Persius/hicric huggingface dataset:
Death receptor 6
Death receptor 6 (DR6), also known as tumor necrosis factor receptor superfamily member 21 (TNFRSF21), is a cell surface receptor of the tumor necrosis factor receptor superfamily which activates the JNK and NF-B pathways. It is mostly expressed in the thymus, spleen and white blood cells. The Gene for DR6 is 78,450 bases long and is found on the 6th chromosome. This is transcribed into a 655 amino acid chain weighing 71.8 kDa. Post transcriptional modifications of this protein include glycosylation on the aspargenines at the 82, 141, 252, 257, 278, and 289 amino acid locations.

# Function
The protein encoded by this gene is a member of the TNF-receptor superfamily. This receptor has been shown to activate NF-B and MAPK8/JNK, and induce cell apoptosis. Through its death domain, this receptor interacts with TRADD protein, which is known to serve as an adaptor that mediates signal transduction of TNF-receptors. Knockout studies in mice suggested that this gene plays a role in T helper cell activation, and may be involved in inflammation and immune regulation. The DR6 is an alpha-helical integral membrane receptor protein that shows evidence that it has something to do with the inhibition of blood vessels forming on tumors which would allow them to grow larger. Death receptor 6 gets a chemical message and starts a signaling pathway that causes apoptosis, also known as cell death, to occur. It is also expressed in endothelial cells. Tumor cells can induce, through exposition of amyloid precursor protein (APP), DR6-mediated endothelial cell necroptosis allowing tumors metastasis.

# Clinical significance
The free serum levels of this DR6 are heightened with anti-cell death factors in patients that have later stage ovarian cancer.
DR6 is also thought to be involved in neurodegeneration in the brain that causes Alzheimer's disease as well as signal transduction in stress response and cellular survival. DR6 induces apoptosis when it is over expressed, however the manner in which the death signal is intracellularly transduced is currently unknown. It has been determined that Bax translocation is necessary for the apoptosis triggered by DR6, but through an unknown pathway instead of the traditional pathways of intrinsic versus extrinsic.  APP (amyloid precursor protein) is the natural ligand of DR6 and is first cleaved into A and N-APP. N-APP is the fragment that interacts with DR6 to trigger axonal degradation in Alzheimer's patients.   This pathway is essentially "hi-jacked" in the aging brain.
David L. Heymann
David L. Heymann, MD (born 1946 in Pennsylvania, USA) was appointed the Assistant Director-General, Communicable Diseases of the World Health Organization (WHO) in February 2007. He is also the Director-General's Special Representative for Polio eradication.
Heymann previously served as the Executive Director of WHO's Communicable Diseases Cluster, Director of the WHO Program on Emerging and other Communicable Diseases, and as the chief of research activities in the Global Program on AIDS.

# Education
Heymann received his Bachelor of Arts from Pennsylvania State University and later obtained an MD from Wake Forest University School of Medicine. He also received a Diploma in Tropical Medicine and Hygiene from the London School of Hygiene and Tropical Medicine. Heymann did two years of practical epidemiology training with the Epidemic Intelligence Service (EIS). He served in India as part of the Smallpox Eradication Program, and directed WHO's response to the global outbreak of SARS.
Dawson's fingers
"Dawson's Fingers" is a condition affecting the brain of Multiple Sclerosis patients. The condition is the result of inflammation around long axis of medular veins. This results in a finger-like appearance of the lesions extending mainly off the ventricles within the brain.
This morphologic appearance is named after the Scottish pathologist James Walker Dawson , who first defined the condition in 1916.

# Refererences
-   Dawson, J.W.: The histology of disseminated sclerosis. Trans Roy Soc Edinb, 50: 517, 1916.
Penile discharge
Steven C. Campbell, M.D., Ph.D.

# Overview
Penile discharge is commonly associated with STD's. A thorough sexual history along with a complete medical history and physical exam are necessary. In addition, cultures for STD's should be taken though rarely are nonsexually transmitted diseases the cause.

# Causes

## Common Causes
- Carcinoma of the urethra
- Foreign body in the urethra
- Infection
- Nonspecific urethritis
- Prostatitis
- Reiter's syndrome

# Risk Factors
A patient that is not circumscised is at higher risk for STD's.

# Diagnosis

## History and Symptoms
- History includes:
- Personal history
- Sexual history
- Note: onset, color, type and duration of discharge

## Physical Examination
- Genital exam

## Laboratory Findings
- Blood culture
- CBC
- Hepatitis B
- Hepatitis C antibodies
- HIV
- RPR
- Urethral cultures - gold standard for gonorrhea and chlamydia
- Urinalysis
- Wet mount for trichomonas

## X Ray
- X-ray for detection of foreign bodies, when necessary.

# Treatment
- Penile discharge should be treated as an STD until definitivly ruled out.

## Medical Therapy

### Pharmacotherapy
- Chlamydia - PO azithromycin, ofloxacin for seven days, doxycycline for seven days or erythromycin for seven days
- Trichomonas - Single dose metronidazole for seven days
- Gonorrhea - Ceftriaxone single dose IM (in office) / PO cefixime / ciprofloxacin

## Primary Prevention
- Suggest the patient inform all sexual partners of disease so they can seek treatment.
- Discuss safe sexual practices.

# Related Chapters
- Discharge
- STD's
Photosensitivity
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# Overview
Photosensitivity is the amount to which an object reacts upon receiving photons of light.

# Interpretation in medicine
People that are photosensitive experience discomfort or get easily sunburned when exposed to UV light, which may come from sunlight or other sources including sunbeds. This is often caused by an allergy or a medication.

# Interpretation in electronic engineering
Certain electronic devices, such as photodiodes and charge-coupled devices, are designed to be sensitive to light. They are constructed to take advantage of the  photoelectric effect, the emission of electrons from matter upon the absorption of electromagnetic radiation. When light (one form of electromagnetic radiation) impinges on the active surface of such a device, electrical current flowing through or electrical charge stored in the device will increase or decrease in proportion to the intensity and wavelength of the light. This trait allows the device to perform regulating and sensing functions of many kinds. For example, a photoresistor circuit may sense ambient light to turn on a street lamp at dusk. Digital cameras use charge-coupled devices whose extreme sensitivity to light allows them to convert incoming photons into varying electrical charges with great accuracy. The varying charges are then encoded in a binary file which can be stored and later viewed on a computer screen or other medium.

# Interpretation in chemistry
Chemicals that are photosensitive may undergo chemical reactions when exposed to light. These chemicals, such as hydrogen peroxide and many prescription drugs, are stored in tinted or opaque containers until they are needed to prevent photodegradation. Devices that are photosensitive include the human retina and photographic film. Film is photosensitive because its photosensitive material undergoes a chemical reaction when struck by light.
Typical substances that are photosensitive are alkali salts and silver halides.

## Causes

## Drug Side Effect
- Alitretinoin
- Atovaquone and proguanil hydrochloride
- Bexarotene
- Chlorpropamide
- Clemastine
- Demeclocycline hydrochloride
- dibucaine
- Doxycycline
- Doxorubicin Hydrochloride
- Epirubicin
- Fosaprepitant
- Hexachlorophene
- Hydrochlorothiazide
- Ciprofloxacin
- Cidofovir
- cromolyn
- Flucytosine
- Lomefloxacin hydrochloride
- Methotrexate
- Olsalazine
- Oxaprozin
- Oxytetracycline
- Perphenazine
- Tiagabine
- Tolbutamide
- Tolazamide
- vandetanib
XX male syndrome

# Overview
XX male syndrome (also called de la Chapelle syndrome, for a researcher who characterized it in 1972) is a rare sex chromosomal disorder. Usually it is caused by unequal crossing over between X and Y chromosomes during meiosis.
It is less common than Klinefelter syndrome.

# Presentation
Symptoms include small testes, gynecomastia and sterility. Many individuals with this condition also have effeminate characteristics.

# Pathophysiology
Men typically have one X chromosome and one Y chromosome in each diploid cell of their bodies.  Women typically have two X chromosomes.
So-called XX males have two X chromosomes; thus they are genetically female but otherwise appear to be male.
Death receptor 3
Death receptor 3 (DR3), also known as tumor necrosis factor receptor superfamily member 25 (TNFRSF25), is a cell surface receptor of the tumor necrosis factor receptor superfamily which mediates apoptotic signalling and differentiation. Its only known TNFSF ligand is TNF-like protein 1A (TL1A).

# Function
The protein encoded by this gene is a member of the TNF-receptor superfamily. This receptor is expressed preferentially by activated and antigen-experienced T lymphocytes. TNFRSF25 is also highly expressed by FoxP3 positive regulatory T lymphocytes. TNFRSF25 is activated by a monogamous ligand, known as TL1A (TNFSF15), which is rapidly upregulated in antigen presenting cells and some endothelial cells following Toll-Like Receptor or Fc receptor activation. This receptor has been shown to signal both through the TRADD adaptor molecule to stimulate NF-kappa B activity or through the FADD adaptor molecule to stimulate caspase activation and regulate cell apoptosis.
Multiple alternatively spliced transcript variants of this gene encoding distinct isoforms have been reported, most of which are potentially secreted molecules. The alternative splicing of this gene in B and T cells encounters a programmed change upon T-cell activation, which predominantly produces full-length, membrane bound isoforms, and is thought to be involved in controlling lymphocyte proliferation induced by T-cell activation. Specifically, activation of TNFRSF25 is dependent upon previous engagement of the T cell receptor. Following binding to TL1A, TNFRSF25 signaling increases the sensitivity of T cells to endogenous IL-2 via the IL-2 receptor and enhances T cell proliferation. Because the activation of the receptor is T cell receptor dependent, the activity of TNFRSF25 in vivo is specific to those T cells that are encountering cognate antigen. At rest, and for individuals without underlying autoimmunity, the majority of T cells that regularly encounter cognate antigen are FoxP3+ regulatory T cells. Stimulation of TNFRSF25, in the absence of any other exogenous signals, stimulates profound and highly specific proliferation of FoxP3+ regulatory T cells from their 8-10% of all CD4+ T cells to 35-40% of all CD4+ T cells within 5 days.

# Therapeutics
Therapeutic agonists of TNFRSF25 can be used to stimulate Treg expansion, which can reduce inflammation in experimental models of asthma, allogeneic solid organ transplantation and ocular keratitis. Similarly, because TNFRSF25 activation is antigen dependent, costimulation of TNFRSF25 together with an autoantigen or with a vaccine antigen can lead to exacerbation of immunopathology or enhanced vaccine-stimulated immunity, respectively. TNFRSF25 stimulation is therefore highly specific to T cell mediated immunity, which can be used to enhance or dampen inflammation depending on the temporal context and quality of foreign vs self antigen availability. Stimulation of TNFRSF25 in humans may lead to similar, but more controllable, effects as costimulatory blockade targeting molecules such as CTLA-4 and PD-1.
Death receptor 4
Death receptor 4 (DR4), also known as TRAIL receptor 1 (TRAILR1) and tumor necrosis factor receptor superfamily member 10A (TNFRSF10A), is a cell surface receptor of the TNF-receptor superfamily that binds TRAIL and mediates apoptosis.

# Function
The protein encoded by this gene is a member of the TNF-receptor superfamily. This receptor is activated by tumor necrosis factor-related apoptosis inducing ligand (TNFSF10/TRAIL), and thus transduces cell death signal and induces cell apoptosis.
Studies with FADD-deficient mice suggested that FADD, a death domain containing adaptor protein, is required for the apoptosis mediated by this protein.

# Interactions
TNFRSF10A has been shown to interact with DAP3.
Death receptor 5
Death receptor 5 (DR5), also known as TRAIL receptor 2 (TRAILR2) and tumor necrosis factor receptor superfamily member 10B (TNFRSF10B), is a cell surface receptor of the TNF-receptor superfamily that binds TRAIL and mediates apoptosis.

# Function
The protein encoded by this gene is a member of the TNF-receptor superfamily, and contains an intracellular death domain. This receptor can be activated by tumor necrosis factor-related apoptosis inducing ligand (TNFSF10/TRAIL/APO-2L), and transduces apoptosis signal. Mice have a homologous gene, tnfrsf10b, that has been essential in the elucidation of the function of this gene in humans. Studies with FADD-deficient mice suggested that FADD, a death domain containing adaptor protein, is required for the apoptosis mediated by this protein.

# Interactions
DR5 has been shown to interact with:
- Caspase 8,
- Caspase 10,
- FADD,  and
- TRAIL.

# Cancer therapy
Monoclonal antibodies targeting DR5 have been developed and are currently under clinical trials for patients suffer from a variety of cancer types, see Tigatuzumab (CS-1008).
Decoy receptor 3
Decoy receptor 3 (Dcr3), also known as tumor necrosis factor receptor superfamily member 6B (TNFRSF6B), TR6 and M68, is a soluble protein of the tumor necrosis factor receptor superfamily which inhibits Fas ligand-induced apoptosis.

# Discovery
Dcr3 was identified in 1998 by the search of genes with homology to the TNFR gene superfamily in expressed sequence tag (EST) database.

# Structure
The open reading frame of TNFRSF6B encodes 300 amino acids with a 29-residue signal sequence and four tandem cystein-rich repeats. Two transcript variants encoding the same isoform, but differing in the 5' UTR, have been observed for this gene. Unlike most of the other members of TNFR superfamily, TNFRSF6 is a soluble protein which contains no transmembrane domain.

# Function
This gene belongs to the tumor necrosis factor receptor superfamily. It acts as a decoy receptor that competes with death receptors for ligand binding. The encoded protein is postulated to play a regulatory role in suppressing FasL- and LIGHT-mediated cell death and T cell activation as well as to induce angiogenesis via neutralization of TL1A. Overexpression of this gene has been noted in various tumors e.g. gastrointestinal tract tumors, and it is located in a gene-rich cluster on chromosome 20, with other potentially tumor-related genes.

# Interactions
TNFRSF6B has been shown to interact with:
- TNFSF14
- Fas ligand.
Deep palmar arch
The deep palmar arch (deep volar arch) is an arterial network found in the palm.  It is usually formed mainly from the terminal part of the radial artery, with the ulnar artery contributing via its deep palmar branch.  This is in contrast to the superficial palmar arch, which is formed predominantly by the ulnar artery.
The deep palmar arch lies upon the bases of the metacarpal bones and on the interossei of the hand, being covered by the oblique head of the adductor pollicis muscle, the flexor tendons of the fingers, and the lumbricals of the hand.
Alongside of it, but running in the opposite directionthat is to say, toward the radial side of the handis the deep branch of the ulnar nerve.
The superficial palmar arch is more distally located than the deep palmar arch.  If one were to fully extend the thumb and draw a line from the distal border of the thumb across the palm, this would be the level of the superficial palmar arch.  The deep palmar arch about a finger width proximal to this.
From the deep palmar arch emerge palmar metacarpal arteries.
Dental auxiliary

# Overview
A dental auxiliary is any of the dentist's supporting team who helps with dental treatment. They include dental assistants, dental therapists, dental hygienists and dental technicians. The role of dental auxiliaries is usually limited by regional dental regulations, to help define the boundaries of treatment that can be performed.

# Dental assistants
Dental assistants help make dental treatment more efficient, by assisting the dental care provider by holding and passing instruments, by retracting tissues and suctioning to assist better vision of the operating field. They also mix materials and help maintain dental record keeping. Also instrument and equipment sterilization is a major role.

# Dental therapists
Dental therapists are licensed dental auxiliaries in some countries, who specialize in treating children's teeth and oral hygiene. Local dental regulations determine the duties therapists are able to perform. Typically, therapists under the prescription of a dentist are licensed to examine children's teeth, administer restricted techniques of local anesthesia, take radiographs, provide sealants, scaling and cleaning in children. Also restoring primary teeth and vital pulp treatments such as pulpotomies.

# Dental hygienists
Dental hygienists are licensed dental auxiliaries who specialize in preventive dental care, typically but not limited to focusing on techniques in oral hygiene. Local dental regulations determine the duties hygienists are able to perform. In most jurisdictions, hygienists work for a dentist, and are licensed to administer restricted techniques of local anesthesia.  Also radiographs, sealants, scaling, root planing and cleaning are common procedures performed by dental hygienists.

# Dental technicians
Dental technicians are dental auxiliaries who fabricates dental appliances such as removable prothesis including dentures, and fixed restorative work such as crown and bridges for the dental operator to insert.
Dental assistant

# Duties
The limitations to the duties dental assistants can perform is often regulated by the local dental governing body. Increasingly more assistant duties are being made legitimate to allow dental operators to focus more on dental treatment.

## Traditional duties
Traditionally, tasks which dental operators require of an assistant include:
- assisting the dental operator by holding and passing instruments
- retracting tissues and suctioning to assist better vision of the operating field
- retrieving, setting up and laying out dental equipment and dental instruments
- mixing materials
- sterilizing dental instruments and equipment ie.
- developing dental radiographs
- charting for the dental operator
General surgery maintenance is also usually included such as mopping floors, cleaning surfaces and the cabinetry.

## Extended duties
Other extended duties, many depending on local dental regulations, can include:
- dental lab work, such as pouring & trimming models
- exposing radiographs
- filing charts
- appointment scheduling
- maintaining dental record keeping
- taking impressions
- giving post-op instructions
- making temporary crowns
- manage patient welfare
- educate patients on oral health
- complete procedures started by dentists
- pack gingival cord for accurate impressions
- ordering dental supplies for office
- placing dental sealants
- rubber-cup prophy for patients 12 & under
Dental emergency

# Overview
A dental emergency is a type of medical emergency involving the teeth or gingiva.  Pain involving these parts of the mouth, even when minor, can indicate a severe underlying problem that could worsen with time.  It is important to contact a dentist as soon as possible for a professional evaluation to minimize damage to the teeth, gums, and supporting bone.  Short-term action can be taken to relieve oral pain, which can be very severe.

# Severe Pain
Oil of cloves, containing eugenol, is commonly used to treat dental pain.  A drop of oil of cloves can be applied with a cotton swab to relieve pain from dental caries.  After wisdom teeth extraction, a condition known as dry socket can develop when nerve endings are exposed to air.  A piece of sterile gauze or cotton soaked in oil of cloves may be placed in the socket after careful cleaning with saline to relieve this form of pain.
Analgesics such as  paracetamol (acetaminophen) and ibuprofen are recommended.  Ibuprofen has the additional benefit of being anti-inflammatory.  Ice and/or heat are also frequently recommended.  A dentist can prescribe additional medications if necessary.
Dental hygienist

# Overview
A dental hygienist is a licensed dental auxiliary who specializes in preventive dental care, typically but not limited to focusing on techniques in oral hygiene . Local dental regulations determine the duties hygienists are able to perform. In most jurisdictions, hygienists work for a dentist, and are licensed to administer restricted techniques of local anesthesia.  Also radiographs, sealants, scaling, root planing and cleaning are common procedures performed by dental hygienists.
In some areas, the dental regulations include extended duties and exemptions for dental hygienists. Some hygienists are allowed to practice without dentist supervision, use restricted bleaching techniques, and in some areas are even allowed to restore teeth using restricted classes of fillings.

# Dental hygiene process of care
The dental hygiene process of care has five steps:
- Assessment: Gathering data.
- Dental hygiene diagnosis: Interpreting the data into a coherent description of a client's condition in terms that can be addressed by a dental hygienist.
- Planning: Determining the techniques that will solve the problems indicated in the dental hygiene diagnosis and the order in which those techniques will be applied.
- Implementation: Carrying out the plan.
- Evaluation: Determining the effectiveness of the work that was performed.
Over a period of months or years a dental hygienist may have evaluated his or her work several times, altering the diagnosis and plan numerous times as the client's condition changes.

# UK Dental Hygienists
There are approximately 20 training providers in the UK who offer dental hygienist and dental therapist training; however ,there are fewer schools that train dental hygiene only as many schools now undertake the combined dental hygiene/therapy course. Generally the entry requirements are 5 GCSE subjects graded A  C including English language and biology or human biology, and a recognised dental nursing qualification, or 2 A level passes and 5 GCSE passes at A-C for those individuals who do not have a dental nursing qualification.

# USA Dental Hygienists
Education
Becoming a dental hygienist requires formal education. The most common requirement for a dental hygiene degree consists of a two-year degree after science and general education prerequisites. Courses include anatomy, oral anatomy, materials science, pharmacology, periodontology, nutrition, and clinical skills. There are also four-year and six-year degrees in dental hygiene. In addition, the American Dental Hygienists' Association has defined a more advanced level of dental hygiene, the Advanced Dental Hygiene Practitioner.
Pay
Salaries for dental hygienists vary depending on experience and geographic location.  The median hourly wage for hygienists in 2004 in the US was $28.05 per hour (Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2006-07 Edition, Dental Hygienists, on the Internet at  (visited September 28, 2006)).