Miracle-dz/UniFAR-FTUs huggingface dataset:
Special Section: Spirituality/Medicine Interface Project Spirituality and Alcoholics Anonymous

Strong opinions, both pro and con, have been voiced about Alcoholics Anonymous (AA). It has been argued that AA is the most effective method to arrest alcoholism. In contrast, it has also been argued that AA is helpful to only 5% of the people who choose to affiliate with the organization. McCrady and Miller suggested that 1 in 10 Americans will attend a 12-step meeting in their lifetime, but Bufe asserted that a majority of individuals who seek relief from alcoholrelated problems by attending AA are coerced to do so, with less than 1 in 30 remaining in AA after one year. Finally, a majority of outpatient and inpatient alcohol treatment programs in the United States routinely include referral to AA, with a recent survey indicating that 79% of all Veteran Affairs substance abuse programs in the United States make such referrals. Court orders to attend the spiritually based program of AA have been successfully challenged as unconstitutional in the United States. However, the Supreme Court has demonstrated unusual leniency in upholding this decision, eg, they levied a $1.00 fine. Ironically, while AA formally eschews public controversy, it has been a lightning rod for conflict among professionals and laypersons regarding the treatment of alcoholism. In spite of the controversy surrounding the spiritually based program of AA, a majority of individuals receiving formal substance abuse treatment will attend AA, even if only for a limited time, and for many people, AA is the first and only point of contact at which they receive help for alcoholrelated problems. Two findings have emerged in reviews of the vast body of AA research: severe drinking is positively associated with initial AA attendance and continued AA attendance is modestly associated with abstinence and improved social functioning. Also, spiritual beliefs and practices of AA members increase over time–changes that are not accounted for by maturation alone. Displayed in Figure 1, for example, are three groups of individuals who received outpatient treatment for alcoholism. Demonstrating the sole influence of maturation, individuals with no AA exposure reported a modest increase in spirituality and religiosity. In contrast, individuals with AA exposure reported significantly larger gains in religious practices (eg, prayer) over the 10year period, and individuals who maintained consistent AA membership reported the largest increases in God consciousness and religious practices. This article reviews what we currently know about AA-related spirituality and how changes in spirituality may account for improved functioning among AA members (Fig. 1).
Maternal Serum Ferritin and Fetal Growth

Objective To determine the relationship between maternal serum ferritin and concentrations and specific types of fetal growth restriction (FGR). Methods Serum ferritin concentrations were measured at approximately 25 and 36 weeks' gestation in 480 multiparas with singleton fetuses who participated in a study of risk factors for repeated FGR. Asymmetric FGR was defined by low birth weight for gestational age criteria and a ponderal index less than 2.32, and symmetric FGR was defined by the same birth weight for gestational age criteria and a ponderal index of at least 2.32. Results Among 480 infants, 370 were appropriate for gestational age (AGA), 58 had asymmetric FGR, and 52 had symmetric FGR. Higher ferritin concentrations were associated with black race, maternal age 25 years or older, and smoking. Mothers of asymmetric-FGR infants had higher mean ferritin levels than mothers of AGA infants at 25 weeks' (38.0 versus 20.2 μg/L, P < .01) and 36 weeks' gestation (21.0 versus 13.3 μg/L, P < .01), whereas mothers of symmetric-FGR infants had significantly lower ferritin levels at 36 weeks (8.3 μg/L). For mothers with serum ferritin levels of at least 26 μg/L (highest quartile at 25 weeks), the adjusted odds ratio (OR) for asymmetric-FGR infants was 3.4, 95% confidence interval (CI) 1.6, 7.2. There was a similar association between the highest quartile of serum ferritin at 36 weeks (at least 20 μg/L) and asymmetric FGR (adjusted OR 2.7, 95% CI 1.3, 5.8). Women with serum ferritin levels less than 3 μg/L (lowest quartile at 36 weeks) had an adjusted OR for symmetric-FGR infants of 2.2, 95% CI 1.01, 4.6. Conclusion High maternal serum ferritin levels are associated with asymmetric FGR, whereas low serum ferritin levels are associated with symmetric FGR.
Neurosurgery 1992-98 May 1994, Volume 34, Number 5 847 Inclusion of the S2 Dorsal Rootlets in Functional Posterior Rhizotomy for Spasticity in Children with Cerebral Palsy

MANY NEUROSURGEONS HAVE made a practice of sectioning the S2 dorsal roots during selective posterior rhizotomy for the treatment of spasticity in children with cerebral palsy, but the efficacy of this treatment has not previously been proven. S2 afferents are involved in reflex arcs of the plantar flexors (PFs), so that S2 lesioning should in theory reduce PF spasticity. To test this assumption, we determined the frequency of postoperative residual spasticity in the PFs when S2 lesioning was or was not performed. We assessed 85 children for whom 6-month follow-up was available. Functional rhizotomy from L2-S1 was performed on 13 of them (26 legs with PF spasticity) and from L2-S2 on 72 (141 legs with PF spasticity). Rootlets were lesioned if there was an abnormal response to intraoperative electrical stimulation. In 20 patients, lesioning of the S2 rootlets was assisted by the "pudendal neurogram," a technique previously shown to prevent bladder dysfunction during sectioning of the sacral roots. When S2 roots were excluded from the lesioning process, residual PF spasticity was detected in 35% of the legs that had it preoperatively, leaving 5 (38%) of 13 children with functionally impairing spasticity. When S2 roots were included, 6% of legs that had PF spasticity retained it postoperatively ( P < 0.001), leaving 8 (11%) of 72 patients with functionally limiting spasticity ( P < 0.05). Thus, the addition of the S2 roots to the procedure resulted in an 81% reduction in the number of legs with residual PF spasticity and a 71% reduction in the number of patients with residual PF spasticity. The use of the pudendal neurogram did not alter the incidence of residual spasticity. We conclude that including the S2 roots in selective functional rhizotomy significantly reduces PF spasticity.
Demographic Associations of Diabetes Status by Both Fasting Plasma Glucose Concentration and Glycated Hemoglobin in a Community Survey in Galle District, Sri Lanka

Diagnostic tools used in detecting individuals with diabetes mellitus (DM) include fasting plasma glucose (FPG), glycated hemoglobin (HbA1C), and oral glucose tolerance test (OGTT). The present study was aimed to determine the demographic associations of diabetes status by both tests (FPG and HbA1C) in Galle district, Sri Lanka. 147 adults (30–60 years) who are having FPG ≥ 126 mg/dL underwent demographic evaluations and testing for HbA1C. Group 01 (diabetes status diagnosed by both tests) and group 2 (diabetes status diagnosed only by FPG) were compared using independant sample t-test and chi-square test. Logistic regression was used to study the association between the demographic factors and the diabetes status by both tests. Of the 147 study subjects, 38.1% were males, 61.9% were females, and 63.3% had a family history of diabetes among first-degree relatives (FDR). Mean age, body mass index (BMI), waist circumference (WC), FPG, and HbA1C of the participants were 48.4 ± 7.2 years, 25.1 ± 4.0 kg/m2, 88.8 ± 9.0 cm, 139.4 ± 30.1 mg/dL, and 6.4 ± 0.7%, respectively. The prevalence of diabetes based on both tests was 55.1%. There is a significant difference in mean BMI and WC while no significant differences in mean age between groups 01 and 02. No association was seen between gender and diabetes status (X2(1) = 0.086, p=0.770), while a significant difference was observed between DM among FDR and diabetes status (X2(1) = 33.215, p < 0.001). Significance of odds of having diabetes by both tests with rising BMI (OR = 1.97, CI 1.15–3.36, p=0.013) and DM among FDR (OR = 7.95, CI 3.54–17.88, p=0.000) was seen. We conclude rising BMI and having DM among FDR are strongly associated with diabetes status diagnosed by both tests of FPG and HbA1C in community screening.
RestrictedDiffusion in the Superior Ophthalmic Vein and Cavernous Sinus in a Case of Cavernous Sinus Thrombosis

A previously healthy 14-year-old boy developed headache, stiff neck, fever, diplopia, right proptosis, and right complete sixth and partial third cranial nerve palsies. Orbital CT showed features of pansinusitis and orbital fat stranding. An initial diagnosis of orbital cellulitis was made. However, closer inspection of the CT disclosed nonfilling of the right superior ophthalmic vein (SOV) and both cavernous sinuses, suggesting cavernous sinus thrombosis (CST). CT venography (CTV) confirmed these features and disclosed nonobstructing thrombus within the left sigmoid sinus and proximal segments of both internal jugular veins. MRI with diffusion imaging disclosed evidence of restricted diffusion within the SOV and cavernous sinuses. These diffusion imaging findings, which may be analogous to those reported with brain parenchymal hematoma, have been described sparingly in intravascular hematoma. (J Neuro-Ophthalmol 2009;29:16–20) Cavernous sinus thrombosis (CST) is a relatively rare but life-threatening cause of a cavernous sinus syndrome in immunocompetent patients (1). The primary source of sepsis may be a distant focus or contiguous regions (2). The dural sinuses and the cerebral and emissary veins have no valves, allowing blood to flow in either direction according to pressure gradients in the vascular system. This feature, together with the extensive direct and indirect vascular connections of the centrally located cavernous sinuses, makes these structures vulnerable to septic thrombosis from infected tributary sites such as the face, nose, tonsils, soft palate, teeth, and ears. Once antibiotic therapy became widely available, however, the sphenoid sinus emerged as the most common primary source of infection predisposing to CST. We report a patient who presented with clinical features initially suggesting orbital cellulitis as the primary process. Careful analysis of the clinical and imaging features led to the diagnosis of CST with secondary thrombosis of the right superior ophthalmic vein (SOV) and ipsilateral orbital congestion. We also report MRI evidence of restricted diffusion within the thrombosed cavernous sinuses and SOV, a feature not previously described.
Rôle et évolution de facteurs de virulence impliqués dans une interaction hôte-parasitoïde

Les associations mutualistes, en permettant l'acquisition de nouvelles fonctions, ont joue un role majeur dans l'evolution des especes. Pour comprendre en quoi ces associations sont impliquees dans l'adaptation des especes nous avons etudie un cas unique de mutualisme associant un virus de type polydnavirus et une guepe parasitoide. Dans cette association, le virus est injecte dans l'hote lepidoptere lors de l'oviposition et joue un role majeur dans le succes parasitaire en induisant une alteration des fonctions physiologiques de l'hote. En regard du nombre d'especes de guepes caracterisees par cette association, le virus doit constituer une innovation adaptative majeure et jouer un role determinant dans l'evolution et la diversification des especes de guepes. En quoi cette association joue t-elle un role determinant dans l'evolution et l'adaptation des guepes ? Quelles sont les fonctions physiologiques ciblees chez l'hote ? Pour repondre a ces questions nous avons etudie l'evolution de deux familles de genes codant pour des facteurs de virulence potentiels et nous avons explore les fonctions physiologiques d'une proteine potentiellement ciblee lors du parasitisme. Nous avons mis en evidence le role important de la selection naturelle dans l'evolution des familles de genes viraux. Par modelisation de la structure tridimensionnelle d'un facteur de virulence codant pour des cystatines, nous avons montre que cette selection agissait preferentiellement au niveau des sites d'interaction avec les proteines cibles. De plus, cette etude souligne le caractere dynamique de l'evolution des facteurs de virulence incluant de multiples evenements de duplication, caracterises par des processus de perte et d'acquisition au cours de l'evolution de l'association. Le caractere adaptatif et dynamique de l'evolution des genes viraux a aussi ete etudie en regard de l'evolution des especes de guepes et de leur spectre d'hote. Par une approche fonctionnelle, nous avons etudie le role physiologique de proteases a cysteine qui constituent des cibles potentielles des cystatines virales. Nous avons montre que ces proteases sont regulees specifiquement au cours du parasitisme au niveau proteique et transcriptionnel. Nous avons egalement montre que l'activite de ces proteases est modifiee apres parasitisme. L'evolution adaptative et dynamique des facteurs de virulence refletent leur role important dans le parasitisme. Il reste maintenant a montrer comment ces facteurs interagissent sur la physiologie de l'hote lepidoptere. Des proteases a cysteine sont specifiquement ciblees par le parasitisme, en etudiant les mecanismes d'interaction de ces proteases avec les cystatines virales et les processus coevolutifs mis en jeu, nous
Pyruvate kinase variant of fission yeast tunes carbon metabolism, cell regulation, growth and stress resistance

Cells balance glycolysis with respiration to support their metabolic needs in different environmental or physiological contexts. With abundant glucose, many cells prefer to grow by aerobic glycolysis or fermentation. Using 161 natural isolates of fission yeast, we investigated the genetic basis and phenotypic effects of the fermentation–respiration balance. The laboratory and a few other strains depended more on respiration. This trait was associated with a single nucleotide polymorphism in a conserved region of Pyk1, the sole pyruvate kinase in fission yeast. This variant reduced Pyk1 activity and glycolytic flux. Replacing the “low‐activity” pyk1 allele in the laboratory strain with the “high‐activity” allele was sufficient to increase fermentation and decrease respiration. This metabolic rebalancing triggered systems‐level adjustments in the transcriptome and proteome and in cellular traits, including increased growth and chronological lifespan but decreased resistance to oxidative stress. Thus, low Pyk1 activity does not lead to a growth advantage but to stress tolerance. The genetic tuning of glycolytic flux may reflect an adaptive trade‐off in a species lacking pyruvate kinase isoforms.
The Role of MicroRNAs in Regulatory T Cells

MicroRNAs are a class of conserved, 20 nt-23 nt long, noncoding small RNAs that inhibit expression of their respective target genes in different cell types. Regulatory T cells (Tregs) are a subpopulation of T cells that negatively regulate immune responses, which is essential to immune homeostasis. Recent studies have indicated that microRNAs play an important role in the proliferation, differentiation, and functions of Treg. Here, we review the recent progress in understanding the roles of microRNAs in Treg and their dysregulation in immune-related diseases. This ongoing research continues to expand the understanding of Treg regulation and the mechanisms of immune disorders.
Evaluation of High Fidelity Neonatal Simulation as a Method to Teach Pediatric Residents Neonatal Airway Management Skills

INTRODUCTION: Current research shows that pediatric residents have poor neonatal airway management skills. In many settings, the general pediatrician is responsible for managing delivery room resuscitation and stabilizing infants in distress. Since 1996, the Accreditation Council for Graduate Medical Education (ACGME) and the Residency Review Committee (RRC) for pediatrics have included neonatal airway management and neonatal intubation as skills required by all trainees prior to graduation. However, multiple changes have taken place over the past 5 years in postgraduate medical education resulting in less opportunity for pediatric residents to practice neonatal airway management skills. Resident work hours have been restricted to 80 hours per week and the number of months residents are allowed to spend in the neonatal intensive care unit (NICU) has decreased. A growing concern for many academic training centers is how to meet the demands of postgraduate medical education, while following RRC and ACGME recommendations. Although there have been few studies documenting current pediatric resident success at neonatal airway management skills, results are concerning. Falck (2003) demonstrated that the success rate of neonatal intubations within three attempts by first year pediatric residents was 50%, by second year residents was 55%, and by third year residents was 62%. A total of 35% of intubation procedures were never successful by pediatric residents at their institution. Leone (2005) reviewed a 10 year database and found the median success rates for first year residents to be 33%, for second and third year residents 40%, and only 68% for neonatal fellows. These studies emphasize that pediatric residents are not mastering a core clinical competency, that of neonatal airway management and intubation skills. As a required competency for graduation and the care of sick newborns there is a need for new and innovative ways to teach this important skill. The goal of this study is to improve pediatric residents’ ability to manage the airway of a critically ill neonate including proper set up of resuscitation equipment, bag-mask ventilation, and endotracheal intubation using the infant simulator, Simbaby (Laerdal).
The ‘‘Borderline’’ Renal Allograft Biopsy: Differential Diagnosis, Pitfalls, and Challenges

A diagnostic category termed ‘‘borderline changes suspicious for acute rejection’’ is included in the Banff schema for allograft pathology to recognize biopsies that do not fulfill the histological criteria for T-cellYmediated rejection. Although some cases represent early stage or treated immune injury, others represent intercurrent clinical conditions such as acute tubular injury, calcineurin inhibitor toxicity, infection, and obstructive uropathy. We document the spectrum of graft dysfunction associated with this diagnosis by reporting a patient who initially fell in the borderline category. Further investigation demonstrated acute antibody-mediated injury, which was treated appropriately but complicated by polyomavirus BK viremia. This triggered reduction in the dose of immunosuppression, which led to rebound grade 1B T-cellYmediated rejection superimposed on antibody-mediated rejection. Inability to maintain the right balance of immunosuppression that could effectively control both rejection and infection led to graft loss. This case illustrates how management of the patient with borderline changes at biopsy requires detailed clinicopathological correlation and careful monitoring.
PRESIDENTIAL ADDRESS New Horizons for Psychosomatic Medicine

What does the future hold for the field of Psychosomatic Medicine and for our Society? And where should we who hold the future be directing our attention and energies? In order to prepare ourselves to address these questions, let us examine three sources of information: a review of the historical development of the field of psychosomatic medicine, an expanded theoretic framework pointing to dimensions in the natural history of health and illness which warrant increased emphasis in psychosomatic research, and epidemiologic projections of future patterns of illness and health care utilization for which our field will be challenged to provide research, understanding, and effective treatment.
MRI and Body Fluid Analysis: New Means to Monitor Early Structural and Metabolic Changes in Joint Cartilage Disease

Emerging knowledge of cartilage metabolism and structure has stimulated efforts to develop new cartilage-monitoring techniques in health and disease. This article gives an overview of cartilage matrix structure, cartilage metabolism, and significant exogenous factors to show how such knowledge can guide the development of new means to monitor cartilage. Delayed contrast enhanced MRI of cartilage (dGEMRIC) and analysis of molecular biomarkers of joint cartilage metabolism in body fluids are two such methods that have made it possible to examine cartilage matrix structure and to study metabolic processes in vivo.
Comments on stress-induced analgesia. Response to the Letter to the Editor by Daniel Le Bars and Pascal Carrive on clinical correlates of stress-induced analgesia: Evidence from pharmacological studies

[28] Vianna DM, Carrive P. Changes in cutaneous and body temperature during and after conditioned fear to context in the rat. Eur J Neurosci 2005;9:2505–12. [29] Vidal C, Jacob J. Hyperalgesia induced by emotional stress in the rat: an experimental animal model of human anxiogenic hyperalgesia. Ann NY Acad Sci 1986;467:73–81. [30] Young AA, Dawson NJ. Evidence for on–off control of heat dissipation from the tail of the rat. Can J Physiol Pharmacol 1982;60:392–8. Daniel Le Bars Team ‘‘Pain”, INSERM UMRS 975, CNRS UMR 7225, Université Pierre et Marie Curie, Faculté de Médecine UPMC, 91 boulevand de l’Hôpital, F-75013 Paris, France Tel. : +33 1 40 77 97 55; fax: +33 1 40 77 96 45 E-mail address: daniel. le_bars@upmc.fr
NANOS Symposium on Optic Neuritis and Multiple Sclerosis Evolving Concepts in the Pathogenesis of Multiple Sclerosis and Their Therapeutic Implications

Recent evidence suggests that multiple sclerosis (MS) is a continuously active neuropathologic process, even during the subclinical relapsing/remitting phase of the disease. Patients commonly feel well and function without disability for many years, experiencing only occasional relapses and nondisabling symptoms. In time, many evolve into a pattern of continuously progressive neurologic disability termed secondary progressive MS (SP-MS). SP-MS is hypothesized to occur once disease severity has exceeded a threshold. Above that threshold, compensatory mechanisms are inadequate to maintain normal function, and further disease progression is accompanied by progressively worsening disability. Inflammation dominates the early stage of disease. Progressive axonal pathology may underlie clinical disease progression in later stages. These concepts have important implications related to the diagnosis, methods for patient follow-up, type and timing of disease therapy, and the testing of neuroprotective drugs in MS.
Natural β-Carotene for the Prevention of Post-ERCP Pancreatitis

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly used procedure. Pancreatitis is its most common complication. As the injury may be mediated by oxidative stress, it could be ameliorated by antioxidants. Methods: We conducted a double-blind trial, giving the patients a single dose of natural β-carotene or placebo, 12 hours prior to procedure, and monitoring them for 24 hours post-procedure for procedure complications, antioxidant levels, and plasma oxidation. Results: The overall incidence of acute pancreatitis according to our definition was 9.6%. The incidence of pancreatitis was not significantly different between the β-carotene group (10%) and the placebo group (9.4%). Four patients in the placebo group had severe pancreatitis (2.22%), but none in the β-carotene group. This difference is statistically significant. Conclusion: We did not see a reduction in the incidence of post-ERCP pancreatitis, but there may be some protective effect of treatment with β-carotene regarding the severity of disease.