Miracle-dz/UniFAR-FTUs huggingface dataset:
Skull-fixated fiducial markers improve accuracy in staged frameless stereotactic epilepsy surgery in children.

OBJECT Surgery to monitor and resect epileptogenic foci may be undertaken in 2 stages, providing an opportunity to use skull-fixated fiducials implanted during the first stage to improve the accuracy of cortical resection during the second stage. This study compared the intrinsic accuracy of skin-based and skull-fixated fiducial markers in registering frameless stereotaxy during pediatric epilepsy surgery. To the authors' knowledge, these modalities of registration have not previously been directly compared in this population. METHODS The authors undertook a retrospective review of pediatric patients who underwent resection of epileptogenic foci in 2 stages with frameless stereotactic assistance, performed by a single surgeon at Oregon Health & Science University. For the first stage (subdural grid implantation), 9 skin fiducial markers were used to register anatomical data in a frameless stereotactic station. Intraoperatively, four 3-mm screws were placed circumferentially around the craniotomy. Postoperatively, thin-slice brain MR and CT images were obtained and fused. For the second stage, the 4 screws were used as fiducial markers to register the stereotactic anatomical data. For both stages, accuracy (difference in millimeters from zero of the manual fiducial registration compared with the computer model) was determined using navigation software. The intrinsic accuracy of these 2 methods of fiducial registration was compared using a paired Student t-test. RESULTS Between 2004 and 2009, 40 pediatric patients with epilepsy underwent frameless stereotactic surgical procedures. Fourteen patients who had 2-stage procedures using skin-based and skull-fixated registration with complete accuracy data were included in this retrospective review. Mean registration error was significantly lower using skull-fixated fiducials (1.35 mm, 95% CI 1.09-1.60 mm) than using skin-based fiducials (1.85 mm, 95% CI 1.56-2.13 mm; p = 0.0016). CONCLUSIONS A significantly higher degree of accuracy was achieved using 4 skull-fixated fiducials compared with using 9 skin-based fiducials. This simple and accurate method for registering frameless stereotactic anatomical data does not involve the potential time, expense, discomfort, and morbidity of extraoperative skull-fixated fiducial placement. The method described in this paper could also be extrapolated to other planned 2-stage cranial surgical procedures such as combined skull base approaches.
Improving specialist drug prescribing in primary care using task and error analysis: an observational study.

BACKGROUND Electronic prescribing has benefited from computerised clinical decision support systems (CDSSs); however, no published studies have evaluated the potential for a CDSS to support GPs in prescribing specialist drugs. AIM To identify potential weaknesses and errors in the existing process of prescribing specialist drugs that could be addressed in the development of a CDSS. DESIGN AND SETTING Semi-structured interviews with key informants followed by an observational study involving GPs in the UK. METHOD Twelve key informants were interviewed to investigate the use of CDSSs in the UK. Nine GPs were observed while performing case scenarios depicting requests from hospitals or patients to prescribe a specialist drug. Activity diagrams, hierarchical task analysis, and systematic human error reduction and prediction approach analyses were performed. RESULTS The current process of prescribing specialist drugs by GPs is prone to error. Errors of omission due to lack of information were the most common errors, which could potentially result in a GP prescribing a specialist drug that should only be prescribed in hospitals, or prescribing a specialist drug without reference to a shared care protocol. Half of all possible errors in the prescribing process had a high probability of occurrence. CONCLUSION A CDSS supporting GPs during the process of prescribing specialist drugs is needed. This could, first, support the decision making of whether or not to undertake prescribing, and, second, provide drug-specific parameters linked to shared care protocols, which could reduce the errors identified and increase patient safety.
Ischemia and No Obstructive Coronary Artery Disease (INOCA): Developing Evidence-Based Therapies and Research Agenda for the Next Decade

The Cardiovascular Disease in Women Committee of the American College of Cardiology, in conjunction with interested parties (from the National Heart, Lung, and Blood Institute, American Heart Association, and European Society of Cardiology), convened a working group to develop a consensus on the syndrome of myocardial ischemia with no obstructive coronary arteries. In general, these patients have elevated risk for a cardiovascular event (including acute coronary syndrome, heart failure hospitalization, stroke, and repeat cardiovascular procedures) compared with reference subjects and appear to be at higher risk for development of heart failure with preserved ejection fraction. A subgroup of these patients also has coronary microvascular dysfunction and evidence of inflammation. This document provides a summary of findings and recommendations for the development of an integrated approach for identifying and managing patients with ischemia with no obstructive coronary arteries and outlines knowledge gaps in the area. Working group members critically reviewed available literature and current practices for risk assessment and state-of-the-science techniques in multiple areas, with a focus on next steps needed to develop evidence-based therapies. This report presents highlights of this working group review and a summary of suggested research directions to advance this field in the next decade.
Dupuytren's disease

Abstract In the early 19th century, Guillaume Dupuytren described a flexion contracture in the palm and its surgical release. Since then, advances in understanding of the etiology, pathophysiology, anatomy, and surgical technique have refined the ability to restore function to those affected. By fully comprehending the pathoanatomy involved, careful surgical excision can lead to satisfactory results. Complication and recurrence rates, however, require that time be spent with patients preoperatively to educate them and adequately explain treatment goals. Copyright © 2003 by the American Society for Surgery of the Hand
Alteration of Cholinergic Anti‐Inflammatory Pathway in Rat With Ischemic Cardiomyopathy–Modified Electrophysiological Function of Heart

Background With chronic ischemia after myocardial infarction, the resulting scar tissue result in electrical and structural remodeling vulnerable to an arrhythmogenic substrate. The cholinergic anti‐inflammatory pathway elicited by vagal nerve via α7 nicotinic acetylcholine receptors (α7‐nAChR) can modulate local and systemic inflammatory responses. Here, we aimed to clarify a novel mechanism for the antiarrhythmogenic properties of vagal nerve during the ischemic cardiomyopathy (ICM). Methods and Results Left anterior descending artery of adult male Sprague‐Dawley rats was ligated for 4 weeks to develop ICM. Western blot revealed that eliciting the cholinergic anti‐inflammatory pathway by nicotine treatment showed a significant reduction in the amounts of collagens, cytokines, and other inflammatory mediators in the left ventricular infarcted border zone via inhibited NF‐κB activation, whereas it increased the phosphorylated connexin 43. Vagotomy inhibited the anti‐inflammatory, anti‐fibrosis, and anti‐arrhythmogenic effect of nicotine administration. And immunohistochemistry confirmed that the nicotine administration‐induced increase of connexin 43 was located in intercellular junctions. Furthermore nicotine treatment suppressed NF‐κB activation in lipopolysaccharide‐stimulated RAW264.7 cells, and α‐bungarotoxin (an α7‐nAChR selective antagonist) partly inhibited the nicotine‐treatment effect. In addition, 4‐week nicotine administration slightly improved the cardiac function, increased cardiac parasympathetic tone, decreased the prolonged QTc, and decreased the arrhythmia score of programmed electric stimulation‐induced ventricular arrhythmia. Conclusions Eliciting the cholinergic anti‐inflammatory pathway exerts anti‐arrhythmogenic effects against ICM‐induced ventricular arrhythmia accompanied by downregulation of cytokines, downgenerating of collagens, decrease in sympathetic/parasympathetic ratio, and prevention of the loss of phosphorylated connexin 43 during ICM. Our findings may suggest a promising therapy for the generation of ICM‐induced ventricular arrhythmia by eliciting the cholinergic anti‐inflammatory pathway.
Reconstructive Endovascular Treatment of Intracranial Fusiform Aneurysms: A 1-Stage Procedure with Stent and Balloon

BACKGROUND AND PURPOSE: Intracranial fusiform aneurysms, which incorporate the branch vessel and require salvaging of the parent vessel, are difficult to manage. The goal of this study was to evaluate the efficacy of reconstructive endovascular treatment of intracranial fusiform aneurysms by using a 1-stage procedure with a stent and balloon. MATERIALS AND METHODS: During a 3-year period, 20 patients with 20 intracranial fusiform aneurysms were treated by using a 1-stage procedure involving a balloon and stent. Subarachnoid hemorrhage was present in 15 patients. Five aneurysms were located in the anterior circulation and 15, in the posterior circulation. Clinical outcomes and periprocedural complications were evaluated in all patients. The extent of coil packing was evaluated by control angiography after embolization and classified as either complete occlusion or partial occlusion. Angiography was performed 6, 12, and 24 months after embolization to evaluate stent patency and coil packing. RESULTS: The 1-stage procedure by using a combination of balloon and stent was technically successful in all patients. There were no complications related to the procedure, complete occlusion was obtained in 16 patients, and partial occlusion, in 4 patients. All patients recovered well except for 2 who died due to causes unrelated to the procedure. Clinical follow-up was performed in all surviving patients at a mean of 12.3 months (range, 7–24 months), and angiography showed that the patent parent arteries were free of aneurysm recanalization or in-stent stenosis. CONCLUSIONS: This 1-stage procedure may provide a feasible and safe treatment strategy for the management of intracranial fusiform aneurysms that are not amenable to deconstructive embolization.
Implementation of a Liquid Chromatography Tandem Mass Spectrometry Assay for Eight Adrenal C-21 Steroids and Pediatric Reference Data

Background: Sensitive and accurate determination of steroids is essential for diagnosing congenital and acquired adrenal diseases. Since plasma concentrations change during childhood, age-specific reference ranges are the prerequisite for clinical interpretation. The objectives of this study were to develop a sensitive and reliable method for simultaneous detection and quantification of progesterone, 17-hydroxyprogesterone, deoxycorticosterone (DOC), 11-deoxycortisol, 21-deoxycortisol, corticosterone, cortisol (F) and cortisone (E) by ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) and to establish age- and sex-specific reference ranges from birth to adulthood. Methods: All eight steroids were measured simultaneously in 0.1 ml plasma by UPLC-MS/MS. Samples of 905 children were measured and grouped in five age groups. Results: The assay was linear up to 70 ng/ml (700 ng/ml for F; r2 > 0.992). The limit of detection ranged between 0.01 ng/ml for DOC and 0.07 ng/ml for E. Correlations with radioimmunoassays yielded a coefficient of determination between 0.82 and 0.99. Reference data are reported as a function of age and sex. Conclusions: The UPLC-MS/MS method presented here for the simultaneous detection of eight C-21 adrenal hormones together with the detailed reference ranges for children provides a valuable methodology for assessing adrenal steroids in clinical routine and research.
Incidence and risk factors of vascular dementia and Alzheimer's disease in a defined elderly Japanese population

Article abstract—We followed 828 nondemented residents of Hisayama Town, Kyushu, Japan, aged 65 years or older (88.3% of the elderly population) for 7 years starting in 1985 in order to determine the type-specific incidence of dementia and its risk factors in the general Japanese population. Only two subjects were lost to the follow-up, during which period 103 subjects developed dementia. Morphologic examination of the brains of 89 subjects (86.4%) was made by autopsy or CT. We made the initial diagnosis of dementia based on the DSM-111-R criteria, with the diagnoses of vascular dementia (VD) being based on the NINDS-AIREN criteria and Alzheimer's disease (AD) on the NINCDS-ADRDA criteria. The incidence of VD and AD increased with age for both sexes. The age-adjusted total incidence (per 1,000 person-years) of dementia was 19.3 for men and 20.9 for women. The corresponding rates for VD were 12.2 for men and 9.0 for women, and for AD, 5.1 for men and 10.9 for women. Among the VD subjects whose brain morphology we examined, the most frequent type of stroke was multiple lacunar infarcts (42%), but half these subjects lacked a stroke episode in their histories. Multivariate analysis showed that age, prior stroke episodes, systolic blood pressure, and alcohol consumption were significant independent risk factors for the occurrence of VD. In contrast, age and a low score on Hasegawa's dementia scale were significant risk factors for AD, and physical activity was a significant preventive factor for AD. Our findings suggest that asymptomatic stroke is an important factor in the development of VD, with age, prior stroke episodes, systolic blood pressure, and alcohol consumption being independent risk factors for its occurrence. Age and a low scare on Hasegawa's dementia scale are significant risk factors for AD, with moderate physical activity having a statistically significant preventive effect.
Attitudes Toward Aging of Physical Therapists and Student Physical Therapists

ABSTRACT Aims: Attitudes toward aging have been reported to guide patterns of practice in healthcare; however, the current attitudes toward aging in physical therapy are unknown. Methods: Physical therapist (PT) and student physical therapist (SPT) members of the American Physical Therapy Association were invited to complete an anonymous online survey using a modified version of the 14-item University of California, Los Angeles-Geriatric Attitudinal Scale (UCLA-GAS) to examine attitudes toward aging. Differences between responses on each item of the UCLA-GAS were completed between groups and within three categories commonly reported in the UCLA-GAS. Results: Significant differences were found between the responses of PTs and SPTs on half of the items of the UCLA-GAS. Conclusions: PTs had slightly more positive attitudes toward aging, which may be a reflection of time spent with older adults and familiarity with the economics of geriatric physical therapy practice.
Letter by Sacha regarding article, "clinical and genetic determinants of torsade de pointes risk".

To the Editor: I have read with a great interest the article by Sauer and Newton-Cheh addressing the important aspects of torsade de pointes (TdP). 1 The authors briefly and elegantly summarize clinical and genetic determinants of TdP. However, one more clinical context that may be related to TdP needs to be mentioned, namely, the QT interval prolongation in acute cardiac diseases associated with large amount of stunned myocardium, ie, the reperfused myocardial infarction and the group of stress-related …
Cardiac transplantation in British Columbia Standard malignancy screening and aggressive management of atherosclerotic risk factors are both needed after a heart transplant.

The first cardiac trans- plantation in the world was per- formed in 1967. Since then it has become standard therapy for end- stage heart failure with over 200 recipients in British Columbia over the past 20 years. Cardiac trans- plantation should be considered in individuals with advanced heart dis- ease who have a poor chance of long-term survival despite optimal medical or surgical therapy. Con- traindications to transplant include pulmonary hypertension, active in - fection, systemic illness, renal dys- function, recent malignancy, active smoking/substance abuse, or the inability to undergo rehabilitation. All patients require immunosuppres- sive therapy following transplanta- tion to prevent allograft rejection. In addition to rejection, common com- plications in the post-transplant period include infections, malignan- cy, post-transplant lymphoprolifera- tive disorder, and allograft coronary artery disease. Given the scarcity of available donor hearts in BC, efforts have been made recently to develop mechanical ventricular assist de - vices to support patients waiting for donor organs.
Cultural definitions of quality of care: Perspectives of Jordanian patients

A descriptive qualitative approach was used to develop a cultural definition of quality of care in clinical settings, and understand the phenomena of quality of care from Jordanian patients’ perspectives. The study was conducted in two major teaching hospitals located in the north of Jordan during the period of May–August 2008. The sample consisted of 26 patients who agreed to participate in the study. Understanding the phenomena of quality of care from a cultural perspective will help health care providers, locally and internationally, provide care to Jordanian and Arab immigrants in Western countries. Four main themes emerged from the data to reflect on patients’ perspectives of the quality of care. These themes were: (a) quality as excellence; (b) being caring and concerned; (c) the demonstration of ethical and professional conduct by health care providers; and (d) reflecting on negative experiences during hospitalisation. Findings from this study reflect what is important for Jordanian patients regarding quality of care, and added new dimensions to the definitions of quality of care, including the role of religion in shaping the ethical and professional aspects of quality of care. These new dimensions open the door for further research that focuses on incorporating social, cultural and spiritual aspects in the measurement of quality of care for the purpose of improving quality of care as determined by patients.
Left Ventricular Passive Diastolic Properties in Chronic Mitral Regurgitation

BackgroundIn chronic mitral regurgitation, the myocardium responds to the increased filling volume by geometric alteration and eccentric hypertrophy. This study was designed to evaluate the effects of a pure volume overload on left ventricular diastolic chamber and myocardial properties and to assess the relation of passive diastolic function to systolic ejection performance. Methods and ResultsBy use of simultaneous cineangiography and left ventricular micromanometry, left ventricular passive diastolic stiffness was evaluated in nine normal controls (group 1), 14 patients with chronic mitral regurgitation and a normal ejection fraction (.57%, group 2), and 13 patients with mitral regurgitation and a reduced ejection fraction (<57%, group 3). Passive diastolic function was evaluated by using a three-constant elastic model. Left ventricular chamber properties were represented by the relation of pressure to volume; myocardial properties were evaluated by relating myocardial midwall stress to midwall strain. The constant of left ventricular chamber stiffness was decreased in group 2 compared with controls (p<0.05) but it was normal in group 3. The constant of myocardial stiffness was increased in group 3 compared with groups 1 and 2 (p<0.01). Among patients with mitral regurgitation, there was a significant inverse relation between ejection fraction and the constant of myocardial stiffness (r= −0.83). ConclusionsThe chronic adaptation to volume overload in chronic mitral regurgitation tends to decrease left ventricular chamber stiffness. Patients with mitral regurgitation and a depressed ejection fraction demonstrated diastolic myocardial dysfunction. Compromised diastolic function in patients with chronic mitral regurgitation and reduced systolic performance may contribute to the clinical manifestations of congestive heart failure. (Circulation 1991;83:797–807)
A Review of the Role of Sensors in Mobile Context-Aware Recommendation Systems

Recommendation systems are specialized in offering suggestions about specific items of different types (e.g., books, movies, restaurants, and hotels) that could be interesting for the user. They have attracted considerable research attention due to their benefits and also their commercial interest. Particularly, in recent years, the concept of context-aware recommendation system has appeared to emphasize the importance of considering the context of the situations in which the user is involved in order to provide more accurate recommendations. The detection of the context requires the use of sensors of different types, which measure different context variables. Despite the relevant role played by sensors in the development of context-aware recommendation systems, sensors and recommendation approaches are two fields usually studied independently. In this paper, we provide a survey on the use of sensors for recommendation systems. Our contribution can be seen from a double perspective. On the one hand, we overview existing techniques used to detect context factors that could be relevant for recommendation. On the other hand, we illustrate the interest of sensors by considering different recommendation use cases and scenarios.
The Efficacy and Safety of Combination Salmeterol (50 μg)/Fluticasone Propionate (500 μg) Inhalation Twice Daily Via Accuhaler in Chinese Patients With COPD

Background Few studies of the efficacy and safety of therapy with combinations of salmeterol/fluticasone propionate (SFCs) have been conducted in Chinese patients with COPD, and the benefits of combination therapy in nonsmoking patients with COPD are, to our knowledge, not known. Study objectives The aims were to establish the efficacy and tolerability of the therapy with SFC (salmeterol, 50 μg/fluticasone, 500 μg, twice daily) in the management of Chinese COPD patients and to investigate the effectiveness of SFC in nonsmokers with COPD. Methods and patients This was a randomized, double-blind, placebo-controlled, parallel-group, multicenter study. Changes in prebronchodilator and postbronchodilator FEV 1 , quality of life determined by the St. George Respiratory Questionnaire (SGRQ) scores, relief bronchodilator use, nighttime awakenings, and frequency of exacerbations of COPD were measured in patients randomized to receive SFC (n = 297) or placebo (n = 148). Never-smokers, former smokers, and current smokers accounted for 11.7%, 66.7%, and 21.6%, respectively, of the study population. Results After 24 weeks, the mean changes in prebronchodilator and postbronchodilator FEV 1 were 180 mL (95% confidence interval [CI], approximately 91 to 268; p 0.05). The mean improvement in the total SGRQ score for the SFC group was 5.74 (p Conclusions SFC therapy achieved sustained improvement in lung function, quality of life, and control of symptoms, and was well tolerated in Chinese patients. Greater improvements in lung function were found only for COPD patients with a history of smoking. Trial registration http://ctr.gsk. co.uk/Summary/fluticasone_salmeterol/studylist.asp Identifier: No. SCO100540.