Miracle-dz/UniFAR-FTUs huggingface dataset:
FUNGAL ENDOPHTHALMITIS: Fourteen Years’ Experience From a Center in India

Background: As fungal endophthalmitis is an emerging challenge, the study was carried out to determine the prevalence and the spectrum of fungal agents causing endophthalmitis from a single center, to identify the risk factors, and to correlate clinical course of illness with the agents involved. Methods: The microbiological and clinical records of all fungal endophthalmitis diagnosed during January 1992 through December 2005 at a tertiary center in India were reviewed retrospectively. During this period, treatment protocol of the patients with fungal endophthalmitis was pars plana vitrectomy, instillation of intravitreal amphotericin B (5 &mgr;g) and dexamethasone (400 &mgr;g). Additionally, oral fluconazole (27 patients) or itraconazole (78 patients) was given in 105 patients. Results: Fungal endophthalmitis was diagnosed in 113 patients and they were categorized into: postcataract surgery (53 patients), posttrauma (48), and endogenous (12) groups. Aspergillus species was the most common (54.4%) agent isolated, followed by yeasts (24.6%), and melanized fungi (10.5%). Among Aspergilli, Aspergillus flavus was the most common (24.6%) species whereas Candida tropicalis (8.8%) was in the yeast. Other rare agents isolated include Fonsecaea pedrosoi, Fusarium solani, Paecilomyces lilacinus, Pseudallescheria boydii, Colletotrichum dematium, Cryptococcus neoformans, and Trichosporon cutaneum. Visual acuity after therapy remained <20/400 in 77.4%, 64.3%, 50.0%, and 16.7% patients infected with Aspergillus species, yeasts, melanized fungi and other mycelial fungi, respectively. The outcome was unfavorable in 52.8%, 66.7%, and 33.3% patients with postoperative, posttrauma, and endogenous groups, respectively. Conclusions: This study is the largest series of fungal endophthalmitis from a single center and highlights the fact that a vast array of fungi can cause endophthalmitis though Aspergilli are the common agents. The combination of pars plana vitrectomy and intravitreal amphotericin B with or without fluconazole/itraconazole was the common mode of therapy in such patients. However, the main challenge is suspecting fungal etiology at the time of presentation and accurately diagnosing those patients.
Tumor Necrosis Factor Induces Phosphorylation and Translocation of BAD through a Phosphatidylinositide-3-OH Kinase-dependent Pathway*

Tumor necrosis factor (TNF) induced the phosphorylation of BAD at serine 136 in HeLa cells under conditions that are not cytotoxic. BAD phosphorylation by TNF was dependent on phosphatidylinositide-3-OH kinase (PI3K) and was accompanied by the translocation of BAD from the mitochondria to the cytosol. Blocking the phosphorylation of BAD and its translocation to the cytosol with the PI3K inhibitor wortmannin activated caspase-3 and markedly potentiated the cytotoxicity of TNF. Transient transfection with a PI3K dominant negative mutant or a dominant negative mutant of the serine-threonine kinase Akt, the downstream target of PI3K and the enzyme that phosphorylates BAD, similarly potentiated the cytotoxicity of TNF. By contrast, transfection with a constitutively active Akt mutant protected against the cytotoxicity of TNF in the presence of wortmannin. Phosphorylation of BAD prevents its interaction with the antiapoptotic protein Bcl-XL. Transfection with a Bcl-XL expression vector protected against the cytotoxicity of TNF in the presence of wortmannin. The mechanism by which the inhibition of the phosphorylation of BAD is likely linked to the induction of lethal mitochondrial damage in TNF-intoxicated cells is discussed.
Collective wage regulation in northern Europe under strain: Multiple drivers of change and differing responses

There has been much recent attention to the upheavals, often externally induced, in collective bargaining and labour market regulation in southern European countries. In this article, we introduce a set of studies of changes, typically employer-driven, in collective wage regulation in northern Europe. We discuss possible drivers of change: contagion from southern Europe, regime competition among the northern countries themselves and/or destabilizing effects of east–north integration, driven by free movement. These drivers interact with internal change dynamics spurring diverging actor responses and institutional outcomes. We outline the common research design, review salient features of wage regulation in six countries, and differences in institutions, production, markets and factor mobility in four sectors. We briefly review findings from the other articles.
Mechanism of the contractile effect of diaspirin-cross-linked hemoglobin in rat isolated aorta strip denuded of endothelium as revealed using an oil-immersion procedure.

Diaspirin-cross-linked hemoglobin (DCLHb) is a chemically modified hemoglobin (Hb) (i.e., alpha-subunits are cross-linked by a covalent bond) currently being tested as a potential oxygen-carrying blood substitute. It was examined for possible vasoactive properties, using the rat isolated aorta strip denuded of endothelium. In this experimental model, DCLHb (1.6-155 microM) was found to be inactive as a vasoconstrictor when added to the Krebs medium but to elicit contractile responses once the Krebs medium containing DCLHb was replaced by mineral oil, a procedure that favors the sequestration of a fixed amount of DCLHb within a substantially reduced volume of extracellular fluid. The contractile activity of DCLHb in our experimental model (i.e., prior exposure of tissues to drugs in the Krebs medium followed by replacement of the Krebs medium by mineral oil) was mimicked by methemoglobin and metmyoglobin, but not by cytochrome c, albumin, hemin, hematin, Fe2+, and a variety of hemorphins. It was abolished by indomethacin, SQ-29548 (prostaglandin H2-thromboxane A2 receptor antagonist), thiourea, or N-2-mercaptopropionylglycine (MCPG), reduced partially by verapamil, but not affected by dazmegrel, MK-886 (leukotriene biosynthesis inhibitor), dimethylsulfoxide, vitamin C or E, deferoxamine, NG-nitro-L-arginine, naloxone, and a variety of other drug receptor antagonists (e.g., prazosin) and protease inhibitors (e.g., pepstatin). Rat aorta strips denuded of endothelium exhibited contractile responses to arachidonic acid added in the Krebs medium (i.e., with no mineral oil added afterwards). Such contractile activity was reduced by SQ-29548, thiourea, or MCPG. Addition of U-46619 (prostaglandin H2-thromboxane A2 mimetic) to the Krebs medium also elicited contractile responses in rat aorta strips denuded of endothelium. Such contractile activity was reduced by SQ-29548, thiourea, or verapamil but not by MCPG. Within the limitations of our experimental approach, these results suggest that (1) the contractile activity of DCLHb in rat aorta strips denuded of endothelium following replacement of the Krebs medium by mineral oil involves the participation of a secondary mediator, which could be a vasoconstrictor metabolite of arachidonic acid; (2) the participation of reactive oxygen species, potential degradation products of DCLHb (e.g., heme, Fe2+, hemorphins), or other mediators in the contractile activity of DCLHb is unlikely; and (3) Ca2+ entry into target cells might be involved in the process by which DCLHb elicits its contractile activity in our experimental model.
Generation and gender differences in the components contributing to the diagnosis of the metabolic syndrome according to the Japanese criteria.

BACKGROUND To clarify whether there are age and gender differences in the components contributing to the diagnosis of metabolic syndrome (MS) in the Japanese population. METHODS AND RESULTS A total of 21,870 individuals (ie, 7,329 men aged 68+/-8.1 years, body mass index (BMI) 23.2+/-2.9 kg/m2 and 14,541 women aged 66+/-9.4 years, BMI 22.8+/-3.3 kg/m2) participated in the study. The subjects were obtained from the general population and examinations were conducted in hospitals located in Kanazawa city. MS was diagnosed according to the Japanese criteria. Information regarding medication is lacking in all participating subjects. Overall, the incidence of MS was 18.4% and 5.78% for men and women, respectively. When analyzed according to age group, the incidence of MS in men did not differ significantly, whereas its prevalence was higher in older women than in younger women. Among the indicators of MS, high blood pressure (BP; high systolic BP and/or high diastolic BP) was the most frequent, followed by dyslipidemia (high triglycerides and/or low high-density lipoprotein-cholesterol (HDL-C)), and high fasting plasma glucose was the least frequently occurring in both genders. In contrast to the high frequency of high BP, isolated high diastolic BP was rare across both genders regardless of age group. Similarly, isolated low HDL-C was quite rare. CONCLUSIONS Frequency of the components contributing to the diagnosis of MS differed considerably according to gender and age group in the Japanese population.
Phenotypic and Genotypic Characterization of Verotoxin-Producing Escherichia coli O103:H2 Isolates from Cattle and Humans

ABSTRACT Characterization of important non-O157 verotoxin-producing Escherichia coli (VTEC) has lagged considerably behind that of O157:H7 strains. This study characterized 91 VTEC O103:H2 strains from bovine and human sources and of North American and European origins by virulence or putative virulence genes, pulsed-field gel electrophoresis (PFGE) patterns, plasmid profiles, antimicrobial resistance, and colicin production. All strains were positive for vt1 and eae-ε; 97% were positive for ehxA; and all were negative for hlyA. Two strains carried vt2. There were 66 PFGE patterns grouped in six clusters, and there were 25 different plasmid profiles. Plasmid-encoded katP and etp genes were significantly more frequent in European than in North American human strains. The distribution of selected phenotypes was as follows: enterohemorrhagic E. coli (EHEC) hemolysin, 95%; colicin production, 38%; antimicrobial resistance, 58%. All the strains were negative for the alpha-hemolytic phenotype. In conclusion, the VTEC O103:H2 strains were diverse, as shown by PFGE, plasmid profiles, virulence markers, and antimicrobial resistance patterns, and all strains showed an EHEC hemolytic phenotype instead of the alpha-hemolytic phenotype that has been shown previously.
Computed tomography in predicting smear‐negative pulmonary tuberculosis in AIDS patients

Background The correct diagnosis of sputum smear‐negative pulmonary tuberculosis in AIDS patients is very important to their therapy. We aimed to assess the value of the computed tomography (CT) and clinical findings in predicting smear‐negative pulmonary tuberculosis in AIDS patients. Methods A total of 121 AIDS patients suspected of smear‐negative pulmonary tuberculosis by clinical and radiographic findings were recruited. Pulmonary tuberculosis was diagnosed in 57 (47.1%) patients. The CT and clinical predictors were selected to diagnose AIDS‐related pulmonary tuberculosis through univariate and multivariate Logistic analysis. Results Multivariate analysis showed that five variables, including weight loss, presence of miliary nodules, necrotic lymph node, lobular consolidation, tree‐in‐bud sign, were independent predictors of pulmonary tuberculosis in AIDS patients. Predicted scores based on the five variables were used to identify pulmonary tuberculosis. If the predicted score of 3 was taken as the ideal cut‐off point in the diagnosis of AIDS‐related smear‐negative pulmonary tuberculosis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.2%, 81.2%, 80.0%, 85.2%, and 82.6%, respectively. Conclusion The prediction method based on five key factors of clinical and CT findings are useful in guiding the diagnosis of smear‐negative pulmonary tuberculosis in AIDS patients.
Prevention of hypotension associated with the induction dose of propofol: A randomized controlled trial comparing equipotent doses of phenylephrine and ephedrine

Background and Aims: Propofol, the most commonly used intravenous (IV) anesthetic agent is associated with hypotension on induction of anesthesia. Different methods have been used to prevent hypotension but with variable results. The objective of this study was to evaluate efficacy of equipotent doses of phenylpehrine and ephedrine in preventing the hypotensive response to the induction dose of propofol. Material and Methods: One hundred thirty five adult patients were randomised to one of the study groups: propofol-saline (PS), propofol-phenylephrine (PP) or propofol-ephedrine (PE) by adding study drugs to propofol. Anesthesia was induced with a mixture of propofol and the study drug. Patients were manually mask-ventilated for 5 min using 40% oxygen in nitrous oxide and isoflurane at 1%. A baseline mean arterial pressure (MAP) was recorded prior to induction of anesthesia. Systolic, diastolic and mean blood pressure and heart rate were recorded every minute for up to 5 min after induction. Hypotension was defined as a 20% decrease from the baseline MAP. Results: There were no significant demographic differences between the groups. Overall incidence of hypotension in this study was 38.5% (52/135). Rate of hypotension was significantly higher in group PS than group PP (60% vs. 24.4% P = 0.001) and group PE (60% vs. 31.1% P = 0.005). In contrast, a significant difference in rate of hypotension was not observed between groups PP and group PE. Conclusion: In equipotent doses, phenylephrine is as good as ephedrine in preventing the hypotensive response to an induction dose of propofol.
Alternative Aging Solutions to Accelerate Resin-Dentin Bond Degradation.

PURPOSE This study evaluated the effect of aging solutions on the durability of resin-dentin bonds by means of microtensile bond strength (μTBS) and nanoleakage (NL) tests. MATERIALS AND METHODS The adhesive system Adper Single Bond 2 (3M ESPE) was applied according to the manufacturer's instructions to the flattened occlusal surface of 40 extracted human molars. After bonding, teeth were sectioned to obtain bonded sticks (0.8 mm2 area) which were tested in tension immediately or after different storage periods (1 week, 1 month, or 6 months). Bonded sticks were kept immersed in 5 different solutions: 1) distilled water (DW); 2) 99.9% propionic acid (PA); 3) 99% acetic acid (AA); 4) 75% ethanol (ET), and 5) mineral oil (MO). To determine NL, bonded sticks from each experimental condition were immersed in silver nitrate and analyzed by SEM. Data were analyzed by two-way repeated measure ANOVA and Tukey's test (α=0.05). RESULTS Faster degradation of bond strength (1 week) could be seen for AA and ET (p<0.05) in comparison with DW. Specimens stored in PA and DW showed bond strengths significantly reduced after one and six months, respectively (p<0.05). No degradation of the resin-dentin bond strengths was observed for specimens stored in MO (p>0.05). Nanoleakage increased for all groups except MO after storage. CONCLUSION Propionic acid, acetic acid, and ethanol can be used as alternative aging solutions to more quickly obtain results on the bond resistance to degradation.
The know-do gap in quality of health care for childhood diarrhea and pneumonia in rural India.

IMPORTANCE In rural India, as in many developing countries, childhood mortality remains high and the quality of health care available is low. Improving care in such settings, where most health care practitioners do not have formal training, requires an assessment of the practitioners' knowledge of appropriate care and the actual care delivered (the know-do gap). OBJECTIVE To assess the knowledge of local health care practitioners and the quality of care provided by them for childhood diarrhea and pneumonia in rural Bihar, India. DESIGN, SETTING, AND PARTICIPANTS We conducted an observational, cross-sectional study of the knowledge and practice of 340 health care practitioners concerning the diagnosis and treatment of childhood diarrhea and pneumonia in Bihar, India, from June 29 through September 8, 2012. We used data from vignette interviews and unannounced standardized patients (SPs). MAIN OUTCOMES AND MEASURES For SPs and vignettes, practitioner performance was measured using the numbers of key diagnostic questions asked and examinations conducted. The know-do gap was calculated by comparing fractions of practitioners asking key diagnostic questions on each method. Multivariable regressions examined the relation among diagnostic performance, prescription of potentially harmful treatments, and the practitioners' characteristics. We also examined correct treatment recommended by practitioners with both methods. RESULTS Practitioners asked a mean of 2.9 diagnostic questions and suggested a mean of 0.3 examinations in the diarrhea vignette; mean numbers were 1.4 and 0.8, respectively, for the pneumonia vignette. Although oral rehydration salts, the correct treatment for diarrhea, are commonly available, only 3.5% of practitioners offered them in the diarrhea vignette. With SPs, no practitioner offered the correct treatment for diarrhea, and 13.0% of practitioners offered the correct treatment for pneumonia. Diarrhea treatment has a large know-do gap; practitioners asked diagnostic questions more frequently in vignettes than for SPs. Although only 20.9% of practitioners prescribed treatments that were potentially harmful in the diarrhea vignettes, 71.9% offered them to SPs (P < .001). Unqualified practitioners were more likely to prescribe potentially harmful treatments for diarrhea (adjusted odds ratio, 5.11 [95% CI, 1.24-21.13]). Higher knowledge scores were associated with better performance for treating diarrhea but not pneumonia. CONCLUSIONS AND RELEVANCE Practitioners performed poorly with vignettes and SPs, with large know-do gaps, especially for childhood diarrhea. Efforts to improve health care for major causes of childhood mortality should emphasize strategies that encourage pediatric health care practitioners to diagnose and manage these conditions correctly through better monitoring and incentives in addition to practitioner training initiatives.
The IAPT@Flinders Service: adapting the Improving Access to Psychological Therapies model to the emergency department setting in Australia

Objective: To describe the implementation of an Improving Access to Psychological Therapies (IAPT) service at Flinders Medical Centre emergency department (IAPT@Flinders). IAPT, a population-based model of guided self-help for anxiety and depression delivered mainly by phone, was rolled-out nationally in the UK in 2010. There is a growing body of evidence demonstrating its clinical effectiveness and efficiency that can improve treatment adherence, reduce stigma, remove appointment attendance barriers and improve access for hard-to-reach populations. Conclusions: IAPT@Flinders was the test site for the first IAPT in Australia and also the first IAPT service that was integrated with an emergency department (ED). IAPT@Flinders offers rapid access, low-intensity cognitive behavioural therapy, social prescribing and signposting to clients with adjustment disorders, anxiety and/or depressive symptoms. Successful implementation within an Australian crisis setting has demonstrated that many IAPT structures and protocols are applicable to ED settings and the model can be implemented with fidelity. Adaption required consideration of positioning of the service within the Australian mental health framework; staff qualifications; the referral pathways; and exclusion criteria. It is recommended additional test sites and larger scale trials are conducted to provide further evidence of the applicability of large-scale adoption of the UK IAPT model into Australian ED settings.
Probabilistic availability analysis of control and automation systems for active distribution networks

The future smart electricity grids will exhibit tight integration between control and automation systems and primary power system equipment. Optimal and safe operation of the power system will be completely dependent on well functioning information and communication (ICT) systems. Considering this, it is essential that the control and automation systems do not constitute the weak link in ensuring reliable power supply to society. At the same time, studies of reliability when considering complex interdependencies between integrated ICT systems becomes increasingly difficult to perform due to the large amount of integrated entities with varying characteristics involved. To manage this challenge there is a need for structured modeling and analysis methods that accommodate this characteristics and interdependencies. In other fields, the analysis of large interconnected systems is done using models that capture the systems and its context as well as its components and interactions. This paper addresses this issue by combining enterprise architecture methods that utilize these modeling concepts, with fault tree analysis and probabilistic relational models. This novel approach enables a holistic overview thanks to the use of formalized models. It also allows use of rigorous analysis thanks to the adaptation of the models to enable Fault Tree Analysis. The paper is concluded with an example of application of the analysis method on a proposed smart grid function in a distribution network.
Continuous Intracisternal and High Cervical Intrathecal Bupivacaine Analgesia in Refractory Head and Neck Pain

Background The upper cervical component of the spinomesencephalic tract and cranial nerves V, VII (nervus intermedius), IX, and X are involved in mechanisms of acute and chronic pain from head and neck structures. To date there is no reliable method for relief of refractory pain (i.e., pain that cannot be relieved by conventional pharmacologic therapies) from these structures. Therefore, we explored continuous intracisternal infusion of bupivacaine for the treatment of refractory pain of the head and neck. Methods Intracisternal catheters were inserted in 13 adults with refractory nonmalignant (n = 4) and malignant (n = 9) pain from the head, face, mouth, neck, and upper extremities; 0.5% plain bupivacaine was infused continuously at rates of 1-7 (median 1.5) mg/h with optional bolus doses of 0.5-2.0 mg 4-2 times/h. The efficacy was assessed from pain relief (daily VASmax, VASmin, and VASmean scores 0-10), daily doses of intracisternal bupivacaine and total opioid (expressed as mg parenteral morphine-eq), amount of nocturnal sleep, and rates of adverse effects. Results The 13 patients were treated for 3-182 days (median 37, total 712 days), 3 patients being treated at home for 10-112 days (median 88, total 210 days). In one patient, the efficacy of the treatment could not be estimated because of advanced senility. Eleven of the remaining 12 patients obtained acceptable pain relief with daily doses of intracisternal bupivacaine ranging from 20 to 118 mg (median 37 mg): VAS sub mean scores decreased from 7 to 2, mean pain relief increased from 30% to 80%, total opioid daily dose decreased from 53 to 36 mg parenteral morphine-eq, and nocturnal sleep increased from 2 to > 6 h (all figures are median values). Speech, eating, walking, and natural functions were generally not affected. Side effects such as tiredness and malaise, somnolence and sleep, feeling of coldness in the neck and skull base, transient post-spinal puncture headache, paresthesias, hoarseness, dysphagia, transient paresis of the upper/lower extremities, episodic miosis and conjunctival hyperemia, and transient orthostatic arterial hypotension were each observed in one or two patients. No patient presented clinical evidence of phrenic nerve paralysis. There was no nausea or vomiting. No persistent neurologic deficit or death could be attributed to the intracisternal pain treatment. Conclusions Continuous intracisternal infusion of bupivacaine may be a useful method in exceptional, well selected patients with refractory pain from the head and neck structures. Further studies are necessary to establish the indications and the safety of the method.