Miracle-dz/UniFAR-FTUs huggingface dataset:
SPORTS CONCUSSION

Concussion is an injury to the brain occurring as the result of biomechanical forces, generally characterized by the rapid onset of a constellation of symptoms or cognitive impairment, which is typically self-limited and resolves spontaneously. Concussion as the result of playing sports is particularly common, estimated to occur up to 3.8 million times each year in the United States. Although most concussions can be considered benign, the symptoms are often severe enough to interfere with daily function. A small percentage of concussions can be more serious, resulting in a prolonged symptom course, significant morbidity, or even death. The management of concussion in the athlete presents a unique set of challenges for the clinician, requiring not only a detailed neurologic history and examination, but also careful consideration of an athlete's risk of further injury and possible long-term sequelae.
REHABILITATION IN THE PATIENT WITH MILD TRAUMATIC BRAIN INJURY

Traumatic brain injury (TBI) has garnered increased public attention in the past several years because of high-profile athletes with possible long-term effects of their injuries as well as large numbers of returning combat veterans injured by blast explosions. Most of these injuries are mild in nature and require no specific surgical treatment but may benefit from brief rehabilitation interventions. To appropriately rehabilitate patients with mild traumatic brain injury (mTBI), one must fully understand its clinical course and the factors that accelerate or delay recovery. Education is the centerpiece of mTBI treatment and should be included in the rehabilitation plan. When devising the rehabilitation plan, the neurologist should take into account the goals of the patient and establish a reasonable time frame for treatment paralleling the expected recovery course. Cognitive and vestibular functions are commonly affected after mTBI and are particularly responsive to rehabilitation interventions. Vocational rehabilitation and community reentry planning are aspects of the global rehabilitation plan that should not be neglected. Combat-injured veterans with mTBI present unique challenges to the rehabilitation team, and assessment of these patients often needs to include assessment of psychological function.
Patient Management Problem-Preferred Responses

Following are the preferred responses for the Patient Management Problem in this CONTINUUM issue. The case, questions, and answer options are repeated, and the preferred response appears in bold print, followed by an explanation and a reference with which you may seek more specific information. You are encouraged to review the responses and explanations carefully to evaluate your general understanding of the material. The comment and references included with each question are intended to encourage independent study.
Metallic Tibial Hemiarthroplasty Utilizing the UniSpacer Knee System: Surgical Technique and Preliminary Results

Metallic tibial hemiarthroplasty is an established procedure for the treatment of isolated medial compartment osteoarthritis. A new implant system for tibial hemiarthroplasty is presented. Patient selection, surgical technique, and postoperative care are discussed. Early clinical data with 12- and 24-month minimum follow-up are presented and demonstrate positive results from the procedure.
Severe Traumatic Brain Injury

Purpose of Review: Although adherence to traumatic brain injury (TBI) guidelines has been associated with improved patient outcomes, guideline adherence remains suboptimal in practice. With neurologists becoming increasingly involved in specialized neurointensive care units and in the care of patients with severe TBI, familiarization with these guidelines is essential. Recent Findings: Intracranial monitoring of different physiologic variables has increased in the past few years. Intracranial pressure (ICP)–driven therapy has been replaced by ICP–cerebral perfusion pressure (CPP)–driven therapy. More recently, the importance of brain oxygen optimization in addition to ICP-CPP has been recognized, and clinical trials are underway to study the effect of this approach. Surgical management of patients with TBI is also evolving rapidly with further studies on decompressive craniectomy. These are significant advances to improve TBI outcomes. Summary: This article summarizes the routine monitoring of patients with severe TBI and offers insight into some novel physiologic monitoring devices available. The guidelines for management of patients with severe TBI are summarized along with outcome measures.
ASPECTOS FISIOLÓGICOS E PATOLÓGICOS DO PUERPÉRIO EM BOVINOS

Foi levado a efeito uma revisao sobre os aspectos fisiologicos e patologicos do puerperio em bovinos. Os seguintes topicos foram discutidos: aspectos gerais do puerperio; PGF2 e involucao uterina; a atividade ovariana; os foliculos ovarianos; o LH e o FSH; o GnRH; os progestagenos; o anestro bovino; as fontes de energia e o anestro; as afeccoes existentes no periodo do puerperio. Abstract A review on the physiological and pathological aspects of the puerperium in bovines is being carried out. The following topics were discussed: general aspects of the puerperium; PGF2 and uterine involution; ovarian activity; ovarian folicles; ovulation; LH and FSH; GnRH; progestagens; bovine anestrus; sources of energy and anestrus; concomitant affections during the puerperium period.
WHO'S PUBLISHING IN JMFT? AN EXAMINATION OF AUTHOR CHARACTERISTICS

This article examines the gender, setting, and degree of the first authors of published articles in JMFT from 1990 to 1995. Findings reveal that men are the first authors of 67% of the articles and women, 33%. PhDs are first authors on 58% of the articles, and authors in university settings write 53% of the published articles. Thirty-nine percent of the articles published during this period were research; 26%, clinical; 16%, theory; and 14%, training. Surprising findings were that MSW authors had a higher acceptance rate than PhDs, and authors in training institutes had a higher acceptance rate than those in university settings.
Confronto dei risultati dell’esame microscopico diretto e dell’identificazione definitiva nei casi di batteriemia

Introduction. All the microbiology texts underline the importance of performing a gram stain on blood culture broth, if positive, with a double purpose: address the microbiologist in the choice of subculture media and provide the clinician with preliminary indication for the choice of the treatment. However, there are few data and literature on the concordance between gram stain and definitive result.The study aims at evaluating, in the reality of our hospital, the reliability of the gram stain performed starting from the blood culture broth. Materials and methods. The results of the gram stain on broth and of the final detection of all positive blood cultures performed from January 1st 2003 to December 31st 2004 by the Microbiology Lab based at Ospedali Riuniti Bergamo have been analysed. Results. In two years 52909 bottles have been processed; 6328 (11.96%) resulted positive, of which 5921 (11.19%) for monomicrobial flora and 407 (0.77%) for polymicrobial flora. Concerning the 6643 definitive identifications, the gram stain resulted fully correct in 6140 cases (92.43%); errors have been interpreted as “minor” in 285 cases (4.29%) for a partial or absent definition of the morphologic-dyeing features, “major” in 14 cases (0.21%) for notification of micro-organisms non grown later, “serious” in 204 (3.07%) for wrong reading of Gram (36 cases, equal to 0.54%) or no interpretation, in case of mixed cultures, of micro-organisms grown later (168 cases equal to 2.53%). Conclusions. Our study confirms the reliability of Gram stain and its role in providing in advance the definitive results of blood culture; however, it highlights the risk that Gram stain cannot detect polymicrobial aetiologies.
Retracted: Advances in the physiological and pathological implications of cholesterol

Cholesterol has evolved to fulfill sophisticated biophysical, cell signalling, and endocrine functions in animal systems. At the cellular level, cholesterol is found in membranes where it increases both bilayer stiffness and impermeability to water and ions. Furthermore, cholesterol is integrated into specialized lipid‐protein membrane microdomains with critical topographical and signalling functions. At the organismal level, cholesterol is the precursor of all steroid hormones, including gluco‐ and mineralo‐corticoids, sex hormones, and vitamin D, which regulate carbohydrate, sodium, reproductive, and bone homeostasis, respectively. This sterol is also the immediate precursor of bile acids, which are important for intestinal absorption of dietary lipids as well as energy homeostasis and glucose regulation. Complex mechanisms maintain cholesterol within physiological ranges and the dysregulation of these mechanisms results in embryonic or adult diseases, caused by either excessive or reduced tissue cholesterol levels. The causative role of cholesterol in these conditions has been demonstrated by genetic and pharmacological manipulations in animal models of human disease that are discussed herein. Importantly, the understanding of basic aspects of cholesterol biology has led to the development of high‐impact pharmaceutical therapies during the past century. The continuing effort to offer successful treatments for prevalent cholesterol‐related diseases, such as atherosclerosis and neurodegenerative disorders, warrants further interdisciplinary research in the coming decades.
Pneumonia adquirida na comunidade em pacientes tratados ambulatorialmente: aspectos epidemiológicos, clínicos e radiológicos das pneumonias atípicas e não atípicas

Objetivo: Avaliar o percentual etiologico das pneumonias atipicas tratadas ambulatorialmente. Identificar os fatores epidemiologicos, clinicos e radiologicos que permitam diferenciar pneumonia atipica de nao atipica. Metodos: Os pacientes foram submetidos a avaliacao clinica, radiologica, coleta de escarro para estudo pelo metodo de Gram e sangue para testes sorologicos, incluindo Legionella pneumophila, Chlamydia sp, Mycoplasma pneumoniae, virus Influenza A e Influenza B, no primeiro dia e 21 dias apos inclusao. As radiografias de torax foram revistas por tres observadores independentes que desconheciam o quadro clinico. Resultados: Avaliados inicialmente 129 pacientes durante 22 meses. A amostra final para estudo comparativo entre os grupos consistiu de 69 pacientes que tinham em media 37 anos, sendo 46 (67%) homens e 23 (33%) mulheres. O diagnostico etiologico foi definido em 34 (50%) dos pacientes. Chlamydia sp foi o agente atipico mais frequente, com 11 (16%) casos, seguido por M. pneumoniae com 7 (10%). Influenza A respondeu por 4 (6%) dos casos e Legionella em 4 (6%) pacientes. Infeccoes mistas foram evidenciadas, com associacao de Chlamydia sp e M. pneumoniae em 5 (7%) casos, Chlamydia sp e Influenza B em um caso e M. pneumoniae e Influenza A em outro. A presenca de sintomas respiratorios e achados gerais sugestivos de pneumonia atipica foram comparados entre os grupos e nao foram observadas diferencas significantes. A avaliacao radiologica realizada por tres observadores independentes mostrou discordância entre eles para os tipos de pneumonia. O diagnostico radiografico de cada observador comparado com o diagnostico clinico nao mostrou associacao significante. Conclusoes: A pneumonia causada por agente atipico ocorre em 50% dos pacientes com pneumonia adquirida na comunidade em tratamento ambulatorial. Nao e possivel distinguir pacientes com pneumonia atipica de pneumonia nao atipica. A apresentacao clinica e a radiologica sao similares nos dois grupos.
Poisons, toxungens, and venoms: redefining and classifying toxic biological secretions and the organisms that employ them

Despite extensive study of poisonous and venomous organisms and the toxins they produce, a review of the literature reveals inconsistency and ambiguity in the definitions of ‘poison’ and ‘venom’. These two terms are frequently conflated with one another, and with the more general term, ‘toxin. ’ We therefore clarify distinctions among three major classes of toxins (biological, environmental, and anthropogenic or man‐made), evaluate prior definitions of venom which differentiate it from poison, and propose more rigorous definitions for poison and venom based on differences in mechanism of delivery. We also introduce a new term, ‘toxungen’, thereby partitioning toxic biological secretions into three categories: poisons lacking a delivery mechanism, i.e. ingested, inhaled, or absorbed across the body surface; toxungens delivered to the body surface without an accompanying wound; and venoms, delivered to internal tissues via creation of a wound. We further propose a system to classify toxic organisms with respect to delivery mechanism (absent versus present), source (autogenous versus heterogenous), and storage of toxins (aglandular versus glandular). As examples, a frog that acquires toxins from its diet, stores the secretion within cutaneous glands, and transfers the secretion upon contact or ingestion would be heteroglandular–poisonous; an ant that produces its own toxins, stores the secretion in a gland, and sprays it for defence would be autoglandular–toxungenous; and an anemone that produces its own toxins within specialized cells that deliver the secretion via a penetrating wound would be autoaglandular–venomous. Adoption of our scheme should benefit our understanding of both proximate and ultimate causes in the evolution of these toxins.
Organic Dusts and Cell Reactions

Agricultural work can involve exposure to a multitude of agents, of which dust is a major component. Agricultural dust is an example of an organic dust that contains many biologically active agents, a circumstance that poses problems when the relationship between exposure and effects is to be evaluated. The traditional concept that the dust particles themselves are responsible for irritation of the airways has been superseded by the understanding that most of the effects are caused by one or several specific biologically active agents. Organic dust can be defined as fine particulates made up of vegetable or animal matter. It is almost always contaminated by microbes. The microbial make-up of the dust can vary greatly, depending on conditions that favor or inhibit the growth of specific microbes. Humidity is a particularly important environmental factor. This article will focus on the exposure conditions of organic dusts in the farm environment, the different specific agents that are present in the dust, and the cell reactions that take place in the lung following exposure. An understanding of these conditions is crucial to the interpretation of what we observe as symptoms or disease in the patient or in populations in epidemiologic studies, and for the diagnostic tests that we apply to decide whether an occupationally related disease is present.
The biology hidden inside residual within‐individual phenotypic variation

Phenotypes vary hierarchically among taxa and populations, among genotypes within populations, among individuals within genotypes, and also within individuals for repeatedly expressed, labile phenotypic traits. This hierarchy produces some fundamental challenges to clearly defining biological phenomena and constructing a consistent explanatory framework. We use a heuristic statistical model to explore two consequences of this hierarchy. First, although the variation existing among individuals within populations has long been of interest to evolutionary biologists, within‐individual variation has been much less emphasized. Within‐individual variance occurs when labile phenotypes (behaviour, physiology, and sometimes morphology) exhibit phenotypic plasticity or deviate from a norm‐of‐reaction within the same individual. A statistical partitioning of phenotypic variance leads us to explore an array of ideas about residual within‐individual variation. We use this approach to draw attention to additional processes that may influence within‐individual phenotypic variance, including interactions among environmental factors, ecological effects on the fitness consequences of plasticity, and various types of adaptive variance. Second, our framework for investigating variation in phenotypic variance reveals that interactions between levels of the hierarchy form the preconditions for the evolution of all types of plasticity, and we extend this idea to the residual level within individuals, where both adaptive plasticity in residuals and canalization‐like processes (stability) can evolve. With the statistical tools now available to examine heterogeneous residual variance, an array of novel questions linking phenotype to environment can be usefully addressed.
Acquired isolated abducens nerve palsies: a retrospective study on etiology in an Iranian population

Objective: We investigated causes of abducens nerve paralysis, the side of the involvements, age, and sex distribution of causes. Background: Abducens nerve paralysis is the most common nerve palsy among ocular motor nerves, which have not been investigated in Iran yet. Material and Methods: This is a retrospective case-series study performed from April 1995 to April 2000. We investigated 50 patients who attended to the Neuro-ophthalmology Clinic in Farabi Eye Hospital and were diagnosed as acquired isolated unilateral or bilateral abducens nerve paralysis. Results: The most common causes were ischemia (44%), tumors (18%), idiopathic intracranial hypertension (14%), and multiple sclerosis (8%). The less common causes were trauma, undetermined, arteriovenous fistula, aneurysm, syphilis, and temporal arteritis. The paralysis was seen in 28 women (56%) and 22 men (44%). Seventy percent of patients were older than 40 years of age, and also peak incidence of abducens nerve paralysis was at the sixth decade of life. Conclusion: In contrast to earlier studies, in our study the most common cause of abducens nerve paralysis was ischemic cause and the undetermined cause was not a prominent cause of paralysis. Moreover, the age peak of abducens nerve paralysis was a decade earlier than a similar earlier study, which is probably due to high prevalence of diabetes mellitus as ischemic cause in our country.
Oxidative shielding and the cost of reproduction

Life‐history theory assumes that reproduction and lifespan are constrained by trade‐offs which prevent their simultaneous increase. Recently, there has been considerable interest in the possibility that this cost of reproduction is mediated by oxidative stress. However, empirical tests of this theory have yielded equivocal support. We carried out a meta‐analysis to examine associations between reproduction and oxidative damage across markers and tissues. We show that oxidative damage is positively associated with reproductive effort across females of various species. Yet paradoxically, categorical comparisons of breeders versus non‐breeders reveal that transition to the reproductive state is associated with a step‐change reduction in oxidative damage in certain tissues and markers. Developing offspring may be particularly sensitive to harm caused by oxidative damage in mothers. Therefore, such reductions could potentially function to shield reproducing mothers, gametes and developing offspring from oxidative insults that inevitably increase as a consequence of reproductive effort. According to this perspective, we hypothesise that the cost of reproduction is mediated by dual impacts of maternally‐derived oxidative damage on mothers and offspring, and that mothers may be selected to diminish such damage. Such oxidative shielding may explain why many existing studies have concluded that reproduction has little or no oxidative cost. Future advance in life‐history theory therefore needs to take account of potential transgenerational impacts of the mechanisms underlying life‐history trade‐offs.
The NIH registry on use of the Wingspan stent for symptomatic70–99% intracranial arterial stenosis

Background: The Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial showed that patients with symptomatic 70% to 99% intracranial arterial stenosis are at particularly high risk of ipsilateral stroke on medical therapy: 18% at 1 year (95% CI = 3% to 24%). The Wingspan intracranial stent is another therapeutic option but there are limited data on the technical success of stenting and outcome of patients with 70% to 99% stenosis treated with a Wingspan stent. Methods: Sixteen medical centers enrolled consecutive patients treated with a Wingspan stent in this registry between November 2005 and October 2006. Data on stenting indication, severity of stenosis, technical success (stent placement across the target lesion with <50% residual stenosis), follow-up angiography, and outcome were collected. Results: A total of 129 patients with symptomatic 70% to 99% intracranial stenosis were enrolled. The technical success rate was 96.7%. The mean pre and post-stent stenoses were 82% and 20%. The frequency of any stroke, intracerebral hemorrhage, or death within 30 days or ipsilateral stroke beyond 30 days was 14.0% at 6 months (95% CI = 8.7% to 22.1%). The frequency of ≥50% restenosis on follow-up angiography was 13/52 (25%). Conclusion: The use of a Wingspan stent in patients with severe intracranial stenosis is relatively safe with high rate of technical success with moderately high rate of restenosis. Comparison of the event rates in high-risk patients in Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) vs this registry do not rule out either that stenting could be associated with a substantial relative risk reduction (e.g., 50%) or has no advantage compared with medical therapy. A randomized trial comparing stenting with medical therapy is needed. GLOSSARY: FDA = Food and Drug Administration; HDE = Humanitarian Device Exemption; ICH = intracerebral hemorrhage; WASID = Warfarin-Aspirin Symptomatic Intracranial Disease.