Miracle-dz/UniFAR-FTUs huggingface dataset:
Differential Diagnosis of Parkinsonism

Parkinsonism refers to a clinical syndrome characterized by a variable combination of tremor, bradykinesia or akinesia, rigidity, and postural instability. In general, two of these four features must be present to make a diagnosis of parkinsonism. However, the situation is complicated by rare cases of pure akinesia in the absence of tremor and rigidity that have the classic pathology of Parkinson’s disease (PD) (1). Within the rubric of parkinsonism there are a myriad of disorders, some yet unclassified (Table 1). The most common cause of parkinsonism is PD. Pathologically, PD is characterized by nigral cell loss and Lewy bodies in the remaining neurons, and the term ‘‘Lewy body parkinsonism’’ is sometimes used synonymously with PD. Some researchers consider it most appropriate to refer to even the pure clinical picture of PD as ‘‘Parkinson’s syndrome’’ on the premise that PD may not be one disease. Whereas the purists demand the presence of Lewy bodies at autopsy to diagnose PD, these inclusions may not be present in some inherited forms of otherwise classical PD. Currently, one such condition, the ‘‘parkin parkinsonism’’ has been mapped to chromosome 6 (2). This autosomal recessive parkinsonism of juvenile onset differs pathologically from sporadic disease in that no Lewy bodies are found in
Monocyte and macrophage apoptosis and activation during HIV-1 infection and antiretroviral therapy

Monocytes and macrophages represent a cell lineage integral to multiple aspects of HIV-1 infection, dissemination, and pathogenesis. They also play a fundamental role in innate host defense and may act as a tissue-privileged viral reservoir during all stages of infection. In the current ART-era of the HIV pandemic, HIV-seropositive patients can maintain undetectable viral loads for years. Nevertheless, this population faces central nervous system, cardiovascular, and other HIV-related co-morbidities, many of which are characterized by underlying monocyte/macrophage contributions. To investigate the regulation of the survival and activation profiles of monocytes/macrophages during HIV-1 infection in vivo, we performed the following sets of experiments: (1) we determined monocyte apoptosis profiles in previously uncharacterized highly viremic HIV (+) donors and assessed monocyte gene expression associated with monocyte apoptosis outcome; (2) we tested the impact of ART and CCR5 antagonism during advanced HIV-1 infection on the reversal of monocyte/macrophage activation; (3) we tested the impact of the interferon stimulated genes (ISGs) IFI6 and IFI27 as an underlying mechanism regulating monocyte apoptosis in the context of HIV-1 infection. Our results indicate both constitutive and oxidative stress-induced monocyte apoptosis are elevated in HIV (+) individuals with viral loads above 40,000 HIV-1 copies/mL and are associated with decreasing CD4 count. Furthermore, elevated apoptosis is associated with a shift in interferon stimulated gene and Bcl-2 family gene expression. Longitudinal analysis of ART treatment during advanced HIV-1 infection (nadir CD4 count < 100 cells/mm3) demonstrated differential reversal of cell-associated and soluble biomarkers of monocyte/macrophage activation. We show the addition of CCR5 antagonism (Maraviroc) does not impact the reversal of monocyte/macrophage activation beyond the impact of standard ART alone. Finally, we investigate the roles of the ISGs IFI6 and IFI27 in the regulation of monocyte apoptosis in vitro. Our work demonstrates the impact of viral and host pressures on monocyte survival/apoptosis and activation state during distinct stages of HIV-1 infection. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Cell & Molecular Biology First Advisor Luis J. Montaner
High blood pressure - determinants and risks Implications for treatment and prevention in a primary care setting

"Superior doctors prevent disease. Mediocre doctors treat the disease before evident. Inferior doctors treat the full-blown disease. " Aim: The overall aim of this thesis was to study determinants and risks associated with increasing blood pressure categories based on a combination of systolic and diastolic blood pressure ranging from optimal blood pressure to manifest hypertension. Emphasis was placed on the importance of focusing on modifiable lifestyle factors and assessment of global risk. The ultimate aim was to identify targets for treatment and prevention. We set out to: 1) study the prevalence and control of hypertension in a representative Swedish population; 2) investigate the association between global risk (SCORE) and ESH/ESC blood pressure categories; 3) study the extent to which physiological factors and lifestyle factors such as physical activity, smoking and alcohol consumption contribute to higher blood pressure levels; 4) investigate the risk of cardiovascular disease associated with different blood pressure categories. Methods: A random sample of residents aged 30-74 years in the municipalities of Vara and Skövde, southwestern Sweden, was surveyed for cardiovascular risk factors in 2002-2005, and 2816 individuals were enrolled (76%). Participants provided detailed information about their medical history and current medication, and completed a questionnaire about lifestyle. Blood pressure was categorised according to the 2007 ESH/ESC recommendations based on a combination of systolic and diastolic blood pressure ranging from optimal blood pressure to manifest hypertension. Information about fatal and non-fatal cardiovascular events was collected from national registers from baseline until end of 2011, and global risk was estimated using the Swedish SCORE chart. Results: In Paper I, the prevalence of hypertension in the age group 30-75 years was 20%. A " rule of thirds " emerged, as 1/3 of the participants were not previously known, 1/3 were treated but not controlled, and only 1/3 were treated and controlled. The largest proportion of high global risk was seen in subjects with both hypertension and diabetes (men 76%, women 61%), and a major proportion of patients with known hypertension with a blood pressure ≥160/100 mmHg were also at a high global risk (Paper II). However, a large proportion of patients with mild hypertension had a low risk according to SCORE (Paper II). In Paper III, age, insulin resistance, BMI, and CRP showed strong age-adjusted associations with increasing blood pressure categories in both men and women (p-values <0.001). In women, lipids (p<0.001), education (p=0.009), physical activity (p=0.038), and alcohol consumption (p=0.002, …
Tumore stromale gastrico a differenziazione neurale (GANT) associato a malattia di Von Recklinghausen

Here we describe a case of gastrointestinal autonomic nerve tumor (GANT) arosen in a patient with von Recklinghausen's disease. To the best of our knowledge, only four other similar cases have been previously reported in the literature. Histologically, the tumour was composed of spindle shaped cells arranged in short bundles. The neoplastic cells had pleomorphic nuclei and numerous mitoses. Immunohistochemical investigation displayed evidence of neural differentiation. Neoplastic cells were diffusely anti-synaptophysin, anti-neuron specific enolase and anti-vimentin positive. The clinicopathological features of the present case are described and discussed together with those of the other previously reported cases.
Absorptiométrie biphotonique à rayons X et composition corporelle: mise au point

Les mesures de composition corporelle permettent d'evaluer et de suivre l'etat nutritionnel. Actuellement, une approche multi-compartimentale, utilisant des methodes mesurant l'os, les mineraux, le muscle et l'eau separement, constitue le gold standard pour mesurer la composition corporelle. Neanmoins, le cout eleve et la longue duree des examens limitent cette approche en routine clinique. C'est pourquoi, d'autres methodes comme l'absorptiometrie biphotonique a rayons X (DXA) sont Investiguees. Celle-ci mesure la composition corporelle totale et regionale de trois compartiments : la masse grasse (MG) et la masse non grasse des tissus mous, et l'os. Ce papier decrit les avantages et limitations de la DXA, et les differences de composition corporelle totale et regionale entre la DXA et d'autres methodes de reference. Le terme de masse maigre (MM) regroupe la masse non grasse des tissus mous et de l'os.
An Update On Taste Masking Technologies For Oral Pharmaceuticals

Taste is an important parameter governing compliance. Several of the oral pharmaceuticals, numerous food and beverage products and bulking agents, have unpleasant bitter-tasting components. In numerous cases, the bitter taste modality is an undesirable trait of the product or formulations and can considerably affect its acceptability by consumers. Bitter characteristics found in such systems have been eliminated or minimized by various known processes, but no universally applicable technology for bitterness inhibition has ever been recognized. The desire for improved palatability of these products has prompted the development of numerous formulations with improved performance and acceptability. This article discusses the recent approaches and methodologies for bitterness reduction for oral pharmaceuticals.
Single Phase Integrated Ćuk Transformerless SiC Inverter for Grid-Connected PV Systems

This paper proposes a new single-phase transformerless inverter, using the principle of Ćuk converter for grid-connected photovoltaic (PV) systems. The new inverter has a common ground between the grid and the PV source, which helps to eliminate the leakage current in grid-connected PV application. Unlike common-ground type charge-pump based transformerless inverters, this topology eliminates inrush current and hence reduces the current stress on the components. Further, application of wide band-gap devices, such as SiC MOSFETs allows higher switching frequency to be achieved, and thus reduction of the size of the passive components. A novel switching strategy proposed here, allows current in both directions, positive and negative (to the load/grid or from the load/grid, for reactive loads), making the converter suitable for grid connection (unity power factor), as well as stand-alone operation with a reactive load. A prototype of the proposed converter has been fabricated, and experimental results has been presented also.
Nonparametric estimation of the association between liver transplantation waiting time and posttransplant graft failure

Liver transplantation is the most effective treatment for patients with end-stage liver disease. While many factors are associated with posttransplant graft failure, it has been suspected that liver transplant waiting time is negatively associated with posttransplant survival. Due to the suspicion, efforts have been made to reduce wait time for patients. There were some studies investigating this relationship recently. However, these studies were performed either with restricted samples or using data from a single center, and the results were inconclusive. For example, a study showed that after the Model for End-Stage Liver Disease (MELD) era, a longer waiting time predicts longer posttransplant survival for adult patients with hepatocellular carcinoma, whereas another study found no significant relationship between waiting time and posttransplant survival. In this study, we quantified the time-varying association (time-varying odds ratio) between liver transplant waiting time and posttransplant mortality in the presence of retransplantation as a competing risk. We also applied two different methods to estimate the cumulative incidence of posttransplant mortality. In the first method, the univariate cumulative incidence function method, we assume independence between the liver transplant waiting time and posttransplant survival. The second method, the bivariate cumulative incidence function method, takes into account the association between transplant waiting time and posttransplant survival. Our analytic dataset was extracted from the United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research (STAR) database. The subjects in our study included 1,265 transplant candidates who were first on the liver transplant waiting list from 2002 to 2012 and were 1-11 years old. Our analysis showed that liver transplant waiting time is positively associated with posttransplant survival. Further investigation is needed to understand whether this finding was because of survivor bias; that is, those who were able to wait longer were healthier. Our analysis also indicated that retransplantation has a weak association with liver transplant waiting time. PUBLIC HEALTH SIGNIFICANCE: We applied two different methods to pediatric liver transplant data in estimating cumulative incidence of posttransplant mortality. The findings will be the first step to help the liver transplant community understand the impact of liver transplant waiting time on posttransplant survival, and will help researchers further identify indicators of liver transplantation for reducing posttransplant mortality thus have a significant impact on future public health research.
Clinical pharmacology of serotonin-altering medications for decreasing alcohol consumption.

Variations in serotonin neurotransmission influence alcohol consumption (AC). Levels of 5-HT and metabolites are low in some brain regions of alcohol preferring rats and in CSF of alcoholics. Pharmacological treatments which enhance serotonergic neurotransmission (uptake inhibitors, releasers, agonists) consistently reduce AC in rats. Serotonin uptake inhibitors (SUI; e.g., citalopram, fluoxetine) have been studied extensively in humans. In several double-blind randomized, placebo-controlled clinical trials, SUI have consistently decreased AC by averages of 15% to 20% in nondepressed mildly/moderately dependent alcoholics who received no other treatment. Effects were dose-dependent and not related to side effects (few and mild) or changes in anxiety or depression (not observed). SUI also decreased desire to drink and liking for alcohol, thus suggesting a mechanism for effects. Other drugs acting on the 5-HT system have been tested in humans, but results are difficult to interpret. For example, buspirone, a 5-HT1A receptor partial agonist, reduced anxiety and alcohol craving, but not AC; a 5-HT partial agonist, m-CPP, increased alcohol craving in abstinent alcoholics; modest reductions in AC were observed with a 5-HT3 antagonist, ondansetron (0.5 mg/day, but not 4 mg/day). The therapeutic potentials of these medications are being studied. For example, SUI effects on AC were enhanced by a brief psychosocial intervention. Since SUI decrease urge to drink, they may be suitable pharmacological adjuncts in relapse prevention strategies. SUI and other serotonin-altering medications are promising new neuropharmacological treatments for reducing AC.
Clinical risk scores for predicting stroke-associated pneumonia: A systematic review

Purpose Several risk stratification scores for predicting stroke-associated pneumonia have been derived. We aimed to evaluate the performance and clinical usefulness of such scores for predicting stroke-associated pneumonia. Method A systematic literature review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, with application of the Quality Assessment of Diagnostic Accuracy-2 tool. Published studies of hospitalised adults with ischaemic stroke, intracerebral haemorrhage, or both, which derived and validated an integer-based clinical risk score, or externally validated an existing score to predict occurrence of stroke-associated pneumonia, were considered and independently screened for inclusion by two reviewers. Findings We identified nine scores, from eight derivation cohorts. Age was a component of all scores, and the NIHSS score in all except one. Six scores were internally validated and five scores were externally validated. The A2DS2 score (Age, Atrial fibrillation, Dysphagia, Severity [NIHSS], Sex) was the most externally validated in 8 independent cohorts. Performance measures were reported for eight scores. Discrimination tended to be more variable in the external validation cohorts (C statistic 0.67–0.83) than the derivation cohorts (C statistic 0.74–0.85). Discussion Overall, discrimination and calibration were similar between the different scores. No study evaluated influence on clinical decision making or prognosis. Conclusion The clinical prediction scores varied in their simplicity of use and were comparable in performance. Utility of such scores for preventive intervention trials and in clinical practice remains uncertain and requires further study.
Every breath you take

it is possible that deprivation may contribute to under-reporting of exacerbations with less chance of treating these events. Meanwhile, it is important to advise patients – especially those with a history of frequent exacerbations – to take advantage of home insulation grants and to wear warm clothes when going outside the home, as this should reduce winter hospital admissions for COPD exacerbations.
Prise en charge du pied diabétique infecté

Les prelevements bacteriologiques des plaies du pied diabetique sont dans la plupart des cas positifs, sans que, pour autant, l'infection ait un role majeur dans la pathogenie. La gravite est liee au terrain ischemique arteriel qui expose au risque de gangrene et d'amputation. La chronicite est secondaire a la neuropathie, responsable d'une non-conscience de la gravite et d'une non-compliance aux soins. L'antibiotherapie, necessaire en cas de cellulite ou d'osteite, n'est qu'une composante du traitement, qui repose en premier lieu sur la mise en decharge complete de la plaie et la revascularisation arterielle si necessaire.
Acute haematoma of the latissimus dorsi with low-intensity exercise – An unusual diagnosis heralding an ageing population

The world’s population is ageing. A significant proportion of this ageing population will undertake exercise, to optimise their health and wellbeing. Age-related changes in muscle physiology and composition may increase susceptibility to muscle injury and reduce the ability for recovery post exercise, which may have public health implications in years to come. This is a case report of a 59-year-old man with an isolated intramuscular haematoma, with onset during non-impact exercise (surfing and subsequently cricket). Injury to the latissimus dorsi muscle and/or tendon is rare. The individual in this report suffered from rheumatoid arthritis, which was well-controlled with methotrexate but had no other relevant medical history, which may have predisposed him to this injury.
Italian primary care system: An overview

Italian Primary Care System has been modelled after the NHS in UK and was established in 1978. In 2000 Italy's healthcare system was regarded, by a World Health Organization's ranking, as the 2nd best in the world after France;since then, the performance has constantly decreased mainly because ofthe austerity policy. This austerity policy is notjustified by the Official OECD figures which show that Italian Health Care expenditures are below the average in OECD Countries. Quality outcomes almost always show a clear North-South divide in almost all health care sectors. Responsibility for health care is now shared between the central government and 19 regions and 2 autonomous provinces (Trento and Bolzano), which traditionally differ a lot in terms ofeconomic development, per capita income, demography and culture. Disparities can be found in almost any area of health care provision, in health policy making, health care expenditure, quality of health care, public satisfaction and health care services organization. The pros ofthe Italian Primary Care System are the continuity of care and the universalism; the cons are the crippling bureaucracy, the workload, the lack of basic social benefits for GPs such as subsidized sick leaves and the lack of University Department of Primary Care and finally the absence of any perspective of professional development in the Academic field. (Less)
Regulatory T cells participation in the infection immunopathogenesis by the human immunodeficiency virus (HIV-1).

The survival of patients infected with human immunodeficiency virus (HIV-1) is related to the prevention and effective treatment of opportunistic infections. It is known that the main parameters to evaluate the progression of disease caused by HIV-1 is the counting of CD4 + T cells and viral load of HIV-1. Regulatory T cells has been considered the focus of intense research within the immune system as well as in the pathogenesis of several diseases. Natural regulatory T cells (Tregs) CD4+CD25+ act in the modulation of immune activation, functioning as critical mediators of immune homeostasis and self-tolerance. Furthermore, recent studies has shown that the function of Tregs cells is not limited to the prevention of autoimmunity, but is also important to control all forms of immune responses in the context of inflammation, infection, allergy, transplantation and tumor immunity. Many authors have identified Tregs as beneficial effector cells in the context of AIDS, but other researchers disagree. Tregs 1 Mestranda do Programa de Pós-Graduação em Patologia Experimental; Graduada em Farmácia pela Universidade Estadual de Londrina (2006), Habilitação em Análises Clínicas pela Universidade Estadual de Londrina (2007) e aperfeicoamento em Biologia Molecular pela Okayama University Hospital, Japão (2008). E-mail: isabele_k@yahoo.com. br * Autor (a) para correspondência 2 Mestrandos do Programa de Pós-Graduação em Patologia Experimental. 3 Doutorado em Ciências Biológicas (Biofísica) pela UFRJ. 4 Doutorado em Microbiologia, UEL. 5 Doutorado em Doutorado Em Ciências pela UNIFESP. 6 Doutorado em Bioquímica pela USP-Ribeirão Preto, Pós-Doutorado em Imunologia pela Fundação Hemocentro de Ribeirão Preto. Semina: Ciências Biológicas e da Saúde, Londrina, v. 31, n. 2, p. 169-178, Jul/Dez. 2010 170 can exert an important role in the immunopathology of HIV infection due to the suppressor activity on cellular activation and effector function. Thus, this review discusses the molecular and immunological aspects of Tregs in the HIV system. Key-words: Tregs. HIV. CD4. AIDS.
Patient Satisfaction with Management of Back Pain Part 1: What Is Satisfaction? Review of satisfaction with medical management

Summary This paper introduces readers to certain aspects of satisfaction. It reviews the reasons why patient satisfaction is important as an outcome, even though there is continuing debate about what exactly satisfaction represents. The best way to obtain information on what patients consider important is through the use of qualitative study designs. Previous research has found that significant dimensions of satisfaction relate to outcome, organisational issues, and interaction with health professionals. The key dimensions specific to back pain patients relate to information provision, empathy, and promoting self-care.