Model: vectorranger/embeddinggemma-300m-medical-300k
Author: vectorranger
Pipeline: sentence-similarity
Library: sentence-transformers
Tags: sentence-transformers, safetensors, gemma3_text, sentence-similarity, feature-extraction, dense, generated_from_trainer, dataset_size:660955, loss:CachedMultipleNegativesRankingLoss, en, dataset:vectorranger/med, arxiv:1908.10084, arxiv:2101.06983, base_model:google/embeddinggemma-300m, base_model:finetune:google/embeddinggemma-300m, license:apache-2.0, model-index, endpoints_compatible, region:us
Base models (finetune): id: google/embeddinggemma-300m
Card metadata: language: en
license: apache-2.0
tags: sentence-transformers, sentence-similarity, feature-extraction, dense, generated_from_trainer, dataset_size:660955, loss:CachedMultipleNegativesRankingLoss
base_model: google/embeddinggemma-300m
widget: source_sentence: What is the role of interim PET in predicting treatment failure and prognosis in pediatric Hodgkin lymphoma?

sentences: The other two patients were included in group 3 and achieved partial responses on interim PET. PET-CT performed in the two patients after six cycles of COPP-ABV demonstrated complete remission. The patients experienced disease relapse 7 and 18 months, respectively, after initial diagnosis. One patient underwent salvage chemotherapy followed by autologous hematopoietic stem-cell transplantation and has had a disease free survival of 1 year. The other patient has received salvage chemotherapy and will subsequently undergo autologous hematopoietic stem-cell transplantation.

 A combined-modality approach in HL yields excellent response rates and EFS. 1 Survivors of pediatric HL experience increased risk of secondary malignancies, cardiovascular dysfunction, and endocrinopathies throughout their lifetime. [1] [2] [3] 13 The tradeoff between cure and late toxicity necessitates the identification of patients who can be treated without RT and those who require intensification of chemotherapy and/or RT. This, in turn, requires a robust treatment approach on the basis of the upfront burden of disease (risk stratification) as well as early, favorable response to chemotherapy (response adaptation). 1, 14 The Lugano classification strongly recommends PET-CT for staging routinely FDG-avid histologic types, including HL. 4 Several studies have established the superior sensitivity of PET-CT in the staging of HL compared with CT. [15] [16] [17] [18] [19] PET-CT changes the stage in 10% to 30% of patients, with upstaging more common than downstaging. 4, 5 This does not significantly alter the management or outcome of disease. 4, 5 Our study reflected similar findings, with 19% of patients upstaged, 3% downstaged, and only two patients requiring allocation to a different treatment group. Extranodal sites of disease (including bone marrow, bone, and spleen), as well as unusual sites (such as parotid gland and adrenal gland), were identified by PET-CT. This reiterates the fact that PET-CT is superior to CT for recognizing extranodal disease. 20 Trephine biopsy has conventionally been used in the staging of pediatric lymphomas. The procedure is often painful and traumatic. The superior sensitivity and negative predictive value of PET in diagnosing marrow infiltration obviates the need for this invasive test in patients with HL, per the Lugano classification. 4, 21, 22 Therefore, PET-CT can be used as an accurate singlemodality staging investigation for upfront staging and risk assessment in pediatric HL.

 Treatment adaptation on the basis of anatomic response to chemotherapy has not yielded consistent results in pediatric HL. The Children's Cancer Group trial CCG 5942 (A Randomized Comparison of Chemotherapy With and Without Radiotherapy for Children With Hodgkin's Lymphoma: A Report from the Children's Oncology Group) randomly assigned patients who achieved anatomic complete remission after receiving COPP/ABV hybrid chemotherapy to receive RT or no further therapy. 23 The EFS was inferior without RT, although the OS did not differ significantly. 23 In the prospective trial conducted by the German Pediatric Oncology Hematology Of the patients in groups 1, 2, and 3, 100%, 29%, and 85% were treated without RT, respectively. (*) Three patients in group 3 had evidence of progression on interim PET. These patients received 4 cycles of the bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisolone, and procarbazine chemotherapy regimen. Subsequent end-oftreatment PET responses were negative, and RT was avoided in these patients.

 Hodgkin Disease Study Group (GPOH-HD95; Treatment of Children and Adolescents With Hodgkin Lymphoma Without Radiotherapy for Patients in Complete Remission After Chemotherapy), RT was omitted for all patients who achieved complete remission after chemotherapy with vincristine, etoposide, prednisolone, doxorubicin, cyclophosphamide, and procarbazine. 24 The progression-free survival (PFS) at 10 years was similar in patients with low-risk disease irrespective of omission of RT and significantly lower in patients with intermediate risk who did not receive RT. Although PFS was lower in patients with advanced disease who did not receive RT, the difference was not significant. 24 Early interim PET performed after two cycles of chemotherapy has emerged as a strong and independent prognostic factor for predicting those patients who experience treatment failure and PFS. 4, 5, 25 The translation of interim metabolic remission on PET to the elimination of RT from treatment needs to be further validated., In the peripheral compartment a cam-type impingement lesion can be assessed visually and dynamically, and can be excised. At this stage it is also possible to assess the iliopsoas tendon, although this normally requires penetration of the anterior capsule in order to be adequately exposed.

 The method of treatment of a torn labrum depends on the configuration of the tear. Small tears, fibrillated and/or degenerative labra can be treated with simple debridement, either mechanically with a shaver or by ablation, using a radiofrequency probe. Fragments of a larger size can be sutured by the use of arthroscopic sutures. Large flaps may also stabilised to the articular capsule by the use of an arthroscopic suture. A detached labrum can be stabilised with bone anchors, which are inserted to the acetabular osseous rim. Another tool for suturing the labrum is the FastFix (Smith & Nephew Inc., Endoscopy Division, Andover, Massachusetts) (Fig. 7) , which permits a rapid and safe method of suturing soft tissue.

 Chondral lesions are treated according to their severity, configuration and extension. Small defects can be treated by microfractures (Fig. 8) [66] , which induces the formation of fibrocartilage after the release of multipotent cells from the subchondral bone. Mosaicplasty [67] and autologous chondrocyte transplantation [68] are other promising techniques. Early degenerative changes may be treated with debridement and smoothening, either mechanically or with ablative probes. However, with chondral delamination (Fig. 2) the surgeon faces the dilemma of either removing the unstable articular cartilage, or trying to preserve it. Unpublished data from our practice have shown the efficacy of fibrin in stabilising acetabular cartilage in patients with delamination.

 When the underlying cause of labral or chondral pathology is femoroacetabular impingement lesion, then removal of the lesion is an inextricable part of the arthroscopic procedure. If the impingement lesion is of the pincer-type, then an acetabular recession is performed, which is the trimming of the osseous acetabular rim by the use of a burr. This may require detachment of the acetabular labrum, with subsequent reattachment using anchors. However, in certain circumstances it is possible to perform an acetabular recession but without detaching the labrum itself. When there is a cam-type impingement lesion then the arthroscopist should move to the peripheral compartment, which contains the femoral head-neck junction and femoral neck. The excision is, again, performed with an arthroscopic burr; the aim being to remove sufficient bone, to stop the abutment between the femoral head-neck junction and acetabulum (Fig. 9) .

 Rehabilitation in the first post-operative months is of paramount importance for the outcome of arthroscopic treatment. This can last up to four months before an athlete is able to return to his sporting activities, sometimes longer. Follow-up examination is also crucial for up to one year post-operatively, as the athlete continuously needs consultation, guidance and reassurance during the process of rehabilitation.

 As the hip is a deeply-situated joint, covered by a thick layer of soft tissues, the healing process after arthroscopy is relatively slow and needs an intensive physiotherapy protocol. Unfortunately, only sporadic articles regarding this matter can be found in the literature [69] .

 In our practice the physiotherapy programme begins on the day of operation with simple exercises and mainly educating the patient in the use of crutches. Most patients are advised to mobilise on crutches touch-weight bearing for a period of four weeks. Patients with excision of an impingement lesion are advised to avoid flexion of more than 90° for four weeks, to avoid discomfort. Intense physiotherapy begins one week post-operatively. The rehabilitation programmes are generally divided into three categories (simple, intermediate and advanced), according to the complexity of the procedures undertaken; however, the main guidelines remain the same. Gait re-education, isometric and range-of-movement exercises begin from the day of the operation. Stretching of the surrounding muscles begin on the second to fourth week, depending on the complexity of procedures undertaken. Strengthening usually begins on the fourth to sixth week. Hydrotherapy begins when sutures have been removed and wounds are dry. The stationary bicycle is an excellent exercise, which can be adjusted according to patient needs by increasing the saddle height for increased range of movement or adding resistance to improve muscle strengthening., The effects of non-adherence are smaller in relation to drugs with a long half-life, in comparison with drugs with a short half-life, for which the consequence of wrong dosages can be higher (21, 27) . Capecitabine is an oral fluoropyrimidine that was developed in response to the clinical need for new treatment options, offering equal efficacy, better tolerability and convenience for patients (8, 13) . Oral administration of this drug mimics the application of 5-FU in continuous infusion and saves the patient from the need for venous access to be implemented. The concentration of capecitabina in the tumor is almost 30 times higher than the plasma. The serum mean life of this drug is 30-45 minutes.

 The efficacy and safety of capecitabine has been documented in treatments for various tumor sites, as an adjuvant or palliative approach, in monotherapy or in association with other drugs, and as a radiosensitizer.

 The objective of this study was to evaluate the adherence of metastatic breast cancer and colorectal cancer patients to treatment with capecitabine, by means of patient reporting and pill counts, in three consecutive evaluations.

 A prospective cohort study was carried out over an eighteen-month period (August 2009 to April 2011) including patients with colorectal cancer, with or without metastasis, and patients with metastatic breast cancer, who were using capecitabine in monotherapy or in association with other drugs, such as oxaliplatin or irinotecan, and drugs with molecular targets, such as bevacizumab. All the patients were treated at the adult chemotherapy outpatient service of Hospital São Paulo, Federal University of São Paulo.

 The local ethics committee approved the study and all the patients signed a consent statement before taking part in the study.

 Patients of both genders were included, with ages between 18 and 85 years. Individuals who were incapable of comprehending or consenting to their participation in the study were excluded.

 The patients involved in the study were asked to bring back the leftover medicine (which had been given out at the start of each new cycle), at their return visits, so that the pillss could be counted with the intention of evaluating the adherence to the oral treatment. As well as the counts, the reports from the patients regarding any possible loss of pills were also assessed. In the event that pills were lost, they were also counted.

 All the individuals answered the quality-of-life questionnaire QLQ-C30 (European Organisation for Research and Treatment of Cancer -EORTC) at the initial visit and 8 or 12 weeks after the beginning of the treatment (9) . The quality of life questionnaire had been correlated to adhesion.

 The Wilcoxon test was used to compare the same variable at different times for each patient. Non-parametric statistical techniques has been done because the conditions for the use of parametric tests and techniques, such as normality and homogeneity of variance were not found. The Mann-Whitney test and the Kruskal-Wallis test were used to compare two or more variables simultaneously. Spearman's correlation was used to "measure" the interconnection among the variables. For the statistical analysis, the SPSS V16, Minitab 15 and Excel Office 2007 software were used.

 Thirty patients were studied, of which 20 (66.6%) were female. The patients' mean age was 60.2 years (SD = 14.06), and 63.3% were over the age of 60 years (Table 1) .

 Regarding the tumor location among the study participants, six (20%) patients had metastatic breast cancer, nine (30%) metastatic colon cancer, ten (33.3%) rectal cancer and five (16.7%) non-metastatic colon cancer (Table 1) . abine in monotherapy had greater adherence than shown by those who used the medication in association with other chemotherapeutic drugs, these differences were not significant ( Figure 2 ). Although patients did not are at the same cycle, the evaluation was done at the same time for all of them (between 8 to 12 weeks after the first treatment)., source_sentence: What are the symptoms commonly associated with a common cold?

sentences: In the levofloxacin group, the most frequent category of adverse events that were treatment-limiting involved the gastrointestinal system (1%).

 There were no differences in the incidence of treatment-emergent markedly abnormal laboratory values between the treatment groups. Given the potential effects of levofloxacin on the musculoskeletal system, abnormal alkaline phosphatase values in 2 children were considered to be clinically relevant. Two children in the levofloxacin group (1.7-year-old girl and 2.3-year-old girl) were noted to have increases in alkaline phosphatase; as the increases did not seem to be caused by either liver or bone disease, these events were possibly the result of transient hyperphosphatemia in infants.

 The results of this large trial demonstrate that levofloxacin is not inferior to standard-of-care therapy for the treatment of infants and children diagnosed as having CAP. Levofloxacin given at a dose of 10 mg/kg twice-a-day for children younger than 5 years and once-a-day for children older than 5 years for 10 days was tolerated as well as comparators and appeared to result in clinical cure rates that were similar to FDA-approved therapies for pneumonia in children. These findings were consistent in hospitalized and nonhospitalized children, and the results of this trial are consistent with those of clinical trials assessing the efficacy of levofloxacin in adults. 8 Clinical cure in levofloxacin-treated children exceeded 90% at TOCV. These rates are comparable to those measured in the comparator group and to rates reported in adult trials of CAP. Furthermore, these rates are similar to those reported in a smaller trial (n ϭ 296) that compared the efficacy of amoxicillin/clavulanate, azithromycin, and erythromycin as treatment of children with pneumonia. 9 In this trial, the cure rates in children younger than 5 years were 89.5% for amoxicillin/clavulanate and 86.5% for azithromycin based on the FDA's analysis of the intent-to-treat population. Corresponding rates in children older than 5 years were 95.6% and 92.9% for azithromycin and erythromycin, respectively.

 The results of this trial are based largely on clinical findings, as are the results of nearly all large comparative clinical trials involving children with CAP. A viral cause of pneumonia was not assessed in most of the children enrolled. The paucity of bacteria isolates (eg, S. pneumoniae, H. influenzae, S. aureus) obtained in this trial is not unexpected, given the difficulty in establishing an accurate bacterial etiology of CAP in children and infants without more invasive techniques. The reliance on sputum and blood cultures is likely to have resulted in an underestimation of the number of children in this trial who had these bacterial infections, whereas the inclusion of nasopharyngeal and oropharyngeal cultures may result in an overestimation. Recent work suggests that performance of DNA amplification on specimens may be more sensitive in detecting bacterial causes of pneumonia than reliance on blood or sputum culture in children; given the clinical presentation of children enrolled in the trial, it is possible that more episodes of documented bacterial infection would have been identified if these methods had been used. 10 The clinical trial experience reported here reflects a difficulty in establishing a microbiologic diagnosis of CAP in children that is similar to the experience in clinical practice. Given the potential for inappropriate use of antibiotics in children with viral lower respiratory tract infection as well as the potential for this use to impact on antibacterial drug resistance among respiratory bacterial pathogens, it is critical to consider microbiologic diagnosis in making decisions to use antibiotics in treating children with CAP, especially in children with mild disease.

 The results of serologic testing in this trial underscored the importance of mycoplasma as a cause of CAP in children. Increasingly in recent years, M. pneumoniae has been recognized as a frequent cause of CAP in infants and young children. Mycoplasma are widely considered to be a leading, if not the most important, cause of CAP in children Ͼ5-yearold. 10, 11 Although mycoplasma are also widely considered to be a less important cause of CAP in children younger than 5 years, most experiences have suggested these pathogens are important cause of CAP even in this younger age group. 12, 13 It has been suggested that most of these infections will eventually resolve without complication. However, M. pneumoniae has been documented to cause bronchopneumonia, parapneumonic effusions and necrotizing pneumonitis.

 14 Symptomatic infections are most often treated in children with macrolides., Based on existing research, I considered the latent period of the cold as being 24 to 72 hours, 11 which meant that insomnia would not be identified as the cause of a common cold if it appeared on the same day as the onset of the cold or on the day before the onset of the illness. Common cold includes multiple symptoms such as rhinorrhea, cough, and sore throat. 6 Patients with only one symptom (eg, rhinorrhea only, cough only, sore throat only) were excluded because diseases other than a common cold may be present if there is only one symptom. To diagnose a common cold, it is essential that the common cold resolves through spontaneous remission. 12 Finally, patients who did not follow up after recovering from their illness at least within one month after consultation were excluded from the final analytic sample.

 A medical questionnaire was given to all patients, and their symptoms were confirmed through a diagnostic interview with a physician. Based on this interview sheet, details on the period of illness and the nature of all symptoms were obtained. The questionnaire included a checklist with the following symptoms: fever, sore throat, 

 Chi-square tests were used to assess differences in gender and age groups. The Mann-Whitney U test was used to evaluate the difference between the two groups with regard to age. Although it was difficult to estimate the sample size because there was no previous research, MSTI was regarded as the primary explanatory variable of common cold, while cough and rhinorrhea were identified as confounding factors based on previous research. In order to use these three explanatory variables, the sample size of both the CC and NCC groups was required to be 30 or more based on the minimum 10 events per variable (EPV) rule. 13 This study satisfied the EPV rule. A significance level of P < .05 was used in the analyses. The relationship between MSTI and other symptoms was analyzed using logistic regression analysis. All statistical analyses were performed using R 

 All data and information provided by participating patients were anonymous. The questions that were given to all patients included a reference to the research that was being conducted and that the questionnaire was being used for this purpose. The completion and return of the questionnaire was considered to indicate consent. All participants were told that they could refuse to participate at any point in time and that there would be no disadvantages or repercussions for their refusal to participate. Additionally, the questionnaire used in the clinic during the initial consultation was used in this study as well. The questionnaire used in this study is one that is commonly used during patients' first visit to this hospital, and no special examination was performed beyond the routine examination by the physician for study participants. Further, I analyzed the data after the patients' diagnosis and treatment to reduce any risks or potential harm to the patients, and no aspects of their treatment were affected by their inclusion in the study. Finally, as research data that contained personal information were not included in the study, no personal information was extracted from the hospital records. This clinical research was carried out in accordance with the 1964 Declaration of Helsinki. The research protocol for this study was approved by the Japan Primary Care Association's Ethics Committee (approval number: approved number: 2019-002).

 The total sample included 32 patients in the CC (10 men; age range 0.5-84 years) and 30 in the NCC (14 men; age range 0.5-82 years). Table 1 shows that the patients' clinical and sociodemographic characteristics were homogenous, given that there were no statistically significant differences in age and gender between the two groups (P > .05). The NCC's final diagnoses included gastroenteritis (n = 11), sinusitis (n = 3), allergic rhinitis (n = 3), fever only (n = 3), asthma (n = 2), bronchitis (n = 1), pneumonia (n = 1), atopic cough (n = 1), urticaria (n = 1), varicella (n = 1), migraine (n = 1), pyelonephritis (n = 1), and myalgia (n = 1). During the study period, no influenza patients visited the clinic.

 Seventy-five percent of the patients in the CC (24 of 32) and 33% of those in the NCC (10 of 30) reported MSTI. The proportion of patients reporting MSTI was significantly larger in the CC than NCC (χ 2 = 10.854, df = 1, P < .001; Table 2 ). Logistic regression analysis revealed that CC was significantly associated with the presence of MSTI, cough, and rhinorrhea (Table 3) ., Pyramidal features (hyperreflexia, Babinski sign and fasciculations) were present in three patients (10%) with more than 20 years of disease duration. Two patients referred manifestations of depression (9%) and fatigue was reported by one case (4.5%). Four subjects (18%) manifested spasticity, resembling a phenotype similar to hereditary spastic paraplegia with cerebellar ataxia. Craniocervical dystonia was present in one patient, who carried the largest CAG repeat and earliest age at onset. Eyelid retraction was not observed. Neither signs of Parkinsonism nor chorea were detected. Up to 20 transmissions of the expanded CAG alleles were observed (15 paternal and 5 maternal). The CAG size of the expanded alleles in patients with paternal inheritance (mean 69.2, SD 3.33) and maternal inheritance (mean 71.6, SD 4.06) were not statistically different (p = 0.420). CAG size transmission was analysed in only three parent-child pairs; without expansions or contractions.

 All control individuals carried non-expanded CAG repeats. Twenty allelic classes were found, ranging from 

 Spinocerebellar Ataxia Type 3 is the commonest autosomal dominant inherited spinocerebellar ataxia worldwide, with variable prevalence according to ethnic background [11] . The present paper showed the epidemiological, clinical and molecular characterization of SCA3 in Cuba, resulting from the nationwide epidemiological survey for SCAs [12] . These findings identify SCA3 as the second most frequent molecularly confirmed autosomal dominant cerebellar ataxia in Cuba, only surpassed by SCA2, but more prevalent than SCA7 (0.10%), and SCA1 (0.05%) [13] .

 The frequency of SCA3 is lower in Cuba than reported in Brazil (72%) [14] , Portugal (58%) [15] , China (48%) [16] , Japan (28%), Germany (42%) and Spain (15%) [6, 11] , but is similar to those in India (5%), a country with a relatively higher frequency of SCA2 mutations [17] . Although our genealogical data revealed the origin of two Cuban kindred from populations with higher SCA3 frequencies, further haplotype studies are needed to determine the ancestral origin of SCA3 mutation in the Cuban population, since previous analyses of ATXN3 gene polymorphisms have supported evidences of independent and multiple origin of SCA3 in different populations [5] .

 Our findings confirmed the progressive, multisystemic and pleomorphic nature of SCA3 [6] . The main clinical features of Cuban SCA3 patients were in agreement with previous reports. [6, 7, 18, 19] . Pathological nystagmus is the most frequent oculomotor alteration of SCA3 patients [19] being present in 90% of the cases. In the present paper we confirmed the higher frequency of this feature, suggesting the marked involvement of cerebellar oculomotor circuitry in these patients, whereas the relatively small lower frequency of saccade slowing suggests the less involvement of pontine nuclei compared to SCA2 and SCA7, which has been previously confirmed by neuropathological findings [20] .

 Non-cerebellar manifestations are common features of SCA3 patients [21] , which were confirmed in the Cuban SCA3 population. Among them, cramps were the most prevalent, with a frequency similar to that reported by Kanai and co-workers in 2003 [22] , who identified an altered motor axonal excitability as the physiopathological origin of this feature. These findings have important implications for the management of patients due to the intensity and frequency of cramps in SCA3. Some patients have reported improvement using carbamazepine and mexiletine [22, 23] , which can be applied in Cuban SCA3 subjects as symptomatic therapeutical options.

 Other frequent non-cerebellar features observed in this cohort were the clinical signs of peripheral neuropathy, which was observed as frequent as in previous reports [24, 25] and suggest the involvement of peripheral nervous system in SCA3, as has been confirmed previously by neurophysiological studies [24] [25] [26] . As the peripheral signs are characteristic for the Type III SCA3 subtype, our findings suggest the higher prevalence of this phenotype in the Cuban population with SCA3 symptoms., source_sentence: What factors should be considered in the selection of patients for autologous hematopoietic stem cell transplantation (AHSCT) in the treatment of systemic sclerosis (SSc)?

sentences: All three entities share several features -varying shades of brown-to-slate-gray macular hyperpigmentation without antecedent inflammatory lesions on the face, trunk and upper limbs [ Figure 1 ]; and thinned epidermis, pigment incontinence and basal cell vacuolization on histopathology [ Figure 2 ]. Even the patient profile is similar -young-to-middle-aged females with dark skin complexion are preferentially affected. Bhutani considered ashy dermatosis and pigmented cosmetic dermatitis to be the same disease as lichen planus pigmentosus, but this view is not shared by all. [5, 6] In a clinicopathological study of ashy dermatosis and lichen planus pigmentosus, patients with ashy dermatosis (n = 20) were described as having symmetrical asymptomatic blue-gray macules with an erythematous border, where as patients with lichen planus pigmentosus (n = 11) had pruritic, darker macules without the active red border. Histological differences were not significant. 7 Notably the erythematous halo, described as a characteristic feature of ashy dermatosis and the primary differentiating feature, was absent in 60% of patients with ashy dermatosis. Further, the authors do not state what "gold standard" was used to reliably distinguish between these two

 What's in a name? That which we call a rose By any other name would smell as sweet -William Shakespeare, Romeo and Juliet

 The first description of ashy dermatosis is credited to Ramirez of El Salvador in 1957 who termed these patients Los cenicientos, meaning the ashen ones. 1 It was later called "erythema dyschromicum perstans" to highlight the erythematous halo around pigmented macules. 2 In the 1970s, Bhutani et al. gave a detailed account of a similar disease presenting as brown-to-slate-gray macules on the face, trunk and flexures of Indian patients. The histopathology showed pigment incontinence, accompanied by interface dermatitis in some cases. It was considered a macular variant of lichen planus and was termed "lichen planus pigmentosus." 3 Around the same time, another pigmentary disorder was described in Japan by Nakayama et al. by the name of "pigmented cosmetic dermatitis," now also known as Riehl's melanosis, and cosmetic allergens were implicated in causing the pigmentation. 4 Ever since, existence of these disorders as distinct entities or as variants of the same disease has been a topic of incessant debate. largely overlapping entities in their study. Recently, Chandran et al. also suggested that ashy dermatosis and lichen planus pigmentosus are distinct entities and that a diagnosis of lichen planus pigmentosus should be considered in patients with past or current evidence of lichen planus. 8 Though a potential clue, majority (70-85%) of patients present with only macular pigmentation without lichen planus elsewhere. 3, 9 One faces similar dilemma when trying to discern lichen planus pigmentosus from pigmented cosmetic dermatitis as well. Nakayama believed that the macules in pigmented cosmetic dermatitis are darker than lichen planus pigmentosus, and are usually bizarre-shaped, patchy or reticulate. Histological differences include epidermal spongiosis and lack of a band-like lichenoid infiltrate. 10 These clinical patterns of pigmentation have been reported in lichen planus pigmentosus as well, whereas a lichenoid infiltrate is seen only in a subset of cases (18-63%), probably in early active lesions. 9, 11 The clinical and histological differences are debatable, and even patch testing does not appear to be a reliable tool. While not every patient diagnosed as pigmented cosmetic dermatitis has a positive patch test, contact sensitivity to para-phenylenediamine, nickel, fragrances and other cosmetics has been reported in lichen planus pigmentosus and ashy dermatosis also. 12 We found one third (n = 17/50, 34%) of our patients with facial lesions of lichen planus pigmentosus to have a positive patch test. Dermoscopic examination revealed gray-brown dots/globules as the most common finding [Figure 3a] , followed by accentuation of pseudoreticular network [ Figure 3b ]. Further, we did not find any significant differences in the dermoscopic findings between patients with and without positive patch test results. 13 Similar dermoscopic findings have been reported by Pirmez et al. in lichen planus pigmentosus., This is an expected figure since it has been observed that there is a slowly progressive decrease in this parameter related to evolving skin fibrotic changes during the long-term disease course, 19 and not due to treatment as rapidly happens in transplanted patients.

 This open study confirms the results obtained in a number of previously published case reports and series of patients with dcSSc where the efficacy of AHSCT treatment in SSc was tested (reviewed in Naraghi et al. 11 ), and also in more recently published multicenter controlled trials 12, 13 where the outcome of transplantation procedure in patients with SSc was compared with that of well-defined CYC treatment regimens.

 A recent multicenter retrospective study has demonstrated that the use of selected CD34+ cells for AHSCT in patients with SSc did not add any benefit to the outcome with respect to the use of nonselected cells. 20 This finding should certainly be considered for future research protocols. We adopted the strategy of CD34+ selection for AHSCT at the beginning of our survey, following some literature data which, at that time, indicated a potential beneficial effect of this procedure in autoimmune diseases, probably due to the preliminary elimination of auto-reactive cells. 20 In the present study, we observed an early drastic reduction of skin thickening in the AHSCT-treated group. Such a result is most important, since persistently high mRss values have been shown to be a predictor of poor disease outcome and high mortality rate. 21, 22 Notably, the present study is the first that included a validated scoring system to assess disease activity among the Table 2 . Mean (and 95% CI) ESSG score, mRss and DLCO values in AHSCT-treated patients at the baseline time before transplantation (T0) and after 2 years (T2) and 5 years (T5) of follow-up Group A Group B   T0  T2  T5  T0  T2  T5 ESSG score Mean (CI) 6.7 (6.0-7.3) 2.1 (1.4-2.7) 2.0 (0. outcome measures adopted to evaluate the treatment efficacy. We believe this is a very important issue, since patients presenting a rapidly evolving and active disease could be the best candidates to undergo such an extremely aggressive treatment, and to have the best possible results. Finally, the present study demonstrates that the patients selected in the control groups with comparable levels of disease activity had a 5-year probability of survival of around 40%. This figure certainly makes the AHSCT-related mortality risk more acceptable. AHSCT-related mortality is reasonably low in our series and at least comparable to that reported in ASTIS trials. 13 Recent studies suggest that a relevant lowering of mortality, as a direct consequence of AHSCT, could be achieved thanks to a more accurate selection of candidate patients and, namely, to a more careful pre-transplant evaluation of lung and heart conditions. 23 This more careful patient selection was suggested after the retrospective analysis of the AHSCT-treated patients that demonstrated that most of the patients that died after AHSCT had such a bad outcome because of poor cardiac conditions before transplant. 23 Thus, a more accurate heart assessment before directing a patient to AHSCT is certainly needed. Right catheterization with fluid challenge and heart magnetic resonance evaluation are the diagnostic tools that have been proposed for this purpose. 24 We did perform fluid challenge only in some of the candidate patients, while the others underwent an accurate echocardiographic evaluation. Furthermore, we excluded from the transplantation procedure also patients with fairly severe lung involvement, that is, with a DLCO below 50% of predicted value. This may account for our quite low transplantation-related mortality rate.

 We are aware that our study suffers from some methodological limitations. First of all, this is a single-center open study, so the results herein described cannot have the same scientific power of those derived from a multicenter controlled trial. Second, the control group we adopted was a historical one, that is, a cohort of patients selected on the basis of demographic and clinical characteristics similar to those of the transplanted patients, but retrospectively analyzed. This may introduce a bias, when one considers the recent paper by Ferri et al., 3 demonstrating that the 10-year survival observed in cohorts of patients with SSc collected in more recent decades was improved with respect to what was reported in cohorts of older patients. This could be ascribed to the availability of more precise and effective diagnostic tools that allow to define the diagnosis in earlier stages, and to the improvement of therapeutic measures. However, the most significantly lower survival difference was observed in cohorts described before 1970s., Also, the hysteria often associated with a contagious disease may interfere with knowledge acquisition or inhibit therapists from viewing these patients in the typical function-dysfunction perspective rather than from a solely diagnostic perspective.

 Recent evidence (Langone, 1985) shows that up to 40% of all persons with AIDS manifest some neurological impairment. The results of post mortem studies demonstrate brain atrophy, demye linization of the cord, and encephalitis and meningitis (Langone; Perry & Jacobsen, 1986) . Originally these neurological complications were thought to be related to the presence of opportunistic infections that had infiltrated the central nervous system. New evidence appears to suggest that the HIV itself may be capable of attacking T-cells in the brain, or glial cells which support neurons and provide the brain with nourishment. Macrophages which devour bacteria may also be targets for the AIDS virus (Langone; Perry & Jacobsen).

 The literature includes reports of neuromotor and psychosocial complications in persons with AIDS (Anders, 1986; Bass, 1984; Beckman, 1986; Dilley, 1985; Goldstick & Mandybur, 1985; Hoffman, 1984; Kermani & Drob, 1984; Lipkin, 1985; Ochitill, Perl, Dilley, & Volberding, 1984; Snider, Simpson & Nelson, 1983) . These complications include spinal cord degeneration resulting in paraparesis, progressive weakness, decreased endurance, sensory-perceptual changes, peripheral neuropathies, dysphagia, and progressive multifocal leucoencephalopathies. Or-ganic brain syndrome, major depressive and adjustment disorders, and gross cognitive deficits have also been described.

 In addition, acute episodes of hypochondriases, diffuse anxiety reactions, panic and phobic attacks, and psychosomatic disturbances have been reported in the "worried well" population (Perry & Jacobsen, 1986; Morin, Charles, & Malyon, 1984) . These problems develop in people who are in high-risk groups and have potential for developing AIDS but currently do not have any of its symptoms.

 Burke states that "our response to new frontiers depends on our own ability to change" (1984, p. 26) . With AIDS the changes may need to occur partially in our attitudes, beliefs, and value systems regarding sexuality and morality which may clash or conflict with those of the patient group. Recognizing the person with AIDS as an individual, rather than as a member of a stereotyped group, may enhance the quantity and quality of the patient-therapist interaction while potentially challenging firmly established beliefs or value systems. In addition, health care professionals who care for persons with AIDS may experience helplessness or hopelessness caused by a disease which most often ends in death. To be successful in these new frontiers therapists must learn to identify and manage the stress associated with these treatment challenges and the feelings the disease evokes.

 Persons with AIDS cannot benefit from occupational therapy services until those proViding the services take responsibility for educating themselves, their peers, and their students about this condition. Siebert emphasized this point by stating, "Keeping current is essential if the profession is to adapt to and adopt change, when it will benefit patient care" (1985, p. 29) .

 The disabilities that result from AIDS (cancer, hemiplegia, adjustment reactions, cognitive disorders, etc.) do not require a change in occupational therapy intervention approaches. There are precautions to adhere to, observations to be made, assessments to complete, and treatment plans and goals to be devised. As with other patient groups, therapists working with AIDS patients may be more effective if they use the "whole person" concept to address the psychosocial, physical, and environmental factors influencing function.

 The follOWing five guidelines are derived from my clinical consultations and volunteer experiences with persons with AIDS and from a review of the literature. They are intended to facilitate the implementa-

 The Americanjournal of Occupational Therapy tion of occupational therapy services for persons with AIDS and AIDS-related disorders.

 As preViously discussed, education is crucial in allaying fears, in correcting misinterpretations of the disease, and in making intervention plausible. It includes educating ourselves by keeping current with research findings and medical advancements, educating our peers formally and informally, and ensuring that AIDS is addressed in the occupational therapy curriculum.

 Precautionary measures may be helpful when dealing with the clinical manifestations of AIDS or AIDS-related conditions. For the patient who is weak, fatigues easily, or has reduced endurance, energy conservation or work simplification techniques may be indicated or evaluation and treatment sessions may be kept brief., source_sentence: What are the potential advantages of using exosomes or their mimics as drug carriers in cancer therapy?

sentences: In our study, we found that newly diagnosed diabetic subjects had significantly lower HMW adiponectin/leptin ratios when compared with control subjects, and saw significant correlations between the HMWA/leptin ratio and multiple measures of autonomic function (LFa/RFa ratio, TSP baseline, and rmSSD baseline) (Lieb et al., 2011) . In a study of 120 non-obese humans without diabetes, Paolisso et al. (2000) demonstrated that increasing plasma leptin concentrations were associated with increasing LFa/HFa ratios, suggesting greater SNS activity as compared with PSN activity. Studies have also shown interesting correlations between adiponectin and autonomic function. Wakabayashi and Aso (2004) studied 105 men and women with T2D and found that adiponectin concentrations correlated negatively with the LFa/RFa ratio. Of note, changes in the adiponectin/leptin balance in the course of diabetes may first be seen by utilizing measures of high-molecular weight adiponectin rather than total adiponectin, as demonstrated by our findings (Table 3) . These findings and the results in animal studies again suggest that the effects on adipose tissue cytokine release may be a consequence of autonomic dysfunction as opposed to the corollary. Clearly a closer look at the relationship between adipose tissue cytokines, obesity, and the impact of weight reduction on the relationship between inflammation and HRV is warranted. With the explosive developments in global obesity and the proliferation of gastric bypass procedures on adults and even children, no doubt this will yield a fertile field for exploring these relationships and their potential for therapeutic intervention.

 

 Physiological health is characterized by organized variability in organ functions which are controlled by neural networks that provide compensatory output to maintain homeostasis around set points which are appropriate for the system in time, gender, age, body weight, and BP among other variables such as exercise, sedentary habits, and smoking. While these neural network imbalances can theoretically be corrected by relatively simple maneuvers they are in general difficult to obtain and maintain. However this is possible. Our interest in falling and fractures in older diabetics has taught us that much of these injuries are due to the loss of the organized variability, strength, and reaction times; furthermore, with very simple strength and balance training falls risk can be significantly reduced (Morrison et al., 2010) . Just as when landing planes in Hong Kong the pilot indulges in serial deviations in wing tip position to allow the computer to correct these and ensure a safe landing we have a need to enhance the imbalance in autonomic and inflammatory reflexes that characterize the loss of physiological and pathological flexibility. Just as in diabetes management, this requires work and of course we all want the magic bullet. Some are on the horizon. However, even simple maneuvers such as walking the dog can restore autonomic balance (Figure 6 ). For the abnormalities in autonomic balance adrenergic excess can be addressed with beta blockers and parasympathetic excess with anticholinergic drugs (Vinik and Erbas, 2006 ; Table 4 ).

 We have reported simple pharmacological manipulation of situations of parasympathetic and sympathetic imbalance with important changes in the symptom complex and quality of life of the afflicted individuals . Intervention studies have documented the protective effects of glycemic control in type 1 diabetes (DCCT) and of multifactorial strategy aimed at lifestyle change with pharmacological correction of hyperglycemia, hypertension, dyslipidemia, and microalbuminuria (Gaede et al., 2003) .

 Immune therapy for patients with antibodies to the ACH receptor has been effective in relieving postural hypotension (Bourcier www.frontiersin.org . Antioxidant therapy with alpha lipoic acid restores autonomic function toward normal .

 More recently interest in the selective muscarinic acetylcholine receptor has been shown to suppress innate immune responses in the periphery by increasing the firing rate of action potential in the vagus (Pavlov et al., 2007) . To quote "The end products of a search for agents with which to restore balance will be a map of the homunculus of sensory and motor components corresponding to neuroanatomical and functional neurophysiologic pathways linking the autonomic and inflammatory pathways and their response to endogenous as well as exogenous stressors of the system." While Kurt Vonnegut had insights in Breakfast of Champions in 1973 it is only now that this link is gaining recognition for the havoc it wreaks and the potential for avoidance and therapeutic intervention. Of great interest are the abnormalities in the diurnal regulation of dopaminergic tone., At present, there are several methods for loading "cargo" into exosomes: (a) transfection of exosome-secreting cells [43] , (b) chemical-based exosome incorporation with exogenous cargoes [44] , (c) electroporation [45] and alternative exosome-loading techniques [46] .

 Exosome mimetics have similar sizes, surface morphologic features, and targeting abilities as exosomes. Jang et al discovered that chemotherapeutic drug-loaded nanovesicles, as exosome mimetics, inhibited tumor growth in vitro and in vivo, with no adverse effects [47] ; Wu et al first reported the preparation for exosome-mimetic nanovesicles (NVs) from primary hepatocytes with almost 100 times the production yield compared with exosomes. Meanwhile, NVs were demonstrated to have both components and biofunctions similar to exosomes from primary hepatocytes [48] . These findings indicate that exosome mimetics, serving as drug carriers to replace exosomes, can effectively overcome two common issues with exosomes: the difficulties of mass production and the time-consuming nature of the purification process. Therefore, exosomes have many advantages over other existing delivery systems. In MM therapy, it may be possible to use exosomes or their mimics as carriers to load miRNA or protein inhibitors or mimics, since endogenous miRNAs can be encapsulated into exosomes to escape endonuclease degradation.

 Taken together, several abnormally expressed components in MM-derived exosomes, including miRNAs, proteins, and sphingolipids are potential targets for MM treatment. Utilizing the regulators of these components may have a tumor-suppressive effect. In addition, exosomes can be developed into vaccines for prophylactic immunity. The natural nano structure of exosomes makes them excellent carriers for drug delivery. However, when it comes to the future use of exosomes, there are still issues that need to be resolved. For components such as miRNAs, proteins, and sphingolipids, mass production of their mimics or regulators remains a major obstacle. Studies of exosome vaccines are still limited. Thus, more studies are needed to ensure that these treatments are effective and safe. Satisfactory efficacy and safety profiles have been demonstrated for exosomes and their mimics in other types of diseases, including NSCLC, type 1 diabetes mellitus, and colon cancer, but clinical trials in MM are still absent. Therefore, MM clinical trials are indispensable., Category B patients are treated as possible dengue cases and are handled similarly to category A cases, except that RT-PCR and virus isolation for DENV are performed retrospectively on the acute sample only if serologic assays on paired acute-and convalescent-phase samples indicate a current DENV infection.

 Category C and category D patients. Category C (febrile) and category D (afebrile) patients receive medical care and tests as indicated by their symptoms. In December 2005 and January 2006 and then from June 2006 to the present, a convenience sample of acute blood specimens from about 40% of category C patients was collected and stored for future dengue testing.

 An annual field visit is conducted to assess and encourage participant participation. Study teams attempt to visit each child at his/her home, which is located by using GPS data. If the team cannot interview a parent or guardian at the first visit, 2 additional attempts are made. Study teams composed of 2 field staff are preassigned a set of participants to visit, maps of the location of each team's set are printed, and the GPS points and children's information are downloaded into hand-held GPS devices. Throughout the day, data are transferred from the field staff's personal data assistants (PDAs) to a supervisor's PDA to prevent data loss and to allow for multiple updates of the study database throughout the day. This allows for real-time monitoring, enabling rapid assessment of progress, efficient reassignment of participant visits when necessary, and effective planning of the next day's visits. Questions in the study participation survey elicit information about attendance to the HCSFV for all illnesses and use of medical providers outside of the cohort. Periodic field visits are also conducted to collect convalescent samples, provide follow-up medical care to children who miss appointments, and check on the status of participants who have not had contact with the study in the prior 6-month period.

 Yearly sample collection Each July or August, an annual blood sample is collected to examine the incidence of subclinical DENV infection. The annual sampling takes place in 2 phases. In the first phase, participants present at the HCSFV, and the annual sample is collected at a temporary specimen collection center in the HCSFV auditorium. Briefly, children are identified by identification card or fingerprint scanning at the identification and registration station, where barcode labels for all documents and sample tubes are automatically printed. Children continue to a nurses' station where a nurse uses a barcode scanner-enabled PDA for automatic retrieval of data and paperless data entry of interview and specimen information. The nurse draws a blood sample for CBC and dengue serologic tests. The CBC results are returned to the parent or guardian within 2 days, and if any abnormalities are noted (e.g., anemia), appropriate medical follow-up is scheduled. When they pick up the CBC results, participants are provided with a study gift of school supplies worth approximately US $1.00. Test results indicating whether the child has been infected with DENV during the previous year are also returned. In the second phase, field teams visit the homes of all participants who did not present to the HCSFV during the first phase. As in field visits, households are located using GPS devices. Each household is visited at least 3 times in an attempt to locate the participant. After 3 unsuccessful attempts to locate the participant or confirmation that the child no longer lives in the study area, study staff record the child as lost to follow-up.

 In order to ensure the quality of samples and laboratory results, a sample-tracking system was developed to handle the thousands of blood samples processed each year (refer to Figure 2 for an example of category A samples). All samples collected in the study are labeled with 2-dimensional barcodes, which are appropriately sized for collection, microcentrifuge, and cryopreservation tubes. This minimizes input error and allows real-time sample tracking from collection in the HCSFV or in the field to processing and storage in the National Virology Laboratory. Barcode labels for sample collection tubes are automatically printed during the year upon a child's presentation with illness at the clinical laboratory in the HCSFV following the scanning of a study identification card or child's fingerprint and selection of the medical tests to be performed. When samples are collected in the field, barcode labels are preprinted prior to the visit. At every step, from collection of the sample to transport to reception at the Virology Laboratory, the tubes are scanned, and an automatic time and date stamp is recorded. Once received at the Virology Laboratory, each sample is scanned, at which time barcode labels are automatically printed for sample processing and storage of all aliquots. The sample-tracking system is used to automatically record the box, rack, and freezer in which a sample is placed for storage., source_sentence: What are the benefits of using laparoscopy in the management of blunt abdominal trauma?

sentences: When the motor end plates are reinnervated electromyography shows polyphasic action potentials 15 .

 In circumstances where electrophysiological studies do not detect a loss of axonal continuity or Wallerian degeneration it is advisable to have a period of "watchful waiting" with regular nerve conduction studies to confirm that nerve transmission is not deteriorating 15, 16 .

 In any of the cases described above, patients presenting with a nerve injury should always be referred to a specialist in order to start the most appropriate treatment as early as possible.

 In facial surgery nerve injuries have been reported following procedures such as blepharoplasties, rhinoplasties, genioplasties and most commonly in rhytidectomies 16 . There have been some distressing reports of blindness following blepharoplasties. Data collected regarding rhinoplasties has reported cases of sensory loss of the nose-tip and injuries resulting from genioplasties have caused anesthesia or dysesthesia affecting the lips, chin and in some cases, paresthesia or paralysis of the lower lip. However rhytidectomies are the commonest cause of facial nerve injuries. Patients can present with paresis with loss of function of the facial nerve-an event which can have a significant psychological impact for the patient 14 .

 The majority of nerve injuries following rhytidectomies show sensory loss with the great auricular nerve being the most commonly affected. This is followed by injuries resulting in loss of motor function affecting in decreasing order the following divisions of the facial nerve: temporal, marginal mandibular, buccal and zygomatic.

 There are some reports that rhytidectomies performed endoscopically on the upper third and upper half of the face can lead to complications such as transitory paresis of the temporal and zygomatic branches of the facial nerve showing recovery within six months after the procedure. When the procedure is carried out using ultrasound-assisted liposuction the incidence of motor nerve injuries is 7.6% (affecting the marginal mandibular branch) 17 .

 Although an uncommon outcome from aesthetic surgery of the neck, injury to the spinal accessory nerve has been documented following cervicofacial lift and is most likely due to scar formation developing around the nerve. 32 About 20% of injuries affecting the motor function of the facial nerve following rhytidectomies fail to show any spontaneous recovery of function.

 The facial nerve and its branches travel along the anteromedial aspect of the parotid gland, running in a deep plane towards the superficial muscular and aponeurotic system (SMAS). The facial muscles are therefore innervated by the facial nerve from a deep position with the exception of the muscles elevating the corner of the mouth: buccinator and mentalis. With this in mind it is therefore necessary to perform a superficial dissection of the SMAS in order to avoid nerve-related complications 2, 14, 16 . Fig. 1 . Zeckel´s nerve risk zones during face lift; major to minor risk; 1= great auricular nerve, 2= frontal branch of facial nerve, 3= marginal branch of facial nerve, 4= buccal branch of facial nerve, 5= supraorbital nerve, 6= infrorbital nerve, 7= mental nerve Furthermore dissections of the posterior aspect of the sternocleidomastoid muscle ought to be undertaken with caution from beneath the mastoid process where the great auricular nerve runs more superficially thus increasing the risk of injury. Care must therefore be taken when using electrocautery while dissecting the superficial nerves.

 Permanent damage to the nerve results in hypoesthesia or, in patients with a neuroma, painful dysesthesia in the lower two thirds of the ear and the skin of the neck and cheek. The temporal branch of the facial nerve poses the greatest risk of motor damage followed by the marginal mandibular and buccal branches. In terms of anatomical regions, the temporofrontal region, the angle of the mandible and the pre-parotid region are the riskiest areas in terms of nerve injury 4, 8 .

 The temporal branch of the facial nerve is the thickest and is located anterior and caudal to the frontal branch of the superficial temporal artery in 91% of cases. Seckel locates the temporal branch in an area he describes as Facial Zone 2, where the nerve branch originates below the parotid gland at the level of the zygomatic arch before innervating the frontal muscle. Injury to the nerve results in paralysis of this muscle but orbicular function remains intact owing to the dual innervation it receives from the inferior zygomatic branches., The use of laparoscopy in trauma has lagged behind in the otherwise rapid progression of this groundbreaking surgical tool. Although reports exist of the use of laparoscopy for the diagnosis of hemoperitoneum as far back as the 1920s, there is still a paucity of literature on this subject to this day. 1, 2 There is no doubt that this is related to the nature of trauma. There is often anxiety and concern to optimize the patient with the quickest possible intervention. It should be stated early in this discourse that there is no role for laparoscopy in the management of the patient with abdominal trauma who is hemodynamically unstable. The priority in this situation follows the standard life-saving principles of resuscitation, with quick access for hemostasis, which must in those situations be open surgery. Associated extraabdominal injuries like head injuries may also be worsened by the hemodynamic effects of carbon dioxide pneumoperitoneum and may preclude laparoscopy. The gasless laparoscopy technique has been described to attenuate this as well as to prevent air embolism and also pneumothorax in patients with occult diaphragmatic injuries. 3 Laparoscopy can be safely used when an intraabdominal injury is suspected in a patient, i.e., hemodynamically stable. These are patients with a systolic blood pressure of >100 mm Hg, diastolic blood pressure of >60 mm Hg, a heart rate of <110 beats per minute, and crystalloid resuscitation requirements of <2 L. 4 The objective of this review is to determine the scope of the diagnostic and therapeutic uses of laparoscopy in blunt abdominal trauma, and also to delineate the benefits, complications, as well as prospects of laparoscopy in patients with blunt abdominal trauma.

 The PubMed search engine was used to search for peer-reviewed articles. The keywords entered were laparoscopy, blunt, abdominal, and trauma. The search was filtered to include only articles written in the last 5 years. All 55 articles obtained from the database were then reviewed for relevance and sample size. Case reports were excluded.

 Several articles discussed the uses of laparoscopy in blunt abdominal trauma. The role of laparoscopy as the most sensitive detector of a breach of the peritoneum in penetrating abdominal trauma is immediately apparent. 5 It is instructive that the authors reviewed equally acknowledged the role of laparoscopy in diagnosis in blunt abdominal trauma. Johnson et al 5 started their study on the established premise that diagnostic laparoscopy (DL) had decreased the rate of nontherapeutic laparotomies in patients with penetrating abdominal injuries. They sort to determine whether DL similarly lowered nontherapeutic laparotomy in blunt abdominal injury. They found that coupled with diagnostic computed tomography (CT) scan, DL yielded a nontherapeutic laparotomy rate of 0% in patients with blunt abdominal trauma. They concluded that when combined with CT scan, DL is a useful tool in the initial evaluation of patients with blunt abdominal trauma. Lee et al 6 had similar findings demonstrating that the use of laparoscopy in patients with abdominal trauma safely decreased the laparotomy rate. 14, 15 Lin et al 16 have described a new approach for management of high-grade splenic injury laparoscopically. They, however, emphasize the need for adequate training on laparoscopy in trauma.

 Evaluation of diagnostic tools in blunt abdominal trauma remains a contemporary issue to clarify the need for appropriate surgical intervention. 17 This study clearly describes the safety of DL as an approach in blunt abdominal trauma. With the increasing trend for limited intervention in appropriately selected hemodynamically stable patients with blunt abdominal trauma, the role of DL is brought to the fore. [18] [19] [20] As minimal access surgery becomes more prominent, laparoscopic surgeons should equally remain aware of the potential complications that could arise when this approach is adopted in the management of patients with blunt abdominal trauma.

 

 Laparoscopy can be safely used both diagnostically and therapeutically in hemodynamically stable patients with blunt abdominal trauma., The study here complements those results; demonstrating that texture-based analysis of the StO 2 -contrast may yield similar statistical differences between response groups (P ¼ 0.044). Grey-level co-occurrence matrices analyses here, provided discriminant features by using volumetric tumour analysis, in addition to second-order statistical analyses that examined the pixel-by-pixel relationships of tumour heterogeneities within the parametric maps. Measures of spatial heterogeneity in tumour Table 2A reports the percentage of the statistical power. The numbers inside parentheses in this column indicate the number of non-responders (n2) required in this study to achieve a statistical power of minimum 80% in case that the number of responders (n1) is fixed at 27. physiology as conducted here, could potentially provide good characterisation of biological traits that influence tumour response to treatment. Such features include tumour hypoxia (Hockel and Vaupel, 2001) , and haematological characteristics such as blood flow and vascular density (Folkman, 2002) . These features have been shown to influence tumour cell proliferation and metabolism, and therefore may also affect chemosensitivity (Folkman, 2002) .

 The use of such measures better reflects tumour physiology, which is not homogeneous but rather spatially heterogeneous.

 Additionally, multiparametric analysis resulted in sensitive and specific combined markers for response classification. Logistic regression analysis demonstrated B10% improvement in all performance measures by using pairwise features compared to the case of using only one single feature. However, the naive Bayes and k-NN did not show a significant improvement. This may be related to the small sample size used and peaking phenomena (Jain et al, 2000) . Features into the pairwise models included: HbO 2 -cor, HbO 2 -hom, Hb-cor, HbO 2 -con, Hb-hom, and Hb-con. Individually, those non-texture DOS parameters were previously correlated to tumour vasculature (Intes, 2005) . Additionally, the heterogenic tumour vasculature has been linked to mediating drug resistance; caused by structural scaffolds that inhibit effective drug delivery (Teicher et al, 1990; Galmarini et al, 2000; Tredan et al, 2007) . These include poor vascular flow, increased interstitial fluid, and a tightly bound cellular matrix that may constrain drugs from reaching into the tumour stroma thereby affecting the efficacy of chemotherapies.

 In comparison to other studies, texture analysis of MRI ( spectroscopy (Sadeghi-Naini et al, 2014) , and DOS (Sadeghi-Naini et al, 2015) images have been used to assess and monitor chemotherapy response in breast tumours during the course of treatment. Textural analysis of pretreatment MRI-based kinetic maps have indicated positive results for predicting chemotherapy response in 'triple-negative' breast tumours (Golden et al, 2013) . Those results also strongly suggest that pretreatment tumour heterogeneity can influence drug resistance (Golden et al, 2013) . Other similar studies have examined texture features of dynamic contrast-enhanced MRI images to predict NAC response (Ahmed et al, 2013; Teruel et al, 2014) . Results have indicated significant differences in GLCM texture features between responders and non-responders at pretreatment (Ahmed et al, 2013) and have reported an increase in textural heterogeneity caused by necrotic tumour areas (Ahmed et al, 2013) . Those studies demonstrated comparable frameworks to the present study. Specifically, that heterogeneous tumour features caused by pathophysiology, and initial biochemical composition might play an important role in chemoresistance.

 In terms of novelty, the results indicate that selecting volumetric tumour-based ROIs may improve the method for DOS texture analysis to predict NAC response. Additionally, we compared the performance of several classification methods and found that using naive Bayes classifier demonstrated high accuracy in predicting chemotherapy treatment response. The preliminary work in this study highlights an important phase in the 'imaging biomarker roadmap' outlined by Cancer Research UK (CRUK) and the European Organisation for Research and Treatment of Cancer (EORTC) (O'Connor et al, 2017) . Diffuse optical spectroscopybased biomarkers have surpassed the initial translational gap outlined within this roadmap; specifically, as a useful tool in medical research (O'Connor et al, 2017) .
datasets: vectorranger/med
pipeline_tag: sentence-similarity
library_name: sentence-transformers
metrics: cosine_accuracy@1, cosine_accuracy@3, cosine_accuracy@5, cosine_accuracy@10, cosine_precision@1, cosine_precision@3, cosine_precision@5, cosine_precision@10, cosine_recall@1, cosine_recall@3, cosine_recall@5, cosine_recall@10, cosine_ndcg@10, cosine_mrr@10, cosine_map@100
model-index: name: EmbeddingGemma-300m trained on vectorranger/med (filtered medical Q/A from MIRIAD)
results: task: type: information-retrieval
name: Information Retrieval
dataset: name: med eval 500q 10kd
type: med-eval-500q-10kd
metrics: type: cosine_accuracy@1
value: 0.878
name: Cosine Accuracy@1
verified: no, type: cosine_accuracy@3
value: 0.966
name: Cosine Accuracy@3
verified: no, type: cosine_accuracy@5
value: 0.986
name: Cosine Accuracy@5
verified: no, type: cosine_accuracy@10
value: 0.99
name: Cosine Accuracy@10
verified: no, type: cosine_precision@1
value: 0.878
name: Cosine Precision@1
verified: no, type: cosine_precision@3
value: 0.32199999999999995
name: Cosine Precision@3
verified: no, type: cosine_precision@5
value: 0.1972
name: Cosine Precision@5
verified: no, type: cosine_precision@10
value: 0.099
name: Cosine Precision@10
verified: no, type: cosine_recall@1
value: 0.878
name: Cosine Recall@1
verified: no, type: cosine_recall@3
value: 0.966
name: Cosine Recall@3
verified: no, type: cosine_recall@5
value: 0.986
name: Cosine Recall@5
verified: no, type: cosine_recall@10
value: 0.99
name: Cosine Recall@10
verified: no, type: cosine_ndcg@10
value: 0.9394101599082495
name: Cosine Ndcg@10
verified: no, type: cosine_mrr@10
value: 0.9224523809523808
name: Cosine Mrr@10
verified: no, type: cosine_map@100
value: 0.9229275528393175
name: Cosine Map@100
verified: no
Likes: 1 | All-time downloads: 149
Created: 2025-12-03 16:17:41