Miracle-dz/UniFAR-FTUs huggingface dataset:
Consequences of bed rest

Bed rest is frequently prescribed for critically ill patients because it is assumed to be beneficial for preventing complications, for conserving scarce metabolic resources, and for providing patient comfort. Furthermore, higher levels of physical activity in critically ill patients have been assumed to be impractical or not feasible. Bed rest has been prescribed in the past for several other clinical conditions including acute flares of rheumatoid arthritis, cavitary tuberculosis, acute myocardial infarction, and acute low back pain. However, randomized, controlled, clinical trials failed to demonstrate beneficial effects of bed rest in most of these conditions. Bed rest can cause several complications that may delay or prevent recovery from critical illnesses including disuse muscle atrophy, joint contractures, thromboembolic disease, and insulin resistance. Recent studies demonstrated the feasibility and safety of physical medicine programs in critically ill patients including those with acute respiratory failure requiring mechanical ventilation. Other physical medicine tools, such as neuromuscular electrical stimulation and passive stretching of muscles, may also reduce some complications of bed rest.
Physical inactivity and muscle weakness in the critically ill

Patients in the intensive care unit commonly develop muscle weakness. In part, this reflects loss of mechanical loading due to physical inactivity, bed rest, or immobilization. Mechanical unloading stimulates a complex adaptive response that results in muscle atrophy and loss of specific force. One element of this response is slowing of protein synthesis, which is regulated by signaling pathways downstream of mammalian target of rapamycin and insulin-like growth factor-1. In parallel, protein degradation is accelerated via three coordinate processes: calcium-dependent proteolysis, adenosine triphosphate-dependent proteolysis, and lysosomal proteolysis. Finally, unloading stimulates apoptosis of a subset of myonuclei within multinucleated muscle fibers. This helps to stabilize the relationship between nuclear number and cell volume during atrophy. Each of these responses is promoted by concurrent development of oxidative stress caused by increased production of reactive oxygen species in unloaded muscle fibers. Countermeasures that lessen the effects of unloading include physical activity, nutritional supplements, hormone therapy, and antioxidant administration. Targeted research is needed to define the role of mechanical unloading in intensive care unit-associated weakness and develop countermeasures to preserve muscle function, lessen illness, and hasten the recovery of critically ill patients.
Performance-enhancing sports supplements: Role in critical care

Many performance-enhancing supplements and/or drugs are increasing in popularity among professional and amateur athletes alike. Although the uncontrolled use of these agents can pose health risks in the general population, their clearly demonstrated benefits could prove helpful to the critically ill population in whom preservation and restoration of lean body mass and neuromuscular function are crucial. Post-intensive care unit weakness not only impairs post-intensive care unit quality of life but also correlates with intensive care unit mortality. This review covers a number of the agents known to enhance athletic performance, and their possible role in preservation of muscle function and prevention/treatment of post-intensive care unit weakness in critically ill patients. These agents include testosterone analogues, growth hormone, branched chain amino acid, glutamine, arginine, creatine, and &bgr;-hydryoxy-&bgr;-methylbutyrate. Three of the safest and most effective agents in enhancing athletic performance in this group are creatine, branched-chain amino acid, and &bgr;-hydryoxy-&bgr;-methylbutyrate. However, these agents have received very little study in the recovering critically ill patient suffering from post-intensive care unit weakness. More placebo-controlled studies are needed in this area to determine efficacy and optimal dosing. It is very possible that, under the supervision of a physician, many of these agents may prove beneficial in the prevention and treatment of post-intensive care unit weakness.
Hypermethylation of the thrombospondin‐1 gene is associated with poor prognosis in penile squamous cell carcinoma

To evaluate the presence of human papillomavirus (HPV) infection, the methylation status in the promoter region of thrombospondin‐1 (TSP‐1), RAS association domain family 1A (RASSF1‐A) and p16 genes, and the expression of TSP‐1, CD31, p16 and p53 proteins in patients diagnosed with penile cancer, and the possible associations between these variables and clinical and pathological features.
Broadening the scope of Image-Guided Radiotherapy (IGRT)

The recent wave of enthusiasm for image guidance in radiation therapy is largely due to the advent of on-line imaging devices. The current narrow definition of image-guided radiotherapy (IGRT), in fact, essentially connotes the use of near real-time imaging during treatment delivery to reduce uncertainties in target position and should therefore be termed IGRT-D. However, a broader (and more appropriate) context of image-guidance should include: (1) detection and diagnosis, (2) delineation of target and organs at risk, (3) determining biological attributes, (4) dose distribution design, (5) dose delivery assurance and (6) deciphering treatment response through imaging i.e. the 6 D's of IGRT. Strategies to advance these areas will be discussed.
“It’s not just what the doctor tells me:” Factors that influence surrogate decision-makers’ perceptions of prognosis*

Objective:Physicians and surrogate decision-makers for seriously ill patients often have different views of patients’ prognoses. We sought to understand what sources of knowledge surrogates rely on when estimating a patient’s prognosis. Design:Prospective, mixed-methods study using face-to-face, semistructured interviews with surrogate decision-makers. Setting:Four intensive care units at the University of California, San Francisco Medical Center in 2006 to 2007. Participants:Participants were 179 surrogate decision-makers for 142 incapacitated, critically ill patients at high risk for death. Main Results:Less than 2% (3 of 179) of surrogates reported that their beliefs about the patients’ prognoses hinged exclusively on prognostic information provided to them by physicians. The majority cited other factors in addition to physicians’ predictions that also contributed to their beliefs about the patients’ prognoses, including perceptions of the patient’s individual strength of character and will to live; the patient’s unique history of illness and survival; the surrogate’s own observations of the patient’s physical appearance; the surrogate’s belief that their presence at the bedside may improve the prognosis; and the surrogate’s optimism, intuition, and faith. For some surrogates, these other sources of knowledge superseded the importance of the physician’s prognostication. However, most surrogates endeavored to balance their own knowledge of the patient with physicians’ biomedical knowledge. Conclusions:Surrogates use diverse types of knowledge when estimating their loved ones’ prognoses, including individualized attributes of the patient, such as their strength of character and life history, of which physicians may be unaware. Attention to these considerations may help clinicians identify and overcome disagreements about prognosis.
Adult T-cell leukemia/lymphoma (ATL) presenting in the skin: Clinical, histological and immunohistochemical features of 52 cases

Background. Adult T-cell leukemia/lymphoma (ATL) is a severe disease caused by HTLV-I. This paper describes the clinicopathological and immunohistochemical findings of 52 cases of ATL with skin involvement and investigates whether there is any relationship between median survival time (MST) and histological patterns, primary cutaneous involvement and CD8 positivity.Material and methods. All cases were HTLV-I+ and HIV- and were clinically classified. HTLV-I proviral integration was investigated in atypical cases. Immunohistochemistry was performed using CD3, CD4, CD5, CD7, CD8, CD20, CD25, CD30 and CD45RO markers. Ki-67 was used to evaluate the proliferative index. Results. Twenty-seven cases were primary, while 25 were secondary. Monoclonal viral integration was demonstrated in all atypical cases. Patterns resembling mycosis fungoides (MF) were found in 19 cases and anaplastic large-cell lymphoma (ALCL) in two cases. Fifteen cases had an atypical immunophenotype and expressed CD8. Primary cutaneous ATL had a longer MST (48 months) than the secondary cutaneous ATL (7 months) and the difference was statistically significant, but no statistically significant difference was found between the MST of CD8-positive and negative cases.Conclusions. It is important to differentiate between primary and secondary cutaneous ATL and classify the cases histologically in order to better evaluate the prognosis. The two forms of primary cutaneous ATL, primary cutaneous smoldering and primary cutaneous tumoral (PCT), should also be identified. The smoldering type presented a longer survival (58 months) and histological aspects suggestive of better prognosis in contrast to the PCT type that had a shorter survival (20 months) and histological characteristics suggestive of worse outcome.
Treatment of Posttraumatic Stress Disorder with Exposure Therapy During Late Term Pregnancy

This paper illustrates the treatment of posttraumatic stress disorder (PTSD), with exposure therapy, on a woman who was in later term pregnancy. The client was successfully treated in 14 sessions with no reported complications to the health of the client or the fetus. Two-month follow-up data showed continued improvement on PTSD symptomatology. The delivery was without complications and the mother and the infant were in good health. Recommendations for treatment of pregnant clients are provided.
Preview : Published ahead of advance online publication Stem cells and cell-based therapies for cerebral palsy : A call for rigor

This is a PDF file of an unedited peer-reviewed manuscript that has been accepted for publication. NPG are providing this early version of the manuscript as a service to our customers. The manuscript will undergo copyediting, typesetting and a proof review before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers apply.
Anthropometric Measurements in Toothed and Toothless Maxillaries and its Consequences in Human Alveolar Bone Resorption

Este estudio propuso medir y comparar las medidas antropometricas entre los maxilares con y sin dientes. Fueron utilizados 26 craneos humanos, 13 maxilares con dientes y 13 sin dientes. Las mediciones fueron realizadas a ambos lados por dos evaluadores entre las distancias del reborde alveolar (RA): a la espina nasal anterior (ENA), al canal incisivo (CI) y a lo foraamenes palatinos mayor (FPMA) y menor (FPME). Los datos mostraron que la media de las mediciones fueron proporcionalmente mayores en las maxilas con dientes, para todas las mediciones en cualquiera de los evaluadores. El RA-ENA (p = 0,001), AR-CI (p = 0,006), RA-APMA derecho (p = 0,001) y RA-APMA izquierdo (p <0,001) y RA-APME en ambos lados (p = 0,001), comprobando la existencia de diferencias significativas entre los dos tipos de maxila. Fue verificado que a partir de la perdida dental ocurren irreversibles cambios anatomicos en el maxilar, que deben ser considerados en el diseno y fabricacion de protesis e implantes osteointegrados.
Empiric Antibiotic Therapy for Sepsis Patients : Monotherapy With-Lactam or-Lactam Plus an Aminoglycoside ? Answers to the November 2008 Journal Club Questions

Editor’s Note: You are reading answers to the fifth installment of Annals of Emergency Medicine Journal Club. The questions and the article they are about (Sinert and Bright. Ann Emerg Med. 2008;52:557-560) were published in the November 2008 issue. Information about journal club can be found at http:// www.annemergmed. com/content/journalclub. Readers should recognize that these are suggested answers. We hope they are accurate; we know that they are not comprehensive. There are many other points that could be made about these questions or about the article in general. Questions are rated “novice,” ( ) “intermediate,” ( ) and “advanced” ( ) so that individuals planning a journal club can assign the right question to the right student. The “novice” rating does not imply that a novice should be able to spontaneously answer the question. “Novice” means we expect that someone with little background should be able to do a bit of reading, formulate an answer, and teach the material to others. Intermediate and advanced questions also will likely require some reading and research, and that reading will be sufficiently difficult that some background in clinical epidemiology will be helpful in understanding the reading and concepts. We are interested in receiving feedback about this feature. Please e-mail journalclub@acep.org with your comments.
Lung cancer guidelines in Sweden, Denmark, Norway and Finland: a comparison

Abstract Background: The Nordic countries are similar in terms of demographics and health care organization. Yet there are marked differences in lung cancer mortality, for which Denmark historically has had the poorest outcome. One of several possible reasons for these differences could have to do with how lung cancer is diagnosed and treated in the different Nordic countries. However, among the four most populous Nordic countries: Sweden, Denmark, Norway and Finland, there is a paucity of knowledge about differences and similarities in recommendations in the national guidelines for non-small cell lung cancer (NSCLC) and the methodology by which the guidelines are developed. Methods: We identified and evaluated the development and content of the available clinical care guidelines for NSCLC in the four countries. Moreover, we compared the integrated cancer pathways in these countries. We have used case examples to illustrate areas with clear differences in clinical care recommendations. Results: There are notable differences in the methodology by which the guidelines are developed, published and updated to comply with international recommendations. The Norwegian guidelines are developed and updated according to the most rigorous methodology and have so far been updated most frequently. We found that on the basis of recommendations patients with NSCLC are treated differently with regard to bevacizumab therapy and radiation dosing regimens. Cerebral imaging practices in patients with locally advanced NSCLC also differ. There is, moreover, a marked difference with regard to efforts to help patients to quit smoking. All except Finland have integrated cancer pathways for fast track diagnosis and treatment. Guidelines for follow-up of lung cancer patients also differ, with the Danish follow-up regimen as the most comprehensive. To obtain consensus on optimal clinical care, areas with differences in recommendations or where recommendations are based on a low level of evidence should be subjected to further studies.
Virtual laboratories in engineering education: The simulation lab and remote lab

Computing and communication technology has had a significant impact on the engineering education system. This technology has improved online and collaborative learning. Besides that, it improves the students learning experiences. One of the distinguishing elements of engineering education is the laboratory requirement. In this paper, we discuss the current trends and key issues in virtual laboratories‐simulation environment laboratories and remote laboratories via the Internet. © 2008 Wiley Periodicals, Inc. Comput Appl Eng Educ 17: 108–118, 2009; Published online in Wiley InterScience (www.interscience.wiley.com); DOI 10.1002/cae20186
Soluble form of the receptor for advanced glycation end products is a marker of acute lung injury but not of severe sepsis in critically ill patients*

Objectives:Levels of the soluble form of the receptor for advanced glycation end products (sRAGE) are elevated during acute lung injury. However, it is not known whether this increase is linked to its involvement in alveolar epithelium injury or in systemic inflammation. Whether sRAGE is a marker of acute lung injury and acute respiratory distress syndrome, regardless of associated severe sepsis or septic shock, remains unknown in the intensive care unit setting. Design:Prospective, observational, clinical study. Setting:Intensive care unit of an academic medical center. Patients:A total of 64 consecutive subjects, divided into four groups: acute lung injury/acute respiratory distress syndrome (n = 15); acute lung injury/acute respiratory distress syndrome plus severe sepsis/septic shock (n = 18); severe sepsis/septic shock (n = 16); and mechanically ventilated controls (n = 15). Interventions:None. Measurements and Main Results:Plasma sRAGE levels were measured at baseline and on days 3, 6, and 28 (or at intensive care unit discharge, whichever occurred first). Baseline plasma levels of sRAGE were significantly higher in patients with acute lung injury/acute respiratory distress syndrome, with (median, 2951 pg/mL) or without (median, 3761 pg/mL) severe sepsis, than in patients with severe sepsis (median, 488 pg/mL) only and in mechanically ventilated controls (median, 525 pg/mL). Levels of sRAGE were correlated with acute lung injury/acute respiratory distress syndrome severity and decreased over time but were not associated with outcome. Lower baseline plasma sRAGE was associated with focal loss of aeration based on computed tomography lung morphology. Conclusions:sRAGE levels were elevated during acute lung injury/acute respiratory distress syndrome, regardless of the presence or absence of severe sepsis. The plasma level of sRAGE was correlated with clinical and radiographic severity in acute respiratory distress syndrome patients and decreased over time, suggesting resolution of the injury to the alveolar epithelium. Further study is warranted to test the clinical utility of this biomarker in managing such patients and to better understand its relationship with lung morphology during acute lung injury/acute respiratory distress syndrome.
Determinants of Maternal Mortality in Eclampsia in India

EDITORIAL COMMENT: We accepted this paper for publication to remind readers of the savage toll on maternal life that can be claimed by eclampsia when there is inadequate antenatal care in the detection and management of cases of preeclampsia. In the 22 years from 1971–1993 there were 108,476 deliveries and 60 cases of eclampsia at the Mercy Hospital for Women, an incidence of 0.06% or 1 in 1,808 deliveries and the maternal mortality rate was 5% (3 of 60). In this large series from India of 271 cases, the maternal mortality rate was 7.8% and the incidence of eclampsia was 1 in 115 deliveries (0.87%). The authors refer to other series of eclampsia in India where the incidences of eclampsia were as high as 4.6% of all deliveries. These high incidences of eclampsia are largely explained by referral of complicated cases to major centres and expectedly the series reported here contains a very high proportion of cases of antepartum eclampsia. Where antenatal care facilities are better most cases of eclampsia occur intrapartum and the distribution of the 60 cases at the Mercy Hospital for Women was 19 (32%) antepartum, 14 (23%) intrapartum and 27 (45%) postpartum whereas in the series from India the distribution was 128 (47%) antepartum, 85 (31%) intrapartum and 58 (22%) postpartum. The causes of death in these cases of eclampsia were similar to those which occur in developed countries. The take‐away message for readers is that we must continue our antenatal vigilance to detect the signs of preclampsia and manage these patients appropriately.
Two Extremes of Autoimmune Hepatitis: Report of Two Cases from Bangladesh

Autoimmune hepatitis is defined as chronic liver disease of unknown aetiology with aberrant autoreactivity and genetic predisposition. It is characterized by female predominance, circulating auto-antibodies, hypergammaglobulinaemia and association with HLA DR3 and HLA DR4 [1]. Differential diagnosis includes chronic viral hepatitis, drug induced hepatitis and alcohol. We present two patients with autoimmune hepatitis representing the two extremes of hepatic involvement in this condition. The first patient is a young lady who was diagnosed with autoimmune chronic hepatitis. The second patient, on the other hand, is an elderly gentleman who presented to us with autoimmune hepatitis-related decompensated cirrhosis of liver.
Evidence for quality indicators to evaluate adult trauma care: A systematic review*

Objective:Multiple quality indicators are available to evaluate adult trauma care, but their characteristics and outcomes have not been systematically compared. We sought to systematically review the evidence about the reliability, validity, and implementation of quality indicators for evaluating trauma care. Data Sources:Search of MEDLINE, EMBASE, CINAHL, and The Cochrane Library up to January 14, 2009; the Gray Literature; select journals by hand; reference lists; and articles recommended by experts in the field. Study Selection:Studies were selected that evaluated the reliability, validity, or the impact of one or more quality indicators on the quality of care delivered to patients ≥18 yrs of age with a major traumatic injury. Data Extraction:Reviewers with methodologic and content expertise conducted data extraction independently. Data Synthesis:The literature search identified 6869 citations. Review of abstracts led to the retrieval of 538 full-text articles for assessment; 40 articles were selected for review. Of these, 20 (50%) articles were cohort studies and 13 (33%) articles were case series. Five articles used control groups, including three before and after case series, a case-control study, and a nonrandomized controlled trial. A total of 115 quality indicators in adult trauma care was identified, predominantly measures of hospital processes (62%) and outcomes (17%) of care. We did not identify any posthospital or secondary injury prevention quality indicators. Reliability was described for two quality indicators, content validity for 22 quality indicators, construct validity for eight quality indicators, and criterion validity for 46 quality indicators. A total of 58 quality indicators was implemented and evaluated in three studies. Eight quality indicators had supporting evidence for more than one measurement domain. A single quality indicator, peer review for preventable death, had both reliability and validity evidence. Conclusions:Although many quality indicators are available to measure the quality of trauma care, reliability evidence, validity evidence, and description of outcomes after implementation are limited.