Miracle-dz/UniFAR-FTUs huggingface dataset:
Coronary artery disease associated with factor V Leiden mutation: a case report.

The prevalence of coronary artery disease in young adults (<45 years of age) has been increasing steadily in recent decades. Although traditional cardiovascular risk factors can be identified in most cases, newly recognized associations are becoming progressively more relevant. The relationship between the factor V Leiden mutation and atherosclerosis has been a matter of debate due to conflicting data presented in previous studies. Presently described is the case of a previously asymptomatic 37-year-old woman with a significant family history of coronary artery disease who developed rapidly progressive angina within 1 month. After a positive non-invasive evaluation, coronary angiography demonstrated a significant obstruction in the proximal left anterior descending artery. Optical coherence tomography revealed a highly vulnerable lipid-rich atherosclerotic plaque. Coronary angioplasty followed by the implantation of 1 drug-eluting stent was successfully performed. A subsequent thrombophilia screening identified a heterozygous factor V R506Q mutation (factor V Leiden). Since there was no history of thromboembolic events, the patient was discharged using only aspirin, clopidogrel, atorvastatin, and atenolol. Further studies are needed to define the most appropriate management of young patients who manifest clinically significant atherosclerotic disease in association with hereditary thrombophilia.
Do stroke survivors agree with their clinicians on the extent of their post-stroke activity limitation and participation restriction?

ABSTRACT This study aimed to examine discrepancies in the reporting of post-stroke functioning between stroke survivors and their clinicians across various disability domains and across current and predicted functioning. Fifty sub-acute stroke survivors (Age M = 70.30 SD = 15.80, 56% female) and their occupational therapist independently completed three measures assessing activity limitations (cognitive, physical, instrumental) and participation restrictions. Assessments were made of current functioning and predicted functioning at three months’ post-discharge. Compared to physical functioning, appraisal discrepancies were more pronounced for cognitive functioning, instrumental activity limitation, and participation restriction. Discrepancies were more pronounced for current, as opposed to predicted, cognitive functioning (Z = −4.21, p < .001) and instrumental activity limitation (Z = −4.00, p < .001). Conversely, discrepancies in participation restriction were greatest for predicted functioning (Z = −4.03, p < .001). Follow-up (n = 39) showed that, compared to survivors’ predictions, clinicians’ predictions were more closely aligned with actual stroke survivor functioning at three months’ post-discharge (as rated by a close other). These findings suggest appraisal discrepancy varies across disability domains and time reference points, with cognitive and complex functional activities being particularly discrepant between stroke survivors and clinicians. Furthermore, clinicians may hold more realistic expectations of short-term functional recovery.
E-cigarette Dependence Measures in Dual Users: Reliability and Relations with Dependence Criteria and E-Cigarette Cessation.

BACKGROUND Electronic cigarettes (e-cigarettes) have drastically changed the nicotine and tobacco product landscape. However, their potential public health impact is still unclear. A reliable and valid measure of e-cigarette dependence would likely advance assessment and prognostication of the public health impact of e-cigarettes. The aim of this research is to examine the internal consistency, structure, and validity of three e-cigarette dependence scales. METHODS Adult dual users (smokers who also vape, N=256) enrolled in an observational cohort study (45.1% women, 70.7% white). At baseline, participants completed the e-cigarette Fagerström Test of Cigarette Dependence (e-FTCD), the e-cigarette Wisconsin Inventory of Smoking Dependence Motives (e-WISDM), and the Penn State Electronic Cigarette Dependence Index (PS-ECDI). All participants provided a urine sample for cotinine analysis and reported e-cigarette use at 1 year. RESULTS The e-WISDM subscales had the highest internal consistency (α=.81-.96), then the PS-ECDI (α=.74) and e-FTND (α=.51). A single-factor structure for the e-FTND and an 11-factor structure for the e-WISDM were supported, but the PS-ECDI did not have a single-factor structure. All three e-cigarette dependence scales were highly correlated with validation criteria including continued e-cigarette use at 1 year, but not with e-liquid nicotine concentration or cotinine. CONCLUSIONS The e-WISDM and PS-ECDI had stronger internal consistency than did the e-FTND, despite the e-FTND's single-factor structure, but all 3 measures appear to be valid measures of e-cigarette dependence as suggested by their significant relations with self-perceived addiction, heavy use, early use after overnight deprivation, and continued use over time. IMPLICATIONS This research provides empirical support for three e-cigarette dependence measures: the e-FTND, the PS-ECDI, and the e-WISDM among dual users of e-cigarettes and combustible cigarettes. The PS-ECDI and e-WISDM are more reliable, but all three measures were strongly correlated with key dependence constructs such as heavy use and continued use over time.
Angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy compared to best medical treatment: One-year interim results of SPACE-2

Background Treatment of individuals with asymptomatic carotid artery stenosis is still handled controversially. Recommendations for treatment of asymptomatic carotid stenosis with carotid endarterectomy (CEA) are based on trials having recruited patients more than 15 years ago. Registry data indicate that advances in best medical treatment (BMT) may lead to a markedly decreasing risk of stroke in asymptomatic carotid stenosis. The aim of the SPACE-2 trial (ISRCTN78592017) was to compare the stroke preventive effects of BMT alone with that of BMT in combination with CEA or carotid artery stenting (CAS), respectively, in patients with asymptomatic carotid artery stenosis of ≥70% European Carotid Surgery Trial (ECST) criteria. Methods SPACE-2 is a randomized, controlled, multicenter, open study. A major secondary endpoint was the cumulative rate of any stroke (ischemic or hemorrhagic) or death from any cause within 30 days plus an ipsilateral ischemic stroke within one year of follow-up. Safety was assessed as the rate of any stroke and death from any cause within 30 days after CEA or CAS. Protocol changes had to be implemented. The results on the one-year period after treatment are reported. Findings It was planned to enroll 3550 patients. Due to low recruitment, the enrollment of patients was stopped prematurely after randomization of 513 patients in 36 centers to CEA (n = 203), CAS (n = 197), or BMT (n = 113). The one-year rate of the major secondary endpoint did not significantly differ between groups (CEA 2.5%, CAS 3.0%, BMT 0.9%; p = 0.530) as well as rates of any stroke (CEA 3.9%, CAS 4.1%, BMT 0.9%; p = 0.256) and all-cause mortality (CEA 2.5%, CAS 1.0%, BMT 3.5%; p = 0.304). About half of all strokes occurred in the peri-interventional period. Higher albeit statistically non-significant rates of restenosis occurred in the stenting group (CEA 2.0% vs. CAS 5.6%; p = 0.068) without evidence of increased stroke rates. Interpretation The low sample size of this prematurely stopped trial of 513 patients implies that its power is not sufficient to show that CEA or CAS is superior to a modern medical therapy (BMT) in the primary prevention of ischemic stroke in patients with an asymptomatic carotid stenosis up to one year after treatment. Also, no evidence for differences in safety between CAS and CEA during the first year after treatment could be derived. Follow-up will be performed up to five years. Data may be used for pooled analysis with ongoing trials.
Flow Patterns in Carotid Webs: A Patient-Based Computational Fluid Dynamics Study

BACKGROUND AND PURPOSE: Carotid webs are increasingly recognized as an important cause of (recurrent) ischemic stroke in patients without other cardiovascular risk factors. Hemodynamic flow patterns induced by these lesions might be associated with thrombus formation. The aim of our study was to evaluate flow patterns of carotid webs using computational fluid dynamics. MATERIALS AND METHODS: Patients with a carotid web in the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) were selected for hemodynamic evaluation with computational fluid dynamics models based on lumen segmentations obtained from CT angiography scans. Hemodynamic parameters, including the area of recirculation zone, time-averaged wall shear stress, transverse wall shear stress, and the oscillatory shear index, were assessed and compared with the contralateral carotid bifurcation. RESULTS: In our study, 9 patients were evaluated. Distal to the carotid webs, recirculation zones were significantly larger compared with the contralateral bifurcation (63 versus 43 mm2, P = .02). In the recirculation zones of the carotid webs and the contralateral carotid bifurcation, time-averaged wall shear stress values were comparable (both: median, 0.27 Pa; P = .30), while transverse wall shear stress and oscillatory shear index values were significantly higher in the recirculation zone of carotid webs (median, 0.25 versus 0.21 Pa; P = .02 and 0.39 versus 0.30 Pa; P = .04). At the minimal lumen area, simulations showed a significantly higher time-averaged wall shear stress in the web compared with the contralateral bifurcation (median, 0.58 versus 0.45 Pa; P = .01). CONCLUSIONS: Carotid webs are associated with increased recirculation zones and regional increased wall shear stress metrics that are associated with disturbed flow. These findings suggest that a carotid web might stimulate thrombus formation, which increases the risk of acute ischemic stroke.
The Sprouty/Spred family as tumor suppressors: Coming of age

The Ras/Raf/ERK pathway is one of the most frequently dysregulated signaling pathways in various cancers. In some such cancers, Ras and Raf are hotspots for mutations, which cause continuous activation of this pathway. However, in some other cancers, it is known that negative regulators of the Ras/Raf/ERK pathway are responsible for uncontrolled activation. The Sprouty/Spred family is broadly recognized as important negative regulators of the Ras/Raf/ERK pathway, and its expression is downregulated in many malignancies, leading to hyperactivation of the Ras/Raf/ERK pathway. After the discovery of this family, intensive research investigated the mechanism by which it suppresses the Ras/Raf/ERK pathway and its roles in developmental and pathophysiological processes. In this review, we discuss the complicated roles of the Sprouty/Spred family in tumor initiation, promotion, and progression and its future therapeutic potential.
Hemisphere‐specific effects of prefrontal theta‐burst stimulation on visual recognition memory accuracy and awareness

The prefrontal cortex has been implicated in episodic memory and the awareness of memory. Few studies have probed the nature and necessity of its role via brain stimulation. There are uncertainties regarding whether the hemisphere of stimulation predicts effects on memory and whether effects of stimulation are format‐specific, with most previous studies utilizing verbal/semantic stimuli.
A Geospatial Analysis of Distances to Hospitals that Admit Pediatric Asthma Patients

Abstract Objective: Pediatric care is now concentrated in urban specialty centers (“regionalization”), even for common conditions such as asthma. At the same time, rural emergency medical services (EMS) faces challenges related to adequate workforce staffing and financing. This statewide study describes how regionalization of pediatric inpatient care for asthma exacerbations affects EMS operations, particularly for rural agencies. Methods: This is a statewide cross-sectional study of EMS encounters for pediatric asthma in patients aged 2–18 years from 2011 to 2016 using Florida’s EMS Tracking and Reporting System (EMSTARS) database. EMSTARS encounters were deterministically linked to Florida’s Agency for Healthcare Administration (AHCA) database. We categorized AHCA hospital facilities that received included patients by whether they did or did not admit pediatric asthma patients during the study period (“admitting facility”). We used geospatial analysis to map the EMS agency’s home county and the admitting facilities addresses. For each county in Florida, we calculated the average estimated EMS travel distance to the nearest admitting facility using a dasymetric mapping approach. Results: The study included a total of 11,226 EMS pediatric asthma encounters, of which 11,153 (99%) matched to an EMS home county. AHCA data was available for 3,812 (34%) patients. Most counties with distances to admitting facilities less than or equal to 15 miles were urban (31 of 39). For distances of 31–45 miles to an admitting facility, 7 of 8 of counties were rural, and for distances greater than 46 miles, all 4 counties were rural. Conclusions: In this statewide study in Florida, we found long average estimated EMS travel distances to admitting facilities for Florida’s pediatric population in rural counties for pediatric asthma exacerbations. Those long distances have great implications for rural EMS operations, including pediatric destination decisions, transport times, and availability for others who call 9-1-1. Further research on bypass and secondary transport rates, and outcomes for asthma and other pediatric conditions are required to further characterize pediatric regionalization’s impact on rural EMS.
Gender advantage? A case study of male nursing students at a New Jersey community college

v List of Figures . x List of Tables . xi Chapter 1: Introduction . 1 The Nursing Profession . 2 Gender and Feminized Fields . 4 The Role of the Community College.6 Problem Statement . 8 Purpose Statement . 10 Research Questions . 10 Theoretical Framework.11 Gender.11 Gender Attribution.12 Significance of Research.13 Policy.13 Practice . 13 Future Research . 14 Delimitations . 15 Overview of Chapters . 16 Chapter 2: Review of the Literature . 18 Relevant Literature . 19 Gender Attribution . 19
Treatment Modalities Of Severe Diabetic Foot Infections

The most common cause of hospitalisation of diabetic patients is softtissue and bone infections involving the foot. Although many patients with severe infections are hospitalised and treated with intravenous antibiotics (IA), the role of early surgical management is often underrated and severe diabetic foot infections (SDFI) can become limbor lifethreatening events that may result in amputation of the lower extremity. Therefore we established our therapeutic strategies within the treatment of SDFI. 109 patients (1998-2000: 24 months) with SDFI (San Antonio: IID, IIIB, IIID) were retrospectively reviewed in the need for above-ankle amputation. Surgical debridement, treatment with IA, evaluation of the vascular status, hyperbaric oxygen therapy (HBO), vacuum-assisted-closure (V.A.C.®) and secondary reconstruction of the foot was performed. In more than 80 % (94 patients) an amputation of the lower extremity could be avoided. In 15 patients (13,8%) an amputation of the lower extremity was performed. A combination of therapies including early surgical management, antimicrobial agents, the input of multiple specialists regarding the revascularisation of the foot and additional therapies like HBO and V.A. C. ® are required, to avoid amputation of the lower extremity in SDFI in a large number of patients.
Endpoints in Clinical Trials: Advantages and Limitations

C) Measurable and interpretable. Secondary endpoints could provide a more global view of the benefit of the treatment being tested and by clarifying its risk-to-benefit ratio; may be of 2 types: A) Those that, like primary endpoints, are clinically relevant and may be taken into consideration for drug indications; and B) “Feel-good” endpoints, which are not likely to lead to a new indication or a change in labelling but might provide reassurance about the primary endpoint along with new information about the disease. Some secondary endpoints might be exploratory analyses, although they might demonstrate biologically plausible effects, they remain hypothesis-generating and will need to be confirmed by additional studies. Table 1 and 2 shows the terms and definitions used in the outcomes of clinical trials [1-4].
Validation de l’Index de sévérité de l’insomnie dans les cliniques de médecine générale

Malgre la prevalence elevee de l’insomnie et sa morbidite importante en termes de problemes de sante et d’utilisation des soins de sante, ce trouble reste sous diagnostique et sous traite chez les patients consultant dans les cliniques de medecine generale. Afin de faciliter son depistage, il importe que des outils d’evaluation simples, pratiques et valides soient mis a la disposition des medecins. Cette etude evalue les proprietes psychometriques de l’Index de severite de l’insomnie (ISI) chez les patients de cliniques de medecine generale. Elle vise egalement a valider la capacite de l’ISI a identifier les cas d’insomnie chez cette population et a determiner le seuil clinique permettant le depistage optimal de l’insomnie. Un echantillon de 410 patients a ete recrute dans six cliniques medicales de la region metropolitaine de Quebec et a rempli l’ISI, un questionnaire de sept items evaluant la nature, severite et impact de l’insomnie (score total allant de 0 a 28). Un sous echantillon de 101 individus a egalement complete une entrevue clinique (Entrevue Diagnostique de l’Insomnie). Le tiers d’entre eux ont recu un diagnostic de trouble d’insomnie. La coherence interne de l’ISI s’est averee excellente, de meme que la capacite discriminante des items individuels. Des analyses de courbe ROC ont ete utilisees afin de determiner le point de rupture optimal a l’ISI permettant de classifier correctement les individus ayant un trouble d’insomnie. L’aire sous la courbe etait de 0,87, indiquant une capacite discriminante moderee a elevee. Un point de rupture de 14 etait optimal (82,4% sensibilite, 82,1% specificite) pour detecter un niveau clinique d’insomnie. La convergence entre le score total a l’ISI et le diagnostic pose a l’entrevue clinique etait moderee (k= 0,62). Ces resultats suggerent que l’ISI est un outil de depistage valide pour detecter l’insomnie dans les cliniques de medecine generale.
Imaging techniques for ageing deep vein thrombosis: a systematic review

Poster: "ECR 2015 / C-1434 / Imaging techniques for ageing deep vein thrombosis: a systematic review" by: "B. Dharmarajah, V. Sounderajah, S. Rowland, A. H. Davies, E. L. Leen; London/UK"
Screening for Abnormal Glucose Homeostasis in Pregnancy in Riyadh

Depistage portant sur 280 Saoudiennes et 200 d'autres nationalites arabes. Mesure unique de la glycemie apres 2 h d'ingestion par voie orale de 75 g de glucose. 14,8% des patientes ont presente une glycemie normale et ont subi un test de tolerance au glucose plus complet. 9% de ces tests etaient anormaux
Preparedness Among Illinois High School Athletic Departments: Does Size Or Location Matter?

Objective:To determine level of medical provider coverage for Illinois high schools athletic teams and coaching staff certification requirements for first-aid, CPR, and /or automated external defibrillator (AED) training. Methods: Previously validated surveys were mailed to all Illinois High School Association (IHSA) member schools as part of an annual newsletter from the IHSA requesting information about their individual athletic programs. Design: Prospective survey. Outcome Measures: Prevalence of coaching staff certification requirements and medical coverage availability of physicians certified athletic trainers, school nurses, and ambulance personnel at IHSA sanctioned practices and athletic events. Results: Forty-four percent (316/724) of survey forms were returned. Overall, 125 schools (41%) require first-aid certification, 111 schools (36%) require CPR certification, 57 schools (19%) require certification in AED use, and 15 schools (5%) require American Sport Education Program certification for their coaching staff. Of the 182 schools (58%) that do not require first-aid training of coaches, 169 schools (93%) have a medical provider available. The majority of IHSA member schools (92%) have at least one nurse, athletic trainer or physician responsible for medical care at athletic events. Seventy-three percent of schools have an athletic trainer, 192 schools (61%) have a nurse, and 136 schools (43%) have a physician responsible for medical care; 201 schools (64%) have more than one level of care. Availability of the medical care providers varied between practice and games. No providers were available during practice at 34% of schools while 32% of schools reported having a provider available during practice. During games, only 16% of schools reported no provider available, and 50% of schools had a provider available for all games. Availability of all levels of medical providers varied significantly by both geographic location and school size. The requirement for certification of coaching staff did not statistically differ between geographic locations or by size of HS. Conclusion: Most of the IHSA HSs surveyed do not require coaching staff to be certified at any level in first-aid, CPR, or AED use. Despite the availability of a medical provider at most Illinois HS athletic practices or events, critical time may be lost while waiting for the trained individual to respond to an acute life-threatening event.
Epidemiological study of drug resistant cholera in and around Miraj, India -

Background: Cholera is an intestinal infection caused by Vibrio cholerae . The hallmark of the disease is profuse secretory diarrhea. Cholera can be endemic, epidemic, or pandemic. Despite all the major advances in research, the condition still remains a challenge to the modern medical world. Objectives: This study was conducted to observe various epidemiological profile of cholera outbreak and to determine the antibiotic sensitivity pattern of isolates . Methods: A descriptive study was conducted from 18th January 2010 to 31st July 2010. All confirmed cases of cholera were included in the present study during the study period. Antibiotic sensitivity testing was performed by disc diffusion method. Results: Total 63 patients of cholera caused by Vibrio cholerae O1 were admitted in the hospital during the present study; majorities (60.32%) of cases were males and cases were more (79.36%) amongst adults (>15 years). All strains were El Tor. The outbreak started on 18th January 2010, peaked in February and lasted till 24 th July 2010. Detection of V. cholera O1 biotype El Tor serotype Ogawa was 81.25% and rests (18.75%) were serotype Inaba. Clinically all cases (100%) presented with profuse watery diarrhea, 28.57% had vomiting, 20.63% had abdominal cramps while fever was present in 9.53% of cases. Majority of isolates were sensitive to amikacin and cephalexin but resistant to ampicillin and chloramphenicol . Conclusions: Provision of safe drinking water, improving sanitation and strengthening of disease surveillance especially in coordination with local health authorities across the border is necessary to avoid recurrences of cholera.