Miracle-dz/UniFAR-FTUs huggingface dataset:
Pathophysiologic Response to Severe Burn Injury

Objective:To improve clinical outcome and to determine new treatment options, we studied the pathophysiologic response postburn in a large prospective, single center, clinical trial. Summary Background Data:A severe burn injury leads to marked hypermetabolism and catabolism, which are associated with morbidity and mortality. The underlying pathophysiology and the correlations between humoral changes and organ function have not been well delineated. Methods:Two hundred forty-two severely burned pediatric patients [>30% total body surface area (TBSA)], who received no anabolic drugs, were enrolled in this study. Demographics, clinical data, serum hormones, serum cytokine expression profile, organ function, hypermetabolism, muscle protein synthesis, incidence of wound infection sepsis, and body composition were obtained throughout acute hospital course. Results:Average age was 8 ± 0.2 years, and average burn size was 56 ± 1% TBSA with 43 ± 1% third-degree TBSA. All patients were markedly hypermetabolic throughout acute hospital stay and had significant muscle protein loss as demonstrated by a negative muscle protein net balance (−0.05% ± 0.007 nmol/100 mL leg/min) and loss of lean body mass (LBM) (−4.1% ± 1.9%); P < 0.05. Patients lost 3% ± 1% of their bone mineral content (BMC) and 2 ± 1% of their bone mineral density (BMD). Serum proteome analysis demonstrated profound alterations immediately postburn, which remained abnormal throughout acute hospital stay; P < 0.05. Cardiac function was compromised immediately after burn and remained abnormal up to discharge; P < 0.05. Insulin resistance appeared during the first week postburn and persisted until discharge. Patients were hyperinflammatory with marked changes in IL-8, MCP-1, and IL-6, which were associated with 2.5 ± 0.2 infections and 17% sepsis. Conclusions:In this large prospective clinical trial, we delineated the complexity of the postburn pathophysiologic response and conclude that the postburn response is profound, occurring in a timely manner, with derangements that are greater and more protracted than previously thought.
Long‐term functional adeno‐associated virus‐microdystrophin expression in the dystrophic CXMDj dog

Duchenne muscular dystrophy (DMD) is a severe, inherited, muscle‐wasting disorder caused by mutations in the dystrophin gene. Preclinical studies of adeno‐associated virus gene therapy for DMD have been described in mouse and dog models of this disease. However, low and transient expression of microdystrophin in dystrophic dogs and a lack of long‐term microdystrophin expression associated with a CD8+ T‐cell response in DMD patients suggests that the development of improved microdystrophin genes and delivery strategies is essential for successful clinical trials in DMD patients.
Polyunsaturated Fatty Acids in Human Milk and Neurological Development in Breastfed Infants

Long-chain polyunsaturated fatty acids (LCPUFA) are bioactive compounds that include docosahexaenoic acid (DHA) and arachidonic acid (AA). DHA seems to be necessary to optimize growth and development of infant's neural functions. For preterm infants there is a wide agreement on LCPUFA benefits, while for term infants results are more controversial. There is presently a growing interest in supplementing pregnant and breastfeeding women with DHA. LCPUFA may act as coadjuvants in conditions of functional and organic brain impairments, as well as some inflammatory states, but caution is urged to prevent false expectations. Therefore, pediatricians should be aware of the present scientific evidence concerning dietary LCPUFA supplementations.
Assessment of Mortality in Older Trauma Patients Sustaining Injuries from Falls or Motor Vehicle Collisions Treated in Regional Level I Trauma Centers

Objective:To compare mortality in elderly trauma patients sustaining fall or motor vehicle collision (MVC) related injuries and who are subsequently treated at regional Level I (tertiary) trauma centers. Summary Background Data:An increase in the mean age of the Canadian population is leading to a higher proportion of older patients injured in falls who are subsequently treated at Level 1 trauma centers in Quebec. The Level 1 centers were designed to treat younger patients injured in MVCs and violent acts. As a result, discordance may exist between the type of care supplied at these centers and the increased demand for care tailored to older trauma patients. Methods:A retrospective cohort study comprised of 4,717 patients over the age of 65; 606 (12.8%) injured in MVCs and 4,111 (87.2%) in falls. The mean (SD) age was 79.6 (8.0) years and 67.9% were female. The mean (SD) Injury Severity Score (ISS) was 10.8 (7.4). Data were obtained from the Quebec Trauma Registry (QTR) for patients treated at 3 Level I trauma centers in the province of Quebec, Canada. The primary outcome measure in this study was mortality. Results:Being injured in a fall was a strong predictor for mortality, with an odds ratio of 5.11 (95% C.I. = 1.84–14.17, P = 0.002). Additionally, the adjusted mortality rate was 25.3% among fall victims, versus 7.8% for MVC patients. Female gender, older age, higher ISS and an increasing number of injuries were all associated with heightened mortality. In contrast, the number of body regions injured, experiencing complications, sustaining a hip fracture, the Revised Trauma Score, the Prehospital Index and the Charlson (comorbidity) Index had no association with mortality in the Level I centers. Conclusions:Elderly patients sustaining fall-related injuries and treated at Level I trauma centers are at risk for excess mortality when compared with those injured in MVCs. Effective and efficient methods for treating this population must be determined.
Successfully implementing total quality management tools within healthcare: what are the key actions?

This article recognises that many total quality management initiatives fail and that the failures are often due to a lack of knowledge, skills and expertise, particularly in relation to the organisation’s leaders/managers. In contrast however, success is more likely if the implementation approach is well planned, executed, assessed and reviewed. There are five key steps that need to be contained within the implementation plan some of which include setting up a steering committee, agreeing the norms, values and behaviours for the organisation and determining indicators associated with success. Furthermore, a number of actions need to be effected within those five key steps. In essence it was concluded that without careful planning the programme for implementing total quality management was likely to fail resulting in an opposite effect on the quality of healthcare delivery to the one that was intended.
The Retinal Ganglion Cell Layer

advocates intravenous Mannitol or urea, but no evidence is given to &femonstrate the efficacy of these agents. As regards local treatment, he advocates Furacin gauze followed later by sterile gauze bandages moistened hourly with Zephiran-acetic acid solution. Dressings are changed three times a day. Most Burns Units in this country would find dressing large numbers of burns three times a day difficult or impossible with the present nursing shortage. It is refreshing to see a whole chapter devoted to the nursing care of burns, and the importance of positioning the limbs and joints is stressed here together with the simple but often forgotten importance of washing of hands before and after a patient has been touched. In a book of only 119 pages, it is not possible to mention all details of care, and some points of necessity are dealt with too briefly. Hence we find occasional dogmatic statements such as "a tracheostomy is usually performed in patients with deep neck burns". More precise indications would have been preferable. The book is written in a simple style and is interesting and easy to read. The author has succeeded in his two aims, and the book will be a useful practical guide for those withou't special experience in burns. Those with experience in treating burns will find much of interest, and some unort'hodox ideas.
Laparoscopic Liver Resection—Understanding its Role in Current Practice: The Henri Mondor Hospital Experience

Objective:To report our complete experience with laparoscopic liver resection (LLR) to understand what role it may play in the broader context of liver surgery. Background:The goal of LLR is to extend the benefits of the laparoscopic approach without compromising the fundamental principles of open liver surgery. LLR, however, presents unique technical challenges and its evaluation is made difficult by the restricted indications for this approach, the few centers world-wide experienced in the technique, and the heterogeneity of procedures and pathologies involved. Methods:Retrospective analysis of a prospectively maintained database of liver resections from a unit with a comprehensive liver program, including resection and transplantation. Results:There were 166 laparoscopic liver resections between May 23, 1996 and December 31, 2007, including 100 (60%) for malignant pathology (64 HCC, 3 cholangiocarcinoma, 33 hepatic metastases) and 66 for benign pathology (adenoma, 23; FNH, 19; cystic, 17; other, 7). Numbers of resections for benign indications remained stable over time whereas those for malignant indications increased. There were 31 major resections, 56 left lateral sectionectomies, 28 segmentectomies, and 51 tumorectomies. There was 0% mortality and 15.1% morbidity. Median blood loss was 200 mL, 9 patients (5.4%) required transfusion, and median operating time was 180 minutes. Left lateral sectionectomies demonstrated reduced bleeding (median, 175 vs. 300 mL, P = 0.0015) and faster operating time (median, 170 vs. 180 minutes, P = 0.0265). In the second half of the experience, there was reduced bleeding (median, 200 vs. 300 mL, P = 0.0022) and a lower conversion rate (2.4% vs. 16.9%, P = 0.0015). Conclusions:Good patient selection and refined surgical technique are the keys to successful LLR. The indications for resection of asymptomatic benign lesions should not be increased because the laparoscopic approach is available. Hepatocellular carcinomas (HCCs) are more likely to be suitable to a laparoscopic approach than colorectal liver metastases. Left lateral sectionectomy and limited resection of solitary peripheral lesions are particularly suitable while hemihepatectomies remain challenging procedures. LLR requires an ongoing robust audit to identify any emerging problems.
Correlation of Thyroid Cytology with Surgical Histology

Objective: 1) To assess the predictive value of thyroid cytology by fine needle aspiration (FNA) at our institution in detecting thyroid malignancy since the introduction of the Bethesda System. 2) To identify other potential predictors of malignancy. Method: Records of patients who underwent thyroid FNA and subsequent surgery at University of Missouri between 2007 and 2012 were reviewed. Data collected included cytologic and pathologic diagnoses as well as potential predictors of malignancy and demographic data, including radiation exposure, radiologic findings of calcification and increased vascularity, age, and gender. Results: A total of 378 cases were eligible for review. Of these, one-third met inclusion criteria. Cytology characterized as malignant or benign were found to have high concordance with surgical pathology findings. The diagnosis atypia of undetermined significance (AUS) and its malignancy risk were observed 2 to 3 times higher than that prescribed by the Bethesda guidelines. The majority of cases with cytologic features of follicular neoplasm were found to be benign. However, a significant number of incidental cases of papillary microcarcinoma were observed within this group. Papillary thyroid carcinoma was identified in 60% of cases with features suspicious for malignancy. Conclusion: While benign and malignant cytologies are highly predictive, there exists wide variation in the interpretation of uncertain categories. Malignancy risk associated with AUS ranges from 6% to 28% in the literature. These results suggest that trends developed from institution-specific data may be more predictive in guiding post-FNA management.
Sorologia Anti PGL-1 e risco de ocorrência de hanseníase em área de alta endemicidade do Estado de São Paulo: quatro anos de seguimento

Os testes sorologicos para diagnostico de hanseniase, usando o glicolipideo-fenolico-1 (PGL-1), considerado antigeno especifico do M. leprae, tem aberto algumas possibilidades de estudo do comportamento epidemiologico desta doenca. Algumas questoes, como tempo de latencia da doenca, infeccao subclinica e importância do contato intra-domiciliar (contatos) no controle da endemia, puderam ser melhor analisadas usando este instrumental. Este estudo teve por objetivo verificar a existencia de associacao entre a situacao sorologica e a ocorrencia de hanseniase. Foram seguidas, durante 4 anos, 6.520 pessoas com idade igual ou superior a 5 anos, submetidas no inicio do seguimento ao teste sorologico Anti PGL-1, pertencentes ao universo de 7.416 habitantes da area urbana de um municipio paulista caracterizado por elevada endemicidade de hanseniase. Foi identificado um grupo de 590 individuos soropositivos (9,0 %). Foram diagnosticados, no periodo, 82 casos novos de hanseniase, 26 no grupo de soropositivos (441 casos novos/10.000 individuos) e 48 no de soronegativos (81/10.000). Entre os que nao fizeram sorologia, surgiram 8 casos novos (89/10.000). Procurou-se controlar, na analise, a condicao de contato, dado que a taxa de soropositividade padronizada por idade e sexo era de 9,61% no grupo de contatos e 7,65% no de nao-contatos. Tomando-se os nao-contatos soronegativos como o grupo de "nao expostos", foram calculados os riscos relativos de adoecimento no periodo, a partir das taxas de deteccao padronizadas por idade, resultando no seguinte: os contatos ID soropositivos apresentaram a taxa de 1.704/10.000, 27 vezes maior que a dos "nao-expostos", igual a 63/10.000; os nao-contatos soropositivos e os contatos soronegativos apresentaram taxas, respectivamente, de 274 e 198/10.000, ambas maiores que as dos "nao-expostos" e iguais entre si. A soropositividade associou-se a elevacao de 8,6 vezes do risco de hanseniase entre os contatos e de 4,4 entre os nao-contatos. Na situacao epidemiologica estudada, caracterizada por elevada endemicidade de hanseniase, 50% dos casos novos surgiram entre os nao-contatos soronegativos, ou seja, sem fonte de infeccao conhecida. Portanto, o teste anti-PGL-1 usado revela-se, na pratica, de pouca aplicabilidade. Resta estudar ainda o comportamento da sorologia anti-PGL-1 em areas de media e baixa endemicidade para que se possa tirar conclusoes mais consubstanciadas sobre sua utilidade no controle da endemia. Recomenda-se o aprofundamento das pesquisas sorologicas e de outras que aprimorem o diagnostico precoce da infeccao subclinica, inclusive para deteccao de formas paucibacilares, para se ampliar as possibilidades de influir no controle endemico.
Improvement of ballistocardiogram processing by inclusion of respiration information

In this paper a novel methodology for processing of a ballistocardiogram (BCG) is proposed in which the respiration signal is utilized to improve the averaging of the BCG signal and ultimately the annotation and interpretation of the signal. Previous research works filtered out the respiration signal while the novelty of the current research is that, rather than removing the respiration effect from the signal, we utilize the respiration information to improve the averaging and thus analysis and interpretation of the BCG signal in diagnosis of cardiac malfunctions. This methodology is based on our investigation that BCG cycles corresponding to the inspiration and expiration phases of the respiration cycle are different in morphology. BCG cycles corresponding to the expiration phase of respiration have been proved to be more closely related to each other when compared to cycles corresponding to inspiration, and therefore expiration cycles are better candidates to be selected for the calculation of the averaged BCG signal. The new BCG average calculated based on this methodology is then considered as the representative and a template of the BCG signal for further processing. This template can be considered as the output of a clinical BCG instrument with higher reliability and accuracy compared to the previous processing methods.
Clients Improve Disease Prevention Behaviors Through Lifestyle‐oriented Nutrition Counseling Provided by Dietetic Students and Interns

An 8-week treatment-control intervention with 6-month follow-up study determined the effectiveness of disease prevention lifestyle-oriented nutrition counseling provided by dietetic interns/students to a convenience sample of 38 executive military and 30 campus clients (52 control subjects). Repeated measures distinguished changes between and within groups on the 4 disease prevention variables: fruit intake, vegetable intake, low-fat eating, and exercise. The executive military clients significantly improved their vegetable intake and low-fat eating behaviors (P < .001). Campus clients made some changes through the counseling, however relapsed by the 6-month follow-up. Clients collaborated with their counselors to pursue a wide variety of individualized goals through this lifestyle-oriented nutrition counseling.
Time and frequency recurrence analysis of persistent atrial fibrillation after electrical cardioversion

Electrical cardioversion (ECV) has become a mainstay of therapy for the treatment of persistent atrial fibrillation (AF), which is an arrhythmia that affects up to 1% of the general population. The procedure is initially effective, but it is also characterized by a high rate of AF recurrence. As a consequence, it would be clinically useful to predict normal sinus rhythm (NSR) maintenance after ECV before it is attempted. In this respect, several clinical, echocardiographic and demographic parameters have been analyzed by other authors. However, these indices are weak predictors of ECV outcome. In this work, surface electrocardiographic (ECG) recordings were used to extract the atrial activity (AA) signal and parametrize the fibrillatory (f) waves, both in time and frequency, to obtain AF recurrence predictors. Parameters as f waves amplitude (fWA), AA mean power, dominant atrial frequency (DAF), its first harmonic, etc were studied. Obtained results showed that fWA was the most significant predictor of AF recurrence 1 month later. Concretely, 72.73% of the patients resulting in NSR, 83.87% relapsing to AF and 80.0% with unsuccessful ECV, were correctly identified. Therefore, fWA classified satisfactorily 79.37% of the analyzed patients. In addition, a forward stepwise discriminant analysis, with a leave-one-out cross validation approach, proved that fWA and DAF combination provided an improved diagnostic ability of 85.71%. In this case 86.36%, 83.87% and 90% of the patients who resulted in NSR, relapsed to AF and with unsuccessful ECV, were correctly discerned, respectively. In conclusion, fWA could be considered as a promising predictor of ECV outcome during the first month following the procedure. Additionally, time and frequency indices could yield complementary information useful to predict the cardioversion outcome. Finally, further studies are needed to validate the robustness of these parameters and the repeatability of the obtained results on wider databases.
List multicoloring problems involving the k‐fold Hall numbers

We show that the four‐cycle has a k‐fold list coloring if the lists of colors available at the vertices satisfy the necessary Hall's condition, and if each list has length at least ⌈5k/3⌉; furthermore, the same is not true with shorter list lengths. In terms of h(k)(G), the k ‐fold Hall number of a graph G, this result is stated as h(k)(C4)=2k−⌊k/3⌋. For longer cycles it is known that h(k)(Cn)=2k, for n odd, and 2k−⌊k/(n−1)⌋≤h(k)(Cn)≤2k, for n even. Here we show the lower bound for n even, and conjecture that this is the right value (just as for C4). We prove that if G is the diamond (a four‐cycle with a diagonal), then h(k)(G)=2k. Combining these results with those published earlier we obtain a characterization of graphs G with h(k)(G)=k. As a tool in the proofs we obtain and apply an elementary generalization of the classical Hall–Rado–Halmos–Vaughan theorem on pairwise disjoint subset representatives with prescribed cardinalities. © 2009 Wiley Periodicals, Inc. J Graph Theory 65: 16–34, 2010.
Effects of aspartame on maternal-fetal and placental weights, length of umbilical cord and fetal liver: a kariometric experimental study

El aspartame es un endulzante sintetico consumido por mas de la mitad de la poblacion adulta, en 75 paises. Sus metabolitos pueden ser toxicos, principalmente en el higado y retina y hay algunos estudios sobre el aspartame en el embarazo. Veinte ratas prenadas fueron pesadas y distribuidas aleatoriamente (n=5 por grupo) y recibieron 14 mg/Kg de aspartame o agua por via oral- gastrica. Tratamiento 1: aspartame diluido en agua a temperatura ambiente; Tratamiento T2: aspartame diluido en agua tibia a 40 oC; control C1: agua a temperatura ambiente, y control C2: agua tibia a 40o C. Las placentas fueron pesadas, el cordon umbilical medido y 1000 nucleos de hepatocitos fetales (250 de cada grupo) se analizaron morfometricamente utilizando la tecnica de cariometria con aplicacion del Test U de Mann-Whitney U-Test. En el grupo tratado con aspartame diluido en agua a temperatura ambiente, hubo reduccion en los pesos promedios de la placenta y materno-fetal, largo del cordon umbilical y en la mayoria de los parametros cariometricos de los hepatocitos. Lo mismo ocurrio en el grupo tratado con aspartame diluido en agua a 40 oC. El uso del aspartame durante las gestacion puede ser perjudicial para el feto
Tiling 3‐Uniform Hypergraphs With K43−2e

Let K43−2e denote the hypergraph consisting of two triples on four points. For an integer n, let t(n,K43−2e) denote the smallest integer d so that every 3‐uniform hypergraph G of order n with minimum pair‐degree δ2(G)≥d contains ⌊n/4⌋ vertex‐disjoint copies of K43−2e . Kühn and Osthus (J Combin Theory, Ser B 96(6) (2006), 767–821) proved that t(n,K43−2e)=n4(1+o(1)) holds for large integers n. Here, we prove the exact counterpart, that for all sufficiently large integers n divisible by 4, A main ingredient in our proof is the recent “absorption technique” of Rödl, Ruciński, and Szemerédi (J. Combin. Theory Ser. A 116(3) (2009), 613–636).
Physical Activity at Child Care Settings: Review and Research Recommendations

Child care settings, such as nursery schools and preschools, provide important opportunities to increase physical activity in children aged 2 to 5 years. Because of the large numbers of children enrolled, physical activity interventions at child care facilities have the potential to reach many children at an age when behaviors are influenced more easily. To learn more about this possibility, the authors conducted a systematic review of the published literature for intervention studies conducted at organized child care settings that focused on increasing children’s physical activity levels. Although 8 databases were searched from their inception, only 9 studies were found that met inclusion criteria, all of which were published since 2003. Of these, 7 studies implemented some type of organized educational program or specific curricula, whereas 2 studies implemented environmental changes. Intervention length across studies varied from 2 days to 12 months. Five studies demonstrated a positive change in physical activity; however, the limited number of studies included and the range of research quality made it difficult to draw clear conclusions. A number of potential targets for increasing physical activity at child care settings were identified, including active opportunities, sedentary opportunities, physical environment, staff training and behavior, center policies, and outreach. All these areas seem to merit further investigation, and specific research questions for each are discussed.