Miracle-dz/UniFAR-FTUs huggingface dataset:
Clinical impact of the use of 16S rRNA sequencing method for the identification of “difficult‐to‐identify” bacteria in immunocompromised hosts

Molecular method of 16S rRNA sequencing is reported to be helpful in the accurate identification of organisms with ambiguous phenotypic profiles. We analyzed the use of 16S rRNA sequencing method to identify clinically significant, “difficult‐to‐identify” bacteria recovered from clinical specimens, and evaluated its role in patient management and consequent clinical outcome. Among the 172 “difficult‐to‐identify” bacteria recovered over a 4‐year period, 140 were gram‐positive cocci or gram‐negative bacilli; identification by 16S rRNA did not play a role in the management of patients infected with these bacteria. From 32 patients, 33 “difficult‐to‐identify” gram‐positive bacilli were identified; the organisms were mycobacteria, Nocardia, Tsukamurella, Rhodococcus, and Gordonia. In 24 patients for whom clinical data were available, results from the 16S rRNA sequencing method led to treatment change in 14 immunocompromised patients (including 7 hematopoietic stem cell recipients and 1 liver transplant recipient). Therapy was modified in 9 patients, initiated in 3 patients, and discontinued in 2 patients. Most patients’ therapy was switched to oral antibiotics with discontinuation of intravascular catheters, facilitating early hospital discharge. All 14 patients were alive 30 days after infection onset. The present study demonstrates the clinical application of 16S rRNA sequencing method to identify “difficult‐to‐identify” mycobacteria and other gram‐positive bacilli in clinical specimens, particularly in immunocompromised hosts.
Pattern of use of analgesics in a surgical unit

The present study was designed to evaluate the prescribing pattern of analgesics in post-operative patients in a surgical unit . Total number of 180 prescriptions containing analgesics was collected randomly. The only drug in the operation day that was used was pethidine (90.6%). Patients (9.4%) did not receive any analgesics in the operation day. Associated analgesics in the operation day were either tramadol (42.2 %) or ketorolac (54.4%). Only 3.3% did not receive any such drugs. In first post-operative day most of the patients received single drug tramadol (48.3%), ketorolac (38.9%) and pethidine (0.6%). In second, third, forth and fifth post-operative day most patients received tramadol (47.8%) (44.4%), (41.4%) and (33.2%) respectively. In sixth post-operative day most of the patients (81.1%) did not receive any analgesics. In this study tramadol was found to be widely used post-operative analgesics with minimal side effects and better adherence to this drug by the patient.
The effects of smoking on periodontal disease: An evidence-based comprehensive literature review

The positive relationship between smoking and major general health diseases such as cancer, cardiovascular disease, pulmonary disease and negative pregnancy outcomes is already established. Moreover, the association between smoking as a major environmental risk factor for periodontal disease has also been established. Smoking is considered to have negative adverse effect on periodontal therapy ranging from non-surgical treatment, periodontal surgery, regenerative procedures and implants. This review article will attempt to build on previous studies in the periodontal literature in order to present an evidence-based comprehensive literature review on the effects of smoking on periodontal therapy.
The influence of short-term high altitude training on inflammatory and prooxidative-antioxidative indices in alpine ski athletes

The influence of short-term high altitude training on inflammatory and prooxidative-antioxidative indices in alpine ski athletes Exposure of alpine skiing athletes, while training, at altitude hypoxia and low ambient temperature can modify the response of the immune system and increase reactive oxygen and nitrogen species (RONS) generation. The aim of this study was to evaluate the impact of six day training model "live low - train high" on selected indicators of immune and antioxidant-prooxidant balance of alpine skiing competitors. The study was performed in 7 men, alpine skiers, who underwent 6-day training at Kaunertal glacier (3160 m). Before departure to glacier training, and after returning to sea level participants underwent series of tests. Somatic characteristics, anaerobic exercise capacity, blood morphological parameters and concentrations of interleukin 6 (IL-6), C-reactive protein (hsCRP), thyroid stimulating hormone (TSH), thiobarbituric acid reactive substances (TBARS), total antioxidant status (TAS), total iron (Fe) and total iron binding capacity (TIBC) were assessed. High altitude training has led to a significant increase in anaerobic capacity (p<0.05) and serum concentrations of IL-6 and hsCRP (p<0.05). A negative correlation among the difference in iron (ΔFe) concentration between two study terms and the change of hsCRP levels was also found (p<0.05). Alpine training conditions led to a slight increase in immunological indices concentration in studied skiers. However, it did not cause any significant change in prooxidant-antioxidant balance, which could be related to earlier anaerobic training adaptation.
Increased Exhaled Hydrogen Peroxide in Human Immunodeficiency Virus- Infected Patients without Clinical Signs and Symptoms of Opportunistic Lung Disease

Background: HIV-infected subjects present with decreased antioxidant defense and increased activation of inflammatory cells which may lead to overproduction of oxidants. This study determined whether HIV-infected patients without clinical signs and symptoms of opportunistic lung disease (OLD-negative) exhaled more H2O2 than healthy controls and whether there was association between the exhalation of H2O2 and whole blood chemiluminescence (CL) and clinical variables. Methods: A cross-sectional study was conducted. H2O2 in exhaled breath condensate and CL, resting and agonist-induced with N-formyl-methionyl-leucyl-phenylalanine (fMLP) were measured in 36 OLD-negative patients and 14 healthy controls. Univariate linear regression was used to summarize the average relationship and quantile regression analyzed the relationship at different points of the exhaled H2O2 distribution. Multivariate analyses were carried out using multiple linear regressions. Results: The fold increase of the geometric mean exhaled H2O2 against healthy controls was 3.76-times higher in OLD-negative patients than in controls (95% CI: 2.65-5.33, p<0.001), whereas that of either resting or fMLPinduced CL was 1.46 or 1.63, respectively (95%: 1.17-1.83 and 1.27-2.08, p<0.01). Exhaled H2O2 was not associated with CL, either resting or fMLP-induced. Linear regression detected positive relationship between the exhalation of H2O2 and viral load (R-squared 0.23, p<0.05). The effects of viral load were best revealed at a higher exhalation of H2O2 (quantiles 0.6 and 0.7; both Pseudo R-squared 0.21, p<0.05). In a multivariate model, the main independent contributors to the exhalation of H2O2 were viral load and highly active antiretroviral therapy (HAART), which together accounted for 35% of the variance in exhaled H2O2. If the analysis was limited exclusively to HAART-treated, a better model fit was obtained (R-squared 0.79), confirming that viral load is the main contributor to the exhaled H2O2. Conclusion: Inordinate increase in exhaled H2O2 may reflect airway oxidative stress in HIV-1 infection which may be related to viral load.
The Self and the Object World.

This volume is the second monograph to be published by the Journal of the American Psychoanalytic Association and deals with the ubiquitous problems of identity. Identity is defined as the ability to experience one's self as something that has continuity, uniqueness, and sameness. The vicissitudes of identity have been assessed by other authors, but they have never integrated this data into orthodox psychoanalytic theory. The author brings this theme within the mainstream of psychoanalysis. Dr. Jacobson is a brilliant clinician and is able to articulate her ideas with simplicity. She graphically harmonizes object relations, psychosexual development, and ego maturation and its role in the development of self. She redefines such basic assumptions as infantile narcissism, masochism, the distinction between ego and self, and self and object representations. She traces the development of identity from the early infantile period to the postadolescent period. To illustrate her concept she discusses her theories
Small bowel obstruction caused by inflammatory cytomegalovirus tumor in a renal transplant recipient: report of a rare case and review of the literature

Cytomegalovirus (CMV) infection in renal transplant recipients can present as asymptomatic viremia or CMV syndrome or, in more severe cases, as tissue‐invasive disease. CMV enteritis, a common manifestation of CMV invasive disease, usually presents with fever, abdominal pain, anorexia, nausea, and diarrhea, and can be rarely complicated by colon perforation, hemorrhage, or megacolon. CMV infection occurs primarily in the first 6 months post transplantation, when immunosuppression is more intense.
Histomorfometria do tecido ósseo em ratas castradas tratadas com tibolona

INTRODUCTION AND OBJECTIVE: The effect of tibolone administered in high dose over a prolonged period was analyzed through histomorphometry of tibia and femur samples from castrated rats. METHODS: The experiment was performed in 20 Wistar rats with average weight of 250 g. The animals were randomly divided into three groups: oophorectomized receiving tibolone (OVX + T) (n = 9), oophorectomized (OVX) (n = 6) and non-oophorectomized as control group (C) (n = 5). The experimental protocol was initiated 30 days after oophorectomy and lasted 20 weeks. Tibolone (1 mg/day) was administered to OVX + T rats and carboxymethyl cellulose to OVX. C rats did not go through any treatment. Right side tibias and femurs were fixed in 10% buffered formalin, decalcified and embedded in paraffin. Histological sections were stained by hematoxylin-eosin for histomorphometric analysis. The cortical thickness and medullary cavity were measured in transverse tibia and femur sections. The percentage of porosity and the trabecular density were determined in longitudinal femur sections. RESULTS AND DISCUSSION: There was no significant statistical difference between OVX and OVX + T in several analyses. The results showed that tibolone did not improve bone quality significantly, although it preserved cortical bone mass in femoral and tibial diaphyses and the trabecular bone in femoral condyles. The administration of tibolone in high dose for a prolonged period may have influenced these effects inasmuch as recent studies have recommended the use of lower doses in osteoporosis prevention. CONCLUSION: Oophorectomy caused bone loss in the analyzed regions. Despite the fact tibolone did not augment bone mass, this was kept at satisfactory levels.
Safety and efficacy of rituximab in systemic lupus erythematosus: results from 136 patients from the French AutoImmunity and Rituximab registry.

OBJECTIVE A number of open-label studies have suggested the potential benefit of rituximab (RTX) in systemic lupus erythematosus (SLE). However, in 2 recent randomized controlled trials (RCTs) of RTX, the primary end points were not met. We undertook this study to evaluate the safety and efficacy of RTX in off-trial patients with SLE seen in regular clinical practice. METHODS We analyzed prospective data from the French AutoImmunity and Rituximab (AIR) registry, which includes data on patients with autoimmune disorders treated with RTX. RESULTS One hundred thirty-six patients received treatment for SLE. The mean +/- SD score on the Safety of Estrogens in Lupus Erythematosus: National Assessment (SELENA) version of the SLE Disease Activity Index (SLEDAI) was 11.3 +/- 8.9 at baseline. Severe infections were noted in 12 patients (9%), corresponding to a rate of 6.6/100 patient-years. Most severe infections occurred within the first 3 months after the last RTX infusion. Five patients died, due to severe infection (n = 3) or refractory autoimmune disease (n = 2). Overall response was observed in 80 of 113 patients (71%) by the SELENA-SLEDAI assessment. Efficacy did not differ significantly between patients receiving RTX monotherapy and those receiving concomitant immunosuppressive agents (who had higher baseline disease activity). Articular, cutaneous, renal, and hematologic improvements were noted in 72%, 70%, 74%, and 88% of patients, respectively. Among responders, 41% experienced a relapse of disease, with a response in 91% after retreatment with RTX. CONCLUSION Data from the AIR registry show a satisfactory tolerance profile and clinical efficacy of RTX in patients with SLE. The contrasting results with those from recent RCTs leave open the question of the therapeutic use of RTX in SLE. Additional controlled studies with new designs are needed to define the place of RTX in the therapeutic arsenal for SLE.
Managing the burden of Alzheimer's disease: a partnership between caregiver and physician

Alzheimer's disease is a progressive, neurodegenerative disease that preferentially afflicts the elderly. Its clinical features include impairment of cognitive function and decline in activities of daily living, as well as emotional and personality changes. The effective management of Alzheimer's disease requires a partnership between physician and caregiver. Caregivers play a crucial role in the long‐term care of demented patients. The demonstration that home‐based care is a more economically viable solution than institutional care has led to the realization that community‐based care must be supported and preserved if society is to cope with the burgeoning number of patients with Alzheimer's disease. Physicians depend upon caregivers to impart information concerning a patient's cognitive, functional and behavioural symptoms, whether for diagnosis, to assess the efficacy of a particular treatment, or to ascertain the staging of the disease. Caregivers suffer an enormous physical, emotional, financial and psychological burden as a consequence of the demands of caring. They are frequently at risk of ill‐health and depression themselves, jeopardizing their ability to care. These problems can be alleviated through support, information, education, counselling, and various treatment programmes, which the physician can provide either directly to the caregivers, or can arrange for them. Where caregivers have a more realistic expectation of their caregiving role, and of the patient's capabilities, they are invariably better able to cope. They can be taught to manage effectively the troublesome behavioural symptoms of Alzheimer's disease, which are the most distressing features for the caregiver. The result of a strong and effective alliance between caregiver and physician is a carer who is more accepting and realistic about the caregiving role, and therefore better able to rise to the demands of caring. In turn, the physician is fully informed about the patient and in the best possible position to prescribe treatment, whether pharmacological or non‐pharmacological, for the patient and/or caregiver. The patient whose behavioural symptoms are better managed, thereby reducing anxiety and aggression, receives an optimal level of care, both from the Caregiver and physician.
Secondary Malar Implant Surgery

Background: Iatrogenic problems may occur after malar implant surgery. These include asymmetry, displeasing contours (too wide, too large, too low, or too prominent) with time, and symptoms related to infraorbital nerve damage. Methods: Implant removal at the time of secondary surgery leaves depressions in the cheek resulting from implant-induced bone erosion and soft-tissue contracture. Secondary surgery requires implant removal, implant replacement with appropriately positioned and sized implants, and cheek resuspension (subperiosteal midface lift) to mask and redistribute implant-induced soft-tissue distortions. Results: Twenty of the 22 patients were satisfied with their secondary operation. One patient requested another revision and, later, implant removal. Another patient who had been previously treated for infection developed another infection requiring implant removal. Conclusion: Malar implant–related midface deformities can be corrected by implant removal, deficiency-specific implant replacement, and subperiosteal midface resuspension.
Complement regulation in the GalT KO era

Miyagawa S, Yamamoto A, Matsunami K, Wang D, Takama Y, Ueno T, Okabe M, Nagashima H, Fukuzawa M. Complement regulation in the GalT KO era. Xenotransplantation 2010; 17: 11–25. © 2010 John Wiley & Sons A/S.
Discussion: Clinical features, epidemiology, classification criteria, and quality of life in psoriasis and psoriatic arthritis

### Are people going to be convinced that the multi/poly arthritis with time is still psoriatic arthritis and not a seronegative rheumatoid that has evolved? This is an important issue. It highlights the difficulty in differentiating psoriatic arthritis (PsA) from seronegative rheumatoid arthritis (RA). Generally, the oligoarticular presentation is identified as a feature of PsA, but PsA does evolve from oligoarticular to polyarticular over time. It is just as important to consider the joints involved as the extent of joint involvement. Generally, the differentiation between PsA and RA is more difficult early in the course, before the more classic changes such as pencil in cup are evident. Later in the disease the radiological features are quite helpful. In the future, magnetic resonance imaging (MRI) and ultrasound may provide early clues. ### How does one define symmetry in PsA? The issue of symmetry has caused confusion in describing the clinical patterns. PsA is considered to be less symmetrical than RA. It clearly tends to be more asymmetrical at presentation due to the oligoarticular onset of psoriatic arthritis. However, as joints accrue over time, it may become more symmetrical. It has been shown that symmetry is indeed a function of the number of …
Source of performance variance as a moderator of the job satisfaction-job performance relationship.

Herman's (1973) proposition that satisfaction and performance can only be related when performance is at least partially under the worker's control was tested. Subjects were hired to work under conditions of high or low situational control of performance. Two performance measures were used, only one of which was designed to be susceptible to the situational control manipulation. Satisfaction was then predicted by performance, situational control condition, and their cross-product. As expected, the interaction term was significant when the performance measure susceptible to situational control was used and nonsignificant when the nonsusceptible measure was used. It was concluded that the amount of performance variance which is individually rather than situationally controlled is an important moderator of the satisfaction-performance relationship.
Metronomic photodynamic therapy (mPDT): concepts and technical feasibility in brain tumor

The concept of metronomic photodynamic therapy (mPDT) is presented, in which both the photosensitizer and light are delivered continuously at low rates over extended periods in order to increase selective tumor cell kill through apoptosis. The focus of the present work is on mPDT treatment of malignant brain tumors, in which selectivity between damage to tumor cells versus normal brain tissue is critical. Previous studies have shown that low-dose PDT using aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) can induce apoptosis in tumor cells without causing necrosis in either tumor or normal brain tissue or apoptosis in the latter. In order to produce enough tumor cell kill to be an effective therapy, multiple PDT treatments, such as hyperfractionation or metronomic delivery, are likely requried, based on the levels of apoptosis achieved and model calculations of tumor growth rates. mPDT poses two substantial technical challenges: extended delivery of ALA and implantation of interstitial devices for extended light delivery while allowing free movement. In rat models ALA administration via the drinking water has been accomplished at significant doses for up to 10 days, and ex vivo spectrofluorimetry of tumore, normal brain and other tissues post mortem demonstrates a 3-4 increase in the tumor-to-brain concentration of PpIX, without toxicity. Prototype light sources and delivery devices are also shown to be practical, either using a laser diode or light emitting diode (LED) coupled to an implanted optical fiber in the case of the rat model or a directly-implanted LED in rabbits. The combined delivery of both drug and light over an extended period, with survival of the animals, is demonstrated. Preliminary evidence of selective apoptosis of tumor under these conditions is presented.
An overview of pediatric obesity

Abstract: Pediatric obesity is increasing worldwide and disproportionately affects the economically and socially disadvantaged. Obese children are at risk of developing the (dys)metabolic syndrome, insulin resistance, early‐onset type 2 diabetes mellitus, polycystic ovarian syndrome, hypertension, hyperlipidemia, and obstructive sleep apnoea. Those with diabetes may have mixed features of type 1 and type 2 diabetes mellitus. Pediatric obesity is the result of persistent adverse changes in food intake, lifestyle, and energy expenditure. It may be because of underlying a genetic syndrome or a conduct disorder. Children living in urban settings often lack safe, affordable, and accessible recreational facilities. Tight educational schedules mean less free time, while computer games and television have become preferred recreational activities. More families are eating out or eating take‐out meals and processed foods at home because of pressures of work and time constraints. Consumer advertising targeted at children and the ready availability of vending machines encourage unwise food choices. Some children eat excessively because they are depressed, anxious, sad, or lonely. Often families and obese children are aware of the need for healthy eating and exercise but are unable to translate knowledge into weight loss. Population‐based measures such as public education, school meal reforms, child‐safe exercise friendly environments, and school‐based and community‐based exercise programs have been shown to be successful to varying degrees, but there remain individuals who will need special help to overcome obesity. Overeating (e.g. binge eating) may be a manifestation of disordered coping behavior but may also be because of defects in the neural and hormonal control of appetite and satiety. New pharmacological approaches are targeting these areas. We need a coordinated approach involving government, communities, and healthcare providers to provide a continuum of population‐based interventions, focused screening, and personalized multidisciplinary interventions for the obese child and family.
Robust wedge-stability analysis and design of continuous constrained systems with stability radii

In this paper, based on stability radii, a sufficient condition is first proposed to ensure the robust wedge stability of continuous-time constrained systems with state feedback. The saturated actuator is reformulated as a conditioned linear actuator subject to structured uncertainties and then an auxiliary matrix is introduced so that the closed-loop system can be characterized into a scheme of stability radius approach. We also investigate the issue of maximizing complex stability radius subject to a wedge region by state feedback. Through iteratively solving a parametrized Riccati equation, a desired maximizing state feedback controller corresponding to the prescribed wedge subregion can be obtained. An example is given to illustrate the design algorithm and to reveal the feasibility of stability radius approach for continuous-time constrained systems.