Miracle-dz/UniFAR-FTUs huggingface dataset:
Predictors of Suicide Attempts in the Korean Adolescent Population

Purposes: The purposes of this study were ① to identify the rate of suicide attempts, and ② to investigate relevant variables(family dynamic environment, personality factors) and risk factors for attempting suicide among Korean adolescents. Method: Data were collected through a questionnaire survey. Internal consistencies for this questionnaire ranged from 0.63 to 0.88. Nine hundred and twenty two adolescents were surveyed (delinquent : 367, student : 555), using a proportional stratified random sampling method. Statistical methods employed were chi-square, t-test, and logistic regression analysis. Results: ① The rate of suicide attempts was 10.8％ for the total sample, and the delinquents(19.6％) had a higher rate of suicide attempts than the students(5.1％). ② Adolescents attempting suicide had a greater dysfunctional family dynamic environment and more maladaptive personality than those who did not attempt suicide. ③ Risk factors for suicide attempts among Korean adolescents were way of coping, psychosomatic symptoms, and parental child-rearing attitudes, in that order. Conclusions: Suicide and suicidal behaviors are multifaceted events. For suicide prevention, there is a need to make an independent assessment of the variables such as familial problems, personality and dynamic environment of the families of the adolescents.
Studies on Starling's Law of the Heart: IV. Observations on the Hemodynamic Functions of the Left Atrium in Man

The hemodynamic functions of the left atrium were studied in 26 patients with disturbances of left ventricular function and in 16 subjects without any abnormalities of the cardiovascular system. Attention was directed to the effect of atrial systole on the relationship between mean left atrial pressure (MLAP) and left ventricular end-diastolic pressure (LVEDP). This relationship was considered to be a meaningful one in view of the importance of the LVEDP in determining the characteristics of ventricular contraction, and of the MLAP in determining the symptoms of left heart failure. In the subjects with normal cardiovascular systems, LVEDP-MLAP averaged 0.2 mm. Hg, but this value averaged 9.0 mm. Hg in patients with left ventricular disease, in whom left atrial contraction elevated LVEDP while permitting MLAP to remain at a significantly lower level. The magnitude of the pressure difference between LVEDP and MLAP was found to be dependent on the characteristics of atrial contraction; the height of the "a" wave appeared to be related to the atrial pressure prior to the onset of atrial contraction. The elevation of atrial pressure produced by atrial systole was found to vary directly with the time interval between the onset and the peak of the "a" wave and to vary inversely with the time interval between the peak of the "a" wave and the onset of ventricular contraction. Evidence was presented that in intact human subjects the characteristics of left atrial and left ventricular contraction are functions of the pressures in these chambers prior to the onset of their contraction, thus lending further support to the concept that Starling's law is operative in the human heart.
Pengetahuan Ibu Dan Pemberian Asi Eksklusif Dengan Kejadian Stunting Pada Balita 2-5 Tahun Di Puskesmas Kawangkoan Minahasa

Nutrition is an important part of growth and development, because there is a connection and is related to health and intelligence, malnutrition. Stunting is a linear growth disorder that can affect the increased risk of illness, death, and impaired late motor development, and stunted mental growth. The type of this research is analytic observational with cross sectional study approach. The population in this study were all children under five in the work area of Kawangkoan Health Center in Minahasa Regency. Children under five 2-5 years. The respondent is mother. The number of samples of this study amounted to 41 people with a sampling technique that is using simple random sampling technique. The results of research on the level of maternal knowledge of 41 respondents were 39.0% who lacked knowledge, and 41.5% had sufficient knowledge, while 19.5% had good knowledge. the rate of exclusive breastfeeding is 41.5% which is less than exclusive breastfeeding, while 39.0% is good, 19.5% is enough to provide exclusive breastfeeding. Toddler respondents who have normal height category are 46%, and category is very short, 31.7%, while the short category is 22.0%. kawangkoan health center.
Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery

Purpose Limited data exist on the use of low midline and transverse incisions for specimen extraction or stoma sites in laparoscopic rectal cancer surgery (LRCS). We compared the short-term and medium-term outcomes of these incisions and assessed whether wound complications in specimen extraction sites (SES) are increased by specimen extraction through the stoma site (SESS) in LRCS. Methods From March 2010 to December 2017, 189 patients who underwent LRCS and specimen extraction through low abdominal incisions were divided into 2 groups: midline (n = 102) and transverse (n = 87), and perioperative outcomes were compared. Results The midline group showed a higher frequency of temporary stoma formation (P = 0.001) and splenic flexure mobilization (P < 0.001) than the transverse group. The overall incisional hernia and wound infection rates in the SES were 21.6% and 25.5%, respectively, in the midline group and 26.4% and 17.2%, respectively, in the transverse group (P = 0.494 and P = 0.232, respectively). In patients who underwent SESS, the incisional hernia and wound infection rates of SES after stoma closure were 39.1% and 43.5%, respectively, in the midline group, and 35.5% and 22.6%, respectively, in the transverse group (P = 0.840 and P = 0.035, respectively). Conclusion In terms of incisional hernia and wound infection at the SES, a low midline incision may be used as a low transverse incision in patients without temporary stoma in LRCS. However, considering the high wound complication rates after stoma closure in patients with SESS in this study, SESS should be performed with caution in LRCS.
Wild Honey Poisoning: A Case Report

Wild honey is consumed in many parts of the world as an alternative source of medicine with the belief of reducing cardiovascular, gastrointestinal and many other ailments. However, intoxication secondary to consumption of wild honey produced from the nectar of a few species rhododendrons has been encountered due to a toxin known as grayanotoxin. It is a sodium channel toxin causing symptoms like bradycardia, arrhythmias, hypotension, sweating, dizziness and altered sensorium. We report a case of a 58 year old man who presented to the emergency room following ingestion of wild honey with bradycardia, hypotension and altered mental status. Keywords: bradycardia; grayanotoxin; hypotension; wild honey poisoning.
Association of preoperative pain in knee and external to knee with postoperative pain outcome after total knee arthroplasty

Background Preoperative pain in the symptomatic knee may predict postoperative pain severity in patients undergoing total knee arthroplasty (TKA). However, the effect of preoperative pain external to the knee on postoperative pain is unclear. This study evaluated postoperative pain outcomes in TKA patients according to the presence of preoperative pain in the knee only or in the knee and external to the knee. Methods We retrospectively assessed medical records of patients who underwent unilateral TKA. The relationship between reported preoperative pain characteristics and morphine equivalent consumption or numerical rating scale (NRS) pain scores on postoperative day (POD) 0–3 was assessed using a multivariable generalized linear model. Results In total, 3,429 adult patients who underwent their first TKA were included; 2,864 (83.5%) patients preoperatively experienced only knee pain and 565 (16.5%) knee pain with external to knee pain. Preoperative pain in the knee and external to the knee was associated with 5% higher morphine equivalent consumption on POD 0–3 compared to preoperative knee pain only (exponentiated regression coefficient: 1.05; 95% confidence interval: 1.02 to 1.09; P = 0.004). However, the NRS pain scores on POD 0, 1, 2, and 3 and adjuvant analgesics consumption (acetaminophen and ketorolac) on POD 0–3 were not significantly different between the two groups (P > 0.05). Conclusions This study showed that there was an increase of morphine equivalent consumption during POD 0–3 in patients with preoperative knee pain with external to knee pain than in patients with preoperative only knee pain.
魚類の成長・飼料効率,肝臓・筋肉成分と消化吸収率に及ぼす飼料デキストリンの影響

In order to investigate the utilization fo carbohydrate by carp, Cyprinus carpio, red sea bream, Chrysphrys major, and yellow tail, Seriola quinqueradiata, the fishes were reared on diets comtaining 0%, 10%, 20%, 30% and 40% dextrin for 30 days. Growty retardation and low feed efficiency were noticed in carp fed on a 40% dextrin diet, red sea bream on 30% dextrin and yellow tail on 20% edxtrin. The rates of the in crease in liver glycogen and the decrease in liver and muscle lipid were lowest tn carp. On the other hand, comparably high percent absorption of protein and dextrin was determined in all species regardless of dietary dextrin levels. From these Findings, it is presumed that the low growth and feed efficiency resulting from feeding high dextrin diests might be caused by the poor capability of utilizing the absorbed dextrin, and that the capacity of carp is highest among the fish tested.
159 Medical Management of Epilepsy

Epilepsy is perhaps the most prevalent of the neurological diseases common in all age groups that require on-going treatment, and can have significant and even devastating consequences for the patient who must face this problem [1]. Loss of employment, automobile driving, or basic independence may develop and become major issues, especially if the seizures are incompletely controlled. The socio-economic consequences of having seizures are profound, and the anti-epileptic drugs themselves, the cornerstone of epilepsy treatment, often have substantial medical and neurological untoward effects. Relevant to the practice of the neurosurgeon, many patients with primary brain tumors present with or have epilepsy, and epilepsy is commonly associated with conditions that a neurosurgeon may face, including stroke, hemorrhage, and brain trauma [2,3]. An understanding of the use of anti-epileptic drugs (AED’s) is important for the efficient care of the surgical patient.
Clinical characteristics and epilepsy in genomic imprinting disorders: Angelman syndrome and Prader–Willi syndrome

Angelman syndrome (AS) and Prader–Willi syndrome (PWS) are considered sister imprinting disorders. Although both AS and PWS congenital neurodevelopmental disorders have chromosome 15q11.3-q13 dysfunction, their molecular mechanisms differ owing to genomic imprinting, which results in different parent-of-the-origin gene expressions. Recently, several randomized controlled trials have been proceeded to treat specific symptoms of AS and PWS. Due to the advance of clinical management, early diagnosis for patients with AS and PWS is important. PWS is induced by multiple paternal gene dysfunctions, including those in MKRN3, MAGEL2, NDN, SNURF-SNPRPN, NPAP1, and a cluster of small nucleolar RNA genes. PWS patients exhibit characteristic facial features, endocrinological, and behavioral phenotypes, including short and obese figures, hyperphagia, growth hormone deficiency, hypogonadism, autism, or obsessive–compulsive-like behaviors. In addition, hypotonia, poor feeding, failure to thrive, and typical facial features are major factors for early diagnosis of PWS. For PWS patients, epilepsy is not common and easy to treat. Conversely, AS is a single-gene disorder induced by ubiquitin-protein ligase E3A dysfunction, which only expresses from a maternal allele. AS patients develop epilepsy in their early lives and their seizures are difficult to control. The distinctive gait pattern, excessive laughter, and characteristic electroencephalography features, which contain anterior-dominated, high-voltage triphasic delta waves intermixed with epileptic spikes, result in early suspicion of AS. Often, polytherapy, including the combination of valproate, levetiracetam, lamotrigine, and benzodiazepines, is required for controlling seizures of AS patients. Notably, carbamazepine, oxcarbazepine, and vigabatrin should be avoided, since these may induce nonconvulsive status epilepticus. AS and PWS presented with distinct clinical manifestations according to specific molecular defects due to genomic imprinting. Early diagnosis and teamwork intervention, including geneticists, neurologists, rehabilitation physicians, and pulmonologists, are important. Epilepsy is common in patients with AS, and after proper treatment, seizures could be effectively controlled in late childhood or early adulthood for both AS and PWS patients.
Tele-nursing versus Routine Outpatient Teaching for Improving Arterial Blood Pressure and Body Mass Index for Hypertensive Patients

Background: Tele-nursing refers to the use of phone conversation and information technology to provide nursing care at a distance to help solve increasing shortages of nurses and to always keep patient in touch when they are out of hospital with best possible positive outcome. It is especially useful for hypertensive patients who have problems of far distance from health care clinics or have to wait a long time for visiting a doctor. Aim of the study: to examine the effect of telenursing versus routine outpatient teaching on improving the levels of arterial blood pressure and body mass index of hypertensive patients. Design: A quasi experimental design (study/control) was utilized. Setting: This study was conducted on the medical out-patients department-Menoufia University Hospital, Egypt. Sample: A convenient sample of 100 subjects, who attend the outpatient clinics of the aforementioned setting. The subjects were divided equally into study and control groups, 50 subjects each. The study group (telenursing intervention) was followed by follow-up phone calls throughout the period of the study. Instruments:- 1. Structured interviewing questionnaire and 2. Bio-physiological measurements including anthropometrics; height, weight, body mass index and blood pressure. Results: There were statically significant differences between both groups regarding mean arterial blood pressure scores after telenursing intervention. The mean level of arterial blood pressure & BMI was significantly lower in the study group than the control after intervention (p < 0.05 & P < 0.05) respectively. Conclusions: telenursing is an effective strategy for improving arterial blood pressure, body mass index and decreasing the risk of its complications. Tele-nursing could be a promising solution for management of hypertension as a chronic disease. Implication: apply tele-nursing via follow up phone services to improve patient’s adherence to a healthy regimen.
Voluntary Thigh Muscle Strength with Resection Stump-Dependent Blood Flow and Vasodilation in an Amputated Lower Leg with Total Surface Bearing Prosthesis during Dynamic Knee Extensor: A Case Trial

Background: The magnitude of the hyperemic response due to repeated thigh stump exercise on incremental contraction intensity might be useful information in localized exercise tolerance for devising cardiovascular physical therapy for amputees. The effect of exercise on amputated leg blood flow (LBF) may potentially be altered due to voluntary muscle contractions after loss of the lower leg compared with the healthy leg. Case Presentation: A 57-year-old male patient with Burger disease attempted 3 min unilateral repeat/dynamic knee extensor exercise at a target muscle contraction frequency (1 s thigh muscle contraction and 1 s relaxation, 90 repetitions) with each leg at six different contraction intensities (rubber resistance belt). Simultaneous measurement of blood velocity/flow (Doppler ultrasound) in the femoral artery, blood pressure, leg vascular conductance (LVC), and peak muscle strength (PMS) were performed during the 3 min exercise period. The maximum voluntary contraction by one-legged isometric knee muscle contraction was 14.7 kg in non-AL and 7.9 kg in the AL with prosthesis. The relative PMS was defined as “PMS/maximum voluntary contraction × 100 (%)”. Pre-exercise LBF was lower in the AL (200 ± 25 ml/min) than the non-AL (275 ± 74 ml/min). Both the non-AL and AL showed good positive linear relationships between absolute-/relative-PMS and LBF or LVC during 30 s at steady-state before the end of the exercise period. Furthermore, there was also similarity seen in the increase rate in LBF and/or LVC for the incremental relative PMS compared with the absolute PMS. Conclusion: In this case, the muscle strength depended on blood flow increase/vasodilation was seen in this “AL” using a TSB prosthesis for repeated dynamic knee extensor exercise. The present amputee’s limb muscle strengthening with the resection stump closely related to the degree of hyperemia in the amputated limb.
Rural and urban general practice: a comparison in 34 countries

Rural areas have problems in attracting and retaining primary care workforce. Comparable problems but with a different background occur in deprived urban areas. Here we focus on primary care practices that do work in rural areas and not on the shortage or lack of access for the rural population. We answer the question whether these practices have a different organisation, lack resources and have different service profiles, compared to practices in semi-rural and urban areas. We used data from the QUALICOPC study, conducted among approximately 7,000 GPs in 34 (mainly European) countries, on the organisation of practices, their human resources and equipment and their service profiles. Data were analysed using multilevel regression analysis, with countries and GPs as levels. In general the practices in rural areas are more often single-handed and have less other primary care workers available. In most countries they have more equipment and their service profiles are broader, in particular as compared to inner-city urban practices. The combination of increasing demand for care and undersupply of health care services can lead to a primary care shortage in rural areas. However, the practices that are currently located in rural area in most countries seem to be able to cope with the situation by providing a broader range of services, compared to service-rich urban areas. Against growing health needs of an ageing and often poorer population, there is a risk of lack of facilities and equipment and ageing staff. Until now this is not manifest in the primary care practices in most countries.
Immunotherapy in metastatic melanoma: a novel scenario of new toxicities and their management

Checkpoint inhibitors can cause an imbalance in immune tolerance that may clinically manifest as immune-related adverse events (irAEs). These events may involve many organs and tissues, including the skin, gastrointestinal (GI) tract, liver, endocrine system, kidneys, central nervous system (CNS), eyes and lungs. The incidence of irAEs appears to be lower with anti-programmed death antigen-1/programmed death antigen-ligand-1 agents than with the anti-cytotoxic T-lymphocyte-associated protein-4 antibody ipilimumab. Combined immunotherapy does not appear to be associated with novel safety signals compared with monotherapy, but more organs may be involved. Increased experience and the use of algorithms for the most common irAEs have resulted in severe toxicity and related deaths being reduced. However, continuous vigilance, especially regarding less common events, is needed to better characterize the wide spectrum of clinical manifestations.
COMPARATIVE STUDY OF ARTHROSCOPIC
ANTERIOR CRUCIATE LIGAMENT
RECONSTRUCTION USING BONE PATELLAR
TENDON BONE GRAFT AND HAMSTRING GRAFT

INTRODUCTION: ACL reconstruction is probably the most common procedure of the knee in adults in recent times, and the choice of graft to be used for it is the most important decision to be made during the surgery.Although several methods of ACL reconstruction exist,the 2 most common procedures done are BTB reconstruction using an autograft of the middle third of the patellar tendon and reconstruction using a (HT) graft. PURPOSE: The purpose of this study was to evaluate the midterm functional outcome of ACL reconstruction using the bone-patellar tendon-bone graft and hamstring graft. MATERIALS AND METHODS: The study was conducted in the Department of Orthopaedics,Kempegowda institute of medical science and research centre.A total of 40 cases were operated out of whom 20 were operated using arthroscopic ACL reconstruction using Hamstring graft and other 20 underwent ACLR using Patellar tendon graft.Patients in our study were assessed by IKDC,Tegners and Lysholm operative scores. RESULTS- The mean age of the patients in our study was around 29 years. Around 70% of our patients were operated within 6 months from the time of injury after achieving complete flexion. Evaluation using IKDC, Lyshom and tegner scoring system showed hamstring graft having statistical significance when compared with BPTB graft, but the difference between the groups was not clinically appreciable. CONCLUSIONS: ACL reconstruction by either hamstring tendon graft or bone patellar tendon graft gives equally satisfactory results.But complications in the form of anterior knee pain were noted in BPTB group
Preoperative echocardiographic evaluation of cardiac systolic and diastolic function in liver transplant recipients with diabetes mellitus: a propensity-score matched analysis

Background Diabetes mellitus (DM) increases risk of heart failure. It has been shown that diabetes leads to DM-cardiomyopathy, characterized by systolic and diastolic dysfunction. Pre-transplant diastolic dysfunction, has been associated with poor graft outcome and mortality. We assessed the hypothesis that end-stage liver disease (ESLD) patients with diabetes (DM-ESLD), have more advanced cardiac systolic and diastolic dysfunction, compared to ESLD patients without diabetes (Non DM-ESLD). Methods We retrospectively evaluated preoperative echocardiography of 1,319 consecutive liver transplant recipients (1,007 Non DM-ESLD vs. 312 DM-ESLD [23.7%]) January 2012–May 2016. Systolic and diastolic indices, such as left ventricular ejection fraction, transmital E/A ratio, tissue doppler s’, e’ velocity, and E/e’ ratio (index of left ventricular end-diastolic pressure), were compared using 1:2 propensity-score matching. Results DM-ESLD patients showed no differences in systolic indices of left ventricular ejection fraction and s’ velocity, whereas diastolic indices of E/A ratio ≤ 1 (49.0% vs. 40.2% P = 0.014), e’ velocity (median = 7.0 vs. 7.4 cm/s, P < 0.001) and E/e’ ratio (10.9 ± 3.2 vs. 10.1 ± 3.0, P < 0.001), showed worse diastolic function compare with Non DM-ESLD patients, respectively. Conclusions DM-ESLD patients suffer higher degree of diastolic dysfunction compared with Non DM-ESLD patients. Based on this, careful preoperative screening for diastolic dysfunction in DM-ESLD patients is encouraged, because poor transplant outcomes have been noted in patients with preoperative diastolic dysfunction.