Miracle-dz/UniFAR-FTUs huggingface dataset:
Simulation-based structured training for developing laparoscopy skills in general surgery and obstetrics & gynecology postgraduates

BACKGROUND: Simulation-based training is an important strategy for skill development in a competency-based curriculum, especially so for laparoscopic surgery given its unique learning curve, need for practice, and patient safety concerns. The study was conducted for postgraduates in two surgical disciplines in a medical college tertiary care center. The study evaluates the acceptability and utility of structured simulation-based training for laparoscopic skills. Simulations provide deliberate practice in the leaner supportive environment. MATERIALSAND METHODS: The educational intervention was carried out among the 16 postgraduates from year 2 and year 3 of general surgery and obstetrics and gynecology. A structured training and assessment module was designed and validated, and a 12-week structured training on laparoscopic box trainers was given to postgraduates under faculty guidance. Feedback from postgraduates and faculty was obtained using separate validated questionnaires. The pre- and post-training assessment scores were compared applying the Wilcoxon matched-pairs signed-rank (2-tailed) test using the SPSS Windows Version 20.0 (IBM Corporation). RESULTS: Sixteen postgraduates participated in the study. The median satisfaction score of the postgraduates was 4 (range 3–5), a scale of a maximum of 5. The group identified faculty feedback, stepwise skills learning, supportive learning environment, and trainers’ motivation as enabling factors in the training. The faculty observed that the trainees were effectively engaged. The group mean improvement scores in percentage were 40.08 for task 1, 42.08 for task 2, 43.13 for task 3, and 45.63 for task 4. CONCLUSIONS: It is feasible to incorporate faculty-guided sessions of simulation training in basic laparoscopy skills for postgraduates in our setup. It is well accepted by the key stakeholders, and we recommend it to be incorporated in the formal training program.
Pastoral subsistence and mounted fighting in the Eastern Tianshan Mountain region: New insights from the Shirenzigou worked bone assemblage

Situated at a geographic crossroads, the eastern Tianshan Mountain region in northwest China is crucial to understanding various economic, social, and cultural developments on the Eurasian Steppes. One promising way to gain a better knowledge of ancient subsistence economy, craft production, and social change in the eastern Tianshan Mountain region is to study the artifact assemblages from archaeological contexts. Here, we present an analysis of 488 worked animal bones from the large site of Shirenzigou (ca. 1300–1 BCE), to date the largest assemblage of this kind uncovered in the eastern Tianshan Mountain region. We classified these worked bones into six categories, including “ritual objects”, “ornaments”, “tools”, “worked astragali”, “warfare and mobility”, and “indeterminate”. The identification of animal species and skeletal elements indicates that worked bones from Shirenzigou are characterized by a predominance of caprine products, particularly worked astragali, which is consistent with the large proportion of caprine fragments found in animal remains associated with food consumption. This demonstrates the contribution of caprine pastoralism to bone working activities at Shirenzigou. The making of most worked bones does not appear to have required advanced or specialized skills. Considering the absence of dedicated bone working space, alongside the variability in raw material selection and in dimensions of certain types of artifacts, we infer that worked bone production at Shirenzigou was not standardized. In terms of raw material selection and mode of production, Shirenzigou differed from their settled, farming counterparts in the Yellow River valley of northern China. In addition, along with the evidence for violence and horseback riding, the increasing use of bone artifacts associated with warfare and mobility during the late occupation phase of Shirenzigou reflects growing social instability and implies the likely emergence of single mounted horsemen, equipped with light armors, in the region during the late first millennium BCE. Our results provide new insights into animal resource exploitation and changing lifeways of early pastoral societies in the eastern Tianshan Mountain region, expanding our knowledge of the economic, social, and political milieu of late Bronze Age and early Iron Age eastern Eurasia.
Competence in providing spiritual care and its relationship with spiritual well-being among Iranian nurses

BACKGROUND: Competence in providing spiritual care to patients has become an increasingly important aspect of nursing care delivery. However, studies on nurses’ competence in spiritual care delivery and the factors affecting it are very limited. The present study was conducted to evaluate Iranian nurses’ competence in providing spiritual care and its relationship with their Spiritual Well-Being. MATERIALS AND METHODS: The present study is descriptive-analytical research conducted in Bam in the south of Iran between 2016 and 2017. All nurses working in the teaching hospitals affiliated with Bam University of Medical Sciences were invited to participate in the study. For data collection, the Spiritual Care Competence Scale (SCCS) and the Spiritual Well-Being Scale (SWBS) were used. Collected data were then analyzed using descriptive statistics (mean and standard deviation), Pearson correlation coefficient, independent t-test, and one-way ANOVA with SPSS software. RESULTS: In this study, 158 nurses were participated. The result showed that the mean score SCCS and SWBS were 101 ± 12.6, 76.92 ± 13.4, respectively. Pearson correlation test showed a significant and direct relationship between the mean score of SCCS and SWBS (P = 0.001, r = 0.264). The results of this test also showed a significant relationship between all the dimensions of SCCS and SWBS (P < 0.05). CONCLUSIONS: In this study, the nurses had a relatively appropriate competence in providing spiritual care to patients. There was also a significant relationship between the nurses’ spiritual care competency and their spiritual well-being. Given the lack of adequate studies in spiritual care delivery competencies, it is recommended that similar studies are conducted among nurses in other parts of the country and worldwide.
Plasma levels of leucocyte elastase-generated cross linked fibrin degradation products (E-XDP) are elevated in chronic venous disease

Patients with chronic venous disease (CVD) have elevated levels of leucocyte elastase (LE) released from the activation of leucocytes. In acute deep venous thrombosis (DVT), LE can degrade fibrin from the thrombus resulting in cross-linked fibrin degradation products (E-XDP) being released into the bloodstream. In patients with CVD the levels and significance of circulating E-XDP are unknown. We aimed to investigate the association between plasma E-XDP concentration and severity of CVD. Levels of E-XDP were quantified with a specific enzyme-linked immunosorbent assay (ELISA) in plasma from 142 consecutively recruited CVD patients (mean age 64 years, (range 23–89), 81 were females and 61 males). Patients were also divided into three groups based on CVD severity using the C-class of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification, with C 0–1 class as the reference group, C 2–3 as the second group and C 4–6 as the third group with the most severely affected patients. We found significantly elevated levels of E-XDP in patients with C 4–6 compared with patients with C 0–1 (p = 0.007) and increased with increasing disease severity across the groups (p = 0.02). Significant independent association was observed between levels of E-XDP and the classes C 4–6 after adjustment for age and sex (p < 0.05), but the association was no longer significant after further adjustment for use of statins, use of anticoagulants and history of DVT (p = 0.247). This exploratory study shows that E-XDP levels are elevated in patients with CVD, encouraging further studies on the role of E-XDP in CVD.
The Big Five Personality Traits and Dispositional Mindfulness as Predictors of Alexithymia in College Students.

Objective The aim of this research was to measure the relationship between the Big Five personality traits, dispositional mindfulness and alexithymia, and to investigate personality traits and dispositional mindfulness as predictors of alexithymia in a group of college students. Method In the present study, 150 college students at Tabriz University, aged between 18 and 26, were selected by convenient sampling method. NEO - Five Factor Inventory (NEO - FFI), Toronto Alexithymia Scale (TAS - 20), and Freiburg Mindfulness Inventory (FMI-SF) were used for data collection. Results The results showed that alexithymia was positively associated with neuroticism, and negatively associated with conscientiousness and openness to experiences. Neuroticism is the strongest predictor of alexithymia. After controlling for the effects of baseline characteristics and the Big Five personality traits, mindfulness did not remain a significant predictor of alexithymia. Conclusions These results suggest that neuroticism, openness to experiences and conscientiousness have an essential role in alexithymia.
Heterologous expression, fermentation strategies and molecular modification of collagen for versatile applications

Abstract Collagen is a kind of high macromolecular protein with unique tissue distribution and distinctive functions in the body. At present, most collagen products are extracted from the tissues and organs of mammals or marine fish. However, this method exhibits several disadvantages, including low efficiency and serious waste generation, which makes it difficult to meet the current market demand. With the rapid development of synthetic biology and the deepening of high-density fermentation technology, the collagen preparation by biosynthesis strategy emerges as the times require. Co-expression with the proline hydroxylase gene can solve the problem of non-hydroxylated collagen, but the yield may be affected. Therefore, improving the expression through molecular modification and dynamic regulation of synthesis is an entry point for future research. Due to the defects in certain properties of the natural collagen, modification of properties would be benefit for meeting the requirements of practical application. In this paper, in-depth investigations on recombinant expression, fermentation, and modification studies of collagen are conducted. Also, it summarizes the research progress of collagen in food, medicine, and beauty industry in recent years. Furthermore, the future development trend and application prospect of collagen are discussed, which would provide guidance for its preparation and application.
Efficacy of cannabis-based medications compared to placebo for the treatment of chronic neuropathic pain: a systematic review with meta-analysis

Background Chronic neuropathic pain (NP) presents therapeutic challenges. Interest in the use of cannabis-based medications has outpaced the knowledge of its efficacy and safety in treating NP. The objective of this review was to evaluate the effectiveness of cannabis-based medications in individuals with chronic NP. Methods Randomized placebo-controlled trials using tetrahydrocannabinol (THC), cannabidiol (CBD), cannabidivarin (CBDV), or synthetic cannabinoids for NP treatment were included. The MEDLINE, Cochrane Library, EMBASE, and Web of Science databases were examined. The primary outcome was the NP intensity. The risk of bias analysis was based on the Cochrane handbook. Results The search of databases up to 2/1/2021 yielded 379 records with 17 RCTs included (861 patients with NP). Meta-analysis showed that there was a significant reduction in pain intensity for THC/CBD by -6.624 units (P < .001), THC by -8.681 units (P < .001), and dronabinol by -6.0 units (P = .008) compared to placebo on a 0–100 scale. CBD, CBDV, and CT-3 showed no significant differences. Patients taking THC/CBD were 1.756 times more likely to achieve a 30% reduction in pain (P = .008) and 1.422 times more likely to achieve a 50% reduction (P = .37) than placebo. Patients receiving THC had a 21% higher improvement in pain intensity (P = .005) and were 1.855 times more likely to achieve a 30% reduction in pain than placebo (P < .001). Conclusion Although THC and THC/CBD interventions provided a significant improvement in pain intensity and were more likely to provide a 30% reduction in pain, the evidence was of moderate-to-low quality. Further research is needed for CBD, dronabinol, CT-3, and CBDV.
Neural Variability in the Prefrontal Cortex as a Reflection of Neural Flexibility and Stability in Patients With Parkinson Disease

Background and Objectives Functional near-infrared spectroscopy (fNIRS) studies provide direct evidence of the important role of the prefrontal cortex (PFC) during walking in aging and Parkinson disease (PD). Most studies explored mean hemoglobin (HbO2) levels, while moment-to-moment variability measures have rarely been investigated. Variability measures can inform on flexibility, which is imperative for adaptive function. We hypothesized that patients with PD will show less variability in HbO2 signals during walking compared to healthy controls. Methods Two hundred six participants, 57 healthy controls (age 68.9 ± 1.0 years, 27 women) and 149 patients with idiopathic PD (age 69.8 ± 0.6 years, 50 women, disease duration 8.27 ± 5.51 years), performed usual walking and dual-task walking (serial 3 subtractions) with an fNIRS sensor placed on the forehead. HbO2 variability was calculated from the SD, range, and mean detrended time series of fNIRS-derived HbO2 signal evaluated during each walking task. HbO2 variability was compared between groups and between walking tasks with mixed model analyses. Results Higher variability (SD, range, mean detrended time series) was observed during dual-task walking compared to usual walking (p < 0.025), but this was derived from the differences within the healthy control group (group × task interaction p < 0.007). On the other hand, task repetition demonstrated reduced variability in healthy controls but increased variability in patients with PD (interaction group × walk repetition p < 0.048). The Movement Disorder Society Unified Parkinson's Disease Rating Scale motor score correlated with HbO2 range (r = 0.142, p = 0.050) and HbO2 SD (r = 0.173, p = 0.018) during usual walking among all participants. Discussion In this study, we suggest a new way to interpret changes in HbO2 variability. We relate increased HbO2 variability to flexible adaptation to environmental challenges and decreased HbO2 variability to the stability of performance. Our results show that both are limited in PD; however, further investigation of these concepts is required. Moreover, HbO2 variability measures are an important aspect of brain function that add new insights into the role of PFC during walking with aging and PD. Trial Registration Information ClinicalTrials.gov Identifier: NCT01732653. Classification of Evidence This study provides Class III evidence that patients with PD have more variability within HbO2 signals during usual walking compared to healthy controls but not during dual-task walking.
Trav15-dv6 family Tcrd rearrangements diversify the Tcra repertoire

Dauphars et al. show that prior Tcrd rearrangement is essential for a combinatorially diverse Tcra repertoire in mouse thymocytes. Trav15-dv6 family Tcrd rearrangements are critical for Tcra repertoire formation because of their central and distal locations in the Vα-Vδ array.
MRI and MR angiography evaluation of pulsatile tinnitus: A focused, physiology‐based protocol

Pulsatile tinnitus (PT) is the subjective sensation of a pulse‐synchronous sound, most often due to a cerebrovascular etiology. PT can severely impact quality of life and may indicate a life‐threatening process, yet a timely and accurate diagnosis can often lead to effective treatment. Clinical assessment with a history and physical examination can often suggest a diagnosis for PT, but is rarely definitive. Therefore, PT should be evaluated with a comprehensive and targeted radiographic imaging protocol. MR imaging provides a safe and effective means to evaluate PT. Specific MR sequences may be used to highlight different elements of cerebrovascular anatomy and physiology. However, routine MR evaluation of PT must comply with economic and practical constraints, while effectively capturing both common and rarer, life‐threatening etiologies of PT.
Prognosis in primary mucinous ovarian carcinoma: focusing on the five pathological findings indicating metastatic mucinous carcinoma to the ovary

Objective Pathological features indicating metastatic mucinous carcinoma to the ovary (MMCO) have been rarely reported in primary mucinous ovarian carcinoma (PMOC). However, little is known about how often they are observed in PMOC and how they relate to patient prognosis. In this study, we investigated the pathological features indicating MMCO in a large cohort of PMOCs and analyzed their association with patient prognosis. Methods We reviewed surgically treated PMOC patients diagnosed at the Seoul National University Hospital from 1995 to 2019, according to the updated WHO classification, and investigated the presence of pathological features indicating MMCO. Results A total of 144 patients with PMOCs were included. The 5 pathological findings indicating MMCO, including an infiltrative invasive pattern, the absence of benign or borderline components, a smaller tumor size, the presence of signet ring cells and the presence of extracellular mucin were observed in PMOC (21.6%, 43.1%, 20.8%, 4.3% and 12.9%, respectively), and were significantly correlated with poor overall and progression-free survival rates in PMOC. The patient’s prognosis worsened as the extent of the infiltrative invasive pattern increased (p<0.001). In addition, the prognostic power was stronger when the 5 pathological factors were analyzed together (new grouping system) than when analyzed individually (p<0.001) and the new grouping system was identified as an independent prognostic factor regardless of FIGO stage. Conclusion Five pathological findings indicating MMCO in PMOC were significantly associated with poor prognosis in PMOC patients. Also, the new grouping system combining these findings was identified as an independent prognostic factor.
Development and Validation of a Prognostic Model to Predict Hearing Recovery for Patients With Chronic Otitis Media

Objective To explore the factors affecting postoperative hearing recovery in chronic otitis media (COM) patients, establish a clinical prediction model for hearing recovery, and verify the accuracy of the model. Methods Data of patients with COM who were admitted to our hospital between January 1, 2012 and September 30, 2020 were retrospectively analyzed. We collected data on relevant clinicopathological characteristics of patients. The patients were randomly divided into the development cohort and validation cohorts. A postoperative air-bone gap (ABG) ≤20 dB was defined as successful hearing recovery. Univariate and multivariable logistic regression analyses were used to investigate the association of several prognostic factors with hearing recovery. These factors were then used to establish a nomogram. The model was subjected to bootstrap internal validation and performance evaluation in terms of discrimination, calibration, and clinical validity. Results This study included 2146 patients with COM: the development cohort comprised 1610 patients (mean [standard deviation; SD] age, 44.1 [14.7] years; 733 men [45.5%]) and the validation cohort included 536 patients (mean [SD] age, 42.9 [14.4] years; 234 men [43.7%]). Multivariable logistic regression analysis showed that age, duration of onset, styles of surgery (tympanoplasty, canal wall up-CWU, or canal wall down-CWD), ossicular prosthesis, granulation or calcified blocks around the ossicular chain, ossicular chain integrity, duration of drilling, eustachian tube dysfunction, mixed hearing loss, semicircular canal fistula, and second surgery were associated with hearing recovery. A nomogram based on these variables was constructed. The area under the curve was 0.797 (95% confidence interval [CI], 0.778–0.812) in the development cohort and 0.798 (95% CI, 0.7605–0.8355) in the validation cohort. Conclusions This study demonstrated the various clinical factors correlated with hearing recovery in patients with COM. The nomogram developed with these data could provide personalized risk estimates of hearing recovery to enhance preoperative counseling and help to set realistic expectations in patients.
Comparison of the effectiveness and safety of insulin and oral hypoglycemic drugs in the treatment of gestational diabetes mellitus: a meta-analysis of 26 randomized controlled trials

Abstract Objective Oral hypoglycemic drugs for the treatment of gestational diabetes mellitus (GDM) are still controversial because they can pass through the placenta. The purpose of this meta-analysis is to evaluate the safety and effectiveness of oral hypoglycemic drugs. Methods PubMed, Ovid Embase, Web of Science, and Cochrane databases were systematically searched (inception to 20 April 2021). Rev Man 5.0 was used to analyze the data. A random-effects model was used to compute the summary risk estimates. Results There were 26 randomized controlled trials (RCTs) involving 4921 GDM patients which were included in this meta-analysis. Compared with metformin, insulin had a significant increase in the risk of preeclampsia (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.06 to 2.45; I2=40%; p < .05), hypertension (OR, 1.42; 95% CI, 1.02 to 1.99; I2=0%; p < .05), hypoglycemia (OR, 3.93; 95% CI, 1.27 to 12.19; I2=0%; p < .05), neonatal hypoglycemia (OR, 1.92; 95% CI, 1.34 to 2.76; I2=41%; p < .0001), neonatal jaundice (OR, 2.70; 95% CI, 1.12 to 6.52; I2=0%; p < .05), and Neonatal Intensive Care Unit Admission (OR, 1.46; 95% CI, 1.09 to 1.95; I2=39%; p < .05), but the risk of neonatal macrosomia (OR, 1.67; 95% CI, 1.12 to 2.40; I2=0%; p < .05) and neonatal injury (OR, 0.70; 95% CI, 0.55 to 0.89; I2=0%; p < .01) is lower. Conclusions Metformin is comparable with insulin in glycemic control and neonatal outcomes and has the potential to replace insulin therapy in clinical practice. Glyburide is behind metformin and insulin, and more RCTs are needed to verify its safety.
Topological phase and thermoelectric properties of bialkali bismuthide compounds (Na, K)2RbBi from first-principles

We report the topological phase and thermoelectric properties of bialkali bismuthide compounds (Na, K)2RbBi, as yet hypothetical. The topological phase transitions of these compounds under hydrostatic pressure are investigated. The calculated topological surface states and Z 2 topological index confirm the nontrivial topological phase. The electronic properties and transport coefficients are obtained using the density functional theory combined with the Boltzmann transport equation. The relaxation times are determined using the deformation potential theory to calculate the electronic thermal and electrical conductivity. The calculated mode Grüneisen parameters are substantial, indicating strong anharmonic acoustic phonons scattering, which results in an exceptionally low lattice thermal conductivity. These compounds also have a favorable power factor leading to a relatively flat p-type figure-of-merit over a broad temperature range. Furthermore, the mechanical properties and phonon band dispersions show that these structures are mechanically and dynamically stable. Therefore, they offer excellent candidates for practical applications over a wide range of temperatures.