Miracle-dz/UniFAR-FTUs huggingface dataset:
Bipolar disorder comorbidity in patients with a primary diagnosis of OCD

Abstract Objective: Bipolar disorder (BD) is considered to be a common comorbid condition in subjects with obsessive-compulsive disorder (OCD), but there is limited literature on the prevalence of BD and its clinical correlates in those with a primary diagnosis of OCD. Methods: We studied the prevalence of BD in a sample of consecutively registered outpatients attending a specialty OCD clinic in India over a period of 13 months. One hundred and seventy-one patients with a primary diagnosis of OCD were assessed systematically using structured and semi-structured instruments. Results: The prevalence of lifetime BD in OCD was 4%. The OCD + BD group had an episodic course of OCD and higher rate of lifetime suicide attempts. Conclusions: BD may not be as highly prevalent in OCD as reported in literature. Those with OCD seem to have only a marginally higher risk for developing BD than the general population. A diagnosis of BD seems to have a pathoplastic effect on the course of OCD. Patients with OCD-BD comorbidity have to be specifically assessed for suicide risk.
Identifying key genes, pathways and screening therapeutic agents for manganese-induced Alzheimer disease using bioinformatics analysis

Abstract Alzheimer disease (AD) is a progressive neurodegenerative disease, the etiology of which remains largely unknown. Accumulating evidence indicates that elevated manganese (Mn) in brain exerts toxic effects on neurons and contributes to AD development. Thus, we aimed to explore the gene and pathway variations through analysis of high through-put data in this process. To screen the differentially expressed genes (DEGs) that may play critical roles in Mn-induced AD, public microarray data regarding Mn-treated neurocytes versus controls (GSE70845), and AD versus controls (GSE48350), were downloaded and the DEGs were screened out, respectively. The intersection of the DEGs of each datasets was obtained by using Venn analysis. Then, gene ontology (GO) function analysis and KEGG pathway analysis were carried out. For screening hub genes, protein–protein interaction network was constructed. At last, DEGs were analyzed in Connectivity Map (CMAP) for identification of small molecules that overcome Mn-induced neurotoxicity or AD development. The intersection of the DEGs obtained 140 upregulated and 267 downregulated genes. The top 5 items of biological processes of GO analysis were taxis, chemotaxis, cell-cell signaling, regulation of cellular physiological process, and response to wounding. The top 5 items of KEGG pathway analysis were cytokine–cytokine receptor interaction, apoptosis, oxidative phosphorylation, Toll-like receptor signaling pathway, and insulin signaling pathway. Afterwards, several hub genes such as INSR, VEGFA, PRKACB, DLG4, and BCL2 that might play key roles in Mn-induced AD were further screened out. Interestingly, tyrphostin AG-825, an inhibitor of tyrosine phosphorylation, was predicted to be a potential agent for overcoming Mn-induced neurotoxicity or AD development. The present study provided a novel insight into the molecular mechanisms of Mn-induced neurotoxicity or AD development and screened out several small molecular candidates that might be critical for Mn neurotoxicity prevention and Mn-induced AD treatment.
The PCL as a brief screen for posttraumatic stress disorder within schizophrenia

Abstract Objectives: To assess the utility of using the posttraumatic checklist (PCL) as a screening measure for identifying posttraumatic stress disorder (PTSD) in individuals diagnosed with a psychotic disorder. Methods: The PCL was administered to 165 participants as part of a clinical trial. Those scoring 44 or above on the PCL underwent further assessment using the clinician administered PTSD scale (CAPS). Results: Overall 18.2% of the sample exhibited a diagnostic level of PTSD symptoms, as indicated by the CAPS assessment. Only 29.7% of those who scored above the PCL threshold were diagnostic of PTSD. Conclusions: The use of PCL for identifying PTSD within this population is not recommended.
Plasma Glicentin Concentration in Patients with Crohn's Disease

Enteroglucagon has been reported to have trophic effects on the intestinal mucosa, and is associated with proliferation and repair after various injuries of the small intestine. Glicentin is an active enteroglucagon, and is present in the largest amount in the intestine. We established a method for quantifying human plasma levels of glicentin, and measured these levels in patients with Crohn's disease. Twenty-three patients with Crohn's disease (14 males and 9 females) and 8 healthy adults were enrolled in this study. A sandwich ELISA method was used to quantify immunoreactive glicentin in plasma sampled from subjects fasting in the early morning and after the oral administration of 75g glucose (Trelan G®). The plasma glicentin levels in fasting subjects were significantly higher in patients with active-stage Crohn's disease, and were similar between the remission-stage Crohn's disease and normal controls. These levels after glucose administration were significantly higher in patients with active-stage Crohn's disease than in those with the disease in remission or in healthy controls. However, the pattern of the changes in the plasma glicentin levels after the glucose administration was similar among the three groups. These data suggest that plasma glicentin levels might reflect the pathological conditions and activity in Crohn's disease.
Elucidating the association between the self-harm inventory and several borderline personality measures in an inpatient psychiatric sample

Abstract Objective: The current study evaluated the utility of the self-harm inventory (SHI) as a proxy for and screening measure of borderline personality disorder (BPD) using several diagnostic and statistical manual of mental disorders (DSM)-based BPD measures as criteria. Methods: We used a sample of 145 psychiatric inpatients, who completed the SHI and a series of well-validated, DSM-based self-report measures of BPD. Results: Using a series of latent trait and latent class analyses, we found that the SHI was substantially associated with a latent construct representing BPD, as well as differentiated latent classes of ‘high’ vs. ‘low’ BPD, with good accuracy. Conclusions: The SHI can serve as proxy for and a good screening measure for BPD, but future research needs to replicate these findings using structured interview-based measurement of BPD.
Clinical Features, Outcome, and Meningococcal Genotype in 258 Adults With Meningococcal Meningitis: A Prospective Cohort Study

Abstract Meningococcal meningitis remains a life-threatening disease. Neisseria meningitidis is the leading cause of meningitis and septicemia in young adults and is a major cause of endemic bacterial meningitis worldwide. The Meningitis Cohort Study was a Dutch nationwide prospective observational cohort study of adults with community-acquired bacterial meningitis, confirmed by culture of cerebrospinal fluid, from October 1998 to April 2002. Patients underwent a neurologic examination at discharge, and outcome was graded with the Glasgow Outcome Scale. Serogrouping, multi-locus sequence typing, and susceptibility testing of meningococcal isolates were performed. The study identified 258 episodes of meningococcal meningitis in 258 patients. The prevalence of the classical triad of fever, neck stiffness, and change in mental status was low (70/258, 27%). When rash was added to the classical triad, 229 of 258 (89%) patients had at least 2 of 4 signs. Systolic hypotension was associated with rash (22/23 vs. 137/222, p = 0.002) and absence of neck stiffness (6/23 vs. 21/220, p = 0.05). Neuroimaging before lumbar puncture was an important cause of delay of therapy: antibiotics were not initiated before computed tomography (CT) scan in 85% of patients who underwent CT scan before lumbar puncture. Unfavorable outcome occurred in 30 of 258 (12%) patients, including a mortality rate of 7%. Neurologic sequelae occurred in 28 of 238 (12%) patients, particularly hearing loss (8%). Factors associated with sepsis and infection with meningococci of clonal complex 11 (cc11) are related with unfavorable outcome. Abbreviations: cc = clonal complex, CRP = C-reactive protein, CSF = cerebrospinal fluid, CT = computed tomography, ESR = erythrocyte sedimentation rate, GCS = Glasgow Coma Scale, IQR = interquartile range, MLST = multi-locus sequence typing, WBCC = white blood cell count.
Differential presentation of endogenous and exogenous hepatitis B surface antigens influences priming of CD8+ T cells in an epitope‐specific manner

Little is known about whether presentation of endogenous and exogenous hepatitis B virus (HBV) surface antigens on APCs targeted by vaccination and/or virus‐harboring hepatocytes influences de novo priming of CD8+ T cells. We showed that surface antigen‐expressing transfectants exclusively display a Kb/S190 epitope, whereas cells pulsed with recombinant surface particles (rSPs) exclusively present a Kb/S208 epitope to CD8+ T cells. The differential presentation of these epitopes largely reflects the selective, but not exclusive, priming of Kb/S190‐ and Kb/S208‐specific T cells in C57BL/6 mice by endogenous/DNA‐ or exogenous/protein‐based vaccines, respectively. Silencing the Kb/S190 epitope (Kb/S190V194F) in antigen‐expressing vectors rescued the presentation of the Kb/S208 epitope in stable transfectants and significantly enhanced priming of Kb/S208‐specific T cells in C57BL/6 mice. A Kb/S190‐mediated immunodominance operating in surface antigen‐expressing cells, but not in rSP‐pulsed cells, led to an efficient suppression in the presentation of the Kb/S208 epitope and a consequent decrease in the priming of Kb/S208‐specific T cells. This Kb/S190‐mediated immunodominance also operated in 1.4HBV‐Smut transgenic (tg) hepatocytes selectively expressing endogenous surface antigens and allowed priming of Kb/S208‐ but not Kb/S190‐specific T cells in 1.4HBV‐Smut tg mice. However, IFN‐γ+ Kb/S208‐specific T cells could not inhibit HBV replication in the liver of 1.4HBV‐Smut tg mice. These results have practical implications for the design of T‐cell‐stimulating therapeutic vaccines.
Early maladaptive schemas in patients with bipolar and unipolar disorder

Abstract Objective: The aim of our study is to determine the difference between the bipolar disorder, unipolar disorder and control groups in terms of maladaptive schemes and childhood trauma. Methods: Two groups of patients under monitoring with a diagnosis of bipolar or unipolar disorder and one group of healthy controls were enrolled in this study. Each group consisted of 60 subjects. The Young Mania Rating Scale and Beck Depression Inventory were used to confirm that patients were in remission. The Childhood Trauma Questionnaire and Young Schema Questionnaire-Short Form 3 were used to identify childhood traumas and early maladaptive schemas. Results: In bipolar disorder, a positive, low power correlation was observed between the vulnerability to threats schema and emotional, physical and sexual abuse. In the unipolar disorder group, there was a positive, low power correlation between the emotional inhibition, failure, approval seeking, dependence, abandonment and defectiveness schemas and social isolation, and a positive, moderate correlation between social isolation and emotional abuse. Conclusions: Individuals with bipolar disorder suffered greater childhood trauma compared to subjects with unipolar disorder and healthy individuals. Greater maladaptive schema activation were present in individuals with bipolar disorder compared to those with unipolar disorder and healthy individuals.
The importance of complete excision of the caudate lobe in resection of hilar cholangiocarcinoma.

BACKGROUND The numbers of margin-negative resections and survival times have greatly improved because of a more aggressive surgical approach to resectable hilar cholangiocarcinoma (Klatskin tumour). It was shown initially by Japanese authors that complete resection of the caudate lobe together with partial hepatectomy leads to more margin-negative resections. However, this concept has not been unanimously taken up by Western authors. The aim of this study was to examine the role of complete caudate lobe resection in our series of resected hilar cholangiocarcinomas. METHODS Between January 1993 and January 2003, 54 patients underwent resection for Klatskin tumours. These patients were divided into two groups, according to the two 5-year periods in which they had been operated. In the first period, patients did not routinely undergo complete excision of the caudate lobe, whereas in the second period, partial liver resection was combined with complete excision of the caudate lobe in 15 patients. These two patient groups were evaluated with respect to postoperative morbidity and mortality, microscopic tumour margins and survival time. RESULTS Postoperative complications occurred in 59% of patients in total, while overall mortality was 11%. No difference was found in postoperative morbidity or mortality between the two periods. A significantly higher number of margin-negative resections was found in the second 5-year period, together with improved survival. CONCLUSION Concomitant complete excision of segment 1 for patients with hilar cholangiocarcinoma did not lead to increased morbidity or mortality. Therefore the addition of complete excision of segment 1 is a safe procedure contributing to a higher rate of R0 resections and improved survival.
Using standardized ambulatory teaching situations for faculty development

The challenges of teaching in the ambulatory setting have been well documented. This article describes a method for developing faculty teaching skills in the ambulatory setting through the use of standardized ambulatory teaching situations (SA TS). Adapted from methods for using simulated or standardized patients, SA TS uses trained individuals to simulate medical students who then interact with faculty in a variety of teaching encounters common to the ambulatory setting. Preliminary results indicate that these high‐fidelity teaching simulations can be effectively used to provide opportunities for faculty to observe, practice, and receive feedback on clinical teaching skills.
Anastomotic leakage in pancreatic surgery.

IntroductionCurrently pancreaticoduodenectomy (PD) is thetreatment of choice for tumours of the periampullaryregion. PD is a complex, high-risk surgical procedure,considered to be one of the most binding operations or, maybe, the most binding in abdominal surgery[1 4]. In 1979 Moossa defined PD as ‘the Cadillac ofabdominal surgery’ [5]. In the same period thein-hospital mortality rate after PD was 20 30% withan extremely high morbidity; severe, life-threateningcomplications were judged to be a part of theprocedure [6,7]. Nowadays PD is a routine procedure in specializedhigh-volume centres and mortality has decreasedsignificantly in the last two decades. Many effortshave been made to gain better results; they must beidentified in preoperative and postoperative manage-ment and appropriate selection of patients, improvedsurgical skills, and development of multidisciplinaryteams dedicated to the care of pancreatic patients[8,9]. However, even if mortality is less than 3 5% inexperienced hands, the overall morbidity rate is stillhigh from 30% to 50% leading to prolonged in-hospital stay and increased costs [1 61]. Anastomotic leakage and the subsequent pancreaticfistula (PF) are the most important complicationsafter PD. The pancreatic leakage is considered to bethe underlying phenomenon of other major complica-tions; the anastomotic dehiscence with autodigestionand destruction of surrounding tissue and vesselsfrom leaking activated pancreatic juice cancause peripancreatic collections, intra-abdominalabscess, delayed gastric emptying and postoperativehaemorrhage.The reported rate of PF is highly variable, rangingfrom 2% to 50% [1 61]. This wide range is due toseveral factors and, among these, the lack of auniversally accepted definition of PF [10 12]. The aim of this paper is to review the causes, riskfactors, definitions, prevention and treatment ofanastomotic leakage in pancreatic surgery, with parti-cular regard to leakage of the pancreatico-entericanastomosis after PD.Pathophysiology and risk factorsThe most important pathophysiological factor in-volved in the development of a pancreatic fistula isthe pancreatic juice itself. In fact it is rich in proteasesthat, whenever activated, determine the digestion andthe destruction of the tissue leading to partial orcomplete anastomotic dehiscence. In addition, pan-creatic juice, through the fistulization of pancreatico-enteric anastomosis can cause inflammation and auto-destruction of the peripancreatic and retroperitonealtissues as well as the surrounding vessels and viscera,with possible dramatic vascular erosions. These phe-nomena can lead to haemorrhage, intra-abdominalabscess, peripancreatic and retroperitoneal collectionsand delayed gastric emptying which is, in most cases,an indirect sign of intra-abdominal complications.The presence of an intra-abdominal abscess isstrongly associated with the presence of a leak fromthe pancreatic anastomosis: at least 50 60% ofabscesses observed following PD are related topancreatic leakage [13 18]. All these complications
Liver transection using the LigaSure sealing system.

BACKGROUND The aim of the present study was to evaluate the feasibility and efficacy of the LigaSure vessel sealing system on a large scale when used for liver resection. METHODS We retrospectively analyzed the short-term outcomes of 277 patients undergoing hepatectomies with the use of the LigaSure system. RESULTS There were two hospital deaths (0.7%), and the morbidity rate was 25.3%. Mean blood loss during liver transection was 352+/-422 ml, and the liver transection speed was 1.9+/-0.86 cm(2)/min. The number of ties required during liver transection was 13.2+/-13. The morbidity and mortality rate was similar when comparing patients with injured livers (chronic hepatitis or cirrhosis) and those with normal livers, but liver transection speed was faster in those with normal livers when compared with those with injured livers (2.00+/-0.88 vs. 1.57+/-0.63 cm(2)/min, p=0.001). CONCLUSIONS The LigaSure system can be applied safely in patients undergoing liver resection, regardless of whether cirrhosis is present or not.
Sepsis, this Hard, Difficult and Serious Syndrome

The word sepsis is derived from the Greek term rotten or “to make putrid” [1]. It’s, defined as the systemic host response to microorganisms in previously sterile tissues. It’s a syndrome related to severe infections and is characterized by end-organ dysfunction away from the primary site of infection (Table 1). To meet the definition of sepsis, patients need to satisfy at least two of the Systemic Inflammatory Response Syndrome (SIRS) criteria in association with having a suspected or confirmed infection [1-3].
Treatment response to transcatheter arterial embolization and chemoembolization in primary and metastatic tumors of the liver.

INTRODUCTION Transcatheter arterial embolization (TAE) and chemoembolization (TACE) are increasingly used to treat unresectable primary and metastatic liver tumors. The purpose of this study was to determine the objective response to TAE and TACE in unresectable hepatic malignancies and to identify clinicopathologic predictors of response. MATERIALS AND METHODS Seventy-nine consecutive patients who underwent 119 TAE/TACE procedures between 1998 and 2006 were reviewed. The change in maximal diameter of 121 evaluable lesions in 56 patients was calculated from pre and post-procedure imaging. Response rates were determined using Response Evaluation Criteria in Solid Tumors (RECIST) guidelines. The Kaplan-Meier method was used to compare survival in responders vs. non-responders and in primary vs. metastatic histologies. RESULTS TAE and TACE resulted in a mean decrease in lesion size of 10.3%+/-1.9% (p<0.001). TACE (vs. TAE) and carcinoid tumors were associated with a greater response (p<0.05). Lesion response was not predicted by pre-treatment size, vascularity, or histology. The RECIST partial response (PR) rate was 12.3% and all partial responders were in the TACE group. Neuroendocrine tumors, and specifically carcinoid lesions, had a significantly greater PR rate (p<0.05). Overall survival, however, was not associated with histology or radiologic response. DISCUSSION TAE and TACE produce a significant objective treatment response by RECIST criteria. Response is greatest in neuroendocrine tumors and is independent of vascularity and lesion size. TACE appears to be superior to TAE. Although an association of response with improved survival was not demonstrated, large cohort studies are necessary to further define this relationship.
Pemphigus is associated with KIR3DL2 expression levels and provides evidence that KIR3DL2 may bind HLA‐A3 and A11 in vivo

Although HLA‐A3 and A11 have been reported to be ligands for KIR3DL2, evidence for any in vivo relevance of this interaction is still missing. To explore the functional importance of KIR3DL2 allelic variation, we analyzed the autoimmune disease pemphigus foliaceus, previously associated (lower risk) with activating KIR genes. KIR3DL2*001 was increased in patients (odds ratio (OR) = 2.04; p = 0.007). The risk was higher for the presence of both KIR3DL2*001 and HLA‐A3 or A11 (OR = 3.76, p = 0.013), providing the first evidence that HLA‐A3 and A11 may interact with KIR3DL2 in vivo. The nonsynonymous single nucleotide polymorphism 1190T (rs3745902) was associated with protection (OR = 0.52, p = 0.018). This SNP results in a threonine‐to‐methionine substitution. Individuals who have methionine in this position exhibit a lower percentage of KIR3DL2‐positive natural killer (NK) cells and also lower intensity of KIR3DL2 on expressing natural killer cells; additionally, we show that the expression of KIR3DL2 is independent of other killer cell immunoglobulin‐like receptors. Pemphigus foliaceus is a very unique complex disease strongly associated with immune‐related genes. It is the only autoimmune disease known to be endemic, showing a strong correlation with environmental factors. Our data demonstrate that this relatively unknown autoimmune disease may facilitate understanding of the molecular mechanisms of KIR3DL2 ligand recognition.
Spontaneous subarachnoid hemorrhage in the emergency department

Subarachnoid hemorrhage (SAH) is one of the major cause of mortality for stroke. The leading cause is the rupture of an intracrnial aneurym. Acute aneurysmal subarachnoid hemorrhage (SAH) is a complex multifaceted disorder that plays out over days to weeks. The development of aneurysms is mainly due to a hemodynamic stress. Considerableadvances have been made in endovascular techniques, diagnostic methods, and surgical and perioperative management guidelines. Rebleeding remains the most imminent danger until the aneurysm is excluded from cerebral circulation. The only effective prevention of rebleeding is repair the aneurysm; choosing the right way with surgical or an endovascular approach. Outcome for patients with SAH remains poor, with population-based mortality rates as high as 45% and significant morbidity among survivors. In this work we analyzed the diagnostic-therapeutic course of patients presenting SAH. We analyzed the types and the occurrence of complications. We present two cases report to better demonstrate that treatments for specific patients need to be individualized.