Miracle-dz/UniFAR-FTUs huggingface dataset:
Relationship of arterial stiffness and early mild diastolic heart failure in general middle and aged population.

AIMS The brachial-ankle pulse wave velocity (baPWV) has been recognized as a marker that reflects arterial stiffness. We conducted an investigation to evaluate whether baPWV is independently associated with early mild diastolic heart failure (DHF) in a general middle and aged population. METHODS AND RESULTS From 1 July 2009 until 31 August 2009, we investigated 2095 subjects for the relevant factors of heart failure in the Lujiazui Community, Shanghai. The baPWV, echocardiography, and blood sampling were performed in the morning after a 12 h overnight fast. A total of 1929 subjects had the complete data, including questionnaire, age, gender, baPWV, brain natriuretic peptide, and E/A ratio. Early mild DHF was defined as a left ventricular ejection fraction >50%, E/A ratio <0.8, and E/E' ≤ 8; finally, 482 subjects with early mild DHF and 1282 subjects with non-DHF entered into analysis. Among 1764 subjects, 31.6% of the subjects were male (average age was 58.0 ± 12.3), 35.8% of the subjects had hypertension, the average body mass index (BMI) was 24.2 ± 3.3 kg/m(2), baPWV was 1513.0 (1329.1, 1763.5) cm/s, and the baPWV was significantly correlated with the E/A ratio (r = -0.39, P < 0.01). There was a difference of the baPWV [1456.0 (1295.3, 1698.3) vs. 1670.5 (1465.6, 1910.8) cm/s] between the non-DHF group and the early mild DHF group (P < 0.01). Multiple logistic-regression analyses demonstrated that age, male gender, BMI, baPWV, posterior left ventricular wall thickness (PVWT), interventricular septal thickness (IVST), E/E' ratio, left ventricular mass index (LVMI), systolic blood pressure (≥140 mmHg), and diastolic blood pressure (≥90 mmHg) were independently correlated with early mild DHF. CONCLUSIONS The increased arterial stiffness is associated with early mild DHF in a general middle and aged population independently of age, male gender, BMI, PVWT, IVST, E/E' ratio, LVMI, and high blood pressure. The non-invasive techniques described may allow serial measurements to be made over time to monitor baPWV changes in arteries provided the introduction of anti-arteriosclerosis therapy.
Risk of coronary heart disease and mortality for adults with subclinical hypothyroidism.

To the Editor: In their study, Dr Rodondi and colleagues addressed the issue of the relationship between subclinical hypothyroidism and coronary heart disease (CHD) or mortality. Previous large prospective cohort studies have provided conflicting results about this extensively studied association. In the study by Rodondi et al, an attempt to reduce the effects of several confounders (including age, sex, degree of thyroid stimulating hormone [TSH] elevation, and pre-existing cardiovascular disease) was performed. However, the finding of no association of risk with subclinical hypothyroidism for TSH concentration up to 10.0 mIU/L may be flawed because it did not provide information about the body mass index (BMI) of the patients diagnosed with subclinical hypothyroidism. This might be a problem because subclinical hypothyroidism, especially when characterized by minor increases in serum TSH levels, is frequently observed among obese patients. The elevated serum TSH found in obese (and particularly in morbidly obese) patients may be a mere consequence of the excess body weight rather than a condition of primary thyroid failure. This concept would imply that obese patients with a moderate elevation in serum TSH would not experience increased systemic vascular resistance, altered endothelial function, increased atherosclerosis, altered coagulability, and lipid abnormalities, which account for the increased risk of CHD associated with subclinical hypothyroidism. Positive tests for thyroid autoantibodies are the only parameters able to discriminate between true subclinical hypothyroidism and obesity-induced hyperthyrotropinemia. Because thyroid antibodies were not taken into account in diagnosing subclinical hypothyroidism in the study by Rodondi et al, the conclusions may have been biased. Indeed, obese patients with a moderately increased TSH (up to 10 mIU/L) may include a subgroup of patients who are not truly hypothyroid, thus underestimating the real CHD risk associations of subclinical hypothyroidism (defined as high serum level of TSH with normal free thyroxine levels and positive test results for thyroid antibodies).
Endothelial Dysfunction in Rheumatoid Arthritis is Improved by Anti-Tumor Necrosis Factorα Treatment

Rheumatoid arthritis (RA) is associated with excess cardiovascular morbidity and mortality. TNFα plays a pivotal role in causing both RA synovial damage and atherosclerosis, also by inducing endothelial dysfunction. The aim of the present study was to assess the occurrence of endothelial dysfunction and the effects of anti-TNFα antagonism on endothelial function in RA. Ten RA women with Disease Activity Score (DAS) ≥ 3.7 despite treatment with at least two disease-modifying antirheumatic drugs for 4 months underwent anti-TNFα treatment with infliximab or etanercept. Endothelium-dependent vasodilation was significantly lower than normal (3.8±3.7 % vs. 13.7 ±5.1, p≤0.05), thus demonstrating the presence of endothelial dysfunction in our RA patient population. Anti-TNF- treatment significantly improved flow-mediated vasodilation, which increased from baseline values of 3.8±3.7% to 10.9±6.6% (p<0.05) at day 1, to 13.4±5.4 % (p < 0.05) at week 1, to 12.7±5.3 % (p<0.05) at week 2 and to 15.5±5.2 % at week 6 (p≤0.05). There was no significant difference between two anti-TNFα treatments regarding mean percentage increase of flow-mediated vasodilation during treatment. RA clinical improvement was demonstrated by a significant decrease in the DAS score (from 6.26±1.6 to 5.26 1.38, p < 0.05) associated to a marked decrease of acute phase reactants serum levels. The present study supports the hypothesis of the pivotal role for TNFα as a mediator of systemic and vascular wall inflammation in RA.
The Effect of Family Participation on Mother's General Health and Length of Hospitalization of Premature Neonate

Background: Pressures arising from premature infant care specially hospitalized infant can affect infant's quality of life and health by causing long term destructive effects on family's psychological and physical health. Aim:To investigate the effect of family participation on mother's general health and length of hospitalization of premature neonate. Methods: In this clinical trial 60 primiparous women and their premature infants hospitalized in neonatal intensive care units, were randomly allocated to family participation and control groups. In the experimental group, empowering family in order to particiapte in the infant fundamental care was implemented in the "teaching" and "indepededant practice"phases. Control group received routin care. Mother's general health was measured using Goldberg General Health questionnaire. Data were analyzed by independent t-test and Mann Whitney test using SPSS version 11/5 was done. Results: There was a significant difference between experimental group (21/18±8/95) and control group (35/38±12/99) in terms of Mother's General Health (p<0/01). There was no significant difference in average length of stay between two groups. Conclusion: Family participation in caring of premature infants may increase mothers' general health and can be suggested as a practical method for increasing mother's general health.
Food fight : the inside story of the food industry, America's obesity crisis, and what we can do about it

This text describes the deeply entrenched biological and cultural forces that lead Americans to over-eat and become physically inactive, and outlines creative, innovative and controversial solutions to the problem. The book has three main themes: an expose of a culture that feeds its pets better than its people, that targets poorer people as a market for high-calorie, low-nutrient junk food, and that allows children to be manipulated into eating poor diets through toy giveaways and in-school promotions; a call to action for social and policy change; and a workable plan to improve individual health and that of one's family with recommendations and controversial stances.
Attitudes of university students towards abortion in Nigeria

The study examined the attitude of university students towards abortion in Nigeria. A total of nine hundred (900) respondents gave their opinions on a self structured questionnaire. The frequency counts and percentages were used to analyse the personal data of the respondents and means, standard deviation, t-test and analysis of variance (ANOVA) for analyzing the hypotheses at α = 0.05 level of significance. Some students support abortion when it is on health condition of either the mother or the baby. Based on the findings, some of the recommendations made include proper reproductive health education and counseling should be given to young ladies and boys about unsafe abortion preventive method; Federal government as a matter of urgency should consider legalization of induced abortion to prevent the practice of clandestine abortion in the back street. Key words: Attitude, university students, abortion, reproductive health, infertility, premarital sex, promiscuity.
Camurati-Engelmann disease : pictorial essay

Camurati-Engelmann disease (CED), or progressive diaphyseal dysplasia, is a rare sclerosing dysplasia of which 250 cases have been described in the English literature. The disease affects one in a million people and is autosomal dominant with variable penetrance. It was initially described by Cockayne in 1920; Camurati was the first to suggest its hereditary nature in 1922. A single case of muscular wasting and marked bone involvement was reported by Engelmann in 1929. As the name suggests, there is progressive hyperostosis and predominant involvement of the diaphyses. The onset of the disease is usually during childhood; patients usually present by puberty and usually before age 30, with limb pain, muscular weakness, waddling gait and easy fatigue. Other symptoms and signs may include delayed growth, reduced muscle mass, anorexia and enlargement of the arms and legs. Systemic manifestations of hepatosplenomegaly, bone marrow dysfunction (anaemia and leucopaenia) and delayed sexual development occasionally occur. In a few patients, abnormal values of bone resorption and formation have been described. Radiologically, the hallmark of the disorder is bilateral, symmetrical cortical thickening of the diaphyses of the long bones on both the periosteal and endosteal sides of the diaphyses. In decreasing order of frequency, the tibia, femur, fibula, humerus, ulna and radius are affected. CED results from disturbance of intramembranous ossification (Fig.1) affecting the long bones, calvaria, mandible and facial bones. There are a few reported cases of involvement of the skull base (a site of endochondral ossification), but these occur in advanced stages.
Care bundle for ventilator-associated pneumonia in a medical intensive care unit in Northern Taiwan

Background: Ventilator-associated pneumonia (VAP) occurs in patients requiring mechanical ventilators for more than 48 h. VAP is the most common nosocomial infection and the leading cause of complications and death in intensive care units (ICUs). Materials and Methods: Two historical comparison groups of 375 patients who used mechanical ventilators for more than 48 h in the medical ICU (MICU) from December 1, 2011 to May 31, 2012 and December 1, 2013 to May 31, 2014 were enrolled in this study. There were 194 adult patients in the control group that received traditional care, and there were 181 patients in the experimental VAP care bundle group. Our VAP care bundle entailed several preventive strategies including daily assessments of sedation, daily consideration of weaning and extubation by the doctors and respiratory therapists charged with the care of the patients, maintenance of the intra-cuff pressure values at approximately 20-30 cm H 2 O, hand hygiene, daily oral hygiene, personal protective equipment for suctioning, the placement of patients in semi-recumbent positions with the head of the bed elevated to at least 30°, aspiration of an endotracheal tube and oral cavity prior to position changes, daily cleaning of the ventilator and suction bottle with sterile distilled water, weekly replacement of the ventilator circuit and heater, sterilization of the circuit by pasteurization, and the use of an independent care room. The data were collected by reviewing the patients′ medical records and by retrieving information from the Nosocomial Infection Control Unit of one medical center in Northern Taiwan. Results: The incidence of VAP in the VAP care bundle group (0.281 cases per 1000 ventilator days) was significantly lower than that in the control group (0.495 cases per 1000 ventilator days). We estimated that the occurrence of VAP in the MICU increased the medical costs by an average of NT $68317 per patient. Conclusions: VAP care bundle is an effective strategy to reduce the incidence of VAP in the MICU and to reduce healthcare costs.
Use of florbetapir-PET for imaging beta-amyloid pathology.

CONTEXT The ability to identify and quantify brain β-amyloid could increase the accuracy of a clinical diagnosis of Alzheimer disease. OBJECTIVE To determine if florbetapir F 18 positron emission tomographic (PET) imaging performed during life accurately predicts the presence of β-amyloid in the brain at autopsy. DESIGN, SETTING, AND PARTICIPANTS Prospective clinical evaluation conducted February 2009 through March 2010 of florbetapir-PET imaging performed on 35 patients from hospice, long-term care, and community health care facilities near the end of their lives (6 patients to establish the protocol and 29 to validate) compared with immunohistochemistry and silver stain measures of brain β-amyloid after their death used as the reference standard. PET images were also obtained in 74 young individuals (18-50 years) presumed free of brain amyloid to better understand the frequency of a false-positive interpretation of a florbetapir-PET image. MAIN OUTCOME MEASURES Correlation of florbetapir-PET image interpretation (based on the median of 3 nuclear medicine physicians' ratings) and semiautomated quantification of cortical retention with postmortem β-amyloid burden, neuritic amyloid plaque density, and neuropathological diagnosis of Alzheimer disease in the first 35 participants autopsied (out of 152 individuals enrolled in the PET pathological correlation study). RESULTS Florbetapir-PET imaging was performed a mean of 99 days (range, 1-377 days) before death for the 29 individuals in the primary analysis cohort. Fifteen of the 29 individuals (51.7%) met pathological criteria for Alzheimer disease. Both visual interpretation of the florbetapir-PET images and mean quantitative estimates of cortical uptake were correlated with presence and quantity of β-amyloid pathology at autopsy as measured by immunohistochemistry (Bonferroni ρ, 0.78 [95% confidence interval, 0.58-0.89]; P <.001]) and silver stain neuritic plaque score (Bonferroni ρ, 0.71 [95% confidence interval, 0.47-0.86]; P <.001). Florbetapir-PET images and postmortem results rated as positive or negative for β-amyloid agreed in 96% of the 29 individuals in the primary analysis cohort. The florbetapir-PET image was rated as amyloid negative in the 74 younger individuals in the nonautopsy cohort. CONCLUSIONS Florbetapir-PET imaging was correlated with the presence and density of β-amyloid. These data provide evidence that a molecular imaging procedure can identify β-amyloid pathology in the brains of individuals during life. Additional studies are required to understand the appropriate use of florbetapir-PET imaging in the clinical diagnosis of Alzheimer disease and for the prediction of progression to dementia.
Worldwide Variation in Human Growth

This is a very large compilation of growth data with an extremely wide coverage of population groups, many of which will be completely unknown to all but the professional ethnographer. There is, however, a disappointingly narrow coverage of variables (length, weight, body widths, circumferences and proportions, skinfold thicknesses, and maturity). Many of the findings are relevant to an important question: should one set of growth reference data be used throughout the world, thus allowing ready comparability between groups, or should there be separate sets for each major racial group or even a multitude of local sets? The studies summarized in this volume indicate many population groups have similar potentials for growth in major body dimensions. For example, the narrower range of means among European than among African groups that range from "tribal" to well-off indicates the range of variation in growth would be reduced greatly if the environmental circumstances allowed
Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis.

CONTEXT Trials comparing higher vs lower levels of positive end-expiratory pressure (PEEP) in adults with acute lung injury or acute respiratory distress syndrome (ARDS) have been underpowered to detect small but potentially important effects on mortality or to explore subgroup differences. OBJECTIVES To evaluate the association of higher vs lower PEEP with patient-important outcomes in adults with acute lung injury or ARDS who are receiving ventilation with low tidal volumes and to investigate whether these associations differ across prespecified subgroups. DATA SOURCES Search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (1996-January 2010) plus a hand search of conference proceedings (2004-January 2010). STUDY SELECTION Two reviewers independently screened articles to identify studies randomly assigning adults with acute lung injury or ARDS to treatment with higher vs lower PEEP (with low tidal volume ventilation) and also reporting mortality. DATA EXTRACTION Data from 2299 individual patients in 3 trials were analyzed using uniform outcome definitions. Prespecified effect modifiers were tested using multivariable hierarchical regression, adjusting for important prognostic factors and clustering effects. RESULTS There were 374 hospital deaths in 1136 patients (32.9%) assigned to treatment with higher PEEP and 409 hospital deaths in 1163 patients (35.2%) assigned to lower PEEP (adjusted relative risk [RR], 0.94; 95% confidence interval [CI], 0.86-1.04; P = .25). Treatment effects varied with the presence or absence of ARDS, defined by a value of 200 mm Hg or less for the ratio of partial pressure of oxygen to fraction of inspired oxygen concentration (P = .02 for interaction). In patients with ARDS (n = 1892), there were 324 hospital deaths (34.1%) in the higher PEEP group and 368 (39.1%) in the lower PEEP group (adjusted RR, 0.90; 95% CI, 0.81-1.00; P = .049); in patients without ARDS (n = 404), there were 50 hospital deaths (27.2%) in the higher PEEP group and 44 (19.4%) in the lower PEEP group (adjusted RR, 1.37; 95% CI, 0.98-1.92; P = .07). Rates of pneumothorax and vasopressor use were similar. CONCLUSIONS Treatment with higher vs lower levels of PEEP was not associated with improved hospital survival. However, higher levels were associated with improved survival among the subgroup of patients with ARDS.
CDC advisory committee recommends nearly universal influenza vaccination.

ered between 34 and 36 weeks without an evidence-based indication were more likely than infants delivered early because of an accepted medical indication to need ventilator support and were at higher risk of major neonatal morbidity (based on a composite of death within 120 days of life, intraventricular hemorrhage, necrotizing enterocolitis, and ventilator support). Similarly, in a separate analysis, he found that physician-initiated late preterm deliveries were also associated with poorer neonatal outcomes than were spontaneous preterm births. Although the reasons for the differences in neonatal outcomes between these groups are not clear, Denney said, “We can’t be cavalier about delivering late preterm. ” Data from another study seemed to confirm that many late preterm deliveries do not follow evidence-based guidelines. Cynthia Gyamfi, MD, of the Columbia University Medical Center in New York City, and colleagues conducted a retrospective cohort study of 2693 late preterm deliveries at 2 medical centers in New York City. About one-third of the deliveries were iatrogenic, 56.7% without an indication supported by the evidence. Whether an indication was evidence-based was determined by the American College of Obstetricians and Gynecologists guidelines (for example, severe preeclampsia/ eclampsia or abruption were considered evidence-based indications). In the study, women who delivered prematurely without an evidencebased indication were more likely to be older, be pregnant with twins, have a physician in private practice, and have more than one complicating factor. The most common reasons for such deliveries were mild preeclampsia and gestational hypertension with normal fetal testing. These deliveries were also more likely to occur at 36 weeks of gestation compared with earlier gestational ages in the evidence-based deliveries. Despite their more advanced gestational ages, a substantial number of the infants in the non–evidencebased delivery group were still admitted to the neonatal intensive care unit (45.1%). However, neonatal intensive care unit admission remained much higher in the evidence-based delivery group, with 66.8% of these infants admitted. Gyamfi said there may be many reasons for the growing rate of late preterm deliveries. For example, physicians may be more confident that neonatal outcomes will be good after 34 weeks. “We need to understand why physicians are delivering [late preterm infants], make sure the deliveries are indicated, and make sure it’s what is best for mom and baby,” Gyamfi said. Silver said that more studies are needed to evaluate the best time for delivery in individuals with various conditions. “But right now, we can try to quit doing deliveries that don’t meet generally accepted criteria,” he noted. “That’s something that can be done tomorrow. ”
Opposite effects of statins on mitochondria of cardiac and skeletal muscles: a 'mitohormesis' mechanism involving reactive oxygen species and PGC-1.

AIMS Statins protect against cardiovascular-related mortality but induce skeletal muscle toxicity. To investigate mechanisms of statins, we tested the hypothesis that statins optimized cardiac mitochondrial function but impaired vulnerable skeletal muscle by inducing different level of reactive oxygen species (ROS). METHODS AND RESULTS In atrium of patients treated with statins, ROS production was decreased and oxidative capacities were enhanced together with an extensive augmentation of mRNAs expression of peroxisome proliferator-activated receptor gamma co-activator (PGC-1) family. However, in deltoid biopsies from patients with statin-induced muscular myopathy, oxidative capacities were decreased together with ROS increase and a collapse of PGC-1 mRNA expression. Several animal and cell culture experiments were conducted and showed by using ROS scavengers that ROS production was the triggering factor responsible of atorvastatin-induced activation of mitochondrial biogenesis pathway and improvement of antioxidant capacities in heart. Conversely, in skeletal muscle, the large augmentation of ROS production following treatment induced mitochondrial impairments, and reduced mitochondrial biogenesis mechanisms. Quercetin, an antioxidant molecule, was able to counteract skeletal muscle deleterious effects of atorvastatin in rat. CONCLUSION Our findings identify statins as a new activating factor of cardiac mitochondrial biogenesis and antioxidant capacities, and suggest the importance of ROS/PGC-1 signalling pathway as a key element in regulation of mitochondrial function in cardiac as well as skeletal muscles.