Miracle-dz/UniFAR-FTUs huggingface dataset:
One Health: a doctor's perspective

One Health has been gaining traction over recent years, particularly among veterinarians and veterinary scientists, but the medical sector appears to be less engaged. Here, Josef Järhult, a doctor practising in Sweden, who is also a proponent of One Health, suggests some reasons why medics have yet to embrace the idea and how this could be overcome.
Ultrasound Guided Stellate Ganglion Block in Postmastectomy Pain Syndrome: A Comparison of Ketamine versus Morphine as Adjuvant to Bupivacaine

Background. The postmastectomy pain syndrome (PMPS) is chronic pain after breast cancer surgery and is reported to influence quality of life. The aim of this study was to provide long term reduction of PMPS, improve range of motion of the shoulder, and decrease the need for postoperative analgesia using ultrasound guided stellate ganglion block. Method. Sixty patients with PMPS were randomly allocated into 1 of 3 groups: bupivacaine group (group 1), bupivacaine plus ketamine group (group 2), and bupivacaine plus morphine group (group 3). Each patient received 3 blocks with an interval of one week in between. Patients were assessed for: pain visual analogue score (VAS), movement of the shoulder, skin temperature, and the need for analgesic drugs. Results. The pain VAS was significantly decreased in group 2 as compared to the other two groups. Shoulder movement improved significantly in the three studied groups with the best results observed after the third block. The need for the analgesic drugs in the form of gabapentin was more in the bupivacaine and bupivacaine plus morphine groups than in bupivacaine plus ketamine group. Conclusion. Treatment of PMPS with ultrasound guided stellate ganglion block using ketamine (0.5 mg/kg) as adjuvant to bupivacaine (0.25%) successfully decreased pain VAS and the need for analgesic drugs.
Letter: glucocorticoids use and the risk of colorectal cancer

tages of avoiding venous puncture, on one hand, and providing the results immediately, on the other. However, it seems to have some limitations. Of note, the concentration of the antibodies against the drug, which is essential for decision making in patients under antiTNFa treatment, could not be measured with this test. 8 Furthermore, as the authors recognise, the accuracy of this new test needs to be validated. In conclusion, the best method for measuring antiTNFa and antibody levels remains to be established, and the impact of monitoring anti-TNFa therapies based on serum levels needs to be proven. The development of new tests to make this measurement more feasible will facilitate the implementation of this strategy in the clinical management of patients receiving anti-TNFa therapies.
Commentary: oral or enteral nutritional supplementation in cirrhosis

1. Chen W-C, Quigley EMM. Commentary: irritable bowel syndrome and the CDAI misleading activity by straw men. Aliment Pharmacol Ther 2013; 37: 1020–1. 2. Lahiff C, Safaie P, Awais A, et al. The Crohn’s disease activity index (CDAI) is similarly elevated in patients with Crohn’s disease and in patients with irritable bowel syndrome. Aliment Pharmacol Ther 2013; 37: 786–94. 3. Keohane J, O’Mahony C, O’Mahony L, O’Mahony S, Quigley EM, Shanahan F. Irritable bowel syndrome-type symptoms in patients with inflammatory bowel disease: a real association or reflection of occult inflammation? The American journal of gastroenterology 2010; 105: 1788, 9–94. 4. Sandborn WJ, Feagan BG, Hanauer SB, et al. A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn’s disease. Gastroenterology 2002; 122: 512–30. 5. Lahiff C, Kane S, Moss AC. Drug development in inflammatory bowel disease: the role of the FDA. Inflammatory bowel diseases 2011; 17: 2585–93.
Reperfusion Injury as the Mechanism of Brain Damage after Perinatal Asphyxia

Upon reperfusion of ischemic tissues, reactive oxygen metabolites are generated and are responsible for much of the organ damage. Experimental studies have revealed two main sources of these metabolites: 1) the oxidation of hypoxanthine to xanthine and on to uric acid by the oxidase form of xanthine oxidoreductase and 2) neutrophils accumulating in ischemic and reperfused tissue. Blocking either source will reduce reperfusion damage in a number of experimental situations. Although xanthine oxidoreductase activity may be unmeasurably low in organs other than liver and intestine, it may be involved in reperfusion injury elsewhere because of its localization in capillary endothelial cells. Time course considerations suggest that substrate accumulation and NADH inhibition of dehydrogenase activity may be more important in the pathogenesis than conversion of xanthine dehydrogenase into the oxidase form. Neutrophil accumulation may be partly due to oxidants in the first place, suggesting a link between the two sources of reactive oxygen metabolites. In the clinical context, many of the sequelae of perinatal asphyxia may be accounted for by reperfusion damage to organs such as brain, kidney, heart, liver, and lungs. During asphyxia, substrates of xanthine oxidase accumulate, upon resuscitation the cosubstrate oxygen is introduced, and evidence for oxidant production and effects has been obtained. In the pathogenesis of brain damage after asphyxia, both microvascular injury and parenchymal cell damage are important. Oxygen metabolites are involved in the former, but in the latter process their role is less clear because ischemia-reperfusion triggers not only oxidant production but many other phenomena, including gene activation, ATP depletion, glutamate accumulation, and increase of intracellular calcium. A severe insult results in cell necrosis, but more moderate asphyxia may cause delayed neuronal death through apoptosis. The time course of the changes in high energy phosphates as well as of selective neuronal death suggest that in the first hours of life there is a“therapeutic window,” with future possibilities for prevention of permanent damage.
Letter: rapid infliximab infusion is not always safe – authors' reply

SIRS, Biological therapies with antitumour necrosis factor-a drugs, including infliximab, are now one of the popular therapies in the treatment of inflammatory bowel diseases and other diseases related to dysregulated immunity. 2 Despite their effectiveness in control of exacerbations and maintaining remission of these diseases, this class of drugs may have serious side effects including death. One of the major recommendations since introduction of infliximab, the first of these drugs to be commercially available, was slow infusion to avoid side effects. Neef et al. in their article have claimed that rapid infusion of infliximab is not associated with more side effects compared with standard infusion rate. As they have mentioned, this could not be generalised to every patient especially those who are naïve to this therapy. After several doses of infusion, patients usually develop antibodies to this chimeric protein. These antibodies could be neutralising or nonneutralising and accordingly could have different effects on occurrence of anaphylactic and other types of acute infusion reactions, as well as the efficacy of drug. I want to emphasise that the work of Neef et al. should not lead to a change in infusion rates for infliximab, especially in naïve patients.
Modest Hypothermia Provides Partial Neuroprotection when Used for Immediate Resuscitation after Brain Ischemia

Intraischemic reduction in temperature of 2-3 °C (modest hypothermia) has been demonstrated to provide partial neuroprotection in neonatal animals. This investigation determined if modest hypothermia initiated immediately after brain ischemia provides neuroprotection. Piglets were studied with rectal temperature maintained during the 1st h after 15 min of brain ischemia at either 38.3 ± 0.3 °C (normothermia, n = 11) or at 35.8± 0.5 °C (modest hypothermia, n = 11). The severity of brain ischemia was similar between groups as indicated by equivalent reduction in mean blood pressure (90 ± 15 to 24 ± 3 versus 92± 13 to 26 ± 3 mm Hg), and changes in cerebral metabolites and intracellular pH (pHi) measured by magnetic resonance spectroscopy(β-nucleoside triphosphate = 44 ± 9 versus 42 ± 18% of control, control = 100%, pHi: 6.25±.15 versus 6.24 ± 0.22 for normothermic and modestly hypothermic groups, respectively). In the first 90 min after ischemia, there were no differences between groups in the duration and extent of brain acidosis, and relative concentrations of phosphorylated metabolites. Categorical assessment of neurobehavior was evaluated at 72 h postischemia (n = 16), or earlier if an animal's condition deteriorated (n = 6). Postischemic hypothermia was associated with less severe stages of encephalopathy compared with normothermia (p = 0.05). Histologic neuronal injury was assessed categorically in 16 brain regions, and postischemic hypothermia resulted in less neuronal injury in temporal (p = 0.024) and occipital (p = 0.044) cortex at 10 mm beneath the cortical surface, and in the basal ganglia (p = 0.038) compared with that in normothermia. Modest hypothermia for 1 h immediately after brain ischemia provides partial neuroprotection and may represent an adjunct to resuscitative strategies.
Maturational Change in the Cortical Response to Hypoperfusion Injury in the Fetal Sheep

A characteristic of perinatal encephalopathies are the distinct patterns of neuronal and glial cell loss. Cerebral hypoperfusion is thought to be a major cause of these lesions. Gestational age is likely to influence outcome. This study compares the cortical electrophysiologic and histopathologic responses to hypoperfusion injury between preterm and near term fetuses. Chronically instrumented 0.65 (93-99-d, n = 9) and 0.9 (119-133-d, n = 6) gestation fetal sheep underwent 30 min of cerebral hypoperfusion injury. The parasagittal cortical EEG and impedance (measure of cytotoxic edema) responses plus histologic outcome (3 d) were compared. The acute rise in impedance was similar in amplitude, but the onset was delayed (5.0 ± 0.7 versus 9.1 ± 1.1 min, p < 0.05) in the preterm fetuses relative to those near term. In contrast the extent of the secondary rise was reduced (p < 0.01) and peaked earlier in the preterm fetuses (19.8 ± 1.0 versus 40.5 ± 3.5 h,p < 0.01). Both groups had a similar fall in EEG spectral edge frequency. The preterm fetuses had a milder loss of EEG intensity at 72 h(-7.7 ± 1.5 versus -12.8 ± 0.9 dB, p < 0.05). At both ages there was a predominantly parasagittal cortical distribution of damage with a similar pattern of neuronal loss in the thalamus and striatum. There was extensive selective neuronal loss within the upper layers of the cortex in those near term. In contrast the preterm fetuses developed subcortical infarcts (p < 0.05). The cortical response to injury altered during the last trimester. The results suggest the severity of the delayed phase of cortical neuronal injury and selective neuronal loss increased near term. In contrast, the preterm fetuses had a more rapidly evolving injury leading to necrosis of the subcortical white matter.
Tissue-Specific and Developmental Regulation of Transforming Growth Factor-β1 Expression in Fetal Lamb Ductus Arteriosus Endothelial Cells

We previously established that increased hyaluronan synthesis in ductus arteriosus (DA) compared with aorta (Ao) endothelial cells (EC) from early gestation fetal lambs (100-d, term = 145 d) is transforming growth factor-β (TGF-β)-dependent. We now address whether this is associated with tissue-specific and developmentally up-regulated expression of TGF-β1 in the 100-d DA EC. Immunoprecipitation revealed TGF-β synthesis doubled in DA versus Ao EC from 100-d gestation lambs (p < 0.05). In 138-d DA EC, TGF-β protein levels were reduced (p < 0.05) and comparable to those in Ao cells. Western immunoblotting with a β1 isoform-specific antibody confirmed these differences as being related to TGF-β1. Northern blot analysis demonstrated that TGF-β1 mRNA levels were slightly but not significantly increased in 100-d DA compared with Ao EC, despite its short half-life in DA (9.5 h) versus Ao EC (20 h). TGF-β1 mRNA levels were reduced in 138-d DA and Ao EC (p < 0.05), and the mRNA half-life was comparable in DA (9 h) versus Ao (13 h). Nuclear run-on analysis confirmed increased TGF-β1 mRNA transcription in 100-d DA versus Ao and 138-d DA EC. Thus, up-regulated TGF-β1 expression in 100-d DA compared with Ao cells is due to increased transcription and translation of a relatively unstable mRNA, and its down-regulation in 138-d DA and Ao EC is related to reduced mRNA transcription and stability, respectively.
Primary α‐sarcoglycan deficiency responsive to immunosuppression over three years

An 8‐year‐old girl developed weakness over 2 years and an elevated creatine kinase. The biopsy was most consistent with an active dystrophy with many inflammatory cells present. A trial of immunosuppression was started. In the first 2 months of treatment with prednisone, she had functionally and quantitatively significant improvement in her proximal strength. Over 3 years of treatment she maintained stable strength. Subsequent genetic studies showed that she had primary α‐sarcoglycan deficiency. The timing and the degree of benefit in strength were similar to that seen in boys with Duchenne muscular dystrophy who are treated with prednisone. © 1998 John Wiley & Sons, Inc. Muscle Nerve 21: 1549–1553, 1998
Editorial: coeliac disease – pathogenesis, prognosis and management

The international prevalence of coeliac disease is increasing and has been the subject of a comprehensive review showing geographical variation in prevalence. The reasons behind higher rates of coeliac disease within populations continue to be debated; alterations in infant feeding have been proposed, and recently reviewed in relation to breast feeding and weaning practices. The identification and diagnosis of coeliac disease is becoming increasingly important as researchers are demonstrating a greater number of associated health risks. Higher levels of mortality from cardiovascular disease have been demonstrated in people with coeliac disease compared to controls in Sweden, irrespective of a more favourable profile of traditional risk factors linked to ischaemic heart disease. It has been suggested that this increased risk may be due in part to some vascular impairment with chronic inflammation playing a role. Associated health risks are confounded in people with coeliac disease by the necessity to adhere to a gluten-free diet. The diet has been shown to be higher compared to population controls in total and saturated fat, significantly higher in males but not females, and significantly higher in kilojoules, after 1 year of gluten exclusion. It is noteworthy that differences and inadequacies in dietary intake are not mirrored to the same extent in children. Diet is the cornerstone to managing coeliac disease and promotion of adherence to a gluten-free diet is fundamental; it is therefore essential to understand individuals’ experiences. Those on a gluten-free diet have reported issues concerning both practical and emotional issues of living with a gluten restriction. 8 A survey from the USA concluded that people with coeliac disease have a diminished quality of life, especially in relation to social activities, and this was reinforced by a grounded theory study illuminating the effect of dietary restrictions on personal identity. Healthcare services therefore need to be organised to support people through diagnosis and management. It has been reported that some people with coeliac disease can suffer symptoms up to 25 years prior to diagnosis and have difficulties adhering to dietary restrictions. The availability of gluten-free products on prescription is a controversial area of management in coeliac disease. Under-prescribing of gluten-free products was identified in a review of electronic patient records in Scotland. However, the authors concluded that further research is required to establish prescribing patterns for the whole of the United Kingdom. This virtual issue brings together a selection of contemporary articles on coeliac disease facilitating an overview of original studies, both qualitative and quantitative, along with systematic reviews giving an exciting insight into current research. This is combined with a view to future developments in the management of coeliac disease.
Development and Environmental Applications of Activated Carbon Cloths

Activated carbon cloths have received growing attention because they offer comparative advantages over the traditional powdered or granular forms of this well-known adsorbent, providing further potential uses for technological innovations in several fields. The present article provides an overview of research studies and advances concerned with the development of activated carbon cloths and their use as adsorbent in environmental applications, mostly reported in the last years. The influence of some fabrics and textile wastes used as precursors, and of main activation process variables on the development and physicochemical, mechanical and/or electrical properties of the resulting activated carbon cloths are first reviewed. Then, investigations dealing with the removal of water and air pollutants by adsorption onto activated carbon cloths, including advances toward optimizing their regeneration after organic vapors saturation, are presented.
Effects of Prematurity on Arousal from Sleep in the Newborn Infant

The incidence of sudden infant death syndrome has been found to be consistently higher in preterm and low birth weight infants than in infants born at term. Failure to arouse from sleep is one possible mechanism for sudden infant death syndrome. This study compared the arousal responses to nasal air-jet stimulation in a longitudinal study between groups of healthy preterm and term infants. Preterm infants (n = 9) were born at 31–35 wk gestation with normal birth weights for gestational age and studied on three occasions: a preterm study at 36 wk, at 2–3 wk post-term, and at 2–3 mo post-term. Term infants (n = 22) were born at 37–42 wk and were studied at 2–3 wk and 2–3 mo post-term. Arousal thresholds were determined in both active sleep (AS) and quiet sleep (QS). In preterm infants, there was no state-related difference in arousal thresholds at either the 36 wk or 2–3 wk study; however, at 2–3 mo, arousal threshold was significantly greater in QS than AS (p < 0.05). In contrast, in term infants, arousal thresholds were significantly elevated in QS compared with AS at both 2–3 wk and 2–3 mo (p < 0.001). Arousal thresholds in AS were not different between the two groups of infants, with both groups of infants remaining readily arousable. However, in QS at 2–3 mo, arousal thresholds were significantly lower in the preterm infants (p < 0.05). This study has demonstrated that arousability is altered by gestational and postnatal age. The lower arousability that characterizes QS in term infants regardless of age is not evident in preterm infants until 2–3 mo post-term age.
The Cardiovascular System, vol 1: The Heart

ABSTRACT An official publication of the American Physiological Society is important. The Heart is the first of a projected five volumes entitled The Cardiovascular System, edited by Robert Berne and Nick Sperelakis. Twenty-five chapters contributed from among the ablest scientists cover normal cardiac function broadly. The utility of this handbook series has already been proved by the first edition, The Handbook of Physiology.All of those concerned with the preparation of this volume have performed admirably, making critical review of each chapter unnecessary.Such massive, expensive, and indepth surveys issued in bound handbooks underscore the persistent problem of communication in rapidly growing fields of knowledge. In this case it is a question of who will derive the most benefit from reading this prodigious work. Although the book is full of material relevant to clinical medicine, I would guess that it will be of most interest to students of physiology and full-time
Algorithmic Aspects of Vertex Elimination on Graphs

We consider a graph-theoretic elimination process which is related to performing Gaussian elimination on sparse symmetric positive definite systems of linear equations. We give a new linear-time algorithm to calculate the fill-in produced by any elimination ordering, and we give two new related algorithms for finding orderings with special properties. One algorithm, based on breadth-first search, finds a perfect elimination ordering, if any exists, in $O(n + e)$ time, if the problem graph has n vertices and e edges. An extension of this algorithm finds a minimal (but not necessarily minimum) ordering in $O(ne)$ time. We conjecture that the problem of finding a minimum ordering is NP-complete
Augmentation Problems

This paper considers problems in which the object is to add a minimum-weight set of edges to a graph so as to satisfy a given connectivity condition. Simple characterizations of the minimum number of edges necessary to make a directed graph strongly connected and to make an undirected graph bridge-connected or biconnected are given. Efficient algorithms for finding such minimum sets of edges are discussed. It is shown that the weighted versions of these problems are NP-complete. Key words, algorithm, augmentation, biconnectivity, bridge-connectivity, connectivity, graph, strong connectivity, NP-complete problem