Persius/hicric huggingface dataset:
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Search question could be broad or narrow based on the specific topic that you want to contribute. Questions related to the microchapters that need general information, such as pathophysiology could be started with broad questions, such as what is the pathogenesis of diabetes mellitus? And then be narrowed accordingly like, what is the role of beta cells dysfunction in pathogenesis of type 2 diabetes? Or even very narrow question like, what is the effect of the potassium pump block for insulin secretion in beta cells in type 2 diabetes?

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Radiopedia.org
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# How To Search Pubmed MeSH database
- The pubmed MeSH database can be used to search for MeSH terms that include heading, sub-headings and publications.
- MeSH is a vocabulary thesaurus used for indexing articles on pubmed.
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Hybrid coronary revascularization

# Overview
Hybrid coronary bypass is a relatively new procedure and alternative to traditional bypass surgery that is defined by the performance of coronary bypass surgery and coronary stenting during the same operation. It is not to be confused with a MIDCAB procedure, which uses the smaller thoracotomy incision but does not involve coronary stenting. Hybrid bypass offers all the benefits of a MIDCAB:
- A much smaller incision (made through the rib cage as opposed to cutting the sternum and opening the rib cage) than with traditional bypass surgery.
- Less pain for the patient and quicker recovery time.
- Less risk of complications, infections etc and also decreases the necessity for two separate cardiac procedures (bypass and stenting).
Not all hospitals and/or surgeons offer this procedure and it requires a specially equipped OR. As such, it is worth inquiring to determine which hospitals do and whether or not a patient can benefit from this procedure.

# 2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)

## Hybrid Coronary Revascularization (DO NOT EDIT)

# Related Chapters
- Coronary artery bypass surgery
- Percutaneous coronary intervention
Hypersomnia (patient information)
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Phone:617-632-7753; Associate Editor-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

# Overview
Idiopathic hypersomnia is excessive sleeping (hypersomnia) without an obvious cause. It is different from narcolepsy in that idiopathic hypersomnia does not involve suddenly falling asleep or losing muscle control associated with strong emotions (cataplexy).

# What are the symptoms of Hypersomnia?
- Symptoms often develop slowly during adolescence or young adulthood. They include:
- Daytime naps that do not relieve drowsiness
- Difficulty waking from a long sleep may feel confused or disoriented
- Increased need for sleep during the day even while at work, or during a meal or conversation
- Increased sleep time up to 14 - 18 hours per day
- Other symptoms may include anxiety, feeling irritated, low energy, restlessness, slow thinking or speech, loss of appetite, and memory difficulty.
- Cataplexy: suddenly falling asleep or losing muscle control which is part of narcolepsy, is NOT a symptom of idiopathic hypersomnia.

# What causes Hypersomnia?
- The usual approach is to consider other potential causes of excessive daytime sleepiness.
- Other sleep disorders that may cause daytime sleepiness include:
- Isolated sleep paralysis
- Narcolepsy
- Obstructive sleep apnea
- Restless leg syndrome
- Other causes of excessive sleepiness include:
- Atypical depression
- Certain medications
- Drug and alcohol use
- Low thyroid function (hypothyroidism)
- Previous head injury

# Diagnosis
- The health care provider will take a detailed sleep history. Tests may include:
- Multiple sleep latency test
- Sleep study (polysomnography, done to identify other sleep disorders)
- A psychiatric evaluation for atypical depression may also be done.

# Treatment options
- Idiopathic hypersomnia is usually treated with stimulant medications such as amphetamine, methylphenidate, and modafinil. These drugs may not work as well for this condition as they do for narcolepsy.
- Important lifestyle changes that can help ease symptoms and prevent injury include:
- Avoiding alcohol
- Avoiding operating motor vehicles or using dangerous equipment
- Avoiding working at night or social activities that delay bedtime

# Where to find medical care for Hypersomnia?
Directions to Hospitals Treating Hypersomnia

# Source
Hypertensive nephropathy overview

# Overview
- Hypertensive nephropathy is a chronic medical condition, characterized by  kidney injury due to long-standing high blood pressure.
- It should be distinguished from "renovascular hypertension", which is a type of secondary hypertension.

# Pathophysiology
- In the kidneys, as a result of benign arterial hypertension, hyaline (pink, amorphous, homogeneous material) accumulates in the wall of small arteries and arterioles, leading to thickening of arterial walls and narrowing of the lumens  hyaline arteriolosclerosis. Consequently, tubular atrophy and interstitial fibrosis will occur.
- Glomerular alterations (smaller glomeruli with different degrees of hyalinization - from mild to severe glomerulosclerosis) and podocyte loss can increase the endothelial permeability and filtration of remaining glomerules, leading to microalbuminuria and development of CKD
- Some studies suggest a genetic component in the development of hypertensive nephropathy and nephrosclerosis.

# Epidemiology and Demographics
- The incidence rate for hypertensive kidney disease has been increasing gradually over the past three decades.
- Annually, 25,000 new cases of CKD associated with hypertension, are diagnosed in the US.
- Hypertension is known as the second leading cause of ESRD.

# Diagnosis

# History and Symptoms
- Most of the patients with hypertensive nephropathy have no symptoms until kidney failure occurs.
Immigrant health care in the U.S.

# Overview
According to research done at the Urban Institute, the children of immigrants is the fastest growing segment of the child population. "Immigrant children will grow up to become a major segment of the US workforce in the coming years. Ensuring access to health services needed for proper growth and development should be a national priority."
"In one of the most comprehensive analyses to date on the costs and benefits of immigrants to the US economy, the National Research Council concluded that immigrants add as much as $10 billion to the economy each year and the immigrants will pay on average $80,000 per capita more in taxes than they use in government services over their lifetime."
In addition to managing physical, emotional, and family strains of immigration, these families find themselves in a social / political environment increasingly hostile to immigrants. Many families find it necessary for both parents to work one or more low wage, high risk jobs to meet basic economic needs, often placing women in the new role of family breadwinner.  Many families lack insurance and are not able to afford preventative care which would keep them healthier and less likely to be in need of more expensive emergency services. Some families are hesitant to participate in community activities and access necessary services, as they are fearful of discovery.
Infarct related artery morphology

# The morphology of the culprit artery is defined as:

## Eccentric
The plaque is twice as large on one side of the arterial border compared with the other. Stenosis noted to have one of its lumen edges in the outer one-quarter of the apparent normal lumen.

## Calcification
Readily apparent  densities noted within the apparent vascular wall at the site of the stenosis.

## Diffuse
Lesion is 20 mm in length.

## Bifurcation
Atherosclerotic plaque involves the origin of two separate arteries. It does not necessarily require two guidewires.

## Ostial
Lesion begins within 3-5 mm of the origin of a major epicardial artery.

## Pulsatile Flow
Cessation of antegrade flow during systole or frank flow reversal during systole. Codes as yes (present) or no (absent).

## Deceleration
Dye flow down the artery is slowed at any point during the course of flow.

# Reference
Posterior interventricular sulcus
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# Overview
The ventricles are separated by two grooves, one of which, the anterior longitudinal sulcus, is situated on the sternocostal surface of the heart, close to its left margin, the other posterior longitudinal sulcus (posterior interventricular sulcus, inferior interventricular groove), on the diaphragmatic surface near the right margin.
In it run the posterior interventricular artery and middle cardiac vein.
Infrared multiphoton dissociation
Infrared multiphoton dissociation (IRMPD) is a technique used in mass spectrometry to fragment molecules in the gas phase usually for structural analysis of the original (parent) molecule. 

# How it works
An infrared laser is directed through a window into the vacuum of the mass spectrometer where the ions are. The mechanism of fragmentation involves the absorption by a given ion of multiple infrared photons. The parent ion becomes excited into more energetic vibrational states until a bond(s) is broken resulting in gas phase fragments of the parent ion.
IRMPD is most often used in Fourier transform ion cyclotron resonance mass spectrometry.
Interferon alfacon-1 how supplied

# How Supplied
Use only one vial per dose; do not re-enter the vial. Discard unused portions. Do not save unused drug for later administration.
Single-use, preservative-free vials containing 9 mcg (0.3 mL) of interferon alfacon-1 are available in dispensing packs of 6 vials (NDC 66435-202-09).
Single-use, preservative-free vials containing 15 mcg (0.5 mL) of interferon alfacon-1 are available in dispensing packs of 6 vials (NDC 66435-201-15).
INFERGEN should be stored in the refrigerator at 2 C to 8 C (36 F to 46 F). Do not freeze. Avoid vigorous shaking and exposure to direct sunlight
Interferon alfacon-1 microbiology

# Microbiology

## Antiviral Activity in Cell Culture
The antiviral activity of INFERGEN, alone or in combination with ribavirin, against HCV or HCV-derived replicons in cell culture has not been determined.

## Resistance
HCV genotypes show wide variability in their response to interferon/ribavirin based therapies. Genetic changes associated with the variable response have not been identified. It has been reported that certain regions of the HCV genome, especially a region in the NS5B protein called IFN-sensitive determining region, may play a role in determination of a patients response to interferon treatment.

## Cross-resistance
The homology between interferon alfacon-1 and other type-I interferons, and the clinical responses for the different HCV genotypes are consistent with cross-resistance.
Interleukin 1 receptor antagonist
The interleukin-1 receptor antagonist (IL-1RA) is a protein that in humans is encoded by the IL1RN gene.
IL-1RA was initially called the IL-1 inhibitor and was discovered separately in 1984 by two independent laboratories. IL-1RA is an agent that binds non-productively to the cell surface interleukin-1 receptor (IL-1R), the same receptor that binds interleukin 1 (IL-1), preventing IL-1 from sending a signal to that cell.

# Function
IL-1RA is a member of the interleukin 1 cytokine family. IL1Ra is secreted by various types of cells including immune cells, epithelial cells, and adipocytes, and is a natural inhibitor of the pro-inflammatory effect of IL1. This protein inhibits the activities of interleukin 1, alpha (IL1A) and interleukin 1, beta (IL1B), and modulates a variety of interleukin 1 related immune and inflammatory responses. This gene and five other closely related cytokine genes form a gene cluster spanning approximately 400 kb on chromosome 2. Four alternatively spliced transcript variants encoding distinct isoforms have been reported.

# Clinical significance
A polymorphism of this gene is reported to be associated with increased risk of osteoporotic fractures and gastric cancer.
Mutations in the IL1RN gene results in a rare disease called deficiency of the interleukin-1receptor antagonist (DIRA). Variants of the IL1RN gene is also associated with risk of schizophrenia.  Elevated levels of IL1RN has been found in serum of schizophrenia patients.
A recombinant, slightly modified version of interleukin 1 receptor antagonist called anakinra is used in the treatment of rheumatoid arthritis, an autoimmune disease in which IL-1 plays a key role. Anakinra differs from native human IL-1Ra in that it has the addition of a single methionine residue at its amino terminus 

## Use in horses
Interleukin 1 receptor antagonist is used in horses for the treatment of equine lameness secondary to joint and soft-tissue injury.
International Chemical Identifier
The IUPAC International Chemical Identifier (InChI), developed by IUPAC and NIST, is a digital equivalent of the IUPAC name for any particular covalent compound. Chemical structures are expressed in terms of five layers of information  connectivity, tautomeric, isotopic, stereochemical, and electronic.  The stated aim of the InChI is to provide a standard way to structure and encode molecular information.
The InChI algorithm converts input structural information into the InChI identifier in a three-step process: normalization (to remove redundant information), canonicalization (to generate a unique set of atom labels), and serialization (to give a string of characters).
The InChIKey, sometimes referred to as a hashed InChI, is a fixed length (25 character) condensed digital representation of the InChI.  It was released in September 2007 in order to facilitate web searches for chemical compounds, since these were problematical with the full-length InChI.

# Examples

# Layer types
There are six InChI layer types:
- Main layer
- Charge layer
- Stereochemical layer
- Isotopic layer
- Fixed-H layer
- Reconnected Layer

# Sub-layers
Each layer can be split into sub-layers. For example, the main layer can be split up into three sub-layers:
- Chemical formula (no prefix)
- Atom connections (prefix: "c")
- Hydrogen atoms (prefix: "h")

# Notation
Layers and sub-layers are both separated by the "/" delimiter. All layers and sub-layers (except for the chemical formula sub-layer of the main layer) start with a lower-case letter indicating the type of information held in that layer.

# InChIKey
The condensed, 25 character InChIKey is a hashed version of the full InChI, designed to allow for easy web searches of chemical compounds.  Most chemical structures on the Web up to 2007 have been represented as GIF files, which are not searchable for chemical content.  The full InChI turned out to be too lengthy for easy searching, and therefore the InChIKey was developed.  There is a very small, but finite chance of two different molecules having the same InChIKey, but the probability for duplication of only the first 14 characters has been estimated as only one duplication in 75 databases each containing one billion unique structures.  With all databases currently having below 50 million structures, such duplication appears unlikely at present.
Morphine has the structure shown on right.
The InChI for morphine is  	 InChI=1/C17H19NO3/c1-18-7-6-17-10-3-5-13(20)16(17)21-15-12(19)4-2-9(14(15)17)8-11(10)18/h2-5,10-11,13,16,19-20H,6-8H2,1H3/t10-,11-,13-,16-,17-/m0/s1
but the InChIKey for morphine is simply BQJCRHHNABKAKU-XKUOQXLYBY
International Nonproprietary Name

# Overview
An International Nonproprietary Name (INN; also known as rINN, for recommended International Nonproprietary Name) is the official non-proprietary or generic name given to a pharmaceutical substance, as designated by the World Health Organization (WHO). The plethora of named proprietary preparations containing a given substance can lead to confusion about the identity of the active ingredient.
INNs facilitate communication by providing a standard name for each substance. A similar role is played in chemistry by IUPAC names; however, these are less suited to common usage, being typically very long and unwieldy.
WHO issues INN names in English, Latin, French, Russian, and Spanish; Arabic and Chinese versions, although not included in the original scheme, are now also being issued.

# Name stems
Drugs from the same therapeutic or chemical class are usually given names with the same stem. Stems are mostly placed word-finally, but in some cases word-initial stems are used. They are collected in a publication informally known as the Stem Book.
Example stems are:
- -anib for angiogenesis inhibitors (e.g. pazopanib)
- -anserin for serotonin receptor antagonists, especially 5-HT2 antagonists (e.g. ritanserin and mianserin)
- -arit for antiarthritic agents (e.g. lobenzarit)
- -ase for enzymes (e.g. asparaginase)
- -azepam for benzodiazepines (e.g. diazepam and oxazepam)
- -caine for local anaesthetics (e.g. procaine or cocaine)
- -cain- for class I antiarrhythmics (e.g. procainamide)
- -coxib for COX-2 inhibitors, a type of anti-inflammatory drugs (e.g. celecoxib)
- -mab for monoclonal antibodies (e.g. infliximab);
see Nomenclature of monoclonal antibodies
- see Nomenclature of monoclonal antibodies
- -navir for antiretroviral protease inhibitors (e.g. darunavir)
- -olol for beta blockers (e.g. atenolol)
- -pril for ACE inhibitors (e.g. captopril)
- -sartan for angiotensin II receptor antagonists (e.g. losartan)
- -tinib for tyrosine kinase inhibitors (e.g. imatinib)
- -vastatin for HMG-CoA reductase inhibitors, a group of cholesterol lowering agents (e.g. simvastatin)
- -vir for antivirals (e.g. aciclovir or ritonavir)
- arte- for artemisinin antimalarials (e.g. artemether)
- cef- for cefalosporins (e.g. cefalexin)
- io- for iodine-containing radiopharmaceuticals (e.g. iobenguane)

# Example
Johansson-Sinding-Larsen syndrome
Synonyms and keywords: Aseptic necrosis of patella, Osteochondrosis of patella, Sinding-Larsen-Johansson Syndrome.

# Overview
Sinding-Larsen-Johansson Syndrome is a type of osteochondrosis affecting the attachment of the patellar tendon to the patella and characterised by tenderness and localized swelling of the patella.

# Pathophysiology
The mechanism in Sinding-Larsen Johansson disease is the persistent traction at the cartilaginous junction of the patella and the patellar ligament/tendon, usually at the inferior patellar pole causing bone fragmentation of the inferior portion of the patella. It is essentially a chronic stress injury with overuse of the patella-patellar tendon junction.

# Causes
Things that can contribute to developing Sinding-Larsen-Johansson Syndrome include recent growth spurts, inappropriate or a sudden increase in training or sporting activity, inappropriate footwear, lower limb muscle tightness or weakness particularly the quadriceps, poor foot posture, tight lateral retinaculum or patella malalignment, poor lower limb dynamic stability and poor lower limb biomechanics.

# Differentiating type page name here from other Diseases
Patella avulsion fractures, Patella stress fracture, Bipartite patella (type I), Osgood-Schlatter disease, Jumper's knee.

# Epidemiology and Demographics
Prevalence is unknown. This disease occurs mostly in adolescents who are active during their growth spurts, especially in young male athletes practising sport.

# Diagnosis

## Symptoms
Sinding-Larsen-Johansson Syndrome causes activity-related anterior knee pain.On examination there is inferior patella tenderness. Pain, swelling or tenderness is felt at the base of the patella, where the patellar tendon inserts into the patella.

## Laboratory Findings
Knee X-ray: can show calcification or ossification at the junction between the patella and the patella ligament.

### MRI
MRI scan can be used.

# Treatment
Rest:Limit the activities as much as possible and keep the weight off your knee.
Ice: Apply ice or a cold compress to the affected area for 15-20 minutes every few hours for 2 to 3 days or until the pain goes away.
Compress: Give your knee added support by using a brace, band, or strap.
Elevate: Try to keep the knee higher than your heart to help keep the swelling down.
Physiotherapy assessment and treatment is highly recommended in the treatment of Sinding-Larsen-Johansson Syndrome. Most patients with this condition heal extremely well with appropriate physiotherapy. Treatment success is largely dictated by patient compliance.

## Pharmacotherapy
Painkillers like ibuprofen and acetaminophen can help relieve pain and reduce swelling.

## Primary Prevention
Stop doing an activity that causes pain in the knee at first signs of irritation. Try to limit the activity until the pain goes away. It's vital to warm up well and stretch before exercising or playing sports. Take a light jog around the track or field for a few minutes to get your blood circulating, then do some dynamic stretching. Massage is beneficial to reduce chronic tightness in your quadriceps, hamstrings, adductors or calf muscles.