Miracle-dz/UniFAR-FTUs huggingface dataset:
Predictive Role Of Body Composition Parameters In Operable Breast Cancer Patients Treated With Neoadjuvant Chemotherapy

Background Fat tissue is strongly involved in BC tumorigenesis inducing insulin resistance, chronic inflammation and hormonal changes. Computed tomography (CT) imaging instead of body mass index (BMI) gives a reliable measure of skeletal muscle mass and body fat distribution. The impact of body composition parameters (BCPs) on chemosensitivity is still debated. We examined the associations between BCPs and tumor response to neoadjuvant chemotherapy (NC) in patients treated for operable breast cancer (BC). Methods A retrospective review of BC patients treated with NC in Modena Cancer Center between 2005 and 2017 was performed. BCPs, such as subcutaneous fat area (SFA), visceral fat area (VFA), lumbar skeletal muscle index (LSMI) and liver-to-spleen (L/S) ratio were calculated by Advance workstation (General Electric), software ADW server 3.2 or 4.7. BMI and BCPs were correlated with pathological complete response (pCR) and survival outcomes. Results 407 patients were included in the study: 55% with BMI < 25 and 45% with BMI ≥ 25. 137 of them had pre-treatment CT scan imagines. Overweight was significantly associated with postmenopausal status and older age. Hormonal receptor positive BC was more frequent in overweight patients (p<0.05). Postmenopausal women had higher VFA, fatty liver disease and obesity compared to premenopausal patients. No association between BMI classes and tumor response was detected. High VFA and liver steatosis were negative predictive factors for pCR (pCR rate: 36% normal VFA vs 20% high VFA, p= 0.048; no steatosis 32% vs steatosis 13%, p=0.056). Neither BMI classes nor BCPs significantly influenced overall survival and relapse-free survival. Conclusion Visceral adiposity as well as steatosis were closely involved in chemosensitivity in BC patients treated with NC. Their measures from clinically acquired CT scans provide significant predictive information that outperform BMI value. More research is required to evaluate the relationship among adiposity site and survival outcomes.
The Importance of Nutrition during Treatment for Oesophageal Cancer—The Patient’s Perspective

Background and Objectives: Nutritional issues are prevalent in patients with oesophageal cancer (OC) across all aspects of treatment, including chemoradiotherapy (CRT) and surgery. There are limited studies investigating nutritional issues faced by people undergoing neoadjuvant or definitive CRT from the patient’s perspective. This study aimed to explore the importance that people with OC place upon nutrition during their treatment which included neoadjuvant or definitive CRT, explore the nutritional issues faced in this patient group and identify areas for improvement of dietetic services. Methods and Study Design: Nine people who had undergone curative treatment for OC in the previous 2 - 25 months participated in semi-structured phone interviews. Interviews were tape-recorded and transcribed verbatim and analysed using an inductive thematic analysis approach. Results: Interviews revealed severe difficulties in food consumption during and following CRT and a period of struggling to adjust eating habits post oesophagectomy. There was significant difficulty in following nutrition advice and, despite participants expressing the importance of nutrition; this was not reflected in attitudes towards weight loss. The medical team significantly influenced the perceptions of some participants in regards to their weight loss. Conclusions: Implications for clinical practice include the need for dietetic services before, during and after treatment for OC, irrespective of treatment type. Patient education regarding detrimental effects of rapid weight loss and effects on body composition is crucial, and this should be consistent from all members of the healthcare team.
Dual endoscopically assisted endoluminal colostomy reversal

Background: Emergent colostomies are associated with increased morbidity related to second closure operations. The purpose of this canine pilot study was to create a minimally invasive procedure that would reduce the time interval and morbidity involved with colostomy reversals after left colon end colostomies. Methods: Six mongrel dogs underwent modified laparoscopic Hartmann’s procedures in which the stapled end of the rectal stump was approximated to the left colon proximal to the stoma. After 1 week, they underwent an endoluminal colostomy reversal with a computer-mediated, circular stapling device and varying anvil insertion methods. Variables recorded included anvil insertion technique and feasibility, OR time, complications, and number of days to first meal and bowel movement. A contrast enema performed 1 week post colostomy reversal ruled out anastomosis leaks and stenosis. The dogs were euthanized and subjected to necropsy. Results: Of four anvil insertion techniques tested, the most feasible employed a large-bore needle to perforate through the stapled end of the Hartmann pouch into the lumen of the left colon. Simultaneous endoluminal views of the rectal stump with a sigmoidoscope and the left colon lumen with an endoscope permitted a controlled and safe needle puncture. Through the needle, a guide wire was inserted to withdraw the anvil via the colostomy into place. A transanally inserted stapler was then married to the anvil under fluoroscopic guidance, thus completing the anastomosis. The colostomy was then taken down and transected at the level of the colocolostomy. Average operating time was 126 min (range 90–180), diet was tolerated within 1.5 days, and average number of days to first bowel movement was 2.5. The absence of stenosis, leaks, and inadvertent visceral injuries confirmed feasibility. Conclusions: In this canine model, a dual endoscopic-assisted colostomy reversal with a computer-mediated, circular stapling device is feasible. Using this technique, colostomy reversals can possibly be performed 1 week post-colostomy without entering the peritoneal cavity, thus reducing the number of invasive operations and subsequent morbidity required to manage emergent colon perforations.
Serum tumor markers and positron emission tomography-computed tomography scan as post-breast cancer treatment surveillance

Background: Post-operative surveillance is an important aspect in managing breast cancers. The primary aim is to allow early detection of metachronous breast cancers. However, post-operative breast cancer surveillance has not been standardized. Mammography has been the only evidence-based imaging modality for detecting metachronous breast cancers. The value of regular monitoring with serum carcinoembryonic antigen (CEA) and CA 15-3 has been controversial. The aim of this study is to evaluate the efficacy of using tumor markers as a surveillance tool in post-operative patients. Methods: This is a retrospective review of all post-breast cancer surgery patients monitored with tumor markers from 2005–2010. Correlation between tumor markers and subsequent detection of metachronous breast cancer was evaluated. Long-term survival data was analyzed. Results: Six hundred and forty-nine patients underwent positron emission tomography-computed tomography (PET-CT) scan, 250 patients had regular tumor markers monitoring. By using 5 ng/mL as cutoff for CEA, and 23 U/mL for CA 15.3, elevated levels are associated with development of metachronous breast cancer (P=0.004 and P Conclusions: Elevated serum CEA and CA 15-3 is associated with metachronous breast cancer and is associated with adverse long-term survival outcome.
Predictive Factors and Clinical Prediction Score for Serious Intracranial Causes in Acute Nontraumatic Headache at an Emergency Department

Purpose The objectives of this study were to investigate the predictive factors and develop a clinical prediction score to identify serious intracranial causes in acute nontraumatic headache (NTH). Methods A retrospective chart review study was conducted from 2013 to 2018 in acute NTH patients who visited the emergency department. The patients were divided into serious intracranial headache and nonserious intracranial headache groups. The two groups were compared in regard to the baseline characteristics, clinical presentation, physical examination, investigation, and diagnosis. The significant factors to predict a serious intracranial cause were examined using a multivariate logistic regression model. The coefficients from the multivariate logistic regression were used to plot the receiver operating characteristic curve to develop a clinical prediction score. Results From 2,372 patients, 454 met the inclusion criteria. Of the 454 patients with acute NTH, 88 (19.4%) patients were serious intracranial cause. The seven significant factors that predicted serious intracranial cause were abrupt onset (odds ratio (OR) 7.96, 95% confidence interval (CI) 2.77‒22.91), awakening pain (OR 3.14, 95% CI 4.15–6.82), duration of headache >1 week (OR 10.59, 95% CI 2.9–38.7), fever (OR 6.01, 95% CI 2.07–17.46), worst headache ever (OR 12.95, 95% CI 5.69–29.45), alteration of consciousness (OR 13.55, 95% CI 2.07‒88.88), and localizing neurological deficit (OR 5.28, 95% CI 1.6‒17.46). A score ≥3 out of 10 points of the clinical prediction score was likely to identify a serious intracranial cause of acute NTH with a sensitivity and specificity of 87.50% (95% CI 78.73–93.59%) and 87.70% (95% CI 83.90–90.89%), respectively. The area under the curve was 0.933. Conclusion Abrupt onset, awakening pain, duration of headache >1 week, fever, worst headache ever, alteration of consciousness, and localizing neurological deficit were the significant predictive factors for serious intracranial cause of acute NTH.
Identification of key genes for predicting colorectal cancer prognosis by integrated bioinformatics analysis

Colorectal cancer (CRC) is a life-threatening disease with a poor prognosis. Therefore, it is crucial to identify molecular prognostic biomarkers for CRC. The present study aimed to identify potential key genes that could be used to predict the prognosis of patients with CRC. Three CRC microarray datasets (GSE20916, GSE73360 and GSE44861) were downloaded from the Gene Expression Omnibus (GEO) database, and one dataset was obtained from The Cancer Genome Atlas (TCGA) database. The three GEO datasets were analyzed to detect differentially expressed genes (DEGs) using the BRB-ArrayTools software. Functional and pathway enrichment analyses of these DEGs were performed using the Database for Annotation, Visualization and Integrated Discovery tool. A protein-protein interaction (PPI) network of DEGs was constructed, hub genes were extracted, and modules of the PPI network were analyzed. To investigate the prognostic values of the hub genes in CRC, data from the CRC datasets of TCGA were used to perform the survival analyses based on the sample splitting method and Cox regression model. Correlation among the hub genes was evaluated using Spearman's correlation analysis. In the three GEO datasets, a total of 105 common DEGs were identified, including 51 down- and 54 up-regulated genes in CRC compared with normal colorectal tissues. A PPI network consisting of 100 DEGs and 551 edges was constructed, and 44 nodes were identified as hub genes. Among these 44 genes, the four hub genes TIMP metallopeptidase inhibitor 1 (TIMP1), solute carrier family 4 member 4 (SLC4A4), aldo-keto reductase family 1 member B10 (AKR1B10) and ATP binding cassette subfamily E member 1 (ABCE1) were associated with overall survival (OS) in patients with CRC. Three significant modules were extracted from the PPI network. The hub gene TIMP1 was present in Module 1, ABCE1 was involved in Module 2 and SLC4A4 was identified in Module 3. Univariate analysis revealed that TIMP1, SLC4A4, AKR1B10 and ABCE1 were associated with the OS of patients with CRC. Multivariate analysis demonstrated that SLC4A4 may be an independent prognostic factor associated with OS. Furthermore, the results from correlation analysis revealed that there was no correlation between TIMP1, SLC4A4 and ABCE1, whereas AKR1B10 was positively correlated with SLC4A4. In conclusion, the four key genes TIMP1, SLC4A4, AKR1B10 and ABCE1 associated with the OS of patients with CRC were identified by integrated bioinformatics analysis. These key genes may be used as prognostic biomarkers to predict the survival of patients with CRC, and may therefore represent novel therapeutic targets for CRC.
Dexmedetomidine as a non-triggering anesthetic agent in a patient with MELAS syndrome and systemic sepsis - A case report -

Background The selection of anesthetic agents is important in mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome patient because serious and unexpected complications can occur after anesthetic exposure. Case A 30-year-old man with MELAS syndrome and sepsis underwent colectomy. Propofol was administered by step-wise until target effect-site concentration (Ce) 1.0 μg/ml and stopped for the loss of consciousness and to avoid hemodynamic instability. After the loss of consciousness, total intravenous anesthesia (TIVA) using dexmedetomidine (1.0 μg/ml/h) and remifentanil (1–4 ng/ml of Ce) was performed for the maintenance of anesthesia to avoid malignant hyperthermia and mitochondrial dysfunction. During the surgery, the bispectral index score stayed between 26 and 44, and increased to 97 after the end of anesthesia. Conclusions TIVA with dexmedetomidine and remifentanil as non-triggering anesthetic agents in patients with MELAS syndrome and systemic sepsis may have advantages to decrease damages associated with mitochondrial stress and metabolic burden.
Incident Reporting System in Pediatric Intensive Care Units of Cairo Tertiary Hospital: An Intervention Study

Background: Incident reporting system (IRS) deepens the understanding of the frequency of adverse events and near misses. Voluntary reporting is an essential step to improve patient safety. Objectives: The study aimed to apply an efficient and reliable system for incident reporting to enhance patient safety practices in pediatric intensive care units (PICUs). Methods: A quasi-experimental pretest-posttest study design was conducted to implement a voluntary anonymous IRS in PICUs. In-depth interviews were conducted with 16 health care personnel. A tailored educational program was provided to 73 health care personnel. A questionnaire was administered before and three months after the intervention to assess their attitude towards incident reporting. Results: The interviewed health care providers highlighted that no IRS was established in the PICUs and most of them never reported any event unless it was a sentinel event. They agreed that an IRS would be beneficial to PICUs. The average percentage of positive responses for “Frequency of error reporting’ increased significantly from 23.8% to 42%. Communication problems, hygienic errors, therapeutic errors, and diagnostic errors accounted for 34%, 32%, 29%, and 5% of the reported potential errors, respectively. Conclusions: IRS implementation improves potential error reporting attitude and practice in PICUs.
A biomechanical study of the role of sitagliptin on the bone characteristics of diabetic rats

An experimental protocol is described aiming to explore the in­fluence of Type 2 Diabetes Mellitus on the biomechanical response of the bone tissue and, also, to quantify the potential beneficial role of a pharma­ceutical treatment, based on sitagliptin, a diabetes drug that increases the levels of natural substances called incretins. Twenty eight male, 10-week old Wistar rats were used, divided into three groups, i.e., the control one, the group including the diabetic rats and, finally, the group including the diabetic rats which were treated using sitagliptin. The biomechanical study was based on a series of three-point bending tests of the femora of the sacrificed rats and the analysis of the experimental data was implemented in terms of the actual geometry of the fractured cross-section. It was concluded that diabetic bones undertake larger forces despite the fact that the “diameter” of their cross-section was some­­how smaller. On the contrary, the slope of the load-deflection curve (cor­responding to a measure of the stiffness) of diabetic bones is slightly lower compared to the control bones. Finally, it seems that treating diabetic animals with sita­gliptin only partly reverses the effect of Type 2 Diabetes Mellitus on their bone tissue, at least concerning its strength and stiffness.
The Impact of HIV TAT and gp120 in Neuroinflammatory Response During HIV Active Infection

Despite the fact that acquired immune deficiency syndrome (AIDS) has been treated effectively by highly active anti-retroviral therapy (HAART), the incidence of HIV associated neurocognitive disorders is still high due to the inability of most HAART to pass through the blood-brain barrier (BBB) and target the virus. Neurocognitive disorder results from an inflammatory cascade in the brain. It is thought that the HIV-1 transactivating protein (TAT) alone or in combination with the major virus envelope glycoprotein gp120 trigger glial cells to secret chemokines that elicit the influx of more immunocytes and results in inflammatory amplification. To test this hypothesis, co-cultures of microglia and astrocytes were incubated with TAT, with gp120, and with TAT plus gp120. Chemokine expression then was estimated using an immunodot blot array. Macrophage chemotactic protein (MCP1) and TIMP metallopeptidase 1 (TIMP1), a tissue inhibitor of metalloproteinases, were present in the three coculture test groups. In addition to MCP1 and TIMP1, interleukin-8 (IL-8) was detected following coculture with TAT plus gp120. These results implicate the role of HIVTAT and gp120 in activating brain glial cells to evoke an inflammatory response.
Assessing the Effect of Exercise During Pregnancy on Myokine Response and Placental Growth and Function In Vitro

of the myokine response in and Background: It is recommended that women accumulate 150-min of weekly moderate-intensity physical activity (MPA) when pregnant. Engaging in regular physical activity (PA) confers many health benefits to both the mother and the fetus. However, the molecular mechanisms by which these health benefits are bestowed are not well understood. One potential factor that may be contributing to the observed benefits is myokines, which are small peptides secreted by skeletal muscles. In the non-pregnant population, myokines are believed to be involved in the molecular mechanisms resulting from PA. The objective of this study was to characterize and compare the myokine profile of pregnant and non-pregnant women, after an acute bout of MPA. Conclusion: This is the first study examining myokine response following an acute bout of PA in pregnancy. Moderate intensity PA, which is recommended during pregnancy, elicited an increase in four myokines post-compared to pre-exercise in the pregnant group. Further research is warranted to understand the role of myokines in pregnancy. activity engagement Abstract Background: Placental function is of utmost importance to ensure proper fetal development in utero . Amongst the placenta’s many roles includes ensuring the passage of sufficient macronutrients to the fetus. The fetus relies heavily on the maternal supply of glucose, amino acids, and fatty acids. These macronutrients are carried to the fetus across transporters embedded within the placenta. The objective of this study was to examine the impact of i) an acute bout of exercise and ii) chronic exercise, which is strongly recommended throughout pregnancy, on changes in placenta nutrient transporter expression, and localization in vitro . Methods: Pre- and post-exercise serum was collected from pregnant (n=5) and non-pregnant (n=5) women who underwent a moderate-intensity exercise session. To investigate the effect of acute exercise, the collected serum was used to treat placental-derived cell lines (BeWo choriocarcinoma). Protein expression and localization for the transporters GLUT1, SNAT1, and FATP4 were then examined. To assess chronic physical activity exposure, we measured protein expression patterns in term placenta from women categorized as active (n=10) vs. inactive (n=10) during pregnancy based on accelerometry. Results: GLUT1 expression in BeWo cells treated with serum from pregnant women was higher compared to treatment with serum from non-pregnant women, independently of exercise . FATP4 protein expression was elevated in term placenta of active women. These results were further supported by immunohistochemistry, which illustrated higher levels of FATP4 in placental tissue of active compared to non-active women. Conclusion: These results show that engagement in chronic exercise during pregnancy increases the expression of the placental fatty acid transporter, FATP4. Future work should aim to investigate the role of chronic exercise on other key placental fatty acid transporters in addition
Efficacy and safety of Eculizumab in Paroxysmal Nocturnal Hemoglobinuria (PNH) after 15 years steroids treatment: a case report description.

Background Paroxysmal Nocturnal Hemoglobinuria (PNH) pathogenesis is due to acquired lack of glycosylphosphatidylinositol-anchored protein complement regulatory proteins (CD55 and CD59) and intra-extravascular hemolysis. Eculizumab is a monoclonal antibody binding complement protein 5 (C5 receptor CD59), blocking complement upstream and reducing hemolysis. Case Summary In 1999 we diagnosed PNH in a male 54 year-old. Therapy with prednisone and blood transfusions started. After 13 years (2012) of continuative steroid, we started eculizumab every 14 days. Clinical and laboratory improvement has been reported, the prednisone therapy has been tapered; no further hemolytic crises reappeared. However, mild anemia, high reticulocytes count, high LDH serum levels are still reported. Actually, despite to suboptimal response, the patient shows a good quality of life. Conclusion Here we report a case of PNH with a fully documented medical history of long-term steroid therapy confirming efficacy and safety of eculizumab. However ÂC3 tick overÂ effect may induce suboptimal clinical results with residual hemolytic activity also on heavy steroid treated patients.