Miracle-dz/UniFAR-FTUs huggingface dataset:
The accuracy of pedicle screw placement using intraoperative image guidance systems.

OBJECT Several retrospective studies have demonstrated higher accuracy rates and increased safety for navigated pedicle screw placement than for free-hand techniques; however, the accuracy differences between navigation systems has not been extensively studied. In some instances, 3D fluoroscopic navigation methods have been reported to not be more accurate than 2D navigation methods for pedicle screw placement. The authors of this study endeavored to identify if 3D fluoroscopic navigation methods resulted in a higher placement accuracy of pedicle screws. METHODS A systematic analysis was conducted to examine pedicle screw insertion accuracy based on the use of 2D, 3D, and conventional fluoroscopic image guidance systems. A PubMed and MEDLINE database search was conducted to review the published literature that focused on the accuracy of pedicle screw placement using intraoperative, real-time fluoroscopic image guidance in spine fusion surgeries. The pedicle screw accuracy rates were segregated according to spinal level because each spinal region has individual anatomical and morphological variations. Descriptive statistics were used to compare the pedicle screw insertion accuracy rate differences among the navigation methods. RESULTS A total of 30 studies were included in the analysis. The data were abstracted and analyzed for the following groups: 12 data sets that used conventional fluoroscopy, 8 data sets that used 2D fluoroscopic navigation, and 20 data sets that used 3D fluoroscopic navigation. These studies included 1973 patients in whom 9310 pedicle screws were inserted. With conventional fluoroscopy, 2532 of 3719 screws were inserted accurately (68.1% accuracy); with 2D fluoroscopic navigation, 1031 of 1223 screws were inserted accurately (84.3% accuracy); and with 3D fluoroscopic navigation, 4170 of 4368 screws were inserted accurately (95.5% accuracy). The accuracy rates when 3D was compared with 2D fluoroscopic navigation were also consistently higher throughout all individual spinal levels. CONCLUSIONS Three-dimensional fluoroscopic image guidance systems demonstrated a significantly higher pedicle screw placement accuracy than conventional fluoroscopy or 2D fluoroscopic image guidance methods.
The Assessment of Endothelial Function: From Research Into Clinical Practice

The discovery of nitric oxide (NO) as a crucial endothelium-derived molecule for vascular relaxation and the recognition of the endothelium as more than a passive interface between blood and the vessel wall led to substantial progress in the field of vascular research.1 Endothelial dysfunction is a pathological condition characterized mainly by an imbalance between substances with vasodilating, antimitogenic, and antithrombogenic properties (endothelium-derived relaxing factors)2 and substances with vasoconstricting, prothrombotic, and proliferative characteristics (endothelium-derived contracting factors). 3 Among the most important vasodilator molecules, particularly in muscular arteries, is NO, which also inhibits other key events in the development of atherosclerosis such as platelet adhesion and aggregation, leukocyte adhesion and migration, and smooth muscle cell proliferation. Particularly in the microcirculation, prostacyclin and endothelium-derived hyperpolarization factors (an umbrella term for substances and signals hyperpolarizing vascular myocytes by opening voltage channels4) also play an important role. Generally, loss of NO bioavailability indicates a broadly dysfunctional phenotype across many properties of the endothelium. Thus, the assessment of its vasodilator properties resulting from NO and other molecules may provide information on the integrity and function of the endothelium. Interestingly, most, if not all, cardiovascular risk factors are associated with endothelial dysfunction,5 and risk factor modification leads to improvement in vascular function. Endothelial dysfunction has been detected in the coronary epicardial and resistance vasculature and in peripheral arteries, so endothelial dysfunction can be regarded as a systemic condition.6 Importantly, the process of atherosclerosis begins early in life, and endothelial dysfunction contributes to atherogenesis and precedes the development of morphological vascular changes.7 Over the past 25 years, many methodological approaches have been developed to measure the (patho)physiological function of the endothelium in humans.8 Although the ability to measure endothelial function has boosted clinical research in this field, its use as a …
Antiepileptic drugs: combination therapy and interactions

Edited by Jerzy Majkowski, Blaise Bourgeois, Philip Patsalos and Richard Mattson. Cambridge: Cambridge University Press, 2005, £85.00 (approx. €125, $150), pp 496. ISBN 052182219x ! [Graphic][1] Combinations of antiepileptic drugs frequently cause concern to prescribers. Interactions are known to occur, and in paediatrics the use of polytherapy indicates a failure of monotherapy to control seizures. Polytherapy may occur when a second drug is introduced before the first is withdrawn, or as a long term measure in order to achieve seizure control. This book was designed by the International League against … [1]: /embed/graphic-1.gif
The Presence of Chronic Mucus Hypersecretion across Adult Life in Relation to Chronic Obstructive Pulmonary Disease Development.

RATIONALE Chronic mucus hypersecretion (CMH) is common among smokers and is associated with chronic obstructive pulmonary disease development and progression. OBJECTIVES To understand how the relationships between smoking, CMH, and chronic obstructive pulmonary disease develop during adult life, and facilitate earlier disease detection and intervention. METHODS We analyzed data on CMH, smoking, and lung function prospectively collected by the Medical Research Council National Survey of Health and Development, a nationally representative British cohort followed since birth in 1946. We analyzed the longitudinal relationships between smoking and CMH, how symptoms during life related to airflow limitation at 60-64 years, and how CMH duration between ages 43 and 60-64 years related to concurrent FEV1 decline. MEASUREMENTS AND MAIN RESULTS From 5,362 individuals enrolled at birth, 4,427 contributed data between ages 20 and 64 years (52% male; 63% ever-smoker). Among smokers CMH prevalence escalated between ages 36 and 43 from 7.6 ± 2.0% to 13.0 ± 2.6%. At these ages, symptoms were associated with a higher risk of subsequent airflow limitation (odds ratio [95% confidence interval], 3.70 [1.62-8.45] and 4.11 [1.85-9.13], respectively). Across adult life, CMH followed a dynamic remitting-relapsing course. Symptom prevalence following smoking cessation returned to levels seen among never-smokers. The longer CMH was present across three occasions (ages 43, 53, and 60-64 yr), the greater the concurrent FEV1 decline, corresponding to an additional decrement of 3.6 ± 2.5 ml/yr per occasion that CMH was present (P = 0.005). CONCLUSIONS CMH among middle-aged smokers represents an early developmental phase of chronic obstructive pulmonary disease. Smoking-related CMH usually resolves following smoking cessation but the longer its duration the greater the FEV1 lost, suggesting the course of CMH across adult life may reflect the underlying course of airway disease activity.
Parental knowledge of coeliac disease

Aim: Little information exists regarding parental knowledge of CD at diagnosis. We aimed for assessment of parental information at disease diagnosis to help us develop a tailored coeliac information package. Methods: Children and teenagers referred for endoscopy and duodenal biopsy, with the sole indication for the diagnosis of CD, were prospectively recruited to the study. Parents were asked information and concerns regarding use of GFD. Results: Sixty-three children (median 6.9 yrs (IQR 3.71–10.94)) and families were prospectively recruited in the study. The parents were very knowledgeable with an impressive 98% of the parents understanding that GFD is the treatment of CD; 95% knowing that this treatment is for life. However, specific dietary information was lacking with one-third correctly identifying all the Gluten containing foods. Internet (70.6%) was the most common source of information. Knowing someone with CD (p = 0.038), particularly in the same household in the family (p = 0.013) and researching about the disease (p = 0.001) rather than level of parental education (p = ns) was predictive of better parental knowledge. Conclusion: Internet is a major influence to parental knowledge in today’s age but there is a continued need for hospitals regarding provision of accurate information and alleviating anxieties regarding use of GFD.
Update in cystic fibrosis 2013.

Update in Cystic Fibrosis 2013 Manu Jain and Christopher H. Goss Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Pulmonary Medicine, Department of Pediatrics, Lurie Children’s Hospital, Chicago, Illinois; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington; and Division of Pulmonary Medicine, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
Optical Coherence Tomography Angiography Study of Choroidal Neovascularization Early Response after Treatment.

AIMS Study the choroidal neovascularization (CNV) morphological evolution after treatment using optical coherence tomography angiography (OCTA). METHOD We used Optovue XR Avanti, with split-spectrum amplitude-decorrelation angiography algorithm. RESULTS OCT Angiography allows to recognize better the CNV type. In our series all our cases seem to follow a 45 to 60 days cycle, after intra vitreal injection. After each injection a pruning of smaller vessels is seen immediately (after 24 hours) that increases for 6 to 12 days when it reaches a maximum. It is followed by a reopening or new sprouting of the vessels 20 to 50 days later. The later cycles seem longer. Our results on early CNV evolution seem to confirm previous observations of CNV abnormalization and arterialization. Pruning the small peripheral branches seems to strengthen the trunk. In OCTA, closing terminal vessels (anti-VEGF effects) seems to cause an increased flow in trunk after the CNV reactivation.
Assessment models for telemedicine services in national health systems

Nowadays, decision makers of all national health systems have to correctly assess telemedicine services in order to take responsible decisions on the their adoption into the routine clinical practice. Since the 90s, a wide range of applications were tested, but evidence of benefits is still quite lacking. Scientific literature is mainly characterised, from the one hand, by few relevant theoretical studies which deepen the assessment dimensions or suggest guidelines about the implementation process. From the other hand, empirical and well-designed studies are generally focused on a single dimension, lacking in giving a comprehensive appraisal of the application. As consequence, the aim of this research consists, first of all, in presenting a complete framework that links the main assessment dimensions to the phases of the assessment process. Secondarily, the framework has to be supported by a good empirical analysis and a systematic methodological approach in order to support decision making.
Management of bacterial severe sepsis and septic shock

Abstract Bacterial sepsis is a leading cause of pediatric morbidity and mortality worldwide. Early diagnosis, a coordinated and aggressive approach to initial resuscitation, and timely and appropriate antibiotic therapy are paramount to improving outcomes of these dangerous infections. The basic tenants of initial and ongoing resuscitation include rapid isotonic intravenous fluid boluses with reassessment for physiologic response, empiric broad-spectrum antibiotics directed to cover suspected sources of infection, source control, vasoactive infusions, supportive critical care and monitoring of response to therapy. In addition to resuscitation of bacterial sepsis, this article will review approaches to empiric antibiotic choice in septic shock, and detail definitive management of infections caused by several specific organisms, including Staphylococcus aureus, group A Streptococcus, Pseudomonas aeruginosa, Mycobacterium tuberculosis, and Clostridium difficile. Lastly, management of several common pediatric infections, including community acquired bacterial pneumonia and bacterial meningitis, will be reviewed.
Chromosomal and MicroRNA Expression Patterns Reveal Biologically Distinct Subgroups of 11q− Neuroblastoma

Purpose: The purpose of this study was to further define the biology of the 11q− neuroblastoma tumor subgroup by the integration of array-based comparative genomic hybridization with microRNA (miRNA) expression profiling data to determine if improved patient stratification is possible. Experimental Design: A set of primary neuroblastoma (n = 160), which was broadly representative of all genetic subtypes, was analyzed by array-based comparative genomic hybridization and for the expression of 430 miRNAs. A 15-miRNA expression signature previously shown to be predictive of clinical outcome was used to analyze an independent cohort of 11q− tumors (n = 37). Results: Loss of 4p and gain of 7q occurred at a significantly higher frequency in the 11q− tumors, further defining the genetic characteristics of this subtype. The 11q− tumors could be split into two subgroups using a miRNA expression survival signature that differed significantly in clinical outcome and the overall frequency of large-scale genomic imbalances, with the poor survival subgroup having significantly more imbalances. miRNAs from the expression signature, which were upregulated in unfavorable tumors, were predicted to target downregulated genes from a published mRNA expression classifier of clinical outcome at a higher-than-expected frequency, indicating the miRNAs might contribute to the regulation of genes within the signature. Conclusion: We show that two distinct biological subtypes of neuroblastoma with loss of 11q occur, which differ in their miRNA expression profiles, frequency of segmental imbalances, and clinical outcome. A miRNA expression signature, combined with an analysis of segmental imbalances, provides greater prediction of event-free survival and overall survival outcomes than 11q status by itself, improving patient stratification. Clin Cancer Res; 16(11); 2971–8. ©2010 AACR.
Hemiplegic Migraine: Clinical Features, Links with Basilar‐type Migraine, Current and Future Treatment

Hemiplegic migraine (HM) is a rare variety of migraine with aura characterized by the presence of a motor weakness during the aura. The HM has two main forms according to the familial history: cases where at least one first- or second-degree relative has aura including motor weakness have familial hemiplegic migraine (FHM), and cases without such familial history have sporadic hemiplegic migraine (SHM). FHM is the only variety of autosomal dominant migraine and all three known genes encode ion-transporters. Typical HM attacks include a motor weakness that is always associated to other aura symptoms, the most frequent being sensory, visual, and speech disturbances. In addition, basilar-type symptoms occur in up to 70% of the patients. Severe attacks may occur in FHM as well as in SHM with prolonged hemiplegia, confusion, coma, fever, and seizures. The clinical spectrum also includes permanent cerebellar signs (nystagmus, ataxia, dysarthria) and less frequently various types of seizures and mental retardation. A genetic diagnosis is now possible by screening the two major genes involved in FHM (CACNA1A and ATP1A2). Treatment of FHM and SHM is based on what is done in other varieties of migraine with aura. According to the new physiopathologic insights, preventive treatments by various antiepileptic agents seem promising.
Duration of Lactation and Incidence of Type 2 Diabetes

ContextLactation is associated with improved glucose and insulin homeostasis, independent of weight change.ObjectiveTo evaluate the association between lactation history and incidence of type 2 diabetes.Design, Setting, and ParticipantsProspective observational cohort study of 83 585 parous women in the Nurses’ Health Study (NHS) and retrospective observational cohort study of 73 418 parous women in the Nurses’ Health Study II (NHS II). Main Outcome MeasureIncident cases of type 2 diabetes mellitus.ResultsIn the NHS, 5145 cases of type 2 diabetes were diagnosed during 1 239 709 person-years of follow-up between 1986 and 2002, and in the NHS II, 1132 cases were diagnosed during 778 876 person-years of follow-up between 1989 and 2001. Among parous women, increasing duration of lactation was associated with a reduced risk of type 2 diabetes. For each additional year of lactation, women with a birth in the prior 15 years had a decrease in the risk of diabetes of 15% (95% confidence interval, 1%-27%) among NHS participants and of 14% (95% confidence interval, 7%-21%) among NHS II participants, controlling for current body mass index and other relevant risk factors for type 2 diabetes.ConclusionsLonger duration of breastfeeding was associated with reduced incidence of type 2 diabetes in 2 large US cohorts of women. Lactation may reduce risk of type 2 diabetes in young and middle-aged women by improving glucose homeostasis.
Factors Related to Attitudes toward Seeking Professional Psychological Help among Japanese Junior High and High School Students

To develop intervention methods of primary prevention for adolescents who are at high risk for mental health disorders, we investigated help-seeking behavior (HSB) and factors related to HSB. We distributed questionnaires to 1222 junior high (age, 13.55 ± 0.5 years) (mean ± SD) and high school students (age, 16.56 ± 0.49 years) in Japan. A total of 1168 questionnaires were answered and returned. Correlation analysis and multiple linear regression analysis were conducted to determine HSB and related factors scales. Among the sample students, 39% had previous knowledge of mental health consultation. However, only 10% said they would seek out a mental health specialist. Friends or senior students were frequently chosen (70%) as the initial consultant. Using multiple regression linear analysis, we found that image of and stigma towards psychiatry and psychological counseling and knowledge of mental health to be factors related to HSB. High school students were more likely than junior high students to display HSB. Initially, students tended to choose friends and family rather than specialized professional support for their mental health concerns. The image of psychiatry, knowledge of services and stigma towards mental health problems and services were related factors. We conclude that educational programs that include students, parents, family and friends are needed for early intervention to change the general image and knowledge of specialized mental health services to increase HSB.
Induced Pluripotent Stem Cells: TherapeuticApplications in Monogenic and Metabolic Diseases, andRegulatory and Bioethical considerations.

The potential use of stem cells in advanced therapies such as tissue engineering, regenerative medicine, cell therapy and gene therapy by virtue of their significant therapeutic potential and clinical applications has aroused keen interest among scientists [1,2]. Cell therapy is based on the transplantation of living cells into an organism with a view to repairing tissue or restoring a lost or deficient function. Stem cells are the most frequently used cells for such purposes given their ability to differentiate into other more specialized cells [3].
Ginsenoside Rb1 Protects the Brain from Damage Induced by Epileptic Seizure via Nrf2/ARE Signaling

Background/Aims: Ginsenoside Rb1 (Rb1) has been reported to have varieties of neuroprotective effects. This study aimed to evaluate the effects of Rb1 on pentylenetetrazol (PTZ)-induced rat brain injury and Mg2+ free-induced neuron injury and analyzed the detailed molecular mechanisms in vivo and in vitro. Methods: Seizure duration and latency were measured in epilepsy kindled rat. The cognitive impairment was assessed by Morris water maze (MWM) test. Oxidative stress parameters, malondialdehyde (MDA) and glutathione (GSH) were measured by the 2-thiobarbituric acid methods and the DTNB-GSSG reductase recycling methods. Neuronal damage was assessed by hematoxylin and eosin (H&E) and Nissl staining. Neuronal apoptosis was measured by Annexin V-FITC and propidium iodide (PI) staining. Immunohistochemistry and immunofluorescence staining were performed to evaluate Nrf2 and HO-1 expressions. Expression of Nrf2, HO-1, Bcl-2, iNOS and LC3 were evaluated by western blot. Results: The PTZ-injured rats presented longer seizure duration and shorter seizure latency. Rb1 ameliorated these effects, as well as the cognitive deficits caused by PTZ exposure. Besides, Rb1 dose-dependently increased GSH levels, decreased MDA levels and alleviated neuronal damage in PTZ-treated rats. In vitro, Rb1 increased cell viability and decreased neuronal apoptosis in a dose-dependent manner under Mg2+ free condition. Moreover, in vivo and in vitro, Rb1 enhanced both the Nrf2 and HO-1 expressions. Furthermore, upregulation of the expression of Bcl-2 and downregulation of the expression of iNOS and LC3 were observed. However, knockdown of Nrf2 adversely affected the protective effects of Rb1 in epileptic hippocampal neurons. Conclusion: Rb1 conferred neuroprotective effects against PTZ-induced brain damage and Mg2+ free-induced neuron injury by activating Nrf2/ARE signaling.
New drugs: New hope in the treatment of MRSA

For more than 60 years, antibiotics have drastically altered the course of the disease. However, the development of new antibiotics is not able to meet the pace of increasing antimicrobial resistance. Resistant pathogens are posing a major public health problem both by increasing the morbidity, mortality and the health care costs. The problem is no longer limited to the hospitals, but has spread to the community as well.
A study of mobile travelers behavior of postgraduatestudents in Universiti Utara Malaysia

The general purpose of this study was to find out whether a relationship between attitudes, subjective norm, perceived behavioral control and mobile travelers of postgraduate students. Theory of Planned Behavior (TPB) employed as the underlying to figure out the description about mobile traveler behavior among postgraduate students. Meanwhile, postgraduate students at Universiti Utara Malaysia (UUM) will be used as a sample of the study. Their perception about each variable of the planned behavior examined through the model existed. Unit of analysis of postgraduate students in every subject of study in master and doctoral level selected as sample to determine their behavior in mobile travelers.