Miracle-dz/UniFAR-FTUs huggingface dataset:
Assessing the outcome of Holmium Laser Enucleation of the Prostate (HoLEP) by age, prostate volume, and a history of blood thinning agents - report from a single-center series of >1,800 consecutive cases.

PURPOSE To assess perioperative outcomes of HoLEP in a real-world scenario and with a focus on demanding patient factors such as large prostate size, advanced patient age, and anticoagulation therapy (AT). MATERIAL & METHODS We retrospectively analysed HoLEP procedures at our institution between 2010-2016. After stratification by prostate volume, age, and AT, perioperative and early voiding characteristics were compared. A multivariable regression model was employed to identify predictors of prolonged time of catheterization (defined as being above groups median). RESULTS The study cohort consisted of 1,816 men with a median age of 71 years (IQR:66-76), a median prostate volume of 80 ml (IQR:58-105) and American Society of Anesthesiologists (ASA) score ≥3 in 618 men (34%). Median time of enucleation and morcellation were 43 min (IQR:31-60) and 10 min (IQR:6-18), respectively. Perioperative blood transfusions were administered in 44 (2.4%) cases, severe postoperative complications (Clavien-Dindo grade ≥3b) occured in 61 (3.3%) of cases. The median time of catheterization was 2 days (IQR: 2-2), with prolonged catheterization occuring in 277 (15%) of cases. After adjustment, very large prostates (4th volume quartile (106-280ml) (OR:1.8, 95%CI:1.3-2.6, p=0.001), therapeutic low-molecular-weight heparin bridging regimen (OR: 2.2, 95%CI:1.4-3.6, p=0.037), low-dose acetylsalicyclic acid (OR:1.5, 95%CI:1.0-2.2, p=0.015), and a history of direct oral anticoagulation (OR:2.3, 95%CI:1.2-4.0, p=0.022), but not patient age, were independently associated with prolonged catherization. CONCLUSIONS We confirm HoLEP as safe and efficient; however, patients with very large prostates and patients with a history of anticoagulation therapy are at risk of prolonged catheterization.
Early Failures of Polyvinyl Alcohol Hydrogel Implant for the Treatment of Hallux Rigidus

Background: The purpose of this study was to evaluate the clinical and radiological outcomes following a polyvinyl alcohol hydrogel implant in the treatment of hallux rigidus. Methods: A retrospective cohort study investigating patients treated with a polyvinyl alcohol hydrogel implant for hallux rigidus was performed. Clinical outcomes were evaluated with the Foot and Ankle Outcomes Score (FAOS) and visual analog scale (VAS) score at the final follow-up. Plain radiographs were assessed postoperatively. Eleven patients (11 feet) with a mean follow-up of 20.9 months (range, 14-27 months) were included. The mean age was 60.3 years. Results: All FAOS subscales showed pre- to postoperative improvements, but there was no statistical significance in all subscales. The mean VAS score showed improvement from 4.1 to 3.0 (P = .012). On postoperative plain radiographs, implant subsidence was observed 60% (6/10) at 4 weeks after surgery and 90% (9/10) at the final follow-up. Fifty percent (5/10) showed radiologic lucency around the implant. Forty percent (4/10) had erosion of the proximal phalanx of the great toe. Four patients (36%) reported no improvement following surgery at the final follow-up, which were considered as failures. Three patients required additional surgery related to the implants. An additional patient is waiting to revise the implant. Conclusion: Our current cohort study demonstrated a high failure rate with the polyvinyl alcohol hydrogel implant in patients with hallux rigidus. Significant radiologic subsidence with lysis around the implant, erosion of the proximal phalanx countersurface, and implant wear are harbingers for concern in the long term. Level of Evidence: Level IV, case series.
The early life education of the immune system: Moms, microbes and (missed) opportunities

ABSTRACT The early life immune system is characterized by unique developmental milestones. Functionally diverse immune cells arise from distinct waves of hematopoietic stem cells, a phenomenon referred to as ‘layered’ immunity. This stratified development of immune cells extends to lineages of both innate and adaptive cells. The defined time window for the development of these immune cells lends itself to the influence of specific exposures typical of the early life period. The perinatal immune system develops in a relatively sterile fetal environment but emerges into one filled with a multitude of antigenic encounters. A major burden of this comes in the form of the microbiota that is being newly established at mucosal surfaces of the newborn. Accumulating evidence suggests that early life microbial exposures, including those arising in utero, can imprint long-lasting changes in the offspring’s immune system and determine disease risk throughout life. In this review, I highlight unique features of early life immunity and explore the role of intestinal bacteria in educating the developing immune system.
The current state of immunization against Gram-negative bacteria in children: a review of the literature

Purpose of review Gram-negative bacteria (GNB) are a major cause of infection worldwide and multidrug resistance in infants and children. The major pathogens include Klebsiella pneumoniae, Escherichia coli, Enterobacter spp. , Pseudomonas aeruginosa and Acinetobacter baumannii. With new antibiotic options limited, immunization is likely to play a critical role in prevention. This review discusses their epidemiology, the current state of vaccine research and potential immunization strategies to protect children. A comprehensive review of the literature, conference abstracts along with web searches was performed to identify current and investigational vaccines against the major GNB in children. Recent findings Phase I--III vaccine trials have been undertaken for the major Gram-negative bacteria but not in infants or children. E. coli is a common infection in immune-competent children, including neonatal sepsis. Several vaccines are in late-phase clinical trials, with some already licensed for recurrent urinary tract infections in women. Klebsiella spp. causes community-acquired and hospital-acquired infections, including sepsis in neonates and immunocompromised children although no vaccine trials have extended beyond early phase 2 trials. P. aeruginosa is a common pathogen in patients with cystic fibrosis. Phase 1--3 vaccine and monoclonal antibody trials are in progress, although candidates provide limited coverage against pathogenic strains. Enterobacter spp. and A. baumannii largely cause hospital-acquired infections with experimental vaccines limited to phase 1 research. Summary The current immunization pipelines for the most prevalent GNB are years away from licensure. Similar to incentives for new antibiotics, global efforts are warranted to expedite the development of effective vaccines.
Stabilisation of betalains and phenolic compounds extracted from red cactus pear (Opuntia ficus-indica) by spray and freeze-drying using oca (Oxalis tuberosa) starch as drying aid

The objective of this work was to evaluate the stabilisation of betalains and phenolic compounds extracted from red cactus pear by spray and freeze-drying. After hydroethanolic extraction and partial solvent removal under reduced pressure, the highly coloured extracts were enriched with oca starch and maltodextrin as drying aids in different ratios (100:0, 70:30, and 50:50, oca starch: maltodextrin) prior to spray and freeze-drying. The obtained microencapsulated extract powders were characterised by moisture content, hygroscopicity, solubility and morphology. In addition, the stability of the encapsulated betalains and phenolics was evaluated during storage at room temperature for 105 days. All microcapsules showed high retentions of betacyanins (69.9–86.5% after 105 days), betaxanthins (72.2–81.9%), phenolic compounds (46.5–63.5%) and antioxidant capacity (60.1–64.9%, FRAP method; 49.7–57.5%, ABTS method). The system with 70:30 starch:maltodextrin ratio as drying aids showed the highest values of retention regarding the polyphenol content (63.5%), antioxidant capacity (64.9% to FRAP method) and betacyanin content (86.5%), as well as a low degradation rate constant of betacyanins (1.23 × 10−3 days−1) and a long half-life (563 days). Oca starch used alone or in combination with maltodextrin has been shown to work adequately as a microencapsulating agent and stabilizer of pigments and antioxidants derived from red cactus pear.
A Retrospective Analysis in 1347 Patients Undergoing Cement Augmentation for Osteoporotic Vertebral Compression Fracture: Is the Sandwich Vertebra at a Higher Risk of Further Fracture?

BACKGROUND Multiple percutaneous vertebral cement augmentation may create sandwich vertebrae. Whether the sandwich vertebra is at higher risk of further fracture remains unknown. OBJECTIVE To compare the incidence of further fractures of sandwich vertebrae and adjacent vertebrae and to identify potential risk factors for sandwich vertebral fractures. METHODS Patients who underwent cement augmentation for osteoporotic vertebral compression fractures (OVCFs) in a single medical center between January 2012 and December 2015 were included. A sandwich vertebra was defined as an intact vertebra located between 2 previously cemented vertebrae. Demographic data and imaging findings were recorded. All patients were followed up for at least 24 mo postoperatively. During follow-up period, if the patient reported new-onset back pain with corresponding imaging findings, a diagnosis of sandwich vertebral fracture was made. RESULTS Among the 1347 patients who underwent vertebroplasty/kyphoplasty for OVCFs, 127 patients with 128 fracture levels met the criteria for sandwich vertebrae (females/males 100/27, mean age 77.8 ± 7.7 yr old). The fracture location was most common in the thoraco-lumbar junction (T10-L2), 68.5% (87/127). The incidence of sandwich vertebral fracture was 21.3%, whereas the incidence of adjacent level fracture of those with no sandwich vertebra was 16.4% (196/1194), P = . 1879. CONCLUSION The incidence of sandwich vertebral fracture is not higher than that at the adjacent levels. The factor associated with further sandwich vertebral fracture was male gender. Once sandwich vertebral fracture occurred, patients may seek more surgical intervention than those with only adjacent fractures.
Radiologic Evaluation of the Influence of Cleft Treatment on Nasal Dorsum Growth

Objective: The study addresses whether the growth of the nasal dorsum is disturbed by cleft treatments, for cleft lip only (CL) and cleft lip with cleft palate (CLP). Design: A total of 576 patients with cleft (278 CL, 298 CLP) and 333 individuals without orofacial clefts were retrospectively enrolled. Cleft lip only group was treated with a modified Millard technique combined with Tajima incision for rhinoplasty at 3 to 6 months. The CLP group underwent the same lip repair technique and then underwent a Sommerlad palatoplasty at 9 to 12 months. Lateral cephalometric radiographs of all individuals were taken to evaluate the nasal length and nasal dorsum height. Dunn test was used to analyze the difference (P < .001). Results: Compared with control, in CL, nasal bone angle and nasal dorsum angle increase by age similarly (5-18 years, P > .05); the total dorsum is significantly shorter (5-18 years, P < .001), while the upper nasal dorsum length is similar (except in 5-6 years), and the lower nasal dorsum is shorter (5-18 years, P < .001). In CLP, nasal bone angle develops insufficiently as children grow (8-18 years, P < .001); the nasal dorsum angle is notably smaller (5-18 years, P < .001); nasal bone length is not significantly different except 11 to 13 years (P < .05); nasal dorsal length is similar at skeletal maturity (17-18 years, P > .05), although it is shorter during 8 to 16 years (P < .05); the upper nasal dorsum is overdeveloped (14-18 years, P < .05), whereas the lower nasal dorsum is underdeveloped (5-18 years, P < .001). Conclusion: Treatments in both CL and CLP could be the important factors in disturbing the growth of cartilaginous portion of the nasal dorsum (including nasal tip) and the nasal dorsum height.
A Six -Year Clinical, Microbiological and Radiological Study Outcome Following Treatment of Peri-implantitis

The present study evaluated the long-term outcome of a combined surgical and composite graft (bovine porous bone mineral BPBM and autogenous bone) in the treatment of peri-implantitis. Six individuals with titanium implants demonstrating a marginal bone loss. Baseline ,1 and 6 years measurements, including introral digital radiographs, gingival index (GI), probing depth(PD) and probing bone level (BL) were performed. In each implant subgingival bacterial samples were obtained and subjected to microbiological analysis by culture. Surgical exposure of the lesions and cleaning of the implants using hydrogen perioxide and2% aqueous solution of chlorohexidine gluconate were performed. The autogenous bone was harvested from the chin combined with BPBM and packed into the bony defects. The treatment was evaluated clinically, microbiologically and radiographically at 1 and 6 years. Results: revealed a significant reduction in plaque and gingival bleeding. The mean probing depth was 6.94+ 1.16 at the baseline and it was 1.91 + 1.21 at the end of the study period. All treated implants showed bonegain. The mean gain in bone level was 5.12 + 0.5 and radiological evaluation of bone density was measured at crest, mid-implant and lateral apical area of interest AOI 32.0 + 0.87, 72.91 +0.83, 63.0 + 0.94 at baseline and it reached 109.5 + 0.53, 141.63 + 1.19 and 144.0 + 0.47 respectively. The presence of putative periodontal pathogens significantly declined at the end of the study period. Conclusions: The results of the study suggest that the use of composite bone grafts as the treatment strategy for peri-implantitis lesions with maintenance of good oral hygiene appears to be an efficacious treatment approach for restoring year follow-up period.
Coping strategies used by patients with relapsing multiple sclerosis from Argentina: correlation with quality of life and clinical features

ABSTRACT Background Multiple sclerosis (MS) is a chronic neurodegenerative and inflammatory disease. The adaptation to MS depends on the effectiveness of coping, which moderates the process of adaptation and psychological well-being. Objectives We aimed to analyze the coping strategies of an Argentinean population of patients with MS (PwMS) and their association with clinical variables and health-related quality of life (QoL). Methods A nationwide cross-sectional study. Screening instruments: Demographics and clinical data, coping strategies (Brief Coping Orientation to Problems Experienced, [COPE-28]), health-related QoL (MS Impact Scale, [MSIS-29]), Fatigue Severity Scale, and physical disability (self-administrated Expanded Disability Status Scale, [EDSS]). Results We included 249 PwMS. Most responders were female (74.7%) with a mean age at survey of 38.6 (±10.7) and had a MS duration of 7.3 years (range: 1–43 years) and a mean EDSS of 1.9 (±1.8). Younger age (r = −0.17), active MS (r = 0.25), higher fatigue (r = 0.22), MSIS-29 total (r = 0.34), MSIS-physical (r = 0.26), MSIS-psychological scores (r = 0.44), higher scores for perception of both severity of MS (r = 0.12) and wheelchair-dependency (r = 0.14) correlated significantly with the use of maladaptive coping strategies. However, active MS (β2.10, p = 0.01), MSIS-psychological score (β0.28, p < 0.0001), high education level (β − 1.15, p = 0.04), and EDSS (β − 0.84, p = 0.0001) were independent predictors of the utilization of maladaptive coping strategies after having applied multivariate analysis via linear regression. Conclusions Maladaptive coping strategies used by PwMS are associated with relevant clinical aspects of the disease and with worse health-related QoL scores.
Association between umbilical cord vitamin D levels and adverse neonatal outcomes

Objective We investigated the associations between cord blood concentration of 25-hydroxyvitamin D [25(OH)D], neonatal outcomes, and the risk of hospitalization during the first year of life. Methods A total of 402 newborn infants and their mothers were prospectively enrolled and divided in four groups according to season of the year. We determined 25(OH)D serum concentrations from maternal–neonatal pairs at delivery by electrochemiluminescence immunoassay. Cut-offs at 25, 50, and 75 nmol/L defined vitamin D status, corresponding to deficiency, insufficiency, and sufficiency, respectively. Crude odds ratio (cOR) and 95% confidence intervals (CI) were estimated using logistic regression. Results Vitamin D severe deficiency (i.e., <25 nmol/L) was present in 18% of newborns. Cord blood severe deficiency was associated with an increased risk of preterm birth (cOR 3.6, 95% CI: 1.1–12.2), neonatal respiratory distress syndrome (cOR 5.9, 95% CI: 1.1–33.2), and increased risk of hospitalization during the first year of life because of acute respiratory infection (cOR 3.9, 95% CI: 1.4–10.6) or acute gastroenterocolitis (cOR 5.2, 95% CI: 1.4–19.1). Conclusion Cord blood vitamin D deficiency is associated with increased risk of preterm birth, neonatal respiratory distress syndrome, and hospitalization during the first year of life.
Behavior of Captive Opossums, Didelphis marsupialis virginiana

The individual and social behavior of 73 captive opossums, Didelphis marsupialis virginiana, was studied. The patterns of behavior seen in Didelphis appear generalized, correlating with the opossum's primitive morphology and taxonomic status. Diverse locomotor patterns, arboreal modifications, and highly unselective food habits explain in part the diversity of habitats frequented by Dudelphis in North America. A well developed attitude of passive defense is seen in interspecific encounters and the adaptive significance of such behavior is considered. Social behavior is poorly developed and, with the exception of mating, most intraspecific encounters between adults are agonistic in nature. Although marsupials are usually not successful in competition with placentals, the opossum is an obvious exception. Presumably, its generalized behavior has allowed Didelphis to exploit a variety of food sources and habitat types. This, together with a high reproductive potential, may account for the evolutionary persistence of the species, and its current ecological success. INTRODUCTION The opossum, Didelphis marsupialis (Family Didelphidae) is the only marsupial native to the United States. Morphologically, Didelphis resembles members of the Upper Cretaceous didelphid stock which underwent adaptive radiation in South America and from which all extant marsupials evolved (Simpson, 1945; Clemens, 1968). Although marsupials are usually not successful in competition with placentals, Didelphis is notable for its persistence, particularly in the eastern United States (Hamilton, 1958). This success may be due, in part, to the opossum's generalized morphology (Haines, 1958); but other aspects of its biology must also be involved. Despite the unique taxonomic position of Didelphis, little attention has been given to the details of its behavior. With the exception of studies on the ontogeny of behavior in pouch young (Langworthy, 1925, 1928), on reproductive behavior (Reynolds, 1952), and on defensive behavior (Francq, 1969), most information on the behavior of the opossum is of an anecdotal nature. The present study attempts to provide an account of the behavior of the opossum, with the specific objective of learning the extent to which behavioral and associated structural features may have contributed to its success. In addition, the primitive status of the opossum makes its behavior of exceptional interest from the broader standpoint of the origin and evolution of mammalian patterns of behavior in general. METHODS AND MATERIALS Opossums were captured in the vicinity of Ithaca, Tompkins Co., New York. A total of 76 individuals (33 males and 43 females) of the 1 Present address: Department of Biology, Fairleigh Dickinson University, Madison, New Jersey 07940.
The application of multivariate adaptive regression splines in exploring the influencing factors and predicting the prevalence of HbA1c improvement.

BACKGROUND Glycosylated hemoglobin (HbA1c) is directly proportional to the level of glucose in the blood, and it has been the gold standard to evaluate the status of long-term blood glucose levels. Exploring the factors that lead to HbA1c improvement is beneficial for effectively controlling of HbA1c levels. METHODS Data collected from 52 hospitals in five cities in northern China were divided into training and test sets at a ratio of 7:3. The training set was used to build models, and the test set was used to evaluate the generalizability of the models. The performance of multivariate adaptive regression splines (MARS) models and logistic regression was evaluated, namely, the accuracy, Youden's index, recall rate, G-mean and area under the ROC curve (AUC) with 95% confidence intervals (CIs). RESULTS The prevalence of improvements in HbA1c levels was 38.35%. Doses of insulin less than 13 U, more than 3 kinds of oral medicine, exercise frequency greater than once per week and 2 h postprandial blood glucose (2hPBG) less than 10.56 mmol/L were found to improve HbA1c. The following interactions were negatively associated with improvement in HbA1c levels: patients with relative complications and 2hPBG less than 10.56 mmol/L, type 2 diabetes mellitus (T2DM) duration more than 7 years and insulin dose less than 13U. Compared to logistic regression, the MARS model performed better in the above aspects, except for accuracy. CONCLUSIONS Given the interaction between factors affecting HbA1c improvement, medical staff should conduct comprehensive interventions to further reduce HbA1c levels in patients. In this study, the MARS model was superior to the traditional logistic regression in improving HbA1c levels. MARS had greater generalizability because it not only considered nonlinear relations in the process of model fitting but also adopted cross-validation. Nevertheless, more studies are needed to provide evidence for this result.
Perfluorooctanesulfonic Acid–Induced Toxicity on Zebrafish Embryos in the Presence or Absence of the Chorion

Perfluorooctanesulfonic acid (PFOS) is a perfluorinated compound used in many industrial and consumer products. It has been linked to a broad range of adverse effects in several species, including zebrafish (Danio rerio). The zebrafish embryo is a widely used vertebrate model to elucidate potential adverse effects of chemicals because it is amenable to medium and high throughput. However, there is limited research on the full extent of the impact the chorion has on those effects. Results from the present study indicate that the presence of the chorion affected the timing and incidence of mortality as well as morphometric endpoints such as spinal curvature and swim bladder inflation in zebrafish embryos exposed to PFOS. Furthermore, removal of the chorion prior to exposure resulted in a lower threshold of sensitivity to PFOS for effects on transcriptional expression within the peroxisome proliferator–activated receptor (PPAR) nuclear signaling pathway. Perturbation of PPAR pathway gene expression can result in disruption of metabolic signaling and regulation, which can adversely affect development, energy availability, and survival. It can be concluded that removal of the chorion has significant effects on the timing and incidence of impacts associated with PFOS exposure, and more research is warranted to fully elucidate the protective role of the chorion and the critical timing of these events. Environ Toxicol Chem 2021;40:780–791. Published 2020. This article is a US Government work and is in the public domain in the USA. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.