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[ { "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": "Anti U1-RNP antibody is seen in?" }, { "role": "assistant", "content": "The correct answer is “Absence of U1 RNP antibodies essentially rules out mixed connective tissue disorder”\nANTINUCLEAR ANTIBODY (ANA) PATTERNS AND CLINICAL ASSOCIATIONS" } ]

[ { "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, Clinical Competence, Female, Humans, Male, Middle Aged, Nursing Assessment, Posture, Pressure Ulcer, Prone Position, Sacrococcygeal Region, Ultrasonography, Young Adult." }, { "role": "user", "content": "Do effects of position and operator on high-frequency ultrasound scan quality? Context: High-frequency ultrasound may evaluate those at risk for pressure ulcers. Images may be obtained by clinicians with limited training. The prone position is recommended for obtaining sacral scans but may not be feasible in the critically ill. This study investigated image quality using multiple operators and a variety of patient positions. Sacral scans were performed in three randomised positions in 50 volunteers by three different investigators using a 20 MHz ultrasound system. General linear models and ANOVA random effects models were used to examine the effects of operator and position on image quality rating, and measures of dermal thickness and dermal density. The best scan for each position and operator was used for analysis (n=447 images). Image rating varied by operator (p=0.0004), although mean ratings were 3.5 or above for all operators. Dermal thickness was less for the prone position than in 90° or 60° side-lying positions (p=0.0137, p=0.0003). Dermal density was lower for the prone position than for the 90° or 60° positions (p<0.0001 for both)." }, { "role": "assistant", "content": "These data show that overall scan quality was acceptable in all positions with all operators. However, differences were found between side-lying positions and the prone for dermal thickness and dermal density measures. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Age Distribution, Age Factors, Aged, Aged, 80 and over, Alzheimer Disease, Biomarkers, Brain, Brain Ischemia, Cardiovascular Diseases, Cross-Sectional Studies, Female, Humans, Inflammation, Inflammation Mediators, Interleukin-6, Magnetic Resonance Imaging, Male, Middle Aged, Osteoprotegerin, Sex Distribution, Tumor Necrosis Factor-alpha." }, { "role": "user", "content": "Are inflammatory biomarkers associated with total brain volume : the Framingham Heart Study? Context: Systemic inflammation is associated with ischemia and Alzheimer disease (AD). We hypothesized that inflammatory biomarkers would be associated with neuroimaging markers of ischemia (i.e., white matter hyperintensities [WMH]) and AD (i.e., total brain volume [TCB]). MRI WMH and TCB were quantified on 1,926 Framingham Offspring participants free from clinical stroke, TIA, or dementia (mean age 60 +/- 9 years; range 35 to 85 years; 54% women) who underwent measurement of a circulating inflammatory marker panel, including CD40 ligand, C-reactive protein, interleukin-6 (IL-6), soluble intracellular adhesion molecule-1, monocyte chemoattractant protein-1, myeloperoxidase, osteoprotegerin (OPG), P-selectin, tumor necrosis factor-alpha (TNFalpha), and tumor necrosis factor receptor II. To account for head size, both TCB (TCBV) and WMH (WMH/TCV) were divided by total cranial volume. We used multivariable linear regression to relate 10 log-transformed inflammatory biomarkers to brain MRI measures. In multivariable models, inflammatory markers as a group were associated with TCBV (p < 0.0001) but not WMH/TCV (p = 0.28). In stepwise models adjusted for clinical covariates with backwards elimination of markers, IL-6 and OPG were inversely associated with TCBV; TNFalpha was inversely related to TCBV in a subset of 1,430 participants. Findings were similar in analyses excluding individuals with prevalent cardiovascular disease. The relations between TCBV and inflammatory markers were modified by both sex and age, and generally were more pronounced in men and in older individuals." }, { "role": "assistant", "content": "Although our observational cross-sectional data cannot establish causality, they are consistent with the hypothesis that higher inflammatory markers are associated with greater atrophy than expected for age. 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: Ambulances, Cross-Sectional Studies, Emergency Medical Services, Humans, Methicillin Resistance, Staphylococcus aureus, United States." }, { "role": "user", "content": "Can methicillin-resistant Staphylococcus aureus be found in an ambulance fleet? Context: To perform an initial screening study of methicillin-resistant Staphylococcus aureus (MRSA) contamination in an ambulance fleet. This was a cross-sectional study of MRSA contamination in an ambulance fleet operating in the western United States in June 2006. Five specific areas within each of 21 ambulances (n = 105) were tested for MRSA contamination using dacron swabs moistened with a 0.85% sterile saline solution. These samples were then plated onto a screening media of mannitol salt agar containing 6.5% NaCl and 4 mcg/mL oxacillin. Thirteen samples isolated from 10 of the 21 ambulances (47.6%) in the sample group tested positive for MRSA." }, { "role": "assistant", "content": "The results of this preliminary study suggest that ambulances operating in the emergency medical services (EMS) system may have a significant degree of MRSA contamination and may represent an important reservoir in the transmission of potentially serious infections to patients." } ]

[ { "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": "Ultrasonography of a pregnant female's uterus shows 'Snow storm appearance', which is indicative of:" }, { "role": "assistant", "content": "The correct answer is Characteristic echogram of molar pregnancy is 'snow storm' appearance due to multiple small sonolucencies due to the hydropic villi. Fetal tissues and amniotic sac are absent. In contrast, sonographic features of a paial molar pregnancy include a thickened, hydropic placenta with a concomitant fetus. Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 37. Gestational Trophoblastic Disease. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: ." }, { "role": "user", "content": "Is the protein Nalpha-terminal acetyltransferase hNaa10p ( hArd1 ) phosphorylated in HEK293 cells? Context: The hNaa10p (hArd1) protein is the catalytic subunit of the human NatA Nalpha-terminal acetyltransferase complex. The NatA complex is associated with ribosomes and cotranslationally acetylates human proteins with Ser-, Ala-, Thr-, Val-, and Gly- N-termini after the initial Met- has been removed. In the flexible C-terminal tail of hNaa10p, there are several potential phosphorylation sites that might serve as points of regulation. Using 2D-gel electrophoresis and hNaa10p specific antibodies, we have investigated whether hNaa10p is phosphorylated in HEK293 cells. Several differently charged forms of hNaa10p are present in HEK293 cells and treatment with Calf Intestine Alkaline Phophatase (CIAP) strongly suggests that hNaa10p is phosphorylated at multiple sites under various cell culture conditions. A direct or indirect role of GSK-3 kinase in regulating hNaa10p phosphorylation is supported by the observed effects of Wortmannin and LiCl, a GSK-3 activator and inhibitor, respectively." }, { "role": "assistant", "content": "We demonstrate that hNaa10p protein is phosphorylated in cell culture potentially pointing at phosphorylation as a means of regulating the function of one of the major Nalpha-terminal acetyltransferases in human cells. 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, Arthritis, Juvenile, CD8-Positive T-Lymphocytes, Child, Child, Preschool, Female, Hematopoietic Stem Cell Transplantation, Humans, Killer Cells, Natural, Leukocyte Common Antigens, Male, Membrane Glycoproteins, Perforin, Pore Forming Cytotoxic Proteins, T-Lymphocyte Subsets." }, { "role": "user", "content": "Is reduced perforin expression in systemic juvenile idiopathic arthritis restored by autologous stem-cell transplantation? Context: Familial haemophagocytic lymphohistiocytosis (FHL) is a disorder characterized by deficient cytotoxic T-cell function and activated macrophages, owing to a defect in the perforin gene and absent perforin expression. Because symptoms of patients with systemic juvenile idiopathic arthritis (sJIA) are sometimes clinically very similar to those with FHL, we studied whether perforin expression in sJIA patients would be reduced also. We determined the perforin expression levels on two subsets of CD8(+) cells (CD8(+)CD28(-)CD45RA(-) and CD8(+)CD28(-)CD45RA(+)) and natural killer (NK) cells from patients with sJIA under conventional treatment as well as before and after autologous stem-cell transplantation (ASCT). CD45RA(-) cytotoxic effector cells of sJIA patients (n=13) express significantly lower levels of perforin than polyarticular juvenile idiopathic arthritis (pJIA, n=9) patients [sJIA mean fluorescence intensity (MFI) 34.6; pJIA MFI 98.0] or control donors (MFI 124.6, n=5). A similar pattern was seen in the CD45RA(+) subset. Also NK cells from sJIA patients expressed significantly less intracellular perforin (sJIA MFI 398.4; controls MFI 972.4). In four patients with sJIA who were treated with ASCT, a clear increase in perforin expression was found at 12 months after ASCT in both cytotoxic effector cell subsets (CD45RA(-) subset before ASCT MFI 13.2; 12 months after ASCT MFI 172.3)." }, { "role": "assistant", "content": "We conclude that perforin expression can be severely reduced in sJIA. This finding may implicate defective cytotoxicity and haemophagocytosis and could thus explain why sJIA may be complicated by macrophage activation syndrome. ASCT leads to a reconstitution of the (T cell) immune system with a normal expression of perforin. 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, Body Composition, Child, Female, Glucose Tolerance Test, Humans, Insulin Resistance, Intra-Abdominal Fat, Male, Obesity, Puberty, Serpins, Sex Characteristics." }, { "role": "user", "content": "Is vaspin related to gender , puberty and deteriorating insulin sensitivity in children? Context: Visceral adipose tissue-derived serine protease inhibitor (vaspin) has been suggested as a novel adipocytokine related to obesity and insulin sensitivity in adults. We quantified vaspin serum concentrations in 65 lean and 67 obese children and aimed to evaluate the relationship of vaspin with physical development, obesity, and metabolic and cardiovascular phenotypes in children. We further assessed the acute vaspin response to glucose provocation in 20 obese adolescents and evaluated tissue expression patterns of vaspin in humans. Vaspin levels were significantly higher in girls than in boys. In girls, vaspin increased with age and pubertal stage, whereas there was no change with development in boys. Obese girls had lower vaspin serum levels than those of lean controls, but there was no significant correlation with body mass index (BMI). Independent of sex, age and BMI, lower vaspin was associated with better insulin sensitivity, with higher systolic blood pressure and impaired endothelial function. In response to glucose provocation during an oral glucose tolerance test, vaspin serum levels declined by approximately 25% in adolescents with hyperinsulinemia, whereas there was no significant decline in normoinsulinemic patients. In support of our clinical data, we not only confirmed vaspin mRNA expression in adipose tissue but also found consistent expression of vaspin in the liver and indications for expression in the pancreas and the skin." }, { "role": "assistant", "content": "We showed that gender differences in circulating vaspin levels develop during pubertal progression in girls. Although vaspin's association with obesity remains controversial, vaspin was increased with worsening insulin resistance already in children and was acutely down-regulated following glucose provocation in insulin-resistant adolescents independent of obesity. Besides adipose tissue, vaspin expression in the liver and the pancreas may potentially contribute to circulating vaspin levels and their regulation. 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: Agmatine, Animals, Brain Ischemia, Cell Death, Cells, Cultured, Cerebral Arteries, Down-Regulation, Enzyme Activation, Enzyme Inhibitors, Matrix Metalloproteinase 2, Matrix Metalloproteinase 9, Mice, Mice, Inbred ICR, Nerve Degeneration, Neuroprotective Agents, Nitric Oxide, Nitric Oxide Synthase Type III, RNA, Messenger, Reperfusion Injury, Up-Regulation." }, { "role": "user", "content": "Does agmatine inhibit matrix metalloproteinase-9 via endothelial nitric oxide synthase in cerebral endothelial cells? Context: Matrix metalloproteinases (MMPs) are up-regulated by ischemic injury and degrade the basement membrane of brain vessels to promote cell death and tissue injury. We previously showed that agmatine has a neuroprotective effect on neurons against ischemic injury. In the present study, we investigated the effect of agmatine on the expression of MMPs and nitric oxide (NO) production in cerebral endothelial cells (CECs) after oxygen-glucose deprivation (OGD)-reperfusion injury and its potential association with endothelial nitric oxide synthase (eNOS). Primary cultured endothelial cells from murine brain and bEnd.3 cells were subjected to OGD-reperfusion injury. Protein and mRNA levels of both MMP-2 and MMP-9 were determined by immunocytochemical analysis, Western blot and RT-PCR. Protein levels of eNOS were evaluated by Western blot in the CECs. The production of NO was measured using the Griess reagent. Agmatine attenuated the expression of MMP-2 and MMP-9 induced by ischemic injury at the protein and mRNA level, while agmatine increased the expression of eNOS directly. NO production was decreased in CECs after similar insult and was increased by agmatine treatment. In the presence of a nitric oxide synthase (NOS) inhibitor, N(omega)-nitro-L-arginine methyl ester (L-NAME), the expression levels of MMP-2 were decreased, but the expression of MMP-9 was not decreased by agmatine administration. However, NO production was suppressed by a non-specific NOS inhibitor in the agmatine treatment group." }, { "role": "assistant", "content": "Our study supports that the down-regulation of MMP-9 by agmatine runs parallel to the up-regulation of eNOS and the maintenance of functional NO release. 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: Aging, Alcohol Drinking, Animals, Brain Chemistry, Disease Susceptibility, Hippocampus, Male, Proteomics, Rats, Rats, Wistar." }, { "role": "user", "content": "Does proteomic analysis demonstrate adolescent vulnerability to lasting hippocampal changes following chronic alcohol consumption? Context: Excessive teenage alcohol consumption is of great concern because alcohol may adversely alter the developmental trajectory of the brain. The aim of the present study was to assess whether chronic intermittent alcohol intake during the adolescent period alters hippocampal protein expression to a greater extent than during adulthood. Adolescent [postnatal day (PND) 27] and adult (PND 55) male Wistar rats were given 8 hours daily access to beer (4.44% ethanol v/v) in addition to ad libitum food and water for 4 weeks. From a large subject pool, subgroups of adolescent and adult rats were selected that displayed equivalent alcohol intake (average of 6.1 g/kg/day ethanol). The 4 weeks of alcohol access were followed by a 2-week alcohol-free washout period after which the hippocampus was analyzed using 2-DE proteomics. Beer consumption by the adult group resulted in modest hippocampal changes relative to alcohol naïve adult controls. The only changes observed were an up-regulation of citrate synthase (a precursor to the Krebs cycle) and fatty acid binding protein (which facilitates fatty acid metabolism). In contrast, adolescent rats consuming alcohol showed more widespread hippocampal changes relative to adolescent controls. These included an increase in cytoskeletal protein T-complex protein 1 subunit epsilon (TCP-1) and a decrease in the expression of 10 other proteins, including glyceraldehyde-3-phosphate dehydrogenase (GAPDH), triose phosphate isomerise, alpha-enolase, and phosphoglycerate kinase 1 (all involved in glycolysis); glutamate dehydrogenase 1 (an important regulator of glutamate); methylmalonate-semialdehyde dehydrogenase (involved in aldehyde detoxification); ubiquitin carboxyl-terminal hydrolase isozyme L1 (a regulator of protein degradation); and synapsin 2 (involved in synaptogenesis and neurotransmitter release)." }, { "role": "assistant", "content": "These results suggest the adolescent hippocampus is more vulnerable to lasting proteomic changes following repeated alcohol exposure. The proteins most affected include those related to glycolysis, glutamate metabolism, neurodegeneration, synaptic function, and cytoskeletal structure. 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: Alcohol Drinking, Animals, Down-Regulation, Ethanol, Gene Deletion, Male, Mice, Mice, 129 Strain, Mice, Inbred C57BL, Mice, Knockout, Mice, Transgenic, PC12 Cells, Protein Kinase C, Rats, Up-Regulation." }, { "role": "user", "content": "Does deletion of Prkcz increase intermittent ethanol consumption in mice? Context: Prkcz has been identified as a gene whose expression is positively correlated with ethanol (EtOH) consumption in mice and is also induced by EtOH. Two proteins are produced from Prkcz: protein kinase M zeta (PKMζ), which is expressed in the nervous system and protein kinase C zeta (PKCζ), which is expressed in other tissues. We examined Prkcz(-/-) mice that lack PKCζ and PKMζ to investigate the role of this gene in behavioral responses to EtOH. Male Prkcz(-/-) and wild-type littermates were tested for EtOH consumption using 4 procedures: 24-hour intermittent access, 4-hour limited intermittent access, 4-day drinking-in-the-dark, and 24-hour continuous access. We also assessed the acute hypnotic effect of EtOH, EtOH reward, and taste preference for sweet-, bitter-, salty-, and umami-flavored solutions. Finally, we determined whether EtOH could increase PKMζ and PKCζ transcripts and protein expression in wild-type mice using quantitative PCR and Western blot analysis. Prkcz(-/-) mice consumed more EtOH than their wild-type littermates in both intermittent access procedures, but not in the drinking-in-the-dark or 24-hour continuous access procedures. EtOH exposure increased Prkcz transcripts in cultured PC12 cells, and intermittent EtOH consumption increased PKMζ protein in the ventral striatum of wild-type mice." }, { "role": "assistant", "content": "Absence of PKMζ in the brain is associated with increased EtOH intake during procedures that incorporate intermittent consumption sessions every other day. Our data suggest that EtOH induces PKMζ, which acts in a negative feedback loop to limit binge-like EtOH consumption. 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: Acoustic Stimulation, Aged, Aged, 80 and over, Arm, Elbow, Elbow Joint, Electromyography, Female, Humans, Male, Middle Aged, Movement, Reflex, Startle, Stroke." }, { "role": "user", "content": "Do deficits in startle-evoked arm movements increase with impairment following stroke? Context: The startle reflex elicits involuntary release of planned movements (startReact). Following stroke, startReact flexion movements are intact but startReact extension movements are impaired by task-inappropriate flexor activity impeding arm extension. Our objective was to quantify deficits in startReact elbow extension movements, particularly how these deficits are influenced by impairment. Data were collected in 8 stroke survivors performing elbow extension following two non-startling acoustic stimuli representing \"get ready\" and \"go\", respectively. Randomly, the \"go\" was replaced with a startling acoustic stimulus. We hypothesized that task-inappropriate flexor activity originates from unsuppressed classic startle reflex. We expected that increasing damage to the cortex (increasing impairment) would relate to increasing task-inappropriate flexor activity causing poor elbow extension movement and target acquisition. Task-inappropriate flexor activity increased with impairment resulting in larger flexion deflections away from the subjects' intended target corresponding to decreased target acquisition." }, { "role": "assistant", "content": "We conclude that the task-inappropriate flexor activity likely results from cortical or corticospinal damage leading to an unsuppressed or hypermetric classic startle reflex that interrupts startReact elbow extension. 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, RESULTS. Meshes: Animals, Atherosclerosis, Bone Marrow Transplantation, Cholesterol, LDL, Cytokines, Gene Expression, Hypercholesterolemia, Macrophages, Mice, Mice, Inbred C57BL, Mice, Knockout, PPAR gamma, Receptors, CCR2, Receptors, Chemokine, Receptors, LDL, Severity of Illness Index." }, { "role": "user", "content": "Does conditional knockout of macrophage PPARgamma increase atherosclerosis in C57BL/6 and low-density lipoprotein receptor-deficient mice? Context: Peroxisome proliferator-activated receptor gamma (PPARgamma) is highly expressed in macrophage-derived foam cells of atherosclerotic lesions, and its expression may have a dramatic impact on atherosclerosis. To investigate the contribution of macrophage PPARgamma expression on atherogenesis in vivo, we generated macrophage-specific PPARgamma knockout (MacPPARgammaKO) mice. C57BL/6 and low-density lipoprotein (LDL) receptor-deficient (LDLR(-/-)) mice were reconstituted with MacPPARgammaKO or wild-type marrow and challenged with an atherogenic diet. No differences were found in serum lipids between recipients reconstituted with MacPPARgammaKO and wild-type marrow. In contrast, both C57BL/6 and LDLR(-/-) mice transplanted with MacPPARgammaKO marrow had significantly larger atherosclerotic lesions than control recipients. In addition, MacPPARgammaKO-->LDLR(-/-) mice had higher numbers of macrophages in atherosclerotic lesions compared with controls. Peritoneal macrophages isolated from the MacPPARgammaKO mice had decreased uptake of oxidized but not acetylated LDL and showed no changes in either cholesterol efflux or inflammatory cytokine expression. Macrophages from MacPPARgammaKO mice had increased levels of migration and CC chemokine receptor 2 (CCR2) expression compared with wild-type macrophages." }, { "role": "assistant", "content": "Thus, macrophage PPARgamma deficiency increases atherosclerosis under conditions of mild and severe hypercholesterolemia, indicating an antiatherogenic role for PPARgamma, which may be caused, at least in part, by modulation of CCR2 expression and monocyte recruitment. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Antimetabolites, Antineoplastic, Bile Duct Neoplasms, Bile Ducts, Intrahepatic, Chemotherapy, Adjuvant, Cholangiocarcinoma, Cholangiopancreatography, Endoscopic Retrograde, Deoxycytidine, Female, Follow-Up Studies, Hepatectomy, Humans, Japan, Male, Middle Aged, Neoplasm Staging, Postoperative Care, Retrospective Studies, Ribonucleotide Reductases, Survival Rate, Tomography, X-Ray Computed, Treatment Outcome." }, { "role": "user", "content": "Does gemcitabine-based adjuvant chemotherapy improve survival after aggressive surgery for hilar cholangiocarcinoma? Context: The prognosis of hilar cholangiocarcinoma is dismal although aggressive surgery including major hepatectomy has been performed. The aim of this study was to clarify useful prognostic factors and the usefulness of gemcitabine-based adjuvant chemotherapy for patients with hilar cholangiocarcinoma who had undergone aggressive surgical resection. Medical records of 42 patients with hilar cholangiocarcinoma who underwent surgical resection were reviewed retrospectively. Univariate and multivariate models were used to analyze the effect of various clinicopathological factors on long-term survival. Overall 1-, 3-, and 5-year survival rates of the 42 patients with hilar cholangiocarcinoma were 81%, 42%, and 30%, respectively (median survival time, 21.5 months). Univariate analysis revealed that adjuvant gemcitabine-based chemotherapy, tumor differentiation, lymph node metastasis, and surgical margin status were associated significantly with long-term survival (P < 0.05). Furthermore, use of a Cox proportional hazards regression model indicated that only adjuvant gemcitabine-based chemotherapy was a significant independent predictor of a favorable prognosis (P = 0.035). The toxicity of adjuvant gemcitabine-based chemotherapy was mild. Five-year actuarial survival rates of patients who did or did not receive adjuvant gemcitabine-based chemotherapy were 57% and 23%, respectively (P = 0.026)." }, { "role": "assistant", "content": "Postoperative adjuvant gemcitabine-based chemotherapy may be a promising strategy to improve survival after surgical resection for hilar cholangiocarcinoma. A prospective randomized study should be done to confirm the results of this study. 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, METHOD, RESULTS. Meshes: Eating, Food Industry, Food Supply, Fruit, Humans, Medically Underserved Area, Northern Territory, Oceanic Ancestry Group, Residence Characteristics, Vegetables." }, { "role": "user", "content": "Does the store-turnover method still provide a useful guide to food intakes in Aboriginal communities? Context: To consider the application of the store-turnover method as a guide to assess food intake in remote Aboriginal communities. Food sources in a remote Aboriginal island community were documented. The contribution of quantifiable food sources to total community-level fresh fruit and vegetable availability was determined. The store remains the single largest supplier of fruit and vegetables overall (54%), however its contribution varies depending on the subpopulation of interest. A store-turnover alone may significantly underestimate community-level dietary intake, depending on the contribution of other food sources." }, { "role": "assistant", "content": "Changes in the food supply in remote communities, coupled with methodological complexities inherent in the store-turnover method, challenge its application in a contemporary context." } ]

[ { "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 6-year-old boy is brought to the physician because of inability to concentrate and difficulties completing assignments at school. His mother says that he frequently interrupts others during conversations at home and that his teachers often reprimand him for talking excessively in school. He refuses to play with the other children and often has physical altercations with his classmates. He can jump up and down but he cannot hop on one foot. He eats without assistance but has difficulty using silverware. He cannot follow three-step directions. There is no family history of serious illness. Examination shows a small head, wide-spaced eyes, and short palpebral fissures. His upper lip is thin and flat. He has a sunken nasal bridge and a small jaw. There is a 3/6 pansystolic murmur heard along the left lower sternal border. Which of the following is the most likely cause of these findings?" }, { "role": "assistant", "content": "Prenatal alcohol exposure" } ]

[ { "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 type of cell is not found in the epithelium of maxillary sinus?" }, { "role": "assistant", "content": "The correct answer is → The sinus is lined by pseudociliated stratified columnar epithelium.\n→ The epithelium shows four types of cells namely:\n\nBasal cells\nNonciliated columnar cell\nCiliated columnar cell\nGoblet 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": "Which of the following is the biochemical marker of choice from cholestatic jaundice of pregnancy?" }, { "role": "assistant", "content": "The correct answer is ." } ]

[ { "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: ." }, { "role": "user", "content": "Is hearing loss part of the clinical picture of ENPP1 loss of function mutation? Context: Ecto/nucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1) loss-of-function mutations have been described in patients with autosomal recessive hypophosphatemic rickets (HR), in patients with generalized arterial calcification of infancy (GACI) and in several patients with both conditions. Out of more than 50 cases of homozygous or compound heterozygous ENPP1 loss-of-function mutations published so far, 1 case with labyrinthine deafness probably due to occlusion of inner ear supplying arteries and 2 cases of conductive hearing loss due to stapedovestibular calcification diagnosed in childhood have been reported. To report a case of ENPP1 loss-of-function novel mutation presenting with HR and very early onset and severe hearing loss. Case report and review of the literature. We report on a patient homozygous for a novel 1-bp deletion in ENPP1 that presented with GACI evolving towards HR associated with a mixed hearing loss (both labyrinthine and conductive) diagnosed at 9 days of life that evolved towards profound labyrinthine deafness." }, { "role": "assistant", "content": "Hearing loss is a rare finding in patients with ENPP1 loss-of-function mutations. Interestingly, it has already been described in other affected patients, in ENPP1 knock-out mice and in other diseases of pyrophosphate metabolism. Conversely it seems to be absent in children with the X-linked form of HR. 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, METHODS, METHODS, RESULTS. Meshes: Adolescent, Adult, Anticonvulsants, Ataxia, Atrophy, Carbamazepine, Cerebellar Ataxia, Cerebellum, Epilepsies, Partial, Female, Humans, Magnetic Resonance Imaging, Male, Nystagmus, Pathologic, Prospective Studies." }, { "role": "user", "content": "Does cerebellar atrophy decrease the threshold of carbamazepine toxicity in patients with chronic focal epilepsy? Context: Cerebellar atrophy (CA) is a frequent finding in patients with chronic epilepsy. Since gaze-evoked nystagmus, dizziness, and ataxia are some of the typical adverse effects (AEs) of the dose-dependent toxicity of carbamazepine, preexisting CA could possible explain in part the interindividual variation in the tolerance of high serum concentrations of carbamazepine. To determine whether CA reduces the threshold for overdose symptoms with carbamazepine in patients with chronic focal epilepsy in a prospective study. Cohort study. A fourth-level epilepsy center to which patients were referred. Twenty-six consecutive patients with chronic focal epilepsy were prospectively studied while they were receiving high-dose monotherapy with carbamazepine. Patients were slowly titrated to doses at which the first toxic AEs of carbamazepine occurred. The determination of multiple serum levels was carried out, together with an evaluation of toxicity that comprised a standardized neurologic examination, a questionnaire for AEs, and posturography. Serum concentrations of carbamazepine at the occurrence of the first dose-dependent AEs were related to the presence or absence of CA in magnetic resonance imaging studies as rated by 2 independent and blinded neuroradiologists. In 9 patients (35%), magnetic resonance imaging scans revealed moderate (n = 7) or severe (n = 2) CA. In these patients, gaze-evoked nystagmus (P = .001, log rank test), dizziness (P = .008), and ataxia of stance as measured by posturography (P = .02) occurred at significantly lower serum concentrations of carbamazepine compared with patients without CA. This was also found for the first individually observed AE (P = .03)." }, { "role": "assistant", "content": "Cerebellar atrophy occurs in a considerable percentage of patients with chronic focal epilepsy and obviously increases the susceptibility for cerebellar AEs of carbamazepine. 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: AIMS, METHODS, RESULTS. Meshes: Adolescent, Adult, Aluminum, Analysis of Variance, Forced Expiratory Volume, Gases, Humans, Logistic Models, Male, Middle Aged, Nickel, Occupational Exposure, Odds Ratio, Respiratory Function Tests, Respiratory Tract Diseases, Tungsten, Welding." }, { "role": "user", "content": "Respiratory symptoms and lung function change in welders: are they associated with workplace exposures? Context: This study investigates whether work-related respiratory symptoms and acute falls in forced expiratory volume in 1 second (FEV1), previously observed in current welders, are related to measured workplace exposures to total fume and metals. At four work sites in New Zealand, changes in pulmonary function (and reported respiratory symptoms) were recorded in 49 welding workers (and 26 non-welders) exposed to welding fume. We also determined the personal breathing zone levels of total fume and various metals. Work-related respiratory symptoms were reported by 26.5% of welders and 11.5% of non-welders. These symptoms were related significantly to their personal breathing zone nickel exposure--with an adjusted odds ratio (OR) and 95% confidence interval [CI] of the high exposure group (compared to a low exposure group of 7.0 [1.3-36.6]). There were non-significant associations with total fume exposure (OR = 2.6, 95% CI 0.6-12.2), and exposure index of greater than 10 years (OR=2.8, 95% CI 0.5-15.0). A fall in FEV1 of at least 5% after 15 minutes of work was significantly associated with aluminium exposure (OR=5.8, 95% CI 1.7-20.6)." }, { "role": "assistant", "content": "Nickel exposure from metal inert gas (MIG) and tungsten inert gas (TIG) welding is associated with work-related respiratory symptoms and aluminium exposure from welding is associated with a fall in FEV1 of at least 5 % after 15 minutes of work." } ]

[ { "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: Apoptosis, Butyrates, Caco-2 Cells, Cell Line, Tumor, Colonic Neoplasms, Cytokine TWEAK, Drug Synergism, HT29 Cells, Humans, Interferon-gamma, Leucine, Ligands, Membrane Potential, Mitochondrial, Mitochondria, PPAR gamma, Prostaglandin D2, Thiazolidinediones, Tumor Necrosis Factors." }, { "role": "user", "content": "Does pPARgamma ligand 15-deoxy-delta 12,14-prostaglandin J2 sensitize human colon carcinoma cells to TWEAK-induced apoptosis? Context: Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) has been shown to induce colon cancer cell apoptosis in the presence of interferon-gamma. We hypothesized that co-treatment using TWEAK with other pro-apoptosis agents could sensitize death receptor-resistant colon cancer cells. The effects of chemopreventive agents and TWEAK on cell death and apoptosis were determined using propidium iodide (PI) exclusion and M30 CytoDEATH. We found that 15d-PGJ(2) sensitizes colon cancer cells to TWEAK-induced apoptosis. Caspase inhibition reduced 15d-PGJ(2)-, but not 15d-PGJ(2)+TWEAK-induced apoptosis. 15d-PGJ(2) promoted reactive oxygen species (ROS) production and dissipation of mitochondrial potential (DeltaPsi(m)) that were more marked with combined treatment. ROS, DeltaPsi(m) and cell death were partially normalized by the antioxidant N-acetylcysteine. TWEAK induced nuclear factor-kappa B activation, which was attenuated by 15d-PGJ(2). 15d-PGJ(2) reduced the expression of the anti-apoptotic proteins BCL-X(L) and MCL-1, while increasing BAX and translocation of cytochrome c and apoptosis-inducing factor." }, { "role": "assistant", "content": "15d-PGJ(2) sensitized cancer cells to TWEAK-induced apoptosis through an ROS-dependent cell death pathway and may have chemotherapeutic utility as an apoptosis-enhancing agent. 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: INTRODUCTION, METHODS, RESULTS. Meshes: Activities of Daily Living, Aged, Aged, 80 and over, Cross-Sectional Studies, Disability Evaluation, Disabled Persons, Female, Humans, Severity of Illness Index, Surveys and Questionnaires." }, { "role": "user", "content": "Does self-reported function correspond to objective measures of functional impairment? Context: The relationship between self-reported function and objective measures of physiological function among disabled older women was analyzed to determine the validity of self-reported function, and to identify the hierarchy of self-reported task difficulty most associated with loss of independence as a basis to inform treatment progress goals. A randomly selected population of older women with moderate to high disability was selected from community-dwelling women 65 to 101 years old from the Women's Health and Aging Study I baseline evaluation (n = 987). Cross-sectional analyses evaluated the association of self-reported function with objective physiological impairment measures. The results indicated that (1) disabled older women self-reported a broad range of physical function levels; (2) self-reported function correlated closely with objective measures of physiological impairments; (3) \"preclinical disability,\" as measured by self-reported modification of task performance in the absence of perceived difficulty, has validity even in a disabled population, and identifies a group intermediate between those who are high functioning in a task and those with difficulty; and (4) there is an apparent gradation in physiological impairment measures with reported loss of functional independence." }, { "role": "assistant", "content": "These findings suggest the validity of self-report functional disability measures and the potential to use these measures to identify already-disabled older adults at risk for further functional degradation and potential targets for intervention." } ]

[ { "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: 11-beta-Hydroxysteroid Dehydrogenase Type 1, Absorptiometry, Photon, Adipose Tissue, Adult, Body Mass Index, Cholestenone 5 alpha-Reductase, Cortisone, Female, Gas Chromatography-Mass Spectrometry, Glucocorticoids, Glucose Intolerance, Glucose Tolerance Test, Humans, Insulin Resistance, Liver, Male, Middle Aged, Obesity, Regression Analysis, Sex Factors." }, { "role": "user", "content": "Are impaired glucose tolerance and insulin resistance associated with increased adipose 11beta-hydroxysteroid dehydrogenase type 1 expression and elevated hepatic 5alpha-reductase activity? Context: The precise molecular mechanisms contributing to the development of insulin resistance, impaired glucose tolerance (IGT), and type 2 diabetes are largely unknown. Altered endogenous glucocorticoid metabolism, including 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD1), which generates active cortisol from cortisone, and 5alpha-reductase (5alphaR), which inactivates cortisol, has been implicated. A total of 101 obese patients (mean age 48 +/- 7 years, BMI 34.4 +/- 4.3 kg/m(2), 66 women, 35 men) underwent 75-g oral glucose tolerance testing (OGTT), body composition analysis (dual-energy X-ray absorptiometry), assessment of glucocorticoid metabolism (24-h urine steroid metabolite analysis by gas chromatography/mass spectrometry), and subcutaneous abdominal adipose tissue biopsies. A total of 22.7% of women had IGT compared with 34.2% of men. Two women and five men were diagnosed with type 2 diabetes. In women, adipose 11beta-HSD1 expression was increased in patients with IGT and correlated with glucose levels across the OGTT (R = 0.44, P < 0.001) but was independent of fat mass. Total glucocorticoid secretion was higher in men with and without IGT (normal 13,743 +/- 863 vs. 7,453 +/- 469 microg/24 h, P < 0.001; IGT 16,871 +/- 2,113 vs. 10,133 +/- 1,488 microg/24 h, P < 0.05), and in women, it was higher in those with IGT (7,453 +/- 469 vs. 10,133 +/- 1,488 microg/24 h, P < 0.001). In both sexes, 5alphaR activity correlated with fasting insulin (men R = 0.53, P = 0.003; women R = 0.33, P = 0.02), insulin secretion across an OGTT (men R = 0.46, P = 0.01; women R = 0.40, P = 0.004), and homeostasis model assessment of insulin resistance (men R = 0.52, P = 0.004; women R = 0.33, P = 0.02)." }, { "role": "assistant", "content": "Increased adipose 11beta-HSD1 expression in women may contribute to glucose intolerance. Enhanced 5alphaR activity in both sexes is associated with insulin resistance but not body composition. Augmented glucocorticoid inactivation may serve as a compensatory, protective mechanism to preserve insulin sensitivity. 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 68-year-old man presents to his primary care physician for fatigue. He is accompanied by his granddaughter who is worried that the patient is depressed. She states that over the past 2 months he has lost 15 lbs. He has not come to some family events because he complains of being “too tired.” The patient states that he tries to keep up with things he likes to do like biking and bowling with his friends but just tires too easily. He does not feel like he has trouble sleeping. He does agree that he has lost weight due to a decreased appetite. The patient has coronary artery disease and osteoarthritis. He has not been to a doctor in “years” and takes no medications, except acetaminophen as needed. Physical examination is notable for hepatomegaly. Routine labs are obtained, as shown below:\n\nLeukocyte count: 11,000/mm^3\nHemoglobin: 9 g/dL\nPlatelet count: 300,000/mm^3\nMean corpuscular volume (MCV): 75 µm^3\nSerum iron: 35 mcg/dL\n\nAn abdominal ultrasound reveals multiple, hypoechoic liver lesions. Computed tomography of the abdomen confirms multiple, centrally-located, hypoattenuated lesions. Which of the following is the next best step in management?" }, { "role": "assistant", "content": "Colonoscopy" } ]

[ { "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, Constriction, Pathologic, Dilatation, Endoscopic Mucosal Resection, Female, Gastric Mucosa, Gastroscopy, Humans, Male, Middle Aged, Postoperative Complications, Pyloric Antrum, Pyloric Stenosis, Pylorus, Retrospective Studies, Risk Factors, Treatment Outcome." }, { "role": "user", "content": "Does antral or Pyloric Deformity be a Risk Factor for the Development of Postendoscopic Submucosal Dissection Pyloric Strictures? Context: Surgeons must be aware of risk factors for strictures before performing endoscopic submucosal dissection (ESD), to enable early interventions to prevent severe strictures. This study was a single-center retrospective study. We reviewed the clinical data of patients who has undergone gastric ESD from January 2007 to December 2012. Among the 3,819 patients who had undergone gastric ESD, 11 patients (7.2%) developed pyloric strictures and received successful endoscopic balloon dilation. Significant differences were noted between the patients without and with post-ESD strictures for pretreatment of antral or pyloric deformities (46.4% vs 81.8%), the proportion of extension to the lumen circumference (>3/4, 9.4% vs 54.5%), the longitudinal extent of mucosal defects (27.9±10.1 mm vs 51.5±10.8 mm), and post-ESD bleeding (2.9% vs 27.3%). Multivariate analysis revealed that pretreatment antral or pyloric deformities (odds ratio [OR], 30.53; 95% confidence interval [CI], 1.476 to 631.565; p=0.027), larger longitudinal extent of mucosal defects (OR, 1.20; 95% CI, 1.074 to 1.340; p=0.001), and circumferential extension of ≥3/4 (OR, 13.69; 95% CI, 1.583 to 118.387; p=0.017) were independent risk factors for post-ESD stricture." }, { "role": "assistant", "content": "Antral or pyloric deformities, sub-circumferential resection over more than 75% of the circumference and greater longitudinal extent of mucosal defects are independent risk factors for post-ESD stricture. 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 young boy presented with a lesion over his right buttock which had peripheral scaling and central clearing with scarring. The investigation of choice would be:" }, { "role": "assistant", "content": "The correct answer is C i.e. Biopsy" } ]

[ { "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, Anti-Bacterial Agents, Arthroplasty, Replacement, Hip, Combined Modality Therapy, Debridement, Female, Hip Joint, Hip Prosthesis, Humans, Injections, Intra-Articular, Male, Methicillin-Resistant Staphylococcus aureus, Middle Aged, Prosthesis-Related Infections, Reoperation, Retrospective Studies, Staphylococcal Infections, Treatment Outcome." }, { "role": "user", "content": "Does one-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully treat Infected THA? Context: Two-stage revision surgery for infected total hip arthroplasty (THA) is commonly advocated, but substantial morbidity and expense are associated with this technique. In certain cases of infected THA, treatment with one-stage revision surgery and intraarticular infusion of antibiotics may offer a reasonable alternative with the distinct advantage of providing a means of delivering the drug in high concentrations. We describe a protocol for intraarticular delivery of antibiotics to the hip through an indwelling catheter combined with one-stage revision surgery and examine (1) the success as judged by eradication of infection at 1 year when treating chronically infected cemented stems; (2) success in treating late-onset acute infections in well-ingrown cementless stems; and (3) what complications were associated with this approach in a small case series. Between January 2002 and July 2013, 30 patients (30 hips) presented to the senior author for treatment of infected THA. Of those, 21 patients (21 hips) with infected cemented THAs underwent débridement and single-stage revision to cementless total hip implants followed by catheter infusion of intraarticular antibiotics. Nine patients (nine hips) with late-onset acute infections in cementless THA had bone-ingrown implants. These patients were all more than 2 years from their original surgery and had acute symptoms of infection for 4 to 9 days. Seven had their original THA elsewhere, and two were the author's patients. All were symptom-free until the onset of their infection, and none had postoperative wound complications, fever, or prolonged pain suggestive of a more chronic process. They were treated with débridement and head and liner exchange, again followed by catheter infusion of intraarticular antibiotics. During this time period, this represented all infected THAs treated by the senior author, and all were treated with this protocol; no patient underwent two-stage exchange during this time, and no patients were lost to followup. At the time of the surgery, two Hickman catheters were placed in each hip to begin intraarticular delivery of antibiotics in the early postoperative period. Antibiotics were infused daily into the hip for 6 weeks with the tubes used for infusion only. Eleven of the single-stage revisions and four of the hips treated with débridement had methicillin-resistant Staphylococcus aureus. Patients were considered free of infection if they had no clinical signs of infection and had a normal C-reactive protein and erythrocyte sedimentation rate at 1 year. Complications were ascertained by chart review. Twenty of 21 (95%) infections in patients who had single-stage revision for chronically infected cemented THA were apparently free from infection and remained so at a mean followup of 63 months (range, 25-157 months). One case grew Candida albicans in the operative cultures and remained free of signs of infection after rerevision followed by infusion of fluconazole. The nine cementless THAs treated with débridement and head/liner exchange all remained free of signs of infection at a mean followup of 74 months (range, 62-121 months). Few complications were associated with the technique. Four patients had elevated serum levels of vancomycin without renal function changes and two patients had transient blood urea nitrogen/creatinine elevations with normal vancomycin levels that resolved with dosage adjustments. No patient had evidence of permanent renal damage. None of the patients in this study developed a chronic fistula or had significant drainage from the catheter site." }, { "role": "assistant", "content": "Single-stage revision for chronically infected cemented THA and débridement of bone-ingrown cementless THA with late-onset acute infection followed with indwelling catheter antibiotic infusion can result in infection eradication even when resistant organisms are involved. Larger study groups would better assess this technique and prospective comparisons to more traditional one- and two-stage revision techniques for infected THA will likely require multi-institutional approaches. 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: Animals, Anti-Inflammatory Agents, Non-Steroidal, Aspirin, Biomarkers, Blotting, Western, Caspase 3, Dose-Response Relationship, Drug, Esophageal Neoplasms, Gastroesophageal Reflux, MAP Kinase Signaling System, Mitogen-Activated Protein Kinases, Rats, Rats, Wistar, Treatment Outcome." }, { "role": "user", "content": "Does low dose aspirin prevent duodenoesophageal reflux induced mucosal changes in wistar rat esophagus by MAP kinase mediated pathways? Context: Investigations of molecular mechanisms behind the progression of neoplastic changes in the esophagus have uncovered the role of the COX & 5-Lox pathways. Human squamous esophageal mucosa produces relatively large amounts of eicosanoids in the presence of inflammation. Laboratory and epidemiological data suggest that aspirin and non-steroidal anti-inflammatory drugs may be chemo preventive through their inhibitory effect on COX25, 10. Cell culture studies have shown that the members of the mitogen activated protein (MAP) kinase family plays an important role in the development of bile acid-induced carcinogenesis. Differences in MAPK pathways activated by bile exposure were also noted in esophageal squamous cell lines and biopsies from patients with GERD. The protective role of aspirin and its molecular mechanism is not well understood. 1. The effect of duodenal reflux on esophageal mucosa. 2. The role of aspirin in preventing duodenal reflux induced esophageal mucosa changes. 3. If it is proven to be preventive, the mechanism of its action. A duodenal reflux rat animal model was used by an end- to-side esophago duodenostomy. Total of 56 rats was included. 3 were \"Naive control\" animals which did not undergo the surgical procedure. The remaining animals were divided into two groups: Surgery alone (experimental) and Surgery + aspirin [therapy group], esophagoduodenostomy. At 40 weeks, the rats were euthanized and appropriate esophageal samples were analysed for histopathology and p38 & ERK MAP kinases, VEGF, protease activity and caspase 3 activities. The presence of gross mucosal nodularity was seen in 21 and 10 rats of the experimental and therapy group respectively (p = 0.03; Table 1). Reflux-associated changes such as basal cell hyperplasia were more common in the experimental group, however this association did not reach statistical significance (p = 0.15; Table 1). Epithelial hyperplasia was seen more in the experimental group, which was prevented by aspirin [p < 0.01]. Papillomatosis, as shown in Fig. 4 was more common in the experimental group (p = 0.02). Activation of p38 & ERK MAP kinases was prevented in aspirin group (p < 0.05, CI -1.796--0.014). Examination of protease activity by zymographic analysis of the esophageal samples revealed a number of gelatinolytic bands in 50% rats of the experimental group, not observed in the therapy group. No significant changes were seen in Caspase 3 [Normal areas -99.74 & nodular areas - 100.34 percent of controls] or VEGF [mean 0.64, sd ± 0.76 Vs 0.69 ± 0.96] activity." }, { "role": "assistant", "content": "Our data demonstrated that low dose aspirin reduced the incidence of duodenoesophageal reflux induced histological changes in the esophagus by preventing activation of proliferative & anti-apoptotic MAP kinases such as p38 & ER as well as protease activity. Though Barretts' changes and adenocarcinoma have not developed, it could explain the role of duodenoesophageal reflux in the development of different histological but potential premalignant lesions and molecular level changes which are prevented by low dose aspirin. 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 Injuries, Adolescent, Adult, Aged, Aged, 80 and over, Alabama, Emergency Treatment, Female, Glasgow Coma Scale, Humans, Male, Middle Aged, Orthopedics, Peritoneal Lavage, Physical Examination, Preoperative Care, Retrospective Studies, Tomography, X-Ray Computed, Urban Health, Wounds, Nonpenetrating." }, { "role": "user", "content": "Emergent extra-abdominal trauma surgery: is abdominal screening necessary? Context: To evaluate the necessity of abdominal screening beyond physical examination in awake and alert blunt trauma patients who require emergent extra-abdominal trauma surgery. Data from an urban Level I trauma center was reviewed for all blunt trauma patients who underwent extra-abdominal emergency procedures during the period from January 1995 through August 1998. Awake and alert patients (Glasgow Coma Scale [GCS] score>or = 14) with negative abdominal physical examination results who underwent extra-abdominal emergent surgery were entered in the study. All patients entered were older than 14 years of age, hemodynamically stable, and underwent further abdominal evaluation with computed tomographic scan or diagnostic peritoneal lavage after the decision for extra-abdominal surgical intervention. Emergent surgery occurred within 8 hours of admission. Data was collected for results of diagnostic studies, hemodynamic status, mechanism of injury, indications for operative intervention, and admission blood ethanol (EtOH) levels. A total of 210 patients with an average age of 33 years (range, 14-92 years) were entered in the study. The most common mechanism of injury was motor vehicle crash (67%). Sixty-six (32%) patients presented with EtOH levels>100 mg/dL; 181 (86%) patients presented with a GCS score of 15, and 29 (14%) presented with a GCS score of 14. The majority of surgical procedures were orthopedic (86%). Diagnostic peritoneal lavage was performed in 55 (26%) patients, and computed tomographic scans were obtained in 155 (74%) patients. Three (1.4%) intraperitoneal injuries were diagnosed in the study population. Two of the injuries were stable grade 1 liver injuries, and missed diaphragmatic injury was diagnosed on postadmission day 1." }, { "role": "assistant", "content": "Before emergent extra-abdominal trauma surgery, abdominal evaluation with physical examination is sufficient to identify surgically significant abdominal injury in the awake and alert blunt trauma patient. Screening with additional studies does not impact patient outcome." } ]

[ { "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: Arthritis, Rheumatoid, Base Sequence, CD4-Positive T-Lymphocytes, Clone Cells, Female, Humans, Longitudinal Studies, Lymphocyte Activation, Male, Molecular Sequence Data, RNA, Messenger, Receptors, Antigen, T-Cell, alpha-beta, Synovial Fluid, T-Lymphocyte Subsets." }, { "role": "user", "content": "Are cD4 T cells in the rheumatoid joint oligoclonally activated and change during the course of disease? Context: To assess the nature of T cell receptor (TCR) utilisation by CD4 T cells in the rheumatoid joint. Sequencing of the joining (NDJ) region of TCR beta chain mRNA isolated from synovial fluid CD4 T cells was performed in three patients in order to determine if oligoclonal expansion of particular sequences was present. Two patients were studied longitudinally to determine if these sequences changed over time. A number of dominant clonotypes were found within the TCR transcripts sequenced in each patient. In the two patients who were studied longitudinally, different dominant clonotypes were detected over time. No single clonotype was persistently dominant during the period of study." }, { "role": "assistant", "content": "The pattern of TCR usage showed multiple oligoclonally expanded CD4 T cells within the rheumatoid joint. The change in clonotypes within the joint over time suggests that different antigens may be able to elicit synovial inflammation during the course of rheumatoid disease. 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": "A3 year old non-vaccinated child presented with fever and fast breathing. His mother told that he has recently developed measles rash. CXR shown below is indicative of which infection?" }, { "role": "assistant", "content": "The correct answer is Ans. (a) Staphylococcus AureusThe Chest X Ray shows a cystic cavity in right upper zone indicative of infection with a virulent organism. In setting of recovery from measles the organism responsible is Staphylococcus Aureus." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, MAIN OUTCOME MEASURE, RESULTS. Meshes: Adult, Aged, Chronic Disease, Cohort Studies, Female, Health Status Indicators, Humans, Male, Mental Health, Middle Aged, Musculoskeletal Diseases, Occupational Diseases, Upper Extremity, Work Capacity Evaluation, Young Adult." }, { "role": "user", "content": "Does the Upper-Limb Work Instability Scale Predict Transitions Out of Work Among Injured Workers? Context: To investigate the predictive ability of the Upper-Limb Work Instability Scale (UL-WIS) for transitioning out of work among injured workers with chronic, work-related upper extremity disorders (WRUEDs). Secondary analysis of a 12-month cohort study with data collection at baseline and 3-, 6-, and 12-month follow-up. Survey questionnaires were used to collect data on an array of sociodemographic, health-related, and work-related variables. Upper extremity specialty clinics. Injured workers (N=356) with WRUEDs who were working at the time of initial clinic attendance. Not applicable. Transitioning out of work. Multivariable logistic regression that considered 9 potential confounders revealed baseline UL-WIS (range, 0-17) to be a statistically significant predictor of a subsequent transition out of work (adjusted odds ratio, 1.18; 95% confidence interval [CI], 1.07-1.31; P=.001). An assessment of predictive values across the UL-WIS score range identified cut-scores of<6 (negative predictive value, .81; 95% CI, .62-.94) and >15 (positive predictive value, .80; 95% CI, .52-.96), differentiating the scale into 3 bands representing low, moderate, and high risk of exiting work." }, { "role": "assistant", "content": "The UL-WIS was shown to be an independent predictor of poor work sustainability among injured workers with chronic WRUEDs; however, when applied as a standalone tool in clinical settings, some limits to its predictive accuracy should also be recognized." } ]

[ { "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": "Preferred treatment approach for locally advanced head and neck cancers is ?" }, { "role": "assistant", "content": "The correct answer is LOCALLY OR REGIONALLY ADVANCED Head and neck cancerLocally or regionally advanced disease-disease with a large primary tumor and/or lymph node metastases-is the stage of presentation for 50% of patients.Such patients can also be treated with curative intent, but not with surgery or radiation therapy alone.Combined modality therapy including surgery, radiation therapy, and chemotherapy is most successful.It can be administered as induction chemotherapy (chemotherapy before surgery and/or radiotherapy) or as concomitant (simultaneous) chemotherapy and radiation therapy. The latter is currently most commonly used and best evidence-suppoed.In patients with intermediate stage (stage III and early stage IV) concomitant chemoradiotherapy is given postoperatively.It can be administered either as a primary treatment for patients with unresectable disease, to pursue an organ-preserving approach, or in the postoperative setting for intermediate-stage resectable tumors. Preferred chemotherapy agents - cisplatin and cetuximab" } ]

[ { "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: Bicycling, Carbohydrates, Fatigue, Humans, Male, North Carolina, Physical Exertion, Placebos, Rest." }, { "role": "user", "content": "Does carbohydrate attenuate perceived exertion during intermittent exercise and recovery? Context: The purpose of this study was to examine the effect of carbohydrate supplementation on differentiated and undifferentiated ratings of perceived exertion (RPE) during prolonged intermittent exercise and recovery. Twelve male subjects cycled for 2.0 h at 64% Wmax and 73% V O2peak with 3-min rest intervals interspersed every 10 min (2.6 h of total exercise time, including rest intervals) with placebo (P) or carbohydrate (C) beverages. RPE was assessed during the last minute of each 10-min exercise interval and then every 30 s during the 3-min recovery period. The pattern of change in RPE over time was significantly different between C and P ingestion (P < 0.05), with attenuated RPE responses found for both overall body (O) and legs (L). A significant main effect was found for recovery RPE-O between C and P ingestion (P < 0.05), with attenuated RPE responses found in the later part of the 2-h run. C relative to P ingestion was associated with higher respiratory exchange ratios and plasma levels of glucose and with lower levels of plasma cortisol." }, { "role": "assistant", "content": "These data indicate that carbohydrate supplementation attenuates perceived exertion during prolonged intermittent exercise and recovery. 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": "Non- selective proteinuria is seen in:" }, { "role": "assistant", "content": "The correct answer is Membranous glomerulonephritis loss of size selectivity + loss of charge selectivity - Non selective proteinuria Minimal change nephropathy loss of the charge selectivity, size selectivity of the glomerular capillary wall is intact - preferential albuminuria" } ]

[ { "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, Crosses, Genetic, Diabetes Mellitus, Type 2, Diet, High-Fat, Endoplasmic Reticulum Stress, Glucose Transporter Type 2, Heat-Shock Proteins, Hyperinsulinism, Insulin, Insulin Resistance, Insulin-Secreting Cells, Islets of Langerhans, Male, Mice, Mice, Inbred C57BL, Mice, Transgenic, Obesity, Promoter Regions, Genetic, Rats, Surface Properties, Tissue Culture Techniques, Up-Regulation." }, { "role": "user", "content": "Does gRP78 overproduction in pancreatic beta cells protect against high-fat-diet-induced diabetes in mice? Context: Endoplasmic reticulum (ER) stress has been detected in pancreatic beta cells and in insulin-sensitive tissues, such as adipose and liver, in obesity-linked rodent models of type 2 diabetes. The contribution of ER stress to pancreatic beta cell dysfunction in type 2 diabetes is unclear. We hypothesised that increased chaperone capacity protects beta cells from ER stress and dysfunction caused by obesity and improves overall glucose homeostasis. We generated a mouse model that overproduces the resident ER chaperone GRP78 (glucose-regulated protein 78 kDa) in pancreatic beta cells under the control of a rat insulin promoter. These mice were subjected to high-fat diet (HFD) feeding for 20 weeks and metabolic variables and markers of ER stress in islets were measured. As expected, control mice on the HFD developed obesity, glucose intolerance and insulin resistance. In contrast, GRP78 transgenic mice tended to be leaner than their non-transgenic littermates and were protected against development of glucose intolerance, insulin resistance and ER stress in islets. Furthermore, islets from transgenic mice had a normal insulin content and normal levels of cell-surface GLUT2 (glucose transporter 2) and the transgenic mice were less hyperinsulinaemic than control mice on the HFD." }, { "role": "assistant", "content": "These data show that increased chaperone capacity in beta cells provides protection against the pathogenesis of obesity-induced type 2 diabetes by maintaining pancreatic beta cell function, which ultimately improves whole-body glucose homeostasis. 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, Burns, Colony Count, Microbial, Female, Humans, Male, Middle Aged, Sepsis, Young Adult." }, { "role": "user", "content": "Do [ The clinical staging and tissue bacterial quantification in the diagnosis of burn wound sepsis ]? Context: To investigate and re-evaluate the relationship between burn wound sepsis and tissue bacterial quantity. Thirty-two patients admitted during past 5 years were enrolled in the study. Bacterial isolation and quantity in burn wound tissue were carried out. Meanwhile clinical signs were evaluated for the staging of burn wound sepsis. 1) Bacterial invasion could be identified in 123 pieces of tissue samples from 32 patients. Samples with tissue bacterial quantity > or = 10(5)/g were found in 82 subeschar tissue samples, and 41 samples with bacteria <10(5)/g. Subeschar tissue samples with bacterial quantity > or = 10(5)/g could be determined in 68 samples from 18 patients, and < 10(5)/g in 20 samples from 5 cases. In addition, samples of subeschar tissue with bacterial quantity > or = 10(5)/g could only be found in some of the samples form 9 cases. 2) Burn wound sepsis could be classified into I-IV stages according to tissue bacterial quantification and clinical signs." }, { "role": "assistant", "content": "Burn wound sepsis could be established by identification of bacterial invasion into living tissue with clinical symptoms of toxemia. 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, METHODS, METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Cochlear Implantation, Female, Foreign-Body Migration, Hearing Loss, Sensorineural, Humans, Infant, Male, Middle Aged, Operative Time, Surgical Flaps, Treatment Outcome, Young Adult." }, { "role": "user", "content": "Do 228 cases of cochlear implant receiver-stimulator placement in a tight subperiosteal pocket without fixation? Context: (1) To investigate the outcomes of cochlear implant receiver-stimulator (RS) placement using a tight subperiosteal pocket technique without device fixation and (2) to compare the efficiency of this approach with the traditional bony well and trough technique. Case series with planned chart review. Single tertiary academic referral center. All cochlear implant surgeries utilizing a tight subperiosteal pocket without additional fixation or use of a bone well were identified retrospectively. Revision cases were only included if the tight subperiosteal pocket technique was used during the initial surgery. Patients with less than 6 months of postoperative follow-up were excluded. Primary outcome measures included RS migration, flap complications, device failure, and percentage reduction in operative time. Two hundred twenty-eight cases (average age 45.3 years) met inclusion criterion and were analyzed. At a mean follow-up of 18.1 months, no patient experienced RS migration. One patient experienced a postoperative hematoma that was managed with observation. One patient developed a surgical site infection that resolved following exploration and intravenous antibiotics. The subperiosteal pocket technique resulted in an 18.9% reduction in total operative time compared to a more conventional RS placement method (P < .01)." }, { "role": "assistant", "content": "The tight subperiosteal pocket without fixation is a safe, durable, and time-saving technique for RS placement during cochlear implantation. Notably, device migration and flap complications are very uncommon. 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: Bicarbonates, Blood Preservation, Glucose, Humans, Plasma, Plateletpheresis, Solutions." }, { "role": "user", "content": "Are in vitro variables of apheresis platelets stably maintained for 7 days with 5 % residual plasma in a glucose and bicarbonate salt solution , PAS-5? Context: Platelet additive solutions (PASs) facilitate improved recovery of plasma and may reduce the severity and/or frequency of plasma-associated transfusion reactions. Current apheresis platelet (PLT) PAS products contain approximately 30 to 40% residual plasma. In an effort to further decrease the residual plasma, two in vitro studies were conducted with PLTs suspended in 5% plasma and a reformulated PAS-3, named PAS-5, that contains additional salts, glucose, and bicarbonate. In Study 1, PLTs suspended in 5% plasma/95% PAS-5 were prepared directly on a separator (Amicus, Fenwal, Inc.) without additional centrifugation or washing. In Study 2, a double unit of hyperconcentrated Amicus PLTs in plasma was collected, divided, and centrifuged to prepare a control unit in 100% plasma and a paired test unit in 5% plasma/95% PAS-5. The in vitro properties of PLTs were assessed in both studies during 7-day storage at 20 to 24°C with continuous agitation. In Study 1, PLT concentration, pH, mean PLT volume (MPV), HCO(3)(-), pCO(2), pO(2), lactate dehydrogenase, and hypotonic shock response (HSR) did not significantly change during storage. By Day 7, glucose levels and morphology scores modestly decreased (17.6 and 14.4%, respectively) and lactate levels modestly increased (to 7.2 mmol/L). In Study 2, MPV, pH, glucose, pO(2), HSR, and morphology were comparable in control and test PLTs during 7-day storage. Glucose consumption and lactate production were significantly less in test versus control PLTs (p≤0.0015). Extent of shape change and %CD62P-positive test PLTs were less than those of controls (p<0.001)." }, { "role": "assistant", "content": "Apheresis PLTs suspended in 5% plasma/95% PAS-5 maintained in vitro properties during 7-day storage. 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 34-year-old woman is recovering in the post-operative unit following a laparoscopic procedure for chronic endometriosis. She had initially presented with complaints of painful menstrual cramps that kept her bedridden most of the day. She also mentioned to her gynecologist that she had been diagnosed with endometriosis 4 years ago, and she could not find a medication or alternative therapeutic measure that helped. Her medical history was significant for surgery she had 6 years ago to remove tumors she had above her kidneys, after which she was prescribed hydrocortisone. An hour after the laparoscopic procedure, she calls the nurse because she is having difficulty breathing. The nurse records her vital signs include: blood pressure 85/55 mm Hg, respirations 20/min, and pulse 115/min. The patient suddenly loses consciousness. Intravenous fluids are started immediately. She gains consciousness, but her blood pressure is unchanged. Which of the following is the most likely cause of the hypotension?" }, { "role": "assistant", "content": "Improper supplementation of steroids" } ]

[ { "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, Biomarkers, Blood Pressure, Chronic Disease, Exercise Test, Female, Follow-Up Studies, Heart Failure, Humans, Male, Middle Aged, Multivariate Analysis, Natriuretic Peptide, Brain, Oxygen Consumption, Physical Endurance, Predictive Value of Tests, Proportional Hazards Models, Research Design, Severity of Illness Index, Stroke Volume, Survival Analysis, Systole, Ultrasonography, Ventricular Dysfunction, Left." }, { "role": "user", "content": "Are exercise duration and peak systolic blood pressure predictive of mortality in ambulatory patients with mild-moderate chronic heart failure? Context: It is a prevailing concept in chronic heart failure (CHF) that ventricular remodelling (evaluated via imaging) and neurohormonal activation (via biomarkers) exert major influences, such that the need to subject patients to haemodynamic evaluations and exercise testing has been questioned. We sought to investigate whether exercise and haemodynamic parameters lack independent prognostic value in a cohort of unselected ambulatory patients with mild-moderate CHF. Eighty-five consecutive patients with stable CHF in New York Heart Association functional classes I-IV, aged 55 +/- 12 years, 84% males, left ventricular ejection fraction (LVEF) 37 +/- 15%, participated in this study. Survivors were followed for a median of 5.08 years. All subjects underwent cardiopulmonary exercise testing to measure standard parameters including peak oxygen consumption, exercise duration and blood pressure. A sample of venous blood was taken to determine the N-terminal pro-brain natriuretic peptide (N-BNP) level. Echocardiography was performed at rest to measure LVEF. Predictors of mortality were sought using the Cox proportional hazards model. All-cause mortality was 19% (16 deaths, 95% CI 11-29%). Age and LVEF did not independently predict mortality. Although various parameters including New York Heart Association class, peak oxygen consumption and N-BNP level were all predictive of outcome on univariate analysis, multivariate analysis identified reduced exercise duration and peak systolic blood pressure (SBP) to be the only independent predictors of all-cause mortality. Hazard ratios of 0.78 (95% CI 0.65-0.93, p = 0.007) and 0.79 (95% CI 0.66-0.95, p = 0.01) were associated with an increase in exercise duration of 1 min and 10 mm Hg peak SBP, respectively." }, { "role": "assistant", "content": "Two simple parameters (exercise duration and peak SBP) that are easily measured by standard exercise testing are the strongest independent predictors of mortality which outperform LVEF and N-BNP in ambulatory patients with mild-moderate CHF. 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": "Gland of Zeis which open into follicles of eyelashes are:" }, { "role": "assistant", "content": "The correct answer is Gland of Zeis are modified sebaceous glands which open into follicles of eyelashes. Gland of Moll are modified sweat glands which open into hair follicles. Meibomian glands are modified sebaceous glands, about 20-30 in each lid. Ref: Review of Ophthalmology A.K.Khurana, 5th Ed, page 9-10" } ]

[ { "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: Autonomic Nervous System, Exercise, Heart Rate, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Pituitary-Adrenal System, Saliva, Sleep, Time Factors, Wakefulness, Young Adult." }, { "role": "user", "content": "Does late-night exercise affect the autonomic nervous system activity but not the hypothalamo- pituitary-adrenal axis in the next morning? Context: Exercise activates hypothalamic-pituitary-adrenal axis (HPA) and autonomic nervous system (ANS) and generally causes beneficial changes in homeostatic balance. However, the health benefits of late-night exercise programs on the activity of HPA and ANS is not known. The aim of this study was to assess effects of late-night exercise on sleep quality and on the activities of the HPA axis (as cortisol awakening response, CAR) and the ANS (as heart rate variability, HRV) measurements in the following morning. Medical students (n = 20 males, 20-24 year-old) filled Karolinska Sleep Diary on the day before exercise program. In the following morning, they provided salivary samples for the assessment of CAR (samples at 0, 15, 30 and 60 min post-awakening) and had a 5-min electrocardiogram recording for the determination of HRV. In the next night, an exercise program consisting of a 90-min football match was implemented at 09:30 p.m. and all procedures were repeated. Cortisol concentrations were measured in the salivary samples and time- and frequency-domain parameters of HRV were calculated. Late-night exercise did not affect (p>0.05) sleep parameters (sleep duration, disturbed sleep, awakening problems) and CAR parameters (0, 15, 30, 60 min cortisol concentrations, mean concentration, area under the curve) but influenced HRV parameters (p<0.05)." }, { "role": "assistant", "content": "The results suggest that late-night exercise is associated with changed HRV activity rather than changes in CAR and, therefore, it might be suggested that late-night exercise affects ANS activity rather than HPA activity in the next morning. 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, Cell Count, Cohort Studies, Deglutition Disorders, Eosinophilic Esophagitis, Eosinophils, Esophageal Stenosis, Esophagoscopy, Female, Heartburn, Humans, Logistic Models, Male, Middle Aged, Retrospective Studies." }, { "role": "user", "content": "Do endoscopic Features and Eosinophil Density Are Associated with Food Impaction in Adults with Esophageal Eosinophilia? Context: Food impaction has been described in both eosinophilic esophagitis and proton pump inhibitor-responsive esophageal eosinophilia. The association between endoscopic/histologic features of esophageal eosinophilia and food impaction remains unclear. We aimed to identify clinical, endoscopic, and histologic findings associated with a history of food impaction in esophageal eosinophilia. This was a retrospective cohort study of adult esophageal eosinophilia patients at a tertiary center in 6/2005-10/2014. Only patients with ≥15 eosinophils/high-power field on mucosal biopsies were included. Demographics, comorbidities, symptoms, endoscopic/histologic findings on initial endoscopy, and history of food impaction were reviewed. Statistical analyses were performed using Fisher's exact test (univariate) and forward stepwise logistic regression (multivariate). 400 patients (42 ± 14 years, 61 % male) were included, with 78 (20 %) having food impaction history. On univariate analyses, rings (62 vs 42 %, p = 0.003), erosions (12 vs 5 %, p = 0.03), eosinophil density on biopsy (40 [IQR = 30-50] vs 30 [IQR = 15-50], p = 0.004), and dysphagia (88 vs 62 %, p < 0.0001) were more prevalent among patients with food impaction history, while heartburn (10 vs 33 %, p < 0.0001) and abdominal pain (1 vs 12 %, p = 0.002) were less common. On multivariate analysis, rings (OR 2.6, p = 0.002), erosions (OR 3.2, p = 0.02), and eosinophil density (β-coefficient = 0.01, p = 0.04) remained associated with food impaction." }, { "role": "assistant", "content": "Findings of rings and erosions on endoscopy and increased eosinophil density on histology were independently associated with a history of food impaction in adult esophageal eosinophilia patients. Food impaction may result from both active inflammation (erosions and increased eosinophil density) and chronic fibrostenotic changes (rings). 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, RESULTS. Meshes: Animals, Atherosclerosis, Bradykinin, Coronary Vessels, Down-Regulation, Endothelium, Vascular, Humans, Lysophospholipids, Membrane Potential, Mitochondrial, Nitric Oxide Synthase Type III, Oxidative Stress, Selenomethionine, Superoxide Dismutase, Superoxide Dismutase-1, Superoxides, Swine, Vasodilation." }, { "role": "user", "content": "Does lysophosphatidic acid cause endothelial dysfunction in porcine coronary arteries and human coronary artery endothelial cells? Context: The objective of this study was to determine the effects of lysophosphatidic acid (LPA) on endothelial functions and molecular alternations in both porcine coronary arteries and human coronary artery endothelial cells (HCAECs). The vessel rings and HCAECs were treated with clinically relevant concentrations of LPA for different times. Vasomotor reactivity was studied with a myograph tension system. LPA (10 and 50 μM) treatment for the vessel rings significantly reduced endothelium-dependent vasorelaxation in response to bradykinin (×10(-5)M) by 32% and 49%, respectively, compared with the control (P<0.05). LPA decreased endothelial nitric oxide synthase (eNOS) mRNA and immunoreactivity levels in the vessel rings. In HCAECs, LPA reduced eNOS mRNA, phospho-eNOS and total eNOS protein levels. In addition, superoxide anion levels in LPA-treated vessel rings and HCAECs were significantly increased by lucegenin-enhanced chemiluminescence assay and dihydroethidium staining, respectively. Mitochondrial membrane potential and ATP content in LPA-treated HCAECs were substantially decreased. The mRNA levels of reactive oxygen species generating enzymes NOX4 and p40(phox) were increased, while endogenous antioxidant enzyme superoxide dismutase 1 was decreased in response to LPA treatment in HCAECs. Furthermore, exogenous antioxidant molecule selenomethionine (SeMet) effectively reversed these LPA-induced effects in both porcine coronary arteries and HCAECs." }, { "role": "assistant", "content": "LPA causes endothelial dysfunction by a mechanism associated with decreased eNOS expression and increased oxidative stress in porcine coronary arteries and HCAECs. 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: Apoptosis, Cytochromes c, Cytoplasm, HeLa Cells, Humans, Microscopy, Fluorescence, Mitochondria, Newcastle disease virus, Protein Conformation, Protein Transport, bcl-2-Associated X Protein." }, { "role": "user", "content": "Does newcastle disease virus infection promote Bax redistribution to mitochondria and cell death in HeLa cells? Context: Newcastle disease virus (NDV) is an avian paramyxovirus that has gained a lot of interest in cancer viro-therapeutic applications because of its ability to selectively induce apoptosis in human cancer cells. However, the underlying mechanisms by which NDV induces apoptosis in human cancer cells are still not entirely understood. In this study we examined the effect of a Malaysian velogenic strain of NDV, known as AF2240, on some elements of the intrinsic pathway of apoptosis. We show that NDV infection leads to conformational change of Bax protein. This is associated with the translocation of Bax from the cytoplasm to mitochondria and the release of cytochrome c into the cytoplasm. Interestingly, the level of Bcl-2 protein was not affected by NDV treatment." }, { "role": "assistant", "content": "We have shown that Bax conformational change and subcellular distribution is involved in the intrinsic pathway of apoptosis induced by NDV. 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: RATIONALE AND OBJECTIVES, MATERIALS AND METHODS, RESULTS. Meshes: Attention, Diagnostic Errors, Humans, Internship and Residency, Patient Safety, Radiology, Telephone." }, { "role": "user", "content": "Do telephone call interruptions have an impact on radiology resident diagnostic accuracy? Context: The purpose of this study was to measure the effect of distractions, in the form of telephone call interruptions, on radiology resident diagnostic accuracy. Radiology resident discrepancy reports and reading room telephone logs at an academic tertiary care pediatric hospital were collected over a 13-month period. Phone call times and durations were recorded. Major discrepancy shifts (defined as a call shift where at least one major discrepancy was discovered the following morning by the attending radiologist between the resident preliminary and attending final reports), and dictation time stamps for each discrepant preliminary dictation were also recorded. Telephone call volume and preliminary report time stamps were compared between \"discrepancy shifts\" and \"no discrepancy shifts.\" Each call shift spanned 14 hours, during which one radiology resident was responsible for the generation of preliminary interpretations. Review of the discrepancy log data revealed 51 major discrepancies in 41 shifts, of which 39 discrepancies had documented error details and resident preliminary report time stamps. The average number of telephone calls for the \"discrepancy shifts\" was slightly greater than the \"no discrepancy shifts\" (48.59 vs. 44.02) but was not statistically significant (P = .0575). However, there was a statistically significant increase in the average number of phone calls in the 1 hour preceding the generation of a discrepant preliminary report versus the \"no discrepancy shifts\" (4.23 vs. 3.24 calls, P = .027). One additional phone call during the hour preceding the generation of a discrepant preliminary report resulted in a 12% increased likelihood of a resident error (P = .017)." }, { "role": "assistant", "content": "Distractions in the form of telephone call interruptions may negatively impact on-call radiology resident diagnostic accuracy. Efforts should be made to limit distractions in the reading room." } ]

[ { "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, Anti-Bacterial Agents, Bacteremia, Bacteria, Cambodia, Community-Acquired Infections, Drug Resistance, Bacterial, Female, HIV Seronegativity, HIV Seropositivity, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Retrospective Studies." }, { "role": "user", "content": "Does HIV status affect the aetiology, bacterial resistance patterns and recommended empiric antibiotic treatment in adult patients with bloodstream infection in Cambodia? Context: The microbiologic causes of bloodstream infections (BSI) may differ between HIV-positive and HIV-negative patients and direct initial empiric antibiotic treatment (i.e. treatment before culture results are available). We retrospectively assessed community-acquired BSI episodes in adults in Cambodia according to HIV status for spectrum of bacterial pathogens, antibiotic resistance patterns and appropriateness of empiric antibiotics. Blood cultures were systematically performed in patients suspected of BSI in a referral hospital in Phnom Penh, Cambodia. Data were collected between 1 January 2009 and 31 December 2011. A total of 452 culture-confirmed episodes of BSI were recorded in 435 patients, of whom 17.9% and 82.1% were HIV-positive and HIV-negative, respectively. Escherichia coli accounted for one-third (n = 155, 32.9%) of 471 organisms, with similar rates in both patient groups. Staphylococcus aureus and Salmonella cholereasuis were more frequent in HIV-positive vs. HIV-negative patients (17/88 vs. 38/383 (P = 0.02) and 10/88 vs. 5/383 (P < 0.001)). Burkholderia pseudomallei was more common in HIV-negative than in HIV-positive patients (39/383 vs. 2/88, P < 0.001). High resistance rates among commonly used antibiotics were observed, including 46.6% ceftriaxone resistance among E. coli isolates. Empiric antibiotic treatments were similarly appropriate in both patient groups but did not cover antibiotic-resistant E. coli (both patient groups), S. aureus (both groups) and B. pseudomallei (HIV-negative patients)." }, { "role": "assistant", "content": "The present data do not warrant different empiric antibiotic regimens for HIV-positive vs. HIV-negative patients in Cambodia. The overall resistance rates compromise the appropriateness of the current treatment guidelines." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All of the following drugs are used in prophylaxis of migraine, except:" }, { "role": "assistant", "content": "The correct answer is Drugs approved by the FDA for migraine prophylaxis are propranolol, timolol, sodium valproate and methysergide. Other used drugs are amitriptyline, noriptyline, verapamil, phenelzine, gabapentine and cyproheptadine. Ref: Harrisons 16th Edition, Page 93 (table 14-11)" } ]

[ { "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: Androstanols, Anesthesia, Inhalation, Anesthetics, Inhalation, Blinking, Child, Child, Preschool, Female, Humans, Male, Methyl Ethers, Movement, Neuromuscular Nondepolarizing Agents, Ophthalmologic Surgical Procedures, Pain, Regression Analysis, Rocuronium, Sample Size, Sevoflurane, Strabismus." }, { "role": "user", "content": "Does a short period of inhalation induction with sevoflurane prevent rocuronium-induced withdrawal in children? Context: the aim of this study was to determine whether or not inhalation induction with sevoflurane can prevent the withdrawal movement associated with the injection of rocuronium. a total of 75 pediatric patients were randomly allocated to five groups (S 1.5, 2.0, 2.5, 3.0, and the control group). In the control group (n=15), 2.5% thiopental 5 mg/kg was injected intravenously. Rocuronium 0.4 mg/kg was injected immediately after loss of consciousness. In the S 1.5, 2.0, 2.5, or 3.0 group, rocuronium 0.4 mg/kg was injected at 1.5, 2, 2.5, or 3 min after inhalation induction, respectively, and the withdrawal response was recorded. End-tidal sevoflurane concentrations were recorded at the time of the rocuronium injection. The inhalation time of sevoflurane before rocuronium injection required to provide no withdrawal response in 50% and 95% of patients (IT(50) and IT(95) ) was calculated. the incidence of withdrawal was 80% (12/15), 71.4% (10/14), 21% (3/14), 0% (0/14), and 0% (0/15) in group C, group S 1.5, group S 2.0, group S 2.5, and group S 3.0, respectively. IT(50) of the rocuronium injection time was 1.7 min (95% CI: 1.5-1.9) and IT(95) was 2.3 min (95% CI: 2.0- 2.9)." }, { "role": "assistant", "content": "this study demonstrated that inhalation induction with sevoflurane can prevent the withdrawal movement induced by rocuronium in children, and IT(50) and IT(95) for the prevention of movement was 1.7 and 2.3 min, respectively. 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": "'C' wave in JVP is due to" }, { "role": "assistant", "content": "The correct answer is Ans. is 'b' i.e., Tricuspid valve bulging into right atrium The Jugular venous pulse (JVP) reflects phasic pressure changes in the right atrium and it consists of three positive waves and two negative troughs.It will be useful to keep in mind the events of the cardiac cycle while evaluating Jugular venous pulse.JUGULAR VENOUS PULSE. a waveIt is the positive presystolic wave produced by right atrial contraction.x descenta wave is followed by the negative systolic wave the 'x' descent.The x descent is produced due to atrial relaxation Q.The atrial relaxation is produced as a result of ventricular contraction.c waveThe x descent is interrupted by second positive wave the 'c' wave.It is produced by bulging of the tricuspid valve into the right atrium Q during RV isovolumetric contraction.v waveIt is the positive systolic wave.It result from increase in the blood volume in the vena cava during systole, when the tricuspid valve is closed Q.y descentFollowing the \"v wave\" this is a negative descending limb referred to as the y descent or diastolic collapse Q.It is due to tricuspid valve opening and rapid inflow of blood into the right ventricle.So there areThree visible major positive waves (a, c and v) andTwo negative waves (x and y)." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND AND AIMS, METHODS, RESULTS. Meshes: Adenocarcinoma, Adult, Aged, Antineoplastic Agents, Brachytherapy, Carcinoma, Squamous Cell, Cisplatin, Combined Modality Therapy, Female, Humans, Hysterectomy, Middle Aged, Radiotherapy, Uterine Cervical Neoplasms." }, { "role": "user", "content": "Should simple hysterectomy be added after chemo-radiation for stage IB2 and bulky IIA cervical carcinoma? Context: Management of bulky cervical tumours is controversial. We describe the addition of high dose rate brachytherapy with concomitant chemotherapy to an attenuated protocol of radiation followed by simple hysterectomy in the management of bulky cervical tumours. Between January, 2003 and December, 2006, 23 patients diagnosed with bulky cervical tumours underwent a fixed chemo-radiation protocol followed by simple hysterectomy. Fractionated external beam pelvic radiation (4500 cGy) followed by two high-dose rate applications of brachytherapy (700 cGy - prescription dose to point A) was given with weekly concomitant cisplatin (35 mg/m(2)). Patients then underwent simple hysterectomy. Clinical information was prospectively collected and patient charts were then further reviewed. Twenty patients had stage IB2 and three bulky IIA. Median tumour size was 5 cm. Sixteen patients (70%) achieved a clinical complete and seven (30%) a clinical partial response. All patients had a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH BSO). On final pathology, 12 patients (52%) had a pathological complete response, whereas 11 patients (48%) had residual carcinoma in the cervix. Surgical margins were not involved. With a median follow-up time of 20 months (range 10-50 months), four patients (17.4%), all from the pathological partial response group, have suffered a pelvic recurrence, within 6 months from therapy; nineteen patients (82.6%) remain free of disease." }, { "role": "assistant", "content": "This attenuated protocol of chemo-radiation using HDR brachytherapy followed by simple hysterectomy is a viable option in the treatment of bulky cervical carcinomas. The rate of residual cervical disease after chemo-radiation is substantial, but simple hysterectomy achieved negative surgical margins in all cases." } ]

[ { "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, Alzheimer Disease, Animals, Brain, Causality, Dementia, Female, Genome-Wide Association Study, Humans, Leukoencephalopathies, Male, Polymorphism, Single Nucleotide, Rats, Rats, Inbred SHR, Rats, Wistar, Risk Factors, Translational Medical Research, White Matter." }, { "role": "user", "content": "Do genes from a translational analysis support a multifactorial nature of white matter hyperintensities? Context: White matter hyperintensities (WMH) of presumed vascular origin increase the risk of stroke and dementia. Despite strong WMH heritability, few gene associations have been identified. Relevant experimental models may be informative. We tested the associations between genes that were differentially expressed in brains of young spontaneously hypertensive stroke-prone rats and human WMH (using volume and visual score) in 621 subjects from the Lothian Birth Cohort 1936 (LBC1936). We then attempted replication in 9361 subjects from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE). We also tested the subjects from LBC1936 for previous genome-wide WMH associations found in subjects from CHARGE. Of 126 spontaneously hypertensive stroke-prone rat genes, 10 were nominally associated with WMH volume or score in subjects from LBC1936, of which 5 (AFP, ALB, GNAI1, RBM8a, and MRPL18) were associated with both WMH volume and score (P<0.05); 2 of the 10 (XPNPEP1, P=6.7×10(-5); FARP1, P=0.024) plus another spontaneously hypertensive stroke-prone rat gene (USMG5, P=0.00014), on chromosomes 10, 13, and 10 respectively, were associated with WMH in subjects from CHARGE. Gene set enrichment showed significant associations for downregulated spontaneously hypertensive stroke-prone rat genes with WMH in humans. In subjects from LBC1936, we replicated CHARGE's genome-wide WMH associations on chromosomes 17 (TRIM65 and TRIM47) and, for the first time, 1 (PMF1)." }, { "role": "assistant", "content": "Despite not passing multiple testing thresholds individually, these genes collectively are relevant to known WMH associations, proposed WMH mechanisms, or dementia: associations with Alzheimer's disease, late-life depression, ATP production, osmotic regulation, neurodevelopmental abnormalities, and cognitive impairment. If replicated further, they suggest a multifactorial nature for WMH and argue for more consideration of vascular contributions to dementia. 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": "Congenital adrenal hyperplasia, most commonly presents as:" }, { "role": "assistant", "content": "The correct answer is b. Female pseudohermaphrodites(Ref: Nelson 20/e p 2714-2718)Note: Male pseudohermaphrodite is now called 46,XY DSD, while female - 46 XX DSD;So female pseudohermaphrodite is genotypically female (46,XX), whose external genitalia looks like that of a male;In CAH due to 21-hydroxylase deficiency, females have ambiguous genitalia, while males have normal genitalia" } ]

[ { "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, Cytokines, Fibrosis, Gene Expression Regulation, Inflammation, Male, Myocarditis, Myocardium, Organ Size, Personal Space, Plasminogen Activator Inhibitor 1, RNA, Messenger, Rats, Rats, Inbred Lew, Thiazolidinediones." }, { "role": "user", "content": "Does a specific inhibitor of plasminogen activator inhibitor-1 suppress rat autoimmune myocarditis? Context: Myocarditis is a serious disease, however no effective treatment exists. Plasminogen activator inhibitor-1 (PAI-1) is critical in cell recruitment and inflammation. Although inflammation is an essential pathological feature of acute myocarditis, the effects of PAI-1 inhibition on the development of acute myocarditis have not been well studied. To clarify the role of PAI-1, we used a rat experimental autoimmune myocarditis (EAM) model. Lewis rats were immunized on day 0 with porcine cardiac myosin to establish EAM. The rats with induced EAM were treated with the PAI-1 inhibitor (IMD-1622) (n = 8) or not treated (n = 6); hearts were harvested on day 21. Echocardiograms, heart weight to body weight ratios (H:B), histological examinations and in vitro studies were performed. Echocardiograms indicated that the PAI-1 inhibitor improved left ventricular fractional shortening (50 +/- 3%) compared with controls (36 +/- 4%, p < 0.05). The inhibitor significantly reduced H:B ratios compared with controls. Pathologically, areas of myocardial cell infiltration and fibrosis in the inhibitor-treated group were significantly smaller than those in the control group. Immunohistochemistry revealed enhanced expression of adhesion molecules and inflammatory factors in non-treated EAM hearts, the inhibitor suppressed this expression." }, { "role": "assistant", "content": "The PAI-1 inhibitor suppressed EAM development; thus this inhibitor is promising for treating clinical myocarditis. 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, Apoptosis, Glial Fibrillary Acidic Protein, Gliosis, Injections, Male, Nerve Growth Factor, Rats, Rats, Sprague-Dawley, Receptor, trkA, Recombinant Proteins, Retina, Retinal Degeneration, Retinal Detachment, Up-Regulation, Vitreous Body." }, { "role": "user", "content": "Does nerve growth factor help protect retina in experimental retinal detachment? Context: To investigate the expression of nerve growth factor (NGF) and its receptor TrkA on the retina at different time points after retinal detachment (RD) and the protection effect of NGF in experimental RD. Sprague-Dawley rats were used as an RD animal model by injection of 0.1% sodium hyaluronate under the neurosensory retina. The expression of endogenous NGF and its receptor TrkA in the rat retina was detected using immunohistochemistry. The NGF (5 mug/eye) or phosphate-buffered saline were injected separately into vitreous every 4 days after the RD. The rat eyes were then observed at various time points. Morphologic changes were investigated by light microscopy. Retinal gliosis was detected by glial fibrillary acidic protein labeling. The expression of endogenous NGF and TrkA was upregulated during RD procedure. Most of the NGF-treated retina had a well-organized structure. In NGF-treated RD eyes, the cells were still significantly more numerous than in phosphate-buffered-saline-treated retina. Glial fibrillary acidic protein labeling increased quickly after RD; the NGF-treated retina had less reactive gliosis than the control groups." }, { "role": "assistant", "content": "Intravitreal injection of exogenous NGF can protect retinal cells from degeneration in experimental RD. It may exert its protective action by preventing the apoptosis of retinal cells after RD. 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 20-year-old woman has mild pulmonary stenosis. Which of the following statements regarding this situation is true?" }, { "role": "assistant", "content": "The correct answer is Adults with mild pulmonic stenosis are generally asymptomatic. Unlike congenital aortic stenosis, this condition usually does not progress; thus, follow-up need not be frequent. The risk of endocarditis is somewhat lower for pulmonic valves than for the other heart valves, whether normal or stenotic. Clinical signs of mild pulmonic stenosis include a prominent a wave on jugular venous pulse, a normal electrocardiogram, and normal cardiac size on chest x-ray." } ]

[ { "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": "Epidemic relapsing fever is transmitted by?" }, { "role": "assistant", "content": "The correct answer is ANSWER: (A) LouseREF: Park textbook of preventive and social medicine 20th edition page 684 \"Epidemic relapsing fever is transmitted by Louse\"Always remember:Epidemic typhus Endemic typhus Epidemic relapsing fever Endemic relapsing feverLouse Rat flea Louse Soft tickDiseases transmitted by louse can be remembered as \"PERT\": Pediculosis, Epidemic typhus, Relapsing fever (Epidemic), Trench fever.Diseases transmitted by soft tick can be memorized as 'QRS\": Q-fever, Relapsing fever (Endemic) by Soft tickDiseases transmitted by hard tick can be memorized as \"Hard tick Takes Very Kind Babe\": Tick typhus (Rocky Mountain spotted fever), Tick Paralysis, Tick fever, Tularemia, Viral encephalitis (Russian spring summer encephalitis), Viral hemorrhagic fever, Kyasanur Forest Disease, Babesiosis" } ]

[ { "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, Analgesics, Antipsychotic Agents, Austria, Cognition, Cognition Disorders, Communication Barriers, Cross-Sectional Studies, Female, Homes for the Aged, Humans, Long-Term Care, Male, Needs Assessment, Nursing Homes, Pain, Pain Management, Pain Measurement." }, { "role": "user", "content": "Does pain treatment for nursing home residents differ according to cognitive state - a cross-sectional study? Context: Communication skills are known to decrease with advancing cognitive impairment. Analgesic treatment in long-term care may be deficient due to the residents' impaired ability to communicate their pain and needs. Undertreated pain frequently leads to rising BPSD in residents with cognitive impairment, resulting in a treatment with antipsychotics. Aim of this study was the analysis of differences in assessment and pharmacological treatment of pain in nursing home residents relative to their cognitive state and ability to articulate pain. Data stems from the baseline of a non-experimental pre-post-study in 12 Austrian nursing homes. Residents' pain prevalence in relation to pain assessment and cognitive decline was assessed, data on medical diagnoses and prescriptions were retrieved from the nursing homes' documentation (n = 425). Residents were first divided into two groups: Residents with MMSE ≥ 18 were selected into group CUS (cognitively unimpaired/slightly impaired), residents with MMSE ≤ 17 were selected into group CI (cognitively moderately to severely impaired). CI residents were then sub-grouped according to their ability to communicate pain via the Verbal Rating Scale (VRS) (i.e. group CI-V, group CI-NV). Pain behavior of CI residents was assessed with a modified German version of PAINAD. Group differences were tested with ANOVA and H-test, 95 % confidence intervals were calculated and associations were tested with log-binomial regression. Pain prevalence in CI residents irrespective of their ability to communicate pain was 80 % and exceeded the CUS group prevalence significantly by 14 %. CI residents had significantly less analgesic prescriptions. Furthermore, CI residents have a significantly higher risk of getting no analgesics when in pain than CUS residents (CI-V: RR =2.6, CI-NV: RR =3.4). Use of antipsychotics was high in all groups (49 - 65 %) with more prescriptions in the cognitively impaired group." }, { "role": "assistant", "content": "Results point toward an underuse of pain medication in cognitively impaired residents, especially those unable to communicate pain verbally. The implementation of standardized pain assessments adapted to the cognitive abilities of residents may foster the recognition of pain, warrant optimized pain management, reduce inadequate medication and consequently raise the chance of equally effective pain treatment regardless of cognitive state. 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": "'Flare' in Triple response is mediated by :" }, { "role": "assistant", "content": "The correct answer is A i.e. Axon reflex" } ]

[ { "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, Age of Onset, Aged, Aged, 80 and over, Cohort Studies, Female, Gene Amplification, Gene Dosage, Humans, Male, Meningeal Neoplasms, Meningioma, Middle Aged, Neoplasm Invasiveness, Oncogenes, Young Adult." }, { "role": "user", "content": "Does low-level amplification of oncogenes correlate inversely with age for patients with nontypical meningiomas? Context: This study sought to identify genes in nontypical meningiomas with gains in copy number (CN) that correlate with earlier age of onset, an indicator of aggressiveness. Among 94 adult patients, 91 had 105 meningiomas that were histologically confirmed. World Health Organization grades I (typical), II (atypical), and III (anaplastic) were assigned to tumors in 76, 14, and 1 patient, respectively. Brain invasion indicated that two World Health Organization grade I meningiomas were biologically atypical. DNA from 15 invasive/atypical/anaplastic meningiomas and commercial normal DNA were analyzed with multiplex ligation dependent probe amplification. The CN ratios (fold differences from normal) for 78 genes were determined. The CN ratio was defined as [tumor CN]/[normal CN] for each gene to normalize results. Characteristic gene losses (CN ratio < 0.75) occurred in >50% of the invasive/atypical/anaplastic meningiomas at 22q11, 1p34.2, and 1p22.1 loci. Gains (CN ratio ≥ 2.0) occurred in each tumor for 2 or more of 19 genes. Each of the 19 genes' CN ratio was ≥ 2.0 in multiple tumors, and their collective sums (up to 49.1) correlated inversely with age (r = -0.72), minus an outlier. In patients ≤ 55 versus >55 years, 5 genes (BIRC2, BRAF, MET, NRAS, and PIK3CA) individually exhibited significantly higher CN ratios (P < 0.05) or a trend for them (P < 0.09), with corrections for multiple comparisons, and their sums correlated inversely with age (r = -0.74)." }, { "role": "assistant", "content": "Low levels of amplification for selected oncogenes in invasive/atypical/anaplastic meningiomas were higher in younger adults, with the CN gains potentially underlying biological aggressiveness associated with early tumor development. 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: Administration, Inhalation, Allergens, Animals, Asthma, Bronchoalveolar Lavage Fluid, Cytokines, Female, Fibrinogen, Immunoglobulin E, Immunoglobulin G, Mice, Mice, Inbred BALB C, Nanoparticles, Ovalbumin, Pneumonia, Respiratory Mechanics, Titanium, Toxicity Tests, Acute." }, { "role": "user", "content": "Does inhalation exposure of nano-scaled titanium dioxide ( TiO2 ) particles alter the inflammatory responses in asthmatic mice? Context: Titanium dioxide (TiO2) nanoparticles (NPs) are regarded as relatively non-toxic in concentrations occurring in occupational environments. Nevertheless, it is conceivable that adverse health effects may develop in sensitive populations such as individuals with respiratory diseases. We investigated whether single or repeated exposure to TiO2 could aggravate inflammatory responses in naïve mice and mice with ovalbumin (OVA)-induced airway inflammation. Exposure to aerosolized TiO2 was performed during OVA sensitization, before, or during the OVA challenge period. The effects on respiratory physiology, inflammatory cells in bronchoalveolar lavage (BAL) and inflammatory mediators in BAL and serum were assessed 24 h after the last OVA challenge or TiO2 exposure. A single exposure of TiO2 had a marked effect on responses in peripheral airways and increasing infiltration of neutrophils in airways of naïve animals. Marked aggravation of airway responses was also observed in animals with allergic disease provided that the single dose TiO2 was given before allergen challenge. Repeated exposures to TiO2 during sensitization diminished the OVA-induced airway eosinophilia and airway hyperresponsiveness but concomitant exposure to TiO2 during the OVA challenge period resulted in neutrophilic airway inflammation and a decline in general health condition as indicated by the loss of body weight." }, { "role": "assistant", "content": "We conclude that inhalation of TiO2 may aggravate respiratory diseases and that the adverse health effects are highly dependent on dose and timing of exposure. Our data imply that inhalation of NPs may increase the risk for individuals with allergic airway disease to develop symptoms of severe asthma. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: PURPOSE, METHODS, RESULTS. Meshes: Adult, Attitude to Health, Breast Neoplasms, Data Collection, Decision Making, Female, Genes, BRCA1, Genes, BRCA2, Genetic Predisposition to Disease, Genetic Testing, Humans, Middle Aged, Mutation, Retrospective Studies, Time Factors." }, { "role": "user", "content": "Are we being overly cautious? Context: Women with breast cancer, who are found to be BRCA1/2 mutation carriers, have a high risk of ovarian cancer and metachronous breast cancer. Treatment-focused genetic testing (TFGT), offered around the time of diagnosis, allows genetic test results to inform surgical treatment decisions. However, concern has been raised that offering TFGT at this time may overly increase psychological burden. This study aimed to qualitatively explore women's attitudes and experiences of TFGT. Women who had been diagnosed with breast cancer at age 50 years or less undertook a semi-structured telephone interview (n = 26). The sample included women who had been offered TFGT, based on family history and/or other risk criteria (n = 14), and women who had been diagnosed within the past 6-12 months and had not been offered TFGT (n = 12). Interviews explored women's attitudes towards TFGT, perceived benefits and disadvantages, implications of TFGT and impact on surgical decision making. Interviews were transcribed verbatim and thematically analysed. Women expressed positive attitudes towards TFGT and felt it was highly relevant to their surgical decision making. They did not feel that an offer of TFGT shortly after, or at the time of diagnosis, added undue psychological burden. The majority of women interviewed felt that TFGT should be incorporated into standard clinical care." }, { "role": "assistant", "content": "TFGT is viewed favourably by women newly diagnosed with breast cancer. Future randomized controlled trials are needed to examine the long-term impact of TFGT. We conclude that an offer of TFGT is not perceived as 'too much, too soon' by relevant patients." } ]

[ { "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: Amniotic Fluid, Female, Fetal Organ Maturity, Gestational Age, Humans, Logistic Models, Lung, Meconium, Pregnancy, Pregnancy Outcome, Pregnancy Trimester, Third, Regression Analysis." }, { "role": "user", "content": "Does meconium guarantee fetal lung maturity? Context: In utero passage of meconium may represent a response to hypoxic stress or a normal maturational event. When found during the third trimester, one may be tempted to use its presence as prima facie evidence of fetal lung maturity. The purpose of our study was to determine the frequency of meconium-stained fluid in the third trimester and the incidence of biochemical and physiologic lung immaturity in these fetuses. Amniotic fluid specimens obtained at our institution from 1991 through 1993 (n = 2,377) were analyzed for maturity and visually inspected for meconium. Perinatal outcome was obtained for intramural deliveries occurring within 3 days of amniotic fluid collection (n = 905). Gestational age was defined as the best obstetric estimate based on menstrual dates, clinical examination, and ultrasound results. Meconium staining was present in 2.7% (n = 64) of specimens. Although meconium-stained specimens were more likely to have mature lecithin-sphingomyelin (L:S) ratios (OR 2.1, 95% confidence interval [CI] = 1.2-3.6) and phosphatidylglycerol (PG) concentrations (OR 3.8, CI 2.2-6.7), 17.2% were immature for both L:S and PG (n = 11, CI = 9.9-28.2%). When analysis was limited to fetuses delivering intramurally within 3 days of amniotic fluid collection, respiratory distress syndrome occurred in 3.0% (CI = 0.5-15%) with meconium-stained fluid." }, { "role": "assistant", "content": "The presence of meconium in amniotic fluid does not guarantee lung maturity. The same consideration of the risks of prematurity must be given to the fetus with meconium-stained fluid as given to the fetus with clear fluid. 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: Adiponectin, Atherosclerosis, Biomarkers, C-Reactive Protein, Carotid Arteries, Carotid Artery Diseases, Carotid Intima-Media Thickness, Disease Progression, Female, Humans, Male, Middle Aged." }, { "role": "user", "content": "Is increased Hs-CRP/adiponectin ratio associated with increase carotid intima-media thickness? Context: High sensitivity C-reactive protein (Hs-CRP) and adiponectin (APN) are two critical cytokines and exert inverse effects on atherosclerosis initiation and progression. The purpose of our study was to investigate the value of Hs-CRP and ANP ratio (Hs-CRP/APN ratio) on evaluating atherosclerosis progression. One hundred sixty consecutive participants underwent carotid intima-media thickness (CIMT) measured by ultrasound were enrolled and drawn fasting blood samples for plasma levels Hs-CRP and APN, serum levels of lipid profiles and fasting blood glucose evaluation. Other anthropometrics and clinical status were collected by questionnaire. All participants were divided into 4 groups according to the baseline Hs-CRP/APN ratio and underwent CIMT measurement every 6 months. CIMT increment and composite cardiovascular endpoints were compared after 24 months' follow-up. At baseline, body mass index (BMI), smoking, diabetic mellitus, usage of statins, Hs-CRP and APN independently correlated with Hs-CRP/APN ratio as analyzed by spearman rank correlation. Smoking, serum level of LDL-C, plasma level of Hs-CRP and Hs-CRP/APN ratio were positively correlated with CIMT while usage of statins and plasma level of APN were negatively correlated with CIMT as analyzed by multiple linear regression analysis. After 24 months' follow-up, the progression of CIMT was the most prominent in the fourth quartile of baseline Hs-CRP/APN ratio. In addition, the incidence of composite cardiovascular endpoint was also higher in the fourth quartile as compared to the other 3 lower quartiles." }, { "role": "assistant", "content": "Hs-CRP/APN ratio was a useful predictor to discriminate subjects who were at increased risk of atherosclerosis progression. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Age of Onset, Aged, Asthma, Denmark, Female, Follow-Up Studies, Forced Expiratory Volume, Humans, Incidence, Male, Middle Aged, Population Surveillance, Respiratory Function Tests, Retrospective Studies, Time Factors, Vital Capacity, Young Adult." }, { "role": "user", "content": "Does lung function impairment increase with age of diagnosis in adult onset asthma? Context: Asthma-onset in older individuals has been associated with an accelerated decline in lung function, but direct comparisons with younger adults have not been reported. In a random population sample comprising 4983 individuals from the Copenhagen City Heart Study without asthma at baseline, we compared young (<35 years), middle-aged (35-64 years) and older (>64 years) adults with newly diagnosed asthma during a 10-year follow-up. The proportion of cases with newly diagnosed asthma during follow-up was similar across age groups (Older adults: 7% (84/1168), middle-aged adults: 7% (223/3147), and young adults: 6% (42/668) (p = ns)). In all three age groups, lung function was reduced at baseline in subjects who were subsequently diagnosed with asthma, but most pronounced in those >35 years. (Mean FEV1%: Young 90.2% (±13.9), middle-aged 80.8% (±20.8), and older adults 80.8% (±24.2), p < 0.001). Furthermore, incident asthma was associated with an accelerated decline in lung function in older adults (young adults 11.0 mL/year, middle-aged adults 18.2 mL/year, and older adults 30.8 mL/year). These differences were independent of FEV1 at baseline and smoking status, and were not explained by undiagnosed asthma in older adults, as the frequency of respiratory symptoms, including wheeze, was similar in all three age groups at baseline." }, { "role": "assistant", "content": "Asthma was diagnosed as frequently in older as in younger adults. Preexisting symptoms were equally common, but lung function was more reduced pre-diagnosis, and declined more rapidly in older adults. This emphasizes the need for a high level of therapeutic attention in patients with asthma diagnosed late in life. 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: ." }, { "role": "user", "content": "Are patients with chronic heart failure encountered in daily clinical practice different from the `` typical '' patient enrolled in therapeutic trials? Context: The aim of this study was to compare the clinical characteristics of patients enrolled in randomized clinical trials on congestive heart failure treatment with those of real-world patients encountered in daily clinical practice. We searched the Cochrane review methodology, Medline and SilverPlatter databases to obtain the clinical characteristics of both patients enrolled in therapeutic clinical trials and real-world patients with heart failure. We selected 27 clinical trials, and 8 prospective epidemiological studies or registries published between 1987 and 2001 which enrolled 53,859 and 18,207 patients, respectively. On average, compared to real-world heart failure patients, patients enrolled in clinical trials were younger (63 +/- 10 vs 75 +/- 11 years respectively, p < 0.0001), and more likely to be male (72 vs 54% respectively, p < 0.0001). Clinical trial patients showed a lower ejection fraction (26 +/- 7 vs 38 +/- 15% respectively, p < 0.0001) but a lower prevalence of NYHA functional class III-IV (62 vs 75% respectively, p < 0.0001) than real-world patients. In clinical trial patients, the prevalence of ischemic heart disease (67 vs 42% respectively, p < 0.0001) and a history of previous myocardial infarction (62 vs 42% respectively, p < 0.0001) were higher than in real-world patients. Conversely, the prevalence of chronic atrial fibrillation (12 vs 31% respectively, p < 0.0001) and of diabetes (22 vs 24% respectively, p < 0.02) was lower in trial patients than in real-world patients." }, { "role": "assistant", "content": "Our data suggest that most clinical trials on congestive heart failure, on which the guidelines for clinical practice are based, have generally included patients who are not representative of the whole spectrum of patients actually managed in clinical practice. 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, Cytokines, Disease Models, Animal, Inflammation Mediators, Liver, Mice, Inbred C57BL, Mice, Knockout, Non-alcoholic Fatty Liver Disease, Obesity, Signal Transduction, Time Factors, Toll-Like Receptor 4." }, { "role": "user", "content": "Is development of steatohepatitis in Ob/Ob mice dependent on Toll-like receptor 4? Context: The etiology of non-alcoholic fatty liver disease (NAFLD) progression, and why some patients develop non-alcoholic steatohepatitis (NASH) vs. uncomplicated NAFLD, is not well understood. Obesity and NAFLD are thought to be associated with high circulating levels of leptin; however, the role of leptin in NASH has been controversial. Secondly, as ob/ob mice are known to have elevated circulating levels of TLR4-stimulating endotoxin secondary to increased intestinal permeability. We evaluated the long-term effects of steatosis on the livers of aleptinemic (OB) mice and the role of TLR4 in the development of hepatic sequelae in these animals. At 20 weeks of age OB animals displayed grossly steatotic livers, but also features of early stage NASH including hepatocellular ballooning and numerous necroinflammatory foci with associated changes in serum aspartate aminotransferase (AST) and alanine transaminase (ALT). TLR4 KO did not affect the development of obesity or steatosis in ob/ob mice, but protected these animals from hepatitis and liver injury." }, { "role": "assistant", "content": "In conclusion, the data presented here indicate that steatohepatitis develops in the absence of leptin, and that TLR4 is integral to the development NASH secondary to hyperphagia. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Adult, Biopsy, Breast Neoplasms, Female, Fibrosis, Humans, Keratosis, Lymphangiogenesis, Lymphatic Vessels, Lymphedema, Middle Aged, Skin, Transforming Growth Factor beta1, Upper Extremity, Vascular Grafting." }, { "role": "user", "content": "Does lymphaticovenous bypass decrease pathologic skin changes in upper extremity breast cancer-related lymphedema? Context: Recent advances in microsurgery such as lymphaticovenous bypass (LVB) have been shown to decrease limb volumes and improve subjective symptoms in patients with lymphedema. However, to date, it remains unknown if these procedures can reverse the pathological tissue changes associated with lymphedema. Therefore, the purpose of this study was to analyze skin tissue changes in patients before and after LVB. Matched skin biopsy samples were collected from normal and lymphedematous limbs of 6 patients with unilateral breast cancer-related upper extremity lymphedema before and 6 months after LVB. Biopsy specimens were fixed and analyzed for inflammation, fibrosis, hyperkeratosis, and lymphangiogenesis. Six months following LVB, 83% of patients had symptomatic improvement in their lymphedema. Histological analysis at this time demonstrated a significant decrease in tissue CD4(+) cell inflammation in lymphedematous limb (but not normal limb) biopsies (p<0.01). These changes were associated with significantly decreased tissue fibrosis as demonstrated by decreased collagen type I deposition and TGF-β1 expression (all p<0.01). In addition, we found a significant decrease in epidermal thickness, decreased numbers of proliferating basal keratinocytes, and decreased number of LYVE-1(+) lymphatic vessels in lymphedematous limbs after LVB." }, { "role": "assistant", "content": "We have shown, for the first time, that microsurgical LVB not only improves symptomatology of lymphedema but also helps to improve pathologic changes in the skin. These findings suggest that the some of the pathologic changes of lymphedema are reversible and may be related to lymphatic fluid stasis. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All of the following enzymes are increased in myocardial infarction, EXCEPT:" }, { "role": "assistant", "content": "The correct answer is In MI, total LDH activity is increased, while H4 iso-enzymes is increased 5-10 times more. The magnitude of the peak value will be roughly propoional to the size of myocardial infarct. CK value in serum is increased in myocardial infarction. The CK level stas to rise within 3-6 hours of infarction. Therefore CK estimation is very useful to detect early cases. The CK level is not increased in hemolysis or in congestive hea failure and therefore CK has an advantage over LDH. Normal level of AST is 8-20U/L. The level is significantly elevated in Myocardial infarction. Isocitrate dehydrogenase is not elevated in myocardial infarction. Must know: The enzymes routinely elevated in myocardial infarction are: Creatine kinase(CK) Lactate dehydrogenase(LDH) Aspaate aminotransferase(AST) Cardiac troponin I(CTI) and Cardiac troponin T(CTT) Brain Natriuretic peptide(BNP). It is reliable marker of congestive cardiac failure. Ref: Textbook of Biochemistry By DM Vasudevan, 5th Ed Page 54-55" } ]

[ { "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, Anesthesia, Caudal, Anesthetics, Local, Auscultation, Bupivacaine, Child, Child, Preschool, Clinical Competence, Female, Humans, Infant, Infant, Newborn, Injections, Intradermal, Male, Needles, Nerve Block." }, { "role": "user", "content": "Do the 'swoosh ' test -- an evaluation of a modified 'whoosh ' test in children? Context: Caudal analgesia is widely used in paediatric anaesthetic practice. In adults, the 'whoosh' test has been recommended as a guide to successful needle insertion, but it has not been extensively studied in paediatric patients. We have investigated a modification of the 'whoosh' test, which we have christened the 'swoosh' test. It avoids the injection of air by performing auscultation during injection of the local anaesthetic solution. We have compared it with clinical judgement of correct placement. We studied 113 children undergoing elective surgery. During insertion of the caudal block, a stethoscope was placed over the lower lumbar spine and the presence or absence of an audible 'swoosh' noted. The operator's clinical impression of successful insertion was also recorded. The overall success rate of caudal anaesthesia was 95.6%. Of the 108 patients with a successful block, 98 had a positive 'swoosh' test. There were no false positive results. Calculations show the 'swoosh' test to have a sensitivity of 91%, a specificity of 100% and a positive predictive value of 100%." }, { "role": "assistant", "content": "The 'swoosh' test is a simple and accurate test to confirm successful caudal insertion in children, and is especially useful as a teaching aid for anaesthetists new to the technique. 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, Apoptosis, Autocrine Communication, Benzamides, Cardiomyopathy, Alcoholic, Cell Movement, Cell Transdifferentiation, Cells, Cultured, Central Nervous System Depressants, Collagen Type I, Dioxoles, Ethanol, Fibroblasts, Heart, Male, Myocardial Contraction, Paracrine Communication, Rats, Rats, Sprague-Dawley, Transforming Growth Factor beta." }, { "role": "user", "content": "Is activation of cardiac fibroblasts by ethanol blocked by TGF-β inhibition? Context: Alcohol abuse is the second leading cause of dilated cardiomyopathy, a disorder specifically referred to as alcoholic cardiomyopathy (ACM). Rodent and human studies have revealed cardiac fibrosis to be a consequence of ACM, and prior studies by this laboratory have associated this occurrence with elevated transforming growth factor-beta (TGF-β) and activated fibroblasts (myofibroblasts). To date, there have been no other studies to investigate the direct effect of alcohol on the cardiac fibroblast. Primary rat cardiac fibroblasts were cultured in the presence of ethanol (EtOH) and assayed for fibroblast activation by collagen gel contraction, alpha-smooth muscle actin (α-SMA) expression, migration, proliferation, apoptosis, collagen I and III, and TGF-β expression. The TGF-β receptor type 1 inhibitor compound SB 431542 and a soluble recombinant TGF-βII receptor (RbII) were used to assess the role of TGF-β in the response of cardiac fibroblasts to EtOH. Treatment for cardiac fibroblasts with EtOH at concentrations of 100 mg/dl or higher resulted in fibroblast activation and fibrogenic activity after 24 hours including an increase in contraction, α-SMA expression, migration, and expression of collagen I and TGF-β. No changes in fibroblast proliferation or apoptosis were observed. Inhibition of TGF-β by SB 431542 and RbII attenuated the EtOH-induced fibroblast activation." }, { "role": "assistant", "content": "EtOH treatment directly promotes cardiac fibroblast activation by stimulating TGF-β release from fibroblasts. Inhibiting the action of TGF-β decreases the fibrogenic effect induced by EtOH treatment. The results of this study support TGF-β to be an important component in cardiac fibrosis induced by exposure to EtOH. 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 farmer presents with pustules showing gram positive cocci, beta hemolysis, catalase negative. To show it is group A streptococci, which of the following test is done -" }, { "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": "Primary health care, true are all except" }, { "role": "assistant", "content": "The correct answer is Ans. is 'b' i.e. Health services are taken to the doors of people \"Unlike the previous approaches (e.g. basic health services, integrated health care, vertical health services) which depended upon taking health services to the doors of the people, primary health care approach starts with the people themselves. This approach signifies a new dynamism in health care and has been described as Health by the people, placing people's health in people's hands. The ends of the primary health care approach are the same as those of earlier approaches (i.e. attainment of an acceptable level of health by every individual), but the means adopted are different\" - Park Primary health careThis approach to health care came into existence in 1978 in an international conference at Alma-Ata (USSR)The Alma-Ata conference defined primary health care as - \"Primary health care is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and country can afford.\"Principles of primary health careEquitable distributionit means, health services must be shared equally by all people irrespective of their ability to pay and all people (urban or rural, rich or poor) have access to health services.Community participationthe local community is involved in planning and implementation of health services.primary health care is thus described as - Health by the people, placing people's health in people hands.village health guides and trained dais are perfect examples of community participation. They belong to the community they serveIntersectoral coordinationthe primary health care is not provided by health sector alone.it involves all other related sectors of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication and other sectors.Appropriate technologyappropriate technology is defined as 'technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principles of self reliance with the resources the community and country can afford.'" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Is adiponectin a Good Marker for Metabolic State among Type 1 Diabetes Mellitus Patients? Context: Adiponectin is secreted from adipose tissue. This hormone has a fundamental role in pathogenesis of insulin resistance, and has anti-inflammatory and anti-atherogenic effects. The objectives of this study were to compare serum adiponectin level between type 1 diabetics and healthy people and to assess its related factors, and also to determine the relationship between adiponectin and metabolic state. This was a case control study involving 60 diabetics (25 good and 35 poor metabolic controlled) and 28 healthy persons (younger than 18 years old). The data about demographic (age and sex), clinical and paraclinical characteristics [body mass index (BMI), duration of disease, puberty state, and glycosylated hemoglobin (HbA1c) and adiponectin level in serum] were collected. Determinants of adiponectin were assessed using univariate and multiple linear regression analyses. Mean (±SD) serum adiponectin level in healthy persons, good-controlled and poor-controlled type 1 diabetes mellitus patients were 9.16 (±4.2) µg/cc, 10.89 (±4.48)µg/cc, and 15.92 (±8.26)µg/cc, respectively. Post hoc analysis revealed that differences of adiponectin between poor- and good-controlled type 1 diabetes mellitus patients (P=0.01) and between healthy persons and poor controlled type 1 diabetes mellitus (P<0.0001) were statistically significant. Adiponectin level was associated with puberty state and BMI in healthy persons. It was associated with puberty state and HbA1c in type 1 diabetic persons." }, { "role": "assistant", "content": "Serum level of adiponectin was higher in type 1 diabetics than in healthy persons and it can be used as a good marker for metabolic control state among diabetics. 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 drug is not used for the treatment of hypeensive emergencies" }, { "role": "assistant", "content": "The correct answer is Enalaprilat is an active form/metabolite of enalapril, an ACE inhibitor. Enalaprilat is used for hypeensive emergencies due to the rapid onset of action. Enalapril isn't used as it 1st has to get activated.Ref: Katzung 10th ed, pg 145" } ]

[ { "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: Child, Humans, Kyphosis, Magnetic Resonance Imaging, Male, Mutation, Ocular Motility Disorders, Oculomotor Nerve Diseases, Pedigree, Receptors, Immunologic, Scoliosis." }, { "role": "user", "content": "Do horizontal gaze palsy and progressive scoliosis without ROBO3 mutations? Context: To describe clinical and genetic observations in a patient with horizontal gaze palsy and progressive scoliosis (HGPPS) without identified mutations in the ROBO3 gene. Neurologic and orthopedic evaluation of the proband; sequencing all exons, exon-intron boundaries, and promoter region of ROBO3 in the proband and his mother. Array CGH was also carried out in the proband and his mother to evaluate possible chromosomal deletion(s) and/or duplication(s). The proband had complete horizontal gaze restriction with full vertical gaze and small amplitude horizontal pendular nystagmus. He also had severe scoliosis and brainstem hypoplasia pathognomonic of HGPPS. However, complete sequencing of ROBO3 twice in both forward and reverse directions did not reveal any mutations. Array CGH investigation revealed no chromosomal abnormalities." }, { "role": "assistant", "content": "This patient had clinical and neuroimaging characteristics considered pathognomonic of HGPPS and yet did not have ROBO3 mutations. A clinical misdiagnosis is unlikely in the absence of facial weakness (typical of Moebius syndrome), deafness (typical of the HOXA1 spectrum), or mental retardation (typical of other central decussation abnormalities). It is perhaps more likely that a phenotype identical to HGPPS can be caused by abnormalities in ROBO3 splice variant expression, by mutations of a gene other than ROBO3, or by some environmental or epigenetic factor(s) inhibiting the action of ROBO3 or its protein product in the developing brainstem. 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: Biopsy, Case-Control Studies, Colitis, Ulcerative, Colon, Crohn Disease, Epistasis, Genetic, Histone Acetyltransferases, Humans, Lysine Acetyltransferase 5, Membrane Proteins, Microarray Analysis, Mitochondrial Proteins, Mutation, N-Acetylgalactosaminyltransferases, Nod2 Signaling Adaptor Protein, Polymorphism, Single Nucleotide, Protein Phosphatase 2, Repressor Proteins, Signal Transduction, Vimentin." }, { "role": "user", "content": "Does tLE1 modify the effects of NOD2 in the pathogenesis of Crohn 's disease? Context: The mechanisms by which specific mutations in NOD2/CARD15 increase the risk for Crohn's disease (CD) are unclear. We identified proteins that interact with NOD2 and investigated them by expression, genetic, and functional analyses. By using a yeast 2-hybrid screen of an intestinal epithelial library, we identified proteins that interact with NOD2 and confirmed the interactions in mammalian cells using co-immunoprecipitation. We used microarray analysis to analyze gene expression patterns in 302 intestinal biopsy samples (129 from patients with ulcerative colitis [UC], 106 with CD, and 67 controls). Eighty single-nucleotide polymorphisms within the genes that encoded 6 interacting proteins were genotyped in a discovery cohort (869 cases of inflammatory bowel disease [IBD], 885 controls) and a replication cohort (504 patients with IBD, 713 controls). We investigated interaction between transducin-like enhancer of split 1 (TLE1) and NOD2 in HEK293 cells. We identified 6 NOD2-interacting proteins (TLE1, UDP-N-acetyl-alpha-D-galactosamine:polypeptide N-acetylgalactosaminyltransferase 2 [GALNT2], HIV-1 Tat interactive protein [HTATIP], Vimentin, fission 1 (mitochondrial outer membrane) homolog [FIS1], and protein phosphatase 2, regulatory subunit B', epsilon isoform [PPP2R5E]). Of these, expression of GALNT2 (CD, P = .004) and vimentin (CD, P = .006; UC, P = .0025) was altered in patients with IBD compared with controls. Single-nucleotide polymorphisms within TLE1 were associated with susceptibility to CD, specifically with ileal disease (rs6559629, P = 3.1 × 10⁻⁵; odds ratio, 1.45). The TLE1 risk allele is required for susceptibility to CD in carriers of NOD2 mutations. In cells, TLE1 and NOD2 co-localized around the nuclear membrane and TLE1 inhibited activation of nuclear factor-κB by NOD2." }, { "role": "assistant", "content": "Epistatic and biological interactions between TLE1 and NOD2 are involved in IBD pathogenesis. NOD2 might be involved in a series of pathways such as epigenetic regulation of expression (via TLE1 and HTATIP), biosynthesis of mucin (via GALNT2), apoptosis (via PPP2R5E and FIS1), and integrity of the intracellular cytoskeleton (vimentin). 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": "Tattooing colors the skin permanently because pigmented dyes are injected into the" }, { "role": "assistant", "content": "The correct answer is The dermis is highly vascular and glandular and contains many nerve endings and hair follicles. Dermis has two layers: (i ) Upper layer called the stratum papillarosum (papillary layer), which is in contact with the epidermis. Numerous projections (papillae) extend from this layer into the epidermis. Papillae form the base for the friction ridges on the fingers and toes. (ii ) The lower layer is called stratum reticularosum. Tattooing colors the skin permanently because the pigmented dyes are injected below the mitotic basal layer into the dermis Ref: Textbook of Forensic Medicine and Toxicology; 5th edition; Page no: 214" } ]

[ { "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: Anthropometry, Aorta, Apgar Score, Birth Weight, Female, Hernia, Diaphragmatic, Hernias, Diaphragmatic, Congenital, Humans, Infant, Newborn, Male, Predictive Value of Tests, Pulmonary Artery, ROC Curve, Retrospective Studies." }, { "role": "user", "content": "Do birth weight and McGoon Index predict mortality in newborn infants with congenital diaphragmatic hernia? Context: Despite improvements in clinical management, mortality of congenital diaphragmatic hernia (CDH) remains high. Early prediction of mortality risk helps in comparing strategies and/or performances of different centers. Birth weight (BW), Apgar Score at 5 minutes, and modified McGoon Index (MGI) calculated by the ratio between the diameters of pulmonary arteries and the descending aorta have been used to determine mortality of CDH. The purpose of this study is to evaluate the relationship between early detectable variables and survival in newborns with CDH intubated at birth, managed with \"gentle\" ventilation and delayed surgery. All medical records of patients affected by high-risk CDH and treated with a standardized protocol at Bambino Gesù Children's Hospital, Rome, Italy, between January 2002 and September 2004 were reviewed. Prenatal diagnosis, gestational age, BW, sex, side of hernia, and MGI were recorded on admission. The relationship with mortality of each variable was evaluated by univariate analysis. Subsequently, a predictive model of mortality was developed using a logistic regression: the explanatory variables, BW, and MGI were dichotomized in high (HBW and HMGI) and low (LBW and LMGI) according to the best cutoff found with receiver-operating characteristic curves. Thirty-four newborns with CDH, treated with a standardized protocol, were studied. The main characteristics of the 34 patients were BW, 2886 g (1500-3620 g); gestational age, 37.7 weeks (32-42 weeks); male/female, 22/12; right/left, 8/26; prenatal diagnosis, 29; MGI, 1.31 (0.9-1.85). Only BW and MGI were significantly (P < .05) associated with mortality at the univariate analysis. The best cutoff values were 2755 g for BW (sensitivity, 70%; specificity, 74%) and 1.25 for MGI (sensitivity, 73%; specificity, 78%). Using these limits, BW and MGI resulted independently associated with mortality in the multivariate analysis. Using the 4 possible combinations, the LBW associated with the LMGI presented the highest prediction of mortality (80%)." }, { "role": "assistant", "content": "Birth weight and MGI, variously combined, were predictive of mortality. Because they are not influenced by subsequent modalities of care, they can be considered as valid early severity scores in CDH and used for comparing strategies and/or performances of different centers. 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": "Cochlear implants are used for" }, { "role": "assistant", "content": "The correct answer is (C) Moderate and severe hearing loss # Cochlear implant stimulate auditory system with electrical impulses, while hearing aid use surviving hair cells.# Indications of cochlear implant:> Postlingually deaf patient (hearing loss after development of language)> Bilateral severe sensorineural deafness who do not respond to amplified sound stimuli.> Inability to benefit from hearing aid.> In order to select the patient for cochlear implant following tests are done to evaluate the degree of deafness and to assess the quality of surviving neuron. Pure tone audiometry, Electrocochleography, Promontory stimulation" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All the primary ossification centers are appeared at fetal age of: WB 11" }, { "role": "assistant", "content": "The correct answer is Ans. 4 months" } ]

[ { "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": "WPW syndrome is caused by?" }, { "role": "assistant", "content": "The correct answer is ANSWER: (B) Right sided extra fibresREF: Harrison s 18th ed ch: 233WPW is caused by the presence of an abnormal accessory electrical conduction pathway between the atria and the ventricles. Electrical signals travelling down this abnormal pathway (known as the bundle of Kent) may stimulate the ventricles to contract prematurely, resulting in a unique type of supraventricular tachycardia referred to as an atrioventricular reciprocating tachycardia.The bundle of Kent is an abnormal extra or accessory conduction pathway between the atria and ventricles that is present in a small percentage (between 0.1% and 0.3%) of the general population. This pathway may communicate betrveen the left atrium and the left ventricle, in which case it is termed a \"type A pre-excitation\", or between the right atrium and the right ventricle, in which case it is termed a \"type B pre-excitation\". Problems arise when this pathway creates an electrical circuit that bypasses the AV node. The AV node is capable of slowing the rate of conduction of electrical impulses to the ventricles, whereas the bundle of Kent lacks this capability. When an aberrant electrical connection is made via the bundle of Kent, tachydysrhythmias may therefore result.WPW is commonly diagnosed on the basis of the electrocardiogram in an asymptomatic individual. In this case it is manifested as a delta wave, which is a slurred upstroke in the QRS complex that is associated with a short PR interval. The short PR interval and slurring of the QRS complex is actually the impulse making it through to the ventricles prematurely (across the accessory pathway) wdthout the usual delay experienced in the AV node." } ]

[ { "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 39-year-old woman presents to her primary care physician because she has been experiencing intermittent abdominal pain for the last 2 weeks. She says that the pain is squeezing in nature, is located in the right upper quadrant, and is particularly severe after eating a meal. After a diagnosis is made, the patient asks why the pain gets worse after eating. The physician explains that food is detected by the gastrointestinal tract through numerous receptors and that this information is transmitted to other parts of the body to cause compensatory changes. The neurons responsible for transmitting this information are most likely located in a layer of the intestine that has which of the following characteristics?" }, { "role": "assistant", "content": "Contains large blood vessels and large lymphatic vessels" } ]

[ { "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": "Cutis anserine is seen in:" }, { "role": "assistant", "content": "The correct answer is Drowning" } ]

[ { "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": "Accepting the null hypothesis when it is false:" }, { "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": "Cyst coming from an unerupted tooth is" }, { "role": "assistant", "content": "The correct answer is Ans. (a) Dentigerous cystRef: Radiopedia.org. Prof Gaillard et al.DENTAL CYST (Radicular or periodontal cyst or Periapical cyst)DENTIGEROUS CYST (Follicular odontoma or Follicular cysts)Most common Odontogenic cyst2nd MC odontogenic CystDevelops at the apex of chronically infected tooth with necrotic pulp'(root of normally erupted tooth)Associated with unerupted permanent toothLined by stratified squamous epitheliumLined by non-keratinizing squamous epitheliumMost common in middle ageMost common in 2nd or 3rd decadeMost common in upper jawMost common in Lower third Molar tooth (Mandible 3rd molar)2nd MC - Maxillary 3rd molar (upper)" } ]

[ { "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: Acquired Immunodeficiency Syndrome, Adult, Antiretroviral Therapy, Highly Active, B-Lymphocyte Subsets, Female, HIV Infections, HIV-1, Humans, Male, Middle Aged, Viral Load." }, { "role": "user", "content": "Does viral load determine the B-cell response in the cerebrospinal fluid during human immunodeficiency virus infection? Context: Human immunodeficiency virus (HIV) infection of the central nervous system (CNS) is frequently associated with intrathecal immunoglobulin synthesis and cerebrospinal fluid (CSF) pleocytosis, but little is known about the B-cell response in the CSF of these patients. In this study, we investigated the relation between virus load and the frequency and phenotype of B cells in the CSF of HIV-infected patients. The distribution of T cells, B cells, short-lived plasmablasts, and long-lived plasma cells was analyzed by flow cytometry in CSF and peripheral blood of 33 patients with HIV infection compared with 12 patients with noninfectious CNS diseases. HIV RNA copy number in CSF and serum was quantified by kinetic polymerase chain reaction. B-cell and plasmablast levels were increased in the CSF of HIV-infected patients compared with patients with noninfectious CNS diseases. Whereas CSF B cells were found at similar frequency during early and late stages of HIV infection, plasmablasts were more prevalent in the CSF during early infection. Plasmablasts in the CSF correlated with intrathecal IgG synthesis and even stronger with HIV RNA copy numbers in CSF, in particular, in untreated, early HIV-infected individuals. Initiation of antiviral treatment in therapy-naive patients strongly decreased HIV copy numbers and plasmablasts in CSF." }, { "role": "assistant", "content": "Our findings demonstrate that HIV infection of the CNS triggers an early profound B-cell response, with plasmablasts serving as the main virus-related B-cell subset in the CSF. 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, Asian Continental Ancestry Group, Case-Control Studies, Chi-Square Distribution, Female, Gastritis, Atrophic, Gastroscopy, Gene Frequency, Genetic Predisposition to Disease, Helicobacter Infections, Helicobacter pylori, Humans, Malaysia, Male, Metaplasia, Middle Aged, Phenotype, Polymorphism, Single Nucleotide, Precancerous Conditions, Predictive Value of Tests, Risk Factors, Stomach Neoplasms." }, { "role": "user", "content": "Are gastric precancerous lesions associated with gene variants in Helicobacter pylori-susceptible ethnic Malays? Context: To identify genes associated with gastric precancerous lesions in Helicobacter pylori (H. pylori)-susceptible ethnic Malays. Twenty-three Malay subjects with H. pylori infection and gastric precancerous lesions identified during endoscopy were included as \"cases\". Thirty-seven Malay subjects who were H. pylori negative and had no precancerous lesions were included as \"controls\". Venous blood was collected for genotyping with Affymetrix 50K Xba1 kit. Genotypes with call rates < 90% for autosomal single nucleotide polymorphisms (SNPs) were excluded. For each precancerous lesion, associated SNPs were identified from Manhattan plots, and only SNPs with a χ² P value < 0.05 and Hardy Weinberg Equilibrium P value > 0.5 was considered as significant markers. Of the 23 H. pylori-positive subjects recruited, one sample was excluded from further analysis due to a low genotyping call rate. Of the 22 H. pylori-positive samples, atrophic gastritis only was present in 50.0%, complete intestinal metaplasia was present in 18.25%, both incomplete intestinal metaplasia and dysplasia was present in 22.7%, and dysplasia only was present in 9.1%. SNPs rs9315542 (UFM1 gene), rs6878265 (THBS4 gene), rs1042194 (CYP2C19 gene) and rs10505799 (MGST1 gene) were significantly associated with atrophic gastritis, complete intestinal metaplasia, incomplete metaplasia with foci of dysplasia and dysplasia, respectively. Allele frequencies in \"cases\" vs \"controls\" for rs9315542, rs6878265, rs1042194 and rs10505799 were 0.4 vs 0.06, 0.6 vs 0.01, 0.6 vs 0.01 and 0.5 vs 0.02, respectively." }, { "role": "assistant", "content": "Genetic variants possibly related to gastric precancerous lesions in ethnic Malays susceptible to H. pylori infection were identified for testing in subsequent trials. 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": "Prophylactic mastectomy is done for all of the following EXCEPT" }, { "role": "assistant", "content": "The correct answer is (A) Cyclical mastalgia # PREVENTIVE or PROPHYLACTIC MASTECTOMY is an elective operation to remove the breasts so that the risk of breast cancer is reduced.# Indications for Prophylactic Mastectomy BRCA1 or BRCA2 mutation carriers; this is the main indication for bilateral prophylactic mastectomy. Cancer in one breast and a family history of breast cancer. Family history of breast cancer (Genetic risk can be passed down through mother's or father's side). Radiation therapy to the chest before the age of 30. Presence of lobular carcinoma in situ. Having dense breasts or breasts with diffuse microcalcification, as the screening for breast cancer is made difficult.# Cyclic Mastalgia or Cyclic Mastitis: Breasts are unusually tender and lumpy, with symptoms of pain & dull heaviness that vary with the menstrual cycle & is often associated with premenstrual syndrome (PMS). When the lumps become significant enough to be called cysts, the condition is called Fibrocystic breast disease." } ]

[ { "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": "Kaposi varicelliform lesion coommonly seen in" }, { "role": "assistant", "content": "The correct answer is kaposis varicelliform eruption / eczema herpeticum disseminated cutaneous infection caused by herpes simplex infection in patients with preexisting active dermatitis. Most common in atopic dermatitis Other skin diseases associated with eczema herpeticum:seborrheicdermatitis, pemphigus foliaceous, pityriasis rubra Pilaris, ichthyosaurs,mycosis fungoides, pemphigus foliaceous,darriers disease,burns. iadvl textbook of dermatology,page 245" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All the statement about lactoferrin are true, EXCEPT:" }, { "role": "assistant", "content": "The correct answer is Transpo of iron for erythropoesis is done by transferin and not by Lactoferin. Lactoferrin is closely related in structure to plasma iron transpo protein transferrin, and binds to excess iron. It prevents the growth of bacterial and viral microorganism and tumors which require iron for its growth. Lactoferrin a bioactive glycoprotein, is one of the body's most powerful immunodefensives. It is found in breast milk, body fluids such as saliva, tears, nasal secretions, intestinal fluids such as bile and secondary granules of neutrophils. Ref: Colostrum: Nature's Gift to The Immune System By Beth M. Ley-Jacobs, Pages 23-4." } ]

[ { "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": "Strength of gypsum products is generally expressed\nin terms of?" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: AIMS, METHODS AND RESULTS. Meshes: Aged, Arrhythmias, Cardiac, Calibration, Defibrillators, Implantable, Electric Conductivity, Female, Heart Diseases, Humans, Male, Middle Aged, Multicenter Studies as Topic, Predictive Value of Tests, Randomized Controlled Trials as Topic, Retrospective Studies, Severity of Illness Index, Stroke Volume, Ventricular Function, Left." }, { "role": "user", "content": "Does defibrillation threshold increase as left ventricular ejection fraction decreases? Context: Advanced cardiac disease, entailing more hypertrophy, fibrosis, scarring, dilatation and conduction delays, poses the question of whether defibrillation thresholds (DFTs) increase as left ventricular ejection fraction (LVEF) decreases. This question has been approached indirectly or insufficiently in previous studies. In this study we add and expand on our previous work, stratifying DFT for various LVEF ranges. This retrospective analysis included DFT data from three acute, multicentre, randomized studies that included 230 ICD/CRT-D patients. All DFTs were obtained with the SVC coil turned ON and with pulse-width optimized waveforms based on a 3.5 ms membrane time constant. As the LVEF decreased, DFT estimates increased from 395.2 +/- 115 V for LVEF>or = 46% to 425.8 +/- 117.6 V for LVEF<or = 25%. However, these changes in DFT estimates were very minor and not statistically significant. Only 3% of the patients in this population had an elevated DFT of>20 J." }, { "role": "assistant", "content": "This analysis shows that over a very broad range of LVEF, DFT changes minimally (approximately 1 J), if at all. Our results are consistent with previous studies that demonstrated no difference in the DFT estimates: (a) between patient groups receiving ICD (typically higher LVEF) vs. CRT-D (typically lower LVEF) and (b) between patient groups receiving a device for primary prevention indications (typically lower LVEF) vs. secondary prevention indications (typically higher LVEF)." } ]

[ { "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": "Crown completion of deciduous Maxillary central incisors occur" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVES, DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS, RESULTS. Meshes: Age Factors, Aged, Aged, 80 and over, Aging, Culture, Female, Health Behavior, Health Status, Humans, Male, Patient Acceptance of Health Care, Physician-Patient Relations, Socioeconomic Factors." }, { "role": "user", "content": "Do older adults expect to age successfully? Context: To measure expectations regarding aging among community-residing-older adults, identify characteristics associated with having low expectations regarding aging, and examine whether expectations regarding aging are associated with healthcare-seeking beliefs for age-associated conditions. Self-administered mail survey. Greater Los Angeles. Four hundred twenty-nine of 588 (73%) randomly selected community-residing adults aged 65 to 100 (mean age 76) cared for by 20 primary care physicians; 54% were women, and 76% were white. The Expectations Regarding Aging Survey, a validated survey measuring expectations regarding aging; 13 items measuring care seeking beliefs; and validated measures of health status. More than 50% of participants felt it was an expected part of aging to become depressed, to become more dependent, to have more aches and pains, to have less ability to have sex, and to have less energy. After adjusting for sociodemographic and health characteristics using multivariate regression, older age was independently associated with lower expectations regarding aging (P<.001), as was having lower physical and mental health-related quality of life. Having lower expectations regarding aging was independently associated with placing less importance on seeking health care (P =.049)." }, { "role": "assistant", "content": "Most older adults in this sample did not expect to achieve the model of successful aging in which high cognitive and physical functioning is maintained. Older age was independently associated with lower expectations regarding aging. Furthermore, having low expectations regarding aging was independently associated with not believing it important to seek health care." } ]

[ { "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": "An otherwise healthy 55-year-old woman comes to the physician because of a 7-month history of insomnia. She has difficulty initiating sleep, and her sleep onset latency is normally about 1 hour. She takes melatonin most nights. The physician gives the following recommendations: leave the bedroom when unable to fall asleep within 20 minutes to read or listen to music; return only when sleepy; avoid daytime napping. These recommendations are best classified as which of the following?" }, { "role": "assistant", "content": "Stimulus control therapy" } ]

[ { "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 suboccipital triangle is bounded superolaterally by:" }, { "role": "assistant", "content": "The correct answer is Ref: BDC -194\nBoundaries\nSuperomedially: Rectus capitis posterior major muscle supplemented by the rectus\ncapitis posterior minor.\n\nSuperolaterally: Superior oblique muscle.\n\nInferiorly: Inferior oblique muscle.\n\nRoof\nMedially: Dense fibrous tissue covered by the semispinalis capitis.\nLaterally: Longissimus capitis and occasionally the splenius capitis.\n\nFloor\n1. Posterior arch of atlas.\n2. Posterior atlanto-occipital membrane\n\nContents\n1. Third part of vertebral artery.\n2. Dorsal ramus of nerve C1 – suboccipital nerve.\n3. Suboccipital plexus of veins." } ]

[ { "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: Angiogenesis Inhibitors, Animals, Cell Division, Enzyme Inhibitors, Epiretinal Membrane, Glial Fibrillary Acidic Protein, Immunoenzyme Techniques, Mice, Mice, Inbred C57BL, Mice, Transgenic, Phthalazines, Platelet-Derived Growth Factor, Protein Kinase C, Proto-Oncogene Proteins c-sis, Pyridines, Retina, Retinal Detachment, Staurosporine." }, { "role": "user", "content": "Does the kinase inhibitor PKC412 suppress epiretinal membrane formation and retinal detachment in mice with proliferative retinopathies? Context: Platelet-derived growth factor (PDGF) is an important stimulatory factor for proliferative retinopathies. Expression of PDGF-B in the retinas of transgenic mice (hemizygous rho/PDGF-B mice) results in rapid-onset retinal detachment caused by proliferation of glial cells, endothelial cells, and pericytes, whereas expression of PDGF-AA (homozygous rho/PDGF-A or PDGF-AA mice) causes slowly progressive retinal detachment from proliferation of glial cells. In this study, we investigated the effect in rho/PDGF-B and rho/PDGF-AA mice of several different receptor kinase inhibitors. Hemizygous rhoPDGF-B or homozygous rho/PDGF-A mice were treated orally with PKC412 (an inhibitor of PDGF, VEGF, and c-kit receptor kinases and several isoforms of PKC), PTK787 (an inhibitor of PDGF, VEGF, and c-kit receptor kinases), SU1498 (an inhibitor of VEGF receptor kinases), imatinib mesylate (an inhibitor of PDGF, c-kit, and v-abl receptor kinases), or vehicle, and at appropriate time points epiretinal membrane (ERM) formation and retinal detachment were quantified. In either rho/PDGF-B or rho/PDGF-A mice, oral administration of PKC412 or PTK787, but not SU1498 or imatinib mesylate, significantly reduced ERM formation. PKC412 reduced the incidence of severe retinal detachments in both models and PTK787 did so in homozygous rho/PDGF-A mice." }, { "role": "assistant", "content": "These data indicate that PKC412 (and possibly PTK787) has appropriate activity and sufficient intraocular bioavailability after oral administration to prevent retinal detachment in models of proliferative retinopathy. PKC412 should be considered for treatment of vascular and nonvascular proliferative retinopathies in humans. Final Decision: yes" } ]