Miracle-dz/UniFAR-FTUs huggingface dataset:
Hypercapnia and surgical site infection: a randomized trial.

BACKGROUND Tissue oxygenation is a strong predictor of surgical site infection (SSI). Mild intraoperative hypercapnia increases peripheral, gastrointestinal, and splanchnic tissue oxygenation and perfusion. Hypercapnia also has anti-inflammatory effects. However, it is unknown whether hypercapnia reduces SSI risk. We tested the hypothesis that mild intraoperative hypercapnia reduces the risk of SSI in patients having colon resection surgery. METHODS With institutional review board approval and subject consent, patients having elective colon resection (e.g. hemicolectomy and low-anterior resection) expected to last >2 h were randomly assigned to intraoperative normocapnia (PE'CO2 ≈ 35 mm Hg; n=623) or hypercapnia ( PE'CO2 ≈ 50 mm Hg; n=592). Investigators blinded to group assignment evaluated perioperative SSI (Center for Disease Control criteria) for 30 postoperative days. SSI rates were compared. RESULTS Patient and surgical characteristics were comparable among the groups. The SSI rate for normocapnia was 13.3%, and for hypercapnia, it was 11.2% (P=0.29). The Executive Committee stopped the trial after the first a priori determined statistical assessment point because of much smaller actual effect compared with the projected. However, because the actual difference found in the SSI rates (15-16%) were within the 95% confidence intervals (CIs) of the projected relative difference of 33% (95% CI -43 to +24%), our results cannot be considered as 'no difference', and cannot exclude a Type II error. Time to first bowel movement was half-a-day shorter in the hypercapnia group. CONCLUSIONS Mild hypercapnia appears to have little or-possibly-no ability to prevent SSI after colon resection. Other strategies for reducing SSI risk should thus take priority.
Effect of Aging and Diffuse Chronic Pancreatitis on Pancreas Elasticity Evaluated using Semiquantitative EUS Elastography

Abstract Purpose: Endosonographic elastography has been introduced as a method of estimating the stiffness of pancreatic tumors. This prospective single-center study was conducted to evaluate changes in the stiffness of the pancreas related to age and diffuse chronic pancreatitis. Patients and Methods: 46 individuals each up to age 60 (group 1) and over age 60 (group 2) with healthy pancreata and 26 patients with diffuse chronic pancreatitis (group 3) were included. Three elastograms were obtained in each case by endosonography in a defined section through the pancreatic body. Elastograms were further evaluated by histogram analysis. Mean strain values, based on a range from 0 (hardest) to 255 (softest), and their standard deviation were calculated from the histogram. The three groups were compared statistically with regard to pancreatic stiffness. A cut-off level for the diagnosis of chronic pancreatitis was defined by testing receiver operating characteristics curves. Results: The strain values (mean, SD) measured in the pancreatic body in groups 1 – 3 were 110.2 (23.9), 80.0 (16.4), and 32.4 (11.9), respectively. Pairwise comparison of the groups revealed highly significant differences (p < 0.001). At a cut-off value of 50, the area under the curve was 0.993 for distinguishing between chronic pancreatitis and healthy pancreata in people aged over 60. Conclusion: Semiquantitative elastography shows that pancreata become significantly harder during aging, but remain softer than in chronic pancreatitis. A cut-off value of 50 is suggested as a possible diagnostic criterion for diffuse chronic pancreatitis.
Funding Sources in Faculty Development: Strategies for Success in Submitting Proposals

Abstract Although the capacity for integrated research and potential for translating research findings to the clinical setting have never been stronger, we are paradoxically entering a period of highly constrained funding. It is more important than ever for clinician scientists and young researchers to be strategic in the approach to funding. The purpose of this article is to discuss strategies for a successful approach to appropriate grant funding agencies.
The role of thoracic expansion exercises during the active cycle of breathing techniques

Fifteen adult cystic fibrosis patients completed a randomised two-period, two-treatment crossover study to investigate whether it is necessary to perform thoracic expansion exercises during the active cycle of breathing techniques (ACBT) with postural drainage. Treatment A comprised the ACBT with postural drainage, incorporating thoracic expansion exercises. Treatment B was as described for treatment A with the exclusion of the thoracic expansion exercises. During treatment By the thoracic expansion exercises were replaced with an equivalent period of relaxed breathing. No significant differences were found between treatments A and B for spirometry, sputum weight or oxygen saturation measured up to 30 min post-treatment. This suggests that, if desired, thoracic expansion exercises can be omitted from the ACBT with postural drainage and be replaced with relaxed breathing with no obvious loss of effect or detrimental sequelae in the short term.
Development of Magnetic Nanoparticles for Cancer Gene Therapy: A Comprehensive Review

Since they were first proposed as nonviral transfection agents for their gene-carrying capacity, magnetic nanoparticles have been studied thoroughly, both in vitro and in vivo. Great effort has been made to manufacture biocompatible magnetic nanoparticles for use in the theragnosis of cancer and other diseases. Here we survey recent advances in the study of magnetic nanoparticles, as well as the polymers and other coating layers currently available for gene therapy, their synthesis, and bioconjugation processes. In addition, we review several gene therapy models based on magnetic nanoparticles.
Biomechanics of dental implants: A FEM study

Biomechanics comprises all kinds of interactions between tissues and organs of the body and the forces acting on them. Biomechanics comprises the response of the biologic tissues to the applied loads. AIMS AND OBJECTIVES: Attempt has been made to understand the basics of biomechanics with a view on finite-element stress distribution analysis in three situations namely: 1. To compare the stress distribution in a single implant with the narrow ceramic occlusal table and wide ceramic occlusal table. 2. To compare the stress distribution in two implants supporting a three-unit bridge, one model with implants placed parallel to each other and the other with one implant placed in angular position to the other. 3. To compare the difference in the stress distribution in six implants and four implants supporting mandibular over-denture. MATERIALS AND METHODS: The three-dimensional (3-D) finite-element mesh model was modeled with the standard dimension of the implant with 11-mm long and 4-mm wide using the software package 'NISA'. RESULTS AND DISCUSSION: The design, number and placement of implants play an important role. SUMMARY AND CONCLUSION: The basic principles of biomechanics must be respected.
Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial.

BACKGROUND Videolaryngoscopes are aggressively marketed, but independent evaluation in difficult airways is scarce. This multicentre, prospective randomized controlled trial evaluates six videolaryngoscopes in patients with a simulated difficult airway. METHODS With ethics committee approval and written informed consent, 12 senior anaesthetists intubated the trachea of 720 patients. A cervical collar limited mouth opening and neck movement, making intubation difficult. We evaluated three unchannelled (C-MAC™ D-blade, GlideScope™, and McGrath™) and three channelled videolaryngoscopes (Airtraq™, A.P. Advance™ difficult airway blade, and KingVision™). The primary outcome was first-attempt intubation success rate. Secondary outcomes included overall success rate, laryngeal view, intubation times, and side-effects. The primary hypothesis for every videolaryngoscope was that the 95% confidence interval of first-attempt success rate is ≥90%. RESULTS Mouth opening was decreased from 46 (sd 7) to 23 (3) mm with the cervical collar. First-attempt success rates were 98% (McGrath™), 95% (C-MAC™ D-blade), 87% (KingVision™), 85% (GlideScope™ and Airtraq™), and 37% (A.P. Advance™, P<0.01). The 95% confidence interval of first-attempt success rate was >90% only for the McGrath™. Overall success, laryngeal view, and intubation times differed significantly between videolaryngoscopes (all P<0.01). Side-effects were minor. CONCLUSIONS This trial revealed differences in the performance of six videolaryngoscopes in 720 patients with restricted neck movement and limited mouth opening. In this setting, first-attempt success rates were 85-98%, except for the A.P. Advance™ difficult airway blade. Highest success and lowest tissue trauma rates were achieved by the McGrath™ and C-MAC™ D-blade, highlighting the importance of the videolaryngoscope blade design. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: identifier NCT01692535.
Beneficial effects of levosimendan on survival in patients undergoing extracorporeal membrane oxygenation after cardiovascular surgery.

BACKGROUND The impact of levosimendan treatment on clinical outcome in patients undergoing extracorporeal membrane oxygenation (ECMO) support after cardiovascular surgery is unknown. We hypothesized that the beneficial effects of levosimendan might improve survival when adequate end-organ perfusion is ensured by concomitant ECMO therapy. We therefore studied the impact of levosimendan treatment on survival and failure of ECMO weaning in patients after cardiovascular surgery. METHODS We enrolled a total of 240 patients undergoing veno-arterial ECMO therapy after cardiovascular surgery at a university-affiliated tertiary care centre into our observational single-centre registry. RESULTS During a median follow-up period of 37 months (interquartile range 19-67 months), 65% of patients died. Seventy-five per cent of patients received levosimendan treatment within the first 24 h after initiation of ECMO therapy. Cox regression analysis showed an association between levosimendan treatment and successful ECMO weaning [adjusted hazard ratio (HR) 0.41; 95% confience interval (CI) 0.22-0.80; P=0.008], 30 day mortality (adjusted HR 0.52; 95% CI 0.30-0.89; P=0.016), and long-term mortality (adjusted HR 0.64; 95% CI 0.42-0.98; P=0.04). CONCLUSIONS These data suggest an association between levosimendan treatment and improved short- and long-term survival in patients undergoing ECMO support after cardiovascular surgery.
Drugs against leishmaniasis: Overview of market needs and pipeline

The goal of this article is to provide an overview of market needs and opportunities regarding the development of new drugs against leishmaniasis, an emergent infection that is spreading throughout the world. We provide an analysis of the current pipeline and discuss how the new scenario in drug discovery and development for neglected diseases may favor the entry of smaller players in the market of new therapeutics. Drug Dev Res 72:463–470, 2011. © 2011 Wiley‐Liss, Inc.
Confounding by drug formulary restriction in pharmacoepidemiologic research

The potential consequences of confounding due to drug formulary restrictions in pharmacoepidemiologic research remain incompletely understood. Our objective was to illustrate this potential bias using the example of fluticasone/salmeterol combination therapy, an oral inhaler used to treat asthma and chronic obstructive pulmonary disease, whose use is restricted in the province of Quebec, Canada.
Go/no‐go decision in anaesthesia: wide variation in risk tolerance amongst anaesthetists

Background. The variability in risk tolerance in medicine is not well understood. Parallels are often drawn between aviation and anaesthesia. The aviation industry is perceived as culturally risk averse, and part of preflight checks involves a decision on whether the flight can operate. This is sometimes termed a go/no‐go decision. This questionnaire study was undertaken to explore the equivalent go/no‐go decision in anaesthesia. We presented anaesthetists with a range of situations in which additional risk might be expected and asked them to decide whether they would proceed with the case. Methods. An electronic questionnaire was distributed to anaesthetic colleagues of all grades in one National Health Service Trust. Eleven scenarios, all drawn from critical incident data, were presented. Participants were invited to consider whether they would proceed, how they would modify their anaesthetic technique, and to predict whether a colleague with similar experience would make the same decision. Textual responses were analysed qualitatively. Results. The scenario response rate was 28%. Consultants were significantly more likely to proceed than trainees. In no scenario was there absolute agreement over whether to proceed, even in scenarios where national guidelines would suggest a case should be cancelled. Thematic analysis suggested a wide variability in what anaesthetists consider acceptable or professional behaviour. Conclusions. It is clear that safety decisions cannot be made in isolation and that clinicians must consider operational requirements, such as throughput, when making a go/no‐go decision. The level of variability in decision‐making was surprising, particularly for scenarios that appeared to go against guidelines.
Comparison of Single Port Access Versus Multiple Port Access Systems in Elective Laparoscopy: 98 Dogs (2005-2014).

OBJECTIVE To report and compare the duration of surgery, the frequency of complications, and the frequency of open conversion for elective surgeries performed with 2 laparoscopic techniques: a single incision port access system (SPAS) and a multiple port access system (MPAS) using a Veress needle. STUDY DESIGN Retrospective case series. ANIMALS Ninety-eight consecutive, client owned dogs. METHODS Medical records of dogs undergoing an elective laparoscopic procedure were reviewed. Dogs were classified as SPAS or MPAS according to the initial surgical approach. Duration of surgery, intraoperative complications, reason for open conversion, and postoperative complications were recorded and compared. RESULTS The duration of surgery for SPAS gastropexy (P = .0039), ovariectomy (P = .0052), and gastropexy/ovariectomy combined (P = .0002) were significantly reduced compared to corresponding MPAS procedures. Nine splenic punctures occurred during MPAS. The frequency of intraoperative complications was significantly less for SPAS (0/44) than MPAS (12/54, P = .004). Elective conversion was performed because of gastric malpositioning in 1 dog and emergent conversion was required because of bleeding from the ovarian pedicle in 2 dogs (0/44 SPAS, 3/54 MPAS, P = .250). There were 14/76 dogs with followup to suture removal with postoperative complications, all incisional (7/31 SPAS, 7/45 MPAS, P = 1.0). CONCLUSION The use of SPAS for laparoscopy reduced surgical time and intraoperative complications in elective procedures.
20,23,26,29,32,35,38,41-Octaoxa-5,9,13-triazapentacyclo[15.14.10.13,30.17,11.115,19]tetratetraconta-1,3(42),7,9,11(44),15(43),16,18,30-nonaene-6,12-dione acetone monosolvate

In the crystal structure of the title compound, C33H39N3O10·C3H6O, the acetone molecule is encapsulated into the cavity of the cryptand and fixed by two N—H⋯O and one C—H⋯O hydrogen bond. C—H⋯O and C—H⋯N interactions link neighbouring cryptands. The dihedral angles between the pyridine ring and the benzene rings are 86.47 (17) and 85.53 (13)°.
Microwave-Assisted Synthesis Core-Fe3O4 Shell-Au Cubic Nanoparticles

Core-Shell (Fe3O4/Au) nanoparticles were synthesized using iron II chloride tetrahydrate (FeCl2H2O) and potassium tetrachloroaurate III (AuCl4K) precursors under microwave-assisted conditions. Products were analyzed using field emission gun electron microscope in transmission and scanning modes; energy disperse X-ray spectroscopy performed during STEM measurements indicated a signal for gold K and M signals at 9 keV and 13 keV, respectively, confirming Au atoms at nanoparticle's perimeter and Fe-L signal at 8 keV to be at the center.
Intraoperative dexamethasone alters immune cell populations in patients undergoing elective laparoscopic gynaecological surgery

Background Anaesthetists use dexamethasone principally for its anti-emetic effect. The purpose of this study was to characterize the effects of a single intraoperative dose of dexamethasone on cellular and metabolic components of the immune system in patients undergoing laparoscopic surgical procedures. Methods In this prospective double-blind trial, female patients undergoing elective major laparoscopic surgery were randomized to receive saline (Control group, n =16) or dexamethasone 4 mg (Dexamethasone group, n =16) i.v. after the induction of anaesthesia. Inflammatory markers and immune cell counts were examined at 24 and 48 h and 6 weeks after surgery. The changes from baseline preoperative values were compared between groups using a Mann-Whitney U -test, and linear mixed models were used to validate the findings. Results No differences in concentrations of serum glucose and interleukin-6 were observed between groups after surgery. The increase in C-reactive protein concentration at 24 h after surgery was greater in the control group [median (interquartile range), 33 (25-65) vs 17 (7-26) mg dl -1 ; P =0.018]. Extensive changes in the counts of white cells, including most lymphocyte subsets, were observed 24 h after surgery, and dexamethasone appeared to attenuate most of these changes. Changes at 48 h and 6 weeks did not differ between groups. Conclusions In female patients undergoing elective laparoscopic gynaecological surgery, dexamethasone administration appears to attenuate inflammation and to alter immune cell counts at 24 h, with no effects identified after this time. The importance of these changes for postoperative immune function is unknown. Trial registration Australia and New Zealand Clinical Trials Registry (ACTRN12608000340336).
Development of Non-Nucleoside Reverse Transcriptase Inhibitors for Anti- HIV Therapy

The NNRTIs play an important role in the present therapy against HIV/AIDS. This review discusses the basic principles in the development of NNRTIs for HIV therapy. It also summarizes the NNRTIs in clinical use and the major series of NNRTIs in development phases. The authors intend to provide an overview of the NNRTI research and to eluci- date some important factors in directing the future in the field such as genetic barrier, QD dosing, safety profile and combination with other anti-HIV agents. Despite the enormous progress that has been achieved in the NNRTI field in the past two decades, the present clinical pipeline appears to be insufficient to tackle the huge medical need. The efforts of finding new NNRTIs are certainly much motivated and can be highly rewarding.
Benefits of the Neutrophil-to-Lymphocyte Ratio for the Prediction of Gestational Diabetes Mellitus in Pregnant Women

Abstract Aims: There is growing consensus in the literature that inflammation plays a central role in the pathophysiology of obesity, Type 2 Diabetes Mellitus (T2DM), Gestational Diabetes Mellitus (GDM) and cardiovascular complications. Measuring the neutrophil-to-lymphocyte ratio (NLR) provides a simple inexpensive method for the assessment of inflammatory status. We investigated the predictive value of pre-procedural (before the oral glucose tolerance test (OGTT)) NLR on the development of GDM in pregnancy. Methods: 42 women with GDM and 68 women without GDM were included in the study. Complete Blood Count and biochemical tests were followed by a diagnostic 4-point 100-g-OGTT within 2 weeks. GDM was diagnosed by the Carpenter and Coustan criteria. The NLR was calculated from the data. Results: The mean NLR level was significantly higher in GDM women (3.00±0.83 vs. 2.26±0.43 p<0.001, respectively). In ROC analysis, NLR>2.93 had 76.2% sensitivity and 94.1% specificity in predicting GDM. Logistic regression analysis showed that elevated NLR (OR: 5.512, 95% CI: 1.352–22.475, p=0.017) was an independent variable for predicting GDM in pregnancy. Conclusions: An elevated NLR level is a powerful and independent predictor of GDM. The results of this study suggested that inflammation plays a central role in the pathogenesis of GDM.
The Microbiome and Probiotics in Childhood

Abstract Infants, from the moment of birth, are colonized by large numbers of microbes. This colonization continues throughout childhood and from preliminary studies seems to be a highly dynamic process, even during the usual physiologic state we refer to as health. In this context, the persistence of bacterial and fungal species in and on the human body likely confers various benefits to the host. One specific approach to modulate such beneficial effects is the administration of probiotics, also known as beneficial microbes. Herein, we outline the highest level evidence in regard to the evolution of the microbiome during childhood and its manipulation by probiotics for genitourinary, enteric, and allergic and atopic disorders. Thus, probiotic approaches are promising alternatives and adjuvants to traditional vaccines and antibiotics. This may usher in a new age in which vaccine and antibiotic side effects and antibiotic resistance are minimal issues in the setting of maintaining children's health and prevention of disease.
Medication Use in the Neonatal Intensive Care Unit

Abstract Objective The aim of the article is to provide an update on medication use in infants admitted to the neonatal intensive care unit (NICU) in the United States and examine how use has changed over time. Study Design We performed a retrospective review (2005–2010) of a large prospectively collected administrative database. Result Medications most commonly administered during the study period were ampicillin, gentamicin, caffeine citrate, vancomycin, beractant, furosemide, fentanyl, dopamine, midazolam, and calfactant (56–681 exposures per 1,000 infants). Those with the greatest relative increase in use included azithromycin, sildenafil, and milrinone. Medications with the greatest relative decrease in use included theophylline, metoclopramide, and doxapram. Conclusion Medication use in the NICU has changed substantially over time, and only 35% of the most commonly prescribed medications are Food and Drug Administration –approved in infants.