mucosal epithelium are indicative for the epithelio-tropism of the AI virus.