Miracle-dz/UniFAR-FTUs huggingface dataset:
Deep learning with convolutional neural networks for identification of liver masses and hepatocellular carcinoma: A systematic review

BACKGROUND Artificial intelligence, such as convolutional neural networks (CNNs), has been used in the interpretation of images and the diagnosis of hepatocellular cancer (HCC) and liver masses. CNN, a machine-learning algorithm similar to deep learning, has demonstrated its capability to recognise specific features that can detect pathological lesions. AIM To assess the use of CNNs in examining HCC and liver masses images in the diagnosis of cancer and evaluating the accuracy level of CNNs and their performance. METHODS The databases PubMed, EMBASE, and the Web of Science and research books were systematically searched using related keywords. Studies analysing pathological anatomy, cellular, and radiological images on HCC or liver masses using CNNs were identified according to the study protocol to detect cancer, differentiating cancer from other lesions, or staging the lesion. The data were extracted as per a predefined extraction. The accuracy level and performance of the CNNs in detecting cancer or early stages of cancer were analysed. The primary outcomes of the study were analysing the type of cancer or liver mass and identifying the type of images that showed optimum accuracy in cancer detection. RESULTS A total of 11 studies that met the selection criteria and were consistent with the aims of the study were identified. The studies demonstrated the ability to differentiate liver masses or differentiate HCC from other lesions (n = 6), HCC from cirrhosis or development of new tumours (n = 3), and HCC nuclei grading or segmentation (n = 2). The CNNs showed satisfactory levels of accuracy. The studies aimed at detecting lesions (n = 4), classification (n = 5), and segmentation (n = 2). Several methods were used to assess the accuracy of CNN models used. CONCLUSION The role of CNNs in analysing images and as tools in early detection of HCC or liver masses has been demonstrated in these studies. While a few limitations have been identified in these studies, overall there was an optimal level of accuracy of the CNNs used in segmentation and classification of liver cancers images.
Interaction of genetic background and exercise training intensity on endothelial function in mouse aorta

The purpose of this study was to characterize the genetic contribution to endothelial adaptation to exercise training. Vasoreactivity was assessed in aortas from four inbred mouse strains (129S1, B6, NON, and SJL) after 4 weeks of moderate intensity continuous exercise training (MOD), high intensity interval training (HIT) or in sedentary controls (SED). Intrinsic variations in endothelium-dependent vasorelaxation (EDR) to acetylcholine (ACh) as well as vasocontractile responses were observed across SED groups. For responses to exercise training, there was a significant interaction between mouse strain and training intensity on EDR. Exercise training had no effect on EDR in aortas from 129S1 and B6 mice. In NON, EDR was improved in aortas from MOD and HIT compared with respective SED, accompanied by diminished responses to PE in those groups. Interestingly, EDR was impaired in aorta from SJL HIT compared with SED. The transcriptional activation of endothelial genes was also influenced by the interaction between mouse strain and training intensity. The number of genes altered by HIT was greater than MOD, and there was little overlap between genes altered by HIT and MOD. HIT was associated with gene pathways for inflammatory responses. NON MOD genes showed enrichment for vessel growth pathways. These findings indicate that exercise training has non-uniform effects on endothelial function and transcriptional activation of endothelial genes depending on the interaction between genetic background and training intensity.
An atypical manifestation of lateral medullary syndrome

ABSTRACT Lateral medullary syndrome is a common brainstem stroke associated with a classical triad of Horner’s Syndrome, ipsilateral ataxia and hypalgesia and thermoanasthesia of ipsilateral face. We report a case of a 49-year-old diabetic, non-hypertensive, postmenopausal female who presented with symptoms involving the left dorsal medulla along with right sided hemiparesis and left UMN-type facial palsy. Contralateral hemiparesis was explained by caudal extension of infarct involving the pyramids before decussation at the medulla, known as Babinski–Nageotte Syndrome. UMN-type facial palsy was attributed to involvement of hypothetical supranuclear aberrant corticobulbar fibres of facial nerve which descend down in the contralateral ventromedial medulla, decussate at level of upper medulla and then ascend in the dorsolateral medulla to reach the facial nerve nucleus. Association of these two entities with Wallenberg’s Syndrome have been reported separately in literature, but not together as in this case.
Novel Respiratory Impedance-Based Phenotypes Re ﬂ ect Different Pathophysiologies in Chronic Obstructive Pulmonary Disease Patients

Purpose: The forced oscillation technique (FOT) is a non-invasive method to measure respiratory impedance, the respiratory resistance (Rrs) and reactance (Xrs). The disease probability measure (DPM) is a useful computed tomography (CT) imaging variable for the assessment of gas trapping and emphysema in patients with chronic obstructive pulmonary disease (COPD) using pairs of inspiratory and expiratory CT images. We aimed to develop FOT-based phenotypes and determine whether the phenotypes and their imaging characteristics could facilitate the understanding of COPD pathophysiology. Patients and methods: FOT and spirometry were examined in 164 COPD patients and 22 non-COPD smokers. COPD patients were divided into four FOT-based phenotypes (NL, normal group; RD, resistance-dominant group; XD, reactance-dominant group; and MIX, mixed group) based on the 3rd quartile values of R5 (Rrs at 5Hz) and X5 (Xrs at 5Hz) in the non-COPD group. The emphysematous lesions and the airway lesions were quantitatively assessed in CTimages by low attenuation volume and the square root of the wall area of a hypothetical airway with an internal perimeter of 10 mm ( √ Aaw at Pi10), respectively. DPM imaging analysis was also performed in 131 COPD patients. We investigated the differences in COPD parameters between the FOT-based phenotypes. Results: √ Aaw at Pi10 were signi ﬁ cantly higher in the RD, XD, and MIX groups than in the NL group. The XD group showed lower pulmonary function and higher dyspnea scores than the RD group. No signi ﬁ cant changes in DPM values were observed between the RD and the NL groups. The gas-trapping area was signi ﬁ cantly higher in the XD group than in the NL group. The MIX group showed the highest dyspnea score, most emphysematous lesions, and the lowest forced expiratory volume in 1 s % predicted value. Conclusion: The FOT-based phenotyping may be useful to assess pathophysiological changes of COPD with CT assessments. mixed group; FOT, forced oscillation technique; R5, respiratory system resistance at 5 Hz; X5, respiratory system reactance at 5 Hz.
Diabetic retinopathy as an independent predictor of subclinical cardiovascular disease: baseline results of the PRECISED study

Objective Detection of subclinical cardiovascular disease (CVD) has significant impact on the management of type 2 diabetes. We examined whether the assessment of diabetic retinopathy (DR) is useful for identifying patients at a higher risk of having silent CVD. Research design and methods Prospective case–control study comprising 200 type 2 diabetic subjects without history of clinical CVD and 60 age-matched non-diabetic subjects. The presence of subclinical CVD was examined using two parameters: (1) calcium coronary score (CACs); (2) composite of CACs >400 UA, carotid plaque ≥3 mm, carotid intima–media thickness ratio >1, or the presence of ECG changes suggestive of previous asymptomatic myocardial infarction. In addition, coronary angio-CT was performed. DR was assessed by slit-lamp biomicroscopy and retinography. Results Type 2 diabetic subjects presented higher CACs than non-diabetic control subjects (p<0.01). Age, male gender, and the presence of DR were independently related to CACs >400 (area under the receiver operating characteristic curve (AUROC) 0.76). In addition, an inverse relationship was observed between the degree of DR and CACs <10 AU. The variables independently associated with the composite measurement of subclinical CVD were age, diabetes duration, the glomerular filtration rate, microalbuminuria, and the presence of DR (AUROC 0.71). In addition, a relationship (p<0.01) was observed between the presence and degree of DR and coronary stenosis. Conclusions The presence and degree of DR is independently associated with subclinical CVD in type 2 diabetic patients. Our results lead us to propose a rationalized screening for coronary artery disease in type 2 diabetes based on prioritizing patients with DR, particularly those with moderate–severe degree.
Quercetin-induced apoptosis ameliorates vascular smooth muscle cell senescence through AMP-activated protein kinase signaling pathway

Aging is one of the risk factors for the development of cardiovascular diseases. During the progression of cellular senescence, cells enter a state of irreversible growth arrest and display resistance to apoptosis. As a flavonoid, quercetin induces apoptosis in various cells. Accordingly, we investigated the relationship between quercetin-induced apoptosis and the inhibition of cellular senescence, and determined the mechanism of oxidative stress-induced vascular smooth muscle cell (VSMC) senescence. In cultured VSMCs, hydrogen peroxide (H2O2) dose-dependently induced senescence, which was associated with increased numbers of senescence-associated β-galactosidase-positive cells, decreased expression of SMP30, and activation of p53-p21 and p16 pathways. Along with senescence, expression of the anti-apoptotic protein Bcl-2 was observed to increase and the levels of proteins related to the apoptosis pathway were observed to decrease. Quercetin induced apoptosis through the activation of AMP-activated protein kinase. This action led to the alleviation of oxidative stress-induced VSMC senescence. Furthermore, the inhibition of AMPK activation with compound C and siRNA inhibited apoptosis and aggravated VSMC senescence by reversing p53-p21 and p16 pathways. These results suggest that senescent VSMCs are resistant to apoptosis and quercetin-induced apoptosis attenuated the oxidative stress-induced senescence through activation of AMPK. Therefore, induction of apoptosis by polyphenols such as quercetin may be worthy of attention for its anti-aging effects.
Sleep, Experimental Pain and Clinical Pain in Patients with Chronic Musculoskeletal Pain and Healthy Controls

Purpose Everyday variations in night sleep in healthy pain-free subjects are at most weakly associated with pain, whereas strong alterations (eg, sleep deprivation, insomnia) lead to hyperalgesic pain changes. Since it remains unclear how substantial sleep alterations need to be in order to affect the pain system and lead to a coupling of both functions, the present study aimed at providing sufficient variance for co-variance analyses by examining a sample consisting of both healthy subjects and chronic pain patients. Methods A sample of 20 chronic musculoskeletal pain patients and 20 healthy controls was examined. This sample was assumed to show high inter-individual variability in sleep and pain, as pain patients frequently report sleep disturbances, whereas healthy subjects were required to be pain-free and normal sleepers. Sleep of two non-consecutive nights was measured using portable polysomnography and questionnaires. Experimental pain parameters (pressure pain thresholds (PPT), temporal summation of pain (TSP), conditioned pain modulation (CPM)) and situational pain catastrophizing (SCQ) were assessed in laboratory sessions before and after sleep. Pain patients’ clinical pain was assessed via questionnaire. Results As expected, both groups differed in several sleep parameters (reduced total sleep time and sleep efficiency, more time awake after sleep onset, lower subjective sleep quality in the patients) and in a few pain parameters (lower PPTs in the patients). In contrast, no differences were found in TSP, CPM, and SCQ. Contrary to our expectations, regression analyses indicated no prediction of overnight pain changes by sleep parameters. Conclusion Since sleep parameters were hardly apt to predict overnight pain changes, this leaves the association of both systems mainly unproven when using between-subject variance for verification.
Prevalence of alcohol consumption and related factors among students of higher education centers in one of the northeastern cities of Iran

Introduction Knowing the prevalence and the factors associated with alcohol abuse among students can be an important step in initiating preventive measures. The purpose of this study was to determine the prevalence of alcohol consumption and its related factors in students of higher education centers in one of the northeastern cities of Iran in 2017. Methods This descriptive-analytical study was performed on 668 students from 7 higher education centers. The samples were selected by stratified random sampling. The valid researcher-made questionnaires were issued to the subjects, and were collected immediately after being filled out. The obtained data were analyzed using appropriate statistical tests. Results Ninety-two (13.77%) students had history of alcohol consumption, with 55.6% continued to drink alcohol. The mean age of the consumers was 23.92 years, of whom 77.41% were male, 75% were single, 55.43% were non-indigenous, and 74.46% had history of smoking. 81.52% of the subjects were undergraduates, while 36.95% studied mathematics and engineering. There was a significant relationship between alcohol consumption and age, gender, GPA, being non-indigenous, personal residence, smoking, history of alcohol consumption in family and friends, satisfaction with academic major and city in which they study (p < 0.05). Conclusion The findings showed that alcohol consumption was relatively high in students of higher education centers and many variables (ten out of fifteen studied variables) were involved in this process. Therefore, careful planning and serious measures are needed to prevent this problem.
Impact of dental clearance on total joint arthroplasty: A systematic review

Many orthopedic surgeons require that their patients obtain dental clearance before elective total joint arthroplasty (TJA). However, there is no consensus substantiating the practice. To this end, a systematic review on the prevalence of dental pathology in TJA patients, risk factors for failing dental screening, and impact of dental evaluations was performed. Literature was sourced from PubMed and Scopus databases. Six papers were sourced from the initial search, one study was extracted from the references of the original six manuscripts, and one new publication was retrieved from a second search conducted after the first. The prevalence of dental pathology ranged from 8.8% to 29.4% across studies. Two of four papers reported lower than average or improvements in post-operative infection with pre-operative dental evaluations while two found no such association. There is insufficient evidence to support universal dental clearance before TJA.
Initiation And Persistence With Antiplatelet Agents Among The Patients With Acute Coronary Syndromes: A Retrospective, Observational Database Study In China Patient Preference and Adherence

Objectives: To investigate the initiation and persistence of antiplatelet agents and the associated factors for patients with acute coronary syndromes (ACS) in Tianjin, China. Methods: Data were obtained from Tianjin Urban Employee Basic Medical Insurance database (2011 – 2015). Adult patients who were discharged alive after the ﬁ rst ACS-related hospitalization (index hospitalization) between January 2012 and December 2014 were included. Patients who initiated with antiplatelet therapy, including aspirin monotherapy, clopidogrel monotherapy, or dual antiplatelet with aspirin and clopidogrel at discharge or within the initial 30-day follow-up after discharge were further identi ﬁ ed. Patients with no gaps of ≥ 30 days in antiplatelet therapy were deemed persistent. The logistic model and Cox model were used to explore the associated factors of initiation and persistence with antiplatelet agents, respectively. Results: In total, 21,450 patients (64.6±10.7 years; 46.0% female) were included. Only 70.3% (N=15,071) of them initiated with antiplatelet agents within the initial 30-day follow-up; 85.0% (N=12,809) of the initial users discontinued their antiplatelet therapy, and the average time to discontinuation was 117.4±119.7 days. The patients who had prior antiplatelet agents utilization (Odds ratio [95% CI]=1.93 [1.78 – 2.09]; hazard ratio [95% CI]=0.78 [0.74 – 0.81]), received percutaneous coronary intervention (PCI) during the baseline period (OR=1.47 [1.26 – 1.73]; HR=0.91 [0.84 – 0.97]) or index hospitalization (OR=22.40 [18.63 – 26.92]; HR=0.51 [0.49 – 0.53]) were more likely to initiate and persist with antiplatelet agents, while the female (OR=0.75 [0.70 – 0.81]; HR=1.22 [1.88 – 1.27]) patients were less likely to initiate and persist with antiplatelet agents. Conclusion: The initiation and persistence with antiplatelet agents are poor among the ACS patients in Tianjin. Females are associated with poorer initiation and persistence, while prior antiplatelet agents use and receiving PCI during baseline period or index hospitalization are associated with better initial use and better persistence.
Hospice and Palliative Nursing Research: 25 Years of Progress

Research is the foundation for good hospice and palliative nursing care. It provides the evidence for practice and practice changes, determines what is taught and how nurses are educated, and drives the policies that shape how palliative nursing care is delivered. This article seeks to help build clinicians' enthusiasm for research and their confidence to participate by reviewing how far palliative nursing research has come in the 25 years since the founding of the Hospice and Palliative Nurses Association. The Hospice and Palliative Nurses Association research activities, federal funding for palliative care research, and the numbers of published research articles have all grown substantially during this period. Pioneers in palliative nursing research date back to the beginning of formal care for the dying and contribute the base for the accumulation of evidence for practice. Current hospice and palliative nurses can take pride in their heritage as they carve out their own role in continuing to build this evidence base.
Interventional Pulmonology: What Can it Offer Your Patient?

The field of Interventional Pulmonology is ever expanding, and it can be daunting to keep abreast of technology that may be of diagnostic or therapeutic benefit to patients. This review provides an overview of important procedures that are available. Discussions include indications, risks, and benefits of the various interventional modalities to help pulmonologists decide when and for what procedures to refer patients.
Modeling the impact of patient treatment preference on health outcomes in relapsing-remitting multiple sclerosis

Abstract Aims: Model how moving from current disease-modifying drug (DMD) prescribing patterns for relapsing-remitting multiple sclerosis (RRMS) observed in the United Kingdom (UK) to prescribing patterns based on patient preferences would impact health outcomes over time. Materials and methods: A cohort-based Markov model was used to measure the effect of DMDs on long-term health outcomes for individuals with RRMS. Data from a discrete choice experiment were used to estimate the market shares of DMDs based on patient preferences (i.e. preference shares). These preference shares and real-world UK market shares were used to calculate the effect of prescribing behavior on relapses, disability progression, and quality-adjusted life-years (QALYs). The incremental benefit of patient-centered prescribing over current practices for the UK RRMS population was then estimated; scenario and sensitivity analyses were also conducted. Results: Compared to current prescribing practices, when UK patients with RRMS were treated following patient preferences, health outcomes were improved. This population was expected to experience 501,690 relapses and gain 1,003,263 discounted QALYs over 50 years under patient-centered prescribing practices compared to 538,417 relapses and 958,792 discounted QALYs under current practices (−6.8% and +4.6%, respectively). Additionally, less disability progression was observed when prescribed treatment was based on patient preferences. In a scenario analysis where only oral treatments were considered, the results were similar, although the magnitude of benefit was smaller. Number of relapses was most sensitive to how the annualized relapse rate was modeled; disability progression was most sensitive to mortality rate assumptions. Limitations: Treatment efficacy estimates applied to various models in this study were based on data derived from clinical trials, rather than real-world data; the impact of patient-centered prescribing on treatment adherence and/or switching was not modeled. Conclusions: The population of UK RRMS patients may experience overall health gains if patient preferences are better incorporated into prescribing practices.
Dermal Autografts in Breast Reconstruction

Abstract Breast cancer affects 1 in 8 women. As the treatment of breast cancer evolves, breast reconstruction does as well. Implant-based reconstructions are increasing, leading to increased use of acellular dermal matrix (ADM) for better implant positioning. Acellular dermal matrices are derived from cadaveric skin and are processed to be immunologically inert. However, ADM can be costly and can have complications such as seroma and infection. This has led to the development of dermal autografts. These were first used in postmastectomy breast reconstruction in women with redundant breast skin that was deepithelialized and used for lower pole coverage of tissue expanders and implants. This evolved into harvesting dermal autografts from the abdomen. Later studies evaluated the use of meshed dermal autografts. Histological analysis of ADM versus dermal autografts shows that there are increased vessels within dermal autografts compared with ADM. This potentially contributes to the decreased complication rate seen with autografts. In addition, one study showed equivalent results in aesthetic outcomes and capsular contracture between ADM and dermal autograft. Analysis of cost has shown that ADM is significantly more costly than harvesting a dermal autograft. Physician reimbursement is also higher for dermal autografts. This review article seeks to summarize key studies that highlight the feasibility of using dermal autografts in breast reconstruction.