Miracle-dz/UniFAR-FTUs huggingface dataset:
Sustained Blood Pressure Control Following Discontinuation of a Pharmacist Intervention

Team‐based care can improve hypertension control. The purpose of the present study was to evaluate blood pressure (BP) control 18 months following the discontinuation of a physician‐pharmacist collaborative intervention. This was a retrospective analysis of patients who had previously participated in a prospective, cluster randomized, controlled clinical trial. Six community‐based family medicine offices were randomized to control or intervention groups. Research nurses measured BPs using an automated device during the prospective trial. The research nurses then abstracted data from medical records, including BPs, medications, changes in therapy, and laboratory values for 18 months following the discontinuation of the 6‐month prospective trial. The study included 228 patients in the control (n=146) or intervention (n=82) groups. The control group contained more patients with diabetes or chronic kidney disease (P<.013), were older (P=.047), and had more coexisting conditions (P<.001) than the intervention group. Systolic BP 9 months following discontinuation of the physician‐pharmacist intervention was 137.2±18.2 mm Hg and 129.8±13.3 mm Hg in the control and intervention groups, respectively (P=.0015). BP control was maintained in 61 (41.8%) control patients and 55 (67.1%) intervention patients (P=.0003). At 18 months post‐intervention, systolic BP was 138.1±20.4 mm Hg and 130.0±16.0 mm Hg in the control and intervention groups, respectively (P=.023). BP control was maintained in 53 (36.3%) control patients and 55 (67.1%) intervention patients at 18 months post‐intervention (P<.0001). A sensitivity analysis was conducted to address the uneven distribution of patients with diabetes or chronic kidney disease, and the differences between groups were still significant. BP control rates remained significantly higher following a physician‐pharmacist intervention compared with usual care for 18 months after discontinuation of the intervention. This model has the potential value as a useful long‐term strategy to benefit patients with hypertension. J Clin Hypertens (Greenwich). 2011;13:431–437. ©2011 Wiley Periodicals, Inc.
Noninvasive optical and nuclear imaging of Staphylococcus-specific infection with a human monoclonal antibody-based probe

ABSTRACT Staphylococcus aureus infections are a major threat in healthcare, requiring adequate early-stage diagnosis and treatment. This calls for novel diagnostic tools that allow noninvasive in vivo detection of staphylococci. Here we performed a preclinical study to investigate a novel fully-human monoclonal antibody 1D9 that specifically targets the immunodominant staphylococcal antigen A (IsaA). We show that 1D9 binds invariantly to S. aureus cells and may further target other staphylococcal species. Importantly, using a human post-mortem implant model and an in vivo murine skin infection model, preclinical feasibility was demonstrated for 1D9 labeled with the near-infrared fluorophore IRDye800CW to be applied for direct optical imaging of in vivo S. aureus infections. Additionally, 89Zirconium-labeled 1D9 could be used for positron emission tomography imaging of an in vivo S. aureus thigh infection model. Our findings pave the way towards clinical implementation of targeted imaging of staphylococcal infections using the human monoclonal antibody 1D9.
A D-Alanine auxotrophic live vaccine is effective against lethal infection caused by Staphylococcus aureus

ABSTRACT Staphylococcus aureus infections are becoming a major global health issue due to the rapid emergence of multidrug-resistant strains. Therefore, there is an urgent need to develop an effective vaccine to prevent and control these infections. In order to develop a universal immunization strategy, we constructed a mutant derivative of S. aureus 132 which lacks the genes involved in D-alanine biosynthesis, a structural component of cell wall peptidoglycan. This unmarked deletion mutant requires the exogenous addition of D-alanine for in vitro growth. The aim of this study was to examine the ability of this D-alanine auxotroph to induce protective immunity against staphylococcal infection. Our findings demonstrate that this deletion mutant is highly attenuated, elicits a protective immune response in mice and generates cross-reactive antibodies. Moreover, the D-alanine auxotroph was completely eliminated from the blood of mice after its intravenous or intraperitoneal injection. We determined that the protective effect was dependent on antibody production since the adoptive transfer of immune serum into naïve mice resulted in effective protection against S. aureus bacteremia. In addition, splenocytes from mice immunized with the D-alanine auxotroph vaccine showed specific production of IL-17A after ex vivo stimulation. We conclude that this D-alanine auxotroph protects mice efficiently against virulent staphylococcal strains through the combined action of antibodies and IL-17A, and therefore constitutes a promising vaccine candidate against staphylococcal disease, for which no licensed vaccine is available yet.
Impact of an Oral Health Education Workshop on Parents’ Oral Health Knowledge, Attitude, and Perceived Behavioral Control among African Immigrants

Purpose. To evaluate the impact of an educational workshop on parental knowledge, attitude, and perceived behavioral control regarding their child’s oral health. Materials and Methods. A one-time oral health education workshop including audio/visual and hands-on components was conducted by a trained dentist and bilingual community workers in community locations. Participants were African parents of children who had lived in Canada for less than ten years. The impact of the workshop was evaluated by a questionnaire developed based on the theory of planned behavior. Results. A total of 105 parents participated in this study. Participants were mainly mothers (mean age years) who came to Canada as refugee (77.1%) and had below high school education (70%). Paired t-test showed a significant difference in participants’ knowledge of caries, preventive measures, and benefits of regular dental visits after the workshop (P valu). A significant improvement was also found in parental attitudes toward preventive measures and their perceived behavioral control (). Parents’ intention to take their child to a dentist within six months significantly altered after the workshop (P valu). Conclusions. A one-time hands-on training was effective in improving parental knowledge, attitude, perceived behavioral control, and intention with respect to their child’s oral health and preventive dental visits in African immigrants.
Cancer of the cervix uteri

Since the publication of the last FIGO Cancer Report there have been giant strides in the global effort to reduce the burden of cervical cancer, with WHO announcing a call for elimination. In over 80 countries, including LMICs, HPV vaccination is now included in the national program. Screening has also seen major advances with implementation of HPV testing on a larger scale. However, these interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for management of these cases. The FIGO Gynecologic Oncology Committee has revised the staging system based on these advances. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.
Polarity establishment by Cdc42: Key roles for positive feedback and differential mobility

ABSTRACT Cell polarity is fundamental to the function of most cells. The evolutionarily conserved molecular machinery that controls cell polarity is centered on a family of GTPases related to Cdc42. Cdc42 becomes activated and concentrated at polarity sites, but studies in yeast model systems led to controversy on the mechanisms of polarization. Here we review recent studies that have clarified how Cdc42 becomes polarized in yeast. On one hand, findings that appeared to support a key role for the actin cytoskeleton and vesicle traffic in polarity establishment now appear to reflect the action of stress response pathways induced by cytoskeletal perturbations. On the other hand, new findings strongly support hypotheses on the polarization mechanism whose origins date back to the mathematician Alan Turing. The key features of the polarity establishment mechanism in yeasts include a positive feedback pathway in which active Cdc42 recruits a Cdc42 activator to polarity sites, and differential mobility of polarity “activators” and “substrates. ”
Comparison of Outcomes following Autologous Breast Reconstruction Using the DIEP and Pedicled TRAM Flaps: A 12-Year Clinical Retrospective Study and Literature Review.

BACKGROUND There are few studies that compare the deep inferior epigastric artery perforator (DIEP) flap to the pedicled transverse rectus abdominis myocutaneous (pTRAM) flap for use in reconstructive breast surgery. The authors examined four factors that aid in decision-making: donor-site morbidity, need for surgery related to abdominal morbidity, operative time, and complications. METHODS This is a retrospective review of patients undergoing breast reconstruction using the DIEP or pTRAM flap at the University of British Columbia between 2002 and 2013. The authors compared operative time and abdomen- and flap-related complications in both groups. RESULTS Reconstruction was performed in 507 patients; 25.6 percent received DIEP flaps (n = 183 breasts) and 74.4 percent underwent pTRAM flap surgery (n = 444 breasts). Pedicled TRAM flap patients were more likely to require abdominal closure with mesh (44.2 percent versus 8.1 percent; p < 0.001); 21.2 percent of them had a postoperative bulge and/or hernia versus 3.1 percent of DIEP flap patients; and 12.7 percent of pTRAM flap patients required surgery for hernia/bulge. Controlling for confounders, there were five times the odds of a hernia/bulge in the pTRAM flap group. DIEP flap surgery was 234 minutes longer than pTRAM flap surgery. CONCLUSIONS The benefits of the pTRAM flap may be offset by the need to correct abdominal wall complications. DIEP flap reconstruction had lower donor complications but increased operative time. A cost analysis is needed to determine the most economical procedure. CLINCIAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
CAP-Gly proteins contribute to microtubule-dependent trafficking via interactions with the C-terminal aromatic residue of α-tubulin

SUMMARY In mammals, the C-terminal tyrosine residue of α-tubulin is subjected to removal/re-addition cycles resulting in tyrosinated microtubules and detyrosinated Glu-microtubules. CLIP170 and its yeast ortholog (Bik1) interact weakly with Glu-microtubules. Recently, we described a Microtubule- Rho1- and Bik1-dependent mechanism involved in Snc1 routing. Here, we further show a contribution of the yeast p150Glued ortholog (Nip100) in Snc1 trafficking. Both CLIP170 and p150Glued are CAP-Gly-containing proteins that belong to the microtubule +end-tracking protein family (known as +Tips). We discuss the +Tips-dependent role of microtubules in trafficking, the role of CAP-Gly proteins as possible molecular links between microtubules and vesicles, as well as the contribution of the Rho1-GTPase to the regulation of the +Tips repertoire and the partners associated with microtubules.
Neuropsychiatric correlates of persistent postconcussive syndrome

Thirty-six cases of head injury with persistent neurologic symptoms presenting to an outpatient head injury clinic were investigated. Cases with mild injury had significantly higher prevalences of chronic pain and depression than more severely Injured cases. The “mild” group had fewer cases with good outcome than the “severe” group. This study and much of the existing literature supports the conclusion that patients with persistent postconcussive syndrome are likely to suffer from the interaction of chronic headache and depression, rather than a specific neurologic cognitive disability.
Extended thromboprophylaxis in the acutely ill medical patient after hospitalization – a paradigm shift in post-discharge thromboprophylaxis

ABSTRACT Venous thromboembolism (VTE) is a significant healthcare burden with approximately 900,000 events annually in the United States, over half of which are healthcare-associated. This number is anticipated to double by 2050. Group prophylaxis strategies confined to the inpatient setting appear to have minimal impact on the reduction of post-discharge VTE in medically ill patients due to shortened lengths of stay and a heterogenous population that includes patients at low risk for VTE. In accordance with current guideline recommendations, very few (<5%) medically ill patients are discharged with extended prophylaxis, which potentially creates a clinical gap for at-risk patients as VTE risk has been shown to persist for up to 90 days. Initial studies of extended thromboprophylaxis in acutely ill medical patients with enoxaparin, rivaroxaban and apixaban showed little to no benefit towards VTE reduction that was consistently outweighed by increased bleeding. The more recent APEX study that compared betrixaban to enoxaparin in an enriched patient population at high-risk for VTE was the first study of extended thromboprophylaxis that showed similar efficacy in VTE prevention without an increase in major bleeding. Based on the APEX results, betrixaban recently gained FDA approval for extended thromboprophylaxis in acutely ill medical patients. Recognition that up to half of medically ill patients are not at sufficient risk to warrant thromboprophylaxis has driven extensive research towards development of scientifically derived and validated VTE risk assessment models intended to identify patients who do not warrant prophylaxis, as well as those at high risk who may derive benefit from extended thromboprophylaxis. This article will review prior and ongoing extended thromboprophylaxis studies, VTE and bleed risk assessment models, incorporation of biomarkers in VTE risk assessment and key issues in the paradigm shift towards individualized VTE prophylaxis in acutely ill medical patients.
Early tailored assertive community case management for hard‐to‐engage adolescents suffering from psychiatric disorders: an exploratory pilot study

The study aims to evaluate the effects of assertive community treatment (ACT) on the mental health and overall functioning of adolescents suffering from severe psychiatric disorders and who refuse any traditional child psychiatric care. There are a few studies evaluating the effects of ACT on a population of adolescents with psychiatric disorders. This short report highlights the impact of an ACT programme tailored to the needs of these patients, not only as an alternative to hospitalization, but also as a new form of intervention for patients that are difficult to engage.
Genetics of psoriasis

Psoriasis is a chronic inflammatory disease of unknown cause with variable clinical expression. In the absence of clearly identified psoriasis autoantigen, there is debate as to whether it can be considered an autoimmune disease. However, considerable evidence obtained from twin studies, demographic studies, and genome‐wide scans performed in several extended patient cohorts and carefully selected psoriasis pedigrees, clearly established that genetics is a key component in the development of psoriasis. The common thought is that psoriasis has a multifactorial mode of inheritance, and that in order for an individual to develop clinical lesions, several psoriasis‐susceptibility genes have to interact together and with various environmental factors. This article reviews some past and current findings on the genetics of psoriasis.
A Descriptive Study of Nasogastric Tube Feeding Among Geriatric Inpatients in Malaysia: Utilization, Complications, and Caregiver Opinions

The strong emphasis on feeding in Asian cultures may influence decisions for nasogastric (NG) tube feeding in geriatric inpatients. We evaluated the utility, complications, and opinions of caregivers toward NG tube feeding in an acute geriatric ward in a teaching hospital in Kuala Lumpur. Consecutive patients aged 65 years and older receiving NG tube feeding were included. Sociodemographic, clinical, and laboratory indices were recorded. Opinion on NG tube feeding were evaluated through face-to-face interviews with caregivers, recruited through convenience sampling. Of 432 patients admitted, 96 (22%), age ± standard deviation = 80.8 ± 7.4 years, received NG tube feeding. The complication and mortality rates were 69% and 38%, respectively. Diabetes (odds ratio [95% confidence interval] = 3.34 [1.07, 10.44], aspiration pneumonia (8.15 [2.43, 27.24]), impaired consciousness (3.13 [1.05, 9.36]), and albumin ≤26 g/dl (4.43 [1.46, 13.44]) were independent predictors of mortality. Other relatives were more likely than spouses (23.5 [3.59, 154.2]) and caregivers with tertiary education more likely than those with no formal education (18 [1.23, 262.7]) to agree to NG feeding. Sixty-four percent of caregivers felt NG tube feeding was appropriate at the end of life, mostly due to the fear of starvation. NG tube feeding is widely used in our setting, despite high complication and mortality rates, with likely influences from cultural emphasis on feeding.
A Descriptive Study of the Fluid Intake, Hydration, and Health Status of Rehabilitation Inpatients without Dysphagia Following Stroke

Adequate hydration is important for all people, particularly when hospitalized with illness. Individuals with dysphagia following stroke are considered to be at risk of inadequate fluid intake and, therefore, dehydration, but there is little information about the fluid intake or hydration of individuals without dysphagia poststroke. This cohort study measured the average beverage intake, calculated the urea/creatinine ratio as a measure of hydration, and documented specific health outcomes of 86 people without dysphagia poststroke who were inpatients in rehabilitation centers. Participants drank on average 1504 ml per day (SD 359 ml), which typically represented 67% of their estimated daily requirement. Approximately 44% of the participants in the sample were dehydrated based on a blood urea nitrogen/creatinine ratio >20:1. Sixteen percent of participants were diagnosed with one or more of the health outcomes of dehydration/hypernatremia, urinary tract infection, or constipation. A greater level of dependence was associated with poorer beverage intake and higher risk of an adverse health outcome. Those in the older/elderly age range (particularly older women) and those with poor mobility were most at risk of poor hydration. This study highlights that patients in rehabilitation facilities poststroke, even without dysphagia, may be at risk of suboptimal fluid intake and hydration.
High‐resolution restoration of dynamic image sequences

We investigated an approach to reconstructing high‐resolution images from dynamic image sequences using local spectral analysis. High‐resolution reconstruction from linearly shifted multiple static image frames has previously been studied, in which the aliasing relationship between the spectrum of the original signal and the DFTs of shifted and sampled signals is exploited. In the high‐resolution reconstruction of dynamic image sequences, difficulties occur as a result of nonuniform shifts in the frames. We use loca spectral analysis to achieve high‐resolution reconstruction by overlapped block decomposition and motion compensation. For each block image in a reference frame in the sequence, motion estimation and subpixel registrations are performed against adjacent frames. High resolution reconstruction is performed on such motion‐compensated block‐image sequences. For some blocks containing motion boundaries, high resolution reconstruction is difficult; a new scene emerges or disappears producing inconsistent information. An interpolation technique is used in such blocks to generate the number of pixels consistent with other high‐resolution blocks. The flower‐garden image sequence is used for the computer simulations. The quality of the restored images are very encouraging; the aliasing effects in the original frames are significantly reduced and sharper edges are produced. The overall procedure to generate such higher‐resolution images from a dynamic image sequence is described in detail. The result can be applied to various image sequence restoration applications including up‐conversion of conventional video signals. ©1994 John Wiley & Sons Inc
RECENT DEVELOPMENTS IN THE TREATMENT OF RHEUMATOID ARTHRITIS

The introduction of biologic response modifiers has revolutionized treatment approaches in rheumatoid arthritis. The ideal treatment approach to induce remission and minimize joint destruction is yet to be determined, however. The guidelines for the treatment of rheumatoid arthritis were updated in 2008. Evidence published recently may help to guide treatment decisions. In this review, advances in treatment approaches are discussed with added emphasis on the cardiovascular risks to this patient population. New data regarding the biologic response modifiers currently available in the US, abatacept and rituximab, are reviewed. Finally, emerging therapies are introduced, including tocilizumab. Investigational agents in development may provide additional options in the future treatment of rheumatoid arthritis.
Effect of Hormone Replacement Therapy on Plasma Lipoproteins and Apolipoproteins, Endothelial Function and Myocardial Perfusion in Postmenopausal Women with Estrogen Receptor-α IVS1–397 C/C Genotype and Established Coronary Artery Disease

Effect of hormone replacement (HRT) therapy on plasma lipoproteins and apolipoproteins, endothelial function and myocardial perfusion in postmenopausal women with estrogen receptor-α (ER-α) IVS1–397 C/C genotype and established coronary artery disease. Background/Aims: Associations between various ER-α polymorphisms and clinical phenotypes have been studied, including lipid levels and coronary atherosclerosis. We studied 48 postmenopausal women to determine the effect of ER-α IVS1–397 polymorphism on the response to treatment with HRT. Methods: The study had a randomized, double-blind, placebo-controlled and crossover design. Patients were divided into two groups according to ER-α IVS1–397 polymorphism: CC genotype (n = 9); CT or TT genotype (n = 39). HRT was given continuously for 4 weeks, with 4-week washout periods between the treatment periods. Brachial artery Doppler and Tl-201 scintigraphy were performed at the end of each treatment period. Results: HRT lowered total cholesterol, LDL-c and Apo-B levels from baseline values (all p < 0.05) and to a similar degree in CC and CT/TT genotype patients. HRT increased estradiol, HDL-c and Apo A-1 levels relative to baseline values, but to a greater degree in CC patients (p = 0.04, 0.05 and 0.04 by ANOVA, respectively). HRT increased peak forearm blood flow, brachial artery diameter during reactive hyperemia and endothelium-dependent dilation in both groups, but to a greater degree in CC patients (p = 0.03, 0.03 and 0.04 by ANOVA, respectively). Summed stress and rest scores were also more markedly reduced in CC patients (p = 0.04 and 0.05, respectively). The increase in estradiol levels was strongly correlated with the improvement in endothelium-dependent dilation (r = 0.66, p < 0.01), which in turn showed negative correlation with summed stress (r = –0.62, p < 0.01) and rest scores (r = –0.52, p < 0.05) in the CC genotype group. Conclusion: These data suggest that the improvement in endothelium-dependent dilation and the reduction in perfusion abnormalities by increasing estradiol levels with HRT in postmenopausal women with coronary artery disease may differ with respect to different genotypes, the effect being more prominent in those patients with ER-α IVS1–397 CC genotype.