Miracle-dz/UniFAR-FTUs huggingface dataset:
Effectiveness of Dose De-escalation of Biologic Therapy in Inflammatory Bowel Disease: A Systematic Review.

INTRODUCTION De-escalation of biologic therapy is a commonly encountered clinical scenario. Although biologic discontinuation has been associated with high rates of relapse, the effectiveness of dose de-escalation is unclear. This review was performed to determine the effectiveness of dose de-escalation of biologic therapy in inflammatory bowel disease. METHODS We searched EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials from inception to October 2019. Randomized controlled trials and observational studies involving dose de-escalation of biologic therapy in adults with inflammatory bowel disease in remission were included. Studies involving biologic discontinuation only and those lacking outcomes after dose de-escalation were excluded. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS We identified 1,537 unique citations with 20 eligible studies after full-text review. A total of 995 patients were included from 18 observational studies (4 prospective and 14 retrospective), 1 nonrandomized controlled trial, and 1 subgroup analysis of a randomized controlled trial. Seven studies included patients with Crohn's disease, 1 included patients with ulcerative colitis, and 12 included both. Overall, clinical relapse occurred in 0%-54% of patients who dose de-escalated biologic therapy (17 studies). The 1-year rate of clinical relapse ranged from 7% to 50% (6 studies). Eighteen studies were considered at high risk of bias, mostly because of the lack of a control group. DISCUSSION Dose de-escalation seems to be associated with high rates of clinical relapse; however, the quality of the evidence was very low. Additional controlled prospective studies are needed to clarify the effectiveness of biologic de-escalation and identify predictors of success.
Secular trends in the incidence of eating disorders in China from 1990 to 2017: a joinpoint and age–period–cohort analysis

Abstract Background Eating disorders (ED) have increasingly become a global topic of concern for public health. A better understanding of ED incidence is a basic requirement for improving its management. However, the temporal trend of ED incidence in China is still unknown. Methods The incidence rates of ED from 1990 to 2017 were collected from the Global Burden of Disease Study 2017 database according to the following: subtype, i.e. anorexia nervosa (AN) and bulimia nervosa (BN); sex; and age group. The average annual percent changes and relative risks were calculated using joinpoint regression and the age–period–cohort model, respectively. Results From 1990 to 2017, age-standardized incidence rates of ED continued to increase in males and females, and this variation trend was observed in AN and BN. Joinpoint regression analysis showed that the incidence rates increased in all age groups. Adolescents had the highest risk of developing ED, followed by young adults. Age effects were the most influential risk factor for ED incidence. Period effects showed that the risk of developing ED continuously increased with increasing time periods in BN, but not in ED and AN. Concerning the cohort effects, people born after the 1990s presented a higher risk of ED, though they presented a lower risk of BN as compared to the whole cohort. Conclusions ED incidence rates continue to increase in China, particularly among adolescents and young adults. Further etiological studies are needed to explain these increases and to facilitate the early identification of high-risk individuals.
The Human Influence Experiment (Part 2): Guidelines for Improved Mapping of Local Climate Zones Using a Supervised Classification

Since 2012, Local Climate Zones (LCZ) have been used for numerous studies related to urban environment. In 2015, this use amplified because a method to map urban areas in LCZs was introduced by the World Urban Database and Access Portal Tools (WUDAPT). However in 2017, the first HUMan INfluence EXperiment showed that these maps often have poor or low quality. Since the maps are used in different applications such as urban modelling and land use/land cover change studies, it is of the utmost importance to improve mapping accuracies and a second experiment was launched. In HUMINEX 2.0, the focus lies on providing guidelines on the use of the mapping protocol based on the results of both HUMINEX 1.0 and 2.0. The results showed that: (1) it is important to follow the mapping protocol as strictly as possible, (2) a reasonable amount of time should be spent on the mapping procedure, (3) all users should perform a driving test, and (4) training area sets should be stored in the WUDAPT database for other users.
Social Experiences of Turkish Parents Raising a Child With Apert Syndrome: A Qualitative Study

Objective: Apert syndrome is a rare and understudied craniofacial condition with regard to its psychosocial impact on children and their parents. Due to the lack of studies focusing solely on the social experiences of children and families with Apert syndrome, it is difficult to develop interventions and strategies to support well-being and positive adjustment for this particular population. This study addressed this gap by assessing the unique social experiences of parents who are raising their children with Apert syndrome including difficulties they face and strategies they use to cope with challenges. Design: Descriptive qualitative study using thematic analysis. Participants: Participants included 21 parents of 12 children (aged 1-12 years) with Apert syndrome (9 couples, 2 fathers, and 1 mother) who were recruited from a pediatric neurosurgery unit in Turkey. Results: The qualitative analysis yielded four main themes describing the experiences of parents including (1) social challenges; (2) coping with negative reactions; (3) promoting socialization and independence; and (4) sources of strength. Conclusions: Parents reported several challenges, including social stigmatization, and utilized a range of strategies to support both their own and their child’s positive adaptation and resiliency, including the use of religion and reliance on their spouses for support. Results offer clinically relevant insights about the strengths and challenges of families coping with Apert syndrome.
The estrogenic activity of resveratrol: a comprehensive review of in vitro and in vivo evidence and the potential for endocrine disruption

Abstract trans-Resveratrol, a polyphenolic stilbene of plant origin is structurally similar to natural and synthetic estrogens and has been classified a phytoestrogen. Direct binding of resveratrol to the nuclear estrogen receptor (ER) and modulation of its genomic activity was among the first of its reported pharmacological actions. Additionally, resveratrol in some investigations interacted with membrane bound ER and modulated non-genomic estrogenic activities. The compound was also reported to interfere in steroidogenesis and estrogen biosynthesis at multiple steps along the pathway. Resveratrol also inhibited hepatic and intestinal metabolism of estrogens and increased circulating levels of sex hormone binding globulin (SHBG). Recent investigations report estrogenic activities for resveratrol metabolites, especially for the predominant sulfate conjugate. The majority of these estrogenic effects have been observed in vitro using micro-molar concentrations. However, the daily consumption of 0.5–1 g of resveratrol supplements is sufficient to furnish plasma levels sufficient to initiate most of these actions. The diverse modes of estrogenic and hormonal activities of resveratrol can produce a progressive shift in the homeostatic balance of estrogens and other steroidal hormones to a new operational set point. While this could represent an opportunity for therapeutic benefit in a variety of endocrine related diseases, it may also pose risk of endocrine disruption following chronic exposure that warrants caution. Herein, a review of the current knowledge of resveratrol’s estrogenic activity at the molecular, cellular and whole organism since it was reported two decades ago is provided followed by an assessment of endocrine disruption via an estrogenic mode of action. KEY MESSAGE Resveratrol interacts with ER and modulates its genomic and non-genomic activities. It also inhibits several enzymes in steroidogenesis and competes in estrogen metabolism. Commercial supplements reach dosages of 1000 mg per serving and the consumption of 0.5–1 g per day furnishes low micro-molar plasma levels sufficient to start these activities. The pleiotropic hormonal actions of resveratrol open an opportunity for clinical benefit, but also risk endocrine disruption if exposure is chronic or during critical windows of development.
COVID-19 in Critical Care Units: Rethinking the Humanization of Nursing Care.

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Recent advances in the treatment of uremic pruritus.

PURPOSE OF REVIEW This article provides a focused update on uremic pruritus, highlighting the latest evidence concerning the epidemiology, pathophysiology, and treatment options for this common and bothersome condition. RECENT FINDINGS Half of dialysis patients and a quarter of those with nondialysis chronic kidney disease experience bothersome itch that reduces quality of life and is increasingly recognized to be associated with poor outcomes including mortality. The KALM-1 trial, which reported effective symptomatic relief with difelikefalin, has bolstered support for the role of an imbalance of μ and κ-opioid receptor activity in pruritogenesis. The role of a chronic inflammatory state, increased cytokine levels and altered immune signaling in pruritogenic nerve activation continues to be elucidated with basic science, which paves the wave for future novel therapeutics. In the meantime, gabapentin appears to be the most evidence-based widely available uremic pruritus treatment, as long as care is taken with dosing and monitoring of side-effects. SUMMARY Uremic pruritus remains a top research priority. Patients with uremic pruritus may be able to look forward to a new decade of understanding, knowledge, and novel treatment options for this burdensome condition. As difelikefalin and other potential agents come to market, cost-effectiveness assessments of these interventions will help determine if the widespread use of them is feasible amongst renal programs.
Gene autoregulation by 3’ UTR-derived bacterial small RNAs

Negative feedback regulation, that is the ability of a gene to repress its own synthesis, is the most abundant regulatory motif known to biology. Frequently reported for transcriptional regulators, negative feedback control relies on binding of a transcription factor to its own promoter. Here, we report a novel mechanism for gene autoregulation in bacteria relying on small regulatory RNA (sRNA) and the major endoribonuclease, RNase E. TIER-seq analysis (transiently-inactivating-an-endoribonuclease-followed-by-RNA-seq) revealed ~25,000 RNase E-dependent cleavage sites in Vibrio cholerae, several of which resulted in the accumulation of stable sRNAs. Focusing on two examples, OppZ and CarZ, we discovered that these sRNAs are processed from the 3’ untranslated region (3’ UTR) of the oppABCDF and carAB operons, respectively, and base-pair with their own transcripts to inhibit translation. For OppZ, this process also triggers Rho-dependent transcription termination. Our data show that sRNAs from 3’ UTRs serve as autoregulatory elements allowing negative feedback control at the post-transcriptional level.
Coronavirus Disease 2019 (COVID-19) Outbreak in a San Francisco Homeless Shelter

Abstract We report the public health response to a COVID-19 outbreak in a San Francisco shelter where 67% of residents and 17% of staff tested positive for SARS-CoV-2. We describe the limited utility of case investigation, person-based contact tracing and symptom screening, and the benefits of mass testing in outbreak response.
Evaluation of an ensemble-based distance statistic for clustering MLST datasets using epidemiologically defined clusters of cyclosporiasis

Abstract Outbreaks of cyclosporiasis, a food-borne illness caused by the coccidian parasite Cyclospora cayetanensis have increased in the USA in recent years, with approximately 2300 laboratory-confirmed cases reported in 2018. Genotyping tools are needed to inform epidemiological investigations, yet genotyping Cyclospora has proven challenging due to its sexual reproductive cycle which produces complex infections characterized by high genetic heterogeneity. We used targeted amplicon deep sequencing and a recently described ensemble-based distance statistic that accommodates heterogeneous (mixed) genotypes and specimens with partial genotyping data, to genotype and cluster 648 C. cayetanensis samples submitted to CDC in 2018. The performance of the ensemble was assessed by comparing ensemble-identified genetic clusters to analogous clusters identified independently based on common food exposures. Using these epidemiologic clusters as a gold standard, the ensemble facilitated genetic clustering with 93.8% sensitivity and 99.7% specificity. Hence, we anticipate that this procedure will greatly complement epidemiologic investigations of cyclosporiasis.
Nursery location and potassium enrichment in Aleppo pine stock 2. Performance under real and hydrogel-mediated drought conditions

Summary This work investigates Aleppo pine performance under severe drought conditions according to seedling size and nutritional status, with special emphasis on potassium. The interaction of drought ameliorating measures such as hydrogels is also studied. Seven fertilization treatments applied in two nursery locations provided 14 stocklots, resulting in different seedling sizes for each nutrient concentration and vice versa. Stocklots were tested in a greenhouse experiment and a harsh site plantation experiment. In the greenhouse, seedlings given two hydrogel doses (0.01 and 0.1 per cent w/w) plus a control were allowed to dry and survival and soil moisture were measured. In parallel to this trial, the effects of hydrogel dosage, brand and soil texture on soil water properties were tested in a laboratory. Results show that large stock survived signifi cantly better than conventionally sized stock in both experiments: 37 and 27 per cent more in the greenhouse and harsh site, respectively. Despite presenting wide variation, macronutrient concentration was not related to survival for a given size. Hydrogel effect on soil water was different according to factors, although in all cases , its effect diminished at suction tensions higher than 30 kPa. Results demonstrate the overriding effect of size over nutritional status on seedling survival in harsh environments.
Effect of dose on the intravenous pharmacokinetics of tolfenamic acid in goats.

The objective of this study was to determine the pharmacokinetics of tolfenamic acid (TA) following intravenous (IV) administration at doses of 2 and 4 mg/kg in goats. In this study, six healthy goats were used. TA was administered intravenously to each goat at 2 and 4 mg/kg doses in a cross-over pharmacokinetic design with a 15-day washout period. Plasma concentrations of TA were analyzed using the high performance liquid chromatography with ultraviolet detector, and pharmacokinetic parameters were assigned by noncompartmental analysis. Following IV administration at dose of 2 mg/kg, area under the concentration-time curve (AUC0-∞ ), elimination half-life (t1/2ʎz ), total clearance (ClT ) and volume of distribution at steady state (Vdss ) were 6.64 ± 0.81 hr* µg/ml, 1.57 ± 0.14 hr, 0.30 ± 0.04 L h-1 kg-1 and 0.40 ± 0.05 L/kg, respectively. After the administration of TA at a dose of 4 mg/kg showed prolonged t1/2ʎz , increased dose-normalized AUC0-∞ , and decreased ClT . In goats, TA at 4 mg/kg dose can be administered wider dose intervals compared to the 2 mg/kg dose. However, further studies are needed to determine the effect of different doses on the clinical efficacy of TA in goats.
Increased emotional eating behaviors in children with autism: Sex differences and links with dietary variety

Although food selectivity and so-called “picky” eating are well documented in autism spectrum disorder, emotion-linked eating has rarely been investigated. This study examined emotion-linked over- and under-eating based on parent ratings of these behaviors in 4- to 17-year-old children with autism spectrum disorder (n = 190) as compared to same-age typically developing children (n = 119). Children with autism spectrum disorder were rated as exhibiting both more emotional over-eating and more emotional under-eating behaviors than their typically developing peers. Furthermore, while sex differences in these emotional eating behaviors were not observed in the typically developing children, girls with autism spectrum disorder were rated as experiencing more emotional over-eating behaviors than boys with autism spectrum disorder. Finally, among all children with autism spectrum disorder, emotional over-eating was linked with increased consumption of sweet foods and decreased consumption of vegetables. These findings have implications for better understanding eating habits in children with autism spectrum disorder and suggest that emotional eating behaviors might have both immediate and downstream health impacts. Lay abstract Although “picky” eating is well documented in autism spectrum disorder, emotional eating has rarely been investigated. This study examined emotional over- and under-eating based on parent ratings of these behaviors in 4- to 17-year-old children with autism spectrum disorder (n = 190) as compared to same-age typically developing children (n = 119). Children with autism spectrum disorder were rated as exhibiting both more emotional over-eating and more emotional under-eating behaviors than their typically developing peers. Furthermore, while sex differences in these emotional eating behaviors were not observed in the typically developing children, girls with autism spectrum disorder were rated as experiencing more emotional over-eating behaviors than boys with autism spectrum disorder. Finally, among all children with autism spectrum disorder, emotional over-eating was linked with increased consumption of sweet foods and decreased consumption of vegetables. These findings have implications for better understanding eating habits in children with autism spectrum disorder and suggest that emotional eating behaviors might have both immediate and downstream health impacts.
Comment on "The Effect of Postoperative Complications After Minimally Invasive Esophagectomy on Long-term Survival: An International Multicenter Cohort Study".

To the Editor: We read with great interest the recent multicenter analysis showing that minimally invasive esophagectomy (MIE) is related with increased incidence of postoperative major complications (1/2 patients). The striking finding was that MIE IvorLewis was associated with 14.8% of anastomotic leak (AL), which was related to significantly worse long-term survival outcomes. We would like to further comment on the results of the study, hoping to generate a scientific discussion around them. During the last decade, there is an increasing body of literature highlighting the incidence and impact of AL in MIE setting. More specifically, multiple studies have reported a 3-fold increase of AL compared to the historic rates of open Ivor-Lewis esophagectomy (15% vs 5%). The most plausible explanation for this finding seems to be the technical difficulty of intrathoracic anastomosis with minimally invasive means which is the Achilles Heel of the procedure. Trial. Ann Surg. 2017;266:232–236.
Sodium concentration of pre-packaged foods sold in Hong Kong

Abstract Objective: To describe the Na concentration of pre-packaged foods available in Hong Kong. Design: The Na concentrations (mg/100 g or mg/100 ml or per serving) of all pre-packaged foods available for sale in major supermarket chains in Hong Kong were obtained from the 2017 Hong Kong FoodSwitch database. Median and interquartile range (IQR) of Na concentration for different food groups and the proportion of foods and beverages considered low and high Na (<120 mg/100 g or mg/100 ml and >600 mg/100 g or mg/100 ml, respectively) were determined. Setting: Hong Kong. Participants: Not applicable. Results: We analysed 11 518 pre-packaged products. ‘Fruit and vegetables (including table salt)’ had the highest variability in Na concentration ranging from 0 to 39 000 mg/100 g, followed by ‘sauces, dressings, spreads and dips’ ranging from 0 to 34 130. The latter also had the highest median Na concentration (mg/100 g or mg/100 ml) at 1180 (IQR 446–3520), followed by meat and meat products (median 800, IQR 632–1068) and snack foods (median 650, IQR 453–926). Fish and fish products (median 531, 364–791) and meat and meat products (median 444, IQR 351–593) had the highest Na concentration per serving. Overall, 46·7 and 26·7 % of products were low and high in Na, respectively. Conclusions: Our results can serve as a baseline for food supply interventions in Hong Kong. We have identified several food groups as priority areas for reformulation, demonstrating the potential of such initiatives to improve the healthiness of the food supply in Hong Kong.
Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions

Background Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas. Objective This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States. Methods A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States. Results A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation. Conclusions The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.