Miracle-dz/UniFAR-FTUs huggingface dataset:
Human fetal anatomy of the coccygeal attachments of the levator ani muscle

In contrast to the attachments to the pubis and rectum, there is little information on fetal development of the coccygeal attachment of the levator ani muscles. We find that at 9 weeks, the coccygeus muscle is a large muscle facing the piriformis or gluteus maximus and inserting onto the ischial spine, whereas the levator ani is restricted to the area near the pubis. By 12 weeks, the levator ani also obtains attachment to the ischial spine immediately ventral to the coccygeus muscle. The most superior part of the coccygeus muscle occupies a space at an angle between the pelvic splanchnic and pudendal nerves. Notably, medial to the coccygeus muscle, a third parasagittal muscle (previously termed the sacrococcygeus anterior) appears by 12 weeks, increases in mass by 18 weeks, and connects and mixes with the dorsal end of the levator ani by 18–20 weeks. Thus, the coccygeal attachment of the levator ani appears not to depend on the dorsal extension of the muscle itself but on fusion with the sacrococcygeus anterior. Therefore, the final levator sheet is formed medial (internal) to the coccygeus muscle and originates from two distinct anlage. Clin. Anat. 23:566–574, 2010. © 2010 Wiley‐Liss, Inc.
Managing diabetes in cystic fibrosis

Cystic fibrosis related diabetes (CFRD) is the most common co‐morbidity in persons with cystic fibrosis (CF). As the life expectancy of persons with CF continues to increase, the need to proactively diagnose and aggressively treat CFRD and its potential complications has become more apparent. CFRD negatively impacts lung function, growth and mortality, making its diagnosis and management crucial in a population already at high risk for early mortality. Compared to type 1 and type 2 diabetes, CFRD is a unique entity, requiring a thorough understanding of its unique pathophysiology to facilitate the creation and utilization of an effective medical treatment plan. The physiology of CFRD is complex, likely consisting of a combination of insulin deficiency, insulin resistance and a genetic predisposition towards the development of diabetes. However, the hallmark of CFRD is insulin deficiency, necessitating the use of exogenous insulin as the mainstay of therapy. Insulin administration, in combination with a multidisciplinary team of health professionals with expertise in the care of patients with CF and CFRD, is the cornerstone of the care for these patients. The goals of treatment of the CFRD population are to reverse protein catabolism, maintain a healthy weight, and reduce acute and chronic diabetes complications. Creating a partnership between the treatment team and the patient is the ideal way to accomplish these goals and is essential for successful diabetes care.
Comparison of diagnostic validity of mannitol and methacholine challenges and relationship to clinical status and airway inflammation in steroid-naïve asthmatic patients

ABSTRACT Objectives: The purpose of this study was to demonstrate and compare the diagnostic validity of two bronchial challenges and to investigate their correlation with patient clinical status, atopy and inflammation markers. Methods: Eighty-eight patients, 47 women and 41 men, mean age 38.56 ± 16.73 years who presented with asthma related symptoms and were not on any anti-asthma medication, were challenged with mannitol and methacholine on separate days. Medical history regarding asthmatic symptoms, physical examination, skin prick tests and FeNO levels were also assessed. The clinical diagnosis of asthma was based on bronchodilator reversibility test. Results: Sixty-seven patients were diagnosed with asthma and 21 without asthma. Both methacholine (P < 0.014) and mannitol (P < 0.000) challenges were significant in diagnosing asthma. The positive/negative predictive value was 93.33%/41.86% for methacholine, 97.72%/45.45% for mannitol and 97.05%/45.45%. for both methods assessed together. Worthy of note that 22% of asthmatics had both tests negative. There was a negative correlation between PC20 of methacholine and the FeNO level P < 0.001, and positive with the PD15 of mannitol P < 0.001 and the pre-test FEV1% pred P < 0.005, whereas PD15 of mannitol was negatively correlated with the FeNO level P < 0.001. Furthermore, dyspnea was the only asthmatic symptom associated with FeNO level P < 0.035 and the positivity of mannitol P < 0.014 and methacholine P < 0.04. Conclusions: Both challenge tests were equivalent in diagnosing asthma. Nevertheless, specificity appeared to be slightly higher in mannitol challenge.
Coexisting COPD in elderly asthma with fixed airflow limitation: Assessment by DLco %predicted and HRCT

ABSTRACT Background: Asthma patients with fixed airflow limitation (FL) are theoretically classified into two phenotypes, that is, coexisting chronic obstructive pulmonary disease (COPD) and asthmatic airway remodeling. However, the precise percentages of such patients are not known. Objective: To assess the prevalence of patients with both FL and COPD components in elderly asthma. Methods: We evaluated patients by lung diffusion impairment and emphysematous findings in high-resolution computed tomography (HRCT) as candidates for COPD components, as a multicenter, cross-sectional survey. Asthma outpatients ≥ 50 years of age were enrolled from Tohoku University Hospital, Sendai, Japan, and four hospitals (Tohoku Medical and Pharmaceutical University Wakabayashi Hospital, Sendai, JAPAN; Wakayama Medical University Hospital, Kimiidera, Japan; Hiraka General Hospital, Yokote, Japan; Iwate Prefectural Isawa Hospital, Oshu, Japan) with pulmonary physicians from March 1, 2013 to November 30, 2014. Results: The prevalence of patients with FEV1/FVC <70% was 31.0% of those in their 50s, 40.2% of those in their 60s and 61.9% of those in their 70s or older. The prevalence of those patients with lung diffusion impairment (i.e. the percent predicted values of diffusing capacity of the lung for carbon monoxide (DLco %predicted) <80%) or emphysematous findings in HRCT (i.e. the appearance of low attenuation area (LAA)) was 18.3% of those in their 50s, 13.8% of those in their 60s and 35.7% of those in their 70s or older. Conclusions: Nearly half of the patients with FL in elderly asthma show coexisting COPD components when assessed by DLco %predicted and LAA in HRCT.
Lack of pharmacokinetic interaction between dapagliflozin, a novel sodium–glucose transporter 2 inhibitor, and metformin, pioglitazone, glimepiride or sitagliptin in healthy subjects

Aims: Dapagliflozin increases urinary glucose excretion by selectively inhibiting renal sodium–glucose transporter 2, an insulin‐independent mechanism of action that may be complementary to that of other oral antidiabetes drugs. The current studies assessed the potential for pharmacokinetic (PK) interaction between dapagliflozin and pioglitazone, metformin, glimepiride or sitagliptin in healthy subjects following single‐dose administration.
Prevalence and associated factors for self-reported asthma in a Canadian population: The Canadian Community Health Survey, 2014

ABSTRACT Background: Asthma prevalence is increasing among adults, yet limited information regarding the association between adult asthma and environmental and personal exposures is available using large nationally representative population-based survey. Objective: To determine the prevalence of asthma and associated factors for self-reported asthma in a Canadian population aged 12 years and older by using the Canadian Community Health Survey (CCHS) 2014 cross-sectional cohort. Methods: We used data from the 2014 CCHS. Asthma was determined through self-reported health professional diagnosis. Information regarding covariates of importance, such as socio-economic status, life style variables, was obtained. A weighted logistic regression analysis was performed with appropriate technique for clustering effects. Results: Estimated self-reported asthma prevalence of 8.1% in the greater than 12 years old Canadian population was observed. We found that a substantial proportion of Canadians (aged 12 and older) reported having asthma and geographical differences and differences between specific provinces in asthma prevalence. Women had higher prevalence of asthma than men, but the relationship depended on age and body mass index (BMI). Interactions between household income and smoking status were observed to predict the probability of asthma. Conclusions: Additional studies are needed to determine which factors influence the asthma prevalence between sex, BMI as well as smoking status and household income and its interactions with each other.
Beliefs and attitudes of nurses and physicians about do not resuscitate orders and who should speak to patients and families about them

Objective:Both physicians and nurses play important roles in discussing do not resuscitate (DNR) orders with patients and surrogates. However, the beliefs and attitudes of health professionals about the role nurses should play in this process have received little systematic study. Design and Setting:An anonymous survey was conducted of 217 attending internists, 132 medical house officers, and 219 staff nurses working on the medical floors and units at two teaching hospitals about their beliefs, attitudes, and confidence regarding DNR discussions. Results:Attendings and house officers were more likely than nurses to believe that nurses should never initiate DNR discussions (p < .001). Nonetheless, 69% of both physician groups agreed that nurses should be allowed to do so. Nurses were the most likely of the three groups to consider DNR discussions rewarding clinical experiences (p < .001). In a multivariate ordinal regression model controlling for sex, attitudes about DNR discussions, and confidence in discussing consent for medical procedures, nurses were less confident than attendings (p = .04) but more confident than house officers in their ability to discuss DNR orders (p = .02). Conclusions:Staff nurses were more likely than their physician colleagues to believe they should be allowed to initiate DNR discussions, were more confident in their ability to discuss DNR than house officers, and had more positive attitudes. These results suggest further exploration of the role nurses should play in the DNR process.
Smokers who have children with asthma: Perceptions about child secondhand smoke exposure and tobacco use initiation and parental willingness to participate in child-focused tobacco interventions

ABSTRACT Objective: This study examined, among parents who smoke and have children with asthma, perceptions about child secondhand smoke exposure (SHSe), child tobacco use (TU) initiation, and parent willingness to participate in child-focused tobacco interventions. Methods: Participants were 300 caregivers who smoked and had a child with asthma (aged 10–14). Parents completed an online survey and self-reported perceptions about child SHSe elimination, child TU prevention, and willingness to participate in three types of interventions with and without their child (SHSe reduction intervention, tobacco prevention intervention, and the combination of the two). Correlates of perceptions and willingness were examined. Results: Parents who were ready to quit smoking and who reported home smoking bans (HSBs) were more motivated to eliminate SHSe (p < 0.05). Being white, younger, ready to quit, and having HSBs were associated with greater confidence to eliminate SHSe (p < 0.05). Parents with HSBs reported higher perceived importance about preventing child TU (p < 0.05). Parents were less confident about preventing male children from using tobacco (p = 0.001). Parents were highly willing to participate in all the described intervention approaches, with or without their child. Conclusions: Parents were willing to participate in child-focused tobacco interventions, with or without their child with asthma, including interventions that address both child SHSe and TU prevention. This research demonstrates the acceptability of child-focused tobacco interventions among a high-risk population and may be a foundational step for intervention development.
Ecological validity of cognitive rehabilitation software

This article presents a case for the use of a more realistic and “ecologically valid” software in cognitive rehabilitation. Beginning with a discussion of the state of the field, the author discusses the variety of programs used in computer-assisted training or cognitive rehabilitation (CACR), along with suggestions for improving the realism depicted in the software in common use in rehabilitation settings. Two newer approaches to CACR are reviewed: one recently introduced by IBM under the title THINKable and the other a system employing interactive video disc. The relative merits of these newer approaches are reviewed, and the need for greater innovation and research is emphasized.
Seasonal patterns of Asthma medication fills among diverse populations of the United States

ABSTRACT Objective: Nonadherence to controller and overuse of reliever asthma medications are associated with exacerbations. We aimed to determine patterns of seasonal asthma medication use and to identify time period(s) during which interventions to improve medication adherence could reduce asthma morbidity. Methods: We conducted a retrospective cohort study of asthmatics 4–50 years of age and enrolled in three diverse health insurance plans. Seasonal patterns of medications were reported by monthly prescription fill rates per 1000 individuals with asthma from 1998 to 2013, and stratified by healthcare plan, sex, and age. Results: There was a distinct and consistent seasonal fill pattern for all asthma medications. The lowest fill rate was observed in the month of July. Fills increased in the autumn and remained high throughout the winter and spring. Compared with the month of May with high medication fills, July represented a relative decrease of fills ranging from 13% (rate ratio, RR: 0.87, 95% confidence interval, 95%CI: 0.72–1.04) for the combination of inhaled corticosteroids (ICS) + long acting beta agonists (LABA) to 45% (RR: 0.55, 95%CI: 0.49–0.61) for oral corticosteroids. Such a seasonal pattern was observed each year across the 16-year study period, among healthcare plans, sexes, and ages. LABA containing control medication (ICS+LABA and LABA) fill rates were more prevalent in older asthmatics, while leukotriene receptor antagonists were more prevalent in the younger population. Conclusions: A seasonal pattern of asthma medication fill rates likely represents a reactive response to a loss of disease control and increased symptoms. Adherence to and consistent use of asthma medications among individuals who use medications in reaction to seasonal exacerbations might be a key component in reducing the risk of asthma exacerbations.
β‐Lactam regimens for the febrile neutropenic patient

A total of 535 evaluable febrile episodes in neutropenic patients were randomly assigned to treatment with ticarcillin‐clavulanate plus vancomycin (TV), ceftazidime plus vancomycin (CV), or all three antibiotics (TCV). The TCV regimen was significantly more effective than TV, considering all evaluable episodes, documented infections, gram‐negative infections, and infections in patients with persistent severe neutropenia (< 100 neutrophils/mm3). The results with CV were intermediate between TV and TCV. The toxicities were similar with all three regimens and consisted primarily of skin rashes. The TCV regimen is effective for empiric therapy of fever in neutropenic patients and probably should be utilized in preference to CV or TV, although its superiority over CV in this study was inconclusive.
Allicin, a major component of garlic, inhibits apoptosis in vital organs in rats with trauma/hemorrhagic shock*

Objective:Allicin is believed to be the main component responsible for the biological activity of garlic. The regulation of cell apoptosis may have therapeutic potential for trauma/hemorrhagic shock, and previous studies have demonstrated that allicin exerts protective effects against tissue ischemia-reperfusion injury. Therefore, this study examined the effects of allicin on apoptosis-related organ damage, induced by trauma/hemorrhagic shock. Methods:Studies were performed on an in vivo model of spontaneously breathing rats with induced trauma/hemorrhagic shock; the left lower lobe of the lungs, left kidney, and intestine were resected, and the rats were subjected to femur fracture, ischemia for 30 mins, and reperfusion for 20 mins. Allicin (30 &mgr;g/kg) was administered during reperfusion. Results:Allicin administered during reperfusion markedly attenuated injury and apoptosis of the lungs, kidneys, and intestine and decreased the concentrations of lactic acid and creatinine, the number of in situ TdT-mediated dUTP nick-end labeling-positive cells, and the activity and expression of caspase-3 and -9 (as determined by Western blot). Furthermore, immunohistochemistry and Western blot performed 24 hrs after reperfusion revealed increases in the levels of nuclear factor &kgr;B, phosphorylated p38, and extracellular signal-regulated kinase 1 mitogen-activated protein kinase in the allicin-untreated group when compared with the sham rats. Allicin treatment downregulated the levels of nuclear factor &kgr;B and phosphorylated p38 mitogen-activated protein kinase but did not modify those of phosphorylated extracellular signal-regulated kinase 1 mitogen-activated protein kinase. Conclusion:Allicin attenuates tissue injury and inhibits trauma/hemorrhagic shock- and reperfusion-induced apoptosis in several important organs via the p38 mitogen-activated protein kinase signal transduction pathway that functions to stimulate the activation of nuclear factor-&kgr;B, caspase-3 and -9, but not of extracellular signal-regulated kinase 1 mitogen-activated protein kinase.
An Internet Study of User’s Experiences of the Synthetic Cathinone 4-Methylethcathinone (4-MEC)

Abstract A synthetic cathinone called 4-methylethcathinone (4-MEC) emerged online in 2010, and was cyber-marketed to be a replacement for mephedrone. The study aimed to present user experiences of 4-MEC as reported on the Internet, with a focus on user profiles, sourcing and product characteristics, routes of administration, dosage, positive and undesirable effects, and comparisons to mephedrone. Twenty-three individual, anonymous trip reports of the sole use of 4-MEC, and 112 screenshots of general 4-MEC user discussion boards, were taken from a purposeful sample of public drug-related sites. A content textual analysis was conducted on extracted qualitative information and produced 41 categories compiled into five general themes: “Type of 4-MEC user”; “Sourcing, informed decision making, product characteristics, and quality assurance”; “Routes of administration, gauging of dosage, and consumption of other drugs”; “Time course effects and outcomes”; and “Comparisons with mephedrone. ” 4-MEC is sold as white beads, crystalline shards, or green balls. User motives centered on curiosity, pricing, and ease of web sourcing. Oral, nasal, injecting, eyeball, and rectal routes of administration were described. Testing for purity, “allergy testing,” and gauging of dosage were common. Users described euphoric but short-lived effects, with little comedown. Continued research is vital to inform harm reduction.
Short‐term intensified insulin treatment in type 2 diabetes: long‐term effects on β‐cell function

The natural history of type 2 diabetes (T2DM) is characterized by progressive deterioration of pancreatic β‐cell function, leading to worsening glycemia over time. As current antidiabetic therapies have not yet been shown to profoundly alter this natural history, many patients ultimately will require exogenous insulin therapy to obtain adequate glycemic control. Interestingly, the temporary use of short‐term intensive insulin therapy early in the course of T2DM has recently emerged as a therapeutic option that may offer favourable long‐term effects on β‐cell function. Indeed, after receiving this treatment, many patients will experience sustained euglycemia without requiring any antidiabetic therapy. This apparent ‘remission’ of diabetes is likely secondary to improved β‐cell function and can last for more than a year, although it is not sustained and hyperglycemia eventually will return. Nevertheless, owing to its effects on β‐cell function, short‐term intensive insulin therapy holds promise as a means for modifying the natural history of T2DM and warrants further study in this context. In this report, we will review the rationale and evidence underlying this interesting therapeutic option, and its implications for both clinical research and the management of patients with T2DM.
Evaluating the Effects of Varenicline on Craving, Withdrawal, and Affect in a Randomized, Double-Blind, Placebo-Controlled Clinical Trial of Varenicline for Smokeless Tobacco Dependence in India

Abstract This study examined changes in tobacco craving, withdrawal, and affect as correlates of efficacy in a phase-2 clinical trial of varenicline for smokeless tobacco dependence in India. Smokeless tobacco users (N = 237) at the All India Institute of Medical Sciences were randomized to placebo or varenicline. Abstinence was defined as cotinine-verified seven-day point prevalence cessation at end of treatment (EOT). General Linear Model repeated measures assessed the effects of treatment condition, time, abstinence state, and interaction effects on changes in craving, withdrawal, positive (PA) and negative affect (NA) from baseline to EOT. All participants showed a significant reduction in withdrawal (p < .001), total craving (p < .001), positive reinforcement (PR) craving (p < .001), and NA (p = .02), and an increase in PA (p = .04) from baseline to EOT. However, there were no differences between placebo and varenicline participants in measures of withdrawal, craving, or affect from baseline to week 3 or at EOT. Significant interactions between time and abstinence state were found for total craving (p = .008), PR craving (p < .001), and withdrawal (p = .001), indicating reductions in these processes among those abstinent vs. those still chewing smokeless tobacco. Additional research is needed concerning the effects of varenicline on craving, withdrawal, and affect among smokeless tobacco users.
Striking out squash injuries – What is the evidence?

Injuries sustained during squash account for only a small proportion of the total injuries to sports participants. However, squash ranks as one of the sports most associated with severe injury. There are four major categories of squash injury: musculoskeletal injuries, eye and head injuries, heat illness, and cardiac injury/death. The indoor nature and specific equipment requirements of the sport highlight the importance of facility design, maintenance and management in preventing squash injuries. The aim of this paper was to critically review the literature for the demonstrated effectiveness of injury prevention measures designed specifically for the game of squash. This review of both formal literature and informal sources has shown that many injury prevention measures can be implemented to help reduce the risk of squash injury. However, few controlled studies of these countermeasures have been undertaken. To date, the most widely evaluated countermeasure has been protective eyewear with a number of stu.