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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, RESULTS. Meshes: Adult, Emergencies, Female, Hemoperitoneum, Hospitals, University, Humans, Laparoscopy, Ovarian Cysts, Ovariectomy, Pregnancy, Pregnancy, Ectopic, Retrospective Studies, Rupture, Spontaneous, Salpingectomy, Treatment Outcome." }, { "role": "user", "content": "Does laparoscopic Approach have Benefits in Gynecological Emergencies - Even for Massive Hemoperitoneum? Context: The purpose of this study is to compare the laparoscopic with the open approach in hemoperitoneum of gynecological origin. Retrospective study of patients admitted to a tertiary emergency hospital between January 2013 - January 2015. There were 56 patients, 27 in the laparoscopic group (LG) and 28 in the open group (OG). The gynecological emergency was a ruptured ovarian cyst in 20 (74%) versus 17 (59%) cases, and an ectopic pregnancy with tubal rupture in 7 (26%) versus 12 (41%) patients in both the laparoscopic and open approaches, respectively. The main outcome - mean intraoperative hemoglobin decrease - was 1.5 +- 1.2 g/dl in the laparoscopic and 1.9 ‚+-1.4 in the open approach (p=0.344). There were no differences regarding red blood transfusion rate, needs for analgesics, postoperative complications and in-hospital stay." }, { "role": "assistant", "content": "The laparoscopic approach in acute abdomen of gynecologic origin is non-inferior to open surgery. 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 patient presented to ENT OPD with complaints of headache and nasal stuffiness. On CT scan Heterogeneous opacification involving multiple sinuses along with Bone erosion (as shown below) was noticed. What would be the most likely diagnosis?" }, { "role": "assistant", "content": "The correct answer is Heterogeneous opacification in multiple sinuses with areas of central hypoattenuation is characteristic of AFRS. Erosion of medial wall of right orbit can be clearly seen without any invasion into the orbit as Medial Rectus Muscle can be clearly seen with out distoion. ( compare with Left Side) Areas of increased signal intensity are thought to be due to the accumulation of heavy metals such as iron, manganese, and calcium within the inspissated allergic mucin." } ]

[ { "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: Case-Control Studies, Confidence Intervals, Female, Herpes Zoster, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Male, Middle Aged, Odds Ratio, Prevalence." }, { "role": "user", "content": "Is herpes zoster associated with prior statin use : a population-based case-control study? Context: This study investigated the association between statin use and herpes zoster (HZ) occurrence in a population-based case-control study. Study subjects were retrieved from the Taiwan Longitudinal Health Insurance Database 2000. This study included 47,359 cases with HZ and 142,077 controls. We performed conditional logistic regression analyses to calculate the odds ratio (OR) to present the association between HZ and having previously been prescribed statin. We found that 13.0% of the sampled subjects had used statins, at 15.5% and 12.1% for cases and controls, respectively (p<0.001). A conditional logistic regression analysis suggested that the adjusted OR of being a statin user before the index date for cases was 1.28 (95% confidence interval (CI): 1.24∼1.32) compared to controls. Subjects aged 18∼44 years had the highest adjusted OR for prior statin use among cases compared to controls (OR: 1.69; 95% CI: 1.45∼1.92). Furthermore, we found that the ORs of being a regular and irregular statin user before the index date for cases were 1.32 (95% CI: 1.27∼1.38) and 1.23 (95% CI: 1.181.29), respectively, compared to controls." }, { "role": "assistant", "content": "We concluded that prior statin use was associated with HZ occurrence. 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": "The Earliest sign of male puberty is :" }, { "role": "assistant", "content": "The correct answer is In boys, first visible sign of puberty and hallmark of SMR2 is testicular enlargement, beginning as early as 9½ years. This is followed by penile growth during SMR3. Peak growth occurs when testis volumes reach approximately 9-10 cm3 during SMR4. Under the influence of LH and testosterone, and prostate enlarge. The left testis normally is lower than the right. Some degree of breast hypertrophy, typically bilateral, occurs in 40-65% of boys during SMR2-3 due to a relative excess of estrogenic stimulation\nIn girls, the first visible sign of puberty and the hallmark of SMR2 is the appearance of breast buds, between 8 and 12 years of age. Menses typically begins 2-2½ years later, during SMR3-4 (median age, 12 years; normal range, 9-16 years), around the peak height velocity. Less obvious changes include enlargement of the ovaries, uterus, labia, and clitoris, and thickening of the endometrium and vaginal mucosa" } ]

[ { "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, Adult, Alcohol Drinking, Antitubercular Agents, Delivery of Health Care, Family Health, Female, Follow-Up Studies, Humans, Life Style, Male, Middle Aged, Odds Ratio, Recurrence, Risk Factors, Smoking, Tuberculosis, Pulmonary, Young Adult." }, { "role": "user", "content": "Does smoking increase the risk of relapse after successful tuberculosis treatment? Context: Recent tobacco smoking has been identified as a risk factor for developing tuberculosis, and two studies which have investigated its association with relapse of tuberculosis after completion of treatment had conflicting results (and did not control for confounding). The objective of this study was to investigate risk factors for tuberculosis relapse, with emphasis on smoking. A cohort of newly diagnosed TB cases was followed up from their discharge after completion of treatment (in 2001-2003) until October 2006 and relapses of tuberculosis ascertained during that period. A case of relapse was defined as a patient who started a second treatment during the follow up. Smoking (OR 2.53, 95% CI 1.23-5.21) and living in an area where the family health program was not implemented (OR 3.61, 95% CI 1.46-8.93) were found to be independently associated with relapse of tuberculosis." }, { "role": "assistant", "content": "Our results establish that smoking is associated with relapse of tuberculosis even after adjustment for the socioeconomic variables. Smoking cessation support should be incorporated in the strategies to improve effectiveness of Tuberculosis Control Programs. 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": "Golden period for treatment of open wounds is .....hours -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., 4" } ]

[ { "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, Appendectomy, Appendicitis, C-Reactive Protein, Case-Control Studies, Emergency Service, Hospital, Female, Humans, Lymphocyte Count, Lymphocytes, Male, Multivariate Analysis, Neutrophils, ROC Curve, Retrospective Studies, Sensitivity and Specificity." }, { "role": "user", "content": "Is neutrophil-to-lymphocyte count ratio associated with perforated appendicitis in elderly patients of emergency department? Context: The diagnostic value of the neutrophil-to-lymphocyte count ratio (NLR) and the Appendicitis Inflammatory Response (AIR) score for identifying acute appendicitis (AA) perforation in elderly patients in the emergency department (ED) were evaluated. A total of 103 patients who were admitted for appendectomy for AA via the ED between January 2012 and December 2014 were reviewed retrospectively. Patients aged 65 and over were included. Patient age, sex, comorbidities, body temperature, clinical findings and initial laboratory results including white blood cell (WBC) count, NLR, serum levels of CRP and total bilirubin (TB) in the ED were assessed, and the AIR score was calculated. Perforation due to AA was identified in 58 (56.3 %) elderly patients. Median WBC count, neutrophil count, CRP and TB were significantly higher in the perforated group compared to the non-perforated group (p = 0.005, p = 0.001, p = 0.004 and p = 0.012) in the ED. The NLR was significantly different in the two groups (perforated vs non-perforated group, 9.5 vs 5.1, p < 0.001). The area under the curve value of NLR was 0.755 (95 % CI 0.660-0.834), and the cutoff value was 5.6 (sensitivity 78.0 % and specificity 65.9 %). In multivariate logistic analysis, NLR > 5.6 [odds ratio (OR) 6.794, p = 0.001] was significant independent factor for AA perforation in elderly patients. The AIR score risk probability did not differ between the two groups of elderly patients (p = 0.094). Twenty-five (42.4 %) patients in the perforated group and five (11.4 %) patients in the non-perforated group were classified as high probability by the modified AIR score including the NLR value (p = 0.001)." }, { "role": "assistant", "content": "We suggest that the initial NLR in the elderly patient is the most powerful predictive factor for the diagnosis of AA perforation in the ED. 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: Aged, Aged, 80 and over, Clinical Decision-Making, Endovascular Procedures, Female, Hospitalization, Humans, Male, Middle Aged, Patient Admission, Prospective Studies, Stroke, Time Factors, Treatment Outcome." }, { "role": "user", "content": "Weekend effect in endovascular stroke treatment: do treatment decisions, procedural times, and outcome depend on time of admission? Context: Epidemiologic studies identified a 'weekend effect' or 'out-of-hours effect', which implies that procedural and clinical outcomes of patients with stroke, who are admitted out-of-hours, are less favorable than for patients admitted during working-hours. To determine (1) whether our procedural times and clinical outcome were affected by an out-of-hours effect and (2) whether the decision in favor of, or against, endovascular stroke treatment (EST) depends on the time of admission. Between February 2010 and January 2015, 6412 consecutive patients presenting with symptoms of acute ischemic stroke were evaluated for EST eligibility according to established local protocols and generally accepted consensus criteria, and dichotomized into working-hours and out-of-hours cohorts according to admission times. Within both groups, patients given EST were identified and the rate of treatment decision, procedural times, and clinical outcome were compared and analyzed. Clinical and radiological features of patients admitted in working-hours and out-of-hours did not differ significantly. Procedural times and clinical outcome were not affected by an out-of-hours effect (p≥0.054). 221/240 (92.1%) out-of-hours patients and 154/166 (92.8%) working-hours patients who were eligible for EST were transferred to the angiography suite for EST (p=0.798). The rationale not to treat patients who were eligible for EST did not differ between working-hours and out-of-hours admission (p=0.756)." }, { "role": "assistant", "content": "It is possible to produce competitive procedural times regardless of the time of admission and to prevent a treatment decision bias when standard operating procedures are applied consistently." } ]

[ { "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": "Patellar tendon bearing P.O.P. cast is indicated in the following fracture -" }, { "role": "assistant", "content": "The correct answer is Sarmiento's total contact below knee cast/PTB cast\n\nSarmiento PTB (patellar tendon bearing) plaster, is a carefully moulded patellar tendon bearing below knee plaster which is used in fractures of shaft of tibia in the later stages of conservative treatment when the fracture is more stable (& sticky) and requires the stimulus of direct weight bearing.\n\n\n\nIt is firmly moulded over-anterior tibial surface, lateral peroneal mass and posterior gastrocnemius mass in order to achieve a triangular shape which will prevent rotation and angulation of fragments. And a hydraulic environment provided by soft tissue is responsible for returning of the fracture to its preload state on the release of pressure (i.g., weight bearing).\nPatellar moulding is done in 45° extension (flexion). Most of the pressure is taken over gastrocnemius mass rather than over the bony prominences. 80% of weight is still taken through the leg. That's why it is not recommended for unstable early fractures." } ]

[ { "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: Asian Continental Ancestry Group, Biomarkers, Tumor, Carcinoma, Squamous Cell, Cyclin D1, Gene Expression, Humans, Lymphatic Metastasis, Mouth Neoplasms, Neoplasm Staging, Odds Ratio, Prognosis, Publication Bias." }, { "role": "user", "content": "Is cyclin D1 overexpression associated with poor clinicopathological outcome and survival in oral squamous cell carcinoma in Asian populations : insights from a meta-analysis? Context: The clinicopathological significance of cyclin D1 overexpression and prognosis of oral squamous cell carcinoma has not been fully quantified. We performed a comprehensive meta-analysis for evaluation of cyclin D1 overexpression in oral squamous cell carcinoma to determine the strength of this association. Using both medical subheadings and free terms, we searched PubMed, Embase and the Institute for Scientific Information Web of Science for all eligible studies published before Nov. 2013. We retrieved 1674 citations, determining that 15 met the selection criteria. We used the odds ratio (OR) and hazard ratio (HR) as the common measures of association to quantitatively determine the correlation between cyclin D1 overexpression and outcomes of oral cancer. We performed a meta-analysis and heterogeneity, sensitivity, and subgroup analyses to clarify and validate the pooled results. The pooled results provided compelling evidence that cyclin D1 overexpression was significantly correlated with increased tumor size (OR = 1.617, 95% confidence interval [CI] = 1.046-2.498, p = 0.031), lymphoid node metastasis (OR = 2.035, 95% CI = 1.572-2.635, p<0.001), tumor differentiation (OR = 1.976, 95% CI = 1.363-2.866, p<0.001), and advancement of clinical stages (OR = 1.516, 95% CI = 1.140-2.015, p = 0.004), and adversely influenced overall survival of OSCC patients (HR = 1.897, 95% CI = 1.577-2.282, p<0.001). The strength of association varied in different oral cavity subsites." }, { "role": "assistant", "content": "Our findings indicated that cyclin D1 expression correlates with detrimental clinicopathological outcome and poor prognosis in oral squamous cell carcinoma. Our results may be useful in the management of oral cancer. 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": "Iodised oil ( usual dose of 1 ml i/m) gives protection for" }, { "role": "assistant", "content": "The correct answer is Intramuscular Iodised Oil (poppy-seed oil): Average dose 1 ml injection provided protection for 4 years\nOral Iodised Oil: 2 ml dose is effective for 2 years" } ]

[ { "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, Adult, Child, Child, Preschool, Decision Making, Evaluation Studies as Topic, Female, Humans, Immunization, Male, Middle Aged, Parents." }, { "role": "user", "content": "Choosing not to immunize: are parents making informed decisions? Context: Childhood immunization is an important aspect of childhood preventive health, world wide, with programmes such as the Expanded Programme on Immunization organized by the World Health Organization. Unlike other countries, the immunization programme is not compulsory in the UK, and the decision whether to immunize a child or not is parental. The objective of this study was to explore the decision-making process of parents who have chosen not to have their children immunized. This was a qualitative study, using semi-structured interviews with parents either in their own homes or at their places of work. The study was set in an inner city area with a high level of deprivation. The district immunization co-ordinator and health visitors within the area referred parents to the researcher. Parents subsequently were selected using purposive maximum variation sampling. Data were analysed using consistent and systematic review. An initial coding frame that was derived from the first few transcripts was revised and developed through its application to subsequent transcripts. The final stage of analysis involved comparing the data using the revised coding frame for drawing conclusions and verification. Interviews were completed with 13 parents. Parents discussed their perceptions of childhood diseases and immunization, and the risk-benefit analysis that occurred between the two. All parents identified the risk of side effects as a reason for choosing not to immunize. A proposed model of the decision-making process that represented the experiences of the parents in this study is presented. In response to the question of immunization, three actions were described by parents: a routine response, an emotional response and delaying the decision by entering a questioning stage followed by a cyclical process of seeking and evaluating information. Key to this model was a stage of reflection that most parents described irrespective of their initial action in response to the question of immunization. Parents also discussed their responsibilities in terms of the consequences of their decisions. Health professionals were perceived as providing unbalanced information that was an obstacle in decision making." }, { "role": "assistant", "content": "The parents included in this study had chosen not to immunize at least one of their children. Most parents felt they had made an informed decision, based on an assessment of the risks and benefits of immunization and an acceptance of responsibility for that decision. Health professionals were not perceived as providers of balanced information. It is therefore important that parents have easy access to accurate information concerning the pros and cons of treatment, and have the opportunity to discuss their concerns with health professionals." } ]

[ { "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, Adult, Aged, Barrett Esophagus, Case-Control Studies, Disease Progression, Esophageal Neoplasms, Esophagus, Female, Follow-Up Studies, GPI-Linked Proteins, Humans, Immunoenzyme Techniques, Male, Middle Aged, Pilot Projects, Prognosis, Retrospective Studies, Risk Factors." }, { "role": "user", "content": "Are tissue and serum mesothelin potential markers of neoplastic progression in Barrett 's associated esophageal adenocarcinoma? Context: Mesothelin is overexpressed in several malignancies and is purportedly a specific marker of malignant transformation. In this pilot study, we investigated whether tissue and serum mesothelin are potential markers of neoplastic progression in Barrett's esophagus (BE) and in esophageal adenocarcinoma (EAC). Mesothelin expression was retrospectively evaluated in normal, BE, and EAC tissue from surgically resected esophageal specimens (n = 125). In addition, soluble mesothelin-related peptide (SMRP) levels were measured in serum. Normal esophageal mucosa did not express mesothelin. BE tissue with high-grade dysplasia specifically expressed mesothelin, whereas BE tissue with low-grade or without dysplasia did not. Fifty-seven (46%) EAC tumors were positive for mesothelin. EAC tumors with BE expressed mesothelin more often than those without BE (58% vs. 35%, P = 0.01). SMRP levels were elevated in 70% of EAC patients (mean = 0.89 nmol/L; range: 0.03-3.77 nmol/L), but not in patients with acid reflux and/or BE." }, { "role": "assistant", "content": "Mesothelin is commonly expressed in BE-associated EAC. On the basis of this pilot study, a prospective study is under way to evaluate tissue and serum mesothelin which are potential markers of neoplastic progression in BE and in EAC (NCT01393483). 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: Adult, Antibodies, Australia, Chi-Square Distribution, Drug Therapy, Combination, Female, Glomerular Filtration Rate, Graft Rejection, Graft Survival, Histocompatibility Testing, Humans, Immunosuppressive Agents, Kaplan-Meier Estimate, Kidney Transplantation, Linear Models, Male, Middle Aged, Proportional Hazards Models, Receptors, Interleukin-2, Registries, Retrospective Studies, Risk Assessment, Risk Factors, Tacrolimus, Time Factors, Transplantation, Homologous, Treatment Outcome." }, { "role": "user", "content": "Does interleukin-2 receptor antibody reduce rejection risk in low immunological risk or tacrolimus-treated intermediate immunological risk renal transplant recipients? Context: The use of interleukin-2 receptor antibody (IL-2Ra) induction has been associated with reduced rejection rates in renal transplant recipients. However, the effect of IL-2Ra induction on graft and patient outcomes in renal transplant recipients with differing immunological risk remains unclear. Using Australia and New Zealand Dialysis and Transplant Registry, renal transplant recipients in Australia between 1995 and 2005 were included. Recipients were stratified into low immunological risk (primary grafts with < or = 2 human leucocyte antigen (HLA)-mismatches and panel-reactive antibody (PRA) < 10%) or intermediate immunological risk (subsequent grafts or >2 HLA-mismatches or PRA > 25%) recipients. Recipients receiving T-cell depletive induction therapy or steroid and/or calcineurin-free inhibitor regimens were excluded. Outcomes analysed included the presence of rejection at 6 months, estimated glomerular filtration rate at 1 and 5 years, graft and patient survival. 218 of 1220 (18%) low-risk and 883 of 3204 (28%) intermediate-risk recipients received IL-2Ra. In intermediate-risk recipients, IL-2Ra induction was associated with a 26% reduction in the incidence of acute rejection; but this benefit was restricted only to recipients initiated on cyclosporine-based immunosuppressive regimens. In contrast, the use of IL-2Ra in low-risk recipients was not associated with reduced rejection risk. There was no association between IL-2Ra induction and other graft or patient outcomes in both low- and intermediate-risk recipients." }, { "role": "assistant", "content": "This registry analysis suggests that IL-2Ra induction may be associated with a reduction in rejection risk in cyclosporine-treated intermediate immunological risk recipients, but not in low-risk renal transplant recipients. 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: Animals, Cattle, Cattle Diseases, Cell Adhesion Molecules, Cytokines, Extraembryonic Membranes, Fatty Acids, Volatile, Female, Gene Expression, Inflammation Mediators, Placenta, Pregnancy, Pregnancy Complications, RNA, Messenger, Receptors, G-Protein-Coupled, Uterus." }, { "role": "user", "content": "Is expression of short chain fatty acid receptors and pro-inflammatory cytokines in utero-placental tissues altered in cows developing retention of fetal membranes? Context: Retention of fetal membranes (RFM) is an economically important condition in dairy cattle disturbing the health and production in affected animals. In spite of extensive research, pathogenesis for RFM and identification of a predictive marker for the condition still remains elusive. Since expulsion of fetal membranes in an inflammatory process, studying the expression of inflammatory molecules is expected to give an idea about the pathogenesis of RFM. Expression of pro-inflammatory cytokines, short chain fatty acid (SCFA) receptors and adhesion molecules was studied using qRT-PCR in the utero-placental tissues obtained from the cows that expelled fetal membranes normally (n = 12) and from the cows that developed RFM (n = 12). Concentrations of SCFAs were estimated in the utero-placental tissues using Gas Chromatography. The concentration of butyrate in the utero-placental tissue extract was 3-4 times lower, and GPR41 and GPR43 mRNA expression was 7.7-10.0 and 3.4-4.4 folds lower (p < 0.05) in cows that developed RFM compared to those that expelled the fetal membranes normally. The expression of IL-1, IL-6, IL-8, TNF-α, ICAM and PECAM was higher (p < 0.05) in the cows that normally expelled the fetal membranes compared to those that developed RFM." }, { "role": "assistant", "content": "Since a clear association of butyrate levels, expression of pro-inflammatory cytokines, adhesion molecules and SCFAs receptors was observed with expulsion of fetal membranes, modulating the levels of these molecules prior to parturition might help in reducing the incidence of RFM in cows. 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: Cadaver, Humans, Male, Middle Aged, Prostatectomy, Time Factors, Urethra, Urinary Incontinence." }, { "role": "user", "content": "Does preservation of putative continence nerves during radical retropubic prostatectomy lead to more rapid return of urinary continence? Context: Urinary incontinence is a significant complication of radical pelvic surgery. A better understanding of the neuroanatomy of the rhabdosphincter has led to the modification of the radical retropubic prostatectomy to optimize the recovery of postoperative urinary control. Mock radical retropubic prostatectomy was performed on fresh cadavers to determine which surgical maneuvers could injure what may be the continence nerves. To assess the clinical significance of modifying the radical retropubic prostatectomy based on these anatomic studies, a contemporary series of 60 consecutive patients who underwent radical retropubic prostatectomy with continence nerve preservation was compared with a control group of 38 consecutive patients who had a standard anatomic radical retropubic prostatectomy. At the level of the prostatic apex, both the pelvic and pudendal nerves gave intrapelvic branches that bilaterally coursed to the external urinary sphincter to enter at the 5 and 7 o'clock positions. The mock radical prostatectomy revealed that the nerves to the external urinary sphincter were most prone to injury when a right angle clamp was used to develop a plane between the posterior rhabdosphincter and anterior rectum and if the urethral anastomotic sutures were placed at the 5 and 7 o'clock positions. In addition, blunt dissection of the tips of the seminal vesicles injured the inferior hypogastric plexus. Modifications to preserve the continence nerves were incorporated in the anatomic radical prostatectomy. Although overall continence rates were similar for the two groups (98.3% for continence nerve-preserving radical prostatectomy versus 92. 1% for standard prostatectomy), continence nerve preservation decreased the time to achieve continence." }, { "role": "assistant", "content": "During radical retropubic prostatectomy, surgical maneuvers that avoid injury to the continence nerves resulted in the more rapid return of urinary control. 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: Abdominal Pain, Adult, Aged, Aged, 80 and over, Carcinoma, Renal Cell, Cohort Studies, Confidence Intervals, Female, Fever, Hematuria, Humans, Incidental Findings, Intraoperative Complications, Kidney Neoplasms, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Nephrectomy, Odds Ratio, Prognosis, Retrospective Studies, Risk Assessment, Survival Analysis, Treatment Outcome, Weight Loss." }, { "role": "user", "content": "Are clinical symptoms related to renal cell carcinoma independent prognostic factors for intraoperative complications and overall survival? Context: It is not yet elucidated whether the symptoms related to renal cell carcinoma have a strong effect on intraoperative complications or survival. We aimed to investigate this association in a cohort of renal cancer patients operated on between June 1997 and December 2004 at the Department of Urology, Semmelweis University School of Medicine. Among 363 consecutive patients with renal masses treated at our institution, only 200 (55.3%) were truly asymptomatic and completely incidental (group A). Among the 259 patients with incidentally detected tumors, 59 (16.1%) had symptoms that were probably related to the renal lesion according to a reviewed history (group B) and 104 patients (28.6%) presented for symptoms related to renal cell cancer (group C). Patients in group B had a higher risk for weight loss (P < 0.0001) and flank pain (P = 0.063), lower risk for symptoms related to distant metastases, while their outcome was not significantly different from group C. The collapsed group (B + C) had an increased risk for metastasis (P = 0.002), higher stage (P = 0.001), and intraoperative complications (P = 0.046) compared to group A according to a logistic regression. The presence of symptoms was significantly related to the overall survival using the Kaplan-Meier method (P < 0.0001)." }, { "role": "assistant", "content": "Weight loss and flank pain were frequently neglected as a possible symptom of renal cancer by the patients. An easily accessible parameter (the presence of symptoms) was independently related to intraoperative complications and survival in renal cancer patients. 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: Adolescent, Adult, Aged, Aged, 80 and over, Child, Clinical Competence, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Patient Selection, Physician Self-Referral, Reproducibility of Results, Retrospective Studies, Thoracic Outlet Syndrome, Ultrasonography, Doppler, Duplex, Young Adult." }, { "role": "user", "content": "Is diagnostic accuracy of physician and self-referred patients for thoracic outlet syndrome excellent? Context: The purpose of this study was to categorize patients referred to a specialized thoracic outlet syndrome (TOS) practice to determine the diagnostic accuracy of those who are physician and self-referred. Demographic and clinical data on all patients who were referred for TOS between 2006 and 2010 were retrospectively reviewed from a prospectively maintained institutional review board-approved database and patient records. Between 2006 and 2010, 621 patients were referred for TOS (433 women and 188 men; mean age 39 years [range 10-87]). Five hundred seventy-one patients (92%) were diagnosed with TOS, with 421 (74%) neurogenic, 126 (22%) venous, and 24 (4%) arterial TOS cases. Of the 525 physician referrals, 478 (91%) had TOS, and of the 93 self-referrals, 90 (97%) had TOS. The 421 patients with neurogenic TOS (NTOS, 304 women and 117 men) had symptoms on average for 56 months (range 1-516). Two hundred seventy-one patients (64%) were initially treated with TOS-specific physical therapy (PT), and 100 (37%) improved. One hundred seventy-eight patients (42%) underwent a lidocaine block, and 145 patients (81%) had a positive block. Seventy-four patients (18%) underwent Botox injections 44 (60%) of which were positive and the average number of Botox injections was 1.3. One hundred forty patients (33%) underwent transaxillary first rib resection and scalenectomy (FRRS), and 128 patients (91%) improved. Of patients undergoing FRRS, 92 (66%) had a lidocaine block, 82 (89%) of which were positive. Of patients with a positive lidocaine block, 74 (90%) improved after FRRS. Of patients undergoing FRRS, 31 (22%) underwent Botox injections, 15 (48%) of which were positive. Of patients with a positive Botox block, 14 (93%) improved after FRRS. Average length of time between initial visit and operation was 6.4 months (range 2 weeks to 34 months), and average follow-up time was 13 months (range 1 week to 49 months)." }, { "role": "assistant", "content": "1) Both referring physicians and patients are very accurate in their preliminary diagnosis of TOS (neurogenic, venous, or arterial TOS). 2) In a specialized TOS practice, two-thirds of patients are sent to TOS-specific PT and one-third improve from this treatment alone. 3) One-third of patients referred for NTOS eventually undergo FRRS with a 91% success rate. 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: Aged, Cerebrovascular Circulation, Evoked Potentials, Visual, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Parkinson Disease, Tomography, Emission-Computed, Single-Photon, Visual Cortex, Visual Perception." }, { "role": "user", "content": "Do P1 and N1 evoked by the ERP task reflect primary visual processing in Parkinson's disease? Context: To evaluate whether P1 and N1 evoked by ERP tasks could appropriately reflect primary visual processing in Parkinson's disease (PD). We recorded ERPs in 13 PD patients with duration of illness less than 5 years and 18 age-matched normal control subjects. P1 and N1 from Oz were evoked by a visual oddball and a delayed matching S1-S2 task. The effect of different events on P1 and N1 was studied. All patients were given an ECD-SPECT examination, and the SPECT images were overlaid on the 3D-MRI. The correlation of P1 or N1 to the regional cerebral blood flow (rCBF) was studied. P1 was not influenced by different events. There was no significant P1 differences between the PD and the normal group. N1 was significantly shorter and smaller in the patients than that in the normal group. N1 amplitude after the waveform subtraction (target-frequent) in the PD group did not show significant difference with that in the normal controls, nor with the N1 before the subtraction. Nd, the subcomponent of N1 after the subtraction in the patients was significantly earlier and smaller than that in the normal controls. P1 only weakly correlated with the rCBF in the occipital lobe. N1 was correlated with the rCBF in a global region." }, { "role": "assistant", "content": "The results provided some evidence that P1 might reflect the primary visual processing, and N1 might be involved in both primary and cognitive visual processing. The altered N1 in the PD patients might be due to the deformed Nd." } ]

[ { "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": "Cushing's disease presents with-" }, { "role": "assistant", "content": "The correct answer is increased production of coisol by adrenals and bilateral adrenal hyperplasia due to hyper secretion of pituitary ACTH( Harrison 17 pg 2255)" } ]

[ { "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": "Process of redistribution is seen with:" }, { "role": "assistant", "content": "The correct answer is Ans. B. ThiopentoneProcess of redistribution is seen with thiopentone, if given intravenously, it reaches the brain and distributed due to high lipid solubility. Therefore, its anesthetic effect is quite rapid. It gains comes out of the brain and gets distributed into blood vessels." } ]

[ { "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, PURPOSE, RESEARCH DESIGN. Meshes: Auditory Perception, Hearing Aids, Hearing Loss, Humans, Individuality, Thinking." }, { "role": "user", "content": "Is there a hearing aid for the thinking person? Context: The history of auditory prosthesis has generally concentrated on bottom-up processing, that is, on audibility. However, a growing interest in top-down processing has focused on correlations between success with a hearing aid and such higher order processing as the patient's intelligence, problem solving and language skills, and the perceived effort of day-to-day listening. Examination of two cases of cognitive effects in hearing that illustrate less-often-studied issues: (1) Individual subjects in a study use different listening strategies, a fact that, if not known to the experimenter, can lead to errors in interpretation; (2) A measure of shared attention can point to otherwise unknown functional effects of an algorithm used in hearing aids. In the two examples described above: (1) Patients with cochlear implants served in a study of the binaural precedence effect, that is, echo suppression. (2) Individuals identifying speech-in-noise benefit from noise reduction (NR) when the criterion was improved performance in simultaneous tests of verbal memory or visual reaction times." }, { "role": "assistant", "content": "Studies of hearing impairment, either in the laboratory or in a fitting session, should include study of the complex stimuli that make up the natural environment, conditions where the thinking auditory brain adopts strategies for dealing with large amounts of input data. In addition to well-known factors that must be included in communication, such things as familiarity, syntax, and semantics, the work here shows that strategic listening can affect even how we deal with seemingly simpler requirements, localizing sounds in a reverberant auditory scene and listening for speech in noise when busy with other cognitive tasks." } ]

[ { "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 tumor associated with AIDS is" }, { "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": "True about cardiac 02 demand is" }, { "role": "assistant", "content": "The correct answer is Experimental studies have shown that oxygen consumption of the hea and the chemical energy expended during contraction are directly related to the external work Ref: Guyton and Hall Textbook of Medical Physiology (12th Edn) page No:209" } ]

[ { "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: AIDS Vaccines, Fowlpox virus, Gene Products, gag, Gene Products, pol, Genotype, HIV Antibodies, HIV Infections, HIV-1, Humans, Immunoglobulin G, Receptors, IgG, Viral Load." }, { "role": "user", "content": "Is vaccine-induced IgG2 anti-HIV p24 associated with control of HIV in patients with a 'high-affinity ' FcgammaRIIa genotype? Context: We have previously shown that vaccination with a recombinant fowlpox virus carrying the genes for HIV Gag-Pol and interferon-gamma (IFN-gamma) was associated with partial control of HIV replication after antiretroviral therapy (ART) was ceased but not with increased anti-HIV T-cell responses. Because IFN-gamma enhances IgG2 production, and IgG2 antibodies to HIV antigens and the 'high-affinity' polymorphism of FcgammaRIIa (the major Fc receptor for IgG2) have been associated with a favourable outcome of HIV infection, we examined the association of IgG2 antibodies to HIV p24 and 'high-affinity' polymorphisms of FcgammaRIIa with control of HIV replication in these patients. Plasma from weeks 0 (cessation of ART 1 week after the last vaccination), 9 and 20 was available from patients who had received the full construct vaccine, a partial construct (without IFN-gamma) or placebo. IgG2 and IgG1 anti-p24 and anti-gp41 were assayed and all patients were genotyped for the FcgammaRIIa 131 R/H polymorphism that affects IgG2 binding. At week 0, IgG2 anti-p24 was present in five of nine full construct patients but none of 14 partial construct or placebo patients and was associated with a smaller increase in plasma HIV RNA over 20 weeks. Patients with IgG2 anti-p24 and the 'high-affinity' polymorphism of FcgammaRIIa exhibited lower HIV replication than other patients at week 20." }, { "role": "assistant", "content": "The role of IgG2 anti-HIV antibodies and FcgammaRIIa in the control of HIV replication should be investigated further. Inclusion of an IFN-gamma gene in DNA vaccine constructs might be a means of enhancing IgG2 antibody production. 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": "Zinc is essential for -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'd' i.e., Carbonic anhydrase" } ]

[ { "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: Analysis of Variance, Body Mass Index, Disease-Free Survival, Graft Rejection, Graft Survival, Humans, Immunosuppressive Agents, Kaplan-Meier Estimate, Kidney Transplantation, Living Donors, Obesity, Retrospective Studies, Risk Assessment, Risk Factors, Taiwan, Time Factors, Treatment Outcome." }, { "role": "user", "content": "Does size do matter-donor-to-recipient body mass index difference may affect renal graft outcome? Context: Obesity, in the either kidney donor or the recipient, has been related to worse graft function. The aim of this study was to compare long-term graft outcomes of living-related kidney recipients regarding the donor-to-recipient body mass index (BMI) ratio. From November 2002 to November 2010, 62 consecutive living-related kidney transplantations were performed at our center. Donor and recipient BMIs were categorized by Taiwan's national standard using dividing values of 18.5, 24, and 27 kg/m(2) to divide subjects into donor-to-recipient BMI categories. These with the same BMI category as their donors were defined as the same-BMI group (group 0); recipients with a lower BMI category than their donors were defined as the large-to-small group (group 1); and those with a higher BMI category than their donors were defined as the small-to-large group (group 2). Baseline parameters and posttransplantation follow-up data were analyzed according to this grouping. Of the 57 recipients followed regularly at our hospital (mean follow-up 48.9 months), 21 (36.8.1%) were in group 0; 26 (45.6%) in group 1, and 10 (17.6%) in group 2. The baseline parameters were similar among these groups. The overall graft survival rates were 81.0% in group 0, 76.9% in group 1, and 90.0% in group 2. The rejection-free graft survival rates were 81.0%, 65.4%, and 90.0%, respectively. By Kaplan-Meier analysis, group 1 showed worse rejection-free graft survival than group 0 or group 2 (log-rank P = .046)." }, { "role": "assistant", "content": "Living-related recipients of kidneys from donors with a higher BMI showed lower long-term graft survival, which might suggest that petite recipients may need time to compensate adequate blood flow for the relative large graft, thus carrying a higher chance of rejection and worse graft outcomes. 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": "Amount of blood loss in class II circulatory failure/Haemorrhagic shock?" }, { "role": "assistant", "content": "The correct answer is -Hemorrhagic shock has been divided into 4 classes according to ATLS course. Class 1 Class2 Class 3 Class 4 Blood volume lost as % of total < 15 % 15-30% 30-40% >40% Four Classes of Hemorrhagic Shock (According to the ATLS course) Parameter I II III IV Blood loss (%) 0-15% 15-30 30-40 >40 CNS Slightly anxious Mildly anxious Anxious or confused Confused or lethargic Pulse (beats/ min) <100 >100 >120 >140 Blood pressure Normal Normal Decreased Decreased Pulse pressure Normal Decreased Decreased Decreased Respiratory rate 14-20/min 20-30/min 30-40/min >35/min Urine (mL/hr) >30 20-30 5-15 Negligible Fluid Crystalloid Crystalloid Crystalloid + blood Crystalloid + blood Base deficit 0 to -2 mEq/L -2 to 6 mEq/L -6 to -10 mEq/L -10 mEq/L or less -Please refer to the above table as many such questions are asked from the table." } ]

[ { "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 Volkmanns contracture which aery is injured ?" }, { "role": "assistant", "content": "The correct answer is Volkmanns ischemic contracture is due to injury to Brachial aery Refer Maheshwari 9th/ed pg102" } ]

[ { "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: Administration, Topical, Anti-Bacterial Agents, Dental Scaling, Doxycycline, Female, Humans, Male, Middle Aged, Periodontal Pocket, Regression Analysis, Root Planing, Single-Blind Method, Smoking, Treatment Outcome." }, { "role": "user", "content": "Does locally delivered doxycycline improve the healing following non-surgical periodontal therapy in smokers? Context: The outcome of non-surgical periodontal therapy is known to be inferior in smokers compared to non-smokers. In the present study, the question was asked whether such a difference in healing response may be less evident following adjunctive use of locally delivered controlled-release doxycycline. One hundred and three patients (42 smokers, 61 non-smokers), each having at least eight periodontal sites with PPD (probing pocket depth) > or =5 mm, were following stratification for smoking randomly assigned to two different treatment protocols; non-surgical scaling/root planing (Control) or ultrasonic instrumentation+application of a 8.5% w/w doxycycline gel (Atridox trade mark ) (Test). Instructions in oral hygiene were given to all patients. Clinical examinations of plaque, PPD, clinical attachment level (CAL) and bleeding following pocket probing were performed at baseline and after 3 months. Primary efficacy endpoints were changes in PPD and CAL. Patient mean values were calculated as basis for statistical analysis (multiple regression analyses). The baseline examination revealed no significant difference in mean PPD between treatment groups or between smokers and non-smokers (mean PPD 5.7-5.9 mm). The mean PPD reduction in the control group at 3-month was 1.1 mm (SD=0.45) for smokers and 1.5 mm (0.67) for non-smokers. In the test group the PPD reduction was 1.4 mm (0.60) and 1.6 mm (0.45) for smokers and non-smokers, respectively. The mean CAL gain for smokers and non-smokers amounted to 0.5 mm (0.56) and 0.8 mm (0.71), respectively, in the control group, and to 0.8 mm (0.72) and 0.9 mm (0.82), respectively, in the test group. Multiple regression analysis revealed that smoking and initial PPD negatively influenced the treatment outcome in terms of PPD reduction and CAL gain, while the use of doxycycline had a significant positive effect." }, { "role": "assistant", "content": "Locally applied controlled-release doxycycline gel may partly counteract the negative effect of smoking on periodontal healing following non-surgical 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: BACKGROUND, METHODS, RESULTS. Meshes: Administration, Oral, Adult, Calcium Channel Blockers, Chronic Disease, Female, Fissure in Ano, Humans, Male, Middle Aged, Nifedipine, Pain, Pressure, Time Factors, Wound Healing." }, { "role": "user", "content": "Does oral nifedipine reduce resting anal pressure and heals chronic anal fissure? Context: Topical preparations have been used in the treatment of anal fissure. However, they are not universally successful and there is confusion over the site and dose of application. This study assessed the effectiveness of oral nifedipine in reducing resting anal pressure and on fissure healing. Anal manometry was performed on eight healthy volunteers and 15 patients with chronic anal fissure before and after oral administration of nifedipine 20 mg. Nifedipine was taken twice daily. Fissure healing was assessed over an 8-week period and pain scores were monitored. Oral nifedipine produced an initial reduction in maximum resting anal pressure (MRP) of 35 per cent (P < 0.001) and of 28 per cent after 5 days (P < 0.001) in healthy volunteers. A reduction in MRP of 36 per cent (P < 0.001) was observed in patients with fissure. Pain scores were significantly reduced during the treatment period. Healing was complete in nine patients after 8 weeks and a further three were asymptomatic. Ten patients experience flushing and four had mild headaches. There were no episodes of postural hypotension or incontinence." }, { "role": "assistant", "content": "Oral nifedipine reduces resting anal pressure. It is well tolerated and offers an alternative treatment for chronic anal fissure. 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, PURPOSES, METHODS, RESULTS. Meshes: Aged, Analgesics, Antithrombin III, Arthroplasty, Replacement, Knee, Biomarkers, Blood Coagulation, Double-Blind Method, Exercise, Female, Fibrin Fibrinogen Degradation Products, Humans, Inflammation Mediators, Interleukin-6, Ischemic Preconditioning, Length of Stay, Lower Extremity, Male, Middle Aged, New York City, Pain Management, Pain Measurement, Pain, Postoperative, Peptide Fragments, Peptide Hydrolases, Prospective Studies, Prothrombin, Recovery of Function, Regional Blood Flow, Synovial Fluid, Time Factors, Tourniquets, Treatment Outcome, Tumor Necrosis Factor-alpha." }, { "role": "user", "content": "Does limb preconditioning reduce pain after total knee arthroplasty? Context: Total knee arthroplasty (TKA) can be associated with considerable postoperative pain. Ischemic preconditioning of tissue before inducing procedure-related underperfusion may reduce the postoperative inflammatory response, which further may reduce associated pain.QUESTIONS/ In this prospective, randomized study, we aimed at evaluating the impact of ischemic preconditioning on postoperative pain at rest and during exercise; use of pain medication; levels of systemic prothrombotic and local inflammatory markers; and length of stay and achievement of physical therapy milestones. Sixty patients undergoing unilateral TKA under tourniquet were enrolled with half (N = 30) being randomized to an episode of limb preconditioning before induction of ischemia for surgery (tourniquet inflation). Pain scores, analgesic consumption, markers of inflammation (interleukin-6 [IL-6], tumor necrosis factor [TNF]-α in periarticular drainage), and periarticular circumference were measured at baseline and during 2 days postoperatively. Changes in prothrombotic markers were evaluated. Patients in the preconditioning group had significantly less pain postoperatively at rest (mean difference = -0.71, 95% confidence interval [CI] = -1.40 to -0.02, p = 0.043) and with exercise (mean difference = -1.38, 95% CI = -2.32 to -0.44, p = 0.004), but showed no differences in analgesic consumption. No differences were seen between the study and the control group in terms of muscle oxygenation and intraarticular levels of IL-6 and TNF-α as well as levels of prothrombotic markers. No differences were found between groups in regard to hospitalization length and time to various physical therapy milestones." }, { "role": "assistant", "content": "Ischemic preconditioning reduces postoperative pain after TKA, but the treatment effect size we observed with the preconditioning routine used was modest." } ]

[ { "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 60-year-old man comes to the physician because his wife has noticed that his left eye looks smaller than his right. He has had worsening left shoulder and arm pain for 3 months. He has smoked two packs of cigarettes daily for 35 years. Examination shows left-sided ptosis. The pupils are unequal but reactive to light; when measured in dim light, the left pupil is 3 mm and the right pupil is 5 mm. Which of the following is the most likely cause of this patient's ophthalmologic symptoms?" }, { "role": "assistant", "content": "Compression of the stellate ganglion" } ]

[ { "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, Aged, Carcinoma, Hepatocellular, Cell Line, Tumor, Down-Regulation, Extracellular Signal-Regulated MAP Kinases, Female, Hepatitis B, Humans, Liver Neoplasms, MAP Kinase Signaling System, Male, Middle Aged, Neoplasm Recurrence, Local, Phosphatidylethanolamine Binding Protein, Prognosis." }, { "role": "user", "content": "Is pEBP1 downregulation associated to poor prognosis in HCC related to hepatitis B infection? Context: Phosphatidylethanolamine-binding protein 1 (PEBP1, also RKIP) plays a pivotal role in cancer by regulating multiple cellular signaling processes and suppressing metastasis in animal models. We examined whether PEBP1 expression in hepatocellular carcinoma (HCC) correlated with the risk of recurrence and survival after resection. A randomly selected cohort of 240 Chinese HCC patients, predominantly hepatitis B related, formed the basis of the study. PEBP1 expression levels were evaluated by immunohistochemistry and real-time reverse-transcriptase PCR. Survival analysis was performed by univariate and multivariate analyses. The results were further validated in an independent series of 403 patients. The relevance of PEBP1 to phospho-ERK was determined by Western blot analysis on clinical samples and hepatoma cell lines. PEBP1, prevalently down-regulated in HCC, was significantly associated with tumor invasive characteristics (such as vascular invasion, lack of encapsulation, poor differentiation and large size). Both PEBP1 protein and mRNA levels were independent predictors for tumor recurrence (hazard ratio (HR) = 1.877, p=0.001; HR = 2.633, p = 0.001; respectively), and patient survival (HR = 1.796, p = 0.004; HR = 1.730, p = 0.044; respectively). The prognostic value of PEBP1 was then confirmed in the validation cohort. In addition, Western blot suggested that loss of PEBP1 led to hyperactivity of MAPK signaling." }, { "role": "assistant", "content": "Down-regulation of PEBP1 in HCC indicated aggressive tumor behaviors and predicted a worse clinical outcome, which may be a useful biomarker to identify the patients at high risk of post-operative recurrence. 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: Actins, Cell Line, Cells, Cultured, Escherichia coli, Fibroblasts, Gingiva, Humans, Immune Tolerance, Inositol Polyphosphate 5-Phosphatases, Interleukin-1 Receptor-Associated Kinases, Interleukin-10, Interleukin-6, Interleukin-8, Lipopolysaccharides, Periodontitis, Phosphoric Monoester Hydrolases, Porphyromonas gingivalis, Skin, Suppressor of Cytokine Signaling 1 Protein, Suppressor of Cytokine Signaling Proteins, Transforming Growth Factor beta1, src Homology Domains." }, { "role": "user", "content": "Are human gingival fibroblasts critical in sustaining inflammation in periodontal disease? Context: A major factor in the pathogenesis of periodontal disease, which is one of the biofilm infectious diseases, is thought to be lipopolysaccharide (LPS), owing to its ability to cause inflammation and promote tissue destruction. Moreover, the elimination of pathogens and their component LPSs is essential for the successful treatment of periodontal disease. Lipopolysaccharide tolerance is a mechanism that prevents excessive and prolonged responses of monocytes and macrophages to LPS. Since persistence of inflammation is necessary for inflammatory cytokine production, cells other than monocytes and macrophages are thought to maintain the production of cytokines in the presence of LPS. In this study, we investigated whether human gingival fibroblasts (HGFs), the most abundant structural cell in periodontal tissue, might be able to maintain inflammatory cytokine production in the presence of LPS bynot displaying LPS tolerance. Human gingival fibroblasts were pretreated with LPS (from Porphyromonas gingivalis and Escherichia coli) and then treated with LPS, and the amounts of interleukin (IL)-6 and IL-8 in the cell culture supernatants were measured. The expression of negative regulators of LPS signalling (suppressor of cytokine signalling-1, interleukin-1 receptor-associated-kinase M and SH2 domain-containing inositol-5-phosphatase-1) was also examined in LPS-treated HGFs. Human gingival fibroblasts did not display LPS tolerance but maintained production of IL-6 and IL-8 when pretreated with LPS, followed by secondary LPS treatment. Lipopolysaccharide-treated HGFs did not express negative regulators." }, { "role": "assistant", "content": "These results demonstrate that HGFs do not show LPS tolerance and suggest that this characteristic of HGFs sustains the inflammatory response in the presence of virulence factors. 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: Adolescent, Adult, Cystitis, Female, General Practice, Humans, Middle Aged, Midwifery, Netherlands, Obstetrics, Physical Therapy Specialty, Postpartum Period, Pregnancy, Prenatal Care, Primary Health Care, Referral and Consultation, Urinary Tract Infections, Young Adult." }, { "role": "user", "content": "Do pregnant women contact their general practitioner? Context: Midwives and obstetricians are the key providers of care during pregnancy and postpartum. Information about the consultations with a general practitioner (GP) during this period is generally lacking.The aim of this study is to compare consultation rates, diagnoses and GP management of pregnant women with those of non-pregnant women. Data were retrieved from the Netherlands Information Network of General Practice (LINH), a nationally representative register. This register holds longitudinal data on consultations, prescriptions and the referrals of all patients listed at 84 practices in the Netherlands in 2007-2009, including 15,123 pregnant women and 102,564 non-pregnant women in the same age-range (15 to 45 years). We compared consultation rates (including all contacts with the practice), diagnoses (ICPC-1 coded), medication prescriptions (coded according to the Anatomical Therapeutic Chemical classification system), and rate and type of referrals from the start of the pregnancy until six weeks postpartum (336 days). Pregnant women contacted their GP on average 3.6 times, compared to 2.2 times for non-pregnant women. The most frequently recorded diagnoses for pregnant women were 'pregnancy' and 'cystitis/urinary infection', and 'cystitis/urinary infection' and 'general disease not otherwise specified' for non-pregnant women. The mean number of prescribed medications was lower in pregnant women (2.1 against 4.4). For pregnant women, the most frequent referral indication concerned obstetric care, for non-pregnant women this concerned physiotherapy." }, { "role": "assistant", "content": "GP consultation rates in pregnancy and postpartum shows that GPs are important providers of care for pregnant women. Therefore, the involvement of GPs in collaborative care during pregnancy and postpartum should be reinforced." } ]

[ { "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, Antioxidants, Arachidonic Acid, Carcinoma, Hepatocellular, Cell Death, Cell Survival, DNA, Neoplasm, L-Lactate Dehydrogenase, Lipid Peroxidation, Liver Neoplasms, Experimental, Oxidative Stress, Phosphatidylcholines, Rats, Tumor Cells, Cultured." }, { "role": "user", "content": "Is dilinoleoylphosphatidylcholine the active antioxidant of polyenylphosphatidylcholine? Context: Polyenylphosphatidylcholine, a mixture of polyunsaturated phospholipids, prevents the fibrosis induced by alcohol in baboons and by CCl4 in rats and opposes the associated oxidative stress. To determine the responsible phosphatidylcholine species, a Morris hepatoma cell line (RH 7777) was incubated with 100 mumol/L arachidonate supplemented with 20 mumol/L dilinoleoylphosphatidylcholine or 20 mumol/L palmitoyllinoleoylphosphatidylcholine which comprise 42% and 24% of polyenylphosphatidylcholine, respectively or with equivalent amounts of polyenylphosphatidylcholine. Distearoylphosphatidylcholine, the saturated analog of dilinoleoylphosphatidylcholine, also was used for comparison. Two markers of lipid peroxidation (4-hydroxynonenal and F2-isoprostanes) were measured by GC/MS. Arachidonate caused 8- and 11-fold rises of cellular 4-hydroxynonenal and F2-isoprostanes, respectively; these increases were reduced more than 50% by polyenylphosphatidylcholine and dilinoleoylphosphatidylcholine. By contrast, palmitoyllinoleoylphosphatidylcholine and distearoylphosphatidylcholine had no significant effect. Lipid peroxidation was associated with a striking exacerbation of cell death, observed microscopically, and documented by a 2.5-fold decrease in cellular DNA and a 2- to 3-fold increase in lactic dehydrogenase leakage. Dilinoleoylphosphatidylcholine and polyenylphosphatidylcholine decreased the release of lactic dehydrogenase (47% and 67%, respectively); whereas, palmitoyllinoleoylphosphatidylcholine had no effect." }, { "role": "assistant", "content": "An in vitro system of oxidative stress revealed that polyenylphosphatidylcholine is a potent antioxidant and that dilinoleoylphosphatidylcholine is mainly responsible for this protective effect; whereas, its saturated counterpart distearoylphosphatidylcholine is inactive. 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, Blood Glucose, Body Mass Index, Cohort Studies, Disease Progression, Early Diagnosis, Fasting, Female, Follow-Up Studies, Humans, Hyperinsulinism, Insulin, Israel, Male, Middle Aged, Prediabetic State, Prospective Studies, Risk Factors, Sex Characteristics." }, { "role": "user", "content": "Does basal state hyperinsulinemia in healthy normoglycemic adults herald dysglycemia after more than two decades of follow up? Context: In a preliminary report, we found an association between hyperinsulinemia in the basal (fasting) state and the development of diabetes. The current analysis further explored the long term link between basal hyperinsulinemia and conversion to dysglycemia. This is a prospective study with up to 24 years of follow-up of 515 normoglycemic individuals (mean age at follow up = 70.3 ± 7.0; range 58-94) of an Israeli cohort. Fasting glucose and insulin were measured, and dysglycemia was defined as fasting glucose > 100 mg/dL. At the end of the follow-up period, almost half had progressed to dysglycemia. Male sex and elevated baseline levels of basal insulin, body mass index, blood glucose and blood pressure each favoured progression to dysglycemia over the subsequent two decades. A multivariate logistic regression model identified basal hyperinsulinemia as the strongest predictor for progression to dysglycemia (odds ratio = 1.79; 95% confidence interval 1.12-2.88), while controlling for ethnicity, blood pressure, fasting glucose, male sex, body mass index and age." }, { "role": "assistant", "content": "Basal hyperinsulinemia in normoglycemic adults constitutes an independent risk factor for metabolic deterioration to dysglycemia over adulthood, and may help to identify apparently healthy subjects at increased risk for diabetes. 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, Antineoplastic Combined Chemotherapy Protocols, Austria, Bleomycin, Cyclophosphamide, Czech Republic, Dacarbazine, Disease-Free Survival, Doxorubicin, Etoposide, Female, Germany, Hodgkin Disease, Humans, Male, Middle Aged, Prednisone, Procarbazine, Radiotherapy, Adjuvant, Switzerland, Treatment Outcome, Vinblastine, Vincristine." }, { "role": "user", "content": "Is bEACOPP , a new dose-escalated and accelerated regimen , at least as effective as COPP/ABVD in patients with advanced-stage Hodgkin 's lymphoma : interim report from a trial of the German Hodgkin 's Lymphoma Study Group? Context: The HD9 trial aims to evaluate whether moderate dose escalation and/or acceleration of standard polychemotherapy is beneficial for advanced-stage Hodgkin's disease (HD). Two variants of a novel bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) scheme (standard and escalated dose) are compared with cyclophosphamide, vincristine, procarbazine, and prednisone (COPP)/doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). The randomized, three-arm trial recruited patients in stages IIB and IIIA with risk factors and stages IIIB and IV. BEACOPP in baseline dose contains all drug dosages of COPP/ABVD (except vincristine and procarbazine) rearranged in a shorter, 3-week cycle. Escalated BEACOPP uses higher doses of cyclophosphamide, doxorubicin, and etoposide with granulocyte colony-stimulating factor (G-CSF) support. After eight chemotherapy cycles, initial bulky and residual disease is irradiated. The trial is monitored and analyzed by means of a sequential strategy. An interim analysis with 505 assessable patients and a median follow-up of 23 months showed a significant inferiority (according to sequential monitoring strategy) of the COPP/ABVD regimen in progression rate and freedom from treatment failure (FFTF) compared with the pooled results of both BEACOPP variants. The 24-month FFTF rate was 75% for COPP/ABVD and 84% for BEACOPP pooled (P = .034). There was 12% progressive disease with COPP/ABVD and 6% with BEACOPP pooled. Differences in survival were not significant in sequential analysis. The acute toxicity of baseline BEACOPP resembled that of COPP/ABVD; escalated BEACOPP showed increased but manageable hematologic toxicity." }, { "role": "assistant", "content": "Combined with local irradiation, BEACOPP in one or both variants shows superior disease control compared with COPP/ABVD, with acceptable acute toxicity. Further follow-up is required to assess the effect of dosage and the effect on survival and late toxicities. 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": "Advantage of palatal strap:" }, { "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": "A 2-year-old child presented with diarrhoea and failure to thrive, Blood examination shows – Na = 122,K – 6. He is most probably suffering from –" }, { "role": "assistant", "content": "The correct answer is Na+ is 122 (hyponatremia). That means, there is salt losing enzyme deficiency, causing hyponatremia and hyperkalemia.\n21 hydroxylase deficiency causes hyponatremia and hyperkalemia. 17α -hydroxylase and 11-β -( hydroxylase deficiency cause hypernatremia and hypokalemia.\nButter syndrome causes excessive loss of Na+, K+ and Cl causing severe hypokalemia and hyponatremia." } ]

[ { "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": "Wof is true regarding tolerance occurring in regular opium abusers" }, { "role": "assistant", "content": "The correct answer is Tolerance and dependence :- High degree of tolerance can be developed to morphine and related opioids if the drug is used repeatedly. It is paly pharmacokinetic (enhanced rate of metabolism), but mainly pharmacodynamic (cellular tolerance). Tolerance is exhibited to most actions, but not to constipating and miotic actions. Addicts tolerate morphine in grams: lethal dose is markedly increased. Ref:- kd tripathi; pg num:-473" } ]

[ { "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, MATERIALS AND METHODS, RESULTS. Meshes: Age Distribution, Age of Onset, Analysis of Variance, Child, Preschool, Cross-Sectional Studies, Female, Humans, Incidence, Infant, Male, Probability, Prognosis, Reference Values, Registries, Risk Assessment, Sensitivity and Specificity, Severity of Illness Index, Sex Distribution, Time Factors, Toilet Training, Urinary Tract Infections, Vesico-Ureteral Reflux." }, { "role": "user", "content": "Is age at toilet training associated with the presence of vesicoureteral reflux or the occurrence of urinary tract infection? Context: We sought to determine whether age at toilet training is influenced by a history of vesicoureteral reflux or urinary tract infection. We reviewed records on 1,184 patients treated at a pediatric urology practice. All patients had information available regarding age at toilet training, renal sonography and voiding cystourethrography, and presence or absence of urinary tract infection. We evaluated possible associations between vesicoureteral reflux and urinary tract infection, and age at toilet training. Of 1,184 patients 280 had unilateral reflux, 339 had bilateral reflux and 565 had normal anatomy. Also, 926 patients had urinary tract infections. Girls tended to be toilet trained 3 months earlier than boys (p<0.001) in all subgroups (normal anatomy, unilateral reflux, bilateral reflux). Children with and without urinary tract infections were toilet trained at similar ages. However, timing of the first urinary tract infection seemed to be associated with age at toilet training. For girls a urinary tract infection occurring earlier tended to delay toilet training, while earlier toilet training seemed to be associated with a later urinary tract infection (p<0.001). The patterns were similar for boys but were not statistically significant." }, { "role": "assistant", "content": "Age at toilet training seems to be independent of the presence of vesicoureteral reflux. Urinary tract infection itself is not necessarily associated with age at toilet training. However, timing of the first urinary tract infection seems to be related to age at toilet training." } ]

[ { "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": "Plaster of paris:" }, { "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": "Secondary tumour may spread to the orbit by all of the following except:" }, { "role": "assistant", "content": "The correct answer is Ans. Via lymphatic channels" } ]

[ { "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, Alleles, Case-Control Studies, Female, Genes, p53, Genetic Predisposition to Disease, Genotype, Humans, Leiomyoma, Middle Aged, Polymorphism, Restriction Fragment Length, Prospective Studies, Tumor Suppressor Protein p53, Uterine Neoplasms." }, { "role": "user", "content": "Is polymorphism of the p53 tumor suppressor gene associated with susceptibility to uterine leiomyoma? Context: To evaluate the association between the presence of uterine leiomyoma and two single nuclear polymorphisms of the p53 tumor suppressor and the angiopoietin-2 (ANGPT2) genes. Prospective case control study. Academic research institution. One hundred thirty-two women with clinically and surgically diagnosed uterine leiomyomas and 280 controls. Peripheral venous puncture. Genotyping was performed by polymerase chain reaction-based amplification of the Arg and Pro variants at codon 72 of the p53 gene and by restriction fragment length polymorphism analysis of the G/G and G/A alleles in exon 4 of the ANGPT2 gene. Comparing women with uterine leiomyomas and controls, no statistically significant difference with respect to allele frequency and genotype distribution were ascertained for the ANGPT2 polymorphism (P=.2 and P=.5, respectively). However, for the p53 tumor suppressor gene polymorphism, statistically significant differences in terms of a higher Pro allele frequency and a higher prevalence of the Pro/Pro genotype among women with uterine leiomyoma (32.0% vs. 16.0%, respectively, and 21.3% vs. 4.7%, respectively) were ascertained (P=.001, OR 1.74; 95% CI 1.24-2.45, P=.001; OR 3.84, 95% CI 1.81-8.14; respectively)." }, { "role": "assistant", "content": "Carriage of the p53 polymorphism at codon 72 predicts the susceptibility to leiomyoma in a Caucasian population and may contribute to the pathogenesis of uterine leiomyoma. 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, PATIENTS AND METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Carcinoma, Pancreatic Ductal, Cohort Studies, Disease-Free Survival, History, Ancient, Humans, Lymph Node Excision, Lymph Nodes, Lymphatic Metastasis, Male, Middle Aged, Multivariate Analysis, Neoplasm Invasiveness, Neoplasm Staging, Pancreatectomy, Pancreatic Neoplasms, Pancreaticoduodenectomy, Prognosis, Retrospective Studies." }, { "role": "user", "content": "Adenocarcinoma of the pancreas: Does prognosis depend on mode of lymph node invasion? Context: Lymph node (LN) invasion in pancreatic ductal adenocarcinoma (PDAC) is the most important prognostic factor after surgical resection. The mechanisms of LN invasion include lymphatic spreading and/or direct extension from the main tumor. However, few studies have assessed the impact of these different patterns of invasion on prognosis. Pathologic reports of pancreatic resections for PDAC from 1997 to 2007 were retrospectively analyzed. The mode of LN invasion was defined as follows: standard lymphatic metastases (S), contiguous from the main tumor (C) and standard with extracapsular invasion (EI). Clinical outcomes were compared according to the mode of invasion and the number of invaded LN. 306 patients were reviewed. Median age at resection was 61 years (range, 34-81). Eighty seven patients were N- (28.9%) and 214 were N+ (71.1%). Of the N+ patients, 195 (91.1%) were S+, 35 (16.3%) were C+, and 24 (12.3% of the S+ patients) were EI+. Median survival in N+ patients was lower than in N- patients (29 vs. 57 months, p<0.001). In patients without standard involvement, C+ patients (n = 19) had worse survival than C- patients (n = 47) (34 vs. 57 months, p = 0.037). In S+ patients, C status was correlated with prognosis when the number of LN S+ was<2 (p = 0.07). EI status had no influence on prognosis. On multivariate analysis, only perineural invasion (p = 0.02) and LN ratio (p = 0.042) were independent prognostic factors." }, { "role": "assistant", "content": "Direct invasion of LN by the tumor is predictive of reduced survival, but has little impact compared to standard LN involvement and perineural invasion." } ]

[ { "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: Adenocarcinoma, Animals, Biological Assay, Blotting, Western, Cricetinae, Cyclic AMP, Cyclic AMP Response Element-Binding Protein, Extracellular Signal-Regulated MAP Kinases, Lung Neoplasms, Male, Mesocricetus, Models, Animal, Nitrosamines, Phosphorylation, Random Allocation, Retinoids, Signal Transduction, Time Factors, beta Carotene." }, { "role": "user", "content": "Does beta-Carotene promote the development of NNK-induced small airway-derived lung adenocarcinoma? Context: beta-Carotene has shown cancer-preventive effects in preclinical studies while increasing lung cancer mortality in clinical trials. We have shown that beta-carotene stimulates cAMP signalling in vitro. Here, we have tested the hypothesis that beta-carotene promotes the development of pulmonary adenocarcinoma (PAC) in vivo via cAMP signalling. PAC was induced in hamsters with the carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), followed by beta-carotene for 1.5 years. Incidence, multiplicity and size of lung tumours were recorded, and phosphorylated CREB and ERK1/2 in tumour cells were determined by Western blots. Cyclic AMP in blood cells was analysed by immunoassays, retinoids in serum and lungs by HPLC. beta-Carotene increased lung tumour multiplicity, lung tumour size, blood cell cAMP, serum and lung levels of retinoids and induced p-CREB and p-ERK1/2 in lung tumours." }, { "role": "assistant", "content": "Our data suggest that beta-carotene promotes the development of PAC via increased cAMP 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: BACKGROUND, METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Attitude to Health, Data Collection, Drug and Narcotic Control, Female, Health Policy, Humans, Male, Middle Aged, Norway, Public Opinion, Young Adult." }, { "role": "user", "content": "Does it matter how you ask? Context: It is important to know whether the public opinion on drug policies can be measured in a reliable and valid way. One of the threats to the validity of surveys on attitudes toward drug policies are wording effects, of which the most well-known is the forbid-allow asymmetry, i.e., people are often more willing to not allow something than to forbid it. The aim of the present study was to estimate the size of the allow-forbid asymmetry when measuring attitudes toward drug policy issues in the Norwegian adult population. The data derive from a sample of 2182 adult Norwegian, aged 18-70, drawn from a large online panel comprising more than 50,000 Norwegian citizens (55% response rate). According to a 2 (allow vs. forbid)×2 (question vs. statement) between-subjects design, participants indicated support for the following three restrictive drug policies: (i) to allow/forbid wine in grocery stores, (ii) to allow/forbid smoking in parks and other public places and (iii) to allow forbid cannabis for recreational purposes. There was not a significant difference between the framing conditions (forbid-allow) across the three policies, with an estimated difference of 2 percentage points (95% confidence intervals 0-5)." }, { "role": "assistant", "content": "The results suggest that survey research in the present context of drug policy is indeed more of a fact-finding enterprise than a process of constructing data." } ]

[ { "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": "Macroglobulin is derived from" }, { "role": "assistant", "content": "The correct answer is Ref Robbins 9/e p191 alpha-2-Macroglobulin (a2M) is a large (720 KDa) plasma protein found in the blood. It is mainly produced by the liver, and also locally synthesized by macrophages, fibroblasts, and adrenocoical cells. In humans it is encoded by the A2M gene" } ]

[ { "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 Disease, Adenoviridae, Cell Line, Tumor, Flow Cytometry, Genetic Vectors, Genome, Viral, Humans, Leukemia, Myeloid, Polymerase Chain Reaction, Transduction, Genetic." }, { "role": "user", "content": "Does short-term culture of myeloid leukemic cells allow efficient transduction by adenoviral vectors? Context: Ex vivo gene therapy of acute myeloid leukemia (AML) requires efficient transduction of leukemic cells. Recombinant adenovirus has been reported to be a poorly efficient vector in leukemic cells. We investigated leukemic cell culture as a possible method of improving the efficacy of this vector. Leukemic cell lines and primary cultured AML cells were incubated with adenoviral vectors carrying GFP, LacZ, or IL-12 cDNA. Transduction efficiency was evaluated by measuring adenoviral genome copy number and transgene expression in leukemic cells. The expression of the coxsackie/adenovirus receptor (CAR), CD29, CD49e, and CD51/61 was measured, as was the effect of blocking integrin on adenoviral transduction. Increasing the multiplicity of infection (MOI) to 300 plaque-forming units per cell enhanced transduction of leukemic cell lines and to a lesser degree of AML cells. Analysis of adenoviral genome copy per cell showed only a partial correlation between gene transfer efficiency and transgene expression. Culture of AML cells for 3 days prior to adenoviral transduction increased both adenoviral copy number per cell and the percentage of transgene-expressing cells. CD29, CD49e, and CD51/61 but not CAR expression increased in cultured AML cells between days 0 and 3 and integrin-blocking experiments showed inhibition of transduction in two of four AML samples tested." }, { "role": "assistant", "content": "Efficient ex vivo gene transfer in primary cultured AML cells can be achieved by short-term culture of leukemic cells prior to gene transfer with adenoviral vectors at a high MOI. This effect appears to be at least partially mediated by enhanced integrin expression. 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": "Absolute contraindication of hormone replacement therapy is:" }, { "role": "assistant", "content": "The correct answer is Ans. is a, i.e. ThrombosisRef: Novak 15th/ed, p1245; John Hopkins Manual of Obs and Gynae 4th/ed, p510MnemonicA = Active liver disease/or Gallbladder diseaseB = Undiagnosed vaginal bleedingC = Cancers of endometrium and breastD = Deep vein thrombosis" } ]

[ { "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: Acetylcholine, Adult, Aged, Analysis of Variance, Antioxidants, Ascorbic Acid, Blood Pressure, Circadian Rhythm, Endothelium, Vascular, Female, Forearm, Humans, Hypertension, Injections, Intravenous, Male, Middle Aged, Nitroprusside, Oxidative Stress, Plethysmography, Regional Blood Flow, Vasodilator Agents, Young Adult." }, { "role": "user", "content": "Does oxidative stress impair endothelial function in nondipper hypertensive patients? Context: Essential hypertension, as well as other established cardiovascular risk factors, is associated with endothelial dysfunction. Hypertensive patients with a nondipper circadian pattern have a greater risk of cerebrovascular and cardiovascular complications in comparison with those with a dipper circadian pattern. In this study, we evaluated the association between nondipper pattern and endothelial function in patients with essential hypertension. We evaluated the forearm blood flow (FBF) response to intraarterial acetylcholine (ACh), an endothelium-dependent vasodilator, and sodium nitroprusside (SNP), an endothelium-independent vasodilator, infusions in 190 hypertensive patients stratified according to dipper and nondipper status. The FBF was measured by strain-gauge plethysmography. Effects of oxidative stress on FBF were evaluated by intraarterial infusion of vitamin C. Ambulatory BP monitorings were obtained by a validated oscillometric device (SpaceLabs 90207 Monitor Inc., Issaquah, WA, USA). Systolic and diastolic blood pressures were higher during daytime and lower during night-time in dipper subjects than in nondippers. The peak percent increase in ACh-stimulated FBF was higher in dippers than in nondippers (473% vs. 228%, P < 0.001). The FBF responses to SNP were similar in dipper and nondipper patients. The FBF response to ACh during coinfusion of vitamin C was higher in nondippers rather than in dipper hypertensives." }, { "role": "assistant", "content": "Present data demonstrate that endothelium-dependent vasodilation is impaired in patients who have nondipper hypertension. The effects of vitamin C on impaired ACh-stimulated vasodilation support the hypothesis that oxidative stress contributes to endothelial dysfunction of nondipper hypertensive patients. 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 15-year-old Caucasian female presents with Parkinson-like symptoms. Serum analysis shows increased levels of free copper and elevated liver enzymes. What test would prove most helpful in diagnosing the patient's underlying disease?" }, { "role": "assistant", "content": "Slit lamp examination" } ]

[ { "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 median of values 2,5,7,10,10,13,25 :" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e. 10 Median is calculated by arranging the data in an ascending or descending order of magnitude and then the value of the middle observation is located." } ]

[ { "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, METHOD, MAIN OUTCOME MEASURE, RESULTS. Meshes: Adult, Communication Barriers, Community Pharmacy Services, Cross-Sectional Studies, Drug-Related Side Effects and Adverse Reactions, Female, Humans, Male, Middle Aged, Multilingualism, Patient Education as Topic, Patient Safety, Pharmacists, Surveys and Questionnaires, Switzerland." }, { "role": "user", "content": "Communication barriers in counselling foreign-language patients in public pharmacies: threats to patient safety? Context: Foreign-language (FL) patients are at increased risk for adverse drug events. Evidence regarding communication barriers and the safety of pharmaceutical care of FL patients in European countries is scarce despite large migrant populations. To investigate Swiss public pharmacists' experiences and current practices in counselling FL patients with a focus on patient safety. In a cross-sectional study heads of public pharmacies in Switzerland were surveyed using an electronic questionnaire. The survey assessed the frequency of communication barriers encountered in medication counselling of FL patients, perceptions of risks for adverse drug events, satisfaction with the quality of counselling provided to FL patients, current strategies to reduce risks, and preferences towards tools to improve safety for FL patients. 498 pharmacists completed the survey (43 % response rate). More than every second pharmacist reported at least weekly encounters at which they cannot provide good medication counselling to FL patients in the regional Swiss language. Ad-hoc interpreting by minors is also common at a considerable number of pharmacies (26.5 % reported at least one weekly occurrence). Approximately 10 % of pharmacies reported that they fail at least weekly to explain the essentials of drug therapy (e.g. dosing of children's medications) to FL patients. 79.8 % perceived the risk of FL patients for adverse drug events to be somewhat or much higher compared to other patients. 22.5 % of pharmacists reported being concerned at least monthly about medication safety when FL patients leave their pharmacy. However, the majority of pharmacists were satisfied with the quality of care provided to FL patients in their pharmacy [78.6 % (very) satisfied]. The main strategy used to improve counselling for FL patients was the employment of multilingual staff. Participants would use software for printing foreign-language labels (41.2 %) and multilingual package inserts (42.0 %) if these were available." }, { "role": "assistant", "content": "Communication barriers with FL patients are frequent in Swiss pharmacies and pharmacists perceive FL patients to be at increased risk for adverse drug events. Development and dissemination of communication tools are needed to support pharmacists in counselling of a diverse migrant population." } ]

[ { "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, Angina, Unstable, Anti-Bacterial Agents, Atherosclerosis, Chlamydophila Infections, Chlamydophila pneumoniae, Clarithromycin, Coronary Artery Bypass, Double-Blind Method, Drug Administration Schedule, Female, Humans, Male, Middle Aged, Myocardial Infarction, Peripheral Vascular Diseases, Stroke, Surgical Wound Infection, Treatment Outcome." }, { "role": "user", "content": "Does treatment with clarithromycin prior to coronary artery bypass graft surgery prevent subsequent cardiac events? Context: Recently, it has been suggested that Chlamydia pneumoniae possibly plays a possible role in the pathogenesis of atherosclerosis. We investigated whether treatment with clarithromycin prior to coronary artery bypass graft (CABG) surgery would prevent subsequent cardiovascular events and mortality. Patients who were scheduled for CABG surgery were randomly assigned to receive either clarithromycin or placebo until the day of surgery in a double-blind trial. During the 2 years of follow-up, mortality and cardiovascular events were assessed. Follow-up at 2 years was achieved for 473 patients. The mean duration of treatment was 16 days. Patient characteristics at baseline were well balanced between the 2 treatment groups. Mortality was equal in the 2 groups: 10 (4.2%) of 238 patients in the clarithromycin group and 9 (3.8%) of 235 patients in the placebo group (relative risk, 1.10; 95% CI, 0.42-2.89; P=1.0). Also, there were no significant differences in the proportion of patients who experienced cardiovascular events during the follow-up period: 20 (8.4%) of 238 patients in the clarithromycin group and 19 (8.1%) of 235 patients in the placebo group (relative risk, 1.04; 95% CI, 0.55-1.98; P=1.0). The overall rate of such events was 58 (12.3%) of 473 patients." }, { "role": "assistant", "content": "Treatment with clarithromycin in patients scheduled for CABG surgery did not reduce the subsequent occurrence of cardiovascular events or mortality during a 2-year follow-up period. 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": "A 57-year-old male is found to have an elevated prostate specific antigen (PSA) level on screening labwork. PSA may be elevated in prostate cancer, benign prostatic hypertrophy (BPH), or prostatitis. Which of the following best describes the physiologic function of PSA?" }, { "role": "assistant", "content": "Liquefaction of semen" } ]

[ { "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: Algorithms, Breast Feeding, Child, Child, Preschool, Cohort Studies, Denmark, Female, Follow-Up Studies, Humans, Hypersensitivity, Immunization, Immunoglobulin E, Infant, Male, Prospective Studies." }, { "role": "user", "content": "Does breast-feeding protect against allergic sensitization in early childhood and allergy-associated disease at age 7 years? Context: Extended breast-feeding is recommended for newborn children at risk of allergy-associated diseases, but the evidence of a protective effect on sensitization and these diseases remains elusive. The aim of this study was to investigate the effects of the duration of exclusive breast-feeding on the development of sensitization in preschool children. Information on breast-feeding was gathered by interviews involving 335 children aged 1, 6, and 12 months from the Copenhagen Prospective Study on Asthma in Childhood2000 birth cohort born to mothers with a history of asthma. Skin prick test responses and specific IgE levels against 12 common inhalant and 10 food allergens were assessed longitudinally at ages ½ year, 1½ years, 4 years, and 6 years. Eczema, wheeze/asthma, and allergic rhinitis were diagnosed at the Copenhagen Prospective Studies on Asthma in Childhood clinic at 7 years of age, strictly adhering to predefined algorithms. Associations between duration of exclusive breast-feeding and outcomes were analyzed by logistic regression. We found no significant association between duration of exclusive breast-feeding and development of sensitization in the first 6 years of life (odds ratio [OR]: ½ year, 1.10 [95% CI, 0.90-1.36]; 1½ years, 1.15 [95% CI, 0.97-1.36]; 4 years, 1.08 [95% CI, 0.93-1.25]; and 6 years, 0.96 [95% CI, 0.84-1.10]) or with current eczema, wheeze/asthma, and allergic rhinitis at age 7 years (OR, 1.07 [95% CI, 0.92-1.24]; OR, 0.97 [95% CI, 0.82-1.14]; and OR, 1.02 [95% CI, 0.84-1.23], respectively). Adjusting for reverse causation by excluding children with eczema, wheeze, or a positive skin prick test response before ending exclusive breast-feeding did not alter the results." }, { "role": "assistant", "content": "Exclusive breast-feeding does not affect sensitization in early childhood or associated diseases at 7 years of age in at-risk children. 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: UNLABELLED, PATIENTS AND METHODS, RESULTS. Meshes: Aged, Cystectomy, Female, Follow-Up Studies, Humans, Male, Mucous Membrane, Neoplasm Staging, Prognosis, Retrospective Studies, Risk Factors, Survival Analysis, Treatment Outcome, Urinary Bladder, Urinary Bladder Neoplasms." }, { "role": "user", "content": "Does the presence of muscularis propria on transurethral resection of bladder tumour specimens affect the rate of upstaging in cT1 bladder cancer? Context: OBJECTIVE • To determine how the presence of MP on T1 biopsy specimens affects the outcome of patients undergoing RC as compared to when no MP is identified in the TURBT specimen. • Patients were retrospectively identified from the Columbia University Urologic Oncology Database. • From January 1986 to October 2009, 114 patients diagnosed with cT1N0M0 bladder cancer who underwent RC within 4 months of their last biopsy were identified. • Patients were stratified based on the presence of MP on T1 biopsy, and upstaging was defined as any tumor T2 or greater, N+, or M+ at the time of radical cystectomy. • The rate of upstaging was assessed using univariate and multivariate regression models; Kaplan meier curves were also extrapolated for each cohort to compare disease specific and overall survival patterns. • Of the 114 patients evaluated in this study, 24 (20.2%) did not have MP on their T1 biopsy before RC. The rate of upstaging (>=pT2) stratified by the presence of MP on biopsy was 50% and 78%, respectively (p = 0.017). • On univariate analysis, lack of MP on biopsy was associated with an increased risk of upstaging (HR 3.52, p = 0.021, CI 1.2-10.3), however did not reach significance as an independent predictor (HR 2.9, p = 0.056, CI 0.97-8.9). • At a mean follow-up of 33.5 months, there was no difference in disease specific (p = 0.41) and overall survival (p = 0.68) between groups." }, { "role": "assistant", "content": "• The lack of MP on TURBT for high grade cT1N0M0 bladder cancer portends a high likelihood of upstaging at RC, although this risk did not translate into a detectable increased risk of disease specific 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: PURPOSE, MATERIALS AND METHODS, RESULTS. Meshes: Adolescent, Attitude to Health, Cross-Sectional Studies, Emotions, Health Services Needs and Demand, Humans, Index of Orthodontic Treatment Need, Interpersonal Relations, Male, Malocclusion, Oral Health, Quality of Life, Surveys and Questionnaires." }, { "role": "user", "content": "Do malocclusions affect the oral health-related quality of life? Context: The aim of this study was to assess the relationship between untreated malocclusions and oral health-related quality of life (OHRQOL) in male adolescents of Mashad (Iran) high schools. In this observational cross-sectional descriptive study, 120 male students were randomly selected among Mashad (Iran) high schools. These students filled out an oral health-related quality of life questionnaire (the modified version of CPQ), and then they were clinically examined to determine their malocclusions according to the Index of Complexity, Outcome and Need (ICON), and finally the relationship between these two variables was assessed with the Pearson correlation test. There was a statistically significant relationship between ICON scores and the quality of life levels (P<0.01). The assessment of four sections of the questionnaire showed that among these four sections (oral symptoms, functional limitations, emotional well-being, social well-being), only oral symptoms were significantly correlated with the ICON score (P<0.05)." }, { "role": "assistant", "content": "Malocclusion plays an important role in the oral health-related quality of life. However, the relationship between emotional well-being, social well-being and malocclusions was not as strong as in previous studies." } ]

[ { "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, RESULTS. Meshes: Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Cross-Sectional Studies, Culture, Diet, Energy Intake, Female, Glycemic Index, Glycemic Load, Humans, Japan, Middle Aged, Surveys and Questionnaires." }, { "role": "user", "content": "Is a Japanese diet with low glycaemic index and glycaemic load associated with both favourable and unfavourable aspects of dietary intake patterns in three generations of women? Context: Western studies have suggested cultural differences in food and nutrient intake patterns associated with dietary glycaemic index (GI) and glycaemic load (GL). Here, we conducted a cross-sectional study to examine the GI and GL of Japanese diets in relation to food and nutrient intakes. Dietary intake was assessed using a validated, self-administered, diet history questionnaire. A total of thirty-five of forty-seven prefectures in Japan. Young (age 18 years), middle-aged (mean age 48 years) and older (mean age 74 years) Japanese women (n 3961, 3800 and 2202, respectively). Irrespective of age, a positive association with dietary GI was seen for white rice only, which contributed most (37-42 %) to the variation in dietary GI. Conversely, all other food groups (such as fruit and vegetable juice, dairy products, noodles and fruit) were negative predictors of dietary GI. For dietary GL, 95-96 % of variation was explained by carbohydrate-rich food groups, all of which were positive predictors of GL. After adjustment for potential confounding factors, only carbohydrate intake was positively associated with dietary GI and GL, irrespective of age. Conversely, dietary GI and GL were inversely associated with intakes of all other nutrients examined (including SFA and Na)." }, { "role": "assistant", "content": "A low-GI and -GL diet, which was characterized principally by a low intake of white rice, was associated with both favourable (higher intakes of dietary fibre and key vitamins and minerals) and unfavourable (higher intakes of SFA and Na) aspects of dietary intake patterns in three generations of Japanese 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 is not a type of Vaccine derived polio virus?" }, { "role": "assistant", "content": "The correct answer is Vaccine derived polio virus (VDPV)\n\nProperties of VDPV:\n\n– Occurs due to Sabin (OPV) vaccine: P3 (60% of all cases) > P2 > P1\n– Clinical presentation indistinguishable from Wild polio virus (WPV)\n– cVDPV present similar public health threat like WPV\n– iVDPV prolonged infection may transmit virus to others\n\nIncidence of VDPV: 4 cases per million birth cohort per year\nTypes of VDPV:\n\n– cVDPV: Person-to-person transmission in community\n– iVDPV: Isolates from immunodeficient persons\n– aVDPV: Ambiguous from healthy person or sewage isolates\n\nKey risk factors for cVDPV emergence:\n\n– Development of immunity gaps (due to low OPV coverage)\n– Prior elimination of WPV types\n– Low routine immunization coverage with trivalent OPV\n– Insensitive AFP surveillance\n\nDiagnosis:\n\n– Real time Reverse transcription\n– PCR nucleic acid amplification" } ]

[ { "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, Carcinoma, Squamous Cell, DNA, Viral, Disease-Free Survival, Female, Humans, Male, Middle Aged, Papillomaviridae, Papillomavirus Infections, Paranasal Sinus Neoplasms, Prognosis, Survival Analysis." }, { "role": "user", "content": "Are human papillomaviruses identified in a subgroup of sinonasal squamous cell carcinomas with favorable outcome? Context: The role of human papillomavirus (HPV) in the pathogenesis of squamous cell carcinomas (SCCs) of the sinonasal tract and its clinicopathological implications were evaluated. All SCCs of the sinonasal tract diagnosed in the Hospital Clinic of Barcelona from 1981 to 2006 were retrospectively evaluated (N = 60). Clinical and pathological data were reviewed. HPV infection was determined and typed by amplification of HPV DNA by polymerase chain reaction using the SPF-10 primers. p16(INK4a) expression was determined by immunohistochemistry. Overall and progression-free survival for HPV-positive and -negative patients was estimated by Kaplan-Meier analysis and by the use of a multivariate Cox proportional hazards model. HPV DNA was detected in tumor tissue of 12 of 60 (20%) patients. HPV16 was identified in 11 tumors and HPV35 in 1. Immunohistochemistry for p16(INK4a) stained all HPV-positive and no HPV-negative tumors (P < .001). No differences were observed in terms of site and histological grade or stage at presentation between HPV-positive and -negative tumors. However, HPV-positive patients had a significantly better 5-year progression-free survival (62%; 95% confidence interval [CI], 23%-86% vs 20%; 95% CI, 9%-34%; P = .0043, log-rank test) and overall survival (80%; 95% CI, 20%-96% vs 31%; 95% CI, 15%-47%; P = .036, log-rank test) than patients with HPV-negative tumors. In multivariate analysis, HPV-positive tumors were associated with improved progression-free survival (hazard ratio, 0.21; 95% CI, 0.17-0.98; P = .012)." }, { "role": "assistant", "content": "A subgroup of sinonasal SCCs is associated with HPV infection. These tumors have a significantly better prognosis. 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, METHODS, RESULTS. Meshes: Alleles, Child, Cognition Disorders, Congenital Hypothyroidism, DNA Mutational Analysis, Female, Growth Disorders, Humans, Mutation, Phenotype, Symporters." }, { "role": "user", "content": "Does sodium/Iodide Symporter Mutant V270E cause Stunted Growth but No Cognitive Deficiency? Context: Iodide (I(-)), an essential constituent of the thyroid hormones, is actively accumulated in the thyroid by the Na(+)/I(-) symporter (NIS), a key plasma membrane protein encoded by the slc5a5 gene. Mutations in slc5a5 cause I(-) transport defects (ITDs), autosomal-recessive disorders in which I(-) accumulation is totally or partially impaired, leading to congenital hypothyroidism. The characterization of NIS mutants has yielded significant insights into the molecular mechanism of NIS. This study aimed to determine the basis of a patient's ITD clinical phenotype, by sequencing her slc5a5 gene. Genomic DNA was purified and the slc5a5 gene sequence determined. Functional in vitro studies were performed to characterize the V270E NIS mutant. The index patient was diagnosed with hypothyroidism with minimal radioiodide uptake in a normally located, although enlarged, thyroid gland. We identified a new NIS mutation: V270E. The patient had the compound heterozygous NIS mutation R124H/V270E. R124H NIS has been characterized previously. We show that V270E markedly reduces I(-) uptake via a pronounced (but not total) impairment of the protein's plasma membrane targeting. Remarkably, V270E is intrinsically active. Therefore, a negative charge at position 270 interferes with NIS cell surface trafficking. The patient's minimal I(-) uptake enabled sufficient thyroid hormone biosynthesis to prevent cognitive impairment." }, { "role": "assistant", "content": "A nonpolar residue at position 270, which all members of the SLC5A family have, is required for NIS plasma membrane targeting. 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: Blood Transfusion, Autologous, Cell Separation, Filtration, Humans, Leukocytes, Neoplastic Cells, Circulating, Tumor Cells, Cultured." }, { "role": "user", "content": "Does leucocyte depletion filter remove cancer cells in human blood? Context: Autologous blood transfusion has been avoided in cancer surgery because of the metastatic potential of reinfused tumour cells. This study evaluated the efficacy of a blood transfusion filter in removing tumour cells from blood. Whole human blood was admixed with two different malignant cell lines (breast cancer PM1 and MCF7). The blood was filtered through a RC400TE leucocyte depletion filter. Unfiltered blood was used as a control. Detection of malignant cells was performed with immunomagnetic beads and clonogenic assays. No viable tumour cells were found after filtration with the leucocyte depletion filter." }, { "role": "assistant", "content": "These findings suggest that the use of a leucocyte filter after intra-operative blood salvage may make autotransfusion safe even in tumour surgery. 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": "Sensory nerve supply if soft palate includes all 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": "Shenton line is seen in X-ray of:" }, { "role": "assistant", "content": "The correct answer is Ans. d. Hip (Ref Apley 9/e p354)Shenton's line is seen in X-ray of hip.\"Shenton's line is an imaginary line drawn along the inferior border of the superior pubic ramus (superior border of the obturator foramen) and along the inferomedial border of the neck of femur. This line should be continuous and smooth. It is breeched in fracture neck of femur, head of femur, superior pubic rami and dislocation of hip.\"Radiological Features of Congenital Dislocation of Hip (Developmental Dysplasia of Hip)In Von Rosen's view (both hips abducted, internally rotated and extended) following parameters are seenHilgenreiner's (H) line: Horizontal line through trirad radiate cartilagesQPerkin's line: Vertical line drawn at the outer border of acetabulum and is perpendicular to H-lineQ.Acetabular index: Angle formed by junction of H line and line drawn along acetabular surfaceQShenton's line: Smooth curve formed by inferior border of neck of femur with superior margin of obturator foramenQCenter-Edge Angle of Wilberg: Angle between Perkin's line and a line drawn from lateral lip of acetabulum through the center of femoral headQ." } ]

[ { "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": "Iatrogenic traumatic facial nerve palsy is MOST commonly produced during which of the following surgical procedure?" }, { "role": "assistant", "content": "The correct answer is Iatrogenic facial nerve trauma most often occurs during mastoidectomy. When injury occur to more than 50% of the neural diameter either primary reanastomosis or reconstruction using a nerve graft is done. Complications of mastoidectomy includes: Infection Labrynthitis ossificans Mucosalization of the middle ear Facial nerve injury CSF leak Encephalocele" } ]

[ { "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, BACKGROUND, METHODS, RESULTS. Meshes: Aged, Aged, 80 and over, Female, Humans, Intestinal Obstruction, Intestine, Small, Male, Postoperative Complications, Proportional Hazards Models, Radiotherapy, Radiotherapy, Adjuvant, Rectal Neoplasms, Risk Factors, SEER Program, Time Factors." }, { "role": "user", "content": "Does postoperative irradiation for rectal cancer increase the risk of small bowel obstruction after surgery? Context: To determine the risk of small bowel obstruction (SBO) after irradiation (RT) for rectal cancer : SBO is a frequent complication after standard resection of rectal cancer. Although the use of RT is increasing, the effect of RT on risk of SBO is unknown. We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results cancer registry data linked to Medicare claims data to determine the effect of RT on risk of SBO. Patients 65 years of age and older diagnosed with nonmetastatic invasive rectal cancer treated with standard resection from 1986 through 1999 were included. We determined whether patients had undergone RT and evaluated the effect of RT and timing of RT on the incidence of admission to hospital for SBO, adjusting for potential confounders using a proportional hazards model. We identified a total of 5606 patients who met our selection criteria: 1994 (36%) underwent RT, 74% postoperatively. Patients were followed for a mean of 3.8 years. A total of 614 patients were admitted for SBO over the study period; 15% of patients in the RT group and 9% of patients in the nonirradiated group (P < 0.001). After controlling for age, sex, race, diagnosis year, type of surgery, and stage, we found that patients who underwent postoperative RT were at higher risk of SBO, hazard ratio 1.69 (95% CI, 1.3-2.1). However, the long-term risk associated with preoperative irradiation was not statistically significant (hazard ratio, 0.89; 95% CI, 0.55-1.46)." }, { "role": "assistant", "content": "Postoperative but not preoperative RT after standard resection of rectal cancer results in an increased risk of SBO over time. 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, Longevity, Lung, Magnetic Resonance Imaging, Matrix Metalloproteinase 13, Mice, Mice, Inbred C57BL, Mice, Knockout, Pulmonary Fibrosis, Radiation Pneumonitis, Tomography, X-Ray Computed." }, { "role": "user", "content": "Does loss of matrix metalloproteinase-13 attenuate murine radiation-induced pulmonary fibrosis? Context: Pulmonary fibrosis is a disorder of the lungs with limited treatment options. Matrix metalloproteinases (MMPs) constitute a family of proteases that degrade extracellular matrix with roles in fibrosis. Here we studied the role of MMP13 in a radiation-induced lung fibrosis model using a MMP13 knockout mouse. We investigated the role of MMP13 in lung fibrosis by investigating the effects of MMP13 deficiency in C57Bl/6 mice after 20-Gy thoracic irradiation (6-MV Linac). The morphologic results in histology were correlated with qualitative and quantitative results of volume computed tomography (VCT), magnetic resonance imaging (MRI), and clinical outcome. We found that MMP13 deficient mice developed less pulmonary fibrosis than their wildtype counterparts, showed attenuated acute pulmonary inflammation (days after irradiation), and a reduction of inflammation during the later fibrogenic phase (5-6 months after irradiation). The reduced fibrosis in MMP13 deficient mice was evident in histology with reduced thickening of alveolar septi and reduced remodeling of the lung architecture in good correlation with reduced features of lung fibrosis in qualitative and quantitative VCT and MRI studies. The partial resistance of MMP13-deficient mice to fibrosis was associated with a tendency towards a prolonged mouse survival." }, { "role": "assistant", "content": "Our data indicate that MMP13 has a role in the development of radiation-induced pulmonary fibrosis. Further, our findings suggest that MMP13 constitutes a potential drug target to attenuate radiation-induced lung fibrosis. 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, Case-Control Studies, Chorionic Gonadotropin, Embryo Implantation, Estradiol, Female, Fertilization in Vitro, Gonadotropin-Releasing Hormone, Humans, Leuprolide, Luteal Phase, Oocytes, Ovulation Induction, Pregnancy, Sperm Injections, Intracytoplasmic." }, { "role": "user", "content": "Is luteal phase oestradiol administration in ovarian stimulation cycles with GnRH antagonist comparable to the GnRH agonist ( long ) protocol? Context: The purpose of the study was to compare the effectiveness of GnRH antagonist with luteal phase estradiol administration to GnRH agonist cycles, long protocol. 55 IVF-ICSI patients received oestradiol in the luteal phase of the cycle, before a cycle with GnRH antagonist. Fifty-five patients submitted to IVF-ICSI with the use of agonist were allocated, age matched, as a control group (historical control). The primary outcome was the number of retrieved oocytes. Patients were similar in terms of clinical characteristics. No differences were found in the number of oocytes retrieved (study group, 8.1 +/- 4.7; control group, 7.4 +/- 4.5) or in oocyte quality." }, { "role": "assistant", "content": "We clearly demonstrated that the effectiveness of GnRH antagonist when combined with luteal phase estradiol is comparable to GnRH agonist cycles. 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: Humans, Isometric Contraction, Knee, Magnetic Resonance Imaging, Male, Muscle Strength, Muscle, Skeletal, Risk Factors, Sprains and Strains, Thigh, Young Adult." }, { "role": "user", "content": "Biceps Femoris Aponeurosis Size: A Potential Risk Factor for Strain Injury? Context: A disproportionately small biceps femoris long head (BFlh) proximal aponeurosis has been suggested as a risk factor for hamstring strain injury by concentrating mechanical strain on the surrounding muscle tissue. However, the size of the BFlh aponeurosis relative to BFlh muscle size, or overall knee flexor strength, has not been investigated. This study aimed to examine the relationship of BFlh proximal aponeurosis area with muscle size (maximal anatomical cross-sectional area (ACSAmax)) and knee flexor strength (isometric and eccentric). Magnetic resonance images of the dominant thigh of 30 healthy young males were analyzed to measure BFlh proximal aponeurosis area and muscle ACSAmax. Participants performed maximum voluntary contractions to assess knee flexion maximal isometric and eccentric torque (at 50° s and 350° s). BFlh proximal aponeurosis area varied considerably between participants (more than fourfold, range = 7.5-33.5 cm, mean = 20.4 ± 5.4 cm, coefficient of variation = 26.6%) and was not related to BFlh ACSAmax (r = 0.04, P = 0.83). Consequently, the aponeurosis/muscle area ratio (defined as BFlh proximal aponeurosis area divided by BFlh ACSAmax) exhibited sixfold variability, being 83% smaller in one individual than another (0.53 to 3.09, coefficient of variation = 32.5%). Moreover, aponeurosis size was not related to isometric (r = 0.28, P = 0.13) or eccentric knee flexion strength (r = 0.24, P ≥ 0.20)." }, { "role": "assistant", "content": "BFlh proximal aponeurosis size exhibits high variability between healthy young men, and it was not related to BFlh muscle size or knee flexor strength. Individuals with a relatively small aponeurosis may be at increased risk of hamstring strain injury." } ]

[ { "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, METHODS, RESULTS. Meshes: Administration, Oral, Adolescent, Allergens, Animals, Antibody Specificity, Child, Child, Preschool, Egg Hypersensitivity, Eggs, Humans, Immunoglobulin E, Infant, Milk, Milk Hypersensitivity, Skin Tests." }, { "role": "user", "content": "Skin prick test and specific serum IgE in the diagnostic evaluation of suspected cow's milk and hen's egg allergy in children: does one replace the other? Context: The measurement of specific serum immunoglobulin E (sIgE) and the skin prick test (SPT) are accepted tools in the diagnostic work-up of suspected food allergy. Often only one of the methods is used to determine sensitization; however, it is still under debate whether these two methods can be used interchangeably. To investigate the concordance of SPT and sIgE serum assays with regard to suspected food allergy. In 395 children referred to our clinic with suspected cow's milk allergy and in 268 children with suspected hen's egg allergy specific immunoglobulin E (IgE) was measured, a SPT and an oral food challenge performed. A weal size ≥ 3 mm and sIgE ≥ 0.35 kU/L were considered positive. The weal size of the SPT and the level of food-specific IgE were tested for correlation for each allergen. Of the 395 (23%) children orally challenged with cow's milk, 92 showed no corresponding results for SPT and sIgE as either positive or negative. For hen's egg, in 27 of 268 (10%) children differing test results for SPT and sIgE in serum were obtained. Moreover, regarding the quantitative values for sIgE and SPT in children with or without clinically relevant food allergy, sIgE and SPT correlated badly." }, { "role": "assistant", "content": "The concordance between SPT and sIgE is surprisingly low for cow's milk and hen's egg on an individual basis. Therefore, the tests should not be used interchangeably. Especially in children who receive a negative test result the alternative test should also be used. Furthermore, our data indicate again that oral food challenges are still the method of choice to diagnose food allergies." } ]

[ { "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, Aged, Atrial Fibrillation, Catheter Ablation, Electrocardiography, Ambulatory, Electrophysiologic Techniques, Cardiac, Feasibility Studies, Female, Humans, Male, Middle Aged, Pulmonary Veins, Recurrence, Treatment Outcome." }, { "role": "user", "content": "Does pulmonary vein isolation predict freedom from arrhythmia after circumferential antral ablation for paroxysmal atrial fibrillation? Context: The aims of this observational study were to evaluate (i) the feasibility of obtaining bidirectional pulmonary vein (PV) isolation by means of circumferential radiofrequency ablation of the antral aspect of the PV ostium; (ii) whether the electrophysiological demonstration of bidirectional PV isolation predicts freedom from atrial tachyarrhythmia recurrence after ablation in patients with paroxysmal atrial fibrillation. The study group comprised 28 patients affected by frequent recurrences of paroxysmal atrial fibrillation refractory to antiarrhythmic drugs, who underwent transcatheter ablation of the PVs by means of a non-fluoroscopic navigation system. Radiofrequency pulses were delivered in a point-by-point fashion at the antral aspect of the ostium of each vein presenting distal PV potentials. After ablation of each PV, bidirectional isolation was tested by means of a basket catheter. No antiarrhythmic drugs were prescribed on discharge. Outpatient visits, 24-h electrocardiographic Holter monitoring, and continuous 7-day digital electrocardiogram were scheduled at 3, 6, and 12 months. A distal potential was detected in 101/123 (82%) mapped PVs. Bidirectional isolation was obtained in 81/101 (80%) PVs; bidirectional isolation of all targeted PVs was obtained in 17 (61%) patients. After a mean follow-up of 12.2 +/- 4.2 months, clinical success was observed in 15 (53%) patients. On multivariate analysis, only bidirectional isolation of all targeted PVs predicted the clinical success of ablation (P < 0.003; hazard ratio 7.504; confidence interval 1.943-28.990)." }, { "role": "assistant", "content": "Circumferential antral ablation achieves bidirectional isolation in 80% of PVs. Bidirectional isolation of all PVs is essential to curing patients with paroxysmal atrial fibrillation. 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": "Some children go through a period of intense appetite when they eat or chew on all sos of inedible substances. This is called" }, { "role": "assistant", "content": "The correct answer is The eating disorder where children consume non-food items on a frequent or regular basis is called pica. A classic example of this disorder is when a child eats sand. Non-food items can include di, sand, paper, paint, chalk, hair, wood and more. Pica eating disorder in children leads to problems in the digestive system and delays in development. As this condition continues to persist for a longer duration, it can cause harm to the child and his/her development. Pica in Children Reference: GHAI Essential pediatrics, 8th 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": "NOT true about HPV is" }, { "role": "assistant", "content": "The correct answer is (A) HHV activating oncogenes" } ]

[ { "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: Aromatic-L-Amino-Acid Decarboxylases, Dopamine, Dopamine beta-Hydroxylase, Female, Head and Neck Neoplasms, Humans, Immunohistochemistry, Male, Metanephrine, Middle Aged, Normetanephrine, Pheochromocytoma, Tyrosine 3-Monooxygenase." }, { "role": "user", "content": "Do catecholamine-Synthesizing Enzymes Are Expressed in Parasympathetic Head and Neck Paraganglioma Tissue? Context: Increased dopamine production may be a feature of head and neck paraganglioma (HNPGL). 18F-fluorodihydroxyphenylalanine positron emission tomography scintigraphy has a high sensitivity for detecting HNPGLs. These observations strongly suggest that HNPGLs have the capacity for L-3,4-dihydroxyphenylalanine uptake and conversion towards dopamine. Therefore, our aim was to demonstrate the presence of catecholamine-synthesizing enzymes, i.e. tyrosine hydroxylase (TH), aromatic L-amino acid decarboxylase (AADC) and dopamine β-hydroxylase (DBH) in HNPGL tissue. A single-center study was performed among patients who underwent surgery for HNPGL at a single university referral center between 1994 and 2012. HNPGL tissue was immunohistochemically stained for TH, AADC and DBH. Data on paraganglioma-associated germline mutations, preoperative biochemical phenotype and imaging studies were retrieved. Catecholamine excess was defined as preoperative plasma and/or urinary levels of metanephrine, normetanephrine or 3-methoxytyramine above the upper reference limit. Nineteen HNPGLs from 18 patients were evaluated. All tumor tissues (100%) stained positive for AADC, 6 (32%) for TH and 2 (11%) for DBH. Of 3 HNPGLs staining positive for DBH, 2 were also positive for AADC and TH. Catecholamine excess was only present in 1 patient (5%). The HNPGLs of this single patient only showed positive staining for AADC." }, { "role": "assistant", "content": "Catecholamine-synthesizing enzymes, in particular AADC, are expressed in the majority of HNPGL tissues. 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 AND RESULTS. Meshes: Angiotensin II, Atrial Natriuretic Factor, Biomarkers, Cardiac Catheterization, Catecholamines, Endothelin-1, Enoximone, Female, Heart Failure, Hemodynamics, Humans, Hypertension, Pulmonary, Infusions, Intravenous, Male, Middle Aged, Peptidyl-Dipeptidase A, Phosphodiesterase Inhibitors, Prognosis, Pulmonary Artery, Pulmonary Veins, Severity of Illness Index." }, { "role": "user", "content": "High-dose enoximone to evaluate reversibility of pulmonary hypertension: is there a diagnostic value of neurohormonal measurements? Context: Heart transplantation is associated with a reduction of the neurohumoral activation seen in patients with severe congestive heart failure. In this study, we investigated whether pharmacologically induced complex hemodynamic improvement during assessment of reversibility of pulmonary hypertension with a phosphodiesterase inhibitor is able to induce neurohormonal changes of diagnostic importance. Twenty-one patients with New York Heart Association class III-IV heart failure underwent infusion of 3 mg/kg enoximone over a period of 30 minutes. Before and after drug infusion, we determined the plasma concentrations of atrial natriuretic peptide, endothelin-I, angiotensin-II, aldosterone, norepinephrine, epinephrine, and angiotensin-converting enzyme activity sampled from a peripheral vein and the pulmonary artery. In addition to the expected significant reduction of pulmonary hypertension and enhancement of cardiac output, increased levels of the vasoconstrictors endothelin-I, angiotensin-II, and norepinephrine were observed. Aldosterone fell after enoximone infusion; a higher baseline aldosterone level correlated to the degree of reduction of the pulmonary arteriolar resistance by enoximone. Baseline atrial natriuretic peptide levels correlated with parameters, indicating the severity of heart failure. However, the plasma concentration of this peptide did not change significantly after enoximone infusion." }, { "role": "assistant", "content": "Acute hemodynamic improvement after enoximone bolus in candidates for heart transplantation is not accompanied by a reduction of the enhanced neurohumoral activity in these patients. The reaction of the investigated hormones cannot predict the individual degree of reversibility of pulmonary hypertension." } ]

[ { "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, Autoantibodies, Autoantigens, Female, Humans, Immunosuppressive Agents, Male, Myasthenia Gravis, Poland, Prevalence, Radioimmunoassay, Receptor Protein-Tyrosine Kinases, Receptors, Cholinergic, Thymectomy." }, { "role": "user", "content": "Is muSK-positive myasthenia gravis rare in the Polish population? Context: MuSK-positive myasthenia gravis (MG) is diagnosed in 0-48% of cases with generalized seronegative MG in different populations. The presence of anti-MuSK antibodies generally relates to a severe course and lack of response to thymectomy. We analyzed for the first time the serology and clinical characteristics of MuSK-positive MG in the Polish population. One hundred and fifty-one patients were tested for the presence of anti-AChR and anti-MuSK antibodies: 62 with seronegative MG, including 14 with ocular seronegative MG, 48 age-matched patients with seropositive MG and 41 controls. All patients with seropositive MG and the disease controls were MuSK-negative. Anti-MuSK antibodies were detected only in four patients with seronegative MG (8.7% of generalized seronegative cases): three women and one man. All four had predominantly bulbar involvement, and underwent thymectomy, with no apparent benefit. All of them improved clinically after immunosuppressive treatment with remissions lasting up to 7 years." }, { "role": "assistant", "content": "MuSK-positive MG is rare in Polish population accounting for only 8.7% of seronegative cases with generalized MG. This is consistent with emerging evidence for lower MuSK antibodies at more northerly latitudes. 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 55-year-old man who is on dialysis because of end-stage renal disease complains of pain in his jaw and left arm for 6 months. An X-ray of the left arm reveals multiple, small bone cysts and pathologic fractures. What is the appropriate diagnosis for this patient's bone lesions?" }, { "role": "assistant", "content": "The correct answer is Secondary hyperparathyroidism is a complication of chronic renal insufficiency due to renal retention of phosphate and resulting hypocalcemia. Excess PTH causes renal osteodystrophy or, in severe cases, osteitis fibrosa cystica. The latter is characterized by severe bone deformities and the formation of \"brown tumors\" of hyperparathyroidism. Patients present with bone pain, bone cysts, pathologic fractures, and localized bone swellings (brown tumors). The other choices are not related to hypocalcemia or hyperparathyroidism.Diagnosis: Osteitis cystica fibrosa, hyperparathyroidism" } ]

[ { "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, Blood Coagulation, Case-Control Studies, Czech Republic, Female, Humans, Pregnancy, Pregnancy Trimester, Third, Prospective Studies, Reference Values, Thrombelastography." }, { "role": "user", "content": "Does new recommendations for thromboelastography reference range for pregnant women? Context: The target of this study was to compare thromboelastography coagulation parameters in pregnant and non-pregnant women. If appropriate, we would propose recommendations for new reference ranges for pregnant women in their third trimester. Prospective observational study, comparing, by using thromboelastography, the blood samples of 60 healthy women in third trimester of pregnancy (group GRAV) to the samples of the control group of 43 healthy non-pregnant fertile women (group NON-GRAV). Selective percentiles were used to determine new reference limits. Mean values and standard deviations (SD) in both groups were as follows (GRAV vs NON-GRAV): time r 4.7 min (SD 1.7) vs. 7.8 (SD 2.8); time k1.5 min (SD 0.5) vs. 2,7 (SD 0,9); alpha angle 69.6° (SD 5.5) vs. 54.4 (SD 11.5); maximum amplitude 71.3mm (SD 4.5) vs. 63.1 (SD 5.4); coagulation index 2.7 (SD 1.8) vs. -1.9 (SD 3.0); LY60 1.1% (SD 1.8) vs. 4.8 (SD 3.6). Due to statistically significant differences between both groups, we established, based on our results, these new thromboelastography reference limits for pregnant women: time r 2-8 min (\"common\" range 4-8 min), time k 1-3 min (\"common\" range 1-4 min), alpha angle 60-77° (\"common\" range 47-74°), maximum amplitude 64-76 mm (\"common\" range 55-73 mm), LY60 0-3% (\"common\" range 0-15%), coagulation index 0-5 (\"common\" range (-3) - (+3))." }, { "role": "assistant", "content": "It may not be suitable to use the same reference ranges for pregnant women as for the general population. Therefore, we suggest new reference limits for thromboelastography in pregnant 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": "Treatment of genuine stress incontinence" }, { "role": "assistant", "content": "The correct answer is Ans. is a, b & c i.e. Anterior colporrhaphy; Colposuspension; Pelvic floor exercise; and Sling operation Genuine stress incontinence (GSI) is defined as involuntary loss of urine when intravesical pressure exceeds the maxitnum urethral pressure in the absence of detrusor activity. Etiopathogenesis : In a normal continent woman, the bladder neck and proximal urethra are intra abdominal structures and lie above the pelvic floor in standing position and urethral pressure is more than intra vesical pressure. Any factor which leads to distoion of normal urethro vesical anatomy or decreased urethral pressure leads to GSI like Developmental weakness, child bih trauma, pregnancy (due to increased progesterone which is a relaxant), menopause (it leads to atrophy of suppoing structures), trauma, obesity and following surgeries like Ant. Colporrhaphy, repair of VVF (as they lead to fibrosis of urethra). Management Aim : To restore the function of muscles of Urethro vesical junction. Strengthen the suppo of urethra. Conservative approach : Pelvic floor exercises Drugs Sympathomimetic drugs (a- adrenergic drugs) as they increase tone of urethra and bladder neck.eg. - lmipramine - Ephedrine Paraurethral implants using teflon or periurethral injection of Glutaraldehyde linked collagen. Surgical approach : Principles : * Restoration of normal anatomy. Strengthening the suppo of bladder neck. Increasing the functional length of urethra. Now a days - Laparoscopic colposuspension is also being done." } ]

[ { "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, Amputees, Electromyography, Feedback, Sensory, Female, Hand, Hand Strength, Humans, Male, Prostheses and Implants, Prosthesis Design, Radial Nerve, Touch, Young Adult." }, { "role": "user", "content": "Does electrotactile EMG feedback improve the control of prosthesis grasping force? Context: A drawback of active prostheses is that they detach the subject from the produced forces, thereby preventing direct mechanical feedback. This can be compensated by providing somatosensory feedback to the user through mechanical or electrical stimulation, which in turn may improve the utility, sense of embodiment, and thereby increase the acceptance rate. In this study, we compared a novel approach to closing the loop, namely EMG feedback (emgFB), to classic force feedback (forceFB), using electrotactile interface in a realistic task setup. Eleven intact-bodied subjects and one transradial amputee performed a routine grasping task while receiving emgFB or forceFB. The two feedback types were delivered through the same electrotactile interface, using a mixed spatial/frequency coding to transmit 8 discrete levels of the feedback variable. In emgFB, the stimulation transmitted the amplitude of the processed myoelectric signal generated by the subject (prosthesis input), and in forceFB the generated grasping force (prosthesis output). The task comprised 150 trials of routine grasping at six forces, randomly presented in blocks of five trials (same force). Interquartile range and changes in the absolute error (AE) distribution (magnitude and dispersion) with respect to the target level were used to assess precision and overall performance, respectively. Relative to forceFB, emgFB significantly improved the precision of myoelectric commands (min/max of the significant levels) for 23%/36% as well as the precision of force control for 12%/32%, in intact-bodied subjects. Also, the magnitude and dispersion of the AE distribution were reduced. The results were similar in the amputee, showing considerable improvements." }, { "role": "assistant", "content": "Using emgFB, the subjects therefore decreased the uncertainty of the forward pathway. Since there is a correspondence between the EMG and force, where the former anticipates the latter, the emgFB allowed for predictive control, as the subjects used the feedback to adjust the desired force even before the prosthesis contacted the object. In conclusion, the online emgFB was superior to the classic forceFB in realistic conditions that included electrotactile stimulation, limited feedback resolution (8 levels), cognitive processing delay, and time constraints (fast grasping). 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: Adult, Aged, Aged, 80 and over, Alleles, Case-Control Studies, Female, Gene Frequency, Genotype, Humans, Interleukin-1, Intestinal Neoplasms, Male, Middle Aged, Minisatellite Repeats, Polymorphism, Genetic, Portugal, Reference Values, Risk Factors, Stomach Neoplasms." }, { "role": "user", "content": "Are interleukin 1B and interleukin 1RN polymorphisms associated with increased risk of gastric carcinoma? Context: Interleukin (IL)-1 gene cluster proinflammatory polymorphisms have been associated with development of gastric atrophy and with increased risk of gastric carcinoma. We aimed to determine the association between IL-1 loci polymorphisms and increased risk of gastric carcinoma in samples from a Portuguese population, and to find whether there was any relationship with the histologic types of gastric carcinoma. In a case-control study including 220 controls and 152 patients with gastric carcinoma (intestinal, 76; diffuse, 37; and atypical, 39), both the IL-1B-511 biallelic polymorphism and the IL-1RN penta-allelic variable number of tandem repeats were genotyped. We found a significant association between the IL-1 polymorphisms and increased risk for tumor development in patients with intestinal-type gastric carcinoma. A trend towards an increased risk of tumor development was also observed in patients with diffuse-type gastric carcinoma. No significant relationship was observed in patients with atypical carcinoma. Carriers of IL-1B-511T and IL-1RN*2 homozygotes had increased risk for developing intestinal-type gastric carcinoma with odds ratios of 2.7 (95% confidence interval [CI], 1.5-4.9) and 3.1 (95% CI, 1.5-6.5), respectively. Statistical analysis showed an interaction between the 2 loci with the risk conferred by the IL-1B-511T allele substantially increased (odds ratio, 9.0; 95% CI, 3.5-23.0) in individuals homozygous for the IL-1RN*2 allele." }, { "role": "assistant", "content": "Our results provide further support to the association between IL-1 gene cluster proinflammatory polymorphisms and increased risk of gastric carcinoma. Furthermore, we found evidence pointing to the existence of a synergistic interaction between the IL-1B and IL-1RN polymorphisms. 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: Aged, Aged, 80 and over, Angioplasty, Balloon, Coronary, Atherosclerosis, Blood Platelet Disorders, Case-Control Studies, Cohort Studies, Female, Follow-Up Studies, Humans, Kidney Failure, Chronic, Male, Middle Aged, Platelet Activation, Platelet Aggregation, Platelet Aggregation Inhibitors, Prognosis, Prospective Studies, Risk Factors, Stents." }, { "role": "user", "content": "Is chronic kidney disease associated with increased platelet activation and poor response to antiplatelet therapy? Context: Chronic kidney disease (CKD) is a common co-morbidity of patients with atherosclerotic vascular disease, and may influence the response to antiplatelet therapy. We, therefore, sought to investigate its effect on platelet activation and on-treatment residual platelet reactivity. We assessed platelet activation and the response to clopidogrel and aspirin in 316 patients after percutaneous intervention with stent implantation. CKD was defined as a glomerular filtration rate <60 mL/min/1.73 m(2) according to the Modification of Diet in Renal Disease formula. Surface expression of activated glycoprotein IIb/IIIa without the addition of agonists was determined to assess baseline platelet activation. GPIIb/IIIa in response to adenosine diphosphate (ADP) and arachidonic acid (AA), as well as the VerifyNow assays and light transmission aggregometry (LTA) were used to measure residual platelet reactivity. Baseline platelet activation was significantly increased in CKD patients compared with patients without renal insufficiency [3.1 versus 2.7 mean fluorescence intensity (MFI), P = 0.001]. Moreover, patients with CKD exhibited a more pronounced expression of GPIIb/IIIa in response to ADP (13 versus 9.6 MFI) and AA (6 versus 5.1 MFI; both P≤ 0.02) than patients without CKD. In the VerifyNow assays, CKD patients showed significantly higher platelet reactivity than patients without CKD (P2Y12 assay: 239 versus 182 P2Y12 Reaction Units; aspirin assay: 415 versus 399 Aspirin Reaction Units; both P≤ 0.03). Further, patients with CKD had significantly higher platelet reactivity by LTA in response to ADP (49.9 versus 43.2%, P = 0.01). Finally, high on-treatment residual ADP-inducible platelet reactivity by the VerifyNow P2Y12 assay and by LTA occurred significantly more frequent in patients with CKD (VerifyNow: 52.2 versus 26.2%, P < 0.001; LTA: 23.3 versus 12.1%, P = 0.01)." }, { "role": "assistant", "content": "Patients with CKD exhibit increased platelet activation, and an attenuated response to dual antiplatelet therapy compared with patients without renal insufficiency. 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: ADP-ribosyl Cyclase 1, Animals, Cells, Cultured, Humans, MAP Kinase Signaling System, Membrane Glycoproteins, Mice, Mice, Knockout, MicroRNAs, Myocytes, Smooth Muscle, NIH 3T3 Cells, PTEN Phosphohydrolase, Proto-Oncogene Proteins c-akt, Respiratory Mucosa." }, { "role": "user", "content": "Does microRNA-708 regulate CD38 expression through signaling pathways JNK MAP kinase and PTEN/AKT in human airway smooth muscle cells? Context: The cell-surface protein CD38 mediates airway smooth muscle (ASM) contractility by generating cyclic ADP-ribose, a calcium-mobilizing molecule. In human ASM cells, TNF-α augments CD38 expression transcriptionally by NF-κB and AP-1 activation and involving MAPK and PI3K signaling. CD38-/- mice develop attenuated airway hyperresponsiveness following allergen or cytokine challenge. The post-transcriptional regulation of CD38 expression in ASM is relatively less understood. In ASM, microRNAs (miRNAs) regulate inflammation, contractility, and hyperproliferation. The 3' Untranslated Region (3'UTR) of CD38 has multiple miRNA binding sites, including a site for miR-708. MiR-708 is known to regulate PI3K/AKT signaling and hyperproliferation of other cell types. We investigated miR-708 expression, its regulation of CD38 expression and the underlying mechanisms involved in such regulation in human ASM cells. Growth-arrested human ASM cells from asthmatic and non-asthmatic donors were used. MiRNA and mRNA expression were measured by quantitative real-time PCR. CD38 enzymatic activity was measured by a reverse cyclase assay. Total and phosphorylated MAPKs and PI3K/AKT as well as enzymes that regulate their activation were determined by Western blot analysis of cell lysates following miRNA transfection and TNF-α stimulation. Dual luciferase reporter assays were performed to determine whether miR-708 binds directly to CD38 3'UTR to alter gene expression. Using target prediction algorithms, we identified several miRNAs with potential CD38 3'UTR target sites and determined miR-708 as a potential candidate for regulation of CD38 expression based on its expression and regulation by TNF-α. TNF-α caused a decrease in miR-708 expression in cells from non-asthmatics while it increased its expression in cells from asthmatics. Dual luciferase reporter assays in NIH-3 T3 cells revealed regulation of expression by direct binding of miR-708 to CD38 3'UTR. In ASM cells, miR-708 decreased CD38 expression by decreasing phosphorylation of JNK MAPK and AKT. These effects were associated with increased expression of MKP-1, a MAP kinase phosphatase and PTEN, a phosphatase that terminates PI3 kinase signaling." }, { "role": "assistant", "content": "In human ASM cells, TNF-α-induced CD38 expression is regulated by miR-708 directly binding to 3'UTR and indirectly by regulating JNK MAPK and PI3K/AKT signaling and has the potential to control airway inflammation, ASM contractility and proliferation. 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 is a Neprilysin inhibitor?" }, { "role": "assistant", "content": "The correct answer is Sacubitril is a prodrug Neprilysin inhibitor approved for the treatment of hea failure in conjunction with the Angiotensin Receptor Blockade, Valsaan(Sacubitril/Valsaan). Sacubitril is also undergoing clinical testing for its role in the treatment of hypeension. Neprilysin (NEP) is an endopeptidase that metabolizes different vasoactive peptides especially natriuretic peptides including Atrial and Brain Natriuretic peptides thereby promoting diuresis, natriuresis and vasodilation. Sacubitril is a prodrug that once activated inhibits the enzyme Neprilysin, which is responsible for the degradation of atrial and brain natriuretic peptide. Sacubitril/Valsaan: Angiotensin Receptor blocker-Neprilysin Inhibitor (ARNI) combination: Sacubitril/Valsaan is a first-in-class medicine that contains a Neprilysin (NEP) inhibitor (Sacubitril) and an Angiotensin II (Ang-II) receptor blocker (Valsaan) Neprilysin(NEP) is an endopeptidase that metabolize different vasoactive peptides including natriuretic peptides, bradykinin and Ang-II. NEP substrates may have biological opposing action and the total effect of the inhibition depends on the net effect of the individual metabolized substrates. Neprilysin inhibition not only increases the levels of both, natriuretic peptides (promoting diuresis, natriuresis and vasodilatation) but also increases the level of Ang-II (producing an opposite action of vasoconstriction and aldosterone release) The benefits of increasing the Natriuretic peptides (NP) system may thus be lost by increasing Ang-II, therefore a simultaneous suppression of the RAAS is necessary. Addition of Valsaan (angiotensin receptor blocker) blocks the undesirable effects of Ang-II (thereby reducing the undesirable effects of vasoconstriction and aldosterone release) Consequently, the ARNI is expected to promote the beneficial effects natriuresis, diuresis and vasodilatation of aerial and venous blood vessels and to inhibit thrombosis, fibrosis, cardiac myocyte hyperophy, and renin release. Ref: Goodman and Gilman 13th edition Pgno: 485" } ]

[ { "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: Analysis of Variance, Biomarkers, Blotting, Western, Calcium-Binding Proteins, Calcium-Transporting ATPases, Case-Control Studies, Coronary Artery Bypass, Echocardiography, Doppler, Female, Humans, Male, Myocardial Infarction, Myocardial Stunning, Predictive Value of Tests, Probability, Prognosis, Reference Values, Sampling Studies, Sarcoplasmic Reticulum Calcium-Transporting ATPases, Sensitivity and Specificity, Severity of Illness Index, Survival Analysis, Tissue Culture Techniques." }, { "role": "user", "content": "Do suppressed phospholamban levels differentiate irreversibly dysfunctional from hibernating myocardium in humans? Context: We studied whether dysfunction of human hibernating (HIB) and irreversibly dysfunctional myocardium (IRDM) are associated with altered levels of the sarcoplasmatic reticulum calcium handling proteins Ca2+-ATPase (SERCA2a) and its inhibitor phospholamban (PLB). In 12 patients myocardial biopsies were taken during bypass surgery and analysed for contents of these proteins. We classified regions as control, HIB, or IRDM based on echocardiographic studies before and 6 months after surgery. SERCA2a content (mean+/-SEM) was similar to control in HIB and IRDM (2.6 +/- 1.7, 3.8 +/- 2.0, and 3.4 +/- 1.9 units/g non-collagen protein (NCP), p = 0.40). PLB content was similar to control in HIB (2.6 +/- 0.4 and 3.5 +/- 0.5 units/microg NCP) but reduced in IRDM (0.9 +/- 0.2 units/microg NCP, p < 0.05). SERCA2a:PLB ratio, an indicator of SERCA2a activity, did not differ between control and HIB (1.2 +/- 0.3 and 1.4 +/- 0.4 units/microg NCP) but was increased in IRDM (5.1 +/- 1.7 units/microg NCP, p < 0.05)." }, { "role": "assistant", "content": "Inappropriate SERCA2a activity due to suppressed PLB levels may represent a maladaptive mechanism in chronic ischemic myocardium being causally linked to irreversibility of left ventricular dysfunction. 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, Cell Line, Tumor, Hematologic Neoplasms, Humans, Mice, Phosphorylation, Protein Kinase Inhibitors, Protein-Serine-Threonine Kinases, Proto-Oncogene Proteins, Proto-Oncogene Proteins c-pim-1, Signal Transduction, TOR Serine-Threonine Kinases, Xenograft Model Antitumor Assays." }, { "role": "user", "content": "Does pan-PIM kinase inhibition provide a novel therapy for treating hematologic cancers? Context: PIM kinases have been shown to act as oncogenes in mice, with each family member being able to drive progression of hematologic cancers. Consistent with this, we found that PIMs are highly expressed in human hematologic cancers and show that each isoform has a distinct expression pattern among disease subtypes. This suggests that inhibitors of all three PIMs would be effective in treating multiple hematologic malignancies. Pan-PIM inhibitors have proven difficult to develop because PIM2 has a low Km for ATP and, thus, requires a very potent inhibitor to effectively block the kinase activity at the ATP levels in cells. We developed a potent and specific pan-PIM inhibitor, LGB321, which is active on PIM2 in the cellular context. LGB321 is active on PIM2-dependent multiple myeloma cell lines, where it inhibits proliferation, mTOR-C1 signaling and phosphorylation of BAD. Broad cancer cell line profiling of LGB321 demonstrates limited activity in cell lines derived from solid tumors. In contrast, significant activity in cell lines derived from diverse hematological lineages was observed, including acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), multiple myeloma and non-Hodgkin lymphoma (NHL). Furthermore, we demonstrate LGB321 activity in the KG-1 AML xenograft model, in which modulation of pharmacodynamics markers is predictive of efficacy. Finally, we demonstrate that LGB321 synergizes with cytarabine in this model." }, { "role": "assistant", "content": "We have developed a potent and selective pan-PIM inhibitor with single-agent antiproliferative activity and show that it synergizes with cytarabine in an AML xenograft model. Our results strongly support the development of Pan-PIM inhibitors to treat hematologic malignancies. 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 male child with gall bladder stone has HB-6 gm%, serum biliruhin 2.5 mg % and high urobilinogen in urine. The diagnosis is" }, { "role": "assistant", "content": "The correct answer is There are three types of jaundice: haemolytic jaundice - caused by destruction of red blood cells. obstructive jaundice - caused by a blockage in the pathway where bilirubin is made in the liver cells and where bile goes into the duodenum. hepatocellular jaundice - caused by damage to liver cells Ref Davidson edition23rd pg860" } ]

[ { "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": "Treatment agent for scarlet fever is" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., Penicillin Treatment : Immediate hospitalization and isolation of the patient is indicated. Penicillin is the treatment of choice." } ]

[ { "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": "True about telomeres:\n(A) Made up of repeated sequence of TTAGGG\n(B) Telomerase shortens it\n(C) it is shortened in cancer cells,\n(D) It is responsible for cell ageing" }, { "role": "assistant", "content": "The correct answer is \"At birth, human telomeres are 15- to 20-kb pairs long and are composed of tandem repeats of a sixnucleotide\nsequence (TTAGGG) that associates with specialized telomere-binding proteins to form a Tloop\nstructure that protects the ends of chromosomes from being mistakenly recognized as damaged. The\nloss of telomeric repeats with each cell division cycle causes gradual telomere shortening, leading to\ngrowth arrest (called senescence) when one or more critically short telomeres trigger a p53-regulated\nDNA-damage checkpoint response\"- \n\nHow dividing cells can count their divisions is under intensive investigation. One likely mechanism is\nthat with each cell division, there is incomplete replication of chromosome ends (telomere shortening),\nwhich ultimately results in cell cycle arrest. Telomeres are short repeated sequences of DNA (TTAGGG) present at the linear ends of chromosomes that are important for ensuring the complete replication of chromosome ends and protecting chromosomal termini from fusion and degradation.\nWhen soma tic cells replicate, a small section ofthe telomere is not duplicated, and telomeres become progressively shortened.\nAs the telomeres become shorter, the ends of chromosomes cannot be protected and are seen as broken DNA, which signals cell cycle arrest. The lengths of the telomeres are normally maintained by nucleotide addition mediated by an enzyme called telomerase. \nTelomerase is a specialized RNA-protein complex that uses its own RNA as a template for adding nucleotides to the ends of\nchromosomes The activity of telomerase is repressed by regulatory proteins, which restrict telomere elongation, thus providing a length sensing mechanism. Telomerase activity is expressed in germ cells and is present at low levels in stem cells, but it is usually absent in most somatic tissues. Therefore, as cells age, their telomeres become shorter, and they exit the cell cycle, resulting in an inability to generate new cells to replace damaged ones. Conversely, in immortal cancer cells, telomerase is reactivated, and telomeres are not shortened, \nsuggesting that telomere elongation might be an important—possibly essential—step in tumor formation.\nDespite such alluring observations, however, the relationship of telomerase activity and telomeric length\nto aging and cancer still needs to be fully established\nGerm cells and stem cells both contain active telomerase, but only the germ cells have sufficient levels of the enzyme to stabilize telomere length completely. Telomerase activation in cancer cells inactivates\nthe teleomericclock that limits the proliferative capacity of normal somatic cells." } ]

[ { "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": "Wavelength of Nd:Yag laser" }, { "role": "assistant", "content": "The correct answer is A i.e. 1040 nm" } ]

[ { "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: ." }, { "role": "user", "content": "Do mET/PKCbeta expression correlate with metastasis and inhibition is synergistic in lung cancer? Context: Treatment of non-small cell lung cancer (NSCLC) remains a difficult task in oncology. Targeted inhibition of oncogenic proteins is promising. In this study, we evaluate the expression of MET and PKCbeta and in vitro effects of their inhibition using SU11274 and enzastaurin (LY317615.HCl) respectively. Patient samples were analyzed by immunohistochemistry for expression of PKCbeta and MET, utilizing tissue microarrays under an IRB-approved protocol. Expression of PKCbeta and MET was evaluated in cell lines by immunoblotting. Treatment with SU1174 against MET and enzastaurin against PKCbeta was performed in H1993 and H358 cell lines, and cell proliferation and downstream signaling (phosphorylation of MET, AKT, FAK, and GSK3beta) were evaluated by immunoblotting. Statistical analysis was performed using SPSS 16.0. Expression of MET positively correlated with lymph node metastases (p=.0004), whereas PKCbeta showed no correlation (p=0.204). MET and PKCbeta expression were also strongly correlated (p<0.001). Expression of MET was observed in 5/8 cell lines (H358, H1703, A549, H1993, H2170; absent from H522, H661, or SW1573), whereas PKCbeta expression was observed in 8/8 cell lines. Cell proliferation was significantly impaired by treatment with SU11274 and enzastaurin, and their effects were synergistic in combination (CI=0.32 and 0.09). Phosphorylation of MET, FAK, AKT, and GSK3beta were strongly inhibited with both agents in combination." }, { "role": "assistant", "content": "Concomitant inhibition of MET and PKCbeta significantly increased cytotoxicity in vitro against NSCLC, disrupting important downstream signaling pathways. Further evaluation in animal models is warranted. 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": "Continuous murmur is seen in all the following except-" }, { "role": "assistant", "content": "The correct answer is A continuous murmur is predicated ona pressure gradient that persists betweentwo cardiac chambers or blood vesselsacross systole and diastole. The murmurstypically begin in systole, envelop thesecond hea sound (S 2 ), and continuethrough some poion of diastole. Theycan often be difficult to distinguish fromindividual systolic and diastolic murmursin patients with mixed valvular hea disease.The classic example of a continuousmurmur is that associated with a patentductus aeriosus, which usually is heardin the second or third interspace at a slightdistance from the sternal border. Othercauses of a continuous murmur includea ruptured sinus of Valsalva aneurysmwith creation of an aoic-right atrialor right ventricular fistula, a coronaryor great vessel aeriovenous fistula, andan aeriovenous fistula constructed toprovide dialysis access. Ref Harrison 20th edition pg 1445" } ]

[ { "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": "Vomer-sphenoidal rostrum junction is -" }, { "role": "assistant", "content": "The correct answer is Vomer-sphenoid rostrum junction is schindylesis type of suture." } ]

[ { "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": "Sappey's plexus drains?" }, { "role": "assistant", "content": "The correct answer is Ans. A BreastRef: Kulkarni Clinical Anatomy, 2nd ed. pg. 11* The lymphatic plexus below the areola is the Sub-areolar plexus of sappey.* 75% of breast lymphatics drain to axillary lymph nodes.Extra MileQuadrant wise breast lymphatic drainage* Lateral quadrant: Axillary nodes and supraclavicular through the pectoral, interpectoral and deltopectoral.* Medial quadrant: Parasternal nodes.* Lower quadrant: Inferior phrenic (abdominal) nodes." } ]

[ { "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: UNLABELLED. Meshes: Animals, Autocrine Communication, CD8-Positive T-Lymphocytes, Cluster Analysis, Complement C3, Complement System Proteins, Disease Models, Animal, Disease Progression, Gene Expression, Gene Expression Profiling, Humans, Immunomodulation, Interleukin-10, Lymphocytes, Tumor-Infiltrating, Mice, Mice, Knockout, Neoplasms, Programmed Cell Death 1 Receptor, Signal Transduction, T-Lymphocytes, Xenograft Model Antitumor Assays." }, { "role": "user", "content": "Does autocrine Complement inhibit IL10-Dependent T-cell-Mediated Antitumor Immunity to Promote Tumor Progression? Context: In contrast to its inhibitory effects on many cells, IL10 activates CD8(+) tumor-infiltrating lymphocytes (TIL) and enhances their antitumor activity. However, CD8(+) TILs do not routinely express IL10, as autocrine complement C3 inhibits IL10 production through complement receptors C3aR and C5aR. CD8(+) TILs from C3-deficient mice, however, express IL10 and exhibit enhanced effector function. C3-deficient mice are resistant to tumor development in a T-cell- and IL10-dependent manner; human TILs expanded with IL2 plus IL10 increase the killing of primary tumors in vitro compared with IL2-treated TILs. Complement-mediated inhibition of antitumor immunity is independent of the programmed death 1/programmed death ligand 1 (PD-1/PD-L1) immune checkpoint pathway. Our findings suggest that complement receptors C3aR and C5aR expressed on CD8(+) TILs represent a novel class of immune checkpoints that could be targeted for tumor immunotherapy. Moreover, incorporation of IL10 in the expansion of TILs and in gene-engineered T cells for adoptive cell therapy enhances their antitumor efficacy." }, { "role": "assistant", "content": "Our data suggest novel strategies to enhance immunotherapies: a combined blockade of complement signaling by antagonists to C3aR, C5aR, and anti-PD-1 to enhance anti-PD-1 efficacy; a targeted IL10 delivery to CD8(+) TILs using anti-PD-1-IL10 or anti-CTLA4-IL10 fusion proteins; and the addition of IL10 in TIL expansion for adoptive cellular therapy. Cancer Discov; 6(9); 1022-35. ©2016 AACR.See related commentary by Peng et al., p. 953This article is highlighted in the In This Issue feature, p. 932. 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: Animals, Culicidae, Disease Models, Animal, Female, Gamma Rays, Insect Bites and Stings, Liver, Malaria, Mice, Plasmodium yoelii." }, { "role": "user", "content": "Does daily Plasmodium yoelii infective mosquito bite do not generate protection or suppress previous immunity against the liver stage? Context: Human populations that are naturally subjected to Plasmodium infection do not acquire complete protection against the liver stage of this parasite despite prolonged and frequent exposure. However, sterile immunity against Plasmodium liver stage can be achieved after repeated exposure to radiation attenuated sporozoites. The reasons for this different response remain largely unknown, but a suppressive effect of blood stage Plasmodium infection has been proposed as a cause for the lack of liver stage protection. Using Plasmodium yoelii 17XNL, the response generated in mice subjected to daily infective bites from normal or irradiated mosquitoes was compared. The effect of daily-infected mosquito bites on mice that were previously immunized against P. yoelii liver stage was also studied. It was observed that while the bites of normal infected mosquitoes do not generate strong antibody responses and protection, the bites of irradiated mosquitoes result in high levels of anti-sporozoite antibodies and protection against liver stage Plasmodium infection. Exposure to daily infected mosquito bites did not eliminate the protection acquired previously with a experimental liver stage vaccine." }, { "role": "assistant", "content": "Liver stage immunity generated by irradiated versus normal P. yoelii infected mosquitoes is essentially different, probably because of the blood stage infection that follows normal mosquito bites, but not irradiated. While infective mosquito bites do not induce a protective liver stage response, they also do not interfere with previously acquired liver stage protective responses, even if they induce a complete blood stage infection. Considering that the recently generated anti-malaria vaccines induce only partial protection against infection, it is encouraging that, at least in mouse models, immunity is not negatively affected by subsequent exposure and infection with the parasite. Final Decision: yes" } ]