Miracle-dz/UniFAR-FTUs huggingface dataset:
Perceptions of the living dead: An assessment of knowledge and opinions about whole body donation, its process, and willingness to become cadaveric donors in Pennsylvania

Despite the many important uses for human cadavers, there is a relative shortage of bodies donated to the scientific community in the United States of America. The purpose of this study was to determine the community's perceptions regarding whole body donation and their willingness to become donors. Moreover, we aimed to investigate people's understanding of the process of whole body donation, and examine their opinions regarding its importance. Individuals in Erie, Pennsylvania were surveyed. Data were collected via a questionnaire, which was offered to friends and family members of patients in the waiting area of the UPMC Hamot Surgery Center. All participants were residents of Erie County. The questionnaire was designed to evaluate knowledge and opinions about whole body donation. A total of 123 people completed the survey. We found people were willing to become whole body donors and understood the importance of this giving act, but lacked understanding about the registration process and the use of donated bodies. Participants revealed the belief that they have the right to decide what is to be done with their bodies after death, but did not indicate specific negative repercussions of becoming whole body donors. In conclusion, our findings indicate that the shortage of cadaveric donors could be due to lack of understanding about whole body donation and the registration process. Clin. Anat. 28:442–448, 2015. © 2015 Wiley Periodicals, Inc.
What are radiologists doing to prevent contrast-induced nephropathy (cin) compared with measures supported by current evidence? a survey of european radiologists on cin associated with computed tomography

Background: Contrast-induced nephropathy (CIN) is a serious complication of the use of iodinated contrast media (CM), and is associated with increased morbidity and mortality. Purpose: To investigate whether radiologists take sufficient measures to prevent CIN in computed tomography (CT). Material and Methods: 2005 survey of 509 European radiologists who had ⩾3 years' experience and performed ⩾50 CT scans/week. Results: The most common methods used to identify patients at risk of CIN were renal function measurements (64%), clinical judgment (55%), and patient questionnaires (31%); 9% made no routine attempt to identify at-risk patients. The most common preventive protocols used in at-risk patients included: intravenous (i.v.) saline volume repletion (59%) or oral hydration (52%) before/after CT; use of low-osmolar CM (LOCM; 40%) or isosmolar CM (IOCM; 36%); and N-acetylcysteine (20%); 8% used no hydration regimen. While 78% of respondents used ⩽100 ml of CM in high-risk patients, 14% used ⩽150 ml, and 9% set no volume limit. For 57% of respondents, osmolality was the most important attribute in choosing an iodinated CM in at-risk patients; 41% agreed that CIN risk is lower with IOCM versus LOCM (31% disagreed). Conclusion: A European radiologist survey identified a need for increased implementation of evidence-based protocols to improve CIN prevention: routine identification of at-risk patients; withdrawal of nephrotoxic drugs; use of volume repletion regimens; lowest possible volume of CM; and appropriate CM.
Impact of High Energy Cosmic Rays on Global Atmospheric Electrical Parameters over Different Orographically Important Places of India

Global atmospheric electrical parameters such as atmospheric conductivity, air-earth current density, atmospheric electric field, and atmospheric potential have been calculated for eighty different orographically important places of India under the influence of cosmic ray modulation factor due to Forbush decrease assuming fair weather conditions. The results have been compared with the earlier work of Kumar et al. (1998) and show that the correlation between cosmic rays and global atmospheric electrical parameters near the earth surface depends upon the relative magnitudes of galactic cosmic ray particles.
Methods of cooling: Practical aspects of therapeutic temperature management

Objectives:To review traditional and newer means of inducing, maintaining, and withdrawing therapeutic hypothermia and normothermia. To suggest treatment algorithms for temperature modulation and review neuromonitoring options. Design:A review of current literature describing methods of performing therapeutic temperature management and neuromonitoring during the cooling, maintenance, and decooling periods. Algorithms for performing therapeutic temperature management are suggested. Results:Temperature management can be safely and effectively performed using traditional or newer modalities. Although traditional means of cooling are feasible and efficacious, modern devices utilizing feedback loops to maintain steady body temperature and prevent overcooling have advantages in ease of application, patient safety, maintenance of target temperature, and control of decooling. Neuromonitoring options should be adapted to an individual patient and situation. Conclusions:Intensivists should be familiar with techniques to induce, maintain, and withdraw therapeutic temperature management, and select the most appropriate method for a given patient and situation.
Are there any specific ultrasound findings of nodular hyperplasia (“leave me alone” lesion) to differentiate it from follicular adenoma?

Background: Among benign thyroid nodules, nodular hyperplasia (NH) is the most common and represents a “leave me alone” lesion with no requirement for further treatment, while follicular adenoma (FA) is a lesion that should potentially be removed due to the difficulty of differentiation from a carcinoma on a biopsy alone. Purpose: To evaluate whether there are specific ultrasound (US) findings for an NH to distinguish it from an FA. Material and Methods: Pathologically proven cases of benign thyroid nodules (95 cases: 53 NH, 42 FA) were reviewed retrospectively. The number of associated nodules, the nodule size, internal content, shape, margin, echogenicity, presence of peripheral halo, and calcification were analyzed using grayscale ultrasonography. Results: NHs were predominantly solid in 40 cases (75.5%) and predominantly cystic in 13 cases (24.5%), while FAs were predominantly solid in all cases (n=42, 100%) (P<0.001). A spongiform appearance was present exclusively in NH (9/53, 17.0%). For NH, 83.0% of the lesions (44/53) showed an isoechoic pattern. For FA, the lesions showed a variable echoic pattern, including a marked hypoechoic pattern (5/42, 11.9%), a hypoechoic pattern (22/42, 52.4%), and an isoechoic pattern (15/42, 35.7%) (P<0.001). The nodule size, shape, margin, presence of peripheral halo, and calcification did not show any difference between FA and NH. Conclusion: The ratio of solid to cystic content, spongiform appearance, and echogenicity is a combination of US findings that may be helpful in distinguishing an NH from an FA, and may thereby help to avoid unnecessary fine-needle aspirations for “leave me alone” lesions.
Ultrasound‐guided central venous catheterization: A review of the relevant anatomy, technique, complications, and anatomical variations

Central venous catheterization is a commonly used and important intervention. Despite its regular use it is still associated with a high incidence of complications especially infection and catheter tip embolization. Addition of ultrasound guidance to the technique has shown great improvement to the time and number of attempts for successful catheterization. The preference of vein depends greatly on the situation; subclavian vein is the preferred method overall but internal jugular vein is preferred in patients undergoing cardiac or thoracic surgery. This is especially true for pediatric patients in whom femoral vein catheterization is still preferred despite it carrying a higher risk than other locales. Addition of ultrasound guidance greatly reduces the incidence of arterial puncture and subsequent hematoma formation regardless of location. This is because it allows for visualization of anatomical variation prior to intervention and continual visualization of the needle during the placement. It is noteworthy however, that addition of ultrasound does not prevent complications such as catheter tip embolization as this may occur even with perfect placement. The value of ultrasound usage is undisputable since all studies assessing the difference between it and landmark based methods showed preferable outcome. Reduction of time and number of attempts is sufficient argument to make ultrasound guidance standard practice. Clin. Anat. 30:237–250, 2017. © 2017 Wiley Periodicals, Inc.
Development of the Anatomical Quality Assessment (AQUA) Tool for the quality assessment of anatomical studies included in meta‐analyses and systematic reviews

Critical appraisal of anatomical studies is essential before the evidence from them undergoes meta‐epidemiological synthesis. However, no instrument for appraising anatomical studies with inherent applicability to different study designs is available. We aim to develop a generic yet comprehensive tool for assessing the quality of anatomical studies using a formal consensus method. The study steering committee formulated an initial conceptual design and generated items for a preliminary tool on the basis of a literature review and expert opinion. A Delphi procedure was then adopted to assess the validity of the preliminary tool. Feedback from the Delphi panelists was used to improve it. The Delphi procedure involved 12 experts in anatomical research. It comprised two rounds, after which unanimous consensus was reached about the items to be included. The preliminary tool consisted of 20 items, which were phrased as signaling questions and organized into five domains: 1. Aim and subject characteristics, 2. Study design, 3. Characterization of methods, 4. Descriptive anatomy, and 5. Results reporting. Each domain was set to end with a risk of bias question. Following round 1, some of the items underwent major revision, although agreement was reached regarding inclusion of all the domains and signaling questions in the preliminary tool. The tool was revised only for minor language inaccuracies after round 2. The AQUA Tool was designed to assess the quality and reliability of anatomical studies. It is currently undergoing a validation process. Clin. Anat. 30:6–13, 2017. © 2016 Wiley Periodicals, Inc.
One-dimensional-ratio measures of atrophy progression in multiple sclerosis as evaluated by longitudinal magnetic resonance imaging

Background: For decades, normalized one-dimensional (1D) measures have been used in the evaluation of brain atrophy. In multiple sclerosis (MS), the use of normalized linear measures over longitudinal follow-up remains insufficiently documented. Purpose: To evaluate the association between different regional atrophy measures and disability in MS patients over four decades in a longitudinal cross-sectional study. Material and Methods: 37 consecutively selected MS patients were included. At baseline, patients had a range of disease duration (1–33 years) and age (24–65 years). Each patient was followed by magnetic resonance imaging (MRI) for a mean of 9.25 years (range 7.3–10 years). Four 1D measures were applied at three time points on axial 5-mm T1-weighted images. Three clinical MS subgroups were represented: relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS). Results: There were significant changes in all 1D ratios during follow-up. The Evans ratio (ER) and the bifrontal ratio (BFR) were associated with the development of disability. Changes of ER and BFR reflected more aggressive disease progression, as expressed by MS severity score (MSSS). Conclusion: All four normalized ratios showed uniform atrophy progression, suggesting a consistent rate of atrophy over long-term disease duration independent of MS course. Disability status correlated with 1D measures, suggesting that serial evaluation of Evans and bifrontal ratios might contribute to the radiological evaluation of MS patients.
Why we should be wary of single-center trials

Objectives: To highlight the limitations of single-center trials in critical care, using prominent examples from the recent literature; to explore possible reasons for discrepancies between these studies and subsequent multicenter effectiveness trials; and to suggest how the evidence from single-center trials might be used more appropriately in clinical practice. Study Selection: Topical and illustrative examples of the concepts discussed including trials of patient positioning, the use of steroids for acute respiratory distress syndrome, the dose of hemofiltration, the control of glycemia, and the targets of resuscitation in sepsis. Data Synopsis: Many positive single-center trials have been contradicted when tested in other settings and, in one case, the subsequent definitive multicentered trial has found a previously recommended intervention associated with active harm. Problems inherent in the nature of single-center studies make recommendations based on their results ill advised. Single-center studies frequently either lack the scientific rigor or external validity required to support widespread changes in practice, and their premature incorporation into guidelines may make the conduct of definitive studies more difficult. Conclusions: We recommend that practice guidelines should rarely, if ever, be based on evidence from single-center trials. Physicians should apply the findings of single-center trials only after careful evaluation of their methodology, and in particular after comparing the context of the trial with their own situation.
Assessing the cultural needs of older lesbians and gay men: Implications for practice

This article maintains that older lesbians and gay men do have cultural differences from other older people and that these differences should be taken into account in the assessment process and in turn should influence service provision. The article will explore our current understanding of older lesbians and gay men by presenting the conflicting images and stereotypes that exist within the literature. The objective is to begin to identify the expressions of lesbian and gay culture and how this is influenced by both history and ageing as expressed by the lives of older lesbians and gay men. From this position, the paper will then explore the practice implications of recognising cultural differences in responding to the needs of older lesbians and gay men and providing services that truly reflect their individual circumstances.
Early prediction of Candida glabrata fungemia in nonneutropenic critically ill patients*

Objective:Candida species represent the fourth cause of nosocomial bloodstream infections worldwide. Because Candida glabrata has become the second most frequently identified yeast and because the rate of fluconazole-resistant C. glabrata strains reaches 10% to 15%, initial antifungal therapy based on fluconazole in nonneutropenic hemodynamically stable patients, as recommended by current guidelines, may be an ineffective option. Our aim was to determine easy-to-identify risk factors for C. glabrata fungemia likely to guide and improve initial antifungal therapy. Design:Prospective multicenter cohort study. Setting:Five French intensive care units. Patients:Consecutive nonneutropenic patients without known Candida colonization who had blood culture-confirmed fungemia over a 4-yr period. Interventions:None. Measurements and Main Results:A total of 8206 patients were screened. One hundred fifty-four patients with blood culture-confirmed fungemia constituted the cohort, of whom 48 had C. glabrata fungemia and 106 had nonglabrata fungemia. Patients' baseline characteristics and in-intensive care unit events potentially related to C. glabrata fungemia were systematically recorded. Compared with patients with nonglabrata fungemia, patients with C. glabrata fungemia were older and more severely ill, had received more antibiotics, and were more likely to have undergone surgery. The stepwise logistic regression analysis identified six independent risk factors for C. glabrata fungemia: age >60 yrs, recent abdominal surgery, interval from intensive care unit admission to first positive blood culture ≤7 days, recent use of cephalosporins, solid tumor, and absence of diabetes mellitus. The model showed satisfying goodness of fit (Hosmer-Lemeshow statistic = .26) and discrimination (c statistic = .89). Conclusions:We found six early available and easy-to-identify risk factors for C. glabrata fungemia. When these factors are present, alternatives to fluconazole for initial antifungal therapy should be considered.
Morphology, metabolism, microcirculation, and strength of skeletal muscles in cancer-related cachexia

Purpose. Cancer-related cachexia is an obscure syndrome leading to muscle wasting, reduced physical fitness and quality of life. The aim of this study was to assess morphology, metabolism, and microcirculation in skeletal muscles of patients with cancer-related cachexia and to compare these data with matched healthy volunteers. Methods. In 19 patients with cancer-induced cachexia and 19 age-, gender-, and body-height-matched healthy volunteers body composition and aerobic capacity (VO2max) were analyzed. Skeletal muscle fiber size and capillarization were evaluated in biopsies of the vastus lateralis muscle. The cross-sectional area (CSA) of the quadriceps femoris muscle was measured by magnetic resonance imaging as well as its isokinetic and isometric force. The energy and lipid metabolism of the vastus lateralis muscle was quantified by 31P and 1H spectroscopy and parameters of its microcirculation by contrast-enhanced ultrasonography (CEUS). Results. Morphologic parameters were about 30% lower in cachexia than in volunteers (body mass index: 20±3 vs. 27±4 kg m−2, CSA: 45±13 vs. 67±14 cm2, total fiber size: 2854±1112 vs. 4181±1461 µm2). VO2max was reduced in cachexia (23±9 vs. 32±7 ml min−1 kg−1, p=0.03), whereas histologically determined capillary density and microcirculation in vivo were not different. Both concentrations of muscular energy metabolites, pH, and trimethyl-ammonium-containing compounds were comparable in both groups. Absolute strength of quadriceps muscle was reduced in cachexia (isometric: 107±40 vs. 160±40 Nm, isokinetic: 101±46 vs. 167±50 Nm; p=0.03), but identical when normalized on CSA (isometric: 2.4±0.5 vs. 2.4±0.4 Nm cm−2, isokinetic: 2.2±0.4 vs. 2.5±0.5 Nm cm−2). Conclusions. Cancer-related cachexia is associated with a loss of muscle volume but not of functionality, which can be a rationale for muscle training.
Activity of a silver-coated endotracheal tube in preclinical models of ventilator-associated pneumonia and a study after extubation*

Objective:To elucidate the mechanism of action of the silver-coated endotracheal tube in models of the early pathogenesis of ventilator-associated pneumonia. Design:Open-labeled, prospective, controlled, sequentially conducted, preclinical studies, and in vitro assessment of tubes from patients. Setting:Microbiology laboratory of a device manufacturer, animal research facility of a university, and a tertiary medical center. Interventions:Endotracheal tubes were similar except for the silver coating. In the 21-day in vitro elution model, tube samples were incubated in saline solution at 37.8°C. In the in vitro adherence model, coated and uncoated tubes were exposed to 21 respiratory isolates of radiolabeled microorganisms for 2–4 hrs. In the animal model, 12 healthy white rabbits were intubated for 16 hrs with noncuffed silver-coated or uncoated tubes and challenged with buccal administration of Pseudomonas aeruginosa. In the in vitro assessment, tubes from 16 patients underwent quantitative culture assessment and qualitative confocal laser scanning microscopy. Measurements and Main Results:After in vitro incubation, the mean residual silver concentration was 2.6 &mgr;g/cm2, confirming that the coating was not entirely depleted. In vitro adherence to the silver-coated endotracheal tube was less than that of the uncoated tube for 12 of 21 isolates and equivalent for seven. For example, adherence to the silver-coated endotracheal tube was reduced >90% for all five isolates of P. aeruginosa (p < .05). In rabbits, P. aeruginosa colonization on the silver-coated endotracheal tube was reduced 99.9% compared with that on the uncoated tube (p < .0001); colonization in the tracheal and lung tissue was reduced ≥99% (p < .05). In the in vitro assessment, pathogens were detected on none of nine silver-coated tubes from patients and three of seven control tubes (p > .05). Conclusions:The collective findings of this series of studies demonstrated that the silver-coated endotracheal tube was active in models designed to mimic the early pathogenesis of ventilator-associated pneumonia.
Safety of pregnancy following breast cancer diagnosis

Kroman et al. recently published on Acta Oncologica [1] an update for their previous work on pregnancy following breast cancer diagnosis. In the current paper, they confirm their previous results [2] on a much larger patient population and conclude that pregnancy subsequent to breast cancer treatment does not have a negative effect on patients’ survival. In the present paper, the relative risk (RR) of death after a full term pregnancy is 0.73 (95% CI 0.54 0.99) with a p-value of 0.04. The authors noted that the impressive 27% reduced RR of death might be to a selection bias including the well known ‘‘healthy mother effect’’ phenomenon. However, on restricting the analysis to non-relapsing controls or to low risk disease patients, the protective value was still observed. An alternative explanation would be that subsequent pregnancies have a real therapeutic effect, thus reducing the RR of death for women with previously diagnosed breast cancer. One possible mechanism is immunological and relies on the hypothesis that foetal antigens are present also on the tumour cells and that pregnancy acts as a kind of tumour vaccination [3]. The second hypothesis is endocrinal. Breast cancer cells expressing oestrogen or progesterone receptors undergo apoptosis when exposed to high doses of oestrogens [4,5]; which is the case during pregnancy. In this regard it would be interesting to analyse the Danish Breast Cancer Cooperative Group (DBCCG) data for hormone receptor status at diagnosis to see if there is any correlation with improved survival. Other evidences correlate subsequent oestrogen deprivation with further inhibitory effect [6]. We have analyzed the data from the IBCSG study [7] and found that women who were reported by their physicians to have breast fed their babies after breast cancer (a natural way of keeping oestrogen levels low after pregnancy) had an even better prognosis compared to those who did not lactate [8]. Again, it would be interesting to know if women who had a subsequent term pregnancy after breast cancer breast fed their babies and if this correlated with a further reduced RR of death in the DBCCG data set. In the treatment of cancer, every single improvement in the understanding of tumour biology adds precious information about new possible therapeutic means. It would be amazing to find hints to improve breast cancer cure in the biologic mystery of giving life.