Miracle-dz/UniFAR-FTUs huggingface dataset:
Cross-Sectional Survey of Workload and Burnout Among Japanese Physicians Working in Stroke Care: The Nationwide Survey of Acute Stroke Care Capacity for Proper Designation of Comprehensive Stroke Center in Japan (J-ASPECT) Study

Background—Burnout is common among physicians and affects the quality of care. We aimed to determine the prevalence of burnout among Japanese physicians working in stroke care and evaluate personal and professional characteristics associated with burnout. Methods and Results—A cross-sectional design was used to develop and distribute a survey to 11 211 physicians. Physician burnout was assessed using the Maslach Burnout Inventory General Survey. The predictors of burnout and the relationships among them were identified by multivariable logistic regression analysis. A total of 2724 (25.3%) physicians returned the surveys. After excluding those who were not working in stroke care or did not complete the survey appropriately, 2564 surveys were analyzed. Analysis of the participants’ scores revealed that 41.1% were burned out. Multivariable analysis indicated that number of hours worked per week is positively associated with burnout. Hours slept per night, day-offs per week, years of experience, as well as income, are inversely associated with burnout. Short Form 36 mental health subscale was also inversely associated with burnout. Conclusions—The primary risk factors for burnout are heavy workload, short sleep duration, relatively little experience, and low mental quality of life. Prospective research is required to confirm these findings and develop programs for preventing burnout.
Individualized Cancer Chemotherapy, Are We Ready for that Yet?

Volume 2 • Issue 3 • 1000e113 to explain the clinical data can not be always straightforward. For example, response to chemotherapy is likely to be multigenic [9]. Inhibition of anticancer drugs against one cancer-related gene may not always result in good tumor inhibition and patient’s survival. These drugs may same time trigger some other cancer-related processes or multidrug resistance genes. This is the difficulty problem in all present gene-related studies. So it is helpful to combine empirical and biomolecular theory in one ICC strategy.
Treatment of acute and recurrent idiopathic pericarditis.

Case Presentation: A 56-year-old previously healthy man presented with 2 days of pleuritic left anterior chest pain, lessened by sitting forward. His examination was pertinent for low-grade fever (37.6°C), blood pressure 122/76 mm Hg without paradox, no jugular venous distension, clear lungs, and a 3-component pericardial friction rub. The ECG showed diffuse concave-upward ST-segment elevation and PR-segment depression in the inferior leads. The serum C-reactive protein level was 64 mg/L, and the cardiac troponin T was not elevated. Echocardiography showed normal left ventricular contractile function without wall motion abnormalities and no pericardial effusion. He was diagnosed with acute pericarditis, and the symptoms responded promptly to oral ibuprofen, continued for 2 weeks. Six weeks later, he redeveloped pleuritic chest pain and clinical and ECG findings identical to the initial presentation. His primary care physician asks for advice about appropriate therapy. Pericarditis accounts for 5% of emergency department visits for chest pain in the absence of myocardial infarction.1 In ≈80% of cases in developed countries, the cause of pericarditis is either postviral or “idiopathic,” in that it cannot be attributed to a specific condition.2,3 Because these 2 etiologies are clinically equivalent, the term idiopathic pericarditis will refer to both in this Clinician Update. Even when managed effectively, many patients with acute pericarditis present with 1 or more repeated episodes, termed recurrent pericarditis . 4 Treatment of idiopathic pericarditis has long been empirical, because until recently, there have been few therapeutic trials addressing this condition. The European Society of Cardiology published the only treatment guideline for pericarditis almost a decade ago, and many of the recommendations were based on opinion because of the lack of available study evidence.4 Most patients with idiopathic pericarditis experience self-limited symptoms that improve spontaneously within days to weeks. More rapid relief can be …
Ophthalmic Care of the Combat Casualty

Abstract : Along with saving the lives and limbs of our soldiers, sailors, and airmen injured in battle, the preservation of their eyes and eyesight is an extremely important goal. Despite comprising as little as 0.1% of the total body surface area and 0.27% of the frontal silhouette, the proportion of eye injuries in nonfatal casualties has been escalating in recent conflicts (Table). Several reasons account for the increasing risk of eye injuries: 1. preferential exposure of the eyes during combat (eg, foxholes, tank turrets); 2. improved body armor protecting the head, thorax, and abdomen, leading to fewer fatal injuries to these regions of the body; 3. improved surgical techniques and rapid evacuation of the wounded, which allow physicians to repair wounds that at one time would have resulted in the death of a soldier; and 4. improved munitions, which create more and smaller fragments that can cause severe, even blinding, injuries.
Ribonucleotide Reductase Catalytic Subunit M1 (RRM1) as a Novel Therapeutic Target in Multiple Myeloma

Purpose: To investigate the biological and clinical significance of ribonucleotide reductase (RR) in multiple myeloma. Experimental Design: We assessed the impact of RR expression on patient outcome in multiple myeloma. We then characterized the effect of genetic and pharmacologic inhibition of ribonucleotide reductase catalytic subunit M1 (RRM1) on multiple myeloma growth and survival using siRNA and clofarabine, respectively, in both in vitro and in vivo mouse xenograft models. Results: Newly diagnosed multiple myeloma patients with higher RRM1 expression have shortened survival. Knockdown of RRM1 triggered significant growth inhibition and apoptosis in multiple myeloma cells, even in the context of the bone marrow microenvironment. Gene expression profiling showed upregulation of DNA damage response genes and p53-regulated genes after RRM1 knockdown. Immunoblot and qRT-PCR analysis confirmed that γ-H2A.X, ATM, ATR, Chk1, Chk2, RAD51, 53BP1, BRCA1, and BRCA2 were upregulated/activated. Moreover, immunoblots showed that p53, p21, Noxa, and Puma were activated in p53 wild-type multiple myeloma cells. Clofarabine, a purine nucleoside analogue that inhibits RRM1, induced growth arrest and apoptosis in p53 wild-type cell lines. Although clofarabine did not induce cell death in p53-mutant cells, it did trigger synergistic toxicity in combination with DNA-damaging agent melphalan. Finally, we demonstrated that tumor growth of RRM1-knockdown multiple myeloma cells was significantly reduced in a murine human multiple myeloma cell xenograft model. Conclusions: Our results therefore demonstrate that RRM1 is a novel therapeutic target in multiple myeloma in the preclinical setting and provide the basis for clinical evaluation of RRM1 inhibitor, alone or in combination with DNA-damaging agents, to improve patient outcome in multiple myeloma. Clin Cancer Res; 23(17); 5225–37. ©2017 AACR.
BI2536, a potent and selective inhibitor of polo-like kinase 1, in combination with cisplatin exerts synergistic effects on gastric cancer cells

BI2536 is a highly selective and potent inhibitor of polo-like kinase 1 (PLK1). In this study, we aimed to determine whether BI2536 and cisplatin can synergistically inhibit the malignant behavior of gastric cancer cells. For this purpose, the expression of PLK1 in gastric cancer cells was determined. The effects of BI2536, cisplatin, and the combination of BI2536 and cisplatin on gastric cancer cell viability, invasion, cell cycle arrest and apoptosis were assessed. Furthermore, the expression of cell cycle-regulated proteins was examined. Moreover, the differentially expressed proteins between the SGC-7901 and SGC-7901/DDP (cisplatin-resistant) cells, and the enriched signaling pathways were analyzed by protein pathway array following treatment with BI2536 (IC50) for 48 h. Our results revealed that PLK1 was upregulated in the SGC-7901/DDP (cisplatin-resistant) gastric cancer cells compared with the SGC-7901 cells. BI2536 enhanced the inhibitory effect of cisplatin on SGC-7901 cell viability and invasion. BI2536 induced G2/M arrest in SGC-7901 and SGC-7901/DDP cells. BI2536 promoted cisplatin-induced gastric cancer SGC-7901/DDP cell apoptosis. It also induced the differential expression of 68 proteins between the SGC-7901 and SGC-7901/DDP cells, and these differentially expressed proteins were involved in a number of cellular functions and signaling pathways, such as cell death, cell development, tumorigenesis, the cell cycle, DNA duplication/recombination/repair, cellular movement, and the Wnt/β-catenin and mitogen-activated protein kinase (MEK)/extracellular signal-regulated kinase (ERK)/ribosomal S6 kinase 1 (RSK1) signaling pathways. On the whole, our findings suggest that BI2536 and cisplatin synergistically inhibit the malignant behavior of SGC-7901/DDP (cisplatin-resistant) gastric cancer cells.
Hippocampal Stratum Radiatum, Lacunosum, and Moleculare Sparing in Mild Cognitive Impairment.

BACKGROUND Alzheimer's disease (AD) is associated with atrophy in entorhinal cortex (ERC), the hippocampus, and its subfields Cornu Ammonis 1 (CA1) and subiculum, which predict conversion from mild cognitive impairment (MCI) to clinical AD. The stratum radiatum, lacunosum, and moleculare (SRLM) are also important gateways involving ERC and CA1, which are affected by early AD pathology. OBJECTIVE To assess whether the SRLM is affected in MCI and AD. METHODS In this proof-of-concept study, 27 controls, 13 subjects with AD, and 22 with MCI underwent 3T MRI. T1 maps were used for whole-hippocampal volumetry, T2 maps were segmented for hippocampal subfield areas, entorhinal cortex and subiculum thickness, and evaluated for SRLM integrity. RESULTS Significant CA1 atrophy and subiculum thinning were found in both AD and MCI compared to similarly aged controls. However, SRLM integrity was only significantly reduced in AD but not in MCI compared to controls. There were no significant differences in other hippocampal subfields (CA2, CA3/dentate gyrus) or ERC thickness between the groups. Finally, CA1 and CA3/DG areas and SRLM clarity were correlated with clinical and cognitive measurements of disease severity. CONCLUSION Although this study was cross sectional, it suggests a progression of specific subfield changes from MCI to established AD that is associated with the reduced integrity of SRLM, which may reflect more widespread hippocampal involvement as the disease progresses and the relative preservation of SRLM in MCI. These results provide new MRI biomarkers for disease staging and understanding of the neurobiology in AD.
Fine Needle Cytology and Flow Cytometry in Hashimoto Thyroiditis and Primary Thyroid Lymphoma

out any phenotypic or molecular signs of clonality. The other 4 cases underwent a strict clinical and ultrasound (US) followup. After 5 years, none of them developed TL. With reference to FC, all our cases showed small λ/k ratio imbalances (less than 20% of the gated cells); PCR analysis demonstrated diffuse (polyclonal) bands in the gel and Gaussian curves at the heteroduplex. Therefore, we thought that light chain imbalances in a relative small number of cells, which are not supported by heavy chain rearrangements, may occur in HT and should not be considered indicative of HT. This occurrence had already been described in HT [4–6] , although the corresponding percentages were quite variable [4–6] , depending also on the different technical procedures [4–6] . Conversely, in 2 of our TL FNC-FC cases [3] , FC showed light chain restrictions in almost all the gated Blymphocytes in 1 case and, paradoxically, light chain restrictions were not expressed in the other case in which the cytological Dear Editor, We read with great interest the article ‘Impact of flow cytometry in thyroid cytopathology’ by Boonyaarunnate et al. [1] published in the last November-December issue of Acta Cytologica . In this study, the authors investigated 13 cases of primary thyroid non-Hodgkin lymphoma (TL) and 33 cases of Hashimoto thyroiditis (HT) by fine needle cytology (FNC) and flow cytometry (FC). The authors assessed the role that FC can play in the FNC diagnosis of HT and TL. Some years ago, we investigated HT and TL by FNC and FC [2, 3] and our results were in agreement with theirs. In addition, we would like to draw attention to a specific aspect of their study: clonality was detected in 3 of their 33 HT cases, but in 1 case only a mucosa-associated non-Hodgkin lymphoma was subsequently proven. In our study [2] performed on 34 HT using FC-FNC, clonality was detected in 5 cases (λ/k ratio >1: 1 or 4: 1, respectively). One case underwent surgery, and the histological examination revealed a florid HT withReceived: January 23, 2014 Accepted after revision: January 28, 2014 Published online: March 12, 2014
Letter by Metzler et al regarding article, "Intracoronary KAI-9803 as an adjunct to primary coronary intervention for acute ST-segment elevation myocardial infarction".

To the Editor: The Direct Inhibition of δ-Protein Kinase C Enzyme to Limit Total Infarct Size in Acute Myocardial Infarction (DELTA MI) Investigators1 report that the intracoronary application of KAI-9803, a δ-protein kinase C inhibitor, during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, was safe and led both to a nonsignificant reduction of infarction as measured by creatine kinase MB …
Régression clinique complète d’une lésion gingivo-mandibulaire de myélome multiple après chimiothérapie exclusive associant dexaméthasone et lénalidomide. A propos d’un cas

Le cas d’une patiente de 55 ans souffrant d’un stade avance de myelome multiple a IgA lamba ayant developpe un plasmocytome gingivo-mandibulaire est rapporte. Les solutions therapeutiques etaient restreintes car les traitements classiques avaient ete tous epuises ; il fut alors decide de realiser une chimiotherapie exclusive avec une association dexamethasone + lenalidomide. La reevaluation post-cure a 1 mois et demi montrait une regression clinique complete de la lesion. Le lenalidomide, molecule derivee du thalidomide, a recu une autorisation de mise sur le marche uniquement pour le traitement du myelome multiple refractaire a la chimiotherapie classique et au thalidomide. Il semble ameliorer sensiblement la duree de survie des patients evaluee a 38 mois. Malgre la reponse initiale positive, l’evolution generale du myelome n’a pas ete modifiee, la patiente decedant d’une localisation cerebrale 9 mois plus tard.
Collected World and Single Center Experience With Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms

Background:Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial. Objective:To clarify these we examined a collected experience with use of EVAR for RAAA treatment from 49 centers. Methods:Data were obtained by questionnaires from these centers, updated from 13 centers committed to EVAR treatment whenever possible and included treatment details from a single center and information on 1037 patients treated by EVAR and 763 patients treated by open repair (OR). Results:Overall 30-day mortality after EVAR in 1037 patients was 21.2%. Centers performing EVAR for RAAAs whenever possible did so in 28% to 79% (mean 49.1%) of their patients, had a 30-day mortality of 19.7% (range: 0%–32%) for 680 EVAR patients and 36.3% (range: 8%–53%) for 763 OR patients (P < 0.0001). Supraceliac aortic balloon control was obtained in 19.1% ± 12.0% (±SD) of 680 EVAR patients. Abdominal compartment syndrome was treated by some form of decompression in 12.2% ± 8.3% (±SD) of these EVAR patients. Conclusion:These results indicate that EVAR has a lower procedural mortality at 30 days than OR in at least some patients and that EVAR is better than OR for treating RAAA patients provided they have favorable anatomy; adequate skills, facilities, and protocols are available; and optimal strategies, techniques, and adjuncts are employed.
The Association of Osteocalcin and Adiponectin with Glucose Metabolism in Nondiabetic Postmenopausal Women

Background/Aim: This study was designed to determine if osteocalcin is associated with insulin resistance, metabolic risk factors and adiponectin levels in nondiabetic postmenopausal women. Methods: A total of 87 menopausal nondiabetic subjects were enrolled into the study. Levels of fasting plasma glucose (FPG), insulin and serum lipids were determined. To estimate insulin sensitivity, homeostasis model assessment (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) were used. Serum total osteocalcin and adiponectin levels were measured and the features of metabolic syndrome were identified. Results: The mean age of the patients was 54.7 years. Among the participants, 28.7% were obese (body mass index, BMI, ≥30). Insulin resistance was detected by HOMA-IR in 42.5% and by the QUICKI index in 63.2% of the cases. Metabolic syndrome was present in 29.8% of the patients. Neither the baseline characteristics nor the metabolic risk factors were correlated with osteocalcin or adiponectin levels (p > 0.05). When the patients were analyzed regarding BMI, osteocalcin levels were significantly lower in overweight women. Serum adiponectin levels were significantly lower in women with metabolic syndrome. Conclusion: No correlation between total osteocalcin and FPG, fasting insulin and insulin resistance parameters was found in nondiabetic postmenopausal women. Serum levels of adiponectin were associated with metabolic syndrome.
Thinking Outside the Inhaler: Potential Barriers to Controlled Asthma in Children

Asthma has reached epidemic proportions in the United States, increasing in prevalence especially among children. Despite the development of national goals and practice guidelines, childhood morbidity and mortality associated with asthma has continued to rise at astonishing rates. Effective management of asthma in children requires both improvements in following nationally recognized guidelines and addressing barriers associated with poor control. This article identifies barriers leading to uncontrolled asthma in children. Barriers in communication, education, resources, parental concerns, and psychosocial influences have resulted in nonadherence to national guidelines. Health care professionals have the opportunity to affect asthma management by addressing these barriers and improving the quality of care for children with asthma.
Stem Cell-Derived Vascular Endothelial Cells and Their Potential Application in Regenerative Medicine

Although a ‘vascular stem cell’ population has not been identified or generated, vascular endothelial and mural cells (smooth muscle cells and pericytes) can be derived from currently known pluripotent stem cell sources including human embryonic stem cells and induced pluripotent stem cells. We review the vascular potential of these human pluripotent stem cells, the mechanisms by which they are induced to differentiate toward a vascular endothelial cell fate, and their applications in regenerative medicine.
Stochastically Ultimate Boundedness and Global Attraction of Positive Solution for a Stochastic Competitive System

A stochastic competitive system is investigated. We first show that the positive solution of the above system does not explode to infinity in a finite time, and the existence and uniqueness of positive solution are discussed. Later, sufficient conditions for the stochastically ultimate boundedness of positive solution are derived. Also, with the help of Lyapunov function, sufficient conditions for the global attraction of positive solution are established. Finally, numerical simulations are presented to justify our theoretical results.
Four Anti-dsDNA Antibody Assays in Relation to Systemic Lupus Erythematosus Disease Specificity and Activity

Objective. Analysis of antibodies against dsDNA is an important diagnostic tool for systemic lupus erythematosus (SLE), and changes in anti-dsDNA antibody levels are also used to assess disease activity. Herein, 4 assays were compared with regard to SLE specificity, sensitivity, and association with disease activity variables. Methods. Cross-sectional sera from 178 patients with SLE, of which 11 were followed consecutively, from a regional Swedish SLE register were analyzed for immunoglobulin G (IgG) anti-dsDNA by bead-based multiplex assay (FIDIS; Theradig), fluoroenzyme-immunoassay (EliA; Phadia/Thermo Fisher Scientific), Crithidia luciliae immunofluorescence test (CLIFT; ImmunoConcepts), and line blot (EUROLINE; Euroimmun). All patients with SLE fulfilled the 1982 American College of Rheumatology and/or the 2012 Systemic Lupus International Collaborating Clinics (SLICC-12) classification criteria. Healthy individuals (n = 100), patients with rheumatoid arthritis (n = 95), and patients with primary Sjögren syndrome (n = 54) served as controls. Results. CLIFT had the highest SLE specificity (98%) whereas EliA had the highest sensitivity (35%). When cutoff levels for FIDIS, EliA, and EUROLINE were adjusted according to SLICC-12 (i.e., double the reference limit when using ELISA), the specificity and sensitivity of FIDIS was comparable to CLIFT. FIDIS and CLIFT also showed the highest concordance (84%). FIDIS performed best regarding association with disease activity in cross-sectional and consecutive samples. Fisher’s exact test revealed striking differences between methods regarding associations with certain disease phenotypes. Conclusion. CLIFT remains a good choice for diagnostic purposes, but FIDIS performs equally well when the cutoff is adjusted according to SLICC-12. Based on results from cross-sectional and consecutive analyses, FIDIS can also be recommended to monitor disease activity.
Rates and Correlates of Self-Reported Pap Testing in African-Caribbean-Black HIV-Positive Women in Ontario, Canada

Cervical dysplasia and cancer are more common and aggressive in HIV-positive women and Papanicolaou (Pap) testing allows for their earlier identification and treatment. Guidelines recommend annual screening for this population. This cross-sectional study assessed prevalence and correlates of self-reported Pap testing among African-Caribbean HIV-positive women who completed an ACASI-administered questionnaire. Participants were recruited through a community health centre in Toronto, Canada. Pap testing history was assessed by a single question asking when the last test was done. Logistic regression examined correlates of Pap testing in the previous year. The 126 participating women’s median age was 40 years (IQR=34-46); 53.2% were East African and 16.7% Caribbean.69. 9% and 82.1% of women had received a Pap test in the previous year and three years, respectively; 10.6% had never been tested. Age: 35-49 vs. >50 years (OR=6.7,95%,CI=1.7-25.1), being in Canada for >2 years (OR=4.6,95%,CI=1.6-13.5), having >2 sexual partners (OR=3.4,95%,CI=1.1-10.7) or having seen a family doctor within 6 months (OR=2.6,95%,CI=1.1-6.2) were significantly associated with Pap testing in the past year. In conclusion, 70% of participating women did have Pap screening in the past year. Program development to reach the 30% unscreened women should be sought; especially for the 10% who never received screening.