Miracle-dz/UniFAR-FTUs huggingface dataset:
A new perspective on the importance of glycine conjugation in the metabolism of aromatic acids

Abstract A number of endogenous and xenobiotic organic acids are conjugated to glycine, in animals ranging from mosquitoes to humans. Glycine conjugation has generally been assumed to be a detoxification mechanism, increasing the water solubility of organic acids in order to facilitate urinary excretion. However, the recently proposed glycine deportation hypothesis states that the role of the amino acid conjugations, including glycine conjugation, is to regulate systemic levels of amino acids that are also utilized as neurotransmitters in the central nervous systems of animals. This hypothesis is based on the observation that, compared to glucuronidation, glycine conjugation does not significantly increase the water solubility of aromatic acids. In this review it will be argued that the major role of glycine conjugation is to dispose of the end products of phenylpropionate metabolism. Furthermore, glucuronidation, which occurs in the endoplasmic reticulum, would not be ideal for the detoxification of free benzoate, which has been shown to accumulate in the mitochondrial matrix. Glycine conjugation, however, prevents accumulation of benzoic acid in the mitochondrial matrix by forming hippurate, a less lipophilic conjugate that can be more readily transported out of the mitochondria. Finally, it will be explained that the glycine conjugation of benzoate, a commonly used preservative, exacerbates the dietary deficiency of glycine in humans. Because the resulting shortage of glycine can negatively influence brain neurochemistry and the synthesis of collagen, nucleic acids, porphyrins, and other important metabolites, the risks of using benzoate as a preservative should not be underestimated.
Managing Menopause: An Ethnographic Study of Women's Midlife Information-Seeking and Decision-Making in the Southwest U.S.

10 CHAPTER 1: INTRODUCTION 12 CHAPTER 2: METHODS & SAMPLE 36 CHAPTER 3: THE MAKING AND MARKETING OF RISK AND VULNERABILITY IN MENOPAUSE 70 CHAPTER 4: MENOPAUSAL SUBJECTIVITY: EMBODYING RISK AND THE LIVED-EXPERIENCE OF MENOPAUSE 139 CHAPTER 5: WOMEN’S WAYS OF KNOWING: INFORMATIONSEEKING AND DECISION-MAKING 205 CHAPTER 6: THE USE OF BIOIDENTICAL HORMONE THERAPY AS A MEANS OF HARM REDUCTION 253 CHAPTER 7: PROVIDER PERSPECTIVES ON MENOPAUSE MANAGEMENT 293 CHAPTER 8: CONCLUSION 336 APPENDIX A: PARTICIPANT CHART 356 APPENDIX B: KEY TERMINOLOGY 358 REFERENCES 363
De-engineering in the NHS

In 1986 the Chrysler Corporation of the United States recruited Robert Lutz to be its executive vice president. Later he was appointed president and chief operating officer. In a recent lecture he explained to the Royal Academy of Engineering how he had turned round the fortunes of what had been an ailing and unprofitable corporation by a process of what he described as “re-engineering”—incidentally making its cash reserves exceptionally attractive to predators. When he arrived he discovered innumerable “little bureaucratic empires,” chock-full of what he called “redo loops— miscommunications, false starts, doubling back to do again what should have been done right first time because nobody really worked together as a team. ” He created four “platform teams” (one for each main vehicle type), each under a single leader. Each was encouraged to help leaders of the other teams in every possible way. Each team was encouraged to view its suppliers as true extensions of the company rather than as “generic interchangeable vendors” whose only purpose in life was to do what they were told to do. “We've totally scrapped the age old system of auctioning off contracts to the lowest bidder. Instead we set what we call a ‘target cost’ for any given part or component, and work closely with trusted, preselected …
Is soluble transferrin receptor a good marker of iron deficiency anemia in chronic kidney disease patients?

Anemia in patients with chronic renal failure is multifactorial with an absolute or functional iron deficiency present in 60–80% of patients. In this study, 102 patients of stage 5 chronic kidney disease (CKD) were enrolled. Thirty six age- and sex-matched anemic patients without any known renal disease were taken as controls. Their sTfR levels were measured with anemia profile. (Fe, TIBC, Ferritin, TSAT). The patients were followed up twice, at four weeks and six months. There was a significant statistical difference in the mean sTfR levels in patients when compared to controls (P < 0.01). The mean level of sTfR in CKD patients was 3.23 ± 2.07 mg/l while in controls this was 5.16 ± 3.64 mg/l. sTfR had no statistically significant correlation with the levels of hemoglobin, iron, ferritin, TIBC and TSAT. We conclude that owing to complexity of iron metabolism in CKD, sTfR can not be used as a reliable marker of iron deficiency anemia.
Increasing rates of preterm twin births coincide with improving twin pair survival

Abstract Objective: To examine trends in twin gestational age over time, with adjustment for potential confounding factors, and to assess twin pair mortality and respiratory support over time. Methods: Rates of preterm births, respiratory support, and neonatal mortality were calculated for 21,569 twin pairs born from 1980 to 2005 in Washington State, using birth certificate and hospital discharge data. Fetal death risks were determined on a “per-pair-at-risk” basis. Results: While the proportion of twins born at 24–31 weeks remained stable at 8%, the proportion born at 32–36 weeks increased from 28% to 48%, and the proportion at 37–42 weeks declined from 64% to 44% (P<0.0001). Controlling individually for a variety of factors, such as maternal age, race, parity, and mode of delivery did not diminish the highly significant trend of increasing preterm births (P<0.0001 for each). Twin pair neonatal mortality decreased significantly through time (P<0.0001); however, the rate of pairs with one or both infants requiring oxygen or ventilation increased significantly through time (P<0.0001). Fetal death risks declined for term twins. Conclusions: The proportion of twins born at 32–36 weeks' gestation has increased over time, along with requirement for respiratory support. Twin pair mortality decreased from 1980 to 2005.
β+-Thalassemia Trait Due to a Novel Mutation in the β-Globin Gene Promoter: −26 (A>C) [HBB c.−76A>C]

We report the case of a woman with β+-thalassemia (β+-thal) trait, in which there were two sequence variants within the β-globin gene promoter: −54 (G>A) [HBB c. −104G>A] and −26 (A>C) [HBB c. −76A>C]. Data from other patients indicate that the −54 substitution is a non pathogenic sequence variant. Therefore, the β-thal phenotype is most likely due to the −26 mutation that is adjacent to the conserved ATAA box.
Comparison of Silver-Enhanced in situ Hybridization and Fluorescence in situ Hybridization for HER2 Gene Status in Breast Carcinomas.

specified elements to reduce assay variation such as specPurpose: Silver-enhanced in situ hybridization (SISH) is a newly developed method to evaluate HER2 gene amplification in invasive breast carcinomas. Most laboratories widely use fluorescence in situ hybridization (FISH) to evaluate the HER2 gene amplification status because FISH is a very sensitive and accurate technique. However, this technique is not the best because it requires specialized equipment and interpretation skills. We compared a new technique of SISH with FISH for assessing HER2 gene amplification in invasive breast carcinomas. Methods: HER2 gene amplification was assessed in 165 cases of invasive breast carcinoma by FISH and SISH with constructing a tissue microarray. The tumors were assessed by the guidelines of the American Society of Clinical Oncology/College of American Pathologists (ASCO/ CAP). Positivity was defined as a HER2/Chromosome 17 ratio greater than 2.2. Negativity was defined if the ratio was less than 1.8. The tumor was considered as equivocal for HER2 gene amplification if the ratio was between 1.8 and 2.2. The HER2 protein status was assessed. Immunostaining for HER2 protein was performed in a Benchmark automatic immunostaining device with using whole tissue sections. Results: There was agreement of the HER2 gene amplification status by SISH and FISH in 162 of 165 cases, which is a concordance rate of 98.2% (κ=0.94). There were three discrepant cases, with two of them being FISH positive and SISH negative (one case was IHC negative and one case was IHC positive) and one case was FISH negative and SISH equivocal. Conclusion: The 98.2% concordance between FISH and SISH meets the ASCO/CAP requirements for test validation of >95% concordance. These results indicate that SISH can be used as an alternative to FISH for assessing the HER2 gene amplification status in breast carcinomas.
Thalassemia and Hemoglobinopathies in Thua Thien Hue Province, Central Vietnam

A community-based assessment of thalassemias and hemoglobinopathies was conducted at the Thua Thien Hue Province, Central Vietnam. By cluster sampling, a total of 410 pregnant women attending the antenatal care service at 30 commune health centers were recruited consecutively from September 2011 to June 2012. Hemoglobin (Hb) analysis was performed using an automated Hb analyzer. α-Thalassemia (α-thal) genes were identified by polymerase chain reaction (PCR)-based techniques. Out of the 410 pregnant women, 2.7% carried α0-thal and 1.2% were β-thal carriers. One woman with the – –THAI deletion was also found. Among the females under survey, structural Hb variants with 3.2% Hb E [β26(B8)Glu→Lys, GAG>AAG; HBB: c.78G>C] and 3.7% Hb Constant Spring [Hb CS; α142, Term→Gln, TAA>CAA (α2); HBA2: c.427T>C] were found. Assessing the frequency of thalassemias and hemoglobinopathies by ethnicity, Kinh (Vietnamese) and ethnic minority groups, Hb CS with a high frequency of 24.0% was observed in the ethnic minority groups. These results provide basic population-based information, are useful not only for implementing measures for prevention and control of thalassemias in the region but also for studying the importance of thalassemias and hemoglobinopathies in ethnic minorities within Southeast Asia.
Resistance pattern of coagulase positive Staphylococcus aureus clinical isolates from Asir region, Kingdom of Saudi Arabia

The objectives of this study were to determine the prevalence of methicillin resistant coagulase positive Staphlococcus aureus (MRSA) infections in two major hospitals in Asir region, Kingdom of Saudi Arabia and to compare it with the community-acquired infections. Two hundreds and ten coagulase positive S. aureus recovered from 9831 specimens from various infections at Asir Central Hospital and Abha General Hospital, KSA (Kingdom of Saudi Arabia), were tested against 44 commonly used antibacterial agents. One hundred of the isolates were from hospital-acquired infections, 100 from community-acquired infections and 10 isolates were collected from the hospital environment. All isolates were found resistant to aztreonam, colistin, mecillinam, metronidazole, polymyxin B and nalidixic acid but were sensitive to vancomycin, nitrofurantoin and novobiocin. Various levels of resistant were recorded for the remaining antibiotics. High resistance to antimicrobial agents was detected among hospital acquired infections compared to community acquired infections (p<0.01). The resistance rates of S. aureus to antimicrobial agents among hospital acquired infections isolates were significantly higher (p<0.05) than community acquired infections. This implies that hospital environment is a strong risk factor for the prevalence of MRSA in the hospitalized patients, visitors, and hospital staff with potential risk of spreading to the community. Key words: Staphlococcus aureus, coagulase positive, Kingdom of Saudi Arabia (KSA).
Maternal and fetal cord blood lipids in intrauterine growth restriction

Abstract Aim: Small for gestational age neonates (SGA) could be subdivided into two groups according to the underlying causes leading to low birth weight. Intrauterine growth restriction (IUGR) is a pathologic condition with diminished growth velocity and fetal compromised well-being, while non-growth restricted SGA neonates are constitutionally (genetically determined) small. Antenatal sonographic measurements are used to differentiate these two subgroups. Maternal metabolic changes contribute to the pathogenesis of IUGR. A disturbed lipid metabolism and cholesterol supply might affect the fetus, with consequences for fetal programming of cardiovascular diseases. We evaluated fetal serum lipids and hypothesized a more atherogenic lipoprotein profile in IUGR fetuses. Methods: Umbilical cord serum lipids and oxidative modified, low-density lipoprotein (oxLDL) concentrations were measured by colorimetric enzymatic measurements, or by ELISA. Values of IUGR (n=36) and constitutionally small for gestational age neonates (SGA, n=22) were compared with those of healthy, adequate for gestational age, born neonates (CN, n=97). SAS-statistic software was used and two-way ANOVA was adjusted for gestational age at delivery. Results: Fetal high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) concentrations were found to be lower in the IUGR compared to the CN and SGA groups (HDL-C: P<0.001, TC: P<0.01). Atherogenic indices, including the oxLDL/LDL-C ratio, were increased in the IUGR compared to the CN group (oxLDL/LDL-C ratio: P<0.001). Conclusion: Our results support the hypothesis of a disturbed cholesterol supply in IUGR fetuses. Born SGA has been shown to be a risk factor for developing cardiovascular disease later in life. Since HDL-C has anti-inflammatory properties, a reduced HDL-C during fetal development, and an increase in atherogenic indices, might provide a link to this observation in IUGR fetuses.
Neoadjuvant chemotherapy in advanced epithelial ovarian cancer: A survival study

Abstract Context: Patients with advanced ovarian cancer have a poor prognosis in spite of the best possible care. Primary debulking surgery has been the standard of care in advanced ovarian cancer; however, it is associated with high mortality and morbidity rates as shown in various studies. Several studies have discussed the benefit of neoadjuvant chemotherapy in patients with advanced ovarian cancer. Aims: This study aims to evaluate the survival statistics of the patients who have been managed with interval debulking surgery (IDS) from January 2007 to December 2009. Materials and Methods: During the period from January 2007 to December 2009, a retrospective analysis of 104 patients who underwent IDS for stage IIIC or IV advanced epithelial ovarian cancer at our institute were selected for the study. IDS was attempted after three to five courses of chemotherapy with paclitaxal (175 mg/m 2 ) and carboplatin (5-6 of area under curve). Overall survival (OS) and progression free survival (PFS) were compared with results of primary debulking study from existing literature. OS and PFS rates were estimated by means of the Kaplan-Meier method. Results were statistically analyzed by IBM SPSS Statistics 19. Results: The median OS was 26 months and the median PFS was 18 months. In multivariate analysis it was found that both OS and PFS was affected by the stage, and extent of debulking. Conclusions: Neoadjuvant chemotherapy, followed by surgical cytoreduction is a promising treatment strategy for the management of advanced epithelial ovarian cancers.
Improving admission temperature in extremely low birth weight infants: a hospital-based multi-intervention quality improvement project

Abstract Objective: To reduce the incidence of hypothermia (admission temperatures <36°C) in extremely low birth weight (ELBW) neonates using a multi-intervention quality improvement (QI) initiative. Study design: We conducted a multi-intervention QI initiative to reduce hypothermia (admission temperatures <36°C) among preterm ELBW (≤1000 g birth weight) neonates born at Hutzel Women’s Hospital. The QI project was conducted in three periods: period 1, traditional thermal care of drying and wrapping in towel; period 2, wrapping in plastic wrap without first drying; and period 3, periodic staff education, additional use of chemical warming mattress, and increase in operating room temperature from 20°C to 21°C. Statistical analysis included ANOVA, χ2, and logistic regression as appropriate. Results: In our cohort of 209 patients, baseline characteristics were comparable in the three periods except for a reduction in the need for surfactant doses in the 3rd period. Temperature on admission to the neonatal intensive care unit was significantly higher, with a reduction in hypothermia in the 3rd period. There was no patient with a temperature of ≥37.5°C. On logistic regression, with gestational age, 5-min Apgar score, and mode of delivery as covariates, time period 3 was significantly associated with a reduction in the incidence of hypothermia (P=0.02). Conclusion: A concerted QI approach improved admission temperature in ELBW neonates, with more neonates in the euthermic range, without increasing the risk for hyperthermia. Such an approach could be associated with improved outcomes in this population.
Follicular mycosis fungoides – A report of four Indian cases

Background: Follicular Mycosis Fungoides (FMF) is an under-recognized disease in India. Its clinical mimics include Hansen’s disease and Sarcoidosis. Aims: To describe the clinical and pathological features of FMF. Materials and Methods: All cases of FMF between January and December 2007 were retrieved. Cases of conventional epidermotropic MF with a minor follicular component were excluded. Slides were reviewed by two observers. The following criteria were assessed: degree and density of folliculotropism of lymphocytes, location of folliculotropism (infundibular / isthmic / bulbar), follicular mucin, eosinophils, granulomas, and conventional epidermotropism. Each feature was assigned a semi-quantitative grade. Results: There were four cases of FMF, with an equal gender distribution and a mean age of 17.5 years. All lesions were on the face. They presented as: hypopigmented patches (2) and erythematous plaques (2). Alopecia was seen in two cases. The clinical diagnosis was Hansen’s disease in all four, with a differential of Alopecia mucinosa / Sarcoidosis in two cases.The histological features seen were: disproportionate folliculotropism, lymphocyte tagging with haloes, follicular mucin, and nucleomegaly / convolution in all four cases, prominent eosinophils (2), epithelioid granulomas (1), eccrine infiltration (4), parakeratosis at the follicular ostia (2), and sebaceotropism (1). The infiltrate was bulbar (4) and isthmic (2). The rest of the epidermis showed no hint of conventional MF. Conclusion: The preferential features for FMF were involvement of face, dominant folliculotropism, nuclear atypia and convolution, and follicular mucin. Presence of granulomas and eosinophils necessitated exclusion of infectious causes. The absence of findings of MF in the rest of the epidermis should not deter pathologists from rendering this diagnosis.
Effects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney Disease

Background: Antiplatelet agents are used to prevent cardiovascular events; however, treatment effects may differ in persons with chronic kidney disease (CKD) because atherosclerotic disease is less prevalent, whereas bleeding hazards may be increased in this population. Purpose: To summarize the effects of antiplatelet treatment on cardiovascular events, mortality, and bleeding in persons with CKD. Data Sources: Embase and Cochrane databases through November 2011 without language restriction. Study Selection: Randomized trials that included adults with CKD and compared antiplatelet agents with standard care, placebo, or no treatment. Data Extraction: Data for populations, interventions, outcomes, and risk for bias were extracted. Quality of evidence for treatment effects on myocardial infarction, death, and bleeding was summarized by using Grading of Recommendations Assessment, Development, and Evaluation guidelines. Data Synthesis: Nine trials (all post hoc subgroup analyses for CKD) involving 9969 persons who had acute coronary syndromes or were undergoing percutaneous coronary intervention and 31 trials involving 11 701 persons with stable or no cardiovascular disease were identified. Low-quality evidence has found that in persons with acute coronary syndromes, glycoprotein IIb/IIIa inhibitors or clopidogrel plus standard care compared with standard care alone had little or no effect on all-cause or cardiovascular mortality or on myocardial infarction but increased serious bleeding. Compared with placebo or no treatment in persons with stable or no cardiovascular disease, antiplatelet agents prevented myocardial infarction but had uncertain effects on mortality and increased minor bleeding according to generally low-quality evidence. Limitations: Data for antiplatelet agents in persons with CKD are frequently derived from post hoc analyses of trials of broader populations. Definitions for bleeding outcomes and trial duration were heterogeneous. Conclusion: Benefits for antiplatelet therapy among persons with CKD are uncertain and are potentially outweighed by bleeding hazards. Primary Funding Source: None.
Síndrome de Guillain-Barré: patogenia, diagnóstico y cuidados críticos en pediatría

El sindrome de Landry-Guillain-Barre-Strohl, se caracteriza por una paralisis motora ascendente o descendente bilateral con relativa simetria, hiporreflexia o arreflexia, toma bulbar, no presencia de trastornos sensitivos objetivos, sintomas disautonomicos y la paralisis respiratoria es la complicacion mas grave. El factor autoinmune y el fenomeno precedente tienen valor en la patogenia. El manejo de los pacientes debe ocurrir en una Unidad de Terapia Intensiva durante la fase de progresion, para el monitoreo ventilatorio y hemodinamico. Se debe garantizar nutricion, balance hidromineral neutro, control de la via aerea y ventilacion mecanica de acuerdo con los criterios clinicos, gasometricos y electrofisiologicos. La plasmaferesis, los esteroides y la gammaglobulina intravenosa parecen ser propuestas razonables de tratamiento si se utilizan en el momento adecuado.
A Retrospective Analysis of Serial Measurement of Serum Cholinesterase in Acute Poisoning with Organophosphate Compounds

Objectives: Retrospective analysis of the utility of serial measurements of serum acetylcholinesterase (AChE) in predicting the duration of stay in the intensive care unit (ICU), duration of mechanical ventilation (MV) and outcome of the patient from MV in organophosphate (OP) compound poisoning patients. Materials and Methods: The medical records of patients who presented to tertiary care hospital with symptomatic insecticidal poisoning from January 2009 to December 2010 were utilized for the study purpose. Forty four patients with history of poisoning were admitted during this period. Out of these 37 patients with history of OP poisoning, without any underlying diseases and whose serial AChE activity levels were available were included in the study. Data regarding clinical manifestation at presentation, AChE activity results and its interpretation, details of patient management and data on outcomes of patients were noted. Results: Serum acetycholinesterase levels below 1,250IU/L, 1,789IU/L and 2,764IU/L on day three, day four and five respectively indicates longer duration of stay in the ICU. Patients with serum AChE levels below 975IU/L, 876IU/L, 1,245IU/L, 1,395IU/L and 1,875IU/L on day one, two, three, four and five respectively take a longer time to be out of mechanical ventilation. Levels below 870IU/L, 1,110IU/L, 1,020IU/L and 885IU/L on day two, three, four and five respectively indicate poor prognosis of the patient and mortality. Conclusion: We conclude that the serial measurements of serum acetylcholinesterase levels can be useful in predicting the length of ICU stay, duration of mechanical ventilation and the prognosis of the patient with OP poisoning.