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[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, METHODS, METHODS, RESULTS. Meshes: Confidence Intervals, Critical Illness, Female, Follow-Up Studies, Glucocorticoids, High-Frequency Ventilation, Humans, Infant, Newborn, Infant, Premature, Infant, Very Low Birth Weight, Intensive Care Units, Neonatal, Male, Pregnancy, Prenatal Diagnosis, Proportional Hazards Models, Pulmonary Surfactants, Respiration, Artificial, Respiratory Distress Syndrome, Newborn, Risk Assessment, Statistics, Nonparametric, Survival Analysis, Treatment Outcome." }, { "role": "user", "content": "Do first intention high-frequency oscillatory and conventional mechanical ventilation in premature infants without antenatal glucocorticoid prophylaxis? Context: Data comparing the effectiveness of high-frequency oscillatory ventilation and of conventional mechanical ventilation in the treatment of respiratory distress syndrome of very low birth weight infants are, to date, still matter of debate. We investigated the effects of first intention high-frequency oscillatory ventilation or conventional mechanical ventilation support on selected primary and secondary outcomes in very low birth weight infants complicated by respiratory distress syndrome in which antenatal glucocorticoid prophylaxis was not performed. Multicenter randomized control trial. Three tertiary centers of neonatal intensive care units from December 2004 to December 2007. Eighty-eight very low birth weight infants complicated by respiratory distress syndrome, without antenatal glucocorticoids, supported by first intention high-frequency oscillatory ventilation (n = 44) or conventional mechanical ventilation (n = 44). All newborns were monitored by standard monitoring procedure, including routine laboratory variables, neurologic patterns, and ultrasound imaging. Primary outcomes were: the length of ventilatory support, the need of reintubation, and the length of nasal continuous positive airway pressure support in the postextubation period. Secondary outcomes were: the length of stay in neonatal intensive care unit and in hospital, death before discharge, adverse short- and long-term pulmonary and neonatal outcomes, and the need for a second dose of surfactant and of postnatal glucocorticoid treatment. High-frequency oscillatory ventilation infants showed a significant lower duration (p < .001 for all) of ventilator dependency, lower need of reintubation and of duration of nasal continuous positive airway pressure support in the postextubation period. Among secondary outcomes in the high-frequency oscillatory ventilation infants, the need of a second dose of surfactant administration, and the length of stay in the neonatal intensive care unit and in hospital were significantly lower (p < .05 for all)." }, { "role": "assistant", "content": "We found that high-frequency oscillatory ventilation in very low birth weight infants without antenatal glucocorticoid prophylaxis reduced the need of ventilatory support, surfactant therapy, and reintubation, and shortened neonatal intensive care unit and hospital stay, thus reducing unit and hospital costs. These data would support the usefulness of first intention high-frequency oscillatory ventilation strategy in managing in a selected population, such as very low birth weight newborns complicated by severe respiratory distress syndrome not antenatally treated with glucocorticoids. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Adenocarcinoma, Adult, Aged, Aged, 80 and over, Carcinoma, Squamous Cell, Esophageal Neoplasms, Esophagectomy, Female, Follow-Up Studies, Humans, Length of Stay, Male, Middle Aged, Minimally Invasive Surgical Procedures, Neoplasm Staging, Postoperative Complications, Prognosis, Prospective Studies, Survival Rate." }, { "role": "user", "content": "Does the implementation of minimally-invasive esophagectomy impact short-term outcome in a high-volume center? Context: Esophagectomy represents the gold standard in the treatment of resectable esophageal cancer. Despite significant improvements in perioperative care, postoperative morbidity and mortality rates remain high. Minimally-invasive surgical techniques introduced to the surgical treatment of esophageal malignancies have been shown to successfully diminish surgical trauma and postoperative morbidity. In the present report we present the stepwise implementation of minimally-invasive techniques in the treatment of esophageal cancer at a high-volume center and its influence on overall patient outcome. A total of 165 consecutive patients with esophagectomy, in two 4-year periods, namely that before (period A) and that after (period B) the implementation of minimally-invasive esophagectomy (MIE) for cancer, were compared. Patients' characteristics, and perioperative, surgical, oncological and survival outcomes were compared. In time period A, 73 patients were treated with open esophagectomy (OE), whereas in time period B 37 patients (40.2%) underwent an OE and 55 (59.8%) a minimally-invasive esophagectomy. Surgical and non-surgical complications did not differ significantly between groups (B: 44.6% vs. A: 54.8%; B: 38% vs. A: 35.6%; p>0.05). Duration of ventilation (B: 1.8 days vs. A: 6.7 days), ICU (B: 5.7 days vs. A: 12.2 days) and hospital stay (B: 20.5 days vs. A: 28.4 days) were significantly reduced in patients of time period B. The number of lymph nodes removed and complete resection rates were comparable (mean=18.1 ± 10.1 lymph nodes; B: 87% R0 vs. A: 93.2% R0). No significant differences between the groups were detectable regarding short-term disease-free or overall survival." }, { "role": "assistant", "content": "The implementation of minimally-invasive esophagectomy is feasible, safe and has the potential to reduce perioperative morbidity without compromising oncological outcome. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Criteria for defining polio epidemic are all except ?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'd' i.e., Cases occuring during 6 month period o An epidemic of polio is defined as 2 or more local cases caused by same virus type in any 4 week period. So, it has following features - i) 2 or more cases of polio ii) Caused by same virus type iii) Within 4 week period" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Biomarkers, Tumor, Carcinoma, Squamous Cell, Cell Nucleus, Cytoplasm, Esophageal Neoplasms, Esophagus, Fluorescent Antibody Technique, Direct, Humans, I-kappa B Kinase, Immunoenzyme Techniques, Middle Aged, NF-kappa B p50 Subunit, NF-kappa B p52 Subunit, Neoplasm Invasiveness, Neoplasm Proteins, Signal Transduction, Tissue Array Analysis, Transcription Factor RelA." }, { "role": "user", "content": "Are nF-kappaB signalling proteins p50/p105 , p52/p100 , RelA , and IKKepsilon over-expressed in oesophageal squamous cell carcinomas? Context: Nuclear factor-kappa B (NF-kappaB) activation has been recognised as an important mechanism in the development of cancers. However, expression status of NF-kappaB-related proteins in oesophageal squamous cell carcinoma (ESCC) tissues is largely unknown. In this study, we analysed expressions of NF-kappaB members (p50/105, p52/p100 and RelA) and IKKepsilon in ESCC tissues. We analysed the expression of p50/105, p52/p100, RelA and IKKepsilon in 58 ESCC patients' tissues by immunohistochemistry using a tissue microarray (TMA) method. Normal oesophageal squamous cells expressed p50/105, p52/p100 and RelA in 5%, 79% and 10% of the tissues in cytoplasm, respectively; however, only p52/p100 was expressed in the nuclei (12%). The cancer tissues expressed p50/105, p52/p100 and RelA in 93%, 95% and 95% in cytoplasm and/or nuclei, respectively. Nuclear immunostainings of NF-kappaB members p50/105, p52/p100 and RelA, which are considered activation of NF-kappaB signalling, were observed in 34%, 60% and 26% of the cancers, respectively. IKKepsilon is expressed in cytoplasm in 50% of the normal squamous tissues and 84% of the cancer tissues. However, none of the expression of p50/105, p52/p100, RelA or IKKepsilon was associated with pathological characteristics, including differentiation, depth of invasion and TNM stage." }, { "role": "assistant", "content": "The increased nuclear expressions of p50/105, p52/p100 and RelA as well as increased cytoplasmic expression of IKKepsilon in the ESCC tissues compared to the normal squamous cells suggested that over-expression of these proteins may be related to activation of the NF-kappaB pathway and might play a role in the development of ESCC. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Aged, Atrial Fibrillation, Biomarkers, Blood Pressure, Carotid Artery, Common, Diastole, Elasticity, Female, Femoral Artery, Heart Atria, Heart Ventricles, Humans, Hypertension, Male, Middle Aged, Natriuretic Peptide, Brain, Peptide Fragments, Pulsatile Flow, Risk Factors, Stroke, Ultrasonography, Ventricular Remodeling." }, { "role": "user", "content": "Is arterial stiffness associated with left atrial size in hypertensive patients? Context: Arterial stiffness is a strong predictor of cardiovascular events and particularly of stroke. A likely explanation is the development of atherosclerotic lesions at the carotid level, favored by increased local stiffness. Another possibility involves cardiac consequences of aortic stiffness and particularly left atrial dilatation with its subsequent risk of atrial fibrillation (AF) and cerebral embolism. The present study investigated the link between arterial stiffness, pulse pressure and left atrial size, a determinant of AF risk. Arterial stiffness was determined from pulse wave velocity (PWV) and pulse pressure (PP). Left atrial size was also measured. Several potential confounders were taken into account including indices of ventricular remodeling and diastolic function (estimated by NT-Pro brain natriuretic peptide (NT-proBNP) levels). Three-hundred and ten hypertensive patients, aged 53 +/- 13 years, were included. Mean 24-h blood pressure (BP) was 154 +/- 20 over 93 +/- 13 mmHg. Significant relationships were found between left atrial diameter (LAD) and PWV (r=0.27, P<0.001) and between LAD and 24-h PP (r=0.32, P<0.001). LAD was also correlated significantly, although not always tightly, with left ventricular dimensions, geometry and NT-proBNP. In two different multivariate models, LAD remained significantly correlated with PWV or with 24-h PP, independently of classical determinants like age, gender, body mass index, ventricular remodeling (i.e. dimensions and geometry) and filling pressure." }, { "role": "assistant", "content": "These results led us to propose AF as a new possible pathophysiological link between arterial stiffness and stroke. These results also emphasize the cardiac consequences of arterial stiffness which can fuel a new approach to AF prevention. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Adaptation, Physiological, Adenoviridae, Amino Acid Sequence, Animals, Antibodies, Viral, Cold Temperature, Cross Protection, Epitopes, Immunity, Influenza A Virus, H1N1 Subtype, Influenza Vaccines, Lung, Mice, Mice, Inbred BALB C, Mice, Inbred C57BL, Molecular Sequence Data, Orthomyxoviridae Infections, Pandemics, T-Lymphocytes, Vaccination, Vaccines, Synthetic, Viral Load." }, { "role": "user", "content": "Do cold-adapted influenza and recombinant adenovirus vaccines induce cross-protective immunity against pH1N1 challenge in mice? Context: The rapid spread of the 2009 H1N1 pandemic influenza virus (pH1N1) highlighted problems associated with relying on strain-matched vaccines. A lengthy process of strain identification, manufacture, and testing is required for current strain-matched vaccines and delays vaccine availability. Vaccines inducing immunity to conserved viral proteins could be manufactured and tested in advance and provide cross-protection against novel influenza viruses until strain-matched vaccines became available. Here we test two prototype vaccines for cross-protection against the recent pandemic virus. BALB/c and C57BL/6 mice were intranasally immunized with a single dose of cold-adapted (ca) influenza viruses from 1977 or recombinant adenoviruses (rAd) expressing 1934 nucleoprotein (NP) and consensus matrix 2 (M2) (NP+M2-rAd). Antibodies against the M2 ectodomain (M2e) were seen in NP+M2-rAd immunized BALB/c but not C57BL/6 mice, and cross-reacted with pH1N1 M2e. The ca-immunized mice did not develop antibodies against M2e. Despite sequence differences between vaccine and challenge virus NP and M2e epitopes, extensive cross-reactivity of lung T cells with pH1N1 peptides was detected following immunization. Both ca and NP+M2-rAd immunization protected BALB/c and C57BL/6 mice against challenge with a mouse-adapted pH1N1 virus." }, { "role": "assistant", "content": "Cross-protective vaccines such as NP+M2-rAd and ca virus are effective against pH1N1 challenge within 3 weeks of immunization. Protection was not dependent on recognition of the highly variable external viral proteins and could be achieved with a single vaccine dose. The rAd vaccine was superior to the ca vaccine by certain measures, justifying continued investigation of this experimental vaccine even though ca vaccine is already available. This study highlights the potential for cross-protective vaccines as a public health option early in an influenza pandemic. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Biomarkers, Biomarkers, Tumor, Carcinoma, Transitional Cell, Cell Cycle, Cell Cycle Proteins, Cystectomy, Disease Progression, Disease-Free Survival, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Models, Biological, Multivariate Analysis, Neoplasm Grading, Neoplasm Invasiveness, Neoplasm Recurrence, Local, Prognosis, Proportional Hazards Models, Risk Assessment, Treatment Outcome, Urinary Bladder Neoplasms." }, { "role": "user", "content": "Do cell-cycle markers improve discrimination of EORTC and CUETO risk models in predicting recurrence and progression of non-muscle-invasive high-grade bladder cancer? Context: To assess if a panel of cell-cycle markers could improve the discrimination of European Organization for Research and Treatment of Cancer (EORTC) and Spanish Urological Club for Oncological Treatment (CUETO) models in predicting recurrence and progression of high-grade non-muscle-invasive bladder cancer (NMIBC). Between January 2007 and January 2012, every patient with high-grade NMIBC treated with transurethral resection of bladder underwent immunohistochemical staining for 5 biomarkers (p21, p27, p53, KI-67, and cyclin E1). We excluded patients who had muscle-insvasive disease, underwent early cystectomy, and those with incomplete follow-up. Kaplan-Meier curves assessed recurrence and progression-free survival. Univariate and multivariate Cox regression analysis assessed the predictive ability of markers after correcting for EORTC or CUETO risk scores. Harrel concordance index assessed for discrimination. There were 131 patients with a median follow-up of 31.1 months. Stage was Ta (50%), T1 (44%), and Tis (8%). For 95 patients this was the primary tumor. Intravesical therapy was used in 76% of cases of which 45% had maintenance. Recurrence-free survival rates at 6, 12, and 24 months were 68.9%, 52.1%, and 33.2%, respectively, whereas progression-free survival rate at 6, 12, and 24 months were 93.8%, 88%, and 84.3%, respectively. No differences in survival based on number of altered markers were noted. Biomarker status was neither a significant predictor of recurrence nor progression. Marker alterations marginally improved discrimination of EORTC and CUETO models, which were confirmed to be mediocre." }, { "role": "assistant", "content": "Markers were not significant predictors of recurrence nor progression in patients with high-grade NMIBC and their addition to prediction models is of little benefit. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Aorta, Thoracic, Blood Flow Velocity, Cardiomegaly, Female, Gestational Age, Homozygote, Humans, Middle Cerebral Artery, Placenta, Predictive Value of Tests, Pregnancy, Risk Factors, Sensitivity and Specificity, Ultrasonography, Prenatal, alpha-Thalassemia." }, { "role": "user", "content": "Ultrasonographic prediction of homozygous alpha0-thalassemia using placental thickness, fetal cardiothoracic ratio and middle cerebral artery Doppler: alone or in combination? Context: To compare the predictive values of three ultrasonographic parameters: placental thickness (PT), fetal cardiothoracic ratio (CTR) and middle cerebral artery peak systolic velocity (MCA-PSV), alone or in combination, in pregnancies affected by homozygous alpha(0)-thalassemia at 12-20 weeks' gestation. Pregnant women at risk of carrying a fetus affected by homozygous alpha(0)-thalassemia were studied from 1995 to 2006 using serial ultrasonography at 12-15 weeks, 16-20 weeks and 30 weeks' gestation. We measured CTR and PT from 1995, and MCA-PSV as well from 1997. An invasive prenatal test was offered if cardiomegaly with or without placentomegaly was detected but the MCA-PSV results were used only retrospectively for analysis. Of a total of 777 at-risk fetuses studied, 138 (17.8%) were affected by homozygous alpha(0)-thalassemia. At 12-15 weeks' gestation, 598 ultrasound examinations were performed. CTR was better than both PT and MCA-PSV in the prediction of affected pregnancies. The highest sensitivity (98.3%) was achieved by the combination of CTR and/or MCA-PSV at a false-positive rate of 15.8%. At 16-20 weeks' gestation, 410 ultrasound examinations were performed, 121 of which were at the patient's first visit and 289 of which were at a follow-up visit. Both CTR and MCA-PSV predicted the affected pregnancies equally well. The sensitivity of CTR was 100.0%, but the false-positive rate was 5.2%. In contrast, the false-positive rate of MCA-PSV alone was 1.4% and that of the combination of CTR and MCA-PSV was 0%, although their sensitivities were less than 65%." }, { "role": "assistant", "content": "The data suggest that adding MCA-PSV to CTR in the prediction of homozygous alpha(0)-thalassemia can increase the sensitivity at 12-15 weeks and decrease the false-positive rate at 16-20 weeks' gestation." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Acute Coronary Syndrome, Aged, Biomarkers, C-Reactive Protein, Chemokine CXCL16, Chemokines, CXC, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Natriuretic Peptide, Brain, Patient Readmission, Prognosis, Proportional Hazards Models, Receptors, Scavenger, Risk Factors, Solubility, Troponin T." }, { "role": "user", "content": "Does soluble CXCL16 predict long-term mortality in acute coronary syndromes? Context: CXCL16/SR-PSOX is an interferon-gamma-regulated chemokine and scavenger receptor for oxidized low-density lipoprotein that is expressed in atherosclerotic lesions. Proteolytic cleavage of membrane-bound CXCL16 releases soluble CXCL16, which may promote migration of effector T cells and augment a proatherogenic inflammatory response. We hypothesized that soluble CXCL16 concentrations are associated with long-term outcome in patients with acute coronary syndromes. We assessed the association between circulating CXCL16 levels obtained within 24 hours after admission and time to death in 1351 patients (median age 67 years, 30% female) with a diagnosis of unstable angina, non-ST-segment-elevation myocardial infarction, or ST-segment-elevation myocardial infarction. During a median follow-up time of 81 months, 377 patients died. Increased levels of CXCL16 were prognostically unfavorable; the fourth versus first quartile was associated with higher risk of death (hazard ratio 2.1; 95% CI 1.6 to 2.8; P<0.0001), triple risk of developing heart failure (hazard ratio 3.0; 95% CI 1.8 to 5.1; P<0.0001), and a doubling of the risk of rehospitalization for myocardial infarction (hazard ratio 2.1; 95% CI 1.3 to 3.3; P=0.002). After adjustment for conventional risk markers, logarithmically transformed CXCL16 level remained a strong independent indicator of long-term mortality (hazard ratio 1.21; 95% CI 1.09 to 1.36 per 1 SD increase in CXCL16; P=0.0006) and congestive heart failure development (hazard ratio 1.25; 95% CI 1.05 to 1.48; P=0.01). In a subsample of 714 patients, after further adjustment for troponin T, high-sensitive C-reactive protein, pro-B-type natriuretic peptide, and left ventricular ejection fraction, CXCL16 still provided significant additional prognostic information on mortality (hazard ratio 1.21; 95% CI 1.02 to 1.42 per 1 SD increase in CXCL16; P=0.02)." }, { "role": "assistant", "content": "In patients with an acute coronary syndrome, CXCL16 levels obtained within 24 hours of admission are associated with long-term mortality after adjustment for other risk factors. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A boy fell from the height on his outstretched hand. The X-ray is similar to the one shown below. The most likely diagnosis?" }, { "role": "assistant", "content": "The correct answer is Ans. (A) Galeazzi fracture(Ref: Text book of Orthopedics by John Ebnezar 5th Ed; Page no-164)Galeazzi FractureDiaphyseal fracture of the radius with dislocation of the distal radioulnar joint results from a direct blow to the radius.It is also called reverse Monteggia fracture.CXR:#Lateral viewRadius is angulated dorsally.#AP viewFracture radius, transverse or short oblique.Dislocation of the distal radioulnar joint.Management: ORIF of the radius and casting of the fractured forearm in supination to reduce the distal radioulnar joint.Colles FractureInvolves the distal radius. Often results from a fall onto an outstretched hand, leading to a dorsally displaced, dorsally angulated fracture. Commonly seen in the elderly (Osteoporosis) and children.Management: Closed reduction followed by application of a long-arm cast; open reduction if the fracture is intra-articular.Monteggia FractureIt is a fracture upper third of ulna with dislocation head of the radius. Most commonly seen in late childhood.It occurs due to fall on the outstretched hands either in hyperpronation or in hyperextension.In monteggia fractures, radial head dislocation is often missed so it is called as treacherous lesion.Radiographs:#AP views: Forearm#Lateral and oblique views: Elbow and Wrist joints.Most common nerve injuries in monteggia fractures: Posterior interosseous nerveRolando's FractureIt is the intraarticular comminuted fracture of the base of the first metacarpal with a T or Y configuration." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Animals, Apoptosis, Arylamine N-Acetyltransferase, Blotting, Western, Brain Neoplasms, Bridged Bicyclo Compounds, Heterocyclic, Cell Cycle, Cell Proliferation, Flow Cytometry, Glioma, Humans, MAP Kinase Kinase 1, Mice, Mitogen-Activated Protein Kinase 1, Mitogen-Activated Protein Kinase 3, Proto-Oncogene Proteins c-bcl-2, Signal Transduction, Tumor Cells, Cultured, bcl-2-Associated X Protein, raf Kinases." }, { "role": "user", "content": "Does norcantharidin induce growth inhibition and apoptosis of glioma cells by blocking the Raf/MEK/ERK pathway? Context: Malignant gliomas represent the most common primary brain tumors. The prognosis of patients with malignant gliomas is poor in spite of current intensive therapy and novel therapeutic modalities are needed. Here we report that norcantharidin is effective in growth inhibition of glioma cell lines in vitro. Glioma cell lines (U87 and C6) were treated with norcantharidin. The effects of norcantharidin on the proliferation and apoptosis of glioma cells were measured by 3-[4,5-dimethylthiazol-2-thiazolyl]-2,5-diphenyl-tetrazolium bromide (MTT) assay and flow cytometry. Western blotting was employed to determine the signaling pathway changes. The results showed that norcantharidin effectively inhibited cell growth and induced apoptosis in glioma cells, which was concurrent with inhibition of the expression of phospho-MEK and phospho-ERK. Furthermore, the expression anti-apoptotic proteins Bcl-2 and Mcl-1 significantly reduced, but no changes in Bcl-xL and Bax." }, { "role": "assistant", "content": "Our findings demonstrate that norcantharidin is effective for growth inhibition of glioma cell lines and suggest that norcantharidin may be a new therapeutic option for patients with glioma. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Humans, Hyaluronic Acid, Interleukin-1beta, Interleukin-6, Intra-Articular Fractures, Middle Aged, Proteoglycans, Retrospective Studies, Synovial Fluid, Tibial Fractures." }, { "role": "user", "content": "Does intra-articular fracture change the lubricant content of synovial fluid? Context: Lubrication function is impaired and the lubricant content of synovial fluid (SF) changes immediately after plateau tibia fractures. Here, we aimed to analyze the lubricant content of SF at chronic term following plateau tibia fracture. Forty-eight surgically treated patients without joint incongruency (<2 mm displacement) were included in the study. Joint aspiration had been possible in 16 of the participants. However, sampling could be made from healthy knees in only ten of these patients. Twenty-six SF samples (16 injured knees, 10 healthy knees) were analyzed for concentrations of hyaluronic acid (HA), proteoglycan-4 (PRG4), TNF-α, IL-1β, and IL-6. The group of experimental samples were obtained at a mean of 31 (12-66) months after injury from patients with a mean age of 45.1 (32-57) years. There were no relationships detected between biochemical analysis results and patient ages, sexes, postoperative time, and fracture type. After excluding six patients for whom we could not sample from their healthy knee, ten patients' values were compared with paired Wilcoxon signed rank test and no significant differences detected between the healthy and injured knee in terms of the SF concentrations of HA and PRG4 (p = 0.225 and 0.893, respectively). Similarly, there were no statistically significant differences in SF sample concentrations of TNF-α, IL-1β, and IL-6 between healthy and injured knees." }, { "role": "assistant", "content": "Despite acute changes, the long-term concentrations of HA and PRG4 were similar after plateau tibial fracture. We could not detect any concentration level differences between healthy knees and injured knees regarding HA and PRG4 in the long-term follow-up." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Aged, 80 and over, Case-Control Studies, Cell Transplantation, Diabetes Mellitus, Extremities, Female, Granulocyte Colony-Stimulating Factor, Humans, In Vitro Techniques, Ischemia, Male, Middle Aged, Monocytes, Neovascularization, Physiologic." }, { "role": "user", "content": "Do g-CSF-mobilized peripheral blood mononuclear cells from diabetic patients augment neovascularization in ischemic limbs but with impaired capability? Context: Autologous transplantation of mobilized peripheral blood mononuclear cells (M-PBMNCs) is a novel approach to improve critical limb ischemia (CLI) in diabetes. However, endothelial progenitor cells (EPCs) from diabetes are dysfunctional and impaired in ischemia-induced neovascularization. This study aimed to confirm the compromised efficiency of diabetic M-PBMNCs in therapeutic neovascularization, and to determine the underlying mechanisms of this impairment. Diabetic M-PBMNCs from 17 diabetic patients or healthy controls, or phosphate-buffered saline (PBS) were injected into the ischemic limbs of streptozotocin-induced diabetic nude mice. The limb blood perfusion, ambulatory score, ischemia damage, capillary/fiber ratio, arteriole density, collateral vessel formation, and pericytes recruitment were evaluated between these three groups. Non-invasive real time image and histopathology were used to detect the in vivo role of transplanted M-PBMNCs. Proliferation and adhesion of EPCs were assayed. In vitro vascular network incorporation and matrigel plug assay were used to test the pro-neovascularization role of M-PBMNCs. Transplantation of diabetic M-PBMNCs also improved neovascularization, but to a lesser extent from that observed with non-diabetic ones. This was associated with the impairment of diabetic M-PBMNCs capacity to differentiate into EPCs, to incorporate into vessel-like tubules in vitro, to participate in vascular-like structure formation in a subcutaneous matrigel plug, and to stimulate the recruitment of pericytes/smooth muscle cells. In addition, there was impairment in vasculogenesis, which was related to the reduced adhesion ability of EPCs from diabetic M-PBMNCs." }, { "role": "assistant", "content": "Diabetes reduced the capacity of M-PBMNCs to augment neovascularization in ischemia. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Most common cause of neovascular glaucoma -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., DiabetesNeovascular glaucoma (Rubeosis iridis)o It is a secondary angle closure glaucoma which results due to formation of neovascular membrane over the iris i.e., neovascularization of iris (rubeosis iridis). Causes of rubeosis iridis are :-Common :- Diabetic retinopathy (most common cause% central retinal vein occlusion. Gale's disease, sickle- cell retinopathyRare causes: - Long standing retinal detachment, central retinal artery occlusion, intraocular inflammation (uveitis), intraocular tumors (choroidal melanoma, retinoblastoma), radiation retinopathy, ocular ischemic syndrome (carotid artery disease, carotid - cavernous fistula), Fuseli's heterochromic iridocyclitis.o In central retinal vein occlusion (CRVO), glaucoma manifests about 100 days after thrombosis of central vein, therefore, it is also called 100 days glaucoma.o The most widely accepted theory for neovascularization is that the hypoxic retina produces diffusible angiogenic factor (VEGF) that stimulates new vessel proliferation.o Treatment of choice is panretinal photocoagulation as it terminates the angiogenic stimulus for neovascularization of retina." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Harakiri means" }, { "role": "assistant", "content": "The correct answer is Harakiri (seppuku) is a form of Japanese ritual suicide by disembowelment. Stab injury in the abdomen (L-shaped), causing instantaneous evisceration of bowel loops. It results in sudden decrease in abdominal pressure and cardiac return resulting in circulatory collapse and death." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All are true regarding mesothelioma except?" }, { "role": "assistant", "content": "The correct answer is • Malignant mesothelioma is MC tumor of the pleura\n• In 20% of malignant mesotheliomas, the tumor arises from peritoneum\n• Exposure to asbestos is the major known risk factor\n• More common in males, most common after 40 years of age.\n• Three types: Epithelial, sarcomatous, and biphasic\n• Epithelial types are associated with a more favorable prognosis\nPathophysiology\n• Physical characteristics of specific fibers (referred to as serpentine or amphibole) have been shown to be important.\n• Serpentine fibers: Large and curly, not able to travel beyond larger airways.\n• Straight amphibole fibers: In particular the crocidoliteQ fibers navigate distally into the pulmonary parenchyma, most clearly associated with mesotheliomas.\n• Latency period between asbestos exposure and the development of mesothelioma is at least 20 years.\n• Multicentric tumor with multiple pleura-based nodules coalescing to form sheets of tumor (but not bilaterally symmetrical)\n• Natural history of the disease in untreated patients culminates in death due to local extension.\nClinical Features\n• Most patients present with dyspnea and chest pain.\n• Over 90% have a pleural effusion.\nDiagnosis\n• Results of thoracentesis are diagnostic in <10% of patients.\n• Chest X-ray: Pleural effusion, generalized pleural thickening and shrunken hemithorax.\n• Thoracoscopy or open pleural biopsy with special staining of tumor samples is required to differentiate mesotheliomas from adenocarcinomas.\nManagement\n• No effective therapy\n• Treatment options: Supportive care only, surgical resection, and multimodality approaches (using a combination of surgery, chemotherapy, and radiation therapy)." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, DESIGN, MAIN OUTCOME MEASURE, RESULTS. Meshes: Animals, Astacoidea, Bites and Stings, Cnidarian Venoms, Cubozoa, Temperature." }, { "role": "user", "content": "Temperature effects on box jellyfish venom: a possible treatment for envenomed patients? Context: To determine the effect of temperature on lethality of venom from Chironex fleckeri (the potentially fatal box jellyfish). Venom extracted from nematocysts of mature Chironex fleckeri specimens was exposed to temperatures between 4 degrees C and 58 degrees C for periods of two, five or 20 minutes, and then injected into freshwater crayfish (Cherax quadricarinatus) to assess lethality. Venom lethality, assessed as time to cardiac standstill in crayfish after intramuscular injection. Venom lethality was significantly affected by both temperature (F(7,34) = 21915; P<0.0001) and time of exposure (F(2,34) = 9907; P<0.0001). No significant loss of lethality was seen after exposure to temperatures<or= 39 degrees C, even after 20 minutes' exposure. At temperatures>or= 43 degrees C, venom lost its lethality more rapidly the longer the exposure time. Venom was non-lethal after exposure to 48 degrees C for 20 minutes, 53 degrees C for five minutes, and 58 degrees C for two minutes." }, { "role": "assistant", "content": "Exposure to heat dramatically reduces the lethality of extracted C. fleckeri venom. Although heat application may be of limited use in treating C. fleckeri envenoming because of the speed of symptom onset, its use in other box-jellyfish envenomings, such as Irukandji syndrome, requires investigation." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "The classic triad of congenital Rubella includes all except:" }, { "role": "assistant", "content": "The correct answer is The classic triad of congenital Rubella does not include Retinal detachment. Rubella virus infection during pregnancy: Virus can cross the placental barrier and infect the fetus. Infection leads to angiopathy with placental and fetal vasculitis, which compromises fetal growth. The classic triad of congenital Rubella includes - Deafness Cataract Congenital hea disease (PDA and PS) Other manifestations - Microcephaly Glaucoma Myopia Retinopathy Inguinal hernia Cryptorchidism Thrombotic thrombocytopenic purpura Hepatosplenomegaly" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Metastatic disease to the oral region is most likely to occur in which of these locations?" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "If a neonate has warm abdomen, but cold extremities then the baby has?" }, { "role": "assistant", "content": "The correct answer is Diagnosis of hypothermia by human touch: Trunk Extremities Interpretation Warm Warm Normal Warm Cold Cold stress Cold Cold Hypothermia" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Apoptosis, Cells, Cultured, Chorionic Villi, Cytokines, Cytophagocytosis, Decidua, Female, Granulocyte-Macrophage Colony-Stimulating Factor, Humans, Inflammation Mediators, Interleukin-1beta, Macrophages, Pregnancy, Pregnancy Trimester, First, Trophoblasts, Tumor Necrosis Factor-alpha, Up-Regulation." }, { "role": "user", "content": "Do pro-inflammatory cytokine-stimulated first trimester decidual cells enhance macrophage-induced apoptosis of extravillous trophoblasts? Context: As human blastocyst-derived extravillous trophoblasts (EVTs) invade the early decidua, they are positioned to interact with immune cells and resident decidual cells, and remodel spiral arteries into high capacity vessels that increase blood flow to the developing fetal-placental unit. Shallow EVT invasion elicits incomplete vascular transformation and reduces uteroplacental blood flow that presages adverse pregnancy outcomes. Excess macrophages in the decidua induce EVT apoptosis via tumor necrosis factor-alpha (TNF-α) secretion. Our previous observation that pro-inflammatory cytokines enhance neutrophil and macrophage activator granulocyte-macrophage colony-stimulating factor (GM-CSF) expression in first trimester decidual cells is now extended to include: (1) the specific macrophage activator M-CSF; (2) macrophage activation and subsequent enhancement of EVT apoptosis by both GM-CSF and M-CSF. Quantitative reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay assessed M-CSF expression in first trimester decidual cells incubated with interleukin-1 beta (IL-1β) or TNF-α. Peripheral monocyte-derived macrophages pre-incubated with conditioned media from decidual cell cultures were co-cultured with a first trimester EVT cell line, HTR-8/SVneo cells. Macrophage activation was examined and EVT apoptosis evaluated by DNA fragmentation, caspase activation and cell membrane asymmetry. IL-1β or TNF-α significantly enhanced M-CSF expression in first trimester decidual cells. The conditioned media from these cultures activates macrophages, which promote caspase 3/7-dependent EVT apoptosis with antibodies against GM-CSF or M-CSF blocking this effect." }, { "role": "assistant", "content": "Pro-inflammatory cytokines increases synthesis of M-CSF in first trimester decidual cells. Both GM-CSF and M-CSF activate macrophages, which initiate caspase-dependent EVT apoptosis. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: PURPOSE, METHODS, RESULTS. Meshes: Adolescent, Adult, Age of Onset, Arthroscopy, Cartilage, Articular, Female, Femoracetabular Impingement, Fractures, Cartilage, Health Status, Hip Injuries, Hip Joint, Humans, Joint Diseases, Lacerations, Male, Middle Aged, Pain, Prospective Studies, Time Factors, Time-to-Treatment, Treatment Outcome, Young Adult." }, { "role": "user", "content": "Timing in hip arthroscopy: does surgical timing change clinical results? Context: To our knowledge, there is no report in the orthopaedic literature that correlates the duration of hip pain with the results of hip arthroscopic surgery. The aim of this study was to compare the modified Harris Hip Score (mHHS) with patient satisfaction in a prospective study over a two year period. We present a prospective single-surgeon series of 525 consecutive patients undergoing hip arthroscopy for a labral tear, femoroacetabular impingement (FAI), or a chondral lesion. Modified HHS was recorded for all patients at the time of surgery and at six weeks, six months and one, two and three years after hip arthroscopy. At the time of surgery, patients were divided into three groups based on duration of preoperative symptoms: group A, under 6 months; group B, six months to three years; group C, over three years. Mean age was 39 years. There were significantly better outcomes for patients who underwent surgery within six months of symptom onset compared with those who waited longer. Patients who had symptoms for over 3 years by the time of surgery had a significantly poorer result than those with a shorter symptom duration and a higher chance of requiring revision surgery." }, { "role": "assistant", "content": "We recommend that patients with a diagnosis of labral tear, FAI or a chondral lesion should undergo hip arthroscopic surgery within six months of symptom onset. Patients with persistent symptoms for over three years should be made aware of the poorer outcome after hip arthroscopy." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Aged, Aged, 80 and over, Aorta, Abdominal, Aortic Aneurysm, Abdominal, Aortic Rupture, Aortography, Arterial Occlusive Diseases, Computed Tomography Angiography, Computer Simulation, Female, Finite Element Analysis, Hemodynamics, Humans, Hydrodynamics, Male, Middle Aged, Models, Cardiovascular, Oregon, Peripheral Arterial Disease, Predictive Value of Tests, Prognosis, Pulmonary Disease, Chronic Obstructive, Radiographic Image Interpretation, Computer-Assisted, Retrospective Studies, Risk Assessment, Risk Factors, Stress, Mechanical, Time Factors." }, { "role": "user", "content": "Does aortic outflow occlusion predict rupture of abdominal aortic aneurysm? Context: Current threshold recommendations for elective abdominal aortic aneurysm (AAA) repair are based solely on maximal AAA diameter. Peak wall stress (PWS) has been demonstrated to be a better predictor than AAA diameter of AAA rupture risk. However, PWS calculations are time-intensive, not widely available, and therefore not yet clinically practical. In addition, PWS analysis does not account for variations in wall strength between patients. We therefore sought to identify surrogate clinical markers of increased PWS and decreased aortic wall strength to better predict AAA rupture risk. Patients treated at our institution from 2001 to 2014 for ruptured AAA (rAAA) were retrospectively identified and grouped into patients with small rAAA (maximum diameter <6 cm) or large rAAA (>6 cm). Patients with large (>6 cm) non-rAAA were also identified sequentially from 2009 for comparison. Demographics, vascular risk factors, maximal aortic diameter, and aortic outflow occlusion (AOO) were recorded. AOO was defined as complete occlusion of the common, internal, or external iliac artery. Computational fluid dynamics and finite element analysis simulations were performed to calculate wall stress distributions and to extract PWS. We identified 61 patients with rAAA, of which 15 ruptured with AAA diameter <60 mm (small rAAA group). Patients with small rAAAs were more likely to have peripheral arterial disease (PAD) and chronic obstructive pulmonary disease (COPD) than were patients in the large non-rAAA group. Patients with small rAAAs were also more likely to have AOO compared with non-rAAAs >60 mm (27% vs 8%; P = .047). Among all patients with rAAAs, those with AOO ruptured at smaller mean AAA diameters than in patients without AOO (62.1 ± 11.8 mm vs 72.5 ± 16.4 mm; P = .024). PWS calculations of a representative small rAAA and a large non-rAAA showed a substantial increase in PWS with AOO." }, { "role": "assistant", "content": "We demonstrate that AOO, PAD, and COPD in AAA are associated with rAAAs at smaller diameters. AOO appears to increase PWS, whereas COPD and PAD may be surrogate markers of decreased aortic wall strength. We therefore recommend consideration of early, elective AAA repair in patients with AOO, PAD, or COPD to minimize risk of early rupture. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Flask shaped heart is seen in -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'b' i.e., Pericardial effusion o Snowman's sign is seen in supracardiac TAPVC,Cardiac configration o \"Boot-shaped\" heart (cour en sabot)Fallot's tetralogyo \"Egg on side\" heart (\"egg in cup\" heart)Transposition of great arterieso \"Egg in cup\" HeartConstrictive pericarditiso \"Snowman\" sign (\"figure of 8,Supracardiac TAPVCor cottage loaf\" sign) o \"Ground - glass\" appearance of lungObstructive TAPVCo \"Sitting-duck\" heartPersistent truncus arteriosuso \"Water-bottle\" or Basked shapedPericardial effusion, hypothyroidismor money bag heart o \"Box-shaped\" heartTricuspid atresia, Ebstein's anomalyo Tubular heartAddison's disease, emphysemao \"Tear -drop\" heartChronic emphysemao \"Cor-triatum\"Pulmonary vein obstructiono \"Jug handle\" appearancePrimary pulmonary hypertensiono \"Pentagon-shaped\" heartMitral incompetenceo \"Triangular-shaped\" heartConstrictive pericarditis" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Animals, Apoptosis, Disease Models, Animal, Enzyme Inhibitors, Female, Lupus Erythematosus, Systemic, Lymphocytes, Mice, Mice, Inbred BALB C, Mice, Inbred MRL lpr, Nitric Oxide, Spleen, omega-N-Methylarginine." }, { "role": "user", "content": "Does nitric oxide induce apoptosis in spleen lymphocytes from MRL/lpr mice? Context: MRL/MpJ-Tnfrsf6lpr(MRL/lpr) mice, a murine model of systemic lupus erythematosus (SLE), have defective expression of Fas, substantially reducing signaling for apoptosis via this mechanism. However, it is known that MRL/lpr mice have increased spontaneous apoptosis of leukocytes. These conflicting observations have stimulated interest in apoptosis in this SLE model. MRL/lpr mice overproduce nitric oxide (NO) as autoimmune disease progresses. In vitro administration of NO may induce or decrease apoptosis depending on the cell type. Therefore, we hypothesized that NO induces MRL/lpr spleen lymphocyte apoptosis independent of Fas receptor engagement. Percentages of apoptotic spleen lymphocytes from MRL/lpr and BALB/cJ mice were determined ex vivo after in vivo treatment with NG-monomethyl-L-arginine (NMMA), a nitric oxide synthase (NOS) inhibitor. After culture in varying concentrations of a slow-acting NO donor, the following were determined in spleen lymphocytes: (1) levels of apoptosis, (2) the effect of phorbol myristate acid (PMA) on levels of NO-induced apoptosis, and (3) protein kinase C (PKC) activity. Spleen lymphocytes from MRL/lpr mice with active disease had increased levels of ex vivo apoptosis when compared with BALB/cJ controls. This increase was reduced by pharmacologic inhibition of NOS in MRL/lpr but not in BALB/cJ mice. Exogenous administration of NO in vitro reduced PKC activity and induced apoptosis in MRL/lpr spleen lymphocytes, an effect that could be reduced via coadministration of PMA in vitro." }, { "role": "assistant", "content": "These results suggest that NO plays a role in spleen lymphocyte apoptosis in MRL/lpr mice, possibly via inhibition of PKC, despite a Fas defect. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All of the following degradation product of Glycine except" }, { "role": "assistant", "content": "The correct answer is Glycine undergoes oxidative deamination by glycine synthase to librate NH4+, COm and one carbon fragment as N5, N10- methylene THF. This provides a major route of glycine break down.Glycine is reversibly conveed to Serin by THF dependent serine hydroxymethyltransferase. Pyruvate produced from serine by serine dehydratase. Serine is degraded to glyoxylate. Glycine is also conveed to oxalate, an excretory product.Ref: Biochemistry, U. Satyanarayana, Fouh edition, page no: 342" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Asian Continental Ancestry Group, Bone Density, Bone Morphogenetic Protein 7, Case-Control Studies, Female, Genetic Predisposition to Disease, Humans, Middle Aged, Osteoporotic Fractures, Polymorphism, Single Nucleotide, Postmenopause." }, { "role": "user", "content": "Are bMP7 gene polymorphisms associated with bone mineral density or osteoporotic fractures in postmenopausal Chinese women? Context: A previous study shows that bone morphogenetic protein 7 (BMP7) gene polymorphisms are associated with bone mineral density (BMD) in 920 European Americans. To determine the association of BMP7 polymorphisms and BMD and osteoporotic fracture susceptibility, we performed a case-control association study in postmenopausal Chinese women with or without osteoporotic fracture. A total of 3815 unrelated postmenopausal Chinese women (1238 with osteoporotic fracture and 2577 healthy controls) were recruited. BMDs of the lumbar spine 1-4 (L1-4) and proximal femur (including total hip and femoral neck) were measured using dual-energy X-ray absorptiometry. Eight tagging single nucleotide polymorphisms (SNPs) in BMP7 gene, including rs11086598, rs4811822, rs12481628, rs6025447, rs230205, rs17404303, rs162316 and rs6127980, were genotyped. Among the 8 SNPs, rs6025447 and rs230205 were associated with total hip BMD (P=0.013 and 0.045, respectively). However, the associations became statistically insignificant after adjusting for age, height and weight. The TGTG haplotype of BMP7 gene was associated with total hip BMD (P=0.032), even after adjusting for age, height and weight (P=0.048); but the association was insignificant after performing the Bonferroni multiple-significance-test correction. Moreover, the 8 SNPs and 9 haplotypes of BMP7 gene were not associated with L1-4 or femoral neck BMD or osteoporotic fracture." }, { "role": "assistant", "content": "This large-sample case-control association study suggests that the common genetic polymorphisms of BMP7 gene are not major contributors to variations in BMD or osteoporotic fracture in postmenopausal Chinese women. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Acyl-CoA Oxidase, Animals, Animals, Genetically Modified, Anticholesteremic Agents, Apolipoprotein A-I, Cholesterol, HDL, Drug Resistance, Fenofibrate, Gene Expression Regulation, Humans, Intestinal Mucosa, Intestines, Lipoprotein Lipase, Lipoproteins, HDL, Liver, Liver Neoplasms, Experimental, Microbodies, Organ Size, Organ Specificity, Oxidoreductases, Peroxisome Proliferators, Rabbits, Recombinant Fusion Proteins, Rodentia, Species Specificity." }, { "role": "user", "content": "Do beneficial effects of fibrates on apolipoprotein A-I metabolism occur independently of any peroxisome proliferative response? Context: In humans, fibrates are frequently used normolipidemic drugs. Fibrates act by regulating genes involved in lipoprotein metabolism via activation of the peroxisome proliferator-activated receptor-alpha (PPARalpha) in liver. In rodents, however, fibrates induce a peroxisome proliferation, leading to hepatomegaly and possibly hepatocarcinogenesis. Although this peroxisome proliferative response appears not to occur in humans, it remains controversial whether the beneficial effects of fibrates on lipoprotein metabolism can occur dissociated from such undesirable peroxisomal response. Here, we assessed the influence of fenofibrate on lipoprotein metabolism and peroxisome proliferation in the rabbit, an animal that, contrary to rodents and similar to humans, is less sensitive to peroxisome proliferators. First, we demonstrate that in normal rabbits, fenofibrate given at a high dose for 2 weeks does not influence serum concentrations or intestinal mRNA levels of the HDL apolipoprotein apoA-I. Therefore, the study was continued with human apoA-I transgenic rabbits that overexpress the human apoA-I gene under control of its homologous promoter, including its PPAR-response elements. In these animals, fenofibrate increases serum human apoA-I concentrations via an increased expression of the human apoA-I gene in liver. Interestingly, liver weight or mRNA levels and activity of fatty acyl-CoA oxidase, a rate-limiting and marker enzyme of peroxisomal beta-oxidation, remain unchanged after fenofibrate." }, { "role": "assistant", "content": "Expression of the human apoA-I transgene in rabbit liver suffices to confer fibrate-mediated induction of serum apoA-I. Furthermore, these data provide in vivo evidence that the beneficial effects of fibrates on lipoprotein metabolism occur mechanistically dissociated from any deleterious activity on peroxisome proliferation and possibly hepatocarcinogenesis. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVES, STUDY DESIGN, RESULTS. Meshes: AIDS-Related Opportunistic Infections, Australia, Cohort Studies, Evidence-Based Medicine, Guidelines as Topic, HIV Infections, Humans, Incidence, Pneumococcal Vaccines, Pneumonia, Pneumococcal, Retrospective Studies, Vaccination." }, { "role": "user", "content": "Is the recommendation for pneumococcal vaccination of HIV patients evidence based? Context: both the current NHMRC guidelines of Australia and the USPHS/IDSA guidelines recommend pneumococcal vaccine be given to all patients with HIV infection despite a paucity of data to support these recommendations. the aim of this study was to assess the incidence of invasive pneumococcal disease and use of pneumococcal vaccine in HIV-infected patients at The Alfred Hospital, Melbourne, Australia, and to review the evidence for the current recommendations. a case record review of all HIV-infected patients followed at The Alfred Hospital diagnosed with pneumonia between 1 June 1996 and 1 June 2000 was performed. Main outcome measures were the incidence of invasive pneumococcal disease and the proportion of these individuals who received pneumococcal vaccination. Invasive pneumococcal disease was a relatively infrequent event with an incidence of 1.9 per 1000 person years. This rate is lower than the 8.2 per 1000 person years reported for confirmed disease by CDC. Of the 34 patients with either definite invasive, presumptive or possible pneumococcal disease, 16 (47%) had received pneumococcal vaccine, seven of these within 5 years prior to the episode of pneumonia. In 15 cases, the vaccine was administered when the CD4 cell count was<500 per microl." }, { "role": "assistant", "content": "lack of efficacy data, rarity of invasive disease plus evidence of infrequent administration delivered predominantly to those who are least likely to benefit, has prompted us to question the value of routinely vaccinating all our HIV-infected patients with pneumococcal vaccine. Review of the published literature provides conflicting data in support of the current recommendations for administration of pneumococcal vaccine in HIV patients. It may be more cost-effective to concentrate efforts on strategies to improve adherence to ARV therapy, as this has unequivocally been shown to be associated with a reduction in the incidence of pneumococcal disease." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Attention, Eye Movements, Facial Expression, Female, Fixation, Ocular, Humans, Interpersonal Relations, Male, Middle Aged, Psychiatric Status Rating Scales, Reference Values, Schizophrenia, Schizophrenic Psychology." }, { "role": "user", "content": "Do eye movements reflect impaired face processing in patients with schizophrenia? Context: Impaired processing of faces in patients with schizophrenia may underlie aspects of disturbance in their social interaction. This study examined patterns of eye fixation in subjects with schizophrenia and non-psychiatric controls, while processing a high resolution picture of a neutral face and a nonbiological complex geometric stimulus. Ten-second sequences of eye movement were recorded video-oculographically (50 samples/sec) while subjects were \"free-viewing\" the stimuli. An essential element of the study was customized software that ensured stimulus presentation on a video display only after subjects were fixated upon a centre-screen cue, so that all subjects began stimulus processing from the same point. Compared with the control group, subjects with schizophrenia exhibited reduced scanpath lengths and a tendency toward fewer fixations for the face stimulus. They also showed an initial relative right spatial hemineglect (for the first voluntary fixation) when viewing the Rey figure, but not when viewing the face stimulus. Overall, there were no significant differences between the schizophrenia and control groups in the lateral distribution of subsequent fixations for either stimulus." }, { "role": "assistant", "content": "Disturbed spatial and temporal patterns of eye movement in some people with schizophrenia may reflect sub-optimal processing of face stimuli, that may predispose these individuals to dysfunctional interpretation of facial communication cues. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHOD, RESULTS. Meshes: Adult, Age Factors, Arthralgia, Body Mass Index, Depression, Female, Headache, Humans, Leg, Male, Middle Aged, Obesity, Pain, Quality of Life, Regression Analysis, Residential Treatment, Retrospective Studies, Sex Factors, Surveys and Questionnaires, Treatment Outcome, Weight Loss." }, { "role": "user", "content": "Does pain predict interference with daily functioning and weight loss in an obese residential treatment-seeking population? Context: Pain may interfere with daily functioning in obese persons and also with outcomes during weight loss. We examined the relationship between pain and (1) interference with daily functioning (DFi) and (2) outcomes in an obese treatment-seeking population. Participants were 386 patients entering a residential weight loss program (body mass index, 40.7 +/- 10.12 kg/m(2)). We examined the relationships of demographic factors, pain types, and emotional status with both baseline DFi and short-term weight loss. Regression analysis showed that overall, total pain scores significantly predicted DFi even after controlling for other confounders (p<.05). Leg pain, joint pain, and headache predicted DFi (p's<.05) among women. Among both men and women, depression severity predicted DFi (p's<.01). For the entire sample, there was an inverse bivariate relationship between total pain score and weight loss (p<.001). Joint pain and depression (among women) and age and depression (among men) predicted reduced weight loss (p's<.05)." }, { "role": "assistant", "content": "These results highlight the value of assessing both pain and emotional status for individuals undergoing weight loss treatment since these may interfere recommendations to increase activity." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Anthroposophy, Child, Preschool, Cohort Studies, Female, Humans, Hydrocortisone, Hypersensitivity, Infant, Life Style, Male, Odds Ratio, Parents, Saliva, Stress, Psychological." }, { "role": "user", "content": "Are anthroposophic lifestyle and salivary cortisol associated with a lower risk of sensitization during childhood? Context: Infants from anthroposophic families have low cortisol levels and low risk of IgE-sensitization during first 2 years of life. Our aim was to study the impact of an anthroposophic lifestyle and cortisol levels at 6 months on allergy sensitization up to age 5 years. A total of 507 families participated from maternal healthcare centers. Parental lifestyle was categorized as anthroposophic, partly anthroposophic, or non-anthroposophic. Blood samples for analyzes of sensitization were obtained from parents at inclusion and from children at 6, 12, 24, and 60 months. Salivary samples were collected at home at 6 months. Sensitization increased from 2.9% to 26.0% in the anthroposophic group, from 8.4% to 26.8% in the partly anthroposophic group, and from 19.1% to 44.1% in the non-anthroposophic group. Children from anthroposophic families had lower cortisol levels in the morning, afternoon, and evening. The odds ratio (OR) for anthroposophic lifestyle was always <1 and lowest at 12 months (OR, 0.10; 95% CI, 0.03-0.36). Adjusting for cortisol levels at 6 months increased these ORs at 12 and 24 months. At the same ages, ORs for sensitization were elevated also for cortisol levels at 6 months. Analyzes in children not sensitized at 6 months confirmed the cortisol-related risk of sensitization." }, { "role": "assistant", "content": "Children from families with an anthroposophic lifestyle have lower risk than comparisons of developing sensitization up to 5 years. This risk is partially explained by low cortisol levels during infancy. High cortisol levels at 6 months predict sensitization up to 24 months. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "'a' wave is absent in" }, { "role": "assistant", "content": "The correct answer is (A) # 'a' wave of JVP: Due to right atrial contraction Synchronous with carotid artery pulse> Absent 'a' wave: Atrial fibrillation> Diminished 'a' wave: Tachycardia; Prolonged PR interval> 'a' Wave Fused with 'c' Wave: Supra ventricular tachycardia> Large 'a' Waves: Pulmonary hypertension Pulmonary stenosis; Tricuspid stenosis Tricuspid atresia; AV dissociation> Cannon Waves (Giant 'a' Waves): Complete heart block when right atrium occasionally contracts against closed tricuspid valve Ventricular tachycardia; Ectopic beats" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Hematuria with dysmorphic RBC are seen in" }, { "role": "assistant", "content": "The correct answer is Acute pyelonephritis, a common suppurative inflammation of the kidney and the renal pelvis, is caused by bacterial infection. It is an impoant manifestation of urinary tract infection (UTI), which can involve the lower (cystitis, prostatitis, urethritis) or upper (pyelonephritis) urinary tract, or both. As we shall see, the great majority of cases of pyelonephritis are associated with infection of the lower urinary tract. Such infection, however, may remain localized without extending to involve the kidney. UTIs constitute an extremely common clinical problem. Refer robbins 9/e p911" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, METHODS, METHODS, METHODS, RESULTS. Meshes: Adult, Brain Injuries, Case-Control Studies, Cognition, Cross-Sectional Studies, Educational Status, Female, Humans, Male, Neuropsychological Tests, Severity of Illness Index." }, { "role": "user", "content": "Does education attenuate the negative impact of traumatic brain injury on cognitive status? Context: To investigate whether the cognitive reserve hypothesis helps to explain differential cognitive impairment among survivors of traumatic brain injury (TBI), whereby survivors with greater intellectual enrichment (estimated with education) are less vulnerable to cognitive impairment. Cross-sectional study. Medical rehabilitation research center. Survivors of moderate or severe TBI (n=44) and healthy controls (n=36). Not applicable. Intellectual enrichment was estimated with educational attainment. Group was defined as TBI or healthy control. Current cognitive status (processing speed, working memory, episodic memory) was evaluated with neuropsychological tasks. TBI survivors exhibited worse cognitive status than healthy persons (P<.001), and education was positively correlated with cognitive status in TBI survivors (r=.54, P<.001). Most importantly, regression analysis revealed an interaction between group and education (R(2) change=.036, P=.004), whereas higher education attenuated the negative impact of TBI on cognitive status. TBI survivors with lower education performed much worse than matched healthy persons, but this TBI-related performance discrepancy was attenuated at higher levels of education." }, { "role": "assistant", "content": "Higher intellectual enrichment (estimated with education) reduces the negative effect of TBI on cognitive outcomes, thereby supporting the cognitive reserve hypothesis in persons with TBI. Future work is necessary to investigate whether intellectual enrichment can build cognitive reserve as a rehabilitative intervention in survivors of TBI. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS. Meshes: Adult, Aged, Alanine Transaminase, Antiviral Agents, Biomarkers, Danazol, Drug Therapy, Combination, Female, Fibrinogen, Hepacivirus, Hepatitis C, Chronic, Humans, Interferon-alpha, Male, Mexico, Middle Aged, Odds Ratio, Pilot Projects, Platelet Count, Polyethylene Glycols, Prospective Studies, RNA, Viral, Recombinant Proteins, Ribavirin, Thrombocytopenia, Time Factors, Treatment Outcome, Viral Load." }, { "role": "user", "content": "Does danazol improve thrombocytopenia in HCV patients treated with peginterferon and ribavirin? Context: Thrombocytopenia is a common hematologic disorder observed in patients with chronic hepatitis C virus (HCV) infection. Combined peginterferon (PEG-INF) and ribavirin treatment may exacerbate thrombocytopenia in patients with HCV. The aim of this pilot clinical trial was to assess the efficacy, tolerability and safety of Danazol in thrombocytopenia associated with PEG-INF and ribavirin treatment in patients with HCV. We included patients whose platelets were < 90,000/mm³ and who were undergoing antiviral treatment. Danazol (300-600 mg/day) was administered during and until the end of antiviral therapy [7.6 months (2 to 11 months)]. The monitoring was performed through platelet analysis and liver function tests. A viral load test was done at the beginning and end of treatment. Fortynine patients receiving a combined therapy of PEG-INF, ribavirin and Danazol increased their platelet levels to 121,081/mm³ (46,000-216,000/mm³); 10.6% of patients gained > 100,000 platelets/mm³, and 71% of patients maintained their initial platelet levels. Sustained viral response (SVR) was achieved in 63% of patients. SVR rates were high in patients with genotype non 1 (78.7%) and decreased in patients with genotype 1 (60.1%). The increase in platelet levels was associated to an increase in fibrinogen levels and a decrease in the activity of ALT. By contrast, patients without SVR presented a delayed response to increased platelet levels and showed no significant improvement in liver function when they received Danazol." }, { "role": "assistant", "content": "Danazol can be used along with PEG-INF and ribavirin to treat thrombocytopenia in patients with HCV. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Therapeutic plasma level of digoxin is" }, { "role": "assistant", "content": "The correct answer is Oral absorption of digoxin is 60-80 %Plasma half-life is about 40 hrsToxic concentration is >2ng/ml(Ref: Essentials of medical pharmacology, K.D Tripathi, 7th edition)" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Vidian neurectomy is done for -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'c' i.e., Vasomotor rhinitisVasomotor rhinitiso Vasomotor is a nonallergic condition that involves a constant runny nose, sneezing and nasal congestion, i.e., the nose is stuffy or runny for reasons other than allergies and infections. The exact etiology is unknown, but triggers include emotions, odors, poor air quality, spicy foods, and medication side effects. Pathogenesis include:-Parasympathetic overactivityHyperactive nasal mucosa to several non-specific stimuli especially in women of 20-40 years.o Symptoms of vasomotor rhinitis include excessive clear rhinorrhoea, nasal obstruction/congestion, irritation, paroxysmal sneezing and post-nasal drip. Nasal mucosa is hypertrophied & congested; and mucosa of turbinates may give mulberry like appearance and is pale to dusky red in colour, o Complications of vasomotor rhinitis include hypertrophic rhinitis & sinusitis, and nasal polyp.Treatmento Treatment of vasomotor rhinitis includes : - 1) Conservative treatmentAvoidance of physical factors which provoke symptoms.Antihistaminics and oral or nasal decongestants.Topical or systemic steroidsSurgical treatmentNasal obstruction can be relieved by measures which reduce the size of hypertrophied nasal turbinate : - Cryosurgery, submucosal diathermy, Linear cauterization, partial or total turbinectomy, submucosal resection of turbinate.# Excessive rhinorrhoea in vasomotor Rhinitis not corrected by medical therapy and bothersome to the patient, is relieved by sectioning the parasympathetic secretomotor fibres to nose i.e., vidian neurectomy." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, BRCA1 Protein, BRCA2 Protein, Breast Neoplasms, Cluster Analysis, DNA Methylation, Epigenesis, Genetic, Family, Female, Gene Expression Profiling, Genes, Neoplasm, Genetic Predisposition to Disease, Humans, Male, Middle Aged, Pedigree, Principal Component Analysis, Promoter Regions, Genetic, RNA, Messenger, RNA, Neoplasm, Receptors, Estrogen." }, { "role": "user", "content": "Does rNA profiling reveal familial aggregation of molecular subtypes in non-BRCA1/2 breast cancer families? Context: In more than 70% of families with a strong history of breast and ovarian cancers, pathogenic mutation in BRCA1 or BRCA2 cannot be identified, even though hereditary factors are expected to be involved. It has been proposed that tumors with similar molecular phenotypes also share similar underlying pathophysiological mechanisms. In the current study, the aim was to investigate if global RNA profiling can be used to identify functional subgroups within breast tumors from families tested negative for BRCA1/2 germline mutations and how these subgroupings relate to different breast cancer patients within the same family. In the current study we analyzed a collection of 70 frozen breast tumor biopsies from a total of 58 families by global RNA profiling and promoter methylation analysis. We show that distinct functional subgroupings, similar to the intrinsic molecular breast cancer subtypes, exist among non-BRCA1/2 breast cancers. The distribution of subtypes was markedly different from the distribution found among BRCA1/2 mutation carriers. From 11 breast cancer families, breast tumor biopsies from more than one affected family member were included in the study. Notably, in 8 of these families we found that patients from the same family shared the same tumor subtype, showing a tendency of familial aggregation of tumor subtypes (p-value = 1.7e-3). Using our previously developed BRCA1/2-signatures, we identified 7 non-BRCA1/2 tumors with a BRCA1-like molecular phenotype and provide evidence for epigenetic inactivation of BRCA1 in three of the tumors. In addition, 7 BRCA2-like tumors were found." }, { "role": "assistant", "content": "Our finding indicates involvement of hereditary factors in non-BRCA1/2 breast cancer families in which family members may carry genetic susceptibility not just to breast cancer but to a particular subtype of breast cancer. This is the first study to provide a biological link between breast cancers from family members of high-risk non-BRCA1/2 families in a systematic manner, suggesting that future genetic analysis may benefit from subgrouping families into molecularly homogeneous subtypes in order to search for new high penetrance susceptibility genes. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, STUDY DESIGN, RESULTS. Meshes: Aged, Cardiovascular Surgical Procedures, Female, Hospitals, Humans, Internet, Male, Mass Media, Quality Assurance, Health Care, Risk Assessment, Survival Analysis, Treatment Outcome, United States." }, { "role": "user", "content": "Do popular media and internet-based hospital quality ratings identify hospitals with better cardiovascular surgery outcomes? Context: Several popular media and Internet-based hospital quality rankings have become increasingly publicized as a method for patients to choose better hospitals. It is unclear whether selecting highly rated hospitals will improve outcomes after cardiovascular surgery procedures. Using 2005 to 2006 Medicare data, we studied all patients undergoing abdominal aortic aneurysm repair, coronary artery bypass, aortic valve repair, and mitral valve repair (n = 312,813). Primary outcomes included risk-adjusted mortality, adjusting for patient characteristics and surgical acuity. We compared mortality at \"Best Hospitals,\" according to US News and World Report and HealthGrades, with all other hospitals. We adjusted for hospital volume to determine whether hospital experience accounts for differences in mortality. Risk-adjusted mortality was considerably lower in US News and World Report's \"Best Hospitals\" for abdominal aortic aneurysm repair only (odds ratio [OR] = 0.76; 95% CI, 0.61 to 0.94). Risk-adjusted mortality was considerably lower in HealthGrades' \"Best Hospitals\" after all 4 procedures: abdominal aortic aneurysm repair (OR = 0.75; 95% CI, 0.58 to 0.97), coronary artery bypass (OR = 0.78; 95% CI, 0.68 to 0.89), aortic valve repair (OR = 0.71; 95% CI, 0.59 to 0.85), and mitral valve repair (OR = 0.77; 95% CI, 0.61 to 0.99). Accounting for hospital volume, risk-adjusted mortality was not substantially lower at the US News and World Report's \"Best Hospitals,\" while risk-adjusted mortality was lower at HealthGrades' \"Best Hospitals\" after coronary artery bypass and aortic valve repair mortality rates were adjusted for hospital volume (OR = 0.77; 95% CI, 0.64 to 0.92 and OR = 0.81; 95% CI, 0.71 to 0.94)." }, { "role": "assistant", "content": "Popular hospital rating systems identify high-quality hospitals for cardiovascular operations. However, patients can experience equivalent outcomes by seeking care at high-volume hospitals." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Stroboscopy is used to assess:" }, { "role": "assistant", "content": "The correct answer is Videostroboscopy is an impoant tool in monitoring rehabilitation and providing feedback during speech therapy. It is also useful in the diagnosis of lesions such as intracordal cysts and in differentiating these lesions from vocal cord nodules.Stroboscopic examination allows visualization of the mucosal wave occurring at the medial edge of the vocal fold, the appearance being one of a 'slow motion' film. This appearance is created by the flickering stroboscopic light illuminating consecutive mucosal waves at a similar point in the wave form." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Anatomy, Cross-Sectional, Animals, Blotting, Western, Body Composition, Caloric Restriction, Diet, Energy Metabolism, Hand Strength, Male, Mice, Mice, Inbred C57BL, Mitochondria, Muscle, Muscle Fibers, Skeletal, Muscle Proteins, Muscle Strength, Muscle, Skeletal, Neural Conduction, Organ Size, Physical Conditioning, Animal, Physical Endurance, Real-Time Polymerase Chain Reaction, SKP Cullin F-Box Protein Ligases, Tripartite Motif Proteins, Ubiquitin-Protein Ligases, Valerates." }, { "role": "user", "content": "Does hMB attenuate muscle loss during sustained energy deficit induced by calorie restriction and endurance exercise? Context: To investigate the efficacy and underlying mechanisms of β-hydroxy-β-methylbutyrate (HMB) on body composition, muscle mass and physical performance under catabolic versus normal training conditions. Mice were divided into four groups (n=10/group): (1) ALT=ad libitum+trained (1 h/d for 3 d/wk); (2) ALTH=ALT+HMB (0.5 g/kg BW/d); (3) C=calorie restricted (-30%)+trained (6 h/d, 6 d/wk); and (4) CH=C+HMB. Repeated in vivo assessments included body composition, grip strength and sensorimotor coordination before and after the experimental protocol, while in vitro analyses included muscle wet weights, expression of selected genes and proteins regulating muscle mass, and myofiber cross-sectional area. ANOVAs were used with significance set at p<0.05. ALTH had greater lean mass than ALT and sensorimotor function increased in ALTH, but decreased in ALT under normal training conditions. Grip strength decreased only in C, but was maintained in CH. Gastrocnemius mass and myofiber CSA were greater in CH than C following catabolic conditions. Gastrocnemius atrogin-1 mRNA expression was elevated in C but not in CH compared to all other groups whereas atrogin-1 protein levels showed no significant changes." }, { "role": "assistant", "content": "HMB improves body composition and sensorimotor function during normal training and attenuates muscle mass and strength loss during catabolic conditions. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Z score measures the bone mineral density compred to -" }, { "role": "assistant", "content": "The correct answer is A Z-score compares your bone density to the average values for a person of your same age and gender. A low Z-score (below -2.0) is a warning sign that you have lessbone mass (and/or may be losingbone more rapidly) than expected for someone your age. Ref essential ohopaedic maheshwari and mhaskar 9TH ED" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 45-year-old African American woman presents to her primary care physician for not feeling well. She states she has had a cough for the past week. In addition, she also has abdominal pain and trouble focusing that has been worsening. She states that she has also lost 5 pounds recently and that her gastroesophageal reflux disease (GERD) has been very poorly controlled recently. The patient is a non-smoker and has a history of GERD for which she takes antacids. Laboratory studies are ordered and are below:\n\nSerum:\nNa+: 139 mEq/L\nK+: 4.1 mEq/L\nCl-: 101 mEq/L\nHCO3-: 24 mEq/L\nUrea nitrogen: 12 mg/dL\nGlucose: 70 mg/dL\nCreatinine: 0.9 mg/dL\nCa2+: 12.5 mg/dL\nAlkaline phosphatase: 35 U/L\nPhosphorus: 2.0 mg/dL\n\nUrine:\nColor: amber\nNitrites: negative\nSodium: 5 mmol/24 hours\nRed blood cells: 0/hpf\n\nWhich of the following is the most likely explanation of this patient's current presentation?" }, { "role": "assistant", "content": "Increased parathyroid hormone (PTH)" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Salt losing nephropathy -" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adenosine Triphosphatases, Child, Cholestasis, Intrahepatic, Female, Frameshift Mutation, Genetic Markers, Genotype, Genotyping Techniques, Humans, Male, Phenotype, Polymorphism, Single Nucleotide, RNA Splice Sites, Reverse Transcriptase Polymerase Chain Reaction, Sequence Analysis, RNA, Siblings." }, { "role": "user", "content": "Does novel splice-site mutation in ATP8B1 result in atypical progressive familial intrahepatic cholestasis type 1? Context: Our objective was to identify the molecular genetic basis of an Alagille-like condition not linked to JAG1 or NOTCH2 in two related sibships. Because of common ancestry, and an autosomal recessive mode of inheritance, it was hypothesized that all affected and no unaffected individuals would be homozygous for the same haplotype in the region of the causative gene. Single nucleotide polymorphism arrays were therefore used to genotype 3 affected individuals from two sibships, their mothers and four unaffected siblings, to identify regions of homozygosity. Genes within the largest regions were prioritized and sequenced for mutations. Mutant RNA transcripts were also sequenced. A novel splice acceptor site mutation in the ATP8B1 gene was identified (a G-C preceding exon 16 resulting in a 4  bp deletion and frameshift from the 5' end of exon 16). This result was unexpected because ATP8B1 mutations are associated with progressive familial intrahepatic cholestasis type 1 (PFIC1). Intrahepatic bile duct paucity, cardiac anomalies, renal tubular acidosis and hypothyroidism led to an initial diagnosis of Alagille syndrome. However, in retrospect, abnormal sweat chloride, normal gamma-glutamyl transferase, normal to low cholesterol, and an autosomal recessive mode of inheritance were consistent with PFIC1. Renal tubular acidosis, hypothyroidism and cardiac anomalies have not previously been associated with PFIC1." }, { "role": "assistant", "content": "This work expands the phenotypic spectrum of PFIC1, and highlights the overlap in clinical phenotype between Alagille syndrome and PFIC1. Knowledge of the causative mutation allows for carrier testing and prenatal diagnosis in this community. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Abatacept, Animals, Animals, Genetically Modified, Cell Death, Graft Survival, Humans, Immune Tolerance, Immunoconjugates, Islets of Langerhans Transplantation, Mice, Mice, Transgenic, Proto-Oncogene Proteins c-bcl-2, Rats." }, { "role": "user", "content": "Does blockade of the passive cell death pathway prevent tolerance induction to islet grafts? Context: T-cell apoptosis is an important regulatory mechanism in transplant tolerance. The aim of this study was to identify specific apoptotic molecules important for tolerance induction. Mice expressing the human Bcl-2 molecule in T cells or Bim -/- mice were used as islet allograft or rat islet xenograft recipients and treated with CTLA4-Fc and MR1 costimulation blockade. hBcl-2 transgenic mice and Bim -/- accepted islet allografts and rat islet xenografts for more than 100 days, similar to wildtype controls. Changes in the dose of the CTLA4-Fc and MR1 did not lead to differences in graft survival and there were no differences in the percentage of CD4+ T cells expressing Fas, CD25, or undergoing apoptosis." }, { "role": "assistant", "content": "Inhibition of the passive cell death pathway in T cells did not block tolerance induction, suggesting that the mechanism by which apoptosis regulates the alloimmune response is more complex than first thought. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Sympathetic supply to the heas is from which of the following:" }, { "role": "assistant", "content": "The correct answer is T1 toT5" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, STUDY DESIGN, PATIENTS AND METHODS, RESULTS. Meshes: Adult, African Americans, Aged, Breast Neoplasms, Continuity of Patient Care, Female, Health Care Costs, Health Maintenance Organizations, Humans, Logistic Models, Mammography, Medicaid, Michigan, Middle Aged, Multivariate Analysis, Patient Acceptance of Health Care, Poverty, Retrospective Studies, Socioeconomic Factors." }, { "role": "user", "content": "Follow-up among women with an abnormal mammogram in an HMO: is it complete, timely, and efficient? Context: To describe the extent to which women with seriously abnormal mammograms complete indicated follow-up, the timeliness of this follow-up, and variations in the pattern of use of diagnostic procedures. Retrospective chart review. Ninety-two women enrolled in a single urban health maintenance organization (HMO) with an abnormal index mammogram (mass or suspicious calcifications) during 1995 or 1996 were identified by review of all HMO mammography reports. Data were abstracted from medical records concerning all clinical services received over the 11 months after the date of the abnormal mammogram. Procedure costs were estimated based on 1997 Medicare relative-value units. Logistic regression and a multivariate accelerated failure-time model were used to evaluate the association between predictor variables and the occurrence and timing of completion of follow-up. Follow-up was not completed by 31 (34%) of the 92 study women and was delayed beyond 60 days for another 32 (35%). In adjusted analysis, factors associated with completion within 60 days included age less than 50 years and inclusion of a specific follow-up recommendation in the mammogram report. Completion by the end of the study (a minimum of 11 months after the index mammogram) was associated only with the presence of a specific follow-up recommendation. The follow-up process (i.e., the diagnostic procedures used) was highly variable but almost always included surgical evaluation. The average cost among those completing follow-up was about $1900 (in 1997 dollars)." }, { "role": "assistant", "content": "Incomplete follow-up after a potentially seriously abnormal mammogram constitutes an important barrier to breast cancer control efforts in the study HMO, but its explanation remains incompletely understood. The follow-up process itself is highly variable, and improvement in its efficiency and timely completion will require a better understanding of its determinants." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 43-year-old man is admitted to the emergency department with a fracture of the base of his skull. A thorough physical examination reveals that a number of structures have been injured, possibly including the right greater petrosal nerve. Which of the following conditions needs to be identified during physical examination to confirm the diagnosis of greater petrosal nerve injury?" }, { "role": "assistant", "content": "The correct answer is The greater petrosal nerve carries parasympathetic fibers that are involved in the innervation of the lacrimal gland, as well as the mucosal glands of the nose, palate, and pharynx. As a result, an injury to the right greater petrosal nerve would be expected to result in decreased lacrimal secretions for the right eye. The sublingual and submandibular glands receive their parasympathetic fibers from the facial nerve via the chorda tympani and the lingual nerve. They would be unaffected by this lesion. The parotid gland receives its parasympathetic secretory innervation from the glossopharyngeal nerve via the lesser petrosal and auriculotemporal nerves and would be unaffected. Taste to the anterior tongue is provided by the facial nerve via the chorda tympani, and general sensation to the anterior tongue is provided by the mandibular division of the trigeminal nerve via the lingual nerve." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adolescent, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Child, Child, Preschool, Female, HIV Infections, Hospitalization, Hospitals, Pediatric, Humans, Infant, Infant, Newborn, Male, Prevalence, South Africa, Survival Analysis." }, { "role": "user", "content": "Changes in pediatric HIV-related hospital admissions and mortality in Soweto, South Africa, 1996-2011: light at the end of the tunnel? Context: With widespread availability of pediatric antiretroviral therapy and improved access to prevention of mother-to-child transmission (PMTCT), it is important to monitor the impact on pediatric HIV-related hospital admissions and in-hospital mortality in South Africa. Over a 15-year period, 4 independent surveillance studies were conducted in the pediatric wards at Chris Hani Baragwanath Hospital in Soweto, South Africa (1996, 2005, 2007, and late 2010 to early 2011). Trends in HIV prevalence and HIV-related mortality were evaluated. HIV prevalence was similar during the first 3 periods: 26.2% (1996), 31.7% (2005), and 29.5% (2007) P>0.10, but was lower in 2010-2011 (19.3%; P = 0.0005). Median age of the children admitted with HIV increased in the latter periods from 9.13 (interquartile range 3.6-28.8) months to 10.0 (3.0-44.5) months (P>0.10) and 18.0 (6.2-69.8) months (P = 0.048). Median admission weight-for-age z-scores were similar (<-3 SD) for the latter 3 periods. Admission CD4 percentage increased from 0.0% (0.0-9.4) in 2005 to 15.0% (8.2-22.8) in 2007 (P<0.0001) and was 18.7% (9.6-24.7) in 2010-2011 (P>0.10). Mortality among all vs. HIV-infected admissions was 63 of 565 (11.2%) and 43 of 179 (24.0%) in 2005, 91 of 1510 (6.0%) and 53 of 440 (12.0%) in 2007, and 18 of 429 (4.2%) and 9 of 73 (12.3%) in 2010-2011." }, { "role": "assistant", "content": "HIV prevalence and mortality among pediatric admissions is decreasing. This is likely a result of improved PMTCT and wider antiretroviral therapy coverage. Continued effort to improve PMTCT coverage and identify and treat younger and older HIV-infected children is required to further reduce HIV-related morbidity and mortality." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Cardiomyopathy, Dilated, Exercise Tolerance, Female, Genetic Markers, Heart Failure, Heterozygote, Homozygote, Humans, Male, Middle Aged, Myocardial Ischemia, Oxygen Consumption, Polymorphism, Genetic, Receptors, Adrenergic, beta-1." }, { "role": "user", "content": "Do polymorphisms of the beta1-adrenergic receptor predict exercise capacity in heart failure? Context: Exercise performance in patients with congestive heart failure is partially dependent on cardiac beta1-adrenergic receptor (beta1AR) function. There are 2 common polymorphisms of the beta1AR gene that alter the encoded amino acids at positions 49 (Ser or Gly) and 389 (Gly or Arg) and alter receptor function in vitro. Their relevance to modification of cardiac function in heart failure is not known. Exercise testing was performed in 263 patients with idiopathic or ischemic cardiomyopathy (left ventricular ejection fraction approximately 25%). Potential associations were sought between beta1AR genotypes and the primary outcome variables of peak oxygen consumption (VO2), heart rate response, and exercise time. The major determinants of exercise capacity were the polymorphisms at position 389, where patients homozygous for Gly389 had significantly lower peak VO2 compared with those with Arg389 (14.5 +/- 0.6 vs 17.7 +/- 0.4 mL/kg/min, P =.006), despite similar clinical characteristics including left ventricular ejection fraction. Consistent with a gene dose-response, heterozygosity was associated with an intermediate response (16.9 +/- 0.6 mL/kg/min, P <.05). When position 49 genotypes were included, a graded relationship between the 5 2-locus haplotypes and VO2 was found. Two haplotypes displayed the most divergent peak VO2: homozygous Gly389/Ser49, and homozygous Arg389/Gly49 carriers (14.4 +/- 0.5 vs 18.2 +/- 0.8 mL/kg/min, P =.001). Genotype did not predict the heart rate response. The above results were independent of beta-blocker or other medication use, left ventricular ejection fraction, beta2AR genotype, or other demographic and clinical characteristics." }, { "role": "assistant", "content": "beta1AR polymorphisms are a significant determinant of exercise capacity in patients with congestive heart failure. Early identification, by genetic testing for these polymorphisms, of heart failure patients at risk for development of depressed exercise capacity may be useful for initiation of specific therapy tailored to genotype. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: PURPOSE, METHODS, RESULTS. Meshes: Adult, Biopsy, Body Mass Index, Endometrial Hyperplasia, Endometrial Neoplasms, Endometrium, Female, Humans, Menorrhagia, Middle Aged, Premenopause, Prospective Studies, Risk Factors, Sensitivity and Specificity, Turkey." }, { "role": "user", "content": "Could body mass index be an indicator for endometrial biopsy in premenopausal women with heavy menstrual bleeding? Context: To evaluate the role of body mass index (BMI) in women with premenopausal heavy menstrual bleeding (HMB) to identify patients who should undergo endometrial biopsy. This prospective cohort study included 1120 premenopausal women who presented to the Gynecology Clinic, Bakirkoy Dr. Sadi Konuk Training and Research Hospital in Istanbul, Turkey, due to HMB and who underwent endometrial sampling. The abnormal endometrial histopathological results were analyzed by separating patients into groups of all abnormal findings (hyperplasia without atypia + hyperplasia with atypia + carcinoma) and hyperplasia with atypia + carcinoma. Sensitivity and specificity of the abnormal histopathological results were calculated in both groups using BMI cut-off values as 25, 30 and 35 and age cut-offs as 40 and 45 years. The rate of hyperplasia with atypia and carcinoma was sevenfold higher in women with a BMI ≥30 compared to those with a BMI ≤30 (95 % CI 2.4-17.9). In the analyses, BMI was a stronger risk factor in women younger than 45 years of age. The risk of endometrial carcinoma and atypical hyperplasia was twofold higher in patients older than 45 years when compared with patients younger than 45 years (95 % CI 1.1-5.1)." }, { "role": "assistant", "content": "All women with a BMI ≥30 and presenting premenopausal HMB should undergo endometrial biopsy regardless of age." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Daily requirement of Iodine in adults is" }, { "role": "assistant", "content": "The correct answer is The daily requirement of iodine is 150 mcg supplied normally by well balanced diets and drinking water." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 23 years old female presented with jaundice and pallor for 2 months. Her peripheral blood smear shows the presence of spherocytes. The most relevant investigation to arrive at a diagnosis is -" }, { "role": "assistant", "content": "The correct answer is . Coombs test" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Adolescent, Cystic Fibrosis, Disease Progression, Exercise Test, Female, Forced Expiratory Volume, Humans, Lung, Male, Oxygen Consumption, Retrospective Studies, Spirometry, Tomography, X-Ray Computed." }, { "role": "user", "content": "Are exercise responses related to structural lung damage in CF pulmonary disease? Context: Early detection of lung disease is a primary objective in monitoring patients with Cystic Fibrosis (CF); High-Resolution-Computed-Tomography (HRCT) assesses structural damage. Spirometry and cardiopulmonary exercise testing are used for functional evaluation of CF lung disease. To evaluate the deterioration of exercise testing parameters over a 2-year period compared to the change of spirometry and HRCT parameters among CF patients. Twenty-eight CF patients were evaluated with HRCT, spirometry, and exercise testing; 15 had two assessments with an interval of 2 years. Correlation analyses between Bhalla score parameters and functional measures were performed. Twenty-eight patients with CF (mean age 14.9 years, mean forced expiratory volume in 1 sec [FEV1 ] 83.2%) were evaluated. FEV1 was not found to change significantly in the 2-year period (P = 0.612). Both mean Bhalla score and mean peak oxygen consumption (VO2 peak %) deteriorated significantly (P = 0.014 and P = 0.026, respectively). VO2 peak and respiratory equivalents for O2 and CO2 at peak exercise were found to be significant predictors of Bhalla score (r = -0.477, P = 0.010; r = 0.461, P = 0.018; r = 0.402; P = 0.042, respectively). Anaerobic threshold was associated with changes in Bhalla score over the following 2 years." }, { "role": "assistant", "content": "Exercise testing is more sensitive than spirometry to detect structural changes in CF lungs. Pediatr Pulmonol. 2016; 51:914-920. © 2016 Wiley Periodicals, Inc. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All of the following drugs act by blocking calcium channels except:" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "In a patient with a transplanted heart which of these are the reasons for increased cardiac output during exercise" }, { "role": "assistant", "content": "The correct answer is Cardiac transplantation results in total denervation of the donor's heart, including the donor sinus node, which usually controls heart rate after transplantation.\nDenervation causes an increase in basal heart rate due to parasympathetic sectioning (normally parasympathetic tone is greater than sympathetic tone on the heart).\n\nFurther increase in heart rate during exercise is dependent primarily on increase in plasma catecholamine concentration, e.g. from the adrenal medulla." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND. Meshes: Animals, Base Composition, Codon, Drosophila, Drosophila Proteins, GC Rich Sequence, Genome, Mutagenesis, Phylogeny, Species Specificity." }, { "role": "user", "content": "Is minor shift in background substitutional patterns in the Drosophila saltans and willistoni lineages insufficient to explain GC content of coding sequences? Context: Several lines of evidence suggest that codon usage in the Drosophila saltans and D. willistoni lineages has shifted towards a less frequent use of GC-ending codons. Introns in these lineages show a parallel shift toward a lower GC content. These patterns have been alternatively ascribed to either a shift in mutational patterns or changes in the definition of preferred and unpreferred codons in these lineages." }, { "role": "assistant", "content": "To gain additional insight into this question, we quantified background substitutional patterns in the saltans/willistoni group using inactive copies of a novel, Q-like retrotransposable element. We demonstrate that the pattern of background substitutions in the saltans/willistoni lineage has shifted to a significant degree, primarily due to changes in mutational biases. These differences predict a lower equilibrium GC content in the genomes of the saltans/willistoni species compared with that in the D. melanogaster species group. The magnitude of the difference can readily account for changes in intronic GC content, but it appears insufficient to explain changes in codon usage within the saltans/willistoni lineage. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 78-year-old woman with a history of cerebrovascular accident (CVA) presents to the emergency department with slurred speech, diplopia and dizziness that has persisted for eight hours. Upon further questioning you find that since her CVA one year ago, she has struggled with depression and poor nutrition. Her dose of paroxetine has been recently increased. Additionally, she is on anti-seizure prophylaxis due to sequelae from her CVA. CT scan reveals an old infarct with no acute pathology. Vital signs are within normal limits. On physical exam you find the patient appears frail. She is confused and has nystagmus and an ataxic gait. What would be an appropriate next step?" }, { "role": "assistant", "content": "Lower the dose of her anti-seizure medication" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Age Factors, Arthritis, Rheumatoid, Cohort Studies, Comorbidity, Disease Progression, Female, Humans, Incidence, Male, Middle Aged, Prognosis, Retrospective Studies, Sex Factors, Survival Rate." }, { "role": "user", "content": "Is occurrence of extraarticular disease manifestations associated with excess mortality in a community based cohort of patients with rheumatoid arthritis? Context: To investigate the occurrence of extraarticular manifestations (ExRA) in a well defined community based cohort of patients with rheumatoid arthritis (RA), and to examine their effect on mortality. Using the resources of the Rochester Epidemiology Project, a retrospective medical record review was conducted of a cohort of 424 cases of RA in Olmsted County, MN, USA, diagnosed during the period 1955-1985. These cases had been classified using the American College of Rheumatology 1987 criteria for RA. Patients were followed 1955-1998 (median followup 14.8 yrs; range 0.2-42.8 yrs), and incident ExRA manifestations were recorded according to predefined criteria. Data on comorbidities were extracted using the definitions of the Charlson comorbidity index. Survival was compared to the general population using Kaplan-Meier estimates. ExRA occurred in 169 patients, corresponding to an incidence rate of 3.67/100 person-yrs. Compared to the general population, survival among patients with RA was decreased. Survival among patients with ExRA was markedly decreased compared to the general population and to patients without ExRA (p < 0.001). A particularly poor prognosis was noted in a subgroup of 63 patients (incidence rate 1.04/100 person-yrs) who fulfilled predefined criteria for severe ExRA (i.e., vasculitis, pericarditis, pleuritis, and/or Felty's syndrome). For RA patients who did not fulfill these criteria, there was no significant increase of mortality (p = 0.09). In a multivariate model of mortality, including age, sex, and the presence of known comorbidities, the presence of one or more of these ExRA was the strongest predictor of mortality." }, { "role": "assistant", "content": "In this first community based study of extraarticular manifestations in RA, virtually all the excess mortality occurred in a subgroup of patients with severe extraarticular disease, suggesting that extraarticular disease is the major predictor of mortality in patients with RA. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: UNASSIGNED, METHODS, RESULTS. Meshes: Animals, Antineoplastic Agents, Asparaginase, Bone Marrow, Cell Line, Female, Macrophages, Male, Metabolic Clearance Rate, Mice, Mice, Inbred C57BL, Mice, Knockout, Molecular Imaging, Organ Specificity, Reproducibility of Results, Sensitivity and Specificity, Single Photon Emission Computed Tomography Computed Tomography." }, { "role": "user", "content": "Does in vivo imaging of antileukemic drug asparaginase reveal a rapid macrophage mediated clearance from the bone marrow? Context: The antileukemic drug asparaginase, a key component in the treatment of acute lymphoblastic leukemia, acts by depleting asparagine from the blood. However, little is known about its pharmacokinetics and mechanisms of therapy resistance are poorly understood. Here, we explored the in vivo biodistribution of radiolabeled asparaginase, using a combination of in vivo imaging and biochemical techniques, and provide evidence for tissue specific clearance mechanisms, which could reduce effectiveness of the drug at these specific sites. In vivo localization of Indium-111-labeled E.coli asparaginase was carried out in C57Bl/6 mice by both microSPECT/CT and by ex vivo biodistribution studies. Mice were treated with liposomal clodronate to investigate the effect of macrophage depletion on tracer localization and drug clearance in vivo. Moreover, macrophage cell line models RAW264.7 and THP-1, as well as cathepsin B deficient mice, were used to identify the cellular and molecular components controlling asparaginase pharmacokinetics. In vivo imaging and biodistribution studies showed a rapid accumulation of asparaginase in macrophage-rich tissues such as liver, spleen and in particular bone marrow. Clodronate-mediated depletion of phagocytic cells markedly prolonged the serum half-life of asparaginase in vivo and decreased drug uptake in target organs. Immunohistochemistry and in vitro binding assays confirmed the involvement of macrophage-like cells in the uptake of asparaginase. We identified the activity of the lysosomal protease cathepsin B in macrophages as a rate-limiting factor in degrading asparaginase both in vitro and in vivo." }, { "role": "assistant", "content": "We show that asparaginase is rapidly cleared from the serum by liver, spleen and bone marrow-resident phagocytic cells. As a consequence of this efficient uptake and protease mediated degradation, particularly bone marrow resident macrophages may provide a protective niche to leukemic cells. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Population attributable risk is defined as:-" }, { "role": "assistant", "content": "The correct answer is Population Attributable Risk (PAR) It is the incidence of disease (or death) in total population minus incidence of disease (or death) among those who were not exposed to suspected causal factor. It is useful as it provides an estimation of amount by which incidence of disease could be reduced in that population if the suspected factor was eliminated or modified. PAR is useful for National health programmes and policies." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Age is an example of which of the following scales?" }, { "role": "assistant", "content": "The correct answer is Metric scale is fuher divided into interval and ratio scales. In a ratio scale, there is a definite zero point and it is correct to say that an age of 6 years is twice that of 3 years. Ref: Medical biostatistics, 1st edition pg: 99" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Underwater autopsy of the hea is done in cases of: DNB 09" }, { "role": "assistant", "content": "The correct answer is Ans. Air embolism" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "In cold caloric stimulation test, the cold water induces movement of the eyeball in the following direction" }, { "role": "assistant", "content": "The correct answer is When Ice cold or warm water or air is irrigated into the external auditory canal, the temperature difference between the body and the injected water creates a convective current in the endolymph of the nearby horizontal semicircular canal. If the water is cold relative to the body temperature (30degC or below), the endolymph falls within the semicircular canal decreasing the rate of vestibular afferent firing. The eyes then turn toward the ipsilateral ear with horizontal nystagmus to the contralateral ear. (Ref: Diseases of EAR, NOSE AND THROAT by PL DHINGRA - 6th Edition)" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Acute Kidney Injury, Animals, Antibiotics, Antineoplastic, Diabetes Mellitus, Experimental, Diabetic Nephropathies, Disease Models, Animal, Male, Mice, Mice, Inbred BALB C, Mice, Inbred C57BL, Reproducibility of Results, Streptozocin." }, { "role": "user", "content": "Can murine diabetic nephropathy be separated from superimposed acute renal failure? Context: Streptozotocin (STZ) is commonly used to induce diabetes in experimental animal models, but not without accompanying cytotoxic effects. This study was undertaken to (1) determine an optimal dose and administration route of STZ to induce diabetic nephropathy in wild-type mice but without the concurrent acute renal injury resulting from cytotoxic effects of STZ and (2) evaluate the pattern of tubular injury and interstitial inflammation in this model. Male Balb/c mice received either (1) STZ (225 mg/kg by intraperitoneal injection.); or (2) two doses of STZ 5 days apart (150 mg/150 mg/kg; 75 mg/150 mg/kg; 75 mg/75 mg/kg; and 100 mg/100 mg/kg by intravenous injection). Another strain of mice, C57BL/6J, also received STZ (200 mg/kg intravenously or intraperitoneally). Renal function and histology were examined at weeks 1, 2, 4, and 8 after induction of diabetes. In initial optimization studies, animals were sacrificed at week 1 or week 2 and histology examined for acute renal injury. Following a single intraperitoneal injection of 225 mg/kg of STZ, only two thirds of animals developed hyperglycemia, yet the model was associated with focal areas of acute tubular necrosis (ATN) at week 2. ATN was also observed in C57BL/6J mice given a single intravenous or intraperitoneal dose of STZ (200 mg/kg), at week 2 post-diabetes. At an optimal diabetogenic dose and route (75 mg/150 mg/kg by intravenous injection 5 days apart), all mice developed diabetes and no ATN was observed histologically. However, even with this regimen, glomerular filtration rate (GFR) was significantly impaired from week 2. This regimen was accompanied by progressive histologic changes, including tubular and glomerular hypertrophy, mesangial area expansion, as well as interstitial macrophage, CD4+ and CD8+ T-cell accumulation." }, { "role": "assistant", "content": "By careful optimization of STZ dose, a stable and reproducible diabetic murine model was established. However, even in this optimized model, renal functional impairment was observed. The frequency of ATN and functional impairment casts doubt on conclusions about experimental diabetic nephropathy drawn from reports in which ATN has not been excluded rigorously." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Low serum iron and low serum ferritin is seen in:" }, { "role": "assistant", "content": "The correct answer is Ans. (a) Iron deficiency anemiaRef-.Chapter 104: Harrison 18th editionDiseaseSerum ironSerum ferritinTIBCIron deficiency anemiaDecreasedDecreasedIncreasedChronic kidney disease (anemia is due to deficiency of erythropoietin)NormalNormal/ decreased if lost in urine due to kidney pathologyNormalSideroblastic anemiaIncreasedIncreasedDecreasedFanconi anemia( anemia is due to congenital aplastic anemia)NormalNormalnormal" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Female, Finland, Follow-Up Studies, Humans, Hypertension, Incidence, Male, Middle Aged, Peripheral Vascular Diseases, Prevalence, Risk Factors, Surveys and Questionnaires, Varicose Veins." }, { "role": "user", "content": "Does arterial disease but not hypertension predispose to varicose veins? Context: The aim of the study was to find out if persons with cardiovascular diseases (CVD) (arterial disease or hypertension) have additional risk of varicose veins (VV) compared with those without arterial disease (AD) or hypertension. We studied, using a validated questionnaire, the prevalence and incidence of VVs in those with and without CVD in a population of 4903 including 40-, 50- and 60-year-old men and women in Tampere, Finland. During the five years of follow-up, we had a special interest on the appearance of new VVs in those without VVs at entry (n = 3065). We found a higher prevalence of VVs in persons with CVD than in those without CVD (with sex and age adjusted odds ratio [OR] 1.3 [95% confidence interval, CI 1.1-1.5]). The prevalence of VVs was higher in persons with AD (OR 1.7 [CI 1.4-2.2]), but not in persons with hypertension (OR 1.1 [CI 0.9-1.2]) than in those who were free of AD or hypertension, respectively. Subjects with AD had higher incidence of VVs (incidence odds ratio, IOR 1.4 [CI 0.8-2.7]) than subjects without AD and the effect was statistically significant in women (IOR 2.2 [CI 1.1-4.5]). Also the incidence of VVs was more affected by AD than by hypertension (IOR 1.1 [CI 0.7-1.8])." }, { "role": "assistant", "content": "There seems to exist a relatively strong additional risk of VVs in persons with AD and practically none in those with hypertension compared to those without. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Chronic Disease, Cytokines, Disease Models, Animal, Female, Forkhead Transcription Factors, Interleukin-10, Mice, Inbred C57BL, Pneumonia, Bacterial, Pseudomonas Infections, Pseudomonas aeruginosa, Random Allocation, T-Lymphocytes, Helper-Inducer, T-Lymphocytes, Regulatory, Transforming Growth Factor beta1." }, { "role": "user", "content": "Is regulatory T cell activity partly inhibited in a mouse model of chronic Pseudomonas aeruginosa lung infection? Context: We aimed to investigate the activity of regulatory T (Treg) cells in chronic Pseudomonas aeruginosa (PA) lung infection and its influence on effector T-cell responses. C57BL/6 mice were randomly inoculated with PA-laden agarose beads (1 × 10(5) CFU/50 μL) or planktonic PA (1 × 10(5) CFU/50 μL), and euthanized at the time points of 4 hour, day 1, 3, 5, and 7. Bacterial load, bronchoalveolar lavage (BAL) fluid cell counts, and lung tissue histology were assessed. BAL fluid concentrations of TGF-β1, IFN-γ, IL-1β, IL-4, IL-6, IL-10, and IL-17A were measured. Messenger RNA (mRNA) levels of TGF-β1, IL-10 and CD4(+) T-cell subtype-specific transcription factors were determined. The expression of CD4(+)CD25(+)forkhead box P3 (FoxP3)(+) cells in lungs and spleens were analyzed. Mice inoculated with PA-laden agarose beads developed chronic PA lung infection during 7-day study period, while mice inoculated with planktonic PA cleared bacteria in 3 days. Compared with mice recovered from acute PA lung infection, those with chronic infection had significantly increased effector T-cell responses, accompanied by a more severe neutrophilic inflammation. Mice with chronic PA lung infection had significantly lower concentration of TGF-β1 and higher concentrations of IFN-γ, IL-1β, IL-6, and IL-17A in BAL fluid. Meanwhile, they had significantly lower mRNA levels of TGF-β1, IL-10 and FoxP3 in lung tissues, and lower expression of CD4(+)CD25(+)FoxP3(+) cells in lungs and spleens." }, { "role": "assistant", "content": "These findings indicate that Treg cell activity is partly inhibited in mice with chronic PA lung infection, which contributes to the enhanced effector T-cell responses in airways. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adenocarcinoma, Papillary, Adult, Aged, Aged, 80 and over, Biomarkers, Tumor, Claudin-5, Cystadenocarcinoma, Serous, Female, Follow-Up Studies, Humans, Immunoenzyme Techniques, Membrane Proteins, Middle Aged, Neoplasm Staging, Ovarian Neoplasms, Prognosis, Survival Rate." }, { "role": "user", "content": "Does claudin-5 overexpression correlate with aggressive behavior in serous ovarian adenocarcinoma? Context: Claudins are essential tight junctional proteins between adjacent epithelial, mesothelial or endothelial cells, and are responsible for the permeability of the paracellular space. The expression of claudin-5 and its correlation to ovarian cancer behavior was investigasted. A total of 85 serous ovarian cancer tissue samples were analyzed using immunohistochemical staining. An association between claudin-5 expression and cancer grade (p=0.016) and advanced stage (p=0.022), strongest claudin-5 expression was found in advanced stage and high-grade carcinomas. An association between claudin-5 expression and cancer-specific (p=0.032) and overall survival (p=0.026) was also found. Only 25-30% of claudin-5-positive patients, but 60% of claudin-5-negative patiens were alive at the 5-years follow-up." }, { "role": "assistant", "content": "Increased claudin-5 expression is associated with aggressive behavior in serous ovarian adenocarcinoma. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Circadian Rhythm, Female, Humans, Hypertension, Indans, Male, Middle Aged." }, { "role": "user", "content": "Is a smooth blood pressure control obtained over 24 h by delapril in mild to moderate essential hypertensives? Context: To assess the homogeneity of the antihypertensive effect of delapril over 24 h. After 2 weeks of placebo 50 mild to moderate essential hypertensives (age 54+/-5 years) were subjected to 8 weeks of treatment with delapril 30 mg once daily. At the end of each period, blood pressure (BP) was assessed by conventional sphygmomanometry (clinic or CBP) and ambulatory (A) BP monitoring. Twenty-four-hour means, trough-to-peak ratio (T/P) and smoothness index (SI, the ratio between the average of the 24-h BP changes after T and its standard deviation) were calculated for systolic (S) and diastolic (D) BP. CBP and ABP were significantly reduced by treatment. Pulse pressure (PP, the SBP-DBP difference) was also significantly (p < 0.01) reduced by delapril (5.7+/-6.2 and 3.3+/-3.8 mmHg, CPP and APP). The median T/P was higher (0.51 and 0.62, SBP and DBP) in the 43 responders at trough than in the whole group (0.44 and 0.51). The SI was similarly high in the whole group (1.3+/-0.6 and 1.4+/-0.6, SBP and DBP) and in the responders (1.4+/-0.5 and 1.5+/-0.6)." }, { "role": "assistant", "content": "Delapril effectively and smoothly reduces BP over 24 h, this effect being evident also on PP, a parameter with a relevant prognostic value. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Antigens, Neoplasm, Antineoplastic Agents, Apoptosis, Cell Line, Tumor, Cisplatin, Enzyme-Linked Immunosorbent Assay, Female, Flow Cytometry, Humans, Integrins, Ovarian Neoplasms." }, { "role": "user", "content": "Does [ Alphavbeta 6 integrin inhibit cisplatin-induced apoptosis in ovarian cancer cell lines ]? Context: To investigate the effects of alphavbeta6 integrin-mediated cell adhesion on cisplatin (DDP) induced apoptosis in ovarian cancer cell lines. The expression of integrin alphavbeta6 in ovarian cancer cell lines SKOV3, AO, and 3AO was analyzed by flow cytometry, and the apoptosis induced by DDP was measured by enzyme-linked immunosorbent assay (ELISA) method and acridine orange-ethidium bromide (AO-EB) double fluorescent dye staining. Ovarian cancer cell lines SKOV3, AO and 3AO all expressed integrin alphavbeta6. Treated by different concentrations of DDP, SKOV3, AO and 3AO displayed significant apoptosis status compared with the control. However, after cultured in medium containing 10 micro g/ml DDP for 48 hours, SKOV3, AO and 3AO planted on fibronectin (FN)-ligand of alphavbeta6 integrin, had lower enrichment factor (EF), compared with those planted on non-integrin ligand polylisin measured by ELISA method (2.11 +/- 0.04 vs 3.51 +/- 0.03, 2.15 +/- 0.06 vs 3.55 +/- 0.04, 2.11 +/- 0.04 vs 3.66 +/- 0.04, P < 0.01). Similarly, by AO-EB double fluorescent dye staining, lower percentages of apoptosis were found in cells planted on FN (5.0 +/- 0.7)%, (5.0 +/- 0.7)%, (6.0 +/- 0.7)%, than on polylisin (28.0 +/- 0.7)%, (28.0 +/- 0.7)%, (29.0 +/- 0.7)% (P < 0.001). When cells preincubated with integrin alphavbeta6 blocking antibody were planted on FN, the percentages of apoptosis rose again, (15.0 +/- 0.7)%, (16.0 +/- 0.7)%, (15.0 +/- 0.7)% (P < 0.01)." }, { "role": "assistant", "content": "The de novo expression of alphavbeta6 integrin occurs in ovarian cancer cell lines SKOV3, AO, and 3AO. alphavbeta6 integrin-mediated cell adhesion to FN can inhibit the effect of cisplatin-induced apoptosis. These results suggest that inhibiting apoptotic cell adhesion may improve drug resistance in ovarian cancer cell lines. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Causes of Shallow Anterior chamber are all except:" }, { "role": "assistant", "content": "The correct answer is Pathological myopia causes deep anterior chamber. Small axial length causes shallow anterior chamber. Pupil block also would decrease it by doing pupillary block. As it would do the bulge . AC would be shallow in periphery. Iris bombe also causes protrusion of iris and shallow AC Aphakia & myopia- have deep Anterior Chamber definitely. Note- in aphakic patients there will be H/O of limbal surgery (scar on limbus), JET BLACK puppil and tremulousness of iris k/a iridionesis along with deep anterior chamber" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Apoptosis, CD4-Positive T-Lymphocytes, Cells, Cultured, Chemokine CXCL12, Chemokines, CXC, Coculture Techniques, GTP-Binding Proteins, HIV Envelope Protein gp120, HIV-1, Heterocyclic Compounds, Humans, Receptors, CXCR4, Signal Transduction." }, { "role": "user", "content": "Is the implication of the chemokine receptor CXCR4 in HIV-1 envelope protein-induced apoptosis independent of the G protein-mediated signalling? Context: The envelope glycoprotein complex (gp120/gp41)n of HIV-1 is one of the viral products responsible for increased apoptosis in HIV infection. Here the role of the chemokine receptor CXCR4 in HIV-1 envelope protein-induced apoptosis was investigated. Apoptosis occurring in cocultures of chronically HIV-1 IIIB-infected cells with CD4 target cells expressing the CXCR4 receptor was quantified by terminal deoxinucleotidyl transferase dUTP nick end labeling (TUNEL) or propidium iodide staining followed by fluorescent antibody cell sorting, which allows the evaluation of single-cell killing. Moreover global (single cell- and syncytium-associated) apoptosis was quantified by a new radioactive TUNEL-derived assay. By using these different techniques it was shown that single and syncytium-forming CD4 T cells die by apoptosis upon contact with envelope protein expressing cells independently of viral replication. Moreover, both the CXCR4 agonist SDF-1alpha, and the antagonist AMD3100, showed inhibitory effects on HIV-1 envelope protein-induced apoptosis in the CD4 T-cell subset of peripheral blood mononuclear cells and CD4 cell lines. CXCR4 signalling-induced by HIV-1 envelope proteins in CD4 T cells was not detected. Furthermore, it was shown that envelope protein-induced apoptosis can occur after treating target cells with the Gi-protein inhibitor pertussis toxin." }, { "role": "assistant", "content": "Evidence is provided for a role of CXCR4 in the mechanisms of HIV envelope protein-induced pathogenesis, contributing to selective CD4 cell killing. The results suggest that CXCR4 is involved in HIV-1-induced apoptosis; however, this role does not appear to involve G-protein-mediated CXCR4 signalling. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Does monitoring of platelet activation in platelet concentrate using transmission electron microscopy? Context: The quality of platelet concentrates (PC) is important for the in vivo recovery of thrombostasis in patients suffering from bleeding disorders and in tumor patients after chemotherapy. In this respect, activated platelets (PLT) cannot display their full functionality in the recipient and even can cause adverse effects. Therefore, we developed a transmission electron microscopy (TEM) method for quality assessment of PC. Score values taken from panorama TEM images describe the progress of PLT activation. To exemplify this method, i) 19 apheresis PC isolated with the Baxter Amicus system (BA) were compared with 14 PC obtained from pooled buffy coats (BC). ii) The score values of 33 PC derived from BA as well from BC were compared with flow-cytometric CD62P determinations by cross correlation. iii) Changes in the score value profiles during storage of a single pathogen-reduced BA PC were monitored over a period of 7 days. The TEM evaluation described allows for demonstrating particular PLT activation stages. i) Significant differences between the percentages of the score values 0, 1 and 2 could be demonstrated in both processing groups. No significant differences were found comparing these two groups. ii) A weak correlation could be shown when comparing the percentages of score values 2 plus 3 with the percentage of CD62P-positive PLT. iii) The pathogen reduction affected slightly the score profiles during storage due to an increase of dead PLT." }, { "role": "assistant", "content": "Our investigations demonstrate the unique detailed quality information of PC obtained by the TEM method. This method can be performed in every routine electron microscopy laboratory. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Antigens, Neoplasm, Carcinoembryonic Antigen, Carcinoma, Squamous Cell, Colposcopy, Combined Modality Therapy, Female, Humans, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Predictive Value of Tests, Serpins, Uterine Cervical Neoplasms." }, { "role": "user", "content": "Are serum level of squamous cell carcinoma antigen and tumor size useful to identify preoperatively patients at high risk of cervical cancer? Context: The benefit of postoperative adjuvant therapy for patients with cervical cancer is uncertain, and moreover, may increase morbidity. In this study, patient age, clinical stage of the cancer, tumor size, and levels of serum squamous cell carcinoma cell antigen and carcinoembryonic antigen were studied in patients with Stage Ib and IIa squamous cell carcinoma of the uterine cervix to determine if these parameters can be used, before the surgical intervention, to distinguish patients who require postoperative adjuvant therapy from those who do not. Ninety-nine patients were studied. After surgery, patients were classified either as high risk or low risk according to the results of histopathologic findings. The age of the patient was noted, and FIGO stage, squamous cell carcinoma antigen, carcinoembryonic antigen, and clinical tumor size were determined. A univariate analysis and then a stepwise logistic regression procedure were performed to select significant clinical predictors from among the five variables mentioned above. Any selected predictors were further analyzed by the receiver operator characteristic curve. Serum squamous cell carcinoma antigen and clinical tumor size measured by colposcopic examination were significant clinical predictors of the treatment strategy postoperatively. From the receiver operator characteristic curve, a sensitivity of 84.2%, a specificity of 91.8%, a positive predictive value of 84.5% were attained." }, { "role": "assistant", "content": "Serum squamous cell carcinoma antigen assays and clinical tumor size estimated by colposcopic examination are helpful in identifying patients who require postoperative adjunctive therapy. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Anticoagulants, Caseins, Coleus, Colforsin, Cytochrome P-450 Enzyme System, Diet, Dietary Proteins, Dose-Response Relationship, Drug, Herb-Drug Interactions, Liver, Male, Mice, Mice, Inbred ICR, Microsomes, Liver, Plant Extracts, Warfarin." }, { "role": "user", "content": "Does hepatic cytochrome P450 mediate interaction between warfarin and Coleus forskohlii extract in vivo and in vitro? Context: This study aimed to determine whether Coleus forskohlii extract (CFE) influences the anticoagulant action of warfarin in mice in vivo and its relationship with hepatic cytochrome P450 (CYP). Mice were fed various doses of CFE standardised with 10% forskolin in a normal diet for one week, or in protein diets containing 7% and 20% casein (low and normal) for four weeks. They were then administered with warfarin by gavage on the last two days of the treatment regimen, and blood coagulation parameters, as well as hepatic CYP, were analysed at 18 h after the last dose. Direct interaction between CFE and forskolin with CYP2C was evaluated in vitro. CFE dose dependently increased hepatic total CYP content and S-warfarin 7-hydroxylase activity at a dietary level of ≥0.05%. Warfarin-induced anticoagulation was attenuated by CFE in parallel with CYP induction. The findings were similar in mice fed diets containing CFE and different ratios of protein. CFE directly inhibited CYP2C activity in mouse and human liver microsomes in vitro, whereas forskolin was only slightly inhibitory." }, { "role": "assistant", "content": "CFE attenuates the anticoagulant action of warfarin by inducing hepatic CYP2C; thus, caution is required with the combination of warfarin and dietary supplements containing CFE. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND AND AIM, METHODS, RESULTS. Meshes: Adult, Algorithms, Austria, Cardiopulmonary Resuscitation, Female, Heart Massage, Humans, Male, Manikins, Practice Guidelines as Topic, Quality Assurance, Health Care, Red Cross, Time and Motion Studies." }, { "role": "user", "content": "Cardiopulmonary resuscitation and the 2005 universal algorithm: has the quality of CPR improved? Context: Chest compressions are crucial in cardiopulmonary resuscitation (CPR), although the optimal number, rate and sequence are unknown. The 2005 CPR guidelines of the European Resuscitation Council (ERC) brought major changes to the basic life support algorithm. One of the major aims of the ERC was to decrease hands-off time in order to improve perfusion of the coronary vessels and the brain. Using a manikin model of basic life support in simulated cardiac arrest, we compared hands-off time and total number of chest compressions according to the guidelines of 2000 and those of 2005. A total of 50 volunteers performed CPR according to the guidelines of 2000 (Group 2000) and 2005 (Group 2005) in a randomized unblinded cross-over study. Volunteers received 10 min of standardized teaching and 10 min of training, including corrective feedback, for each set of guidelines before performing 5 min of basic life support on a manikin. We compared hands-off time as the primary outcome parameter and the total number of chest compressions as the secondary outcome parameter. Fifty volunteers were enrolled in the study, one individual dropped out after randomization. In Group 2005, hands-off time was significantly lower (mean 107 +/- 19 [SD] s vs. 139 +/- 15 s in Group 2000 (P<0.0001) and the total number of chest compressions was significantly higher (347 +/- 64 compressions vs. 233 +/- 51 compressions; P<0.0001)." }, { "role": "assistant", "content": "In this manikin setting, both hands-off time and the total number of chest compressions improved with basic life support performed according to the ERC guidelines of 2005." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Absorptiometry, Photon, Adult, Aged, Aged, 80 and over, Blood Glucose, Body Composition, Body Mass Index, Cardiovascular Diseases, Cholesterol, HDL, Cholesterol, LDL, Female, Hormone Replacement Therapy, Human Growth Hormone, Humans, Hypopituitarism, Insulin-Like Growth Factor I, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Risk Factors, Sex Factors, Treatment Outcome." }, { "role": "user", "content": "Does fifteen years of GH replacement improve body composition and cardiovascular risk factors? Context: Few studies have determined the effects of more than 5-10 years of GH replacement in adults on body composition and cardiovascular risk factors. In this prospective, single-center, open-label study, the effects of 15 years of GH replacement on body composition and cardiovascular risk factors were determined in 156 hypopituitary adults (93 men) with adult-onset GH deficiency (GHD). Mean age was 50.5 (range 22-74) years at study start. Body composition was measured using dual-energy X-ray absorptiometry. The mean initial GH dose of 0.55 (S.E.M. 0.03) mg/day was gradually lowered to 0.40 (0.01) mg/day after 15 years. The mean serum IGF1 SDS increased from -1.53 (0.10) at baseline to 0.74 (0.13) at study end (P<0.001 vs baseline). Lean soft tissue (LST) increased to 3% above the baseline level at study end (P<0.001). After a 9% decrease during the first year of treatment (P<0.001 vs baseline), body fat (BF) started to increase and had returned to the baseline level after 15 years. Serum levels of total cholesterol and LDL-cholesterol decreased and serum HDL-cholesterol level increased. Fasting plasma glucose increased from 4.4 (0.1) at baseline to 4.8 (0.1) mmol/l at study end (P<0.001). However, blood HbA1c decreased from 5.0 (0.1) to 4.6 (0.1) % (P<0.001)." }, { "role": "assistant", "content": "Fifteen-year GH replacement in GHD adults induced a transient decrease in BF and sustained improvements of LST and serum lipid profile. Fasting plasma glucose increased whereas blood HbA1c was reduced. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 17-year-old girl comes to the emergency department because of a 6-day history of gradual onset abdominal pain, fever, vomiting, and decreased appetite. Her pain started as dull and diffuse over the abdomen but has progressed to a sharp pain on her right side. She has taken ibuprofen twice daily since the onset of symptoms, which has provided moderate pain relief. She has no history of serious illness. She is sexually active with one male partner and uses condoms consistently. She appears stable. Her temperature is 38.2°C (100.8°F), pulse is 88/min, respirations are 18/min, and blood pressure is 125/75 mm Hg. The abdomen is soft. There is tenderness to palpation of the right lower quadrant. Laboratory studies show:\nLeukocyte count 16,500/mm3\nSerum\nNa+ 135\nK+ 3.5\nCl- 94\nHCO3- 24\nUrea nitrogen 16\nCreatinine 1.1\nβ-hCG negative\nUrine\nWBC 3/hpf\nRBC < 3/hpf\nNitrite negative\nLeukocyte esterase negative\nCT scan of the abdomen shows a small (3-cm) fluid collection with an enhancing wall surrounded by bowel loops in the right pelvis. The patient is placed on bowel rest and started on IV fluids and antibiotics. Which of the following is the most appropriate next step in management?\"" }, { "role": "assistant", "content": "Continue conservative management and schedule appendectomy in 6-8 weeks" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Body Mass Index, Body Weight, Female, Humans, National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division, Obesity, Odds Ratio, Overweight, Pregnancy, Pregnancy Trimester, Second, Prospective Studies, United States, Weight Gain, Young Adult." }, { "role": "user", "content": "Does early Second Trimester Weight Gain in Obese Women predict Excessive Gestational Weight Gain in Pregnancy? Context: To assess gestational weight gain (GWG) in obese women to determine an inflection point that identifies women at risk for excessive weight gain. This is an observational prospective cohort study of pregnancies managed through the UC San Diego Maternal Weight and Wellness Program from 2011 to 2014. The primary outcome was total gestational weight gain. GWG was categorized as inadequate (<11 pounds), adequate (11-20 pounds), and excessive (>20 pounds) based on Institute of Medicine (IOM) recommendations. Other outcomes were GWG by trimester and postpartum weight retention. Bivariate and multivariate analyses were used to assess factors associated with GWG. Ninety-five patients had a mean prepregnancy body mass index (BMI) of 41.9 ± 8.9 kg/m(2) and a net weight gain of 21.9 ± 19 pounds. First trimester GWG was -0.3 ± 4.9 pounds, second trimester was 10.4 ± 10.8 pounds, and third trimester was 11.4 ± 8.5 pounds for all participants. Women who exceeded IOM recommendations accelerated weight gain at 12-14 weeks and gained a majority of weight during the second trimester. Weight gain of more than two pounds at 12-14 weeks had a 96 % positive predictive value (95 % CI 79-99) for excessive GWG. Postpartum women with excessive GWG retained more weight than those with inadequate GWG (10.7 ± 15.6 pounds compared with -13.6 ± 10.9 pounds, P < 0.001). On multiple linear regression GWG by trimester was predictive of total GWG with second and third trimester GWG having the greatest effect on total GWG. Prepregnancy BMI and gestational diabetes were not predictors of total GWG." }, { "role": "assistant", "content": "Obese women at risk for excessive GWG may be identified as early as 12-14 weeks and gain most weight during the second trimester. GWG less than 11 pounds resulted in significant postpartum weight loss among obese women. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Which of the following transpos nitrogen from muscle to liver?" }, { "role": "assistant", "content": "The correct answer is Glucogenic amino acids i. Glucogenic amino acids are shown in Figure 9.27. (Alanine, glutamic acid, aspaic acid, etc). ii. When glucose is not readily available (starvation or diabetes mellitus), the glucogenic amino acids are transaminated to corresponding carbon skeletons. (Fig. 9.27). These then enter the TCA cycle and form oxaloacetate or pyruvate. iii. Alanine released from the muscle is the major substrate for gluconeogenesis (Fig. 9.29). Fig. 9.33. Hormonal regulation of gluconeogenesis i. Alanine is transpoed to liver, transaminated to pyruvate and conveed to glucose. This glucose may again enter the glycolytic pathway to form pyruvate, which in turn, can be transaminated to alanine. ii. Glucose-alanine cycle is impoant in conditions of starvation (Fig. 9.30). Thus net transfer of amino acid (nitrogen) from muscle to liver and corresponding transfer of glucose (energy) from liver to muscle is effected. iii. Alanine cycle is intimately related with Cori&;s cycleRef: DM Vasudevan - Textbook of Biochemistry, 6th edition, page no: 105" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Bacterial Infections, Burns, Child, Child, Preschool, Cross Infection, Female, Hospitals, Special, Humans, Infant, Iran, Male, Middle Aged, Wound Infection." }, { "role": "user", "content": "Do bacterial infections in burn patients at a burn hospital in Iran? Context: The major challenge for a burn team is nosocomial infection in burn patients, which is known to cause over 50% of burn deaths. Most studies on infection in burn patients focus on burn wound infection, whereas other nosocomial infections in these patients are not well described. We undertook this study to determine three types of nosocomial infections viz., burn wound infection, urinary tract infection, and blood stream infection in burn patients in a burn hospital in Iran. During the one year period (May 2003 to April 2004), 182 patients were included in this study. Blood, urine and wound biopsy samples were taken 7 and 14 days after admission to Taleghani Burn hospital. Isolation and identification of microorganisms was done using the standard procedure. Disk diffusion test were performed for all the isolates for antimicrobial susceptibility. Of the 182 patients, 140 (76.9%) acquired at least one type of infection of the 140, 116 patients (82.8%) were culture positive on day 7 while 24 (17.2%) on 14 days after admission. Primary wound infection was most common (72.5%), followed by blood stream (18.6%) and urinary tract infections (8.9 %). The microorganisms causing infections were Pseudomonas aeruginosa (37.5%), Staphylococcus aureus (20.2%), and Acinetobacter baumanni (10.4%). Among these isolates P. aeruginosa was found to be 100 per cent resistant to amikacin, gentamicin , carbenicillin, ciprofloxacin, tobramycin and ceftazidime; 58 per cent of S. aureus and 60 per cent of coagulase negative Staphylococcus were methicillin resistant." }, { "role": "assistant", "content": "High prevalence of nosocomial infections and the presence of multidrug resistant bacteria, and methicillin resistant S. aureus in patients at Taleghani Burn Hospital suggest continuous surveillance of burn infections and develop strategies for antimicrobial resistance control and treatment of infectious complications. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Female, Humans, Living Donors, Male, Middle Aged, Nephrectomy, Personality, Predictive Value of Tests, Psychiatric Status Rating Scales, Stress, Psychological, Time Factors, Wound Healing." }, { "role": "user", "content": "Does stress predict the trajectory of wound healing in living kidney donors as measured by high-resolution ultrasound? Context: Psychological stress has been shown to be an influential factor on the rate of wound healing; however these findings have been demonstrated predominantly on artificially created wounds. Due to the absence of major co-morbidities, living kidney donors are a unique group in which to study this relationship. This study investigated the effect of preoperative stress and personality on surgical wound healing through the use of high-resolution ultrasound. Living kidney donors due to undergo a hand-assisted laparoscopic donor nephrectomy were asked to complete the Perceived Stress Scale, the Life Orientation Test-Revised and the Ten Item Personality Inventory prior to surgery. High-resolution ultrasound scans of surgical wounds were performed on the first three post-operative days and once following discharge (mean=15.3 days; s.d. 2.8). Two measurements from each image were obtained: wound width (size of wound) and median intensity (a marker of tissue fluid). Latent Growth Curve Models (LGCMs) were used to evaluate wound healing. 52 living kidney donors participated. Higher pre-operative life stress, lower optimism and lower conscientiousness were associated with delayed wound healing in living kidney donors for both outcomes. Increased emotional stability was associated with faster wound healing as demonstrated by a change in median intensity. Possible confounding factors, such as age, BMI, smoking status, local anaesthetic use and wound drain placement were not influential." }, { "role": "assistant", "content": "This study, which measured wound healing in a novel patient sample using a novel technique, has demonstrated a negative association between stress and wound healing and the positive influence of optimism, conscientiousness and emotional stability. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Acetaminophen, Analgesics, Non-Narcotic, Animals, Antioxidant Response Elements, Chemical and Drug Induced Liver Injury, Cyclooctanes, Dioxoles, Gene Expression Regulation, Hep G2 Cells, Humans, Lignans, Liver, Male, Mice, Mice, Inbred C57BL, NF-E2-Related Factor 2, Protective Agents, RNA, Messenger, Schisandra, Signal Transduction." }, { "role": "user", "content": "Does schisandrol B protect against acetaminophen-induced acute hepatotoxicity in mice via activation of the NRF2/ARE signaling pathway? Context: The nuclear factor erythroid 2-related factor 2 (NRF2) acts through the antioxidant response element (ARE) to regulate the expression of many detoxifying and antioxidant genes responsible for cytoprotective processes. We previously reported that Schisandrol B (SolB) isolated from Schisandra sphenanthera produced a protective effect against acetaminophen (APAP)-induced liver injury. In this study we investigated whether the NRF2/ARE signaling pathway was involved in this hepato-protective effect. Male C57BL/6 mice were treated with SolB (200 mg · kg(-1) · d(-1), ig) for 3 d before injection of APAP (400 mg/kg, ip). Serum and liver tissue samples were collected 6 h later. The mRNA and protein expression were measured using qRT-PCR and Western blot assay, respectively. The activation of NRF2 was examined in HepG2 cells using luciferase reporter gene assay. SolB pretreatment significantly alleviated the hepatic injury (large patchy necrosis and hyperemia of the hepatic sinus), the increase of serum AST, ALT levels and hepatic MDA contents, and the decrease of liver and mitochondrial glutathione levels in APAP-treated mice. Furthermore, SolB pretreatment significantly increased nuclear accumulation of NRF2 and increased hepatic expression of NRF2 downstream proteins, including GCLC, GSR, NQO1, GSTs, MRP2, MRP3 and MRP4 in APAP-treated mice. Moreover, treatment with SolB (2.5-20 μmol/L) dose-dependently increased the activity of NRF2 reporter gene in HepG2 cells." }, { "role": "assistant", "content": "SolB exhibits a remarkable protective effect against APAP-induced hepatotoxicity, partially via activation of the NRF2/ARE pathway and regulation of NRF2 target genes, which induce detoxification and increase antioxidant capacity. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Aged, Angiotensin-Converting Enzyme Inhibitors, Female, Humans, Kidney Transplantation, Male, Middle Aged, Proteinuria, Renin-Angiotensin System, Sodium, Dietary." }, { "role": "user", "content": "Does a high sodium intake reduce antiproteinuric response to renin-angiotensin-aldosterone system blockade in kidney transplant recipients? Context: Post-transplant proteinuria is associated with lower graft and patient survival. Renin-angiotensin-aldosterone system blockers are used to reduce proteinuria and improve renal outcome. Although it is known that a high salt intake blunts the antiproteinuric effect of ACEI and ARB drugs in non-transplant patients, this effect has not been studied in kidney transplant recipients. To analyse the relationship between sodium intake and the antiproteinuric effect of ACEI/ARB drugs in kidney transplant recipients. We selected 103 kidney transplant recipients receiving ACEI/ARB drugs for more than 6 months due to proteinuria>1 g/day. Proteinuria was analysed at baseline and at 6 months after starting ACEI/ARB treatment. Salt intake was estimated by urinary sodium to creatinine ratio (uNa/Cr). Proteinuria fell to less than 1g/day in 46 patients (44.7%). High uNa/Cr was associated with a smaller proteinuria decrease (r=-0.251, P=.011). The percentage proteinuria reduction was significantly lower in patients in the highest uNa/Cr tertile [63.9% (IQR 47.1%), 60.1% (IQR 55.4%), 38.9% (IQR 85.5%), P=.047]. High uNa/Cr independently relates (OR 2.406 per 100 mEq/g, 95% CI: 1.008-5.745, P=.048) to an antiproteinuric response <50% after renin-angiotensin-aldosterone system blockade." }, { "role": "assistant", "content": "A high salt intake results in a smaller proteinuria decrease in kidney transplant recipients with proteinuria treated with ACEI/ARB drugs. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "YAG laser is used in -" }, { "role": "assistant", "content": "The correct answer is After cataract is treated by Nd-YAG laser posterior capsulotomy" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Which of the following is the primary acid-base disorder\nassociated with haemorrhagic shock, diabetic ketosis and chronic renal failure?" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Aqueous Humor, Capsule Opacification, Cataract Extraction, Dose-Response Relationship, Drug, Edetic Acid, Electroretinography, Epithelial Cells, Epithelium, Corneal, Injections, Intraocular, Intraocular Pressure, Lens Capsule, Crystalline, Matrix Metalloproteinase 2, Matrix Metalloproteinase Inhibitors, Microscopy, Electron, Scanning, Postoperative Complications, Rabbits." }, { "role": "user", "content": "Does modulation of matrix metalloproteinase activity by EDTA prevent posterior capsular opacification? Context: To evaluate the effect of ethylenediaminetetraacetic acid (EDTA) on posterior capsular opacification (PCO) of rabbits and to assess its effect on intraocular tissues. Modulation of matrix metalloproteinase (MMP) activity in the aqueous following cataract surgery in rabbits and its prevention by different doses of EDTA was determined by zymography. For evaluation of PCO, lensectomized rabbits were intracamerally injected with single dose of either 5 mg EDTA or normal saline. After one month, the degree of PCO was determined by slitlamp biomicroscopy, Miyake-Apple view, and histology of the lens capsule. The effect of EDTA on intra ocular pressure (IOP), corneal endothelial cells, and the retina was evaluated by tonometry, specular microscopy and scanning electron microscopy, and electroretinography. The concentration of EDTA in the aqueous was determined by high performance liquid chromatography (HPLC) at different time points. The MMP activity was significantly increased in the aqueous of the operated eyes, and EDTA reduced the degree of increase in a dose-dependent manner. EDTA treatment significantly reduced the degree of PCO (p<0.05). Histopathology of the lens capsule showed a reduction in the number of proliferating and migrating cells as well as MMP2 expression in the EDTA-treated eyes. EDTA treatment did not change the IOP; density, morphology and ultrastructure of the corneal endothelial cells; and electroretinography (ERG). EDTA was detectable in the aqueous humor up to 72 h following a single intracameral injection." }, { "role": "assistant", "content": "EDTA reduces the degree of PCO by suppressing the MMP activity and it is not toxic to intra ocular structures at the concentration used. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Angiotensin Receptor Antagonists, Animals, Blood Proteins, Brain Edema, Capillary Permeability, Cats, Cerebrovascular Circulation, Disease Models, Animal, Losartan, Male, Models, Cardiovascular, Renin-Angiotensin System." }, { "role": "user", "content": "Does losartan prevent cerebral edema? Context: The purpose of this study was to ascertain the effect of Losartan, a non-peptide angiotensin II receptor antagonist used for the treatment of hypertension, on the movement of proteins and fluids across the vascular compartment in ischemic cat brains.MATERIAL/ The experiments were carried out on anesthetized cats under artificial ventilation and autohemoperfusion of the brain with a stable volume of blood with the help of a resistograph. Cerebral ischemia was induced by a 15-minute arrest of the autohemoperfusion pump, tying various anastomoses in the neck region, and reducing arterial pressure to 40-30 mm Hg by hemorrhage with subsequent reinfusion of the lost blood. In the postischemic period in the cat brain, control experiments showed the onset of metabolic acidosis and an increase in permeability of the brain capillaries to fluids and protein molecules. Intravenous introduction of losartan, an angiotensin II receptor antagonist, at a dose of 3 mg x kg(-1) 10 minutes into the postischaemic period, enhanced the normalization of metabolic and transcapillary exchange. Thus vector permeability was reversed from blood-to-tissue in the control situation (without losartan) to tissue-to-blood during losartan administration." }, { "role": "assistant", "content": "The results provide strong evidence that losartan may play a role in preventing cerebral edema, and that the renin-angiotensin system plays an important role in postischemic cerebrovascular events." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Under classification of Renal injuries, Laceration more than 1 cm without extension into the renal pelvis or collecting system comes under which Grade?" }, { "role": "assistant", "content": "The correct answer is Grade Type Description I Contusion Microscopic (>3 RBCs/HPF)or gross hematuria, urological studies normal Hematoma Subcapsular, nonexpanding without parenchymal laceration. II Hematoma Nonexpanding perirenal hematoma, confined to renal retroperitoneum Laceration <1 cm parenchymal depth of renal coex without urine extravasation. III Laceration >1 cm parenchymal depth of renal coex without collection system rupture or urinary extravasation IV Laceration Parenchymal laceration extending through collecting system Vascular Main renal aery or vein injury with contained hemorrhage V Laceration Completely \"Shattered kidney\" Vascular Avulsion of renal hilum, devascularising the kidney." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Biomarkers, Cytokines, Diagnosis, Differential, Female, Humans, Immunoglobulin G, Male, Middle Aged, Multiple Sclerosis, Nervous System Diseases, T-Lymphocyte Subsets, T-Lymphocytes, Helper-Inducer, Young Adult." }, { "role": "user", "content": "Do immune Parameters That Distinguish Multiple Sclerosis Patients from Patients with Other Neurological Disorders at Presentation? Context: Multiple sclerosis (MS) is an inflammatory, demyelinating disease of the central nervous system. Effector T helper cells, mainly Th1 and Th17, cytotoxic T-cells, B-cells, macrophages, microglia, and the cytokines they secrete, are implicated in the initiation and maintenance of a deregulated immune response to myelin antigens and the ensuing immune-mediated demyelination. In this study, we investigated whether signature cytokines exist in MS patients at presentation to gain an insight into the underlying immunopathogenic processes at the early stage of the disease. We collected serum and cerebrospinal fluid (CSF) samples from 123 patients at presentation, eventually diagnosed with MS or non-inflammatory (NIND) or inflammatory neurological diseases (IND) or symptomatic controls (SC). The levels of cytokines IFN-γ, TNF-α, TGF-β1, IL-2, IL-4, IL-6, IL-10 and IL-17 were measured, and cytokine ratios, such as Th1/Th2, Th1/Th17, and Type-1/Type-2, were calculated. All parameters were tested for their correlations with the intrathecal IgG synthesis. Cytokine levels in CSF were lower than in serum in all the patients, with the exception of IL-6. Serum or CSF cytokine levels of MS patients did not differ significantly from NIND or SC, with the exception of serum IFN-γ and TNF-α that were significantly higher in NIND. IND patients presented with the highest levels of all cytokines in serum and CSF, with the exception of serum IL-10 and CSF IL-17. MS patients had a significantly lower serum Th1/Th2 ratio compared to the NIND and IND groups, and significantly lower serum Type-1/Type-2, IFN-γ/IL-10 and CSF Th1/Th17 ratios compared to IND patients. MS patients had a significantly higher CSF IL-17/IL-10 ratio compared to IND patients. The IgG index was higher in MS patients compared to the control groups; the differences reached statistical significance between the MS and the NIND and SC groups. Reiber-Felgenhauer analysis of the QIgG and QAlb indices revealed higher intrathecal IgG synthesis in MS patients, and higher blood-CSF barrier dysfunction in IND patients. The IgG index correlated with CSF IL-4 in MS patients only." }, { "role": "assistant", "content": "We found no signature cytokines or profiles thereof in MS patients at presentation. Only IND patients presented with a clear Th1 cytokine polarization in serum and CSF. The parameters that distinguished MS patients from patients with other neurological disorders were IgG intrathecal synthesis, the IgG index and its correlation with CSF IL-4 levels. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Cell Line, Cluster Analysis, Gene Expression Profiling, Gene Expression Regulation, High-Throughput Nucleotide Sequencing, Humans, Multiplex Polymerase Chain Reaction, Polymerase Chain Reaction, Real-Time Polymerase Chain Reaction, Reproducibility of Results, Sensitivity and Specificity, Single-Cell Analysis, Transcriptome, Workflow." }, { "role": "user", "content": "Does rNA-Seq following PCR-based sorting reveal rare cell transcriptional signatures? Context: Rare cell subtypes can profoundly impact the course of human health and disease, yet their presence within a sample is often missed with bulk molecular analysis. Single-cell analysis tools such as FACS, FISH-FC and single-cell barcode-based sequencing can investigate cellular heterogeneity; however, they have significant limitations that impede their ability to identify and transcriptionally characterize many rare cell subpopulations. PCR-activated cell sorting (PACS) is a novel cytometry method that uses single-cell TaqMan PCR reactions performed in microfluidic droplets to identify and isolate cell subtypes with high-throughput. Here, we extend this method and demonstrate that PACS enables high-dimensional molecular profiling on TaqMan-targeted cells. Using a random priming RNA-Seq strategy, we obtained high-fidelity transcriptome measurements following PACS sorting of prostate cancer cells from a heterogeneous population. The sequencing data revealed prostate cancer gene expression profiles that were obscured in the unsorted populations. Single-cell expression analysis with PACS was subsequently used to confirm a number of the differentially expressed genes identified with RNA sequencing." }, { "role": "assistant", "content": "PACS requires minimal sample processing, uses readily available TaqMan assays and can isolate cell subtypes with high sensitivity. We have now validated a method for performing next-generation sequencing on mRNA obtained from PACS isolated cells. This capability makes PACS well suited for transcriptional profiling of rare cells from complex populations to obtain maximal biological insight into cell states and behaviors. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVES, METHODS, RESULTS. Meshes: Capacity Building, Health Services Administration, Humans, Inservice Training, Leadership, Organizational Innovation, Quality Improvement, Quality Indicators, Health Care, Research Support as Topic." }, { "role": "user", "content": "Building Systemwide Improvement Capability: Does an Organization's Strategy for Quality Improvement Matter? Context: Health care organizations have used different strategies to implement quality improvement (QI) programs but with only mixed success in implementing and spreading QI organization-wide. This suggests that certain organizational strategies may be more successful than others in developing an organization's improvement capability. To investigate this, our study examined how the primary focus of grant-funded QI efforts relates to (1) key measures of grant success and (2) organization-level measures of success in QI and organizational learning. Using a mixed-methods design, we conducted one-way analyses of variance to relate Veterans Affairs administrative survey data to data collected as part of a 3.5-year evaluation of 29 health care organization grant recipients. We then analyzed qualitative evidence from the evaluation to explain our results. We found that hospitals that focused on developing organizational infrastructure to support QI implementation compared with those that focused on training or conducting projects rated highest (at α = .05) on all 4 evaluation measures of grant success and all 3 systemwide survey measures of QI and organizational learning success." }, { "role": "assistant", "content": "This study adds to the literature on developing organizational improvement capability and has practical implications for health care leaders. Focusing on either projects or staff training in isolation has limited value. Organizations are more likely to achieve systemwide transformation of improvement capability if their strategy emphasizes developing or strengthening organizational systems, structures, or processes to support direct improvement efforts." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, Breast Neoplasms, Chemotherapy, Adjuvant, Cyclophosphamide, Disease-Free Survival, Doxorubicin, Drug Administration Schedule, Female, Humans, Lymphatic Metastasis, Middle Aged, Paclitaxel, Risk Factors." }, { "role": "user", "content": "Are six cycles of doxorubicin and cyclophosphamide or Paclitaxel superior to four cycles as adjuvant chemotherapy for breast cancer in women with zero to three positive axillary nodes : Cancer and Leukemia Group B 40101? Context: The ideal duration of adjuvant chemotherapy for patients with lower risk primary breast cancer is not known. Cancer and Leukemia Group B trial 40101 was conducted using a phase III factorial design to define whether six cycles of a chemotherapy regimen are superior to four cycles. We also sought to determine whether paclitaxel (T) is as efficacious as doxorubicin/cyclophosphamide (AC), but with reduced toxicity. Between 2002 and 2008, the study enrolled women with operable breast cancer and zero to three positive nodes. Patients were randomly assigned to either four or six cycles of either AC or T. Study stratifiers were estrogen receptor/progesterone receptor (ER/PgR), human epidermal growth factor receptor 2 (HER2), and menopausal status. After 2003, all treatment was administered in dose-dense fashion. The primary efficacy end point was relapse-free survival (RFS). A total of 3,171 patients were enrolled; 94% were node-negative and 6% had one to three positive nodes. At a median follow-up of 5.3 years, the 4-year RFS was 90.9% and 91.8% for six and four cycles, respectively. The adjusted hazard ratio (HR) of six to four cycles regarding RFS was 1.03 (95% CI, 0.84 to 1.28; P=.77). The 4-year OS was 95.3% and 96.3% for six and four cycles, respectively, with an HR of six to four cycles of 1.12 (95% CI, 0.84 to 1.49; P=.44). There was no interaction between treatment duration and chemotherapy regimen, ER/PgR, or HER2 status on RFS or OS." }, { "role": "assistant", "content": "For women with resected primary breast cancer and zero to three positive nodes, we found no evidence that extending chemotherapy regimens of AC or single-agent T from four to six cycles improves clinical outcome. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adolescent, Child, Child, Preschool, Female, Germany, Hepatoblastoma, Humans, Infant, Liver Neoplasms, Liver Transplantation, Magnetic Resonance Imaging, Male, Multidetector Computed Tomography, Surgery, Computer-Assisted, Tomography, X-Ray Computed." }, { "role": "user", "content": "Does computer-assisted surgery planning in children with complex liver tumors identify variability of the classical Couinaud classification? Context: In complex malignant pediatric liver tumors there is an ongoing discussion regarding surgical strategy; for example, primary organ transplantation versus extended resection in hepatoblastoma involving 3 or 4 sectors of the liver. We evaluated the possible role of computer-assisted surgery planning in children with complex hepatic tumors. Between May 2004 and March 2016, 24 Children with complex liver tumors underwent standard multislice helical CT scan or MRI scan at our institution. Imaging data were processed using the software assistant LiverAnalyzer (Fraunhofer Institute for Medical Image Computing MEVIS, Bremen, Germany). Results were provided as Portable Document Format (PDF) with embedded interactive 3-dimensional surface mesh models. Median age of patients was 33months. Diagnoses were hepatoblastoma (n=14), sarcoma (n=3), benign parenchyma alteration (n=2), as well as hepatocellular carcinoma, rhabdoid tumor, focal nodular hyperplasia, hemangioendothelioma, or multiple hepatic metastases of a pancreas carcinoma (each n=1). Volumetry of liver segments identified remarkable variations and substantial aberrances from the Couinaud classification. Computer-assisted surgery planning was used to determine surgical strategies in 20/24 children; this was especially relevant in tumors affecting 3 or 4 liver sectors. Primary liver transplantation could be avoided in 12 of 14 hepaoblastoma patients who theoretically were candidates for this approach." }, { "role": "assistant", "content": "Computer-assisted surgery planning substantially contributed to the decision for surgical strategies in children with complex hepatic tumors. This tool possibly allows determination of specific surgical procedures such as extended surgical resection instead of primary transplantation in certain conditions. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Adolescent, Adult, Aged, Amino Acid Sequence, Animals, Brugada Syndrome, Female, Genetic Predisposition to Disease, HEK293 Cells, Humans, Male, Mice, Middle Aged, Molecular Sequence Data, Mutation, Protein Structure, Secondary, Rabbits, Rats, Sulfonylurea Receptors, Young Adult." }, { "role": "user", "content": "Is aBCC9 a novel Brugada and early repolarization syndrome susceptibility gene? Context: Genetic defects in KCNJ8, encoding the Kir6.1 subunit of the ATP-sensitive K(+) channel (I(K-ATP)), have previously been associated with early repolarization (ERS) and Brugada (BrS) syndromes. Here we test the hypothesis that genetic variants in ABCC9, encoding the ATP-binding cassette transporter of IK-ATP (SUR2A), are also associated with both BrS and ERS. Direct sequencing of all ERS/BrS susceptibility genes was performed on 150 probands and family members. Whole-cell and inside-out patch-clamp methods were used to characterize mutant channels expressed in TSA201-cells. Eight ABCC9 mutations were uncovered in 11 male BrS probands. Four probands, diagnosed with ERS, carried a highly-conserved mutation, V734I-ABCC9. Functional expression of the V734I variant yielded a Mg-ATP IC₅₀ that was 5-fold that of wild-type (WT). An 18-y/o male with global ERS inherited an SCN5A-E1784K mutation from his mother, who displayed long QT intervals, and S1402C-ABCC9 mutation from his father, who displayed an ER pattern. ABCC9-S1402C likewise caused a gain of function of IK-ATP with a shift of ATP IC₅₀ from 8.5 ± 2 mM to 13.4 ± 5 μM (p<0.05). The SCN5A mutation reduced peak INa to 39% of WT (p<0.01), shifted steady-state inactivation by -18.0 mV (p<0.01) and increased late I(Na) from 0.14% to 2.01% of peak I(Na) (p<0.01)." }, { "role": "assistant", "content": "Our study is the first to identify ABCC9 as a susceptibility gene for ERS and BrS. Our findings also suggest that a gain-of-function in I(K-ATP) when coupled with a loss-of-function in SCN5A may underlie type 3 ERS, which is associated with a severe arrhythmic phenotype. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Calcium, Denervation, Dose-Response Relationship, Drug, Indoles, Jejunum, Male, Muscle, Smooth, Myenteric Plexus, Nifedipine, Rats, Rats, Sprague-Dawley." }, { "role": "user", "content": "Does myenteric denervation of rat jejunum alter calcium responsiveness of intestinal smooth muscle? Context: Long-term myenteric and extrinsic denervation of a segment of rat jejunum results in increased stress generation by the longitudinal muscle layer of the denervated segment 15 days after denervation. This study examined whether alterations in the properties of either cell membrane calcium channels and/or sarcoplasmic reticular Ca(2+)-adenosine triphosphatase (ATPase) contribute to the increased stress development. The effects of the calcium channel blocker nifedipine and the sarcoplasmic reticular Ca(2+)-ATPase inhibitor cyclopiazonic acid on the contractile activity of denervated and control smooth muscle were determined. The ability of nifedipine to inhibit KCl-induced contractions was significantly increased in denervated tissues; however, there was no difference in the potency of nifedipine when tissues were stimulated with carbachol. Calcium concentration-response curves obtained in the presence of either KCl or carbachol were determined in tissues previously depleted of calcium. Long-term denervated tissues showed an increased sensitivity to calcium and a decreased maximum contractile response after stimulation with carbachol. Cyclopiazonic acid inhibited repletion of intracellular calcium stores of control muscle but had no effect in denervated tissue." }, { "role": "assistant", "content": "Long-term denervation of a segment of rat small intestine results in profound alterations in calcium metabolism at the cell membrane and, to a lesser extent, at the sarcoplasmic reticulum of smooth muscle cells of the longitudinal muscle layer. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVES, METHODS, RESULTS. Meshes: Brachytherapy, Carcinoma, Hepatocellular, Female, Humans, Liver, Liver Neoplasms, Liver Transplantation, Male, Middle Aged, Neoplasm Recurrence, Local, Radiography, Interventional, Retrospective Studies, Tomography, X-Ray Computed." }, { "role": "user", "content": "CT-guided Interstitial Brachytherapy of Hepatocellular Carcinoma before Liver Transplantation: an Equivalent Alternative to Transarterial Chemoembolization? Context: Transarterial chemoembolization (TACE) is established as bridging therapy of HCC listed for transplantation (LT). CT-guided brachytherapy (CTB) has not been evaluated as a bridging concept. We compared CTB and TACE for bridging before LT in HCC patients. Twelve patients with HCC received LT after CTB (minimal tumour dose, 15-20 Gy). Patients were matched (CTB:TACE, 1:2) by sex, age, number and size of lesions, and underlying liver disease with patients who received TACE before transplantation. Study endpoints were extent of necrosis at histopathology and recurrence rate after OLT. There were no significant differences between the CTB and TACE groups regarding Child-Pugh category (p = 0.732), AFP (0.765), time on waiting list (p = 0.659), number (p = 0.698) and size (p = 0.853) of HCC lesions, fulfilment of Milan-criteria (p = 0.638), or previous liver-specific treatments. CTB achieved higher tumour necrosis rates than TACE (p = 0.018). The 1- and 3-year recurrence rate in the CTB group was 10 and 10 % vs. TACE, 14 and 30 % (p = 0.292)." }, { "role": "assistant", "content": "Our data show comparable or even better response and post-LT recurrence rates of CTB compared to TACE for treating HCC in patients prior to LT. CTB should be further evaluated as an alternative bridging modality, especially for patients not suited for TACE." } ]