Miracle-dz/UniFAR-FTUs huggingface dataset:
Current strategies for managing chronic thromboembolic pulmonary hypertension: results of the worldwide prospective CTEPH Registry

Background Pulmonary endarterectomy (PEA), pulmonary arterial hypertension (PAH) therapy and balloon pulmonary angioplasty (BPA) are currently accepted therapies for chronic thromboembolic pulmonary hypertension (CTEPH). This international CTEPH Registry identifies clinical characteristics of patients, diagnostic algorithms and treatment decisions in a global context. Methods 1010 newly diagnosed consecutive patients were included in the registry between February 2015 and September 2016. Diagnosis was confirmed by right heart catheterisation, ventilation–perfusion lung scan, computerised pulmonary angiography and/or invasive pulmonary angiography after at least 3 months on anticoagulation. Results Overall, 649 patients (64.3%) were considered for PEA, 193 (19.1%) for BPA, 20 (2.0%) for both PEA and BPA, and 148 (14.7%) for PAH therapy only. Reasons for PEA inoperability were technical inaccessibility (n=235), comorbidities (n=63) and patient refusal (n=44). In Europe and America and other countries (AAO), 72% of patients were deemed suitable for PEA, whereas in Japan, 70% of patients were offered BPA as first choice. Sex was evenly balanced, except in Japan where 75% of patients were female. A history of acute pulmonary embolism was reported for 65.6% of patients. At least one PAH therapy was initiated in 35.8% of patients (26.2% of PEA candidates, 54.5% of BPA candidates and 54.1% of those not eligible for either PEA or BPA). At the time of analysis, 39 patients (3.9%) had died of pulmonary hypertension-related causes (3.5% after PEA and 1.8% after BPA). Conclusions The registry revealed noticeable differences in patient characteristics (rates of pulmonary embolism and sex) and therapeutic approaches in Japan compared with Europe and AAO. There are distinct regional differences in the management of CTEPH patients but globally, the proportion of patients managed by PEA remains stable, independently of the new established treatment options of PAH therapies and BPA https://bit.ly/3zEXxkv
Public Awareness, Attitudes, and Adherence to COVID-19 Quarantine and Isolation in Saudi Arabia

Background This study aims to assess the general population’s awareness, attitude, and adherence regarding COVID-19 and quarantine in Saudi Arabia. Methods A descriptive cross-sectional design with a consecutive sampling method was used in this study. All accessible Saudi population during the study period were invited to participate in the survey from 1st April to 25th April 2020. The study questionnaire was constructed by the researchers based on experts’ consultation. Results A total sample of 1998 respondents with complete data was included in the survey. A total of 1936 participants reported that they were aware of regarding COVID-19 outbreak (96.9%). The most identified symptom was fever (92.3%; 1843), followed by respiratory distress (90.8%; 1813). About 81% of the participants reported that quarantine should be applied with travel or contact with infected persons. Also, 98.3% of the participants reported that the quarantine period should be a minimum of 14 days. In total, more than three-quarters of the participants had good awareness levels regarding COVID-19 and quarantine. Conclusion This study showed that the Saudi population had very high levels of awareness, adherence regarding COVID-19 quarantine and isolation measures.
Feasibility of Randomized Controlled Trials for Cancer Drugs Approved by the Food and Drug Administration Based on Single-Arm Studies

Abstract Background The US Food and Drug Administration (FDA) introduced an Accelerated Approval (AA) pathway to expedite patient access to new drugs. AA accepts less rigorous trial designs, including single-arm studies (SAS), owing to perceived lack of feasibility of timely randomized controlled trials (RCTs). Methods We designed hypothetical RCTs with endpoints of overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) for FDA approvals based on SAS for solid tumors during 2010-2019. Existing standards of care served as controls. RCTs were designed to detect a difference with power of 0.80, α-error of 5% (2-sided), and 1:1 randomization. Accrual duration was estimated based on participation by less than 5% of eligible patients derived from cancer-specific incidence and mortality rates in the United States. Results Of 172 (18.0%) approvals during the study period, 31 (18.0%) were based on SAS. Median sample size was 104 (range = 23-411), and 77.4% were AA. All studies reported ORR, 55% reported duration of response, 19.4% reported PFS, and 22.5% reported OS. Median sample sizes needed to conduct RCTs with endpoints of ORR, PFS, and OS were 206, 130, and 396, respectively. It would have been theoretically possible to conduct RCTs within duration comparable with that required by SAS for 84.6%, 94.1%, and 80.0% of approvals with endpoints of ORR, PFS, and OS, respectively. Conclusion An overwhelming majority of FDA approvals based on SAS should be feasible as RCTs within a reasonable time frame. Given the collateral harms to patients and to scientific rigor, drug approval based on SAS should only be permitted under exceptional circumstances.
Comparing the Sensitivities of Measures of Adherence to Antihypertensive Drugs Using Korean National Health Insurance Claims Data

Purpose Numerous studies have utilized various forms of adherence measures. However, methods for measuring adherence are inconsistent. Moreover, few studies are available that have compared sensitivities of the effects of several criteria on medication adherence. This study aims to compare measures of adherence using varied analytical decisions. Materials and Methods We included three measures for adherence: proportion of days covered with one or more medications (PDCwith≥1), duration weighted mean PDC (PDCwm), and daily polypharmacy possession ratio (DPPR). We compared the sensitivities of the measures by changing parameters in the Korean nationwide claims database. First, we used PDCwith≥1 as our base model. Then, we divided an adherence measure algorithm into three categories: (1) definition of data cleaning, (2) inclusion criteria and observation period, and (3) calculation methods of medication adherence. The categories included eight decision nodes that incorporated 25 alternative options. Finally, we assessed the medication adherence for the base-case with commonly used values and then varied to measure with each alternative option. Results The base-case included 14,288 beneficiaries with antihypertensives. Among eight decisions, both handling an end-date-of-study and overlaps had the strongest impacts on measuring PDCwith≥1, PDCwm, and DPPR, with small differences in sample size. Instead of the estimates of adherence from PDCwm, those of PDCwith≥1 and DPPR were similar. Furthermore, a tendency toward a higher medication adherence was observed with a smaller study population. Conclusion The decisions regarding identifying an end-date-of-study and overlaps showed meaningful impacts of all three measures including PDCwith≥1, PDCwm, and DPPR on measuring medication adherence.
Tuberculosis and Public Health Care Workers: Infection Prevention and Control Practices and Associated Factors Among Governmental Health Centers and Hospitals in Wolaita Zone, Southern Ethiopia

Purpose Institutional settings, including health care facilities, have been identified to be at high risk of tuberculosis (TB) transmissions. But no study has been conducted in hospitals and health centers concurrently in Wolaita Zone, Southern Ethiopia. Therefore, the aim of this study was to assess tuberculosis infection prevention and control (TBIPC) practices and associated factors among public health care workers in Wolaita Zone, Southern Ethiopia. Material and Methods A facility-based cross-sectional quantitative study supplemented with qualitative interview and observation was conducted in 16 sampled governmental health facilities in Wolaita Zone, Southern Ethiopia, from 25 July 2020 to 25 August 2020. A multistage sampling technique was used to select 748 health care workers, while purposive sampling was used to identify participants for the qualitative study. Results The proportion of proper TBIPC practices was 44.78%. Years of service (AOR=4.182, 95% CI: 2.024–8.639), working in a TB clinic (AOR=4.009, 95% CI: 1.311–12.261), working in an anti-retroviral therapy clinic (AOR=2.796, 95% CI: 1.009–7.743), TB-related training (AOR=0.024, 95% CI: 11.483–34.92), availability of personal protective equipment (AOR=1.712, 95% CI: 1.057–2.776), good knowledge of TBIPC measures (AOR=2.66, 95% CI: 1.119–4.196), and positive attitude (AOR=2.011, 95% CI: 1.242–3.255) were significantly associated with proper TBIPC practices. Conclusion and Recommendation The proportion of proper TBIPC practices among public health care workers was low in the study area. For better intervention, further studies could focus on experimental research into possible factors that are responsible for TBIPC practices in health care facilities in the study area.
Short- to Mid-Term Clinical Outcomes of Posterior-Stabilized Cementless Total Knee Arthroplasty with Trabecular Metal Components

Objective This study aimed to evaluate the short- to mid-term clinical results of posterior-stabilized trabecular metal total knee arthroplasty (TKA) with cementless fixation of all components and investigate the radiographic changes of tibial and patellar components and cut bone surfaces over time. Methods We retrospectively collected the data of 128 knees from 88 consecutive patients who had undergone initial TKA with NexGen LPS-Flex TM implants. A total of 66 knees from 45 patients (mean ± standard deviation age: 70.3 ± 7.5 years) met the selection criteria, which had been employed cementless fixation of all parts and at least 3 years of postoperative follow-up duration. Clinical evaluations included range of motion, conventional knee score, function score, postoperative complications, and revision. For radiological evaluations, the bone contact surface of each implant was divided into 7 zones for tibial component and 2 zones for patellar component. Each region was examined immediately after surgery, at 6 and 12 months, and then every year afterwards. Results The mean observation period of 45 subjects was 4.2 years. Adequate fixation of tibial components was maintained during follow-up, although the patellar components of 2 knees required revision after repeated falls. No loosening was observed in any implants. The initial gap in tibial components disappeared in all knees, and a reactive line remained in 4 knees. There were no revisions, except for 2 cases, which were ascribed to patellar component fracture caused by repeated falls. Conclusion Cementless posterior-stabilized trabecular metal TKA appears to be a good surgical option. Longer-term examination for revision cases is required to validate our results.
Vitamin D and Its Metabolites Deficiency in Acute Coronary Syndrome Patients Undergoing Coronary Angiography: A Case–Control Study

Background Vitamin D deficiency is considered an emerging health problem that affects at least one billion patients worldwide. Calcitriol 1,25(OH)2D3 has several systemic effects, including anti-inflammatory, anti-thrombotic and anti-atherosclerotic impacts that explain its cardioprotective effects. The precise association between vitamin D and its metabolites and the value of supplements in acute coronary syndrome (ACS) is still controversial. This study aims to search the association between vitamin D2, D3, and metabolites and ACS in patients undergoing coronary angiography. Materials and Methods This was a case–control study on 73 consecutive adult patients with ACS undergoing coronary angiography compared to 50 controls without coronary artery disease and matched for age and sex from June 2019 till July 2019. Echocardiography and coronary angiography were done for all cases. Plasma vitamin D and its metabolites were measured at admission for all participants along with chemistry profiles. Results Vitamin D and its metabolites were statistically significantly lower in ACS patients than the controls. Multivariate regression analysis revealed that low levels of 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) significantly predicted ACS occurrence; the other significant predictors were high systolic blood pressure (BP), high total cholesterol, and low high-density lipoprotein-cholesterol. Interestingly, vitamin D2 and D3 did not significantly predict ACS (p>0.05). We did not find a statistically significant association between the number of affected coronary vessels and vitamin D metabolites. Moreover, there was no statistically significant correlation between vitamin D and its metabolites and left ventricular ejection fraction measured by echocardiography. Conclusion There was a strong association between vitamin D and all its metabolites with ACS. Significantly, low 25(OH)D and 1,25(OH)2D predicted ACS, but vitamin D2 and D3 did not. Large randomized controlled trials are needed to verify the beneficial values of vitamin D supplementation in ACS patients.
Plasma Nesfatin-1: Potential Predictor and Diagnostic Biomarker for Cognitive Dysfunction in T2DM Patient

Purpose Nesfatin-1 plays a crucial role in glucose metabolism and cognitive function. This study aimed to investigate the correlation between plasma nesfatin-1 levels and clinical indicators and cognitive function in patients with type 2 diabetes mellitus (T2DM). Methods Demographic and medical history data, physical examination, and biochemical test results of 132 T2DM patients were collected. The plasma concentrations of nesfatin-1, C-reactive protein (CRP), interleukin-6 (IL-6), soluble triggering receptors expressed on myeloid cells 1 (sTREM1), and sTREM2 in T2DM patients were measured. Cognitive function was evaluated using the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A). The patients were divided into two groups: a low-nesfatin-1 group (n = 75) and a high-nesfatin-1 group (n = 57) based on a plasma nesfatin-1 concentration less than or above the 50th percentile value of all the samples. Results The results showed that plasma HbA1c levels were positively correlated with CRP, IL-6, sTREM1, and sTREM2 levels in patients with T2DM (P < 0.05). Plasma nesfatin-1 concentrations were positively associated with diabetes-related biochemical indicators including glycated haemoglobin (HbA1c), insulin, and homeostatic model assessment of insulin resistance (HOMA-IR), and inflammation-related indicators including CRP, IL-6, sTREM1, and sTREM2 among patients with T2DM (P < 0.05). Moreover, T2DM patients with high nesfatin-1 levels showed higher HbA1c and fasting plasma glucose (FPG) levels (P < 0.05). Furthermore, T2DM patients with high nesfatin-1 levels also showed higher BRIEF-A scores (P = 0.01). Additionally, T2DM patients with high total scores of BRIEF-A (scores > 50th percentile) could be identified with a sensitivity of 59.1% and a specificity of 72.7% by nesfatin-1. Conclusion These findings indicate that plasma nesfatin-1 might be involved in the T2DM-associated comorbidities and the development of cognitive dysfunction, and the mechanism underlying this involvement is related to the imbalance in the expression of CRP, IL-6, sTREM1, and sTREM2 levels.
Soil respiration variation along an altitudinal gradient in the Italian Alps: Disentangling forest structure and temperature effects

On the mountains, along an elevation gradient, we generally observe an ample variation in temperature, with the associated difference in vegetation structure and composition and soil properties. With the aim of quantifying the relative importance of temperature, vegetation and edaphic properties on soil respiration (SR), we investigated changes in SR along an elevation gradient (404 to 2101 m a.s.l) in the southern slopes of the Alps in Northern Italy. We also analysed soil physicochemical properties, including soil organic carbon (SOC) and nitrogen (N) stocks, fine root C and N, litter C and N, soil bulk densities and soil pH at five forest sites, and also stand structural properties, including vegetation height, age and basal area. Our results indicated that SR rates increased with temperature in all sites, and 55–76% of SR variability was explained by temperature. Annual cumulative SR, ranging between 0.65–1.40 kg C m-2 yr-1, decreased along the elevation gradient, while temperature sensitivity (Q10) of SR increased with elevation. However, a high SR rate (1.27 kg C m-2 yr-1) and low Q10 were recorded in the mature conifer forest stand at 1731 m a.s. l. , characterized by an uneven-aged structure and high dominant tree height, resulting in a nonlinear relationship between elevation and temperature. Reference SR at 10°C (SRref) was unrelated to elevation, but was related to tree height. A significant negative linear relationship was found between bulk density and elevation. Conversely, SOC, root C and N stock, pH, and litter mass were best fitted by nonlinear relationships with elevation. However, these parameters were not significantly correlated with SR when the effect of temperature was removed (SRref). These results demonstrate that the main factor affecting SR in forest ecosystems along this Alpine elevation gradient is temperature, but its regulating role can be strongly influenced by site biological characteristics, particularly vegetation type and structure, affecting litter quality and microclimate. This study also confirms that high elevation sites are rich in SOC and more sensitive to climate change, being prone to high C losses as CO2. Furthermore, our data indicate a positive relationship between Q10 and dominant tree height, suggesting that mature forest ecosystems characterized by an uneven-age structure, high SRref and moderate Q10, may be more resilient.
Cysteine-Rich Intestinal Protein 1 Served as an Epithelial Ovarian Cancer Marker via Promoting Wnt/β-Catenin-Mediated EMT and Tumour Metastasis

Objective To explore the expression, functions, and the possible mechanisms of cysteine-rich intestinal protein 1 (CRIP1) in epithelial ovarian cancer. Methods Using open microarray datasets from The Cancer Genome Atlas (TCGA), we identified the tumorigenic genes in ovarian cancer. Then, we detected CRIP1 expression in 26 pairs of epithelial ovarian cancer tissue samples by immunohistochemistry (IHC) and performed a correlation analysis between CRIP1 and the clinicopathological features. In addition, epithelial ovarian cancer cell lines A2780 and OVCAR3 were used to examine CRIP1 expression by western blot and qRT-PCR. Various cell function experiments related to tumorigenesis were performed including the CCK8 assay, EdU, Annexin V-FITC/PI apoptosis assay, wound healing, and Transwell assay. In addition, the expression of epithelial-mesenchymal transition (EMT) markers was detected by western blot to illustrate the relationship between CRIP1 and EMT. Furthermore, KEGG pathway enrichment analysis and western blot were conducted to reveal the signaling pathways in which CRIP1 is involved in ovarian cancer pathogenesis. Results CRIP1 was identified as an oncogene from the TCGA database. The IHC score demonstrated that the CRIP1 protein was expressed at a higher level in tumours than in tumour-adjacent tissues and was associated with a higher pathological stage, grade, and positive lymphatic metastasis. In cell models, CRIP1 was overexpressed in serous epithelial ovarian cancer. Cell function experiments showed that the knockdown of CRIP1 did not significantly affect cell proliferation or apoptosis but could exert an inhibitory effect on cell migration and invasion, and also induce changes in EMT markers. Furthermore, KEGG pathway enrichment analysis and western blot showed that CRIP1 could induce ovarian cancer cell metastasis through activation of the Wnt/β-catenin pathway. Conclusion This study is the first to demonstrate that CRIP1 acts as an oncogene and may promote tumour metastasis by regulating the EMT-related Wnt/β-catenin signaling pathway, suggesting that CRIP1 may be an important biomarker for ovarian cancer metastasis and progression.
Pharmacological blood pressure control and outcomes in patients with hypertensive crisis discharged from the emergency department

Pharmacological blood pressure (BP) intervention for high blood pressure is controversial for a wide spectrum of hypertensive crisis in the emergency department (ED). We evaluated whether medical control of BP altered the short- and long-term outcomes among patients with hypertensive crisis who were discharged from the ED under universal health care. This retrospective cohort comprised 22 906 adults discharged from the ED of a tertiary hospital with initial systolic BP ≥ 180 mmHg or diastolic BP ≥ 120 mmHg between 2010 and 2016. The main exposure was the use of antihypertensive medication during the ED stay. Clinical endpoints were revisits to the ED or inpatient admission (at 7, 30, and 60 days), cardiovascular mortality (at 1, 3, and 5 years), and incident stroke (at 1, 3, and 5 years). The associations between pharmacological intervention for BP and outcomes were evaluated using multivariable Cox proportional-hazards models. Of the patient data analyzed, 72.2% were not treated pharmacologically and 68.4% underwent evaluation of end-organ damage. Pharmacological intervention for BP was significantly associated with a 11% and 11% reduced risk of hospital revisits within 30 or 60 days of discharge from ED, respectively, particularly among patients with polypharmacy. No association between pharmacological intervention for BP and incident stroke and cardiovascular mortality was observed. A revision of diagnostic criteria for hypertensive crisis is essential. Although pharmacological intervention for BP may not alter the long-term risk of cardiovascular mortality, it significantly reduces short-term health care utilization.
Antifungal and Antibacterial Activities of Apple Vinegar of Different Cultivars

This study was designed to assess the antimicrobial potencies of apple vinegar against pathogenic microbes. The acidity and total phenolic content were carried out by titration with NaOH 0.1 N and the Folin–Ciocalteu method, respectively, while the spread plate method, agar well diffusion, and MIC assays were used to determine the antimicrobial activities of different vinegar samples. Acidity and phenolic content were dependent on the variety, where the highest values were observed in S2 with 4.02 ± 0.04% and 1.98 ± 0.05 mg GAE/mL for acidity and total phenolic content, respectively. The spread plate method revealed that samples S1 and S2 obtained from the Red delicious variety and Golden delicious variety, respectively, inhibit the growth of all tested strains, while S3 obtained from different varieties and S4 obtained from the Gala royal variety inhibit only two microbes (Escherichia coli and Vibrio cholerae). Sample S1 presented moderate antimicrobial effect against all examined strains with a diameter of inhibition ranging from 11 ± 0.7 to 19 ± 0.5 mm and with MIC values ranging between 1/2 and 1/100. The findings of the current study confirm the usefulness of apple vinegar as a natural sanitizer that inhibits the growth of pathogenic microbes.