Miracle-dz/UniFAR-FTUs huggingface dataset:
Albanian Journal of Trauma and Emergency Surgery AJTES Official Publication of the Albanian Society for Trauma and Emergency Surgery -ASTES Chairman of the editorial board:

Inappropriate activation of the mineralocorticoid receptor (MR) plays a significant role in developing hypertension, the development of cardiac pathological changes, and chronic kidney disease (CKD), where death related to cardiovascular (CV) causes is the primary competing for the outcome to the progress to end-stage renal disease (esrD) in patients with CKD. Congestive heart failure (CHF) is a frequent comorbidity in patients with CKD. mr overactivation within the heart might cause coronary endothelial dysfunction, myocardial apoptosis, and reactive myocardial fibrosis and thus contribute to cardiac remodeling and its adverse consequences. mr antagonists (mras) are evidence-based therapy in symptomatic patients with heart failure and reduced ejection fraction (HFreF). Finerenone, a novel, nonsteroidal, selective mineralocorticoid receptor antagonist (MRA) with anti-inflammatory and antifibrotic effects, is a promising tool in treating heart failure in patients with t2Dm and CKD. it is felt to have higher potency and less hyperkalemia than steroidal mras such as spironolactone and eplerenone. it is unclear and a matter of discussion if it could be first-line therapy in this group of patients. Conclusion: Nonsteroidal MRAs are currently tested in clinical trials. Based on preclinical and first clinical data, these nonsteroidal mras might overcome the limitations of today’s steroidal antagonists.
Late‐onset facioscapulohumeral muscular dystrophy type 1 in previously undiagnosed families: Presenting clinical features in an often‐misdiagnosed disorder

In our experience, patients with late‐onset facioscapulohumeral muscular dystrophy type 1 (FSHD1) are frequently misdiagnosed, some for many years. The aim of this report is to document this clinical experience including the presenting symptoms and misdiagnoses and to discuss the challenges in diagnosing patients with late‐onset FSHD1.
Effects of level of social contact on dairy calf behavior and health

Abstract Housing preweaned dairy calves in pairs rather than individually has been found to positively affect behavioral responses in novel social and environmental situations, but concerns have been raised that close contact among very young animals may impair their health. In previous studies, the level of social contact permitted in individual housing has been auditory, visual, or physical contact. It is unclear how these various levels of social contact compare with each other and to pair housing, when their effects on behavior and health are considered, and whether the timing of pair housing has an effect. To investigate this, 110 Holstein calves (50 males, 60 females) in 11 blocks were paired according to birth date. Within 60h of birth, each pair of calves was allocated to 1 of 5 treatments: individual housing with auditory contact (I), individual housing with auditory and visual contact (V), individual housing with auditory, visual, and tactile contact (T), pair housing (P), or individual housing with auditory and visual contact the first 2wk followed by pair housing (VP). At 6wk of age, calves were subjected to a social test and a novel environment test. In the social test, all pair-housed calves (P and VP) had a shorter latency to sniff an unfamiliar calf than did individually housed calves (I, V, and T), whereas calves with physical contact (T, P, and VP) sniffed the unfamiliar calf for longer than calves on the remaining treatments (I and V). In the novel environment test, calves with physical contact (T, P, and VP) had a lower heart rate, and more of these calves vocalized during the test compared with calves without physical contact (I and V). No effect of treatment was found for clinical scores, levels of the 5 most common pathogens in feces, or in development of serum antibodies against the 3 most common respiratory pathogens. Calves housed individually are more fearful of unfamiliar calves than are pair-housed calves. Contrary to common belief, the allowance of physical contact and pair housing had no effects on the health of the calves.
Prolonged survival of a patient with active MDR-TB HIV co-morbidity: insights from a Mycobacterium tuberculosis strain with a unique genomic deletion

Coinfection of HIV and multidrug-resistant tuberculosis (MDR-TB) presents significant challenges in terms of the treatment and prognosis of tuberculosis, leading to complexities in managing the disease and impacting the overall outcome for TB patients. This study presents a remarkable case of a patient with MDR-TB and HIV coinfection who survived for over eight years, despite poor treatment adherence and comorbidities. Whole genome sequencing (WGS) of the infecting Mycobacterium tuberculosis (Mtb) strain revealed a unique genomic deletion, spanning 18 genes, including key genes involved in hypoxia response, intracellular survival, immunodominant antigens and dormancy. This deletion, that we have called "Del-X", potentially exerts a profound influence on the bacterial physiology and its virulence. Only few similar deletions were detected in other non-related Mtb genomes worldwide. In vivo evolution analysis identified drug resistance and metabolic adaptation mutations and their temporal dynamics during the patient's treatment course.
Tc‐99m mebrofenin hepatobiliary scintigraphy to assess future liver remnant function before major liver surgery

Assessment of liver function is paramount before hepatectomy. This study aimed to assess future liver remnant function (FLR‐F) using hepatobiliary scintigraphy (HBS) and to compare it to FLR volume (FLR‐V) in the prediction of posthepatectomy liver failure (PHLF). The impact of volume and function gains were also assessed in patients undergoing portal vein embolization (PVE) or liver venous deprivation (LVD).
Electroencephalography, Magnetic Resonance Imaging and Response to Treatment in Children with Focal Seizures A Prospective Cohort Study

Objectives: This study aimed to evaluate patients with focal seizures, their clinical manifestations, and their response to treatment, then compared the accuracy of electroencephalography and Magnetic Resonance Imaging (MRI) to assess the cost-effectiveness of the latter. Materials & Methods: After selecting the appropriate individuals, the authors obtained the data by clinically evaluating the cases and interviewing them or their caretaker(s) on admission and the six-month follow-up visit. The researchers then analyzed the obtained data. Results: Most cases (88.4%) had idiopathic seizures. A positive family history of seizures was observed in eight cases (5.4%). Respectively, the occipital, frontal, and temporal lobes showed the highest frequency of abnormalities on electroencephalography, while periventricular leukomalacia was the highest abnormal MRI finding (4.1%). However, in 87.8% of cases, this modality’s results were normal. No recurrence of seizures was observed in 116 cases (78.9%) on the six-month follow-up visit, pointing towards an appropriate response to treatment. Conclusion: While this study revealed that most had normal MRI, reporting an abnormality in electroencephalography was a more prevalent occurrence. This finding undermines the cost-effectiveness of the former modality, even though its importance in diagnosing the underlying abnormalities necessitates further studies regarding the subject at hand. Furthermore, the study of age groups showed that treatment response is less desirable in children under two years of age, suggesting more intense workups.
Évolution chimique du Grand Nuage de Magellan

Malgre des annees de travaux theoriques et observationnels intensifs, nous sommes toujours loin d’une complete comprehension de l’univers proche, la Voie Lactee (MW) et ses galaxies voisines. Parmi les satellites de la MW, le Petit et le Grand Nuage de Magellan (LMC) sont particulierement interessants puisqu’ils forment le plus proche exemple de galaxies en interaction gravitationnelle et hydrodynamique, et partant, constituent un laboratoire unique pour etudier les effets des marees et l’echange de matiere sur l’evolution chimique et l’histoire de la formation stellaire d’une galaxie. Le LMC est une galaxie de petite masse barree a disque, prototype des galaxies riches en gaz que l’on pense jouer un role important dans la construction des grandes galaxies dans le cadre du ΛCDM. De plus, avec sa metallicite actuelle d’environ le tiers de la metallicite solaire, le chemin d’enrichissement chimique suivi par le LMC donne un grand poids aux yields des generations stellaires pauvres en metaux, ce qui fait du LMC un environnement ideal pour etudier la nucleosynthese aux basses metallicites. Ce travail de doctorat vise a: 1) caracteriser chimiquement la population de la barre du LMC, 2) comparer les tendances des elements de la MW et du LMC et interpreter les differences ou ressemblance en termes d’evolution chimique et/ou de processus nucleosynthetiques (contraintes sur les sites et les processus nucleosynthetiques), 3) comparer l’evolution chimique de la barre et du disque interne du LMC et interpreter les difference ou ressemblance dans le contexte de la formation de la barre. Nos resultats montrent que l’histoire chimique du LMC a connu un forte contribution des supernovae de type I ainsi qu’un fort enrichissement en elements s par les vents d’etoiles AGB pauvres en metaux. Par rapport a la MW, les etoiles massives ont eu une contribution plus petite a l’enrichissement chimique du LMC. Les differences observees entre la barre et le disque parlent en faveur d’un episode de formation stellaire accrue il y a quelques Gyr, ayant lieu dans les zones centrales du LMC et conduisant a la formation de la barre. Ceci est en accord avec les histoires de la formation stellaire recemment derivees.
Tumor heterogeneity from the viewpoint of pathologists

Morphological and functional heterogeneity are found in tumors, with the latter reflecting the different levels of resistance against antitumor therapies. In a therapy‐resistant subpopulation, the expression levels of differentiation markers decrease, and those of immature markers increase. In addition, this subpopulation expresses genes involved in drug metabolism, such as aldehyde dehydrogenase 1A1 (ALDH1A1). Because of their similarity to stem cells, cells in the latter therapy‐resistant subpopulation are called cancer stem cells (CSCs). Like normal stem cells, CSCs were originally thought not to arise from non‐CSCs, but this hierarchical model is too simple. It is now believed that CSCs are generated from non‐CSCs. The plasticity of tumor phenotypes between CSCs and non‐CSCs causes difficulty in completely curing tumors. In this review, focusing on ALDH1A1 as a marker for CSCs or immature tumor cells, the dynamics of ALDH1A1‐expressing tumor cells and their regulatory mechanisms are described, and the plausible regulatory mechanisms of plasticity of ALDH1A1 expression phenotype are discussed. Genetic mutations are a significant factor for tumorigenesis, but non‐mutational epigenetic reprogramming factors yielding tumor heterogeneity are also crucial in determining tumor characteristics. Factors influencing non‐mutational epigenetic reprogramming in tumors are also discussed.
The protective role of phosphodiesterase inhibitors in preventing colorectal cancer and advanced colorectal polyps: a systematic review and meta‐analysis

Inflammatory cells within the tumour microenvironment are the driving forces behind colorectal cancer (CRC) tumourigenesis. Understanding the different pathways involved in CRC carcinogenesis paves the way for effective repurposing of drugs for cancer prevention. Emerging data from preclinical and clinical studies suggest that, due to their antiproliferative and anti‐inflammatory properties, phosphodiesterase‐5 inhibitors (PDE5i) might have an anticancer effect. The aim of this study was to clarify through systematic review and meta‐analysis of published peer‐reviewed studies whether an association exists between PDE5i use and CRC risk.
Membrane free-energy landscapes derived from atomistic dynamics explain nonuniversal cholesterol-induced stiffening.

All lipid membranes have inherent morphological preferences and resist deformation. Yet adaptations in membrane shape can and do occur at multiple length scales. While this plasticity is crucial for cellular physiology, the factors controlling the morphological energetics of lipid bilayers and the dominant mechanisms of membrane remodeling remain to be fully understood. An ongoing debate regarding the universality of the stiffening effect of cholesterol underscores the challenges facing this field, both experimentally and theoretically, even for simple lipid mixtures. On the computational side, we have argued that enhanced-sampling all-atom molecular dynamics simulations are uniquely suited for the quantification of membrane conformational energetics, as they minimize a priori assumptions and permit analysis of bilayers in deformed states. To showcase this approach, we examine reported inconsistencies between alternative experimental measurements of bending moduli for cholesterol-enriched membranes. Specifically, we analyze lipid bilayers with different chain saturation and compute free-energy landscapes for curvature deformations distributed over areas from ∼5 to ∼60 nm2. These enhanced simulations, totaling over 100 μs of sampling time, enable us to directly quantify both bending and tilt moduli and to dissect the contributing factors and molecular mechanisms of curvature generation at each length scale. Our results show that the effects of cholesterol on bending rigidity are lipid-specific and suggest that this specificity arises from differences in the torsional dynamics of the acyl chains. In summary, we demonstrate that quantitative relationships can now be established between lipid structure and bending energetics, paving the way for addressing open fundamental questions in cell membrane mechanics.
Prediction of postnatal abnormal umbilical cord coiling by antenatal evaluation in pregnant women: Diagnostic accuracy study; a systematic review

Umbilical cord abnormalities increase neonatal morbidity and mortality. Considering uncertainties about the best time of an antenatal ultrasonography scan to evaluate the umbilical coiling index (UCI), this systematic review was designed to assess the diagnostic accuracy value of antenatal ultrasound assessments to predict abnormal postpartum UCI.
Protracted COVID‐19 pneumonitis early post‐ABO incompatible kidney transplantation: Management considerations and the role of whole genome sequencing

We present the case of a recent ABO incompatible kidney transplant recipient with persistent SARS‐CoV‐2 infection and pneumonitis. Serial whole genome sequencing confirmed intra‐host viral evolution, which was used as a surrogate to confirm active viral replication and support re‐treatment with antivirals, late in the course of infection. A prolonged course of remdesivir combined with immunosuppression modulation resulted in successful clearance of virus and clinical improvement. The diagnostic process undertaken in this case provides a useful guide for other clinicians when approaching similar patients.
Alexithymia in Chinese patients with chronic schizophrenia: Prevalence, clinical correlates, and relationship with neurocognition and empathy

Alexithymia is highly prevalent and strongly related to adverse consequences in patients with schizophrenia. However, its associated factors remain largely unexplored. The present study aimed to determine the prevalence of alexithymia and its association with sociocultural characteristics, clinical symptoms, neurocognition, and empathy in 854 Chinese patients with schizophrenia.
Using the wide-range attention U-Net for road segmentation

ABSTRACT Recently, the U-Net-like convolutional neural network architecture composed of encoder, decoder, and symmetric skip-connection has shown impressive performance and has quickly become the de-facto standard in road segmentation tasks. In this letter, a novel Wide-Range Attention Unit (WRAU) is introduced and incorporated into a densely-connected U-Net architecture which we term the Wide-Range Attention U-Net (WRAU-Net). New architecture achieves a wide-range channel-wise attention mechanism by two major contributions. Firstly, we add a partially dense-connections branch to the U-Net architecture to aggregate informative feature map channels with multiple spatial resolutions from different levels of encoder. Secondly, before encoding back into the network, the WRAU is employed at the cluster node of partially dense-connections to learn to weight aggregated feature map channels by a three-layer convolutional network. We evaluate our WRAU-Net on the Massachusetts road segmentation benchmark. The cross-validation results show that the employment of the proposed attention mechanism to classic U-Net architecture gives a tangible boost to test accuracy when compared to U-Net itself and another two state-of-the-art baselines.
Laparoscopic Versus Open Colorectal Surgery: Cost-Benefit Analysis in a Single-Center Randomized Trial

Summary Background Data:Studies comparing the costs of colorectal resection by laparoscopic (LPS) and open approaches are small sized or not randomized. The main purpose of this study is to compare the hospital costs of LPS and open colorectal surgery in a large series of randomized patients. Methods:A total of 517 patients with colorectal disease were randomly assigned to LPS (n = 258) or open (n = 259) resection. The following costs were calculated: surgical instruments, operative room (OR) occupation, routine care, postoperative morbidity, and length of hospital stay (LOS). Follow-up for postoperative morbidity was carried out for 30 days after hospital discharge. Results:Operative time was 37 minutes longer in the LPS group. Overall morbidity rate was 18.2% (47 of 258) in the LPS versus 34.7% (90 of 259) in the open group (P = 0.0005). The mean LOS was 9.9 (2.6) days in the LPS group and 12.4 (3.9) days in the open group (P < 0.0001). The additional OR charge in the LPS group was &U20AC;1171 per patient randomized (&U20AC;864 due to surgical instruments and &U20AC;307 due to longer time). The saving in the LPS group was &U20AC;1046 per patient randomized (&U20AC;401 due to shorter LOS and &U20AC;645 due to the lower cost of postoperative complications). The net balance resulted in &U20AC;125 extra cost per patient allocated to the LPS group. Conclusions:The present cost-benefit analysis showed a slight additional cost in the LPS group. The better postoperative short-term outcome in patients receiving LPS had a key role to nearly balance the operative room charges due to laparoscopy.
The Effect of Japanese Herbal Medicines (Kampo) Goreisan and Saireito on the Prevention of Recurrent Chronic Subdural Hematoma: A Prospective Randomized Study

BACKGROUND AND OBJECTIVES: Chronic subdural hematoma (CSDH) sometimes recurs after surgical treatment and requires reoperation. In Japan, Japanese herbal medicines (Kampo), such as Goreisan and Saireito, have been used as adjunctive therapies to prevent the recurrence of CSDH. However, no prospective randomized study has proven the efficacy of Kampo medicine in all patients. To investigate whether Goreisan and Saireito reduce the postoperative recurrence of CSDH in a prospective randomized study. METHODS: Between April 2017 and July 2019, a total of 118 patients who underwent initial burr hole surgery for CSDH were randomly assigned to the following 3 groups: (1) Goreisan for 3 months (Group G), (2) Saireito for 3 months (Group S), and (3) no medication (Group N). The primary end point was symptomatic recurrence within 3 months postoperatively, and the secondary end point was complications associated with the administration of Kampo medicine. RESULTS: Among 118 patients, 114 (Group N, n = 39; Group G, n = 37; and Group S, n = 38) were included in our analysis. In this study, byakujutsu (containing Atractylodes rhizome) Goreisan and Saireito were used, unlike other prospective randomized studies in which sojutsu (containing Atractylodes lancea rhizome) Goreisan was used. The overall recurrence rate was 11.4% (13/114: 10 for Group N, 2 for Group G, and 1 for Group S). The recurrence rate of Group G was significantly lower than that of Group N (5.4% vs 25.6%; P = .043). The recurrence rate of Group S was also significantly lower than that of Group N (2.6% vs 25.6%; P = .02). No patients developed complications associated with the administration of Kampo medicine. CONCLUSION: This is the first study to show that Kampo medicine reduced the recurrence rate of CSDH in an overall population. This study demonstrated that byakujutsu Goreisan and Saireito may have favorable effects, unlike other studies, because byakujutsu has stronger anti-inflammatory activity than sojutsu.
Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation.

BACKGROUND Catheter-based pulmonary vein isolation is an effective treatment for paroxysmal atrial fibrillation. Pulsed field ablation, which delivers microsecond high-voltage electrical fields, may limit damage to tissues outside the myocardium. The efficacy and safety of pulsed field ablation as compared with conventional thermal ablation is not known. METHODS In this randomized, single-blind, noninferiority trial, we assigned patients with drug-refractory paroxysmal atrial fibrillation in a 1:1 ratio to undergo pulsed field ablation or conventional radiofrequency or cryoballoon ablation. The primary efficacy end point was freedom from a composite of initial procedural failure, documented atrial tachyarrhythmia after a 3-month blanking period, antiarrhythmic drug use, cardioversion, or repeat ablation. The primary safety end point included acute and chronic device- and procedure-related serious adverse events. RESULTS A total of 305 patients were assigned to undergo pulsed field ablation, and 302 were assigned to undergo thermal ablation. At 1 year, the primary efficacy end point was met (i.e., no events occurred) in 204 patients (estimated probability, 73.3%) who underwent pulsed field ablation and 194 patients (estimated probability, 71.3%) who underwent thermal ablation (between-group difference, 2.0 percentage points; 95% Bayesian credible interval, -5.2 to 9.2; posterior probability of noninferiority, >0.999). Primary safety end-point events occurred in 6 patients (estimated incidence, 2.1%) who underwent pulsed field ablation and 4 patients (estimated incidence, 1.5%) who underwent thermal ablation (between-group difference, 0.6 percentage points; 95% Bayesian credible interval, -1.5 to 2.8; posterior probability of noninferiority, >0.999). CONCLUSIONS Among patients with paroxysmal atrial fibrillation receiving a catheter-based therapy, pulsed field ablation was noninferior to conventional thermal ablation with respect to freedom from a composite of initial procedural failure, documented atrial tachyarrhythmia after a 3-month blanking period, antiarrhythmic drug use, cardioversion, or repeat ablation and with respect to device- and procedure-related serious adverse events at 1 year. (Funded by Farapulse-Boston Scientific; ADVENT ClinicalTrials.gov number, NCT04612244.).
The influence of the presence of intraductal carcinoma of the prostate on the grade group system's prognostic performance

Although the presence of intraductal carcinoma of the prostate (IDC‐P) influences biochemical failure in radical prostatectomy patients, no data are available regarding the impact of its integration into the classification grade group system. Thus, the aim of this study was to enhance the utility of the grade group system by integrating the presence of IDC‐P.