Miracle-dz/UniFAR-FTUs huggingface dataset:
Development of new CdZnTe detectors for room-temperature high-flux radiation measurements.

Recently, CdZnTe (CZT) detectors have been widely proposed and developed for room-temperature X-ray spectroscopy even at high fluxes, and great efforts have been made on both the device and the crystal growth technologies. In this work, the performance of new travelling-heater-method (THM)-grown CZT detectors, recently developed at IMEM-CNR Parma, Italy, is presented. Thick planar detectors (3 mm thick) with gold electroless contacts were realised, with a planar cathode covering the detector surface (4.1 mm × 4.1 mm) and a central anode (2 mm × 2 mm) surrounded by a guard-ring electrode. The detectors, characterized by low leakage currents at room temperature (4.7 nA cm-2 at 1000 V cm-1), allow good room-temperature operation even at high bias voltages (>7000 V cm-1). At low rates (200 counts s-1), the detectors exhibit an energy resolution around 4% FWHM at 59.5 keV (241Am source) up to 2200 V, by using commercial front-end electronics (A250F/NF charge-sensitive preamplifier, Amptek, USA; nominal equivalent noise charge of 100 electrons RMS). At high rates (1 Mcounts s-1), the detectors, coupled to a custom-designed digital pulse processing electronics developed at DiFC of University of Palermo (Italy), show low spectroscopic degradations: energy resolution values of 8% and 9.7% FWHM at 59.5 keV (241Am source) were measured, with throughputs of 0.4% and 60% at 1 Mcounts s-1, respectively. An energy resolution of 7.7% FWHM at 122.1 keV (57Co source) with a throughput of 50% was obtained at 550 kcounts s-1 (energy resolution of 3.2% at low rate). These activities are in the framework of an Italian research project on the development of energy-resolved photon-counting systems for high-flux energy-resolved X-ray imaging.
Limitations of Embryo Selection Methods

Abstract In in vitro fertilization (IVF), the selection of embryos for transfer is generally based on the morphology of the available embryos. However, not all embryos with good morphology implant and on average only one in four treatments are successful. This has driven a quest for alternative selection methods. The best known alternative selection method is preimplantation genetic screening (PGS), which has been used for over a decade before it was shown to be inferior to morphological selection. Now, new forms of PGS (performing biopsy at another stage of development and new methods for analysis) are emerging, just like alternative noninvasive embryo selection methods. However, the concept that better selection will lead to improved IVF results is not so certain anymore. Evidence is accumulating that all available embryos in an IVF cycle can be cryopreserved and transferred in subsequent cycles without impairing pregnancy rates or maybe even with an improvement in pregnancy rates. Embryo selection will then no longer be able to improve the live birth rate in IVF; it could even lower the live birth rate. Embryo selection will only be able to improve the time to pregnancy, if embryos with the highest implantation potential are transferred first.
Organic light emitting diode improves diabetic cutaneous wound healing in rats

A major complication for diabetic patients is chronic wounds due to impaired wound healing. It is well documented that visible red wavelengths can accelerate wound healing in diabetic animal models and patients. In vitro and in vivo diabetic models were used to investigate the effects of organic light emitting diode (OLED) irradiation on cellular function and cutaneous wound healing. Human dermal fibroblasts were cultured in hyperglycemic medium (glucose concentration 180 mM) and irradiated with an OLED (623 nm wavelength peak, range from 560 to 770 nm, power density 7 or 10 mW/cm2 at 0.2, 1, or 5 J/cm2). The OLED significantly increased total adenosine triphosphate concentration, metabolic activity, and cell proliferation compared with untreated controls in most parameters tested. For the in vivo experiment, OLED and laser (635 ± 5 nm wavelength) treatments (10 mW/cm2, 5 J/cm2 daily for a total of seven consecutive days) for cutaneous wound healing were compared using a genetic, diabetic rat model. Both treatments had significantly higher percentage of wound closure on day 6 postinjury and higher total histological scores on day 13 postinjury compared with control. No statistical difference was found between the two treatments. OLED irradiation significantly increased fibroblast growth factor‐2 expression at 36‐hour postinjury and enhanced macrophage activation during initial stages of wound healing. In conclusion, the OLED and laser had comparative effects on enhancing diabetic wound healing.
Public access defibrillation: improving accessibility and outcomes.

BACKGROUND Worldwide, out-of-hospital cardiac arrest (OHCA) remains a serious problem. Public access defibrillation (PAD) has been shown to be effective in improving survival in OHCA with good neurological outcome. SOURCES OF DATA Original articles, reviews and national/international guidelines. AREAS OF AGREEMENT Limitations to how much we can improve ambulance response times mean that the public have an essential role to play in OHCA survival. Training of laypersons in the use of automated external defibrillators (AEDs) has been shown to improve outcomes. Placement of AEDs should be related to underlying population demographics. AREAS OF CONTROVERSY Placements of AEDs face cost constraints. PAD programs also face challenges in the upkeep of AEDs. Concerns about legal liability for lay rescuers to act remain. GROWING POINTS Systematic programs should be in place to train the public in PAD. All AEDs should be listed in national registries and available for usage in an emergency. AREAS TIMELY FOR DEVELOPING RESEARCH 'Smart' technology is being developed to improve accessibility of AEDs.
Presepsin as a predictor of critical colonization in CLI hemodialysis patients

Infection during critical limb ischemia (CLI) is a challenging issue. Plasma presepsin is a novel biomarker for infection, which is related to bacterial phagocytosis by macrophages. The purpose of this study was to investigate the validity of presepsin as an indicator and predictor for early detection of infectious CLI. A retrospective observational study was conducted among 20 CLI patients (Rutherford 5 and 6) on hemodialysis (HD). Twenty CLI patients on HD (mean age 70.7 ± 5.6 years, male 85%) and 15 healthy patients on HD without CLI and infection (control group) were analyzed. All CLI patients received appropriate revascularization and plastic surgical treatment. CLI patients were classified into two groups: the healing group with complete epithelialization without discharge and the nonhealing group with infection signs. Plasma presepsin was measured and compared among the two groups and the control group using an automated immunoanalyzer, PATHFAST, based on a noncompetitive chemiluminescent enzyme immunoassay. The median plasma presepsin and its interquartile range were 1,320 (1,055–1,465) pg/mL in the control group, 1,320 (1,050–1,613) pg/mL in the healing group and 3,193 (2,519–3,832) pg/mL in the nonhealing group. The plasma presepsin concentrations were significantly higher in the nonhealing group compared with the control group (p < 0.001) and the healing group (p < 0.01). A receiver operating characteristic curve analysis revealed that presepsin had highest accuracy (0.979) among various inflammatory markers, including C‐reactive protein and the white blood cell count. The diagnostic cutoff value of 2,083 pg/mL was able to distinguish the nonhealing group and healing group with a sensitivity of 100% and a specificity of 88.9%. Our results suggest that plasma presepsin may be useful for predicting “critical colonization” and “infection” in nonhealing CLI in HD patients, therefore, the definitive cutoff value may be used for determinating the indication for reintervention and/or major limb amputation.
Long‐term scar quality in burns with three distinct healing potentials: A multicenter prospective cohort study

The laser Doppler imager is used in cases of indeterminate burn depth to accurately predict wound healing time at an early stage. The laser Doppler imager classifies burns into three estimated healing potentials as follows: high, <14 days; intermediate, 14–21 days; and low, >21 days. At this time, the relationship between these healing potentials and long‐term scar quality is unknown. The objective of this study was to determine the long‐term scar quality of burns with three distinct healing potentials. The secondary objectives were to compare treatment strategies in intermediate wounds, to study the effect of the timing of surgery on low healing potential wounds and to identify predictors of reduced scar quality. Hence, in a prospective cohort study, scar quality was determined in patients whose burns were assessed with laser Doppler imaging. Scar Quality was assessed with objective and subjective measurement tools, including overall scar quality (Patient and Observer Scar Assessment Scale) as a primary outcome and color and elasticity parameters. A total of 141 patients (>19 months postburn) with 216 scars were included. Wounds with high and intermediate healing potential did not significantly differ regarding scar quality. Wounds with a low healing potential had a significantly lower scar quality. Analysis of 76 surgically treated low healing potential wounds showed no significant differences in the primary outcome regarding the timing of surgery (≤14 days vs. >14). Predictors of reduced long‐term scar quality were darker skin type and multiple surgeries. In conclusion, scar quality was strongly related to the healing potential category. Scar quality was very similar in high and intermediate healing potential wounds. No positive effects were found on scar quality or on healing time in surgically treated wounds with intermediate healing potential, advocating a conservative approach. Further studies should focus on the optimal timing of surgery in low healing potential wounds.
Graves' Disease Pharmacotherapy in Women of Reproductive Age

Graves' disease is an autoimmune disorder in which inappropriate stimulation of the thyroid gland results in unregulated secretion of thyroid hormones resulting in hyperthyroidism. Graves' disease is the most common cause of autoimmune hyperthyroidism during pregnancy. Treatment options for Graves' disease include thioamide therapy, partial or total thyroidectomy, and radioactive iodine. In this article, we review guideline recommendations for Graves' disease treatment in women of reproductive age including the recent guideline from the American College of Obstetricians and Gynecologists. Controversy regarding appropriate thioamide therapy before, during, and after pregnancy is reviewed. Surgical and radioactive iodine therapy considerations in this patient population are also reviewed. In patients who may find themselves pregnant during therapy or develop Graves' disease during their pregnancy, consideration should be given to the most appropriate treatment course for the mother and fetus. Thioamide therapy should be used with either propylthiouracil or methimazole at appropriate doses that target the upper range of normal to slightly hyperthyroid to avoid creating hypothyroidism in the fetus. Consideration should also be given to the adverse effects of thioamide, such as agranulocytosis and hepatotoxicity, with appropriate patient consultation regarding signs and symptoms. Individuals who wish to breastfeed their infants while taking thioamide should receive the lowest effective dose. Surgery should be reserved for extreme cases and limited to the second trimester, if possible. Radioactive iodine therapy may be used in nonpregnant individuals, with limited harm to future fertility. Radioactive iodine therapy should be withheld in pregnant women and those who are actively breastfeeding. Clinicians should keep abreast of developments in clinical trials and evidence‐based recommendations regarding Graves' disease in reproductive‐age women for any changes in evidence‐based practice.
Do Statins Attenuate Postoperative Atrial Fibrillation in Isolated Heart Valve Surgery?

Postoperative atrial fibrillation (POAF) is a major complication occurring in 10–65% of patients undergoing cardiothoracic surgeries. The incidence of POAF differs among cardiac surgeries, from 40% after isolated heart valve surgeries to 60% after combined coronary and valvular surgeries. 2 Of all the pharmacological options for preventing POAF, statins have been shown to be associated with a significant decrease in the development of POAF in patients undergoing cardiac surgeries. We read with great interest the article by Bolesta and Kong on the effect of statins on POAF in patients undergoing isolated heart valve surgeries. The authors noted that preoperative statin use, defined as receiving at least one dose of a statin within 24 hours before surgery, did not reduce POAF incidence compared to those not receiving a statin (34.3% vs 27.5%; p=NS). We believe, however, that some points should be borne in mind when reading this report or using it as evidence. First, this study was neither prospective nor randomized as the authors themselves did mention. An additional challenge also arises because of the confounding factors that may have further influenced their results, including prior medical conditions, statin type and/or dosage, and preoperative b-blocker use. According to the study findings, the patients who received statins had increased incidence of b-blocker use and of diabetes mellitus and hypertension. In addition, POAF incidence was greater in these patients. It has been demonstrated that these factors have a great impact on the incidence of POAF in cardiac surgeries; hence, subgroup analysis may be more informative than the analysis in the present article to elucidate these effects. In a latest meta-analysis, it was shown that atorvastatin was more effective than other statins in the prevention of POAF after cardiac surgeries, although there were insufficient data to provide evidence in the setting of isolated valvular surgeries. Most of the studies of patients undergoing isolated heart valve surgeries that have demonstrated the inefficacy of statins in the prevention of POAF have been retrospective. 6 However, in a recently published randomized study―the only evidence of a randomized study in this background―preoperative atorvastatin (40 mg) reduced POAF incidence in patients undergoing isolated heart valve surgeries compared with those receiving placebo, with a number needed to treat of four (21% vs 45%; p=0.05). In summary, continued evolution of evidence regarding the effect of statins on POAF after isolated heart valve surgeries requires further largescale randomized studies to clarify the protective role of statins in this setting.
Untersuchungen zum Verlauf von Interleukin-6-Serumspiegeln bei neonatalen Risikopatienten in der ersten Lebenswoche

in der vorliegenden Arbeit wurden die IL-6-Serumkonzentrationen von Risikoneugeborenen in den ersten zehn Lebenstagen und ihre Veranderungen im Rahmen einer Early-Onset-Sepsis (EOS), von weiteren neonatologischen Krankheitsbildern sowie in Abhangigkeit vom Gestationsalter untersucht. Dafur wurden die Daten von 100 Neugeborenen sowie die Daten der zugehorigen Mutter retrospektiv erhoben und statistisch ausgewertet. Das durchschnittliche Gestationsalter dieser Kinder lag bei 33,4 SSW, fur die Auswertung wurden weiterhin die Subgruppen der sehr unreifen (≤ 29+0 SSW), unreifen (29+1 bis 35+0 SSW) und reifen Neugeborenen (≥ 35+1 SSW) berucksichtigt. Die Diagnose einer EOS wurde retrospektiv anhand von anamnestischen, klinischen und laborchemischen Kriterien gestellt. Insgesamt 11 Neugeborene erkrankten an einer EOS. Die IL-6-Serumkonzen-trationen dieser Kinder waren zu den Untersuchungszeitpunkten nach Geburt und nach einem Tag signifikant hoher als bei den Neugeborenen ohne Sepsis, ab einem Lebensalter von zwei Tagen fand sich kein signifikanter Unterschied mehr. Fur einen IL-6-Cutoff von 165 pg/ml ergab sich eine Sensitivitat von 81,8%, eine Spezifitat von 88,8%, PPV von 47,4% sowie ein NPV von 97,5%. Die IL-6-Werte zeigten eine hochsignifikante Korrelation mit den einen Tag spater gemessenen CRP-Konzentrationen. Bei den sehr unreifen Neugeborenen mit einem Reifealter ≤ 29+0 SSW waren prolongiert erhohte IL-6-Serumkonzentrationen in der ersten Lebenswoche auffallig. Auserdem zeigten sich bei Neugeborenen mit Atemnotsyndrom (ANS) ab einem Lebensalter von einem Tag in der gesamten ersten Lebenswoche signifikant erhohte IL-6-Serumkonzentrationen gegenuber den Kindern ohne ANS. Auch das Auftreten einer intraventrikularen Hamorrhagie war in einem Lebensalter von funf bis sieben Tagen mit einer signifikanten IL-6-Erhohung assoziiert. Diese Beobachtungen weisen auf eine Aktivierung systemischer Inflammationsprozesse im Rahmen dieser beiden Krankheitsbilder hin, die bei der Interpretation von IL-6-Werten in der ersten Lebenswoche Berucksichtigung finden sollte. Bei Patienten mit spaterer bronchopulmonaler Dysplasie waren signifikant niedrigere IL-6-Serumkonzentrationen unmittelbar nach Geburt auffallig, bei keinem dieser Kinder wurde eine EOS diagnostiziert.
Fluoroquinolone‐Associated Tendinopathy: Does Levofloxacin Pose the Greatest Risk?

Fluoroquinolone antibiotics recently have gained increased national attention due to safety concerns. A well‐described and serious adverse event associated with receipt of fluoroquinolones is tendinitis and tendon rupture. These tendon injuries can result in long‐term sequelae, including chronic pain and mobility restrictions, and may warrant surgery. Due to the severity of these adverse events, a black box warning is included in the product labeling of all fluoroquinolones. In light of the mounting concerns surrounding fluoroquinolone‐associated toxicities, the purpose of this clinical review is to provide a comprehensive summary of the risk of tendinopathy associated with levofloxacin, one of the most widely prescribed antibiotics in the United States, across in vitro, animal, and clinical studies, relative to other antibiotics. As part of this review, clinical presentation and onset, proposed mechanisms, patient‐specific risk factors, and management of fluoroquinolone‐induced tendon injury are summarized. Data were obtained from a comprehensive PubMed literature search and a review of U.S. Food and Drug Administration documents. Although tendinopathy is considered a fluoroquinolone class–wide toxicity, data from in vitro studies, animal studies, patient‐level analyses, and large national and international surveillance reports suggest that levofloxacin, as well as its parent compound ofloxacin, possess higher propensities to cause tendon damage relative to other fluoroquinolones. Risk with ofloxacin and levofloxacin appears to be exposure dependent, with higher doses and longer durations being most commonly associated with tendinopathy. Other well‐described patient risk factors for fluoroquinolone‐associated tendinopathy include older age (older than 60 yrs), receipt of concomitant corticosteroid therapy, presence of renal dysfunction, and history of solid organ transplantation. Given widespread use of levofloxacin across patient care settings, knowledge of both patient‐ and drug‐specific characteristics associated with increased risk of tendinitis and tendon rupture can promote safe use of levofloxacin and other fluoroquinolones.
Clonidine for Sedation and Analgesia and Withdrawal in Critically Ill Infants and Children

The need for sedation and analgesia and treatment of iatrogenic drug withdrawal is common in critically ill children. First‐line therapy typically includes opioid agonists. However, clonidine, a central α2 agonist, has been suggested as a treatment option for sedation and analgesia and iatrogenic drug withdrawal. Therefore, we conducted a literature search to identify articles evaluating the use of enteral (PO) and transdermal clonidine in critically ill infants and children for sedation and analgesia and treatment of iatrogenic drug withdrawal. The literature search was limited to English‐language articles in Medline (1946–May 2016), Embase (1988–May 2016), and International Pharmaceutical Abstracts (1970–May 2016). Reference citations from relevant articles were also reviewed. Ten case reports and studies, representing a total of 114 children receiving clonidine, were included. Fifty patients (43.9%) received clonidine for sedation and analgesia while mechanically ventilated, and 33 (29.0%) received clonidine for treatment or prevention of drug withdrawal. The remaining 31 patients (27.1%) were included in a pharmacokinetic study that did not evaluate clinical outcomes. Seventy‐nine patients (69.3%) received PO clonidine, with a dosage range of 2–15 µg/kg/day divided every 6–8 hours. Thirty‐five patients (30.7%) received transdermal clonidine, with a dosage range of 2.3–20 µg/kg/day. Whole, cut, and occluded transdermal patches were used in the reports. Patients receiving cut patches had more variable and significantly higher serum clonidine concentrations than those receiving whole patches. Only three studies reported that the PO clonidine dose was tapered at the end of therapy; however, no report specifically described the process. The two most common adverse events reported with PO and transdermal clonidine were bradycardia and hypotension. PO and transdermal clonidine have a potential role for sedation and analgesia and drug withdrawal in critically ill infants and children. The use of cut transdermal patches should be avoided. Future prospective studies are needed to further define clonidine's role as adjunct therapy or monotherapy.
Laboratory and Clinical Monitoring of Direct Acting Oral Anticoagulants: What Clinicians Need to Know

The direct acting oral anticoagulants (DOACs), including dabigatran, rivaroxaban, apixaban, and edoxaban, have favorable pharmacokinetic and pharmacodynamic properties and equal or superior efficacy and an improved safety profile compared with warfarin. Noted shortcomings with DOACs are shorter half‐lives requiring stricter adherence, lack of standardized laboratory monitoring, lack of anticoagulation reversal agents, and loss of routine coagulation monitoring leading to fewer patient–clinician interactions. This review addresses many of these limitations including monitoring of DOACs for efficacy and toxicity, an assessment of selected qualitative and quantitative tests, and development of monitoring strategies for special populations. Coagulation monitoring is generally recommended only in overdose situations, but once standardized assays are readily available, they could be helpful to ensure efficacy, assess bleeding, and aid in drug selection in a number of other patient scenarios. Coagulation tests that may provide qualitative assessment include activated partial thromboplastin time, prothrombin time, and thrombin time. Methods with potential utility for quantitative assessment of DOACs include plasma drug concentrations, ecarin clotting time, dilute thrombin time, and anti–factor Xa concentrations. Noncoagulation laboratory monitoring should include serum creatinine, liver function tests, and complete blood counts. Clinical monitoring of the DOAC‐treated patient should include routine assessment of adherence, bleeding risks, and drug interactions. Frequency of monitoring should be 1–3 months after initiation and then at least every 6 months, with more frequent follow‐up (i.e., 3 months) based on patient specific characteristics such as age, renal impairment, hepatic impairment, and concomitant drug therapy. The authors provide a practical tool to assist in DOAC monitoring and recommend that pharmacists collaborate with physicians in selecting appropriate patients and tailoring patient‐specific monitoring plans.