Miracle-dz/UniFAR-FTUs huggingface dataset:
The West Nile Virus Encephalitis Outbreak in the United States (1999‐2000)

Abstract: Viruses cause most forms of encephalitis. The two main types responsible for epidemic encephalitis are enteroviruses and arboviruses. The City of New York reports about 10 cases of encephalitis yearly. Establishing a diagnosis is often difficult. In August 1999, a cluster of five patients with fever, confusion, and weakness were admitted to a community hospital in Flushing, New York. Flaccid paralysis developed in four of the five patients, and they required ventilatory support. Three, less severe, cases presented later in the same month. An investigation was conducted by the New York City (NYC) and New York State (NYS) health departments and the national Centers for Disease Control and Prevention (CDC). The West Nile virus (WNV) was identified as the etiologic agent. WNV is an arthropod‐borne flavivirus, with a geographic distribution in Africa, the Middle East, and southwestern Asia. It has also been isolated in Australia and sporadically in Europe but never in the Americas. The majority of people infected have no symptoms. Fever, severe myalgias, headache, conjunctivitis, lymphadenopathy, and a roseolar rash can occur. Rarely, encephalitis or meningitis is seen. The NYC outbreak resulted in the first cases of WNV infection in the Western Hemisphere and the first arboviral infection in NYC since yellow fever in the nineteenth century. The WNV is now a public health concern in the United States.
Cost-effectiveness of optimizing prevention in patients with coronary heart disease: the EUROASPIRE III health economics project.

AIMS The EUROASPIRE III survey indicated that the guidelines on cardiovascular disease prevention are poorly implemented in patients with established coronary heart disease (CHD). The purpose of this health economic project was to assess the potential clinical effectiveness and cost-effectiveness of optimizing cardiovascular prevention in eight EUROASPIRE III countries (Belgium, Bulgaria, Croatia, Finland, France, Italy, Poland, and the U.K.). METHODS AND RESULTS The individual risk for subsequent cardiovascular events was estimated, based on published Framingham equations. Based on the EUROASPIRE III data, the type of suboptimal prevention, if any, was identified for each individual, and the effects of optimized tailored prevention (smoking cessation, diet and exercise, better management of elevated blood pressure and/or LDL-cholesterol) were estimated. Costs of prevention and savings of avoided events were based on country-specific data. A willingness to pay threshold of €30,000/quality-adjusted life year (QALY) was used. The robustness of the results was validated by sensitivity analyses. Overall, the cost-effectiveness analyses for the eight countries showed mainly favourable results with an average incremental cost-effectiveness ratio (ICER) of €12,484 per QALY. Only in the minority of patients at the lowest risk for recurrent events, intensifying preventive therapy seems not cost-effective. Also, the single impact of intensified cholesterol control seems less cost-effective, possibly because their initial 2-year risk was already fairly low, hence the room for improvement is rather limited. CONCLUSION These results underscore the societal value of optimizing prevention in most patients with established CHD, but also highlight the need for setting priorities towards patients more at risk and the need for more studies comparing intensified prevention with usual care in these patients.
Quantification of l‐carvone in toothpastes available on the Swedish market

Toothpastes have widespread use in the population, and contain flavours to give a pleasant and often minty aroma. Flavours are prevalent allergens in toothpastes, and adverse reactions often present as perioral dermatitis or stomatitis. l‐Carvone, a mint flavour found in spearmint oil, is one of these allergens. There are few studies on contact allergy to l‐carvone, and some of them have indicated a positive relationship with oral lichenoid lesions.
Coverage of nevirapine-based services to prevent mother-to-child HIV transmission in 4 African countries.

CONTEXT Few studies have objectively evaluated the coverage of services to prevent transmission of human immunodeficiency virus (HIV) from mother to child. OBJECTIVE To measure the coverage of services to prevent mother-to-child HIV transmission in 4 African countries. DESIGN, SETTING, AND PATIENTS Cross-sectional surveillance study of mother-infant pairs using umbilical cord blood samples collected between June 10, 2007, and October 30, 2008, from 43 randomly selected facilities (grouped as 25 service clusters) providing delivery services in Cameroon, Côte d'Ivoire, South Africa, and Zambia. All sites used at least single-dose nevirapine to prevent mother-to-child HIV transmission and some sites used additional prophylaxis drugs. MAIN OUTCOME MEASURE Population nevirapine coverage, defined as the proportion of HIV-exposed infants in the sample with both maternal nevirapine ingestion (confirmed by cord blood chromatography) and infant nevirapine ingestion (confirmed by direct observation). RESULTS A total of 27,893 cord blood specimens were tested, of which 3324 were HIV seropositive (12%). Complete data for cord blood nevirapine results were available on 3196 HIV-seropositive mother-infant pairs. Nevirapine coverage varied significantly by site (range: 0%-82%). Adjusted for country, the overall coverage estimate was 51% (95% confidence interval [CI], 49%-53%). In multivariable analysis, failed coverage of nevirapine-based services was significantly associated with maternal age younger than 20 years (adjusted odds ratio [AOR], 1.44; 95% CI, 1.18-1.76) and maternal age between 20 and 25 years (AOR, 1.28; 95% CI, 1.07-1.54) vs maternal age of older than 30 years; 1 or fewer antenatal care visits (AOR, 2.91; 95% CI, 2.40-3.54), 2 or 3 antenatal care visits (AOR, 1.93; 95% CI, 1.60-2.33), and 4 or 5 antenatal care visits (AOR, 1.56; 95% CI, 1.34-1.80) vs 6 or more antenatal care visits; vaginal delivery (AOR, 1.22; 95% CI, 1.03-1.44) vs cesarean delivery; and infant birth weight of less than 2500 g (AOR, 1.34; 95% CI, 1.11-1.62) vs birth weight of 3500 g or greater. CONCLUSION In this random sampling of sites with services to prevent mother-to-child HIV transmission, only 51% of HIV-exposed infants received the minimal regimen of single-dose nevirapine.
Abstract 137: A Photoplethysmography Signal Can Show the Presence of a Spontaneous Pulse at Sub--Life-Supporting Blood Pressure During Experimental Cardiopulmonary Resuscitation

Introduction: Detecting return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR) is challenging, time-consuming and interrupts chest compressions. Previously, in pigs undergoing 30:2 automated-CPR, we have shown that a spontaneous pulse can be recognized in a photoplethysmography (PPG) signal during compressions, supporting ROSC detection. When a spontaneous pulse appeared in the PPG signal during compressions, complexity of the signal increased, as frequency components associated with the spontaneous pulse appeared in addition to compression frequency components (Fig. 1). Here we determine at what arterial blood pressure (ABP) a spontaneous pulse appears. Methods: We analyzed data from 9 pigs. The ABP was measured in the aortic arch. We calculated the mean arterial pressure (MAP) over 2.4 s (4 compression periods). We determined the MAP when a spontaneous pulse appeared in the PPG signal for the first time, the average MAP in the interval with increased complexity of the PPG si.
Implementation of Medicare Part D and nondrug medical spending for elderly adults with limited prior drug coverage.

CONTEXT Implementation of Medicare Part D was followed by increased use of prescription medications, reduced out-of-pocket costs, and improved medication adherence. Its effects on nondrug medical spending remain unclear. OBJECTIVE To assess differential changes in nondrug medical spending following the implementation of Part D for traditional Medicare beneficiaries with limited prior drug coverage. DESIGN, SETTING, AND PARTICIPANTS Nationally representative longitudinal survey data and linked Medicare claims from 2004-2007 were used to compare nondrug medical spending before and after the implementation of Part D by self-reported generosity of prescription drug coverage before 2006. Participants included 6001 elderly Medicare beneficiaries from the Health and Retirement Study, including 2538 with generous and 3463 with limited drug coverage before 2006. Comparisons were adjusted for sociodemographic and health characteristics and checked for residual confounding by conducting similar comparisons for a control cohort from 2002-2005. MAIN OUTCOME MEASURE Nondrug medical spending assessed from claims, in total and by type of service (inpatient and skilled nursing facility vs physician services). RESULTS Total nondrug medical spending was differentially reduced after January 1, 2006, for beneficiaries with limited prior drug coverage (-$306/quarter [95% confidence interval {CI}, -$586 to -$51]; P = .02), relative to beneficiaries with generous prior drug coverage. This differential reduction was explained mostly by differential changes in spending on inpatient and skilled nursing facility care (-$204/quarter [95% CI, -$447 to $2]; P = .05). Differential reductions in spending on physician services (-$67/quarter [95% CI, -$134 to -$5]; P = .03) were not associated with differential changes in outpatient visits (-0.06 visits/quarter [95% CI, -0.21 to 0.08]; P = .37), suggesting reduced spending on inpatient physician services for beneficiaries with limited prior drug coverage. In contrast, nondrug medical spending in the control cohort did not differentially change after January 1, 2004, for beneficiaries with limited prior drug coverage in 2002 ($14/quarter [95% CI, -$338 to $324]; P = .93), relative to beneficiaries with generous prior coverage. CONCLUSION Implementation of Part D was associated with significant differential reductions in nondrug medical spending for Medicare beneficiaries with limited prior drug coverage.
Use of radioactive iodine for thyroid cancer.

CONTEXT Substantial uncertainty persists about the indications for radioactive iodine for thyroid cancer. Use of radioactive iodine over time and the correlates of its use remain unknown. OBJECTIVE To determine practice patterns, the degree to which hospitals vary in their use of radioactive iodine, and factors that contribute to this variation. DESIGN, SETTING, AND PATIENTS Time trend analysis of radioactive iodine use in a cohort of 189,219 patients with well-differentiated thyroid cancer treated at 981 hospitals associated with the US National Cancer Database between 1990 and 2008. We used multilevel analysis to assess the correlates of patient and hospital characteristics on radioactive iodine use in the cohort treated from 2004 to 2008. MAIN OUTCOME MEASURE Use of radioactive iodine after total thyroidectomy. RESULTS Between 1990 and 2008, across all tumor sizes, there was a significant increase in the proportion of patients with well-differentiated thyroid cancer receiving radioactive iodine (1373/3397 [40.4%] vs 11,539/20,620 [56.0%]; P < .001). Multivariable analysis of patients treated from 2004 to 2008 found that there was a statistical difference in radioactive iodine use between American Joint Committee on Cancer stages I and IV (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.31-0.37) but not between stages II/III and IV (for stage II vs stage IV, OR, 0.97; 95% CI, 0.88-1.07 and for stage III vs stage IV, OR, 1.06; 95% CI, 0.95-1.17). In addition to patient and tumor characteristics, hospital volume was associated with radioactive iodine use. Wide variation in radioactive iodine use existed, and only 21.1% of this variation was accounted for by patient and tumor characteristics. Hospital type and case volume accounted for 17.1% of the variation. After adjusting for available patient, tumor, and hospital characteristics, 29.1% of the variance was attributable to unexplained hospital characteristics. CONCLUSION Among patients treated for well-differentiated thyroid cancer at hospitals in the National Cancer Database, there was an increase in the proportion receiving radioactive iodine between 1990 and 2008; much of the variation in use was associated with hospital characteristics.
Chronic kidney disease and statin therapy: to treat or not to treat?

This editorial refers to ‘Effect of statin therapy on cardiovascular and renal outcomes in patients with chronic kidney disease: a systematic review and meta-analysis’[†][1], by W. Hou et al. , on page 1807 Scientific knowledge and available good quality studies are ranked according to an accepted ‘evidence ladder’. The ladder is headed by a randomized controlled trial (RCT), if possible confirmed by a second, followed by prospective cohort studies and case–control studies. The latter are observational studies, usually subject to bias and confounding. In case the evidence is insufficient or of moderate quality, systematic reviews are undertaken, in order to integrate the available knowledge into a meta-analysis which then goes to the top of the hierarchy of evidence. Hou and colleagues now present a meta-analysis from a therapeutic area which has been studied most extensively in clinical medicine.1 The evidence is abundant and the issue of statin therapy for elevated LDL-cholesterol in persons from the general population is considered as being solved.2 Apparently this is not the case for patients with chronic kidney disease (CKD), and the debate on who to treat and not to treat is ongoing. Thus, the analyses of Hou and colleagues contribute to solving these uncertainties. In their analysis, statin therapy produced a 23% reduction in the risk of major cardiovascular events (but not cerebrovascular disease) or an 18% per 1 mmol/L lowering of LDL-cholesterol in patients with CKD including those receiving dialysis. These results may be discussed controversially among nephrologists caring for dialysis patients. It is important to recognize that in this meta-analysis, trials from non-dialysis and dialysis patients were combined, although the trials exhibit different levels of … [1]: #fn-2
Dental Panoramic Radiographs in Prediction of Osteoporosis in Postmenopausal Women

Osteoporosis is a skeletal disorder characterized by low bone mass and micro-architectural deterioration, with a resulting increase in bone fragility and susceptibility to fracture.Computer-aided diagnosis system is designed to measure mandibular inferior cortical width on dental panoramic radiographs and evaluation of the system efficacy in indentifying postmenopausal women with low skeletal bone mineral density.Mandibular inferior cortical width was measured by enhancing the original panoramic image,determining cortical boundaries,and evaluating distance between the upper and the lower boundaries in the region of interest by using the MATLAB (Matrix Laboratory)software.The distance measured is compared with the DXA(dual energy absorptiometry) scan report to determine the osteoporosis. Keywords—Osteoporosis, Low bone mineral density, Panoramic radiograph, Mandibular cortical width, Matlab, DXA.
Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease

Aims The first aim was to critically evaluate the extent to which familial hypercholesterolaemia (FH) is underdiagnosed and undertreated. The second aim was to provide guidance for screening and treatment of FH, in order to prevent coronary heart disease (CHD). Methods and results Of the theoretical estimated prevalence of 1/500 for heterozygous FH, <1% are diagnosed in most countries. Recently, direct screening in a Northern European general population diagnosed approximately 1/200 with heterozygous FH. All reported studies document failure to achieve recommended LDL cholesterol targets in a large proportion of individuals with FH, and up to 13-fold increased risk of CHD. Based on prevalences between 1/500 and 1/200, between 14 and 34 million individuals worldwide have FH. We recommend that children, adults, and families should be screened for FH if a person or family member presents with FH, a plasma cholesterol level in an adult ≥8 mmol/L(≥310 mg/dL) or a child ≥6 mmol/L(≥230 mg/dL), premature CHD, tendon xanthomas, or sudden premature cardiac death. In FH, low-density lipoprotein cholesterol targets are <3.5 mmol/L(<135 mg/dL) for children, <2.5 mmol/L(<100 mg/dL) for adults, and <1.8 mmol/L(<70 mg/dL) for adults with known CHD or diabetes. In addition to lifestyle and dietary counselling, treatment priorities are (i) in children, statins, ezetimibe, and bile acid binding resins, and (ii) in adults, maximal potent statin dose, ezetimibe, and bile acid binding resins. Lipoprotein apheresis can be offered in homozygotes and in treatment-resistant heterozygotes with CHD. Conclusion Owing to severe underdiagnosis and undertreatment of FH, there is an urgent worldwide need for diagnostic screening together with early and aggressive treatment of this extremely high-risk condition.
Guías de manejo de enfermedad pericárdica y miocarditis

Pericardium is a structure that can be primarily affected by a series of different agents and in a secondary way by systemic processes. Its response is not specific and in general it corresponds to an inflammatory process that can be acute, chronic or recurrent. The recognition of these pathologies is of vital significance in the making of a right therapeutic approach. Some basic orientations for the correct classification, diagnosis and therapy of main pericardial syndromes, based on clinical and etiological aspects and paraclinical available aids are presented. Likewise, some recommendations for the specific treatment of each one of the main entities usually affecting the pericardium are given. Next, a brief mention of some physiopathological aspects of acute myocarditis, its main etiologies, and the treatment of the cardiac failure secondary to the disease with its specific differences, is made, and the controversy on its handling with immunosuppressors and the experimental therapy measures are studied in depth. We intended to follow until possible the recommendations of medicine based on evidence with grades already recognized in international medical literature.
Comparison of three‐dimensional high‐resolution manometry and endoanal ultrasound in the diagnosis of anal sphincter defects

Three‐dimensional high‐resolution anorectal manometry (3D HRAM) is a new technique that can simultaneously provide physiological and topographical data. Our aim was to assess whether it can identify anal sphincter defects by comparing it with endoanal ultrasonography (EUS) considered as the gold standard.
Monocyte subset accumulation in the human heart following acute myocardial infarction and the role of the spleen as monocyte reservoir.

AIMS Monocytes are critical mediators of healing following acute myocardial infarction (AMI), making them an interesting target to improve myocardial repair. The purpose of this study was a gain of insight into the source and recruitment of monocytes following AMI in humans. METHODS AND RESULTS Post-mortem tissue specimens of myocardium, spleen and bone marrow were collected from 28 patients who died at different time points after AMI. Twelve patients who died from other causes served as controls. The presence and localization of monocytes (CD14(+) cells), and their CD14(+)CD16(-) and CD14(+)CD16(+) subsets, were evaluated by immunohistochemical and immunofluorescence analyses. CD14(+) cells localized at distinct regions of the infarcted myocardium in different phases of healing following AMI. In the inflammatory phase after AMI, CD14(+) cells were predominantly located in the infarct border zone, adjacent to cardiomyocytes, and consisted for 85% (78-92%) of CD14(+)CD16(-) cells. In contrast, in the subsequent post-AMI proliferative phase, massive accumulation of CD14(+) cells was observed in the infarct core, containing comparable proportions of both the CD14(+)CD16(-) [60% (31-67%)] and CD14(+)CD16(+) subsets [40% (33-69%)]. Importantly, in AMI patients, of the number of CD14(+) cells was decreased by 39% in the bone marrow and by 58% in the spleen, in comparison with control patients (P = 0.02 and <0.001, respectively). CONCLUSIONS Overall, this study showed a unique spatiotemporal pattern of monocyte accumulation in the human myocardium following AMI that coincides with a marked depletion of monocytes from the spleen, suggesting that the human spleen contains an important reservoir function for monocytes.
The relation between quality of clinical trials and acupuncture efficacy

Introduction: Clinical trials of acupuncture not always have concordant results, mostly due to their great heterogeneity. Two indexes have been developed to analyze the quality of acupuncture trials. This study hypothesizes that, the more adequate the intervention and the control techniques, the more efficacious the acupuncture. Methods: Both indexes were applied to 27 randomized clinical trials comparing acupuncture to placebo. Results were compared by using the Mann-Whitney test. Results: Studies favorable to acupuncture had a intervention score’s median of 11.5; for the unfavorable ones, it was 7, p: 0.0017. Articles with and without statistically significant differences, though, had the same median for their scores in the control index: 6. Discussion: There is a positive relation between a better score for acupuncture technique and a statistically significant difference between acupuncture and interventional control. However, due to the little heterogeneity in the degree of physiological effect from each article, the control index had no statistical significance. Conclusion: This study established that, among acupuncture RCT controlled by placebo or sham of moderate physiological effect, the adequacy of the technique is more important than the adequacy of control in establishing a statistically significant difference between acupuncture and interventional control.
Radiation Protection: A Guide for Scientists, Regulators and Physicians

The author takes the novel approach of introducing the whole range of energies possessed by particles and electromagnetic waves at the beginning of the text, thus integrating coverage of ionizing and nonionizing radiation rather than considering them as two separate disciplines. He goes on to cover the entire spectrum of radiation sources, including radionuclides, x-ray machines, accelerators, nuclear reactors, power lines, microwave towers, and cellular phones.
Hepatocellular carcinoma mimicking an atrial mixoma.

A 60-year-old female (P.G.) suffering from palpitations and dyspnoea was referred first to trans-thoracic echocardiography; then she was referred to trans-oesophageal echocardiography that indicated the presence of a right atrial mass that was classified as atrial mixoma (Supplementary material online, Movie S1 ). Because of the low cardiovascular risk, the patient was then referred to 64-slice Cardiac CT (CCT) to exclude the presence of obstructive coronary artery disease prior to open heart surgery. Cardiac CT showed normal coronary arteries ( Panels …
Vitamin E and the Risk of Prostate Cancer The Selenium and Vitamin E Cancer Prevention Trial ( SELECT )

Eric A. Klein, MD Ian M. Thompson Jr, MD Catherine M. Tangen, DrPH John J. Crowley, PhD M. Scott Lucia, MD Phyllis J. Goodman, MS Lori M. Minasian, MD Leslie G. Ford, MD Howard L. Parnes, MD J. Michael Gaziano, MD, MPH Daniel D. Karp, MD Michael M. Lieber, MD Philip J. Walther, MD, PhD Laurence Klotz, MD J. Kellogg Parsons, MD, MHS Joseph L. Chin, MD Amy K. Darke, MS Scott M. Lippman, MD Gary E. Goodman, MD Frank L. Meyskens Jr, MD Laurence H. Baker, DO