Miracle-dz/UniFAR-FTUs huggingface dataset:
Bispectral Index During Asleep-Awake Craniotomies

Background: Asleep-awake craniotomy presents challenges for the anesthetist who has to provide adequate sedation and analgesia but also requires an awake and cooperative patient for neurological testing. In this setting, we hypothesized that Bispectral Index (BIS) monitoring might be helpful in shortening the patient’s awakening and in predicting recovery of consciousness in order to initiate reliable intraoperative brain mapping. Methods: An observational prospective study was performed on 27 consecutive asleep-awake craniotomies, in which BIS was monitored and BIS data collected offline. Nine critical intraoperative time points were defined and analyzed [preinduction, start of surgery, termination of hypnotic drug, eye opening, obeying simple commands, laryngeal mask airway (LMA) removal, initiation of brain mapping, initiation of closure, and end of surgery]. Results: A shorter time to LMA removal was associated with a higher BIS at the termination of the hypnotic drug (P=0.016, Mann-Whitney U test). From the initiation of surgery to the time of LMA removal, BIS was significantly lower than the preinduction values, whereas at the initiation of brain mapping, BIS returned to the preinduction values (Friedman test P<0.0001, Dunns multiple comparisons test). Compared with LMA removal, BIS values >85 predicted the initiation of brain mapping with a sensitivity of 44% (95% confidence interval, 25.5%-64.7%) and a specificity of 74% (95% confidence interval, 53.7%-89%). Conclusions: During asleep-awake craniotomies, higher BIS values at the end of the asleep phase are associated with shorter time to LMA removal, suggesting that BIS monitoring may be beneficial in shortening recovery from anesthesia. During the awake phase, the return of BIS to the preinduction values appeared to indicate full recovery of consciousness, thereby allowing a reliable language testing.
Stereoselective pharmacokinetic study of rhynchophylline and isorhynchophylline epimers in rat plasma by liquid chromatography–tandem mass spectrometry

Abstract 1. In this study, the stereoselective pharmacokinetics of rhynchophylline (RIN) and isorhynchophylline (IRN) in rat plasma were investigated using liquid chromatography–tandem mass spectrometry (LC–MS/MS). 2. A rapid, robust and sensitive LC–MS/MS method for simultaneous quantification of RIN and IRN in rat plasma was established and validated. Chromatographic separation was performed on a Poroshell 120 EC-C18 column under a gradient elution with methanol and water containing 0.01% ammonia as mobile phase. Calibration curve was linear over a concentration range of 1–2000 ng/mL for both epimers. 3. After intravenous administration, there was no apparent difference in pharmacokinetic parameters between two epimers. However, after oral administration, RIN showed remarkable higher plasma exposure than IRN. The bioavailability, Cmax and AUC0–t of RIN were about 9.2-fold, 6.4-fold and 9.1-fold higher than those of IRN at 10 mg/kg, and 7.8-fold, 4.3-fold and 7.7-fold at 20 mg/kg, respectively. Additionally, with dosage enhanced from 10 mg/kg to 20 mg/kg, the plasma concentrations of RIN or IRN increased significantly and the bioavailability enhanced about three times. 4. In conclusion, the results of this work demonstrated for the first time that the pharmacokinetics of RIN and IRN have stereoselectivity.
Radiology of pancreatic adenocarcinoma: Current status of imaging

Pancreatic adenocarcinoma is one of the leading causes of cancer death in the West, with a poor overall 5‐year survival rate of only 4%. Late clinical presentation with an advanced disease results in a low rate of surgical intervention. Tumor serum marker CA 19‐9 is sensitive, although not specific for the diagnosis of adenocarcinomas of the pancreas. The treatment approach is based on whether the tumor is resectable or non‐resectable at presentation. Therefore, imaging plays a crucial role in the management of this disease. Many modalities are available to image the pancreas. They include non‐invasive techniques, like ultrasound, contrast‐enhanced multidetector computed tomography, magnetic resonance imaging and integrated positron emission tomography/computed tomography, and invasive techniques, like endoscopic retrograde cholangiopancreatography and endoscopic ultrasound. Each of these modalities has its peculiar strengths and weaknesses.
AIDS and malnutrition inextricably linked

The importance of the links between AIDS, nutrition, and food security is only just being realised, a conference in London was told last week. The disease is having a devastating impact on the availability of food. And a shortage of food is increasing deaths from the disease, the conference heard. In April last year, the World Health Organization held a consultation meeting in Durban, South Africa, on nutrition and HIV/AIDS in Africa, at which participants concluded that “the HIV epidemic is increasingly driven by, and contributes to, factors that also …
Ca2+‐induced pancreatic cell death: Roles of the endoplasmic reticulum, zymogen granules, lysosomes and endosomes

Alcohol induces Ca2+‐dependent intracellular trypsinogen activation in the apical granular area via non‐oxidative metabolites, such as fatty acid ethyl esters and fatty acids. Intracellular trypsinogen activation is a crucial initiating event in the development of acute pancreatitis, but the specific organelle in which this process takes place has been unknown. Recent data demonstrate that the Ca2+‐dependent trypsinogen activation occurs in postexocytotic endocytic vacuoles. These vacuoles are acid due to a bafilomycin‐sensitive vacuolar H+ ATPase and have a very Ca2+‐permeable membrane. Acid endocytic structures, together with lysosomes, zymogen granules and elements of the endoplasmic reticulum, also play an important role in the physiological Ca2+ signal generation that normally regulates enzyme and fluid secretion from the exocrine pancreas.
Clinical evaluation of P-glycoprotein inhibition by venetoclax: a drug interaction study with digoxin

Abstract 1. Venetoclax is a novel, small molecule B-cell lymphoma-2 (BCL-2) inhibitor that has demonstrated clinical efficacy in a variety of haematological malignancies. Since venetoclax is an inhibitor of P glycoprotein (P-gp) transporter, a study was conducted in healthy, female volunteers to evaluate the effect of venetoclax on the pharmacokinetics of digoxin, a P-gp probe substrate. 2. Volunteers received a single oral dose of digoxin (0.5 mg) with or without a single oral dose of venetoclax (100 mg). Serial blood samples were obtained for pharmacokinetic assessments of digoxin and venetoclax and serial urine samples were obtained for measurement of digoxin concentrations. Safety was assessed throughout the study. 3. Coadministration of digoxin and venetoclax increased digoxin maximum observed plasma concentration (Cmax) by 35% and area under the plasma-concentration time curve (AUC0–∞) by 9%. Digoxin half-life, renal clearance and the fraction excreted unchanged in urine remained relatively similar. The results of this study indicate that venetoclax can increase the concentrations of P-gp substrates. Narrow therapeutic index P-gp substrates should be administered six hours prior to venetoclax to minimise the potential interaction.
Metabolism of deltamethrin and cis- and trans-permethrin by human expressed cytochrome P450 and carboxylesterase enzymes

Abstract The metabolism of the pyrethroids deltamethrin (DLM), cis-permethrin (CPM) and trans-permethrin (TPM) was studied in human expressed cytochrome P450 (CYP) and carboxylesterase (CES) enzymes. DLM, CPM and TPM were metabolised by human CYP2B6 and CYP2C19, with the highest apparent intrinsic clearance (CLint) values for pyrethroid metabolism being observed with CYP2C19. Other CYP enzymes contributing to the metabolism of one or more of the three pyrethroids were CYP1A2, CYP2C8, CYP2C9*1, CYP2D6*1, CYP3A4 and CYP3A5. None of the pyrethroids were metabolised by CYP2A6, CYP2E1, CYP3A7 or CYP4A11. DLM, CPM and TPM were metabolised by both human CES1 and CES2 enzymes. Apparent CLint values for pyrethroid metabolism by CYP and CES enzymes were scaled to per gram of adult human liver using abundance values for microsomal CYP enzymes and for CES enzymes in liver microsomes and cytosol. TPM had the highest and CPM the lowest apparent CLint values for total metabolism (CYP and CES enzymes) per gram of adult human liver. Due to their higher abundance, all three pyrethroids were extensively metabolised by CES enzymes in adult human liver, with CYP enzymes only accounting for 2%, 10% and 1% of total metabolism for DLM, CPM and TPM, respectively.
The clinical pharmacology of therapeutic monoclonal antibodies

Seventeen monoclonal antibodies are currently approved in the United States for therapeutic use in organ transplantation, percutaneous coronary intervention, prophylaxis of respiratory syncytial virus disease, rheumatoid arthritis, Crohn's disease, asthma, chronic lymphocytic leukemia, acute myeloid leukemia, non‐Hodgkin's lymphoma, breast cancer, and colorectal cancer. All approved antibodies are of the IgG class. Thirteen are unconjugated intact antibodies, three are intact immunoconjugates, and one is a Fab fragment. Three of the antibodies are murine, five are chimeric, eight are humanized, and one is a fully human antibody generated by phage display technology. The antigen target and the structural and binding characteristics of the antibody determine the antibody's mechanism of action, pharmacokinetics, safety, and immunogenicity. Antibodies act through multiple mechanisms that include functional modulation of the antigen, recruitment of ADCC and CDC, and delivery of radionuclide or toxin payloads to target cells. Antibody half‐life is usually governed by interaction with the FcRn receptor. In some cases, the antigen may act as a sink for antibody elimination. Safety profiles are determined by the pharmacology and tissue distribution of the target antigen, antibody isotype, the antibody payload, cytokine release, hypersensitivity reactions to xenogeneic protein, and immunogenicity. Fully human antibody technology may allow development of antibodies that have reduced risks of hypersensitivity reactions and immunogenicity, thereby enhancing safety and efficacy. The exquisite target specificity of antibodies, improvements in antibody engineering technology, and the wide availability of novel and validated therapeutic targets provide many current and future opportunities for the clinical development of therapeutic antibodies. Drug Dev. Res. 61:108–120, 2004. © 2004 Wiley‐Liss, Inc.
Changes in the expression of claudins in active ulcerative colitis

Background and Aim: Epithelial barrier function is impaired in ulcerative colitis (UC), but the pathophysiological mechanisms leading to this barrier defect are still far from clear. Because epithelial barrier function is primarily regulated by the most apical intercellular junction, referred to as the tight junction (TJ), we investigated the expression of TJ proteins on rectal epithelial mucosa in UC.
Advocacy: It Is What We Do

Our nation is on the verge of change in the healthcare system. Although we do not yet know how this change will affect our patients, our practice, or us, we do know that with change comes opportunity. We have the opportunity to become more involved in health policy and advocacy than ever before. Many nurses are already taking the first steps, which are recognizing the importance of advocacy and articulating the issues that they believe are of greatest importance. To communicate their views to the right elected officials, nurses need to be aware of how government operates and how legislation is created and shepherded through the legislative process. Nurses must learn the fundamental principles of expressing themselves and making clear requests for what they want of their elected officials. With these skills, every nurse can become an advocate in the political arena and partner with other individuals or groups to facilitate change. Nurses who find this experience rewarding and exhilarating can pursue additional education in health policy and advocacy.
The Influence of Human Factors on Medical Record First Page Filling, on HQMS Data

AbstractObjective. To analyze the influence of the preliminary rectification of medical record first page filling on the HQMS data, in order to propose corresponding management measures to improve the extraction quality of HQMS data. Methods. Data about the first page of the discharge medical records were collected and a statistical analysis was carried out before rectification, between September and November in 2013, and after rectification, between December in 2013 and January and February in 2014. Results. After rectification, some data of HQMS are significantly improved, such as the no-filling rate of the grade of surgical anesthesia, which fell from 12.80% to 9.61% (χ2 = 4.84, P < 0.05); the filling error rate of blood transfusion reaction, which fell from 2.69% to 0.88% (χ2 = 22.20, P < 0.05); and the filling error rate of surgical complications, which fell from 2.33% to 0.88% (χ2 = 43.66, P < 0.05). However, some data of HQMS have not shown significant improvement after rectification. Conclusion. T.
Avaliação da qualidade dos discos com antimicrobianos para testes de disco-difusão disponíveis comercialmente no Brasil

Introducao: O teste de suscetibilidade a antimicrobianos representa um dos testes de maior importância clinica realizados pelo laboratorio de microbiologia. Devido ao grande numero de antimicrobianos e a complexidade dos mecanismos de resistencia desenvolvidos pelas bacterias, fica muito dificil hoje a deteccao de problemas nos testes de suscetibilidade pela simples avaliacao dos resultados obtidos. Sendo assim, e extremamente importante que haja uma avaliacao constante da qualidade destes testes. Objetivo: O objetivo do presente estudo foi avaliar a qualidade dos discos de antimicrobianos comercializados no Brasil. Material e metodos: Foram avaliados discos de 18 antimicrobianos obtidos de cinco diferentes fontes comerciais, os quais foram testados frente a quatro cepas bacterianas oriundas da ATCC, pelo metodo de difusao em agar, seguindo as recomendacoes do National Committee for Clinical Laboratory Standards (NCCLS). Cada teste foi repetido 20 vezes. Resultados: Nenhuma das marcas apresentou desempenho satisfatorio para o uso na rotina de um laboratorio de microbiologia. O melhor desempenho foi apresentado pela marca Cecon®, com 89,6% de concordância. A marca Sensifar® apresentou taxa de concordância geral semelhante (90,8%). A marca com o pior desempenho foi a Pimenta Abreu®, com apenas 58,6% de concordância. Conclusao: Os resultados do presente estudo indicam que os discos de antimicrobianos comercializados no Brasil sao de baixa qualidade, possivelmente refletindo a falta de controle de qualidade na producao e/ou estocagem dos produtos antes da sua distribuicao. Esses dados chamam a atencao para a necessidade de implantacao de sistemas efetivos de fiscalizacao da comercializacao desses produtos e de programas criteriosos de controle de qualidade por parte dos laboratorios que os utilizam.
Successful Pain Relief by Treatment of Myofascial Components In Patients with Hip Pathology Scheduled for Total Hip Replacement

SUMMARYObjective: To establish the efficacy of the treatment of myofascial component in patients scheduled for total hip replacement.Materials and Methods: Thirty two patients with hip pain from different diseases have been evaluated and treated for myofascial pain syndrome of the muscles in the hip area. Only 21 patients, 7 male and 14 female, participated in the follow-ups and were included in the study. Their average age was 57 years [ranging from 22 to 84]. Osteoarthritis was the most prevalent disorder, followed by previous total hip replacement and aseptic necrosis. Assessment of pain was done by visual analog scale [VAS] and pressure algometry [PA]. In-activation of myofascial trigger points [MTrPs] was performed according to the technique described by Fischer and was followed by physical therapy procedures and home stretching exercises.Results: Significant improvement was achieved in both VAS [form 6.1 ± 2.5 to 3.3 ± 3.6 cm] and in algometry [from 2.5 ± 1.4 to 4.2 ± 1.9 kg/cm2] from initial evalua.
Rastreamento e diagnóstico ecocardiográfico das arritmias e cardiopatias congênitas fetais

PURPOSE: to analyze the results of a screening and diagnostic program of arrhythmias and congenital heart disease in a reference hospital and the relevance of early diagnosis in the fetal and neonate evolution. METHODS: cardiac evaluation of 1159 fetuses was done in two different levels. Level I: by morphological ultrasound examination with the objective to detect the existence of either arrhythmias or structural cardiac malformations. Level II: by fetal echocardiography to establish the differential diagnosis. The results of level I in the arrhythmia group were compared with those of level II, and in the group with malformations the results of both levels were confronted with the neonate echocardiogram or necropsy. The kappa index was calculated to evaluate the concordance between the two levels. RESULTS: all detected arrhythmias in level I were confirmed in level II, there were no false negative cases and five patients with severe arrhythmia required pharmacological therapy. The diagnosis of structural malformation by level I had sensitivity of 72% and specificity of 98% and there were 28% of false-positive cases. In level II, the sensitivity and specificity of the diagnosis of congenital heart disease were 100 and 99%, respectively. The kappa index was 57% and indicated a moderate degree of concordance between the two levels. Fifty-one percent of the fetuses with diagnosis of cardiac malformations required pharmacological or invasive intervention immediately after birth. CONCLUSION: morphological ultrasound examination is a important tool in the screening of arrhythmias and congenital heart defects during fetal life. The sensitivity and specificity of the fetal echocardiogram were very high and the early diagnosis made it possible to treat the fetus with severe cardiac disease either during pregnancy or immediately after birth.
Intraductal ultrasonography combined with percutaneous transhepatic cholangioscopy for the preoperative evaluation of longitudinal tumor extent in hilar cholangiocarcinoma

Background and Aim: In hilar cholangiocarcinoma, an accurate assessment of preoperative resectability is important to optimize surgical resection. We investigated the accuracy of the combination of intraductal ultrasonography (IDUS) and percutaneous transhepatic cholangioscopy (PTCS) for evaluating longitudinal extent in hilar cholangiocarcinoma.
Secreted protein acidic and rich in cysteine (SPARC) gene polymorphism association with hepatocellular carcinoma in Italian patients

Background and Aim: Hepatocellular carcinoma (HCC) is a multifactorial disease driven by both genetic and epigenetic factors. Infection, inflammation and the immune response against hepatitis B virus and hepatitis C virus have been shown to play an important role in increasing cancer risk and promoting tumor development. In order to investigate the genetic component influencing HCC development, we analyzed 50 single nucleotide polymorphisms (SNP) spanning 34 different genes in 230 Italian patients affected by HCC and 230 controls.
Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome

Background and Aim: Reduction of short‐chain poorly absorbed carbohydrates (FODMAPs) in the diet reduces symptoms of irritable bowel syndrome (IBS). In the present study, we aimed to compare the patterns of breath hydrogen and methane and symptoms produced in response to diets that differed only in FODMAP content.
Peripheral Nerve Blocks in the Treatment of Migraine in Pregnancy

OBJECTIVE: To describe the use of peripheral nerve blocks in a case series of pregnant women with migraine. METHODS: A retrospective chart review of all pregnant patients treated with peripheral nerve blocks for migraine over a 5-year period was performed. Injections targeted greater occipital, auriculotemporal, supraorbital, and supratrochlear nerves using local anesthetics. RESULTS: Peripheral nerve blocks were performed 27 times in 13 pregnant women either in a single (n=6) or multiple (n=7) injection series. Mean patient age was 28 years and gestational age was 23.5 weeks, and all women had migraine, including 38.5% who had chronic migraine. Peripheral nerve blocks were performed for status migrainosus (51.8%) or short-term prophylaxis of frequent headache attacks (48.1%). Before peripheral nerve blocks were performed, oral medications failed for all patients and intravenous medications failed for most. In patients with status migrainosus, average pain reduction was 4.0 (±2.6 standard deviation) (P<.001) immediately postprocedure and 4.0 (±4.4 standard deviation) (P=.007) 24 hours postprocedure in comparison to preprocedure pain. For patients receiving peripheral nerve blocks for short-term prophylaxis, immediate mean pain score reduction was 3.0 (±2.1 standard deviation). No patients had any serious immediate, procedurally related adverse events, and the two patients who had no acute pain reduction ultimately developed preeclampsia and had postpartum headache resolution. CONCLUSION: Peripheral nerve blocks for treatment-refractory migraine may be an effective therapeutic option in pregnancy. LEVEL OF EVIDENCE: III
Three‐dimensional delayed gadolinium‐enhanced MRI of cartilage (dGEMRIC) for in vivo evaluation of reparative cartilage after matrix‐associated autologous chondrocyte transplantation at 3.0T: Preliminary results

To use a 3D gradient‐echo (GRE) sequence with two flip angles for delayed gadolinium‐enhanced MRI of cartilage (dGEMRIC) to evaluate relative glycosaminoglycan content of repair tissue after matrix‐associated autologous chondrocyte transplantation (MACT).
Emerging roles of microRNA in the intracellular signaling networks of hepatocellular carcinoma

MicroRNAs (miRNAs) are small non‐coding RNAs of 19–23 nucleotides that negatively regulate gene expression through binding to the 3′‐untranslated regions of target messenger RNAs (mRNAs). Although the miRNA family constitutes only a minor fraction of the human genome, they hold fundamental importance in diverse physiological and developmental processes due to their pleiotropic effects on the post‐transcriptional regulation of many vital genes. This class of regulatory RNAs has also emerged as important players in carcinogenesis; most, if not all, cancer types have abnormal miRNA expression patterns. In hepatocellular carcinoma (HCC), miRNA dysregulation plays a key role in mediating the pathogenicity of several etiologic risk factors and, more importantly, they promote a number of cancer‐inducing signaling pathways. Recent studies have also demonstrated their potential values in the clinical management of HCC patients as some miRNAs may be used as prognostic or diagnostic markers. The significance of miRNAs in liver carcinogenesis emphasizes their values as therapeutic targets, while technological advances in the delivery of miRNA has shed new possibilities for their use as novel therapeutic agents against HCC.