Miracle-dz/UniFAR-FTUs huggingface dataset:
Effect of Moderate Aerobic Exercise Training on Endothelial Function and Arterial Stiffness in CKD Stages 3-4: A Randomized Controlled Trial.

BACKGROUND Evidence of a beneficial effect of exercise training on mediators of vascular disease is accumulating in chronic kidney disease (CKD), but its effect on vascular function in vivo still has to be established. The present study was designed to investigate whether a formal aerobic exercise training program improves peripheral endothelial function in patients with CKD stages 3 to 4. STUDY DESIGN Randomized controlled trial with a parallel-group design. SETTING & PARTICIPANTS 48 patients with CKD stages 3 to 4 without established cardiovascular disease were randomly assigned to either an exercise training program or usual care. 40 patients completed the study (exercise training, 19; usual care, 21). INTERVENTION The 3-month home-based aerobic training program consisted of 4 daily cycling sessions of 10 minutes each at a target heart rate, calculated as 90% of the heart rate achieved at the anaerobic threshold. Patients in the usual-care group were given standard therapy. OUTCOMES The primary outcome was peripheral endothelial function. Secondary outcomes were aerobic capacity, arterial stiffness, numbers of endothelial (EPCs) and osteogenic progenitor cells (OPCs), migratory function of circulatory angiogenic cells, and health-related quality of life. MEASUREMENTS Endothelial function was assessed with flow-mediated dilation of the brachial artery, aerobic capacity by peak oxygen uptake (VO(2peak)), arterial stiffness by carotid-femoral pulse wave velocity, numbers of EPCs and OPCs by flow cytometry, circulatory angiogenic cell function by an in vitro migratory assay, and quality of life by the Kidney Disease Quality of Life-Short Form questionnaire. RESULTS Exercise training significantly improved VO(2peak) and quality of life, but not in vivo vascular function (flow-mediated dilation and carotid-femoral pulse wave velocity) or cellular markers for vascular function (EPC and OPC count and circulatory angiogenic cell migratory function). LIMITATIONS Short duration and intermittent nature of the exercise intervention. CONCLUSIONS In patients with CKD stages 3 to 4 without overt cardiovascular disease, 3 months of aerobic exercise training improved VO(2peak) and quality of life, without altering endothelial function or arterial stiffness.
Levocarnitine Improves Cardiac Function in Hemodialysis Patients With Left Ventricular Hypertrophy: A Randomized Controlled Trial.

BACKGROUND Levocarnitine deficiency in hemodialysis patients is common. Although the effect of levocarnitine therapy on uremic anemia has been studied in small trials, its effects on cardiac function remain unclear. STUDY DESIGN Multicenter, prospective, open-label, parallel, randomized, controlled trial. SETTING & PARTICIPANTS Patients undergoing maintenance hemodialysis with carnitine deficiency (free carnitine plasma concentration < 40μmol/L) enrolled in 3 hemodialysis centers. INTERVENTION Random assignment to treatment for 12 months with oral levocarnitine therapy at a dose of 20mg/kg/d or control group (no levocarnitine therapy). OUTCOMES & MEASUREMENTS Cardiac function was assessed by echocardiography. The primary end point was change in ejection fraction from baseline at the end of the study. Secondary end points included changes in left ventricular mass index and clinical parameters from baseline at the end of the study. RESULTS 222 patients were randomly assigned, of whom 148 patients (levocarnitine group, n=75; control group, n=73) were analyzed. Ejection fraction increased from baseline to the end of the study in the levocarnitine group by 5.43% (95% CI, 4.53%-6.32%), but not in the control group (change, -0.14%; between-group difference, 5.57% [95% CI, 4.48%-6.66%]; P<0.001). Left ventricular mass index decreased from baseline to the end of the study in the levocarnitine group (change of -8.89 [95% CI, -11.7 to -6.09] g/m(2)), but not in the control group (change of 1.62g/m(2); between-group difference, 10.50 [95% CI, 7.51 to 13.60] g/m(2); P<0.001). Levocarnitine therapy reduced N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and improved the erythropoietin responsiveness index, whereas no such effects were observed in the control group. LIMITATIONS Not a double-blinded study. CONCLUSIONS Levocarnitine therapy is useful for hemodialysis patients with carnitine deficiency; these patients may benefit from such therapy, with amelioration of cardiac function and reduction of left ventricular mass index.
Prevalence and antimicrobial susceptibility pattern of Coagulase-negative Staphylococcus

Background: The vast majority of infections assumed to be caused by Coagulase-negative Staphylococcus (CoNS) are a signifi cant consequence of hospitalization. Current antibiotic-prescribing practices, including preoperative antibiotic prophylaxis, have led to the selection of antibiotic-resistant organisms. The purpose of the present study is to provide a current scenario, species distribution in clinical specimens and antimicrobial susceptibility testing, mainly to screen for methicillin resistance, multi-drug resistant strains. Methodology : Total 113 isolates of Coagulase- negative Staphylococci were isolated from clinical specimens over a 6 month period in a non consecutive non random manner. Antimicrobial resisitance pattern to 20 antimicrobial agents were performed Results : Coagulase-negative Staphylococci consisting of 10 different species were isolated. Staphylococcus epidermidis ( 49), Staphylococcus haemolyticus ( 19) , Staphylococcus hominis ( 11) were the most commonly isolated species. Antimicrobial susceptibility pattern revealed that they were all universally sensitive to vancomycin and linezolid. Methicillin resistance was noted among 48% of the isolates. Maximum resistance was seen with penicillin (91%) and least with Teicoplanin(3%) Conclusion : CoNS are a signifi cant cause of nosocomial bacteremia and their susceptibility to beta-lactamase-stable penicillins is unpredictable. Hence the methicillin resistant CoNS which are also multidrug resistant act as a reservoir for drug resistance in hospitals. Low level glycopeptide resistance encountered in recent years limits its use. For all these reasons, accuracy and promptness in the detection of resistance pattern is of key importance to ensure appropriate antibiotic treatment in infected patients as well as control the spread of resistance in hospital environments.
Prevalence and characteristics of depressive symptoms in university students in Melaka, Malaysia: a cross-sectional study.

Aims: To determine the prevalence and evaluate the specific characteristics of depressive symptoms in medical, law and pre-university students, as well as to perform an exploratory analysis to survey the relationships of depression with several risk factors. Study Design: An analytical cross sectional study was conducted on medical, law and preuniversity students of two private institutions in Melaka, Malaysia. Place and Duration of Study: Melaka, Malaysia, between September and October 2014. Methodology: A total of 376 students participated in this study (MBBS= 142, Law= 129, PreU=105). They completed self-administered questionnaires which included socio-demographic questions and the Beck Depression Inventory (BDI) survey. Each item in the BDI can be further divided into 3 clusters: Affective, cognitive and somatic. Statistical analysis was performed using post-hoc test for multiple comparisons and multiple logistic regression. Original Research Article Rong et al.; BJMMR, 6(7): 675-687, 2015; Article no.BJMMR. 2015.244 676 Results: There were 162 (43.1%) students with depressive symptoms (BDI>9). Law students were found to be more depressed with the highest mean BDI score (11.7±8.7) compared to MBBS (8.4±8.1) and pre-university students (8.9±6.8). Affective, cognitive and somatic clusters were significantly higher among law students. For exploratory analysis of risk factors, law students and those staying in hostel were significantly more likely to develop depressive symptoms. Conclusion: There is high prevalence of depressive symptoms among law, medical and preuniversity students. If detected early, students with depressive symptoms may be successfully managed with behavioral therapy, emotional support and interpersonal psychotherapy.
The Use of a Ceramic Surfaced Oxinium™ Implant in Total Knee Replacement

This paper reports the results of using a ceramic-surfaced zirconium femoral component (Oxinium™) in knee replacement surgery. Laboratory testing had indicated that the material, when articulated against high-density polyethylene, resulted in lower abrasive and adhesive wear then did a cobalt chrome implant. A randomized prospective study comparing this implant with an identical one in cobalt chrome indicated that there was a more rapid return of flexion in the ceramic-surfaced zirconium group, although eventual range of motion in both groups was equal. There were no adverse effects attributable to the Oxinium™ implant. The ceramic-surfaced zirconium implant was nickel-free and was indicated in patients with nickel allergy.
Exploring National Surveillance for Health-Related Workplace Absenteeism: Lessons Learned From the 2009 Influenza A Pandemic

Abstract Background During the 2009 influenza A (H1N1) virus pandemic, the Centers for Disease Control and Prevention did a pilot study to test the feasibility of using national surveillance of workplace absenteeism to assess the pandemic's impact on the workplace to plan for preparedness and continuity of operations and to contribute to health awareness during the emergency response. Methods Population-based and sentinel worksite approaches were used. Monthly measures of the 1-week prevalence of health-related absenteeism among full-time workers were estimated using nationally representative data from the Current Population Survey. Enhanced passive surveillance of absenteeism was conducted using weekly data from a convenience sample of sentinel worksites. Results Nationally, the pandemic's impact on workplace absenteeism was small. Estimates of 1-week absenteeism prevalence did not exceed 3.7%. However, peak workplace absenteeism was correlated with the highest occurrence of both influenza-like illness and influenza-positive laboratory tests. Conclusions Systems for monitoring workplace absenteeism should be included in pandemic preparedness planning. (Disaster Med Public Health Preparedness. 2013;0:1–7)
Anaplastic astrocytomas with abundant Rosenthal fibers in elderly patients: A diagnostic pitfall of high‐grade gliomas

To investigate the clinicopathological features of anaplastic astrocytoma (AA) with abundant Rosenthal fibers (RFs), this study assessed four cases of AA (elderly patients; age ≥70 years). Histologically, these tumors were composed of diffusely infiltrating astrocytomas with brightly eosinophilic cytoplasmic granules or cork‐screw or beaded bundles. Tumor cells showed pleomorphism, bizarre giant cells, and mitotic activity, but no necrosis. The cytoplasmic granules showed negativity on PAS staining. Immunohistochemically, the tumor cells with cytoplasmic granular cells showed a positive reaction for GFAP. The cytoplasmic eosinophilic granules or bundles were positive for αB‐crystallin, ubiquitin and HSP27. In addition, tumor cells showed strong cytoplasmic positivity for isocitrate dehydrogenase 1 (IDH1)‐R132H protein in all cases. The MIB‐l labeling index of these cases ranged from 7% to 10%. In cases 1 and 2, ultrastructurally, the tumor cells had electron‐dense, amorphous structures in the cytoplasm and in the processes. These structures were bound to glial intermediate filaments. Based on these microscopic, immunohistochemical and ultrastructural findings, case 1 was diagnosed as AA with abundant, mixed, common type of RFs and miniature (m) RFs, and cases 2,3, and 4 were diagnosed as AA with abundant mRFs. These results indicate that the presence of RFs in astrocytic tumors does not necessarily exclude a diagnosis of high‐grade astrocytoma. In addition, AAs with abundant mRFs in elderly patients should be classified as a peculiar variant of AA.
Just-in-Time Training of Dental Responders in a Simulated Pandemic Immunization Response Exercise

ABSTRACT Objective The reauthorization of the Pandemic and All-Hazards Preparedness Act in 2013 incorporated the dental profession and dental professionals into the federal legislation governing public health response to pandemics and all-hazard situations. Work is now necessary to expand the processes needed to incorporate and train oral health care professionals into pandemic and all-hazard response events. Methods A just-in-time (JIT) training exercise and immunization drill using an ex vivo porcine model system was conducted to demonstrate the rapidity to which dental professionals can respond to a pandemic influenza scenario. Medical history documentation, vaccination procedures, and patient throughput and error rates of 15 dental responders were evaluated by trained nursing staff and emergency response personnel. Results The average throughput (22.33/hr) and medical error rates (7 of 335; 2.08%) of the dental responders were similar to those found in analogous influenza mass vaccination clinics previously conducted using certified public health nurses. Conclusions The dental responder immunization drill validated the capacity and capability of dental professionals to function as a valuable immunization resource. The ex vivo porcine model system used for JIT training can serve as a simple and inexpensive training tool to update pandemic responders’ immunization techniques and procedures supporting inoculation protocols.
Cognitive Decline and Its Risk Factors in Prevalent Hemodialysis Patients.

BACKGROUND Cognitive impairment is common in patients treated with hemodialysis. The trajectory of cognitive function and risk factors for cognitive decline remain uncertain in this population. STUDY DESIGN Longitudinal cohort. SETTING & PARTICIPANTS 314 prevalent hemodialysis patients. PREDICTORS Age, sex, race, education level, hemodialysis vintage, cause of end-stage renal disease, and baseline history of cardiovascular disease. OUTCOMES Cognitive function as determined by a comprehensive neurocognitive battery, administered at baseline and yearly when possible. Individual cognitive test results were reduced into 2 domain scores using principal components analysis, representing memory and executive function, which were used as our coprimary outcomes and by definition have a mean of zero and SD of 1. RESULTS Mean age was 63 years; 54% were men, 22% were black, and 90% had at least a high school education. During a median follow-up of 2.1 (IQR, 0.9-4.2) years, 196 had at least 1 follow-up test, 156 died, and 43 received a kidney transplant. Linear mixed models and joint models, which accounted for competing risks from death, dropout, or kidney transplantation, showed nearly identical results. The joint model demonstrated a decline in executive function (-0.09 [95% CI, -0.13 to -0.05] SD per year), whereas memory improved slightly (0.05 [95% CI, 0.02 to 0.08] SD per year). A significant yearly decline was also seen in the Mini-Mental State Examination score (median change, -0.41; 95% CI, -0.57 to -0.25). Older age was the only significant risk factor for steeper executive function decline (-0.04 [95% CI, -0.06 to -0.02] SD steeper annual decline for each 10 years of age). LIMITATIONS Prevalent hemodialysis patients only, limited follow-up testing due to high mortality rate, and exclusion of participants with severe cognitive deficits or dementia. CONCLUSIONS Prevalent hemodialysis patients demonstrate significant cognitive decline, particularly within tests of executive function. Older age was the only statistically significant risk factor for steeper cognitive decline, which may have important clinical consequences for patient management and education. Future studies should evaluate strategies to maintain or improve cognitive function.
Restless legs syndrome

Sleep is essential to maintain quality of life. Restless legs syndrome (RLS) is a disorder which is characterized by uncomfortable feeling in legs, irresistible urge to move them and compromised sleep quality. It is a common problem but is usually under diagnosed or misdiagnosed. It can be easily diagnosed by using criteria proposed by International Restless Legs Society. Though no specific investigations are require for diagnosis, investigations are required to discern the cause. Treatment of the cause relieves the symptoms of secondary RLS. In case of primary RLS most patients improve with non-pharmacological treatment. Those who require drug treatment should be classified as per frequency and severity of symptoms. Dopamine agonists are first line drugs, however, the treatment needs to be individualized depending upon the symptoms of the patients. This review aims at comprehensive overview of RLS including diagnosis and management.
Non-GFR Determinants of Low-Molecular-Weight Serum Protein Filtration Markers in the Elderly: AGES-Kidney and MESA-Kidney.

BACKGROUND Studies in chronic kidney disease populations suggest that the non-glomerular filtration rate (GFR) determinants of serum levels of the low-molecular-weight protein filtration markers cystatin C, β2-microglobulin (B2M), and beta-trace protein (BTP) are less affected by age, sex, and ethnicity than those of creatinine. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS Predominantly elderly participants selected from the Age, Gene/Environment Susceptibility Kidney Study (AGES-Kidney; N=683; mean [SD] age, 79 [4] years; GFR, 62 [17]mL/min/1.73 m2) and from the Multi-Ethnic Study of Atherosclerosis Kidney Study (MESA-Kidney; N=273; mean [SD] age, 70.5 [9] years; GFR, 73 [19]mL/min/1.73 m2). PREDICTORS Demographic and clinical factors hypothesized to be associated with conditions affecting non-GFR determinants of the filtration markers. OUTCOMES Measured GFRs and estimated GFRs (eGFRs) based on creatinine, cystatin C, B2M, and BTP levels (eGFRcr, eGFRcys, eGFRB2M, and eGFRBTP, respectively). Residual associations of factors with eGFR after accounting for measured GFR as the parameter of interest. RESULTS eGFRcys, eGFRB2M, and eGFRBTP had significantly less strong residual associations with age and sex than eGFRcr in both AGES-Kidney and MESA-Kidney and were not associated with ethnicity (black vs white) in MESA-Kidney. After adjusting for age, sex, and ethnicity, residual associations with most clinical factors were smaller than observed with age and sex. eGFRcys and eGFRB2M, but not eGFRBTP, had significant residual associations with C-reactive protein levels in both studies. LIMITATIONS Small sample size may limit power to detect associations. Participants may be healthier than the general population. CONCLUSIONS Similar to previous studies in chronic kidney disease, in community-dwelling elders, cystatin C, B2M, and BTP levels are less affected than creatinine level by age and sex and are not affected by ethnicity. Both cystatin C and B2M levels may be affected by inflammation. These findings are important for the development and use of GFR estimating equations based on low-molecular-weight serum proteins throughout the range in GFRs.
Social Capital and Mental Health in Post-Disaster/Conflict Contexts: A Systematic Review

Abstract Social capital (SC) is highlighted as an important factor for post-crisis mental health outcomes. However, the heterogeneous nature of the construct makes it difficult to get a clear picture of the evidence concerning the association between SC indices and mental health. This review examines how SC is conceptualized and measured, and the relationships with other variables in quantitative empirical studies investigating the associations between SC and mental health in post-disaster and post-conflict contexts. It includes primary data studies focusing on this association in civilian populations. Studies were identified by searching electronic databases, bibliographic mining, cited reference searching, and personal contact with experts. In total, 15 studies were included: 12 in post-natural disaster contexts and 3 in conflict-affected settings. Findings suggested that individual cognitive SC had an inverse association with post-traumatic stress disorder, anxiety, and depression, and that ecological cognitive SC was positively associated with mental well-being. Individual structural SC (in the form of community networks) may be psychologically protective. However, most of the evidence was cross-sectional, limiting conclusions about causal relationships. More clarity and consistency is needed in the conceptualization and measurement of SC in order to inform post-crisis mental health interventions. (Disaster Med Public Health Preparedness. 2018;12:791-802)
War and Tsunami PTSD Responses in Sri Lankan Children: Primacy of Reexperiencing and Arousal Compared to Avoidance-Numbing

This article addresses post-traumatic stress disorder symptoms in Sri Lankan children in response to war and the 2004 tsunami. Exposure to war and the tsunami each predicted severity of posttraumatic symptomatology. In both studies, reexperiencing and arousal symptoms were reported more than avoidance-numbing. Furthermore, symptom severity was greater in groups reporting many symptoms compared to those reporting fewer symptoms, and there was no difference in symptom severity when the DSM–IV set of six symptoms was compared to a different set of 6 symptoms (with just one avoidance-numbing symptom). The relative primacy of reexperiencing and arousal symptoms are highlighted in this understudied South Asian population, informing cultural variation in diagnostic criteria and clinical interventions for post-traumatic stress symptoms.
Intra-subject variability in the auditory brainstem response using a vertical montage recording

Abstract Purpose The present study investigated the intra-subject variability in auditory brainstem responses (ABRs) recorded using a vertical montage and compared the results with the ABRs recorded using an ipsilateral montage. Methods A total of 31 adults with normal hearing were involved in this study. The ABRs from vertical and ipsilateral montages were recorded at 80, 50, and 30 dBnHL using 0.1 ms click stimuli on the right ear with a stimulus rate of 19.1 Hz. Each participant was tested in two clinical sessions with a 7-day interval between sessions. The ABR results between the sessions and montages were compared and statistically evaluated. Results The ABR results were generally consistent between the two sessions in both the ipsilateral and vertical montages. The test–retest mean differences (test session 2 minus test session 1) between the ipsilateral ABR and vertical montage ABR results were also similar. Coefficient of variation values indicated that more variability was associated with smaller amplitude ABRs than higher amplitude ABRs. Conclusion The ABR recorded through the vertical montage had, in general, a similar reliability to the ABR recorded using the ipsilateral montage.
Localization of liposomal mTHPC formulations within normal epithelium, dysplastic tissue, and carcinoma of oral epithelium in the 4NQO‐carcinogenesis rat model

Foslip and Fospeg are liposomal formulations of the photosensitizer mTHPC (Foscan), which is used for photodynamic therapy (PDT) of malignancies. Literature suggests that liposomal mTHPC formulations have better properties and increased tumor uptake compared to Foscan. To investigate this, we used the 4NQO‐induced carcinogen model to compare the localization of the different mTHPC formulations within normal, precancerous, and cancerous tissue. In contrast to xenograft models, the 4NQO model closely mimics the carcinogenesis of human oral dysplasia.