Miracle-dz/UniFAR-FTUs huggingface dataset:
Universal Depression Screen of Ambulatory Heart Transplant Recipients With Referral for Mental Health Intervention: A Quality Improvement Project.

BACKGROUND Patients with a heart transplant and depression have higher rates of graft failure and noncompliance. LOCAL PROBLEM The heart transplant clinic had no standardized approach to assess for depression. METHODS The heart transplant clinic implemented routine use of the Patient Health Questionnaire (PHQ). INTERVENTIONS Team members were educated via an online module about depression. A process for depression screening and follow-up was developed and implemented. RESULTS From July 2018 to February 2019, there were 834 visits; PHQ2 screens were completed during 779 (93%) of those visits with 40 (5%) positive screens. All 40 patients had PHQ9 assessment, with 33 patients (4%) exhibiting moderate or severe depressive symptoms. All 33 patients were provided with mental health resources and received follow-up. Median time to administer PHQ2 was 2 minutes (range 1-3 minutes). CONCLUSIONS Implementation of universal depression screening in a heart transplant clinic is feasible, identifies patients with depression, and does not add significant clinical burden.
Homelessness and people with intellectual disabilities: A systematic review of the international research evidence.

BACKGROUND People with intellectual disabilities can experience homelessness, and some of the reasons differ from the general homeless population. Specific policy and practice responses are required. METHOD A systematic review of studies examining homelessness among people with intellectual disabilities utilizing CINAHL, MEDLINE, PsycINFO and Sociological Abstracts databases from inception to November 2019. RESULTS The search produced 259 papers, and following screening, a total of 13 papers were included in the review. The themes identified were (i) pathways into homelessness, (ii) experiencing homelessness and (iii) routes out of homelessness. CONCLUSIONS People with ID become homeless due to multifactorial issues. The identification of people within homeless services and their care and support concerns remains challenging, impacting upon the provision of assessments, interventions, care and supports. Psychosocial assessments, interventions and supports are necessary to assist people with ID to leave homelessness.
Response to comment on “the effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction

To the Editor, We have read with great interest the comments of Drs. Binay Safer and Safer regarding our recently published article, “The effect of sarcopenia on perioperative complications in abdominally based free‐flap breast reconstruction. ” We thank the authors for their comments and are very grateful to them for giving us the opportunity to further discuss the methodology of our study. There have been numerous studies which have reported outcomes data based on the diagnosis of sarcopenia by radiologic means and support its validity. Su et al. recently published a 2019 systematic review and meta‐analysis of 70 studies and 21,875 patients which evaluated the effect of computed tomgraphy‐assessed sarcopenia on short‐term and long‐term outcomes in gastrointestinal oncology patients. Patients that undergo autologous breast reconstruction are less debilitated than many other studied populations due to the fact that obviously frail or deconditioned patients are unlikely to be offered this procedure; this is supported by the relative rarity of rehabilitative service utilization in both our sarcopenic and non‐sarcopenic patient cohorts, which suggests that muscle strength has less utility in this particular patient group. Muscle strength measures may be confounded by differences in baseline patient strength, applied effort, bias during the measurement process, and sequelae from prior or current treatment, amongst others. Although certain automated programs such as the Osirix Grow Region 2D/3D Segmentation tool utilize Hounsfield Unit attenuation to differentiate between different tissue types and generate a measurement of the patient's skeletal muscle mass, even with this technology manual adjustment may be necessary to correct the software. In our study such software was not used, and cross‐ sectional area of the skeletal muscle mass was measured manually using software as described by the same trained clinician using the same technique for each patient following an internal validation process. We are very grateful to the authors for their comments and for the opportunity to respond and give further perspective. Justin M. Broyles MD J. Michael Smith MD Mark Schaverien MBChB, MD, MSc, MEd, FRCS
Laparoscopic pancreaticodoudenectomy

Abstract Background: Management of malignant diseases in elderly patients has become a global clinical issue because of increased life expectancy worldwide. Advancements in surgical techniques and perioperative management have reduced age-related contraindications for LPD. Past articles have reported that elderly patients undergoing laproscopic pancreatoduodenectomy (LPD) are at an increased risk compared to younger patients. The aim of this article is to compare a multicenter center risk of LPD in elderly and nonelderly patients. Methods: Retrospective review (n = 237) of perisurgical outcomes in patients undergoing LPD during the months of September 2012 to December 2017. Outcomes in elderly patients (aged ≥75 years) were compared with those in nonelderly patients. Results: Transfer to ICU was more frequent in elderly patients (odds ratio [OR] 6.49, P = .001) and the mean hospital stay was longer (21.4 days compared with 16.6 days), (P = .0033) than for nonelderly patients. There was no statistically significant difference in operation time (P = .494), estimated blood loss (P = .0519), blood transfusion (P = .863), decreased gastric emptying (P = .397), abdominal pain (P = .454), food intake (P = .241), time to self-ambulation (P = 1), reoperation (P = .543), postoperative pancreatic fistula (POPF) grade A (P = .454), POPF grade B (P = .736), POPF grade C (P = .164), hemorrhage (P = .319), bile leakage (P = .428), infection (P = .259), GI bleeding (P = .286), morbidity (P = .272) or mortality (P = .449) between the 2 groups. Conclusions: Elderly patients who underwent LPD in this study had good overall outcomes after LPD that were similar to young patients. The perioperative and long-term outcomes of LPD are not worse. Rates of ICU admission and hospital stays increased in elderly patients undergoing LPD when compared with nonelderly ones. LPD can be performed on elderly patients with similar outcomes as younger patients; therefore, age itself should not be a contraindication for LPD for pancreatic cancer, but it suggests that elderly patients with comorbidities should be more stringently selected for surgery.
Prenatal and foetal autopsy findings in glutaric aciduria type II

Glutaric aciduria type 2 is a rare, lethal disorder that affects metabolism of fatty acids caused by genetic defects in electron transfer (ETF) or in electron transfer flavoprotein dehydrogenase (ETFDH). We aimed to describe the pathological findings of 15 week old foetus, born from a consanguineous couple with 3 previous perinatal deaths. The last son died at 4 days of life and genetic analyses revealed a novel probably pathogenic variant at ETFDH (c.706dupG + c.706dupG) that codifies for a truncated protein (p.Glu236Glyfs*5 + p.Glu236Glyfs*5).
Human Stromal Cell Aggregates Concentrate Adipose Tissue Constitutive Cell Population by In-Vitro DNA Quantification Analysis.

BACKGROUND Regenerative cell strategies rely on stromal cell implants to attain an observable clinical outcome. Yet, the effective cell dose to ensure a therapeutic response remains unknown. To achieve a higher cell dose, we hypothesized that reducing the volume occupied by mature adipocytes in lipoaspirate will concentrate the stromal vascular fraction present in the original tissue. METHODS Human standardized lipoaspirate (n = 6) was centrifuged (1200 g for 3 min) and the water phase was discarded. Mechanical disaggregation was achieved by shearing tissue through 2.4 and 1.2 mm Luer-to-Luer transfers. After a second centrifugation (800 g for 10 min), stromal cell aggregates were separated from the supernatant oil phase. Lipoaspirate percentage composition was determined by its constituent weights. Cell content was measured by total DNA quantification and partial cell viability was determined by image cytometry. Tissue sections were evaluated histologically (hematoxylin-eosin and Masson's trichrome). RESULTS Stromal cell aggregates reduced the standardized lipoaspirate mass to 28.6 ± 4.2 percent. Accordingly, the cell density increased by 222.6 ± 63.3 percent (from 9.9 ± 1.4 to 31.3 ± 6.6 million cells/g, p < 0.05). Cell viability was unaffected in stromal cell aggregates (71.3 ± 2.5 percent) compared to standardized lipoaspirate (72.2 ± 2.3 percent) and histologic analysis revealed large density areas enriched with stromal cells (622.9 ± 145.6 percent) and extracellular matrix (871.2 ± 80.3 percent). CONCLUSIONS Stromal cell aggregates represent a biological agent that triplicates the cell density versus unprocessed lipoaspirate, low on oil and water fluids, and enriched extracellular matrix components.
Natural Killer (NK)//T-Cell Lymphoma, Nasal Type, with Periorbital Involvement: A Case Report and Literature Review

Patient: Female, 36-year-old Final Diagnosis: NK/T-cell lymphoma Symptoms: Nasal congestion • rhinorrea • sinus congestion Medication: — Clinical Procedure: — Specialty: Otolaryngology Objective: Rare disease Background: Extranodal natural killer (NK)/T-cell lymphomas are rare neoplasms that result in the destruction of mid-facial tissues. Infrequently seen in ear, nose, and throat clinical practice, they are often misdiagnosed and treated as chronic sinusitis, which delays proper diagnosis. This study aimed to describe the insidious course of NK/T-cell lymphomas, nasal type. Case Report: A 36-year-old woman with a 2-year history of recurrent exacerbation of chronic sinusitis and allergies was admitted to our clinic. Multiple endoscopic sinus surgical procedures were performed. Repeated histopathological tissue examinations revealed extranodal NK/T-cell lymphoma, nasal type. Positron emission tomography combined with computed tomography (PET-CT) was performed to assess the extent of the disease. The patient was treated with antibiotics, steroids, and antifungal drugs for many months before the definitive diagnosis was made. The patient was eligible for modified SMILE chemotherapy; however, the patient died suddenly from septic shock several days before the beginning of treatment. Conclusions: Chronic rhinosinusitis with progressive necrosis of sinonasal tissue that persists despite adequate antibacterial and antifungal treatment should prompt further investigation. In such cases, it is important to consider the diagnosis of NK/T-cell lymphomas, nasal type. Early diagnosis increases the opportunity for successful treatment.
A Near-Infrared Fluorogenic Pyrrole-Imidazole Polyamide Probe for Live-Cell Imaging of Telomeres.

Telomeres are closely associated with cellular senescence and cancer. Although some techniques have been developed to label telomeres in living cells for study of telomere dynamics, few biocompatible near-infrared probes based on synthetic molecules have been reported. In this study, we developed a near-infrared fluorogenic pyrrole-imidazole polyamide probe (SiR-TTet59B) to visualize telomeres by conjugating a silicon-rhodamine (SiR) fluorophore with a tandem tetramer pyrrole-imidazole polyamide targeting 24 bp in the telomeric double-stranded (ds)DNA. SiR-TTet59B was almost nonfluorescent in water but increased its fluorescence dramatically on binding to telomeric dsDNA. Using a peptide-based delivery reagent, we demonstrated the specific and effective visualization of telomeres in living human cells. Moreover, SiR-TTet59B could be used to observe the dynamic movements of telomeres during interphase and mitosis. This simple imaging method using a synthetic near-infrared probe could be a powerful tool for studies of telomeres and for diagnosis.
J. P. Hill and Katherine Watson's studies of the neural crest in marsupials

In the early part of the 20th century, J. P. Hill and K. P. Watson embarked on a comprehensive study of the development of the brain in Australian marsupials. Their work included series from three major groups: dasyurids, peramelids, and diprotodonts, covering early primitive streak through brain closure and folding stages. While the major part of the work was on the development of the brain, in the course of this work they documented that cellular proliferations from the neural plate provided much of the mesenchyme of the branchial arches. These proliferations are now known to be the neural crest. However, except for a very brief note, published shortly after Hill's death, this work was never published. In this study, I present Hill and Watson's work on the development of the early neural plate and the neural crest in marsupials. I compare their findings with published work on the South American marsupial, Monodelphis domestica and demonstrate that patterns reported in Monodelphis are general for marsupials. Further, using their data I demonstrate that in dasyurids, which are ultra‐altricial at birth, the neural crest migrates early and in massive quantities, even relative to other marsupials. Finally, I discuss the historical context and speculate on reasons for why this work was unpublished. I find little support for ideas that Hill blocked publication because of loyalty to the germ layer theory. Instead, it appears primarily to have been a very large project that was simply orphaned as Watson and Hill pursued other activities.
Microglia–Astrocyte Communication via C1q Contributes to Orofacial Neuropathic Pain Associated with Infraorbital Nerve Injury

Trigeminal nerve injury causes a distinct time window of glial activation in the trigeminal spinal subnucleus caudalis (Vc), which are involved in the initiation and maintenance phases of orofacial neuropathic pain. Microglia-derived factors enable the activation of astrocytes. The complement component C1q, which promotes the activation of astrocytes, is known to be synthesized in microglia. However, it is unclear whether microglia–astrocyte communication via C1q is involved in orofacial neuropathic pain. Here, we analyzed microglia-astrocyte communication in a rat model with infraorbital nerve injury (IONI). The orofacial mechanical hypersensitivity induced by IONI was significantly attenuated by preemptive treatment with minocycline. Immunohistochemical analyses revealed that minocycline inhibited the increase in c-Fos immune-reactive (IR) cells and the fluorescence intensity of both Iba1 and glial fibrillary acidic protein (GFAP) in the Vc following IONI. Intracisternal administration of C1q caused orofacial mechanical hypersensitivity and an increase in the number of c-Fos-IR cells and fluorescence intensity of GFAP. C1q-induced orofacial mechanical hypersensitivity was completely abrogated by intracisternal administration of fluorocitrate. The present findings suggest that the enhancement in the excitability of Vc nociceptive neurons is produced by astrocytic activation via the signaling of C1q released from activated microglia in the Vc following IONI, resulting in persistent orofacial neuropathic pain.
What do Brazilian owners know about canine obesity and what risks does this knowledge generate?

Canine obesity is associated with genetic, environmental, and behavioural factors, with the latter including both the behaviour of the dog and the owner. Knowledge about owner perception of canine obesity and its treatment can inform the development of new strategies to help prevent and manage this disease. Therefore, the aim of this study was to evaluate the opinions of dog owners regarding canine obesity and weight management. Dog owners residing in the city of Sao Paulo (Brazil) completed a questionnaire, either at home or in the waiting rooms of 3 veterinary hospitals. Owners determined their dog’s body condition score (BCS), and this was compared with BCS determined by a veterinarian. Questionnaire findings from dogs that were in overweight (BCS 6-7/9) or obese (BCS (8-9/9) condition were compared with those in ideal weight (4-5/9) using chi-square tests and odds ratios. A total of 926 dogs were included, of which 480 (52%), 317 (34%) and 129 (14%) were in ideal, overweight and obese condition, respectively. Many owners under-estimated their dog’s weight status, with the proportion increasing as the dog’s weight status increased (ideal 60/480, 13%; overweight 174/317, 55%; obese 88/129, 68%; P<0.001). Although most owners (890/926, 96%) believed that canine obesity could pose health risks, the proportion that disagreed increased as weight status increased (ideal 12/480, 2%; overweight 14/317, 4%; 10/129, 8%; P = 0.006). Finally, although most owners (880/926, 95%) stated that they would let their dog undergo weight management, only a minority (182/926; 20%) believed that a trained professional was needed, and they had various misperceptions including potential cost and what the strategies that would be effective. Based on the findings of this study, it would be advisable for veterinarians to spend time addressing these misperceptions, in the hope of both improving awareness of obesity and the outcomes of weight management.
Why Are Parts of the World Green? Multiple Factors Control Productivity and the Distribution of Biomass

This paper evaluates the multiple factors that determine the production of plant biomass and its distribution among producers and various trophic groups of con_ ? ^)^ Osumers. In rough order of their importance, water and nutrient availability, factors 0*S that deter herbivores (plant defenses, environmental heterogeneity and disturbance, nutrient stoichiometry), and consumption by herbivores appear to be the most universal determinants of the production and distribution of plant biomass. In some times and places, indirect effects from enemies of herbivores (predators, parasites, parasitoids and pathogens) propagate through the food web to influence plant biomass, in a manner somewhat consistent with green world and exploitation ecosystem mechanisms. I discuss why such food web dynamics appear to be much more important in water than on land. The only demonstrated cases of communitylevel trophic cascades occur in water. Although species-level cascades are moderately frequent on land, community-level cascades rarely or never occur.
Pre-analytical Sample Handling Conditions and Their Effects on the Human Serum Metabolome in Epidemiological Studies.

Many epidemiological studies use metabolomics for discovery-based research. The degree to which sample handling may influence findings, however, is poorly understood. Serum from 13 volunteers from the USDA Beltsville center were subjected to different clotting (30/120 minutes) and refrigeration (0/24 hours) conditions, as well as number (0/1/4) and temperature (ice/refrigerator/room temperature) of thaws (2016). Median absolute percentage difference (APD) between metabolite levels and correlations across conditions were estimated for 628 metabolites. The potential for handling artifacts to induce false positives was estimated using variable hypotheticals where 1-100% of case samples had different handling than control samples. All handling conditions influenced metabolite levels. Across metabolites, the median APD when extending clotting was 9.08%. When increasing from 0 to 4 thaws, the median APD was 10.05% for ice, and 5.54% APD for room temperature. Metabolites correlated highly across conditions (all r>0.84), indicating relative ranks were preserved. However, if handling varied even modestly by case status, our hypotheticals show results can be biased and result in false positives. Sample handling affects levels of metabolites, and special care should be taken to minimize effects. Shorter room temperature thaws should be preferred over longer ice thaws, and handling should be meticulously matched by case status.
Circulating testican-2 is a podocyte-derived marker of kidney health

Significance All existing blood biomarkers of kidney function such as creatinine and cystatin C undergo renal clearance and are thus inversely correlated with estimated glomerular filtrate rate (eGFR). Using a proteomic approach, we highlight the renal release of testican-2 among individuals undergoing invasive catheterization and show that higher blood testican-2 levels are associated with higher eGFR and slower rate of subsequent eGFR decline in two large racially diverse cohorts. In conjunction with microscopy and single-cell RNA sequencing of human kidney samples, these studies advance the concept that a protein released by the podocyte can provide insight into the kidney’s health and prognosis. Cell-based studies also raise the possibility that this protein has functional effects on neighboring glomerular endothelial cells. In addition to their fundamental role in clearance, the kidneys release select molecules into the circulation, but whether any of these anabolic functions provides insight on kidney health is unknown. Using aptamer-based proteomics, we characterized arterial (A)-to-renal venous (V) gradients for >1,300 proteins in 22 individuals who underwent invasive sampling. Although most of the proteins that changed significantly decreased from A to V, consistent with renal clearance, several were found to increase, the most significant of which was testican-2. To assess the clinical implications of these physiologic findings, we examined proteomic data in the Jackson Heart Study (JHS), an African-American cohort (n = 1,928), with replication in the Framingham Heart Study (FHS), a White cohort (n = 1,621). In both populations, testican-2 had a strong, positive correlation with estimated glomerular filtration rate (eGFR). In addition, higher baseline testican-2 levels were associated with a lower rate of eGFR decline in models adjusted for age, gender, hypertension, type 2 diabetes, body mass index, baseline eGFR, and albuminuria. Glomerular expression of testican-2 in human kidneys was demonstrated by immunohistochemistry, immunofluorescence, and electron microscopy, while single-cell RNA sequencing of human kidneys showed expression of the cognate gene, SPOCK2, exclusively in podocytes. In vitro, testican-2 increased glomerular endothelial tube formation and motility, raising the possibility that its secretion has a functional role within the glomerulus. Taken together, our findings identify testican-2 as a podocyte-derived biomarker of kidney health and prognosis.