Miracle-dz/UniFAR-FTUs huggingface dataset:
Methotrexate Efficacy in the Tight Control in Psoriatic Arthritis Study

Objective. Methotrexate (MTX) is a commonly used disease-modifying antirheumatic drug in psoriatic arthritis, but there is conflicting evidence to support its efficacy. Methods. Within the Tight Control of Psoriatic Arthritis (TICOPA) study, patients were treated with MTX as part of the tight control protocol or standard care. Outcomes were recorded at the 12-week visit, including joint counts, skin, nail, enthesitis, dactylitis, and patient-reported measures. Results. Of the 206 patients enrolled, 188 received MTX in the first 12 weeks of the trial with 104 receiving a mean dose > 15 mg/week. The proportions of patients achieving the American College of Rheumatology (ACR) outcomes at 12 weeks were ACR20 40.8%, ACR50 18.8%, and ACR70 8.6%, with 22.4% achieving minimal disease activity. Improvements were seen in psoriasis with 27.2% reaching a Psoriasis Area and Severity Index (PASI) 75. The proportion of patients with dactylitis and Leeds dactylitis instrument (LDI) scores decreased significantly (62.7% decrease in patients with dactylitis, median change LDI −59.7, −157.4 to −26.4, p = 0.033). The decrease in proportion of patients with enthesitis (25.7%) was significant, but the median change in enthesitis score was 0. There was a trend to higher proportions of patients receiving over 15 mg/week achieving ACR20, ACR50, and PASI75. Conclusion. Despite the open-label design of the data, improvements in multiple clinical outcomes were seen. The proportion of patients reaching ACR20 in the TICOPA study was higher than in the Methotrexate in Psoriatic Arthritis study (41% vs 34%), but no comparative data are available for other outcomes. There is a suggestion of a dose response, but this is hard to assess when patients doing well may be maintained on lower doses.
Haemorrhage control in pelvic trauma

A pelvic fracture usually indicates high energy transfer from a significant mechanism and a high likelihood of associated injuries. Mortality from pelvic trauma is usually due to massive haemorrhage mandating expedient resuscitation of the patient and immediate control of exsanguinating haemorrhage. Damage control resuscitation incorporates permissive hypotensive resuscitation and early replacement of clotting factors with early aggressive surgical control of bleeding. A commercially available pelvic binder provides circumferential compression and rapidly closes the pelvis, leading to fracture splintage and reduction in pelvic volume, both of which reduce haemorrhage. It is critical to distinguish ongoing bleeding due to a pelvic ring injury from intra-peritoneal haemorrhage. The identification of intra-peritoneal bleeding in a haemodynamically unstable patient mandates laparotomy. On-going haemorrhage from the pelvis requires diagnostic pelvic angiography, followed by selective embolisation if a source of bleeding is identified. If angiography is not available pelvic packing can be life-saving.
FDA Approval Summary: Sonidegib for Locally Advanced Basal Cell Carcinoma

On July 24, 2015, the FDA approved sonidegib (ODOMZO; Novartis) for the treatment of patients with locally advanced basal cell carcinoma (laBCC) not amenable to curative surgery or radiotherapy. The approval was based on data from one randomized, double-blind, noncomparative trial of two doses of sonidegib administered to 230 hedgehog inhibitor–naïve patients with metastatic basal cell carcinoma (mBCC, n = 36) or laBCC (n = 194). Patients were randomized 2:1 to receive sonidegib 800 mg (n = 151) or 200 mg (n = 79) daily. The objective response rate (ORR) for patients with laBCC was 58% [95% confidence interval (CI), 45–70] in the 200 mg group and 44% (95% CI, 35–53) in the 800 mg group. The median duration of response for patients with laBCC was nonestimable (NE) in the 200 mg arm and 15.7 months (95% CI, NE) in the 800 mg arm. The ORR for patients with mBCC was 8% (95% CI, 0.2–36) and 17% (95% CI, 5–39) in patients treated with 200 and 800 mg, respectively. The most common adverse events occurring in ≥10% of patients were muscle spasms, alopecia, dysgeusia, nausea, fatigue, increased serum creatine kinase, decreased weight, and diarrhea. Clin Cancer Res; 23(10); 2377–81. ©2017 AACR.
Response by Grassi et al to Letter Regarding Article, "The Sympathetic Nervous System Alterations in Human Hypertension".

Drs Zhou and Zhou1 write a challenging letter that aims to turn concepts of sympathetic nerve biology and norepinephrine plasma kinetics upside down. Their letter claims that there is a previously unsuspected primary importance for platelets in norepinephrine disposition after release of the transmitter from sympathetic nerves in individual organs and in clearance of norepinephrine from the circulation. Imagination is a fine thing in science, not least for overturning a dominant paradigm, but supporting quantitative analysis must buttress this. Before addressing the specific issues raised by the 2 authors in their letter,1 we would like to emphasize that, as extensively discussed in our article,2 the evidence of a sympathetic hyperactivity in hypertension is based not only on the results of the isotope-dilution studies but also, and probably to a greater extent, on other techniques assessing neuroadrenergic drive, the most important of them being represented by the microneurographic nerve traffic recording. Thus, the statement by Drs Zhou and Zhou that “the importance of sympathetic hyperactivity in hypertension is primarily based on the results of isotope-dilution studies” is not supported …
Delayed Transfers of Care — An Early Review of Progress

Using the findings from a CSCI study undertaken in the first months after the implementation of the Community Care (Delayed Discharges) Act 2003, this article outlines key issues for the immediate future. It is the third in a sequence of articles in the Journal of Integrated Care on this priority policy issue, and the first to report on implementation.
Black African migrants' perceptions of cancer: are they different from those of other ethnicities, cultures and races?

Purpose – Cancer discussion is perceived as a taboo subject among different cultures and societies including Africans. This perception has caused limited knowledge about the disease and prevented some from seeking early diagnosis and treatment. With West Africans now living in western societies where cancer is openly discussed, this study aims to explore how black Africans perceive the disease and the implications for healthcare.Design/methodology/approach – Five focus groups of 53 persons from Ghanaian and Nigerian migrant communities in Luton participated in this study.Findings – Perceptions of fear, shame and denial were identified as key elements of how people perceive and react to cancer among the study population.Originality/value – Secrecy and apprehension were identified as major barriers and have prevented some from adequately accessing and utilizing cancer facilities in the country. The feelings of fear, secrecy and stigma associated with the disease across different ethnic groups, cultures and .
Erythromycin Resistance in Streptococcus pyogenes Group A throatisolates in Sukkur city

Objective: To examine and evaluate the predominant and common etiologic agent(s) of pharyngitis in Sukkur city and to determine their current antibiotic susceptibility/resistance trends. Methods: Out of 257 throat samples, 149 positive for Streptococcus pyogenes Group A between November 2001 and May 2003 from adult population of Sukkur city were tested for their susceptibility to erythromycin, clindamycin, azithromycin and clairithromycin. The throat samples (swabs) were examined by Gram-stain, API system, and for presence of β-hemolysis. Samples were further cultured on Muller Hinton agar for determination of antibiotic sensitivity patterns. The sensitivity was performed on only those samples which were positive for S. pyogenes. Results: Of all throat isolates, 95% were predominantly resistant to erythromycin. Their sensitivity towards clindamycin was 30%, azithromycin 44% and clairithromycin 76% respectively. Conclusion: The current pharyngeal isolates of S. pyogenes exhibited frequent and alarmingly high erythromycin resistance which may be due to both intrinsic and acquired mechanisms. (Rawal Med J 2007;32:11-13)
Failed Back Surgery: A Clinical Review: Sahin Net al. Failed Back Surgery

Failed back surgery syndrome (FBSS, failed back syndrome) is a chronic disorder that has many impacts on the patients and health care systems. The predisposing factors may occur in the preoperative, intraoperative, and postoperative periods. The term FBSS is often misused. It is not actually a syndrome, but is a very generalized term that is often used to describe the condition of patients who had unsuccessful results with back surgery or spine surgery, or experienced continued pain after surgery. Patients describe uncontrolled persistent back, back/leg or leg pain with functional insufficiency with or without sciatica after 10-40% of the all spinal surgeries. Literature about the FBSS is insufficient, due to the complexity of this entity with variety of the underlying etiology and lack of high-quality clinical trials determining response to treatment modalities. This review aims to summarize current concepts in the ligthnings of literature findings. © 2015 The Authors. Published by ACT Publishing Group Ltd.
Updating the OMERACT Filter at OMERACT 11

The Outcome Measures in Rheumatology (OMERACT) community strives to develop core outcome sets for rheumatologic conditions to specify, for each condition, the minimum set of outcomes necessary to provide consistent estimates of the benefits of an intervention. The original and successful OMERACT filter of “truth, discrimination, and feasibility” requires development and updating because of application to a widening range of conditions by an expanding group, particularly patients. It should more explicitly identify the relevant core outcomes that might be universal to all randomized controlled trials within rheumatology. Working from first principles, comparing proposals against actual procedures adopted by OMERACT working groups, and seeking a broad consensus over several major sessions at the OMERACT 11 meeting, a new version has emerged, OMERACT Filter 2.0, which will form the central theme of the intended OMERACT handbook and offers an approach to core outcome set development in many areas of healthcare.
Epidemiology of Chronic Obstructive Pulmonary Disease (COPD) in Aging Populations

Abstract Current epidemiologic practice evaluates COPD based on self-reported symptoms of chronic bronchitis, self-reported physician-diagnosed COPD, spirometry confirmed airflow obstruction, or emphysema diagnosed by volumetric computed chest tomography (CT). Because the highest risk population for having COPD includes a predominance of middle-aged or older persons, aging related changes must also be considered, including: 1) increased multimorbidity, polypharmacy, and severe deconditioning, as these identify mechanisms that underlie respiratory symptoms and can impart a complex differential diagnosis; 2) increased airflow limitation, as this impacts the interpretation of spirometry confirmed airflow obstruction; and 3) “senile” emphysema, as this impacts the specificity of CT-diagnosed emphysema. Accordingly, in an era of rapidly aging populations worldwide, the use of epidemiologic criteria that do not rigorously consider aging related changes will result in increased misidentification of COPD and may, in turn, misinform public health policy and patient care.
Are phloem sieve tubes leaky conduits supported by numerous aquaporins?

PREMISE OF THE STUDY Aquaporin membrane water channels have been previously identified in the phloem of angiosperms, but currently their cellular characterization is lacking, especially in tree species. Pinpointing the cellular location will help generate new hypotheses of how membrane water exchange facilitates sugar transport in plants. METHODS We studied histological sections of balsam poplar (Populus balsamifera L.) in leaf, petiole, and stem organs. Immuno-labeling techniques were used to characterize the distribution of PIP1 and PIP2 subfamilies of aquaporins along the phloem pathway. Confocal and super resolution microscopy (3D-SIM) was used to identify the localization of aquaporins at the cellular level. KEY RESULTS Sieve tubes of the leaf lamina, petiole, and stem were labeled with antibodies directed at PIP1s and PIP2s. While PIP2s were mostly observed in the plasma membrane, PIP1s showed both an internal membrane and plasma membrane labeling pattern. CONCLUSIONS The specificity and consistency of PIP2 labeling in sieve element plasma membranes points to high water exchange rates between sieve tubes and adjacent cells. The PIP1s may relocate between internal membranes and the plasma membrane to facilitate dynamic changes in membrane permeability of sieve elements in response to changing internal or environmental conditions. Aquaporin-mediated changes in membrane permeability of sieve tubes would also allow for some control of radial exchange of water between xylem and phloem.
Intervención educativa escolar para prevenir el tabaquismo: evaluación del proceso

FUNDAMENTO: Los datos publicados sobre eficacia de programas escolares para la prevencion del tabaquismo son inconsistentes. No esta suficientemente estudiado el proveedor de tales programas como variable de confusion. El objetivo de este estudio fue evaluar el proceso de una intervencion educativa intraescolar. METODO: Lideres estudiantiles y profesores, entrenados y con guias, desarrollaron un programa de base social. Se encuesto aleatoriamente a 2 alumnos por cada aula, mediante cuestionario validado y pilotado: 318 ninos. Se utilizo el Indice Kappa para medir la fiabilidad, y el Coeficiente de Correlacion Intraclase, el de Pearson y el analisis de las diferencias individuales para comparar los datos de ajuste al programa, proporcionados por alumnos y profesores. RESULTADOS: La media de ajuste por aula fue 30,07 puntos (48 =100% de ajuste). El 26% de los ninos no pudo citar una alternativa a las ventajas de fumar, 71,7% desconocia la frecuencia de consumo en adultos y 19,5% no pudo evocar ningun truco propio de la publicidad del tabaco. Menos de la mitad realizo un sociodrama sobre el tema, como era preceptivo. El CCI fue 0,21, Pearson 0,25 (p = 0,02) y el intervalo de concordancia entre las calificaciones de profesores y alumnos fue de 6,93 puntos (-1,70 a 5,23). CONCLUSIONES: El ajuste de la implementacion al modelo de programa propuesto fue insuficiente. Encontramos escasa correspondencia entre la autocalificacion del profesorado y la puntuacion alcanzada por los alumnos en el ajuste al programa. La evaluacion del proceso es esencial para interpretar correctamente la evaluacion del impacto.
Hypertrophy in Mesenchymal Stem Cell Chondrogenesis: Effect of TGF-β Isoforms and Chondrogenic Conditioning

Induction of chondrogenesis in mesenchymal stem cells (MSCs) with TGF-β leads to a hypertrophic phenotype. The hypertrophic maturation of the chondrocytes is dependent on the timed removal of TGF-β and sensitive to hypertrophy-promoting agents in vitro. In this study, we have investigated whether TGF-β3, which has been shown to be more prochondrogenic compared to TGF-β1, similarly enhances terminal differentiation in an in vitro hypertrophy model of chondrogenically differentiating MSCs. In addition, we tested the impact of the time of chondrogenic conditioning on the enhancement of hypertrophy. MSCs were chondrogenically differentiated in pellet culture in medium containing TGF-β1 or TGF-β3. After 2 or 4 weeks, chondrogenic medium was switched to hypertrophy-inducing medium for 2 weeks. Aggregates were analyzed histologically and biochemically on days 14, 28 and 42. The switch to hypertrophy medium after 14 days induced hypertrophic cell morphology and significant increase in alkaline phosphatase activity compared to the chondrogenesis only control using both TGF-β1 and TGF-β3. After 28 days predifferentiation, differences between hypertrophic and control groups diminished compared to 14 days predifferentiation. In conclusion, chondrogenic conditioning with both TGF-β isoforms similarly induced hypertrophy in our experiment and allowed the enhancement of the hypertrophic chondrocyte phenotype by hypertrophic medium. Enhancement of hypertrophy was seen more clearly after the shorter chondrogenic conditioning. Therefore, to utilize this experimental model as a tool to study hypertrophy in MSC chondrogenesis, a predifferentiation period of 14 days is recommended.
Higher Pneumococcal Disease Vaccination Rates Needed to Protect More At-Risk US Adults

Abstract Pneumococcal disease, which includes pneumococcal pneumonia, meningitis, and bacteremia, is associated with substantial morbidity, mortality, and health care costs in adults. Advanced age, chronic lung or cardiovascular disease, immunosuppressive conditions, and smoking increase the risk for infection. Despite the availability of an effective pneumococcal polysaccharide vaccine (PPSV23), vaccination rates among adults remain suboptimal. This is of immediate concern given the current H1N1 pandemic, since secondary bacterial infection with Streptococcus pneumoniae is common and can contribute to morbidity and mortality. The Centers for Disease Control and Prevention has recently called for increased efforts to vaccinate recommended persons against pneumococcal disease. Long-term trends including the growth of the elderly population and an increase in the number of patients with chronic conditions also underscore the importance of improving pneumococcal vaccination rates. It is important for health care providers, public health officials, and policy makers to recognize the serious health impact of pneumococcal disease in adults and to ensure increased coverage; at present, this is the best way to protect against invasive pneumococcal infection and its consequences.
The effect of tophaceous gout on the structure and function of the Achilles tendon

Gout is the most prevalent form of inflammatory arthritis in men older than forty years of age and has a significant functional and social impact. Tophaceous gout is the most progressed phase of gout and is associated with foot pain, impairment and disability in joints (first metatarsophalangeal joint) and soft tissue (Achilles tendon). The structural characteristics of the Achilles tendon (AT) enables it to withstand the large forces imposed during the gait cycle. Any alteration to the internal structure of the AT may affect the ability of the gastro-soleus complex to generate force, transfer muscle power and absorb energy during the gait cycle. Current research has reported tophus deposition in the AT. However, there is limited information on the impact of tophus on the AT structure and the impact of gait characteristics in people with gout. Therefore, the aims of this thesis were to investigate the prevalence of ultrasound (US) lesions in the AT and the gait parameters of walking velocity, ankle power and ankle range of motion in participants with tophaceous gout compared to age and sex-matched control participants. Two systematic reviews with meta-analysis were also undertaken. The first systematic review was conducted on US lesions in the AT of people with inflammatory arthritis. The results demonstrated that the majority of studies reporting US lesions were in spondyloarthropathies, but limited data relating to tophaceous gout. The meta-analysis demonstrated the AT was significantly thicker in people with spondyloarthropathies, erosions more prevalent in both spondyloarthropathies and rheumatoid arthritis, but enthesophyte formation was not significantly more prevalent in participants with spondyloarthropathies when compared to control participants. The review highlighted inconsistencies in both defining and scoring US lesions indicative of inflammation and structural damage in people with inflammatory arthritis. The second systematic review evaluated gait parameters in inflammatory arthritis. The findings from the review identified the most commonly assessed gait parameters used to define gait adaptation in inflammatory arthritis, with the majority of studies focusing on gait adaptation in rheumatoid arthritis. The meta-analysis demonstrated significant differences in walking velocity, cadence, stride length, double support time, ankle power and forefoot plantar pressure, but no significant differences in ankle range of motion when participants with inflammatory arthritis were compared to controls. The review
Are Survivors of Childhood Acute Lymphoblastic Leukemia at Increased Risk for Low Bone Mass

Acute lymphoblastic leukemia is the most prevalent cancer in children. As an increasing number of cancer survivors reaches adulthood, there may be consequences of the treatment, and there is an issue if low bone mass might be included as a significant late effect. Acute lymphoblastic leukemia patients may have their bone mass compromised during therapy and many years after its withdrawal, but the degree of bone mass decline or recovery are not well elucidated to date. Survivors of stem cell transplantation for leukemia have additional risk factors for bone loss and should be evaluated with caution. Our target is to make a warning about the difficulties in assessing and interpreting bone mass in children and adolescents, the limitations in this assessment in acute lymphoblastic leukemia young survivors (including survivors of stem cell transplantation), the possibility of misdiagnoses, the reasons (if there are any) of low bone mass in this particular group of cancer survivors, as well as consider the therapeutic issues available.
Microadenomas hipofisários: revisão de 95 casos

We reviewed 95 cases of patients with pituitary microadenomas diagnosed by magnetic resonance imaging in two institutions: "Hospital Santa Cruz/Beneficencia Portuguesa de Niteroi" and "Clinica X-Labs/Rio de Janeiro". Our aim was to establish the main type of pituitary microadenoma, incidence and proximity to the hypophisial stalk, and correlate these findings with clinical and laboratorial data. A Philips Gyroscan T5 III (0.5 Tesla), a GE Vectra (0.5 Tesla) and a GE Signa (1.0 Tesla) scanners were used to scan the patients with rapid sequences before and after intravenous administration of paramagnetic contrast medium (gadolinium). There was a predominance of women with prolactinomas associated to galactorrhea and hyperprolactinemia. In contrast to the current literature, we observed that the pituitary stalk was centered in most cases. Contrast medium injection immediately before scanning is essential to identify microadenomas. The use of half of the preconized dose of gadolinium is recommended.