Persius/hicric huggingface dataset:
Arytenoid cartilage

# Overview
The arytenoid cartilages are a pair of small three-sided pyramids which form part of the larynx, to which the vocal cords are attached.
Each is pyramidal in form, and has three surfaces, a base, and an apex.

## Surfaces
The posterior surface is a triangular, smooth, concave, and gives attachment to the Arytnoidei obliquus and transversus.
The antero-lateral surface is somewhat convex and rough. On it, near the apex of the cartilage, is a rounded elevation (colliculus) from which a ridge (crista arcuata) curves at first backward and then downward and forward to the vocal process. The lower part of this crest intervenes between two depressions or fove, an upper, triangular, and a lower oblong in shape; the latter gives attachment to the Vocalis muscle.
The medial surface is narrow, smooth, and flattened, covered by mucous membrane, and forms the lateral boundary of the intercartilaginous part of the rima glottidis.

## Base and apex
The base of each cartilage is broad, and on it is a concave smooth surface, for articulation with the cricoid cartilage.
- Its lateral angle is short, rounded, and prominent; it projects backward and lateralward, and is termed the muscular process; it gives insertion to the posterior cricoarytenoid muscles behind, and to the lateral cricoarytenoid muscles in front.
- Its anterior angle, also prominent, but more pointed, projects horizontally forward; it gives attachment to the vocal ligament, and is called the vocal process.
The apex of each cartilage is pointed, curved backward and medialward, and surmounted by a small conical, cartilaginous nodule, the corniculate cartilage.

# Function
They allow the vocal cords to be tensed, relaxed, or approximated.
The arytenoids articulate with the supero-lateral parts of the cricoid cartilage lamina, forming the cricoarytenoid joints at which they can come together, move apart, tilt anteriorly or posteriorly, and rotate.

# Additional images
- Sagittal section of the larynx and upper part of the trachea.
- The entrance to the larynx, viewed from behind.
- Muscles of the larynx, seen from above.
Ascending paralysis

# Overview
Ascending paralysis refers to a form of paralysis where the presentation appears in the lower limbs before the upper limbs.
It can be associated with:
- Guillain-Barre syndrome (another name for this condition is "Landry's ascending paralysis")
- Tick paralysis
It can be contrasted to "descending paralysis", which occurs in conditions such as botulism.
Asystasia gangetica
Asystasia gangetica, a species in the plant family Acanthaceae, occurs throughout the tropics.
In some parts of Africa, the leaves are eaten as a vegetable.  It is also used as an ornamental plant.
It is commonly known as Chinese violet, or by incorrect synonyms Asystasia bojeriana Ness, Asystasia coromandelina Ness and Justicia gangetica L..
Atypical depression

# Overview
Atypical Depression (AD) is a subtype of Dysthymia and Major Depression characterized by mood reactivity  being able to experience improved mood in response to positive events.  In contrast, sufferers of  "melancholic" depression generally cannot experience positive moods, even when good things happen.  Additionally, atypical depression is characterized by reversed vegetative symptoms, namely over-eating and over-sleeping.
Despite its name, "atypical" depression is actually the most common subtype of depression  up to 40% of the depressed population may be classified as having atypical depression.

# Diagnostic criteria (DSM-IV-TR)
The DSM-IV-TR, a widely used manual for diagnosing mental disorders, defines Atypical Depression as a subtype of depression or dysthymia, characterized by Atypical Features:
- Significant weight gain or increase in appetite ("comfort eating")
- Hypersomnia (sleeping too much, as opposed to the insomnia present in melancholic depression)
- Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
- long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment
By the ICD-10 classification, it will fall in the category of F32 or F39.

# Research
In general, atypical depression tends to cause greater functional impairment than other forms of depression.  Atypical depression is a chronic syndrome that tends to begin earlier in life than other forms of depression  usually beginning in teenage years.  Similarly, patients with atypical depression are more likely to suffer from other psychiatric syndromes such as panic disorder, social phobia, avoidant personality disorder, or body dysmorphic disorder.  Atypical depression is more common in females  nearly 70% of the atypical population are women.
Medication response differs between chronic atypical depression and acute melancholic depression.  While some studies suggest that an older class of drugs, MAOIs, may be more effective at treating atypical depression, the modern SSRIs are usually quite effective, while the tricyclic antidepressants are not.  In addition, SSRI response can often be enhanced with "booster" medications.  And, medication treatment works best when combined with appropriate psychotherapy.  It is important to remember that such co-morbid syndromes as panic disorder may not be fully treated without additional medication.
It has been noted that patients with atypical depression often suffer from intense cravings for carbohydrates.  A mineral supplement, chromium picolinate, was found to assuage these cravings in one study, though the conclusion reached has not been replicated.
Some hypothesize that atypical depression may be related to thyroid dysregulation.  Some studies have found subtle thyroid abnormalities in people with atypical depression.  Another study suggests that patients may benefit from triiodothyronine, a medication used to treat hypothyroidism.
Reactive lymphocyte

# Overview
Reactive lymphocytes are lymphocytes that become large as a result of antigen stimulation. Typically they can be more than 30 m in diameter with varying size and shape.
The nucleus of a reactive lymphocyte can be round, elliptic, indented, cleft or folded. The cytoplasm is often abundant and can be basophilic. Vacuoles and/or azurophilic granules are also sometimes present. Most often the cytoplasm is gray, pale blue or deep blue in colour.
The distinctive cell associated with EBV or CMV is known as a "Downey cell", after Hal Downey, who contributed to the characterization of it in 1923. It is sometimes erroneously called a "Downy cell".

# Causes
Reactive lymphocytes are usually associated with viral illnesses, however, they can also be present as a result of drug reactions (such as phenytoin), immunisations, radiation, hormonal causes (such as stress and Addison's disease) as well as some auto-immune disorders (such as rheumatoid arthritis).
Some pathogen-related causes include:
- Epstein-Barr virus
- Cytomegalovirus
- Treponema pallidum (Syphilis)
- Streptococcus agalactiae (Group B Streptococci),
- Hepatitis C
- Hantavirus
Austin Flint murmur

# Overview
In cardiology, an Austin Flint murmur is a low-pitched, mid to late diastolic rumbling murmur which is best heard at the cardiac apex.  It is associated with severe aortic regurgitation.

# Mechanism
Echocardiography, conventional and colour flow doppler ultrasound, and cine nuclear magnetic resonance (cine NMR) imaging suggest the murmur is the result of aortic regurgitant flow impingement on the inner surface of the heart, i.e. the endocardium.

## Classical description
Classically, it is described as being the result of mitral valve leaftlet displacement and turbulent mixing of antegrade mitral flow and retrograde aortic flow:
- The blood jets from the aortic regurgitation strike the anterior leaflet of the mitral valve, which often results in premature closure of the mitral leaflets.
- Turbulance of the two columns of blood, one from left atrium to left ventricle and another from aorta to left ventricle.
- Absence of both a loud S1 and an opening snap of the mitral valve helps in differentiating it from mitral stenosis.

# Treatment
Aortic valve replacement may be necessary to correct the abnormality if symptomatic.

# Eponym
It is named after the 19th century American physician Austin Flint (18121886).

# Related Chapters
- Heart murmur
- Aortic insufficiency

# Resources
- Biography of Austin Flint
Limbic encephalitis

# Overview
Limbic encephalitis is a form of encephalitis.
In a small number of cases, the pathogens responsible for encephalitis attack primarily the limbic system (a collection of structures at the base of the brain responsible for basic autonomic functions), often causing memory deficits similar to those observed in Alzheimer's disease or Creutzfeldt-Jakob disease (although limbic encephalitis does not cause the same cognitive deficits as these diseases.   Unfortunately for 20% of people with the diagnosis of limbic encephalitis an MRI will not show any neurological abnormalities 
60% of the time, limbic encephalitis is paraneoplastic in origin.  
Paraneoplastic limbic encephalitis (PLE) is a particularly severe form of limbic encephalitis caused by neoplasms most commonly associated with small cell lung carcinoma. Whereas the majority of encephalitides are viral in nature, PLE is often associated with cancer.   In fact, it is thought that up to 1 in 100 people with cancer have in fact got paraneoplastic limbic encephalitis which is commonly misdiagnosed as neurological diseases such as Alzheimer's.

# Diagnostic Findings

## MRI
(Images courtesy of RadsWiki)
- Limbic encephalitis
- Limbic encephalitis
- Limbic encephalitis
- Limbic encephalitis
- Limbic encephalitis
- Limbic encephalitis
- Limbic encephalitis
Azaspirodecanedione
Azaspirodecanediones are a class of drugs with anxiolytic effects used in the treatment of anxiety.  Azaspirodecanediones have fewer side effects than some other common antianxiety drugs such as benzodiazepines. Unlike benzodiazepines, azaspirodecanediones are not addictive and do not induce tolerance. They are thought to agonize serotonin (specifically the 5-HT1A receptor), primarily in the hippocampus.

# Examples
The common azaspirodecanediones used include buspirone (Buspar), gepirone, and ipsapirone.

# Pharmacokinetics
Buspirone is well absorbed from the gastrointestinal
tract, and peak blood levels are achieved in 1 to 1.5
hours; the drug is more than 95% bound to plasma proteins.
Buspirone is extensively metabolized, with less
than 1% of the parent drug excreted into the urine unchanged.
At least one of the metabolic products of buspirone
is biologically active. The parent drug has an
elimination half-life of 4 to 6 hours.

# Uses
Useful as an augmentation to SSRI for Parkinson's disease, social phobia, MD and sexual dysfunction.
Biophysical profile

# Overview
A biophysical profile is a prenatal ultrasound evaluation of fetal wellbeing, involving a scoring system.

# Components
- The biophysical profile (BPP) has 5 components: 4 ultrasound (US) assessments and a nonstress test (NST).
- The US assessments are:
- amniotic fluid volume,
- fetal tone,
- fetal activity, and
- fetal breathing movements.
- Each component is graded either 0 or 2 points, and then added up to yield a number between 0 and 10.
- A BPP of 8 to 10 is generally considered reassuring.

# Indication
A BPP normally is not performed before the second half of a pregnancy (fetal breathing movements do not occur in the first half.)
Bacterial oxidation
Bacterial oxidation is a bio-hydrometallurgical process developed for pre-cyanidation treatment of refractory gold ores or concentrates.  The bacterial culture is a mixed culture of Thiobacillus ferrooxidans, Thiobacillus thiooxidans and Leptospirillum ferrooxidans.  The bacterial oxidation process comprises contacting refractory sulfide ROM ore or concentrate with a strain of the  bacterial culture for a suitable treatment period under an optimum operating environment.  The bacteria oxidise the sulfide minerals, thus liberating the occluded gold for subsequent recovery via cyanidation.
Under controlled continuous plant conditions, the number of bacterial cells and their activity is optimised to attain the highest rate of sulfide oxidation.  The bacteria require a very acidic environment (pH 1.0 to 2.0), a temperature of between 30 and 45 C, and a steady supply of oxygen and carbon dioxide for optimum growth and activity.  The unusual operating conditions for the bacteria are not favourable for the growth of most other microbes, thus eliminating the need for sterility during the bacterial oxidation process.  Due to the fact that organic substances are toxic to the bacteria, they are non-pathogenic and incapable of causing disease.  The bacteria employed in the process do not, therefore, pose a health risk to humans or any animals.
The bacterial oxidation of iron sulfide minerals produces iron(III) sulfate and sulfuric acid, and in the case of arsenopyrite, arsenic acid is also produced.  The arsenic is removed from the liquor by coprecipitation with the iron and sulfate in a two stage neutralisation process.  This produces a solid neutralisation precipitate containing largely calcium sulfate, basic iron(III) arsenate and iron(III) hydroxide. The iron(III) arsenate is sufficiently insoluble and stable to allow the neutralisation product to be safely disposed of on a slimes dam.  The neutralisation liquor, purified to contain an acceptable level of arsenic, can be re-used in the milling, flotation or bacterial oxidation circuits.
Bado Classification

# Overview
In 1803, Giovanni Battista Monteggia, an Italian surgeon, describe the Monteggia fracture as: a fracture of the proximal third of the ulna with the dislocation of the head of radius.
In 1967, Jose Luis Bado, used the "Monteggia lesion" terminology and classified this injury into the four types.
In 1991, Jupiter JB and colleagues from Boston expanded the Bados type II description of posterior Monteggia fracture-dislocation.

# Bado Classification
Monteggia Fracture-Dislocations

# Related Chapters
- Monteggia fracture
Barotrauma overview

# Overview
Barotrauma is physical damage to body tissues caused by a difference in pressure between an air space inside or beside the body and the surrounding gas or liquid.
Barotrauma typically occurs to air spaces within a body when that body moves to or from a higher pressure environment, such as when a SCUBA diver, a free-diving diver or an airplane passenger ascends or descends. Boyle's law defines the relationship between the volume of the air space and the ambient pressure.
Damage occurs in the tissues around the body's air spaces because gases are compressible and the tissues are not. During increases in ambient pressure, the internal air space provides the surrounding tissues with little support to resist the higher external pressure. During decreases in ambient pressure, the higher pressure of the gas inside the air spaces causes damage to the surrounding tissues if that gas becomes trapped.
Bartonella henselae

# Overview
Bartonella henselae is a proteobacterium that can cause bacteremia, endocarditis, bacillary angiomatosis, and peliosis hepatis.  It is also the causative agent of cat-scratch disease (Bartonellosis) which, as the name suggests, occurs after a cat bite or scratch. The disease is characterized by lymphadenopathy (swelling of the lymph nodes) and fever.
Peliosis hepatis caused by B. henselae can occur alone or develop with cutaneous bacillary angiomatosis or bacteremia.  Patients with peliosis hepatitis present with gastrointestinal symptoms, fever, chills, and an enlarged liver and spleen containing blood-filled cavities.  This systemic disease is seen in patients infected with HIV and other immunocompromised individuals.
Bartonella henselae is a member of the class of the Bartonella genus, one of the most common type of bacteria in the world.

# Antimicrobial therapy
- Bartonella henselae
- Cat scratch disease
- No treatment recommended for typical cat scratch disease, consider treatment if there is an extensive lymphadenopathy
- If extensive lymphadenopathy
- Preferred regimen (1) (pediatrics): Azithromycin 500 mg PO on day 1 THEN 250 mg PO qd on days 2 to 5
- Preferred regimen (2) (adults): Azithromycin 1 g PO at day 1 THEN 500 mg PO for 4 days
- Endocarditis
- Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g/day IV for 6 weeks  Doxycycline 100 mg PO bid for 6 weeks
- Retinitis
- Preferred regimen: Doxycycline 100 mg bid AND Rifampin 300 mg bid PO for 4-6 weeks
- Bacillary angiomatosis
- Preferred regimen (1): Erythromycin 500 mg PO qid for 2 months at least
- Preferred regimen (2): Doxycycline 100 mg PO bid for 2 months at least
- Bacillary Pelliosis
- Preferred regimen (1): Erythromycin 500 mg PO qid  for 4 months at least
- Preferred regimen (2): Doxycycline 100 mg PO bid for 4 months at least
Bartonella quintana

# Overview
Bartonella quintana, also known as Rochalimaea quintana, is a microorganism that is transmitted by the human body louse. This microorganism is trench fever's etiologic agent. This bacteria resulted in about 1 million soldiers in Europe during World War I being infected with Trench Fever.

# Antimicrobial regimen
- 1. Bartonella quintana
- 1.1 Acute or chronic infections without endocarditis
- Preferred regimen: Doxycycline 200 mg PO qd or 100 mg bid for 4 weeks AND Gentamicin 3 mg/kg IV qd for the first 2 weeks
- 1.2 Endocarditis
- Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g IV q24h for 6 weeks  Doxycycline 100 mg PO bid for 6 weeks
Basivertebral veins
The basivertebral veins emerge from the foramina on the posterior surfaces of the vertebral bodies.
They are contained in large, tortuous channels in the substance of the bones, similar in every respect to those found in the diploe of the cranial bones.
They communicate through small openings on the front and sides of the bodies of the vertebr with the anterior external vertebral plexuses, and converge behind to the principal canal, which is sometimes double toward its posterior part, and open by valved orifices into the transverse branches which unite the anterior internal vertebral plexuses.
They become greatly enlarged in advanced age.

# Additional images
- Gray301
Bedwetting overview

# Overview
Bedwetting is involuntary urination while asleep after the age at which bladder control would normally be anticipated.

# Epidemiology and Demographics
Bedwetting is the most common childhood urologic complaint  and one of the most common pediatric-health issues.Most bedwetting, however, is just a developmental delaynot an emotional problem or physical illness. Only a small percentage (5% to 10%) of bedwetting cases are caused by specific medical situations. Bedwetting is frequently associated with a family history of the condition. Most girls can stay dry by age six and most boys stay dry by age seven. By ten years old, 95% of children are dry at night. Studies place adult bedwetting rates at between 0.5% to 2.3%.

# Diagnosis

## History and Symptoms
The main symptom is involuntary urination, usually at night, that occurs at least twice per month.

## Laboratory Findings
A urinalysis will be done to rule out infection or diabetes.

## X Ray
X-rays of the kidneys and bladders and other studies are not needed unless there is reason to suspect some other problems.

# Treatment

## Medical Therapy
Treatments range from behavioral-based options such as bedwetting alarms, to medication such as hormone replacement, and even surgery such as urethral enlargement. Since most bedwetting is simply a developmental delay, most treatment plans aim to protect or improve self-esteem. Bedwetting children and adults can suffer emotional stress or psychological injury if they feel shamed by the condition. Treatment guidelines recommend that the physician counsel the parents, warning about psychological damage caused by pressure, shaming, or punishment for a condition children cannot control.

## Primary Prevention
Getting plenty of sleep and going to the bathroom at regular times during the day and night can help prevent some aspects of bedwetting.
Bence Jones protein

# Overview
A Bence Jones protein is a monoclonal globulin protein found in the blood or urine.  The isolated finding of a Bence Jones protein is known as monoclonal gammopathy of uncertain significance.  Finding this protein in the context of end-organ manifestations such as renal failure, lytic bone disease, or anemia, or large numbers of plasma cells in the bone marrow of patients can be diagnostic of multiple myeloma.
The proteins are antibody immunoglobulin free light chains (paraproteins) and are produced by neoplastic plasma cells.  The light chains can be detected by heating or electrophoresis of concentrated urine. Light chains precipitate when heated to 50 - 60 degrees C and redisolve at 90 -100 degrees C. These tests are essential in patients suspected of having Bence Jones proteins in their urine as these proteins don't react with the reagents normally utilized in urinalysis dipsticks.  This leads to false negative results in people with Bence Jones proteins in their urine undergoing standard urinalysis.  There are various rarer conditions which can produce Bence Jones proteins, such as Waldenstrom's macroglobulinemia and other malignanices.
The Bence Jones protein was described by the English physician Henry Bence Jones in 1847 and published in 1848. The protein was later sequenced by Frank Putnam at the laboratory of Fred Sanger in Cambridge, who was the first to report the entire sequence.
Bergman cyclization
The Bergman cyclization or Bergman reaction or Bergman cycloaromatization is an organic reaction and more specifically a rearrangement reaction taking place when an enyne is heated in presence of a suitable hydrogen donor (Scheme 1) . It is named for the American chemist Robert George Bergman (b. 1942). The reaction product is a derivative of benzene.
The reaction proceeds by a thermal reaction or pyrolysis (above 200C) forming a short-lived and very reactive para-benzyne biradical species. It will react with any hydrogen donor such as 1,4-cyclohexadiene which converts to benzene. When quenched by  tetrachloromethane the reaction product is a 1,4-dichlorobenzene and with methanol the reaction product is benzyl alcohol.
When the enyne moiety is incorporated into a 10-membered hydrocarbon ring (e.g. cyclodeca-3-ene-1,5-diyne in scheme 2) the reaction,  taking advantage of increased ring strain in the reactant, is possible at the much lower temperature of 37C.
Naturally occurring compounds exist containing the same 10-membered enyne ring and are found to be cytotoxic. These compounds generate the diradical intermediate described above which cause single- and double stranded DNA cuts. Novel drug research attempts to make use of this property, mylotarg one of them .
A biradical mechanism is also proposed for the formation of certain biomolecules found in marine sporolides that have a chlorobenzene unit as part of their structure. In this mechanism a halide salt provides the halogen. A model reaction with the enediyene cyclodeca-1,5-diyn-3-ene, lithium bromide as halogen source and acetic acid as hydrogen source in DMSO at 37C supports the theory  :
The reaction is found to be first order in enediyne with the formation of p-benzyne A as the rate-limiting step. The halide ion then donates its two electrons in the formation of a new Br-C bond and radical electron involved is believed to shuttle over a transient C1-C4 bond forming the anion intermediate B. The anion is a powerful base, stripping protons even from DMSO to final product. The dichloride or dihydrogen product (tetralin) never form.