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[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, PATIENTS AND METHODS, RESULTS. Meshes: Adult, Anesthetics, Local, Bupivacaine, Cholecystectomy, Laparoscopic, Cholecystitis, Chronic Disease, Humans, Instillation, Drug, Pain, Postoperative, Shoulder Pain." }, { "role": "user", "content": "Bupivacaine instillation into gallbladder bed after laparoscopic cholecystectomy: does it decrease shoulder pain? Context: Shoulder pain is common after laparoscopic cholecystectomy (60.5%) and can delay return to normal activities. The cause is unclear but may involve referral of pain from the traumatized area. A total of 75 patients with chronic cholecystitis who underwent laparoscopic cholecystectomy were randomized into two groups. Group I (37 patients) had 10 mL of 0.25 % bupivacaine instilled into the gallbladder bed and Calot's triangle area at the end of cholecystectomy. Group II (38 patients) served as controls and had no bupivacaine instillation. Postoperative shoulder pain was evaluated. Six patients in Group I developed shoulder pain (16%) compared with 23 patients in Group II (60.5%). The difference was statistically significant (P = 0.0002)." }, { "role": "assistant", "content": "The raw area of the removed organ is at least partially responsible for shoulder pain after laparoscopic cholecystectomy. Local bupivacaine is effective in reducing such pain." } ]

[ { "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 following is true about bronchial carcinoids" }, { "role": "assistant", "content": "The correct answer is BRONCHIAL CARCINOID AND OTHER NEUROENDOCRINE TUMOURS\nNeuroendocrine tumours of the lung represent a continuum spectrum of lung tumours with progressively increasing\naggressiveness which include: typical carcinoid (least aggressive), atypical carcinoid, and large cell endocrine\ncarcinoma, and also small cell carcinoma (most aggressive). All these tumours arise from neuroendocrine (Kulchitsky)\ncells of bronchial mucosa. Formerly, bronchial carcinoids used to be classified as ‘bronchial adenomas’ but now it is\nknown that they are locally invasive and have the capacity to metastasise. Bronchial carcinoids tend to occur at a\nyounger age than bronchogenic carcinoma, often appearing below the age of 40 years, and are not related to cigarette\nsmoking.\nCLINICAL FEATURES. Bronchial carcinoids occur at a relatively early age and have equal sex incidence. Most of\nthe symptoms in bronchial carcinoids occur as a result of bronchial obstruction such as cough, haemoptysis, atelectasis\nand secondary infection. About 5-10% of bronchial carcinoids metastasise to the liver and these cases are capable of\nproducing carcinoid syndrome." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Antigens, CD, Blotting, Western, Cadherins, Carcinoma, Hepatocellular, Cell Differentiation, Cell Movement, Epithelial-Mesenchymal Transition, Female, Gene Expression Profiling, Hep G2 Cells, Humans, Immunohistochemistry, Liver Neoplasms, Male, Matrix Metalloproteinase 2, Matrix Metalloproteinase 9, MicroRNAs, Middle Aged, Oligonucleotide Array Sequence Analysis, Polymerase Chain Reaction, Transfection, Vimentin." }, { "role": "user", "content": "Is microRNA-491 involved in metastasis of hepatocellular carcinoma by inhibitions of matrix metalloproteinase and epithelial to mesenchymal transition? Context: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related mortality worldwide; the prognosis of HCC patient remains poor owing to intrahepatic and extrahepatic metastasis and postsurgical recurrence. The aim of the present study is to determine the molecular mechanisms underlying the metastasis of HCC. HCC patients and treated HCC cells were molecularly characterized by miRNA microarray analysis, qRT-PCR, Western blots, transwell assay, and immunohistochemistry. Here, by employing a miRNAs microarray analysis, we found that miR-491 level was the most significant down-regulation in poorly differentiated HCC tissue compared with well-differentiated HCC tissue. We then selected HepG2 (very low migratory capacity), MHCC97L (low migratory capacity) and MHCC97H (high migratory capacity), as well as HCC tissues with different status to further investigate the effects of miR-491 on the metastasis of HCC. Our data showed that miR-491 levels were inversely correlated with different status of differentiation in HCC tissues and with migratory potential in HCC cell lines. In HepG2 cells, inhibition of miR-491 increased the expression of matrix metalloproteinase 2/9 (MMP-2/9) and the migratory potential; however, in MHCC97H cells, overexpression of miR-491 level decreased the expression of MMP-2/9 and the migratory capacity. Moreover, miR-491 had a positive relationship with E-cadherin level; however, it had a negative relationship with vimentin level both in cell lines and tissue samples of HCC. MiR-491 levels of non-metastasis HCC tissue are higher than that of metastasis HCC tissue." }, { "role": "assistant", "content": "Our results suggest that miR-491 is involved in metastasis of HCC by blocking EMT and decreasing MMP-9 levels, which may provide a new clue for preventing tumour metastasis of HCC. 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, Case-Control Studies, Cause of Death, China, Emigration and Immigration, Environment, Female, Hong Kong, Humans, Logistic Models, Male, Middle Aged, Myocardial Ischemia, Puberty, Risk Factors, Sex Factors, Socioeconomic Factors." }, { "role": "user", "content": "Does economic development contribute to sex differences in ischaemic heart disease mortality? Context: The male excess risk of premature ischemic heart disease (IHD) mortality may be partially due to an unknown macro-environmental influence associated with economic development. We examined whether excess male risk of IHD mortality was higher with birth in an economically developed environment. We used multivariable logistic regression in a population-based case-control study of all adult deaths in Hong Kong Chinese in 1998 to compare sex differences in IHD mortality (1,189 deaths in men, 1,035 deaths in women and 20,842 controls) between Hong Kong residents born in economically developed Hong Kong or in contemporaneously undeveloped Guangdong province in China. Younger (35-64 years) native-born Hong Kong men had a higher risk of IHD death than such women (odds ratio 2.91, 95% confidence interval 1.66 to 5.13), adjusted for age, socio-economic status and lifestyle. There was no such sex difference in Hong Kong residents who had migrated from Guangdong. There were no sex differences in pneumonia deaths by birth place." }, { "role": "assistant", "content": "Most of these people migrated as young adults; we speculate that environmentally mediated differences in pubertal maturation (when the male disadvantage in lipids and fat patterning emerges) may contribute to excess male premature IHD mortality in developed environments." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adolescent, Adult, Antisocial Personality Disorder, Comorbidity, Diagnosis, Dual (Psychiatry), Discriminant Analysis, Female, Humans, Male, Mental Disorders, Methadone, Middle Aged, Opioid-Related Disorders, Prevalence, Retrospective Studies, Severity of Illness Index, Sex Factors, Substance-Related Disorders." }, { "role": "user", "content": "Do psychiatric and substance use comorbidity among treatment-seeking opioid abusers? Context: Major studies of psychiatric comorbidity in opioid abusers reported rates of comorbidity that far exceeded general population estimates. These studies were published more than a decade ago and reported on few women and few substance use diagnoses. Psychiatric and substance use comorbidity was assessed in 716 opioid abusers seeking methadone maintenance. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition diagnostic assessment was conducted 1 month after admission. Rates of psychiatric and substance use disorder were compared by gender, and associations were assessed between psychiatric comorbidity and dimensional indexes of substance use severity, psychosocial impairment, and personality traits. Psychiatric comorbidity was documented in 47% of the sample (47% women and 48% men). Antisocial personality disorder (25.1%) and major depression (15.8%) were the most common diagnoses. Patients had at least 2 substance use diagnoses, most often opioid and cocaine dependence. Demographics, substance use history, and personality variables discriminated between patients with vs without comorbidity. Psychiatric comorbidity also was associated with a more severe substance use disorder." }, { "role": "assistant", "content": "Psychiatric comorbidity, especially personality and mood disorder, was common in men and women. The positive associations between psychiatric comorbidity and severity of substance use and other psychosocial problems were most consistent among those with antisocial personality. Final Decision: yes" } ]

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

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Humans, Hydromorphone, Low Back Pain, Osteoarthritis, Quality-Adjusted Life Years, Sleep." }, { "role": "user", "content": "Do mapping MOS Sleep Scale scores to SF-6D utility index? Context: Deriving preference scores for the Medical Outcomes Study (MOS) Sleep Scale would enable its use in cost-utility analyses. The objective of this study was to map scores of the MOS Sleep Scale to a preference-based health-state utility index (SF-6D) scored from the SF-36 Health Survey (SF-36). Three datasets were used: (1) the MOS study, a 4-year observational study of chronically ill patients, (2) a 7-week open-label, non-comparative clinical trial of an osmotic controlled-release oral delivery system (OROS) hydromorphone in the treatment of chronic low back pain (CLBP), and (3) a 6-week open-label randomized controlled trial of OROS hydromorphone in the treatment of pain associated with chronic osteoarthritis (OA). Various models were tested, where SF-6D was regressed onto the Sleep Problem Index-II (SLP9) in 1000 random half (developmental) samples of the MOS (n = 1413). The best fitting model was applied to the other 1000 random half (cross-validation) samples of the MOS (n = 1412), and to the two trial samples (n = 199 in the CLBP trial; n = 124 in the OA trial). The best fitting model in the MOS samples included a quadratic term for the SLP9 which explained 34% of the variance in SF-6D in the developmental samples. Errors in prediction were greatest at higher SLP9 scores. Addition of demographic and clinical variables to the model explained minimal incremental amounts of variance (< 5%) in SF-6D scores. These results were replicated in the cross-validation MOS samples. In both developmental and cross-validation MOS samples, mean predicted and observed SF-6D scores were nearly identical. When the mapping algorithm developed in the MOS was applied to the CLBP sample, mean predicted SF-6D scores were 0.09 points higher than observed SF-6D scores at both baseline and final visits, while changes in predicted and observed SF-6D scores were identical." }, { "role": "assistant", "content": "Results indicate that it is possible to map MOS SLP9 to SF-6D yielding useable preference-based scores essential for cost-utility analyses. A limitation concerns the interpretation of SF-6D scores estimated from SLP9 scores above 60, where the prediction errors increased considerably. 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 28-year-old medical student presents to the student health center with the complaint being unable to sleep. Although he is a very successful student, over the past few months he has become increasingly preoccupied with failing. The patient states that he wakes up 10-15 times per night to check his textbooks for factual recall. He has tried unsuccessfully to suppress these thoughts and actions, and he has become extremely anxious and sleep-deprived. He has no past medical history and family history is significant for a parent with Tourette's syndrome. He is started on cognitive behavioral therapy. He is also started on a first-line medication for his disorder, but after eight weeks of use, it is still ineffective. What drug, if added to his current regimen, may help improve his symptoms?" }, { "role": "assistant", "content": "Risperidone" } ]

[ { "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, Bronchoalveolar Lavage Fluid, Disease Models, Animal, Dogs, Extravascular Lung Water, Glycine, Hemodynamics, Lung Transplantation, Proteinase Inhibitory Proteins, Secretory, Proteins, Reperfusion Injury, Sulfonamides." }, { "role": "user", "content": "Does neutrophil elastase inhibitor ameliorate reperfusion injury in a canine model of lung transplantation? Context: We investigated the effects of neutrophil elastase inhibitor ONO-5046 Na on lung ischemia-reperfusion injury in a canine model of single lung transplantation. 24 mongrel dogs, 12 donors and 12 recipients, were used for single lung transplantation. Lung grafts were preserved for 18 h by cold ischemia then transplanted into the left thoracic cavity of recipients. In 6 recipients (ONO group), a bolus of ONO-5046 Na (10 mg/kg) was introduced before reperfusion and followed by continuous infusion (10 mg/kg/h). The remaining 6 recipients (control group) did not receive ONO-5046 Na and thus served as controls. We evaluated lung function and respiratory parameters over 240 min. The total cell number in bronchoalveolar lavage fluid increased significantly in the control group in comparison to that in the ONO group. Histologic scores after 4 h of reperfusion and myeloperoxidase activity were significantly lower in the ONO group than in the control group." }, { "role": "assistant", "content": "Neutrophil elastase inhibitor ONO-5046 Na may be useful in ameliorating lung reperfusion injury after transplantation. 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": "Sense organ for hearing is" }, { "role": "assistant", "content": "The correct answer is Organ of Coi is the sense organ of hearing and is situated on the basilar membrane. (Ref: Diseases of EAR, NOSE and THROAT PL Dhingra 6th edition; page no.13)" } ]

[ { "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: Alkaline Phosphatase, Bone Marrow, Bone Marrow Cells, Cell Differentiation, Cells, Cultured, Humans, Leptin, Mesenchymal Stem Cells, Osteoblasts, Osteogenesis." }, { "role": "user", "content": "Does leptin improve osteoblast differentiation of human bone marrow stroma stem cells? Context: To study the effects of leptin (LEP) on the osteogenic differentiation of human bone marrow stromal cells (hBMSCs) and to explore the mechanism controlling the process. Respectively cultivated the third-generation hBMSCs with 100 ng/ml bone morphogenetic protein (BMP) culture media containing 320, 160, 80 and 40 ng/mL LEP, and regular medium. We administered alkaline phosphatase (ALP) dye (on the 7th day) and mineralized nodules alizarin red (on the 21st day) and tested the ALP activity as well as osteocalcin (OCN) level on 7th, 14th, 21st day in each group to establish the best inducing concentration of LEP. 7 days later, we tested bone differentiation related genes expression in the control, 160 ng/mL LEP and 100 ng/mL BMP groups using RT-PCR. The activity of ALP and OCN in the 160 ng/mL LEP group after 7, 14 and 21 days was lower than that of the BMP group but higher than that of other groups. However, LEP significantly promoted the expression of bone differentiation related genes, namely, Cbfal, ALP, COL-I and OCN." }, { "role": "assistant", "content": "LEP promoted the bone differentiation in hBMSCs by promoting the expression of genes related to bone differentiation. 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, RESULTS. Meshes: Adult, Airway Resistance, Body Temperature Regulation, Cohort Studies, Cold Temperature, Computer Simulation, Female, Humans, Linear Models, Male, Nasal Cavity, Nasal Mucosa, Nasal Obstruction, Perception, Pilot Projects, Predictive Value of Tests, Prospective Studies, Reference Values, Reproducibility of Results, Rheology, Rhinomanometry, Sensory Thresholds, Tomography, X-Ray Computed, Young Adult." }, { "role": "user", "content": "Does regional peak mucosal cooling predict the perception of nasal patency? Context: Nasal obstruction is the principal symptom that drives patients with rhinosinus disease to seek medical treatment. However, patient perception of obstruction often bears little relationship to actual measured physical obstruction of airflow. This lack of an objective clinical tool hinders effective diagnosis and treatment. Previous work has suggested that the perception of nasal patency may involve nasal trigeminal activation by cool inspiratory airflow; we attempt to derive clinically relevant variables following this phenomenon. Prospective healthy cohort. Twenty-two healthy subjects rated unilateral nasal patency in controlled room air using a visual analog scale, followed by rhinomanometry, acoustic rhinometry, and butanol lateralization thresholds (BLTs). Each subject then immediately underwent a computed tomography scan, enabling the construction of a real-time computational fluid dynamics (CFD) nasal airway model, which was used to simulate nasal mucosa heat loss during steady resting breathing. Among all measured and computed variables, only CFD-simulated peak heat loss posterior to the nasal vestibule significantly correlated with patency ratings (r = -0.46, P < .01). Linear discriminant analysis predicted patency categories with 89% success rate, with BLT and rhinomanometric nasal resistance being two additional significant variables. As validation, CFD simulated nasal resistance significantly correlated with rhinomanometrically measured resistance (r = 0.41, P < .01)." }, { "role": "assistant", "content": "These results reveal that our noses are sensing patency via a mechanism involving localized peak nasal mucosal cooling. The analysis provides a strong rationale for combining the individualized CFD with other objective and neurologic measures to create a novel clinical tool to diagnose nasal obstruction and to predict and evaluate treatment outcomes. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, METHODS, RESULTS. Meshes: Aged, Aged, 80 and over, Calcifediol, Calcium, Dietary Fats, Dietary Supplements, Double-Blind Method, Energy Intake, Energy Metabolism, Fatty Acids, Monounsaturated, Female, Fractures, Bone, Humans, Male, Osteoporosis, Vitamin D." }, { "role": "user", "content": "Is type of dietary fat associated with the 25-hydroxyvitamin D3 increment in response to vitamin D supplementation? Context: Mono- and polyunsaturated fats may have opposing effects on vitamin D absorption. The purpose of this study was to determine whether intakes of different dietary fats are associated with the increase in serum 25-hydroxyvitamin D (25OHD) after supplementation with vitamin D(3). This analysis was conducted in the active treatment arm of a randomized, double-blind, placebo-controlled trial of vitamin D and calcium supplementation to prevent bone loss and fracture. Subjects included 152 healthy men and women age 65 and older who were assigned to 700 IU/d vitamin D(3) and 500 mg/d calcium. Intakes of monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), and saturated fatty acids (SFA) were estimated by food frequency questionnaire. The change in plasma 25OHD during 2 yr vitamin D and calcium supplementation was assessed. The change in plasma 25OHD (nanograms per milliliter) during vitamin D supplementation was positively associated with MUFA, (β = 0.94; P = 0.016), negatively associated with PUFA, (β = -0.93; P = 0.038), and positively associated with the MUFA/PUFA ratio (β = 6.46; P = 0.014)." }, { "role": "assistant", "content": "The fat composition of the diet may influence the 25OHD response to supplemental vitamin D(3). Diets rich in MUFA may improve and those rich in PUFA may reduce the effectiveness of vitamin D(3) supplements in healthy older adults. More studies are needed to confirm these findings. 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: Centrifugation, Density Gradient, Humans, Immunohistochemistry, Immunomagnetic Separation, Leukocytes, Mononuclear, Sensitivity and Specificity, Tumor Cells, Cultured, Urologic Neoplasms." }, { "role": "user", "content": "Does immunomagnetic cell enrichment detect more disseminated cancer cells than immunocytochemistry in vitro? Context: We describe a method to improve tumor cell detection compared to currently available immunocytochemical methods by using immunomagnetic cell enrichment. Two different methods of immunomagnetic cell enrichment using antibody coated magnetic beads were tested and compared with unenriched immunocytochemistry. One method was positive selection of epithelial cells from mononuclear cells with the antiepithelial antibody BER-EP4 and the other was depletion of mononuclear cells with the antileukocyte antibody CD45. Mononuclear cells were isolated from peripheral blood by density centrifugation and various numbers of tumor cells were added. The 5 different cell lines from urological malignancies used in the study were DU-145, RT-4, CAKI-2, KTCTL-2 and KTCTL-30. Following incubation of cell suspensions with the beads, cell separation was performed in a magnetic field. After centrifugation on glass slides immunocytochemical staining for cytokeratin was performed. A total of 112 experiments were completed and negative controls were obtained. The number of tumor cells detected by positive selection and depletion was significantly higher than by immunocytochemistry (p <0.001). The median enrichment factor and tumor cell recovery rate for positive selection and depletion were 15.3 and 61.2%, and 13.0 and 57.3%, respectively (not significant). With less than 1 tumor cell suspended in 106 mononuclear cells, the probability of tumor cell detection was 23% for immunocytochemistry alone and 93.3% for both enrichment methods (p <0.01). No false-positive results were observed." }, { "role": "assistant", "content": "Compared to immunocytochemistry, immunomagnetic cell enrichment significantly improves the sensitivity of detection of epithelial cells added to mononuclear cells. Both methods of enrichment were equally effective and may be important for clinical practice in the future. 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": "In adducted eye, action of superior oblique muscle of the eye is" }, { "role": "assistant", "content": "The correct answer is Ans. b (Depression of the eye ball) (Ref. Ganong Physiology 21st ed., Fig. 8-30; Chapter 8)EYE MOVEMENTS# Since the oblique muscles pull medially, their actions vary with the position of the eye. When the eye is turned nasally, the inferior oblique elevates it and the superior oblique depresses it. When it is turned laterally, the superior rectus elevates it and the inferior rectus depresses it.# Extraocular muscles subserving the six cardinal positions of gaze. The eye is adducted by the medial rectus and abducted by the lateral rectus. The adducted eye is elevated by the inferior oblique and depressed by the superior oblique; the abducted eye is elevated by the superior rectus and depressed by the inferior rectus. EO muscleNerve supplyPrimary actionSecondary actionTertiary actionMedial rectusCN IIIAdduction----Superior rectusCN IIIElevationIntortionAdductionInferior rectusCN IIIDepressionExtortionAdductionInferior obliqueCN IIIExtorsionElevationAbductionSuperior obliqueCN IVIntorsionDepressionAbductionLateral rectusCN VIAbduction----Extraocular muscles subserving the six cardinal positions of gaze:# The eye is adducted by the medial rectus and abducted by the lateral rectus.# The adducted eye is elevated by the inferior oblique and depressed by the superior oblique.# The abducted eye is elevated by the superior rectus and depressed by the inferior rectus." } ]

[ { "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: Aged, Angiotensin II Type 1 Receptor Blockers, Benzimidazoles, Blood Flow Velocity, Coronary Artery Disease, Coronary Circulation, Coronary Vessels, Disease-Free Survival, Endothelium, Vascular, Female, Follow-Up Studies, Humans, Male, Middle Aged, Tetrazoles, Treatment Outcome, Ultrasonography, Doppler." }, { "role": "user", "content": "Does candesartan improve impaired endothelial function in the human coronary artery? Context: Endothelial dysfunction is closely related to cardiovascular events. Several studies have documented that angiotensin II type 1 receptor blockers (ARB) improve peripheral endothelial dysfunction. However, the effect of ARB on coronary endothelial function remains elusive. The purpose of this study was to ascertain the beneficial effects of ARB on human coronary artery endothelial function. Twenty-seven patients were randomly assigned to either the candesartan group (n=14) or the control group (n=13) and followed for 12 months. Coronary blood flow velocity was measured in the left anterior descending artery without stenosis using an intracoronary Doppler-tipped guide-wire. We evaluated coronary endothelial function as the coronary blood flow velocity reserve (CFR), which was defined as the percent change in the coronary blood flow velocity after an intracoronary acetylcholine infusion. At baseline, the CFR in both groups was below 300%, implying that these patients had endothelial dysfunction. After treatment with candesartan for 6 months, the CFR increased significantly from 199 ± 20 to 337 ± 27% (P<0.001), whereas the CFR did not change in the control group (194 ± 32 vs. 185 ± 41%, P=0.52). During 12 months of observation, the cardiovascular event-free survival rate of the patients with an increased CFR was significantly greater than the rate in patients with a decreased CFR (P=0.02). Moreover, the cardiovascular event-free survival rate was greater in the candesartan group than in the control group (P=0.04)." }, { "role": "assistant", "content": "Our results suggest that candesartan improves coronary endothelial dysfunction of human coronary arteries and may prevent cardiac events. 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: Aged, Aged, 80 and over, Bone Cements, Female, Femoral Neck Fractures, Hemiarthroplasty, Humans, Incidence, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Risk Management, Singapore, Venous Thrombosis." }, { "role": "user", "content": "Cemented hemiarthroplasty in traumatic displaced femoral neck fractures and deep vein thrombosis: is there really a link? Context: Traumatic displaced femoral neck fractures in the elderly can be treated with cemented or uncemented hemiarthroplasty with good outcomes. Earlier studies reported a higher incidence of deep vein thrombosis (DVT) associated with cemented prostheses in elective total hip or knee arthroplasty. In addition, the hypercoagulable state after a traumatic femoral neck fracture and possible thrombogenic properties of bone cement could put these patients at greater risk for thromboembolism. We aimed to compare the incidence of DVT and progression to pulmonary embolism (PE) or mortality in cemented and uncemented hemiarthroplasty. The data of 271 patients treated with cemented or uncemented hemiarthroplasty after a traumatic displaced femoral neck fracture was retrospectively analysed for the incidence of DVT. The level of thrombosis, progression to PE and mortality were compared. There were 133 (49.1%) patients with cemented hemiarthroplasty, while 138 (50.9%) had uncemented hemiarthroplasty. The patients had an average age of 76.6 (range 53-99) years and 11 (4.1%) patients had DVT. There were no significant differences in development of DVT, level of thrombosis, PE and mortality regardless of whether a cemented or an uncemented prosthesis was used." }, { "role": "assistant", "content": "Cemented hemiarthroplasty is not associated with higher risks of DVT, PE or mortality in patients with traumatic displaced femoral neck fracture. Cemented prostheses can be safely used for this group of 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": "A 64-year-old woman presents to her primary care physician complaining of difficulty maintaining her balance while walking. Her husband comes along to the appointment with her, because he feels that she has not been acting herself at home lately. After further questioning him, it is noted that she has recently been voiding urine unintentionally at inappropriate times. If there is suspicion for an intracranial process, what would most likely be seen on MRI and what is the treatment?" }, { "role": "assistant", "content": "Dilated ventricles; ventricular shunt" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Biomarkers, Cross-Sectional Studies, Disabled Persons, Female, Humans, Hydrocortisone, Immunoglobulin A, Immunoglobulin A, Secretory, Male, Middle Aged, Models, Psychological, Occupational Health, Reward, Saliva, Self Report, Stress, Physiological, Stress, Psychological." }, { "role": "user", "content": "Is effort-reward imbalance associated with salivary immunoglobulin a and cortisol secretion in disability workers? Context: This study attempted to determine the relationship of physiological indices of stress (ie, cortisol and salivary immunoglobulin A) to the effort-reward imbalance model (ERI). A sample of 98 direct-care disability workers completed the Work-Related Questions II-III and provided morning saliva samples on the same day of completion, which were subsequently analyzed for cortisol and salivary immunoglobulin A concentration levels. Using structural equation modeling, the ERI successfully predicted potentially adverse physiological outcomes. The salivary immunoglobulin A scores were predicted more successfully by the ERI than the cortisol data." }, { "role": "assistant", "content": "The present investigation suggests that the ERI may be useful in determining which aspects of work life are associated with ill health and as such may be useful in identifying meaningful intervention. 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 50-year old male presents with large bowel type diarrhea and rectal bleeding. On sigmoidoscopy, a cauliflower-like growth is seen in the rectum. Colectomy specimen on histopathology shows adenocarcinoma. Which of the following prognostic investigations is not required?" }, { "role": "assistant", "content": "The correct answer is Ans. c. EGFR mutations Epidermal growth factor receptor (EGFR) is overexpressed in many types of cancers, especially colorectal cancer (CRC), and seems to reflect more aggressive histological and clinical behaviours. It was observed that EGFR was significantly associated with TNM (tumor-node-metastasis) stage T3. In the context of a new therapeutic strategy using EGFT-targeted therapies (e.g. cetuximab), although EGFR remains a controversial prognostic factor, this expression-stage association may play a crucial role in a decision to initiate an adjuvant treatment.\"- Deng Y, Jurland B, Wang .1, Bi .1, Li W, Rao S, Lan P, Lin T and Lin E. High epidermal growth factor receptor expression in metastatic colorectal cancer lymph nodes may be more prognostic of poor survival than in primary tumor. Am J Clin Oncol. 2009;32:(3):245-52High EGFR expressions in metastatic lymph nodes seem to be more accurate in predicting survival than in primary or metastatic tissues. Microsatellite Instability: (Robbil,) The microsatellite instability pathway is characterized by genetic lesions in mismatched repair genes. It is involved in 10 to 15% of sporadic cases of colon cancer and in the hereditary non-polyposis colon cancer (HNPCC) syndrome. Mutations in the mismatch repair genes cause alternation of microsatellites, leading to microsatellite instability. These satellites are prone to misalignment during DNA replication. Most microsatellite sequences are in the non-coding regions of the genes, and hence, mutations in these genes are probably harmless. However, some microsatellite sequences are located in the coding or promotor regions of genes involved in regulation of cell growth. Loss of mismatch repair genes leads to accumulation of these and other growth-regulating genes, culminating in the emergence of colorectal carcinoma. C-MYC Mutations: In human colorectal adenocarcinomas, overexpression of the c-myc mRNA has been repoed to occur in 60-80% of cases. C-myc has been characterized as a proto-oncogene, which promotes cell proliferation. However, overexpression of the c-myc mRNA is associated with a more ourable prognosis. k-RAS mutations: The k-RAS is the most frequently observed activated oncogene in adenomas and colon cancers. k-RAS plays a role in intracellular signal transduction and is mutated in fewer than 10% of adenomas less than 1 cm in size, in about 50% of adenomas larger than I cam and in approximately 50% of carcinomas." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All are polyunsaturated fatty acids except:" }, { "role": "assistant", "content": "The correct answer is Ans: C (Palmitic acid) Ref: Harper 's Illustrated Biochemistry, 29th edition. Pgl42Explanation:Palmitic acid is 16 carbon containing saturated fatty acid.All human cells can synthesize palmitic acid from acetyl coA.Linoleic and linolenic acid are the nutritionally essential fatty acids.Arachidonic acid is semi-essential FA. if we take enough of essential fatty acids arachidonic acid can be synthesized in our body, or else this also becomes essential.1. Arachidonic acid is a PUFA but arachidic acid is saturated FA. Both contain 20 carbons.2. Active fatty acid is called as acyl coA and active acetate is called as acetyl coA.3. Eicosonoids are 20 carbon containing physiologically active compounds synthesized from arachidonic acid." } ]

[ { "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: APACHE, Creatinine, Emergency Treatment, Female, Hospital Mortality, Humans, Intestinal Perforation, Male, Multivariate Analysis, Platelet Count, Prognosis, ROC Curve, Retrospective Studies, Risk Assessment, Severity of Illness Index, Treatment Outcome." }, { "role": "user", "content": "Does sOFA score predict postoperative outcome of patients with colorectal perforation? Context: Colorectal perforation remains a life-threatening condition associated with high mortality. Various factors and operative procedures have been discussed in regard to prediction of outcome, and several scoring systems have been proposed to predict the outcome of critically ill patients. The present study was undertaken to identify factors and determine predictive scoring systems for the postoperative outcome of patients with colorectal perforation. Between January 1996 and December 2000, 45 consecutive patients underwent emergency operation for colorectal perforation. Twelve patients (26.7%) died in hospital. The correlation of outcome with various preoperative factors, APACHE II and SOFA scores were assessed retrospectively. Univariate analysis showed that outcome was significantly related to maximum SOFA score (p=0.0069). Multivariate logistic regression analysis demonstrated that the maximum SOFA score was an independent predictor (p=0.016). Serum creatinine level (p=0.013) and platelet count (p=0.036) were associated with patient outcome in the SOFA score. Patients with a SOFA score higher than 7 had a greater risk of hospital death (p=0.0085)." }, { "role": "assistant", "content": "The maximum postoperative SOFA score is a useful predictor of the outcome from surgery for colorectal perforation. 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, METHODS, RESULTS. Meshes: Adult, Amrinone, Cardiotonic Agents, Dopamine, E-Selectin, Endothelium, Vascular, Flow Cytometry, Humans, Intercellular Adhesion Molecule-1, Interleukin-1, Neutrophils, Prospective Studies, Umbilical Veins, Vascular Cell Adhesion Molecule-1." }, { "role": "user", "content": "Do inotropes inhibit endothelial cell surface adhesion molecules induced by interleukin-1beta? Context: Leukocyte-endothelial cell interactions play a critical role in sepsis-induced multiple organ system failure and acute respiratory distress syndrome. Increased cyclic adenosine 3',5'-monophosphate (cAMP) has been previously reported to inhibit expression of the cytokine-stimulated endothelial cell adhesion molecules, E-selectin, and vascular cell adhesion molecule-1 (VCAM-1). We hypothesized that clinically relevant concentrations of inotropes, such as amrinone and dopamine, which increase cAMP, could inhibit cytokine-stimulated upregulation of endothelial adhesion proteins. Prospective, controlled in vitro study. Leukocyte biology laboratory. Human umbilical vein endothelial cells isolated from neonatal umbilical cord specimens and whole blood obtained from normal human adult volunteers were used in this study. Endothelial cell monolayers were pretreated with increasing concentrations of amrinone or dopamine, or left untreated as controls, followed by exposure to recombinant human interleukin (IL)-1beta for 6 hrs. Monolayers were then incubated with monoclonal antibodies to E-selectin, VCAM-1, and intercellular adhesion molecule-1 (ICAM-1), fluorescence labeled, and assessed for mean fluorescence intensity by flow cytometry as a measure of surface adhesion molecule concentrations. Whole blood neutrophils were pretreated with or without inotropes, then stimulated with n-formyl methyl leucine phenylalanine. Stimulated neutrophils were incubated with antibodies against the neutrophil adherence protein CD11b and assessed by flow cytometry. IL-1beta markedly increased E-selectin (p = .01), VCAM-1 (p < .01), and ICAM-1 (p < .001) concentrations (n = 6). Pretreatment with amrinone significantly decreased endothelial E-selectin surface values at all concentrations (p < .001 by analysis of variance, n = 5), including therapeutic concentration ranges. Amrinone also inhibited upregulation of ICAM-1 (p < .001) at therapeutic concentrations, and VCAM-1 (p < .001) at higher concentrations. Dopamine inhibited only E-selectin at relevant concentrations. Neutrophil pretreatment with inotropes did not prevent CD11b upregulation." }, { "role": "assistant", "content": "Pretreatment with amrinone, and to a lesser degree, with dopamine, at clinically relevant concentrations inhibits in vitro IL-1alpha-induced increases in human umbilical vein endothelial cell adhesion molecule concentrations. Future studies are necessary to investigate the mechanisms of these effects and to determine in vivo efficacy of inotropes as anti-inflammatory agents. 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 among the following is not a cause of hypoglycaemia?" }, { "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: BACKGROUND, METHODS, RESULTS. Meshes: Adjuvants, Immunologic, Adult, Antimalarials, Doxycycline, Erythrocytes, Female, Humans, Levamisole, Malaria, Falciparum, Male." }, { "role": "user", "content": "Does levamisole inhibit sequestration of infected red blood cells in patients with falciparum malaria? Context: Sequestration of infected red blood cells (iRBCs) in the microcirculation is central to the pathophysiology of falciparum malaria. It is caused by cytoadhesion of iRBCs to vascular endothelium, mediated through the binding of Plasmodium falciparum erythrocyte membrane protein-1 to several endothelial receptors. Binding to CD36, the major vascular receptor, is stabilized through dephosphorylation of CD36 by an alkaline phosphatase. This is inhibited by the alkaline phosphatase-inhibitor levamisole, resulting in decreased cytoadhesion. Patients with uncomplicated falciparum malaria were randomized to receive either quinine treatment alone or treatment with a single 150-mg dose of levamisole as an adjunct to quinine. Peripheral blood parasitemia and parasite stage distribution were monitored closely over time. Compared with those in control subjects, peripheral blood parasitemias of mature P. falciparum parasites increased during the 24 h after levamisole administration (n=21; P=.006). The sequestration ratio (between observed and expected peripheral blood parasitemia) of early trophozoite and midtrophozoite parasites increased after levamisole treatment, with near complete prevention of early trophozoite sequestration and >65% prevention of midtrophozoite sequestration." }, { "role": "assistant", "content": "These findings strongly suggest that levamisole decreases iRBC sequestration in falciparum malaria in vivo and should be considered as a potential adjunctive treatment for severe falciparum malaria. 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: METHODS, RESULTS. Meshes: Administration, Oral, Age Factors, Aged, Anticoagulants, Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Risk Factors." }, { "role": "user", "content": "Oral anticoagulation in older patients with vascular or cardiovascular diseases. Aged over 70 years: same risk? Context: Two-hundred and twenty-three patients with anticoagulant treatment for an average duration of 2.6 years at an angiologic outpatient clinic were subdivided into 2 groups (above 70 years n=114; below 70 years n=109). The 2 groups were compared with regard to patient-specific data, treatment-related and compliance parameters as well as complications. The group of older patients included a higher number of female patients, presented with a less favorable risk profile and revealed tendency or significance in showing better compliance data. No differences were found for the incidence of bleeding complications, while recurrences were more frequent in patients below the age of 70 years. Treatment-related parameters reflecting quality and stability of anticoagulant therapy (standard deviation of international ratio (INR), frequency of laboratory controls) represent predictors of bleeding risk being of more critical importance than the age of the patient. Recurrent events also showed correlation with same relevant parameters. Younger patients undergoing the same intensity of treatment for similarly distributed indications show a higher rate of recurrences." }, { "role": "assistant", "content": "The lower recurrence rate in older patients is consistent with the observation that anticoagulant therapy is more profitable in elderly with atrial fibrillation. Since older patients being treated with the same therapy intensity for comparable periods of time showed no higher bleeding risk than that seen for younger patients, we believe that there is no need for specific guidelines for older patients provided treatment is carefully monitored and controlled." } ]

[ { "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": "Where are the deposits found in IgA Nephropathy?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'c' i.e., Mesangium" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND. Meshes: Adult, Aged, Aging, Angina Pectoris, Antigens, Differentiation, T-Lymphocyte, Atherosclerosis, Blood Glucose, Female, Humans, Lipids, Lymphocyte Activation, Lymphocyte Count, Male, Middle Aged, Myocardial Infarction, T-Lymphocyte Subsets, T-Lymphocytes, Regulatory." }, { "role": "user", "content": "Is regulatory/effector T-cell ratio reduced in coronary artery disease? Context: The protective function of regulatory T cells (Treg) has been identified in experimental atherosclerosis, but the contribution of Treg to the pathogenesis of human coronary artery disease (CAD) remains poorly understood. We investigated Treg and regulatory T-cell/effector T-cell (Treg/Teff) ratio in peripheral blood samples from CAD patients using a new strategy for precise identification of Treg. METHODS AND RESULTS: Peripheral blood samples were collected from 73 stable CAD patients (55 middle-aged CAD patients and 18 old CAD patients) and 64 controls (47 middle-aged controls and 17 young controls). CD3(+)CD4(+)FoxP3(+)T cells were divided into 3 fractions: CD45RA(+)FoxP3(low)resting Treg(Fr1), CD45RA(-)FoxP3(high)activated Treg(Fr2), and CD45RA(-)FoxP3(low)non-Treg(Fr3). CAD patients had lower percentages of Fr1 and Fr2 and higher percentages of Fr3 and CD45RA(-)Foxp3(-)Teff(Fr4+5) within the CD3(+)CD4(+)T-cell population compared to age-matched controls. Treg/Teff ratio (Fr1+2/Fr3+4+5) in CAD patients was also markedly lower than in controls (middle-aged control, 0.17±0.09 vs. middle-aged CAD, 0.10±0.05; P<0.001). The percentage of CD4(+)CD28(null)T cells within the CD4(+)T-cell population was negatively correlated with Treg/Teff ratio, excluding CD4(+)CD28(null)T cells <0.3% (r=-0.27, P<0.05). High-sensitivity C-reactive protein was also negatively correlated with Treg/Teff ratio (r=-0.22, P<0.05)." }, { "role": "assistant", "content": "CAD patients had reduced Treg and Treg/Teff ratio compared to healthy controls. The present findings may be helpful when developing immunotherapy for the prevention of CAD. 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": "Mandibular second premolar 3-cusp type is developed from:" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Antigens, CD, Antineoplastic Agents, CD4 Lymphocyte Count, CD4-Positive T-Lymphocytes, CD8-Positive T-Lymphocytes, Cell Division, Cells, Cultured, Cytokines, Dose-Response Relationship, Drug, Humans, Hydroxyurea, Immunosuppressive Agents, Interferon-gamma, Lymphocyte Activation, Macaca mulatta, Simian Acquired Immunodeficiency Syndrome, T-Lymphocytes." }, { "role": "user", "content": "Does hydroxyurea exert a cytostatic but not immunosuppressive effect on T lymphocytes? Context: To demonstrate that, despite a dose-dependent cytostatic effect, hydroxyurea (HU) does not have immunosuppressive effects. The effects of HU on T lymphocyte proliferation parameters, activation phenotype and cytokine production were examined in vitro after exposure to clinically relevant concentrations of HU (10, 50, and 100 micromol/l). The effects of HU in vivo on CD4 T cell counts, viral load, activation phenotype and virus-specific response were examined in 17 Rhesus macaques infected with SIV(mac251) and randomized into three groups: untreated controls; treated with (R)-9-(2-phosphonylmethoxypropyl)adenine (PMPA) and didanosine (ddI) only; and treated with PMPA, didanosine, and HU. The in vitro inhibition of T lymphocyte proliferation confirmed the cytostatic effect of HU, with a linear dose-dependent effect; however, no relevant differences were found in the expression of activation markers between treated and untreated controls. Both T helper type 1 and type 2 cytokine production were enhanced by HU. Consistent with the in vitro results, a blunted increase of peripheral CD4 T cells was observed in vivo in the HU group, without relevant effects on the expression of activation markers, and SIV-specific T cell responses were not affected by HU." }, { "role": "assistant", "content": "Hyper-proliferation of T-lymphocytes is a major factor contributing to HIV pathogenesis. HU exerts a cytostatic effect on T lymphocytes, without altering their activation and apparently without having an immunosuppressive effect. The increase in cytokine production at the single cell level might compensate for the decrease in the percentage of activated CD4 T lymphocytes, without overall impairment of HIV-specific immune responses. 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: Analysis of Variance, Arthroplasty, Replacement, Cervical Vertebrae, Diskectomy, Female, Follow-Up Studies, Health Surveys, Humans, Intervertebral Disc, Intervertebral Disc Degeneration, Kaplan-Meier Estimate, Male, Middle Aged, Pain Measurement, Patient Satisfaction, Prospective Studies, Quality of Life, Treatment Outcome." }, { "role": "user", "content": "Does total disc arthroplasty affect the incidence of adjacent segment degeneration in cervical spine : results of 93 patients in three prospective randomized clinical trials? Context: Advancements in the philosophy of \"motion preservation\" have led to the use of total disc arthroplasty (TDA) as an alternative to fusion for degenerative disc disease (DDD) in the cervical spine. A commonly proposed theory is that TDA could reduce the incidence of adjacent segment disease. All the published clinical studies for TDA discuss the \"equal efficacy\" results of different investigational device exemption (IDE) trials between TDA and anterior cervical discectomy and fusion (ACDF) but have not addressed the issue of adjacent segment disease. To present the comparison of outcome data with respect to clinical success rates, symptom-free period, and incidence of adjacent segment disease in 93 patients with one- and two-level cervical DDD treated with TDA or ACDF in three different Food and Drug Administration (FDA) investigational trials. Prospective, randomized, FDA IDE trials. Ninety-three patients with established symptomatic one-or two-level cervical disc disease who failed to respond to conservative treatment were randomized to receive TDA (59) or ACDF (34) as part of clinical trials involving three different artificial discs at our institution. Subjects were blind to the assigned group until after the surgery. Visual analog pain score (VAS), Neck Disability Index, and cervical spine radiographs were collected at 6 weeks and at 3, 6, 12, 24, 36, and 48 months after surgery. Success of the index surgery was assessed based on outcome measures at the seven data points. Success was defined as reduction by more than 30 points in both VAS and Neck Disability Index, absence of neurological deficits, and no further intervention at the index level. Adjacent segment disease was established by radiology, neurophysiology, and subsequent interventions administered to the patients. At median follow-up of 37 months (range, 24-49 months), 64 (25 ACDF and 39 TDA) patients satisfied the criteria for clinical success. Neck Disability Index was a better predictor of outcome than pain score (p<.05). Sixteen percent of TDA patients and 18% ACDF patients developed adjacent segment degeneration and were treated actively (p=.3). Concurrent lumbar DDD significantly increased the risk of adjacent segment degeneration (p=.01). Age, gender, smoking habits, and number of levels at index surgery had no predictive value." }, { "role": "assistant", "content": "Total disc arthroplasty is equivalent to ACDF for providing relief from symptoms in the treatment of one- and two-level DDD of cervical spine. The risk of developing adjacent segment degeneration is equivalent after both procedures but is significantly higher in patients with concurrent DDD in lumbar spine. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 65-year-old obese man presents to his primary care clinic feeling weak. He was in the military and stationed in Vietnam in his youth. His current weakness gradually worsened to the point that he had to call his son to help him stand to get on the ambulance. He smokes a pack of cigarettes every day and drinks a bottle of vodka a week. He has been admitted for alcohol withdrawal multiple times and has been occasionally taking thiamine, folic acid, and naltrexone. He denies taking steroids. His temperature is 98°F (36.7°C), blood pressure is 170/90 mmHg, pulse is 75/min, and respirations are 20/min. He is obese with a significant pannus. Hepatomegaly is not appreciable. Abdominal striae are present. His workup is notable for the following:\n\nSerum:\nNa+: 142 mEq/L\nCl-: 102 mEq/L\nK+: 3.9 mEq/L\nHCO3-: 25 mEq/L\nBUN: 24 mg/dL\nGlucose: 292 mg/dL\nCreatinine: 1.5 mg/dL\nCa2+: 10.1 mg/dL\nAST: 7 U/L\nALT: 14 U/L\n24-hour urinary cortisol: 400 µg (reference range < 300 µg)\nSerum cortisol: 45 pg/mL (reference range < 15 pg/mL)\n\nA 48-hour high dose dexamethasone suppression trial shows that his serum cortisol levels partially decrease to 25 pg/mL and his adrenocorticotropin-releasing hormone (ACTH) level decreases from 10 to 6 pg/mL (reference range > 5 pg/mL). What is the best next step in management?" }, { "role": "assistant", "content": "MRI of the pituitary gland" } ]

[ { "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 is true about dashboard injury except-" }, { "role": "assistant", "content": "The correct answer is posterior dislocation of hip = xray *The injury is sustained by violence directed along the shaft of the femur, with the hip flexed. It requires a moderately severe force to dislocate a hip, as often occurs in motor accidents. The occupant of the car is thrown forwards and his knee strikes against the dashboard. The force is transmitted up the femoral shaft, resulting in posterior dislocation of the hip. *Injury to sciatic nerve may cause foot drop. AVN of femoral head may occur as a late complication. Ref: Apley's 9th/e p.844" } ]

[ { "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, Bothrops, Cell Differentiation, Crotalid Venoms, Matrix Metalloproteinase 14, Mice, Muscle, Skeletal, Myoblasts, Necrosis." }, { "role": "user", "content": "Do homogenates of skeletal muscle injected with snake venom inhibit myogenic differentiation in cell culture? Context: Viperid snakebite envenomings are characterized by muscle necrosis and a deficient regenerative response. Homogenates from gastrocnemius muscles of mice injected with the venom of the snake Bothrops asper or with 2 tissue-damaging toxins were added to cultures of C2C12 myogenic cells. Myoblasts proliferation and fusion were assessed. Venom was detected by immunoassay in mouse muscle during the first week after injection. Homogenates from venom-injected muscle induced a drop in the number of proliferating myoblasts and a complete elimination of myotube formation. The inhibitory effect induced by homogenates from venom-injected mice was abrogated by preincubation of the homogenate with antivenom antibodies but not with control antibodies. This finding provides evidence that the effect is due to the action of venom in the tissue." }, { "role": "assistant", "content": "Our observations suggest that traces of venom in muscle tissue might inhibit myotube formation and preclude a successful regenerative response. 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: STUDY DESIGN, OBJECTIVE, SUMMARY OF BACKGROUND DATA, METHODS, RESULTS. Meshes: Abnormalities, Multiple, Adolescent, Arnold-Chiari Malformation, Chi-Square Distribution, Child, Child, Preschool, Choristoma, Female, Humans, Magnetic Resonance Imaging, Male, Palatine Tonsil, Radiography, Retrospective Studies, Scoliosis, Syringomyelia, Thoracic Vertebrae." }, { "role": "user", "content": "Is curve direction correlated with the dominant side of tonsillar ectopia and side of syrinx deviation in patients with single thoracic scoliosis secondary to Chiari malformation and syringomyelia? Context: A retrospective imaging study. To conduct an assessment of the correlation of the coronal asymmetries between tonsillar ectopia, syrinx, and scoliosis. A few reports have shown that the convex side of scoliosis was on the same side as the dominant tonsillar ectopia or syrinx deviation in a majority of patients. However, this issue remains controversial. A retrospective study was conducted on young patients with a single thoracic scoliosis secondary to Chiari malformation type I and syringomyelia. The curve direction, side of the dominant tonsillar ectopia and side of the syrinx deviation were recorded and assessed quantitatively. The correlations between the asymmetrically displaced tonsils, eccentrically located syrinx, and curve convexity were investigated. A total of 39 patients were included. The concordance between the deviated side of the eccentrically located syrinx and dominant side of the asymmetrically displaced tonsils was 87.0%. In 88.5% of the patients with an asymmetrically displaced tonsil, the convex side of the scoliosis was concordant with the dominant side of the tonsillar ectopia, and in 86.2% of patients with an eccentrically located syrinx, the convex side of the scoliosis was on the same side as the deviated side of the syrinx. In addition, the dominant tonsillar ectopia, syrinx deviation, and curve direction were all on the same side in 82.6% patients with asymmetrically displaced tonsils and eccentrically located syrinx." }, { "role": "assistant", "content": "Asymmetrically displaced tonsils and eccentrically located syrinxes were common imaging features in these patients. The thoracic spine tended to be convex to not only the dominant side of the asymmetrically displaced tonsil, but also the deviated side of the eccentrically located syrinx. The effect of syrinx deviation on curve convexity is similar to that of dominant tonsillar ectopia in the majority of 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, BACKGROUND, METHODS, RESULTS. Meshes: Animals, Disease Models, Animal, Estrogens, Female, Hippocampus, Humans, Maze Learning, Motor Activity, Ovariectomy, Physical Conditioning, Animal, Rats, Rats, Sprague-Dawley, Spatial Memory." }, { "role": "user", "content": "Does exercise improve hippocampal estrogen and spatial memory of ovariectomized rats? Context: The present study aimed at examining the effects of regular exercise on hippocampal estrogen and estrogen receptor β (ERβ) levels, as well as the spatial memory of ovariectomized rats. A decrease of estrogen levels leads to dysfunctions of hippocampus, including spatial learning and memory. Studies have shown that physical exercise improved spatial memory of ovariectomized rats and was associated with an increased extragonadal aromatization. This in turn affects the expression of estrogen receptors. Ovariectomized Sprague Dawley rats were randomly assigned into the two groups, i.e. exercise and control groups. Rats of the exercise group were trained to run on a treadmill. The exercise was performed five times per week for 12 weeks. The spatial memory of rats was measured using the Morris water maze. The hippocampal estrogen and ERβ  levels of rats were determined using ELISA. The spatial memory retention of the exercise group was significantly better than that of the control group. The hippocampal estrogen level of the exercise group was significantly higher than that of the control group." }, { "role": "assistant", "content": "Regular exercise increases hippocampal estrogen levels and improves spatial memory retention of ovariectomized rats (Tab. 1, Fig. 4, Ref. 53). Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Is guideline uptake influenced by six implementability domains for creating and communicating guidelines : a realist review? Context: To identify factors associated with the implementability of clinical practice guidelines (CPGs) and to determine what characteristics improve their uptake. We conducted a realist review, which involved searching multiple sources (eg, databases, experts) to determine what about guideline implementability works, for whom, and under what circumstances. Two sets of reviewers independently screened abstracts and extracted data from 278 included studies. Analysis involved the development of a codebook of definitions, validation of data, and development of hierarchical narratives to explain guideline implementability. We found that guideline implementability is associated with two broad goals in guideline development: (1) creation of guideline content, which involves addressing the domains of stakeholder involvement in CPGs, evidence synthesis, considered judgment (eg, clinical applicability), and implementation feasibility and (2) the effective communication of this content, which involves domains related to fine-tuning the CPG's message (using simple, clear, and persuasive language) and format." }, { "role": "assistant", "content": "Our work represents a comprehensive and interdisciplinary effort toward better understanding, which attributes of guidelines have the potential to improve uptake in clinical practice. We also created codebooks and narratives of key concepts, which can be used to create tools for developing better guidelines to promote better care. 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, BACKGROUND, METHODS, RESULTS. Meshes: Adenosine, Animals, Blood Flow Velocity, Coronary Circulation, Coronary Disease, Disease Models, Animal, Dogs, Piperazines, Platelet Aggregation, Purines, Sildenafil Citrate, Sulfones." }, { "role": "user", "content": "Does sildenafil citrate ( Viagra ) exacerbate myocardial ischemia in canine models of coronary artery stenosis? Context: Our aim was to determine whether sildenafil citrate (Viagra) unfavorably alters coronary perfusion in canine models of coronary artery stenosis. Concern has been raised that sildenafil may exacerbate ischemia in patients with coronary artery disease. However, the effects of sildenafil on coronary perfusion are largely unexplored. Using anesthetized dogs, a micromanometer constrictor was applied to either an intact coronary artery (model of stable hypoperfusion: Protocol 1) or a site of arterial injury (model of recurrent platelet-mediated thrombosis: Protocol 2). After monitoring coronary flow for 1 h, dogs received two escalating, clinically relevant doses of sildenafil or placebo. Perfusion was assessed during the initial hour pretreatment, for 1 h following dose 1 and 1 h following dose 2 by measuring the area of the flow-time profile, normalized to baseline flow x 60 min. Interaction between sildenafil and adenosine-mediated inhibition of platelet aggregation was evaluated by in vitro platelet aggregometry (Protocol 3). In Protocol 1, flow-time area was maintained at 50% to 60% of baseline in both placebo- and sildenafil-treated groups. In Protocol 2, controls exhibited an expected modest, temporal adenosine-mediated improvement in flow-time area (from 40 +/- 5% to 61 +/- 7%; p < .05) while in contrast, perfusion in sildenafil-treated dogs remained unchanged (37 +/- 6% vs. 33% to 35% before vs. after treatment). In vitro aggregometry confirmed that sildenafil rendered platelets refractory to the inhibitory effects of adenosine receptor stimulation." }, { "role": "assistant", "content": "Sildenafil did not exacerbate ischemia in canine models of coronary stenosis. However, in the setting of recurrent thrombosis, sildenafil-treated dogs were apparently unresponsive to the platelet inhibitory effects of endogenous adenosine. 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: Adult, Anesthesia, Epidural, Anesthetics, Local, Cross-Over Studies, Female, Heating, Humans, Leg, Procaine, Sensory Thresholds, Shivering, Skin Temperature." }, { "role": "user", "content": "Does lower-body warming mimic the normal epidural-induced reduction in the shivering threshold? Context: Neuraxial anesthesia reduces the shivering threshold approximately 0.6 degrees C. This effect might be mediated by an apparent (as opposed to actual) increase in lower body temperature. Accordingly, sufficient lower body warming should result in thermoregulatory inhibition comparable to that exerted by epidural anesthesia. We tested the hypothesis that increasing leg skin temperature to 38 degrees C mimics the normal approximately 0.6 degrees C reduction in the shivering threshold during epidural anesthesia. Shivering threshold during internal body cooling was determined in nine female volunteers on two separate days: one unanesthetized control day, and one day with a T10-11 epidural block. On each study day, lower body skin temperature was maintained near 38 degrees C and upper body skin temperature near 33 degrees C. We assessed equivalency of the shivering thresholds on the control and epidural days using the two one-sided tests method. The thresholds on the control (35.8 degrees C +/- 0.5 degrees C; mean +/- sd) and epidural (35.8 degrees C +/- 0.5 degrees C) days were shown to be equivalent because the 95% CI for the difference in means, 0.0 (-0.4, 0.4), was within our prespecified limits of -0.6 degrees C to +0.6 degrees C (P < 0.025 for both one-sided equivalency tests)." }, { "role": "assistant", "content": "Lower body warming mimics the normal epidural-induced reduction in the shivering threshold. Our results support a mechanism based on increased apparent lower body skin temperature during neuraxial anesthesia. 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 6-month-old female infant is brought to the physician with a 2-day history of severe cough, wheezing, and respiratory distress. Physical examination shows rhinitis, mild cyanosis, and fever. Which of the following is the most likely etiology of this child's pulmonary infection?" }, { "role": "assistant", "content": "The correct answer is RSV is an RNA virus, which is the major cause of bronchiolitis and pneumonia in infants. RSV bronchiolitis or pneumonitis presents with expiratory and inspiratory wheezing, cough, and hyper expansion of both lung fields. Hyperinflation, interstitial infiltrates, and segmented atelectasis are expected findings on chest X-ray. The illness is usually self-limited and typically resolves within 1 to 2 weeks. Mortality is low in healthy babies. The other viruses cause pneumonia much less frequently.Diagnosis: Respiratory syncytial virus, bronchiolitis" } ]

[ { "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, Bacterial Proteins, Cell Wall, Defensins, Gene Expression Regulation, Lung, Male, Molecular Weight, Mycobacterium bovis, Pseudomonas aeruginosa, RNA, Messenger, Rats, Rats, Wistar, Reverse Transcriptase Polymerase Chain Reaction." }, { "role": "user", "content": "Do [ BCG cell wall proteins enhance clearance of Pseudomonas aeruginosa in rat lungs ]? Context: To test the function of BCG cell wall proteins in enhancing the clearance of Pseudomonas aeruginosa in rat lungs. The BCG cells were broken by supersonic technique. The cell wall proteins were isolated by discontinues sucrose density-gradient centrifugation, and fractionated by Sephadex G-150 chromatography. The relative molecular mass of the isolated proteins was analyzed by SDS-PAGE. The hBD-1 gene mRNA expression in the SPC-A-1 cells was identified by Northern blot and RT-PCR. The cell wall component was injected intraperitoneally to the rats. Forty eight hours later, 5 X 10(6) CFU of P. aeruginosa ATCC27853 or Staphylococcus aureus ATCC25923 were inoculated via trachea. The bacteria colony in the supernatant of the homogenated lungs of the rats was counted 24 hours after the inoculation. Two protein components of BCG cell wall were fractionated. The relative molecular mass of component 2 was in the range of 18 X 10(3) -30 X 10(3). The hBD-1 mRNA expression detected by Northern blot was markedly enhanced by the stimulation of heat-inactivated BCG whole cells. The BCG-induced hBD-1 mRNA expression in the SPC-A-1 cells detected by RT-PCR was mainly contributed by fraction 2 of the BCG cell wall proteins. The bacteria decreased significantly in the lungs of the rats with the injection of BCG component 2 (n=8, P<0. 01)." }, { "role": "assistant", "content": "The fraction (relative molecular mass is 18 X 10(3) -30 X 10(3)) of BCG cell wall proteins improve the defense of rat lungs against P. aeruginosa infection. 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, DESIGN, METHODS, AND RESULTS. Meshes: Adolescent, Adult, Blood Pressure, Carotid Artery Diseases, Carotid Artery, Common, Echocardiography, Femoral Artery, Heart Rate, Heart Ventricles, Humans, Male, Sports, Tunica Intima, Tunica Media, Ventricular Function." }, { "role": "user", "content": "Is carotid artery intima-media thickening a reliable marker of early atherosclerosis? Context: It is widely believed that carotid artery intima-media thickening represents an early marker for the development of atheroma. However, carotid intima-media thickening might also be expected to occur in response to an increased tensile stress and decreased wall shear stress which may accompany physical exercise. In order to test this hypothesis 24 athletes (professional footballers) were compared to 14 age and sex matched control subjects. Each subject underwent carotid and femoral ultrasonography and echocardiography. The athletes had a greater left ventricular mass index compared with the controls: 135 (127-143) vs. 104 (91-116) g/m2, p<0.001. In addition, they had a greater carotid intima-media thickness (IMT): 0.55 (0.52-0.57) vs. 0.51 (0.48-0.54) mm, p<0.05. However, carotid artery diameters, femoral IMT and femoral artery diameters were similar: 6.0 (5.9-6.2) vs. 5.8 (5.6-6.1) mm, 0.43 (0.42-0.45) vs. 0.43 (0.41-0.45) mm and 8.3 (8.0-8.6) vs. 8.4 (8.0-8.7) mm, respectively." }, { "role": "assistant", "content": "The increased carotid IMT of the athletes may result from intermittent exposure to markedly elevated systemic arterial pressures during exercise, resulting in intermittent elevations in carotid wall tensile stress. The lack of a disparity between athletes and controls for femoral IMT may be explained by the intermittent elevation of femoral wall tensile stress being accompanied by increased femoral artery blood flow and wall shear stress, which would tend to reduce any wall thickening. This is an important observation, since it suggests that an increased carotid IMT cannot be relied on solely as a marker of early atherosclerosis." } ]

[ { "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, Aspirin, Biomarkers, Female, Humans, Intensive Care Units, Male, Middle Aged, Netherlands, Platelet Aggregation Inhibitors, Propensity Score, Prospective Studies, Sepsis." }, { "role": "user", "content": "Is chronic antiplatelet therapy associated with alterations in the presentation , outcome , or host response biomarkers during sepsis : a propensity-matched analysis? Context: Sepsis is a major health burden worldwide. Preclinical investigations in animals and retrospective studies in patients have suggested that inhibition of platelets may improve the outcome of sepsis. In this study we investigated whether chronic antiplatelet therapy impacts on the presentation and outcome of sepsis, and the host response. We performed a prospective observational study in 972 patients admitted with sepsis to the mixed intensive care units (ICUs) of two hospitals in the Netherlands between January 2011 and July 2013. Of them, 267 patients (27.5%) were on antiplatelet therapy (95.9% acetylsalicylic acid) before admission. To account for differential likelihoods of receiving antiplatelet therapy, a propensity score was constructed, including variables associated with use of antiplatelet therapy. Cox proportional hazards regression was used to estimate the association of antiplatelet therapy with mortality. Antiplatelet therapy was not associated with sepsis severity at presentation, the primary source of infection, causative pathogens, the development of organ failure or shock during ICU stay, or mortality up to 90 days after admission, in either unmatched or propensity-matched analyses. Antiplatelet therapy did not modify the values of 19 biomarkers providing insight into hallmark host responses to sepsis, including activation of the coagulation system, the vascular endothelium, the cytokine network, and renal function, during the first 4 days after ICU admission." }, { "role": "assistant", "content": "Pre-existing antiplatelet therapy is not associated with alterations in the presentation or outcome of sepsis, or the host response. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Aged, Antineoplastic Combined Chemotherapy Protocols, Breast Neoplasms, Cisplatin, Disease Progression, Epirubicin, Female, Humans, Indazoles, Logistic Models, Middle Aged, Survival Analysis." }, { "role": "user", "content": "Is time to progression in metastatic breast cancer patients treated with epirubicin improved by the addition of either cisplatin or lonidamine : final results of a phase III study with a factorial design? Context: To investigate the value of the addition of either cisplatin (CDDP) or lonidamine (LND) to epirubicin (EPI) in the first-line treatment of advanced breast cancer. Three hundred seventy-one metastatic breast cancer patients with no prior systemic chemotherapy for advanced disease were randomized to receive either EPI alone (60 mg/m(2) on days 1 and 2 every 21 days), EPI and CDDP (30 mg/m(2) on days 1 and 2 every 21 days), EPI and LND (450 mg orally daily, given continuously), or EPI, CDDP, and LND. Time to progression, response rates, side effects, and survival were compared according to the 2 x 2 factorial design of this study. The groups were well balanced with respect to prognostic factors. Time to progression did not differ in the comparison between CDDP arms and non-CDDP arms (median, 10.9 months v 9.4 months, respectively; P =.10) or between that of LND arms and non-LND arms (median, 10.8 months v 9.9 months, respectively; P =.47), nor did overall survival. The response rate did not significantly differ in the comparison between LND arms and non-LND arms (62.9% v 54.0%, P =.08). No difference in treatment activity was observed between CDDP arms and non-CDDP arms. Toxicity was significantly higher in the CDDP arms, leading to CDDP dose adjustment in 40% of cases. The most frequent side effects were of a hematologic and gastrointestinal nature. The addition of LND produced more myalgias and fatigue." }, { "role": "assistant", "content": "Neither CDDP nor LND was able to significantly improve the time to progression obtained by EPI. CDDP, however, significantly worsened the drug's tolerability. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "TRUE/FALSE statements about Ischemic rest pain: 1. More at night 2. Usually confined to forefoot 3. Increases upon elevation of limb 4. Relieved by dependent position 5. Often associated with trophic changes" }, { "role": "assistant", "content": "The correct answer is Ischemic Rest Pain: Ischemic rest pain is a grave symptom caused by ischemic neuritis- indicates advanced aerial insufficiency that usually terminates in gangrene and amputation of the extremity if aerial reconstruction cannot be performed. In ischemic rest pain there is severe burning pain usually confined to the forefoot distal to the metatarsals. It may be localized to the vicinity of an ischemic ulcer or pre gangrenous toe. It is aggravated by the elevation of the extremity or by bringing the leg to the horizontal position. Thus, it appear at bed rest (hence the name) and may prevent sleep. Because gravity aids the delivery of aerial blood, classically, the patient with rest pain can obtain relief by simply hanging the leg over the side of the bed. This simple maneuver will not relieve the pain caused by peripheral neuropathy, the most common cause of foot pain at rest. If the foot is constantly kept dependant to relieve pain, the leg and foot may be swollen, causing some confusion in diagnosis. Ischemic neuritis pain is severe and resistant to opioid for relief. Rest pain occur when blood flow is inadequate to meet metabolic requirements. In the lower extremity, ischemic rest pain is localized to the forefoot and generally is easily distinguished from benign nocturnal muscle cramps in the calf, which are also common in old patients. Patients often have trophic changes, such as muscle wasting, thinning of skin, thickening of nails, and hair loss in the distal affected limb. Ref: L & B 25/e, page 909-10 ; Sabiston 18/e, page 1954-59 ; Textbook of Surgery By S. Das 5/e, page 180-82" } ]

[ { "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 25-year-old woman develops a sore, red, hot, swollen left knee. She has no history of trauma and no familial history of joint disease. Fluid aspirated from the joint space shows an abundance of segmented neutrophils. Aspirin is effective in relieving symptoms of acute inflammation in the patient because it inhibits which of the following enzymes?" }, { "role": "assistant", "content": "The correct answer is Cyclooxygenase. Arachidonic acid is metabolized by cyclooxygenases (COX-1, COX-2) and lipoxygenases (5-LOX) to generate prostanoids and leukotrienes, respectively. The early inflammatory prostanoid response is COX-1 dependent. COX-2 becomes the major source of prostanoids as inflammation progresses. Inhibition of COX is one mechanism by which nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, indomethacin, and ibuprofen, exert their potent analgesic and anti-inflammatory effects. NSAIDs block COX-2-induced formation of prostaglandins, thereby mitigating pain and inflammation. Myeloperoxidase (choice B) catalyzes the conversion of H2 O2 , in the presence of a halide (e.g., chloride ion) to form hypochlorous acid. This powerful oxidant is a major bactericidal agent produced by phagocytic cells. Superoxide dismutase (choice E) reduces the superoxide radical to H2 O2 .Diagnosis: Gonococcal arthritis" } ]

[ { "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": "Endemic relapsing fever is caused by all except?" }, { "role": "assistant", "content": "The correct answer is Endemic relapsing fever is caused by Borreliae duttoni,B.hermsii which normally live in their natural host rodents, or in other mammals which the vector takes feed. Borrelia recurrentis causes epidemic relapsing fever. It is also called louse borne relapsing fever. Characteristic corkscrew shaped appearance of Borrelia" } ]

[ { "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, Alanine Transaminase, Female, Ferritins, Hepatitis C, Chronic, Humans, Interferon alpha-2, Interferon-alpha, Iron, Male, Middle Aged, Phlebotomy, RNA, Viral, Recombinant Proteins, Treatment Outcome." }, { "role": "user", "content": "Is iron depletion effective in inducing a virologic response in patients with chronic hepatitis C who failed to respond to interferon therapy? Context: Some studies have suggested that increased iron stores may impact negatively on the response to interferon in patients with chronic hepatitis C infection. We performed this prospective trial to determine the effects of iron depletion on ALT and HCV-RNA levels in patients with chronic hepatitis C infection and to assess whether the response to interferon in patients who had previously failed to respond to interferon was enhanced by iron depletion. Patients with chronic hepatitis C resistant to interferon therapy and no evidence of iron overload underwent weekly phlebotomies until the serum ferritin level was below lower limits of normal for the subject's age and sex. Patients were then started on interferon-alpha2b, 3 million units subcutaneously three times per week for a period of 24 weeks. Iron studies, ALT, and HCV-RNA levels were monitored at baseline, after phlebotomy and at 12 and 24 weeks of interferon therapy. Thirty-three patients were enrolled, 28 completed the study. A mean of 7.2 units of blood were removed to achieve iron depletion. ALT levels decreased significantly with phlebotomy (142 IU/L before phlebotomy vs 82 IU/L after phlebotomy; p < 0.001), but log HCV-RNA levels remained unchanged (6.49 before phlebotomy vs 6.51 after phlebotomy). Interferon therapy did not improve ALT levels further. HCV-RNA levels were minimally reduced during interferon therapy (log HCV-RNA 6.49 before interferon vs 6.00 after 24 weeks of interferon therapy). Two patients achieved a virologic end of treatment response, both relapsed within 3 months after discontinuation of interferon. No patient achieved a sustained virologic response." }, { "role": "assistant", "content": "In patients who previously failed treatment with interferon, iron depletion induced by phlebotomy improves ALT levels but is ineffective in achieving viral eradication in patients retreated with interferon 3 million units three times per week. 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: Apoptosis, Carcinoma, Hepatocellular, Cell Growth Processes, Cell Line, Tumor, Dose-Response Relationship, Drug, Gallium, Gene Expression, Humans, Liver Neoplasms, Organometallic Compounds, Pyrones, Receptors, Transferrin, Ribonucleoside Diphosphate Reductase." }, { "role": "user", "content": "Is gallium maltolate a promising chemotherapeutic agent for the treatment of hepatocellular carcinoma? Context: Hepatocellular carcinoma (HCC) is a particularly lethal cancer with few treatment options. Since gallium is known to accumulate specifically in HCC tumors but not in non-tumor liver, we investigated two gallium compounds, gallium nitrate (GaN) and gallium maltolate (GaM), as potential new agents for treating HCC. The anti-proliferative and apoptotic activities of GaN and GaM were assessed in vitro using four HCC cell lines. HCC gene expression data was analyzed to provide a mechanistic rationale for using gallium in the treatment of HCC. Both compounds showed dose-dependent antiproliferative activity in all four HCC cell lines after 6-day drug exposure (IC50 values range from 60-250 microM for gallium nitrate and 25-35 microM for gallium maltolate). Gallium maltolate at 30 microM additionally induced apoptosis after 6 days. HCC gene expression data showed significantly elevated expression of the M2 subunit of ribonucleotide reductase, which is a target for the antiproliferative activity of gallium." }, { "role": "assistant", "content": "These data support clinical testing of gallium maltolate, an orally active compound, in the treatment of HCC. 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, DESIGN, SETTING, PARTICIPANTS, MAIN OUTCOME MEASURES, RESULTS. Meshes: Attitude of Health Personnel, Family Practice, Female, Health Knowledge, Attitudes, Practice, Humans, Interprofessional Relations, Maternal-Child Nursing, Midwifery, Obstetrics, Pregnancy, Professional Practice, Quebec." }, { "role": "user", "content": "Midwifery defined by physicians, nurses and midwives: the birth of a consensus? Context: To describe the form of midwifery practice preferred by physicians practising obstetrics, nurses providing maternity care and midwives. Mail survey conducted in 1991. Province of Quebec. A systematic random sample of 844 physicians, 808 nurses and 92 midwives; 597, 723 and 92 respectively completed the questionnaire, for an overall response rate of 80%. Midwife training options, range of responsibilities, location of midwifery care, relationship to other maternity care providers and degree of autonomy. Most of the physicians, nurses and midwives surveyed agreed that if midwifery was legalized, midwives should have a university degree, provide basic care to women with normal pregnancy and delivery, provide prenatal and postnatal care in hospitals and community health centres, perform delivery in hospitals and work in close collaboration with the other maternity care professionals. Disagreement existed concerning the level of university training required, the need for training in nursing first, the scope of medical intervention performed by midwives, out-of-hospital delivery, the autonomy of midwives and control over their practice." }, { "role": "assistant", "content": "Some consensus on midwifery practice exists between physicians, nurses and midwives. In jurisdictions where opposition to midwives is strong, such consensus could serve as the starting point for the introduction of midwifery." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Most common affected tendon in the Swimmer's shoulder?" }, { "role": "assistant", "content": "The correct answer is Swimmer's shoulder /supraspinatus syndrome/ Painful arc syndrome/Shoulder impingement syndrome. Causes of swimmer's shoulder: Supraspinatus tendinitis - Most common cause Complete or paial rupture of the rotator cuff Osteoahritis of the acromioclavicular joint" } ]

[ { "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": "Cholinergic drug which acts on hea by decrease in levels of cAMP and due to opening of K+ channels is?" }, { "role": "assistant", "content": "The correct answer is Ans. 'a' i.e., Methocholine" } ]

[ { "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": "Meningitis in immunocompromised host is frequently caused by" }, { "role": "assistant", "content": "The correct answer is (B) Cryptococcus neoformans # Cryptococcus neoformans is the leading cause of meningitis in immunocompromised patients (AIDS)." } ]

[ { "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": "Who coined term anaesthesia ?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., Reversal of anaesthesia Second gas effect and diffusion hypoxia In initial pa of induction, diffusion gradient from alveoli to blood is high and larger quantity of anaesthetic is entering blood. If the inhaled Concentration of anaesthetic is high (eg N20), Substantial loss of alveolar gas volume will occur and it creates negative intralveolar pressure that leads to removal of more gas from cylinder to alveoli --> Concentration effect. If another inhalation agent is (eg Halothane) is being given at the same time, it also will be delivered to lung from the cylinder (due to negative intraalveolar pressure) --> Second gas effect. During recovery reverse occurs - N20 having low blood solubility, rapidly diffuses into alveoli and dilutes the alveolar air --> paial pressure of oxygen in alveoli is reduced. The resulting hypoxia is known as diffusion hypoxia. Diffusion hypoxia can be prevented by continuing 100% 02 inhalation for a few minutes after discontinuing N20, instead of straight away switching over to air. Remember Concentration effect and secondary gas effect during induction. Diffusion hypoxia --> during recovering. All these occur with N20 only" } ]

[ { "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": "Cesarean section is preferred in:" }, { "role": "assistant", "content": "The correct answer is Herpes:Risk of fetal infection is high in primary genital HSV,at term due to high virus shedding compared to recurrent infection.CS delivery is indicated in an active primary genital HSV infection where the membranes are intact or recently ruptured VZV:VZIG should be given to exposed non immune patients as it reduces the morbidity.VZIG given to newborn within 5 days of delivery. D.C.DUTTA&;S TEXTBOOK OF OBSTETRICS,Pg no:300,7th edition" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Which of the following helminths primarily pro¬duces gastrointestinal symptoms, without lung involvement, during the course of its infection?" }, { "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: BACKGROUND, METHODS, RESULTS. Meshes: Cell Line, Helicobacter pylori, Humans, Janus Kinases, Macrophages, Oncostatin M, Receptors, Oncostatin M, STAT Transcription Factors, Signal Transduction, Up-Regulation." }, { "role": "user", "content": "Does helicobacter pylori induce expression and secretion of oncostatin M in macrophages in vitro? Context: Helicobacter pylori is pathogenic bacterium that is associated with several gastric diseases in humans. Disease is characterized by severe inflammatory responses is the stomach that are induced by various chemokines and cytokines. Previous reports indicated that some of these responses are mediated through Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling. We performed JAK/STAT specific microarrays to identify new components of this signaling pathway, which are affected by Helicobacter pylori infection of THP-1 cells. We found that expression and secretion of oncostatin M and of its receptor were strongly up-regulated by Helicobacter pylori. OSM secretion was independent of CagA, VacA or Type IV secretion system. Helicobacter pylori culture supernatant induced OSM secretion." }, { "role": "assistant", "content": "The induction of the pleiotropic cytokine oncostatin M suggests a possible role in Helicobacter pylori-mediated inflammation and diseases. 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, Brain, Electroencephalography, Emotions, Evoked Potentials, Facial Expression, Facial Recognition, Female, Humans, Impulsive Behavior, Male, Neuropsychological Tests, Personality, Personality Tests, Reaction Time, Self Report." }, { "role": "user", "content": "Is neurophysiological modulation of rapid emotional face processing associated with impulsivity traits? Context: Sensori-perceptual processing of emotional stimuli under attentive conditions effectively prevents response disinhibition. This is observed saliently in low-impulsive people, because of their high sensitivity to warning signals, such as emotional faces. Results from human neurophysiological studies have been used to develop a dual detector model for early sensori-perceptual processing. A transient detector mechanism is related to automatic neurophysiological arousal in response to warning signals, which is reflected by early frontal event-related potential effects. The memory-based detector mechanism is associated with subsequent mismatch negativity (MMN), which reflects a short-term memory trace of signals. Based on previous findings, we predicted that impulsivity affects functional associations among the dual detector mechanisms, and modulates early frontal and/or MMN activities. In the present study, we recorded electroencephalograms for twenty-one healthy adults using a visual oddball paradigm with neutral faces as frequent stimuli, and angry and happy faces as infrequent stimuli. We measured the impulsivity traits by a self-report scale (the Barratt Impulsiveness Scale, 11th version). Main findings were that only happy faces increased early frontal negativity and subsequent occipital visual MMN (vMMN) for emotional change, and these neurophysiological effects positively correlated with each other in a temporally causal manner. However, an impulsivity sub-trait positively correlated selectively with vMMN for the happy faces." }, { "role": "assistant", "content": "These findings demonstrate that higher impulsivity is associated with attenuated vMMN for emotional change detection in healthy populations, potentially because of weakened fronto-occipital functional connection that is responsible for the dual detector mechanism. 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 27-year-old woman comes to the emergency room because of fever and severe left knee pain for the past week. She has not sustained any trauma or injury to the area, nor has she traveled or taken part in outdoor activities in the recent past. She is sexually active with one male partner, and they use condoms inconsistently. She appears ill. Her temperature is 38°C (100.4°F), pulse is 98/min, respirations are 17/min, and blood pressure is 106/72 mm Hg. Physical examination shows multiple painless pustular lesions on her ankles and the dorsum and soles of her feet bilaterally, as well as a swollen, erythematous, exquisitely tender left knee. Her wrists are also mildly edematous and tender, with pain on extension. X-ray of the knees shows tissue swelling. Arthrocentesis of the knee shows yellow purulent fluid. Gram stain is negative. Analysis of the synovial fluid shows a leukocyte count of 58,000/mm3 with 93% neutrophils and no crystals. Which of the following is the most appropriate pharmacotherapy?" }, { "role": "assistant", "content": "Intramuscular ceftriaxone and oral azithromycin" } ]

[ { "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": "Terminal portion of Hertwig's epithelial root sheath will form a tapering tooth root.The terminal portion has been called:" }, { "role": "assistant", "content": "The correct answer is The terminal portion of Hertwig's epithelial root sheath will form a tapering tooth root. The terminal portion has been called the apical loop." } ]

[ { "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, STUDY DESIGN, METHODS, RESULTS. Meshes: Adult, Age Distribution, Aged, Aged, 80 and over, Cause of Death, Chile, Chronic Disease, Cohort Studies, Educational Status, Female, Follow-Up Studies, Humans, Income, Male, Middle Aged, Mortality, Prevalence, Proportional Hazards Models, Prospective Studies, Risk Assessment, Risk Factors, Sex Distribution." }, { "role": "user", "content": "Impact of education, income and chronic disease risk factors on mortality of adults: does 'a pauper-rich paradox' exist in Latin American societies? Context: To test the hypothesis that an inverse association exists between socio-economic position and all-cause mortality in a developing country in Latin America. Prospective cohort study carried out in Chile using data from a simple random sample of 920 apparently healthy subjects (weighted population 11,600 aged 30-89 years) followed for 8 years. Education level (0-8 years, 9-12 years and>or = 13 years) and income quartiles were established at the outset of the study, along with behavioural and biological risk factors for chronic diseases: smoking, alcohol use, obesity, diabetes, hypertension, lipids and family history of death by cardiovascular disease. Relative risks of all-cause mortality were estimated using age-adjusted Cox regression models. During the follow-up period, 46 deaths were observed. Adjusting for age, gender, and behavioural and biological risk factors, the mortality risk for increasing categories of education after controlling for income was 1.0, 0.76 and 0.33 (P for trend<0.01). In contrast, the relative risk for increasing levels of income after controlling for education was 1.0, 0.98, 1.33 and 1.17 (P for trend=0.07)." }, { "role": "assistant", "content": "While education level had a protective effect on mortality risk of Chilean adults, income had a slightly unfavourable effect on survival. This finding is described as suggestive of a 'pauper-rich paradox', since the higher income quantiles in this study correspond with the lower income levels in most developed countries. Nevertheless, due to the small number of deaths, additional research is required to assess the validity of these findings." } ]

[ { "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: Archaea, DNA Repair, DNA Replication, Genome, Archaeal, Protein Binding, Protein Biosynthesis, Systems Biology." }, { "role": "user", "content": "Does genomic context analysis in Archaea suggest previously unrecognized links between DNA replication and translation? Context: Comparative analysis of genomes is valuable to explore evolution of genomes, deduce gene functions, or predict functional linking between proteins. Here, we have systematically analyzed the genomic environment of all known DNA replication genes in 27 archaeal genomes to infer new connections for DNA replication proteins from conserved genomic associations. Two distinct sets of DNA replication genes frequently co-localize in archaeal genomes: the first includes the genes for PCNA, the small subunit of the DNA primase (PriS), and Gins15; the second comprises the genes for MCM and Gins23. Other genomic associations of genes encoding proteins involved in informational processes that may be functionally relevant at the cellular level have also been noted; in particular, the association between the genes for PCNA, transcription factor S, and NudF. Surprisingly, a conserved cluster of genes coding for proteins involved in translation or ribosome biogenesis (S27E, L44E, aIF-2 alpha, Nop10) is almost systematically contiguous to the group of genes coding for PCNA, PriS, and Gins15. The functional relevance of this cluster encoding proteins conserved in Archaea and Eukarya is strongly supported by statistical analysis. Interestingly, the gene encoding the S27E protein, also known as metallopanstimulin 1 (MPS-1) in human, is overexpressed in multiple cancer cell lines." }, { "role": "assistant", "content": "Our genome context analysis suggests specific functional interactions for proteins involved in DNA replication between each other or with proteins involved in DNA repair or transcription. Furthermore, it suggests a previously unrecognized regulatory network coupling DNA replication and translation in Archaea that may also exist in Eukarya. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adenocarcinoma, Adult, Aged, Carbon, Chemoradiotherapy, Adjuvant, Coloring Agents, Female, Humans, Injections, Intestinal Mucosa, Logistic Models, Lymph Node Excision, Lymphatic Metastasis, Male, Middle Aged, Nanoparticles, Neoadjuvant Therapy, Neoplasm Staging, Preoperative Care, Rectal Neoplasms, Retrospective Studies." }, { "role": "user", "content": "Does preoperative Submucosal Injection of Carbon Nanoparticles improve Lymph Node Staging Accuracy in Rectal Cancer after Neoadjuvant Chemoradiotherapy? Context: The aim of this study was to evaluate the association between the number of nodes harvested and the rate of node positivity, and to evaluate the effect of carbon nanoparticles (CNPs) in improving lymph node detection and staging accuracy in patients who received neoadjuvant chemoradiotherapy (NCRT) followed by curative resection. Between September 2008 and June 2014, 152 consecutive rectal cancer patients treated with NCRT and curative resection were included. Forty-five patients underwent preoperative submucosal injection of CNPs (CNP group); the other patients underwent surgery only (control group). The relationship between the number of lymph nodes harvested and the rate of node positivity was investigated. A comparison of the number of harvested lymph nodes and the node positivity rate between the 2 groups was also performed. The lymph nodes in the CNP group were analyzed in detail. The rate of node positivity increased gradually from 8.6% in patients with 1 to 5 nodes assessed to 37.8% in patients with 17 to 44 nodes assessed. The number of lymph nodes harvested was an independent risk factor for node positivity (p = 0.036). The mean number of lymph nodes retrieved in the CNP group was more than in the control group (21.1 vs 8.0, p = 0.000). The percentage of patients with positive lymph nodes was lower than in the control group (19.6% vs 35.6%, p = 0.037). In the CNP group, of 58 metastatic lymph nodes, 45 (77.6%) were dyed. Of 37 metastatic lymph nodes smaller than 5 mm, 33 (89.2%) were dyed." }, { "role": "assistant", "content": "More precise oncologic prognosis assessment was provided for patients with rectal cancer after NCRT by increasing the number of lymph nodes counted using a dye-tracing method, indicating that the use of CNPs is beneficial. 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": "In Nalgonda Technique of deflouridation addition of the _______ in following sequence:" }, { "role": "assistant", "content": "The correct answer is Nalgonda technique was developed by the national environmental engineering research institute (NEERI) at Nagpur in 1974. The process comprises Addition in sequence of sodium aluminate (filter alum), lime and bleaching powder to fluoride water followed by flocculation, sedimentation, and filtration. The technique is extremely useful for both domestic as well as for community water supplies." } ]

[ { "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: Anti-Infective Agents, Calcium, Calcium Channels, Cell Line, Dose-Response Relationship, Drug, Electrophysiology, Fluorometry, Humans, Membrane Potentials, Nerve Tissue Proteins, Patch-Clamp Techniques, Phenols, Structure-Activity Relationship, TRPA1 Cation Channel, Thymol, Transient Receptor Potential Channels." }, { "role": "user", "content": "Do thymol and related alkyl phenols activate the hTRPA1 channel? Context: Thymol, a major component of thyme and oregano, has medical uses in oral care products as an astringent and antibiotic. Its distinctive sharp odour and pungent flavour are considered aversive properties. The molecular basis of these aversive properties is not well understood. The ability of thymol to activate human transient receptor potential channel A1 (hTRPA1) expressed in stably transfected human embryonic kidney 293 (HEK293) cells was measured by membrane potential and calcium-sensitive dyes in a fluorescence-imaging plate reader (FLIPR) assay. Direct activation of hTRPA1 currents was measured by whole-cell voltage clamp recording. Intracellular calcium changes were measured using fura-2 dye. The FLIPR assay was also used to measure membrane potential changes elicited by thymol after pretreatment with camphor, a known TRPA1 inhibitor. The ability of related alkyl phenols to activate hTRPA1 was also determined. Thymol potently activated a membrane potential response and intracellular calcium increase in hTRPA1-expressing HEK293 cells in a concentration-dependent manner. Activation by thymol desensitized hTRPA1 to further exposure to thymol or the known ligand allyl isothiocyanate (AITC). The related phenols 2-tert-butyl-5-methylphenol, 2,6-diisopropylphenol (propofol) and carvacrol also activated hTRPA1. Phenols with less bulky carbon substitutions and lower logP values were less potent in general. The response to thymol was blocked by camphor." }, { "role": "assistant", "content": "These results suggest a role for hTRPA1 activation in the reported pungent and aversive properties of some of these pharmaceutically important phenols. 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: UNLABELLED, OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Cell Differentiation, Cytokines, Dendritic Cells, Humans, Immunologic Memory, Interleukin-17, Ligands, Phenotype, T-Lymphocytes, Helper-Inducer, Th2 Cells, Toll-Like Receptor 3." }, { "role": "user", "content": "Do human TSLP and TLR3 ligands promote differentiation of Th17 cells with a central memory phenotype under Th2-polarizing conditions? Context: BACKGROUND\" Human thymic stromal lymphopoietin (TSLP) is expressed in the human asthmatic lung and activates dendritic cells (DCs) to strongly induce proallergic T-helper type 2 (Th2) cell responses, suggesting that TSLP plays a critical role in the pathophysiology of human asthma. Th2 cells are predominantly involved in mild asthma, whereas a mixture of Th1 and Th2 cells with neutrophilic inflammation, probably induced by Th17, affects more severe asthmatic disease. Exacerbation of asthmatic inflammation is often triggered by airway-targeting RNA viral infection; virus-derived double-stranded RNA, Toll-like receptor (TLR)3 ligand, activates bronchial epithelial cells to produce pro-inflammatory mediators, including TSLP. Because TSLPR-expressing DCs express TLR3, we examined how the relationship between TSLP and TLR3 ligand stimulation influences DC activation. CD11c(+)DCs purified from adult peripheral blood were cultured in TLR ligands containing media with or without TSLP and then co-cultured with allogeneic naïve CD4(+)T cells. CD11c(+) DCs responded to a combination of TSLP and TLR3 ligand, poly(I : C), to up-regulate expression of the functional TSLP receptor and TLR3. Although TSLP alone did not induce IL-23 production by DCs, poly(I : C) alone primed DCs for the production of IL-23, and a combination of TSLP and poly(I : C) primed DCs for further production of IL-23. The addition of poly(I : C) did not inhibit TSLP-activated DCs to prime naïve CD4(+) T cells to differentiate into inflammatory Th2 cells. Furthermore, DCs activated by a combination of TSLP and poly(I : C) primed more naïve CD4(+) T cells to differentiate into Th17-cytokine-producing cells with a central memory T cell phenotype compared with DCs activated by poly(I : C) alone." }, { "role": "assistant", "content": "These results suggest that through DC activation, human TSLP and TLR3 ligands promote differentiation of Th17 cells with the central memory T cell phenotype under Th2-polarizing conditions. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, DESIGN AND SETTING, METHODS, RESULTS. Meshes: Acute Disease, Aged, Biomarkers, CA-125 Antigen, Cardiac Output, Low, Case-Control Studies, Cohort Studies, Female, Heart Failure, Hospitalization, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Prognosis, Proportional Hazards Models, Risk Factors." }, { "role": "user", "content": "Carbohydrate antigen 125: an emerging prognostic risk factor in acute heart failure? Context: To assess whether circulating levels of carbohydrate antigen 125 (CA125) predict subsequent 6-month all-cause mortality in patients after the index hospitalisation for acute heart failure (HF). Prospective cohort study at a single teaching centre in Spain. 529 consecutive patients with acute HF admitted in a single university centre were analysed. In addition to the traditional clinical information, CA125 (U/ml) was measured during the early course of hospitalisation. The independent association between baseline CA125 and mortality was assessed with Cox regression analysis. The follow-up was limited to 6 months. 349 (66%) patients showed serum levels of CA125>35 U/ml (established cut-off point value). At a 6-month follow-up, 89 (16.8%) deaths were identified. A positive trend between mortality and CA125 quartiles was observed; 3.8%, 15.2%, 22% and 26.5% of deaths occurred from quartile 1 to 4 of CA125 (p<0.001). Likewise, a monotonic, ascending trend in the risk ratios was estimated from the multivariable Cox model. Compared with the first quartile of CA125, the HRs (95% CI) for the second, third and fourth quartiles were 3.25 (1.20 to 8.79), 4.91 (1.88 to 12.85) and 8.41 (3.24 to 21.79), respectively." }, { "role": "assistant", "content": "Serum levels of CA125 obtained in patients admitted with a diagnosis of acute HF was shown to be an independent predictor of mortality up to the 6-month follow-up." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Anti-HIV Agents, Cross-Sectional Studies, Female, HIV Infections, Health Services Accessibility, Humans, Male, Prisoners, Substance Abuse, Intravenous, Thailand, Young Adult." }, { "role": "user", "content": "Is compulsory drug detention exposure associated with not receiving antiretroviral treatment among people who inject drugs in Bangkok , Thailand : a cross-sectional study? Context: Thailand has experienced a longstanding epidemic of HIV among people who inject drugs (PWID). However, antiretroviral treatment (ART) coverage among HIV-positive PWID has historically remained low. While ongoing drug law enforcement involving periodic police crackdowns is known to increase the risk of HIV transmission among Thai PWID, the impact of such drug policy approaches on the ART uptake has been understudied. Therefore, we sought to identify factors associated with not receiving ART among HIV-positive PWID in Bangkok, Thailand, with a focus on factors pertaining to drug law enforcement. Data were collected from a community-recruited sample of HIV-positive PWID in Bangkok who participated in the Mitsampan Community Research Project between June 2009 and October 2011. We identified factors associated with not receiving ART at the time of interview using multivariate logistic regression. In total, 128 HIV-positive PWID participated in this study, with 58 (45.3%) reporting not receiving ART at the time of interview. In multivariate analyses, completing less than secondary education (adjusted odds ratio [AOR]: 3.32 ; 95% confidence interval [CI]: 1.48 - 7.45), daily midazolam injection (AOR: 3.22, 95% CI: 1.45 - 7.15) and exposure to compulsory drug detention (AOR: 3.36, 95% CI: 1.01 - 11.21) were independently and positively associated with not receiving ART. Accessing peer-based healthcare information or support services was independently and positively associated with receiving ART (AOR: 0.21, 95% CI: 0.05 - 0.84)." }, { "role": "assistant", "content": "Approximately half of our study group of HIV-positive PWID reported not receiving ART at the time of interview. Daily midazolam injectors, those with lower education attainment, and individuals who had been in compulsory drug detention were more likely to be non-recipients of ART whereas those who accessed peer-based healthcare-related services were more likely to receive ART. These findings suggest a potentially adverse impact of compulsory drug detention and highlight the need to expand interventions to facilitate access to ART among HIV-positive PWID in this setting. 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": "Pleomorphic adenoma is usually arise from" }, { "role": "assistant", "content": "The correct answer is (Parotid gland) (546-HM) (584-Basic pathology 8th)Pleomorphic adenoma (Mixed salivary tumour) is the commonest tumour in the parotid gland and occurs less often in other major and minor salivary gland, common in females." } ]

[ { "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": "permenant cerebellar damage is seen in lithium toxcity at what levels?" }, { "role": "assistant", "content": "The correct answer is ref : kd tripathi 8th ed" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A diagnosis of fungal corneal ulcer is not made if there is presence of" }, { "role": "assistant", "content": "The correct answer is Symptoms of fungal corneal ulcer are similar to central bacterial corneal ulcer , but in general, they are less marked than the equal-sized bacterial ulcer and the overall course is slow and torpid. Signs are more prominent than symptoms. Corneal ulcer is greyish white, dry-looking with elevated rolled out margins. Delicate feathery finger-like extensions are present into the surrounding strorna under the intact epitheliium. Hypopyon usually a big one is present even if the ulcer is very small. Unlike bacterial ulcer, the hypopyon not sterile as the fungi can penetrate into the anterior chamber without perforation." } ]

[ { "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": "Methotrexate should be given with which of the following to decrease its side effects?" }, { "role": "assistant", "content": "The correct answer is Ans. d (Folinic acid). (Ref. Harrison 18th/Chapter 326. The Vasculitis Syndromes)To lessen toxicity, methotrexate is often given together with folic acid, 1 mg daily, or folinic acid, 5-10 mg once a week 24h following methotrexate.METHOTREXATE# acts by inhibiting hydrofolate reductase - blocking the conversion of dihydrofolate to tetrahydrofolate, which is an essential coenzyme required for one carbon atom transfer reactions in de novo purine synthesis and amino acid interconversions.# It has cell specific action and acts on the S phase of cell cycle.- USES:- It is apparently curative in choricarcinoma.- It is also useful in acute leukemias, rheumatoid arthritis, psoriasis and as an immunosupressant.- High dose methotrexate is used in management of osteosarcoma and Histiocytosis X.# Its toxicity cannot be overcomed by folic acid, because it will not be converted to active co-enzyme form.# However, folinic acid (citrovorum factor) rapidly reverses its effect. Thymidine also counteracts its toxicity.Antidotes for some drug toxicities Toxin/ DrugANTIDOTE/TREATMENT1AcetaminophenA/-acetylcysteine2SalicylatesAlkalinize urine, dialysis3Anticholinesterases, organophosphatesAtropine, pralidoxime4Antimuscarinic, anticholinergic agentsPhysostigmine salicylate5b-blockersGlucagon6DigitalisStop dig, normalize K+, lidocaine, anti-dig Fab fragments, Mg2+7IronDeferoxamine8LeadCaEDTA, dimercaprol, succimer, penicillamine9Arsenic, mercury, goldDimercaprol (BAL), succimer10Copper, arsenic, goldPenicillamine11CyanideNitrite, hydroxocobalamin, thiosulfate12MethemoglobinMethylene blue13Carbon monoxide100% O2, hyperbaric O214Methanol, ethylene glycol (antifreeze)Ethanol, dialysis, fomepizole15OpioidsNaloxone/naltrexone16BenzodiazepinesFlumazenil17TCAsNaHCO3 (nonspecific)18HeparinProtamine19WarfarinVitamin K, fresh frozen plasma20tPA, streptokinaseAminocaproic acid21CisplatinAmifostine22CyclophosphamideMESNA23DoxorubicinDexrozoxazone" } ]

[ { "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": "Shortest incubation perkm in malaria -" }, { "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: BACKGROUND, METHODS, RESULTS. Meshes: Animals, Antineoplastic Agents, Cell Line, Tumor, Cell Movement, Cell Survival, Cell Transformation, Neoplastic, Disease Progression, Gene Expression Regulation, Neoplastic, Histones, Humans, Male, Methylation, Mice, Mice, SCID, Neoplastic Stem Cells, Polycomb-Group Proteins, Prostatic Neoplasms, RNA, Messenger, Repressor Proteins, Spheroids, Cellular, Tumor Cells, Cultured, Xenograft Model Antitumor Assays." }, { "role": "user", "content": "Does pharmacologic disruption of Polycomb Repressive Complex 2 inhibit tumorigenicity and tumor progression in prostate cancer? Context: Polycomb repressive complex 2 (PRC2) mediates gene silencing through histone H3K27 methylation. PRC2 components are over-expressed in metastatic prostate cancer (PC), and are required for cancer stem cell (CSC) self-renewal. 3-Dezaneplanocin-A (DZNeP) is an inhibitor of PRC2 with broad anticancer activity. we investigated the effects of DZNeP on cell proliferation, tumorigenicity and invasive potential of PC cell lines (LNCaP and DU145). Exploring GEO and Oncomine databases, we found that specific PRC2 genes (EED, EZH2, SUZ12) predict poor prognosis in PC. Non-toxic DZNeP concentrations completely eradicated LNCaP and DU145 prostatosphere formation, and significantly reduced the expression of CSC markers. At comparable doses, other epigenetic drugs were not able to eradicate CSCs. DZNeP was also able to reduce PC cell invasion. Cells pre-treated with DZNeP were significantly less tumorigenic (LNCaP) and formed smaller tumors (DU145) in immunocompromised mice." }, { "role": "assistant", "content": "DZNeP is effective both in vitro and in vivo against PC cells. DZNeP antitumor activity is in part mediated by inhibition of CSC tumorigenic potential. 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 Factors, Aged, Aged, 80 and over, Echocardiography, Female, Heart Atria, Humans, Hypertrophy, Left Ventricular, Kidney Transplantation, Male, Middle Aged, Myocardial Infarction, Percutaneous Coronary Intervention, Predictive Value of Tests, Preoperative Period, Retrospective Studies, Risk Assessment, Stroke, Young Adult." }, { "role": "user", "content": "Does echocardiography predict major adverse cardiovascular events after renal transplantation? Context: Cardiovascular disease is a leading cause of morbidity and mortality after renal transplantation. We analysed whether pre-transplant transthoracic echocardiograms (TTE) predicted major adverse cardiovascular events (MACE) after transplant. We retrospectively analysed clinical and TTE data from patients having renal transplantation at a single centre between 1 January 2000 and 31 December 2010. The TTE were classified as: group A - normal; group B - mild abnormalities expected in renal failure; group C - moderate to severe abnormalities likely to change management. They were also scored based on four independent risk factors [age ≥50, left ventricular (LV) end systolic diameter ≥3.5 cm, LV wall thickness ≥1.4 cm and mitral annulus calcification]. Post-transplantation clinical notes were examined for MACE (death, stroke, myocardial infarction, and surgical or percutaneous revascularisation). There were 343 patients, mean age 47 (range 21-83) years, 210 of whom were male. MACE occurred in 29 (8.5%) at a mean of 3.6 (SD 3.3) years after transplantation. They were older (p ≤ 0.001), had larger LV mass (p = 0.02), LV wall thickness (p = 0.008) and left atrial size (p = 0.001) than those without MACE. The MACE rate for groups A, B and C were 1.8, 13.6 and 16.4% (p ≤ 0.001), respectively. Using the score, the risk of MACE was 4.7, 10.7, 9.2 and 40% for scores 0, 1, 2 and 3 (p = 0.023), respectively." }, { "role": "assistant", "content": "Preoperative transthoracic echocardiography identifies patients at risk of death or non-fatal cardiovascular events even late after renal transplantation. This suggests that echocardiography might be useful to identify patients requiring more aggressive long-term treatment of modifiable vascular risk factors. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All of the following are seen in Goodpasture's syndrome, except:" }, { "role": "assistant", "content": "The correct answer is Goodpasture syndrome Type II hypersensitivity reaction) Presence of antibodies against non-collagenous domain of a3 chain of collagen IV causing destruction of basement membrane in renal glomeruli and pulmonary alveoli. Histologically, the alveoli show focal necrosis (not diffuse involvement), intra-alveolar hemorrhage, presence of hemosiderin laden macrophages and hyperophy of type II Pneumocytes." } ]

[ { "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 child is below the third percentile for height. Growth velocity is normal, but chronologic age is more than skeletal age. The most likely diagnosis is:" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "You are counseling a pregnant woman who plans to breast-feed exclusively regarding her newborn's nutritional requirements. The child was born at home and the mother only plans for her newborn to receive vaccinations but no other routine medical care. Which vitamins should be given to the newborn?" }, { "role": "assistant", "content": "Vitamin K and Vitamin D" } ]

[ { "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": "Cause of death in diabetic ketoacidosis in children" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., Cerebral edema High blood sugar will cross the blood brain barrier and simultaneously will draw water inside leading to cerebral edema. Cerebral edema accounts for 60-90% of all DKA related deaths in children. Infection is a precipitator for development of DKA. Other precipitating factor can be tissue ischemia, inadequate insulin administration, drugs (cocaine) and pregnancy." } ]

[ { "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, Antibodies, Cell Count, Cell Division, Cell Line, Colon, Dose-Response Relationship, Drug, Epidermal Growth Factor, ErbB Receptors, Growth Inhibitors, Growth Substances, Intercellular Junctions, Mice, Osmolar Concentration, Phosphorylation, Receptors, Tumor Necrosis Factor, Tumor Necrosis Factor-alpha, Tyrosine." }, { "role": "user", "content": "Does tumor necrosis factor alpha regulate proliferation in a mouse intestinal cell line? Context: Tumor necrosis factor (TNF)-alpha is a prominent cytokine in the pathogenesis of inflammatory bowel disease, yet its effects on the intestinal epithelium remain poorly understood. This study was designed to investigate the action of TNF-alpha on intestinal cell proliferation. Young adult mouse colon cells were studied under nontransformed conditions with epidermal growth factor, keratinocyte growth factor, insulin-like growth factor 1, or serum in the presence or absence of TNF-alpha and cell numbers determined. The expression and independent actions of the 55-kilodalton TNF-alpha R1 and 75-kilodalton TNF-alpha R2 receptors were studied by immunologic methods. TNF-alpha stimulated proliferation at 0.1 and 1 ng/mL and inhibited proliferation at 100 and 1000 ng/mL without altering cell viability. TNF-alpha inhibited the mitogenic effect of growth factors and epidermal growth factor receptor tyrosine phosphorylation. TNF-alpha R1 receptor agonist antibody inhibited proliferation, whereas a TNF-alpha R2 receptor-blocking antibody prevented the proliferative effect of low-dose TNF-alpha." }, { "role": "assistant", "content": "TNF-alpha displays a novel influence on intestinal cell growth, stimulating proliferation at physiological concentrations and inhibiting proliferation at pathological concentrations. The regulation of intestinal cell mitogenesis by TNF-alpha seems to be mediated differentially by the two TNF-alpha receptors, with the TNF-alpha R1 receptor inhibiting proliferation and the TNF-alpha R2 receptor promoting proliferation. 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: METHOD, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Allied Health Personnel, Cognition, Disabled Persons, Female, Health Services for the Aged, Homes for the Aged, Humans, Male, Middle Aged, New Zealand, Nursing Homes, Professional-Patient Relations, Quality of Health Care." }, { "role": "user", "content": "Quality of residential care for older people: does education for healthcare assistants make a difference? Context: A pre- and post-intervention evaluation study was undertaken within a residential home for older people. Quality of care was established by two periods of non-participant time-sampling observation of residents, separated by a programme of 10 interactive teaching sessions for healthcare assistants. Informed consent was gained from all observed residents and staff. Using the Quality Assessment Project (QAP) quality measure, the non-participant time-sampling observation data identified a 12.5% increase in resident care that was considered appropriate and adequate (chi-squared=12.05) and an 11.53% decrease in resident care that was considered inappropriate and inadequate (chi-squared=11.43). The intermediate grades did not alter significantly. Residents with low functional activity scores (Barthel Index) received better care after the education intervention (chi-squared=32.99), as did residents with moderate cognitive impairment (Abbreviated Mental Test Score [AMTS]<8/10)." }, { "role": "assistant", "content": "Healthcare assistant education can positively impact on the quality of care given to older people in residential care." } ]

[ { "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: Adenoviridae, Animals, Disease Models, Animal, Fibrinolysis, Humans, Injections, Intraperitoneal, Male, Peritoneal Diseases, Rats, Rats, Wistar, Severity of Illness Index, Tissue Adhesions, Tissue Plasminogen Activator, Transfection." }, { "role": "user", "content": "Does adenovirus-mediated overexpression of human tissue plasminogen activator prevent peritoneal adhesion formation/reformation in rats? Context: Tissue-plasminogen activator (tPA) demonstrated beneficial effects on peritoneal adhesion formation; however, its short half-life limits its continual fibrinolytic effect. Therefore, we delivered adenovirus encoding tPA to prevent adhesions. Rats were subjected to peritoneal injury and assigned to two protocols. In de novo adhesion protocol, adenovirus encoding human tPA gene (Ad-htPA) was instilled after peritoneal injury in group 1 (n = 22), whereas group 2 received phosphate-buffered saline (PBS) (n = 24). In recurrent adhesion protocol, group 1 (n = 15) received the same Ad-htPA dose after adhesiolysis and group 2 (n = 13) received PBS. Adhesion severity was scored 1 week after ad-htPA instillation. Adhesions were analyzed for htPA mRNA by reverse transcription-polymerase chain reaction and levels of htPA, and fibrinolytic inhibitors PAI-1, TIMP-1, and TGF-beta1 were measured using enzyme-linked immunosorbent assay. htPA mRNA and protein were only expressed in adhesions from treated groups. A reduction in adhesion scores (P < .01) and in fibrinolytic inhibitors (P < .001) occurred in the treatment groups. Also, negative correlation was found (r = -.69, P < .01) between adhesion scores and htPA protein, but a positive correlation was found (r = .90, P < .01) between adhesion score and fibrinolytic inhibitors. No bleeding or wound complications were encountered." }, { "role": "assistant", "content": "Administration of adenovector encoding htPA is safe and decreased de novo and recurrent peritoneal adhesions. 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: Absorptiometry, Photon, Adiposity, Adolescent, Adult, Asian Continental Ancestry Group, Child, European Continental Ancestry Group, Female, Humans, Linear Models, Obesity, Abdominal, Torso." }, { "role": "user", "content": "Is asian ethnicity associated with a higher trunk/peripheral fat ratio in women and adolescent girls? Context: Ethnic differences in body fat mass and distribution may develop in childhood and contribute to increased obesity-related disease risk among Asians. We used dual-energy X-ray absorptiometry (DXA) to evaluate adiposity measures among adult women and their adolescent daughters, who were of predominantly Japanese and white ethnicity. We obtained DXA whole body scans for 101 mothers aged 30 years or older and 112 daughters aged 10 to 16 years. The participants were classified as Asian, part-Asian, mixed/other, or white. As a measure of central adiposity, we calculated the trunk/peripheral fat ratio (TPFR). General linear models were used to evaluate differences in adiposity measures by ethnic category. In mothers, TPFR was significantly higher (P(trend) < 0.01) in Asians and part-Asians (1.38 ± 0.42 and 1.32 ± 0.51) than in mixed/others and whites (1.18 ± 0.27 and 1.09 ± 0.21). The trend was similar among daughters (P(trend) < 0.001), with respective values of 1.09 ± 0.18, 0.97 ± 0.17, 0.99 ± 0.16, and 0.87 ± 0.11. Among mothers, gynoid fat mass and peripheral fat mass were significantly lower in Asians than in whites, whereas none of the regional DXA adiposity measures differed by ethnicity in daughters." }, { "role": "assistant", "content": "These results confirm previous reports of greater central adiposity in women of Asian ancestry and indicate that ethnic differences in adiposity are already present in adolescence. 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": "DNA fragments formed by the action of Restriction endonucleases, are separated by -" }, { "role": "assistant", "content": "The correct answer is DNA is cut into large fragments, using restriction enzymes. These fragments are then separated by gel electrophoresis (either agarose or polyacrylamide gel electrophoresis)." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All are chemokines except -" }, { "role": "assistant", "content": "The correct answer is Histamines are most impoant vasoactive amines , formed by decarboxylation of histidine found in granules of mast cells, basophils & in platelets. Reff: Ananthanarayan & Panikers textbook of microbiology 9th edition pg: 164" } ]

[ { "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: Antineoplastic Agents, Apoptosis, Dose-Response Relationship, Drug, Histones, Humans, JNK Mitogen-Activated Protein Kinases, K562 Cells, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Phosphorylation, Protein Kinase Inhibitors, RNA Interference, Resveratrol, Signal Transduction, Stilbenes, Time Factors, Transfection, p38 Mitogen-Activated Protein Kinases." }, { "role": "user", "content": "Does resveratrol induce apoptosis of human chronic myelogenous leukemia cells in vitro through p38 and JNK-regulated H2AX phosphorylation? Context: The phosphorylation of histone H2AX, a novel tumor suppressor protein, is involved in regulation of cancer cell apoptosis. The aim of this study was to examine whether H2AX phosphorylation was required for resveratrol-induced apoptosis of human chronic myelogenous leukemia (CML) cells in vitro. K562 cells were tested. Cell apoptosis was analyzed using flow cytometry, and the phosphorylation of H2AX and other signaling proteins was examined with Western blotting. To analyze the signaling pathways, the cells were transfected with lentiviral vectors encoding H2AX-wt or specific siRNAs. Treatment of K562 cells with resveratrol (20-100 μmol/L) induced apoptosis and phosphorylation of H2AX at Ser139 in time- and dose-dependent manners, but reduced phosphorylation of histone H3 at Ser10. Resveratrol treatment activated two MAPK family members p38 and JNK, and blocked the activation of another MAPK family member ERK. Pretreatment with the p38 inhibitor SB202190 or the JNK inhibitor SP600125 dose-dependently reduced resveratrol-induced phosphorylation of H2AX, which were also observed when the cells were transfected with p38- or JNK-specific siRNAs. Overexpression of H2AX in K562 cells markedly increased resveratrol-induced apoptosis, whereas overexpression of H2AX-139m (Ser139 was mutated to block phosphorylation) inhibited resveratrol-induced apoptosis. K562 cells transfected with H2AX-specific siRNAs were resistant to resveratrol-induced apoptosis." }, { "role": "assistant", "content": "H2AX phosphorylation at Ser139 in human CML cells, which is regulated by p38 and JNK, is essential for resveratrol-induced apoptosis. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adolescent, Antineoplastic Agents, Child, Child, Preschool, Daunorubicin, Disease-Free Survival, Doxorubicin, Female, Humans, Infant, Kaplan-Meier Estimate, Male, Precursor Cell Lymphoblastic Leukemia-Lymphoma." }, { "role": "user", "content": "Are doxorubicin or daunorubicin given upfront in a therapeutic window equally effective in children with newly diagnosed acute lymphoblastic leukemia . A randomized comparison in trial CoALL 07-03? Context: The anthracyclines daunorubicin (DNR) and doxorubicin (DOX) are among the most important drugs in the treatment of childhood acute lymphoblastic leukemia, however there are conflicting in vitro data about the comparative efficacy and equivalent doses of both anthracyclines. To address the question of in vivo efficacy of both anthracyclines, patients enrolled in the CoALL 07-03 trial were randomized to receive one single dose of either doxorubicin 30 mg/m(2) , daunorubicin 30 mg/m(2) , or daunorubicin 40 mg/m(2) upfront induction therapy. Children with newly diagnosed B-Precursor ALL or T-ALL were eligible for the randomized comparison. From the percentage of blasts and the white blood cell count (WBC) the absolute number of leukemic cells per µl peripheral blood (PB) was calculated and the initial value before DOX/DNR infusion equated as 100%. Main target criterion of this study was the leukemic cell decrease from Day 0 to Day 7. Seven hundred forty three patients were randomized: 247 to the DOX; 252 to the DNR 30 mg/m(2) ; and DNR to the 40 mg/m(2) arm. The in vivo response was similar in all three treatment arms with a comparable blast decline in the peripheral blood. The percentages of patients with a clear non-response (M3 marrow) and moreover, the level of minimal residual disease (MRD) on Day 15 or at the end of induction were similar." }, { "role": "assistant", "content": "In vivo efficacy of a single dose daunorubicin 30 or 40 mg/m(2) is similar to that of doxorubicin given in a dose of 30 mg/m(2) . 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: Adrenal Cortex Hormones, Adult, Aged, Antigens, CD20, Child, Chronic Disease, Female, Humans, Immunosuppressive Agents, Male, Middle Aged, Platelet Count, Purpura, Thrombocytopenic, Idiopathic, Remission Induction, Rituximab, Splenectomy, Treatment Failure." }, { "role": "user", "content": "Is splenectomy necessary for immune thrombocytopenic purpura? Context: Corticosteroid therapy followed by splenectomy for immune thrombocytopenic purpura (ITP) is the standard practice. Rituximab is mostly used in patients with chronic refractory ITP who have failed multiple previous treatments, including splenectomy. We explored the potential role of rituximab as an early therapeutic option for patients with corticosteroid-resistant ITP who preferred to avoid splenectomy in favor of other treatment. Twenty-five patients with corticosteroid-resistant ITP were treated with rituximab between May 1, 2009, and June 30, 2012, at a single center. Rituximab was administered at 100 mg/m(2) on days 7, 14, 21, and 28. The response to rituximab therapy and adverse effects were observed. Complete remission was achieved in 19 patients (76%), partial remission in 3 patients (12%), and minimal response in none of the patients; 1 patient was considered a treatment failure (4%). Two patients (8%) were lost to follow-up. Twenty-two patients (88%) achieved a platelet count>50 × 10(9)/L. The median time from administration of the first rituximab dose to partial remission was 2 months (range, 0.7-3 months) for all the patients. Response classified as sustained was achieved in 21 patients (84%). No serious adverse effects were observed during rituximab therapy." }, { "role": "assistant", "content": "Rituximab therapy is effective and safe for patients with corticosteroid-resistant ITP before splenectomy, resulting in high complete remission and overall response rates. A multicenter study with a larger sample should be performed to further explore the role of rituximab therapy." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adolescent, Australia, Bronchiectasis, Child, Cohort Studies, Cystic Fibrosis, Disease Outbreaks, Electrophoresis, Gel, Pulsed-Field, Female, Humans, Infection Control, Male, Methicillin-Resistant Staphylococcus aureus, Prevalence, Pseudomonas Infections, Pseudomonas aeruginosa, Young Adult." }, { "role": "user", "content": "Does australian epidemic strain pseudomonas ( AES-1 ) decline further in a cohort segregated cystic fibrosis clinic? Context: To evaluate changes in prevalence of an epidemic strain of Pseudomonas aeruginosa (AES-1, Australian epidemic strain, type 1) in a paediatric cystic fibrosis (CF) centre practising cohort segregation, to describe the patients' clinical characteristics at acquisition and observe mortality rates. Cohort segregation was introduced in our paediatric CF clinic January 2000. The prevalence of AES-1 was analysed in 1999, 2002 and 2007. Age at acquisition, lung function, presence of bronchiectasis, hospitalisations, prior P. aeruginosa infection and mortality rates were collected. AES-1 infection was determined by pulse-field-gel-electrophoresis (PFGE) on airway specimen cultures taken three monthly. The prevalence of AES-1 declined from 21% in 1999 to 14% in 2002 (risk difference 7% (95% CI 1,13) p=0.0256) and to 6% in 2007 (risk difference 8% (95% CI 3,13) p=0.0018). New acquisitions after the introduction of cohort segregation were uncommon (10 by 2002 and another 7 by 2007) with a declining incidence of 3.3 cases/year (1999 to 2002) compared to 1.4 cases/year (2002 to 2007). Twenty-two of 32 (69%) deaths between 1999 and 2007 occurred in patients infected with AES-1." }, { "role": "assistant", "content": "Cohort segregation has been associated with reductions in the prevalence of AES-1 in our CF clinic. Mortality was higher in patients infected with AES-1 than other organisms. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Which of the following is (are) Heredofamilial amyloidosis -a) Alzheimer's diseaseb) Multiple myelomac) Familial mediterranean fever d) RAe) Systemic senile amyloidosis" }, { "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: BACKGROUND, OBJECTIVES, RESULTS. Meshes: Blood Coagulation, Cardiolipins, Enzyme Activation, Enzyme Stability, Factor VIIa, Fibrinolysis, Heparin, Humans, Kinetics, Polyphosphates, Protein Denaturation, Recombinant Proteins, Serine Endopeptidases, Substrate Specificity, Thermolysin, Urokinase-Type Plasminogen Activator." }, { "role": "user", "content": "Factor seven activating protease (FSAP): does it activate factor VII? Context: Factor seven activating protease (FSAP) was initially reported as an activator of single-chain urokinase-type plasminogen activator (scuPA) and factor VII (FVII). Subsequently, numerous additional substrates have been identified, and multiple other biological effects have been reported. Due to the apparent lack of specificity, the physiological role of FSAP has become increasingly unclear. Rigorous studies have been limited by the difficulty of obtaining intact FSAP from blood or recombinant sources. Our aim was to produce intact recombinant human FSAP, and to assess its role as a trigger of coagulation and fibrinolysis. Expression of wild-type FSAP in various mammalian cells invariably resulted in the accumulation of degraded FSAP due to autoactivation and degradation. To overcome this problem, we constructed a variant in which Arg(313) at the natural activation site was replaced by Gln, creating a cleavage site for the bacterial protease thermolysin. HEK293 cells produced FSAP(R313Q) in its intact form. Thermolysin-activated FSAP displayed the same reactivity toward the substrate S-2288 as plasma-derived FSAP, and retained its ability to activate scuPA. Polyphosphate and heparin increased V(max) by 2-3-fold, without affecting K(m) (62 nm) of scuPA activation. Surprisingly, FVII activation by activated FSAP proved negligible, even in the presence of calcium ions, phospholipid vesicles and recombinant soluble tissue factor. On membranes of 100% cardiolipin FVII cleavage did occur, but this resulted in transient activation and rapid degradation." }, { "role": "assistant", "content": "While FSAP indeed activates scuPA, FVII appears remarkably resistant to activation. Therefore, reappraisal of the putative role of FSAP in hemostasis seems appropriate." } ]

[ { "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": "Delayed prolonged increase in vascular permeability in inflammation is due to:" }, { "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": "During surgery on the submandibular gland" }, { "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: BACKGROUND, METHODS, RESULTS. Meshes: Analgesics, Opioid, Anesthetics, Dissociative, Animals, Chronic Disease, Drug Synergism, Electric Stimulation, Female, Hyperalgesia, Ketamine, Long-Term Potentiation, Morphine, Nerve Fibers, Unmyelinated, Random Allocation, Rats, Rats, Sprague-Dawley, Spinal Cord, Time Factors." }, { "role": "user", "content": "Does ketamine block enhancement of spinal long-term potentiation in chronic opioid treated rats? Context: Long-term opioid treatment is associated with the development of hyperalgesia. In a rat model we wanted to study if chronic opioid treatment changed the induction and maintenance of spinal long-term potentiation (LTP), a form of hyperexcitability in the spinal cord. We also wanted to investigate if the clinically available NMDA receptor antagonist ketamine inhibited the effect of chronic opioid treatment on LTP. The animals were randomized into four groups (saline, morphine 20 mg/kg/day, ketamine 20 mg/kg/day, morphine 20 mg/kg/day and ketamine 20 mg/kg/day). Drugs were given as continuous subcutaneous infusions by means of osmotic minipumps. After 7 days of treatment and during ongoing treatment single unit extracellular recordings were made from the lumbar deep dorsal horn under urethane anesthesia. Single electrical stimuli were applied to the sciatic nerve, and the C-fiber evoked responses of WDR neurons were recorded before and during 3 h following low frequency (3 Hz) electrical conditioning stimulation. The potentiation of C-fiber evoked responses by conditioning stimulation was significantly increased in the morphine-treated group compared to the saline group, while there was no significant difference between the saline, the ketamine and the morphine/ketamine groups. The potentiated responses in the morphine/ketamine group were significantly reduced compared to the morphine group (P=0.01)." }, { "role": "assistant", "content": "Our results indicate that animals treated with long-term opioid show amplification of stimulus-induced central sensitisation compared to opioid naïve animals. Ketamine inhibited the morphine-induced enhancement of LTP, supporting the role of ketamine in prevention of opioid induced hyperalgesia. 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: Activities of Daily Living, Adolescent, Child, Cross-Sectional Studies, Dental Caries, Eating, Employment, Facial Pain, Family, Female, Gingival Diseases, Greece, Humans, Male, Prevalence, Single-Parent Family, Sleep, Socioeconomic Factors, Surveys and Questionnaires, Tooth Injuries, Toothache, Toothbrushing." }, { "role": "user", "content": "Is family structure associated with oral pain in 12-year-old Greek schoolchildren? Context: To determine the prevalence, associated correlates and impact of oral pain in 12-year-old schoolchildren in Stayroypoli, Greece. Cross-sectional survey of all schoolchildren attending the last year of government primary schools using self-administered questionnaires. Approval was granted by the Greek Ministry of Education and Religion. Cooperation was obtained from the schools. Children whose parents did not refuse their participation were invited to complete a questionnaire. Oral pain prevalence was estimated and association with sociodemographic/economic factors tested. Associations between pain experience and impact on daily activities were examined. Of the 296 children registered, 225 (76.0%) were present on the days data were collected. Usable questionnaires were completed by 187 children (83.1%). Oral pain in the previous 4 weeks, reported by 70 (37.4%), was more likely to affect children living with one parent/other people (OR 3.0, 95% CI = 1.2-7.4, P = 0.013) and those who brushed less than twice a day (OR 2.8, 1.5-5.2, P = 0.001). Impact on daily activities was reported by 64 children (91.4%). The most commonly stated impacts were eating (40.0%), cleaning teeth (25.7%) and sleeping (18.6%)." }, { "role": "assistant", "content": "Oral pain prevalence was high in 12-year-old schoolchildren in Stayroypoli, is associated with family structure, and impacts substantially on daily activities. 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": "Five sets of PCR primers were designed and sythesized, one for each of the viruses listed below. The viral genomic material from each virus was extracted and added to a PCR reaction containing a DNA-dependent Taq polymerase with the corresponding primers. However, of the five PCR reactions, only one yielded an amplified product as detected by gel agarose. From which of the following viruses did the PCR product arise?" }, { "role": "assistant", "content": "Adenovirus" } ]

[ { "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": "Does lignin monomer composition affect Arabidopsis cell-wall degradability after liquid hot water pretreatment? Context: Lignin is embedded in the plant cell wall matrix, and impedes the enzymatic saccharification of lignocellulosic feedstocks. To investigate whether enzymatic digestibility of cell wall materials can be improved by altering the relative abundance of the two major lignin monomers, guaiacyl (G) and syringyl (S) subunits, we compared the degradability of cell wall material from wild-type Arabidopsis thaliana with a mutant line and a genetically modified line, the lignins of which are enriched in G and S subunits, respectively. Arabidopsis tissue containing G- and S-rich lignins had the same saccharification performance as the wild type when subjected to enzyme hydrolysis without pretreatment. After a 24-hour incubation period, less than 30% of the total glucan was hydrolyzed. By contrast, when liquid hot water (LHW) pretreatment was included before enzyme hydrolysis, the S-lignin-rich tissue gave a much higher glucose yield than either the wild-type or G-lignin-rich tissue. Applying a hot-water washing step after the pretreatment did not lead to a further increase in final glucose yield, but the initial hydrolytic rate was doubled." }, { "role": "assistant", "content": "Our analyses using the model plant A. thaliana revealed that lignin composition affects the enzymatic digestibility of LHW pretreated plant material. Pretreatment is more effective in enhancing the saccharification of A. thaliana cell walls that contain S-rich lignin. Increasing lignin S monomer content through genetic engineering may be a promising approach to increase the efficiency and reduce the cost of biomass to biofuel conversion. 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": "False about HCG are all except :" }, { "role": "assistant", "content": "The correct answer is Non specific a and specific b - subunit" } ]

[ { "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, AIMS, METHODS, RESULTS. Meshes: Canada, Clinical Competence, Data Collection, Educational Measurement, Humans, Internship and Residency." }, { "role": "user", "content": "Assessing postgraduate trainees in Canada: are we achieving diversity in methods? Context: Resident evaluation is a complex and challenging task, and little is known about what assessment methods, predominate within or across specialties. To determine the methods program directors in Canada use to assess residents and their perceptions of how evaluation could be improved. We conducted a web-based survey of program directors from The Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited training programs, to examine the use of the In-Training Evaluation Report (ITER), the use of non-ITER tools and program directors' perceived needs for improvement in evaluation methods. One hundred forty-nine of the eligible 280 program directors participated in the survey. ITERs were used by all but one program. Of the non-ITER tools, multiple choice questions (71.8%) and oral examinations (85.9%) were most utilized, whereas essays (11.4%) and simulations (28.2%) were least used across all specialties. Surgical specialties had significantly higher multiple choice questions and logbook utilization, whereas medical specialties were significantly more likely to include Objective Stuctured Clinical Examinations (OSCEs). Program directors expressed a strong need for national collaboration between programs within a specialty to improve the resident evaluation processes." }, { "role": "assistant", "content": "Program directors use a variety of methods to assess trainees. They continue to rely heavily on the ITER, but are using other tools." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adenocarcinoma, Adolescent, Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, Deoxycytidine, Disease-Free Survival, Erlotinib Hydrochloride, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Male, Middle Aged, Neoplasm Staging, Pancreatic Neoplasms, Retrospective Studies, Survival Rate, Young Adult." }, { "role": "user", "content": "Does concomitant Statin Use have a Favorable Effect on Gemcitabine-Erlotinib Combination Chemotherapy for Advanced Pancreatic Cancer? Context: Erlotinib-gemcitabine combined chemotherapy is considered as the standard treatment for unresectable pancreatic cancer. This study aimed to determine the clinical factors associated with response to this treatment. This retrospective study included 180 patients with unresectable pancreatic cancer who received ≥2 cycles of gemcitabine-erlotinib combination therapy as first-line palliative chemotherapy between 2006 and 2014. \"Long-term response\" was defined as tumor stabilization after >6 chemotherapy cycles. The median progression-free survival (PFS) and overall survival (OS) were 3.9 and 8.1 months, respectively. On univariate analysis, liver metastasis (p=0.023) was negatively correlated with long-term response. Locally advanced stage (p=0.017), a history of statin treatment (p=0.01), and carcinoembryonic antigen levels <4.5 (p=0.029) had a favorable effect on long-term response. On multivariate analysis, a history of statin treatment was the only independent favorable factor for long-term response (p=0.017). Prognostic factors for OS and PFS were significantly correlated with liver metastasis (p=0.031 and 0.013, respectively). A history of statin treatment was also significantly associated with OS after adjusting for all potential confounders (hazard ratio, 0.48; 95% confidence interval, 0.26-0.92; p=0.026)." }, { "role": "assistant", "content": "These results suggest that statins have a favorable effect on \"long-term response\" to gemcitabine-erlotinib chemotherapy in unresectable pancreatic cancer patients. Statins may have a chemoadjuvant role in stabilizing long-term tumor growth. Final Decision: yes" } ]