Miracle-dz/UniFAR-FTUs huggingface dataset:
Hypofractionated Robotic Stereotactic Radiosurgery for Vagal Paragangliomas: A Novel Treatment Strategy for Cranial Nerve Preservation

Objective To provide the first description of hypofractionated stereotactic radiosurgery (SRS) and evaluate tumor control and safety for vagal paragangliomas (VPs), which begin at the skull base but often have significant extracranial extension. Study Design Retrospective chart review. Setting Tertiary-referral neurotology and neurosurgery practice. Subjects and Methods Five VPs in 4 patients (all male, ages 15-56 years) underwent SRS between 2010 and 2018. Outcome measures included tumor dimensions on serial imaging, cranial nerve function, and radiation side effects. Results CyberKnife hypofractionated SRS was performed. The prescription dose was 24 or 27 Gy (maximum dose 33.4 Gy; range, 29.3-35.5 Gy) delivered in 3 equal fractions. The mean isodose line was 79% (range, 76%-82%). Four VPs were treated primarily, and 1 tumor underwent SRS to treat regrowth 2 years after microsurgical subtotal resection via the modified infratemporal fossa approach. The treatment volume ranged from 8.81 to 86.3 cm3 (mean, 35.7 cm3). All demonstrated stable size (n = 3) or regression (n = 2) at last follow-up, 63 to 85 months after SRS (mean, 76 months). One patient had stable premorbid vocal fold paralysis from a prior ipsilateral glomus jugulare tumor resection. All others demonstrated normal vagal function following SRS. Treatment-related side effects, including dysgeusia (n = 1), mucositis (n = 1), and neck soft-tissue edema (n = 2), were self-limited. Conclusions Hypofractionated SRS appears to be both safe and effective for treating VPs, including large-volume and predominantly extracranial tumors, while preserving vagal function. SRS should be considered as a cranial nerve preservation option, especially in settings of contralateral lower cranial nerve deficits or in those with multiple paragangliomas risking both vagal nerves.
HIV programmatic outcomes following implementation of the ‘Treat‐All’ policy in a public sector setting in Eswatini: a prospective cohort study

The Treat‐All policy – antiretroviral therapy (ART) initiation irrespective of CD4 cell criteria – increases access to treatment. Many ART programmes, however, reported increasing attrition and viral failure during treatment expansion, questioning the programmatic feasibility of Treat‐All in resource‐limited settings. We aimed to describe and compare programmatic outcomes between Treat‐All and standard of care (SOC) in the public sectors of Eswatini.
Comprehensive fitness maps of Hsp90 show widespread environmental dependence

Gene-environment interactions have long been theorized to influence molecular evolution. However, the environmental dependence of most mutations remains unknown. Using deep mutational scanning, we engineered yeast with all 44,604 single codon changes encoding 14,160 amino acid variants in Hsp90 and quantified growth effects under standard conditions and under five stress conditions. To our knowledge, these are the largest determined comprehensive fitness maps of point mutants. The growth of many variants differed between conditions, indicating that environment can have a large impact on Hsp90 evolution. Multiple variants provided growth advantages under individual conditions; however, these variants tended to exhibit growth defects in other environments. The diversity of Hsp90 sequences observed in extant eukaryotes preferentially contains variants that supported robust growth under all tested conditions. Rather than favoring substitutions in individual conditions, the long-term selective pressure on Hsp90 may have been that of fluctuating environments, leading to robustness under a variety of conditions.
Retrospective study of perforated peptic ulcer: a surgical emergency

Background: Peptic ulcer disease and acid peptic disorder are medical diseases and now managed mainly by medical treatment with advent of H2 blockers, proton pump inhibitors and antibiotics, with eradication of Helicobacter pylor i, the complications have reduced, but perforation of peptic ulcer is still frequently occurring and is always a surgical emergency. Methods: This is a retrospective study of patients who were diagnosed, managed and operated for perforated peptic ulcer at Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India from January 2009 to December 2014. Data of 373 patients were collected from case records using a standard proforma and their risk factors, post-operative progress and outcome were analysed. Results: In our study of 373 cases, patients between ages of 30-50 years (72%) were commonly affected and there was male predominance (83%). Smoking, alcohol consumption and improper treatment for peptic ulcer were major risk factors. The significantly related complications were due to co-morbid illness, age and delayed presentation for treatment. Conclusions: Perforated peptic ulcer (PPU) is a frequent surgical emergency in this southern part of our state, predominantly affecting young and middle aged male, may be because of dietary habits (very spicy food) and other risk factors. Surgical intervention is always warranted. Simple closure with omental patch is the standard procedure, followed by treatment for H. pylori eradication. It was effective and majority of patients survived despite delayed preoperative admission.
Internal architecture of the mandibular condyle of rabbits is related to dietary resistance during growth

ABSTRACT Although there is considerable evidence that bone responds to the loading environment in which it develops, few analyses have examined phenotypic plasticity or bone functional adaptation in the masticatory apparatus. Prior work suggests that masticatory morphology is sensitive to differences in food mechanical properties during development; however, the importance of the timing/duration of loading and variation in naturalistic diets is less clear. Here, we examined microstructural and macrostructural differences in the mandibular condyle in four groups of white rabbits (Oryctolagus cuniculus) raised for a year on diets that varied in mechanical properties and timing of the introduction of mechanically challenging foods, simulating seasonal variation in diet. We employed sliding semilandmarks to locate multiple volumes of interest deep to the mandibular condyle articular surface, and compared bone volume fraction, trabecular thickness and spacing, and condylar size/shape among experimental groups. The results reveal a shared pattern of bony architecture across the articular surface of all treatment groups, while also demonstrating significant among-group differences. Rabbits raised on mechanically challenging diets have significantly increased bone volume fraction relative to controls fed a less challenging diet. The post-weaning timing of the introduction of mechanically challenging foods also influences architectural properties, suggesting that bone plasticity can extend well into adulthood and that bony responses to changes in loading may be rapid. These findings demonstrate that bony architecture of the mandibular condyle in rabbits responds to variation in mechanical loading during an organism's lifetime and has the potential to track dietary variation within and among species. Summary: The trabecular structure of the mandibular condyle varies between rabbit groups raised on diets that differ in their mechanical properties and the timing of the introduction of mechanically challenging foods.
“Puffing” in Sarcoscypha austriaca: Back to Ziegenspeck

ABSTRACT Many discomycetes show the phenomenon of “puffing”: the quasi-simultaneous discharge of large numbers of ascospores, rendering them visible to the unaided eye as a whiff of smoke above the fruitbody. Obviously, some kind of synchronization mechanism must be present to make all asci involved burst at about the same time. This mechanism has generally been understood to be of a mechanical nature. For a (small, dung-inhabiting) Ascobolus species, puffing was shown to involve a discharge wave propagating radially outward from a random origin at a speed of about 1.5 cm/s. Using high-speed imaging, we have found no evidence for such a wave in puffing by the (much larger, wood-inhabiting) apothecia of Sarcoscypha austriaca. Rather, extended (but limited) areas seem to become active essentially simultaneously, and within these areas a few percent of the asci discharge their spores randomly. In these large fruitbodies, puffing is found to be preceded by a small but distinct deformation of the apothecium, the geometry of which is such that it increases the lateral compressive stress in the hymenium. The observations suggest that this increase in stress is instrumental in causing many asci to burst quasi-simultaneously in the affected area, a hypothesis essentially already proposed by H. Ziegenspeck, about a century ago.
Actigraphic estimates of sleep and the sleep-wake rhythm, and 6-sulfatoxymelatonin levels in healthy Dutch children

ABSTRACT Sleep and the sleep-wake rhythm are essential for children’s health and well-being, yet reference values are lacking. This study therefore aimed to assess actigraphic estimates of sleep and the 24-h sleep-wake rhythm, as well as 6-sulfatoxymelatonin (aMT6s) levels in healthy children of different age groups. Additionally, relationships between the outcomes and sex, highest parental educational level (as an indication of socioeconomic status (SES)), and body-mass-index (BMI) were explored. In this cross-sectional study, healthy Dutch children (2–18 years) wore an actigraph (GT3x) for 7 consecutive days, collected first-morning void urine and completed a sleep log and sociodemographic questionnaire. Actigraphically estimated sleep variables were sleep onset latency (SOL), sleep efficiency (SE), total sleep time (TST), and wake after sleep onset (WASO). Non-parametric sleep-wake rhythm variables were intradaily variability (IV); interdaily stability (IS); the activity counts and timing of the least active 5-h period (L5counts and midpoint) and of the most active 10-h period (M10 counts and midpoint); and the relative amplitude (RA), i.e. the ratio of the difference and the sum of M10 and L5 counts. Finally, creatinine-corrected aMT6s levels were obtained by isotope dilution mass spectrometry. Effects of age group (preschool 2–5 years/school-aged 6–12 years/teenager 13–18 years), sex, highest parental educational level and BMI (Z-scores) were explored. Ninety-four children participated, equally divided across age groups (53% boys). Teenagers slept less, but more efficiently, than younger children, while their 24 h sleep-wake rhythm was the least stable and most fragmented (likely due to fragmentation of daytime activity). Additionally, aMT6s levels significantly declined over the age groups. Children from highly educated parents had lower sleep efficiency, but a more stable sleep-wake rhythm. Finally, sex or increase in BMI was not associated with any of the outcomes in this study. In conclusion, this study provides reference values of healthy children across different age groups and different sociodemographic factors. In the future, this information may help to better interpret outcomes in clinical populations.
Histopathology‐validated machine learning radiographic biomarker for noninvasive discrimination between true progression and pseudo‐progression in glioblastoma

Imaging of glioblastoma patients after maximal safe resection and chemoradiation commonly demonstrates new enhancements that raise concerns about tumor progression. However, in 30% to 50% of patients, these enhancements primarily represent the effects of treatment, or pseudo‐progression (PsP). We hypothesize that quantitative machine learning analysis of clinically acquired multiparametric magnetic resonance imaging (mpMRI) can identify subvisual imaging characteristics to provide robust, noninvasive imaging signatures that can distinguish true progression (TP) from PsP.
Physical Function, Physical Activity, and Quality of Life After Liver Transplantation

Robust physical activity after liver transplantation is an important determinant of longterm health, similar in its importance to the value of pretransplant activity for withstanding the immediate stress of transplantation. Although transplantation normally enables rapid recovery of liver synthetic and metabolic functions, the recovery of physical capacity and performance to normal levels is delayed and often incomplete. Anatomic measurements of sarcopenia and the physical performance indicators of frailty both tend to improve slowly, and they may, in fact, decrease further in the posttransplant period, especially when the common extrahepatic drivers of muscle loss, such as the elements of the metabolic syndrome, persist or intensify after transplantation. Posttransplant exercise improves fitness, which is a conclusion based on 2 observational studies and 3 randomized trials that assessed endpoints of strength testing, energy expenditure in metabolic equivalents, and peak or maximal oxygen uptake. Importantly, 1 controlled trial found that exercise also improved quality of life (QOL) measured by the Short Form 36 survey, consistent with multiple reports of the value of social support and engagement in sports activity for improving posttransplant QOL. Developing evidence‐based standards for post–liver transplant physical activity baseline testing and sustainment of intensity and quality is a key unmet need in transplant hepatology. At present, it is reasonable for transplant teams to assess fitness and design a tailored exercise program when a recipient is first discharged, to record and reinforce progress at all posttransplant visits, and to set realistic longterm performance goals that will often achieve recommended standards for the healthy general population.
Study of the relationship between urinary level of uromodulin, renal involvement and disease activity in patients with systemic lupus erythrematosus

Systemic lupus erythematosus (SLE) is a multifactorial chronic inflammatory autoimmune connective tissue disease. Lupus nephritis (LN) is a common and serious complication of SLE which can progress to end-stage renal disease. Renal biopsy is the gold standard in the diagnosis and classification of LN, but since it is an invasive procedure, it is neither desirable nor applicable for all cases. This has led to the search for an alternative, noninvasive, site-specific, and immune process-related biomarkers. Uromodulin (Tamm-Horsfall glycoprotein) is the most abundant urinary protein expressed exclusively by the thick ascending limb cells and released into urine of healthy controls. Studies showed that it may act as a danger signaling molecule eliciting an inflammatory response following conditions that damage the nephron integrity and leading to uromodulin release into the interstitial space. This study aimed to assess uromodulin as a screening biomarker of tubulointerstitial involvement in patients with SLE and to elucidate its correlation with disease activity and progression. The study was conducted on 70 patients divided into two groups: control group (Group I) consisted of 20 apparently healthy volunteers of comparable age and sex to the patients’ group, and 50 SLE patients (Group II) diagnosed according to the 2012 Systemic Lupus Collaborating Clinics (SLICC) classification criteria. Group II was further subdivided into 23 patients without manifestations of LN (Group II A) and 27 patients with manifestations of LN (Group II B). Urinary uromodulin level showed statistically significant difference among the studied groups, being lowest among the LN patients with a mean value 5.6 ± 3.4, in SLE patients without nephritis 9.9 ± 5.2 and 12.9 ± 4.6 in the control group. Urinary uromodulin also correlated positively with estimated glome- rular filtration rate. A negative correlation was found between urinary uromodulin and serum creatinine, 24 h urinary proteins and SLICC renal activity score. No statistically significant correlation was found between urinary uromo- dulin and SLE disease activity index. Thus, decreasing urinary uromodulin levels can be a marker for renal involvement and tubulo- interstitial nephritis in active SLE patients and a marker for chronic kidney disease and nephron loss in the absence of activity markers.
Bidirectional relations between cognitive function and oral health in ageing persons: a longitudinal cohort study.

BACKGROUND evidence suggests a reciprocal relationship between cognitive function (CF) and oral health (OH), but no study has demonstrated this inter-relationship in a longitudinal population. OBJECTIVE to investigate the bidirectional relationship between CF and OH in an ageing cohort. DESIGN cohort study. SETTING general community. SUBJECTS participants from the English Longitudinal Study of Ageing. METHODS OH, measured by teeth status, self-reported OH and OH-related quality of life (OHRQoL), and CFs were collected at three time points in 2006/07, 2010/11 and 2014/15. Cross-lagged structural equation models were used to investigate the association between CF and OH, adjusted for potential confounding factors. RESULTS 5477 individuals (56.4% women) were included (mean age = 63.1 years at 2006/07, 67.2 at 2010/11 and 70.4 at 2014/15, SD = 8.9) in analyses. The average CF score was 46.5(SD = 12.3) at baseline and 41.2 (SD = 13.4) at follow-up. 3350 (61.2%) participants had natural teeth only and 622 (11.2%) were edentulous. In the fully adjusted model, better cognition at baseline was associated with better OH at follow-up (beta coefficient = 0.02, 95% CI: 0.01-0.03); conversely better OH at baseline predicted better cognition (beta coefficient = 0.12, 95% CI: 0.06-0.18). Similar magnitude and direction of the reciprocal association was evident between cognition and OHRQoL. CONCLUSIONS This is the first longitudinal study to demonstrate the positive reciprocal association between CF and OH. The findings suggest the importance of maintaining both good CF and OH in old age.
Peripheral arterial disease diagnosed by ankle–brachial index: Predictor for early renal replacement therapy in chronic kidney disease

Our study aimed to investigate the relationship between ankle-brachial index (ABI) and need for early renal replacement therapy (RRT) in predialysis patients with chronic kidney disease (CKD). A total of 112 patients (62% men) with pre-dialysis CKD, seen in the outpatient clinic, were included, and ABI was obtained as per standard protocol. Peripheral arterial disease (PAD) was defined as ABI <0.9 or >1.3 in either leg. The clinical data were analyzed, and the risk factors for early RRT were determined by multivariate logistic regression analysis. The prevalence of PAD was 44% in predialysis CKD patients. Over three years’ follow- up, 14.2% required RRT; 11.3% developed major cardiovascular event (myocardial infarction, stroke, or death). A total of 26 events occurred. The incidence of all events was significantly higher in patients with abnormal ABI than in those with normal ABI (34.7% vs. 12.7%; log rank P = 0.02). PAD was associated with all events [hazard ratio (HR): 2.72; 95% CI: 1.04-7.17; P = 0.042] as also the need for RRT (HR 3.2; 95% Cl: 1.005-10.23; P = 0.049), on univariate cox proportional hazard analysis. Multivariate logistic regression analysis adjusted for other risk factors identified that PAD remained an independent predictor for the need for early RRT (HR: 12.2; 95%Cl: 2.2-66.5; P = 0.004) and all events (HR: 3.5; 95% Cl: 0.9-13.5; P = 0.032). PAD was an independent predictor for RRT requirement in predialysis CKD.
Health-care waste management status in Iran (case study of Gachsaran County, 2012–2013)

Aims: The quantity, composition and physiochemical characteristics of wastes are important factors in selecting an appropriate treatment method. Having knowledge about the current status of medical wastes in any region is necessary for the establishment of effective medical waste management. Martials and Methods: In this field study, official data obtained from the national statistical center were used. The statistical population for sampling and physical analysis includes two hospitals and five health-care centers, selected randomly, and WHO standard procedures were followed for wastes segregation. Results: Based on data obtained, 1335 kg of medical wastes is daily generated in Gachsaran County of which 563 kg are infected and 772 kg are noninfected. A minor part of medical wastes are incinerated or delivered to the municipality untreated. However, the major part is hydroclaved. The largest medical center in the region is Shahid Rajaei Hospital located in Dogonbadan city and infected wastes from the whole region are sent to this center to be hydroclaved. Conclusion: In conclusion, the quantity of infected wastes in the region is higher when compared to other cities in Iran. The high quantity of infected wastes may be a result of poor separation of infected and noninfected wastes by personnel due to lack of required knowledge.
The National Mental Health Survey of India (2016): Prevalence, socio-demographic correlates and treatment gap of mental morbidity

Background: Recognizing the need for good quality, scientific and reliable information for strengthening mental health policies and programmes, the National Mental Health Survey (NMHS) of India was implemented by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, in the year 2015–2016. Aim: To estimate the prevalence, socio-demographic correlates and treatment gap of mental morbidity in a representative population of India. Methods: NMHS was conducted across 12 Indian states where trained field investigators completed 34,802 interviews using tablet-assisted personal interviews. Eligible study subjects (18+ years) in households were selected by a multi-stage, stratified, random cluster sampling technique. Mental morbidity was assessed using MINI 6. Three-tier data monitoring system was adopted for quality assurance. Weighted and specific prevalence estimates were derived (current and lifetime) for different mental disorders. Mental morbidity was defined as those disorders as per the International Statistical Classification of Diseases, Tenth Revision Diagnostic Criteria for Research (ICD-10 DCR). Multivariate logistic regression was conducted to examine risk for mental morbidity by different socio-demographic factors. Survey was approved by central and state-level institutional ethical committees. Results: The weighted lifetime prevalence of ‘any mental morbidity’ was estimated at 13.67% (95% confidence interval (CI) = 13.61, 13.73) and current prevalence was 10.56% (95% CI = 10.51, 10.61). Mental and behavioural problems due to psychoactive substance use (F10–F19; 22.44%), mood disorders (F30–F39; 5.61%) and neurotic and stress-related disorders (F40–F48; 3.70%) were the most commonly prevalent mental morbidity in India. The overall prevalence was estimated to be higher among males, middle-aged individuals, in urban-metros, among less educated and in households with lower income. Treatment gap for overall mental morbidity was 84.5%. Conclusion: NMHS is the largest reported survey of mental morbidity in India. Survey estimated that nearly 150 million individuals suffer from one or the other mental morbidity in India. This information is to be used for planning, delivery and evaluating mental health programming in the country.