Miracle-dz/UniFAR-FTUs huggingface dataset:
The effect of preoperative embolization on surgical outcomes for carotid body tumor resection

Objective: Compare the effects of preoperative embolization for carotid body tumor resection on surgical outcomes to carotid body tumor resections without preoperative embolization. Methods: Single-center retrospective review of all consecutive patients who underwent carotid body tumor resection from 2001 to 2019. Surgical outcomes with emphasis on operative time (estimated blood loss and cranial nerve injury) of patients undergoing carotid body tumor resection following preoperative embolization were compared to those undergoing resection alone using unpaired Student’s t-test and Fisher’s exact test. Results: Forty-six patients (15% male, mean age 50 ± 15 years) underwent resection of 49 carotid body tumors. Patients undergoing preoperative embolization (n = 20 (40%)) had larger mean tumor size (4.0 ± 0.7 vs 3.2 ± 1 cm, p = 0.006), increased Shamblin II/III tumor classification (18 (90%) vs 22 (76%), p < 0.001), operative time (337 ± 195 vs 199 ± 100 min, p = 0.004), and cranial nerve injuries overall (8 (40%) vs 2 (10%), p = 0.01) compared to patients undergoing resection without preoperative embolization (n = 29 (60%)). In subgroup analysis of Shamblin II/III classification tumors (n = 40), preoperative embolization (n = 18) was associated with increased tumor size (4.1 ± 0.6 vs 3.5 ± 0.9 cm, p = 0.01), operative time (351 ± 191 vs 244 ± 105 min, p = 0.02), and cranial nerve injury overall (8 (44%) vs 2 (9%), p = 0.03) compared to resections alone (n = 19). In further subgroup analysis of large (⩾ 3 cm) tumors (n = 37), preoperative embolization (n = 18) was associated with increased operative time (350 ± 191 vs 198 ± 99 min, p = 0.006) and cranial nerve injury overall (8 (44%) vs 2 (11%), p = 0.03) compared to resections alone (n = 19). There were no significant differences in estimated blood loss, transfusion requirement, or hematoma formation between any of the embolization and non-embolization subgroups. Conclusion: After controlling for tumor Shamblin classification and size, carotid body tumor resections following preoperative embolization were associated with increased operative time and inferior surgical outcomes compared to those tumors undergoing resection alone. Nonetheless, such results remain susceptible to the confounding effects of individual tumor characteristics often used in the decision to perform preoperative embolization, underscoring the need for prospective studies evaluating the utility of preoperative embolization for carotid body tumors.
Apathy, Cognitive Impairment, and Social Support Contribute to Participation in Cognitively Demanding Activities Poststroke

Objective To understand the extent to which apathy, cognition, and social support predict participation in activities with cognitive demands. Design Prospective, quantitative correlational, cross-sectional study. Setting. Outpatient treatment centers and community stroke support groups located in St. Louis, MO, and Boston, MA. Participants. 81 community-dwelling individuals ≥ 6-month poststroke with and without aphasia. Measures. Participants completed the Activity Card Sort (ACS), Apathy Evaluation Scale (AES), Medical Outcomes Study Social Support Survey (MOS-SSS), and Delis-Kaplan Executive Function System (DKEFS) Design Fluency and Trail-Making subtests. Results Cognitive deficits limit participation in activities with high cognitive demands. Apathy and positive social interaction influence participation, regardless of high or low cognitive demands. Poststroke aphasia did not impact return to participation in activities with high and low cognitive demands. Conclusions and Relevance. Cognitive deficits seen poststroke contribute to participation only for activities with high cognitive demands. Apathy has a significant and negative influence on participation overall. Social support is a modifiable contextual factor that can facilitate participation. Poststroke apathy can be detrimental to participation but is not well recognized. The availability of companionship from others to enjoy time with can facilitate participation.
Safety and Tolerability of Cariprazine in Patients with Schizophrenia: A Pooled Analysis of Eight Phase II/III Studies

Background Long-term treatment with antipsychotic agents is indicated for patients with schizophrenia, but treatment is associated with adverse events (AEs) that contribute to medication discontinuation and nonadherence. Understanding drug safety profiles is critical to avoid unwanted side effects. Cariprazine is a potent dopamine D3/D2 receptor partial agonist that is approved for the treatment of adults with schizophrenia (EU, US) and acute manic/mixed and depressive episodes associated with bipolar I disorder (US). Methods Post hoc analyses were conducted to characterize the safety profile of cariprazine within the recommended 1.5–6 mg/d dose range for schizophrenia; data from 8 short- or long-term clinical trials were analyzed. Results In the pooled cariprazine-treated safety population (n=2048), the rate of study completion was 52.8%, with withdrawal of consent, insufficient response, and AEs the most common reasons for premature discontinuation. The most commonly reported AEs (>10%) in the overall cariprazine-treatment group were akathisia (14.6%), insomnia (14.0%), and headache (12.1%); most AEs were considered mild (71.0%) or moderate (26.5%). Most akathisia was mild/moderate (97.5%) and >93% of patients remained on treatment; akathisia events were managed by rescue medications (56.3%) or dose reduction (18.3%). The metabolic profile of cariprazine was neutral in patients with short- and long-term exposure; mean weight gain was 1 kg for overall cariprazine, with an AE of weight increased reported for 5.1%. Other AEs of special interest that occurred at >3% for overall cariprazine were extrapyramidal disorder (7.0%), sedation (3.7%), and somnolence (3.1%); prolactin elevation, cognition impairment, sexual dysfunction, suicidality, and QT prolongation occurred at ≤1%. Conclusion Akathisia, the most common cariprazine-related AE, was mild/moderate and resulted in few study discontinuations; symptoms were well managed and most patients remained on treatment. Results of this analysis indicated that cariprazine in the recommended dose range was safe and generally well tolerated in patients with schizophrenia. Trial Registration Studies registered with ClinicalTrials.gov (NCT00404573, NCT01104779, NCT00694707, NCT01104766, NCT01104792, NCT00839852, and NCT01412060) and EudraCT (2012–005485-36).
Iron and Folic Acid Supplementation Compliance and Associated Factors among Pregnant Women Attending Antenatal Clinic in Shalla District, Southwest Ethiopia: A Cross-Sectional Study

Background Iron-folate supplementation for a pregnant mother is a cost-effective intervention to reduce iron deficiency anemia during pregnancy. The aim of this study was to assess the iron-folic acid supplements and associated factors among pregnant women attending antenatal clinics in the public health center of Shalla district, Southwest Ethiopia. Methods Institutional-based cross-sectional study design was conducted among 402 randomly selected pregnant mothers between February and April 2019. Data were collected using an interviewer-administered structured questionnaire from pregnant mothers attending antenatal care and using iron-folate supplements. Descriptive and multivariate logistic regression analyses were employed. Results Pill count compliance rate was found to be (154) 38.3%. Pregnant mothers who had anemia in their previous pregnancy [(AOR = 11.35, 95% CI: 4.76–27.03)], counseling on iron-folate supplements [(AOR = 11.39, 95% CI: 5.09–27.03)], awareness of the benefit of the iron-folate supplements [(AOR = 2.22, 95% CI: 1.18–3.92)], and being a member of the Health Development Army [(AOR = 2.11, 95% CI: (1.2, 3.9)] were significantly associated with compliance with iron-folate supplement. Conclusion Compared to the World Health Organization cut-off point, the pill count compliance rate of iron-folate supplementation among pregnant women in the study area was very low. Previous history of anemia and lack of knowledge about its benefit were some of the factors associated with it. Therefore, the healthcare providers should give continuous awareness creation and counseling services focusing on the benefit of iron-folate supplementation for pregnant mothers and their neonates.
Arsenic transfer along the soil-sclerotium-stroma chain in Chinese cordyceps and the related health risk assessment

Background Chinese cordyceps (Lepidoptera: Ophiocordyceps sinensis)is a larval-fungus complex. The concentration and distribution of arsenic (As) may vary during the stroma (ST) germination process and between the sclerotium (SC) and the ST. The soil-to-Chinese cordyceps system is an environmental arsenic exposure pathway for humans. We studied the As concentration in the soil, the SC, and the ST of Chinese cordyceps, and performed a risk assessment. Methods Soil and Chinese cordyceps samples were collected from the Tibetan Plateau in China. The samples were analyzed for the total As concentration and As species determination, which were conducted by inductively coupled plasma mass spectrometry (ICP-MS) and HPLC-ICP-MS, respectively. Results The concentration of total As in the soil was much higher than in SC and ST. The major As species in the soil was inorganic AsV. In SC and ST, organic As was predominant, and the majority of As was an unknown organic form. There are significant differences in the As distribution and composition in soil, SC, and ST. Our risk assessment indicated that chronic daily ingestion was higher than inhalation and dermal exposure in children and adults. The hazard index (HI) of the non-carcinogenic and cancer risks (CR) for human health were HI ≤ 1 and CR < 1 × 10−4, respectively. Conclusion The Chinese cordyceps possesses highly-efficient detoxifying characteristics and has a significant role in As transformation during its life cycle. We found that the levels of As in soils from the habitat of Chinese cordyceps were higher than the soil background values in China, but the probability for incurring health risks remained within the acceptable levels for humans.
Magnitude of Mycobacterium tuberculosis Infection and Its Resistance to Rifampicin Using Xpert-MTB/RIF Assay Among Presumptive Tuberculosis Patients at Motta General Hospital, Northwest Ethiopia

Background Mycobacterium Tuberculosis (MTB) and its drug resistance form are the devastating infectious diseases in the world. It is the major cause of morbidity and mortality in low-income countries with Ethiopia carrying a heavy burden. Data on the magnitude of MTB and rifampicin resistance using Xpert- MTB/RIF assay is limited in the study area. Therefore, this study aimed to assess the prevalence of Mycobacterium tuberculosis and rifampicin resistance among presumptive TB patients using GeneXpert at Motta General Hospital, North West Ethiopia. Methods A retrospective cross-sectional study was conducted from 1st October to 30 November 2020 among patients tested for GeneXpert at Motta General Hospital, Northwest Ethiopia. Data recorded on GeneXpert test results were collected on laboratory registration book in Microbiology laboratory. Data were analyzed by using the Statistical Package for Social Sciences (SPSS) version 20. Results A total of 4109 specimens were tested using the GeneXpert automated system. Of these, the majority 2148 (52.3%) of participants were males and 1961 (47.7%) were females. Similarly, about 1553 (37.8%) were in the age range of 25–44 years followed by 1347 (32.8%) in 45–64 years. Moreover, about 2486 (60.5%) participants were from rural. The overall prevalence of M. tuberculosis was 346 (8.4%) among these, the majority 222 (5.4%) had unknown HIV status, 48 (1.2%) were HIV positive, and 314 (7.6%) was new MTB cases. The overall prevalence of rifampicin resistance was 15 (4.3%) and 8(1.7%) were intermediate. Among rifampicin resistance, 10 (2.9%) were males, 8(2.3%) lived in rural, 9 (2.6%) had unknown HIV status, 13 (3.8%) were new TB patients, and 13 (3.8%) had pulmonary tuberculosis. Conclusion The prevalence of M. tuberculosis was 8.4% and relatively higher rate of rifampicin-resistant M. tuberculosis was found.
Detection of SARS-CoV-2 specific IgA in the human milk of COVID-19 vaccinated, lactating health care workers

Importance: In 2019, a deadly virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for COVID-19, emerged. In December 2020, two mRNA-based COVID-19 vaccines were approved for use in the United States (US) which provide immunity to those receiving the vaccine. Maternally derived antibodies are a key element of infants' immunity. Certain vaccines given to pregnant and lactating mothers provide immunity to infants through transmission across the placenta, umbilical cord (IgG) and human milk (IgA). Human milk produced by mothers with a history of COVID-19 infection contains SARS-CoV-2 IgA and IgG. Objective: To determine whether SARS-CoV-2 specific immunoglobulins are found in human milk after the COVID-19 vaccination, and to characterize the types of immunoglobulins present. Design, setting and participants: This is a prospective observational study conducted at Shands Hospital, University of Florida from December 2020 to March 2021. Twenty-two lactating healthcare workers who received the SARS-CoV-2 mRNA vaccine (Pfizer/BioNtech or Moderna) made up the sample group. Plasma and human milk were collected at three-time points (pre-vaccination, post first vaccine dose , and post-second vaccine dose). SARS-CoV-2 specific IgA and IgG in human milk and in plasma were measured by ELISA. Maternal demographics was compiled. Exposures: Pfizer/BioNtech or Moderna vaccination. Main outcome and measure: Levels of SARS-CoV-2 IgA and IgG in human milk and plasma. Results: We found significant secretion of SARS-CoV-2 specific IgA and IgG in human milk and plasma after SARS-CoV-2 vaccination. Conclusions and relevance: Our results show that the mRNA-based COVID-19 vaccines induce SARS-CoV-2 specific IgA and IgG secretion in human milk. Further studies are needed to determine the duration of this immune response, its capacity to neutralize the COVID-19 virus, the transfer of passive immunity to breastfeeding infants, and the potential therapeutic use of human milk IgA to combat SARS-Cov-2 infections and COVID-19.
Impaired HA-specific T follicular helper cell and antibody responses to influenza vaccination are linked to inflammation in humans.

Antibody production following vaccination can provide protective immunity to subsequent infection from pathogens such as influenza. However, circumstances where antibody formation is impaired after vaccination, such as in older people, require us to better understand the cellular and molecular mechanisms that underpin successful vaccination in order to improve vaccine design for at risk groups. Here, by studying the breadth of anti-hemagglutinin (HA) IgG, serum cytokines, and B and T cell responses by flow cytometry before and after influenza vaccination, we show that formation of circulating T follicular helper cells (cTfh) cells are the best predictor of high titre antibody responses. Using MHC class II tetramers we demonstrate that HA-specific cTfh cells can derived from pre-existing memory CD4+ T cells and have a diverse TCR repertoire. In older people, the differentiation of HA-specific cells into cTfh cells was impaired. This age-dependent defect in cTfh cell formation was not due to a contraction of the TCR repertoire, but rather was linked with an increased inflammatory gene signature in cTfh cells. Together this suggests that strategies that temporarily dampen inflammation at the time of vaccination may be a viable strategy to boost optimal antibody generation upon immunisation of older people.
Volumetric lung cancer screening reduces unnecessary low-dose computed tomography scans: results from a single-centre prospective trial on 4,119 subjects

Purpose. To compare low-dose computed tomography (LDCT) outcome and volume-doubling time (VDT) derived from measured volume (MV) and estimated volume (EV) of pulmonary nodules (PN) detected in a single-centre lung cancer screening trial. Materials and Methods. MV, EV and VDT were obtained for prevalent pulmonary nodules detected at the baseline round of the bioMILD trial. LDCT outcome (based on bioMILD thresholds) and VDT categories were simulated on a PN- and a screenees-based analysis. Weighted Cohen's kappa test was used to assess the agreement between diagnostic categories as per MV and EV. Results. 1,583 screenees displayed 2,715 pulmonary nodules. On a PN-based analysis 40.1% PNs would have been included in different LDCT categories if measured by MV or EV. Agreement between MV and EV was moderate ({kappa} = 0.49) and fair ({kappa} = 0.37) for LDCT outcome and VDT categories, respectively. On a screenees-based analysis, 46% pulmonary nodules would have been included in different LDCT categories if measured by MV or EV. Agreement between MV and EV was moderate ({kappa} = 0.52) and fair ({kappa} = 0.34) for LDCT outcome and VDT categories, respectively. Conclusions. Within a simulated lung cancer screening based on recommendation by estimated volumetry, the number of LDCT performed for the evaluation of pulmonary nodules would be higher as compared to the prospective volumetric management.
A High Activity Level Is Required for Augmented Muscle Capillarization in Older Women

Supplemental digital content is available in the text. ABSTRACT Purpose This study aimed to evaluate the influence of lifelong regular physical activity on skeletal muscle capillarization in women. Methods Postmenopausal women, 61±4 yr old, were divided according to self-reported physical activity level over the past 20 yrs: sedentary (SED; n = 14), moderately active (MOD; n = 12), and very active (VERY; n = 15). Leg blood flow (LBF) was determined by ultrasound Doppler, and blood samples were drawn from the femoral artery and vein for calculation of leg oxygen uptake (LVO2) at rest and during one-legged knee extensor exercise. A skeletal muscle biopsy was obtained from the vastus lateralis and analyzed for capillarization and vascular endothelial growth factor (VEGF) and mitochondrial OXPHOS proteins. Platelets were isolated from venous blood and analyzed for VEGF content and effect on endothelial cell proliferation. Results The exercise-induced rise in LBF and LVO2 was faster (P = 0.008) in VERY compared with SED and MOD. Steady-state LBF and LVO2 were lower (P < 0.04) in MOD and VERY compared with SED. Capillary–fiber ratio and capillary density were greater (P < 0.03) in VERY (1.65 ± 0.48 and 409.3 ± 57.5) compared with MOD (1.30 ± 0.19 and 365.0 ± 40.2) and SED (1.30 ± 0.30 and 356.2 ± 66.3). Skeletal muscle VEGF and OXPHOS complexes I, II, and V were ~1.6-fold and ~1.25-fold (P < 0.01) higher, respectively, in VERY compared with SED. Platelets from all groups induced an approximately nine-fold (P < 0.001) increase in endothelial cell proliferation. Conclusion A very active lifestyle is associated with superior skeletal muscle exercise hemodynamics and greater potential for oxygen extraction concurrent with a higher skeletal muscle capillarization and mitochondrial capacity.
Circulating miR-449a predicts survival outcome for colorectal cancer following curative resection

Abstract Previous studies showed that microRNA (miR)-449a may function as a tumor suppressor. However, the expression pattern and value of circulating miR-449a in colorectal cancer (CRC) remain unclear. Therefore, the purpose of this study was to measure circulating miR-449a level of CRC patients and evaluate its value for predicting prognosis. Plasma samples of 343 consecutive CRC patients and 162 healthy controls were obtained. Circulating miR-449a levels were measured by using real-time quantitative reverse transcription polymerase chain reactions. All enrolled patients were followed up in a regular interval after surgery. The clinical data and survival outcome of all 343 patients were collected. The correlation between circulating miR-449a level and survival outcomes was analyzed by univariate and multivariate analysis. Circulating miR-449a level in CRC patients was significantly decreased (P < .05) comparing with healthy controls. Low miR-449a was significantly associated with CEA and CA19-9 level (both P < .05). Furthermore, patients with a decreased miR-449a level had a lower 5-years overall survival (OS) rate than those with a high miR-449a (67.4% vs 76.9%, P = .03). Low circulating miR-449a level also been demonstrated as an independent risk factor for CRC in multivariate COX analysis (HR, 2.56; 95%CI: 1.15–8.63; P < .05). Circulating miR-449a was significantly decreased in CRC patients and closely related to poor prognosis, suggesting that miR-449a might can be used as a useful diagnostic and prognostic marker for CRC.
Procedural training models among emergency medicine residency programs

Objective Optimal training methods remain controversial for rarely performed emergency procedures. Previous research has failed to demonstrate the superiority or inferiority of live anesthetized animal models (LAA) as compared to other modalities. Most of the data on LAA use comes from military contexts; less information is available for civilian emergency medicine (EM) training. We sought to characterize the prevalence of LAA use among civilian EM residency programs and reasons for its use or discontinuation. Methods Survey study of program directors of EM residency programs accredited by the Accreditation Council for Graduate Medical Education. A 16-item questionnaire was electronically delivered to program directors, including program region, current and historical use of LAA, and attitudes regarding the optimal procedural training modalities. Results Of 179 survey recipients, 83 completed the survey (46.4%). Twelve programs (14.3%) currently use LAA, and 17 programs (20.5%) report previous LAA use. Reasons for discontinuing LAA use included ethical concerns, financial and logistical limitations, political pressures, and feeling that there were superior or equivalent alternative models available. Programs that currently use LAA were more likely to rank LAA as being the most preferable training modality while programs that do not currently use LAA were more likely to rank human cadavers as the most preferable modality. Conclusion Despite a lack of data showing educational outcomes-driven differences between LAA and alternative training models, LAA use is declining among civilian EM residencies. Despite this, disagreement exists among programs that do and do not use LAA regarding the most optimal procedural training.