Miracle-dz/UniFAR-FTUs huggingface dataset:
Erken Postpartum Dönemde Gelişen Akut Tip A Aort Diseksiyonu Acil Cerrahisinde Anestezik Yaklaşim

Akut aort diseksiyonu gebeliğin ender fakat potansiyel olarak katastrofik bir komplikasyonu olup, eğer tedavi edilmezse anne ve bebek için % 1 mortaliteye sahiptir. Peripartum dönemde gelişen aort diseksiyonun nedenleri arasında; sistemik hipertansiyon, aort kökünün genişlemesi, konjenital biküspit aort kapağı, Marfan Sendromu, Ehlers-Danlos sendromu sayılabilir . Özellikle gebeliğe bağlı gelişen aort diseksiyonlarının yarısından Marfan Sendromu sorumlu tutulmaktadır . Gebelikte gözlenen taşikardi, kardiyak output ve intravasküler volüm artışı ve özellikle üçüncü trimesterde uterusun distal aortaya ve iliak arterlere basısı sonrası proksimal aortada meydana gelen stres olası patofizyolojik nedenler arasındadır . Ayrıca gebeliğe bağlı östrojen ve progesteron hormonlarının konsantrasyonlarındaki değişimler vasküler duvar yapısında değişikliğe neden olur, bu da hemodinamik güçlere duyarlılığı artırmaktadır .
Hunger and socioeconomic disparities in chronic disease.

The rate of food insecurity rose by 32% in 2008, to 14.6% of U.S. households. Drs. Hilary Seligman and Dean Schillinger argue that the widening price differential between unhealthful and healthful foods may increase socioeconomic disparities in the incidence and management of obesity, hypertension, diabetes, and other diet-sensitive chronic diseases.
Weighing risks and benefits of liraglutide--the FDA's review of a new antidiabetic therapy.

On January 25, the FDA approved liraglutide, a glucagon-like-peptide-1 receptor agonist that can improve glycemic control in adults with type 2 diabetes. Drs. Mary Parks and Curtis Rosebraugh discuss the benefits and potentially serious safety concerns associated with this new therapy.
Splenius capitis is a reliable target for measuring cervical vestibular evoked myogenic potentials in adults

The cervical vestibular evoked myogenic potential (cVEMP) is a common and simple test of vestibulospinal reflex patency. In the clinic, cVEMPs are measured in response to loud sounds from the sternocleidomastoid (SCM) on the ventral neck, as subjects maintain an uncomfortable head posture needed to recruit SCM. Here we characterize the cVEMP in a dorsal neck turner (splenius capitis; SPL), and compare it with the SCM cVEMP. cVEMPs were recorded simultaneously via surface electromyography from SCM and SPL from 17 healthy subjects in a variety of postures, including head‐turned postures adopted while either seated or standing, and the clinical posture. Like the SCM cVEMP recorded ipsilateral to the side of sound stimulation, the cVEMP on the contralateral SPL (synergistic with ipsilateral SCM) was characterized by a biphasic wave of muscle activity that began at ~ 13 ms. cVEMP reliability was higher on SPL vs. SCM in standing postures (chi‐squared; P < 0.05), and equivalent results were obtained from SPL in a standing or seated posture. In 9 of the 17 subjects, we also obtained bilateral intramuscular (IM) recordings from SPL at the same time as the surface recordings. In these subjects, the initial surface response in SPL was associated with a consistent decrease in multi‐unit IM SPL activity. Overall, these results demonstrate that SPL recordings offer a complimentary target for cVEMP assessments. The expression of SPL cVEMPs in simple head‐turned postures may also improve the utility of cVEMP testing for vestibular assessment in children, the elderly, or non‐compliant.
Efficacy and Safety of Spironolactone in Acute Heart Failure: The ATHENA-HF Randomized Clinical Trial

Importance Persistent congestion is associated with worse outcomes in acute heart failure (AHF). Mineralocorticoid receptor antagonists administered at high doses may relieve congestion, overcome diuretic resistance, and mitigate the effects of adverse neurohormonal activation in AHF. Objective To assess the effect of high-dose spironolactone and usual care on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels compared with usual care alone. Design, Setting, and Participants This double-blind and placebo (or low-dose)-controlled randomized clinical trial was conducted in 22 US acute care hospitals among patients with AHF who were previously receiving no or low-dose (12.5 mg or 25 mg daily) spironolactone and had NT-proBNP levels of 1000 pg/mL or more or B-type natriuretic peptide levels of 250 pg/mL or more, regardless of ejection fraction. Interventions High-dose spironolactone (100 mg) vs placebo or 25 mg spironolactone (usual care) daily for 96 hours Main Outcomes and Measures The primary end point was the change in NT-proBNP levels from baseline to 96 hours. Secondary end points included the clinical congestion score, dyspnea assessment, net urine output, and net weight change. Safety end points included hyperkalemia and changes in renal function. Results A total of 360 patients were randomized, of whom the median age was 65 years, 129 (36%) were women, 200 (55.5%) were white, 151 (42%) were black, 8 (2%) were Hispanic or Latino, 9 (2.5%) were of other race/ethnicity, and the median left ventricular ejection fraction was 34%. Baseline median (interquartile range) NT-proBNP levels were 4601 (2697-9596) pg/mL among the group treated with high-dose spironolactone and 3753 (1968-7633) pg/mL among the group who received usual care. There was no significant difference in the log NT-proBNP reduction between the 2 groups (−0.55 [95% CI, −0.92 to −0.18] with high-dose spironolactone and −0.49 [95% CI, −0.98 to −0.14] with usual care, P = .57). None of the secondary end point or day-30 all-cause mortality or heart failure hospitalization rate differed between the 2 groups. The changes in serum potassium and estimated glomerular filtration rate at 24, 48, 72, and 96 hours. were similar between the 2 groups. Conclusions and Relevance Adding treatment with high-dose spironolactone to usual care for patients with AHF for 96 hours was well tolerated but did not improve the primary or secondary efficacy end points. Trial Registration clinicaltrials.gov Identifier: NCT02235077
Anti-Müllerian hormone concentrations in androgen-suppressed women with polycystic ovary syndrome.

BACKGROUND Current data suggest that excessive androgen exposure can lead to the development of polycystic ovaries and polycystic ovary syndrome (PCOS). Anti-Müllerian hormone (AMH) levels reflect the number of small antral follicles in the ovaries and are elevated in PCOS. We hypothesized that protracted reduction of circulating androgens and/or insulin resistance would reduce circulating AMH concentrations in women with PCOS. METHODS A prospective, randomized, double-blind 26 week long study was undertaken in 50 women with PCOS. They all received diet and lifestyle counselling, and metformin 850 mg three times daily. Concomitantly, they were randomized to either dexamethasone 0.25 mg daily (n = 25) or placebo (n = 25). Thirty-eight women completed the study. AMH (primary outcome) and other hormone levels were measured at inclusion and after 8 and 26 weeks of treatment. RESULTS At baseline in univariate regression analyses, AMH levels associated positively with testosterone levels (P = 0.041) and ovarian volume (P = 0.002). In multivariate regression analyses, AMH associated positively with testosterone P = 0.004), and negatively with dehydroepiandrosterone sulphate (DHEAS) (P = 0.001) and C-peptide levels (P = 0.020). Circulating AMH concentrations were unaffected by 6 months of lifestyle counselling with metformin and placebo treatment. AMH levels were also unaffected by 6 months of androgen suppression with dexamethasone in addition. CONCLUSIONS AMH levels in untreated PCOS women associated positively with testosterone, and negatively with DHEAS and C-peptide levels. Six months of androgen suppression by either metformin or low-dose dexamethasone treatment failed to influence circulating AMH levels.
Diagnosis of Heart Failure With Preserved Ejection Fraction

As Dr. Cao and colleagues point out, our recently published cost-effectiveness analysis, based on patient-level data from the PARTNER (Placement of Aortic Transcatheter Valves Trial) (1) has some important limitations. Our analysis used a 12-month timeframe. From a health economic perspective, this analytic timeframe is similar to an analysis that assumes that long-term outcomes between study groups will be comparable. Although there is presently no empirical evidence suggesting otherwise, this remains an unproven assumption, which we explicitly noted in the manuscript. Also correctly noted was the fact that hospital length of stay (LOS) was shorter after transcatheter aortic valve replacement (TAVR) than after surgical aortic valve replacement (AVR), and the savings associated with reduced LOS play a key role in offsetting the higher acquisition cost of a transcatheter valve. The LOS following surgical AVR in the PARTNER trial was indeed long—about 6 days longer than average LOS for AVR for all U.S. patients (2). We believe the long LOS after surgical AVR in the PARTNER trial was primarily related to the unique risk profile of the patient population, who represent the highest 5% to 8% risk of patients operated on for aortic stenosis in the United States. Based on recent publications, it is clear that “high-risk” patients who currently undergo TAVR in other countries tend to be lower risk than those who were studied in the PARTNER A trial. For example, the SOURCE-XT registry f 2,700 consecutive patients undergoing TAVR in 17 countries nrolled patients with a mean Society of Thoracic Surgeons (STS) ortality risk of 8.5% (4) whereas the PARTNER trial population ad a mean STS mortality risk of 11.8% (3). Moreover, as we oted in our discussion, even for similar patients, clinical results nd resource utilization patterns may differ across healthcare ystems. We agree that country-specific analyses are needed, but e are concerned about conclusions reached by comparing nonandomized groups (5). In the absence of randomization, careful isk adjustment is required to reach balanced conclusions. Finally, it is not correct to state that our analysis ignored or eglected complications associated with TAVR. For the TAVR nd AVR groups in the trial, we measured costs for index and ollow-up hospitalizations primarily by collecting and analyzing ospital bills from the enrolling centers. Thus, while we have not et reported the excess costs associated with specific complications, hose costs were incorporated into analysis through the 12-month imeframe of the study.
Tone identification behavior in Rattus norvegicus: muscarinic receptor blockage lowers responsiveness in nontarget selective neurons, while nicotinic receptor blockage selectively lowers target responses

Learning to associate a stimulus with reinforcement causes plasticity in primary sensory cortex. Neural activity caused by the associated stimulus is paired with reinforcement, but population analyses have not found a selective increase in response to that stimulus. Responses to other stimuli increase as much as, or more than, responses to the associated stimulus. Here, we applied population analysis at a new time point and additionally evaluated whether cholinergic receptor blockers interacted with the plastic changes in cortex. Three days of tone identification behavior caused responsiveness to increase broadly across primary auditory cortex, and target responses strengthened less than overall responsiveness. In pharmacology studies, behaviorally impairing doses of selective acetylcholine receptor blockers were administered during behavior. Neural responses were evaluated on the following day, while the blockers were absent. The muscarinic group, blocked by scopolamine, showed lower responsiveness and an increased response to the tone identification target that exceeded both the 3‐day control group and task‐naïve controls. Also, a selective increase in the late phase of the response to the tone identification stimulus emerged. Nicotinic receptor antagonism, with mecamylamine, more modestly lowered responses the following day and lowered target responses more than overall responses. Control acute studies demonstrated the muscarinic block did not acutely alter response rates, but the nicotinic block did. These results lead to the hypothesis that the decrease in the proportion of the population spiking response that is selective for the target may be explained by the balance between effects modulated by muscarinic and nicotinic receptors.
Association of Public Health Initiatives With Outcomes for Out-of-Hospital Cardiac Arrest at Home and in Public Locations

Importance Little is known about the influence of comprehensive public health initiatives according to out-of-hospital cardiac arrest (OHCA) location, particularly at home, where resuscitation efforts and outcomes have historically been poor. Objective To describe temporal trends in bystander cardiopulmonary resuscitation (CPR) and first-responder defibrillation for OHCAs stratified by home vs public location and their association with survival and neurological outcomes. Design, Setting, and Participants This observational study reviewed 8269 patients with OHCAs (5602 [67.7%] at home and 2667 [32.3%] in public) for whom resuscitation was attempted using data from the Cardiac Arrest Registry to Enhance Survival (CARES) from January 1, 2010, through December 31, 2014. The setting was 16 counties in North Carolina. Exposures Patients were stratified by home vs public OHCA. Public health initiatives to improve bystander and first-responder interventions included training members of the general population in CPR and in the use of automated external defibrillators, teaching first responders about team-based CPR (eg, automated external defibrillator use and high-performance CPR), and instructing dispatch centers on recognition of cardiac arrest. Main Outcomes and Measures Association of resuscitation efforts with survival and neurological outcomes from 2010 through 2014. Results Among home OHCA patients (n = 5602), the median age was 64 years, and 62.2% were male; among public OHCA patients (n = 2667), the median age was 68 years, and 61.5% were male. After comprehensive public health initiatives, the proportion of patients receiving bystander CPR increased at home (from 28.3% [275 of 973] to 41.3% [498 of 1206], P < .001) and in public (from 61.0% [275 of 451] to 70.5% [424 of 601], P = .01), while first-responder defibrillation increased at home (from 42.2% [132 of 313] to 50.8% [212 of 417], P = .02) but not significantly in public (from 33.1% [58 of 175] to 37.8% [93 of 246], P = .17). Survival to discharge improved for arrests at home (from 5.7% [60 of 1057] to 8.1% [100 of 1238], P = .047) and in public (from 10.8% [50 of 464] to 16.2% [98 of 604], P = .04). Compared with emergency medical services–initiated CPR and resuscitation, patients with home OHCA were significantly more likely to survive to hospital discharge if they received bystander-initiated CPR and first-responder defibrillation (odds ratio, 1.55; 95% CI, 1.01-2.38). Patients with arrests in public were most likely to survive if they received both bystander-initiated CPR and defibrillation (odds ratio, 4.33; 95% CI, 2.11-8.87). Conclusions and Relevance After coordinated and comprehensive public health initiatives, more patients received bystander CPR and first-responder defibrillation at home and in public, which was associated with improved survival.
Primary Gasterointestinal Lymphoma, Clinicopathologic Study of 49 Small Intestinal Lymphoma Casess and the Treatment Option of Choice

Introduction: A study was made conserning 142 patients who were suffering from gastrointestinal lymphoma, were seen at the department of Hematology and Oncology, Esfahan Medical School, during the period 1982-2002. Method: All patients had laparotomy, and biopsy of the site lesion. Histopathological subtypes were done in the International Working Formulation. Stage groupings were done applying the Crowther and Blackledge staging system. The post-laparotomy was made depending on the patient's general condition, the completeness of surgery and histological subtype. Results: There were 52 cases of gastrointestinal lymphoma in the stomach, 49 in the small intestine, 12 in the ileocecal region, 22 in the rectosigmoid and in seven of the cases, multiple sites in the gastrointestinal tract were involved. Conclusion: The overall survival rate was 47.8% at 5 years. Early stage disease and high-grade lymphoma have a better prognosis if treated adequately. Patients who had complete surgical removal of primary tumour (befor any metastasis) had a longer survival.
The relationships between AMH, androgens, insulin resistance and basal ovarian follicular status in non-obese subfertile women with and without polycystic ovary syndrome.

BACKGROUND Hyperandrogenaemia and insulin resistance are prominent features of polycystic ovary syndrome (PCOS) and influence the process of folliculogenesis in women with the endocrinopathy. Anti-Müllerian hormone (AMH) levels are elevated in women with PCOS and studies including IVF subjects have shown that this is a reliable marker of ovarian performance. The aims of this prospective study were to assess the relationship between insulin resistance, androgens and AMH, and whether AMH contributes to altered folliculogenesis in non-obese women with PCOS. METHODS A total of 232 IVF candidates, 49 of whom had PCOS according to the Rotterdam 2003 consensus criteria, were recruited. AMH levels and ovarian morphology were assessed. The relationships between AMH and insulin resistance and androgenaemia in patients with and without PCOS were studied. RESULTS PCOS patients were slightly older than controls (median ages 34 and 30 years, respectively). AMH generally increased with antral follicle count (AFC), insulin, homeostatic model assessment of tissue insulin sensitivity (HOMA-IR), testosterone, free androgen index and luteinising hormone, and decreased with chronological age, homeostatic model assessment of steady state beta cell function (HOMA-B) and serum sex hormone binding globulin (SHBG). For these relationships there were no significant differences in the slopes between PCOS and non-PCOS patients. The ratio of AMH per antral follicle (AMH/AF) was higher in PCOS patients. Both PCOS and non-PCOS groups showed a very similar increase in AMH with increases in AFC, but the PCOS patients had consistently higher AMH across all AFC levels. CONCLUSIONS These observations indicate that AMH is similarly related to insulin resistance and androgens in women with and without PCOS. This effect appears to be independent of age although an indirect causal effect due to ageing or some other mechanism cannot be ruled out. Excessive granulosa cell activity may be implicated in the abnormal follicular dynamic of the syndrome.
How to demonstrate that eSET does not compromise the likelihood of having a baby?

BACKGROUND In several randomized studies, elective single embryo transfer (eSET) has proven its effectiveness in reducing twin pregnancy rates while obtaining acceptable overall pregnancy rates. However, there is no outcome measurement consensus to evaluate the effectiveness of eSET versus double-embryo transfer (DET). METHODS This study evaluated whether or not adopting an eSET strategy instead of a DET strategy lowers the probability of having at least one live-born infant in good prognosis couples. Seven hundred and twenty-six couples were divided into two groups. The retrospective arm of the study was undertaken on the first group of couples (n = 483, DET group) and the prospective arm performed on the second group of couples (n = 243, SET group). In these specific populations, the probability of a woman having at least one live-born infant and the probability that one embryo utilized leads to a child were the main outcome measures. RESULTS The probability of a woman having at least one live-born infant was 60.5% in the DET group compared with 60.8% in the SET group. The probability of a live-born child per embryo utilized was not significantly different between the SET and the DET groups, 18.9% and 17.6%, respectively. In addition, the cumulative multiple live birth rate was significantly lower in the SET compared with the DET group. CONCLUSIONS In this observational study, using appropriate cryopreservation techniques, the chance of delivering a live baby, per utilized embryo, in an elective SET strategy is as good as that for DET.
Antibacterial Acivity of Gold and Silver Nanoparticles Impregnated With Antimicrobial Agents

Introduction: The bactericidal activity of Ag-NPs and Au-NPs impregnated with ceftriaxone, rifampicin and vancomycin is evalauted. Results: Ag-NPs impregnated with rifampicin, vancomycin and ceftriaxone showed a respective inhibition zone of 15.0 mm, 11.3 mm and 26.0 mm to E.coli. Whereas Au-NPs impregnated with rifampicin and vancomycin showed a non inhibition zone, ceftriaxone showed a zone of 27.0 mm. When Ag-NPs were impregnated with rifampicin, vancomycin and ceftriaxone, they showed a zone of 10.0 mm against P. aeruginosa, but Au-NPs showed a non inhibition zone. When Ag-NPs were impregnated against S. aureus with rifampicin, vancomycin and ceftriaxone, they showed an inhibition zone of 36.7 mm, 18.0 mm and 10.0 mm, respectively. When Au-NPs were impregnated with vancomycin, rifampicin and ceftriaxone, they showed an inhibition zone respectively of 36.0 mm, 18.0 mm and 13.3 mm. Conclusion: Results showed that the efficiency of the nanoparticles impregnated with antibiotics may depend on the antibiotics used.
Effects of the availability of accurate proprioceptive information on older adults' postural sway and muscle co‐contraction

During conditions of increased postural instability, older adults exhibit greater lower limb muscle co‐contraction. This response has been interpreted as a compensatory postural strategy, which may be used to increase proprioceptive information from muscle spindles or to stiffen the lower limb as a general response to minimise postural sway. The current study aimed to test these two hypotheses by investigating use of muscle co‐contraction during sensory transitions that manipulated proprioceptive input. Surface EMG was recorded from the bilateral tibialis anterior and gastrocnemius medialis muscles, in young (aged 18–30) and older adults (aged 68–80) during blind‐folded postural assessment. This commenced on a fixed platform (baseline: 2 min), followed by 3 min on a sway‐referenced platform (adaptation) and a final 3 min on a fixed platform again (reintegration). Sensory reweighting was slower in older adults, as shown by a significantly larger and longer postural sway after‐effect once a stable platform was restored. Muscle co‐contraction showed similar after‐effects, whereby older adults showed a larger increase in co‐contraction once the stable platform had been restored, compared to young adults. This co‐contraction after‐effect did not return to baseline until after 1 min. Our evidence for high muscle co‐contraction during the reintroduction of veridical proprioceptive input suggests that increased co‐contraction in older adults is not dependent on contemporaneous proprioceptive input. Rather, it is more likely that co‐contraction is a general postural strategy used to minimise postural sway, which is increased during this sensory transition. Future research should examine whether muscle co‐contraction is typically a reactive or anticipatory response.