Miracle-dz/UniFAR-FTUs huggingface dataset:
Therapeutic plasma exchange for pediatric nonrenal disease indications and outcomes: A single-center experience

Introduction: Outcome data in pediatric plasma exchange, especially in nonrenal indications are scarce. We aimed to evaluate its role and outcome in our patients. Subjects and Methods: A retrospective study of children admitted in the year 2016 to the Pediatric Intensive Care Unit requiring plasma exchange for nonrenal indications was undertaken. Plasma exchange was given as adjunctive therapy along with primary treatment for the disease concerned. Demographic and clinical data were studied, and descriptive statistical analysis was carried out. Results: Ten children underwent plasma exchange during this 1-year period with a male: female ratio of 3:2 and a mean age of 10 years (range 3–16 years). The indications were acute disseminated encephalomyelitis (n = 2), acute neuromyelitis optica (n = 1), catastrophic antiphospholipid antibody syndrome secondary to systemic lupus erythematosus (SLE) (n = 1), severe SLE with cerebritis/hemophagocytic lymphohistiocytosis (HLH) (n = 2), severe dengue sepsis with HLH/multi-organ dysfunction syndrome (n = 2), and thrombotic microangiopathy secondary to snake bite envenomation (n = 2). All received either 1.5 or 2 times plasma volume exchange (mean sessions – 4, range = 1–6). The mean duration of stay in hospital was 17.2 days (range = 3–40 days), and follow-up was 78 days (range = 3–180 days), with the majority of children (8/10, 80%) survived from the catastrophic illness at the time of discharge. Two children (2/10, 20%) succumbed due to the disease per se in severe dengue sepsis in one and enterobacteriaceae sepsis (hospital-acquired pneumonia) in another. Conclusion: Plasma exchange was found to be beneficial as complementary therapy in a critical care setting, especially for nonrenal indications.
Physiological and operative severity score for the enumeration of mortality and morbidity, frailty, and perioperative quality of life in the elderly

Background: Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) is a validated instrument used to predict morbidity. The aim of our study was to evaluate the performance of the POSSUM score system on predicting perioperative frailty and quality of life (QOL) in elderly surgical patients. Patients and Methods: An observational prospective study was conducted during 3 months. POSSUM was used to determine operative morbidity risk. Patients with a POSSUM score ≥26 were considered as having a high POSSUM (PHP). WHODAS 2.0, EuroQOL-5 dimensions (EQ-5D), Charlson score, and the Clinical Frailty Scale were used to assess the QOL and frailty. Chi-square, Fisher's exact, or Mann–Whitney tests were used for comparisons. Results: Two hundred and thirty-five patients were included. Median age was 69 years; 58% were ASA I/II and 42% ASA III/IV. Frailty was present in 53 patients (23%). Median POSSUM score was 26. Patients PHP were older (median age 71 vs. 68, P = 0.008), more frequently ASA III/IV (P = 0.001), had higher median Charlson scores (7 vs. 5, P = 0.006) and were more frail (49% vs. 26%, P < 0.001). PHP presented more problems in EQ-5D dimensions preoperatively (mobility: 59% vs 41%, P = 0.008; care: 41% vs. 25%, P = 0.013; activity: 52% vs. 32%, P = 0.002; pain: 59% vs. 45%, P = 0.041) but not anxiety (P = 0.137). Three months after surgery, PHP patients presented more problems in mobility: 63% vs. 38%, P < 0.001; care: 48% vs. 31%, P = 0.009; activity: 58% vs. 44%, P = 0.036; pain 59% vs. 37%, P = 0.001 and anxiety: 54% vs. 50%, P = 0.025. Conclusions: Patients PHP were frailer and had worse perioperative QOL.
Development of an Evaluation Framework for Health Information Systems (DIPSA)

Introduction: Use of Integrated Health Information Systems (IHIS) for the provision of healthcare services benefits both healthcare professionals and patients, while requiring continuous evaluation and upgrading to fully support its role. Aim: The main purpose of the study was to develop an evaluation framework for hospitals utilizing IHIS, within the three main areas identified as Human factor, Technology and Organization. Material and methods: The questionnaire consisted of 43 questions, with 17 questions (related to categories procedures, system quality and satisfaction), 25 questions (related to categories, safety and collaboration) and 1 question related to accessibility to the system (within the category system quality). Three open questions were added to evaluate users’ perception on what was needed for the improvement of health services in their respective hospitals for all 3 variables being evaluated. The open questions were included to allow participants to express their opinion in a more detailed setting. A database was developed, and the data were processed and analyzed. Results: Factor analysis formed 5 categories for the evaluation framework. Cronbach’s alpha coefficient was found in all categories to be above > 0.85. Conclusion: Evaluation frameworks can be designed, developed and implemented by using different methodologies. For an evaluation framework to be effective it should be designed and implemented based on the aims and purpose of the research and the specific needs of the particular healthcare setting or hospital. Considering the categories satisfaction, collaboration, safety, system quality, procedures, and by using Likert scale and open questions in the current study, DIPSA can provide a holistic image of IHIS by evaluating any hospital system.
Sleep disturbance and intrusive memories after presenting to the emergency department following a traumatic motor vehicle accident: an exploratory analysis

ABSTRACT Background: Sleep disturbances are common after traumatic events and have been hypothesized to be a risk factor in the development of psychopathology such as that associated with posttraumatic stress disorder (PTSD). Objective: To assess the association between intrusive memories, a core clinical feature of PTSD, and self-reported sleep disturbance shortly after experiencing or witnessing a motor vehicle accident, and whether a brief behavioural intervention (trauma reminder cue and Tetris gameplay) reduced sleep disturbance post-trauma. Method: The exploratory analyses included 71 participants (mean age 39.66, standard deviation 16.32; 37 women, 52.1%) enrolled in a previously published proof-of-concept randomized controlled trial. Participants were recruited from the emergency department after experiencing or witnessing a traumatic motor vehicle accident. Intrusive memories were assessed with a daily paper-and-pen diary for one week post-trauma, and sleep disturbances with three questions from the Impact of Event Scale-Revised assessing problems initiating sleep, problems maintaining sleep and dreams about the event at one week and one month post-trauma. Missing data were imputed 15 times. Results: The total number of intrusive memories during the first week post-trauma suggested weak to moderate pooled intercorrelations with problems initiating and maintaining sleep. An ordinal regression using imputed data suggested that the intervention had no effect on sleep disturbances, while completers only analyses suggested an improvement in problems maintaining sleep at one week. Conclusions: This exploratory study suggested that experiencing early intrusive memories is related to sleep disturbances. Sleep disturbance might be a particularly important construct to assess in studies involving intrusive memories post-trauma. HIGHLIGHTS • Sleep disturbances are common after trauma. • We assessed the association between intrusive memories and sleep, and whether a brief behavioural intervention targeting intrusive memories (trauma reminder cue and Tetris gameplay) affected sleep post-trauma. • More intrusive memories post-trauma are potentially related to a greater severity of sleep disturbances. • The intervention had mixed effects on the experience of sleep disturbances. • Sleep disturbance might be a particularly important construct to assess in studies involving intrusive memories post-trauma.
A longitudinal evaluation of active outreach after an aeroplane crash: screening for post-traumatic stress disorder and depression and assessment of self-reported treatment needs

ABSTRACT Background: In 2009, an aeroplane crashed near Amsterdam. To remedy unmet mental health needs, active outreach was used to identify victims at risk for post-traumatic stress disorder (PTSD) and depression. Objective: The active outreach strategy was evaluated by examining the accuracy of screening methods in predicting PTSD and depression, self-reported treatment needs, and the extent to which perceived treatment needs predict trajectories of PTSD. Method: In 112 adult survivors, semi-structured telephone interviews were held at 2 (T1, n = 76), 9 (T2, n = 77) and 44 months (T3, n = 55) after the crash. The Trauma Screening Questionnaire (TSQ) and the Patient Health Questionnaire-2 (PHQ-2) measured symptoms of PTSD and depression, respectively. At T3, a clinical interview assessed PTSD and depression diagnoses. Based on the TSQ scores at the three time-points, participants were grouped into five ‘trajectories’: resilient (n = 38), chronic (n = 30), recovery (n = 9), delayed onset (n = 9) and relapse (n = 3). Results: The TSQ accurately predicted PTSD at T3 (sensitivity: .75–1.00; specificity: .79–.90). The PHQ-2 showed modest accuracy (sensitivity: .38–.89; specificity: .67–.90). Both measures provided low positive predictive values (TSQ: 0.57; PHQ-2: .50 at T3). A number of participants reported unmet treatment needs (T1: 32.9%; T2: 19.5%; T3: 10.9%). Reporting unmet needs at T2 was more often assigned to a chronic PTSD trajectory compared to reporting no needs (p < .01). Conclusions: The prevalence of unmet needs at 44 months after the crash within a chronic PTSD trajectory indicated that active outreach may be warranted. Nevertheless, although the TSQ was accurate, many participants screening positive did not develop PTSD. This implies that, although active outreach may benefit those with unmet needs, it also has its costs in terms of possible unnecessary clinical assessments. HIGHLIGHTS • Reporting unmet needs 2 months after the crash (n = 2532.9%) was related to a chronic PTSD trajectory. Furthermore11% of survivors reported unmet treatment needs 44 months after the crash. • Using a brief screener (TSQ)participants at risk for PTSD are accurately detected. • A significant proportion (n = 2127.6%) of participants reported no treatment needsmost of whom were classified into the resilient trajectory. This suggests that after the crashparticipants themselves can often provide an accurate estimation of their need for professional care.
The relation between adverse childhood experiences and moral injury in the Canadian Armed Forces

ABSTRACT Background: There is increasing evidence that moral injuries (MIs) may affect the mental health of Canadian Armed Forces (CAF) members and veterans. Despite knowledge suggesting that MIs are related to multiple negative mental health outcomes, including the onset of post-traumatic stress disorder (PTSD), it is unknown whether pre-traumatic variables, including the presence of childhood abuse, are related to MIs. Objective: This study seeks to investigate the potential relationship between adverse childhood experiences and later onset MI in military members. Methods: Thirty-three patients newly admitted to an inpatient unit for treatment of trauma-related disorders received a standardized self-assessment package, including the PTSD Checklist for DSM-5 (PCL-5), the Moral Injury Events Scale (MIES; adapted for the Canadian context), and the Adverse Childhood Experiences Questionnaire (ACE-Q), which is a retrospective measure of childhood abuse. Results: Analyses revealed a significant relation between childhood emotional abuse and the presence of MI in adulthood. Specifically, emotional abuse during childhood was correlated with total score on the MIES (p = 0.006) and with its two subscales, perceived betrayals (p = 0.022) and perceived transgressions (p = 0.016). These correlations remained significant when controlling for age and gender. Conclusions: Among CAF members and veterans, childhood events are related to the presence of MI during adulthood. These preliminary data are provocative in suggesting that emotional abuse during childhood may increase the likelihood of endorsing MI during adult military service. Further work is needed to identify pre-traumatic variables that may serve to increase risk or enhance resilience to the development of MI in military members. HIGHLIGHTS • Prior research suggests that adverse childhood experiences influence the development of adult post-traumatic stress disorder (PTSD) in civilian and military populations. • Moreover, research suggests a relation between PTSD and moral injury (MI) in military populations. • The current study finds that experiencing childhood emotional abuse is related to the presence of MI during adult military service, even after controlling for age and gender.
Comparative evaluation of open flap debridement alone and in combination with anorganic bone matrix/cell-binding peptide in the treatment of human infrabony defects: A randomized clinical trial

Background: The synthetic anorganic bone matrix/cell-binding peptide (ABM/P-15) has displayed an increased fibroblast migration and attachment with bone graft material, thus enhancing periodontal regeneration. The objective of the present study was to evaluate and to correlate the efficacy of open flap debridement (OFD) with and without ABM/P-15 in the treatment of human infrabony periodontal defects. Materials and Methods: A total of 20 chronic periodontitis patients with equal number infrabony defects were randomly selected and assigned into two groups depending on the treatment received: Control group (treated with OFD) and Test group (treated with OFD + ABM/P-15). Clinical parameters recorded included plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), gingival recession, and radiographic defect depth (RDD) which were evaluated at baseline and 6 months postsurgically. Results: When compared to baseline, both the treatment groups demonstrated improvements in the clinical parameters at 6 months. Test group exhibited a mean PPD reduction of 4.15 ± 1.04 mm, CAL gain of 3.10 ± 1.42 mm, and reduction in RDD of 1.90 ± 0.72 mm postoperatively at 6 months. In contrast to Control group, the Test group showed greater reduction in PPD (P < 0.05) which was statistically significant, greater CAL gain and greater mean RDD reduction (P < 0.001) which was highly significant. Conclusion: In the surgical management of periodontal infrabony defects, Test group elicited in statistically significant PPD reduction, CAL gain, and better infrabony defect fill at 6 months' postoperatively.
Osteocalcin Serum Levels in Gestational Diabetes Mellitus and Their Intrinsic and Extrinsic Determinants: Systematic Review and Meta-Analysis

Background Undercarboxylated osteocalcin (ucOC) increases insulin release and insulin resistance in mice. In humans, evidence is scarce but a correlation of ucOC and total osteocalcin (tOC) with glycemic status markers has been demonstrated. The relationship of ucOC and tOC with gestational diabetes mellitus (GDM) has been even less characterized. Objective To assess the mean difference of tOC and ucOC serum concentrations among nondiabetic pregnant women and women diagnosed as GDM in the second trimester of pregnancy and to determine the possible intrinsic and extrinsic contributors to this difference. Methods A systematic search was performed to identify relevant studies published in English and Spanish using PubMed, SCOPUS, ISI Web of Knowledge, and PROSPERO database for meta-analysis. Observational studies measuring mean serum levels of osteocalcin among GDM, with at least 10 subjects analyzed in each group were selected. Mean difference (MD) by random effects model was used. Heterogeneity between studies was assessed using Cochran's Q, H, and I 2 statistics. Results From 38 selected studies, 5 were retained for analysis for a total of 1119 pregnant women. Serum concentrations of tOC were not significantly different among women with GDM and nondiabetic pregnant controls (MD: 1.56; 95% CI: −0.70 to 3.82; p = 0.175). Meanwhile, ucOC serum levels were significantly higher among women with GDM (MD: 1.17; 95% CI: 0.24 to 2.11; p = 0.013). The only factor influencing tOC was the UV index, showing a reduction in mean difference between GDM and controls when exposed to higher concentrations of UV rays. Conclusions This meta-analysis provides evidence to support the use of ucOC as a potential marker for GDM rather than tOC, yielding very little variability among studies and no difference among methods or brands used for its analysis.
Rapid optical tissue clearing using poly(acrylamide-co-styrenesulfonate) hydrogels for three-dimensional imaging.

Optical tissue clearing methods are attractive for three-dimensional imaging of intact tissues and organs. A CLARITY (clear lipid-exchanged acrylamide-hybridized rigid imaging/immunostaining/in situ-hybridization-compatible tissue-hydrogel) method using polyacrylamide gels was recently developed. In the current study, we used poly(acrylamide-co-styrenesulfonate) gels as a polyelectrolyte gel for a passive CLARITY method. First, radical copolymerization of acrylamide (AAm) and sodium p-styrenesulfonate (SS) at different ratios was performed. The composition of the copolymer could be controlled by changing the monomer ratio. With increased SS content, the molecular weight decreased and the refractive index slightly increased. The poly(AAm-co-SS) hydrogels with a higher SS content were more swollen and looser. The clearing time could be reduced using the poly(AAm-co-SS) hydrogel with a higher SS content. Three-dimensional fluorescence imaging of the poly(AAm-co-SS) hydrogel-cleared tissues was successfully performed after treatment using a blue fluorescent DNA stain. Therefore, the use of the poly(AAm-co-SS) hydrogel improved the clearing process in the passive CLARITY method, and the technique is useful for fluorescence imaging of DNA. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res B Part B, 2019.
Adiponectin Relieves Human Adult Cardiac Myocytes Injury Induced by Intermittent Hypoxia

BACKGROUND Obstructive sleep apnea (OSA) is associated with many cardiovascular disorders. Intermittent hypoxia (IH) is a key pathological hallmark of OSA. This study was conducted to evaluate the potential therapeutic effects and the associated mechanisms of adiponectin (APN) on IH induced human adult cardiac myocytes (HACMs) injury. MATERIAL AND METHODS HACMs were exposed to normoxia or IH (1% to 21% O₂) using a novel cell culture bio-reactor with gas-permeable membranes. Cell viability was detected by Cell Counting Kit-8 assay. Cell membrane integrity was assessed by the detection of lactate dehydrogenase (LDH) release. Cell apoptosis was analyzed by flow cytometry. Malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) levels were determined using specific assay kits. P-AMPK (AMP-activated protein kinase), p-LKB1, and p-p65 protein levels were measured by western blotting. Pro-inflammatory factors including interleukin (IL)-1β, IL-6, IL-8 expressions were detected by enzyme-linked immunosorbent assay and quantitative real-time polymerase chain reaction. RESULTS The results showed that APN had no cytotoxic to HACMs. Compared with the control group, HACMs cell viability significantly decreased, LDH release increased and cell apoptosis increased in the IH group. The levels of IL-1β, IL-6, IL-8, MDA, and p-p65 were higher, while the levels of SOD, GSH-Px, p-AMPK, and p-LKB1 were lower in HACMs cells in the IH group than that in the control group. However, APN treatment significantly rescued these effects compared with the IH group in a dose-dependent manner. CONCLUSIONS In conclusion, these results indicated that APN protected against IH induced HACMs injury possibly mediated by AMPK and NF-κB pathway.
First printed 3D heart model based on cardiac magnetic resonance imaging data in Slovakia.

OBJECTIVES To present our experience with initial fabrication of 3D printed model of heart from cardiac magnetic resonance (CMR) imaging data. METHODS A 20-year-old patient with a congenital heart defect after a surgical correction underwent CMR imaging. A novel whole-heart CMR imaging sequence, not requiring gadolinium contrast material application, was performed. Image data from this CMR sequence were used for 3D heart model printing. RESULTS A life-like 3D printed copy of the heart with a congenital defect with superior visualization of cardiovascular anatomical details was successfully fabricated. CONCLUSION 3D printing of the heart copies from novel whole heart CMR imaging data is feasible and harmless to patients. These models can be used for operative planning of complex congenital heart defects (Fig. 4, Ref. 14).
Taking a Stand: An Untapped Strategy to Reduce Waterpipe Smoking in Adolescents

Abstract Introduction: Waterpipe use amongst adolescents is on the rise globally. Thus, there is a need to understand adolescents ‘attitudes towards and perceptions of waterpipe use in order to develop specific interventions against this form of tobacco use. Methods: Focus group interviews were conducted among 37 Swedish adolescents (14 boys and 23 girls) from grades 10 to 12. Waterpipe users and nonusers were interviewed separately, with two groups each for users and nonusers. Interviews were audiotaped, transcribed, and thematically analyzed using content analysis. Results: Six themes emerged including taking a stand, weighing the risks, Lack of knowledge, Social context, Waterpipe new and unknown, and Family influence. Taking a stand was about being able to stand up for one’s owns views rather than giving in to peer pressure to smoke waterpipe. Participants feared harming others via secondhand smoke and expressed criticism of the tobacco industry. Participants considered the health consequences and feared addiction. Lack of knowledge concerning health effects of waterpipe smoking due to the unavailability of credible information was also reported. Waterpipe smoking was considered a social event carried out in the company of friends. Perceived as novel and fun, waterpipe was smoked out of curiosity. Parents’ and siblings’ smoking behaviors influenced adolescent waterpipe use. Conclusion: Adolescents reported lacking information about the possible health effects of waterpipe smoking and that gaining such knowledge would make it easier for them to take a stand and refuse smoking waterpipe. Prevention strategies should focus on providing adolescents with factual information about the dangers of waterpipe use.