Miracle-dz/UniFAR-FTUs huggingface dataset:
Left ventricular strain and strain rate in a general population.

AIMS Strain and strain rate (SR) are measures of deformation that reflect left ventricular (LV) function. To our knowledge, no previous study described these indexes in a general population. We therefore described peak-systolic strain and SR of the LV in the general population and derived diagnostic thresholds for these measurements in a healthy subgroup. METHODS AND RESULTS In 480 subjects enrolled in a family-based population study (50.5% women; mean age, 50.5 years; 37.2% hypertensive), we measured: (i) end-systolic longitudinal strain and peak-systolic SR from the basal portion of the LV inferior and inferolateral free walls; (ii) radial deformation of the LV inferolateral wall. Longitudinal (mean, 22.9%) and radial (59.2%) strain and longitudinal (1.31 s(-1)) and radial (3.40 s(-1)) SR decreased with age (P </= 0.007). Longitudinal and radial strain independently decreased (P </= 0.006) with relative wall thickness (RWT), longitudinal strain with the waist-to-hip ratio, and radial strain with body weight. In contrast, LV ejection fraction increased (P </= 0.0001) with age and RWT. Longitudinal and radial stain rate increased with heart rate (P </= 0.05). In healthy subgroup (n = 236), the fifth percentiles were 18.4 and 44.3%, and 0.99 and 2.43 s(-1), for longitudinal and radial strain and SR, respectively. CONCLUSION We explored the early signs of LV systolic dysfunction in a general population, using tissue Doppler imaging technique. LV strain and SR decrease with age, body weight, central obesity, and RWT. Our current study resulted in the proposal for diagnostic thresholds for strain and SR, based on a healthy subgroup recruited via random sampling of the population.
Morbidity and mortality associated with nosocomial transmission of oseltamivir-resistant influenza A(H1N1) virus.

CONTEXT The sudden emergence and rapid spread of oseltamivir-resistant influenza A(H1N1) viruses with neuraminidase (NA) gene H274Y amino acid substitution is the hallmark of global seasonal influenza since January 2008. Viruses carrying this mutation are widely presumed to exhibit attenuated pathogenicity, compromised transmission, and reduced lethality. OBJECTIVE To investigate nosocomial viral transmission in a cluster of patients with influenza A(H1N1) virus infection. DESIGN, SETTING, AND PATIENTS Descriptive outbreak investigation of 2 hematopoietic stem cell transplant recipients and an elderly patient who developed hospital-acquired influenza A virus infection following exposure to an index patient with community-acquired H274Y-mutated influenza A(H1N1) virus infection in a medical ward at a Dutch university hospital in February 2008. The investigation included a review of the medical records, influenza virus polymerase chain reaction and culture, phenotypic oseltamivir and zanamivir susceptibility determination, and hemagglutinin chain 1 (HA(1)) gene and NA gene sequence analysis. MAIN OUTCOME MEASURE Phylogenetic relationship of patient cluster influenza A(H1N1) viruses and other 2007-2008 seasonal influenza A(H1N1) viruses. RESULTS Viral HA(1) and NA gene sequence analysis from the 4 patients revealed indistinguishable nucleotide sequences and phylogenetic clustering of H274Y-mutated, oseltamivir-resistant influenza A(H1N1) virus, confirming nosocomial transmission. Influenza virus pneumonia (3 patients) and attributable mortality (2 patients) during active infection was observed in patients with lymphocytopenia at onset. CONCLUSION Seasonal oseltamivir-resistant influenza A(H1N1) viruses with NA gene H274Y mutation are transmitted and retain significant pathogenicity and lethality in high-risk patients.
Endothelial progenitor cell levels in obese men with the metabolic syndrome and the effect of simvastatin monotherapy vs. simvastatin/ezetimibe combination therapy.

AIMS Endothelial progenitor cells (EPCs) contribute to endothelial regeneration and thereby protect against cardiovascular disease (CVD). Patients with manifest CVD have reduced EPC levels, but it is not clear if this also occurs in subjects at high CVD risk without manifest atherosclerotic disease. Therefore, we aimed to first, measure circulating levels of EPCs in subjects without manifest CVD but at high cardiovascular risk due to obesity and presence of the metabolic syndrome. Second, we evaluated the effect on EPC levels of two lipid-lowering treatments. METHODS AND RESULTS Circulating CD34+KDR+ EPC levels were reduced by nearly 40% in obese men with the metabolic syndrome compared to non-obese healthy controls (331 +/- 193 vs. 543 +/- 164 EPC/mL, P = 0.006). In a randomized double-blind cross-over study comparing intensive lipid-lowering treatment using 80 mg simvastatin mono-treatment with combination treatment of 10 mg simvastatin and 10 mg ezetimibe, we found a similar treatment effect on EPC levels. Secondary analyses of these data suggested that both treatment regimens had increased circulating EPCs to control levels (626 +/- 428 after combination treatment, P < 0.01; 524 +/- 372 EPC/mL after monotherapy, P < 0.05). Serum levels of EPC-mobilizing factor SCF-sR correlated with reduced EPC levels and normalized concurrently with treatment. CONCLUSION EPC levels are reduced in apparently healthy men with abdominal obesity and the metabolic syndrome, even in the absence of manifest CVD. This is important as EPCs contribute to endothelial regeneration and thereby protect against CVD. SCF-sR may be a candidate serum marker of circulating EPC levels. Treatment with low-dose statin with ezetimibe combination therapy or high-dose statin monotherapy has similar effects on the reduced EPC levels.
Función del retículo sarcoplásmico y su papel en las enfermedades cardíacas

El reticulo sarcoplasmico (RS) es el principal almacen de calcio intracelular en el musculo estriado y participa de forma importante en la regulacion del proceso acoplamiento-excitacion-contraccion (AEC) en el musculo esqueletico y cardiaco, regulando las concentraciones intracelulares de calcio durante la contraccion y la relajacion muscular. Esta regulacion esta dada por la interaccion de las principales proteinas del RS que son el canal de liberacion de calcio o receptor de rianodina, la ATPasa de Ca2+, fosfolamban y calsecuestrina. Por la relevancia del AEC en la fisiopatologia de varias enfermedades cardiacas, se ha estudiado extensamente el papel que mantiene el RS y sus distintos componentes proteicos en distintas patologias, principalmente en la hipertrofia cardiaca, la insuficiencia cardiaca y en las arritmias hereditarias. Por lo anterior, las proteinas del RS constituyen un area de gran interes para el desarrollo de nuevas terapias, por lo que resulta de gran importancia el comprender la funcion del RS. En este articulo de revision se analiza la estructura y funcion de las principales proteinas del RS, su papel en los procesos de contraccion y relajacion muscular, asi como los cambios en expresion y funcion que ocurren en diferentes patologias cardiacas
Late stent malapposition risk is higher after drug-eluting stent compared with bare-metal stent implantation and associates with late stent thrombosis.

AIMS Late stent malapposition (LSM) may be acquired (LASM) or persistent. LSM may play a role in patients who develop late stent thrombosis (ST). Our objective was to compare the risk of LASM in bare metal stents (BMS) with drug-eluting stents (DES) and to investigate the possible association of both acquired and persistent LSM with (very) late ST. METHODS AND RESULTS We searched PubMed and relevant sources from January 2002 to December 2007. Inclusion criteria were: (a) intra-vascular ultrasonography (IVUS) at both post-stent implantation and follow-up; (b) 6-9-month-follow-up IVUS; (c) implantation of either BMS or the following DES: sirolimus, paclitaxel, everolimus, or zotarolimus; and (d) follow-up for LSM. Of 33 articles retrieved for detailed evaluation, 17 met the inclusion criteria. The risk of LASM in patients with DES was four times higher compared with BMS (OR = 4.36, CI 95% 1.74-10.94) in randomized clinical trials. The risk of (very) late ST in patients with LSM (five studies) was higher compared with those without LSM (OR = 6.51, CI 95% 1.34-34.91). CONCLUSION In our meta-analysis, the risk of LASM is strongly increased after DES implantation compared with BMS. Furthermore, LSM seems to be associated with late and very late ST.
Isolated gingival recession coverage by lateral pedicle graft procedure: A case report

The coverage of denuded roots represents one of the challenges of periodontal treatment as clinician is not only required to treat disease and improve function but also cope with ever demanding esthetics of patients. Among the several techniques is the laterally positioned fl ap. A 19-year-old female patient presented with Miller Class I gingival recession in tooth no 31. Her main concern was unpleasant elongated tooth appearance of front tooth. As adjacent tooth showed good periodontal condition with adequate keratinized gingival and no interproximal bone loss, lateral pedicle graft procedure was selected. To conclude, post-treatment assessment showed complete root coverage and an excellent aesthetic outcome of lateral pedicle graft root coverage procedure of an isolated gingival recession.
A polymer-free dual drug-eluting stent in patients with coronary artery disease: a randomized trial vs. polymer-based drug-eluting stents.

AIMS Long-term polymer residue in the coronary milieu is a consequence of current drug-eluting stent (DES) therapy and has been implicated in late adverse events. We developed a novel polymer-free rapamycin- and probucol-eluting stent (Dual-DES) and compared its efficacy against commercially available permanent polymer-based sirolimus-eluting (SES; Cypher) and zotarolimus-eluting (ZES; Endeavor) stents. METHODS AND RESULTS Between March 2006 and July 2007, a total of 1007 patients undergoing coronary stenting of de novo lesions, in native vessels, were randomized to treatment with SES (n = 335), Dual-DES (n = 333), or ZES (n = 339). The primary endpoint was binary angiographic restenosis at 6-8 month follow-up angiography. Secondary endpoints were angiographic in-stent late loss; and target lesion revascularization (TLR), death/myocardial infarction and stent thrombosis at 12 months. Follow-up angiographic data were available for 828 (82.2%) patients. There was a significant difference in both binary restenosis and TLR across treatment groups (P = 0.003 and P < 0.001, respectively). Binary restenosis in the Dual-DES group (11.0%) was significantly lower than that in the ZES group (19.3%; P = 0.002) but comparable with that in the SES group (12.0%; P = 0.68). Similarly, TLR with Dual-DES (6.8%) was significantly lower than ZES (13.6%; P = 0.001) but not different to that of SES (7.2%; P = 0.83). These differences were mirrored in the extent of late loss across the groups. No differences were observed between stent groups in terms of death/myocardial infarction or stent thrombosis. CONCLUSION A novel polymer-free Dual-DES is associated with high anti-restenotic efficacy without recourse to carrier polymer. Potential long-term clinical advantage of this platform remains subject to investigation. Study registered at ClinicalTrials.gov. Identifier number: NCT00332397.
Tumors of the cervix, vagina, and vulva

The publication of this edition marks the transition in diagnosis of lower genital tract lesions from a largely morphologic activity to one based upon integrated assessment using microscopy and molecular biology. Furthermore, the ability to integrate these diagnostic approaches with clinical data for patient management has been heightened. The introduction of prophylactic vaccines for preventing human papillomavirus (HPV) infections and cervical cancer precursors also thrusts pathology into a new unprecedented public health role with regard to disease monitoring, which will likely expand over time. Finally, the realisation that cervical cancer is becoming increasingly preventable carries with it both a sense of accomplishment and the recognition that this must now be translated into an achievable goal of cancer prevention in underdeveloped nations. Although the text has remained concise in order to maintain the primary function of the book as an atlas rather than a comprehensive textbook, it has been substantially updated to reflect the changes in the field since the previous edition was published in 1992. In this regard, the number of illustrations, all of which are in colourr, has almost doubled. Both the text and the photomicrographs emphasise the importance of immunohistochemistry and molecular in situ hybridisation as adjuncts to morphology in routine clinical diagnosis. A binary (low-grade and high-grade squamous intraepithelial lesion) classification for histology, analogous to TBS for cytology, replaces the four-tiered dysplasia/CIS system and the three-tiered CIN system. This Atlas will be a useful reference for pathologists, residents, and students for years to come.
Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study.

AIMS The aim of this study was to investigate serious clinical outcomes associated with atrial fibrillation (AF) and the effects of routine blood pressure lowering on such outcomes in the presence or absence of AF, among individuals with type 2 diabetes. METHODS AND RESULTS About 11 140 patients with type 2 diabetes (7.6% of whom had AF at baseline) were randomized to a fixed combination of perindopril and indapamide or placebo in the Action in Diabetes and Vascular Disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE) study. We compared total mortality and cardiovascular disease outcomes and effects of randomized treatment for 4.3 years on such outcomes between patients with and without AF at baseline. After multiple adjustments, AF was associated with a 61% (95% confidence interval 31-96, P < 0.0001) greater risk of all-cause mortality and comparable higher risks of cardiovascular death, stroke, and heart failure (all P < 0.001). Routine treatment with a fixed combination of perindopril and indapamide produced similar relative, but greater absolute, risk reductions for all-cause and cardiovascular mortalities in patients with AF, compared with those without AF. The number of patients needed to be treated with perindopril-indapamide for 5 years to prevent one cardiovascular death was 42 for patients with AF and 120 for patients without AF at baseline. CONCLUSION Atrial fibrillation is relatively common in type 2 diabetes and is associated with substantially increased risks of death and cardiovascular events in patients with type 2 diabetes. This arrhythmia identifies individuals who are likely to obtain greater absolute benefits from blood pressure-lowering treatment. Atrial fibrillation in diabetic patients should be regarded as a marker of particularly adverse outcome and prompt aggressive management of all risk factors.
Intervalos de referencia para troponina I, creatina quinasa fracción MB masa y mioglobina

La inclusion de determinaciones nuevas como troponina I (cTnI), creatina quinasa fraccion MB masa (CK-MB masa) y mioglobina hace que cada laboratorio deba verificar los intervalos de referencia (IR) dados por el fabricante. Cuando esto no ocurre dicho intervalo debera ser creado a los efectos de una correcta interpretacion de los resultados emitidos para su comparacion frente a un intervalo de referencia confiable. Para ello se procesaron 247 muestras de suero de donantes de sangre y se hizo el calculo de los percentilos 0,5 y 99,5 para la obtencion del IR del 99% de cTnI y 2,5 y 97,5 para obtencion del IR del 95% de mioglobina y CK-MB masa (metodo no parametrico). En cTnI el IR fue verificado; en los otros dos marcadores (CK-MB masa y mioglobina) los IR debieron ser creados. Para CK-MB masa el IR obtenido fue de 0,5-4,4 ng/mL (IR reportado por el fabricante de 0,6-6,3 ng/mL). En mioglobina, el IR obtenido para mujeres fue de 8,3-40,3 ng/mL (IR reportado por el fabricante 14,3-65,8 ng/mL), para hombres fue de 11,5-56,5 ng/mL (reportado por el fabricante de 17,4-105,7 ng/mL). Cada laboratorio debera establecer sus propios IR para garantizar la representacion adecuada de poblaciones especificas y tipos de muestra
The Supply of Physician Services in OECD Countries

The delivery of an appropriate quantity and quality of health care in an efficient way requires, among other things, matching the supply with the demand for the services of physicians, over time. Such matching has led to very different levels of physicians per million population across OECD countries – because of variations, among other things, in: morbidity and mortality, health expenditure as a share of GDP and the design of health systems. In addition, there are signs that a higher density of physicians is found in countries which have left the supply of physicians mainly to the market whereas lower density is found in countries which have planned the intake to medical schools centrally over many years. Pour qu'un systeme de sante puisse assurer de facon efficace un niveau de soins satisfaisant, en quantite comme en qualite, il faut, entre autres choses, que l'offre et la demande de medecins parviennent a s'equilibrer. De ce point de vue, et si l'on en juge d'apres le nombre de medecins par million d'habitants, les pays de l'OCDE affichent une grande diversite, pour des raisons qui tiennent notamment a des differences dans les taux de morbidite et de mortalite, les depenses de sante en proportion du PIB et la conception des systemes de sante. En outre, il semble que la densite medicale soit plus elevee dans les pays qui ont pour l'essentiel laisse au marche le soin de reguler l'offre de medecins, et moins elevee dans ceux ou l'acces aux etudes de medecine a longtemps ete encadre a l'echelon national.
Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials.

CONTEXT The optimal treatment of acute myeloid leukemia (AML) in first complete remission (CR1) is uncertain. Current consensus, based on cytogenetic risk, recommends myeloablative allogeneic stem cell transplantation (SCT) for poor-risk but not for good-risk AML. Allogeneic SCT, autologous transplantation, and consolidation chemotherapy are considered of equivalent benefit for intermediate-risk AML. OBJECTIVE To quantify relapse-free survival (RFS) and overall survival benefit of allogeneic SCT for AML in CR1 overall and also for good-, intermediate-, and poor-risk AML. METHODS Systematic review and meta-analysis of prospective trials evaluating allogeneic SCT vs nonallogeneic SCT therapies for AML in CR1. The search used the combined search terms allogeneic; acut* and leukem*/leukaem*/leucem*/leucaem*/aml; myelo* or nonlympho* in the PubMed, Embase, and Cochrane Registry of Controlled Trials databases in March 2009. The search identified 1712 articles. STUDY SELECTION Prospective trials assigning adult patients with AML in CR1 to undergo allogeneic SCT vs nonallogeneic SCT treatment(s) based on donor availability and trials reporting RFS and/or overall survival outcomes on an intention-to-treat, donor vs no-donor basis were identified. DATA EXTRACTION Two reviewers independently extracted study characteristics, interventions, and outcomes. Hazard ratios (HRs) with 95% confidence intervals (CIs) were determined. DATA SYNTHESIS Overall, 24 trials and 6007 patients were analyzed (5951 patients in RFS analyses and 5606 patients in overall survival analyses); 3638 patients were analyzed by cytogenetic risk (547, 2499, and 592 with good-, intermediate-, and poor-risk AML, respectively). Interstudy heterogeneity was not significant. Fixed-effects meta-analysis was performed. Compared with nonallogeneic SCT, the HR of relapse or death with allogeneic SCT for AML in CR1 was 0.80 (95% CI, 0.74-0.86). Significant RFS benefit of allogeneic SCT was documented for poor-risk (HR, 0.69; 95% CI, 0.57-0.84) and intermediate-risk AML (HR, 0.76; 95% CI, 0.68-0.85) but not for good-risk AML (HR, 1.06; 95% CI, 0.80-1.42). The HR of death with allogeneic SCT for AML in CR1 was 0.90 (95% CI, 0.82-0.97). Significant overall survival benefit with allogeneic SCT was documented for poor-risk (HR, 0.73; 95% CI, 0.59-0.90) and intermediate-risk AML (HR, 0.83; 95% CI, 0.74-0.93) but not for good-risk AML (HR, 1.07; 95% CI, 0.83-1.38). CONCLUSION Compared with nonallogeneic SCT therapies, allogeneic SCT has significant RFS and overall survival benefit for intermediate- and poor-risk AML but not for good-risk AML in first complete remission.
Hepatology - A Clinical Textbook, Fifth Edition

Hepatology - A Clinical Textbook is now in its fifth year and has been substantially updated to reflect the latest medical progress achieved in treating hepatitis C. Because of the timely revisions it remains an up-to-date reference for all relevant aspects of clinical hepatology. This would not have been possible without the continuous contributions of all the authors who have dutifully and elegantly revised and updated their chapters. Again, the book is available in print, but probably more important as a free download at www.hepatologytextbook. com.
Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block.

CONTEXT Prolongation of the electrocardiographic PR interval, known as first-degree atrioventricular block when the PR interval exceeds 200 milliseconds, is frequently encountered in clinical practice. OBJECTIVE To determine the clinical significance of PR prolongation in ambulatory individuals. DESIGN, SETTING, AND PARTICIPANTS Prospective, community-based cohort including 7575 individuals from the Framingham Heart Study (mean age, 47 years; 54% women) who underwent routine 12-lead electrocardiography. The study cohort underwent prospective follow-up through 2007 from baseline examinations in 1968-1974. Multivariable-adjusted Cox proportional hazards models were used to examine the associations of PR interval with the incidence of arrhythmic events and death. MAIN OUTCOME MEASURES Incident atrial fibrillation (AF), pacemaker implantation, and all-cause mortality. RESULTS During follow-up, 481 participants developed AF, 124 required pacemaker implantation, and 1739 died. At the baseline examination, 124 individuals had PR intervals longer than 200 milliseconds. For those with PR intervals longer than 200 milliseconds compared with those with PR intervals of 200 milliseconds or shorter, incidence rates per 10 000 person-years were 140 (95% confidence interval [CI], 95-208) vs 36 (95% CI, 32-39) for AF, 59 (95% CI, 40-87) vs 6 (95% CI, 5-7) for pacemaker implantation, and 334 (95% CI, 260-428) vs 129 (95% CI, 123-135) for all-cause mortality. Corresponding absolute risk increases were 1.04% (AF), 0.53% (pacemaker implantation), and 2.05% (all-cause mortality) per year. In multivariable analyses, each 20-millisecond increment in PR was associated with an adjusted hazard ratio (HR) of 1.11 (95% CI, 1.02-1.22; P = .02) for AF, 1.22 (95% CI, 1.14-1.30; P < .001) for pacemaker implantation, and 1.08 (95% CI, 1.02-1.13; P = .005) for all-cause mortality. Individuals with first-degree atrioventricular block had a 2-fold adjusted risk of AF (HR, 2.06; 95% CI, 1.36-3.12; P < .001), 3-fold adjusted risk of pacemaker implantation (HR, 2.89; 95% CI, 1.83-4.57; P < .001), and 1.4-fold adjusted risk of all-cause mortality (HR, 1.44, 95% CI, 1.09-1.91; P = .01). CONCLUSION Prolongation of the PR interval is associated with increased risks of AF, pacemaker implantation, and all-cause mortality.