Miracle-dz/UniFAR-FTUs huggingface dataset:
Geometric semi-automatic analysis of radiographs of Colles’ fractures

Fractures of the wrist are common in Emergency Departments, where some patients are treated with a procedure called Manipulation under Anaesthesia. In some cases, this procedure is unsuccessful and patients need to revisit the hospital where they undergo surgery to treat the fracture. This work describes a geometric semi-automatic image analysis algorithm to analyse and compare the x-rays of healthy controls and patients with dorsally displaced wrist fractures (Colles’ fractures) who were treated with Manipulation under Anaesthesia. A series of 161 posterior-anterior radiographs from healthy controls and patients with Colles’ fractures were acquired and analysed. The patients’ group was further subdivided according to the outcome of the procedure (successful/unsuccessful) and pre- or post-intervention creating five groups in total (healthy, pre-successful, pre-unsuccessful, post-successful, post-unsuccessful). The semi-automatic analysis consisted of manual location of three landmarks (finger, lunate and radial styloid) and automatic processing to generate 32 geometric and texture measurements, which may be related to conditions such as osteoporosis and swelling of the wrist. Statistical differences were found between patients and controls, as well as between pre- and post-intervention, but not between the procedures. The most distinct measurements were those of texture. Although the study includes a relatively low number of cases and measurements, the statistical differences are encouraging.
Medical management of eating disorders: an update

Purpose of review Eating disorders are associated with numerous medical complications. The aim of this study was to review recent progress in improving the medical management of patients with eating disorders. Recent findings With close medical monitoring and electrolyte supplementation, accelerated refeeding protocols improve weight restoration without increasing the risk of refeeding syndrome. Olanzapine improves weight restoration better than placebo, without leading to adverse metabolic effects seen in individuals not in starvation. Alterations of the gut microbiome in anorexia nervosa have been demonstrated, but their clinical relevance remains unclear. Summary Medical complications of eating disorders may facilitate the first contact with health professionals and treatment initiation. Medical complications of anorexia nervosa generally occur due to starvation, malnutrition and their associated physiological effects, whereas medical complications of bulimia nervosa are generally due to purging behaviors. Most medical complications in patients with binge eating disorder are secondary to obesity. Most medical complications of eating disorders can be effectively treated with nutritional management, weight normalization and the termination of purging behaviors. In summary, eating disorders are associated with many medical complications that have to be carefully assessed and managed as early as possible to improve long-term outcomes.
Estimating Risk Ratios and Risk Differences: Alternatives to Odds Ratios.

The goal of many medical research studies is to estimate the direction and magnitude of the effect of an intervention or treatment on a clinical outcome (in clinical trials) or the association between an exposure and an outcome (in observational studies). This effect or association can be presented in various forms, depending on the measured outcome. For example, if the outcome is a continuous measure (eg, blood pressure), the effect or association could be represented as a mean difference between the groups. If the outcome is a time-to-event outcome (eg, time to death), the effect or association is often expressed as a hazard ratio. For binary outcomes (eg, 90-day survival), the measure of the effect or association is often presented as an odds ratio (ie, dividing the odds of the outcome in one group with the odds of the outcome in another), in which the odds are the probability divided by 1 minus the probability. Odds ratios are commonly reported in clinical research because of the frequent use of logistic regression when there is a need to adjust for various characteristics (eg, to adjust for potential confounders in an observational study). Logistic regression yields odds ratios, is relatively straightforward to perform, and is widely available in statistical software. However, as explained in an earlier JAMA Guide to Statistics and Methods article,1 there are limitations to odds ratios. For instance, odds ratios do not approximate risk ratios when the outcome is frequent (Table) and odds ratios are easily misinterpreted by researchers, clinicians, and patients. An observational study by Grunau et al2 in this issue of JAMA evaluated survival to hospital discharge among patients who received ongoing resuscitation for out-of-hospital cardiac arrest during transport to the hospital compared with continuous resuscitation at the scene. Instead of reporting odds ratios, the authors estimated risk ratios and risk differences, measures of association that are more intuitive to interpret.
Feelings of depression, pain and walking difficulties have the largest impact on the quality of life of people with multiple sclerosis, irrespective of clinical phenotype

Background: The symptoms that have the largest impact on health-related quality of life (HRQoL) in people with multiple sclerosis (MS) may vary by MS phenotype (relapsing-remitting MS (RRMS), secondary progressive MS (SPMS) and primary progressive MS (PPMS)). Knowing these symptoms assists in symptom management. Objective: To examine the associations between 13 common MS symptoms and HRQoL in the total sample and stratified by MS phenotype. Method: The study included 1985 participants. HRQoL was measured with two multi-attribute utility instruments: assessment of quality of life with eight dimensions (AQoL-8D) and European quality of life with five dimensions and five levels for each dimension (EQ-5D-5L). Multivariable linear regression was used to identify the symptoms that had the largest impact on the HRQoLs. Results: Feelings of depression, pain, fatigue, and feelings of anxiety were most strongly associated with AQoL-8D and EQ-5D-5L. Walking difficulties additionally contributed to reduced EQ-5D-5L. The strongest single predictors in the multivariable analyses were feelings of depression or pain for AQoL-8D and walking difficulties for EQ-5D-5L, irrespective of MS phenotype. Conclusion: The strongest single predictors for the AQoL-8D and EQ-5D-5L were feelings of depression, pain and walking difficulties, irrespective of MS phenotype. Reducing these symptoms may have the largest impact on improving HRQoL in all MS phenotypes of people with MS.
Intradermal acupuncture for primary dysmenorrhea

Abstract Background: Primary dysmenorrhea (PD) is one of the common gynecological diseases, the incidence of PD is on the rise and young women are more likely to have it, which seriously affects women's physical, mental health and work life. Intradermal acupuncture is effective in treating PD. However, due to the lack of evidence, there is no specific method or suggestion, so it is necessary to carry out systematic evaluation on intradermal acupuncture and provide effective evidence for further research. Methods: We will search the following electronic databases from their inception to July 2020: Electronic database includes PubMed, Embase, Cochrane Library, Chinese Biomedical Database WangFang, VIP medicine information, and CNKI (China National Knowledge Infrastructure). Primary outcomes: the overall effective rate, VAS score. Secondary outcomes: blood serum estradiol (E2), progesterone (P), prostaglandin F2α (PGF-2α), adverse events Data will be extracted by 2 researchers independently, risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5. 3. and Stata V.12. 0. Results: The results of this study will systematically evaluate the effectiveness and safety of intradermal acupuncture in the treatment of primary dysmenorrhea. Conclusion: The systematic review of this study will summarize the currently published evidence of intradermal acupuncture therapy for primary dysmenorrhea to further guide its promotion and application.
Evaluation of the Hemostatic Efficacy of Two Powdered Topical Absorbable Hemostats Using a Porcine Liver Abrasion Model of Mild to Moderate Bleeding

Abstract Introduction Topical hemostatic agents, used alone or in combination, have become common adjuncts to manage tissue and organ bleeding resulting from trauma and surgical procedures. Oxidized regenerated cellulose (ORC) is one of the most commonly used adjunctive hemostatic agents. The aim of the present study was to compare the hemostatic efficacy of a novel ORC-based product, SURGICEL® Powder Absorbable Hemostat (Surgicel-P) to that of HEMOBLAST™ Bellows (Hemoblast-B), a collagen-based combination powder. Methods Using an established porcine liver abrasion model, we randomly tested Surgicel-P and Hemoblast-B in 60 experimental lesion sites (30 per product tested). Primary endpoints included hemostatic efficacy measured by absolute time to hemostasis (TTH) within 5 minutes. We also examined number of applications required to achieve hemostasis, and sustained hemostasis following saline irrigation of test sites that achieved hemostasis. Results Surgicel-P demonstrated significantly higher hemostatic efficacy and lower TTH (p < 0.01) than Hemoblast-B. Surgicel-P-treated lesion sites achieved hemostasis in 73.3% of cases following one product application vs. 3.3% of Hemoblast-B-treated sites. Of all sites that were assessed, hemostasis was achieved and sustained following irrigation at 93.3% of Surgicel-P-treated sites vs. 50.0% of Hemoblast-B-treated sites. The average number of Surgicel-P applications per site was 51% lower than the average number of applications used for Hemoblast-B. Conclusion Surgicel-P provided more effective and sustained hemostasis and faster TTH than Hemoblast-B. Surgicel-P represents a novel clinical alternative to provide adjunctive control of diffuse mild and moderate bleeding. Surgicel-P combines an ORC powder formulation and a delivery system in a device that is particularly useful for application on large surfaces and difficult-to-access anatomical locations where application of other forms of topical hemostats may be impractical.
Maximal Exercise Testing Using the Incremental Shuttle Walking Test Can Be Used to Risk-Stratify Patients with Pulmonary Arterial Hypertension

Rationale: Exercise capacity predicts mortality in pulmonary arterial hypertension (PAH), but limited data exist on the routine use of maximal exercise testing. Objectives: This study evaluates a simple-to-perform maximal test (the incremental shuttle walking test) and its use in risk stratification in PAH. Methods: Consecutive patients with pulmonary hypertension were identified from the ASPIRE (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre) registry (2001–2018). Thresholds for levels of risk were identified at baseline and tested at follow-up, and their incorporation into current risk stratification approaches was assessed. Results: Of 4,524 treatment-naive patients with pulmonary hypertension who underwent maximal exercise testing, 1,847 patients had PAH. A stepwise reduction in 1-year mortality was seen between levels 1 (≤30 m; 32% mortality) and 7 (340–420 m; 1% mortality) with no mortality for levels 8–12 (≥430 m) in idiopathic and connective tissue disease–related PAH. Thresholds derived at baseline of ≤180 m (>10%; high risk), 190–330 m (5–10%; intermediate risk), and ≥340 m (<5%; low risk of 1-yr mortality) were applied at follow-up and also accurately identified levels of risk. Thresholds were incorporated into the REVEAL (Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management) 2.0 risk score calculator and French low-risk approach to risk stratification, and distinct categories of risk remained. Conclusions: We have demonstrated that maximal exercise testing in PAH stratifies mortality risk at baseline and follow-up. This study highlights the potential value of the incremental shuttle walking test as an alternative to the 6-minute walking test, combining some of the advantages of maximal exercise testing and maintaining the simplicity of a simple-to-perform field test.
Ergonomics in design and design in ergonomics: Issues and experience in education.

BACKGROUND Articulating design and ergonomics skills through education is a major challenge for both fields. Indeed, professional ergonomists are increasingly deeply involved in design processes, and ergonomics education should train them in design skills. As courses in ergonomics education are often time-constrained, and it is difficult to mobilize students in real-scale projects and to involve them in design processes. Conversely, activity analysis and active involvement of users in design projects (through co-creation or co-design processes) are rarely convened in architecture and design curricula. OBJECTIVE It is therefore necessary to develop effective and relevant pedagogical settings, enabling students of both fields to develop their abilities and equip them to act in concrete design situations. METHODS In this paper, we describe a large-scale pedagogical setting involving groups of students from different disciplines gathered around a real-scale design project (re-shaping the waiting room of a mental health center). The ergonomics students' main task is to analyze the needs and real activities of end-users; the interior design students' task is to produce the design project. This communication more precisely focuses on describing the ergonomics students' fieldwork and the practical and pedagogical innovations put in place to help them face the various challenges encountered during the project. RESULTS Based on formal feedback from students, teachers and stakeholders, we address three main challenges: (1) dealing with the temporal constraints of the intervention, (2) documenting and observing a sensitive situation and (3) involving end-users to place them at the core of the design process. For each challenge, we describe the issue at stake, the work conducted to deal with this issue, and eventually the feedback collected from students, teachers and stakeholders. CONCLUSION The paper concludes with an analysis of success and failure factors for such pedagogical settings, in particular for physical enquiry devices, co-creation processes, and co-constructed pedagogical settings. It shows the impact of these settings for students, but highlight that collaboration between ergonomists and designers is a key issue for learning in a positive experience.
The role of perceived pedestrian safety on designing safer built environments

Abstract Objective This study aimed to explore how pedestrians´ safety perception concerning the built environmental characteristics can assist in designing a safer built environment in an urban area in Mexico. Methods The study involved two stages of data collection. In the first stage, a physical audit on selected urban roads was performed to assess the characteristics that may increase the perceived risk of a collision. An observational framework to evaluate the crossing areas, sidewalks and organizational factors was developed and used for data collection. In the second stage, an on-street questionnaire was applied to collect the perception of a group of 299 pedestrians about safety risks, road characteristics and their ideas for designing a safer built environment. Results The physical road audit identified several features in the crossing areas and sidewalks, such as parked cars, movable and fixed obstacles, and lack of traffic signage, which may increase the risk of a pedestrian being involved in a collision. More than half of the road users who were interviewed either agree (27%) or strongly agree (29%) with the statement that crossing the roads in the area was safe. However, pedestrians also identified the following elements as detrimental for the safe use of roads: lack of traffic lights, too much traffic, lack of signs, and parked cars that obstruct visibility. Participants also raised issues beyond the physical infrastructure; for instance, a lack of respect shown by drivers to pedestrians. For designing a safer built environment, participants suggested several ideas highlighting pedestrianization of the road and widening the sidewalks, along with restricting parking of cars on the road. Conclusions This combination of findings provide valuable support for the premise that pedestrians may have a good sense of recognizing safety problems and the ability to see the solutions. Although the research was undertaken in the context of a municipality in Guadalajara, the role of pedestrian safety perception may be applicable in other urban settings in low and middle-income countries (LMICs), where local authorities are in charge of designing the road environment. This study highlights the relevance of including pedestrians’ participation for a safer and human-centred design of our cities.
Inhibition of WNT/ß catenin is necessary and sufficient to induce Scx expression in developing tendons of chicken limb.

The cell differentiation of the musculoskeletal system is highly coordinated during limb development. In the distal-most region of the limb, the WNT and FGF signaling released from the apical ectodermal ridge maintain the mesenchymal cells in the undifferentiated stage. Once the cells stop receiving WNT and FGF signaling, they respond to differentiation signals. Particularly during tendon development, the mesenchymal cells enter the cell differentiation program once Scleraxis (Scx) gene expression occurs. Among the signals that trigger the cell differentiation programs, TGFβ signaling has been closely involved in tendon differentiation. However, whether the Scx gene expression depends merely on TGFβ signaling or other signals is still not fully understood. In the present study, considering that WNT/β catenin is an inhibitory signal of cell differentiation, we speculated possible antagonistic or additive effects between canonical Wnt/β catenin and TGFβ/SMAD signaling pathways to control the Scx gene expression. According to our results, the blockade of WNT/β catenin promoted the Scx gene expression. In contrast, the inhibition of TGFβ/SMAD signaling did not maintain the Scx gene expression. Interestingly, the blockade of both WNT/β-catenin and TGFβ/SMAD signaling at the same time promoted the Scx gene expression. Thus, as our results suggest, the inhibition of WNT/β signaling is necessary and sufficient to induce Scx gene expression.
Rapid thrombelastography predicts perioperative massive blood transfusion in patients undergoing coronary artery bypass grafting

Abstract Massive blood transfusion (MBT) is a relatively common complication of cardiac surgery, which is independently associated with severe postoperative adverse events. However, the value of using rapid thrombotomography (r-TEG) to predict MBT in perioperative period of cardiac surgery has not been explored. This study aimed to identify the effect of r-TEG in predicting MBT for patients undergoing coronary artery bypass grafting (CABG). This retrospective study included consecutive patients first time undergoing CABG at the Zhongnan Hospital of Wuhan University between March 2015 and November 2017. All the patients had done r-TEG tests before surgery. The MBT was defined as receiving at least 4 units of red blood cells intra-operatively and 5 units postoperatively (1 unit red blood cells from 200 mL whole blood). Lower preoperative hemoglobin level (P = .001) and longer cardiopulmonary bypass time (P = .001) were the independent risk factors for MBT during surgery, and no components of the r-TEG predicted MBT during surgery. Meanwhile, longer activated clotting time (P < .001), less autologous blood transfusion (P = .001), and older age (P = .008) were the independent risk factors for MBT within 24 hours of surgery. Preoperative r-TEG activated clotting time can predict the increase of postoperative MBT in patients undergoing CABG. We recommend the careful monitoring of coagulation system with r-TEG, which allows rapid diagnosis of coagulation abnormalities even before the start of surgery.
The anti-neuroinflammatory effects of Clinacanthus nutans leaf extract on metabolism elucidated through 1H NMR in correlation with cytokines microarray

Clinacanthus nutans (CN) (Acanthaceae) is well-known for its anti-inflammatory properties among Asian communities; however, there are currently no data specifically focused on the anti-inflammatory effects of CN on the brain tissue. Neuroinflammation is a common consequence of toxin intrusion to any part of the central nervous system (CNS). As an innate immune response, the CNS may react through both protective and/or toxic actions due to the activation of neuron cells producing pro- and/or anti-inflammatory cytokines in the brain. The unresolved activation of the inflammatory cytokines’ response is associated with the pathogenesis of neurological disorders. The present study aimed to decipher the metabolic mechanism on the effects of 14 days oral treatment with CN aqueous extract in induced-lipopolysaccharides (LPS) rats through 1H NMR spectroscopic biomarker profiling of the brain tissue and the related cytokines. Based on the principal component analysis (PCA) of the nuclear magnetic resonance (NMR) spectral data, twenty-one metabolites in the brain tissue were profiled as biomarkers for the LPS (10 μL)-induced neuroinflammation following intracerebroventricular injection. Among the twenty-one biomarkers in the neuroinflammed rats, CN treatment of 1000 and 500 mg/kg BW successfully altered lactate, pyruvate, phosphorylcholine, glutamine, and α-ketoglutarate when compared to the negative control. Likewise, statistical isolinear multiple component analysis (SIMCA) showed that treatments by CN and the positive control drug, dextromethorphan (DXM, 5 mg/kg BW), have anti-neuroinflammatory potential. A moderate correlation, in the orthogonal partial least squares (OPLS) regression model, was found between the spectral metabolite profile and the cytokine levels. The current study revealed the existence of high levels of pro-inflammatory cytokines, namely IL-1α, IL-1β, and TNF-α in LPS-induced rats. Both CN dose treatments lowered IL-1β significantly better than DXM Interestingly, DXM and CN treatments both exhibited the upregulation of the anti-inflammatory cytokines IL-2 and 4. However, DXM has an advantage over CN in that the former also increased the expression of IL-10 of anti-inflammatory cytokines. In this study, a metabolomics approach was successfully applied to discover the mechanistic role of CN in controlling the neuroinflammatory conditions through the modulation of complex metabolite interactions in the rat brain.