Miracle-dz/UniFAR-FTUs huggingface dataset:
Myomectomy during cesarean section

Objective. To evaluate the safety and effectiveness of myomectomy during cesarean section (CS). Design. Retrospective case‐control study. Setting. Tertiary referral university hospital. Population and methods. A study group of 1,242 pregnant women with fibromyomas who underwent myomectomy during CS and three control groups of 200 matched pregnant women without fibromyomas who underwent CS deliveries (Group A), 145 patients with fibromyomas who underwent CS deliveries without removal of fibromyomas (Group B) and 51 patients with fibromyomas who had a hysterectomy during CS (Group C). Main outcome measures. The difference between pre‐ and postoperative hemoglobin levels, the incidence of hemorrhage, blood transfusion, postoperative fever, duration of operation and length of hospital stay. Results. No difference was found in the median parity or mean gestational age, but maternal age was higher and the gestational age lower in Group C than the study group. The median number and diameter of fibromyomas in Group B were lower than in the study group. Compared to the study group, Group B women had more single fibromyomas, while those in Group C had more multiple fibromyomas. Group B had more uterine cornual fibromyomas than the study group. There were no differences in the mean hemoglobin change, the incidence of postoperative fever and the length of hospital stay among groups. Conclusion. Myomectomy during CS was a safe and an effective procedure.
Naltrexone Depot Formulations for Opioid and Alcohol Dependence: A Systematic Review

Naltrexone is an opioid receptor antagonist that blocks the reinforcing effects of opioids and reduces alcohol consumption and craving. It has no abuse potential, mild and transient side effects, and thus appears an ideal pharmacotherapy for opioid dependence. Its effectiveness in alcohol dependence is less evident, but compliance with naltrexone combined with psychosocial support has been repeatedly shown to improve drinking outcomes. Limited compliance with oral naltrexone treatment is a known drawback. Several naltrexone implant and injectable depot formulations are being investigated and provide naltrexone release for at least 1 month. Studies among opioid‐dependent patients indicate significant reductions in heroin use, but sample sizes are usually small. In alcohol dependence, two large multicenter trials report alcohol and craving reductions for naltrexone and placebo groups, indicating a significant but moderate effect. The pharmacokinetic profile of the injectable formulation indicates reliable naltrexone release over 1 month at therapeutic levels. Implant formulations releasing naltrexone up to 7 months are reported. Findings on safety and tolerability confirm the generally mild adverse effects described for naltrexone tablets. However, further research on therapeutic levels (i.e., opioid blocking) is warranted. The majority of naltrexone implants lacks approval for regular clinical use and larger longitudinal studies are needed. The available naltrexone depot formulations have the potential to significantly improve medication compliance in opioid and alcohol dependence. In certain circumstances, they may constitute a promising new treatment option.
Protective Role of Isoflavones Against the Toxic Effect of Cypermethrin on Semen Quality and Testosterone Levels of Rabbits

Cypermethrin is considered as one of the endocrine disruptors. Isoflavones play an important role in various physiological processes in the body. It has both estrogenic and antioxidant effects. The objective of this study was to evaluate the protective role of isoflavones (2 mg/kg B.W) on semen quality and plasma testosterone levels of male New Zealand White rabbits given sublethal dose (24 mg/kg BW every other day for 12 weeks) of cypermethrin. Results showed that treatment with cypermethrin caused a significant decreases (P < 0.05) in ejaculate volume, sperm concentration, total sperm output, sperm motility (%), total motile sperm per ejaculate (TMS), packed sperm volume (PSV), semen initial fructose and plasma testosterone. In addition, live body weight (LBW), dry matter intake (DMI) and relative weights of testes and epididymis were decreased. On the other hand, treatment with cypermethrin increased (P < 0.05) the numbers of abnormal and dead sperms, and initial hydrogen ion concentration (pH). Results indicated that the presence of isoflavones together with cypermethrin was capable to minimize its harmful effects. Treatment with isoflavones alone had positive effects on some semen characteristics in spite of it is considered as estrogen‐like compound. Since it causes significant increases in libido (by decreasing the reaction time), PSV, sperm motility and TMS, while abnormal and dead sperm were reduced compared to control animals. Meanwhile, isoflavones had no negative effect on ejaculate volume, total sperm output, sperm concentration, initial fructose concentration, pH and plasma testosterone levels. Results demonstrated the beneficial influences of isoflavones in reducing the negative effects of cypermethrin on reproductive characteristics of mature male rabbits. Interestingly, data showed that isoflavones alone caused an improvement in some semen quality and had no negative effects on male fertility, and did not have negative effects on male fertility.
Measurements of depolarization distribution in the healthy human macula by polarization sensitive OCT

Polarization sensitive optical coherence tomography (PS‐OCT) allows for depth resolved imaging of polarization properties of retinal structures. Different layers in the retina can be distinguished not only based on their reflectivity but also due to their birefringent, depolarizing or polarization preserving character. In contrast to other structures in the posterior segment, the retinal pigment epithelium (RPE) is depolarizing, i.e., it scrambles the polarization state of light. A spectral domain (SD) PS‐OCT system was used to record 3D data sets of the retina. The depolarizing effect of the RPE was analyzed by quantitative evaluation of the spatial depolarization distribution in the macula regions of healthy eyes. Depolarization in the RPE is most pronounced close to the center of the fovea and decreases with eccentricity. (© 2009 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
Comparison of permissible source region and multispectral data using efficient bioluminescence tomography method

As a novel molecular imaging technology, bioluminescence tomography (BLT) has become an important tool for biomedical research in recent years, which can perform a quantitative reconstruction of an internal light source distribution with the scattered and transmitted bioluminescent signals measured on the external surface of a small animal. However, BLT is severely ill‐posed because of complex photon propagation in the biological tissue and limited boundary measured data with noise. Therefore, sufficient a priori knowledge should be fused for the uniqueness and stability of BLT solution. Permissible source region strategy and spectrally resolved measurements are two kinds of a priori knowledge commonly used in BLT reconstruction. This paper compares their performance with simulation and in vivo heterogeneous mouse experiments. In order to improve the efficiency of large‐scale source restoration, this paper introduces an efficient iterative shrinkage thresholding method that not only has faster convergence rate but also has better reconstruction accuracy than the modified Newton‐type optimization approach. Finally, a discussion of these two kinds of a priori knowledge is given based on the comparison results. (© 2011 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
Raman spectroscopy for the non‐contact and non‐destructive monitoring of collagen damage within tissues

The non‐destructive and label‐free monitoring of extracellular matrix (ECM) remodeling and degradation processes is a great challenge. Raman spectroscopy is a non‐contact method that offers the possibility to analyze ECM in situ without the need for tissue processing. Here, we employed Raman spectroscopy for the detection of heart valve ECM, focusing on collagen fibers. We screened the leaflets of porcine aortic valves either directly after dissection or after treatment with collagenase. By comparing the fingerprint region of the Raman spectra of control and treated tissues (400–1800 cm–1), we detected no significant differences based on Raman shifts; however, we found that increasing collagen degradation translated into decreasing Raman signal intensities. After these proof‐of‐principal experiments, we compared Raman spectra of native and cryopreserved valve tissues and revealed that the signal intensities of the frozen samples were significantly lower compared to those of native tissues, similar to the data seen in the enzymatically‐degraded tissues. In conclusion, our data demonstrate that Raman microscopy is a promising, non‐destructive and non‐contact tool to probe ECM state in situ. (© 2012 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
CE: Continuing Education Article PREVENTION OF INFECTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE PART III: SURVEILLANCE AND AUDITING IN A RENAL CARE ENVIRONMENT

SUMMARY This third paper, in a three-part CE series on the preventions of infection in patients with chronic kidney disease, focuses on surveillance and auditing of healthcare-associated infections within the renal care environment. The last decade has seen an increased awareness of the threat to patient safety from healthcare-associated infection (HCAI) and the emergence of multidrug resistance organisms. Effective HCAI prevention strategies include adequate governance structures, access to expert advice, adherence to standard and transmission-based precautions, minimising the use of invasive medical devices, and surveillance. Surveillance data can be collected using outcome (e.g. infection) and/or process (e.g. hand hygiene compliance audit) measures. Establishing a surveillance programme requires: commitment from senior management and the multidisciplinary team, prompt feedback of the data to clinical managers resulting in action been taken if necessary, to address specific areas of concern. While many renal units have access to infection prevention and control expertise to assist in the development of such a programme, units without such expertise should also have a surveillance programme in place.
GOP-1 promotes apoptotic cell degradation by activating the small GTPase Rab2 in C. elegans

Apoptotic cells generated by programmed cell death are engulfed by phagocytes and enclosed within plasma membrane–derived phagosomes. Maturation of phagosomes involves a series of membrane-remodeling events that are governed by the sequential actions of Rab GTPases and lead to formation of phagolysosomes, where cell corpses are degraded. Here we identified gop-1 as a novel regulator of apoptotic cell clearance in Caenorhabditis elegans. Loss of gop-1 affects phagosome maturation through the RAB-5–positive stage, causing defects in phagosome acidification and phagolysosome formation, phenotypes identical to and unaffected by loss of unc-108, the C. elegans Rab2. GOP-1 transiently associates with cell corpse–containing phagosomes, and loss of its function abrogates phagosomal association of UNC-108. GOP-1 interacts with GDP-bound and nucleotide-free UNC-108/Rab2, disrupts GDI-UNC-108 complexes, and promotes activation and membrane recruitment of UNC-108/Rab2 in vitro. Loss of gop-1 also abolishes association of UNC-108 with endosomes, causing defects in endosome and dense core vesicle maturation. Thus, GOP-1 is an activator of UNC-108/Rab2 in multiple processes.
TOG–tubulin binding specificity promotes microtubule dynamics and mitotic spindle formation

XMAP215, CLASP, and Crescerin use arrayed tubulin-binding tumor overexpressed gene (TOG) domains to modulate microtubule dynamics. We hypothesized that TOGs have distinct architectures and tubulin-binding properties that underlie each family’s ability to promote microtubule polymerization or pause. As a model, we investigated the pentameric TOG array of a Drosophila melanogaster XMAP215 member, Msps. We found that Msps TOGs have distinct architectures that bind either free or polymerized tubulin, and that a polarized array drives microtubule polymerization. An engineered TOG1-2-5 array fully supported Msps-dependent microtubule polymerase activity. Requisite for this activity was a TOG5-specific N-terminal HEAT repeat that engaged microtubule lattice-incorporated tubulin. TOG5–microtubule binding maintained mitotic spindle formation as deleting or mutating TOG5 compromised spindle architecture and increased the mitotic index. Mad2 knockdown released the spindle assembly checkpoint triggered when TOG5–microtubule binding was compromised, indicating that TOG5 is essential for spindle function. Our results reveal a TOG5-specific role in mitotic fidelity and support our hypothesis that architecturally distinct TOGs arranged in a sequence-specific order underlie TOG array microtubule regulator activity.
The potential of serum amyloid A–LDL as a novel biomarker for cardiovascular disease risk

Abstract While oxidative modification of LDL, a crucial step in atherogenesis, occurs in the arterial subintimal space and oxidized LDL (oxLDL) is observed chiefly in arterial lesions, oxLDL has also been shown to exist in the circulation, where it can become a surrogate biomarker of cardiovascular disease. The serum amyloid A–LDL (SAA–LDL) complex is currently considered to be a novel oxLDL marker in a broad sense. There have been several reports using SAA–LDL measurements in human subjects with lipid disorders, the metabolic syndrome and coronary artery disease. These reports have shown that there are higher circulating SAA–LDL levels in the aforementioned disease status and that a reduction in the levels of SAA–LDL can be achieved by intervention treatments including lifestyle modifications and drugs such as highly purified eicosapentaenoic acid. Data also suggest a prognostic value of SAA–LDL on cardiac events in patients with coronary artery disease. This article summarizes the current clinical data that indicate the usefulness of SAA–LDL measurements for understanding the pathophysiology of and assessing the risk of cardiovascular disease development.
Symptom burden in chronic kidney disease: a review of recent literature.

BACKGROUND People living with chronic kidney disease (CKD) experience multiple symptoms due to both the disease and its treatment. However, these symptoms are often underrecognised. In addition, the majority of studies have focused on an individual symptom; however, these symptoms rarely occur in isolation and may instead occur in clusters. AIM OF REVIEW To investigate the total symptom burden in advanced CKD (Stages 4 and 5) and to identify the key instruments that are used to assess multiple symptoms. METHODS A literature search from 2006 to 2012 was undertaken and a total of 19 articles were included. RESULTS The most common CKD symptoms were fatigue or lack of energy, feeling drowsy, pain and pruritus. However, symptom assessment instruments varied between studies, often with inconsistent or inadequate symptom dimensions. CONCLUSION People with CKD experience a high symptom burden, although little is known about the burden for people with CKD Stage 4 and for those with CKD Stage 5 receiving peritoneal dialysis. This review recommends that a full range of symptoms be assessed for those at different stages of CKD. Improved understanding of the burden of symptoms can be used as the basis for treatment choices and for identifying priorities which are likely to contribute to a better quality of life and improve the quality of care.
The safer clinical systems project in renal care.

BACKGROUND Current systems in place in healthcare are designed to detect harm after it has happened (e.g critical incident reports) and make recommendations based on an assessment of that event. Safer Clinical Systems, a Health Foundation funded project, is designed to proactively search for risk within systems, rather than being reactive to harm. OBJECTIVES The aim of the Safer Clinical Systems project in Renal Care was to reduce the risks associated with shared care for patients who are undergoing surgery but are looked after peri-operatively by nephrology teams on nephrology wards. This report details our findings of the diagnostic phase of Safer Clinical Systems: the proactive search for risk. METHODS We have evaluated the current system of care using a set of risk evaluation and process mapping tools (Failure Modes and Effects Analysis (FMEA) and Hierarchical Task Analysis HTA). RESULTS We have engaged staff with the process mapping and risk assessment tools. We now understand our system and understand where the highest risk tasks are undertaken during a renal in-patient stay during which a patient has an operation. These key tasks occur across the perioperaive period and are not confined to one aspect of care. A measurement strategy and intervention plan have been designed around these tasks. CONCLUSION Safer Clinical Systems has identified high risk, low reliability tasks in our system. We look forward to fully reporting these data in 2014.
Predictors of psychological distress, sexual dysfunction and physical functioning among women with upper extremity lymphedema related to breast cancer

Sixty‐nine women presenting for rehabilitation treatment for upper extremity lymphedema (UEL) were assessed by physical examination and validated self‐report assessment instruments measuring demographics, psychological distress, sexual functioning, social support, coping style, pain and functional status. Statistical analyses revealed that women with UEL had high levels of psychological distress, and high levels of sexual, functional and social dysfunction. There were no linear relationships between severity of UEL and levels of distress. Women with UEL in their dominant hand, however, had more distress and less overall sexual satisfaction than those with UEL in their non‐dominant limb. Women with pain of any intensity were the most distressed, and had the most significant difficulties in psychological and physical functioning. Women with pain also perceived significantly less interpersonal support than those without pain. Virtually none were receiving pain treatment. An avoidant coping style and low perceived social support were significant correlates of psychological distress. UEL poses significant functional, social and sexual functioning problems in women following breast cancer treatment. An assessment of pain, as well as social support and coping, might help identify those in need of consultation by psychiatry and pain specialists. Patients may also benefit from psychological support and sexual therapy in addition to physical rehabilitation. A psycho‐educational and support group within the clinic may prevent the worsening of UEL through the adoption of preventive strategies, maximizing compliance with rehabilitative efforts, augmenting better coping methods through group support, decreasing isolation that accompanies the condition, and facilitating the identification of patients in need of formal consultation.
Treatment of Comatose Survivors of Out-of-hospital Cardiac Arrest With Induced Hypothermia

A BSTRACT Background Cardiac arrest outside the hospital is common and has a poor outcome. Studies in laboratory animals suggest that hypothermia induced shortly after the restoration of spontaneous circulation may improve neurologic outcome, but there have been no conclusive studies in humans. In a randomized, controlled trial, we compared the effects of moderate hypothermia and normothermia in patients who remained unconscious after resuscitation from outof-hospital cardiac arrest. Methods The study subjects were 77 patients who were randomly assigned to treatment with hypothermia (with the core body temperature reduced to 33°C within 2 hours after the return of spontaneous circulation and maintained at that temperature for 12 hours) or normothermia. The primary outcome measure was survival to hospital discharge with sufficiently good neurologic function to be discharged to home or to a rehabilitation facility. Results The demographic characteristics of the patients were similar in the hypothermia and normothermia groups. Twenty-one of the 43 patients treated with hypothermia (49 percent) survived and had a good outcome — that is, they were discharged home or to a rehabilitation facility — as compared with 9 of the 34 treated with normothermia (26 percent, P=0.046). After adjustment for base-line differences in age and time from collapse to the return of spontaneous circulation, the odds ratio for a good outcome with hypothermia as compared with normothermia was 5.25 (95 percent confidence interval, 1.47 to 18.76; P=0.011). Hypothermia was associated with a lower cardiac index, higher systemic vascular resistance, and hyperglycemia. There was no difference in the frequency of adverse events. Conclusions Our preliminary observations suggest that treatment with moderate hypothermia appears to improve outcomes in patients with coma after resuscitation from out-of-hospital cardiac arrest. (N Engl J Med 2002;346:557-63.)
Military- and sports-related mild traumatic brain injury: an overview

Concussions are more serious than previously believed, and awareness of this fact has been increasing in both military and sports settings. Also known as mild traumatic brain injury (mTBI), concussions often occur multiple times in the same service member or athlete. These brain injuries can seriously and negatively affect patients, leading to changes in personality, sleep problems, and cognitive impairments. They can also increase the risk for suicide, posttraumatic stress disorder, depression, and anxiety. In some people, repetitive mTBI can lead to chronic traumatic encephalopathy (CTE), a neurodegenerative disorder. Evidence-based treatments are needed for both mTBI and CTE. Currently, symptom management and patient education are the best strategies to help those who have received multiple concussions. Education about preventing concussions and the use of return-to-play guidelines are especially important for young athletes. Language: en
Physicians' Attitudes Toward Reporting Medical Errors-An Observational Study at a General Hospital in Saudi Arabia

Objective: Accurate medical error reporting is crucial for reducing the occurrence of such errors and their adverse consequences. This study aims to investigate the views of physicians about medical error reporting in a tertiary care hospital in Saudi Arabia. Methods: This is a cross-sectional self-administrated survey study. All physicians in the hospital were invited to complete an anonymous survey questionnaire addressing demographic details, as well as attitudes, practice, and views on medical error reporting. Results: One hundred seven physicians completed the questionnaires (66.5% response rate). Mean (SD) age was 39.8 (9.0) years. One-fifth of the respondents worked in the emergency department, and half had a workload of 40 to 59 h/wk. The reason given by 41.1% for not reporting a medical error by a colleague was that "it is not their responsibility. " However, the gravity of the outcome of a medical error by a colleague to the patient was thought to be an important incentive for reporting. Of the physicians, 43% agreed that they would conceal the occurrence of a medical error they incurred to "avoid punishment. " Nevertheless, most of the respondents held the view that there exists an ethical underpinning for reporting medical errors and that reporting of medical errors serve a valuable purpose. Conclusions: The physicians in our study are likely to disclose errors made by a colleague only if the error resulted in a severe damage to the patient, and as such, medical errors go underreported for a variety of reasons. It was felt that assurance of confidentiality and protection from backlash would promote medical error disclosure.