Persius/hicric huggingface dataset:
Neutrophil elastase
Neutrophil elastase (EC 3.4.21.37, leukocyte elastase, ELANE, ELA2, elastase 2, neutrophil, elaszym, serine elastase, subtype human leukocyte elastase (HLE)) is a serine proteinase in the same family as chymotrypsin and has broad substrate specificity. Secreted by neutrophils and macrophages during inflammation, it destroys bacteria and host tissue. It also localizes to Neutrophil extracellular traps (NETs), via its high affinity for DNA, an unusual property for serine proteases.
As with other serine proteinases it contains a charge relay system composed of the catalytic triad of histidine, aspartate, and serine residues that are dispersed throughout the primary sequence of the polypeptide but that are brought together in the three dimensional conformation of the folded protein. The gene encoding neutrophil elastase, ELA2, consists of five exons. Neutrophil elastase is closely related to other cytotoxic immune serine proteases, such as the granzymes and cathepsin G. It is more distantly related to the digestive CELA1.
The neutrophil form of elastase (EC 3.4.21.37) is 218 amino acids long, with two asparagine-linked carbohydrate chains (see glycosylation). It is present in azurophil granules in the neutrophil cytoplasm. There appear to be two forms of neutrophil elastase, termed IIa and IIb.

# Gene
In humans, neutrophil elastase is encoded by the ELANE gene, which resides on chromosome 19.

# Function
Elastases form a subfamily of serine proteases that hydrolyze many proteins in addition to elastin. Humans have six elastase genes that encode the structurally similar proteins elastase 1, 2, 2A, 2B, 3A, and 3B. Neutrophil elastase hydrolyzes proteins within specialized neutrophil lysosomes, called azurophil granules, as well as proteins of the extracellular matrix following the protein's release from activated neutrophils. Neutrophil elastase may play a role in degenerative and inflammatory diseases by its proteolysis of collagen-IV and elastin of the extracellular matrix. This protein degrades the outer membrane protein A (OmpA) of E. coli as well as the virulence factors of such bacteria as Shigella, Salmonella and Yersinia. Mutations in this gene are associated with cyclic neutropenia and severe congenital neutropenia (SCN). This gene is clustered with other serine protease gene family members, azurocidin 1 and proteinase 3 genes, at chromosome 19pter. All 3 genes are expressed coordinately and their protein products are packaged together into azurophil granules during neutrophil differentiation.

# Clinical significance
Neutrophil elastase is an important protease enzyme that when expressed aberrantly can cause emphysema or emphysematous changes.  This involves breakdown of the lung structure and increased airspaces. Mutations of the ELANE gene cause severe congenital neutropenia, which is a failure of neutrophils to mature.

# Inhibitors
In order to minimize damage to tissues, there are few inhibitors of neutrophil elastase. One group of inhibitors are the Serpins (Serine Protease Inhibitors). Neutrophil elastase has been shown to interact with Alpha 2-antiplasmin, which belongs to the Serpin family of proteins.
Hydroa vacciniforme

# Overview
Hydroa vacciniforme' (HV) is a very rare, chronic photodermatitis-type skin condition with usual onset in childhood. It was first described in 1862 by Bazin. It is sometimes called "Bazin's hydroa vacciniforme". A study published in Scotland in 2000 reviewed the cases of 17 patients and estimated a prevalence of 0.34 cases per 100,000 population.  In this study they reported an average age of onset of 7.9 years. Frequently the rash first appeared in the spring or summer months and involved sun-exposed skin.  The rash starts as a vesicular eruption, later becoming umbilicated, and resulted in vacciniform scarring. It is most frequently found on the nose, cheeks, ears, dorsum of the hand, and arms (places that are most exposed to light).

# Natural History
In many children hydroa vacciniforme (HV) regresses spontaneously by early adulthood. In the 29 patients followed by Iwatuski et al, 11 of the 18 with definite or probable HV were available for follow-up and all were alive without progression of their symptoms. Some had recurrent eruptions of HV. In contrast out of 11 severe patients in this study, 6 had evidence of chronic EBV infection, 5 had hypersensitivity to mosquito bites, 4 had virus-associated hemophagocytic syndrome. 6 of the severe group had natural killer-cell lymphocytosis in the peripheral blood.

# Physical examination

## Gallery

### Head
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### Trunk
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# Histology
Histology of the affected area commonly shows dense perivascular lymphocytic infiltration with reticulated degeneration of the epidermis. A study by Iwatsuki et al. detected Epstein-Barr virus (EBV) positive T-cells in the perivascular infiltration on biopsy in 28/29 patients tested. Antibody titers to EBV were measured in 14 of these patients and only five had abnormal antibody patterns consistent with chronic active EBV infection.

# Medical Therapy
Antiviral treatment has been tried with some success in a small number of patients. In some cases, Heliocare Ultra-D capsules have proven to be a success in the treatment of the disease.
Hydrolysis constant
A hydrolysis constant is an equilibrium constant for a hydrolysis reaction.
For example, if a metal salt such as AlCl3 dissolves in an aqueous solution, the metal cation behaves as a Lewis acid and hydrolyzes the water molecules in the solvent.
The hydrolysis constant for this reaction is:
In a more generalized form, the hydrolysis constant can be described as:
where A- represents any base, and HA represents any acid.
Hypocholesterolemia

# Overview
Hypocholesterolemia is the presence of abnormally low (hypo-) levels of cholesterol in the blood (-emia). Low cholesterol levels can be defined as a total cholesterol and LDL-C levels inferior to the 5th percentile of the general population adjusted for age, gender and race.  The cut-off point used to define hypocholetsterolemia lies between 120 mg/dl  and 150m/dl.

# Causes
Possible causes of low cholesterol are:
- hyperthyroidism, or an overactive thyroid gland
- liver disease
- malabsorption (inadequate absorption of nutrients from the intestines)
- malnutrition
- celiac disease
- abetalipoproteinemia - a rare genetic disease that causes cholesterol readings below 50mg/dl. It is found mostly in Jewish populations.
- hypobetalipoproteinemia - a genetic disease that causes cholesterol readings below 50mg/dl
- manganese deficiency
- Smith-Lemli-Opitz syndrome
- HIV infection

# Natural History, Complications, and Prognosis
With the increased use of medication to suppress cholesterol, some have expressed concern that lowering cholesterol levels excessively will itself cause disease. While hypercholesterolemia, the presence of high cholesterol, has been linked strongly with cardiovascular disease, it is much less certain whether low cholesterol levels are intrinsically harmful.

## Specific disease entities
Demographic studies suggest that cholesterol levels form an U-shape curve when plotted against mortality; this suggests that low cholesterol is associated with increased mortality, mainly due to depression, cancer, hemorrhagic stroke and respiratory diseases. It is possible that whatever causes the low cholesterol level also causes mortality, and that the low cholesterol is simply a marker of poor health.
Links with depression have been supported by studies. In contrast, no evidence was found for a link with hemorrhagic stroke (although higher cholesterol levels conferred a relative protection), and neither did statin drugs worsen the risk.
The Heart Protection Study found no increase in either respiratory disease or neuropsychiatric illness in a large trial population taking a statin drug.

## Elderly
In the elderly, low cholesterol may confer a health risk that may not be offset by the beneficial effects of cholesterol lowering. Similarly, for elderly patients admitted to hospital, low cholesterol may predict short-term mortality

## Critical illness
Low cholesterol levels are predictive of clinical deterioration, and are correlated with altered cytokine levels.
Low cholesterol might be a prognostic sign in hospitalized patients.
Low cholesterol might be a prognostic sign in viral liver cirrhosis.

# Diagnosis

## Laboratory Findings
According to most authorities, only total cholesterol levels below 160 mg/dL or 4.1 mmol/l are to be classified as "hypocholesterolemia".
Hypolipidemic agent
Hypolipidemic agents, or antihyperlipidemic agents, are a diverse group of pharmaceuticals that are used in the treatment of hyperlipidemias. They are called lipid-lowering drugs (LLD) or agents.

# Classes of hypolipidemic drugs
There are several classes of hypolipidemic drugs. They may differ in both their impact on the cholesterol profile and adverse effects.  For example, some may lower the "bad cholesterol" low density lipoprotein (LDL) more so than others, while others may preferentially increase high density lipoprotein (HDL), "the good cholesterol". Clinically, the choice of an agent will depend on the patient's cholesterol profile, cardiovascular risk, and the liver and kidney functions of the patient, evaluated against the balancing of risks and benefits of the medications. In the United States, this is guided by the evidence-based guideline from the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII).
- statins are particularly well-suited for lowering LDL, the cholesterol with the strongest links to cardiovascular diseases. In studies using standard doses, statins have been found to lower LDL-C by 18% to 55%, depending on the specific statin being used.  There is a risk of severe muscle damage (myopathy & rhabdomyolysis) with statins.
- fibrates are indicated for hypertriglyceridemia.  Fibrates typically lower triglycerides by 20% to 50%. Level of the good cholesterol HDL is also increased. Fibrates may decrease LDL, though generally to a lesser degree than statins.  Similar to statins, there is a risk of severe muscle damage (myopathy & rhabdomyolysis) with fibrates.
- niacin, like fibrates, is also well-suited for lowering triglycerides by 20-50%. It may also lower LDL by 5-25% and increase HDL by 15-35%.  Niacin may cause hyperglycemia, and may also cause liver damage.
- bile acid sequestrants (resins) are particularly effective for lowering LDL-C by sequestering the cholesterol-containing bile acids released into the gut and preventing their reabsorption from the gut. It decreases LDL by 15-30% and raises HDL by 3-5%.  It has little effect on triglycerides but can cause a slight increase.  Bile acid sequestrants may cause gastrointestinal problems, and may also reduce the absorption of other drugs and vitamins from the gut.
- ezetimibe (Zetia) is a selective inhibitor of dietary cholesterol absorption.
- phytosterols may be found naturally in plants.  Similar to ezetimibe, phytosterols reduce the absorption of cholesterol in the gut.  Hence, they are most effective when consumed with meals.  However, the precise mechanism of action of phytosterols differs from ezetimibe.
Investigational classes of hypolipidemic agents:
- CETP Inhibitors (cholesteryl ester transfer protein inhibitors) are still under development.  It is expected that these drugs will mainly increase HDL while lowering LDL.
- squalene synthase inhibitor
- ApoA-1 Milano
- AGI-1067
ICU scoring systems

# Overview
There are several scoring systems in intensive care units (ICUs) today.

# Adult scoring systems
These scoring systems can be used on patients age 15 and up.
- APACHE II was designed to provide a morbidity score for a patient. It is useful to decide what kind of treatment or medicine is given. Methods exist to derive a predicted mortality from this score, but these methods are not too well defined and rather unprecise.
- SAPS II was designed to provide a predicted mortality, that does not reflect the expected mortality for a particular patient, but is good for benchmarking. In a rather simple way, it makes it possible to provide a single number that describes the morbidity of a number of patients.
- SAPS III was designed to provide a realistic predicted mortality for a particular patient or a particular group of patients. It does this by calibrating against known mortalities on an existing set of patients, for a specific definition of mortality (like 30-days mortality). This way, it can answer questions like "Did we improve our quality of care from 2004 to 2005?" or "If hospital A's patients had been treated at hospital B, would they have a better or a worse mortality?".

# Children scoring systems
- PIM2 delivers a predicted mortality value, intended to be used for benchmarking.

# Other scoring systems
- SOFA was designed to provide a simple daily score, that indicates how the status of the patient evolves over time.
- Glasgow Coma Scale (also named GCS) is designed to provide the status for the central nervous system. It is often used as part of other scoring systems.
Iatrogenic artifact

# Overview
An iatrogenic artifact is a disease made up by doctors, often a diagnostic trend or fad that has become or is expected to become obsolete or discredited.
Examples of diseases considered or accused of being iatrogenic artifacts include nymphomania, hystero-epilepsy, repressed memory, autogynephilia, and multiple personality disorder.
In many cases, it has been shown that "experts" who believe in the disease are able to observe or even induce symptoms matching the disease's description in suggestible patients. In the case of hystero-epilepsy, it was shown that moving those allegedly afflicted with the disease into different settings made their symptoms disappear.
The concept of iatrogenic artifact has important implications for those who diagnose "diseases" of behavior.
Icthycosis acquista

# Overview
Ichthyosis acquisita (or "acquired ichthyosis") is a disorder clinically and histologically similar to ichthyosis vulgaris.:565

# Associated conditions
The development of ichthyosis in adulthood can be a manifestation of systemic disease, and it has been described in association with malignancies, drugs, endocrine and metabolic disease, HIV, infection, and autoimmune conditions.:494
It usually is associated with people who have Hodgkin's disease but it is also occurs in people with mycosis fungoides, other malignant sarcomas, Kaposi's sarcoma and visceral carcinomas. It can occur in people suffering from leprosy, AIDS, tuberculosis, and typhoid fever.

# Diagnosis

## Physical Examination

### Skin
Ignoring Formatting

# Overview
Sometimes there is value in displaying the underlying code so that others can learn how to edit pages.
This is called ignoring formatting.
There are 3 ways to ignore the formatting:
- Surrond the text with the words  text .
- Put a space in front of the text.
- Use the editing toolbox to highlight the words and use the 9th button from the left (a w with a red line through it).

# Using  Tags
Wiki formatting can be ignored by using the  and  tags.  This is particularly handy when writing tutorials on how to use wikimarkup and templates.  Examples of the former use can be seen throughout the Editing Help Area. The quick button for inserting non-wikiformatted text is above the edit box, third button from the right.
Here is an example of a normal wiki table that has simply been surrounded by the  tags:
{| border="1"
(Note: normally, any excerpt of code should really be surrounded with the  tags, the  tags, or with leading spaces to match W3C convention. The above example was not due to it being a literal representation of what a naked table would look like.)
When you click on "edit", the above looks like this:
Without the  tags, the above wikimarkup will normally produce a bordered table with a grey background color:
It should be noted that many people are using a leading space in combination with the  tags. This is inefficient. The  tags should be used instead.

# Using  Tags
Note that even surrounded by  tags, the output text for the table still got mushed onto one line. By default, the wiki ignores line breaks and repeated whitespace. In order to preserve your original line breaks and tabs, you need to use tags to inform the wiki that your material is pre-formatted. If you surround your poem with  and , the wiki will respect your use of whitespace.
Using the  tag stops the wiki from altering the layout (line breaks and whitespace). In addition, the  tag blocks wiki markup. The  tag will also place your text inside a grey box with a dashed blue outline.
For example, the following code in the edit window:
comes out as:
Markup symbols and links contained inside the  tags are ignored -- the code inside the blue-dashed box below looks exactly like the same as it appears in the edit window:

# Using Leading Space
In order to preserve line breaks and whitespace while still using wiki markup, put a space in front of each line of the block of text. Any series of one or more lines that each begin with a space will be placed inside a blue-dashed box. The layout and whitespace seen in the editing window will be preserved, while all the wiki markup (such as bold, italics, signatures, and links) will be interpreted normally.
For example, the following code in the edit window:
will produce:
This line doesn't have    leading space.    Whitespace is ignored.
Implementation Plan

# Plans for 2013-2014
- Goal: Differentiate our Wiki community from other well known Wikis (such as Wikipedia).
- Emphasize our focus on sub-specialty based approach.
- Redefine "the myth of copyleft reliability"
- High quality content that is open, free, without commercial bias
- Helping our end-users better understand "the culture of Wiki" and what a Wiki is used for.
- Goal: Continue to curate high quality training materials.
- Implement a mentoring system (similar to fraternities Big/Little programs) with both on-site and remote fellows
- Review training tools for consistency and ensure information is up to date.  Create more videos for training.
- Goal: Build out our team-based approach.
- Allow for mastery-based teams
- Allow for individuals to self-select teams based on interest.
- Goal: Engage more English speaking premedical students.
- Start a campaign to write to medical schools.
- Create a database of medical school deans.  Collect contact information for these individuals + AMSA leaders on campuses.
- Goal: Engage retired doctors to serve as overseers for team-based approach.
- Potential methods to do this: NEJM ad, social media-based (LinkedIn, Twitter, etc)
- Goal: Perfect the template for the housestaff page.
- This will give identity to program and allow for individuals to step up into leadership roles to facilitate involvement.
- Goal: Create better content on Why Volunteer?
- Increase exposure to foreign medical graduates who may see this as a way to help them on their aspirations to gain access to US residency programs.
Impression (Dental)
A dental impression may be described as  an accurate representation of part or all of a person's dentition and other areas of the mouth. It forms a "negative" of a person's teeth and gums which can then be used to make a cast or model (physical) of the dentition. This may be used for the fabrication of dentures, crowns or other prostheses.
An impression is carried out by placing a viscous liquid material into the mouth usually in a customised tray. The material then sets to become an elastic solid, and when removed from the mouth retains the shape of the teeth.
Common materials used for dental impressions are sodium alginate, polyether and silicones - both condensation-cured silicones and addition-cured silicones (Polyvinyl siloxane).  Historically plaster of paris, zincoxide/eugenol and agar have been used.
In-Methylcyclophane
In-Methylcyclophanes are organic compounds and members of a larger family of cyclophanes. These compounds only exist in the laboratory and help to explain how chemical bonds in molecules adapt to strain. In-methylcyclophanes in particular have a methyl group in proximity to a benzene ring. This is only possible when both methyl group and ring are attached to the same rigid scaffold. In one In-methylcyclophane molecule this is accomplished with a triptycene frame .
This particular compound is synthesed starting from anthracene with a methyl group added to each arene ring (1,8,9-trimethylanthracene). A triptycene compound is formed from a reaction of this anthracene compound with an aryne in a Diels-Alder reaction in isoamyl nitrite. In this synthesis the precursor to the reactive aryne is 2-amino-6-methylbenzoic acid. Next the methyl substituents are functionalized with bromine groups by the photochemical reaction with N-bromosuccinimide or NBS. The final cyclophane is put together by reaction with 1,3,5-tris(mercaptomethyl)benzene with  nucleophilic sulfhydryl groups and electrophilic alkyl bromides in a Nucleophilic aliphatic Substitution.
X-ray crystallography of the tri-sulfone derivative of this cyclophane shows that the methyl group located 2.896 angstroms (289.6 picometers) from the center of the benzene ring. The carbon to carbon bond linking the methyl group to the triptycene frame is actually shortened and measures 1.475 to 1.495 angstroms (147.5 to 149.5 pm). The similar bond in the triptycene precursor is 1.54 angstroms (154 pm). Proton NMR analysis shows a chemical shift of 2.52 ppm for the methyl protons compared to that of 3.16 to 3.85 in the anthracene compound. The reason for this anomaly is that the methyl protons are in line with the Aromatic ring current of the benzene ring and are therefore severely shielded. In certain paracyclophanes bridging methylene protons can even experience negative chemical shifts in proton NMR.
Infraorbital artery
The infraorbital artery is an artery in the head that runs in the maxilla, emerging just under the orbit of the eye.

# Course
The infraorbital artery appears, from its direction, to be the continuation of the trunk of the maxillary artery, but often arises in conjunction with the posterior superior alveolar artery.
It runs along the infraorbital groove and canal with the infraorbital nerve, and emerges on the face through the infraorbital foramen, beneath the infraorbital head of the levator labii superioris muscle.

## Branches
While in the canal, it gives off
- (a) orbital branches which assist in supplying the rectus inferior and inferior oblique and the lacrimal sac, and
- (b) anterior superior alveolar arteries - branches which descend through the anterior alveolar canals to supply the upper incisor and canine teeth and the mucous membrane of the maxillary sinus.
On the face, some branches pass upward to the medial angle of the orbit and the lacrimal sac, anastomosing with the angular artery, a branch of the facial artery; others run toward the nose, anastomosing with the dorsal nasal branch of the ophthalmic artery; and others descend between the levator labii superioris and the levator anguli oris, and anastomose with the facial artery, transverse facial artery, and buccal artery.
The four remaining branches arise from that portion of the maxillary artery which is contained in the pterygopalatine fossa.

# Additional images
- Diagram showing the origins of the main branches of the carotid arteries.
- Plan of branches of internal maxillary artery.
- Bloodvessels of the eyelids, front view.