Miracle-dz/UniFAR-FTUs huggingface dataset:
Multispectral optoacoustic tomography

To the Editor: In chronic inflammatory diseases, uncontrolled inflammation is associated with increased rates of hospitalization, complications, and death. Because of the potential severity of these conditions, there is an increased demand for new diagnostic approaches.1,2 Multispectral optoacoustic tomography (MSOT) is a new imaging technique that permits the noninvasive quantification of hemoglobin-dependent tissue perfusion and oxygenation as surrogates of inflammation.3 This approach uses the excitation of short-pulsed laser light with near-infrared wavelengths to induce the photoacoustic effect in targeted tissues, which results in detectable sound waves induced by thermoelastic expansion. In this single-center, cross-sectional diagnostic study (ClinicalTrials.gov number, NCT02622139), MSOT Acuity Echo (iThera Medical) was used to perform transabdominal evaluation of intestinal inflammation in 108 patients with Crohn’s disFigure 1 (facing page). MSOT Imaging for the Assessment of Crohn’s Disease Activity. Panel A shows the transabdominal imaging approach, which uses the same detector for laser light emission and ultrasonic detection of signal levels by means of multispectral optoacoustic tomography (MSOT). Erythrocytes are the target for laser-light absorption and ultrasonic emission. Six different wavelengths (700, 730, 760, 800, 850, and 900 nm) were used for MSOT data acquisition; MSOT measurements, such as total hemoglobin (Hb), oxygenated Hb, deoxygenated Hb, and oxygen saturation, are calculated from these measurements. These hemoglobin-based measurements permit the evaluation of tissue perfusion and oxygenation as surrogates of inflammation with MSOT. Panel B shows MSOT-derived total Hb signal levels in the intestinal wall (in both the large bowel and the small intestine) in 44 patients with Crohn’s disease with different degrees of endoscopic inflammation. Such evaluation was performed by means of the Simplified Endoscopic Score for Crohn’s Disease (SES-CD), which ranges from 0 to 56, with higher scores indicating a greater severity of intestinal inflammation; remission is defined as a score of less than 3, low disease activity as a score of 3 to 6, moderate disease activity as a score of 7 to 15, and high disease activity as a score of 16 or more. The signal levels are expressed as normalized z scores and transformed into a linear scale of arbitrary units (au). The red dots represent single measurements for each patient; the horizontal lines indicate medians, and I bars the interquartile range. A single asterisk denotes P<0.05 and a double asterisk P<0.001 for the comparison with remission. Panel C shows representative images of MSOT measurements of total Hb in the large bowel and small intestine in patients with different grades of endoscopic disease activity (as evaluated by means of SES-CD). The top row shows representative MSOT measurements of total Hb as color-coded maps with an overlay of B-mode ultrasonographic images. The middle row shows schematic representations of the images shown in the top row. The bottom row shows the corresponding endoscopic evaluation. this week’s letters
Is It Statin Induced Polymyalgia Rheumatica or Just a Coincidence

©2015 Turkish League Against Rheumatism. All rights reserved. A 53-year-old female presented with pain in her bilateral shoulders, hips and neck, stiffness (lasting one hour), and proximal weakness for three months. She declared that her symptoms had ensued one week after the usage of daily 40 mg atorvastatin for hyperlipidemia. As such, atorvastatin was discontinued; however, her complaints did not decline. Physical examination revealed painful and restricted shoulder and neck movements, weakness in shoulder and hip muscles, and a swollen, warm right knee. Laboratory investigations including creatine kinase (CK), rheumatoid factor and anti-nuclear antibody levels were within normal values, except for the increased C-reactive protein (0.744 mg/dL, N: 0-0.5) and erythrocyte sedimentation rate (75 mm/h, N: 0-20). X-rays of the hand, knee, hip and shoulder were non-contributory. Ultrasound illustrated biceps tenosynovitis and trochanteric bursitis bilaterally, and increased suprapatellar fluid in right knee (Figure 1). Overall, the patient was diagnosed with polymyalgia rheumatica (PMR) according to the 2012 European League Against Rheumatism/American College of Rheumatology classification criteria.1 Her symptoms and clinical findings (erythrocyte sedimentation rate and C-reactive protein levels) responded to medium dose of prednisolone (20 mg/d) treatment dramatically. Although statins have been reported to be associated with some musculoskeletal side effects such as myalgia, myositis, myopathy, and elevated CK, statin induced PMR is a very rare condition which has been reported only in a few anecdotal reports.2-4 Likewise, statin treatment might trigger the development of PMR in our patient. Since statin induced PMR and myalgia have similar clinical features, the exact diagnosis can be challenging. Statin induced myalgia presents with/without increased CK levels with normal erythrocyte sedimentation rate and C-reactive protein levels. Therefore, patients with statin induced myalgia may have normal serum CK levels, which sometimes make it difficult to distinguish PMR from myopathy syndromes. In case of drug discontinuation, symptoms heal in a period of one-week to four-month in statin, myopathy and treatment of steroid is rarely required.5 PMR patients do not recover spontaneously and corticosteroid treatment is usually needed.6
Carers perceived : policy and practice in informal care

Explores the reality of how service providers like doctors, social workers and community nurses respond to carers. This book presents a study of the relationship between carers and service providers. Carers are the bedrock of community care, and yet our understanding of how they do and do not fit into the care system is limited. Concern is often expressed about the need to support carers, but the best way to do this is not always clear. This book breaks new ground in exploring the reality of how service providers the doctors, social workers, and community nurses respond to carers. It looks at which carers get help and why, analyzing how age, relationship, class and gender structure the responses of service providers and carers. It examines the moral and policy issues posed by trying to incorporate carers' interests into service provision. What would services look like if they took the needs of carers seriously? How far can they afford to do so? Is this only achieved at the expense of disabled people? What is the proper relationship between carers and services? Carers pose in acute form many of the central dilemmas of social welfare, and the account presented here has the widest significance for the analysis of community care. Focusing on the views of carers as well as service providers, the book looks at caring across a variety of relationships and conditions, including people with mental health problems and learning disabilities.
Integrating new approaches to atrial fibrillation management: the 6th AFNET/EHRA Consensus Conference

There are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new approaches to screening and diagnosis, enhancing integration of AF care, developing clinical pathways for treating complex patients, improving stroke prevention strategies, and better patient selection for heart rate and rhythm control. Ultimately, these approaches can lead to better outcomes for patients with AF.
Preliminary evidence of the impact of early childhood maltreatment and a preventive intervention on neural patterns of response inhibition in early adolescence.

Maltreated youths in foster care often experience negative developmental and psychological outcomes, which have been linked with poor response inhibition. Recent evidence suggests that childhood maltreatment is also associated with alterations in the neural circuitry underlying response inhibition. However, a burgeoning line of research has begun to explore the mitigating effects of preventive interventions on neural functioning. The current study used event-related functional magnetic resonance imaging to explore the impact of early childhood maltreatment and a preventive intervention on response inhibition in early adolescence. Thirty-six demographically similar adolescents (ages 9-14 years) completed a Go/NoGo task. The sample included nonmaltreated adolescents (n = 14) and maltreated adolescents who were in foster care as preschoolers and randomly assigned to receive services as usual (n = 11) or a preventive intervention, Multidimensional Treatment Foster Care for Preschoolers (n = 11). The groups demonstrated similar behavioral performance but significantly different neural patterns. The maltreated adolescents who received services as usual demonstrated subcortical hypoactivity during successful response inhibition and subcortical hyperactivity during unsuccessful response inhibition. In contrast, the nonmaltreated adolescents and maltreated adolescents who received the intervention exhibited strikingly similar neural patterns during successful response inhibition, but the maltreated adolescents who received the intervention demonstrated prefrontal hypoactivity during unsuccessful response inhibition. These findings offer preliminary evidence that early childhood maltreatment alters the neural patterns underlying response inhibition in early adolescence and that participating in a preventive intervention could mitigate maltreatment-related effects on these neural systems.
Determinação in vitro do fator de proteção solar (FPS) de moderadores solares

Os Fatores de Protecao Solar (FPS) de varios produtos comerciais brasileiros, estrangeiros e um produto padrao FPA foram determinados in vitro por duas tecnicas de transmissao otica simples. Os produtos solares foram aplicados sobre uma nova pele artificial biologica (Biofill). Os resultados estao de acordo com os valores FPS determinados in vivo. A tecnica e o material do substrato podem xonduzir a um novo protocolo padrao para a determinacao in vitro rapida e segua dos valores FPS dos moderadores solares.
Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial.

IMPORTANCE Laparoscopic procedures are generally thought to have better outcomes than open procedures. Because of anatomical constraints, laparoscopic rectal resection may not be better because of limitations in performing an adequate cancer resection. OBJECTIVE To determine whether laparoscopic resection is noninferior to open rectal cancer resection for adequacy of cancer clearance. DESIGN, SETTING, AND PARTICIPANTS Randomized, noninferiority, phase 3 trial (Australasian Laparoscopic Cancer of the Rectum; ALaCaRT) conducted between March 2010 and November 2014. Twenty-six accredited surgeons from 24 sites in Australia and New Zealand randomized 475 patients with T1-T3 rectal adenocarcinoma less than 15 cm from the anal verge. INTERVENTIONS Open laparotomy and rectal resection (n = 237) or laparoscopic rectal resection (n = 238). MAIN OUTCOMES AND MEASURES The primary end point was a composite of oncological factors indicating an adequate surgical resection, with a noninferiority boundary of Δ = -8%. Successful resection was defined as meeting all the following criteria: (1) complete total mesorectal excision, (2) a clear circumferential margin (≥1 mm), and (3) a clear distal resection margin (≥1 mm). Pathologists used standardized reporting and were blinded to the method of surgery. RESULTS A successful resection was achieved in 194 patients (82%) in the laparoscopic surgery group and 208 patients (89%) in the open surgery group (risk difference of -7.0% [95% CI, -12.4% to ∞]; P = .38 for noninferiority). The circumferential resection margin was clear in 222 patients (93%) in the laparoscopic surgery group and in 228 patients (97%) in the open surgery group (risk difference of -3.7% [95% CI, -7.6% to 0.1%]; P = .06), the distal margin was clear in 236 patients (99%) in the laparoscopic surgery group and in 234 patients (99%) in the open surgery group (risk difference of -0.4% [95% CI, -1.8% to 1.0%]; P = .67), and total mesorectal excision was complete in 206 patients (87%) in the laparoscopic surgery group and 216 patients (92%) in the open surgery group (risk difference of -5.4% [95% CI, -10.9% to 0.2%]; P = .06). The conversion rate from laparoscopic to open surgery was 9%. CONCLUSIONS AND RELEVANCE Among patients with T1-T3 rectal tumors, noninferiority of laparoscopic surgery compared with open surgery for successful resection was not established. Although the overall quality of surgery was high, these findings do not provide sufficient evidence for the routine use of laparoscopic surgery. Longer follow-up of recurrence and survival is currently being acquired. TRIAL REGISTRATION anzctr.org Identifier: ACTRN12609000663257.
Pembrolizumab for Advanced Urothelial Carcinoma.

n engl j med 376;23 nejm.org June 8, 2017 2302 twice the risk of diabetic ketoacidosis as were DPP4 inhibitors, although cases of diabetic keto­ acidosis leading to hospitalization were infre­ quent. The increased risk of diabetic ketoacido­ sis with SGLT2 inhibitors is among the factors to be considered at the time of prescribing and throughout therapy if patients present with symptoms suggestive of diabetic ketoacidosis. Michael Fralick, M.D. Sebastian Schneeweiss, M.D., Sc.D. Elisabetta Patorno, M.D., Dr.P.H.
Evaluation and Treatment of Pericarditis: A Systematic Review.

IMPORTANCE Pericarditis is the most common form of pericardial disease and a relatively common cause of chest pain. OBJECTIVE To summarize published evidence on the causes, diagnosis, therapy, prevention, and prognosis of pericarditis. EVIDENCE REVIEW A literature search of BioMedCentral, Google Scholar, MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews was performed for human studies without language restriction from January 1, 1990, to August 31, 2015. After literature review and selection of meta-analyses, randomized clinical trials, and large observational studies, 30 studies (5 meta-analyses, 10 randomized clinical trials, and 16 cohort studies) with 7569 adult patients were selected for inclusion. FINDINGS The etiology of pericarditis may be infectious (eg, viral and bacterial) or noninfectious (eg, systemic inflammatory diseases, cancer, and post-cardiac injury syndromes). Tuberculosis is a major cause of pericarditis in developing countries but accounts for less than 5% of cases in developed countries, where idiopathic, presumed viral causes are responsible for 80% to 90% of cases. The diagnosis is based on clinical criteria including chest pain, a pericardial rub, electrocardiographic changes, and pericardial effusion. Certain features at presentation (temperature >38°C [>100.4°F], subacute course, large effusion or tamponade, and failure of nonsteroidal anti-inflammatory drug [NSAID] treatment) indicate a poorer prognosis and identify patients requiring hospital admission. The most common treatment for idiopathic and viral pericarditis in North America and Europe is NSAID therapy. Adjunctive colchicine can ameliorate the initial episode and is associated with approximately 50% lower recurrence rates. Corticosteroids are a second-line therapy for those who do not respond, are intolerant, or have contraindications to NSAIDs and colchicine. Recurrences may occur in 30% of patients without preventive therapy. CONCLUSIONS AND RELEVANCE Pericarditis is the most common form of pericardial disease worldwide and may recur in as many as one-third of patients who present with idiopathic or viral pericarditis. Appropriate triage and treatment with NSAIDs may reduce readmission rates for pericarditis. Treatment with colchicine can reduce recurrence rates.
Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial.

IMPORTANCE Low back pain (LBP) is responsible for more than 2.5 million visits to US emergency departments (EDs) annually. These patients are usually treated with nonsteroidal anti-inflammatory drugs, acetaminophen, opioids, or skeletal muscle relaxants, often in combination. OBJECTIVE To compare functional outcomes and pain at 1 week and 3 months after an ED visit for acute LBP among patients randomized to a 10-day course of (1) naproxen + placebo; (2) naproxen + cyclobenzaprine; or (3) naproxen + oxycodone/acetaminophen. DESIGN, SETTING, AND PARTICIPANTS This randomized, double-blind, 3-group study was conducted at one urban ED in the Bronx, New York City. Patients who presented with nontraumatic, nonradicular LBP of 2 weeks' duration or less were eligible for enrollment upon ED discharge if they had a score greater than 5 on the Roland-Morris Disability Questionnaire (RMDQ). The RMDQ is a 24-item questionnaire commonly used to measure LBP and related functional impairment on which 0 indicates no functional impairment and 24 indicates maximum impairment. Beginning in April 2012, a total of 2588 patients were approached for enrollment. Of the 323 deemed eligible for participation, 107 were randomized to receive placebo and 108 each to cyclobenzaprine and to oxycodone/acetaminophen. Follow-up was completed in December 2014. INTERVENTIONS All participants were given 20 tablets of naproxen, 500 mg, to be taken twice a day. They were randomized to receive either 60 tablets of placebo; cyclobenzaprine, 5 mg; or oxycodone, 5 mg/acetaminophen, 325 mg. Participants were instructed to take 1 or 2 of these tablets every 8 hours, as needed for LBP. They also received a standardized 10-minute LBP educational session prior to discharge. MAIN OUTCOMES AND MEASURES The primary outcome was improvement in RMDQ between ED discharge and 1 week later. RESULTS Demographic characteristics were comparable among the 3 groups. At baseline, median RMDQ score in the placebo group was 20 (interquartile range [IQR],17-21), in the cyclobenzaprine group 19 (IQR,17-21), and in the oxycodone/acetaminophen group 20 (IQR,17-22). At 1-week follow-up, the mean RMDQ improvement was 9.8 in the placebo group, 10.1 in the cyclobenzaprine group, and 11.1 in the oxycodone/acetaminophen group. Between-group difference in mean RMDQ improvement for cyclobenzaprine vs placebo was 0.3 (98.3% CI, -2.6 to 3.2; P = .77), for oxycodone/acetaminophen vs placebo, 1.3 (98.3% CI, -1.5 to 4.1; P = .28), and for oxycodone/acetaminophen vs cyclobenzaprine, 0.9 (98.3% CI, -2.1 to 3.9; P = .45). CONCLUSIONS AND RELEVANCE Among patients with acute, nontraumatic, nonradicular LBP presenting to the ED, adding cyclobenzaprine or oxycodone/acetaminophen to naproxen alone did not improve functional outcomes or pain at 1-week follow-up. These findings do not support use of these additional medications in this setting. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01587274.
Intravenous and Oral l-α-Acetylmethadol: Pharmacodynamics and Pharmacokinetics in Humans

Levo-α-acetylmethadol (LAAM) is a long-acting opioid agonist approved for use as a maintenance treatment for opioid dependence. Previous clinical studies report that the onset of the effects of LAAM is slower after parenteral administration than oral administration; however, preclinical studies suggest otherwise. This study examined the pharmacodynamic and pharmacokinetic profile of LAAM when given orally and intravenously to humans. Opioid-experienced volunteers ( n = 6), who were not physically dependent on opioids, received LAAM (20 and 40 mg/70 kg i.v. and p.o.) and placebo under double-blind, double-dummy conditions during five weekly experimental sessions. Behavioral, physiological, subjective and pharmacokinetic measures were collected before and for 96 hr after drug administration. Intravenous LAAM produced significant subjective and physiological effects that appeared within 5 min, whereas the effects of oral LAAM appeared more slowly within 1 to 2 hr after drug administration. Pharmacokinetic data indicate that the immediate effects of intravenous LAAM are largely attributable to the parent drug rather than the active metabolites, nor-LAAM and dinor-LAAM. LAAM produced prototypic opioid agonist effects ( i.e., miosis, subjective ratings of high, nodding) that were of equal magnitude across routes, dose-related and of long duration (up to 60 hr). These data are in contrast to previous clinical reports and indicate that LAAM produces effects of immediate onset when administered parenterally, which suggests that intravenous LAAM possesses greater abuse potential than previously believed.
Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome.

From the New York University Langone Comprehensive Epilepsy Center, New York (O.D.); the University College London Great Ormond Street Institute of Child Health (J.H.C.) and GW Pharmaceuticals (S.W.) — both in London; Lurie Children’s Epilepsy Center, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago (L.L.); the Children’s Hospital of Philadel­ phia, Philadelphia (E.M.); Miami Children’s Hospital, Miami (I.M.); Hôpital Necker– Enfants Malades, Paris (R.N.); Florey Insti­ tute, Austin Health and Royal Children’s Hospital, University of Melbourne, Mel­ bourne, VIC, Australia (I.E.S.); and Massa­ chusetts General Hospital, Boston (E.A.T.). Address reprint requests to Dr. Devinsky at the Department of Neurology, NYU Langone School of Medicine, 223 E. 34th St., New York, NY 10016, or at od4@ nyu . edu.
Incremento de óxido nítrico en el suero y sobrenadantes de cultivo de células mononucleares de pacientes con la enfermedad de Hansen en estado reaccional tipo II.

The word "reaction" is used in leprosy to describe signs and symptoms of acute inflammation. Type II reactions, including erythema nodosum leprosum (ENL) occur in the multibacillary forms of Hansen's disease. Nitric oxide (NO) could play a role in the response of the host, where a high NO production would be involved in acute inflammatory processes. In this paper we evaluate NO production in serum and in the supernatants of mononuclear cell cultures (MNCC), measured indirectly by Griess' method. The results obtained in serum showed that 52% of patients with ENL (15/29) had a production over 30 microM, distributed as follows: 8/15 had a mean concentration of 36.38 +/- ? 5.71 microM; 1/15, 70.5 microM and 6/15 had a mean concentration greater than 100 microM (205.97 +/- 5 microM). Forty eight percent presented nitrite and nitrate levels lower than 30 microM (18.93 +/- 6.15). Only supernatants of mononuclear cell cultures from ENL patients collected at 120 hours of incubation presented NO production levels higher than 10 microM +/- 6.53, as compared with the supernatants from the stable polar forms of the disease (lepromatous leprosy and tuberculoid leprosy), where values were 2.52 microM +/- 1.18 and 2.69 microM +/- 1.07, respectively. These preliminary results show a different metabolic activity in the group of patients with Type II reaction state (ENL).