Miracle-dz/UniFAR-FTUs huggingface dataset:
Osseointegrated Implants in Children: Experience from Our First 100 Patients

This study was undertaken on 100 children aged 16 years or under intended for installation of osseointegrated implants. Of these, 76 had implants installed for bone-anchored hearing aids or prostheses. The main indication for implant installation was a bilateral ear malformation. Surgery was generally performed as a two-stage procedure with a healing time of 3 to 4 months in between. Available bone thickness was on average 2.5 mm, and lack of bone necessitated bone augmentation in 12 patients. Thirty-nine percent of implants were installed in contact with the dura, sigmoid sinus, or an air cell. Implant failures were 5.8% of 170 inserted fixtures. Adverse skin reactions appeared in 9.1% of patients over a 21-year follow-up period. Revision surgery was undertaken in 22% of patients because of appositional growth of the temporal bone. Of the 24 children considered but not found suitable for osseointegration surgery, plastic surgery was considered a better option, or growth of the temporal bone was awaited. It is concluded that the rate of implant failure is lower in children; the frequency of skin reactions is the same as in adults, but revision surgery is more common in young patients because of new bone formation. Our clinical experience supported by the data presented in this article suggests that the concept could be used with good functional and aesthetic results in children.
Magnetic‐guided catheter ablation of twin AV nodal reentrant tachycardia in a patient with left atrial isomerism, interrupted inferior vena cana, and Kawashima‐Fontan procedure

Twin AV nodal reentrant tachycardia most commonly occurs in patients with complex congenital heart disease who have two distinct AV nodes, His bundles, and non‐preexcited QRS morphologies. Catheter ablation of the weaker AV node may be hindered by anatomical complexities. In such cases, remote magnetic guidance offers a potentially effective solution.
Limits of Incremental Conductance for determining the Maximum Power Point under rapidly changing irradiance and an alternative technique based on fast scanning

In Photovoltaic (PV) energy systems, Maximum Power Point Tracking (MPPT) is essential in order to efficiently use the solar energy converted. There are many MPPT algorithms. Incremental Conductance (IncCond) is a popular algorithm which is widely used for rapidly changing atmospheric conditions. It is shown that it has no significant increase in convergence speed compared with the most popular empirically based Perturb and Observe (P&O) methods. In this paper, an alternative is proposed to track the MPP under rapidly changing atmospheric and partial shading conditions. In response to a sudden change in radiation from 100% to 30%, this method can converge to the MPP in 20ms. This is the fastest convergence time reported to date, which also has the capability of finding the global peak under partial shading conditions. The ultimate limit of how fast any MPPT algorithm can converge is also discussed.
Between Professionalism and Managerialism : Competing logics at the regulatory front-lines.

In his seminal book Street-level bureaucracy: dilemmas of the individual in public services , Michael Lipsky (1980/2010: 3) presents street-level bureaucrats as public workers “who interact directly with citizens in the course of their job, and who have substantial discretion in the execution of their work”. Teachers, police officers or social workers are all involved. Lipsky defines the tensions and dilemmas these front-line workers have to cope with and identifies the coping mechanisms and behaviors they use to respond to them. More than 30 years after its publication, his views are still very influential in public policy studies and in public management (Brodkin, 2012; Rowe, 2012). Nonetheless, Lipsky did not specifically examine the influence of the New Public Management (NPM) which began to rise in the public sector after his book was published (Hjorne et al., 2010). Traditionally, street-level bureaucrats operate in a regime of bureau-professionalism organizing public services along principles of professional discretion and expertise coupled with the foundations of Weberian administration (Clarke et al., 1994). NPM-based reforms have introduced new rationalities and practices challenging these bureau-professional organizing principles. As she evokes the understudied influence of these transformations on street-level bureaucracies, Brodkin (2012: 6) points the evolution of the argument developed by Lispky: “Studies have shown how the discretion that is essential to responsiveness may be squeezed out, reducing opportunities for staff to respond to client needs as they understand them (Brodkin 2011; Jewell 2007; Lindhorst and Padgett 2005; Soss, et al. 2011). In short, they suggest that the dilemmas that Lipsky first identified three decades ago have intensified”. Challenging this latter quote, this contribution addresses the impact of NPM-based managerial reforms upon street-level bureaucracy by drawing on an institutional logics perspective. Revisiting Lipsky in a contemporary context, the paper argues that managerial reforms have contributed to profoundly re-formulate the question of discretion and control at the front-lines, and to transform the nature of the tensions and dilemmas experienced by street-level officials. On the one hand, the paper claims that the very essence of NPM-based reforms is not so much the containment of discretion through street-level work ; rather, it resides in the production of a new subject –a Managerial Street-level Bureaucrat – acting in a self-regulated, standardized and output-oriented way. The penetration of this identity project engrained in these reforms is a complex dynamics of internalization and resistance in which front-line officials engage by drawing on the enduring professional logic. On the other hand, proposing an institutional reading of Aili et al. (2007), the paper argues that the introduction of NPM-based reforms has
Met‐enkephalin immunoreactive neurons recruited by acute stress are innervated by axon terminals immunopositive for tyrosine hydroxylase and dopamine‐α‐hydroxylase in the anterolateral division of bed nuclei of the stria terminalis in the rat

The bed nuclei of the stria terminalis (BST) are highly heterogeneous forebrain structures, which play a central role in the regulation/modulation of stress responses. Studies using the inducible immediate early gene c‐fos as a marker of activated neurons have demonstrated significant stress‐induced neuronal activation in this limbic region. The BST also exhibit a dense network of dopamine and noradrenaline immunoreactive (ir) axon terminals. These catecholaminergic projections from various brainstem sources to the BST play an important role in a neurochemically mediated coordination of stress responses. In the anterolateral division of bed nuclei of the stria terminalis, the distribution of several Met‐enkephalin immunopositive perikarya overlaps with that of catecholaminergic axon terminals. Both monoaminergic and enkephalinergic structures have been postulated to play a role in the regulation/modulation of the central regulatory pathways of endocrine, behavioural and physiological responses during stress. Therefore the aims of this study were: (i) to study the possible involvement of dopaminergic fibre terminals in stress‐induced activation of BST perikarya; (ii) to investigate whether Met‐enkephalin‐immunoreactive neurons are recruited by acute volumen/osmotic challenge; and (iii), to demonstrate synaptic interactions between Met‐enkephalin‐ir neurons and fibre terminals immunopositive for dopamine or noradrenaline in the anterolateral division of the BST. From the results of this study we can conclude that depletion of dopamine in fibre terminals completely abolished stress‐induced activation of perikarya in the anterolateral division of BST. Furthermore, the innervation of stress‐induced Met‐enkephalin‐ir perikarya by dopaminergic fibre terminals in the oval nucleus of BST was demonstrated, whereas noradrenergic axons contacted enkephalinergic structures in the fusiform and subcomissural nuclei of BST. These interactions can be central in the modulatory control of the major stress regulatory pathway, the limbic hypothalamo–pituitary–adrenal axis.
Base and Nucleotide Excision Repair of Oxidatively Generated Guanine Lesions in DNA*

The well known biomarker of oxidative stress, 8-oxo-7,8-dihydroguanine, is more susceptible to further oxidation than the parent guanine base and can be oxidatively transformed to the genotoxic spiroiminodihydantoin (Sp) and 5-guanidinohydantoin (Gh) lesions. Incubation of 135-mer duplexes with single Sp or Gh lesions in human cell extracts yields a characteristic nucleotide excision repair (NER)-induced ladder of short dual incision oligonucleotide fragments in addition to base excision repair (BER) incision products. The ladders were not observed when NER was inhibited either by mouse monoclonal antibody (5F12) to human XPA or in XPC−/− fibroblast cell extracts. However, normal NER activity appeared when the XPC−/− cell extracts were complemented with XPC-RAD23B proteins. The Sp and Gh lesions are excellent substrates of both BER and NER. In contrast, 5-guanidino-4-nitroimidazole, a product of the oxidation of guanine in DNA by peroxynitrite, is an excellent substrate of BER only. In the case of mouse embryonic fibroblasts, BER of the Sp lesion is strongly reduced in NEIL1−/− relative to NEIL1+/+ extracts. In summary, in human cell extracts, BER and NER activities co-exist and excise Gh and Sp DNA lesions, suggesting that the relative NER/BER product ratios may depend on competitive BER and NER protein binding to these lesions.
Phase I/IIa study of cilengitide and temozolomide with concomitant radiotherapy followed by cilengitide and temozolomide maintenance therapy in patients with newly diagnosed glioblastoma.

PURPOSE Invasion and migration are key processes of glioblastoma and are tightly linked to tumor recurrence. Integrin inhibition using cilengitide has shown synergy with chemotherapy and radiotherapy in vitro and promising activity in recurrent glioblastoma. This multicenter, phase I/IIa study investigated the efficacy and safety of cilengitide in combination with standard chemoradiotherapy in newly diagnosed glioblastoma. PATIENTS AND METHODS Patients (age > or = 18 to < or = 70 years) were treated with cilengitide (500 mg) administered twice weekly intravenously in addition to standard radiotherapy with concomitant and adjuvant temozolomide. Treatment was continued until disease progression or for up to 35 weeks. The primary end point was progression-free survival (PFS) at 6 months. RESULTS Fifty-two patients (median age, 57 years; 62% male) were included. Six- and 12-month PFS rates were 69% (95% CI, 54% to 80%) and 33% (95% CI, 21% to 46%). Median PFS was 8 months (95% CI, 6.0 to 10.7 months). Twelve- and 24-month overall survival (OS) rates were 68% (95% CI, 53% to 79%) and 35% (95% CI, 22% to 48%). Median OS was 16.1 months (95% CI, 13.1 to 23.2 months). PFS and OS were longer in patients with tumors with O(6)-methylguanine-DNA methyltransferase (MGMT) promoter methylation (13.4 and 23.2 months) versus those without MGMT promoter methylation (3.4 and 13.1 months). The combination of cilengitide with temozolomide and radiotherapy was well tolerated, with no additional toxicity. No pharmacokinetic interactions between temozolomide and cilengitide were identified. CONCLUSION Compared with historical controls, the addition of concomitant and adjuvant cilengitide to standard chemoradiotherapy demonstrated promising activity in patients with glioblastoma with MGMT promoter methylation.
Shortages of medical personnel at community health centers: implications for planned expansion.

CONTEXT The US government is expanding the capacity of community health centers (CHCs) to provide care to underserved populations. OBJECTIVE To examine the status of workforce shortages that may limit CHC expansion. DESIGN AND SETTING Survey questionnaire of all 846 federally funded US CHCs that directly provide clinical services and are within the 50 states and the District of Columbia, conducted between May and September 2004. Questionnaires were completed by the chief executive officer of each grantee. Information was supplemented by data from the 2003 Bureau of Primary Health Care Uniform Data System and weighted to be nationally representative. MAIN OUTCOME MEASURES Staffing patterns and vacancies for major clinical disciplines by rural and urban location, use of federal and state recruitment programs, and perceived barriers to recruitment. RESULTS Overall response rate was 79.3%. Primary care physicians made up 89.4% of physicians working in the CHCs, the majority of whom are family physicians. In rural CHCs, 46% of the direct clinical providers of care were nonphysician clinicians compared with 38.9% in urban CHCs. There were 428 vacant funded full-time equivalents (FTEs) for family physicians and 376 vacant FTEs for registered nurses. There were vacancies for 13.3% of family physician positions, 20.8% of obstetrician/gynecologist positions, and 22.6% of psychiatrist positions. Rural CHCs had a higher proportion of vacancies and longer-term vacancies and reported greater difficulty filling positions compared with urban CHCs. Physician recruitment in CHCs was heavily dependent on National Health Service Corps scholarships, loan repayment programs, and international medical graduates with J-1 visa waivers. Major perceived barriers to recruitment included low salaries and, in rural CHCs, cultural isolation, poor-quality schools and housing, and lack of spousal job opportunities. CONCLUSIONS CHCs face substantial challenges in recruitment of clinical staff, particularly in rural areas. The largest numbers of unfilled positions were for family physicians at a time of declining interest in family medicine among graduating US medical students. The success of the current US national policy to expand CHCs may be challenged by these workforce issues.
Communication modelling and synthesis for NoC-based systems with real-time constraints

This paper addresses the communication modelling and synthesis problem for applications implemented on networks-on-chip. Due to the communication complexity of such systems it is difficult to estimate the communication delay. On the other hand, guaranteeing the timing constraints without detailed know-how about the communication is impossible. In this work we propose a communication modelling and synthesis approach for networks-on-chip where communication infrastructure is not able to provide communication interleaving (such as TDMA, virtual channels) or to guarantee communication delays. The idea is, to design a communication synthesis method, which would not be run off-chip as a CAD tool on a workstation, but on-chip and being activated whenever the system-on-chip (SoC) is re-configured.
Antihypertensive effects and arterial haemodynamic alterations during angiotensin converting enzyme inhibition

Objective To assess the respective roles of the antihypertensive and blood pressure-independent effects of angiotensin converting enzyme (ACE) inhibition in the changed arterial haemodynamics observed in hypertensive patients with end-stage renal disease (ESRD) treated by haemodialysis. Design and methods Twelve hypertensive patients with ESRD were included in a double-blind, cross-over study comparing a single 20 mg dose of the ACE inhibitor quinapril versus placebo. Two study periods each of 172 h duration were separated by a 2-week placebo period. Repeated measurements of the following parameters were performed: brachial artery systolic blood pressure (SBP); diastolic blood pressure and mean blood pressure (using a mercury sphygmomanometer); carotid artery SBP and pulse pressure (by applanation tonometry); aortic stiffness (by pulse wave velocity); and the effect of arterial wave reflections in the common carotid artery (the augmentation index, by applanation tonometry). A radioimmunoassay was used to determine plasma angiotensin II levels. Quinaprilat pharmacokinetics were studied using a specific assay. Twoway (time-treatment) analysis of variance for repeated measures, analysis of covariance for two within-factors and a covariate changing with the level of the factor time (pressures measured at each time) and baseline values of the studied parameter as a second covariate were used for statistical analysis. Results Quinapril treatment induced a long-lasting decrease in arterial wave reflections, which was still observable 172h after quinapril administration and still present after removing the effect of the decrease in blood pressure. The effect on wave reflections was associated with a more pronounced and sustained decrease in carotid SBP and pulse pressure than that in brachial SBP and pulse pressure. Quinapril administration also induced a long-lasting decrease in aortic pulse wave velocity, but this effect was entirely dependent on parallel changes in blood pressure. Arterial haemodynamic changes were not related to plasma angiotensin II or quinaprilat levels. Conclusions The results of this controlled study indicate that, in ESRD patients, ACE inhibition results in a longlasting, blood pressure-independent decrease in arterial wave reflections. The consequence of this was a decrease in pulsatile pressure load in the central arteries with increased aortic distensibility. The increased aortic distensibility resulted from the decrease in blood pressure. The observed arterial haemodynamic alterations suggest that ACE inhibition induces alterations in arterial wave reflections in the distal parts of the arterial tree.
Reciprocal Crosstalk between Dendritic Cells and Natural Killer T Cells: Mechanisms and Therapeutic Potential

Natural killer T cells carrying a highly conserved, semi-invariant T cell receptor (TCR) [invariant natural killer T (iNKT) cells] are a subset of unconventional T lymphocytes that recognize glycolipids presented by CD1d molecules. Although CD1d is expressed on a variety of hematopoietic and non-hematopoietic cells, dendritic cells (DCs) are key presenters of glycolipid antigen in vivo. When stimulated through their TCR, iNKT cells rapidly secrete copious amounts of cytokines and induce maturation of DCs, thereby facilitating coordinated stimulation of innate and adaptive immune responses. The bidirectional crosstalk between DCs and iNKT cells determines the functional outcome of iNKT cell-targeted responses and iNKT cell agonists are used and currently being evaluated as adjuvants to enhance the efficacy of antitumor immunotherapy. This review illustrates mechanistic underpinnings of reciprocal DCs and iNKT cell interactions and discusses how those can be harnessed for cancer therapy.
Therapeutic leukapheresis in hyperleucocytic leukaemias: lack of correlation between degree of cytoreduction and early mortality rate

The clinical and laboratory data of 48 leukapheresis‐treated patients with hyperleucocytic leukaemia (HL) was reviewed to assess the correlation between the degree of leucoreduction and early mortality. Leukapheresis resulted in > 50% leucoreductions and postapheresis WBC counts <100 × 109/l in most patients (64.5%). Patients presenting with neurological, respiratory or renal complications had higher early mortality rates than patients without such complications, despite similar initial WBC counts and comparable leucoreductions. Thus, in these patients, more efficient leucoreduction was not associated with improved early survival.
Measurement of acute pain after eye surgery in children.

This study was performed to assess the degree of acute pain in children following eye surgery using a Face Pain Rating Scale (FPRS), with a validity and reliability test employing a Numeric/Word Graphic Rating Scale (NWGRS). The degree of pain was obtained at 2, 4, 6, 8 and 24 hours after surgery using the FPRS and NWGRS. The changes in pain intensities were analyzed using a RM-ANOVA, while the relationship between the FPRS and NWGRS was analyzed by a Pearson coefficient in SPSS/WIN. Two third of the children experienced pain equal to, or greater, than moderate to severe, and about one fifth of the subjects expressed the most severe pain at 2 hours after surgery. At 4 hours after surgery, 95.3% of the children still complained of pain, and 8 hours after surgery, 82.8% of the patients experienced 'a little bit' or 'a little more' pain or discomforts. At 1 day after surgery, only 34.4% of children were free of pain. A high correlation between the FPRS and NWGRS was identified over 5 time-points (.887 < r < .735). The gender, type of the surgery and past operation experience had no effects on the degree of pain. Our results suggest that FPRS is a reliable and valid measurement for acute pain assessment in Korean children following eye surgery, and warrants application in the integrated clinical protocol, including non-pharmacological and pharmacological management of acute pediatric pain reduction following surgery.
Dermal Dendritic Cells, and Not Langerhans Cells, Play an Essential Role in Inducing an Immune Response1

Langerhans cells (LCs) serve as epidermal sentinels of the adaptive immune system. Conventional wisdom suggests that LCs encounter Ag in the skin and then migrate to the draining lymph nodes, where the Ag is presented to T cells, thus initiating an immune response. Platelet-activating factor (PAF) is a phospholipid mediator with potent biological effects. During inflammation, PAF mediates recruitment of leukocytes to inflammatory sites. We herein tested a hypothesis that PAF induces LC migration. Applying 2,4-dinitro-1-fluorobenzene (DNFB) to wild-type mice activated LC migration. In contrast, applying DNFB to PAF receptor-deficient mice or mice injected with PAF receptor antagonists failed to induce LC migration. Moreover, after FITC application the appearance of hapten-laden LCs (FITC+, CD11c+, Langerin+) in the lymph nodes of PAF receptor-deficient mice was significantly depressed compared with that found in wild-type mice. LC chimerism indicates that the PAF receptor on keratinocytes but not LCs is responsible for LC migration. Contrary to the diminution of LC migration in PAF receptor-deficient mice, we did not observe any difference in the migration of hapten-laden dermal dendritic cells (FITC+, CD11c+, Langerin−) into the lymph nodes of PAF receptor-deficient mice. Additionally, the contact hypersensitivity response generated in wild-type or PAF receptor-deficient mice was identical. Finally, dermal dendritic cells, but not LCs isolated from the draining lymph nodes after hapten application, activated T cell proliferation. These findings suggest that LC migration may not be responsible for the generation of contact hypersensitivity and that dermal dendritic cells may play a more important role.