Persius/hicric huggingface dataset:
Vascular anomalies
For information on vascular tumors, click here.
For information on vascular malformations, click here.
For information on provisionally unclassified vascular anomalies, click here.

# Overview
Vascular anomalies constitute a wide array of disorders ranging from benign lesions such as infantile hemangioma to aggressive malignant tumors such as angiosarcoma. Commonly used misnomers and confusing nomenclature has often presented difficulties for accurate diagnosis and appropriate management. International Society for the Study of Vascular Anomalies (ISSVA) has now classified vascular anomalies into vascular tumors and vascular malformations with an unclassified category for lesions that show clinical and histological characteristics unique from disorders classified in vascular tumors and vascular malformations.

# Classification

## Classification of Vascular Tumors
*congenital hemangioma (rapidly involuting type) and tufted angioma may be associated with thrombocytopenia and/or consumptive coagulopathy in some cases. Many experts consider tufted angioma and kaposiform hemangioendothelioma to be part of a spectrum rather than distinct entities
Adapted from International Society for the Study of Vascular Anomalies

## Classification of Vascular Malformations
Abbreviations: CM:capillary malformation; VM:venous malformation; CVM:capillary venous malformation; LM:lymphatic malformation; CLM:capillary lymphatic malformation; AVM:arteriovenous malformation; CAVM:capillary arteriovenous malformation; LVM:lymphatic venous malformation; CLVM:capillary lymphatic venous malformation; CVAVM:capillary venous arteriovenous malformation; CLVAVM:capillary lymphatic venous arteriovenous malformation; AVF:arteriovenous fistula; CLOVES:congenital lipomatous overgrowth, vascular malformations, epidermal nevi, skeletal/scoliosis and spinal abnormalities; M-CM:macrocephaly-capillary malformation; MCAP:megalencephaly-capillary malformation-polymicrogyria; MICCAP:microcephaly-capillary malformation; CNS:central nervous system; DCMO:diffuse capillary malformation with overgrowth; CM-AVM:capillary malformation-arteriovenous malformation; CMTC:cutis marmorata telangiectatica congenita; HHT:hereditary hemorrhagic telangiectasia; GLA:generalized lymphatic anomaly; KLA:kaposiform lymphangiomatosis; VMCM:venous malformation cutaneo mucosal; GVM:glomuvenous malformation; CCM:cerebral cavernous malformation.
Adapted from International Society for the Study of Vascular Anomalies

## Provisionally unclassified vascular anomalies
Abbreviations: VM:venous malformation; AVM:arteriovenous malformation; CAVM:capillary arteriovenous malformation; MLT:Multifocal lymphangioendotheliomatosis with thrombocytopenia; CAT:cutaneovisceral angiomatosis with thrombocytopenia; PHOST:PTEN hamartoma of soft tissue; FAVA:Fibro adipose vascular anomaly; AST:angiomatosis of soft tissue.

# Genetics in Vascular Anomalies

# Vascular anomalies possibly associated with platelet count / coagulation disorders
Capsule (pharmacy)
In the manufacture of pharmaceuticals, encapsulation refers to a range of techniques used to enclose medicines in a relatively stable shell known as a capsule, allowing them to, for example, be taken orally or be used as suppositories. The two main types of capsules are hard-shelled capsules, which are normally used for dry, powdered ingredients, and soft-shelled capsules, primarily used for oils and for active ingredients that are dissolved or suspended in oil.  Both of these classes of capsule are made both from gelatine and from plant-based gelling substances like carrageenans and modified forms of starch and cellulose.
Since their inception, capsules have been viewed by consumers as the most efficient method of taking medication. For this reason, producers of drugs such as OTC analgesics wanting to emphasize the strength of their product developed the "caplet" or "capsule-shaped tablet" in order to tie this positive association to more efficiently-produced tablet pills.  After the 1982 Tylenol tampering murders, capsules experienced a minor fall in popularity as tablets were seen as more resistant to tampering.

# Soft gel encapsulation
In 1834, Mothes and Dublanc were granted a patent for a method to produce a single-piece gelatin capsule that was sealed with a drop of gelatin solution.  They used individual iron moulds for their process, filling the capsules individually with a medicine dropper.  Later on, methods were developed that used sets of plates with pockets to form the capsules.  Although some companies still use this method, the equipment is not produced commercially any more.  All modern soft-gel encapsulation uses variations of a process developed by R.P. Scherer in 1933.  His innovation was to use a rotary die to produce the capsules, with the filling taking place by blow molding.  This method reduced wastage, and was the first process to yield capsules with highly repeatable dosage.
In 1949, the Lederle Laboratories division of the American Cyanamid Company developed the "Accogel" process, allowing powders to be accurately filled into soft gelatin capsules.

# Two-part gel capsules
James Murdock patented the two-part telescoping gelatin capsule in London in 1847.  Basically, the capsules are made in two parts by dipping metal rods in molten gelatin solution.  The capsules are supplied as closed units to the pharmaceutical manufacturer.  Before use, the two halves are separated, the capsule is filled with powder (either by placing a compressed slug of powder into one half of the capsule, or by filling one half of the capsule with loose powder) and the other half of the capsule is pressed on.  The advantage of inserting a slug of compressed powder is that control of weight variation is better, but the machinery involved is more complex.
Carbon-carbon bond

# Overview
A carbon-carbon bond is a covalent bond between two carbon atoms.  The most common form is the single bond  a bond composed of two electrons, one from each of the two atoms. The carbon-carbon single bond is a sigma bond and is said to be formed between one sp3 hybridized orbital from each of the carbon atoms. Carbon atoms can also form double bonds called alkenes or triple bonds called alkynes. A double bond is formed with an sp2 hybridized orbital and a p-orbital that isn't involved in the hybridization. A triple bond is formed with an sp hybridized orbital and two p-orbitals from each atom. The use of the p-orbitals forms a pi bond.
Carbon has the unique characteristic among all elements to form long chains of its own atoms, a property called catenation. This coupled with the strength of the carbon-carbon bond gives rise to an enormous number of molecular forms, many of which are important structural elements of life, and so carbon compounds have their own field of study: organic chemistry.

# Synthesis
Carbon-carbon bond forming reactions are organic reactions in which a new carbon carbon bond is formed. They are important in the production of many man-made chemicals such as pharmaceuticals and plastics.
Some examples of reactions which form carbon-carbon bonds are Aldol reactions, Diels-Alder reaction, the addition of a Grignard reagent to a carbonyl group, a Heck reaction and a Wittig reaction
Carbon tetraiodide
Carbon tetraiodide is CI4, a tetrahalomethane. Being bright red, it is a relatively rare example of a highly colored methane derivative. It is only 2% by weight carbon, although other methane derivatives are known with still less carbon.
The tetrahedral molecule features C-I distances of  2.12  0.02 A.  The molecule is slightly crowded with short I---I contacts of 3.459  0.03 A, and possibly for this reason, it is thermally and photochemically unstable.  Hexaiodoethane is unknown, probably for the same reason.
Carbon tetraiodide crystallizes in monoclinic crystal structure (a 22.39, b 12.93, c 25.85 (.10-1 nm),  125.26).
It has dipole moment of 0 Debyes due to its symmetrically substituted tetrahedral molecule.

# Properties, synthesis, uses
CI4 is slightly reactive towards water, giving iodoform and I2. Otherwise it is soluble in nonpolar organic solvents.  It decomposes thermally and photochemically to tetraiodoethylene, I2C=CI2.  Its synthesis entails AlCl3-catalyzed halide exchange, which is conducted at room temperature:
The product crystallizes from the reaction solution.
CI4 is used as an iodination reagent, often upon reaction with base.
   Ketones are converted to 1,1-diiodoethenes upon treatment with PPh3 and CI4.  Alcohols are converted in and to iodide, by a mechanism similar to the Appel reaction. In an Appel reaction carbon tetrachloride is used to generate the chloride from alcohols.

# Safety considerations
Manufacturers recommend that CI4 be stored near 0 C.  As a ready source of iodine, it is an irritant.  LD50: 178 mg.kg1.  In general perhalogenated organic compounds should be considered toxic.
Carboxylesterase 1
Liver carboxylesterase 1 also known as carboxylesterase 1 (CES1, hCE-1 or CES1A1) is an enzyme that in humans is encoded by the CES1 gene. The protein is also historically known as serine esterase 1 (SES1), monocyte esterase and cholesterol ester hydrolase (CEH).  Three transcript variants encoding three different isoforms have been found for this gene.  The various protein products from isoform a, b and c range in size from 568, 567 and 566 amino acids long, respectively.
CES1 is present in most tissues with higher levels in the liver and low levels in the gastrointestinal tract.

# Function
Carboxylesterase 1 is a serine esterase and member of a large multigene carboxylesterase family. It is also part of the alpha/beta fold hydrolase family.  These enzymes are responsible for the hydrolysis of ester- and amide-bond-containing xenobiotics and drugs such as cocaine and heroin. They also hydrolyze long-chain fatty acid esters and thioesters. As part of phase II metabolism, the resulting carboxylates are then often conjugated by other enzymes to increase solubility and eventually excreted.
This enzyme is known to hydrolyze aromatic and aliphatic esters and can manage cellular cholesterol esterification levels. It may also play a role in detoxification in the lung and/or protection of the central nervous system from ester or amide compounds.
The protein contains an amino acid sequence at its N-terminus that sends it into the endoplasmic reticulum where a C-terminal sequence can bind to a KDEL receptor.

# Clinical significance
Carboxylesterase 1 deficiency may be associated with non-Hodgkin lymphoma or B-cell lymphocytic leukemia.  Inhibition of CES1 by in particular organophosphates reduces tumor-killing activity by monocytes.  The loss of this protein in monocytes is one product of organophosphate poisoning.
CES1 can activate or deactivate various drugs.  CES1 is responsible for the activation of many prodrugs such as angiotensin-converting enzyme (ACE) inhibitors, oseltamivir, and dabigatran. Genetic variants of CES1 can significantly affect both pharmaocokinetics and pharmacodynamics of drugs metabolized by CES1, such as methylphenidate and clopidogrel.  The ability of CES1 to metabolize heroin and cocaine among other drugs has suggested a therapeutic role for the enzyme.

# Interactive pathway map
Cardiac herniation
Pericardial rupture with cardiac herniation is a rare, highly lethal injury with most patients dying before arrival at a hospital.
Diagnosis in survivors is often delayed because initial chest radiography results are normal or show nonspecific abnormalities before cardiac herniation through the pericardial tear.
Pericardial tears range from short and insignificant to long tears that may lead to cardiac herniation. Tears 8-12 cm in length are associated with cardiac herniation, 90% of which occur along the left pleuropericardium.

# Diagnosis
- CT has shown pericardial tears before cardiac herniation and herniation itself.
- Signs of a tear include focal pericardial discontinuity; pneumopericardium; and interposition of lung between the aorta and pulmonary artery, heart and diaphragm, or right atrium and right ventricular outflow tract signs similar to congenital absence of the pericardium.
- The primary sign of herniation is cardiac displacement when no large pleural effusion, atelectasis, or tension pneumothorax accounts for this displacement.
- Pneumopericardium is nonspecific, but a large volume of unilateral gas within the pericardium is more diagnostic of cardiac herniation, and has been termed the empty pericardial sac.
Cardiac monitoring
- The phrase cardiac monitoring generally refers to continuous electrocardiography with assessment of the patients condition relative to their cardiac rhythm.
- It is different from hemodynamic monitoring which monitors the pressure and flow of blood within the circulatory system. The two may be performed simultaneously on critical heart patients.
- It is different from neurological monitoring of intracranial pressure and electroencephalography
- A small monitor worn by an ambulatory patient is known as a Holter monitor
- Transmitting data from a monitor to a distant monitoring station is known as Telemetry or Biotelemetry

# Emergency Medical Services
Ambulance services and other emergency medical services providers utilize heart monitors to assess the patient's cardiac rhythm. Providers licensed or certified at the Intermediate or Paramedic level are qualified to interpret EKGs. The finding of a cardiac dysrhythmia (or for that matter, a normal sinus rhythm) may give additional information about the patients condition or may be a sufficient diagnosis on its own to guide treatment. Treatment for specific cardiac rhythms is guided by ACLS. Basic EMTs are allowed to apply the electrodes and physically operate the monitor but not interpret the rhythm. The most common monitors used in the United States are made by Philips Healthcare (Heartstart Series) Physio-Control (Lifepak series) and ZOLL (E and M series), but other brands exist.
CME Category::Cardiology
Carnivorous fungus
Carnivorous fungi are fungi that derive some or most of their nutrients from trapping and digesting microscopic or other minute animals. More than 200 species have been described, belonging to the phyla Ascomycota, Mucoromycotina, and Basidiomycota. They usually live in soil and many species trap or stun nematodes (nematophagous fungus), while others attack amoebae or collembola. Fungi that grow on the epidermis, hair, skin, nails, scales or feathers of living or dead animals are considered to be dermatophytes rather than carnivores. Similarly fungi in orifices and the digestive tract of animals are not carnivorous, and neither are internal pathogens. Neither are insect pathogens that stun and colonize insects normally labelled carnivorous if the fungal thallus is mainly in the insect as does Cordyceps, or if it clings to the insect like the Laboulbeniales.
Two basic trapping mechanisms have been observed in carnivorous fungi that are predatory on nematodes:
- constricting rings (active traps)
- adhesive structures (passive traps)
Sequencing of ribosomal DNA has shown that these trap types occur in separate fungus lineages.
Celecoxib overdose

# Overdose topics
General
Treatment

## General
No overdoses of CELEBREX were reported during clinical trials. Doses up to 2400 mg/day for up to 10
days in 12 patients did not result in serious toxicity. Symptoms following acute NSAID overdoses are
usually limited to lethargy, drowsiness, nausea, vomiting, and epigastric pain, which are generally
reversible with supportive care. Gastrointestinal bleeding can occur. Hypertension, acute renal failure,
respiratory depression and coma may occur, but are rare. Anaphylactoid reactions have been reported
with therapeutic ingestion of NSAIDs, and may occur following an overdose. Return to top

## Treatment
Patients should be managed by symptomatic and supportive care following an NSAID overdose.
There are no specific antidotes. No information is available regarding the removal of celecoxib by
hemodialysis, but based on its high degree of plasma protein binding (>97%) dialysis is unlikely to be
useful in overdose. Emesis and/or activated charcoal (60 to 100 g in adults, 1 to 2 g/kg in children)
and/or osmotic cathartic may be indicated in patients seen within 4 hours of ingestion with symptoms
-r following a large overdose. Forced diuresis, alkalinization of urine, hemodialysis, or hemoperfusion
may not be useful due to high protein binding. Return to top
Adapted from the FDA Package Insert.
Charles Hollenberg

# Overview
Charles H. Hollenberg, O.C., M.D., D.Sc., F.R.S.C., (1930  April 8, 2003) was a Canadian physician, educator and researcher.
Born in Winnipeg, Manitoba, he received a Bachelor of Science in 1950 and a Doctor of Medicine in 1955 from the University of Manitoba. In 1960, he joined the Department of Medicine at McGill University. From 1970 to 1981, he was the Sir John and Lady Eaton Professor of Medicine and Chair of the Department of Medicine, University of Toronto, and Physician-in-Chief of the Toronto General Hospital.
In 1981, he was appointed Charles H. Best Professor of Medical Research at the University of Toronto, and help create the Banting and Best Diabetes Centre, an interdisciplinary centre for diabetes research. In 1983, he was appointed Vice-Provost of Health Sciences of the University of Toronto. In 1991, he became of the Ontario Cancer Treatment and Research Foundation. He helped found Cancer Care Ontario where he was President and Chief Executive Officer from 1997 to 1999.
In 1983, he was awarded a Mastership of the American College of Physicians (MACP). In 1990, he was made an Officer of the Order of Canada for being "an acknowledged leader in medical education and patient care who has exerted a considerable influence on academic institutions and teaching hospitals through his many professional appointments".  In 1999, he was awarded the Gairdner Foundation Wightman Award "in recognition of his outstanding contributions to Canadian medicine and medical science as a leader of the Canadian academic medical community". In 2003, he was inducted into the Canadian Medical Hall of Fame.
He died of prostate cancer.
Chemical imbalance
Chemical imbalance is a term used as a lay explanation of mental illness or mental disorders. The term is used in consumer literature and and advertising for psychoactive drugs (e.g., ). It is not used to scientific literature explain the process that causes mental illness, but may have its origins in the now discredited 'monoamine hypothesis' of clinical depression. The use of the term chemical imbalance is controversial because it may be leading to innappropriate prescribing, particularly of anti-depressants. 

# 'Chemical imbalances'
Change in levels of neurotransmitters and other neural level phenomena are hypothesised to be the underlying psychopathology for certain mental illnesses, notably Parkinsons Disease and schizophrenia.

## Clinical depression
In 1965, Joseph Schildkraut hypothesized that depression was associated with low levels of norepinephrine in the brain, and later researchers thought serotonin might be the culprit. Initially, relatively simple changes in the level of these neurotransmitters were thought to be found in individuals with depression.  However, advanced findings began to fine tune the more simple explanations. For example, certain drugs used to treat depression were found to change the levels of neurotransmitters for several days, but then return to normal, well before any effect was observed on the depressive episode.  Such findings implicate more complex mechanisms, such as changes in neurotransmitter production, transmission, re-uptake, and neural sensitivity. With respect to causality, a number of environmental factors have been suggested.

## Use of drugs to 'correct'
Lay explanations, put forward by pharmaceutical companies, suggest that psychiatric drugs work by "correcting" the levels of these neurotransmitters. However, rather than restoring 'normal' levels, these drugs have more complex modes of action.
Chemical synthesis

# Overview
In chemistry, chemical synthesis is purposeful execution of chemical reactions in order to get a product, or several products. This happens by physical and chemical manipulations usually involving one or more reactions. In modern laboratory usage, this tends to imply that the process is reproducible, reliable, and established to work in multiple laboratories.
A chemical synthesis begins by selection of compounds that are known as reagents or reactants. Various reaction types can be applied to these to synthesize the product, or an intermediate product. The amount of product in a chemical synthesis is the reaction yield. Typically, chemical yields are expressed as a weight in grams or as a percentage of the total theoretical quantity of product that could be produced. A side reaction is an unwanted chemical reaction taking place that diminishes the yield of the desired product.
The word synthesis in the present day meaning was first used by the chemist Adolph Wilhelm Hermann Kolbe.

# Strategies
Many strategies exist in chemical synthesis that go beyond converting reactant A to reaction product B. In cascade reactions multiple chemical transformations take place within a single reactant, in  multi-component reactions up to 11 different reactants form a single reaction product and in a telescopic synthesis one reactant goes through multiple transformations without isolation of intermediates.

# Organic synthesis
Organic synthesis is a special branch of chemical synthesis dealing with the synthesis of organic compounds.
In the total synthesis of a complex product it may take multiple steps to synthesize the product of interest, and inordinate amounts of time. Skill in organic synthesis is prized among chemists and the synthesis of exceptionally valuable or difficult compounds has won chemists such as Robert Burns Woodward the Nobel Prize for Chemistry. If a chemical synthesis starts from basic laboratory compounds and yields something new, it is a purely synthetic process. If it starts from a product isolated from plants or animals and then proceeds to a new compounds, the synthesis is described as a semisynthetic process.

# Other meanings
The other meaning of chemical synthesis is narrow and restricted to a specific kind of chemical reaction, a direct combination reaction, in which two or more reactants combine to form a single product. The general form of a direct combination reaction is:
where A and B are elements or compounds, and AB is a compound consisting of A and B. Examples of combination reactions include:
4 special synthesis rules:
Chinese bellflower
Platycodon grandiflorus is a species of perennial flowering plant of the family Campanulaceae and the only member of the genus Platycodon. These species are commonly referred to as platycodon, Chinese bellflower, sometimes also Japanese bellflower, common balloon flower, or simply balloon flower. It is native to Northeast Asia (China, East Siberia, Korea and Japan) and bears big blue flowers, although varieties with white and pink flowers are in cultivation.
The root of this species (radix platycodi) is used extensively in Asia as an anti-inflammatory in the treatment of coughs and colds. In Korea the plant is known as doraji () and its root, either dried or fresh, is a popular ingredient in salads and traditional herbal cooking. However, Chinese bellflower and Korean bellflower are different. Chinese bellflower (called  in Chinese) is used in Chinese herbology.
The plant is also a popular garden ornamental. It is hardy to USDA plant hardiness zone 3 and requires little care.

# Trivia
- Rumiko Takahashi named her character Kikyo from her manga Inuyasha after the flower.
- Kikyou (aka Reverse Sia) from the Shuffle! series is named after this flower.
- Byakuya Kuchiki from the anime Bleach enjoys this flower.
- in Korea this is entitled to a folk song.
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