Miracle-dz/UniFAR-FTUs huggingface dataset:
Hypertensive Disorders of Pregnancy

Abstract This article reviews 4 categories of hypertensive disorders of pregnancy: chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension. It focuses on the diagnosis and management of preeclampsia with emphasis on the pharmacologic management of blood pressure during pregnancy. Preeclampsia is one of the most common medical disorders affecting pregnancy, with significant maternal and fetal morbidity and mortality. The most serious maternal complications of preeclampsia include intracerebral hemorrhage, eclampsia, and renal failure, as well as hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and posterior reversible encephalopathy syndrome (PRES).
Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis

Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are increasing globally. Treatment options for these patients are very limited. Although treatment of these patients with standardized regimen is associated with high mortality and morbidity, rational usage of new drugs might be promising. In this study we will review epidemiology of XDR-TB and TDR-TB in Iran and the world.
Capecitabine and Celecoxib as Second-Line Treatment of Advanced Pancreatic and Biliary Tract Cancers

Objective: An increasing number of patients with advanced pancreatic or biliary tract cancer who progress after a gemcitabine-containing regimen are candidates for further chemotherapy. We therefore evaluated a fully oral regimen of capecitabine and celecoxib (CapCel) as second-line treatment in these patients. Methods: Thirty-five patients with documented progressive disease after first-line treatment were enrolled. Capecitabine was administered at a dose of 1,000 mg/m2 b.i. d. for 2 consecutive weeks followed by 1 week of rest; celecoxib was given continuously at 200 mg b.i. d. Progression-free survival at 3 months was the primary study endpoint. Results: The CapCel combination was associated with an overall response rate of 9% and median survival duration of 19 weeks. Sixty percent of patients were free from progression 3 months after the start of treatment. Multivariate analysis identified a positive clinical benefit response and a decline in CA 19.9 serum levels >25% compared with baseline levels as independent predictors of prolonged survival. The treatment protocol was well tolerated with negligible hematological toxicity. The most common grade 3 non-hematological toxicities were hypertransaminasemia, diarrhea and asthenia. Conclusions: The CapCel combination is a safe treatment option with moderate activity in patients with pancreatic/biliary tract cancer after failure of a previous gemcitabine-containing regimen.
Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Articular Cartilage. Part I: Tissue Design and Chondrocyte-Matrix Interactions*†

In 1892, Walt Whitman observed that “the narrowest hinge in my hand puts to scorn all machinery. ”78 Despite the remarkable advances in joint replacement, Whitman's observation stands unchallenged; no current prostheses come close to duplicating the function and durability of synovial joints. These complex structures, developed and progressively refined over hundreds of millions of years1, are formed by an arrangement of multiple distinct tissues, including joint capsule, ligament, meniscus, subchondral bone, synovial tissue, and hyaline articular cartilage. These tissues are self-renewing, respond to alterations in use, and provide stable movement with a level of friction less than that achieved by any prosthetic joint. The tissue that contributes the most to these extraordinary functional capacities is the hyaline articular cartilage15,19. It varies in thickness, cell density, matrix composition, and mechanical properties within the same joint, among joints, and among species2; however, in all synovial joints it consists of the same components, has the same general structure, and performs the same functions. Although it is at most only a few millimeters thick, it has surprising stiffness to compression and resilience; it also has an exceptional ability to distribute loads52,53, thereby minimizing peak stresses on subchondral bone. Perhaps most important, it has great durability; in most people, it provides normal joint function for eighty years or more. No synthetic material approaches this level of performance. Grossly and histologically, adult articular cartilage appears to be a simple inert tissue. When examined from inside a synovial joint, normal articular cartilage appears as a slick firm surface that resists deformation. Light microscopy shows that it consists primarily of extracellular matrix, with only one type of cell, the chondrocyte, and that it lacks blood vessels, lymphatic vessels, and nerves (Fig. 1). Compared with tissues …
The absorption of fat

Steatorrhoea may be produced by the interference of a variety of processes which are involved in fat absorption (Senior, 1964; Dawson, 1967; Johnston, 1968). The main dietary lipid is triglyceride and the normal naturally occurring triglyceride tends to have an unsaturated fatty acid in the beta position. The function of the luminal changes in fat is to convert a water-insoluble substance which aggregates in large particles, eg, oil emulsion if predominantly unsaturated fats are fed but debris if the solid tristearin is used, into so finely dispersed a form that it can penetrate between the microvilli and then pass through the microvillous membrane. This is largely brought about by the digestion of the triglyceride and solubilization of these digestion products in an aqueous bile salt solution.
Stress and Its Relationship to Acute Exacerbations in Multiple Sclerosis

The relationship of stressful life events (SLEs) to acute exacerbations of multiple sclerosis (MS) was prospectively studied in 55 consecutive patients with a relapsing-remitting disease course. The quantity and quality of SLEs were determined by the Psychiatric Epidemiology Research Interview (PERI-M) administered at 4-month intervals. Exacerbating cases (n = 20) did not experience a greater number of SLEs than nonexacerbating controls (n = 35); however, patients who experienced qualitatively extreme events were 3.7 times as likely to exacerbate as those not exposed to such events. The quality rather than the quantity of SLEs was associated with acute exacerbations of MS.
Sample Size Reestimation for Triple Blind Clinical Trials

This paper outlines the purpose and requirement for sample size reestimation, reviews some of the proposed methods, and discusses practical aspects of implementing the procedures. Special attention is paid to two issues: 1) keeping the interim relative treatment effect unrevealed, and 2) maintaining the overall Type I error rate.
A Pot of Urine at the End of the Rejection Rainbow?

Accessible online at: www.karger. com/nec Induction of tolerance and non-invasive means of diagnosing graft dysfunction remain long-standing, yet unfulfilled goals in transplantation. The difficulty in providing a solution to both these problems lies in the similarity of immune responses to allogeneic and infective antigens. A non-universal means of approaching this problem has been to examine organ-specific excretions (urine from kidney, bile from liver and bronchial lavage from lung transplants) rather than blood. An ideal diagnostic test should firstly distinguish between rejection, infection and other causes of allograft dysfunction such as calcineurin inhibitor toxicity, and secondly become abnormal before evidence of organ damage. The report by Lederer et al. [1] in this issue of Nephron Clinical Practice falls short of the ideal because they exclude infective and other causes of allograft toxicity from their investigation. Nevertheless, their study confirms previous observations [2] of significant differences in the levels of soluble C4d (sC4d) and VCAM (sVCAM) in the urine of different groups of renal transplant patients and controls. Of the renal transplant patients, those with steroid-resistant rejections had the highest mean levels of sC4d and sVCAM. If the steroid-resistant group of patients had higher levels before any attempt at treatment, then this might be a useful test, but if it occurs after treatment with steroids when the rejection is deemed to be Table 1. Studies which have correlated soluble ICAM-1, VCAM-1 or C4d with rejection
Transitioning From Inpatient to Outpatient Therapy in Patients with In-Hospital Hyperglycemia

Abstract Transition from inpatient to outpatient care for patients with type 2 diabetes mellitus is an important aspect of patient management for which there is no guidance. Intensive glucose lowering with insulin is generally favored for seriously ill hospitalized patients, but after discharge, patients often resume their prior regimens, which may include an array of oral or injected glucose-lowering agents. Factors that should be considered in this transition include goals of care/life expectancy, glycated hemoglobin at hospital admission, home medications for other illnesses and their potential for interactions with antidiabetes treatment, comorbidities, nutritional status, physical disabilities, ability to carry out self-monitoring of blood glucose, risk for hypoglycemia, contraindications to oral medications, health literacy, and financial and other resources. Traditional oral therapies that may be used after the patient leaves the hospital include sulfonylureas, α-glucosidase inhibitors, thiazolidinediones, and metformin. α-Glucosidase inhibitors are limited by gastrointestinal adverse events, and thiazolidinediones by fluid retention and increased risk for heart failure. Thiazolidinediones also require a long period of administration for onset glucose lowering and are not suitable for transitioning hospitalized patients who have been receiving insulin to outpatient care. Metformin is contraindicated in patients with renal, cardiac, or pulmonary insufficiency. Incretin-based therapies, glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors, have limited use in hospitals, but may be suitable for the transition to outpatient treatment. The most common adverse events with glucagon-like peptide-1 inhibitors involve the gastrointestinal system. More formal studies of treatment regimens for patients with hyperglycemia leaving the hospital are needed to guide care for this group.
Intra-operative Ultrasound Elastography and Registered Magnetic Resonance Imaging of Brain Tumours: A Feasibility Study

Following craniotomy, the decision to resect a brain tumour is based on (1) the surgeon's interpretation of preoperative imaging, such as MRI, (2) correlating the imaging to the surgical field, (3) visual inspection of the surgical field, and (4) palpation thus providing biomechanical information on tumour and brain. There is a degree of subjectivity in the use of palpation for biomechanical evaluation. Ultrasound elastography is a technique for determining more objective biomechanical information at depth in the form of relative strain, thus indirectly stiffness, within an ultrasound scan plane. In addition, neuro-navigation techniques assist in correlating preoperative imaging to the surgical field. We present two cases where ultrasound elastography with co-registered MRI, using neuro-navigation, was used intra-operatively during brain tumour resection. Correlation with the co-registered MRI was excellent in both patients. Strain contrast between brain and tumour was evident in elastograms produced in both patients; the tumour had a lower strain, hence was stiffer compared with brain. When strain applied was increased slip between tumour and brain was detected. All these findings corresponded with the surgical findings. Ultrasound elastography with co-registered MRI is a promising imaging technique, which can be used intra-operatively to provide biomechanical information prior to resection.
PPARγ Agonists: Potential as Therapeutics for Neovascular Retinopathies

The angiogenic, neovascular proliferative retinopathies, proliferative diabetic retinopathy (PDR), and age-dependent macular degeneration (AMD) complicated by choroidal neovascularization (CNV), also termed exudative or “wet” AMD, are common causes of blindness. The antidiabetic thiazolidinediones (TZDs), rosiglitazone, and troglitazone are PPARγ agonists with demonstrable antiproliferative, and anti-inflammatory effects, in vivo, were shown to ameliorate PDR and CNV in rodent models, implying the potential efficacy of TZDs for treating proliferative retinopathies in humans. Activation of the angiotensin II type 1 receptor (AT1-R) propagates proinflammatory and proliferative pathogenic determinants underlying PDR and CNV. The antihypertensive dual AT1-R blocker (ARB), telmisartan, recently was shown to activate PPARγ and improve glucose and lipid metabolism and to clinically improve PDR and CNV in rodent models. Therefore, the TZDs and telmisartan, clinically approved antidiabetic and antihypertensive drugs, respectively, may be efficacious for treating and attenuating PDR and CNV humans. Clinical trials are needed to test these possibilities.
Antiplatelet Therapy in Combination with rt-PA Thrombolysis in Ischemic Stroke (ARTIS): Rationale and Design of a Randomized Controlled Trial

Background: Thrombolysis with recombinant tissue plasminogen activator (rt-PA) is currently the only approved acute therapy for ischemic stroke. After rt-PA-induced recanalization, reocclusion is observed in 20–34%, probably caused by platelet activation. In acute myocardial infarction, the combination of thrombolytic and antiplatelet therapy leads to a better outcome compared to thrombolytic treatment alone. In patients with acute ischemic stroke, several studies showed that those on antiplatelet treatment prior to rt-PA had an equal or even better outcome compared to patients without prior use of antiplatelet therapy, despite an increased risk of bleeding. Methods: We present the protocol of a multicenter randomized clinical trial (n = 800) investigating the effects of immediate addition of aspirin to rt-PA on poor outcome (modified Rankin score >2) in ischemic stroke patients. Conclusion: This study will answer the question whether the combination of rt-PA and antiplatelet therapy improves the functional outcome in ischemic stroke patients.
International Expert Consensus on Switching Platelet P2Y12 Receptor–Inhibiting Therapies

Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is the treatment of choice for the prevention of atherothrombotic events in patients with acute coronary syndromes and for those undergoing percutaneous coronary interventions. The availability of different oral P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) has enabled physicians to contemplate switching among therapies because of specific clinical scenarios. The recent introduction of an intravenous P2Y12 inhibitor (cangrelor) further adds to the multitude of modalities and settings in which switching therapies may occur. In clinical practice, it is not uncommon to switch P2Y12 inhibitor, and switching may be attributed to a variety of factors. However, concerns about the safety of switching between these agents have emerged. Practice guidelines have not fully elaborated on how to switch therapies, leaving clinicians with limited guidance on when and how to switch therapies when needed. This prompted the development of this expert consensus document by key leaders from North America and Europe with expertise in basic, translational, and clinical sciences in the field of antiplatelet therapy. This expert consensus provides an overview of the pharmacology of P2Y12 inhibitors, different modalities and definitions of switching, and available literature and recommendations for switching between P2Y12 inhibitors.
Hedonic and ergonomic quality aspects determine a software's appeal

The present study examines the role of subjectively perceived ergonomic quality (e.g. simplicity, controllability) and hedonic quality (e.g. novelty, originality) of a software system in forming a judgement of appeal. A hypothesised research model is presented. The two main research question are: (1) Are ergonomic and hedonic quality subjectively different quality aspects that can be independently perceived by the users? and (2) Is the judgement of appeal formed by combining and weighting ergonomic and hedonic quality and which weights are assigned? The results suggest that both quality aspects can be independently perceived by users. Moreover, they almost equally contributed to the appeal of the tested software prototypes. A simple averaging model implies that both quality aspects will compensate each other. Limitations and practical implication of the results are discussed.
A New Approach to Prevention of Knee Osteoarthritis: Reducing Medial Load in the Contralateral Knee

Objective. Few if any prevention strategies are available for knee osteoarthritis (OA). In those with symptomatic medial OA, the contralateral knee may be at high risk of disease, and a reduction in medial loading in that knee might prevent disease or its progression there. Our aim was to determine how often persons with medial OA on 1 side had either concurrent or later medial OA on the contralateral side, and whether an intervention known to reduce medial loading in affected knees with medial OA might reduce medial loading in the contralateral knee. Lateral wedge insoles reduce loading across an affected medial knee but their effect on the contralateral knee is unknown. Methods. To determine the proportion of persons with medial knee OA who had concurrent medial contralateral OA or developed contralateral medial OA later, we examined knee radiographs from the longitudinal Framingham Osteoarthritis Study. Then, to examine an approach to reducing medial load in the contralateral knee, 51 people from a separate study with painful medial tibiofemoral OA underwent gait analysis wearing bilateral controlled shoes with no insoles, and then with 2 types of wedge insoles laterally posted by 5°. Primary outcome was the external knee adduction moment (EKAM) in the contralateral knee. Nonparametric CI were constructed around the median differences in percentage change in the affected and contralateral sides. Results. Of Framingham subjects with medial radiograph knee OA, 137/152 (90%) either had concurrent contralateral medial OA or developed it within 10 years. Of those with medial symptomatic knee OA, 43/67 (64%) had or developed the same disease state in the contralateral knee. Compared to a control shoe, medial loading was reduced substantially on both the affected (median percentage EKAM change −4.84%; 95% CI −11.33% to −0.65%) and contralateral sides (median percentage EKAM change −9.34%; 95% CI −10.57% to −6.45%). Conclusion. In persons with medial OA, the contralateral knee is also at high risk of medial OA. Bilateral reduction in medial loading in knees by use of strategies such as lateral wedge insoles might not only reduce medial load in affected knees but prevent knee OA or its progression on the contralateral side.
The Cornell Program Synthesizer: a syntax-directed programming environment

The followin~ is an announcement of the recently developed Cornell Program Syn-thesizer~ first used at the ~979 session of the Cornell Summer School. Additional information and demonstration versions can be obtained from the author. The Cornell Program Synthesizer is a self~contained programming environment with integrated facilities to edit~ files execute and debug programs at a video display ~ermi-halo The principal innovation of the system is its syntax-directed, full-screen editor: entry and modification of program text is guided by a grammar for the host programming languages Because the compiler is incorporated into the editor~ it is normally impossible to create a syntactically incorrect program. All but the simplest statement" types are predefined in the editor as ~o The template is a formatted syntactic skeleton that contains the keywords, matched parentheses and other punctuation marks of the given statement form. The template includes piacenold-ere at each position where additional code is required to complete the statement. The placeholders serve as prompts indicating the syntactic class of each component required to complete the statement° Programs are created top-down by insertimg new statements arid expressions within the skeleton of previously entered templates. Syntax error detection is i~mediate because placeholders can only be replaced by syntactically appropriate inser-tions~ The text of a template is never typed~ rather, it is inserted into the program by commando The effect of each template insertion is instantly visible in the program display. Because a template is immutable, errors are not only prevented on entry, but can not be introduced after the fact. The entire template and its constituent parts can be moved or deleted as a unit. Expressions and assignment statements are typed directly as text. Since the compiler is invoked by the editor on a phrase-by-phrase basis, errors in user-typed tex~ are detected immediately. Most errors are typographical and can be corrected by local edisir~g of the erroneous phrase. It is possible, however, to override the error prevention mechanism when non-local modification is required to correct the program° Erroneous code remaining in the program is then highlighted on the display until corrected. Such highlighted sections are also introduced when changing a declaration introduces non-local errors in the rest of the program. For example, when a declaration is deleted, all phrases containing uses of undeclared variables are ~Lighlighted on the display. The video display allows the incorporation of some unique run time debugging features. The flow of execution through …
Improving Chronic Kidney Disease Care in Primary Care Practices: An Upstate New York Practice-based Research Network (UNYNET) Study

Background: With the prevalence of chronic kidney disease (CKD) in the United States rising from 10% to 13%, implementation of the evidence-based Kidney Disease Outcomes Quality Initiative guidelines, which were developed for the delay of progression of CKD, is of increasing importance in primary care offices. Previous studies have shown limited knowledge and uptake of Kidney Disease Outcomes Quality Initiative guidelines by primary care physicians. CKD and its complications are still largely under-diagnosed and under-treated. A multifaceted quality improvement study was undertaken to test if these guidelines could be implemented to improve CKD care in underserved practices. Methods: Using a combination of practice enhancement assistants, computer decision-making support, and academic detailing, we sought to increase physician awareness and care of CKD in 2 inner-city practices. Using these 3 modalities, a rapid-cycle quality improvement process was implemented. Results: One hundred eighty-one patients met the inclusion criteria of having a glomerular filtration rate <60. This represented a 100% sample of patients with CKD at baseline. Recognition of CKD improved significantly from 30 (21%) to 114 (79%) (P < .001). Diagnosis of anemia also increased significantly from 26 (33%) to 53 (67%) (P < .001). Angiotensin-converting enzyme inhibitor and aspirin use did not change significantly (P = .31 and P = .233, respectively). Changes in medications that did show significance were metformin use, which decreased 50% from 12 to 6 patients (P < .001), and nonsteroidal anti-inflammatory drug use, which decreased 41% from 23 to 14 patients (P < .001). Mean glomerular riltration rate increased significantly from 45.75 to 47.34 (P < .001). Discussion: Recognition and treatment of CKD and its complications can be markedly improved in primary care offices using a combination of practice enhancement assistants, computer decision-making support, and academic detailing. A significant rise in glomerular riltration rate, although small, was a surprising and encouraging result. Larger studies in a more geographically spread region are needed to confirm these preliminary results.