Miracle-dz/UniFAR-FTUs huggingface dataset:
Diagnosis and Treatment of Pituitary Adenomas: A Review

Importance Pituitary adenomas may hypersecrete hormones or cause mass effects. Therefore, early diagnosis and treatment are important. Observations Prevalence of pituitary adenomas ranges from 1 in 865 adults to 1 in 2688 adults. Approximately 50% are microadenomas (<10 mm); the remainder are macroadenomas (≥10 mm). Mass effects cause headache, hypopituitarism, and visual field defects. Treatments include transsphenoidal surgery, medical therapies, and radiotherapy. Prolactinomas account for 32% to 66% of adenomas and present with amenorrhea, loss of libido, galactorrhea, and infertility in women and loss of libido, erectile dysfunction, and infertility in men; they are generally treated with the dopamine agonists cabergoline and bromocriptine. Growth hormone–secreting tumors account for 8% to 16% of tumors and usually present with enlargement of the lips, tongue, nose, hands, and feet and are diagnosed by elevated insulin-like growth factor 1 levels and growth hormone levels; initial treatment is surgical. Medical therapy with somatostatin analogues, cabergoline, and pegvisomant is often also needed. Adrenocorticotropic hormone (ACTH)–secreting tumors account for 2% to 6% of adenomas and are associated with obesity, hypertension, diabetes, and other morbidity. Measurement of a late-night salivary cortisol level is the best screening test but petrosal sinus sampling for ACTH may be necessary to distinguish a pituitary from an ectopic source. The primary treatment of Cushing disease (hypercortisolism due to ACTH-producing adenomas, which is the cause in approximately 65% of the cases of hypercortisolism) is adenoma resection and medical therapies including ketoconazole, mifepristone, and pasireotide. Hyperthyroidism due to thyroid-stimulating hormone–secreting tumors accounts for 1% of tumors and is treated with surgery and somatostatin analogues if not surgically cured. Clinically nonfunctioning adenomas account for 15% to 54% of adenomas and present with mass effects; surgery is generally required, although incidentally found tumors can be followed if they are asymptomatic. Conclusions and Relevance Patients with pituitary adenomas should be identified at an early stage so that effective treatment can be implemented. For prolactinomas, initial therapy is generally dopamine agonists. For all other pituitary adenomas, initial therapy is generally transsphenoidal surgery with medical therapy being reserved for those not cured by surgery.
Maltose and maltotriose utilisation by group I strains of the hybrid lager yeast Saccharomyces pastorianus

Brewer's wort is a challenging environment for yeast as it contains predominantly α-glucoside sugars. There exist two subgroups of the lager yeast Saccharomyces pastorianus which differ in sugar utilisation. We performed wort fermentations and compared representative strains from both groups with respect to their ability to transport and ferment maltose and maltotriose. Additionally, we mapped the transporters MALx1, AGT1, MPHx and MTT1 by Southern blotting. Contrary to previous observations, group I comprises a diverse set of strains, with varying ability to transport and ferment maltotriose. Of the eight group I strains, three efficiently utilised maltotriose, a property enabled by the presence of transmembrane transporters SeAGT1 and MTT1. A58, a variant of the group I type strain (CBS1513) performed particularly well, taking up maltotriose at a higher rate than maltose and retaining significant transport activity at temperatures as low as 0°C. Analysis of transporter distribution in this strain revealed an increased copy number of the MTT1 gene, which encodes the only permease known with higher affinity for maltotriose than maltose and low temperature dependence for transport. We propose that much of the variation in lager yeast fermentation behaviour is determined by the presence or absence of specific transmembrane transporters.
Effect of liraglutide on ectopic fat in polycystic ovary syndrome: A randomized clinical trial

Women with polycystic ovary syndrome (PCOS) were treated with the GLP‐1 receptor agonist liraglutide to investigate the effect on liver fat content, visceral adipose tissue (VAT) and the prevalence of nonalcoholic fatty liver disease (NAFLD). In a double‐blind, placebo‐controlled, randomized clinical trial 72 women with PCOS, with a BMI > 25 kg/m2 and/or insulin resistance, were treated with liraglutide or received placebo 1.8 mg/d (2:1) for 26 weeks. Liver fat content was assessed by 1 HMR spectroscopy, VAT by MRI, body composition by DXA, and glucose metabolism by oral glucose tolerance test. Compared with placebo, liraglutide treatment reduced body weight by 5.2 kg (5.6%), liver fat content by 44%, VAT by 18%, and the prevalence of NAFLD by two‐thirds (all P < .01). Sex‐hormone‐binding‐globulin (SHBG) levels increased by 19% (P = .03), and free testosterone decreased by 19% (P = .054). HbA1c, fasting glucose and leptin were reduced (all: P < .05), whereas measures of insulin resistance, adiponectin and glucagon did not change. In conclusion, 26 weeks of liraglutide treatment in PCOS resulted in significant reductions in liver fat content, VAT and the prevalence of NAFLD.
Do lifestyle changes reduce serious outcomes in diabetes?

Recommendations to reduce weight through increased physical activity and dietary restriction have been a mainstay of diabetes care dating back to antiquity.1 In modern times, “lifestyle modification” has been formally recommended as the foundation on which all additional diabetes therapies should rest. These recommendations are supported by physiological studies, clinical experience, observational studies, and randomized, controlled trials showing reduced levels of glucose, blood pressure, and some lipids, as well as improvements in general well-being and other indexes of health. However, most of these studies were of relatively short duration, and no prospective trial has previously assessed the long-term effects of .
Mass, serial and sensational homicides.

M 4 Y task today-that of conveying information about three understudied classes of offenses-compels me to speak to you without the quantitative cloak of social science with which I would prefer to dress this grue-some subject. Of necessity, I rely on case examples and fragments of research, because no quantitative data are available on most of the topics addressed here. My approach is to describe the elements common to these three classes of offense, to describe examples of each class, and to suggest the subtypes most often observed for each class.
Diagnostic surgical pathology

Vol 1: skin, soft tissue, bone, and joints - nonneoplastic diseases of the skin, Alvin R. Solomon, neoplasms of skin, Daniel J. Santa Cruz and Mark A. Hurt, melanocytic lesions, Michael J. Imber and Martin C. Mihm, Jr, muscle biopsy in neuromuscular disorders, Reid R. Heffner, Jr, disorders of soft tissue, John J. Brooks, joint diseases, Peter G. Bullough, nonneoplastic disease of bones, Peter G. Bullough, bone tumours, K. Krishnan Unni breast - the breast, Rosemary R. Millis, et al central nervous system - the brain, spinal cord, and meninges, Paul E. McKeever and Mila Blaivas endocrine system - the pituitary and sellar region, Bernd W. Scheithauer, the thyroid and parathyroid, Virginia A. LiVolsi, the neuroendocrine and paracrine systems, Ricardo V. Lloyd, the adrenal glands, Ronald A. DeLellis, paragangliomas, Ernest E. Lack hematopoietic and lymphatic systems - disorders of bone marrow, Robert W. McKenna, lymph nodes, Robert D. Collins, et al, the spleen, Jerome S. Burke head and neck - the jaws and oral cavity, Kenneth D. McClatchey and Richard J. Zarbo, salivary glands, Andrew G. Huvos, the nose, paranasal sinuses, and nasopharynx, Stacey E. Mills and Robert E. Fechner, the larynx, John A. Kirchner and Darryl Carter, the ear, Leslie Michaels, the eye and ocular adnexa, Mark W. Scroggs and Gordon K. Klintworth intrathoracic organs and blood vessels - nonneoplastic pulmonary disease, Arthur S. Patchefsky, pulmonary neoplasms, Yukio Shimosato, the pleura, Hector Battifora, the mediastinum, Mark R. Wick, the heart, H. Thomas Aretz, blood vessels, Patrick J. Gallagher. Vol 2: alimentary canal and associated organs - esophagus, Randall G. Lee, stomach, David A. Owen, nonneoplastic intestinal diseases, Robert E. Petras, intestinal neoplasms, Harry S. Cooper, pancreas, James E. Oertel, Yolanda C. Oertel, and Clara S. Heffess, nonneoplastic liver disease, Dale C. Snover, neoplasms of liver, Scott H. Saul, Gallbladder and estrahepatic biliary tree, Scott H. Saul, anus and perianal area, Donald A. Antoniolo and Henry D. Appleman urinary tract and male genital system female reproductive system and peritoneum. (part contents).
Association Between Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival

Importance Tracheal intubation is common during adult in-hospital cardiac arrest, but little is known about the association between tracheal intubation and survival in this setting. Objective To determine whether tracheal intubation during adult in-hospital cardiac arrest is associated with survival to hospital discharge. Design, Setting, and Participants Observational cohort study of adult patients who had an in-hospital cardiac arrest from January 2000 through December 2014 included in the Get With The Guidelines–Resuscitation registry, a US-based multicenter registry of in-hospital cardiac arrest. Patients who had an invasive airway in place at the time of cardiac arrest were excluded. Patients intubated at any given minute (from 0-15 minutes) were matched with patients at risk of being intubated within the same minute (ie, still receiving resuscitation) based on a time-dependent propensity score calculated from multiple patient, event, and hospital characteristics. Exposure Tracheal intubation during cardiac arrest. Main Outcomes and Measures The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC) and a good functional outcome. A cerebral performance category score of 1 (mild or no neurological deficit) or 2 (moderate cerebral disability) was considered a good functional outcome. Results The propensity-matched cohort was selected from 108 079 adult patients at 668 hospitals. The median age was 69 years (interquartile range, 58-79 years), 45 073 patients (42%) were female, and 24 256 patients (22.4%) survived to hospital discharge. Of 71 615 patients (66.3%) who were intubated within the first 15 minutes, 43 314 (60.5%) were matched to a patient not intubated in the same minute. Survival was lower among patients who were intubated compared with those not intubated: 7052 of 43 314 (16.3%) vs 8407 of 43 314 (19.4%), respectively (risk ratio [RR] = 0.84; 95% CI, 0.81-0.87; P < .001). The proportion of patients with ROSC was lower among intubated patients than those not intubated: 25 022 of 43 311 (57.8%) vs 25 685 of 43 310 (59.3%), respectively (RR = 0.97; 95% CI, 0.96-0.99; P < .001). Good functional outcome was also lower among intubated patients than those not intubated: 4439 of 41 868 (10.6%) vs 5672 of 41 733 (13.6%), respectively (RR = 0.78; 95% CI, 0.75-0.81; P < .001). Although differences existed in prespecified subgroup analyses, intubation was not associated with improved outcomes in any subgroup. Conclusions and Relevance Among adult patients with in-hospital cardiac arrest, initiation of tracheal intubation within any given minute during the first 15 minutes of resuscitation, compared with no intubation during that minute, was associated with decreased survival to hospital discharge. Although the study design does not eliminate the potential for confounding by indication, these findings do not support early tracheal intubation for adult in-hospital cardiac arrest.
Assessment of abdominal scarification as a treatment for malaria-induced splenomegaly in a rural community: Implications for child health

Abstract This descriptive cross-sectional study was conducted in Ugbegun, a rural community in the rainforest belt of Edo State, Nigeria. The objective of the survey was to determine the prevalence of abdominal scarification and associated factors. There were 640 houses within the community; using a sampling ratio of 1:2, 320 houses were selected by a systematic sampling technique. Within the 320 houses were 425 households. Fifteen of them had no children in the age group 2–9 years. A total of 410 households had children eligible to participate in the study. Twenty (4.9%) of the heads of households declined to participate, while 390 (95.1%) agreed and constituted the study population. The parents' perception of splenomegaly and the use of scarification in its treatment were sought while children within the age range were examined for splenomegaly. Results showed that parents' perception of splenomegaly was poor. Eighty-three per cent claimed that splenomegaly is an enlarged painful abdomen, 80.0% believed that it is a common childhood disease, while 51.0% believed that it is an accumulation of bad blood. Only 24.3% attributed it to malaria. Indicators for abdominal scarification were common signs and symptoms of simple and complicated malaria. Of the 390 children examined, 302 (77.4%) were scarified and of these only 106 (35.1%) had splenomegaly. In conclusion, abdominal scarification is still a common practice in the community, undertaken as treatment for enlarged spleen resulting from malaria. The practice is not beneficial but, on the contrary, compromises the health of the sick child. There is a need for the education of parents in rural communities about simple prevention methods, such as the use of insecticide-treated nets (ITNs), correct identification of early signs and symptoms and the adequate treatment of malaria to reduce complications and eventual death. This can be achieved using the village health worker and health committee.
Taming the transplantation troll by targeting terminase.

The immunosuppressive drugs required after stem-cell transplantation render patients susceptible to opportunistic infections. The most important of these infections, in terms of both abundance and severity, is cytomegalovirus (CMV), which has been dubbed the “troll of transplantation. ”1 Fortunately, the clinical effects of CMV infection have been reduced by preemptive therapy. Levels of CMV DNA in the blood (viremia) are monitored with the use of polymerase-chain-reaction (PCR) assays and, if viremia is detected, patients receive ganciclovir (or its prodrug valganciclovir) until viral DNA is no longer detectable.2 In addition to controlling overt CMV end-organ disease, since these agents are used only .
Evaluation of platelet transfusion clinical trials – response to Corash & Sherman

posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients. Blood, 105, 4106– 4114. Slichter, S.J., Kaufman, R.M. , Assman, S.F. , McCullough, J., Triulzi, D.J., Strauss, R.G. , Gernsheimer, T.B. , Ness, P.M. , Brecher, M.E. , Josephson, C.D. , Konkle, B.A., Woodson, R.D. , Ortel, T.L. , Hillyer, C.D. , Skerrett, D.L. , McCrae, K.R. , Sloan, S.R. , Uhl, L. , George, J.N. , Aquino, V.M. , Manno, C.S. , McFarland, J.G. , Hess, J.R. , Leissinger, C. & Granger, S. (2010) Dose of prophylactic platelet transfusios and prevention of hemorrhage. New England Journal of Medicine, 362, 600–613. Snyder, E. , McCullough, J., Slichter, S.J., Strauss, R.G. , Lopez-Plaza, I. , Lin, J.S. , Corash, L. & Conlan, M.G. (2005) Clinical safety of platelets photochemically treated with amotoslaen HCl and ultraviolet A light for pathogen inactivation: the SPRINT trial. Transfusion, 45, 1864–1875.
Heart-rhythm monitoring for evaluation of cryptogenic stroke.

Observational studies suggest that we often fail to detect paroxysmal atrial fibrillation as the cause of ischemic stroke.1 However, owing to the limitations of existing studies, guidelines have yet to endorse specific strategies for detecting atrial fibrillation in patients with a new stroke.2,3 The results of two studies published in this issue of the Journal indicate that prolonged monitoring of heart rhythm should now become part of the standard care of patients with cryptogenic stroke.4,5 This finding represents an important advance, because typical evaluations fail to determine the cause of one third of ischemic strokes. Cryptogenic strokes often .
Shortening treatment for tuberculosis--to basics.

With approximately 8 million incident cases and 1.3 million deaths each year, increasing drug resistance, and exacerbating coexisting conditions such as the human immunodeficiency virus–acquired immunodeficiency syndrome and diabetes, tuberculosis continues to pose a massive threat to global health. In the absence of a vaccine to provide long-term protection, control of drug-susceptible tuberculosis is largely dependent on a standard 6-month chemotherapy regimen that has been in use for more than three decades. Any experimental therapy designed to modify this short-course regimen — which comprises a 2-month intensive phase with four drugs (rifampin, isoniazid, pyrazinamide, and ethambutol) followed by a 4-month .
Control of hypertension in pregnancy--if some is good, is more worse?

Entering pregnancy with chronic hypertension is increasingly common. A nationwide study of deliveries in the United States revealed that the prevalence of chronic hypertension among pregnant women had increased significantly, from 0.9% in 1995–1996 to 1.5% in 2007–2008.1 The frequency of gestational hypertension (i.e., hypertension first detected during pregnancy) has also increased.2 Older maternal age at delivery and higher rates of obesity at least partially explain these increases. Chronic hypertension is an important risk factor for pregnancy complications, including, for the fetus or neonate, poor fetal growth, preterm birth, low birth weight, requirement for neonatal intensive care, and death, and .
An Exploratory Study of Older Peoples' Experiences ofAcquired Hearing Loss and Hearing Aid Use

The provision of hearing aids is a central component in the rehabilitation of individuals who have acquired a hearing impairment, and costs the NHS a significant sum each year. However, there exist concerns that a large proportion of hearing aids are not used regularly. Given that acquired hearing impairment rises in prevalence in later life, and that research indicates that older people make less use of the hearing aids they are prescribed, it seems important to explore the factors limiting hearing aid use in older people. Previous researchers have examined a range of variables hypothesised to mediate the relationship between amount of hearing aid use and age. However, few have considered how values about the meaning and management of ageing might contextualise the experience of acquired hearing impairment in later life, and impact on hearing aid use. This study uses an interview format and qualitative analysis to explore the interplay between experiences of acquired hearing impairment, hearing aid use and ageing in a sample of older people. The main themes drawn from the data are 1) that hearing impairment is widely constructed as a problem of 'old age', and 2) that decisions about how to manage hearing problems are reflective of values about how to manage ageing and the threat of stigma. Amongst the recommendations made are that professionals should recognise the complexities of managing self- and social-identity for older peoplewith hearing impairments, and should move away from measuring 'successful' hearing management in terms of hours of hearing aid use.
A Candidate Dengue Vaccine Walks a Tightrope.

The most advanced candidate vaccine against dengue viruses, called CYD-TDV, is progressing toward potential registration and review by the World Health Organization (WHO) in 2016. CYD-TDV is a formulation of four chimeric yellow fever 17D vaccine viruses, each one engineered to express the surface envelope and prM (membrane) proteins from one of the four serotypes of dengue virus. The surface envelope protein is a target of virus-neutralizing antibodies. The safety and efficacy of CYD-TDV after the administration of three doses over a 12-month period was recently measured in two pediatric phase 3 trials in Latin America1 and Southeast Asia.2 The .
Targeting Myocardial Reperfusion Injury--The Search Continues.

Timely reperfusion by means of primary percutaneous coronary intervention (PCI) is the most effective therapy for limiting myocardial infarct size in patients with ST-segment elevation myocardial infarction (STEMI). Although mortality in this patient population is falling, the number of patients in whom heart failure develops is increasing. As such, new treatments are needed to reduce myocardial infarct size and to preserve left ventricular function, so as to prevent the onset of heart failure. One neglected therapeutic target is myocardial reperfusion injury, the term given to the cardiomyocyte death that paradoxically results from reperfusion of ischemic myocardium.1 This phenomenon is mediated, .
Remote Ischemic Preconditioning in Cardiac Surgery--Ineffective and Risky?

Every year millions of patients undergo cardiac surgery, which may be associated with short- and long-term cardiovascular complications in as many as 20% of patients. Although the perioperative care of patients undergoing cardiac surgery has become highly sophisticated and is facilitated by the availability of guidelines, there is ample room to improve clinical outcomes. However, the search for a magic bullet — a cardioprotective strategy that could be successfully administered in addition to the current standard treatment to provide additional benefits — is tantalizing but frustrating, as evidenced by the negative results of two trials of remote ischemic preconditioning in .
The relationship between cognitive function and physical performance in older women: results from the women's health initiative memory study.

BACKGROUND Cognitive function and physical performance are associated, but the common sequence of cognitive and physical decline remains unclear. METHODS In the Women's Health Initiative Memory Study (WHIMS) clinical trial, we examined associations at baseline and over a 6-year follow-up period between the Modified Mini-Mental State (3MS) Examination and three physical performance measures (PPMs): gait speed (meters/second), chair stands (number of stands in 15 seconds), and grip strength (kilograms). Using mixed models, we examined the baseline 3MS as predictor of change in PPM, change in the 3MS as predictor of change in PPM, and baseline PPM as predictors of 3MS change. RESULTS Among 1,793 women (mean age = 70.3 years, 89% white, and mean 3MS score = 95.1), PPM were weakly correlated with 3MS-gait speed: r = . 06, p = . 02; chair stands: r = . 09, p < . 001; and grip strength: r = . 10, p < . 001. Baseline 3MS score was associated with subsequent PPM decline after adjustment for demographics, comorbid conditions, medications, and lifestyle factors. For every SD (4.2 points) higher 3MS score, 0.04 SD (0.04 m/s) less gait speed and 0.05 SD (0.29 kg) less grip strength decline is expected over 6 years (p </= .01 both). Changes in 3MS and PPM were associated, particularly with chair stands and grip strength (p < .003 both). Baseline PPMs were not associated with subsequent 3MS change. CONCLUSIONS Baseline global cognitive function and change in global cognitive function were associated with physical performance change, but baseline physical performance was not associated with cognitive change in this cohort. These analyses support the hypothesis that cognitive decline on average precedes or co-occurs with physical performance decline.