Miracle-dz/UniFAR-FTUs huggingface dataset:
S3-Leitlinie zur Vermeidung von Zwang und Urteil des Bundesverfassungsgerichts zu Fixierungen: Was ändert sich?

Grundsatzurteil zu Fixierungen [1]. Am selben Tag – durchaus beabsichtigt – publizierte die DGPPN die S3-Leitlinie „Verhinderung von Zwang: Prävention und Therapie aggressiven Verhaltens bei Erwachsenen“ [2]. Mehr als je zuvor ist das Thema damit im Mittelpunkt der psychiatrischen Versorgungsrealität angekommen und jede Klinik mit Pflichtversorgungsauftrag ist gezwungen, sich damit auseinanderzusetzen. Zum Urteil des Bundesverfassungsgerichts werden wir häufig gefragt: Bringt es denn außer mehr Bürokratie auch einen echten Mehrwert für irgendjemanden? Und zur Leitlinie: Was ändert das wirklich an der Praxis? Das Urteil des Bundesverfassungsgerichts hat mit dem Richtervorbehalt tatsächlich einen erhöhten bürokratischen Aufwand für Ärztinnen und Ärzte in Kliniken und für Gerichte eingeführt. Aber es hat auch die Rechtssicherheit erheblich verbessert. Patientinnen und Patienten wissen jetzt, dass schwere Grundrechtseingriffe, wie auch die ärztliche Zwangsbehandlung, keineswegs willkürlich durchgeführt werden, sondern unabhängiger richterlicher Kontrolle unterliegen und künftig noch strenger gesetzlich zu regeln sind. Damit wird der Charakter des Grundrechtseingriffs für alle Beteiligten hervorgehoben, mit Beschwerden und Klagen ist vermutlich künftig häufiger zu rechnen. Für Ärztinnen und Ärzte sowie Pflegende ist dies kein Damoklesschwert, sondern eine Entlastung. Dies betrifft nicht zuletzt die seit Jahren teils mit großer Vehemenz geführten Auseinandersetzungen um die Stellungnahmen des Ausschusses für die Rechte von Menschen mit Behinderungen der UN, der von Deutschland wie von den anderen Vertragsstaaten explizit gefordert hat, „die Verwendung körperlicher und chemischer Freiheitseinschränkungen, die Absonderung und andere schädliche Praktiken [. ] als Folterhandlungen“ anzuerkennen und die entsprechenden Maßnahmen zu verbieten [3]. Die Diskussion wird zum Teil mit erheblicher Polemik geführt. Durch einen Ausschuss der UN der Folter bezichtigt zu werden, empfinden viele Psychiater als unerträglichen Affront. Diesbezüglich hat das Bundesverfassungsgericht nun eine wichtige Klarstellung vorgenommen: Eine Fixierung ist zwar das „letzte Mittel“, sie kann aber „zur Abwendung einer drohenden gewichtigen Gesundheitsschädigung sowohl des Betroffenen selbst als auch anderer Personen, wie des Pflegepersonals oder der Ärzte, gerechtfertigt sein“. Die UN-Behindertenrechtskonvention stehe „der Zulässigkeit einer nicht nur kurzfristigen Fixierung, auch in der Sache, nicht grundsätzlich entgegen“. Der UN-Ausschuss habe kein Mandat zur verbindlichen Interpretation des Vertragstextes (sondern für Deutschland habe dies eben das Bundesverfassungsgericht). Es wies den Foltervorwurf ausdrücklich zurück und wies darauf hin, S3-Leitlinie zur Vermeidung von Zwang und Urteil des Bundesverfassungsgerichts zu Fixierungen: Was ändert sich? S3 Treatment Guideline Prevention of Coercion and Decision of the German Constitutional Court on Mechanical Restrained: What is Going to Change?
Vessel Size and Long-Term Outcome After Coronary Stent Placement

Background—The role of coronary stenting in the treatment of patients with small vessels is not well defined. The purpose of this study was to investigate the influence of vessel size on long-term clinical and angiographic outcome after coronary stent placement. Methods and Results—The study comprised 2602 patients with successful stent implantation for symptomatic coronary artery disease. Patients were subdivided into 3 equally sized groups (tertiles) according to vessel size, with respective ranges of 3.2 mm. Event-free survival at 1 year was 69.5% in the group with smaller vessels, 77.5% in the second group, and 81% in the group with larger vessels (P<0.001). Late lumen loss was similar between the 3 groups (1.12±0.73, 1.12±0.79, and 1.09±0.88 mm, respectively). Angiographic restenosis rate was significantly higher in the small-vessel group (38.6%, 28.4%, and 20.4% in groups 1, 2, and 3, respectively; P<0.001). The analysis identified subgroups with different risk for restenosis .
Acute Ischemic Stroke Management-The Updated 2018 Stroke Guidelines

Following publication of the 2013 Stroke Guidelines, revisions were made to the 2015 update after publication of randomized clinical studies with high levels of evidence. The 2018 guidelines on the early management of patients with ischemic stroke containing these revisions were provided online as an epub ahead of print on January 24, 2018, and were published in the March 2018 issue of Stroke (1). The DAWN (January 4, 2018) and DEFUSE-3 (February 22, 2018) studies published in The New England Journal of Medicine just before the release of the new guidelines prompted important revisions in the 2018 Stroke Guidelines (2, 3). In the DAWN study, among patients with acute stroke lastknown to be well 6-24 hours previously among patients with acute ischemic stroke who known to be well between 6 and 24 hours, and who had a discrepancy between the clinical deficit and infarct volume, the 90-day neurological outcomes were better in patients who underwent thrombectomy and were given standard care than in those who received standard care only (2).
MiRNA-424 Protects Against Permanent Focal Cerebral Ischemia Injury in Mice Involving Suppressing Microglia Activation

Background and Purpose—We observed that microRNA-424 (miR-424) significantly decreased in an miRNA profile of circulating lymphocytes of patients with ischemic stroke. The present study focused on the potential and mechanism of miR-424 in protecting ischemic brain injury in mice. Methods—Cerebral ischemia was induced by middle cerebral artery occlusion in C57/BL6 mice. Cerebral infarction volume, neuronal apoptosis, and microglia activation were determined by 2,3,5-triphenyltetrazolium chloride staining, immunofluorescence, and Western blot. BV2 microglial cell activity, cell cycle, mRNA, and protein levels of miR-424 targets were accessed by enzyme-linked immunosorbent assay, flow cytometry, real-time polymerase chain reaction, and Western blot, respectively. Results—MiR-424 levels were decreased in the plasma of patients with acute ischemic stroke, as well as in mouse plasma and ipsilateral brain tissue at 4, 8, and 24 hours after ischemia, likewise, in the cortex, hippocampus, and basal ganglia, respec.
Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome

Background Patients who have had an acute coronary syndrome are at high risk for recurrent ischemic cardiovascular events. We sought to determine whether alirocumab, a human monoclonal antibody to proprotein convertase subtilisin–kexin type 9 (PCSK9), would improve cardiovascular outcomes after an acute coronary syndrome in patients receiving high‐intensity statin therapy. Methods We conducted a multicenter, randomized, double‐blind, placebo‐controlled trial involving 18,924 patients who had an acute coronary syndrome 1 to 12 months earlier, had a low‐density lipoprotein (LDL) cholesterol level of at least 70 mg per deciliter (1.8 mmol per liter), a non‐high‐density lipoprotein cholesterol level of at least 100 mg per deciliter (2.6 mmol per liter), or an apolipoprotein B level of at least 80 mg per deciliter, and were receiving statin therapy at a high‐intensity dose or at the maximum tolerated dose. Patients were randomly assigned to receive alirocumab subcutaneously at a dose of 75 mg (9462 patients) or matching placebo (9462 patients) every 2 weeks. The dose of alirocumab was adjusted under blinded conditions to target an LDL cholesterol level of 25 to 50 mg per deciliter (0.6 to 1.3 mmol per liter). The primary end point was a composite of death from coronary heart disease, nonfatal myocardial infarction, fatal or nonfatal ischemic stroke, or unstable angina requiring hospitalization. Results The median duration of follow‐up was 2.8 years. A composite primary end‐point event occurred in 903 patients (9.5%) in the alirocumab group and in 1052 patients (11.1%) in the placebo group (hazard ratio, 0.85; 95% confidence interval [CI], 0.78 to 0.93; P<0.001). A total of 334 patients (3.5%) in the alirocumab group and 392 patients (4.1%) in the placebo group died (hazard ratio, 0.85; 95% CI, 0.73 to 0.98). The absolute benefit of alirocumab with respect to the composite primary end point was greater among patients who had a baseline LDL cholesterol level of 100 mg or more per deciliter than among patients who had a lower baseline level. The incidence of adverse events was similar in the two groups, with the exception of local injection‐site reactions (3.8% in the alirocumab group vs. 2.1% in the placebo group). Conclusions Among patients who had a previous acute coronary syndrome and who were receiving high‐intensity statin therapy, the risk of recurrent ischemic cardiovascular events was lower among those who received alirocumab than among those who received placebo. (Funded by Sanofi and Regeneron Pharmaceuticals; ODYSSEY OUTCOMES ClinicalTrials.gov number, NCT01663402.)
Research on Key Technology of Vehicle Electronic Image Stabilization

The study of image stabilization algorithms plays an important role in achieving electronic image stabilization. This paper firstly introduces the basic concepts, principles and common typical algorithms of vehicle-borne electronic image stabilization technology. Then, based on the characteristics of vehicle-mounted image processing, this paper analyzes the influence of the instability of vehicle-mounted image sequences on the observation results of vehicle-borne systematic images, and introduces the vehicle-mounted electronic image stabilization technology. Besides, a method to achieve the stabilization of the inter-frame translation motion of vehicle-mounted dynamic image sequences using the gray projection matching algorithm is proposed. In the vehicle-mounted imaging system, the maximum gray value in the feature image is used to estimate the inter-frame motion of the image sequence, and a partition method is used to estimate the motion vector by selecting the gray-scale maximum point as the feature point in a certain scanning order, to ensure the validity of the algorithm. At the same time, based on characteristics of vehicle imaging, the necessity and possibility of detecting long-focus picture pick-up system and compensating the rotation movement are proposed, and the method of using the maximum gray value points as the image feature to estimate the inter-frame motion of the image sequence are presented.
Isoproterenol Activates Extracellular Signal–Regulated Protein Kinases in Cardiomyocytes Through Calcineurin

Background—Extracellular signal–regulated kinases (ERKs) and calcineurin have been reported to play important roles in the development of cardiac hypertrophy. We examined here the relation between calcineurin and ERKs in cardiomyocytes. Methods and Results—Isoproterenol activated ERKs in cultured cardiomyocytes of neonatal rats, and the activation was abolished by chelation of extracellular Ca2+ with EGTA, blockade of L-type Ca2+ channels with nifedipine, or depletion of intracellular Ca2+ stores with thapsigargin. Isoproterenol-induced activation of ERKs was also significantly suppressed by calcineurin inhibitors in cultured cardiomyocytes as well as in the hearts of mice. Isoproterenol failed to activate ERKs in either the cultured cardiomyocytes or the hearts of mice that overexpress the dominant negative mutant of calcineurin. Isoproterenol elevated intracellular Ca2+ levels at both systolic and diastolic phases and dose-dependently activated calcineurin. Inhibition of calcineurin also attenuated isop.
Iron Overload Augments Angiotensin II–Induced Cardiac Fibrosis and Promotes Neointima Formation

Background— Abnormal iron deposition may cause oxidant-induced damage in various organs. We have previously reported that continuous administration of angiotensin II to rats results in an overt iron deposition in the renal tubular epithelial cells, which may have a role in angiotensin II–induced renal damage. In the present study, we investigated the role of iron in the development of cardiac injury induced by angiotensin II. Methods and Results— Angiotensin II was continuously infused to rats at a dose of 0.7 mg/kg per day for 7 consecutive days. No iron deposits were observed in the hearts of untreated rats, whereas iron deposition was seen in the cells in the subepicardial and granulation regions after angiotensin II infusion. Concomitant administration of deferoxamine, an iron chelator, significantly reduced the extent of cardiac fibrosis, which suggests that iron deposition aggravates the cardiac fibrosis induced by angiotensin II. Iron overload caused by the administration of iron-dextran resulted i.
Coronary-to-Pulmonary Artery Fistula in Adults: Natural History and Management Strategies

Objective To evaluate the natural course of coronary-to-pulmonary artery fistula (CPAF) detected on coronary computed tomography angiography (CCTA) and to propose potential treatment strategies. Materials and Methods In this retrospective multicenter study, we assessed the CCTA reports of 188 CPAF patients evaluated between March 2009 and June 2016. Fifty-seven patients were excluded because their follow-up (FU) periods were less than 2 years. Information regarding demographic characteristics, past history, treatment method, and the occurrence of major adverse cardiac events (MACE) during the FU period was collected. We analyzed the morphologic features of CPAF and the various factors associated with surgical treatment. Patients who had undergone FU CCTA after being diagnosed with CPAF were assessed for the presence of morphological changes on FU imaging. Results The median age of the study population was 63.0 years (range, 57.0–72.0 years), and the median FU period was 5.72 years (range, 4.08–6.96 years). The most common origin of the CPAF was both coronary arteries in 76 (58.0%) cases. An aneurysm or aneurysms was/were present in 41 (31.3%) cases. Fifty-four (41.2%) fistulas were less than 2 mm in size. Eight patients underwent surgery, and 123 (93.9%) patients received optimal medical treatment (OMT). The fistula size was significantly different between the two treatment groups (p = 0.013) and was the only factor associated with surgical treatment (odds ratio = 1.14, p = 0.021). Only one patient in the OMT group reported MACE during the FU period due to preexisting coronary artery disease. Twenty-nine patients (22.1%) underwent FU CCTA after CPAF diagnosis, with a median FU period of 3.81 years. None of the patients in the OMT group demonstrated morphological changes in the CPAF on FU imaging. Conclusion Most CPAFs identified on CCTA have a favorable prognosis. Observation with OMT is usually an appropriate strategy. Fistula size is a possible determinant for surgical treatment.
Review of adhesion estimation approaches for rail vehicles

ABSTRACT The estimation of adhesion conditions between wheels and rails during railway operations is an important task as it helps to characterise the braking and traction control system. Since the adhesion condition is influenced by many factors, its estimation process is complex. This paper reviews the existing approaches to estimate adhesion conditions. These approaches are model-based prediction, inverse dynamic modelling, Kalman filter method, artificial neural network method and particle swarm optimisation method. The classification, methodologies, theories and applications of these approaches are included in this paper. The advantages and limitations of these methods are analysed to provide an application recommendation for adhesion estimation. This review has concluded that all estimation approaches undergo a linearisation stage where error cannot be avoided. The trade-off between accuracy and analysis time must be considered. This review also discusses how to improve existing approaches to achieve a more precise estimation of adhesion conditions.
An Open Framework for Deploying Experimental SCADA Testbed Networks

A scalable framework for automatically deploying locally (or remotely) a number of virtual machines that replicate a Supervisory Control And Data Acquisition (SCADA) network is proposed. This includes multiple virtual hosts emulating sensors and actuators, with a Human Machine Interface (HMI) controlling the hosts. The presented framework contains a collection of automation scripts which build and deploy a variable number of virtual machines, pre-configured to act as either a Remote Terminal Unit (RTU), HMI or Data Historian. The presented work includes a standards compliant implementation of IEC 60870-5-104 (IEC104) and OPC Unified Architecture (OPC-UA), with the capability to support other protocols such as Modbus-TCP (Modbus) and IEC61850. This allows researchers to build testbeds that can be configured to replicate realworld deployments of SCADA networks. The framework builds upon open source libraries and is released under the Free Software Foundation approved licence, GNU General Public License version 3.
Pericardial sarcoidosis presenting as PUO diagnosed on FDG PET CT scan

Pyrexia of unknown origin (PUO) is a common problem in day-to-day practice. FDG PET CT is an established investigation that aids in identifying the cause of PUO. Due to its high sensitivity PET detects an occult hypermetabolic focus in the body where CT helps in anatomical localization, vascularity, enhancement characteristics of the lesion detected on PET. It helps to differentiate benign versus malignant cause and target biopsy. Tuberculosis, lymphoma, pyelonephritis, thyroiditis appear hypermetabolic on FDG PET CT. Pericardial sarcoidosis is rare and not reported in literature as a cause of PUO. Presented here is a case of PUO secondary to pericardial granulomatosis diagnosed on PET CT. Cardiac MRI also helps in better tissue characterization and associated myocardial involvement of sarcoidosis. Histology confirmed the diagnosis of pericardial sarcoidosis in this case.
An open-label, single-arm pilot study to evaluate the efficacy of daily low dose tadalafil on depression in patients with erectile dysfunction.

Background Many studies have reported not only that depression and antidepressant medications can cause erectile dysfunction (ED), but also that having ED may increase the risk of depression. We investigated the effect of a daily low dose of a phosphodiesterase (PDE) type 5 inhibitor (tadalafil, 5 mg) on depression and levels of brain-derived neurotrophic factor (BDNF) in patients with ED. Methods Ten male patients with at least a 3-month history of ED [International Index of Erectile Function (IIEF)-5 score ≤21] and depression [the Korean version of the Patient Health Questionnaire (PHQ)-9 score ≥5] were analyzed in this study. The subjects were prescribed a low dose of a PDE5 inhibitor (tadalafil 5 mg) once daily for 8 weeks. The survey questionnaires were performed using the PHQ-15 and the PHQ-9 before and after administration of 8 weeks of tadalafil. Blood samples used for measuring serum BDNF levels were taken and measured at baseline and after 8 weeks of treatment. Results The mean changes in the PHQ-9 and PHQ-15 scores were 3.60±3.27 and 2.00±2.98, respectively. Analyses of the mean changes in the PHQ-9 scores revealed that the depressive symptoms of the subjects were significantly improved after administration of eight weeks of tadalafil (P<0.05). And, there was also a statistically significant increase in the PHQ-15 scores (P<0.05). Serum levels of BDNF were higher after tadalafil treatment compared to before treatment; however, this difference was not statistically significant. Conclusions The results of this prospective, clinical study suggest that daily low dose tadalafil may have a potential role in the treatment of depression in patients with ED.
Work Related Musculoskeletal Disorders among Egyptian Dentists Working at Faculty of Dentistry-Ain Shams University

Introduction: The prevalence of musculoskeletal complaints among dentists is high. The symptoms mightimpair work capacity and the future possibility to stay in the profession. In Egypt, data about the prevalence andrisk factors of this problem are scanty. Aim of work: To estimate the prevalence of musculoskeletal disorders(MSDs) and its distribution among dental staff, house officers and students at faculty of Dentistry, to find out theinfluence of personal and job characteristics, physical and psychological risk factors at work on the occurrenceof MSDs and to detect the impact of MSDs on participants’ life. Materials and methods: A cross sectionalstudy was carried out among (403) participants. A self-administered questionnaire that included informationabout: personal and job characteristics, a version of Standard Nordic Questionnaire for occurrence of MSDsand modified version of Demand/Control model Questionnaire from Karasek for psychosocial factors. Results:The overall MSDs prevalence among participants was 66.7%, in which 29.3% had chronic complaints. Neckand shoulder pain were the most prevalent sites of complaint reported by 66.5% and 61.8% of the subjectsrespectively, followed by low back pain and wrist pain (59.3%, 46.2%, respectively). The severity of MSDsforced 24.2% of respondents to take analgesic, 30.1% to reduce their daily activities, and 8.6% to go on sickleave. Dental staff significantly had the highest prevalence of MSDs compared to dental students and houseofficers. Older age participants were more prone to MSDs compared to younger ones; female respondents hadhigher MSDs than male but without statistical significance. As regard the physical factors at work: the useof vibration tool, excessive arm elevation and prolonged standing / sitting were significantly associated withincrease in the prevalence of MSDs. Also psychosocial factors: as poor job control was significantly associatedwith the development of MSDs while high work demand didn’t. Conclusion: Work related musculoskeletaldisorders are significant occupational health problems among both dentists and dental students. Their medicalconsequences justify extensive preventive efforts. Specific occupational health education programs, includingergonomic workplace adaptation should be implemented.
Identification of the plateau in maximal oxygen consumption: proposal and application of a new method of analysis

Objective: The classic criterion for VO2máx plateau identification was proposed by Taylor et al. (1955), however, there are many critiques of this method. In this paper, we propose a new statistic-based VO2max plateau identification methodology. In addition, we aim to test for eventual differences between characteristics of the individuals who presented and those who did not present the maximum VO2max plateau. Method: Forty-one (n = 41) physically active men participated. The subjects underwent a cardiopulmonary exercise test using ramp protocol to measure the VO2max and other physiological variables. The identification of VO2max plateau was performed by segmented linear regression with unknown breakpoints for each individual. Results: Although 58.54% (24) of the sample presented VO2max plateau, no significant differences were observed in metabolic, ventilatory and velocity variables between the groups. Conclusion: The methodology presents advantages, since it is adequate to analyze VO2 variations individually and because it is based on statistical techniques, which considers the continuous records of the maximal effort test, not segmenting it in sections for analysis. The comparison between groups, according to the occurrence of the plateau, showed no differences between them.