Miracle-dz/UniFAR-FTUs huggingface dataset:
Rapid clinical deterioration in an individual with Down syndrome

A small percentage of adolescents and young adults with Down syndrome experience a rapid and unexplained deterioration in cognitive, adaptive, and behavioral functioning. Currently, there is no standardized work‐up available to evaluate these patients or treat them. Their decline typically involves intellectual deterioration, a loss of skills of daily living, and prominent behavioral changes. Certain cases follow significant life events such as completion of secondary school with friends who proceed on to college or employment beyond the individual with DS. Others develop this condition seemingly unprovoked. Increased attention in the medical community to clinical deterioration in adolescents and young adults with Down syndrome could provide a framework for improved diagnosis, evaluation, and treatment. This report presents a young adult male with Down syndrome who experienced severe and unexplained clinical deterioration, highlighting specific challenges in the systematic evaluation and treatment of these patients. © 2016 Wiley Periodicals, Inc.
A New Mathematical Model For Assessment of Memorization Dynamics

A new memory model is proposed based on regression analysis and exponential- shaped learning curves. The efficacy of the model is tested with several types of experiments including food aversion in snails, maze learning in rats and memory tests for adults and children. The model is also tested on drug abusers and alcoholics. The results of goodness of fit tests indicate that our model can accurately be used to predict the memory dynamics of diverse experiments and populations. The model can also be used to predict both group and individual performance. The application of the model to detect memory impairment is discussed, as are limitations. Se propone un nuevo modelo de memoria basado en el análisis de regresión y las curvas exponenciales de aprendizaje. La eficacia del modelo se verifica con varios tipos de experimentos incluyendo la aversión a la comida en caracoles, el aprendizaje de laberintos en ratas y las pruebas de memoria en adultos y niños. El modelo también se pone a prueba en drogadictos y alcohólicos. Los resultados de las pruebas de bondad de ajuste indican que nuestro modelo puede ser empleado con precisión para predecir las dinámicas de la memoria en diversos experimentos y poblaciones. También puede emplearse el modelo para predecir tanto la ejecución grupal como la individual. Se comenta la aplicación del modelo para detectar el deterioro de la memoria, así como las limitaciones del mismo.
Effect of HCAHPS reporting on patient satisfaction with physician communication.

INTRODUCTION Prior studies, using limited data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, reported that public reporting increases satisfaction scores in all domains except physician communication. Our objective was to examine changes in patient satisfaction with physician communication using all available data. METHODS We used publicly accessible datasets: HCAHPS (2007-2013), socioeconomic datasets from the US Census Bureau, and hospital service area (HSA) dataset from the Dartmouth Atlas of Health Care. Satisfaction scores were determined by the percentage of responses to "doctors always communicated well. " Hospitals were grouped into quartiles based on 2007 scores. We used multilevel models to account for correlation between within-hospital observations. RESULTS HCAHPS data were reported by 2273 hospitals in 2007. During the 7-year period, overall satisfaction scores with physician communication increased by 2.8% (P < 0.001). The lowest quartile hospitals had significant increase in satisfaction scores, whereas the highest quartile scores decreased (0.87% per year vs -0.23% per year; P < 0.001). These differences remained significant after adjusting for hospital and local population characteristics. Survey response rate and the number of acute-care beds and physicians in the HSA were positively associated, whereas HSA population size and being a teaching hospital were negatively associated with patient satisfaction scores (all P < 0.005). CONCLUSIONS Although there has been an improvement in patient satisfaction with physicians during the past 7 years, this improvement was not seen in all hospitals. The overall gap between hospitals has narrowed, which can be further improved through sharing best practices.
Prevalence of COPD and tobacco smoking in Malopolska region--results from the BOLD study in Poland.

INTRODUCTION There is a paucity of population-based data on chronic obstructive pulmonary disease (COPD) prevalence in Poland. To address this problem we participated in the Burden of Obstructive Lung Disease (BOLD) Initiative which was developed to provide standardized methods for estimating the prevalence of COPD and its risk factors. OBJECTIVES The study aimed to assess the prevalence of COPD and some of its risk factors in adults aged 40 years and older in the Malopolska region in southern Poland. PATIENTS AND METHODS Region--representative sample was drawn, basing on the current census data. Detailed BOLD questionnaires as well as pre- and post-bronchodilator spirometry were applied to eligible individuals. RESULTS Six hundred and three subjects provided questionnaire and spirometry data; of those 526 provided spirometry data of appropriate quality and were included in the final analysis. Estimated population prevalence of COPD was 22.1%, whereas 10.9% had COPD in GOLD Stage > or = 2. COPD was far more common in men and its prevalence increased with age and exposure to tobacco smoke, and was inversely related to education level. The prevalence of current tobacco smoking was 28% (34% and 22% in men and women, respectively). Seventy-nine percent of men and 42% of women were ever-smokers. Twenty-nine percent of never smoking individuals were passively exposed to tobacco smoke in their households. CONCLUSIONS Our results confirm the high prevalence of COPD in the studied region of Poland and emphasize the need to increase efforts to improve COPD awareness and limit tobacco smoking habit.
Assessment of hydroalcoholic and hexane extracts of Rosa persica Mich. flower on rat ileum spasm

It has been reported that Rosa damascena hydroalcoholic extract has inhibitory effect at higher concentration but stimulatory action at lower concentrations on ileum. This could be due to the presence of stimulatory components in the extract. R. persica Mich. is another species which belongs to Rose family but so far there is no report about pharmacological action of its extract. Therefore, the objective of this research was to investigate inhibitory effect of hydroalcoholic and hexane extract of this plant on ileum contraction to see which type of extract would be more appropriate as antispasmodic agents. Hydroalcoholic and hexane extracts were prepared by percolation method. A section of rat ileum was suspended in an organ bath containing Tyrode's solution. The tissue was kept under 1 g tension at 37°C and continuously gassed with O2. Effects of R. persica extracts or vehicle were studied on ileum contractions induced by electrical field stimulation (EFS), KCl or acetylcholine (ACh) and compared with that of atropine. Hydroalcoholic extracts of R. persica (10-640 μg/ml) concentration dependently inhibited ileum contraction induced by KCl (IC50 = 244 ± 35 μg/ml), ACh (IC50 = 129 ± 7.4 μg/ml) and EFS (IC50 = 172 ± 18.7 μg/ml). Hexane extract of R. persica (10-320 μg/ml) concentration dependently inhibited ileum contraction induced by KCl (IC50 = 117 ± 12.4 μg/ml), ACh (IC50 = 78 ± 9.1 μg/ml) and EFS (IC50 = 67 ± 10.5 μg/ml). Atropine only inhibited the responses to ACh and EFS. The vehicle had no significant effect on ileum contractions. From this experiment it was concluded that R. persica extract have inhibitory effect on rat isolated ileum. Therefore, separation and identification of active component is recommended.
Iterative Threshold Decoding Of High Rates Quasi-Cyclic OSMLD Codes

Majority logic decoding (MLD) codes are very powerful thanks to the simplicity of the decoder. Nevertheless, to find constructive families of these codes has been recognized to be a hard job. Also, the majority of known MLD codes are cyclic which are limited in the range of the rates. In this paper a new adaptation of the Iterative threshold decoding algorithm is considered, for decoding Quasi-Cyclic One Step Majority logic codes (QC-OSMLD) codes of high rates. We present the construction of QC-OSMLD codes based on Singer difference sets of rate 1/2, and codes of high rates based on Steiner triple system which allows to have a large choice of codes with different lengths and rates. The performances of this algorithm for decoding these codes on both Additive White Gaussian Noise (AWGN) channel and Rayleigh fading channel, to check its applicability in wireless environment, is investigated.
Soluble CD163 is associated with CD163 mRNA expression in adipose tissue and with insulin sensitivity in steady-state condition but not in response to calorie restriction.

CONTEXT Soluble CD163 (sCD163) was suggested as a biomarker of insulin sensitivity and CD163 mRNA expression representing macrophage content in adipose tissue (AT). OBJECTIVE The aim of this study was to investigate, in cross-sectional and prospective design, the relationship between sCD163 circulating levels and CD163 mRNA expression in adipose tissue and insulin sensitivity assessed by euglycemic-hyperinsulinemic clamp. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS Two cohorts of subjects were examined in the study. Cohort 1 included 42 women with a wide range of body mass index (17-48 kg/m(2)); cohort 2 included 27 obese women who followed a dietary intervention consisting of 1 month of a very low-calorie diet and 5 months of a weight-stabilization period. MAIN OUTCOME MEASURES Serum levels of CD163 and mRNA expression of CD163 and CD68 in sc and visceral (visc) AT were determined, and insulin sensitivity [expressed as glucose disposal rate (GDR)] was measured in cohort 1. In cohort 2, serum levels of CD163, mRNA expressions of CD163, CD68, and CD163-shedding factors [TNF-α-converting enzyme (TACE) and tissue inhibitor of metalloproteinase (TIMP3)] in sc AT were examined and GDR was measured before and during dietary intervention. RESULTS In cohort 1, circulating sCD163 correlated with CD163 mRNA levels in both sc and visc AT. sCD163 and CD163 mRNA expression in both fat depots correlated with GDR. In cohort 2, the diet-induced changes of sCD163 levels did not correlate with those of CD163, CD68, TACE, and TIMP3 mRNA levels. Although the pattern of the diet-induced change of sCD163 paralleled that of GDR, there was no correlation between the changes of these two variables. CONCLUSION sCD163 correlates with CD163 mRNA expression in sc and visc AT and with whole-body insulin sensitivity in the steady-state condition. These associations are not observed with respect to the diet-induced changes during a weight-reducing hypocaloric diet.
Pregnancy Outcome: A Prospective Study

Folate levels in serum and red cells, as determined by a microbiological assay using Lactobacillus casei, and plasma anticonvulsant concentrations were monitored concurrently in nonpregnant (50 subjects) and pregnant (49 pregnancies in 46 subjects) epileptic women. Twenty-three (46%) nonpregnant women had subnormal serum folate levels and 4 nonpregnant women (8%) showed subnormal red cell folate levels. In pregnant women not taking folate supplements, the incidence of folate deficiency increased as the pregnancy advanced. Pregnant women taking folate supplements achieved normal or supranormal blood folate concentrations. In both nonpregnant and pregnant women, serum and red cell folate levels were inversely correlated with plasma concentrations of phenytoin and of phenobarbital, and with the number of anticonvulsants. In 49 pregnancies, there were 10 abnormal outcomes (20.4%): 4 spontaneous abortions (8.2%) and 6 children with major congenital malformations (12.2%). Blood folate levels were significantly lower in pregnancies with an abnormal outcome than in those with a normal outcome. The results suggest a doseresponse relationship among anticonvulsants, folate, and adverse pregnancy outcome.
Treatment of aggressive B‐cell lymphomas

The treatment of aggressive B‐cell lymphomas is in evolution, largely based on the recognition of major genetic and biologic subtypes harboring distinct pathogenetic lesions. In this review, we will consider current treatment options with the caveat that many trials do not address some of the high‐risk subsets with enough power to conclude on definitive approaches. Since its introduction in 1976, CHOP has been the backbone of treatment in aggressive lymphomas. Efforts to improve upon CHOP have included shortening the cycle length (14 days versus 21 days), adding more cytotoxic agents, or delivering chemotherapy in an infusional regimen (ie, DA‐EPOCH‐R). However, a pivotal US intergroup study showed that “more” chemotherapy does not improve survival and only added toxicity, and serial European trials have shown that any benefit from added etoposide or shortening of the treatment cycle disappeared once rituximab was introduced. The major advance in diffuse large B‐cell lymphoma (DLBCL) came with the addition of rituximab to CHOP, which improved survival by approximately 15% to 20% across age groups, and established R‐CHOP as the standard of care. Despite the overall success of R‐CHOP, it is clear that many patient subsets are not cured (Figure 1). From a clinical perspective, elderly patients and patients with a high International Prognostic Index (IPI) have cure rates of approximately 50% (Table 1). From a biologic perspective, DLBCL has emerged as an extremely diverse disease. The 2016 WHO update highlights the heterogeneity of aggressive B‐cell lymphomas via the following changes: the requirement for cell‐of‐origin (COO) testing, the elimination of B‐cell lymphoma, unclassifiable (BCLU), and replacement by high‐grade lymphomas with shared genetic lesions (ie, dual MYC and BCL2 or BCL6 rearrangements, “double hit lymphoma [DHL]”) as a separate entity and the acknowledgement of dual expression of MYC and BCL2 (double expressor lymphomas [DEL]) as an adverse prognostic feature. With these updates in mind, should the treatment of aggressive B‐cell lymphomas be altered? Unfortunately, as the discussion below
Posttraumatic Stress Disorder Increases Sensitivity to Long Term Losses among Patients with Major Depressive Disorder

Background Decisions under risk and with outcomes that are delayed in time are ubiquitous in real life and can have a significant impact on the health and wealth of the decision-maker. Despite its potential relevance for real-world choices, the degree of aberrant risky and intertemporal decision-making in patients suffering from major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) has received little attention to date. Method We used a case-control design to compare decision-making in healthy control subjects (N=16) versus untreated depressed subjects in a current major depressive episode (N=20). In order to examine how major depressive disorder (MDD) may impact decision-making, subjects made decisions over (1) risky outcomes and (2) delayed outcomes in the domain of gains and losses using choice paradigms from neuroeconomics. In a pre-planned analysis, depressed subjects were subdivided into those with primary PTSD along with comorbid MDD (MDD+PTSD) versus those with primary MDD without PTSD (MDD-only). Choice behavior was modeled via a standard econometric model of intertemporal choice, a quasi-hyperbolic temporal discounting function, which was estimated for each subject group separately. Results Under conditions of potential gain, depressed subjects demonstrated greater discounting for gains across all time frames compared to controls. In the realm of losses, both subgroups of depressed subjects discounted more steeply than controls for short time frames. However, for delayed losses ranging from >1-10 years, MDD+PTSD subjects showed shallower discounting rates relative to MDD-only subjects, who continued to discount future losses steeply. Risk attitudes did not contribute to differences in intertemporal choice. Conclusions Depressed patients make choices that minimize current pain and maximize current reward, despite severe later consequences or lost opportunities. Anxiety associated with PTSD may serve as a partially protective factor in decision-making about long-term potential losses compared to MDD patients without PTSD.
Immediate anticoagulation for acute stroke in atrial fibrillation: yes.

Geoffrey A. Donnan MD, FRACP Section Editors Stephen M. Davis MD, FRACP Meta-analyses contest the value of “immediate” anticoagulation in acute stroke1 although the trials included in these analyses referred to patients treated protractedly and the anticoagulants examined had significant pharmacological differences.2 Post hoc analyses of some of these trials extend the overall negative effects of anticoagulation to patients with stroke secondary to atrial fibrillation (AF). 3 The value of immediate anticoagulation in patients with acute stroke secondary to AF, alike its role in any other stroke subtype, has not been adequately explored. Thus, I agree that “delayed” anticoagulation is not beneficial for stroke attributable to AF, although I defend that to bring down the value of “immediate” anticoagulation is premature. Absence of evidence is not equal to evidence of absence. Observational data suggest that full anticoagulation with unfractionated heparin (UH) started within <6 hours from clinical onset is better than delayed anticoagulation.4 The Rapid Anticoagulation Prevents Ischemic Damage (RAPID) …
Reduction of postreplication DNA repair in two Escherichia coli mutants with temperature-sensitive polymerase III activity: implications for the postreplication repair pathway

Daughter strand gaps are secondary lesions caused by interrupted DNA synthesis in the proximity of UV-induced pyrimidine dimers. The relative roles of DNA recombination and de novo DNA synthesis in filling such gaps have not been clarified, although both are required for complete closure. In this study, the Escherichia coli E486 and E511 dnaE(Ts) mutants, in which DNA polymerase I but not DNA polymerase III is active at 43 degrees C, were examined. Both mutants demonstrated reduced gap closure in comparison with the progenitor strain at the nonpermissive temperature. These results and those of previous studies support the hypothesis that both DNA polymerase I and DNA polymerase III contribute to gap closure, suggesting a cooperative effort in the repair of each gap. Benzoylated, naphthoylated diethylaminoethyl-cellulose chromatography analysis for persistence of single-strand DNA in the absence of DNA polymerase III activity suggested that de novo DNA synthesis initiates the filling of daughter strand gaps.
Evaluation of a Matrix Tablet Prepared with Polyacrylamide-g-Sodium Alginate Co-polymers and Their Partially Hydrolyzed Co-polymers for Sustained Release of Diltiazem Hydrochloride

Diltiazem hydrochloride (DTZ) matrix tablets were prepared using polyacrylamide-grafted sodium alginate (PAam-g-SA) co-polymers having different percentages of grafting and their partially hydrolyzed products with a view to achieve sustained release of the highly water-soluble drug. PAam-g-SA co-polymers having different percentages of grafting were synthesized by free radical polymerization using acrylamide (Aam) as monomer and ammonium persulphate (APS) as initiator, and the resulting co-polymers were subjected to alkaline hydrolysis to produce their corresponding partially hydrolyzed co-polymers. Matrix tablets of DTZ were prepared by wet granulation using either PAam-g-SA co-polymers or partially hydrolyzed PAam-g-SA co-polymers. The effect of percentage grafting, drug load and calcium gluconate (CG), used as excipient, was studied in simulated gastrointestinal fluid. While the tablets prepared using the co-polymer having higher percentages of grafting provided faster drug release (100% in 5.5 h), the tablets prepared with the corresponding hydrolyzed co-polymer released the drug slowly (71% in 12 h). This behaviour in release appeared to be controlled by the relative magnitude of the viscosity and the swelling capacity of the copolymers. Moreover, increase in drug load tended to decrease the drug release from all types of tablets and increase in the amount of CG increased the drug release. FT-IR and DSC studies revealed the absence of any interaction between the drug and the co-polymers. The matrix tablet made of partially hydrolyzed graft co-polymer having the highest percentage of grafting provided the most sustained release of the drug.
Effect of Pectin Methylesterase Gene Expression on Pea Root Development

Expression of an inducible gene with sequences common to genes encoding pectin methylesterase (PME) was found to be tightly correlated, both spatially and temporally, with border cell separation in pea root caps. Partial inhibition of the gene's expression by antisense mRNA in transgenic pea hairy roots prevented the normal separation of root border cells from the root tip into the external environment. This phenotype was correlated with an increase in extracellular pH, reduced root elongation, and altered cellular morphology. The translation product of the gene exhibited PME activity in vitro. These results are consistent with the long-standing hypothesis that the demethylation of pectin by PME plays a key role in cell wall metabolism.
Nerve Guides Seeded with Autologous Schwann Cells Improve Nerve Regeneration

This study evaluates the ability of Schwann cells (SCs) transplanted into a nerve guide to improve regeneration and reinnervation after sciatic nerve resection and repair, leaving a 6-mm gap, in the mouse. SCs were isolated from predegenerated adult sciatic nerves and expanded in culture using a chemically defined medium. Syngeneic, isogeneic, and autologous SCs were suspended in Matrigel and seeded in resorbable, permeable poly(l-lactide-co-epsilon-caprolactone) guides at 150,000 cells/tube. Guides containing SCs were compared to guides filled with Matrigel alone and with peroneal nerve autografts. Functional reinnervation was assessed by noninvasive methods to determine recovery of sweating, nociceptive, sensory, and motor functions in the hindpaw during 4 months postoperation. Morphological analysis of the regenerated nerves was performed at the end of follow-up. The group with an autograft achieved faster and higher levels of reinnervation and higher number of regenerated myelinated fibers than groups repaired by tubulization. The immunogenicity of transplanted SCs influenced the outcome of nerve regeneration. Transplants of autologous SCs resulted in slightly lower levels of reinnervation than autografts, but higher recovery and number of regenerated fibers reaching the distal nerve than transplants of isologous and syngeneic SCs, although most of the differences were not statistically significant. Syngeneic SCs did not improve regeneration with respect to acellular guides. Prelabeled transplanted SCs were found to survive into the guide 1-3 months after implantation, to a larger number when they were autologous than syngeneic. Cellular prostheses composed of a resorbable guide seeded with autologous SCs appear as an alternative for repairing long gaps in injured nerves, approaching the success of autografts.