Miracle-dz/UniFAR-FTUs huggingface dataset:
Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with cerebral palsy

Clinicians use a range of clinical and objective measures to quantify the positive and negative features (impairments) of the upper motor neurone syndrome. These measures play an important role in the assessment and selection of suitable candidates for intervention and monitoring of outcome. Intervention strategies often focus on the positive features; however, outcome may be more contingent upon the severity of the negative features. The clinical protocol for patient selection and treatment used by our multidisciplinary team is presented, together with details of the assessment procedure. Measurement tools in routine use are described, including: the Modified Ashworth Scale, the Modified Tardieu Scale (‘R1’), muscle length by joint range of motion ‘R2’, three‐dimensional gait analysis, assessments of strength by the Medical Research Council Scale, Selective Motor Control, the Gross Motor Function Measure and the Observational Gait Scale. Three case studies of children with cerebral palsy who underwent botulinum toxin type A treatment as part of their management of gait disorder are presented, a 2‐year‐old girl with mild hemiplegia (‘true equinus’), a 3‐year‐old boy with moderate hemiplegia (‘apparent equinus’) and a 6‐year‐old girl with diplegia, where a targeted approach was used to treat a distal problem and resulted in correction Of a proximal problem.
Pet loss: a survey of the attitudes and feelings of practicing veterinarians

AbstractAll 150 teaching clinicians at the six British veterinary schools and an equivalent number of veterinarians in small-animal practice were sent a ten-page questionnaire to survey their attitudes to and experiences with companion-animal euthanasia. Of the 300 questionnaires, 167 were returned, with responses being divided approximately evenly between the two groups. Seventy-two percent of the responses were from men. Data were collected on background, length of time in practice, pet ownership, attitudes on animal consciousness, and reactions to the deaths of both client and their own animals. For example, 22% of the respondents said that the death of one of their own pets had led to long-term emotional effects.Seventy-four percent said that they would euthanize a healthy animal if the owner requested it, while 91% said they would euthanize a severely injured animal that could be saved if the owner requested euthanasia. Ninety-six percent said that they had received no formal training in how to expla.
Respiratory viruses in healthy infants and infants with cystic fibrosis: a prospective cohort study

Rationale Acute viral respiratory tract infections in children with cystic fibrosis (CF) are known causes of disease exacerbation. The role of viral infections during infancy is, however, less known, although early infancy is thought to be a crucial period for CF disease development. We prospectively assessed symptomatic and asymptomatic viral detection in the first year of life in infants with CF and healthy controls. Methods In a prospective cohort study, we included 31 infants with CF from the Swiss Cystic Fibrosis Infant Lung Development Cohort and 32 unselected, healthy infants from the Basel Bern Infant Lung Development Cohort and followed them throughout the first year of life. Respiratory symptoms were assessed by weekly telephone interviews. Biweekly nasal swabs were analysed for 10 different viruses and two atypical bacteria with real-time seven duplex PCR (CF=561, controls=712). Measurements and results Infants with CF and healthy controls showed similar numbers of swabs positive for virus (mean 42% vs 44%; OR 0.91, 95% CI 0.66 to 1.26, p=0.6). Virus-positive swabs were less often accompanied by respiratory symptoms in infants with CF (17% vs 23%; OR 0.64, 95% CI 0.43 to 0.95, p=0.026). This finding was pronounced for symptomatic human rhinovirus detection (7% vs 11%; OR 0.52, 95% CI 0.31 to 0.9, p=0.02). Conclusions Viral detection is not more frequent in infants with CF and respiratory symptoms during viral detection occur even less often than in healthy controls. It is likely an interplay of different factors such as local epithelial properties and immunological mechanisms that contribute to our findings.
Cholesterol, lipoproteins and subclinical interstitial lung disease: the MESA study

We investigated associations of plasma lipoproteins with subclinical interstitial lung disease (ILD) by measuring high attenuation areas (HAA: lung voxels between −600 and −250 Hounsfield units) in 6700 adults and serum MMP-7 and SP-A in 1216 adults age 45–84 without clinical cardiovascular disease in Multi-Ethnic Study of Atherosclerosis. In cross-sectional analyses, each SD decrement in high density lipoprotein cholesterol (HDL-C) was associated with a 2.12% HAA increment (95% CI 1.44% to 2.79%), a 3.53% MMP-7 increment (95% CI 0.93% to 6.07%) and a 6.37% SP-A increment (95% CI 1.35% to 11.13%), independent of demographics, smoking and inflammatory biomarkers. These findings support a novel hypothesis that HDL-C might influence subclinical lung injury and extracellular matrix remodelling.
A histomorphometric evaluation of bone‐to‐implant Eontact on machine‐prepared roughened titanium and dental implants. A pilot study in the dog.

This investigation was performed to assess the bone-to-implant surface contact at fixtures of titanium that either had a standard machine prepared or a TiO2-blasted surface. Five beagle dogs were used in the experiment. Extractions of the premolars were performed in the maxilla. After 4 months of healing, 5 standard machine-prepared fixtures and 5 prepared according to the TioBlast technique were inserted. Two months later another 5 “standard” and 5 TiO Blast-prepared implants were inserted. Four months after the first fixture installation, the animals were killed and ground sections prepared from each implant site. Of the 20 implants installed, 19 were successfully incorporated. The mean bone-to-implant surface for “standard” fixtures was about 40% both at the 2 and 4 months observation interval. The corresponding figures for the TiO Blast-prepared fixtures were similar during the first 2 months of observation, while subsequently the TioBlast-prepared fixture surface seemed to stimulate to a more close bone-to-implant contact (65%) than the “standard” one.
The Effect of a Hypocaloric Diet With and Without Exercise Training on Body Composition, Cardiometabolic Risk Profile, and Reproductive Function in Overweight and Obese Women With Polycystic Ovary Syndrome

Although regular exercise is the cornerstone of management of overweight women with polycystic ovary syndrome, there are little data on additional benefits of regular exercise and exercise training when combined with an energy-restricted diet. This prospective, randomized, parallel study assessed the added benefit of aerobic or aerobic-resistance exercise training when combined with a moderate hypocaloric weight-loss diet on metabolic risk factors and reproductive function in women with PCOS. Ninety-four overweight and obese women with PCOS (age, 18-41 years; body mass index, 25-55 kg/m 2 ) were randomized to receive diet only (DO), diet and aerobic exercise (DA), or diet and combined aerobic-resistance exercise (DC) for 20 weeks. All participants received the same energy-restricted, high-protein diet (5000-6000 kJ/d). Fat mass was decreased more and free fat-free mass was decreased less at 20 weeks among the women in the DA and DC groups compared with those in the DO group (all values, P < 0.05). Larger reductions occurred in systolic and diastolic blood pressure among women in the DA and DC groups than those in the DO group, but only the decrease within the DC group reached statistical significance (P < 0.01). Statistically significant reductions from baseline values occurred within both the DA and DC groups for fasting insulin, total cholesterol, low-density lipoprotein cholesterol, testosterone, and free androgen index (all values, P < 0.05). Compared with baseline values, increases were found within the DA and DC groups in levels of serum sex hormone binding globulin. With respect to reproductive function, there were improvements in ovulation and menstrual cyclicity over the 20-week study period within the 3 treatment groups. There were no statistically significant differences in these cardiometabolic, hormonal, and reproductive parameters between the treatment groups. Among women with PCOS on an energy-restricted high-protein diet, the lack of additional improvements by exercise in cardiometabolic risk factors, hormonal status, and reproductive function suggests that improvements in these parameters were primarily related to energy restriction and weight loss.
Primary angle‐closure glaucoma: an update

Primary angle‐closure glaucoma is potentially a devastating disease, responsible for half of glaucoma‐related blindness worldwide. Angle closure is characterized by appositional approximation or contact between the iris and trabecular meshwork. It tends to develop in eyes with shallow anterior chambers, anteriorly positioned or pushed lenses, and angle crowding. Risk of primary angle‐closure glaucoma is high among women, the elderly and the hyperopic, and it is most prevalent in Asia. Investigation into genetic mechanisms of glaucoma inheritance is underway. Diagnosis relies on gonioscopy and may be aided by anterior segment optical coherence tomography and ultrasound biomicroscopy. Treatment is designed to control intraocular pressure while monitoring changes to the angle and optic nerve head. Treatment typically begins with medical management through pressure‐reducing topical medications. Peripheral iridotomy is often performed to alleviate pupillary block, while laser iridoplasty has been found effective for mechanisms of closure other than pupillary block, such as plateau iris syndrome. Phacoemulsification, with or without goniosynechialysis, both in eyes with existing cataracts and in those with clear lenses, is thus far a viable treatment alternative. Long‐term research currently underway will examine its efficacy in cases of angle closure in early stages of the disease. Endoscopic cyclophotocoagulation is another treatment option, which can be combined with cataract surgery. Trabeculectomy remains effective therapy for more advanced cases.
Hospital and surgeon volume in relation to survival after esophageal cancer surgery in a population-based study.

PURPOSE The influence of hospital and surgeon volume on survival after esophageal cancer surgery deserves clarification, particularly the prognosis after the early postoperative period. The interaction between hospital and surgeon volume, and the influence of known prognostic factors need to be taken into account. METHODS A nationwide Swedish population-based cohort study of 1,335 patients with esophageal cancer who underwent esophageal resection in 1987 to 2005, with follow-up for survival until February 2011, was conducted. The associations between annual hospital volume, annual surgeon volume, and cumulative surgeon volume and risk of mortality were calculated with multivariable parametric survival analysis, providing hazard ratios (HRs) with 95% CIs. HRs were mutually adjusted for the surgery volume variables and further adjusted for the prognostic factors age, sex, comorbidity, calendar period, tumor stage, tumor histology, and neoadjuvant therapy. RESULTS There was no independent association between annual hospital volume and overall survival, and hospital volume was not associated with short-term mortality after adjustment for hospital clustering effects. A combination of higher annual and cumulative surgeon volume reduced the mortality occurring at least 3 months after surgery (P trend < .01); the HR was 0.78 (95% CI, 0.65 to 0.92) comparing surgeons with both annual and cumulative volume above the median with those below the median. These results remained when hospital and surgeon clustering were taken into account. CONCLUSION Because surgeon volume rather than hospital volume independently influences the prognosis after esophageal cancer surgery, centralization of this surgery to fewer surgeons seems warranted.
A Management Program for University Students with Allergic Rhinitis

The purpose of this study was to develop a program for university health centers to help them cope with the rapidly increasing occurrence of allergic rhinitis. In order to develop the allergic rhinitis managing program, in-depth literature review, conducted surveys and physical check-ups and consulted with relevant professionals were done during the period from May, 2012 to April, 2013. Self-efficacy theory and self-regulation theory were utilized for the theoretical framework which resulted in a 6-session program that consisted of 6 weekly sessions being established. This program was created based on information gathered from various different sources and utilized the feed-back principle to focus on enhancing self-management abilities. The education program was established with regard to the sources of self-efficacy, that is, role performance, vicarious experience, verbal persuasion and Physiologic states. Making a pledge and taking quizzes were also used for self-regulation purposes. Proactive use of this program in the field is recommended.
Severity-of-illness assessment in community-acquired pneumonia

We believe the authors of the 2009 update of the guidelines for the management of community-acquired pneumonia1 have confused mortality predictors with severity-of-illness scores. They state ‘we have concentrated only on studies that have used mortality as the main outcome measure’. We recognise that there are difficulties in using intensive care admission as an outcome measure because of variation in admission criteria. However, 30-day survival of patients with low mortality predictor scores does not mean they were not severely ill, merely that …
Melanoma epidemic: an analysis of six decades of data from the Connecticut Tumor Registry.

PURPOSE Melanoma is the most commonly fatal form of skin cancer, with nearly 50,000 annual deaths worldwide. We sought to assess long-term trends in the incidence and mortality of melanoma in a state with complete and consistent registration. METHODS We used data from the Connecticut Tumor Registry, the original National Cancer Institute SEER site, to determine trends in invasive melanoma (1950-2007), in situ melanoma (1973-2007), tumor thickness (1993-2007), mortality (1950-2007), and mortality to incidence (1950-2007) among the 19,973 and 3,635 Connecticut residents diagnosed with invasive melanoma (1950-2007) and who died as a result of melanoma (1950-2007), respectively. Main outcome measures included trends in incidence and mortality by age, sex, and birth cohort. RESULTS In the initial period (1950-1954), a diagnosis of invasive melanoma was rare, with 1.9 patient cases per 100,000 for men and 2.6 patient cases per 100,000 for women. Between 1950 and 2007, overall incidence rates rose more than 17-fold in men (1.9 to 33.5 per 100,000) and more than nine-fold in women (2.6 to 25.3 per 100,000). During these six decades, mortality rates more than tripled in men (1.6 to 4.9 per 100,000) and doubled in women (1.3 to 2.6 per 100,000). Mortality rates were generally stable or decreasing in men and women through age 54 years. CONCLUSION Unremitting increases in incidence and mortality of melanoma call for a nationally coordinated effort to encourage and promote innovative prevention and early-detection efforts.
Unusual life-threatening Rosai–Dorfman disease of the trachea: role of NF-κB

Rosai–Dorfman disease (RDD) is a rare non-neoplastic histioproliferative disorder characterised by painless lymphadenopathy, low fever, high erythrocyte sedimentation rate, leucocytosis and hypergammaglobulinaemia. Overactivity of nuclear factor κB (NF-κB) is linked with inflammatory, cancerous and autoimmune diseases. The first case is described of an unusual life-threatening RDD of the trachea with no lymphadenopathy at risk of suffocation in a 39-year-old Chinese woman. A diagnosis of RDD was made following CT scans, thoracotomy and histological examination. Gel shift assay revealed an essential role for NF-κB overactivity in RDD. The patient remains well with no evidence of progression without treatment. Histological confirmation should be sought in all cases as the clinical manifestation of RDD is similar to asthma or lung carcinoma.
Mindfulness-based stress reduction compared with cognitive behavioral therapy for the treatment of insomnia comorbid with cancer: a randomized, partially blinded, noninferiority trial.

PURPOSE Our study examined whether mindfulness-based stress reduction (MBSR) is noninferior to cognitive behavioral therapy for insomnia (CBT-I) for the treatment of insomnia in patients with cancer. PATIENTS AND METHODS This was a randomized, partially blinded, noninferiority trial involving patients with cancer with insomnia recruited from a tertiary cancer center in Calgary, Alberta, Canada, from September 2008 to March 2011. Assessments were conducted at baseline, after the program, and after 3 months of follow-up. The noninferiority margin was 4 points measured by the Insomnia Severity Index. Sleep diaries and actigraphy measured sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency. Secondary outcomes included sleep quality, sleep beliefs, mood, and stress. RESULTS Of 327 patients screened, 111 were randomly assigned (CBT-I, n = 47; MBSR, n = 64). MBSR was inferior to CBT-I for improving insomnia severity immediately after the program (P = .35), but MBSR demonstrated noninferiority at follow-up (P = .02). Sleep diary-measured SOL was reduced by 22 minutes in the CBT-I group and by 14 minutes in the MBSR group at follow-up. Similar reductions in WASO were observed for both groups. TST increased by 0.60 hours for CBT-I and 0.75 hours for MBSR. CBT-I improved sleep quality (P < .001) and dysfunctional sleep beliefs (P < .001), whereas both groups experienced reduced stress (P < .001) and mood disturbance (P < .001). CONCLUSION Although MBSR produced a clinically significant change in sleep and psychological outcomes, CBT-I was associated with rapid and durable improvement and remains the best choice for the nonpharmacologic treatment of insomnia.
Tumor exome analysis reveals neoantigen-specific T-cell reactivity in an ipilimumab-responsive melanoma.

The evidence for T-cell–mediated regression of human cancers such as non–small-cell lung carcinoma, renal cell carcinoma, and—in particular—melanoma after immunotherapy is strong. Anti-CTLA4 (ipilimumab) treatment has been approved for treatment of meta-static melanoma,1 and antibody-mediated blockade of PD-1, a second inhibitory receptor on T cells, has shown highly encouraging results in early clinical trials.2,3 Although the clinical activity of these treatments is apparent, it is still unknown which T-cell reactivities are involved in immunotherapy-induced cancer regression.4 T-cell reactivity against nonmutated tumor-associated self-antigens has been analyzed in patients treated with ipilimumab or with autologous tumor-infiltrating T cells, but the magnitude of the T-cell responses observed has been relatively modest.5,6 In part on the basis of such data, recognition of patient-specific mutant epitopes (hereafter referred to as neoantigens) has been suggested to be a potentially important component.7 A potential involvement of mutated epitopes in T-cell control would also fit well with the observation that the mutation load in sun-exposed melanomas is particularly high.8-10 Intriguingly, on the basis of animal model data, it has recently been suggested that (therapy-induced) analysis of T-cell reactivity against patient-specific neoantigens may be feasible through exploitation of cancer genome data.11,12 However, human data have thus far been lacking. Here we report a case of a patient with stage IV melanoma who exhibited a clinical response to ipilimumab treatment. Cancer exome–guided analysis of T-cell reactivity in this patient revealed reactivity against two neoantigens, including a dominant T-cell response against a mutant epitope of the ATR (ataxia telangiectasia and Rad3 related) gene product that increased strongly after ipilimumab treatment. These data provide the first demonstration (to our knowledge) of cancer exome–guided analysis to dissect the effects of melanoma immunotherapy.
An inexpensive particle monitor for smoker behaviour modification in homes

Objective To compare the response of a new particle counting instrument (Dylos DC1700) with that produced by a device (TSI Sidepak Personal Aerosol Monitor AM510) commonly used to measure PM2.5 in settings where secondhand smoke (SHS) is encountered. Methods Controlled chamber experiments with different SHS concentrations were generated by burning a cigarette for varying time periods and running both devices simultaneously. Results The Dylos and Sidepak devices produced similar responses to changes in SHS concentrations up to 1000 μg/m3. Using 591 min of contemporaneous measurements from 13 chamber experiments, an equation was developed to allow conversion of particle number concentration data from the Dylos to estimated mass concentration data for SHS aerosol. Conclusions The Dylos DC1700 can provide real-time data that may be converted to an estimate of SHS levels in smoky environments. Given the low cost, low noise and simplicity of use, this device is likely to be a useful tool for interventions to provide feedback of SHS concentrations to help motivate changes in smoking behaviour at home.
Precursors of age‐related macular degeneration: associations with vitamin A and interaction with CFHY402H in the Inter99 Eye Study

To investigate associations of very early age‐related macular degeneration (AMD) with daily intake of vitamin A, beta‐carotene, vitamin E, vitamin C, zinc and copper and interactions with AMD‐associated polymorphisms in complement factor H (CFHY402H) and ARMS2/LOC387715.
Electronic nicotine delivery systems: regulatory and safety challenges: Singapore perspective

Objective Many electronic nicotine delivery systems (ENDS) are marketed as safer tobacco alternative products or effective cessation therapies. ENDS samples were evaluated for design features, including nicotine and glycols content. This could be useful in developing a legal framework to handle ENDS. Methods Identification of the nicotine, glycerol and propylene glycol (PPG) contents was conducted using gas chromatography mass spectrometry with quantification performed using flame ionisation techniques. Results Varying nicotine amounts were found in ENDS cartridges which were labelled with the same concentration. Chemicals such as PPG and glycerol were found to be present in the nicotine-containing liquid of the cartridges. ENDS varied in their contents and packaging information. Limited information was available on the contents of nicotine and other chemicals present in a variety of ENDS sampled. Conclusions Based on samples tested in this study, many contain misleading information on product ingredients. The results show poor consistency between actual nicotine content analysed on ENDS cartridges and the amount labelled. These findings raise safety and efficacy concerns for current and would-be recreational users or those trying to quit smoking.