Miracle-dz/UniFAR-FTUs huggingface dataset:
Twenty-year trend in mortality among hospitalized patients with pneumococcal community-acquired pneumonia

Background There is only limited information on mortality over extended periods in hospitalized patients with pneumococcal community-acquired pneumonia (CAP). We aimed to evaluate the 30-day mortality and whether is changed over a 20-year period among immunocompetent adults hospitalized with pneumococcal CAP. Methods We conducted a retrospective observational study of data that were prospectively collected at the Hospital Clinic of Barcelona of all adult patients hospitalized with diagnosis of pneumococcal CAP over a 20-year period. To aid analysis, results were divided into four periods of 5 years each (1997–2001, 2002–2006, 2007–2011, 2012–2016). The primary outcome was 30-day mortality, but secondary outcomes included intensive care unit (ICU) admission, lengths of hospital and ICU-stays, ICU-mortality, and need of mechanical ventilation. Results From a cohort of 6,403 patients with CAP, we analyzed the data for 1,120 (17%) adults with a diagnosis of pneumococcal CAP. Over time, we observed decreases in the rates of alcohol consumption, smoking, influenza vaccination, and older patients (age ≥65 years), but increases in admissions to ICU and the need for non-invasive mechanical ventilation. The overall 30-day mortality rate was 8% (95% confidence interval, 6%–9%; 84 of 1,120 patients) and did not change significantly between periods (p = 0.33). Although, we observed a decrease in ICU-mortality comparing the first period (26%) to the second one (10%), statistical differences disappeared with adjustment (p0.38). Conclusion Over time, 30-day mortality of hospitalized pneumococcal CAP did not change significantly. Nor did it change in the propensity-adjusted multivariable analysis. Since mortality in pneumococcal pneumonia has remained unaltered for many years despite the availability of antimicrobial agents with proven in vitro activity, other non-antibiotic strategies should be investigated.
Loss of vimentin intermediate filaments decreases peri-nuclear stiffness and enhances cell motility through confined spaces

The migration of cells through tight constricting spaces or along fibrous tracks in tissues is important for biological processes, such as embryogenesis, wound healing, and cancer metastasis, and depends on the mechanical properties of the cytoskeleton. Migratory cells often express and upregulate the intermediate filament protein vimentin. The viscoelasticity of vimentin networks in shear deformation has been documented, but its role in motility is largely unexplored. Here, we studied the effects of vimentin on cell motility and stiffness using mouse embryo fibroblasts derived from wild-type and vimentin-null mice. We find that loss of vimentin increases motility through small pores and along thin capillaries. Atomic force microscopy measurements reveal that the presence of vimentin enhances the perinuclear stiffness of the cell, to an extent that depends on surface ligand presentation and therefore signaling from extracellular matrix receptors. Together, our results indicate that vimentin hinders three-dimensional motility by providing mechanical resistance against large strains and may thereby protect the structural integrity of cells.
I. LIFE AT SEA

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Maternal peripartum antibiotic exposure and the risk of postpartum depression

Postpartum depression is a relatively common occurrence that may carry lifelong consequences. Also common is the exposure of pregnant and postpartum women in the United States to antibiotics, especially during the peripartum period. Antibiotic exposure is known to alter gut microbial composition and structure, contributing to a dysbiotic, or imbalanced gut microbiome, and is a mechanism suggested for the increased risk of depressive symptoms following antibiotic exposure in non-pregnant, non-postpartum populations. We sought to determine the relationship between antibiotic exposure intrapartum through the first 14 days postpartum and depressive symptoms within the first 6-months postpartum. In this secondary data analysis, 124 pregnant women from a prospective cohort were enrolled into the study and provided demographic characteristics and health history. Participants completed questionnaires including the Edinburgh Postnatal Depression Scale between 32-36 weeks, and 1- and 2-weeks and 1-, 2-, 3-, and 6-months postpartum. Clinical measures including hours in labor, perineal injury, and mode of giving birth were ascertained by medical record abstraction. Antibiotic exposure was identified by self-report at 1- and 2-weeks postpartum. Antibiotic exposure was found to be independently predictive of postpartum depressive symptoms at 1-month (Beta = 0.43; CI [0.01, 0.86]) and 2-months (Beta = 0.51; CI [0.08, 0.94]) postpartum after controlling for baseline predictors. The relationship between antibiotic exposure and postpartum depressive symptoms did not maintain significance at 3- or 6-months postpartum. Additional studies are needed to further investigate the relationship between onset and duration of antibiotic exposure, the peripartum gut microbiome, and the risk for postpartum depressive symptoms.
Clostridium difficile infection in patients with chronic kidney disease in Mexico .

BACKGROUND Clostridium difficile infection (CDI) is a leading cause of healthcare-associated diarrhea worldwide. Patients with chronic kidney disease (CKD) are especially vulnerable, as they are exposed to CDI risk factors including frequent antibiotics. MATERIALS AND METHODS In order to identify the risk factors for CDI in CKD patients, a 33-month long case-control study was carried out at a tertiary-care hospital in Mexico. CDI was confirmed at the genetic level, and univariate and multivariate analyses were performed to identify the association between risk factors, biomarkers, and outcome options (survival, relapse, death). RESULTS Among the 1,198 patients with healthcare-associated diarrhea, 354 (29.5%) were CDI cases. 105 (29.6%) CDI cases and 192 (22.7%) controls had CKD. 84 (80%) CKD+CDI cases had a favorable outcome, 10 (9.5%) relapsed, and the 3-month mortality rate included 11 (10.4%) patients. Compared with controls, CDI cases had more previous hospitalizations (63.8 vs. 46.9%, p = 0.005), abdominal distension (46.7 vs. 36.5%, p = 0.056), abdominal pain (60.0 vs. 41.1%, p = 0.002), and polymorphonuclear leukocyte in stools (71.4 vs. 40.5%, p = 0.001) as well as poorer outcomes at 3 months. The patients in the 027-strain group were older, and most of the patients had CKD stage 5 (88.5% vs. 71.1%, p = 0.007), while CKD stage-4 patients were more frequently infected with non-027 strains. In the multivariate analysis of risk factors for CDI, only previous antibiotic exposure (odds ratio = 2.01, 95% confidence interval: 1.05 - 3.84; p = 0.034) was independently associated with CDI in patients with CKD stage 5. CONCLUSION Mexican patients with CKD are at risk for CDI. This susceptible group should be protected by promoting appropriate guidelines.
CORR Insights®: No Clinically Important Difference in Pain Scores After THA Between Periarticular Analgesic Injection and Placebo A Randomized Trial

The evidence base about periarticular injection (PAI) in hip and knee replacement includes a substantial number of studies proclaiming its benefits [2, 9], although others have questioned its value [4, 5]. Not long ago, before the advent of multimodal pain control and rapid-recovery protocols for hip and knee replacement, postoperative pain was an expected, even accepted, part of recovery. Acute pain was a leading cause of delayed discharge [10] with hospital stays routinely exceeding 3 days. Pain management has improved substantially among arthroplasty patients over the last decade, and lengths of stay have decreased correspondingly, with many high-volume centers typically discharging patients the same day or the day after surgery. In addition to multimodal pain control (including PAI), systematic use of early mobilization, tranexamic acid, and less-aggressive anticoagulation have transformed postoperative recovery after joint replacement. But which of these factors has had the greatest effect? In the current study, Hirasawa and colleagues [6] perform a randomized, double-blind, placebo-controlled trial to evaluate the effect of PAI on VASmeasured pain after THA. This rare Level-1 (yet brilliantly simple) study takes place in the context of one surgeon performing bilateral surgery with patients randomized to get PAI in one hip and placebo in the other. While there was a difference in VAS pain scores, the difference did not achieve the predetermined minimum clinically important difference (MCID) of > 20 mm out of 100 on the VAS scale. This was true at all measured time points, up to 24 hours. There were no complications in either group. The authors correctly conclude that the expense of PAI did not justify its use. Perhaps PAI is not as valuable as we may have thought.
Two-year adherence and costs for biologic therapy for rheumatoid arthritis.

OBJECTIVES To evaluate adherence to newly initiated biologic disease-modifying antirheumatic drugs (bDMARDs) in effectively treated patients with rheumatoid arthritis (RA). STUDY DESIGN Retrospective cohort study of administrative claims data (IMS PharMetrics Plus) for services incurred from July 1, 2008, to December 31, 2014. METHODS Data from patients with RA aged 18 to 64 years with continuous enrollment for at least 30 months and initiating abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab were analyzed. Treatment effectiveness was determined using a validated algorithm. Outcomes included adherence rates (proportion of days covered ≥80%) for 1 year and 2 years, year 2 adherence among patients effectively and noneffectively treated in year 1, year 2 adherence predictors, and year 2 costs and cost predictors. RESULTS Across 10,374 patients, adherence rates were 46% for year 1 and 34% for 2 years; rates were lowest for golimumab and highest for infliximab. In year 1, 3076 (29.7%) patients were considered effectively treated. Year 2 adherence was 59% in effectively treated patients, 32% in patients who failed any effectiveness criteria, and 12% in patients who failed only the adherence criterion. Intravenous bDMARDs, older age, male sex, Northeast region, commercial payer, prior DMARD use, index year 2010 or later, and lower preindex all-cause costs each predicted better adherence. Adjusted year 2 all-cause and RA-related costs were $39,425 and $22,123, respectively, for effectively treated patients and $25,313 and $9250 for noneffectively treated patients. Cost predictors included effective treatment, region, payer, and index year. CONCLUSIONS Adherence to the first bDMARD was suboptimal even in effectively treated patients, suggesting opportunities to improve adherence in patients with RA initiating biologics.
Immune protection conferred by three commonly used commercial live attenuated vaccines against the prevalent local strains of avian infectious bronchitis virus in southern China

Live attenuated vaccines are critical in the control of avian infectious bronchitis. It is necessary to know the protection conferred by commonly used commercial live vaccines. In this study, specific pathogen-free chicks were vaccinated with the commercial live vaccines H120, 4/91 and LDT3-A. Blood samples were collected at weekly intervals for the detection of IBV-specific antibodies and quantification of CD4+ and CD8+ T lymphocytes. At 21 days post-inoculation the vaccinated birds were challenged with the IBV prevalent local strains GX-YL5, GX-GL11079 and GX-NN09032, respectively. Trachea and kidney samples were collected at 5 days post-challenge for the detection of the virus. The results showed that the H120 group exhibited medium antibody levels, the lowest percentages of CD4+, CD8+ T lymphocytes and the highest viral loads. The 4/91 group showed the lowest antibody levels, but the highest percentages of CD4+, CD8+ T lymphocytes and the lowest viral loads. The LDT3-A group showed the highest antibody levels, the medium percentages of CD4+, CD8+ T lymphocytes and the medium viral loads. The protection rates of H120, 4/91 and LDT3-A groups were 41.7–58.3%, 75.0–83.7% and 66.7–75.0%, respectively. The present study demonstrated that the vaccines H120, 4/91 and LDT3-A could stimulate the immunized chicks to produce different levels of humoral and cellular immunity to resist the infection of IBV, but couldn’t provide complete protection against the prevalent local strains of IBV in southern China. Also, the vaccine 4/91 offered the best immune protection among the three vaccines.
Racial/Ethnic Discrimination and Well-Being During Adolescence: A Meta-Analytic Review

This meta-analytic study systematically investigates the relations between perceived racial/ethnic discrimination and socioemotional distress, academics, and risky health behaviors during adolescence, and potential variation in these relations. The study included 214 peer-reviewed articles, theses, and dissertations, with 489 unique effect sizes on 91,338 unique adolescents. Random-effects meta-analyses across 11 separate indicators of well-being identified significant detrimental effects. Greater perceptions of racial/ethnic discrimination were linked to more depressive and internalizing symptoms; greater psychological distress; poorer self-esteem; lower academic achievement and engagement; less academic motivation; greater engagement in externalizing behaviors, risky sexual behaviors, and substance use; and more associations with deviant peers. Metaregression and subgroup analyses indicated differences by race/ethnicity, Gender × Race/Ethnicity interactions, developmental stage, timing of retrospective measurement of discrimination, and country. Overall, this study highlights the pernicious effects of racial/ethnic discrimination for adolescents across developmental domains and suggests who is potentially at greater risk.
Adjusting Expectations: Hearing Abilities in a Population-Based Sample Using an SSQ Short Form

The German short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ) was administered in a cross-sectional study based on stratified random samples complemented by audiometric tests and a general interview. Data from 1,711 unaided adults aged 18 to 97 years were analyzed in order to determine a distribution of hearing abilities considered as normal and the main factors that impact self-assessments. An innovative mathematical approach was used to overcome the constraints of statistics based on the mean. Quantile regression analysis yielded a benchmark distribution of SSQ scores that might support audiologists in setting realistic SSQ score targets and estimated how the effect of auditory and nonauditory factors changes across the distribution of SSQ scores. Regression models showed significant effects for nonauditory factors on SSQ ratings when controlled for pure-tone hearing and interaural asymmetry. Self-reporting of hearing difficulties, when asked in general terms, was substantially related to SSQ ratings. This effect was observed in both high and low scoring participants and led to a considerable score decrease in all SSQ subscales. Gender, educational level, and self-reporting of health issues also were significantly related to SSQ ratings, but the corresponding effects were regularly unbalanced across the score distribution and particularly large at lower quantiles. The estimated effects of age, however, were mostly small in size, inconsistent regarding the direction, and failed significance for all SSQ items. Overall, the results suggest that nonauditory factors and cumulative effects must be considered when evaluating rehabilitative interventions against an ideal outcome.
Propofol for gastrointestinal endoscopy

Most gastrointestinal endoscopic procedures are now performed with sedation. Moderate sedation using benzodiazepines and opioids continues to be widely used, but propofol sedation is becoming more popular because its unique pharmacokinetic properties make endoscopy almost painless, with a very predictable and rapid recovery process. There is controversy as to whether propofol should be administered only by anesthesia professionals. According to published values, endoscopist-directed propofol has a lower mortality rate than endoscopist-delivered benzodiazepines and opioids, and a comparable rate to general anesthesia by anesthesiologists. Rapid recovery has a major impact on patient satisfaction, post-procedure education and the general flow of the endoscopy unit. According to estimates, the absolute economic benefit of endoscopist-directed propofol implementation in a screening setting is probably substantial, with 10-year savings of $3.2 billion in the USA. Guidelines concerning the use of propofol emphasize the need for adequate training and certification in sedation by non-anesthetists.
Evolutionary and Medical Consequences of Archaic Introgression into Modern Human Genomes

The demographic history of anatomically modern humans (AMH) involves multiple migration events, population extinctions and genetic adaptations. As genome-wide data from complete genome sequencing becomes increasingly abundant and available even from extinct hominins, new insights of the evolutionary history of our species are discovered. It is currently known that AMH interbred with archaic hominins once they left the African continent. Modern non-African human genomes carry fragments of archaic origin. This review focuses on the fitness consequences of archaic interbreeding in current human populations. We discuss new insights and challenges that researchers face when interpreting the potential impact of introgression on fitness and testing hypotheses about the role of selection within the context of health and disease.
Precision and accuracy of cross‐sectional area measurements used to measure coronary endothelial function with spiral MRI

Coronary endothelial function (CEF) reflects vascular health and conventional invasive CEF measures predict cardiovascular events. MRI can now noninvasively measure CEF by quantifying coronary artery cross‐sectional area changes in response to isometric handgrip exercise, an endothelial‐dependent stressor. Area changes (10 to 20% in healthy; 2 to −12% in impaired vessels) are only a few imaging voxels because of MRI's limited spatial resolution. Here, with numerical simulations and phantom studies, we test whether Fourier interpolation enables sub‐pixel area measurement precision and determine the smallest detectable area change using spiral MRI.
A novel microbial technique for producing high‐quality sophorolipids from horse oil suitable for cosmetic applications

Horse oil contains linoleic, palmitoleic and unsaturated fatty acids that are similar to those in human skin, and may therefore be an ideal substance from which to isolate biosurfactants for cosmetic products to improve human skin quality. Herein, an innovative approach was developed to synthesise sophorolipids from horse oil by hydrolysis, followed by fermentation using the yeast Candida bombicola. The yield of sophorolipids from direct fermentation of horse oil and hydrolysed horse oil was 40.6 ± 1.3 g l−1 and 58.4 ± 1.8 g l−1 respectively. To further increase the yield, 30–40 g l−1 glucose was added in a fed‐batch fermentation process to maintain the pH between 4.0 and 4.5, resulting in a conversion yield of 71.7 ± 0.8 g l−1. The purity and structure of the synthesised sophorolipids were analysed by ultra‐performance liquid chromatography‐mass spectrometry and nuclear magnetic resonance. An in vitro human dermal fibroblast model was used as a surrogate for human skin to measure elastase inhibition activity. Antiwrinkle properties of isolated sophorolipids were better than those of horse oil or hydrolysed horse oil in several in vitro assays. Furthermore, no cytotoxicity was observed at a concentration of 50 μg ml−1, and wound‐healing capacity was evident in a cell culture model. Additionally, the synthesised sophorolipids attenuated lipopolysaccharide‐induced expression of inflammatory cytokines in macrophages, and efficiently inhibited several strains of bacteria and yeast. In conclusion, fed‐batch fermentation of hydrolysed horse oil is a novel and efficient approach for producing high‐quality and high‐yield sophorolipids that exhibit great potential as cosmetic ingredients.
Postdischarge engagement decreased hospital readmissions in Medicaid populations.

OBJECTIVES To investigate the effect of managed care organization (MCO)-implemented postdischarge engagement, supported by other broadly focused interventions, on 30-day hospital readmissions in 6 at-risk Medicaid populations. STUDY DESIGN Prospective cohort study. METHODS One-year follow-up analysis of member claims data was performed following an intervention period from January 1, 2014, to December 31, 2014. Postdischarge engagement, supported by additional MCO-initiated interventions, was implemented to reduce 30-day hospital readmissions in Medicaid members having 1 or more dominant chronic conditions. Hospital readmission rates were calculated at baseline and at 1 year post intervention. Bivariable and multivariable generalized estimating equation analysis was used to quantify the likelihood of hospital readmissions. RESULTS Following implementation, postdischarge engagement rates increased significantly, whereas provider follow-up rates remained unchanged. Increased member engagement resulted in statistically significant reductions in weighted readmission rates enterprise-wide (-10.1%; P <.01) and in 3 of 6 MCOs (-3.9% to -15.8%; P ≤.05) in 2014. Compared with nonparticipants, members who were successfully reached for postdischarge engagement displayed a 33% decrease in 30-day readmissions enterprise-wide (adjusted odds ratio, 0.67; 95% CI, 0.62-0.73) and a comparable decrease (-23% to -39%) in 5 of the 6 MCOs. In this context, greater frequency of postdischarge engagement was associated with proportionally decreased likelihood of readmissions. CONCLUSIONS Postdischarge engagement, against the backdrop of multifaceted MCO-implemented interventions, was associated with significantly reduced hospital readmissions in at-risk Medicaid subjects. Reduced likelihood of readmissions was observed at both the enterprise-wide and plan levels in a manner proportional to the frequency of engagement, a novel reported outcome for this population.