Miracle-dz/UniFAR-FTUs huggingface dataset:
Jumping stump phenomenon: a case report

Case description: The jumping stump phenomenon is a peripherally induced movement disorder that is due to peripheral nerve damage. We report on a very resistant case in which different treatment strategies were applied. Objectives: To inform physicians about this condition, its implications, and treatment options. Study design: Case report of a 52-year-old man with a transtibial amputation, experiencing very painful involuntary muscle contractions in the residual limb. Treatment and outcomes: Various drug treatments, including baclofen, diazepam, clonazepam, clotiazepam, pramipexole, and pregabalin, peroneal nerve block, prosthesis modifications, and physiotherapy were ineffective for our patient. Botulinum toxin A treatment showed temporary decrease of symptoms but was not repeated because of high cost for the patient and his fear of injections. In our case, tibial nerve neuroma had no ectopic trigger zone, so local treatment was not indicated. Surgical interventions, based on contraction location and muscle tension, were partially successful. Eventually, due to serious functional and psychological impact, a transfemoral amputation was performed, with complete resolution of symptoms but recurrence later that year. Relapse was correlated with recurrence of local residual limb pain. Conclusions: Treating this phenomenon remains challenging because pathophysiology is still not fully understood, and the available literature is limited. A multiprofessional and interdisciplinary treatment approach is recommended, and botulinum toxin treatment is promising.
Journal of Homeland Security and Emergency Management Tornado Warnings in Three Southern States : A Qualitative Analysis of Public Response Patterns

Recent research in three Southern states supplied data describing the role community structure and culture played in shaping public response to tornado risks. The following study identifies and describes how residents received, made sense of, and ultimately used information to make decisions about responding to warnings. In addition to a range of theoretical concerns, research was also intended to develop a set of safety policies derived from what the data reveals about the social psychology of risk perception, economic constraints to shelter, and the cultural aspects of response. Data analysis reveals a diverse set of social factors governing community response to tornado warnings, including social networks, language, issues in comprehension, siren ambiguities, false alarms, tornado tracking, local business behaviors, warning specificity, and cultural myths.
Timing of surgery in essential infantile esotropia – What more do we know since the turn of the century?

This review summarizes the results and interpretations of studies pertaining to the long-standing debate regarding the timing of surgery in infantile esotropia, more recently referred to as essential infantile esotropia. A systematic search of studies from the year 2000 onward pertaining to the timing of surgery in infantile esotropia as listed in PubMed, Google Scholar, and the Cochrane database was performed. Appropriate cross-references from the articles were also included. Data collected included demographics, presentation, time of surgery, complications, and outcomes. Very early surgery, that is, within 6 months of the onset of infantile esotropia, offers significant advantages in terms of the quality of stereopsis and binocular vision as well as promoting the development of cortical visual processing, thereby benefiting cortical development in human infants. However, the postoperative alignment was not found to be significantly different in the very early, early, or late surgery groups. The reduction in the incidence of manifest dissociated vertical deviation postoperatively in the very early surgery group also showed measurable benefits. The results of this recent literature review demonstrated that very early surgery, within 6 months of misalignment, showed demonstrable benefits in essential infantile esotropia.
Junctophilins 1, 2, and 3 all support voltage-induced Ca2+ release despite considerable divergence

Muscle junctophilins 1 and 2 and neuronal junctophilins 3 and 4 differ in sequence and in interactions with RYR1. Junctophilin 2 has been shown to support voltage-induced calcium release. Perni and Beam show that junctophilins 1 and 3 also support such a release, but that junctophilin 4 does not.
Effective connectivity of the human mirror neuron system during social cognition

Abstract The human mirror neuron system (MNS) can be considered the neural basis of social cognition. Identifying the global network structure of this system can provide significant progress in the field. In this study, we use dynamic causal modeling (DCM) to determine the effective connectivity between central regions of the MNS for the first time during different social cognition tasks. Sixty-seven healthy participants completed fMRI scanning while performing social cognition tasks, including imitation, empathy and theory of mind. Superior temporal sulcus (STS), inferior parietal lobule (IPL) and Brodmann area 44 (BA44) formed the regions of interest for DCM. Varying connectivity patterns, 540 models were built and fitted for each participant. By applying group-level analysis, Bayesian model selection and Bayesian model averaging, the optimal family and model for all experimental tasks were found. For all social-cognitive processes, effective connectivity from STS to IPL and from STS to BA44 was found. For imitation, additional mutual connections occurred between STS and BA44, as well as BA44 and IPL. The results suggest inverse models in which the motor regions BA44 and IPL receive sensory information from the STS. In contrast, for imitation, a sensory loop with an exchange of motor-to-sensory and sensory-to-motor information seems to exist.
Staying vigilant during recurrent sleep restriction: dose-response effects of time-in-bed and benefits of daytime napping

Abstract Study Objectives We characterized vigilance deterioration with increasing time-on-task (ToT) during recurrent sleep restriction of different extents on simulated weekdays and recovery sleep on weekends, and tested the effectiveness of afternoon napping in ameliorating ToT-related deficits. Methods In the Need for Sleep studies, 194 adolescents (age = 15–19 years) underwent two baseline nights of 9-h time-in-bed (TIB), followed by two cycles of weekday manipulation nights and weekend recovery nights (9-h TIB). They were allocated 9 h, 8 h, 6.5 h, or 5 h of TIB for nocturnal sleep on weekdays. Three additional groups with 5 h or 6.5 h TIB were given an afternoon nap opportunity (5 h + 1 h, 5 h + 1.5 h, and 6.5 h + 1.5 h). ToT effects were quantified by performance change from the first 2 min to the last 2 min in a 10-min Psychomotor Vigilance Task administered daily. Results The 9 h and the 8 h groups showed comparable ToT effects that remained at baseline levels throughout the protocol. ToT-related deficits were greater among the 5 h and the 6.5 h groups, increased prominently in the second week of sleep restriction despite partial recuperation during the intervening recovery period and diverged between these two groups from the fifth sleep-restricted night. Daytime napping attenuated ToT effects when nocturnal sleep restriction was severe (i.e. 5-h TIB/night), and held steady at baseline levels for a milder dose of nocturnal sleep restriction when total TIB across 24 h was within the age-specific recommended sleep duration (i.e. 6.5 h + 1.5 h). Conclusions Reducing TIB beyond the recommended duration significantly increases ToT-associated vigilance impairment, particularly during recurrent periods of sleep restriction. Daytime napping is effective in ameliorating such decrement. Clinical Trial Registration NCT02838095, NCT03333512, and NCT04044885.
Low-voltage low-power CMOS flip-flops

As the clock frequency scales, the pipeline depth increases and the number of logic gates per stage decreases. The System-on-Chip (SoC) designs will therefore integrate tens of millions of transistors on one chip. But the packaging and cooling designs have only a limited ability to remove the excess heat produced by the systems. All these factors have resulted in power consumption to be considered as one of the main problems in achieving high performance designs. The energy consumption of the clocking sub-system that is composed of the clock distribution networks (buffers and wires) and clock storage elements (flip-flops and latches) is about 30% to 60% of the total system energy. For this clock system power, 90% is consumed by the flip-flops themselves and the last branches of the clock distribution network that drives the flip-flop directly. As clock frequency increases, the latency of the flip-flop will play an even greater role in the overall cycle time. As a result, it is essential to continue venturing into higher-end approaches and realizing more refined solutions to achieve low-voltage/lowpower design while sustaining high-speed performance and small-area consumption. In this thesis, several innovative flip-flop designs for low-voltage low-power environments used are described. The new designs of low-power high-performance output feedback single and double edge-triggered flip-flops presented which are mainly derived from its existing counterparts by successfully addressing the weakness of their counterpart circuits. Extensive simulation works using the 1.8 V/0.18 um CMOS process from Chartered Semiconductor Manufacturing Pte. Ltd. (CHRT) have verified that the new flip-flop architectures reported provided significant improvement in terms of delay and power consumption while promising a small-area feature. These are achieved mainly by the legitimate and appropriate usage of logic structure and circuit techniques. An area-efficient explicit-pulsed single/double edge-triggered flip-flop, which is based on the recently reported design is proposed to meet the increasing requirement for v ATTENTION: The Singapore Copyright Act applies to the use of this document. Nanyang Technological University Library
Deducing the cellular mechanisms associated with the potential genotoxic impact of gold and silver engineered nanoparticles upon different lung epithelial cell lines in vitro

Abstract Human ENP exposure is inevitable and the novel, size-dependent physicochemical properties that enable ENPs to be beneficial in innovative technologies are concomitantly causing heightened public concerns as to their potential adverse effects upon human health. This study aims to deduce the mechanisms associated with potential ENP mediated (geno)toxicity and impact upon telomere integrity, if any, of varying concentrations of both ∼16 nm (4.34 × 10−3 to 17.36 × 10−3 mg/mL) Gold (Au) and ∼14 nm (0.85 × 10−5 to 3.32 × 10−5 mg/mL) Silver (Ag) ENPs upon two commonly used lung epithelial cell lines, 16HBE14o− and A549. Following cytotoxicity analysis (via Trypan Blue and Lactate Dehydrogenase assay), two sub-lethal concentrations were selected for genotoxicity analysis using the cytokinesis-blocked micronucleus assay. Whilst both ENP types induced significant oxidative stress, Ag ENPs (1.66 × 10−5 mg/mL) did not display a significant genotoxic response in either epithelial cell lines, but Au ENPs (8.68 × 10−3 mg/mL) showed a highly significant 2.63-fold and 2.4-fold increase in micronucleus frequency in A549 and 16HBE14o− cells respectively. It is hypothesized that the DNA damage induced by acute 24-h Au ENP exposure resulted in a cell cycle stall indicated by the increased mononuclear cell fraction (>6.0-fold) and cytostasis level. Albeit insignificant, a small reduction in telomere length was observed following acute exposure to both ENPs which could indicate the potential for ENP mediated telomere attrition. Finally, from the data shown, both in vitro lung cell cultures (16HBE14o− and A549) are equally as suitable and reliable for the in vitro ENP hazard identification approach adopted in this study.
Predicting Atrial Fibrillation Recurrence by Combining Population Data and Virtual Cohorts of Patient-Specific Left Atrial Models

Supplemental Digital Content is available in the text. Background: Current ablation therapy for atrial fibrillation is suboptimal, and long-term response is challenging to predict. Clinical trials identify bedside properties that provide only modest prediction of long-term response in populations, while patient-specific models in small cohorts primarily explain acute response to ablation. We aimed to predict long-term atrial fibrillation recurrence after ablation in large cohorts, by using machine learning to complement biophysical simulations by encoding more interindividual variability. Methods: Patient-specific models were constructed for 100 atrial fibrillation patients (43 paroxysmal, 41 persistent, and 16 long-standing persistent), undergoing first ablation. Patients were followed for 1 year using ambulatory ECG monitoring. Each patient-specific biophysical model combined differing fibrosis patterns, fiber orientation maps, electrical properties, and ablation patterns to capture uncertainty in atrial properties and to test the ability of the tissue to sustain fibrillation. These simulation stress tests of different model variants were postprocessed to calculate atrial fibrillation simulation metrics. Machine learning classifiers were trained to predict atrial fibrillation recurrence using features from the patient history, imaging, and atrial fibrillation simulation metrics. Results: We performed 1100 atrial fibrillation ablation simulations across 100 patient-specific models. Models based on simulation stress tests alone showed a maximum accuracy of 0.63 for predicting long-term fibrillation recurrence. Classifiers trained to history, imaging, and simulation stress tests (average 10-fold cross-validation area under the curve, 0.85±0.09; recall, 0.80±0.13; precision, 0.74±0.13) outperformed those trained to history and imaging (area under the curve, 0.66±0.17) or history alone (area under the curve, 0.61±0.14). Conclusion: A novel computational pipeline accurately predicted long-term atrial fibrillation recurrence in individual patients by combining outcome data with patient-specific acute simulation response. This technique could help to personalize selection for atrial fibrillation ablation.
The Effect of Internet-Delivered Cognitive Behavioral Therapy Versus Psychoeducation Only on Psychological Distress in Patients With Noncardiac Chest Pain: Randomized Controlled Trial

Background Patients with recurrent episodes of noncardiac chest pain (NCCP) experience cardiac anxiety as they misinterpret the pain to be cardiac related and avoid physical activity that they think could threaten their lives. Psychological interventions, such as internet-delivered cognitive behavioral therapy (iCBT), targeting anxiety can be a feasible solution by supporting patients to learn how to perceive and handle their chest pain. Objective This study aims to evaluate the effects of a nurse-led iCBT program on cardiac anxiety and other patient-reported outcomes in patients with NCCP. Methods Patients with at least two health care consultations because of NCCP during the past 6 months, and who were experiencing cardiac anxiety (Cardiac Anxiety Questionnaire score ≥24), were randomized into 5 weeks of iCBT (n=54) or psychoeducation (n=55). Patients were aged 54 (SD 17) years versus 57 (SD 16) years and were mainly women (32/54, 59% vs 35/55, 64%). The iCBT program comprised psychoeducation, mindfulness, and exposure to physical activity, with weekly homework assignments. The primary outcome was cardiac anxiety. The secondary outcomes were fear of bodily sensations, depressive symptoms, health-related quality of life, and chest pain frequency. Intention-to-treat analysis was applied, and the patients were followed up for 3 months. Mixed model analysis was used to determine between-group differences in primary and secondary outcomes. Results No significant differences were found between the iCBT and psychoeducation groups regarding cardiac anxiety or any of the secondary outcomes in terms of the interaction effect of time and group over the 3-month follow-up. iCBT demonstrated a small effect size on cardiac anxiety (Cohen d=0.31). In the iCBT group, 36% (16/44) of patients reported a positive reliable change score (≥11 points on the Cardiac Anxiety Questionnaire), and thus an improvement in cardiac anxiety, compared with 27% of (13/48) patients in the psychoeducation group. Within-group analysis showed further significant improvement in cardiac anxiety (P=.04) at the 3-month follow-up compared with the 5-week follow-up in the iCBT group but not in the psychoeducation group. Conclusions iCBT was not superior to psychoeducation in decreasing cardiac anxiety in patients with NCCP. However, iCBT tends to have better long-term effects on psychological distress, including cardiac anxiety, health-related quality of life, and NCCP frequency than psychoeducation. The effects need to be followed up to draw more reliable conclusions. Trial Registration ClinicalTrials.gov NCT03336112; https://www.clinicaltrials. gov/ct2/show/NCT03336112
A Portrait of Menière's Disease Using Contemporary Hearing and Balance Tests

Objective: Menière's disease (MD) is characterized by recurrent vertigo and fluctuating aural symptoms. Diagnosis is straightforward in typical presentations, but a proportion of patients present with atypical symptoms. Our aim is to profile the array of symptoms patients may initially present with and to analyze the vestibular and audiological test results of patients with a diagnosis of MD. Design: A retrospective study of patient files. Setting: A tertiary, neuro-otology clinic Royal Prince Alfred Hospital, Sydney, Australia. Method: We identified 375 patients. Their history, examination, vestibular-evoked myogenic potentials (VEMP), video head-impulse test, canal-paresis on caloric testing, subjective visual horizontal (SVH), electrocochleography, ictal nystagmus, and audiometry were assessed. Results: Atypical presenting symptoms were disequilibrium (n = 49), imbalance (n = 13), drop-attacks (n = 12), rocking vertigo (n = 2), and unexplained vomiting (n = 3), nonspontaneous vestibular symptoms in 21.6%, fluctuation of aural symptoms only (46%), and headaches (31.2%). Low velocity, interictal spontaneous-nystagmus in 13.3% and persistent positional-nystagmus in 12.5%. Nystagmus recorded ictally in 90 patients was mostly horizontal (93%) and of high velocity (48 ± 34°/s). Testing yielded abnormal caloric responses in 69.6% and abnormal video head impulse test 12.7%. Air-conducted cervical VEMPs were abnormal in 32.2% (mean asymmetry ratio [AR] 30.2 ± 46.5%) and bone-conducted ocular VEMPs abnormal in 8.8% (AR 11.2 ± 26.8%). Abnormal interictal SVH was in 30.6%, (ipsiversive n = 46 and contraversive n = 19). Mean pure-tone averages 50 dB ± 23.5 and 20 dB ± 13 for affected and unaffected ears. Conclusion: Menière's disease has a distinctive history, but atypical presentations with normal vestibular function and hearing are a diagnostic challenge delaying treatment initiation.
Cyclosporin-A reduced the cytotoxicity of propranolol in HUVECs via p38 MAPK signaling

Abstract Propranolol (PROP) is a nonselective β-adrenergic receptor antagonist used to treat hypertension and cardiac arrhythmias. Oral administration of PROP has recently emerged as a new treatment modality for hemangiomas. However, the side effects of PROP at the cellular level have not been adequately described. The present study investigates and highlights the mechanisms of coupling of the drugs cyclosporin-A (CyA) and PROP on cell proliferation and the occurrence of apoptosis. It also relays the antioxidant effect of PROP on human umbilical vein endothelial cells (HUVECs). HUVECs were treated with CyA and PROP. At 24 hours after treatment, the levels of reactive oxygen species (ROS), cell proliferation, and apoptosis were determined using the ROS kit, MTT assay, and Annexin V staining. In addition, the related proteins of phospho-p38 mitogen-activated protein kinase were determined by western blotting. Subsequently, HUVECs pretreated with CyA or PROP were treated with the p38 inhibitor (SB203580). Finally, the ROS level, cell proliferation, and apoptosis were measured again in both active HUVECs and HUVECs, in which the p38 proteins were inhibited. The combination of CyA and PROP reversed the effect of CyA on cell viability, reduced the ROS level and the cell apoptosis induced by PROP. Moreover, inhibition of p38 protein catalase activity immediately stopped the effect of CyA–propranolol in HUVECs. The effect of the CyA–propranolol combination on HUVECs is associated with the p38 pathway changes, which is proven to be a potential chemotherapeutic agent that minimizes the side effects of PROP in hemangioma therapy.
Reliability of dentin translucency and incremental cemental lines in age estimation using light and stereomicroscopes: A comparative study

Age estimation of the dead and human remains has been challenging in forensic medicine, both in mass disasters and criminal investigations. There are several approaches to accurately evaluate age, each with its own benefits and drawbacks. Dentine translucency (DT) and incremental cemental lines (ICL) have often been used for age estimation in living adults and unknown skeletal remains. We attempted to estimate age using both these parameters and compare accuracy of age estimated using these parameters in a larger sample. A total of 300 extracted single‐rooted permanent teeth were collected from the patients aged between 15 and 75 years. Longitudinal ground sections in the buccolingual direction of 250 μm thickness were prepared, and the images obtained were subsequently analyzed to measure the length of DT using the ImageJ software program. In addition, the number of ICL were also counted in each tooth section. The age of the individuals was estimated using both methods individually, and the results have shown that both parameters have shown reliable age estimates in the middle age groups. However, there was overestimation of age up to 10.6 years in the younger age group using DT and an underestimation of age up to 13.4 years in the older age group with ICL. Pearson’s correlation statistics revealed a strong positive and statistically significant correlation of both the parameters with the chronological age (0.973 and 0.917). To conclude, the method using the ICL should be preferred due to the relatively higher number of errors (<±3 years) which were considered excellent.