Miracle-dz/UniFAR-FTUs huggingface dataset:
Hemodynamic treatment algorithms should follow physiology or they fail to improve outcome.

Ariel L. Shiloh, MD, Lewis A. Eisen, MD, FCCP, Michael Yee, MD, Jay B. Langner Critical Care Service, Division of Critical Care, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY; Jack LeDonne MD, Department of Surgery, Greater Baltimore Medical Center, Baltimore, MD; Dimitrios Karakitsos MD, Intensive Care Unit, General State Hospital of Athens, Athens, Greece is highlighted by the acoustic shadow of the first rib (Fig. 1). Steeper angles of cannulation, especially when needle guides are used, can increase the risk of vascular or pleural damage (1, 2). In contrast, using free hand access (without the aid of a needle guide) and a careful application of technique (facilitated by oblique angulation), the abovementioned risks can be decreased (1, 2). Some technical difficulties may be encountered with this infraclavicular technique. When inserted in close proximity to the sternum, the clavipectoral fascia may pose a barrier to cannulation with larger catheters; however this is often not the case with typical central venous catheters (1). Malposition of the catheter tip into the ipsilateral internal jugular vein or in the contralateral SCV may occur. Ultrasound can visualize the malposition and assist in the repositioning of the catheter. In addition, ultrasound guidance for SCV cannulation results in reduced mechanical complications when compared to the landmark technique (1). Whenever our vascular cannula enters the SCV, under ultrasound guidance and in close proximity to the sternum via an infraclavicular approach, Robert Aubaniac could be in fact revisiting us in modern critical care settings. The authors have not disclosed any potential conflicts of interest.
Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients

Objective:To evaluate the literature and identify important aspects of insulin therapy that facilitate safe and effective infusion therapy for a defined glycemic end point. Methods:Where available, the literature was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology to assess the impact of insulin infusions on outcome for general intensive care unit patients and those in specific subsets of neurologic injury, traumatic injury, and cardiovascular surgery. Elements that contribute to safe and effective insulin infusion therapy were determined through literature review and expert opinion. The majority of the literature supporting the use of insulin infusion therapy for critically ill patients lacks adequate strength to support more than weak recommendations, termed suggestions, such that the difference between desirable and undesirable effect of a given intervention is not always clear. Recommendations:The article is focused on a suggested glycemic control end point such that a blood glucose ≥150 mg/dL triggers interventions to maintain blood glucose below that level and absolutely <180 mg/dL. There is a slight reduction in mortality with this treatment end point for general intensive care unit patients and reductions in morbidity for perioperative patients, postoperative cardiac surgery patients, post-traumatic injury patients, and neurologic injury patients. We suggest that the insulin regimen and monitoring system be designed to avoid and detect hypoglycemia (blood glucose ⩽70 mg/dL) and to minimize glycemic variability.Important processes of care for insulin therapy include use of a reliable insulin infusion protocol, frequent blood glucose monitoring, and avoidance of finger-stick glucose testing through the use of arterial or venous glucose samples. The essential components of an insulin infusion system include use of a validated insulin titration program, availability of appropriate staffing resources, accurate monitoring technology, and standardized approaches to infusion preparation, provision of consistent carbohydrate calories and nutritional support, and dextrose replacement for hypoglycemia prevention and treatment. Quality improvement of glycemic management programs should include analysis of hypoglycemia rates, run charts of glucose values <150 and 180 mg/dL. The literature is inadequate to support recommendations regarding glycemic control in pediatric patients. Conclusions:While the benefits of tight glycemic control have not been definitive, there are patients who will receive insulin infusion therapy, and the suggestions in this article provide the structure for safe and effective use of this therapy.
Dynamic modeling and rendering of grass wagging in wind

Simulation of dynamic natural scene is one of the most challenging tasks in computer graphics. In this paper, we propose a new approach to dynamic modeling and rendering of grasses wagging in wind. Through length preserving free‐form deformation of the 3D skeleton lines of each grass blade and using the alpha test to implement transparent texture mapping, we successfully model grasses of different shapes with rich details. To simulate the real time waggle of grasses, the grasses of a meadow are represented in LOD, while their skeleton lines are dynamically deformed according to some physical models. Simplification technique is also employed to accelerate the collision detection between neighboring grasses. Experiments show that our method can realistically render the animated grass scenes under wind of different speeds and types in real time. Copyright © 2005 John Wiley & Sons, Ltd.
Recomendaciones de GESIDA/PETHEMA sobre el diagnóstico y tratamiento de los linfomas en pacientes infectados por el virus de la inmunodeficiencia humana

Resumen La incidencia de linfoma no hodgkiniano y linfoma de Hodgkin es mayor en pacientes con infeccion por el VIH que en la poblacion general. Tras la introduccion del tratamiento antirretroviral de combinacion (TARc) ha disminuido la importancia pronostica de variables relacionadas con el VIH, adquiriendo mayor peso factores relacionados con el linfoma. Actualmente, los tratamientos de los linfomas en pacientes infectados por VIH no difieren de los empleados en la poblacion general. Pero existen algunos aspectos diferenciales de los pacientes con VIH como la necesidad de TARc, de profilaxis y de tratamientos de algunas infecciones oportunistas. En este documento se actualizan las recomendaciones sobre el diagnostico y el tratamiento de los linfomas en pacientes infectados por VIH publicadas por GESIDA/PETHEMA en 2008.
Obesity A Worldwide Epidemic

Obesity is an epidemic that is quickly becoming one of the most common chronic diseases among children and adults (Centers for Disease Control and Prevention [CDC], 2007). Currently, 64.5% of adults are either overweight or obese, and 30% of children are at risk for or are overweight (CDC, 2007). It appears that the weight trend is moving in the opposite direction from the Healthy People 2010 objectives of (a) reducing the prevalence of overweight and obesity in adults to less than 15% and (b) reducing the prevalence of overweight and obesity in children and adolescents to less than 5% (CDC, 2007).
Resistance Exercise for Persons With Coronary Heart Disease

RESISTANCE EXERCISE (RE) traditionally has been proscribed for persons with coronary heart disease (CHD). The basis for this was primarily related to the observed increases in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in response to moderate to heavy RE. It was believed that the increased pressure increased the work of the heart, leading to myocardial ischemia (reduced blood flow to a region of the heart) and myocardial hypertrophy (enlargement of the left ventricle). McDougall et al., e.g., observed increases in intra-arterial systolic and diastolic blood pressure of 320 mm Hg and 250 mm Hg, respectively, during a maximal leg-press testing in resistance trained persons (15). However, Haslam et al. demonstrated that intra-arterial blood pressures during moderate intensity resistance training at 40–60% of 1RM were within clinically acceptable ranges in low to moderate risk persons with CHD (12). This article will briefly review the physiology, rationale, and safety of and basic guidelines for RE in persons with CHD. A brief discussion of the emerging role of RE in higher risk persons with congestive heart failure will also be presented.
Value and Limitations of Transpulmonary Pressure Calculations During Intra-Abdominal Hypertension

Objective:To clarify the effect of progressively increasing intra-abdominal pressure on esophageal pressure, transpulmonary pressure, and functional residual capacity. Design:Controlled application of increased intra-abdominal pressure at two positive end-expiratory pressure levels (1 and 10 cm H2O) in an anesthetized porcine model of controlled ventilation. Setting:Large animal laboratory of a university-affiliated hospital. Subjects:Eleven deeply anesthetized swine (weight 46.2 ± 6.2 kg). Interventions:Air-regulated intra-abdominal hypertension (0–25 mm Hg). Measurements:Esophageal pressure, tidal compliance, bladder pressure, and end-expiratory lung aeration by gas dilution. Main Results:Functional residual capacity was significantly reduced by increasing intra-abdominal pressure at both positive end-expiratory pressure levels (p ⩽ 0.0001) without corresponding changes of end-expiratory esophageal pressure. Above intra-abdominal pressure 5 mm Hg, plateau airway pressure increased linearly by ~ 50% of the applied intra-abdominal pressure value, associated with commensurate changes of esophageal pressure. With tidal volume held constant, negligible changes occurred in transpulmonary pressure due to intra-abdominal pressure. Driving pressures calculated from airway pressures alone (plateau airway pressure – positive end-expiratory pressure) did not equate to those computed from transpulmonary pressure (tidal changes in transpulmonary pressure). Increasing positive end-expiratory pressure shifted the predominantly negative end-expiratory transpulmonary pressure at positive end-expiratory pressure 1 cm H2O (mean –3.5 ± 0.4 cm H2O) into the positive range at positive end-expiratory pressure 10 cm H2O (mean 0.58 ± 1.2 cm H2O). Conclusions:Despite its insensitivity to changes in functional residual capacity, measuring transpulmonary pressure may be helpful in explaining how different levels of positive end-expiratory pressure influence recruitment and collapse during tidal ventilation in the presence of increased intra-abdominal pressure and in calculating true transpulmonary driving pressure (tidal changes of transpulmonary pressure). Traditional interpretations of respiratory mechanics based on unmodified airway pressure were misleading regarding lung behavior in this setting.
High-intensity focused ultrasound ablation: a new strategy to manage primary bone tumors

This review attempts to summarize the current status of the experimental and clinical studies using high intensity focused ultrasound ablation to manage malignant primary bone tumors. A novel extracorporeal and noninvasive strategy for managing solid tumors compared with surgical removal or other minimally invasive modalities, high intensity focused ultrasound ablation has been used mostly in China to treat human patients. By using imaging techniques like computed tomography and magnetic resonance images, as well as pathologic examination, efficacy of this strategy for the treatment of primary bone tumors were evaluated and compared. Results have shown good potentiality of high intensity focused ultrasound ablation in complete tumor ablation and improvement of secondary host anti-tumor immunity. Although further investigations on long-term follow-up results after high intensity focused ultrasound ablation are still needed, this modality may be one of the most promising treatment technologies for bone tumors and limb salvage in the future.
Rain, temperature, and child–adolescent height among Native Amazonians in Bolivia

Background: Global climate change and recent studies on early-life origins of well-being suggest that climate events early in life might affect health later in life. Aim: The study tested hypotheses about the association between the level and variability of rain and temperature early in life on the height of children and adolescents in a foraging–farming society of native Amazonians in Bolivia (Tsimane'). Subject and methods: Measurements were taken for 525 children aged 2–12 and 218 adolescents aged 13–23 in 13 villages in 2005. Log of standing height was regressed on mean annual level and mean intra-annual monthly coefficient of variation (CV) of rain and mean annual level of temperature during gestation, birth year, and ages 2–4. Controls include age, quinquennium and season of birth, parent's attributes, and dummy variables for surveyors and villages. Results: Climate variables were only related with the height of boys age 2–12. The level and CV of rain during birth year and the CV of rain and level of temperature during ages 2–4 were associated with taller stature. There were no secular changes in temperature (1973–2005) or rain (1943–2005). Conclusion: The height of young females and males is well protected from climate events, but protection works less well for boys ages 2–12.
Impact of Acute Streptozotocin‐Induced Diabetes on ABC Transporter Expression in Rats

Hepatic ABC efflux transporters control the cellular uptake (in basolateral membranes) and excretion (in apical membranes) of many substrates. Since type‐1 diabetes mellitus (T1DM) is associated with altered hepatobiliary excretion of many endogenous and exogenous substances, we examined key hepatic ABC transporters and levels of the endogenous substrate glutathione in rats with acute streptozotocin‐induced T1DM. Renal transporters and inflammatory markers were also examined. Abcb1, Abcc1–4, and Abcg2 were measured using qRT‐PCR. Glutathione was measured in liver tissue, plasma, and urine. Inflammatory markers, including C‐reactive protein (CRP), were measured in plasma via ELISA. In diabetic rats, Abcb1a, Abcc2, and Abcg2 (apical) were decreased, while Abcc4 (basolateral) was increased. Abcb1a and Abcc2 inversely correlated with plasma CRP. Diabetic and control rats exhibited similar hepatic glutathione, but levels in diabetic plasma were lower. When standardized to urinary output, diabetic rats excreted 6.7‐fold more glutathione in urine than controls. Renal transporter levels were normal in diabetic rats. Results show apical transporters involved in hepatobiliary excretion are downregulated in T1DM, possibly through an inflammation‐mediated process. Findings suggest that there may be a vectorial shift from hepatic to renal excretion for some substrates in T1DM.
Impact of a National Multimodal Intervention to Prevent Catheter-Related Bloodstream Infection in the ICU: The Spanish Experience

Objective:Prevention of catheter-related bloodstream infection is a basic objective to optimize patient safety in the ICU. Building on the early success of a patient safety unit-based comprehensive intervention (the Keystone ICU project in Michigan), the Bacteremia Zero project aimed to assess its effectiveness after contextual adaptation at large-scale implementation in Spanish ICUs. Design:Prospective time series. Setting:A total of 192 ICUs throughout Spain. Patients:All patients admitted to the participating ICUs during the study period (baseline April 1 to June 30, 2008; intervention period from January 1, 2009, to June 30, 2010). Intervention:Engagement, education, execution, and evaluation were key program features. Main components of the intervention included a bundle of evidence-based clinical practices during insertion and maintenance of catheters and a unit-based safety program (including patient safety training and identification and analysis of errors through patient safety rounds) to improve the safety culture. Measurements and Main Results:The number of catheter-related bloodstream infections was expressed as median and interquartile range. Poisson distribution was used to calculate incidence rates and risk estimates. The participating ICUs accounted for 68% of all ICUs in Spain. Catheter-related bloodstream infection was reduced after 16–18 months of participation (median 3.07 vs 1.12 episodes per 1,000 catheter-days, p < 0.001). The adjusted incidence rate of bacteremia showed a 50% risk reduction (95% CI, 0.39–0.63) at the end of the follow-up period compared with baseline. The reduction was independent of hospital size and type. Conclusions:Results of the Bacteremia Zero project confirmed that the intervention significantly reduced catheter-related bloodstream infection after large-scale implementation in Spanish ICUs. This study suggests that the intervention can also be effective in different socioeconomic contexts even with decentralized health systems.
Consumption of milk, but not other dairy products, is associated with height among US preschool children in NHANES 1999–2002

Background: Little is known about how cow's milk consumption affects growth of young children. Aim: The present study evaluated associations between milk consumption and height among preschool-age children in three ethnic groups in the USA. Subjects and methods: A sample of 1002 children aged 24–59 months from NHANES 1999–2002 was used. Multivariate regression tested for associations between milk consumption (milk kJ/total kJ from 24 h recall, daily vs less frequent intake over 30 days) and height, controlling for age, sex, ethnicity, birth weight, and energy intake. Results: Children in the highest quartile of milk intake (QIV) were taller (1.1–1.2 cm; p<0.01) than those in QII and QIII but not QI. Total calcium had a positive effect on height (p<0.01), but did not change the height differences among percentiles. Total protein was not associated with height and QIV children were taller (0.9–1.2 cm) than those in all other quartiles. Children who drank milk daily were taller (1.0 cm; p<0.02) than those with less frequent intake. Consumption of other dairy products (other dairy kJ/total kJ) had no association with height. Blacks were taller than Whites and Mexican-Americans; controlling for milk intake did not alter this pattern. Conclusion: Milk contributes positively to height among preschool children; this association was not found for non-milk dairy products.
Some Problems in Health Communication in a Multicultural Clinical Setting: A South African Experience

Because of their different perceptions and frames of reference regarding health care, it is unlikely that doctor and patient communicate with total accuracy. This situation is exacerbated if they do not share a sociocultural orientation, even though both doctor and patient apply specific strategies in attempts to overcome the barriers that prevent effective communication. This article deals with some problems that arise in a multicultural clinical setting involving a group of Xhosa-speaking patients and Western medical practitioners in South Africa, the source of the problems, and their implications for the communication process.
Assessment of the pathogenicity of an emu-origin influenza A H5 virus in ostriches (Struthio camelus)

Ostriches were inoculated with a laboratory-derived highly pathogenic avian influenza (HPAI) virus of emu origin, A/emu/TX/39924/93 (H5N2) clone c1B. The aim of this study was to evaluate the pathogenicity of this isolate for ostriches and assess the ability of routine virological and serological tests to detect infection. Avian influenza virus (AIV) was isolated from cloacal and tracheal swabs from 2 to 12 days post-infection. AIV was also isolated from brain, thymus, eyelid, spleen, ovary/testis, liver, air sac, proventriculum, duodenum, caecal tonsil, heart, pancreas, kidney, nasal gland and lung. Virus isolation was also possible from swabs of the luminal surfaces of the cloaca, jejunum, lower ileum, bursa of Fabricius, trachea and bone marrow. Birds seroconverted as early as 7 days post-infection. This study suggests that HPAI virus of emu origin replicates extensively in infected ostriches without causing significant clinical disease or mortality.
The risk of being sick: morbidity trends in four countries.

THE REDUCTION OF DEATH RATES in the developed countries, a trend that has been underway typically for more than a century, is one of the most substantial achievements of humankind. As a result of this revolutionary change in the risk of death, the average number of years that people live has more than doubled. Many observers believe that the mortality decline signals a proportional long-run improvement in health. But the health surveys conducted in a number of countries in recent years suggest that health has failed to improve or has actually deteriorated. When questioned about their health, respondents report larger numbers of health problems, and rising proportions of people identify maladies, especially chronic maladies, and report that their ordinary activities are curtailed by health problems. This article will review evidence about recent trends in mortality and sickness in four countries. ' Three of these, Japan, the United States, and Britain, are developed countries where the trend of declining death rates is of long duration, and where health surveys have been conducted regularly for a number of years.2 In the fourth, Hungary, after a steady downward trend since about 1880, death rates have increased since the mid-1960s. There, health has been surveyed in a series of periodic investigations of which two, the surveys of 1981 and 1986, provide information that can be compared on the same terms. Previous discussions of the health trend have focused on an attempt to choose between competing views, one of which is usually called optimistic and the other pessimistic. The optimistic view holds that ill health rates are decreasing, while the pessimistic view holds that ill health rates are increasing. Whereas most measures of sickness incidence indicate that age-specific rates of new episodes have remained stable or decreased, most measures of sickness prevalence or of the average duration of sickness indicate that rates have
Sonographisches Bildessay: Periphere Nerventumoren

: High-resolution ultrasound is an excellent diagnostic modality for visualising peripheral nerves and differentiate tumours of the peripheral nerve. With high-frequency transducers (5-15 MHz), peripheral nerves can be visualised, the hypoechoic nerve fascicles, the surrounding tissue and tumourous lesions including the relation to their nerve of origin can be evaluated. By using colour Doppler sonography (CDS), it is possible to detect and assess vascularisation of tumours of the nerve. We present sonographic features of common and uncommon benign and malignant tumours of the peripheral nerve.