Miracle-dz/UniFAR-FTUs huggingface dataset:
Cardiovascular shunting in vertebrates: a practical integration of competing hypotheses

This review explores the long‐standing question: ‘Why do cardiovascular shunts occur? ’ An historical perspective is provided on previous research into cardiac shunts in vertebrates that continues to shape current views. Cardiac shunts and when they occur is then described for vertebrates. Nearly 20 different functional reasons have been proposed as specific causes of shunts, ranging from energy conservation to improved gas exchange, and including a plethora of functions related to thermoregulation, digestion and haemodynamics. It has even been suggested that shunts are merely an evolutionary or developmental relic. Having considered the various hypotheses involving cardiovascular shunting in vertebrates, this review then takes a non‐traditional approach. Rather than attempting to identify the single ‘correct’ reason for the occurrence of shunts, we advance a more holistic, integrative approach that embraces multiple, non‐exclusive suites of proposed causes for shunts, and indicates how these varied functions might at least co‐exist, if not actually support each other as shunts serve multiple, concurrent physiological functions. It is argued that deposing the ‘monolithic’ view of shunting leads to a more nuanced view of vertebrate cardiovascular systems. This review concludes by suggesting new paradigms for testing the function(s) of shunts, including experimentally placing organ systems into conflict in terms of their perfusion needs, reducing sources of variation in physiological experiments, measuring possible compensatory responses to shunt ablation, moving experiments from the laboratory to the field, and using cladistics‐related approaches in the choice of experimental animals.
Training Inhibitory Control Induced Robust Neural Changes When Behavior Is Affected: A Follow-up Study Using Cognitive Event-Related Potentials

Cognitive training results in significant, albeit modest, improvements in specific cognitive functions across a range of mental illnesses. Inhibitory control, defined as the ability to stop the execution of an automatic reaction or a planned motor behavior, is known to be particularly important for the regulation of health behaviors, including addictive behaviors. For example, several studies have indicated that inhibitory training can lead to reduced alcohol consumption or a loss of weight/reduced energy intake. However, the exact neurocognitive mechanisms that underlie such behavioral changes induced by training are still matter of debate. In the present study, we investigated the long-term impact (ie, at 1 week posttraining) of an inhibitory training program (composed of 4 consecutive daily training sessions of 20 minutes each) on the performance of a Go/No-go task. Healthy participants were randomly assigned to 1 of 3 designated groups: (1) an Inhibition Training (IT) group that received training based on a hybrid flanker Go/No-go task; (2) a group that received a noninhibition-based (ie, episodic memory; EM) training; and (3) a No-Training (NT) group to control for test-retest effects. Each group underwent 3 sessions of a Go/No-go task concomitant with the recording of event-related potentials. Our results revealed a specific impact of the Inhibitory Training on the Go/No-go task, indexed by a faster process compared with the other 2 groups. This effect was neurophysiologically indexed by a faster N2 component on the difference NoGo-Go waveform. Importantly, effects at both the behavioral and at the neural level were still readily discernible 1 week posttraining. Thus, our data clearly corroborate the notion that cognitive training is effective, while also indicating that it may persist over time.
Implementation of a multifaceted nurse-led intervention to reduce indwelling urinary catheter use in four Australian hospitals: A cluster controlled study.

AIMS AND OBJECTIVES This study aimed to reduce indwelling urinary catheter (IDC) use and duration through implementation of a multifaceted "bundled" care intervention. BACKGROUND IDCs present a risk for patients through the potential development of catheter-associated urinary tract infection (CAUTI), with duration of IDC a key risk factor. CAUTI is considered preventable yet accounts for over a third of all hospital acquired infections. The most effective CAUTI reduction strategy is to avoid IDC use where ever possible and to remove the IDC as early as appropriate. DESIGN A cluster-controlled pre-post study at a facility level with a phased intervention implementation approach. METHODS A multifaceted intervention involving a "No CAUTI" catheter care bundle was implemented, in 4 acute care hospitals, 2 in metropolitan and 2 in rural locations, in New South Wales, Australia. IDC point prevalence and duration data were collected at the bedside on 1,630 adult inpatients at pre-intervention and 1677 and 1551 at 4 and 9 months post-intervention. This study is presented in line with the StaRI checklist (See Supplementary File 1). RESULTS A non-significant trend towards reduction in IDC prevalence was identified, from 12% pre-intervention to 10% of all inpatients at 4 and 9 months. Variability in pre intervention IDC prevalence existed across hospitals (8% to 16%). Variability in reduction was evident across hospitals at 4 months (between -2% and 4%) and 9 months (between 0% and 8%). Hospitals with higher pre-intervention prevalence showed larger decreases; up to 50% when pre-intervention prevalence was 16%. IDC duration increased as more of the short term IDC placements were avoided. CONCLUSIONS Implementation of a multifaceted intervention resulted in reduced IDC use in four acute care hospitals in Australia. This result was not statistically significant but did reflect a positive trend of reduction. There was a significant reduction in short term IDC use at 9 months post intervention. RELEVANCE TO CLINICAL PRACTICE Clinical nurse leaders can effectively implement change strategies that influence patient outcomes. Implementation of the evidence-based "No CAUTI" bundle increased awareness of appropriate indications and provided nurses with the tools to inform decision making related to insertion and removal of IDCs in acute inpatient settings. Working in partnership with inpatients and the multidisciplinary team is essential in minimising acute care IDC use.
Prognostic Impact of Postoperative Lymph Node Metastases After Neoadjuvant Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of Esophagus

Supplemental Digital Content is available in the text Objective: To determine the prognostic impact of pathologic lymph node (LN) status and investigate risk factors of recurrence in esophageal squamous cell carcinoma (ESCC) patients with pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT). Summary Background Data: There are no large-scale prospective study data regarding ypN status and recurrence after pCR in ESCC patients receiving NCRT. Methods: The NEOCRTEC5010 trial was a prospective multicenter trial that compared the survival and safety of NCRT plus surgery (S) with S in patients with locally advanced ESCC. The relationships between survival and cN, pN, and ypN status were assessed. Potential prognostic factors in patients with ypN+ and pCR were identified. Results: A total of 389 ESCC patients (NCRT: 182; S: 207) were included. Patients with pN+ in the S group and ypN+ in the NCRT group had decreased overall survival (OS) and disease-free survival (DFS) compared with pN0 and ypN0 patients, respectively. Partial response at the primary site [hazard ratio (HR), 2.09] and stable disease in the LNs (HR, 3.26) were independent risk factors for lower DFS, but not OS. For patients with pCR, the recurrence rate was 13.9%. Patients with distant LN metastasis had a median OS and DFS of 16.1 months and 14.4 months, respectively. Failure to achieve the median total dose of chemotherapy was a significant risk factor of recurrence and metastasis after pCR (HR, 44.27). Conclusions: Persistent pathologic LN metastasis after NCRT is a strong poor prognostic factor in ESCC. Additionally, pCR does not guarantee a cure; patients with pCR should undergo an active strategy of surveillance and adjuvant therapy.
Factors Associated With Half- and Full-Marathon Race-Related Injuries: A 3-Year Review

Supplemental Digital Content is Available in the Text. Objective: To better evaluate the relationships between training, demographics, and injury, this study sought to define race-related injury risk factors for half- and full-marathon runners. Design: This 3-year, observational cross-sectional study included adults who participated in a half or full marathon. Prerace and 2-week postrace surveys collected data on demographics, training factors, and injuries. Setting: This study took place during a nationally recognized marathon affiliated with a local hospital. Participants: Runners were recruited during the Expo in the days before the race. Postrace surveys were returned by 1043 half marathoners and 624 full marathoners (response rate, 83%). Interventions: This was an observational study; independent variables included demographic data and race year. Main Outcome Measure: The primary outcome was race-related injury that occurred during the race or within 2 weeks after the race. Results: Race-related injuries were reported by 24% of half marathoners and 30% of full marathoners. For half and full marathoners, respectively, significant factors for injuries were previous injury, lower peak weekly training mileage, and lower weekly mileage before race training. Factors significant for only half-marathon injuries were younger age, female sex, shorter distance of longest training run, and no formal training program. Factors significant for only full-marathon injuries were higher body mass index, fewer days running per week, and fewer years of running experience. Conclusions: Previous running injuries, undertraining, and inexperience increased race-related injury risk; women had higher risk than men. Decreased risk of injury was associated with training loads of greater than 23 miles/week for half marathoners and 40 miles/week for full marathoners.
Prevalence of ulnar nerve palsy with flexion-type supracondylar fractures of the humerus

The aim of this study is to report the rate and type of neurologic injury associated with flexion supracondylar fractures at a tertiary, university institution treated over a 10-year period. All supracondylar humerus fracture cases treated at our institution between January 2004 and January 2014 were retrospectively reviewed. Twenty-three flexion-type fractures were identified. Patient demographics as well as fracture classification, treatment modalities, and pre-and post-treatment neurologic status were analyzed. Twenty-three flexion-type supracondylar humerus fractures were identified and reviewed out of a total of 1000 supracondylar humerus fractures (2.3%). Details of the patients’ neurologic status upon presentation demonstrated that 17 (74%) patients were intact and six (26%) patients presented with an ulnar neuropraxia. Zero type I fractures, one type II fractures (14.3%), and five type III fractures (33.3%) demonstrated an ulnar nerve palsy. Of these, all six nerve deficits resolved following treatment. One additional patient was identified with median nerve neuropraxia following treatment with closed reduction casting, which resolved following observation. A total of 4 (17.4%) patients were treated with closed reduction casting, 15 (65.2%) with closed reduction percutaneous pinning, and four (17.4%) with open reduction internal fixation. Flexion-type supracondylar fractures of the humerus are rare yet significant injuries. The 26% of patients who developed an ulnar neuropraxia following a displaced flexion supracondylar fracture were higher than previous studies reported in the literature. This increased prevalence may be due to the high rates of type III fractures reported in the current study. Level of evidence: III, Retrospective comparative cohort analysis.
Two-week bismuth-containing quadruple therapy and concomitant therapy are effective first-line treatments for Helicobacter pylori eradication: A prospective open-label randomized trial

BACKGROUND Increasing levels of antibiotic resistance have reduced the Helicobacter pylori (H. pylori) eradication rates afforded by the standard triple therapy. Thus, 2-wk first-line four-drug regimens must be considered. AIM To analyze the eradication rates of modified bismuth-containing quadruple therapy (mBCQT) and concomitant therapy (CT), the associated adverse events, and compliance. METHODS Patients infected with H. pylori were prospectively randomized to receive mBCQT or CT for 2 wk. mBCQT featured a proton pump inhibitor (PPI), bismuth, metronidazole, and tetracycline, taken twice daily. CT included a PPI, clarithromycin, metronidazole, and amoxicillin, taken twice daily. The 13C-urea breath test was performed no earlier than 4 wk after therapy concluded to confirm eradication. If either the histological or rapid urease test was positive, H. pylori infection was diagnosed. RESULTS The demographic characteristics of 68 patients who received mBCQT and 68 who received CT did not differ significantly. On intention-to-treat analysis, the eradication rate was 88.2% (60/68) in the mBCQT group and 79.4% (54/68) in the CT group (P = 0.162). By per-protocol analysis, the respective eradication rates were 98.4% (60/61) and 93.1% (54/58) (P = 0.199). More CT than mBCQT patients experienced adverse events [33.8% (23/68) mBCQT vs 51.5% (35/58) CT patients, respectively, P = 0.037]. All patients showed good compliance [85.3% (58/68) mBCQT vs 82.4% (56/68) CT patients, P = 0.641]. CONCLUSION The H. pylori eradication rates of the 2-wk mBCQT and CT regimens are high. Most patients show good compliance, and more CT than mBCQT patients experience adverse events.
Vitamin D and Calcium for the Prevention of Fracture

Key Points Question What is the available evidence for the efficacy of vitamin D with or without calcium supplementation for reducing the risk of fracture? Findings This systematic review and meta-analysis of randomized clinical trials of vitamin D alone (11 randomized clinical trials with 34 243 participants) showed no significant association with risk of any fracture or of hip fracture. In contrast, daily supplementation with both vitamin D and calcium (6 randomized clinical trials with 49 282 participants) was associated with a 16% reduced risk of hip fracture. Meaning In this study, neither intermittent nor daily dosing with standard doses of vitamin D alone was associated with reduced risk of fracture, but daily treatment with both vitamin D and calcium was a more promising strategy.
A feature‐based convolutional neural network for reconstruction of interventional MRI

Real‐time interventional MRI (I‐MRI) could help to visualize the position of the interventional feature, thus improving patient outcomes in MR‐guided neurosurgery. In particular, in deep brain stimulation, real‐time visualization of the intervention procedure using I‐MRI could improve the accuracy of the electrode placement. However, the requirements of a high undersampling rate and fast reconstruction speed for real‐time imaging pose a great challenge for reconstruction of the interventional images. Based on recent advances in deep learning (DL), we proposed a feature‐based convolutional neural network (FbCNN) for reconstructing interventional images from golden‐angle radially sampled data. The method was composed of two stages: (a) reconstruction of the interventional feature and (b) feature refinement and postprocessing. With only five radially sampled spokes, the interventional feature was reconstructed with a cascade CNN. The final interventional image was constructed with a refined feature and a fully sampled reference image. With a comparison of traditional reconstruction techniques and recent DL‐based methods, it was shown that only FbCNN could reconstruct the interventional feature and the final interventional image. With a reconstruction time of ~ 500 ms per frame and an acceleration factor of ~ 80, it was demonstrated that FbCNN had the potential for application in real‐time I‐MRI.
Commentary: Considerations regarding area of internal limiting membrane peeling during macular hole surgery

The internal limiting membrane (ILM) peeling is a recognised technique for management of various vitreoretinal disorders like macular holes, myopic foveoschisis, epiretinal membranes, vitreomacular traction, recalcitrant diabetic macular edema, retinal detachment, etc.[1] A Cochrane review in 2013 has concluded favourable role of ILM peeling in management of stages 2, 3 and 4 idiopathic macular holes. [2] ILM peeling causes reduction of tangential traction at fovea, increased retinal compliance and stimulation of retinal glial cells secondary to trauma to Muller cell end feet[2] as well as thickening of outer and middle inner retinal inner layers at macula. Papillofoveal distance is also shortened. [3,4] These changes are postulated to help in realignment of the external limiting membrane and photoreceptor restoration leading to macular hole closure and visual recovery. There is also thinning of retinal nerve fibre layer (RNFL), ganglion cell layer and inner plexiform layer, which is more marked in temporal side of the fovea than nasal. It could be attributed to instrument trauma or Brilliant Blue G (BBG) dye exposure. [3]
Production of a surface-localized oxidant during oxygenation of mackinawite (FeS).

The oxygenation of mackinawite (FeS) frequently occurs at anoxic-oxic interfaces in both natural and engineered systems such as intertidal sediments, activated sludge in water treatment processes and during sulfidized zero-valent iron particle corrosion. During re-oxygenation events, FeS may drive a Fenton-like process leading to the production of strong oxidants though the details of this process are poorly understood. In this study, benzoic acid (BA) has been used to probe both the magnitude and identity of these strong oxidants under circumneutral pH conditions. The major product of BA oxidation during FeS oxygenation was found to be 2,5-dihydroxybenzoic acid (2,5-DHBA) rather than monohydroxybenzoic acids identified to be the major products in a range of hydroxyl radical (HO•) dominated systems. Based upon relative reactivity with other competitive probes and nature of the hydroxybenzoate product distribution, it is hypothesised that the strong oxidant must be a surface-localized entity such as high valent iron or surface-associated hydroxyl or sulfur-based radicals with reactivity differing from those formed in free solution. The importance of both the reactivity of the oxidant and adsorption of the substrate to the surface is demonstrated.
Trajectories and Predictors of Functional Capacity Decline in Older Adults From a Brazilian Northeastern Hospital.

BACKGROUND AND PURPOSE Older adults can increase the risk of loss of functional capacity both before and during hospitalization so, identifying older adults at risk for loss in functional capacity during hospitalization would help researchers and clinicians make informed decisions. This study aims to evaluate functional changes from preadmission (baseline) until discharge of hospitalized older adults and identify predictors of loss in functional capacity. METHODS This is a prospective cohort study conducted at a tertiary care hospital in Natal, Brazil, and enrolled all consecutive patients aged 60 years and older between January 1, 2014, and April 30, 2015. Independent variables included personal characteristics, instrumental daily living (evaluated by the Lawton and Brody scale), cognition (evaluated by the Leganés cognitive test), depression (assessed by the Geriatric Depression Scale-15), and inhospital mobility (evaluated by the Short Physical Performance Battery). The dependent variable functional capacity was assessed by the Katz scale. These instruments were applied at 2 different times: upon admission (within first 24 hours) and at discharge (12-24 hours before). Functional trajectories were defined as the course of functioning from preadmission until discharge using functional capacity data. A multivariate analysis with generalized estimating equation estimated the longitudinal changes in functional capacity. RESULTS AND DISCUSSION The final sample consisted of 1191 older adults and 53.9% were less than 70 years of age. Regarding changes in functional capacity, 52.5% of the older adults presented worse functional capacity at discharge than at baseline. Being dependent for instrumental daily living activities, the presence of depressive symptoms, low levels of cognition, and inhospital mobility were risk factors for greater loss in functional capacity after a hospitalization event. CONCLUSION Hospitalization events may be catastrophic for functional capacity in older adults in Brazil. Functional, cognitive, and emotional status and inhospital mobility must be carefully assessed at hospital admission and monitored during hospitalization. Effective strategies for preventing loss in functional capacity in older people must improve in the Brazilian hospital system.
Häufigkeit eines Risikos für Mangelernährung bei Patienten in onkologischen Schwerpunktpraxen – eine Querschnittserhebung

Zusammenfassung Hintergrund Daten zum Ernährungsstatus von Patienten mit Tumorerkrankungen in ambulanten Einrichtungen fehlen in Deutschland. Die durchgeführte Querschnittserhebung bei Patienten mit Tumorerkrankungen hatte daher das Ziel, die Häufigkeit eines Risikos für Mangelernährung bei Tumorpatienten in onkologischen Schwerpunktpraxen zu ermitteln. Methode Patienten mit Tumorerkrankungen wurden mittels eines standardisierten Fragebogens konsekutiv in 17 onkologischen Schwerpunktpraxen in Südbayern zwischen Juni 2017 und Mai 2018 befragt. Neben Fragen zum Gesundheitszustand und zur Ernährung wurden die validierten Screening-Fragebögen Malnutrition Universal Screening Tool (MUST) und Nutritional Risk Screening Tool-2002 (NRS-2002) zur Erfassung des Risikos für Mangelernährung (primärer Endpunkt) eingesetzt. Die statistische Auswertung erfolgte deskriptiv. Ergebnisse Insgesamt wurden Datensätze von 765 Patienten (60,9 % Frauen) ausgewertet. Die Teilnehmer waren im Mittel 63,1 ± 13,1 Jahre alt, der durchschnittliche Body-Mass-Index (BMI) betrug 25,2 ± 5,1 kg/m2. Bei Anwendung des MUST-Fragebogens hatten 15,4 % der Teilnehmer ein mittleres und 19,5 % ein hohes Risiko für eine Mangelernährung. Darunter wiesen am häufigsten Patienten mit Tumoren des Verdauungssystems ein Risiko für eine Mangelernährung auf (46,6 %). Die Kriterien für ein Mangelernährungsrisiko nach dem NRS-2002-Score (≥ 3 Punkte) erfüllten hingegen 29,1 % der befragten Patienten. Weniger als ein Drittel der Tumorpatienten hatte nach Diagnosestellung eine Ernährungsberatung erhalten (29,9 %). Schlussfolgerung Etwa jeder dritte Patient mit einer Tumorerkrankung in ambulanter Betreuung weist ein erhöhtes Risiko für eine Mangelernährung auf. Die Ergebnisse dieser Erhebung unterstreichen die Notwendigkeit für ein systematisches Screening auf Mangelernährung und ein leitliniengerechtes Ernährungsmanagement von Tumorpatienten in der ambulanten Versorgung.