Miracle-dz/UniFAR-FTUs huggingface dataset:
Fewer and older patients with rheumatoid arthritis need total knee replacement

Objectives: Recent studies have suggested a decreased need for orthopaedic surgery in patients with rheumatoid arthritis (RA). We analysed trends in total knee replacement (TKR) in RA using TKR in osteoarthritis (OA) as a point of reference. Methods: Data on TKRs from the Finnish Arthroplasty Register and population data from Statistics Finland were used to analyse the trends in TKRs among patients aged ≥ 40 years with primary osteoarthritis (OA) or RA in Finland for the period from 1980 to 2010. Results: During 1980–2010, the overall incidence of TKRs increased 20-fold from 14.2 to 305.3 operations per 105 person-years. After peaking in 1992, the annual incidence of TKRs for RA decreased gradually from 19.6 to 10.8 per 105 [incidence rate ratio (IRR) 0.97, p < 0.001]. The decrease was more pronounced in women and the older (≥ 60 years) age group. The mean age at the time of TKR among patients with RA increased over time, converging with that of patients with OA. Conclusion: There is a clear decrease in the annual incidence of TKRs in RA, while among OA patients the incidence is increasing steadily. Furthermore, patients with RA seem to receive their TKRs at an older age. Both of these findings suggest improving long-term outcome in RA.
Progressive Filtering Approach for Query by Humming System Through Empirical Mode Decomposition and Multiresolution Histograms

Abstract This research work proposes an implementation of adept content-based music retrieval technique that attempts to address the demands of the rising availability of digital music. The primary objective of this research work is to balance the perilous impact of non-relevant songs through progressive filtering (PF) for query by humming (QBH) music information retrieval system. The PF is a technique of searching in manifolds for problem solving through reduced search space. A new strategy for empirical mode decomposition (EMD) analysis is adopted, and outcomes are propelled as a significant source of information for multiresolution histogram (MRH) representations. Finally, the concept of PF is realized through MRH to retrieve the desired song by humming. The proposed multiresolution QBH system is evaluated on a music database of 1200 fragments, and the experimental results effectively locate the humming patterns and recite the eminence of EMD analysis for retrieving the desired song through humming.
ProSeal™ laryngeal mask airway cuff pressure changes with and without use of nitrous oxide during laparoscopic surgery

Background: The ProSeal™ laryngeal mask (PLMA) is increasingly being used as an airway device for laparoscopic surgery. Its silicone cuff allows diffusion of nitrous oxide, carbon dioxide and other gases with resultant rise in its intracuff pressure during anesthesia. The present study was designed to investigate the intracuff pressure changes during anesthesia with and without nitrous oxide in patients undergoing laparoscopic surgery lasting up to two hours. Materials and Methods: One hundred patients, American Society of Anesthesiologists physical status 2 and 3, undergoing general anesthesia with muscle paralysis, were randomized into two groups of 50 patients each to receive an anesthetic gas mixture containing either oxygen and nitrous oxide (group N) or oxygen and air (group A). Following insertion of an appropriate size PLMA, its cuff was inflated with air to an intracuff pressure of 45 mm Hg. The cuff pressure was measured every 10 minutes for the entire course of anesthesia. The position of the device was also assessed fiberoptically and postoperative airway complications were recorded. Results: The maximum intracuff pressure recorded in group N was 103 ± 4.7 mm Hg vs. 45.5 ± 1.5 mm Hg in group A. The percentage rise in cuff pressure every 10 minutes was also highly significant (P < 0.001) being maximum in first 10 min in group N. The incidence of postoperative airway complications was comparable between the two groups. Conclusion: The results of this study demonstrate that the intracuff pressure of the PLMA increases progressively over time when the breathing gas mixture contains nitrous oxide.
Intrathecal clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing inguinal herniorrhaphy: A randomized double-blinded study

Background: Clonidine is added to intrathecal local anesthetics to improve intraoperative analgesia and to increase the duration of sensory and motor block. Aim of this study was to evaluate and compare the effects of addition of two different doses of clonidine (15 and 30 mcg) to 11 mg hyperbaric bupivacaine in patients undergoing inguinal herniorrhaphy surgery under spinal anesthesia. Materials and Methods: Seventy-five patients enrolled in the study were randomly divided into three groups of 25 each. Group I patients received 11 mg hyperbaric bupivacaine, whereas groups II and III received 15 mcg and 30 mcg clonidine, respectively, as an adjuvant to 11 mg hyperbaric bupivacaine. The volume of solution was kept constant to 2.4 ml by adding saline wherever needed. Results: Highest level of sensory block, time to achieve this level, and highest Bromage scale recorded were comparable among the groups. The mean time to two-segment regression, regression of sensory block to L3 dermatome, and mean duration of motor block were the greatest in group III followed by group II and group I. There was significant fall in mean arterial pressure (MAP) in groups II and III as compared to group I (P = 0.04). Episodes of hypotension were more in group III than in group II. Conclusion: 30 mcg clonidine was associated with more incidence and duration of hypotension than 15 μg of clonidine. 15 mcg clonidine added to 11 mg hyperbaric bupivacaine provides better sensory and motor blockade for inguinal herniorrhaphy.
Pain in primary Sjögren’s syndrome: the role of catastrophizing and negative illness perceptions

Objectives: Pain is a major factor in health quality in Sjögren’s syndrome (SS), but little is known about the factors that contribute to pain severity. Because pain perception has been linked to catastrophizing in other diseases, we assessed subjects with primary SS (pSS) to explore a possible link between pain, illness appraisal, and catastrophizing. Method: A total of 92 subjects who met American–European consensus criteria for the diagnosis of pSS completed a questionnaire that included health history, medication use, illness perceptions, pain severity, mood, fatigue, pain anxiety, and pain catastrophizing. Linear regression was used to test the effect of each variable on pain severity. Multivariate models were constructed using backwards elimination to assess the significant predictors of pain severity. Results: From linear regression analysis, catastrophizing was more strongly predictive of pain severity than age, fatigue, depression, or anxiety in both seropositive and seronegative pSS patients. In the multivariate model identified using backwards selection, four variables (pain catastrophizing, fibromyalgia status, serological status, and the conviction that illness would have severe consequences) predicted 55% of the variance in pain severity. Conclusions: Pain catastrophizing was a significant predictor of pain severity in both seropositive and seronegative pSS patients. This study suggests that behavioural interventions designed to reduce pain catastrophizing and negative appraisal of illness could be of benefit in pSS patients. Research is needed to test the effect of psycho-educational therapies on key patient-reported outcomes, particularly pain, depression, and fatigue, in pSS.
Polyhedral Gauß–Seidel converges

Abstract - We prove global convergence of an inexact extended polyhedral Gauß-Seidel method for the minimization of strictly convex functionals that are continuously differentiable on each polyhedron of a polyhedral decomposition of their domains of definition. While pure Gauß-Seidel methods are known to be very slow for problems governed by partial differential equations, the presented convergence result also covers multilevel methods that extend the Gauß-Seidel step by coarse level corrections. Our result generalizes the proof of [10] for differentiable functionals on the Gibbs simplex. Example applications are given that require the generality of our approach.
Public health: ethical issues.

Is there a right to live an unhealthy life? This core question is addressed through a series of controversial questions: If there is a right to live an unhealthy life, what kind of right is this? Can an autonomous person choose to live an unhealthy life? Is a choice to live an unhealthy life an autonomous choice? Do we have a duty or a responsibility to live healthy life? Does health neglect or own responsibility for poor health have consequences for access to health care and health care prioritization? How to justify public health interventions in order to make people live healthier lives? What is “health” and “unhealthy” in a right to lead an unhealthy life? By addressing these questions I will highlight that they have many answers, resulting in different responses to the question of whether there is a right to lead an unhealthy life. Which of the answers one prefers, strongly depends on perspectives and theoretical viewpoints, which are discussed in the paper. Acknowledging the strengths and weaknesses in the answers and their justifications is important for framing and implementing policies in public health.
Characterizing the concept of activity pacing as a non-pharmacological intervention in rheumatology care: results of an international Delphi survey

Objective: To develop a consensual list of the most important aspects of activity pacing (AP) as an intervention within the context of non-pharmacological rheumatology care. Method: An international, multidisciplinary expert panel comprising 60 clinicians and/or healthcare providers experienced in AP across 12 different countries participated in a Delphi survey. Over four Delphi rounds, the panel identified and ranked the most important goals of AP, behaviours of AP (the actions people take to meet the goal of AP), strategies to change behaviour in AP, and contextual factors that should be acknowledged when instructing AP. Additionally, topics for future research on AP were formulated and prioritized. Results: The Delphi panel prioritized 9 goals, 11 behaviours, 9 strategies to change behaviour, and 10 contextual factors of AP. These items were integrated into a consensual list containing the most important aspects of AP interventions in non-pharmacological rheumatology care. Nine topics for future research on AP with the highest ranking were included in a research agenda highlighting that future research should focus on the effectiveness of AP interventions and on appropriate outcome measures to assess its effectiveness, as selected by 64% and 82% of the panellists, respectively. Conclusions: The diversity and number of items included in the consensual list developed in the current study reflect the heterogeneity of the concept of AP. This study is an important first step in achieving more transparency and homogeneity in the concept of AP in both rheumatology daily clinical practice and research.
Current concepts of optimal cerebral perfusion pressure in traumatic brain injury

Traumatic brain injury (TBI) consists of varied pathophysiological consequences and alteration of intracranial dynamics, reduction of the cerebral blood flow and oxygenation. In the past decade more emphasis has been directed towards optimizing cerebral perfusion pressure (CPP) in patients who have suffered TBI. Injured brain may show signs of ischemia if CPP remains below 50 mmHg and raising the CPP above 60 mmHg may avoid cerebral oxygen desaturation. Though CPP above 70 mmHg is influential in achieving an improved patient outcome, maintenance of CPP higher than 70 mmHg was associated with greater risk of acute respiratory distress syndrome (ARDS). The target CPP has been laid within 50-70 mmHg. Cerebral blood flow and metabolism are heterogeneous after TBI and with regional temporal differences in the requirement for CPP. Brain monitoring techniques such as jugular venous oximetry, monitoring of brain tissue oxygen tension (PbrO2), and cerebral microdialysis provide complementary and specific information that permits the selection of the optimal CPP. This review highlights the rationale for use CPP directed therapies and neuromonitoring to identify optimal CPP of head injured patients. The article also reviews the evidence provided by various clinical trials regarding optimal CPP and their application in the management of head injured patients.
Principles of neuroanesthesia in aneurysmal subarachnoid hemorrhage

Aneurysmal subarachnoid hemorrhage is associated with high mortality. Understanding of the underlying pathophysiology is important as early intervention can improve outcome. Increasing age, altered sensorium and poor Hunt and Hess grade are independent predictors of adverse outcome. Early operative interventions imposes an onus on anesthesiologists to provide brain relaxation. Coiling and clipping are the two treatment options with increasing trends toward coiling. Intraoperatively, tight control of blood pressure and adequate brain relaxation is desirable, so that accidental aneurysm rupture can be averted. Patients with poor grades tolerate higher blood pressures, but are prone to ischemia whereas patients with lower grades tolerate lower blood pressure, but are prone to aneurysm rupture if blood pressure increases. Patients with Hunt and Hess Grade I or II with uneventful intraoperative course are extubated in operation theater, whereas, higher grades are kept electively ventilated. Postoperative management includes attention toward fluid status and early management of vasospasm.
Reply to letter entitled ‘How dense, how intense? Role of tumour‐infiltrating lymphocytes across colorectal cancer stages’. Re: Nosho et al. Tumour‐infiltrating T‐cell subsets, molecular changes in colorectal cancer, and prognosis: cohort study and literature review. J Pathol 2010; 222: 350–366

We are grateful for the opportunity to respond to the letter by Laghi et al. With regard to analysis of CD3 and other T cell markers, evidence from the study by Nosho et al [1] suggests that an evaluation of PTPRC (CD45RO)+ cells is superior to other markers, including CD3, CD8 and FOXP3. Similarly, another study [2] has reported that intraepithelial PTPRC (CD45RO)+ cell evaluation is superior to CD3+ cell evaluation. One issue in a number of previous studies is that those investigators did not perform comprehensive evaluation of markers using a large sample (eg a total sample size of at least 500 cases). Many studies analysed only CD3 [3,4], only CD8 [5–10] or only FOXP3 [11,12], and many used total sample sizes of less than 500 cases [3–9,11,12]. Small studies without appropriate validation cohorts have been problematic and publication bias might have been substantial [13]. For the next point, we agree that an immune cell evaluation can serve as a potential prognostic or predictive biomarker, although further studies are needed, particularly to assess its predictive roles. We believe that providing prognostic information in any disease stage is important for oncologists and patients. So far, most literature data are on the prognostic role of immune cell evaluation [1,3–9,11,12,14,15]. In contrast, there have not been enough data on the predictive roles of immune cell evaluation. Thus, there are few supporting data for aggressively treating a subset of stage II cases in a ‘high-risk’ category defined by certain immune cell data. What if we find in future studies that scantiness of immune cells turns out to be a marker predicting resistance against adjuvant chemotherapy? Finally, we would comment on frequent claims of prognostic biomarker studies that a certain marker has a prognostic role only at a particular disease stage (eg stage II). In fact, very few studies have formally tested the statistical significance of a difference in prognostic roles of a potential prognostic marker between stages (eg stage II versus III). As a result, only few such claims have been replicated and confirmed, indicating that many such claims actually represent chance associations. By definition, a prognostic biomarker needs to be associated with prognosis independent of disease stage. Unless evidence by well-powered studies supports a statistically significant difference between disease stages, all validated prognostic biomarkers should be regarded as prognostic regardless of disease stage, since a validation process should have assessed its prognostic role independent of disease stage [16].
Trends in hospitalizations among children with type 1 diabetes in Spain, 2001–2009

Abstract Aim: To examine the trends in the incidence of hospital discharges among children between 0 and 14 years with type 1 diabetes in Spain (2001–2009). Methods: We identified all hospital discharges with a diagnosis of type 1 diabetes, using national hospital discharge data. Results: A total of 22,955 type 1 diabetes discharges to Spanish hospitals were recorded. The discharge incidence per year increased from 39.6 in 2001 to 40.02 per 100,000 inhabitants in 2009. There was no significant change in hospital discharge rates for children 0–14 years old. In the 0–4 years group, the incidence increased significantly over the study period (incidence rate ratio, 1.031; 95% confidence interval, 1.017–1.045). Conclusion: Hospitalization trends in children 0–4 years old with type 1 diabetes has increased over the study period, consistent with an increase in the incidence of diabetes in Spain. The stable rate for those aged 10–14 years may indicate that the control of these patients in specialized outpatient settings is preventing the expected increase in hospitalizations.
EARLY RESULTS OF PERCUTANEOUS CORONARY INTERVENTIONS ON CHRONIC TOTAL OCCLUSION

Background- PTCA has been performed for more than 25 years as a treatment for coronary artery disease and now exceeds the annual volume of CABG. The first reported PTCA of a total occlusion was in 1982. Procedural success and restenosis rates have gradually improved since then. Methods-We studied 150 patients who underwent PTCA for recanalization of total occluded coronary artery from 2000 to 2003. The mean age of the subjects was 25-67 years. The locations of total occlusions were 50% in LAD, 38% in RCA and 12% in LCX. 65% of the patients had single vessel disease. Results- The success rate was 65%, and stenting was done for 85% of the patients. Conclusion- It is now recognized that opening the chronic total occlusions of coronary arteries has proven benefits for patients, including an improvement in global and regional LV function, exercise capacity and reduced need for late CABG (by 50%). Angioplasty of total occlusions seems to be a safe and effective procedure in selected patients (Iranian
GAMMA GLOBULIN AND ANTIBODY FORMATION IN VITRO

Antibody formation in vitro by red and white pulp of the spleen and by bone marrow tissue was studied at various days after an intravenous booster injection of soluble antigens such as ovalbumin and bovine gamma globulin (BGG). When the booster injection of antigen was given early (10 days) after an intravenous primary injection, high antibody formation could be demonstrated in the spleen primarily 2 to 3 days after the injection, but much less afterwards. When the booster injection was given later (1 month) after the primary, the antibody production by the spleen lasted longer and higher serum titers were obtained. The bone marrow formed antibody in both cases but, particularly with the short interval between injections, its response was delayed as compared to the spleen. It was also shown that during antibody formation the production of gamma globulin in vitro was enhanced. Histologically the antibody production was always correlated to immature plasma cell proliferation, located at the border of red and white pulp and in the red pulp of the spleen. When endotoxin had been injected at the time of a primary BGG injection, and a second antigen injection was given 5 to 10 days later, a booster response could be elicited which was sometimes limited to the white pulp on day 1, and on day 2 was divided between "red" and "white" pulp. The response induced at day 10, at the peak of secondary nodule proliferation, lasted very long and was accompanied by an enormous plasma cellular proliferation in and around the periarteriolar lymphoid areas of the spleen. The possible importance of the secondary nodules of the white pulp in the preparation for a secondary response is discussed.
Endotracheal tube cuff pressure monitoring during neurosurgery - Manual vs. automatic method

Background: Inflation and assessment of the endotracheal tube cuff pressure is often not appreciated as a critical aspect of endotracheal intubation. Appropriate endotracheal tube cuff pressure, endotracheal intubation seals the airway to prevent aspiration and provides for positive-pressure ventilation without air leak. Materials and Methods: Correlations between manual methods of assessing the pressure by an experienced anesthesiologists and assessment with maintenance of the pressure within the normal range by the automated pressure controller device were studied in 100 patients divided into two groups. In Group M, endotracheal tube cuff was inflated manually by a trained anesthesiologist and checked for its pressure hourly by cuff pressure monitor till the end of surgery. In Group C, endotracheal tube cuff was inflated by automated cuff pressure controller and pressure was maintained at 25-cm H2O throughout the surgeries. Repeated measure ANOVA was applied. Results: Repeated measure ANOVA results showed that average of endotracheal tube cuff pressure of 50 patients taken at seven different points is significantly different (F-value: 171.102, P-value: 0.000). Bonferroni correction test shows that average of endotracheal tube cuff pressure in all six groups are significantly different from constant group (P = 0.000). No case of laryngomalacia, tracheomalacia, tracheal stenosis, tracheoesophageal fistula or aspiration pneumonitis was observed. Conclusions: Endotracheal tube cuff pressure was significantly high when endotracheal tube cuff was inflated manually. The known complications of high endotracheal tube cuff pressure can be avoided if the cuff pressure controller device is used and manual methods cannot be relied upon for keeping the pressure within the recommended levels.
Puberty as a life history transition

Background: James Tanner's landmark publication, Growth at Adolescence, was not only the first and most comprehensive treatise on the subject of human pubertal development of its time, its core insights have held up remarkably well over time. Review: This review connects Tanner's contributions to contemporary understanding of puberty as a process fundamentally driven by neuroendocrine maturation. It introduces the concepts of the ‘hour-glass of puberty’ and ‘somatic strategy’ as heuristic constructs. The ‘hour-glass of puberty’ describes the converging pathways of information flow influencing the timing of the neuroendocrine events of puberty and its ramifying consequences throughout the body. Somatic strategy refers to the pattern of sex-specific, adult body morphology that develops at puberty as the individual undergoes a life history transition from juvenile to adult.