Miracle-dz/UniFAR-FTUs huggingface dataset:
Facial injury management undertaken at US and UK medical treatment facilities during the Iraq and Afghanistan conflicts: a retrospective cohort study

Objectives To perform the first direct comparison of the facial injuries sustained and treatment performed at USA and UK deployed medical treatment facilities (MTFs) in support of the military campaigns in Iraq and Afghanistan. Setting The US and UK Joint Theatre Trauma Registries were scrutinised for all patients with facial injuries presenting alive to a UK or US deployed MTF between 1 March 2003 and 31 October 2011. Participants US and UK military personnel, local police, local military and civilians. Primary and secondary outcome measures An adjusted multiple logistic regression model was performed using tracheostomy as the primary dependent outcome variable and treatment in a US MTF, US or UK military, mandible fracture and treatment of mandible fracture as independent secondary variables. Results Facial injuries were identified in 16 944 casualties, with the most common being those to skin/muscle (64%), bone fractures (36%), inner/middle ear (28%) and intraoral damage (11%). Facial injuries were equally likely to undergo surgery in US MTF as UK MTF (OR: 1.06, 95% CI 0.4603 to 1.142, p=0.6656); however, variations were seen in injury type treated. In US MTF, 692/1452 (48%) of mandible fractures were treated by either open or closed reduction compared with 0/167 (0%) in UK MTF (χ2: 113.6; p≤0.0001). US military casualties who had treatment of their mandible fracture (open reduction and internal fixation or mandibulo-maxillary fixation) were less likely to have had a tracheostomy than those who did not undergo stabilisation of the fractured mandible (OR: 0.61, 95% CI 0.44 to 0.86; p=0.0066). Conclusions The capability to surgically treat mandible fractures by open or closed reduction should be considered as an integral component of deployed coalition surgical care in the future.
Species Composition and Toxigenic Potential of Fusarium Isolates Causing Fruit Rot of Sweet Pepper in China

Apart from causing serious yield losses, various kinds of mycotoxins may be accumulated in plant tissues infected by Fusarium strains. Fusarium mycotoxin contamination is one of the most important concerns in the food safety field nowadays. However, limited information on the causal agents, etiology, and mycotoxin production of this disease is available on pepper in China. This research was conducted to identify the Fusarium species causing pepper fruit rot and analyze their toxigenic potential in China. Forty-two Fusarium strains obtained from diseased pepper from six provinces were identified as F. equiseti (27 strains), F. solani (10 strains), F. fujikuroi (five strains). This is the first report of F. equiseti, F. solani and F. fujikuroi associated with pepper fruit rot in China, which revealed that the population structure of Fusarium species in this study was quite different from those surveyed in other countries, such as Canada and Belgium. The mycotoxin production capabilities were assessed using a well-established liquid chromatography mass spectrometry method. Out of the thirty-six target mycotoxins, fumonisins B1 and B2, fusaric acid, beauvericin, moniliformin, and nivalenol were detected in pepper tissues. Furthermore, some mycotoxins were found in non-colonized parts of sweet pepper fruit, implying migration from colonized to non-colonized parts of pepper tissues, which implied the risk of mycotoxin contamination in non-infected parts of food products.
Putting the Pieces Together: Advance Directives in the Rehabilitation Setting

In this ethics legal column, we explore advance directives (ADs), the prototypical means for individuals in the United States to document their wishes for future treatment or nontreatment. I have invited Preya S. Tarsney, JD, to be the guest editor of this collection. Her scholarly interests include informed refusals, negotiation and mediation in clinical rehabilitation, and best practices in ethics consultation. Ms. Tarsney is a senior bioethicist at the Shirley Ryan AbilityLab, a lecturer of physical medicine and rehabilitation (PM&R) at Northwestern University Feinberg School of Medicine, and faculty lecturer at the MacLean Center for Clinical Medical Ethics at the University of Chicago. As always, I welcome ideas and reactions to the PM&R ethics/legal column at dmukherjee@sralab.org.
Clinical observation on the effect of Wuzhi soft capsule on FK506 concentration in membranous nephropathy patients

Abstract The current research aimed to investigate the correlation between the effect of Wuzhi soft capsule (WZC) on FK506 concentration and CYP3A5 gene polymorphism in patients with membranous nephropathy (MN). Seventy-five patients with idiopathic MN were enrolled and divided according to the expression of CYP3A5 gene metabolic enzyme into group A (CP3A5 metabolic enzyme function expression types CYP3A5∗1/∗1 type and CYP3A5∗1/∗3 type), and group B (non-expression type CYP3A5∗3/∗3 type). All patients were given oral administration of tacrolimus capsule at the initial dose of 1 mg for twice a day 1 hour before breakfast and dinner. Afterwards, the oral administration of WZC was added at the dose of 0.5 g for 3 times a day within half an hour after 3 meals. The blood concentrations of FK506 in groups A and B were significantly higher than those before administration. Compared with that before administration, the FK506 blood concentration was increased by 3.051 ± 0.774 ng/ml after adding the WZC. Besides, the blood concentrations of FK506 in group A were lower than those in group B before and after administration; meanwhile, the 24 hours total urine protein and the biochemical indexes in both groups displayed no statistically significant difference. Only 1 case of diarrhea was observed, which was relieved after the reduction of tacrolimus. Wuzhi soft capsule can significantly increase the blood concentration of FK506 in MN patients. Moreover, the CYP3A5 genotyping should be considered when WZC is used to increase the blood concentration of FK506.
Studies on the antibacterial activity and phytochemical screening of Tylophora indica linn on opportunistic bacterial pathogens coinfected with HIV

Tylophora indica is an extensively used Indian traditional medicine to cure various human ailments, and acts as a folk remedy for the treatment of bronchial asthma, inflammation, bronchitis, allergies, rheumatism and dermatitis. It also seems to be a good remedy in traditional medicine as anti psoriasis, seborrheic dermatidis, anaphylactic, leucopenia. The roots are suggested to be a good natural preservative of food. Antibacterial activity of ethyl acetate and methanol extracts of plant was investigated by well-diffusio n method against bacterial pathogens associated with HIV. The plant extracts showed better inhibitory activity against the tested organisms. Methanolic leaf extract of Tylophora indica showed highest inhibitory activity when compared with all treatments. Phytochemical screening of the methanolic leaf extract of the plant revealed the presence of tannins, saponins, flavonoids, carbohydrates and alkaloids. Thin Layer Chromatography(TLC) value of the leaf extract showed the highest Retention Factor(RF) value. This study creates social awareness among the HIV patients who were infected by various opportunistic bacterial pathogens.
The proximate determinants of age at first birth in Tanzania.

In the demographic literature age at marriage has long been regarded as one of the proximate determinants of fertility. However in most situations age at first marriage might have no effect on fertility. First if women start having children no matter when they marry then the effect of age at marriage on fertility may be limited. Second if fertility is controlled within marriage by using contraceptives or other means age at marriage may not have much of an effect on fertility because couples may decide how many children they would like to have regardless of the age at marriage. In Tanzania many traditional values and social practices concerning procreation have undergone changes during the course of modernization. Therefore in modern times the concept of marriage being universal and birth occurring only in marriage is a misleading idea. Hence the change in the timing of the first birth is undoubtedly an important element of the fertility decline than age at first union. This paper focuses on the proximate determinants of age at first birth i.e. age at first sexual intercourse age at first marriage the incidence of primary sterility the practice of contraception to delay first conception and induced abortion and early pregnancy wastage prior to the first birth. Though an important determinant of age at first birth as it signifies the beginning of puberty age at menarche will not be discussed as the 1996 Tanzania Demographic and Health Survey (TDSH) data did not collect information on it. By using the 1996 TDHS data mean age at first sexual intercourse was found to be 16 years age at first marriage was found to be 17 years while the mean age at first birth was estimated to be 18 years. It was further found that 3 out of 4 mothers in Tanzania start childbearing during their adolescence i.e. only 25% of all mothers got their first child after adolescence. The paper also made a comparison between the Tanzania situation with other countries which participated in the DHS III and found out that in general early entrance into sexual relations means early entrance into childbearing and consequently high fertility in sub-Saharan. (authors)
Aminotransferase Ratio Is a Useful Index for Hepatosteatosis in Children and Adolescents

Nonalcoholic fatty liver disease (NAFLD) and childhood obesity are emerging global health issues. The aim of this study was to identify a simple predictor of NAFLD in children and adolescents. This community-based study was conducted from December 2012 to September 2013 in Taiwan and included 1,222 children between 10 and 19 years of age. After excluding alcohol consumption and hepatic-related lesions, NAFLD was diagnosed according to sonographic criteria. Potential confounding factors (including age, gender, and anthropometric and laboratory data) were tested by logistic regression analysis. The cutoff value was determined using receiver operating characteristic (ROC) curve analysis. In addition to older age, heavier weight, and wider waist, subjects with NAFLD had significantly higher blood pressure, lipid disturbances, and alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratios. The correlation between NAFLD and ALT/AST ratio remained significant even after adjusting for confounders (adjusted odds ratio [OR], 2.19; 95% confidence interval [CI], 1.24–3.87; p = .007). The risk score of having a fatty liver, based on ALT/AST ratio, was greater than 0.981 according to ROC curve analysis (sensitivity, 60.5%; specificity, 80.3%; area under the curve, 0.756; CI, 0.71–0.80; p < .001). Therefore, ALT/AST ratio may represent a powerful index of hepatosteatosis in children and adolescents.
Effect of heat shock protein 70 modulators on the development of morphine analgesic tolerance in rats

The clinical use of opioid analgesics, such as morphine, is limited by analgesic tolerance, molecular mechanism of which is not well understood. Recently, molecular chaperone heat shock protein 70 (Hsp70) has been demonstrated to play important roles in morphine-induced neuroadaptation. Here, we focused on the involvement of Hsp70 in the development of analgesic tolerance to morphine. Rats were treated with morphine (5, 10, 20 mg/kg, subcutaneously) or saline once daily for 10 consecutive days. Hsp70 modulator N-formyl-3, 4-methylenedioxybenzylidine-γ-butyrolactam [KNK437, 100 mg/kg, intraperitoneally (i.p.)], geranylgeranylacetone (500 mg/kg, i.p.) or pifithrin-μ (20 mg/kg, i.p.) was administered before morphine (10 mg/kg, subcutaneously)/saline treatment. Analgesic effect of morphine was measured using the tail-flick latency test, and Hsp70 protein expression was examined by western blot. Analgesic effect of morphine decreased gradually with the increase in the number of days of morphine injection, indicating development of analgesic tolerance. A significant increase of Hsp70 expression in the periaqueductal gray was observed during the development of analgesic tolerance after repeated morphine injections. The development of morphine analgesic tolerance was suppressed by pre-treatment with Hsp70 transcriptional inhibitor KNK437 or functional antagonist pifithrin-μ, while promoted by pre-treatment with Hsp70 transcriptional inducer geranylgeranylacetone. Our results demonstrated that the development of morphine analgesic tolerance was dual regulated by Hsp70 modulators, suggesting Hsp70 as an interesting and new target for preventing the development of opioid analgesic tolerance.
Prediction of pedestrian brain injury due to vehicle impact using computational biomechanics models: Are head-only models sufficient?

Abstract Objectives: Accident reconstruction using computational biomechanics models plays an important role in research and prevention of human brain injury caused by car-to-pedestrian impacts. Finite element (FE) “head-only” models (that represent only the pedestrian head and brain) used in such reconstruction do not account for the influence of the rest of the pedestrian body on the head kinematics due to the accident and, consequently, on the brain injury risk prediction. Application of full-scale FE pedestrian models, on the other hand, is limited by their high computational cost and, more importantly, by the time-consuming preprocessing when repositioning the model to represent the pedestrian posture and location in relation to the impacting car. The objective of this study is to propose a computational biomechanics modeling approach to overcome these challenges. Methods: First, we couple a validated commercial FE head-neck complex model and a multibody (MB) pedestrian model. This coupled FE-MB model is evaluated through application in reconstruction of a real-world car-to-pedestrian impact accident and comparison of the pedestrian kinematics predicted using this model with the results obtained from the established full-scale MB pedestrian model. Finally, we compare the results obtained using the coupled FE-MB model proposed in this study and FE head-only model in terms of both the head kinematics and brain injury risk predicted using the two models. Results: The results of analysis of head injury criterion (HIC15) and brain deformation-based injury criteria (instantaneous value of cumulative strain damage measure iCSDM and maximum shear strain of the brain tissue) indicate substantial differences in the head kinematics and brain injury risk predicted using the two models. The coupled FE-MB model predicts a high risk of the brain injury which is consistent with the database record of the analyzed accident, in particular for the impact between the pedestrian head and road surface. In contrast, the head-only model did not predict that such impact can occur. The FE head head-only model with rigid skull and prescribed acceleration–time history of the head center of gravity determined from accident reconstruction using the purely MB pedestrian model, predicted appreciably lower iCSDM than the coupled FE-MB model that accounts for skull deformations using the linear elastic-plastic material model. Conclusions: This study suggests that the FE head-only models may be deficient for car-to-pedestrian impact accident reconstruction and estimation of risk of the pedestrian brain injury. In particular, this applies to the models that simplify the pedestrian skull as a rigid body.
A stress-responsive enhancer induces dynamic drug resistance in acute myeloid leukemia

The drug efflux pump ABCB1 is a key driver of chemoresistance, and high expression predicts treatment failure in acute myeloid leukemia (AML). In this study, we identified and functionally validated the network of enhancers that controls expression of ABCB1. We show that exposure of leukemia cells to daunorubicin activated an integrated stress response–like transcriptional program to induce ABCB1 through remodeling and activation of an ATF4-bound, stress-responsive enhancer. Protracted stress primed enhancers for rapid increases in activity following re-exposure of cells to daunorubicin, providing an epigenetic memory of prior drug treatment. In primary human AML, exposure of fresh blast cells to daunorubicin activated the stress-responsive enhancer and led to dose-dependent induction of ABCB1. Dynamic induction of ABCB1 by diverse stressors, including chemotherapy, facilitated escape of leukemia cells from targeted third-generation ABCB1 inhibition, providing an explanation for the failure of ABCB1 inhibitors in clinical trials. Stress-induced upregulation of ABCB1 was mitigated by combined use of the pharmacologic inhibitors U0126 and ISRIB, which inhibit stress signaling and have potential for use as adjuvants to enhance the activity of ABCB1 inhibitors.
IOX-101 Reverses Drug Resistance Through Suppression of Akt/mTOR/NF-κB Signaling in Cancer Stem Cell-Like, Sphere-Forming NSCLC Cell

Drug discovery research to fight lung cancer is incessantly challenged by drug resistance. In this study, we used drug-resistant lung cancer stem like cells (A549-CS) to compare the efficacy of standard drugs like cisplatin (DDP) and gemcitabine (GEM) with a novel arylidene derivative IOX-101. A549-CS was derived from regular A549 cells by growing in special media. Resistance proteins were detected using Western blotting. Cell proliferations were assessed by MTT assay. Cytokine release was enumerated using enzyme-linked immunosorbent assay. The effect of drugs on apoptosis and cell cycle was studied with flow cytometry protocols. Apoptosis-related proteins, caspases, and other signaling protein expressions like Akt and mammalian target of rapamycin (mTOR) were assessed by Western blotting. Expression of CD133 and nuclear factor κB (NF-κB) phosphorylation was assessed using flow cytometry. A549-CS showed significant increase in CD133 expression in comparison with A549 cells. Expression of resistance markers like MDR-1, lung resistance protein (LRP), and GST-II were detected in A549-CS. While DDP and GEM had relatively lower efficacy in A549-CS, IOX-101 inhibited the proliferation of both A549 and A549-CS with GI50 values of 268 and 296.5 nM, respectively. IOX-101 increased the sub-G0 phase in the cell cycle of A549-CS and increased the percentage of apoptotic cells. Western blot analysis revealed activation of caspases, Bax, and reduction in Bcl-2 levels. Further mechanistic investigation revealed IOX-101 to deactivate Akt, mTOR, and NF-κB signaling in A549-CS cells. Additionally, IOX-101 treatment to A549-CS also reversed MDR-1 and LRP expressions. Collectively, our results demonstrate efficacy of IOX-101 in A549-CS, which was resistant against the tested standard drugs. The activity was mediated by suppressing Akt/mTOR/NF-κB signaling.
Association Between Quality of Life and Improvement in Psoriasis Severity and Extent in Pediatric Patients.

Importance Treatment of psoriasis is associated with improved quality of life (QOL) in those with the disease. However, in daily clinical practice, the association between the degree of psoriasis clearance and QOL has not been studied to date, especially in the pediatric population. Objectives To identify the association between the degree of psoriasis improvement (as measured by the Psoriasis Area Severity Index [PASI] and body surface area [BSA] response) and QOL (as measured by the Children's Dermatology Life Quality Index [CDLQI]) in pediatric psoriasis, and to assess the association of treatment type with QOL, independent of psoriasis improvement. Design, Setting, and Participants Data used in this single-center cohort study were extracted from the Child-CAPTURE (Continuous Assessment of Psoriasis Treatment Use Registry), a prospective, observational, daily clinical practice cohort of all children (aged <18 years) with a psoriasis diagnosis who attended the outpatient clinic of the Department of Dermatology at the Radboud University Medical Center in Nijmegen, the Netherlands, between September 3, 2008, and May 4, 2018. All records of treatment episodes with CDLQI, PASI, and BSA scores were included in the analysis. Exposures Patients were treated according to daily clinical care. Treatments were clustered into topical, dithranol, conventional systemic, and biological treatments. Because of low numbers of UV-B phototherapy, this treatment was not assessed. Main Outcomes and Measures Primary outcomes were mean change of CDLQI scores per PASI and BSA response categories (0 to <50, 50 to <75, 75 to <90, and ≥90) and mean CDLQI change per treatment categories. Results In total, 319 patients (median [interquartile range] age, 10.0 [7.0] years; 183 female [57.4%]) were analyzed for PASI score improvement (399 treatment episodes) and improvement in BSA involvement (366 treatment episodes). The greatest improvements in CDLQI scores were seen in the PASI ≥90 response category, with an estimated marginal mean change in CDLQI score of -6.6 (95% CI, -7.5 to -5.7). The greatest improvements in CDLQI scores were also observed in the BSA ≥90 response category, with an estimated marginal mean change in CDLQI score of -6.8 (95% CI, -7.5 to -6.1). Systemic treatment demonstrated a greater degree of improvement of CDLQI compared with topical treatment, independent of PASI response categories. Conclusions and Relevance This cohort study in a real-world setting found that the greatest improvements in QOL were associated with PASI 90 or greater, a decrease in BSA involvement of 90% or greater, and systemic treatments. These findings suggest that reaching PASI 90 or greater and decreasing BSA involvement by at least 90% may be clinically meaningful treatment goals that will help pediatric patients with psoriasis reach optimal QOL.
Cattle and sheep farmers’ opinions on the provision and use of abattoir rejection data in the United Kingdom

Background Communication between farmers and veterinary surgeons is reported to differ when involving abattoir rejection data on cattle or sheep. Methods Using surveys, distributed online and on paper at livestock markets, this study describes the interest and positive opinion of a sample of UK cattle and sheep farmers in receiving abattoir data. Results Forty-nine per cent of respondents always received abattoir data (n=37/76). Over 80 per cent of respondents were interested in all suggested rejection conditions and particularly liver fluke and respiratory conditions. Eighty-two per cent of farmers were willing to share data with their veterinary surgeon as the information could be used to inform health plans. Conclusion The study findings indicate that having an accurate and consistent data system, which is easily accessible to farmers and veterinary surgeons, appears an essential next step to improve the use of existing abattoir data and enhance animal health, welfare and production.