Miracle-dz/UniFAR-FTUs huggingface dataset:
Psychometric validation of the Afrikaans translation of two patient-reported outcomes instruments for reflux disease

Objectives : To verify the validity and reliability of two Afrikaans patient-reported outcomes instruments, a disease-specific and a health-related quality of life instrument in patients with reflux disease. Design : Psychometric validation study. Setting : South African, major referral gastroenterology clinic. Subjects : Consecutive patients with predominant symptoms of heartburn. Outcome measures : Patients completed the Afrikaans versions of the Gastrointestinal Symptom Rating Scale (GSRS), the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD) and the Short Form Health-36 (SF-36). The frequency and severity of heartburn during the previous 7 days were recorded. Results : 125 patients (aged of 46.0 ±12.3 years, 74.4% female, 87% mixed race) completed the assessments. Most patients (62%) had severe symptoms and half (54%) had symptoms on more than 5 days in the previous week. Patients were most bothered by symptoms of reflux (mean GSRS score of 4.9), indigestion (4.0) and abdominal pain (4.0). These symptoms caused patients problems with food and drink (mean QOLRAD score of 3.5), emotional distress (3.6), impaired vitality (3.7) and sleep disturbance (3.8). The internal consistency of the GSRS symptom clusters was between 0.65 and 0.86 and, for QOLRAD dimensions, it was in the range 0.82 0.94. Test-retest reliability was 0.620. 75 (GSRS) and 0.710.82 (QOLRAD). Relevant domains of GSRS and QOLRAD were significantly correlated. GSRS domains of abdominal pain and indigestion, and relevant QOLRAD domains, showed negative correlation with related SF-36 domains. Conclusions : The Afrikaans translations of GSRS and QOLRAD are valid and reliable instruments for use in clinical trials for the assessment of reflux symptoms and their impact on South African patients' healthrelated quality of life. South African Gastroenterology Review Vol. 4(1) 2006: 5-9
Levofloxacin use in the elderly: focus on pneumonia

Levofloxacin is a broad-spectrum, rapid-acting bactericidal agent that exhibits concentration-dependent killing activity as well as a postantibiotic effect. Its activity includes enteric Gram-negative bacilli, Acinetobacter spp. , Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus aureus and most species of streptococci, including Streptococcus pneumoniae. With increasing age, there is a natural decline in renal function by approximately 1 ml/min/year after the age of 30 years, or an average decrease in creatinine clearance of 40% by the age of 80 years. This decline in renal function can have a significant impact on antibiotics that are predominantly eliminated from the body via the kidneys, such as levofloxacin. The favorable pharmacodynamic, safety and efficacy profiles, in addition to in vitro activity versus the usual respiratory pathogens, make levofloxacin among the first-line agents for the management of pneumonia, and an option for other respiratory bacterial infections in which more r.
Mechanical ventilation-induced diaphragm disuse in humans triggers autophagy.

RATIONALE Controlled mechanical ventilation (CMV) results in atrophy of the human diaphragm. The autophagy-lysosome pathway (ALP) contributes to skeletal muscle proteolysis, but its contribution to diaphragmatic protein degradation in mechanically ventilated patients is unknown. OBJECTIVES To evaluate the autophagy pathway responses to CMV in the diaphragm and limb muscles of humans and to identify the roles of FOXO transcription factors in these responses. METHODS Muscle biopsies were obtained from nine control subjects and nine brain-dead organ donors. Subjects were mechanically ventilated for 2 to 4 hours and 15 to 276 hours, respectively. Activation of the ubiquitin-proteasome system was detected by measuring mRNA expressions of Atrogin-1, MURF1, and protein expressions of UBC2, UBC4, and the α subunits of the 20S proteasome (MCP231). Activation of the ALP was detected by electron microscopy and by measuring the expressions of several autophagy-related genes. Total carbonyl content and HNE-protein adduct formation were measured to assess oxidative stress. Total AKT, phosphorylated and total FOXO1, and FOXO3A protein levels were also measured. MEASUREMENTS AND MAIN RESULTS Prolonged CMV triggered activation of the ALP as measured by the appearance of autophagosomes in the diaphragm and increased expressions of autophagy-related genes, as compared with controls. Induction of autophagy was associated with increased protein oxidation and enhanced expression of the FOXO1 gene, but not the FOXO3A gene. CMV also triggered the inhibition of both AKT expression and FOXO1 phosphorylation. CONCLUSIONS We propose that prolonged CMV causes diaphragm disuse, which, in turn, leads to activation of the ALP through oxidative stress and the induction of the FOXO1 transcription factor.
Novel MSH6 Mutations in Treatment-Naïve Glioblastoma and Anaplastic Oligodendroglioma Contribute to Temozolomide Resistance Independently of MGMT Promoter Methylation

Purpose: The current standard of care for glioblastoma (GBM) involves a combination of surgery, radiotherapy, and temozolomide chemotherapy, but this regimen fails to achieve long-term tumor control. Resistance to temozolomide is largely mediated by expression of the DNA repair enzyme MGMT; however, emerging evidence suggests that inactivation of MSH6 and other mismatch repair proteins plays an important role in temozolomide resistance. Here, we investigate endogenous MSH6 mutations in GBM, anaplastic oligodendroglial tumor tissue, and corresponding brain tumor–initiating cell lines (BTIC). Experimental Design: MSH6 sequence and MGMT promoter methylation were determined in human tumor samples and BTICs. Sensitivity to temozolomide was evaluated in vitro using BTICs in the absence and presence of O6-benzylguanine to deplete MGMT. The influence of MGMT and MSH6 status on in vivo sensitivity to temozolomide was evaluated using intracranial BTIC xenografts. Results: We identified 11 previously unreported mutations in MSH6 in nine different glioma samples and six paired BTIC lines from adult patients. In addition, MSH6 mutations were documented in three oligodendrogliomas and two treatment-naïve gliomas, both previously unreported findings. These mutations were found to influence the sensitivity of BTICs to temozolomide both in vitro and in vivo, independent of MGMT promoter methylation status. Conclusions: These data demonstrate that endogenous MSH6 mutations may be present before alkylator therapy and occur in at least two histologic subtypes of adult glial neoplasms, with this report serving as the first to note these mutations in oligodendroglioma. These findings broaden our understanding of the clinical response to temozolomide in gliomas. Clin Cancer Res; 20(18); 4894–903. ©2014 AACR.
Arachnoiditis From Intrathecally Given Corticosteroids in the Treatment of Multiple Sclerosis

To the Editor. — In a previous report, 1 arachnoiditis and sterile meningitis were listed as serious side effects from methylprednisolone acetate given intrathecally to patients with acute-phase multiple sclerosis. In addition to the four previously reported patients with arachnoiditis, we have seen three others, bringing the total reported cases to seven. The following report is typical. Report of a Case. — Beginning 36 years ago, a 53-year-old man developed retrobulbar neuritis, spasticity of the legs, paresthesia of the hands, and papillitis of the optic disks in exacerbations and remissions. Elsewhere, he was given a series of 16 intrathecal injections of methylprednisolone acetate (40 to 80 mg each) over a seven-year period. The spinal fluid protein content gradually increased from 82 to 159 mg/100 ml. He had subjective spasticity of the legs during a five-year period that necessitated hospitalization in 1974. A myelogram revealed multiple adhesions in the subarachnoid space at T-1
GIARDIASIS AND ITS TREATMENT: A CLINICAL STUDY

In recent years, atabrine (dihydrochloride of methoxychlorodiethyl amino-pentyl amino-acridine) has been described as a specific parasiticide for Giardia lamblia. Our clinical experience has substantiated this claim, and we are of the opinion that it is now possible to study the effects of giardiasis on human beings much more accurately than it was before a specific remedy for this parasite was known. Our interest in the subject was stimulated by a meeting of the Pan American Medical Association in 1938, and it was at that time that we first began our investigations. Our purpose in this paper is to review briefly a few pertinent contributions to our knowledge of the subject and to present an analysis of the symptoms in 100 cases of giardiasis and the effect of treatment with atabrine in 46 cases. LITERATURE Giardia lamblia, or Giardia intestinalis, is a flagellate of the intestine. Geographically, it has a wide
Strong lymphoid nuclear expression of SOX11 transcription factor defines lymphoblastic neoplasms, mantle cell lymphoma and Burkitt’s lymphoma

The authors surveyed lymphomas to determine the range of expression of the mantle cell lymphoma- associated SOX11 transcription factor and its relation to cyclin D1. In addition to mantle cell lymphoma, SOX11 was strongly expressed only in lymphoblastic malignancies and Burkitt’s lymphomas, and its expression was independent of cyclin D1. See related perspective article on page 1488. Background We surveyed lymphomas to determine the range of expression of the mantle cell lymphoma-associated SOX11 transcription factor and its relation to cyclin D1. Design and Methods On hundred and seventy-two specimens were immunostained for the SOX11 N and C termini. Cyclin D1 was detected by immunohistochemistry and quantitative reverse transcriptase polymerase chain reaction; in situ hybridization for t(11;14) was applied when needed. Results Nuclear SOX11 was strongly expressed in most B and T-lymphoblastic leukemia/lymphomas and half of childhood Burkitt’s lymphomas, but only weakly expressed in some hairy cell leukemias. Chronic lymphocytic leukemia/lymphoma, marginal zone, follicular and diffuse large B-cell lymphomas were negative for SOX11, as were all cases of intermediate Burkitt’s lymphomas/diffuse large B-cell lymphoma, myeloma, Hodgkin’s lymphomas and mature T-cell and NK/T-cell lymphomas. Conclusions In addition to mantle cell lymphoma, SOX11 is strongly expressed only in lymphoblastic malignancies and Burkitt’s lymphomas. Its expression is independent of cyclin D1 (except for weak expression in hairy cell leukemias) and unlikely to be due to translocations in lymphoid neoplasia.
Quality Prediction and Control of Reducing Pipe Based on EOS-ELM-RPLS Mathematics Modeling Method

The inspection of inhomogeneous transverse and longitudinal wall thicknesses, which determines the quality of reducing pipe during the production of seamless steel reducing pipe, is lags and difficult to establish its mechanism model. Aiming at the problems, we proposed the quality prediction model of reducing pipe based on EOS-ELM-RPLS algorithm, which taking into account the production characteristics of its time-varying, nonlinearity, rapid intermission, and data echelon distribution. Key contents such as analysis of data time interval, solving of mean value, establishment of regression model, and model online prediction were introduced and the established prediction model was used in the quality prediction and iteration control of reducing pipe. It is shown through experiment and simulation that the prediction and iteration control method based on EOS-ELM-RPLS model can effectively improve the quality of steel reducing pipe, and, moreover, its maintenance cost was low and it has good characteristics of real time, reliability, and high accuracy.
2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society.

Preamble 2072 1. Introduction 2074 2. Clinical Characteristics and Evaluation of AF 2076 3. Thromboembolic Risk and Treatment 2077 4. Rate Control: Recommendations 2079 5. Rhythm Control: Recommendations 2080 6. Specific Patient Groups and AF: Recommendations 2086 7. Evidence Gaps and Future Research Directions 2089 References 2090 Appendix 1. Author Relationships With Industry and Other Entities (Relevant) 2095 Appendix 2. Reviewer Relationships With Industry and Other Entities (Relevant) 2097 Appendix 3. Initial Clinical Evaluation in Patients With AF 2104 The medical profession should play a central role in evaluating the evidence related to drugs, devices, and procedures for the detection, management, and prevention of disease. When properly applied, expert analysis of available data on the benefits and risks of these therapies and procedures can improve the quality of care, optimize patient outcomes, and favorably affect costs by focusing resources on the most effective strategies. An organized …
Managing Costs in High Risk Obstetrics: The Value of Technology thatImproves Diagnostic Accuracy

In the USA, about 12.8% of babies (more than half a million a year) are born prematurely. The rate of premature birth has increased by 36% since the early 1980’s, [1] and is now responsible for an estimated $26 billion in costs to the American healthcare system annually [2]. Unfortunately, little progress has been made to decrease prevalence in so serious condition. From a managed care perspective, a premature birth constitutes a potential high cost episode of care and high-risk pregnancies constitute a major category of high-cost for payers. In Medicaid, 27% of all inpatient charges and 60% of all hospital procedures covered by Medicaid [3] are related to pregnancy and although only 10% of pregnancies are considered high risk, they account for 57% of total newborn costs [4]. A recent analysis found that overall, 4% of the Medicaid population was responsible for 48% of program spending in 2001 [5]. These high-cost members translate into highly concentrated spending on only a small fraction of the entire population. In this paper we will identify ways in which new technology can improve the diagnostic accuracy of pregnancy-related disorders and assist in managing the costs of high risk obstetrics.
Trends in Congenital Heart Disease: The Next Decade

Congenital heart disease (CHD) is the most common class of major congenital malformations. Although there is slight variation between many population-based studies, CHD occurs in ≈1% of live births, with similar prevalence throughout world,1–3 and in 10% of aborted fetuses.4 It is also the leading cause of mortality from birth defects.5 Approximately one-quarter of the 40 000 children born with CHD annually in the United States require intervention in the first year of life. In the 60 years since the first successful repair of a congenital heart defect using cardiopulmonary bypass in 1953, the accurate diagnosis and effective treatment of even the most complex congenital heart lesions have become standard practice. Critical CHD is often lethal in the absence of treatment, and effective surgical, catheter, and medical therapies have dramatically extended life expectancy. With advances in the survival of patients with CHD, there have been major demographic shifts, so that adult patients with CHD now outnumber children even with complex forms of CHD.6 The expected surgical outcomes for patients with simpler congenital cardiovascular lesions (eg, typical forms of septal defects) have continually improved7 and have long since reached a very high level of excellence. These procedures can now be reasonably viewed as a commodity, which is widely available in the developed world. In treatment of simpler lesions, research is increasingly focused on methods to increase the safety, efficiency, and value of therapeutic procedures, and to provide high-quality alternatives to children in nations with resource-constrained healthcare infrastructure and budgets, as well. On the other end of the spectrum of disease severity, outcomes continue to improve in patients with more complex lesions (Figure 1). 8 Survival through childhood is now common even in the most complex and lethal malformations, such as hypoplastic left heart syndrome. …
Twenty-Year History of the Evolution of Stroke Thrombolysis With Intravenous Alteplase to Reduce Long-Term Disability

It has been now 20 years since the publication of the National Institute of Neurological Disorders and Stroke (NINDS) tissue-type plasminogen activator (tPA) trial.1 This randomized controlled trial initiated a paradigm shift in the management of ischemic stroke. Before 1995, it was standard for patients with stroke to languish in emergency departments with no need to perform urgent brain imaging because it was argued that even the fundamental differentiation of intracerebral hemorrhage and ischemic stroke would not change management. The subsequent licensing of tPA provided an impetus to redesign stroke services to allow rapid assessment and delivery of therapy. One of the keys to the success of the NINDS tPA study was the remarkable number of patients who were able to be treated within 90 minutes of stroke symptom onset, a major logistic achievement that remains challenging for routine practice at many centers even today. Subsequently, there have been 6 further randomized trials comparing tPA and placebo in various time windows 0 to 6 hours from stroke symptom onset (Figure 1; Table). The latest individual patient meta-analysis published in 2014 emphasized the generalized efficacy of tPA in the 0- to 4.5-hour time window, regardless of baseline stroke severity or age, but again confirming a striking relationship with treatment time.3 No trial has demonstrated benefit beyond 4.5 hours. Although there remain isolated but vocal opponents of the evidence for tPA, the therapy is no longer controversial among clinicians who treat patients with stroke. It is a pillar of every evidence-based acute stroke guideline around the world.4,5 In this review, we will examine the origins and implications of various indications and contraindications for tPA and the importance, 20 years on, of not just giving tPA to all eligible patients but optimizing efficient delivery to maximize the …
Serum Retinol, β-Carotene, α-Tocopherol and Cholesterol in Healthy French Children

Age- and sex-specific reference intervals of data derived from a healthy paediatric population are presented for retinol, beta-carotene, alpha-tocopherol, cholesterol and related proteins in serum. Age was an important covariate for the micronutrient concentration values. Retinol was highly correlated with alpha-tocopherol and cholesterol. Strong correlation was found with both beta-carotene and cholesterol. Serum levels were considered for their appropriateness as indicators of micronutrient status.
Psychosomatische Betreuung von Patientinnen mit Endometriose

Psychosomatic Care for Patients with Endometriosis. Endometriosis is a disease, which may accompany the whole reproductive life span of the woman affected. At different times patients need comprehensive care, which is based on a biopsycho- social understanding of this disease. The most impor- tant characteristics of the disease from the patient's point of view are: delayed diagnosis of a chronic dis- order of which the cause is not clear, onset at young age, chronic pain, infertility. Patients therefore need an integrated basic psychosomatic care, which is composed of three elements: stable physician-patient relationship in the context of a multidisciplinary team, psychoeducation and empowerment, support and re- laxation training. Based on this care more special- ized psychosomatic interventions may be necessary according to the individual clinical situation and needs: specialized integrative pain management, psycho- somatic care for infertile couples, sexual counselling and therapy, therapy of mental health comorbidity. J Gynakol Endokrinol 2008; 18 (2): 54 -57.
Climate reconstruction analysis using coexistence likelihood estimation (CRACLE): a method for the estimation of climate using vegetation.

UNLABELLED • PREMISE OF THE STUDY Plant distributions have long been understood to be correlated with the environmental conditions to which species are adapted. Climate is one of the major components driving species distributions. Therefore, it is expected that the plants coexisting in a community are reflective of the local environment, particularly climate. • METHODS Presented here is a method for the estimation of climate from local plant species coexistence data. The method, Climate Reconstruction Analysis using Coexistence Likelihood Estimation (CRACLE), is a likelihood-based method that employs specimen collection data at a global scale for the inference of species climate tolerance. CRACLE calculates the maximum joint likelihood of coexistence given individual species climate tolerance characterization to estimate the expected climate. • KEY RESULTS Plant distribution data for more than 4000 species were used to show that this method accurately infers expected climate profiles for 165 sites with diverse climatic conditions. Estimates differ from the WorldClim global climate model by less than 1.5°C on average for mean annual temperature and less than ∼250 mm for mean annual precipitation. This is a significant improvement upon other plant-based climate-proxy methods. • CONCLUSIONS CRACLE validates long hypothesized interactions between climate and local associations of plant species. Furthermore, CRACLE successfully estimates climate that is consistent with the widely used WorldClim model and therefore may be applied to the quantitative estimation of paleoclimate in future studies.
My patient has no blood pressure: point-of-care ultrasound in the hypotensive patient – FAST and RELIABLE

There is perhaps no greater challenge to the emergency and critical care physician than management of the hypotensive patient. A rapid, yet accurate, assessment is essential in this clinical setting. Point-of-care ultrasound (PoCUS) has evolved to become an indispensable test in the critical care and emergency setting. This article addresses the use of ultrasound in the evaluation of the hypotensive patient and reviews some of the scanning protocols and algorithms that have been described. We use the mnemonic FAST and RELIABLE to describe key aspects of PoCUS for undifferentiated hypotension.