Miracle-dz/UniFAR-FTUs huggingface dataset:
Aspartate aminotransferase-to-platelet ratio index for predicting late recurrence of hepatocellular carcinoma after radiofrequency ablation

Abstract Background Our study aimed to explore the prognostic value of the aspartate aminotransferase–platelet ratio index (APRI) and to develop a new nomogram for patients with hepatocellular carcinoma (HCC) who experience late recurrence after radiofrequency ablation (RFA). To date, no study has explored the value of APRI for assessing the late recurrence of HCC after RFA. Materials and Methods The prognostic value of APRI was evaluated and validated in our multicenter retrospective analysis. A total of 466 HCC patients undergoing RFA were reviewed as a training cohort, and 234 HCC patients were included in the external validation cohort. The nomogram was built based on significant prognostic factors in a multivariate analysis and validated in the external validation cohort. Results The cutoff APRI score was 0.78, and it appropriately discriminated between low- and high-risk groups for late recurrence in HCC patients. The cumulative recurrence-free survival rates of the low-risk group were significantly higher than those of the high-risk group (p < 0.001), according to the Kaplan–Meier curves. Late recurrence in HCC patients after RFA was associated with APRI, sex and multiple tumors. The nomogram based on potential risk factors (APRI score, sex and multiple tumors) as indicated by multivariate Cox regression analysis showed good discrimination and calibration in the training and external verification groups. Conclusions The APRI score is a feasible independent prognostic factor for the late recurrence of HCC after RFA. The proposed nomogram could aid clinicians in following disease progression and providing tailored therapy for patients.
Managing uncertainty: Physicians' decision-making for stroke prevention for patients with atrial fibrillation and intracerebral haemorrhage.

Background Stroke prevention in patients with atrial fibrillation (AF) post-intracerebral haemorrhage (ICH) is an area of clinical equipoise. Little is known about the tools and processes that physicians use to make decisions regarding anticoagulation in this high-risk patient population. Objective To explore physicians' decision-making process regarding stroke prevention in patients with AF and a recent history of ICH. Method Qualitative study, utilising semi-structured interviews and analysed using Framework analysis. Results Twenty physicians from five European countries (Austria, France, Germany, Spain, United Kingdom) participated. The over-arching theme 'Managing uncertainty', addressed the process of making high-risk clinical decisions in the context of little available robust clinical evidence for best practice. Three sub-themes were identified under the umbrella theme: (1) 'Computing the Risks', captured the challenge of balancing the risks of ischaemic stroke with the risk of recurrent ICH in a complex patient population; (2) 'Patient Factors' highlighted the influence that patients' beliefs and previous experience of stroke had on physicians' decisions; and (3) 'Making a Decision' explored the process of reaching a final decision regarding initiation of OAC therapy or not. Conclusion Physicians described the process of deciding on stroke prevention in patients with AF post-ICH as 'challenging' due to considerable 'clinical equipoise'. Key factors that affected decision-making was patient comorbidities, functional status, and patient willingness to engage with oral anticoagulation therapy. Shared decision-making was believed to be beneficial, but physicians believed that the ultimate responsibility to decide on stroke prevention lay with the clinician.
Virtual consultation in paediatric urology during the COVID-19 pandemic: The effect of pathology on the outcome

Introduction Virtual consultation (VC) has exponentially increased during the COVID-19 pandemic. Lessons from using this modality during the pandemic will need to be appraised carefully before integrating it into the routine practice. Some paediatric urology patients can potentially be excellent candidates for routine VC. Objectives Investigate the ability of clinicians to make management plans using VCs and identify accordingly the group of patients that can benefit from routine VC. Evaluate the routine use of VC without travel restrictions. Methods Designed in two phases. Phase 1, during the lockdown, prospective collection of data after the consultation assessing the clinician satisfaction in making a decision by VC. The results were then divided according to the patient pathology; internal organ pathology (IOP), functional urological pathology (FUP) or external organ pathology (EOP). Data was then analysed to demonstrate if different outcomes can be related to the pathology. Phase 2 after the ease of the lockdown to judge the lessons learnt looking at the same parameters in patients who are selected to receive VC and evaluate journey saved by the patients, measured in miles. Results One hundred and forty-four consultations were assessed. One hundred and fourteen in phase 1 and 30 from phase 2. Mean age 7.2 years. In phase 1, 57% of patients were reviewed by consultants and 72% were followed up. Thirty-seven per cent had IOP, 24.5% FUP and 38.5% EOP. Clinicians were more likely to reach a decision with patients with IOP and FUP P < 0.0001 and 0.0024, respectively. Phase 2 demonstrated the change of practice where 93% of the patients were either IOP or FUP. An average of 27 miles per patient was saved on journeys. Discussion VC for paediatric urology patients was employed effectively to avoid hospital contact during the lockdown. From the lessons learnt that patients with IOP and FUP can continue to benefit from VC after the ease of lockdown without compromising the decision making. VC is a viable way to structure services in the future for selected paediatric urology conditions.
Association of CTLA-4 gene polymorphisms and alopecia areata: a systematic review and meta-analysis

Abstract Objective To provide evidence of the association between CLTA-4 gene polymorphisms and alopecia areata (AA). Methods PubMed, EMBASE, Web of Science, Cochrane, Wanfang, and CNKI databases were searched until 30 April 2021. The selection was completed according to the inclusion and exclusion criteria. The study quality assessment was based on Newcastle-Ottawa Scale. The assessment of the association was measured by ORs and 95%CIs. Results Nine studies, containing 2858 AA cases and 5444 disease-free control subjects were included. For rs231775 polymorphism, no significant association with AA was found, which was A vs. a, OR = 1.02 [0.81, 1.30], p = 0.85; AA vs. aa, OR = 1.26 [0.81, 1.97], p = 0.31; Aa vs. aa, OR = 1.04 [0.54, 2.01], p = 0.91; AA + Aa vs. aa, OR = 1.04 [0.71, 1.53], p = 0.82; AA vs. Aa + aa, OR = 1.31 [0.97, 1.78], p = 0.08. For rs3087243 polymorphism, also no significant association was found, which was A vs. a, OR = 0.93 [0.78, 1.11]; p = 0.40, AA vs. aa, OR = 0.68 [0.44, 1.06]; p = 0.09; Aa vs. aa, OR = 0.87 [0.45, 1.68], p = 0.68; AA + Aa vs. aa, OR = 0.93 [0.68, 1.28], p = 0.66; AA vs. Aa + aa, OR = 0.78 [0.34, 1.81], p = 0.57. For rs231726 polymorphism, a significant correlation was found, which was A vs. a, OR = 0.76 [0.70, 0.82], p < 0.05. Conclusions A significant correlation between CTLA-4 rs231726 polymorphism and AA susceptibility was found, but no significant association of CTLA-4 gene rs231775 and rs3087243 polymorphisms and AA susceptibility was found.
Practices and attitudes about delayed umbilical cord clamping for term infants: a descriptive survey among midwives

Abstract The aim of this study was to assess variations in midwives’ practices of cord clamping (early versus delayed) and to identify factors potentially associated with delayed clamping. This was a descriptive cross-sectional survey by self-administered online questionnaire among French midwives working in delivery rooms from March to July 2018. We obtained complete responses from 350 midwives. Only 120 (34.3%) reported always or sometimes performing delayed cord clamping at one minute or more after birth. Delayed cord clamping was significantly associated with midwives' experience (adjusted OR 3.99; 95% confidence interval [CI] 2.10, 7.83 for experience >10 years), maternity unit written protocol (adjusted OR (aOR) 5.17; 95% CI 1.88, 16.00), knowledge of guidelines (aOR 3.33; 95% CI 1.98, 5.71) and neonatal care level 1 (aOR 2.95; 95% CI 1.53, 5.78). Impact Statement What is already know on this subject? Despite benefits and the safety of delayed cord clamping, many newborns likely had their umbilical cords clamped immediately after delivery as part of routine care or because providers were not convinced of the benefits of delayed clamping. What do the results of this study add? Most of the midwives surveyed did not systematically delay cord clamping. Individual and organisational factors were associated with adherence to guidelines regarding delayed cord clamping. What are the implications of these findings for clinical and/or further research? A protocol should be implemented in every maternity unit with information about the benefits and risks of delayed cord clamping to reduce variations in practice and improve the safety of care.
Occlusion and coupling effects with different earmold designs – all a matter of opening the ear canal?

Abstract Objective Ear canal occlusion by a hearing aid leads to an unnatural sound of the own voice due to a level increase of bone-conducted low-frequency components of the ear canal. Opening the ear through vents or domes reduces this so-called occlusion effect, however at the cost of reduced hearing aid performance. For individual earmolds, several other design options to reduce the occlusion effect have been proposed but not reliably evaluated. Design The occlusion effect and coupling parameters were assessed through subjective ratings and real-ear measurements. Study sample Six individual earmold designs, each with different venting options, were tested in 10 subjects. Results In line with previous studies, our data show that the opening of the ear as described by the acoustic mass of the vent is the prime parameter that predicts both the occlusion effect and coupling parameters. However, the design of the earmold, most importantly the location where sealing of the ear canal is achieved, is another important factor for occlusion and coupling effects. Conclusions Although no reduction of the occlusion effect seems possible without additional opening of the ear canal, some earmold modifications seem to aggravate the occlusion effect as compared to a standard earmold with equivalent vent.
Major complications of airway management: a prospective multicentre observational study

We conducted an observational study of serious airway complications, using similar methods to the fourth UK National Audit Project (NAP4) over a period of 1 year across four hospitals in one region in the UK. We also conducted an activity survey over a week, using NAP4 methods to yield an estimate for relevant denominators to help interpret the primary data. There were 17 serious airway complications, defined as: failed airway management leading to cancellation of surgery (eight); airway management in recovery (five); unplanned intensive care admission (three); and unplanned emergency front of neck access (one). There were no reports of death or brain damage. This was an estimate of 0.028% (1 in 3600) complications using the denominator of 61,000 general anaesthetics per year in the region. Complications in patients with ‘predicted easy’ airways were rare (approximately 1 in 14,200), but 45 times more common in those with ‘predicted difficult’ airways (approximately 1 in 315). Airway management in both groups was similar (induction of anaesthesia followed by supraglottic airway or tracheal tube). Use of awake/sedation intubation, videolaryngoscopy and high‐flow nasal oxygenation were uncommon even in the predicted difficult airway patients (in 2.7%, 32.4% and 9.5% of patients, respectively). We conclude that the incidence of serious airway complications is at least as high as it was during NAP4. Despite airway prediction being used, this is not informing subsequent management.
Biomechanical Characterization of a New Acellular Dermal Matrix for Oral Soft Tissue Regeneration

Abstract Objectives Acellular dermal matrices (ADM) are a suitable alternative to autogenous soft tissue grafts (ASG). The aim of this study was to analyze the biomechanical properties and architectural features of ASG and ADM. Materials and methods ASG were harvested from the hard palate of fresh frozen body donors as connective tissue grafts and compared to ADM of porcine origin (NovoMatrix, NM; mucoderm, MD). Maximum load (ML, Newton [N]) and expansion (E, [mm]) were measured after rehydration in saline solution by tensile strength measurement. Light microscopy (LM) and scanning electron microscopy (SEM) were performed to analyze the architectural features of ASG and ADM in high resolution. Results ASG demonstrated a significantly decreased ML compared to NM and MD (p < 0.0001 and p = 0.019). NM showed a significantly increased ML compared to MD (p = 0.001). ASG demonstrated a non-significantly reduced E compared to NM (p = 0.13) and a significantly increased E compared to MD (p = 0.025). NM showed an increased E compared to MD (p < 0.0001). LM and SEM highlighted the surface characteristics and internal structures of ASG and ADM, such as the surface compact layer of MD and the densely packed, parallel running and ordered collagen fibers of NM and MD. Conclusions Significant differences concerning the biomechanical properties and architectural features of ASG, and ADM were found. Clinical relevance Information about the biomechanical properties and architectural features of ASG and ADM can contribute to a better understanding of the clinical performance and extend the application area.
Development and Evaluation of Khellin-loaded Microemulgel for Dermatological Applications

Abstract Microemulsions are optically nanosized emulsions, isotropic and thermodynamically stable. They represent versatile drug delivery systems with high potential because they can be administered regardless of route. In the present study, we report on the formulation of a microemulsion made with glycerol (2.25%), Labrasol (20.25%) vitamin E acetate (2.50%), and water (75.00%), which was developed using the pseudo-ternary phase diagram. Globules of the microemulsion had PdI less than 0.25 and size of about 17 nm, evaluated by DLS analysis. These values did not change after loading khellin, a natural lipophilic molecule with interesting biological activities, used as a model of lipophilic drug. Carboxymethyl cellulose was selected as gelling polymer to obtain a microemulgel. Viscosity was 22 100.0 ± 1555.6 mPas·s at 21 ± 2 °C, while it was 8916.5 ± 118.1 mPas·s at 35 ± 2 °C, remaining stable over time. Khellin recovery was 93.16 ± 4.39% and was unchanged after 4 weeks of storage (93.23 ± 2.14%). The pH was 6.59 ± 0.19 and it was found to be 6.42 ± 0.34 at the end of the storage lifetime. The diffusion of khellin from the developed formulation was prolonged over an extended period. Based on overall results and due to the dermatological properties of the ingredients of the formulation, the developed microemulgel loaded with khellin is very promising and suitable for skin care applications.
Protective effect of naringin ameliorates TNBS‐induced colitis in rats via improving antioxidant status and pro-inflammatory cytokines

Abstract Aim: Ulcerative colitis (UC) is a chronic inflammatory bowel disease that disturbs the colon mucosal lining and is characterized by oxido-nitrosative stress and the release of pro-inflammatory cytokines. Naringin (NG) belongs to a group of chemicals called bioflavonoids derived from grapefruit and related citrus species. NG has been widely used as folk medicine in many countries, due to its several health benefits. Method: This study examined the effect of NG on 2,4,6 trinitrobenzene sulfonic acid (TNBS)-induced colitis in rats. Forty-two male Wistar rats were divided into seven groups like Normal Control (NC), Ethanol Control (EC), Disease Control (DC), NG 20 (20 mg/kg, p.o.), NG 40 (40 mg/kg, p.o.), NG 80 (80 mg/kg, p.o.), and Dexamethasone (DEX) (2 mg/kg, p.o.). Colitis was induced in Wistar albino rats by administering TNBS intra-rectally (in 50% ethanol). The rats were then given 14 days of NG (20, 40, and 80 mg/kg) and DEX (2 mg/kg) treatment. Several behavioral, biochemical, molecular, and histological analyses were performed. Result: The treatment of rats with NG significantly increased the body weight (p < .05, p < .01), hematological parameters like hemoglobin (p < .05, p < .01, p < .001), red blood cells (p < .01, p < .001), and platelets count (p < .01, p < .001) and decreased in spleen weight (p < .01, p < .001), colon weight (p < .01, p < .001), colon weight to length ratio (p < .05, p < .01, p < .001), macroscopic score (p < .01, p < .001), adhesion score (p < .01, p < .001), diarrhea score (p < .05, p < .001), stool consistency (p < .01, p < .001), rectal bleeding score (p < .05, p < .01, p < .001), white blood cells count (p < .01, p < .001). NG significantly (p < .01, p < .001) increased colonic superoxide, glutathione, and catalase levels and decreased malondialdehyde and myeloperoxidase levels. It also significantly (p < .01, p < .001) decreased the biochemical parameters, proinflammatory cytokines and reduced the histological damage in the colon tissue caused by TNBS. Conclusion: Our results demonstrated that NG treatment attenuated pathologic changes of TNBS-induced colitis in rats through restoring colonic damage and reducing inflammatory response in the colon tissue. Thus, NG might be considered as an effective candidate for the treatment of UC patients.
A dual-purpose real-time indicator and transcriptional integrator for calcium detection in living cells

Calcium is a ubiquitous second messenger in eukaryotes, correlated with neuronal activity and T-cell activation among other processes. Real-time calcium indicators such as GCaMP have recently been complemented by newer calcium integrators that convert transient calcium activity into stable gene expression. Here we introduce LuCID, a dual-purpose real-time calcium indicator and transcriptional calcium integrator that combines the benefits of both calcium detection technologies. We show that the calcium-dependent split luciferase component of LuCID provides real-time bioluminescence readout of calcium dynamics in cells, while the GI/FKF1 split GAL4 component of LuCID converts calcium-generated bioluminescence into stable gene expression. We also show that LuCID’s modular design enables it to also read out other cellular events such as protein-protein interactions. LuCID adds to the arsenal of tools for studying cells and cell populations that utilize calcium for signaling.
Poor performance of predictive equations to estimate resting energy expenditure in patients with Crohn’s disease

Abstract Studies exploring the accuracy of equations calculating resting energy expenditure (REE) in patients with Crohn’s disease (CD) are lacking. The aim of this study was to investigate the accuracy of REE predictive equations against indirect calorimetry in CD patients. REE was measured using indirect calorimetry (mREE) after an overnight fasting. Fourteen predictive equations, with and without body composition analysis parameters, were compared with mREE using different body weight approaches. Body composition analysis was performed using dual X-ray absorptiometry. One hundred and eighty-six CD outpatients (102 males) with mean age 41·3 (sd 14·1) years and 37·6 % with active disease were evaluated. Mean mREE in the total sample was 7255 (sd 1854) kJ/day. All equations underpredicted REE and showed moderate correlations with mREE (Pearson’s r or Spearman’s rho 0·600–0·680 for current weight, all P-values < 0·001). Accuracy was low for all equations at the individual level (28–42 and 25–40 % for current and adjusted body weight, respectively, 19–33 % for equations including body composition parameters). At the group level, accuracy showed wide limits of agreement and proportional biases. Accuracy remained low when sample was studied according to disease activity, sex, BMI and medication use. All predictive equations underestimated REE and showed low accuracy. Indirect calorimetry remains the best method for estimating REE of patients with CD.
Growth and globalization of point‐of‐care ultrasound publications in emergency medicine

Since the introduction of point‐of‐care ultrasound (POCUS) in emergency medicine (EM), the applications, indications, and training for POCUS have grown. POCUS training in EM residency is standard and POCUS fellowships are common. We sought to quantify and characterize changes in POCUS publications over time with a scoping review of the literature
Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca

Background: Evidence suggests that psychedelic-assisted therapy carries transdiagnostic efficacy in the treatment of mental health conditions characterized by low mood and the use of avoidance coping strategies. Aims: While preliminary evidence suggests that psychological flexibility and emotion regulation processes play an important role within psychedelic therapy, this prospective study addressed methodological gaps in the literature and examined the ability of ayahuasca to stimulate acute states of cognitive reappraisal and long-term changes in psychological flexibility and mood. The study also explored whether moderating factors predisposed participants to experience therapeutic changes. Methods: Participants (N = 261) were recruited from three Shipibo ayahuasca retreat centers in Central and South America and completed assessments on mood, psychological flexibility, and acute ceremonial factors. Expectancy, demand characteristics, and invalid responding were controlled for with several validity scales. Results/Outcomes: Participants reported significant reductions in negative mood after three months, as well as increases in positive mood and psychological flexibility. Acute experiences of reappraisal during the ayahuasca ceremony exerted the strongest moderating effects on increases in positive mood and psychological flexibility. Increases in psychological flexibility statistically mediated the effects of acute psychological factors, including reappraisal, on changes in positive mood. Conclusions/Interpretation: These results highlight the role of acute psychological processes, such as reappraisal, and post-acute increases in psychological flexibility as putative mechanisms underlying positive outcomes associated with psychedelics. These results also provide support for the integration of third-wave and mindfulness-based therapy approaches with psychedelic-assisted interventions.