Miracle-dz/UniFAR-FTUs huggingface dataset:
Computed tomography analysis of sacropelvic parameters in relation to anterior access to the lumbosacral disc

Abstract Purpose: Anecdotally a higher pelvic incidence (PI) confers a ‘deeper’ pelvis with the potential for challenging access, yet this is ill-defined in the existing literature. The aim of this study was to assess the relationship of sacropelvic sagittal parameters and their relationship with the projection angle (PA), an indicator of access to and orientation of the lumbosacral disc with respect to the pelvis and identify a threshold PI value beyond which more difficult surgical access may be anticipated. Materials and methods: Computed tomography (CT) scans taken for trauma were studied. Measures including the PI, sacral kyphosis (SK), sacral table angle (STA), PA and anterior pelvic angle (APA) were taken. The PA is the angle subtended by a line from the apex of the pubic symphysis to the sacral promontory and a line running along the sacral endplate. A positive value is obtained when the line from the endplate runs superior to the symphysis. Results: 168 scans were reviewed, mean age 44.2 years (s.d. 18.4). The mean PI was 50.0 (s.d. 10.2), SK 24.4 (s.d. 12.3), and STA 102.0 (s.d. 6.1). The mean PA was 20.1 (range −14 to 46; s.d. 10.3). PA correlated with PI (R = −0.892; p < .001) and also SK (R = −0.760; p < .001). With PI values above 73 the PA is likely to be negative with the lumbosacral disc orientation falling behind the pubic symphysis. One-way analysis of variance showed differences in PA according the six subclasses of PI. Conclusion: The PA, as an indicator of the orientation of the lumbosacral disc with respect to the pelvis, correlated strongly with the PI. Patients with high PI are more likely to have a lumbosacral disc with trajectory falling behind the pubic symphysis and surgeons should closely analyse pelvic anatomy, particularly in patients with high PI.
PMCA Applications for Prion Detection in Peripheral Tissues of Patients with Variant Creutzfeldt-Jakob Disease

Prion diseases are neurodegenerative and invariably fatal conditions that affect humans and animals. In particular, Creutzfeldt-Jakob disease (CJD) and bovine spongiform encephalopathy (BSE) are paradigmatic forms of human and animal prion diseases, respectively. Human exposure to BSE through contaminated food caused the appearance of the new variant form of CJD (vCJD). These diseases are caused by an abnormal prion protein named PrPSc (or prion), which accumulates in the brain and leads to the onset of the disease. Their definite diagnosis can be formulated only at post-mortem after biochemical and neuropathological identification of PrPSc. Thanks to the advent of an innovative technique named protein misfolding cyclic amplification (PMCA), traces of PrPSc, undetectable with the standard diagnostic techniques, were found in peripheral tissues of patients with vCJD, even at preclinical stages. The technology is currently being used in specialized laboratories and can be exploited for helping physicians in formulating an early and definite diagnosis of vCJD using peripheral tissues. However, this assay is currently unable to detect prions associated with the sporadic CJD (sCJD) forms, which are more frequent than vCJD. This review will focus on the most recent advances and applications of PMCA in the field of vCJD and other human prion disease diagnosis.
Gold nanostars-diagnosis, bioimaging and biomedical applications

Abstract Gold Nanostars (GNS) have attracted tremendous attention toward themselves owing to their multi-branched structure and unique properties. These state of the art metallic nanoparticles possess intrinsic features like remarkable optical properties and exceptional physiochemical activities. These star-shaped gold nanoparticles can predominantly be utilized in biosensing, photothermal therapy, imaging, surface-enhanced Raman spectroscopy and target drug delivery applications due to their low toxicity and extraordinary optical features. In the current review, recent approaches in the matter of GNS in case of diagnosis, bioimaging and biomedical applications were summarized and reported. In this regard, first an overview about the structure and general properties of GNS were reported and thence detailed information regarding the diagnostic, bioimaging, photothermal therapy, and drug delivery applications of such novel nanomaterials were presented in detail. Summarized information clearly highlighting the superior capability of GNS as potential multi-functional materials for biomedical applications.
Empowering self-help groups for caregivers of children with disabilities in Kilifi, Kenya: Impacts and their underlying mechanisms

Bringing up a child with disabilities in a low-income setting is challenged by inadequate resources, limited psycho-social support and poverty. Not surprisingly, many caregivers experience fatigue, distress and isolation. To address and investigate these issues, action was taken to set up twenty self-help groups focusing on caregiver empowerment. A realist evaluation design was adopted to evaluate impacts associated with the self-help process and to identify mechanisms determining the outcomes. Monthly monitoring visits were conducted to the groups during a ten-month set-up period, at the end of which eleven active groups remained, nine having dissolved due to disputes, corruption and extreme environmental conditions. A facilitated intervention was delivered to the active groups (N = 154) over a six-month period. The members were guided to review and discuss topics such as economic empowerment, personal situation, peer support, community inclusion, access to health and education. Evaluation employed mixed methods using questionnaires (n = 75) and semi-structured interviews (n = 36) pre- and post-intervention. At baseline, the burden of caregiving was characterised by aloneness, challenges, stigma and discrimination. Post-intervention, caregiver agency was defined by togetherness, capacity-building, acceptance and well-being. Significant impacts associated with caregiver perceptions included increased social support, reduced severity of child’s disability and decreased effects of extrinsic factors affecting the caregiver’s role. Mechanisms of ‘handling goods and money’ and ‘social ties and support’ appeared to underpin the outcomes. Caregiver empowerment was associated with newly developed skills, social connectedness and resource mobilisation. Documentation of group processes contributes to the evidence on community-based inclusive development.
Central Sensitisation and functioning in patients with chronic low back pain: protocol for a cross-sectional and cohort study

Introduction A relevant subsample of patients with chronic low back pain (CLBP) have manifested augmented central pain processing, central sensitisation (CS). Patients with CLBP have limited functioning and participation. Theoretically, physical functioning in patients with CLBP can plausibly be linked to CS; however, evidence to explain such association is scarce. Moreover, there is no gold standard for CS diagnosis. The objectives of the study are: (1) to analyse the association between instruments assessing reference symptoms and signs attributed to CS; (2) to analyse whether reference symptoms and signs attributed to CS are associated with functioning measurement outcomes; and (3) to analyse whether changes (between baseline and discharge) in reference symptoms and signs attributed to CS are related to changes in each of the functioning measurement outcomes. Methods and analysis A cross-sectional and longitudinal observational study is performed with measurements taken at baseline and discharge of an interdisciplinary rehabilitation programme. A sample size of 110 adult patients with CLBP has been calculated for the study. CS measurements are: Central Sensitisation Inventory, quantitative sensory testing and heart rate variability. Functioning measurements are: lifting capacity, maximal aerobic capacity, accelerometry and reported functioning. Statistical analyses to be performed are: (1) correlation between CS measurements, (2) multiple regression between functioning (dependent variable) and CS measurements (independent variable), and (3) multiple regression between changes in scores of functioning (dependent variable) and CS measurements (independent variable), and corrected for sex and age. Ethics and dissemination The study obtained the clearance to its implementation from the Medical Research Ethics Committee of the University Medical Center Groningen in July 2017. The results will be disseminated through scientific publications in peer-reviewed journals, presentations at relevant conferences, and reports to stakeholders. Trial registration number NTR7167/NL6980.
Language and stigmatization of individuals with mental health problems or substance addiction in the Netherlands: An experimental vignette study

Abstract Persons with mental health problems and/or substance addictions (MHPSA) are stigmatised more than persons with physical conditions. This includes stigmatisation by care professionals. Stigma is considered one of the most important barriers for recovery from these conditions. There is an ongoing debate that use of language can exacerbate or diminish stigmatisation. Therefore, we conducted an experiment examining how four different ways of referring to a person with (a) alcohol addiction, (b) drug addiction, (c) depression and (d) schizophrenia are related to stigmatising attitudes by care professionals in the Netherlands. We partially replicated two studies performed in the United States and used surveys with vignettes containing either ‘disorder‐first’, ‘person‐first’, ‘victim’ and ‘recovery’ language, which were randomly assigned to participants (n = 361). No significant differences between language conditions were found for any of the vignettes. Our findings suggest that subtle differences in language to refer to persons with mental health problems or substance addictions have no effect on stigmatising attitudes by care professionals in the Netherlands. However, more research is needed to determine the effect of language use on other groups, such as individuals with MHPSA.
Overt thyroid dysfunction and anti-thyroid antibodies predict response to anti-PD-1 immunotherapy in cancer patients.

BACKGROUND Thyroid dysfunction is among the most common adverse effects during anti-PD-1 immunotherapy, and alongside correlations with elevated anti-thyroid antibodies (ATAb), studies have found correlations with survival. However, the exact relations remain to be clarified. We therefore aimed to clarify the relationship between thyroid dysfunction, ATAbs and survival in anti-PD-1 treated cancer patients. METHODS We included 168 patients with non-small-cell lung carcinoma, renal cell carcinoma, and metastatic melanoma treated with nivolumab or pembrolizumab. TSH and free T4 (FT4) levels were measured before each anti-PD-1 infusion. ATAb levels (anti-thyroid peroxidase (TPO) and anti-thyroglobulin (Tg)) were measured at baseline and after 2 months of treatment. Although the vast majority of patients had detectable levels of ATABs, only few patients had positive ATAbs when using conventional cut-offs. To study the consequences of detectable ATABs, the cut-off levels were a priori set at the median concentrations at baseline in the study population. Tumor progression was classified according to RECIST v1.1. RESULTS Patients who acquired overt thyroid dysfunction during treatment had significantly higher overall survival (OS) (HR=0.18 [95%CI: 0.04-0.76]; p=0.020) and progression free survival (PFS) (HR=0.39 [0.15-0.998]; p=0.050) than patients without thyroid dysfunction with one-year OS rates of 94% vs 59% and one-year PFS rates of 64% vs 34%. During treatment, patients with ATAb levels above the median had a higher OS (HR=0.39 [0.21-0.72]; p=0.003) and PFS (HR=0.52 [0.33-0.81]; p=0.004) than patients with ATAb levels below the median, with one-year OS rates of 83% vs 49% and PFS rates of 54% vs 20%, respectively. When analyzing ATAb levels over time, patients with a persistent ATAb level above the median had a higher OS (HR=0.41 [0.19-0.89], p=0.025) and PFS (HR=0.54 [0.31-0.95], p=0.032) compared to patients with a persistent ATAb level below the median. Patients whose ATAb levels increased above the median during treatment had an improved OS (HR=0.27 [0.06-1.22], p=0.088) and PFS (HR=0.24 [0.07-0.77], p=0.017) compared to patients whose ATAb levels decreased below the median. CONCLUSIONS Acquired overt thyroid toxicity and above median ATAb levels during anti-PD-1 treatment are associated with improved PFS and OS. Additionally, our results suggest that ATAb levels at baseline are of clinical relevance for PFS and OS.
Is perfusate exchange during ex vivo lung perfusion beneficial?

Lung transplantation is a therapeutic option for patients with end-stage lung disease. The number of lung transplantations worldwide has been increasing since 2012 and has almost doubled over the last decade (1). Despite the increase in lung transplant rates, 326 patients died on the waitlist or became too sick to undergo transplant in 2017, and the overall waitlist mortality rate was 17.2 per 100 waitlist-years (2). Shortage of acceptable donor lungs remains a major limitation to lung transplantation. Ex vivo lung perfusion (EVLP) is an increasingly utilized technology to assess and recondition donor organs that are otherwise marginal for transplantation and may be used to expand the donor pool.
Comparison of A 1940 nm Thulium-Doped Fiber Laser and A 1470 nm Diode Laser for Cutting Efficacy and Hemostasis in A Pig Model of Spleen Surgery

Partial and total splenectomies are associated with a high risk of substantial blood loss. Lasers operating at wavelengths strongly absorbed by water have the potential to improve hemostasis and cut while providing a narrow zone of thermal damage. The aim of this study is to compare a thulium-doped fiber laser (TDFL) emitting a wavelength of 1940 nm and a diode laser (DL) operating at 1470 nm for spleen surgery in a pig model. A partial splenectomy and spleen incisions were made in 12 animals using the two laser devices. The hemostasis was evaluated visually during surgeries. Post-mortem and histopathological evaluations were done on days 0, 7, and 14 following surgery. Neither TDFL nor DL caused bleeding on day 0 or delayed bleeding. On day 14, pale streaks at the site of incision were slightly wider after cutting with DL than with TDFL. Histological analysis revealed a carbonized zone with exudation and a deeper zone of thermal tissue damage on day 0. The width of the thermal changes was 655.26 ± 107.70 μm for TDFL and 1413.37 ± 111.85 μm for DL. On day 7, a proliferation of fibroblasts and splenocytes was visible, as well as a formation of multinucleated giant cells adjacent to the residues of carbonization. The zone of thermal damage was broader for DL (1157.5 ± 262.77 μm) than for TDFL (682.22 ± 116.58 μm). On day 14, cutting sites were filled with connective and granulation tissues with the residues of carbonization. The zone of thermal damage was narrower for TDFL (761.65 ± 34.3 μm) than for DL (1609.82 ± 202.22 μm). Thus, both lasers are efficient in spleen surgery, providing good hemostasis. However, TDFL produces a narrower zone of thermal damage, which suggests its better efficiency for spleen surgery, especially when performing more precise procedures.
A dynamic anchor domain in slc13 transporters controls metabolite transport

Metabolite transport across cellular membranes is required for bioenergetic processes and metabolic signaling. The solute carrier family 13 (slc13) transporters mediate transport of the metabolites succinate and citrate and hence are of paramount physiological importance. Nevertheless, the mechanisms of slc13 transport and regulation are poorly understood. Here, a dynamic structural slc13 model suggested that an interfacial helix, H4c, which is common to all slc13s, stabilizes the stationary scaffold domain by anchoring it to the membrane, thereby facilitating movement of the SLC13 catalytic domain. Moreover, we found that intracellular determinants interact with the H4c anchor domain to modulate transport. This dual function is achieved by basic residues that alternately face either the membrane phospholipids or the intracellular milieu. This mechanism was supported by several experimental findings obtained using biochemical methods, electrophysiological measurements in Xenopus oocytes, and fluorescent microscopy of mammalian cells. First, a positively charged and highly conserved H4c residue, Arg108, was indispensable and crucial for metabolite transport. Furthermore, neutralization of other H4c basic residues inhibited slc13 transport function, thus mimicking the inhibitory effect of the slc13 inhibitor, slc26a6. Our findings suggest that the positive charge distribution across H4c domain controls slc13 transporter function and is utilized by slc13-interacting proteins in the regulation of metabolite transport.
Stroke in systemic lupus erythematosus: epidemiology, mechanism, and long-term outcome

Objective To determine stroke prevalence, mechanisms, and long-term outcome in a cohort of Hispanic patients with systemic lupus erythematosus (SLE). Methods We analyzed demographical data, the timing between SLE diagnosis and stroke onset, stroke type, recurrence, and outcomes from an institutional database of 4451 patients with SLE followed from 1993 to 2018. Results We observed 139 strokes (3.1%), for an incidence rate of 1.25 per 1000 person-years: 81 (58.3%) acute ischemic stroke (AIS), 19 (13.7%) subarachnoid hemorrhage (SAH), 17 (12.2%) cerebral venous thrombosis, 13 (9.4%) intracerebral hemorrhage (ICH), and 9 (6.5%) transient ischemic attack. Median time from SLE diagnosis to acute stroke was 60 months (interquartile range 12–132 months). AIS had a bimodal presentation with 26% occurring within the first year and 30% >10 years after SLE diagnosis. In contrast, 75% of ICH cases occurred >3 years (and 34% >10 years) after SLE diagnosis. The most important cause of AIS was secondary antiphospholipid syndrome (48%). Hypertension was associated with 69% of ICH cases, while aneurysmal rupture was observed in 78% of SAH cases. Excellent recovery at hospital discharge was observed in 65%. Stroke recurrence was observed in 7%. The long-term all-cause fatality rate was 8%. Conclusions The prevalence of stroke in this cohort was 3.1%. Ischemic strokes had a bimodal presentation, occurring either early after SLE diagnosis or after a several-year delay. Half of the hemorrhagic strokes occurred >10 years after the diagnosis of SLE. Clinical outcome was usually good with a relatively low recurrence rate.
Epidemiology of Lyme Disease in a Highly Endemic European Zone

Background and objective: Lyme disease, also known as Lyme borreliosis (LB), is a tick-borne infectious disease caused by the spirochete bacteria Borrelia. The risk of infection depends on the geographical area, ecological factors, and human behavior. Clinical manifestations of Lyme borreliosis have a wide range, but the most frequent clinical symptom, which is also a diagnostic symptom, is a skin rash called erythema migrans (EM). The disease is very common worldwide. In Lithuania, the disease frequency is 99.9 cases per 100,000 population (Centre for Communicable Diseases and AIDS, Lithuania, 2017). The main aim of this study was to obtain the baseline characteristics of the disease regarding the infected Lithuanian population. Materials and Methods: We analyzed data from the Centre for Communicable Diseases and AIDS about all Lyme disease (A69.2) diagnosed patients over a three-year period (from 2014 to 2016) in Lithuania. Results: In 2014–2016, 7424 (crude incidence rate 85.4) cases with LB were diagnosed in Lithuania. Most of them (4633 (62.4%)) were identified in women. Older people were more likely to suffer from LB. Urban residents were 2.6 times more often affected that those living in villages. Tick bites were primarily observed in high season months, from May to September (90%), with the highest peak in July. There was a higher number of observed tick bites (p = 0.003) in the urban residents. Erythema migrans occurred in 75.6% LB cases, while other symptoms did not exceed a quarter of all LB cases. There were 7353 (99.6%) cases where LB was confirmed via clinical symptoms and/or laboratory tests. Also, 1720 (23.2%) patients were tested for LB immunoglobulins. Conclusions: This study found a high incidence of Lyme disease in Lithuania. We elucidated the baseline characteristics regarding the infected Lithuanian population which may ease medical clinicians’ work on new Lyme diagnoses.
Efficacy of Complementary Food Supplementation with Lipid-Based Nutrient Supplements on Growth of Malawian Children

We aimed to analyse growth and recovery from undernutrition among moderately underweight ambulatory children receiving micronutrient-fortified maize–soy flour (Likuni Phala, LP) or ready-to-use fortified spread (FS) supplementary diet. One hundred and seventy-six 6–18- month-old individuals were randomized to receive 500 g LP or 350 g FS weekly for 12 weeks. Baseline and end of intervention measurements were used to calculate anthropometric gains and recovery from underweight, wasting and stunting. Mean weight-for-age increased by 0.22 (95% CI 0.07–0.37) and 0.28 (0.18–0.40) Z-score units in the LP and FS groups respectively. Comparable increase for mean weight-for-length was 0.39 (0.20–0.57) and 0.52 (0.38–0.65) Z-score units. Recovery from underweight and wasting was 20% and 93% in LP group and 16% and 75% in FS group. Few individuals recovered from stunting and mean length-for-age was not markedly changed. There were no statistically significant differences between the outcomes in the two intervention groups. In a poor food-security setting, underweight infants and children receiving supplementary feeding for 12 weeks with ready-to-use FS or maize–soy flour porridge show similar recovery from moderate wasting and underweight. Neither intervention, if limited to a 12-week duration, appears to have significant impact on the process of linear growth or stunting.