Miracle-dz/UniFAR-FTUs huggingface dataset:
Transthoracic echocardiographic simulator: normal and the abnormal.

Despite anesthesiologists’ use of transesophageal echocardio-graphy (TEE) and familiarity with cardiovascular imaging,TTE has not been as widely used perioperatively. With therecent availability of relatively inexpensive and portable ultra-sound systems, there has been a resurgence of interest in usingthis modality to its full potential. Another possible reason for itsunderutilization could be the lack of structured training programsfor anesthesiologists. The National Board of Echocardiographymandates a minimum of 150 TTE examinations to be per-formed by operators, with 300 interpretations under appropriatesupervision, as requirements for certiﬁcation. However, a short-age of trained personnel and stafﬁng-related issues are two ofthe reasons for a comprehensive TTE examination either notbeing performed routinely or not in a timely fashion, particu-larly for preoperative risk stratiﬁcation. TTE is a modality that requires considerable skill in imageacquisition and supervised training for interpretation. Tradi-tionally, cardiologists have employed the services of trainedechocardiography technicians for image acquisition, whereasemergency room and critical care physicians have to acquireand interpret transthoracic images themselves. Major nationalprofessional societies (eg, the American Society of Anesthesi-ologists, the Society of Cardiovascular Anesthesiologists, andthe Society of Critical Care Medicine) have taken the initiativeto educate their members about the beneﬁts and applications ofechocardiography in routine practice. However, currently thereare no formal TTE image-acquisition training opportunitiesavailable for anesthesiologists.As a result, an increasing demand for this clinical skill isfurther exacerbated by a paucity of training opportunities, ne-cessitating the employment of alternate training methods totrain physicians in TTE. Therefore, the use of simulation tech-nology provides a unique opportunity to create a virtual train-ing environment to offset the initial learning curve and shortenthe eventual training duration.
Isokinetics : muscle testing, interpretation, and clinical applications

Preface to Second Edition Preface to First Edition 1. Physiological and biomechanical aspects of isokinetics 2. Hardware, test parameters and issues in testing 3. Reproducibility of isokinetic measurements 4. Application of isokinetics to muscle conditioning and rehabilitation 5. Medicolegal applications 6. Isokinetics of the hip muscles 7. Isokinetics of the knee muscles 8. Isokinetics of the ankle muscles 9. Isokinetics of the trunk muscles 10. Isokinetics of the shoulder muscles 11. Isokinetics of elbow, forearm, wrist and hand muscles Index
MAGNETIC RESONANCE IMAGING OF THE EQUINE FOOT

The purpose of this study was to assess the ability of magnetic resonance imaging to depict abnormalities of the equine foot. MRI was performed on isolated limbs which had lesions of the foot. These images were made in 3 perpendicular planes (sagittal, transverse and frontal) using a T1 weighted sequence and were 5mm thick. Images accurately depicted normal and pathologic structures in the foot and proved to be very precise for documenting degenerative joint disease, navicular disease and laminitis lesions. This preliminary study demonstrates the considerable potential of MRI in the diagnosis of locomotor problems in the horse.
A novel differential evolution algorithm for a flange coupling using ANSYS simulations

A novel modified multi-objective differential evolution algorithm was proposed to minimize material mass and margin strength of a flange couplings optimization system. Chaos operator was used to calculate the scaling factor of differential evolution algorithm for the reduction of user participation. Finite element simulation was facilitated to validate the effectiveness of the modified evolution algorithm. Results demonstrate that the structural dimensions influenced material mass more evidently than performance. Hence, this study verifies the feasibility of the modified evolution algorithm for multi-objective optimization on non-standard flange couplings in mechanical industry.
Beneficial effects of mangiferin on hyperlipidemia in high-fat-fed hamsters.

SCOPE Mangiferin, a natural polyphenol, has been shown to have hypolipidemic effect in rat and mouse. However, the mechanism of action is not well understood. This study was conducted to determine the effect and mechanism of action of mangiferin on hyperlipidemia induced in hamsters by a high-fat diet. METHODS AND RESULTS Forty male hamsters were randomly assigned to normal control, high-fat control, and high fat with mangiferin (50 and 150 mg/kg BW) groups. Mangiferin treatment significantly decreased final body weight, liver weight and visceral fat-pad weight, serum triglyceride (TG) and total free fatty acid (FFA) concentrations, hepatic TG levels and hepatic and muscle total FFA contents. Mangiferin upregulated mRNA expression of peroxisome proliferator-activated receptor-α (PPAR-α), fatty acid translocase (CD36) and carnitine palmitoyltransferase 1 (CPT-1), but downregulated mRNA expression of sterol regulatory element-binding protein 1c (SREBP-1c), acetyl CoA carboxylase (ACC), acyl-CoA:diacylglycerol acyltransferase 2 (DGAT-2) and microsomal triglyceride transfer protein (MTP) in liver. Mangiferin also stimulated mRNA expression of PPAR-α, CD36, CPT-1 and lipoprotein lipase (LPL) in muscle. CONCLUSIONS The results suggest that mangiferin may ameliorate hypertriglyceridemia partly by modulating the expression levels of genes involved in lipid oxidation and lipogenesis.
Ringed sideroblasts with thrombocytosis: an uncommon mixed myelodysplastic/myeloproliferative disease of older adults – response to Bain

Dr Shaw (Shaw, 2005) suggests changes to the World Health Organization (WHO) criteria for the diagnosis of ‘ringed sideroblasts with thrombocytosis’, which falls within the WHO category of ‘myelodysplastic/myeloproliferative disease, unclassifiable’ (Bain et al, 2001). Only one of the suggested changes is justified in the discussion, specifically that the platelet count required for diagnosis should be lowered from 600 to 500 · 10/l to increase sensitivity, although this would necessarily decrease specificity. One of the purposes of consensus guidelines, such as the WHO classification, is to provide uniform criteria so that different groups of patients can be validly compared. There is no basis for requiring that the bone marrow blast cell count should not exceed 3%, nor for requiring blast cells to be consistently absent from the peripheral blood (the WHO criteria permit up to 20% in bone marrow or blood), nor for requiring that cytogenetic analysis be normal (the WHO criteria require only that the Philadelphia chromosome, BCR-ABL, 5q–, inv(3)(q21q26) and t(3;3)(q21;q26) be excluded). All classifications of haematological neoplasms, including the WHO classification, have an element of arbitrariness. It is very much to be hoped that the WHO classification will be updated within the next few years, in order to incorporate new knowledge. Until then, there is no advantage in replacing one arbitrary set of criteria with a different set of arbitrary criteria, thus losing the benefit of uniformity of criteria between centres and countries.
Continuous-wave terahertz quantum cascade laser based on a hybrid bound to bound quantum design

We report a low threshold power density and high power output terahertz quantum cascade laser emitting at ∼3.9 THz operating in continuous-wave mode. The high output power and wall-plug efficiency are achieved based on a hybrid bound-to-bound quantum active design. A record output power of 312 mW and a low threshold power density of 0.8 kW/mm3 (threshold current density of 109 A/cm2) in continuous-wave mode at 20 K is demonstrated for a 300-μm-wide and 2-mm-long single-ridge device. The highest wall-plug efficiency is 1.38% and the slope efficiency is 684 mW/A with an internal quantum efficiency of ∼120 photons per injected electron. The demonstration of this low-threshold and high-power THz laser will promote THz-based remote sensing and standoff detection for pharmaceutical and health industry applications.
Community-Based Services for the Taking but Few Takers: Reasons for Nonuse

This study examined reasons for not using nine community-based services and characteristics associated with these reasons among a sample of 293 older person–caregiver dyads in a Canadian province. The most frequent reasons were that the older person's health did not necessitate use, family/friends provided assistance, and the caregiver was unaware of the service. Cognitive impairment was associated with not using homemaker and/or cleaning services, in-home nursing services, and home-delivered meals as family/friends provided assistance; higher caregiver burden also emerged as significant for these services and personal care services. Male caregivers and caregivers with less education were more likely to be unaware of the availability of day centers, day hospitals, and formal respite services. Implications for future research and practice are highlighted.
Influence of Mental Health Assessment on Prescription of Psychoactive Medication Among New Nursing Home Residents

This article presents preliminary evidence for a novel way of promoting use of non-psychopharmacological interventions for mental health problems among nursing home (NH) residents. Mental health assessments addressing cognitive status, mood, behavior problems, typical activities, and quality of life were conducted on newly admitted NH residents, with recommendations supporting non-psychopharmacological alternatives conveyed to the NH staff. The purpose was to determine whether non-psychopharmacological recommendations based on the assessments would have a significant influence on psychoactive prescribing patterns, use of psychological interventions, number of falls, and the number of hospitalizations among NH residents. Chart reviews were conducted 1 month post-NH assessment in a non-randomized design comparing the 23 residents in four for-profit NHs who received a mental health assessment with 25 residents in one of the for-profit NHs who did not receive an assessment. A mental health assessment administered to all incoming NH residents is feasible and takes a brief amount of time to implement. One month post-assessment, those residents who received the mental health assessment were less likely to begin to be prescribed psychoactive medication and insomnia medication, and there was a trend for them to be more likely to receive mental health consultations. Findings of this pilot study suggest that the systematic provision of such an assessment/intervention may promote good quality mental health care by reducing prescriptions of psychoactive medications and by increasing broadly defined psychological interventions. This evidence-based approach could lead to reduced medical costs that more than offset the expense of the assessments, but more controlled long-term studies with better comparison groups are needed.
Adding Heparin to Aspirin Reduces the Incidence of Myocardial Infarction and Death in Patients With Unstable Angina: A Meta-analysis

Objective. —To estimate the risk of myocardial infarction (MI) and death in patients with unstable angina who are treated with aspirin plus heparin compared with patients treated with aspirin alone. Data Sources. —Studies were retrieved using MEDLINE, bibliographies, and consultation with experts. Study Selection. —Only published trials that enrolled patients with unstable angina, randomized participants to aspirin plus heparin vs aspirin alone, and reported incidence of myocardial infarction or death were included in the meta-analysis. Data Extraction. —Patient outcomes including MI or death, recurrent ischemic pain, and major bleeding during randomized treatment; revascularization procedures after randomization; and MI or death during the 2 to 12 weeks following randomization were extracted by 2 authors, 1 of whom was blinded to the journal, institution, and author of each study. Data Synthesis. —Six randomized trials were included. The overall summary relative risk (RR) of MI or death during randomized treatment was 0.67 (95% confidence interval [CI], 0.44-1.02) in patients with unstable angina treated with aspirin plus heparin compared with those treated with aspirin alone. The summary RRs for secondary endpoints in patients treated with aspirin plus heparin compared with those treated with aspirin alone were 0.68 (95% CI, 0.40-1.17) for recurrent ischemic pain; 0.82 (95% CI, 0.56-1.20) for MI or death 2 to 12 weeks following randomization; 1.03 (95% CI, 0.74-1.43) for revascularization; and 1.99 (95% CI, 0.52-7.65) for major bleeding. We found no statistically significant heterogeneity among individual study findings. Conclusions. —Our findings are consistent with a 33% reduction in risk of MI or death in patients with unstable angina treated with aspirin plus heparin compared with those treated with aspirin alone. The bulk of evidence suggests that most patients with unstable angina should be treated with both heparin and aspirin.
Goal-directed therapy: evidence and outcome.

GOAL-DIRECTED TRANSFUSION therapy is part of patient blood management programs. The purpose of patient blood management is to mitigate inappropriate blood transfusion practices and improve patient outcomes by identifying patients at risk for transfusions and by providing a standardized procedure for reducing or eliminating the need for transfusion. It is well documented that a large number of patients receive inappropriate transfusion, especially of non-red blood cell products, and the significant variability in transfusion incidence among institutions in all types of blood products is also well documented. There is also a growing documentation in the literature that transfusion of allogeneic blood is an independent predictor of unfavorable outcomes—in particular, more frequent postoperative infections, longer hospital stays, and higher mortality. Finally, the cost of blood products is increasing, and the aging of the industrialized world’s population is resulting in increasing blood shortages, because the young tend to donate blood and the old tend to receive blood.
Hibiscus sabdariffa extract lowers blood pressure and improves endothelial function.

Polyphenols from Hibiscus sabdariffa calices were administered to patients with metabolic syndrome (125 mg/kg/day for 4 wk, n = 31) and spontaneously hypertensive rats (125 or 60 mg/kg in a single dose or daily for 1 wk, n = 8 for each experimental group). The H. sabdariffa extract improved metabolism, displayed potent anti-inflammatory and antioxidant activities, and significantly reduced blood pressure in both humans and rats. Diuresis and inhibition of the angiotensin I-converting enzyme were found to be less important mechanisms than those related to the antioxidant, anti-inflammatory, and endothelium-dependent effects to explain the beneficial actions. Notably, polyphenols induced a favorable endothelial response that should be considered in the management of metabolic cardiovascular risks.
Biofunctionalized microfiber-assisted formation of intrinsic three-dimensional capillary-like structures.

OBJECTIVES A vascular supply network is essential in engineered tissues >100-200-μm thickness. To control vascular network formation in vitro, we hypothesize that capillarization can be achieved locally by using fibers to position and guide vessel-forming endothelial cells within a three-dimensional (3D) matrix. MATERIALS AND METHODS Biofunctionalization of poly-(L-lactic acid) (PLLA) fibers was performed by amino-functionalization and covalent binding of RGD peptides. Human foreskin fibroblasts (HFFs) and human umbilical vein endothelial cells (HUVECs) were seeded on the fibers in a mould and subsequently embedded in fibrin gel. After 9-21 days of coculture, constructs were fixed and immunostained (PECAM-1). Capillary-like structures with lumen in the 3D fibrin matrix were verified and quantified using two-photon microscopy and image analysis software. RESULTS Capillary-like networks with lumen formed adjacent to the PLLA fibers. Increased cell numbers were observed to attach to RGD-functionalized fibers, resulting in enhanced formation of capillary-like structures. Cocultivation of HFFs sufficiently supported HUVECs in the formation of capillary-like structures, which persisted for at least 21 days of coculture. CONCLUSIONS The guidance of vessel growth within tissue-engineered constructs can be achieved using biofunctionalized PLLA microfibers. Further methods are warranted to perform specified spatial positioning of fibers within 3D formative scaffolds to enhance the applicability of the concept.
Acute myeloid leukemia in children: Current status and future directions

Acute myeloid leukemia (AML) accounts for 25% of pediatric leukemia and affects approximately 180 patients annually in Japan. The treatment outcome for pediatric AML has improved through advances in chemotherapy, hematopoietic stem cell transplantation (HSCT), supportive care, and optimal risk stratification. Currently, clinical pediatric AML studies are conducted separately according to the AML subtypes: de novo AML, acute promyelocytic leukemia (APL), and myeloid leukemia with Down syndrome (ML‐DS). Children with de novo AML are treated mainly with anthracyclines and cytarabine, in some cases with HSCT, and the overall survival (OS) rate now approaches 70%. Children with APL are treated with an all‐trans retinoic acid (ATRA)‐combined regimen with an 80–90% OS. Children with ML‐DS are treated with a less intensive regimen compared with non‐DS patients, and the OS is approximately 80%. HSCT in first remission is restricted to children with high‐risk de novo AML only. To further improve outcomes, it will be necessary to combine more accurate risk stratification strategies using molecular genetic analysis with assessment of minimum residual disease, and the introduction of new drugs in international collaborative clinical trials.
Dietary CML-enriched protein induces functional arterial aging in a RAGE-dependent manner in mice.

SCOPE Advanced glycation end-products (AGEs) are endogenously produced and are present in food. N(ε)-carboxymethyllysine (CML) is an endothelial activator via the receptor for AGEs (RAGEs) and is a major dietary AGE. This work investigated the effects of a CML-enriched diet and RAGE involvement in aortic aging in mice. METHODS AND RESULTS After 9 months of a control diet or CML-enriched diets (50, 100, or 200 μg(CML)/g of food), endothelium-dependent relaxation, RAGE, vascular cell adhesion molecule-1, and sirtuin-1 expression, pulse wave velocity and elastin disruption were measured in aortas of wild-type or RAGE(-/-) male C57BL/6 mice. Compared to the control diet, endothelium-dependent relaxation was reduced in the wild-type mice fed the CML-enriched diet (200 μg(CML)/g) (66.8 ± 12.26 vs. 94.3 ± 2.6%, p < 0.01). RAGE and vascular cell adhesion molecule-1 (p < 0.05) expression were increased in the aortic wall. RAGE(-/-) mice were protected against CML-enriched diet-induced endothelial dysfunction. Compared to control diet, the CML-enriched diet (200 μg(CML)/g) increased the aortic pulse wave velocity (86.6 ± 41.1 vs. 251.4 ± 41.1 cm/s, p < 0.05) in wild-type animals. Elastin disruption was found to a greater extent in the CML-fed mice (p < 0.05). RAGE(-/-) mice fed the CML-enriched diet were protected from aortic stiffening. CONCLUSION Chronic CML ingestion induced endothelial dysfunction, arterial stiffness and aging in a RAGE-dependent manner.
Visualized absorption of anti-atherosclerotic dipeptide, Trp-His, in Sprague-Dawley rats by LC-MS and MALDI-MS imaging analyses.

SCOPE The basic dipeptide, Trp-His, was found to show an in vivo anti-atherosclerotic effect when orally administered to apo E-deficient mice. In addition, this dipeptide causes vasorelaxation in contracted rat aorta via suppression of intracellular Ca(2+) signaling cascades. In this study, we attempted to determine whether Trp-His can be absorbed after single oral administration in Sprague-Dawley (SD) rats. METHODS AND RESULTS Trp-His and His-Trp (10 or 50 mg/kg) was orally administered to 8-week-old male SD rats. Both peptides in plasma were assayed by LC-MS/MS in combination with 2,4,6-trinitrobenzene sulfonate derivatization technique. In vitro transport experiments using Caco-2 cell monolayers were performed to evaluate the apparent permeability (Papp ). A phytic acid-aided MALDI-MS imaging (MSI) was conducted to visualize the distribution of dipeptides in the rat intestinal membrane. Trp-His was absorbed intact into SD rat blood, showing a maximal level at 1 h after administration at 10 mg/kg dose (Cmax , 28.7 ± 8.9 pmol/mL-plasma; area under the curve, 71.3 ± 18.7 pmol·h/mL-plasma). In contrast, His-Trp was surprisingly not detected, although the Papp was compatible to that of Trp-His. MSI analysis provided crucial evidence that Trp-His was visualized in the overall intestinal membrane. The Trp-His peptide was not visualized in the presence of Gly-Sar, which is a model peptide that is transported via the intestinal proton-coupled peptide transporter 1 (PepT1) transporter. The His-Trp molecular ion was not observed at the intestinal membrane. The MSI analysis illustrated that there is no absorption of His-Trp due to its unexpected hydrolysis by brush border proteases. CONCLUSION To the best of our knowledge, this is the first study demonstrating that the vasoactive Trp-His is preferably transported across the rat intestinal membrane by PepT1 and is absorbed intact into the circulation. However, no absorption of His-Trp, a reverse sequence of absorbable Trp-His, is observed owing to hydrolysis by intestinal proteases. This suggests that the bioavailability of peptides may be determined in part by their protease resistance in the intestinal membrane.
Effect of daily intake of pomegranate juice on fecal microbiota and feces metabolites from healthy volunteers.

SCOPE The purpose of the study was to evaluate the effect, regarding the metabolic and microbial profile of feces, of diet supplementation of healthy adults with pomegranate juice (PJ). METHODS AND RESULTS Twelve healthy adults were recruited to the study, which consisted of the intake of 200 mL/day of PJ during 4 weeks. Feces were collected before and after the supplementation with PJ. Metabolites (phenolic catabolites, short-chain fatty acids, and fecal steroids) and microbial profile were analyzed at baseline and at 4 weeks. Fecal phenolic metabolites, 3-phenylpropionic acid, catechol, hydroxytyrosol, and urolithin A, showed a significant increase in their concentration after supplementation with PJ. Among fecal steroids, parallel to the significant increase of cholesterol concentration, a significant decrease of coprostanol was observed. Although no significant changes in the microbiota profile were observed, different relationships between initial microbiota and the metabolites produced were found. Catechol showed positive and negative correlation with Oscillospora and Paraprevotella genera, respectively, and 3-phenylpropionic acid was positively correlated with Odoribacter genus. CONCLUSION Inclusion of PJ in the diet did not significantly alter the gut microbiota composition in healthy adults, but the individual bacterial composition could contribute to the generation of potential health-promoting phenolic metabolites.
A Complex Atrial Septal Defect and Three-Dimensional Echocardiography: A Question and an Answer.

From the Departments of *Anesthesia; and †Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Address reprint requests to Feroze Mahmood, MD, Harvard Medical School, Beth Israel Deaconess Medical Center, 1 Deaconess Road, CC-454, Boston, MA, 02215. E-mail: fmahmood@bidmc.harvard. edu © 2015 Elsevier Inc. All rights reserved. 1053-0770/2602-0033$36.00/0 http://dx.doi. org/10.1053/j.jvca. 2015.09. 027