Miracle-dz/UniFAR-FTUs huggingface dataset:
In vivo magnetic resonance elastography to estimate left ventricular stiffness in a myocardial infarction induced porcine model

To estimate change in left ventricular (LV) end‐systolic and end‐diastolic myocardial stiffness (MS) in pigs induced with myocardial infarction (MI) with disease progression using cardiac magnetic resonance elastography (MRE) and to compare it against ex vivo mechanical testing, LV circumferential strain, and magnetic resonance imaging (MRI) relaxometry parameters (T1, T2, and extracellular volume fraction [ECV]).
Liver transplant in siblings--a single center experience.

The authors declare no funding or conflicts of interest. Address correspondence to: Henry D De’Ath, M.R. C.S. , Ph.D., Oxford Transplant Centre, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, United Kingdom. E-mail: henryde-ath@doctors.org. uk Received 7 May 2014. Accepted 6 June 2014. Copyright * 2014 by Lippincott Williams & Wilkins ISSN: 0041-1337/14/9806-e60 DOI: 10.1097/TP.0000000000000343
Double-Blind, Placebo-Controlled Food Challenges (DBPCFC) Demonstrating Acute IgE-Mediated Allergic Reactions to Good Start, Ultrafiltered Good Start, Alfaré, Nutramigen, and Alimentum in a Seven-Year-Old

A 7-year-old girl with IgE-mediated cows' milk allergy (immediate reactor) underwent double-blind, placebo-controlled food challenge (DBPCFC) with three whey hydrolysate formulas (Good Start, Ultrafiltered Good Start, Alfare) and two casein hydrolysates (Nutramigen, Alimentum), using a soy protein formula (Isomil) as a control. She developed acute reactions to Good Start (3 ml; gastrointestinal, respiratory), Ultra Good Start (8 ml; respiratory, cutaneous), Alfare (158 ml; respiratory), Nutramigen (3 ml; respiratory, cutaneous), and Alimentum (4 ml; respiratory, cutaneous, gastrointestinal) and tolerated the Isomil control (318 ml) on three separate challenges under similar conditions. The generalized urticarial reactions to Nutramigen and Alimentum began 90 minutes after receiving less than 1 teaspoonful (3 ml and 4 ml, respectively) of formula. These observations indicate that all current commercially available cows' milk protein hydrolysate formulas can cause serious allergic reactions in the highly se.
WE‐C‐J‐6C‐01: Residual Motion of Lung Tumors in Gated Radiotherapy with External Respiratory Surrogates

Purpose: To mitigate the motion-induced irradiation of healthy lung tissue, clinics have begun using external markers to gate the therapy beam. This technique assumes that the correlation between the external signal and the internal tumor position remains constant inter-fractionally and intra-fractionally. A study has been performed to assess the validity of this correlation assumption within a gating window. Method and Materials: Eight lung patients with implanted fiducials were studied. Synchronized internal and external data was taken during the entire course of treatment. Stereoscopic imaging was used to find the internal markers in four dimensions. The data was used retrospectively to assess conventional external surrogate respiratory-gated treatment. Both amplitude and phase-based gating methods were investigated. For each method, three gating windows were investigated, each giving 40%, 30% and 20% duty cycle, respectively. The residual motion of the internal marker within these six gating windows was calculated. The beam-to-beam variation and day-to-day variation in the residual motion were calculated for both gating modalities. Results: We found that the residual motion (95th percentile) was between 0.9–6.2 mm for a 40% duty cycle window. There is no clear preference for either gating modality. Large fluctuations (>300%) were seen in the residual motion between some beams. Overall, the mean beam-to- beam variation was 37% and 42% for amplitude and phase-based gating, respectively, compared to the previous beam. The day-to-day variation was 29% and 34% for amplitude and phase-based gating, respectively, compared to the previous day. Conclusion: Although gating significantly reduced tumor motion, the residual motion behaved unpredictably. Treatment margins that account for motion should be individualized and daily imaging should be performed to ensure that the residual motion is not exceeding the planned motion on a given day. Conflict of Interest: This work was sponsored, in part, by a grant from Varian Medical Systems, Inc.
Profile of volatile organic compounds in exhaled breath changes as a result of gluten-free diet

In the present longitudinal study, we followed volatile organic compounds (VOCs) excreted in exhaled breath of 20 healthy individuals over time, while adhering to a gluten-free diet for 4 weeks prior to adherence to a normal diet. We used gas chromatography coupled with mass spectrometry (TD-GC-tof-MS) in combination with chemometric analysis to detect an array of VOCs in exhaled breath. Multivariate analysis was applied to extract the maximal information from the obtained data. Dietary intake was assessed to verify adherence to the diet and to get insight into macronutrient intake during the intervention period. A set of 12 volatile compounds distinguished the samples obtained during the gluten-free diet from those obtained during a normal diet. Seven compounds could be chemically identified (2-butanol, octane, 2-propyl-1pentanol, nonanal, dihydro-4-methyl-2(3H)-furanone, nonanoic acid and dodecanal) and speculated on a possible origin. Our findings suggest that a gluten-free dietary period had a reversible impact on participants' excreted metabolites visible in their breath. Several explanations are proposed of influencing metabolic status through dietary interventions. Although the exact origin of the discriminating compounds is not yet known, the main goal of this paper was to share a new potential use of exhaled air analysis and might become a useful tool in fields of nutrition and metabolism.
CD4+CD45RO+CD25-/lowCD127+: CD4+CD45RO+CD25hiCD127-/low Ratio in Peripheral Blood A Useful Biomarker to Detect Cardiac Allograft Vasculopathy in Heart Transplanted Patients

Background Cardiac allograft vasculopathy (CAV) is a major limitation in long-term graft survival after heart transplantation (HTx). Its prediction and detection at an early stage is a challenge because an accurate, minimally invasive blood test is lacking. The aim of this study was to analyze the relationship of Tact (CD4+CD45RO+CD25-/lowCD127+) cells, Th1 cells, and thymus-derived regulatory (Treg) (CD4+CD45RO+CD25hiCD127-/low) cells in peripheral blood with the development of CAV in HTx patients. Methods First, we performed a cross-sectional study in 29 patients at least 2 years after HTx, 17 with CAV and 12 without CAV. We then prospectively followed a group of 38 patients for 2 years immediately after HTx surgery. In both groups, we analyzed the relationship between CAV and the effector-to-regulatory T cell ratio. Results In the cross-sectional study, patients with CAV showed statistically significant higher values of Th1-to-FoxP3+Treg and Tact-to-CD127-/lowTreg ratios than non-CAV patients, with P less than 0.01 and P less than 0.001, respectively. Receiver operating characteristic curve analysis showed that the Tact:CD127-/lowTreg ratio was a potential biomarker of CAV, clearly discriminating CAV and non-CAV patients (area under curve [AUC] = 0.955; P = 0.001). In the prospective part of the study, we monitored the Th1:FoxP3+Treg and Tact:CD127-/lowTreg ratios using the best tradeoff between anterior receiver operating characteristic sensitivity and specificity as a cutoff. Changes in the Tact:CD127-/lowTreg ratio were detected earlier than changes in the Th1:FoxP3+Treg ratio. Both ratios were higher in HTx patients with CAV. Conclusion The Tact-to-Treg ratio is a valuable follow-up marker to detect HTx patients at risk of developing CAV.
Impact of vessel wall lesions and vascular stenoses on cerebrovascular reactivity in patients with intracranial stenotic disease

To compare cerebrovascular reactivity (CVR) and CVR lagtimes in flow territories perfused by vessels with vs. without proximal arterial wall disease and/or stenosis, separately in patients with atherosclerotic and nonatherosclerotic (moyamoya) intracranial stenosis.
Risk management is not objective

Risk management affects profoundly maternity services in the UK, and some large units now have a full-time risk manager post, commonly a midwife. The official line on the advent of risk management is its dovetailing with clinical governance, ensuring quality in care and the avoidance or diminution of risk in clinical care and the working environment. Commonly, complaints management will form part of its strategy.
What makes people decide to visit and use an internet-delivered behavior-change intervention? A qualitative study among adults.

Purpose – The purpose of this study is to explore adults' cognitive deliberations in deciding to visit an internet intervention, to extend the visit to use and process the intervention's content, and to revisit the intervention.Design/methodology/approach – A qualitative study was conducted consisting of five focus group interviews (n = 29, 25‐69 years). The interview transcriptions were subjected to systematic content analysis.Findings – The results indicate that being motivated to change a health behavior and curiosity about the content were important factors in the decision to visit an internet intervention. To extend a visit, mainly intervention aspects were considered such as visual appeal, the number of questions needed to complete within the program, and the existence of a registration procedure. To induce revisits, regularly updated content and the possibility to monitor behavior change were important.Practical implications – These findings suggest that activities to promote use of internet interv.
Radiation Induced Hand Necrosis of an Orthopaedic Surgeon Who Had Treated a Patient with Fluoroscopy-Guided Spine Injection

As the frequency of radiation exposure by fluoroscopy continues to increase in orthopaedic fields, the level of hazard for the orthopaedic surgeon increases at the same time. Exposure of the clinician’s hand is highest during performance of surgery or procedures within the actual clinics. Studies on radiation exposure on thyroid, eye or whole body, or reports on radiation treatment of cancer or for dermal lesions occurring from therapeutic intervention on the body such as heart and liver, and studies on radioactive damage to hands derived from radioactive material handlers have been reported; however, no studies on radioactive damage to a clinician’s hand have been reported. Therefore, we report on a case of chronic radiation dermatitis and necrosis of an orthopaedic surgeon’s hand as well as its soft tissue defect.
Follow-up Imaging After Liver Transplantation Should Take Into Consideration Primary Hepatocellular Carcinoma Characteristics

Background Tumor recurrence occurs in almost 10% after liver transplantation (LT) for early stage hepatocellular carcinoma (HCC). Evidence-based recommendation regarding these techniques and their schedule remains unclear. The aim was to analyze the imaging characteristics of HCC recurrence after LT according to the initial primary tumor characteristics to provide relevant evidence regarding their role. Methods Among 336 cirrhotic patients undergoing LT between 2000 and 2011, 25 (7.4%) experienced HCC recurrence. Their pre-LT characteristics, long-term outcome and imaging characteristics of recurrences were retrospectively analyzed. Results All patients were men and median age at the time of recurrence was 54 (41-64) years. Before LT, 13 (52%) patients had HCC outside the Milan criteria. Median time to HCC recurrence was 13.8 months (1-75) after LT and 8 patients (32%) experienced recurrence longer than 24 months after LT. The most frequently involved organs were the lungs (n = 13, 52%) and the bones (n = 9, 36%). Recurrent HCC involved more than 1 organ in 11 patients (44%). Recurrences were limited to the liver in 1 patient (4%), exclusively extrahepatic in 18 patients (72%), and were both intra and extrahepatic in 6 patients (24%). Delay of recurrence was shorter in the presence of microvascular invasion (17 vs 28 months), but this was not significant (P = 0.208). Poorly differentiated tumors showed a trend toward decreased recurrence-free survival (8 vs 28 months, P = 0.075). Conclusions Both pattern and delay of HCC recurrence support performing regular whole-body imaging initially every 6 to 12 months and continuing beyond 2 years after LT for HCC, especially in patients with pejorative pathological features of the primary tumor that could influence HCC recurrence pattern.
Pretreatment and posttreament positron emission tomographic scan imaging in a 20‐year‐old patient with Wilson's disease

Wilson's disease is an autosomal‐recessive inherited diorder that results in predominantly hepatic and neurologic manifestations. Neurologic abnormalities include tremor, ataxia, bradykinesia, rigidity, chorea, and dystonia. We report the clinical, radiologic, and serial FDG PET findings in a 20‐year‐old woman who presented with an asymmetric upper limb tremor caused by Wilson's disease. Reduced striatal and cerebral cortical glucose metabolism was demonstrated on a FDG PET study performed before the commencement of D‐penicillamine therapy. After 6 months of treatment, the patient had shown only minimal clinical improvement, despite an increase in striatal and cerebral cortical glucose metabolism on a repeat FDG PET study. After 14 months of treatment, however, a moderate clinical improvement was noted and there was further increase in glucose metabolism on FDG PET.
Adipose- and Bone Marrow–Derived Mesenchymal Stem Cells Prolong Graft Survival in Vascularized Composite Allotransplantation

Background Strategies aiming at minimization or elimination of systemic immunosuppression are key immediate goals for clinical expansion of vascularized composite allotransplantation (VCA). We compared the in vitro and in vivo immunomodulatory efficacy of adipose-derived mesenchymal stem cells (AD-MSCs) and bone marrow (BM)–derived MSCs in a rat VCA model. Methods Both cell types were tested in vitro for suppressor function using mixed lymphocyte reactivity assays. AD-MSCs or BM-MSCs were administered intravenously (1 × 106 or 5 × 106 cells/animal) to Lewis rat recipients of mismatched Brown Norway hindlimb transplants. Short course tacrolimus (FK-506) monotherapy was withdrawn at postoperative day 21. In vivo regulatory T-cell induction, peripheral blood chimerism, and microchimerism in lymphatic organs were analyzed. Results AD-MSCs and BM-MSCs exhibited strong dose-dependent suppressor function in vitro, which was significantly more pronounced for AD cells. In vivo, all animals revealed peripheral multi-lineage chimerism at four weeks (P < 0.01) independent of cell type and dosage. Regulatory T-cell levels were increased with both cell types, the most in AD-MSC groups. These immunomodulatory effects were only transient. MSC treatment resulted in long-term (>120 day) allograft survival in 47% of the animals, which correlated with durable microchimerism in BM and spleen. Conclusions AD-MSCs and BM-MSCs exert immunomodulatory effects that prolong survival of immunogenic skin-bearing VCA grafts with short course (21 day) tacrolimus induction therapy. The in vivo findings in terms of allograft survival did not reflect superior immunomodulatory characteristics of AD-MSCs found in vitro.
Cluster analysis on breath print of newly diagnosed COPD patients: effects of therapy

Background: Chronic obstructive pulmonary disease (COPD) is a highly heterogeneous disease and airflow limitation and symptoms only partially capture such heterogeneity. Since COPD is known to affect the production of volatile organic compounds (VOCs), we aimed to verify to which extent exhaled VOCs can characterize newly diagnosed COPD patients and changes in response to inhaled therapy. Materials and methods: Fifty newly diagnosed COPD patients were consecutively recruited among those attending the pulmonary medicine outpatient clinic at ‘Campus Bio-Medico’ University Hospital. VOCs were collected using the Pneumopipe® and analysed by the BIONOTE electronic nose both at baseline and after 12 weeks of inhaled therapy. Patients were grouped using K-mean cluster analysis on BIONOTE responses and the obtained clusters were compared via non-parametric tests. Results: We identified three clusters of subjects: (a) without remarkable comorbidities; (b) with air trapping and higher BODE index score (mean 1.2); (c) without air trapping and with a lower BODE index. Inhaled bronchodilators caused a quantitative reduction in the amound of VOCs, while inhaled steroids provided a qualitative modification of the breath profile. Conclusion: VOCs patterns categorize newly diagnosed COPD subjects. VOCs production declines after bronchodilators administration and changes in quality after topic steroid treatment.
Clinical applications of chemical exchange saturation transfer (CEST) MRI

Chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) has been developed and employed in multiple clinical imaging research centers worldwide. Selective radiofrequency (RF) saturation pulses with standard 2D and 3D MRI acquisition schemes are now routinely performed, and CEST MRI can produce semiquantitative results using magnetization transfer ratio asymmetry (MTRasym) analysis while accounting for B0 inhomogeneity. Faster clinical CEST MRI acquisition methods and more quantitative acquisition and analysis routines are under development. Endogenous biomolecules with amide, amine, and hydroxyl groups have been detected during clinical CEST MRI studies, and exogenous CEST agents have also been administered to patients. These CEST MRI tools show promise for contributing to assessments of cerebral ischemia, neurological disorders, lymphedema, osteoarthritis, muscle physiology, and solid tumors. This review summarizes the salient features of clinical CEST MRI protocols and critically evaluates the utility of CEST MRI for these clinical imaging applications.
Sexual behaviour and networking: anthropological and socio-cultural studies on the transmission of HIV

protagonists when they are nearer the twilight of their careers. As the volume of empirical research on the effects of the reforms slowly accumulates, yet another story will emerge. In the meantime, this book has succeeded in showing that sense can be made of even the most complex events in the very recent past by a well informed, detached observer. NICHOLAS MAYS Director Health and Health Care Research Unit, The Queen's University of Belfast
Surgical assistance - who can help?

Changes affecting surgical training, together with the implementation of the European Working Time Directive, have necessitated increased reliance on non-medically qualified assistants. Such assistance must be performed by suitably educated personnel. The RCS, The Perioperative Care Collaborative (PCC) and The Association for Perioperative Practice (AfPP) all play a role in ensuring high standards of patient care. In so doing, they have determined the circumstances and the level at which such assistance may be given by three grades of perioperative personnel. It is essential that surgeons understand and support such non-medically qualified colleagues in adhering to these standards.
Recurrent Primary Focal Segmental Glomerulosclerosis Managed With Intensified Plasma Exchange and Concomitant Monitoring of Soluble Urokinase-Type Plasminogen Activator Receptor–Mediated Podocyte &bgr;3-integrin Activation

Background Primary focal segmental glomerulosclerosis (FSGS) often causes nephrotic proteinuria and frequently results in end-stage renal disease and recurrence after kidney transplantation. Recent studies describe soluble urokinase-type plasminogen activator receptor (suPAR) as a circulating factor implicated in FSGS. Methods This single-center study included 12 adult patients with histologically proven primary FSGS (n = 2) or recurrent FSGS after transplantation (n = 10). The effect of plasma exchange (PE) on clinical outcome, suPAR levels, and in vitro podocyte &bgr;3-integrin activation was investigated over a median of 11 (6-18) sessions of PE. Results The course of treatment was monitored in a total of 70 sessions of PE, which partly eliminated suPAR, with a mean reduction of 37 ± 12% of serum concentration per session. However, a substantial rebound was observed between sessions, with suPAR levels reaching 99 ± 22% of the pretreatment levels after a median of 4 days. Podocyte &bgr;3-integrin activation dropped significantly after PE but rebounded within 4 days concomitant with a rising suPAR level. In 11 of 12 patients, multimodal treatment (including extensive PE) reduced proteinuria significantly (from 5.3 [2.0-7.8] to 1.0 [0.4-1.6] g/d), indicating clinical efficacy of the therapy. One patient suffered allograft loss due to FSGS recurrence. A persisting response was independent of a lasting reduction in the level of total suPAR because there was no sustained significant change in suPAR levels before and after the course of intensified treatment (3814 ± 908 to 3595 ± 521 pg/mL; P = 0.496). Conclusions We conclude that multimodal therapy including extensive PE was associated with stabilization of recurrent FSGS and a temporary lowering of plasma suPAR as well as podocyte &bgr;3-integrin activation. Whether a sustained lowering of total suPAR results in further improved outcomes requires additional study.
Lysis at the anterior vertebral body margin: evidence for brucellar spondylitis?

Recently, palaeopathologists have begun to diagnose brucellosis in skeletal remains from minor lytic lesions located on the anterior margins of one or some few vertebral bodies, taking these lesions to represent brucellar epiphysitis. However, review of the literature indicates that these lesions have been sporadically noted for some time by palaeopathologists and various different interpretations have been placed upon them. In view of this, a study of these vertebral marginal lesions (VML) was undertaken in a large series of archaeological skeletons from England, with the aim of characterising their morphology and frequency and shedding light upon their causes. In the study material, VML were found only in the lumbar spine, where they occurred with a prevalence of approximately 4%. It was argued that VML are consistent with two principal alternative diagnoses: brucellosis and traumatic anterior disc herniation. Differentiating these possibilities for the VML in the study material was difficult, but the balance of the evidence seemed to favour traumatic anterior disc herniation as the more likely cause. It is concluded that VML should not be used to identify the presence of brucellosis in skeletal remains unless there is further evidence, in the form of additional skeletal lesions or biomolecular evidence for residual brucella bacterial DNA, to support such a diagnosis. Copyright © 2007 John Wiley & Sons, Ltd.