Miracle-dz/UniFAR-FTUs huggingface dataset:
The Medical Emergency Team Call: A Sentinel Event That Triggers Goals of Care Discussion*

Objective:Several studies have questioned the effectiveness of rapid-response systems when measured by outcomes such as decreased overall hospital mortality or cardiac arrest rates. We studied an alternative outcome of rapid-response system implementation, namely, its effect on goals of care and designation of do not resuscitate. Design:Retrospective chart review. Setting:Veterans Administration Hospital in New York City. Subjects:All patients requiring a medical emergency team call. Interventions:None Measurements and Main Results:Monthly hospital census and discharge data, death occurrences, and do-not-resuscitate order placements were collected over an 8-year pre-medical emergency team and 5-year post-medical emergency team period. All medical emergency team calls and subsequent transfers to a critical care unit were reviewed and correlated to the placement and timing of do-not-resuscitate orders. Interrupted time-series analysis was used to evaluate the impact of the medical emergency team implementation on the change in trend of do-not-resuscitate orders and the hospital mortality. A total of 390 medical emergency team calls were associated with 109 do-not-resuscitate orders (28%). Of the 209 medical emergency team calls (54%) resulting in transfer to a critical care unit, 66 were associated with do-not-resuscitate orders, 73% of which were obtained after transfer. The odds of becoming do not resuscitate for a patient going to the ICU after the medical emergency team call were 2.9 (95% CI, 1.6–5.5; p = 0.001) times greater than for patients staying on the floors after the medical emergency team call. The medical emergency team implementation significantly changed the trend of do-not-resuscitate orders (p < 0.001) but had no impact on hospital mortality rate (p = 0.638). Conclusion:Implementation of a rapid-response system was associated with an increase in do-not-resuscitate order placement. As a sentinel event, medical emergency team activation and transfer to a critical care unit foster consideration of goals of care and frequently results in a transition to a palliative care strategy.
Cytokines and beta-cell destruction

Several genetic and environmental factors appear to cooperate to precipitate type1 diabetes, a spontaneous autoimmune disease in humans and in the nonobese diabetic (NOD) mouse. NOD mice, like type1 diabetic patients, develop insulitis, an early infiltration of leukocytes into the pancreas that leads to inflammatory lesions within the islets. However, overt type1 diabetes requires the subsequent destruction of the vast majority of insulin producing islet β-cells, a process mediated by activation of autoreactive T-helper type1CD4 and subsequently, CD8 Tcells.
Filterless integrated class-D audio amplifier achieving 0.0012% THD+N and 96dB PSRR when supplying 1.2W

High power efficiency, small size and reduced heat dissipation are highly desirable in battery-powered mobile systems and switched-mode class-D amplifiers can readily satisfy these requirements. However, full adoption of class-D technology in mobile systems has been somewhat limited due to concerns such as signal distortion and noise, poor power supply noise rejection, electromagnetic interference (EMI) and the requirement for external LC filters.
Venous thromboemboli and exacerbations of COPD

The aim of the present study was to determine the prevalence of and risk factors for venous thromboembolism (VTE) in exacerbations of chronic obstructive pulmonary disease (COPD). COPD patients hospitalised with an exacerbation were included consecutively. Symptoms, signs and clinical, haematological and epidemiological parameters on admission were noted. All patients underwent computed tomographic angiography and ultrasonographic examination for deep vein thrombosis and pulmonary embolism (PE). Wells and Geneva scores were calculated. Patients were followed-up for 1 yr in order to determine mortality. Deep vein thrombosis and PE were detected in 14 and 18 patients, respectively. The prevalence of VTE was three times higher in patients with an exacerbation of unknown origin than in patients with an exacerbation of known origin (p = 0.016). Of patients with VTE, 20 (95%) had high D-dimer levels. The negative predictive value of D-dimer testing was 0.98. Although the moderate- and high-risk categories of both the Wells and Geneva methods covered all PE patients, the Wells method identified 49% less potential patients for PE investigation. Mortality at 1 yr was higher (61.9% versus 31.8%) in VTE patients (p = 0.013). VTE is a common problem in COPD patients hospitalised with an exacerbation, leading to high long-term mortality. D-dimer levels and the Wells criteria can be used to determine whether or not these patients are assessed for a thromboembolic event.
The meningococcal autotransporter AutA is implicated in autoaggregation and biofilm formation.

Autotransporters (ATs) are proteins secreted by Gram-negative bacteria that often play a role in virulence. Eight different ATs have been identified in Neisseria meningitidis, but only six of them have been characterized. AutA is one of the remaining ATs. Its expression remains controversial. Here, we show that the autA gene is present in many neisserial species, but its expression is often disrupted by various genetic features; however, it is expressed in certain strains of N. meningitidis. By sequencing the autA gene in large panels of disease isolates and Western blot analysis, we demonstrated that AutA expression is prone to phase variation at AAGC nucleotide repeats located within the DNA encoding the signal sequence. AutA is not secreted into the extracellular medium, but remains associated with the bacterial cell surface. We further demonstrate that AutA expression induces autoaggregation in a process that, dependent on the particular strain, may require extracellular DNA (eDNA). This property influences the organization of bacterial communities like lattices and biofilms. In vitro assays evidenced that AutA is a self-associating AT that binds DNA. We suggest that AutA-mediated autoaggregation might be particularly important for colonization and persistence of the pathogen in the nasopharynx of the host.
Performance Evaluation of Innovatively Reengineered Process in Cardiology Hospital using Devil's Quadrangle

Medical industry is of vital importance as it deals with the health affairs of humanity, an effort to contribute the assistance with respect to saving of health, wealth and time of the individual and the system (community). In cardiology hospital patients and attendants normally face many troubles (problems) while seeking the treatment for their disease, like access to proper place, excess of waiting time, lack of information in admin and control etc. It is necessary to reengineer tasks hierarchy and sequence in cardiology sector for solving patient’s problems and saving the financial cost. Business process reengineering recovers the procedures of the business process including its improvement. In this paper we present a case study of cardiology hospital named Armed Forces Institute of Cardiology and National Institute of Heart Diseases” (AFIC-NIHD). First of all we reengineer tasks and present them with the help of workflow optimization tool called Bonita Soft. And then calculate the performance of all reengineered tasks using four parameters like cost, quality, time and flexibility with the help of devil’s quadrangle. We have explored how workflow reengineering steps effect on these four parameters and how this reengineering methodology implementation is fruitful.
Inactivation of I(A) channels of frog skeletal muscle is modulated by ATP.

Whole cell, voltage clamp experiments were performed in vesicles derived from frog skeletal muscle plasma membranes to characterize the influence of ATP on the kinetic properties of fast inactivating K(+) currents (I(A)). I(A) was recorded in ATP-free solutions. Peak I(A) decayed with a time constant of 27 ms at large depolarizations. Steady state inactivation reached half maximal values at -66 mV. In the presence of ATP, these values were 196 ms and -41 mV, respectively, indicating a major effect of ATP on inactivation. In contrast, activation of I(A) was unaffected by ATP. The protein kinase C (PKC) inhibitors, H7 and staurosporine, greatly prevented the effects of ATP on inactivation. Inactivation remained unchanged by the protein kinase A inhibitor HA1004 or by the catalytic subunit of cAMP protein kinase. We conclude that ATP decreases inactivation of skeletal muscle I(A) and that this effect may be mediated by protein kinase C.
Heat induced changes in protein expression profiles of Norway spruce (Picea abies) ecotypes from different elevations

Although tree species typically exhibit low genetic differentiation between populations, ecotypes adapted to different environmental conditions can vary in their capacity to withstand and recover from environmental stresses like heat stress. Two month old seedlings of a Picea abies ecotype adapted to high elevation showed lower level of thermotolerance and higher level of tolerance to oxidative stress relative to a low elevation ecotype. Protein expression patterns following exposure to severe heat stress of the two ecotypes were compared by means of 2‐DE. Several proteins exhibiting ecotype and tissue specific expression were identified by MS/MS. Among them, small heat shock proteins of the HSP 20 family and proteins involved in protection from oxidative stress displayed qualitative and quantitative differences in expression between the ecotypes correlated with the observed phenotypic differences. On the basis of these results, it can be speculated that the observed interpopulation polymorphism of protein regulation in response to heat stress could underlie their different capacities to withstand and recover from heat stress. These local adaptations are potentially relevant for the species adaptation to the conditions predicted by the current models for climate change.
Topographic differences in adult neurogenesis in the mouse hippocampus: A stereology‐based study using endogenous markers

The hippocampus plays a critical role in various cognitive and affective functions. Increasing evidence shows that these functions are topographically distributed along the dorsoventral (septotemporal) and transverse axes of the hippocampus. For instance, dorsal hippocampus is involved in spatial memory and learning whereas ventral hippocampus is related to emotion. Here, we examined the topographic differences (dorsal vs. ventral; suprapyramidal vs. infrapyramidal) in adult neurogenesis in the mouse hippocampus using endogenous markers. The optical disector was applied to estimate the numerical densities (NDs) of labeled cells in the granule cell layer. The NDs of radial glia‐like progenitors labeled by brain lipid binding protein were significantly lower in the infrapyramidal blade of the ventral DG than in other subdivisions. The NDs of doublecortin‐expressing cells presumed neural progenitors and immature granule cells were significantly higher in the suprapyramidal blade of the dorsal DG than in the other subdivisions. The NDs of calretinin‐expressing cells presumed young granule cells at the postmitotic stage were significantly higher in the suprapyramidal blade than in the infrapyramidal blade in the dorsal DG. No significant regional differences were detected in the NDs of dividing cells identified by proliferating cell nuclear antigen. Taken together, these findings suggest that a larger pool of immature granule cells in dorsal hippocampus might be responsible for spatial learning and memory, whereas a smaller pool of radial glia‐like progenitors in ventral hippocampus might be associated with the susceptibility to affective disorders. Cell number estimation using a 300‐μm‐thick hypothetical slice indicates that regional differences in immature cells might contribute to the formation of topographic gradients in mature granule cells in the adult hippocampus. Our data also emphasizes the importance of considering such differences when evaluating changes in adult neurogenesis in pathological conditions and following experimental procedures. © 2010 Wiley‐Liss, Inc.
The Long-Term Effects of Homeopathic Treatment of Chronic Headaches: 1 Year Follow Up

Little is known about the long-term effects of homeopathic treatment. Following a double-blind, placebo-controlled trial of classical homeopathy in chronic headaches, we conducted a complete follow-up study of all trial participants. All patients enrolled in the double-blind study were sent a 6-week headache diary, a follow-up questionnaire. Eighty-seven of the original 98 patients enrolled returned questionnaires, 81 returned diaries. There was no additional change from the end of the trial to the 1-year follow up. The improvement seen at the end of the 12-week trial was stable after 1 year. No differential effects according to treatment after the trial could be seen. Patients with no treatment following the trial had the most improvement after 1 year. Approximately 30% of patients in homeopathic treatment will benefit after 1 year of treatment. There is no indication of a specific, or of a delayed effect of homeopathy.
Untersuchung des Zusammenhangs zwischen VEGF Gewebsexpression und des Sauerstoffpartialdrucks in primären Mammakarzinomen am Modell der primär systemischen Chemotherapie

Die vorliegende Arbeit ist Teil eines wissenschaftlichen Kooperationsprojektes zwischen der Frauenklinik vom Roten Kreuz in Munchen und der Klinik fur Strahlentherapie und radiologische Onkologie am Klinikum rechts der Isar der Technischen Universitat Munchen. Ziel des Gesamtprojektes ist es den pradiktiven Wert fur das Tumoransprechen auf primar systemische Chemotherapie von pO2 in malignen Mammatumoren zu bestimmen und seine Abhangigkeit von Serumhamoglobin, dem p53-Status und dem VEGF-Status zu untersuchen. In dieser Arbeit wurde der Zusammenhang zwischen dem intratumoralen Sauerstoffpartialdruck und dem VEGF-Status untersucht. Hierzu wurde das von 95 primaren Mammakarzinomen stanzbiobtisch gewonnene Gewebe immunhistochemisch untersucht und die VEGF-Gewebeexpression bestimmt. Schlieslich konnte, aus 109 ausgewerteten Sauerstoffmessungen und aus 95 bestimmten VEGF-Gewebeexpression, bei 77 Patientinnen sowohl Ergebnisse der Sauerstoffmessungen als auch der VEGF-Bestimmung zueinander in Beziehung gesetzt und statistisch ausgewertet werden. Zusatzlich wurden sowohl die pO2-Werte als auch der VEGF-Status mit den sog. klassischen Prognosefaktoren des Mammakarzinoms in Relation gesetzt. Hier wurden die gewonnen Werte mit dem Alter, der Tumorgrose, dem Nodalstatus, dem Grading und dem Hormonrezeptorstatus des untersuchten Patientinnenkollektivs zu einander in Beziehung gesetzt. Die der Arbeit zugrunde liegende Annahme war, dass, durch die Gewebehypoxie induzierte Hif-1 alpha Protein-Ausschuttung bedingte Steigerung der VEGF-Gewebeexpression, hypoxische Tumore einen gegenuber normoxischen Geweben erhohten VEGF-Status haben mussten. Es konnte jedoch kein statistisch signifikanter Zusammenhang zwischen dem Oxygenierungsstatus und der VEGF-Gewebeexpression bei primaren Mammakarzinomen nachgewiesen werden. Lediglich wurde eine statistisch nicht signifikante Verminderung in anoxischen Geweben von VEGF-positiven Tumoren nachgewiesen. Die erziehlten Ergebnisse entsprechen zwar nicht den Erwartungen, dennoch kann gefolgert werden, dass der intratumorale pO2 und die VEGF-Gewebeexpression voneinander unabhangige Faktoren sind, von denen jeder fur sich, wie aus der Literatur bekannt ist, mit einer schlechten Prognose vergesellschaftet ist. Auch konnte keine Assoziation mit den klassischen Prognosefaktoren nachgewiesen werden.
Salmonella Meningitis in Adults Infected with HIV: Case Report and Review of the Literature

&NA; We report a case of Salmonella infantis meningitis in a patient infected with HIV who was successfully treated with 4 weeks of therapy and has had no relapses after 12 months of follow‐up. Only 10 episodes of Salmonella species meningitis in patients infected with HIV are reported in the literature.
Biochemotherapy of metastatic melanoma in patients with or without recently diagnosed brain metastases

Brain metastases are an alarming complication of advanced melanoma, frequently contributing to patient demise. The authors performed a retrospective analysis to determine whether the treatment of metastatic melanoma with biochemotherapy would result in similar outcomes if brain metastases were first controlled with aggressive, central nervous system (CNS)‐directed treatment.
Optimal fractionation in radiotherapy for non-small cell lung cancer – a modelling approach

ABSTRACT Background. Conventionally fractionated radiotherapy (CFRT) has proven ineffective in treating non-small cell lung cancer while more promising results have been obtained with stereotactic body radiotherapy (SBRT). Hypoxic tumours, however, might present a challenge to extremely hypofractionated schedules due to the decreased possibility for inter-fraction fast reoxygenation. A potentially successful compromise might be found in schedules employing several fractions of varying fractional doses. In this modelling study, a wide range of fractionation schedules from single-fraction treatments to heterogeneous, multifraction schedules taking into account repair, repopulation, reoxygenation and radiosensitivity of the tumour cells, has been explored with respect to the probability of controlling lung tumours. Material and methods. The response to radiation of tumours with heterogeneous spatial and temporal oxygenation was simulated including the effects of accelerated repopulation and intra-fraction repair. Various treatments with respect to time, dose and fractionation were considered and the outcome was estimated as Poisson-based tumour control probability for local control. Results. For well oxygenated tumours, heterogeneous fractionation could increase local control while hypoxic tumours are not efficiently targeted by such treatments despite reoxygenation. For hypofractionated treatments employing large doses per fraction, a synergistic effect was observed between intra-fraction repair and inter-fraction fast reoxygenation of the hypoxic cells as demonstrated by a reduction in D50 from 53.3 Gy for 2 fractions to 52.7 Gy for 5 fractions. Conclusions. For well oxygenated tumours, heterogeneous fractionation schedules could increase local control rates substantially compared to CFRT. For hypoxic tumours, SBRT-like hypofractionated schedules might be optimal despite the increased risk of intra-fraction repair due to a synergistic effect with inter-fraction reoxygenation.
Effect of high frequency transcutaneous electrical nerve stimulation on viability of random skin flap in rats.

PURPOSE To determine the effect of high frequency Transcutaneous Electrical Nerve Stimulation (TENS) on viability of random skin flap in rats. METHODS The sample of this study was 75 Wistar rats. The skin flap measured 10 x 4 cm and a plastic barrier was interposed between the flap and donor site. After the operative procedure, animals of all groups were maintained anesthetized one more hour with electrodes positioned in the base of the flap and submitted to treatment according of their respective group. This procedure was repeated on the two subsequent days. G1: sham stimulation (control), G2: TENS (f = 80 Hz and I = 5 mA), G3: TENS (f = 80 Hz and I = 10 mA), G4: TENS (f = 80 Hz and I = 15 mA), G5: TENS (f = 80 Hz and I = 20 mA). RESULTS The average percentage of necrotic area was 43,11, 34,65, 49,44, 23,52, 45,10 in groups 1, 2, 3, 4 and 5 respectively. CONCLUSION The amplitude of 15 mA presented a lower necrotic area than control group and Transcutaneous Electrical Nerve Stimulation was efficient in increasing the random skin flap viability.
Middle Ear Gentamicin-Soaked Pledgets in the Treatment of Ménière’s Disease

Objective Assess the relative efficacy and results of the round window hyaluronic acid pledget depot method for intratympanic gentamicin delivery in Ménière’s disease. Study Design Retrospective case review. Setting Tertiary referral hospital. Patients Prospective symptomatic and audiologic data were collected on 28 patients undergoing intratympanic gentamicin therapy for Ménière’s disease refractory to medical treatment between 2003 and 2009. Intervention All patients had the round window membrane exposed via a tympanomeatal flap, and any adhesions were removed. Hyaluronic acid pledgets soaked in 40 mg/ml of gentamicin were then packed into the round window niche and posterior mesotympanum, and the tympanomeatal flap was replaced. Main Outcome Measures Patients audiologic and vertigo symptom outcome scores were recorded at follow-up according to the AAO-HNS 1995 guidelines for reporting results in Ménière’s disease. Results Complete or substantial improvement in vertigo (class A or B) was achieved in 88.5% (23/26) of patients. Hearing loss, defined as greater than 10 dB (PTA average at 0.5, 1, 2, and 4 kHz) was noted in 12 (50%) of 24 patients including 4 patients who had developed “dead ears” (16%). The average hearing loss for all patients excluding the 4 patients with dead ears was 10.7 dB. Conclusion Round window hyaluronic acid pledget technique used as a sustained delivery vehicle for intratympanic gentamicin treatment for Ménière’s disease produces similar rates ofvertigo control compared with other techniques but a greater risk of hearing loss. We would recommend the intratympanicinjection titration technique as first line for most patients.
Signaling Angiogenesis via p42/p44 MAP Kinase Cascade

Abstract: Vascular endothelial growth factor (VEGF), a potent agonist secreted by virtually all cells, controls migration and division of vascular endothelial cells. Disruption of one VEGF allele in mice has revealed a dramatic lethal effect in early embryogenesis, suggesting a key role in vasculogenesis. We analyzed the regulation of VEGF mRNA in normal and transformed CCL39 fibroblasts and then dissected the VEGF promoter to identify the signaling pathway(s) controlling the activation of this promoter in response to growth factors, oncogenes, and hypoxic stress. We demonstrated that the p42/p44 MAP kinase signaling cascade controls VEGF expression at least at two levels. In normoxic conditions, MAPKs activate the VEGF promoter at the proximal (−88/−66) region where Sp‐1/AP‐2 factors bind. Activation of p42/p44 MAPKs is sufficient to turn on VEGF mRNA. At low O2 tension, hypoxia inducible factor‐1α (HIF‐1α), a limiting factor rapidly stabilized and phosphorylated, plays a key role in the expression of several genes including VEGF. We demonstrated that p42/p44MAPKs stoichiometrically phosphorylate HIF‐1αin vitro and that HIF‐1‐dependent VEGF gene expression is strongly enhanced by the exclusive activation of p42/p44MAPKs. Finally, we demonstrated that the regulation of p42/p44MAPK activity is critical for controlling proliferation and growth arrest of vascular endothelial cells at confluency. These results point to at least three major targets of angiogenesis where p42/p44 MAP kinases exert a determinant action.