Miracle-dz/UniFAR-FTUs huggingface dataset:
Factors Associated With Minimum Effective Volume of Lidocaine 1.5% for Sciatic Nerve Blocks

Objectives: The objectives of this study were to investigate the correlations between the minimum effective volume (MEV) of lidocaine 1.5% for an ultrasound-guided popliteal sciatic nerve block and individual factors including the cross-sectional nerve area, sex, age, body mass index, and the depth of the sciatic nerve and to evaluate the safety of combined femoral and sciatic nerve blocks by monitoring the plasma concentration of local anesthetics. Methods: Forty patients received combined single-shot femoral and continuous sciatic nerve blocks. The femoral nerve block was performed with an in-plane technique and 15 mL of lidocaine 1.5%. A continuous peripheral nerve block annular tube was positioned between the tibial and peroneal nerves inside the paraneural sheath. Thirty minutes after the femoral nerve block, a loading dose of 5 mL of lidocaine 1.5% was given to block the sciatic nerve after obtaining the maximum compound muscle action potential (CMAP) amplitude using nerve conduction studies. Additional lidocaine 1.5% was pumped at a rate of 30 mL/h through the indwelling annular tube if, after 8 minutes, the CMAP amplitude was still present. The CMAP amplitude monitored by the nerve conduction studies and pinprick tests were recorded every 2 minutes after the administration of lidocaine 1.5%. When the CMAP amplitude decreased to nearly 0 mV, this MEV was recorded. The influences of the cross-sectional area of the sciatic nerve, sex, age, body mass index, and the depth of the sciatic nerve on the MEV were analyzed using stepwise multiple linear regression. Blood samples were collected from 10 patients to evaluate the safety of combined femoral and sciatic nerve blocks by ultra-performance liquid chromatography-tandem mass spectrometry. Blood was drawn at 0 minutes before femoral nerve injection; 0 minutes before sciatic nerve injection; 8 minutes after sciatic nerve injection; and 0, 10, 20, 30, 45, 60, 75, 90, and 120 minutes after the pumping of lidocaine 1.5% stopped. Results: A significant correlation was found between the MEV of lidocaine 1.5% and the cross-sectional area of the sciatic nerve (r=0.459), with a regression equation of the MEV (mL)=5.969+0.095×(the cross-sectional area of the sciatic nerve). The coefficient of determination was 0.211 (P<0.05). The MEV of lidocaine 1.5% for complete sciatic nerve blocks ranged from 7 to 15 mL. The maximum concentrations of lidocaine, monoethylglycinexylidide, and glycinexylidide were 1672.9 (227.6), 265.7 (32.7), and 42.2 (22.4) ng/mL, respectively. Conclusions: There is a positive correlation between the cross-sectional area of the sciatic nerve and the MEV. The regression equation can help to predict the MEV of lidocaine 1.5% for popliteal sciatic nerve blocks. The maximum concentrations of lidocaine and its metabolites did not approach toxic threshold limits in this study.
Autonomic modulation of cardiac activity across levels of sleep depth in individuals with depression and sleep complaints.

OBJECTIVE We assessed mean heart rate (HR) and heart rate variability (HRV) across wake, rapid eye movement (REM) and non-rapid eye movement (NREM) sleep, and across varying levels of NREM sleep depth in individuals with depression and sleep complaints. METHODS Retrospective polysomnographic data were obtained for 25 individuals diagnosed with depression (84% female; mean age = 33.8±12.2 years) and 31 mentally healthy controls (58.1 % female; mean age = 37.2±12.4 years). All were free of psychotropic and cardiovascular medication, cardiovascular disease, and sleep-related breathing disorders. HR and time-domain HRV parameters were computed on 30-second electrocardiography segments and averaged across the night for each stage of sleep and wake. RESULTS Compared to the control group, the depression group had higher HR across wake, REM and all levels of NREM depth (F(1, 51)=6.3, p=. 015). Significant group by sleep stage interactions were found for HRV parameters: standard deviation of normal-to-normal intervals (SDNN; F(2.1, 107.7)=4.4, p=0.014), and root mean square differences of successive R-R intervals (RMSSD; F(2.2, 113.5)=3.2, p=. 041). No significant group difference was found for SDNN or RMSSD during wake (all p>.32). However, compared to the control group, the depression group had significantly lower SDNN in REM (p=.040) and all NREM stages (all p<.045), and lower RMSSD during NREM 2 (p=.033) and NREM 3 (p=.034). CONCLUSIONS This study suggests that the abnormalities in autonomic cardiac regulation associated with depression and sleep problems are more prominent during sleep, especially NREM sleep, than during wake. This may be due to abnormalities in parasympathetic modulation of cardiac activity.
Isolation and Characterization of [D-Leu1]microcystin-LY from Microcystis aeruginosa CPCC-464

[D-Leu1]MC-LY (1) ([M + H]+ m/z 1044.5673, Δ 2.0 ppm), a new microcystin, was isolated from Microcystis aeruginosa strain CPCC-464. The compound was characterized by 1H and 13C NMR spectroscopy, liquid chromatography–high resolution tandem mass spectrometry (LC–HRMS/MS) and UV spectroscopy. A calibration reference material was produced after quantitation by 1H NMR spectroscopy and LC with chemiluminescence nitrogen detection. The potency of 1 in a protein phosphatase 2A inhibition assay was essentially the same as for MC-LR (2). Related microcystins, [D-Leu1]MC-LR (3) ([M + H]+ m/z 1037.6041, Δ 1.0 ppm), [D-Leu1]MC-M(O)R (6) ([M + H]+ m/z 1071.5565, Δ 2.0 ppm) and [D-Leu1]MC-MR (7) ([M + H]+ m/z 1055.5617, Δ 2.2 ppm), were also identified in culture extracts, along with traces of [D-Leu1]MC-M(O2)R (8) ([M + H]+ m/z 1087.5510, Δ 1.6 ppm), by a combination of chemical derivatization and LC–HRMS/MS experiments. The relative abundances of 1, 3, 6, 7 and 8 in a freshly extracted culture in the positive ionization mode LC–HRMS were ca. 84, 100, 3.0, 11 and 0.05, respectively. These and other results indicate that [D-Leu1]-containing MCs may be more common in cyanobacterial blooms than is generally appreciated but are easily overlooked with standard targeted LC–MS/MS screening methods.
Serum Inflammatory Markers in Patients With Knee Osteoarthritis

Supplemental Digital Content is available in the text. Objectives: Osteoarthritis (OA) is known to be a slowly progressive disease that alters all tissue compartments of the joint involved with a characteristic degradation of the cartilage, bone remodeling, and inflammation. One of the prominent symptoms in OA patients is pain, but a few radiologic, inflammatory, or structurally related biomarkers have shown few if any associations with pain. This study aimed to assess serum levels of 92 markers involved in inflammatory pathways in patients with knee osteoarthritis (KOA) and evaluate their possible associations with the clinical pain intensity. Materials and Methods: Serum samples were collected from 127 KOA patients and 39 healthy participants with no knee pain. Each serum sample was analyzed for 92 inflammatory markers using the Proximity Extension Array (PEA) technology. Clinical pain intensity was assessed using a Visual Analog Scale, and patients completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Results: Fifteen markers were significantly different when comparing KOA patients and healthy participants. Two markers, fibroblast growth factor-21 and Eukaryotic translation initiation factor 4E-binding protein 1 (4E-BP1), correlated positively with pain intensity (R=0.235, P=0.008; R=0.233, P=0.008). Moreover, a linear regression model showed interleukin-6, macrophage colony-stimulating factor 1, fibroblast growth factor-21, and tumor necrosis factor superfamily member 12 (TWEAK) as significant independent parameters for pain intensity. Discussion: The associations between specific cytokines and KOA pain intensities provide new insights into the understanding of the underlying factors driving the pain in OA.
High Interest in Syphilis Pre-exposure and Post-exposure Prophylaxis Among Gay, Bisexual and Other Men Who Have Sex With Men in Vancouver and Toronto

There is considerable interest in syphilis preexposure (44.1%) and postexposure (60.1%) prophylaxis among gay, bisexual, and other men who have sex with men attending Toronto/Vancouver sexual health clinics. Background We assessed the acceptability of doxycycline-based syphilis pre-exposure and post-exposure prophylaxis (PrEP/PEP) as well as human immunodeficiency virus (HIV) PrEP/PEP in gay, bisexual, and other men who have sex with men (gbMSM). Methods We recruited gbMSM from Toronto and Vancouver sexually transmitted infection (STI) clinics during routine visits from June 2018 to August 2018. We analyzed data using descriptive statistics and constructed multivariable logistic regression models for willingness to use syphilis and HIV PrEP and PEP respectively. Results Among 424 participants (56.4% Toronto, 43.6% Vancouver), median (interquartile range [IQR]) age was 31.0 years (26.0–39.0 years), 61.7% had completed postsecondary education and 54.4% were white. Median (IQR) number of male partners in the past 6 months was 6.0 (3.0–13.0), and 18.2% had 1 or more prior syphilis diagnosis. 60.1%/44.1% indicated willingness to use syphilis PEP/PrEP; 36.6% were unwilling to use either. Among HIV-negative participants, 74.0% and 75.2% were willing to use HIV PrEP and PEP, respectively. Most participants were familiar with antibiotic resistance (89.0%) and agreed that syphilis rates are rising in Canada (68.2%), but only 55.4% believed they were at risk for syphilis. Agreement with the latter statement was associated with willingness to use syphilis PrEP (adjusted odds ratio [aOR], 1.6; 95% confidence interval [95%CI], 1.0–2.5), as was previous/existing HIV PrEP use (aOR, 2.2; 95% CI, 1.1–4.3) and being “very concerned” about STI acquisition (aOR, 1.9; 95% CI, 1.0–3.4). Odds of being willing to use syphilis PEP were higher in Toronto versus Vancouver (aOR, 2.0; 95% CI, 1.2–3.4) and increased with the number of different STIs previously diagnosed (aOR, 1.4; 95% CI, 1.2,1.7). Conclusions There is considerable interest in syphilis PrEP/PEP in gbMSM attending Toronto/Vancouver STI clinics.
Prostate-Specific Membrane Antigen Expression in Primary Juvenile Nasal Angiofibroma-A Pilot Study.

PURPOSE Prostate-specific membrane antigen (PSMA) is highly expressed in prostate cancer cells and is exploited for imaging and treatment of patients with prostate cancer. Prostate-specific membrane antigen expression is also demonstrated in the tumor-associated neovasculature endothelium. Juvenile nasal angiofibroma (JNA), being a similar highly vascular tumor, may also demonstrate significant PSMA expression, which may be utilized for its imaging and treatment. METHODS In this prospective study, 25 clinicoradiologically diagnosed primary JNA patients underwent PSMA PET/CT scan. The scan was performed after 45 to 60 minutes of intravenous injection of 2 to 3 mCi (74-111 MBq) of Ga-PSMA-HBED-CC on a dedicated PET/CT scanner. Low-dose CT scan was acquired from vertex to sternoclavicular joint (100 mA, 20 kVp, 3-mm slice thickness, 0.8 pitch). Images were reconstructed with iterative reconstruction technique (4 iterations, 24 subsets). The objective was to assess the intensity and pattern of PSMA uptake in primary JNA patients. RESULTS All cases (n = 25) of primary JNA showed PSMA expression in the tumor (100%). The median PSMA SUVmax ratio of tumor to background was 4.57 (range, 2.08-7.27). Intracranial extension in 14 of 25 patients was prominently visualized because of absence of background uptake in the brain. Advanced stage tumors demonstrated greater uptake than early tumors (P = 0.011). A statistically nonsignificant trend was noted for decreasing uptake with increasing age after normalizing for stage (Spearman correlation coefficient r = -0.08). CONCLUSIONS Assessment of PSMA expression in JNA by PSMA PET/CT opens up a new window of opportunity with respect to its radiological staging, vascularity assessment, and molecular characterization. A potential role in identification of the difficult residual-recurrent disease is anticipated and perhaps also in radioligand therapy for residual/recurrent JNA.Clinical Trials Registry of India (CTRI/2018/08/015479).
“Sim One, Do One, Teach One”

Supplemental digital content is available in the text. Objectives The objective of this study was to determine the effectiveness of a simulation-based curriculum in improving confidence in trauma resuscitation skills and increasing attendance during trauma resuscitations for pediatric residents during their emergency medicine rotation. Methods A simulation-based orientation curriculum was implemented for the 2017–2018 academic year. Participants completed a qualitative survey before and after each session to assess their comfort level with skills required in a trauma resuscitation. Responses were compared using the Wilcoxon ranked sum test. Nursing documentation was reviewed for the 2016–2017 and 2017–2018 academic years to determine the frequency of resident attendance at trauma resuscitations. Pediatric resident attendance before and after intervention were compared via χ2 analysis. Results Survey responses showed a significant increase in confidence in all skills assessed, including primary and secondary survey performance, knowledge of pediatric resident role, knowledge of necessary equipment, ability to determine acuity of patient illness or injury, and ability to differentiate between modes of oxygen delivery (P < 0.01). There was no statistically significant change in the frequency of pediatric resident attendance at trauma bay resuscitations before and after curriculum implementation (21.2% vs 25.7%, P = 0.09). Conclusions Through the implementation of a simulation-based trauma orientation for pediatric residents, we were able to improve self-reported confidence in trauma resuscitation skills. This improvement did not result in an increased attendance at trauma resuscitations. Next steps include identifying additional barriers to pediatric resident attendance at trauma bay resuscitations.
Genotypes and estimated prevalence of phosphomannomutase 2 deficiency in Turkey differ significantly from those in Europe

Phosphomannomutase 2 deficiency (PMM2‐CDG) is an autosomal recessive congenital disorder of glycosylation, characterized by multisystem phenotypes, mostly including neurological involvement. In Turkey, due to high rates of consanguinity, many patients with autosomal recessive disorders have homozygous variants and these diseases are more common, compared to Europe. However, published reports of PMM2‐CDG from Turkey are scarce. Here, we describe clinical and molecular characteristics of PMM2‐CDG patients diagnosed in three centers in Turkey, using data obtained retrospectively from hospital records. We also analyzed an in‐house exome database of 1,313 individuals for PMM2 variants and estimated allele, carrier and disease frequencies, using the Hardy–Weinberg law. Eleven patients were identified from 10 families, displaying similar characteristics to previous publications, with the exception of the first report of epilepsia partialis continua and increased prevalence of sensorineural hearing loss. p.Val231Met was the most common variant, and was homozygous in four patients. This novel genotype results in a neurological phenotype with subclinical visceral involvement. Exome database analysis showed an estimated prevalence of 1:286,726 for PMM2‐CDG, which is much lower than expected (1:20,000 in Europe) because of the lack of predominance of the common European p.Asp141His allele, associated with a severe phenotype (allele frequency of 1:2,622 compared to 1:252 in gnomAD). These data suggest that prevalence, phenotypes and genotypes of PMM2‐CDG in Turkey differ significantly from those in Europe: Milder phenotypes may be more common, but the disease itself rarer, requiring a higher clinical suspicion for diagnosis. The association of sensorineural hearing loss with PMM2‐CDG warrants further study.
Retraction: Use of Granulocyte Colony-Stimulating Factor for the Treatment of Thin Endometrium in Experimental Rats

After this article [1] was published, PLOS ONE was notified of similarities between lanes 1–3 in the Vimentin, CK19, and β-actin blots shown in Fig 3 of the PLOS ONE article, and panels in Fig 3A of a Fertility and Sterility article [2]. The western blot data represented results of different experiments in the two articles as detailed in the Methods sections. [1] and [2] were under review during overlapping periods, but the authors did not declare the related submission to the PLOS ONE Editors as is required by journal policy. Lanes 1–3 of the Vimentin and β-actin panels and lane 1, 4 of the CK19 panel in Fig 3 [1] are also similar to results reported in Fig 3A of [3] (later corrected in [4] to provide updated Figs 2–4). The figures in these articles were used to represent results of different experiments, as detailed in the Methods sections. The authors commented that they had made an error in preparing Fig 3 for the PLOS ONE article, and provided images in support of the CK19 and Vimentin results. However, these files did not clarify the concerns about data reporting in Fig 3. The authors noted that the western blots were done by a colleague whose contributions were not indicated in the published article, and that the authors received the results in figure form but did not obtain the original raw blot images. The underlying data for the western blots and for other results reported in the article are not available. The authors apologized for the above issues and requested retraction of the PLOS ONE article, yet also commented that they are confident in the findings and stand by the published results. In light of the above concerns, the PLOS ONE Editors retract this article. Note, Fig 3 [1] reports material from [2], published earlier in 2013 [Elsevier, Inc. on behalf of the American Society for Reproductive Medicine], which is not offered under a CC-BY license. Fig 3 is therefore excluded from this article’s [1] license. At the time of retraction, the article [1] was republished to note this exclusion in the Fig 3 legend and the article’s copyright statement. JZ, TT, YL agreed with retraction. QZ, YW either could not be reached or did not respond directly.
Anti-GQ1b antibody syndrome presenting with visual deterioration as the initial symptom

Abstract Rationale: Anti-GQ1b antibody syndrome refers to a distinct variant of Guillain– Barré syndrome. Involvement of the optic nerve in anti-GQ1b antibody syndrome is extremely rare. Patient concerns: Here, we report a case of anti-GQ1b antibody syndrome presenting with visual deterioration as the initial symptom. A 73-year-old man presented with a 5-day history of bilateral blurred vision and ptosis. He had a previous history of diarrhea starting 10 days before admission. Physical examination showed visual deterioration, ophthalmoplegia, and peripheral facial paralysis. Testing of both serum and cerebrospinal fluid was positive for anti-GQ1b immunoglobulin G antibodies and negative for anti-aquaporin 4antibodies. Diagnosis: Anti-GQ1b antibody syndrome. Interventions: The patient was treated with intravenous methylprednisolone and human immunoglobulin. Outcomes: After a 20-day follow-up, the patient's condition took a favorable turn. Lessons: This case reminds us that anti-GQ1b antibody syndrome should be suspected in patients with visual deterioration and preceding infection.
Does Empathy Decline in the Clinical Phase of Medical Education? A Nationwide, Multi-Institutional, Cross-Sectional Study of Students at DO-Granting Medical Schools

Purpose To examine differences in students’ empathy in different years of medical school in a nationwide study of students of U.S. DO-granting medical schools. Method Participants in this cross-sectional study included 10,751 students enrolled in 41 of 48 campuses of DO-granting medical schools in the United States (3,616 first-year, 2,764 second-year, 2,413 third-year, and 1,958 fourth-year students). They completed a web-based survey at the end of the 2017–2018 academic year that included the Jefferson Scale of Empathy and the Infrequency Scale of the Zuckerman-Kuhlman Personality Questionnaire for measuring “good impression” response bias. Comparisons were made on empathy scores among students in different years of medical school using analysis of covariance, controlling for the effect of “good impression” response bias. Also, comparisons were made with preexisting data from students of U.S. MD-granting medical schools. Results A statistically significant decline in empathy scores was observed when comparing students in the preclinical (years 1 and 2) and the clinical (years 3 and 4) phases of medical school (P < .001); however, the magnitude of the decline was negligible (effect size =0.13). Comparison of findings with MD students showed that while the pattern of empathy decline was similar, the magnitude of the decline was less pronounced in DO students. Conclusions Differences in DO-granting and MD-granting medical education systems, such as emphasis on provision of holistic care, hands-on approaches to diagnosis and treatment, and patient-centered care, provide plausible explanations for disparity in the magnitude of empathy decline in DO compared with MD students. More research is needed to examine changes in empathy in longitudinal study and explore reasons for changes to avert erosion of empathy in medical school.
Effects of concurrent training on irisin and fibronectin type-III domain containing 5 (FNDC5) expression in visceral adipose tissue in type-2 diabetic rats

Abstract Context Evidence suggests that myokines could have clinical implications for metabolic diseases such as type-2 diabetes. Objective We investigated the effects of concurrent training (CT) on irisin and fibronectin type-III domain containing five (FNDC5) expressions in visceral adipose tissue (VAT) in type-2 diabetic rats. Materials and methods Eighteen male Wistar rats (ages four to eight weeks) became diabetic using nicotinamide and streptozotocin and were assigned to either a control (CON) or a CT group using a randomised block design. The CT group exercised on a motor-driven treadmill at 60 to 75 per cent of VO2max (0% grade) for 10–40 min/day (aerobic training) and performed 10 climbs on a 1-meter ladder utilising weighted resistance of 30–100% of body mass (resistance exercise) for 5 days/week over 8 weeks. Forty-eight hours after the last training session, the VAT of rats was removed and washed. FNDC5-relative gene expression and irisin were measured by the reverse transcription polymerase chain reaction (RT-PCR) method and enzyme-linked immunosorbent assay (ELISA) kit. Additionally, insulin resistance and plasma insulin and glucose levels were determined. Results Our findings revealed that CT significantly increased FNDC5-relative gene expression in the VAT of type-2 diabetic rats compared to controls. Furthermore, eight weeks of CT improved insulin resistance and insulin and glucose levels but did not significantly alter irisin levels in type-2 diabetic rats. Discussion and conclusion The results of this study demonstrated that CT increased FNDC5 mRNA and improved insulin resistance, insulin, and glucose levels. Also observed were increased trends (non-significant, p = .051) in irisin levels. Hence, CT may play a role in attenuating metabolic disorders such as obesity and type-2 diabetes.