Miracle-dz/UniFAR-FTUs huggingface dataset:
Complications Associated with Contralateral Prophylactic Mastectomy: A Systematic Review and Meta-Analysis

Background: No meta-analysis has examined whether contralateral prophylactic mastectomy increases complication risk for unilateral breast cancer patients undergoing unilateral mastectomy. Methods: Fifteen studies on complications of unilateral mastectomy plus contralateral prophylactic mastectomy met inclusion criteria. Meta-analyses compared complications of (1) diseased versus contralateral breasts in unilateral plus contralateral prophylactic mastectomy patients and (2) patients undergoing unilateral plus contralateral prophylactic mastectomy versus unilateral alone when grouped by reconstructive method. Results: For all unilateral plus contralateral prophylactic mastectomy patients, the diseased breast was significantly more prone to complications versus the contralateral breast (relative risk, 1.24; p = 0.03). In studies that stratified by reconstructive method, the complication risk was significantly higher for unilateral plus contralateral prophylactic mastectomy versus unilateral mastectomy alone for patients with no reconstruction (relative risk, 2.03; p = 0.0003), prosthetic-based reconstruction (relative risk,1.42; p = 0.003), and autologous reconstruction (relative risk, 1.32; p = 0.005). The only prospective trial showed similar results, including for more severe complications. Smaller retrospective studies without stratification by reconstructive method showed similar complications for unilateral plus contralateral prophylactic mastectomy versus unilateral mastectomy alone (relative risk, 1.06; p = 0.70). These groups had similar incidences of complication-related delay in adjuvant therapy, as demonstrated by one study. Conclusions: After unilateral plus contralateral prophylactic mastectomy, diseased breasts are at higher risk for complications. Stronger evidence supports higher complication risk for unilateral plus contralateral prophylactic mastectomy than unilateral alone. More work is needed to determine the effect of complications on timing of adjuvant therapy.
Effect of Virtual Reality on Pediatric Pain and Fear During Procedures Involving Needles: Systematic Review and Meta-analysis

Background Virtual reality (VR) is used as a distraction measure during painful clinical procedures associated with the use of needles. These procedures include vaccinations, blood draws, or the administration of medications, which can cause children to feel increased levels of pain and fear. Objective The objective of this study was to collect and analyze the current evidence regarding the effectiveness of VR as a tool to distract children from pain and fear during needle procedures as compared to that of standard techniques. Methods A systematic review and meta-analysis was performed. We included randomized clinical trials (RCTs) or quasi-RCTs with participants younger than 21 years who underwent needle procedures in which the main distraction measure used was VR and where the main outcome measure was pain. The databases searched included the PubMed, Web of Science, Scopus, PsycINFO, CINAHL, and Cochrane libraries. In this systematic review, the studies were analyzed by applying the Critical Appraisal Skills Program guide in Spanish and the Jadad scale. In the meta-analysis, the effect size of the studies was analyzed based on the results for pain and fear in children. Results From 665 unique search results, 21 studies were included in this systematic review, most of which reported low methodological quality. The study sample cohorts ranged from a minimum of 15 participants to a maximum of 220 participants. Ten studies were included in the meta-analysis. The global effect of using VR as a distraction measure was a significant reduction in pain (inverse variance [IV] –2.37, 95% CI –3.20 to –1.54; Z=5.58; P<.001) and fear (IV –1.26, 95% CI –1.89 to –0.63; Z=3.92; P<.001) in children in the experimental groups. Conclusions The quality of the studies was mostly low. The main limitations were the impossibility of blinding the participants and health care personnel to the VR intervention. Nonetheless, the use of VR as a distraction measure was effective in reducing pain and fear in children during procedures involving needles.
Time Trends of Step-Determined Physical Activity Among Adolescents With Different Activity Levels in Czech Republic.

BACKGROUND This study aimed to present step-determined physical activity trends in adolescents with different activity levels over a period of 10 years. METHODS Pedometers were used to monitor weekly physical activity in 1855 boys and 2648 girls aged 15-19 years recruited from 155 schools in the Czech Republic between 2009 and 2018. Trends for average steps/day and percent of accumulating various levels of steps/day (<10,000, 10,000-13,000, and >13,000 steps/d) were analyzed by sex. RESULTS There was a statistically significant decrease in average steps/day between 2009-2010 and 2017-2018 in boys from 12,355 (3936) steps/d to 10,054 (3730) steps/d and girls from 11,501 (3278) steps/d to 10,216 (3288) steps/d. The percent accumulating <10,000 steps/d increased by 21% in boys and 12% in girls. The percent achieving >13,000 steps/d decreased by 17% in boys and 10% in girls. CONCLUSIONS Objectively collected evidence indicates an overall decrease in Czech adolescents' steps/day over a 10-year period concurrent with an increase in the percent of boys and girls accumulating <10,000 steps/d. These trends are concerning as they portend a decline in physical activity as adolescents transition to adulthood and continue to age, which also may have major health implications.
Therapeutic thoroughfares for adults living with Pompe disease

Purpose of review Pompe disease is caused by autosomal recessive mutations in the acid α-glucosidase gene leading to a multiorgan deficiency of the enzyme acid glucosidase alfa. To recover to a nondiseased status, a lift over a threshold of 25% acid glucosidase alfa enzyme activity is required. This update on therapeutic thoroughfares for adult Pompe disease aims to assist neuromuscular and metabolic specialists. Recent findings We reviewed the recent studies covering enzyme replacement therapy, gene therapy, and substrate reduction therapy in adult Pompe disease. Results of phase 3 studies and the first sets of long-term data of both novel enzyme replacement therapies, avalglucosidase alfa, and ciplaglucodsidase alfa combined with miglustat, are public. First gene therapy trials are ongoing. Substrate reduction therapy is in early transition to the clinical trial phase. We still miss dose escalation and intensification of frequency trials on enzyme replacement therapy in adults, probably suitable to echo current results in infantile and juvenile Pompe disease. Summary Therapy of Pompe disease reaches new thoroughfares reducing the overall disease burden of patients; however, individualization of these novel therapeutic options remains challenging. Consensus-based and shared decision-based recommendations need to be established based on reliable real-world data to allow the best standards of care worldwide.
Targeted Inhibition of DNA-PKcs, ATM, ATR, PARP, and Rad51 Modulate Response to X Rays and Protons

Small molecule inhibitors are currently in preclinical and clinical development for the treatment of selected cancers, particularly those with existing genetic alterations in DNA repair and DNA damage response (DDR) pathways. Keen interest has also been expressed in combining such agents with other targeted antitumor strategies such as radiotherapy. Radiotherapy exerts its cytotoxic effects primarily through DNA damage–induced cell death; therefore, inhibiting DNA repair and the DDR should lead to additive and/or synergistic radiosensitizing effects. In this study we screened the response to X-ray or proton radiation in cell lines treated with DDR inhibitors (DDRis) targeting ATM, ATR, DNA-PKcs, Rad51, and PARP, with survival metrics established using clonogenic assays. We observed that DDRis generate significant radiosensitization in cancer and primary cells derived from normal tissue. Existing genetic defects in cancer cells appear to be an important consideration when determining the optimal inhibitor to use for synergistic combination with radiation. We also show that while greater radiosensitization can be achieved with protons (9.9 keV/µm) combined with DDRis, the relative biological effectiveness is unchanged or in some cases reduced. Our results indicate that while targeting the DDR can significantly radiosensitize cancer cells to such combinations, normal cells may also be equally or more severely affected, depending on the DDRi used. These data highlight the importance of identifying genetic defects as predictive biomarkers of response for combination treatment.
PTX3 structure determination using a hybrid cryoelectron microscopy and AlphaFold approach offers insights into ligand binding and complement activation

Significance Long pentraxins are soluble pattern-recognition molecules. There is a wealth of functional data linking them to processes as varied as innate immune defense, female fertility, and neurobiology. However, structural information is missing. Here, we present a complete high-resolution model of a long pentraxin, PTX3, using a hybrid structural biology approach combining cryoelectron microscopy, mass spectrometry, and AlphaFold-based artificial intelligence structure prediction, which was able to model flexible regions of the complex. This gives insights into the functions of PTX3, such as immune defense, as well as exemplifying a method to resolving flexible domains of protein complexes.
Opportunities in digital health and electronic health records for acute kidney injury care

Purpose of review The field of digital health is evolving rapidly with applications relevant to the prediction, detection and management of acute kidney injury (AKI). This review will summarize recent publications in these areas. Recent findings Machine learning (ML) approaches have been applied predominantly for AKI prediction, but also to identify patients with AKI at higher risk of adverse outcomes, and to discriminate different subgroups (subphenotypes) of AKI. There have been multiple publications in this area, but a smaller number of ML models have robust external validation or the ability to run in real-time in clinical systems. Recent studies of AKI alerting systems and clinical decision support systems continue to demonstrate variable results, which is likely to result from differences in local context and implementation strategies. In the design of AKI alerting systems, choice of baseline creatinine has a strong effect on performance of AKI detection algorithms. Summary Further research is required to overcome barriers to the validation and implementation of ML models for AKI care. Simpler electronic systems within the electronic medical record can lead to improved care in some but not all settings, and careful consideration of local context and implementation strategy is recommended.
Enhancement of antibacterial activity through phyto‐fabrication of silver nanoparticles with Ficus thonningii aqueous extracts

Abstract The World Health Organisation reports higher levels of bacterial resistance to cephalosporins and carbapenems of above 54%. The sufficient redox capabilities of Ficus thonningii phytochemicals for Ag+ reduction to Ag0 and ultimately aggregation to nucleation are exploited for the first time in attempting to enhance the antibacterial activity. Solution colour change to brown due to surface plasmon resonance phenomenon confirmed nanoparticle fabrication with a UV/Vis absorption peak at 426 nm. Fourier Transform Infrared spectra revealed functional groups (C=C at 1620–1680 cm−1; C=H at 1400–1600 cm−1 aromatics) for encapsulation, stabilisation, and reduction of the silver ion. The Dynamic Light Scattering technique verified F. thonningii encapsulated silver nanoparticles particle size of 57.84 nm with a negative zeta potential (−19.8 mV) as proof of stability. The surface, shape and topographical features were shown by Scanning Electron Microscopy as spherical orientations. An enhanced antimicrobial efficacy was displayed by the nanoparticles (inhibition zones of 26.1, 24.1 and 15.2 mm from 11.5, 10.6 and 6.5 mm) for Staphylococcus aureus, Streptococcus pyrogenes and Escherichia coli, respectively, compared to Flucloxacillin standard that was in the ranges of 21.5, 23.5 and 25.7 mm. The enhanced potency provides a basis for diversified approaches of generating novel drugs for treating bacterial infections.
Characteristics of plaque lipid-associated macrophages and their possible roles in the pathogenesis of atherosclerosis

Purpose of review Recent findings from single-cell transcriptomic studies prompted us to revisit the role of plaque foamy macrophages in the pathogenesis of atherosclerosis. In this review, we compared the gene expression profile of plaque foamy macrophages with those of other disease-associated macrophages and discussed their functions in the pathogenesis of atherosclerosis. Recent findings To understand the phenotypes of macrophages in atherosclerotic aorta, many research groups performed single-cell RNA sequencing analysis and found that there are distinct phenotypic differences among intimal foamy, nonfoamy and adventitial macrophages. Especially, the plaque foamy macrophages express triggering receptor expressed on myeloid cells 2 (TREM2), a key common feature of disease-associated macrophages in Alzheimer's disease, obesity, cirrhosis and nonalcoholic steatohepatitis. These TREM2+ macrophages seem to be protective against chronic inflammation. Summary As the gene expression profile of plaque foamy macrophages is highly comparable to that of lipid-associated macrophages from obesity, we named the plaque foamy macrophages as plaque lipid-associated macrophages (PLAMs). PLAMs have a high level of gene expression related to phago/endocytosis, lysosome, lipid metabolism and oxidative phosphorylation. Considering the protective function of lipid-associated macrophages against adipose tissue inflammation, PLAMs may suppress atherosclerotic inflammation by removing modified lipids and cell debris in the plaque.
The Utility of Transcranial Stimulated Motor-Evoked Potential Alerts in Cervical Spine Surgery Varies Based on Preoperative Motor Status

Study Design. A prospective multicenter observational study. Objective. The aim was to investigate the validity of transcranial motor-evoked potentials (Tc-MEP) in cervical spine surgery and identify factors associated with positive predictive value when Tc-MEP alerts are occurred. Summary of Background Data. The sensitivity and specificity of Tc-MEP for detecting motor paralysis are high; however, false-positives sometimes occur. Materials and Methods. The authors examined Tc-MEP in 2476 cases of cervical spine surgeries and compared patient backgrounds, type of spinal disorders, preoperative motor status, surgical factors, and the types of Tc-MEP alerts. Tc-MEP alerts were defined as an amplitude reduction of more than 70% from the control waveform. Tc-MEP results were classified into two groups: false-positive and true-positive, and items that showed significant differences were extracted by univariate analysis and detected by multivariate analysis. Results. Overall sensitivity was 66% (segmental paralysis: 33% and lower limb paralysis: 95.8%) and specificity was 91.5%. Tc-MEP outcomes were 33 true-positives and 233 false-positives. Positive predictive value of general spine surgery was significantly higher in cases with a severe motor status than in a nonsevere motor status (19.5% vs. 6.7%, P=0.02), but not different in high-risk spine surgery (20.8% vs. 19.4%). However, rescue rates did not significantly differ regardless of motor status (48% vs. 50%). In a multivariate logistic analysis, a preoperative severe motor status [P=0.041, odds ratio (OR): 2.46, 95% confidence interval (95% CI): 1.03–5.86] and Tc-MEP alerts during intradural tumor resection (P<0.001, OR: 7.44, 95% CI: 2.64–20.96) associated with true-positives, while Tc-MEP alerts that could not be identified with surgical maneuvers (P=0.011, OR: 0.23, 95% CI: 0.073–0.71) were associated with false-positives. Conclusion. The utility of Tc-MEP in patients with a preoperative severe motor status was enhanced, even in those without high-risk spine surgery. Regardless of the motor status, appropriate interventions following Tc-MEP alerts may prevent postoperative paralysis.
Leishmaniasis vectors in the environment of treated leishmaniasis cases in Spain

Abstract Transmission of leishmaniasis in endemic areas is characterized by microfocality related to the presence of the vector. Most entomological studies in southwestern Europe have focused on sylvatic areas and town outskirts, very few have sampled town or urban centres, and no survey has investigated inside households. The aim of this study was to determine the sand fly species diversity and vector density in the surroundings of human leishmaniasis cases compared with environments in which there was no association. Sand flies were captured in 26 households associated with recently treated leishmaniasis patients, 15 neighbouring houses without associated cases, and in others environments. Overall 7495 sand flies belonging to six species were captured. The highest sand fly density was found in farmhouses where there is a great availability of blood sources and breeding sites. In the environment of human leishmaniasis cases, Sergentomyia minuta was the most prevalent species followed by Phlebotomus perniciosus. Nevertheless, lower Leishmania infantum infection rates and lower intensity of infection were detected in S. minuta sand flies than in P. perniciosus. The density of P. perniciosus in households with recently treated leishmaniasis patients varies between 0 and 108 sand flies per light trap/night, with the maximum values corresponding to farmhouses. This species appears to be adapted to both indoors and outdoors domestic biotopes, including urban households.
New-onset atrial fibrillation following left bundle branch area pacing vs. right ventricular pacing: a two-centre prospective cohort study

Abstract Aims To investigate whether left bundle branch area pacing (LBBAP) can reduce the risk of new-onset atrial fibrillation (AF) compared with right ventricular pacing (RVP). Methods and results Patients with indications for dual-chamber pacemaker implant and no history of AF were prospectively enrolled if they underwent successful LBBAP or RVP. The primary endpoint was time to the first occurrence of AF detected by pacemaker programming or surface electrocardiogram. Follow-up at clinic visit was performed and multivariate Cox regression models were applied to evaluate the effect of LBBAP on new-onset AF. The final analysis included 527 patients (mean age 65.3 ± 12.6, male 47.3%), with 257 in the LBBAP and 270 in the RVP groups. During a mean follow-up of 11.1 months, LBBAP resulted in significantly lower incidence of new-onset AF (7.4 vs. 17.0%, P < 0.001) and AF burden (3.7 ± 1.9 vs. 9.3 ± 2.2%, P < 0.001) than RVP. After adjusting for confounding factors, LBBAP demonstrated a lower hazard ratio for new-onset AF compared with RVP {hazard ratio (HR) [95% confidence interval (CI)]: 0.278 (0.156, 0.496), P < 0.001}. A significant interaction existed between pacing modalities and the percentage of ventricular pacing (VP%) (P for interaction = 0.020). In patients with VP ≥ 20%, LBBAP was associated with decreased risk of new-onset AF compared with RVP [HR (95% CI): 0.199 (0.105, 0.378), P < 0.001]. The effect of pacing modalities was not pronounced in patients with VP < 20% [HR (95% CI): 0.751 (0.309, 1.823), P = 0.316]. Conclusion Left bundle branch area pacing demonstrated a reduced risk of new-onset AF compared with RVP. Patients with a high ventricular pacing burden might benefit from LBBAP.
Intestinal injury in Ugandan children hospitalized with malaria.

BACKGROUND Severe malaria is associated with multiple organ dysfunction syndrome (MODS), which may involve the gastrointestinal tract. METHODS In a prospective cohort study in Uganda, we measured markers of intestinal injury (intestinal fatty-acid binding protein, I-FABP, and zonula occludens-1, ZO-1), and microbial translocation (lipopolysaccharide binding protein, LBP, and soluble complement of differentiation 14, sCD14) among children admitted with malaria. We examined their association with biomarkers of inflammation, endothelial activation, clinical signs of hypoperfusion, organ injury, and mortality. RESULTS We enrolled 523 children (median age 1.5 years, 46% female, 7.5% mortality). I-FABP was above the normal range (≥400 pg/mL) in 415/523 patients (79%). I-FABP correlated with ZO-1 (ρ=0.11, p = 0.014), sCD14 (ρ=0.12, p = 0.0046), as well as markers of inflammation and endothelial activation. Higher I-FABP levels were associated with lower systolic blood pressure (ρ= -0.14, p = 0.0015), delayed capillary refill time (ρ= 0.17, p = 0.00011), higher lactate level (ρ= 0.40, p < 0.0001), increasing stage of acute kidney injury (ρ= 0.20, p = 0.0034), and coma (p < 0.0001). Admission I-FABP levels ≥5.6 ng/mL were associated with a 7.4-fold higher relative risk of in-hospital death (95%CI 1.4-11, p = 0.0016). CONCLUSION Intestinal injury occurs commonly in children hospitalized with malaria and is associated with microbial translocation, systemic inflammation, tissue hypoperfusion, MODS, and fatal outcome.
The relationships of psychological capital and influence regulation with job satisfaction and job performance

Background and aims The individual difference predictors of positive work attitudes and behaviors have been widely investigated in the field of positive organizational scholarship. However, to date, integrating studies linking positive psychological resources, such as Psychological Capital and influence regulation, with positive organizational outcomes are still scarce. Thus, the main aim of the present study was to examine the relationships of Psychological Capital and influence regulation with job satisfaction and job performance both at the individual and team levels. Methods Within the cross-sectional multi-source research involving both team leaders and team members from 34 different teams, we examined the relationships of Psychological Capital and influence regulation with job satisfaction and job performance. The relationships of the study variables were based on the positive organizational behavior and the broaden-and-build theory of positive emotions, which suggest the positive relationships of distinct positive psychological resources with positive work outcomes. Accordingly, in addition to the widely accepted concept of Psychological Capital (PsyCap), we employed and analyzed the complimentary construct of influence regulation (i.e., the ability to intentionally share social influence with others in the workplace) both at the individual and group levels. Results The results of hierarchical linear modeling with 304 individuals from 34 teams from a diverse sample of Polish employees indicated that team members’ PsyCap was positively linked to individual-level job satisfaction and two facets of job performance, i.e. creative performance and in-role performance. In contrast, no relationship was found between influence regulation and job satisfaction or job performance at both levels of analysis. Conclusion With regard to positive interpersonal resources, the findings highlight the role of PsyCap in predicting job satisfaction and job performance and broaden the understanding of positivity in the workplace by introducing the construct of influence regulation. Also, based on the study results, managerial implications are discussed.