Datasets:

clinicalnlplab

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PubmedSumm_train

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[ { "from": "human", "value": "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***\nthe input is a biomedical literature\n\n***output***\nthe output is the summary of an input biomedical literature in six sentences\n\n***documentation***\n\n***examples***\n\ninput: poor scapular stability and alignment are often associated with neuromusculoskeletal dysfunction in the neck and shoulder region . scapulothoracic muscle weakness is a cause of scapular instability and can contribute to secondary subacromial impingement syndrome1 , 2 . weakness of the serratus anterior causes poor scapular orientation and instability , contributing to pathological kinematics , such as impingement3 , 4 . as a closed - kinetic chain exercise , the push - up requires no equipment and is effective for activating the proximal scapulothoracic musculature , as well as distal parts of the upper extremity4 , 5 . push - up exercise is used to induce scapular elevation , and upward rotation should have a minimal effect on the upper trapezius and selective stimulation of the serratus anterior4 . several studies have revealed the importance of scapular muscle strength , neuromuscular control , and scapular stability in normal shoulder function6 . however , the best exercise speed for push - up exercises is uncertain . thus , in this study , we assessed the use of different exercise speeds and isokinetic feedback on the middle and lower serratus anterior muscles during push - up exercises . the subjects were 10 males ( age , 23.02.4 years ( meansd ) ; height , 175.13.5 cm ; and body weight , 65.53.6 kg ) who consented to participate in this study . all subjects were right - side dominant , and none had any congenital deformity of the upper extremities or any orthopedic or neurological disorder . all subjects provided informed consent before participating . this study was approved by the yonsei university faculty of health sciences human ethics committee . muscle activities of the upper and lower serratus anterior muscles were recorded with an electromyography ( emg ) system ( biopac systems , santa barbara , ca , usa ) . all emg signals were amplified and sampled at 1000 hz using the acqknowledge software ( ver . the mean value of the emg data for all tasks was expressed as a percentage relative to the maximal voluntary contraction . surface electrodes were placed on the dominant right side of the middle serratus anterior ( middle sa ) , at approximately the midaxillary line of the right side over the fifth rib , and the lower serratus anterior ( lower sa ) , on the belly of the muscle that branched to the seventh rib . ten push - ups were performed , each taking 3 s. we used the mean value of three randomly selected push - ups from the ten . speed was controlled with a metronome at 60 beats / min , and the investigator initiated and stopped the emg program at the start and end of the phase . condition 3 was a push - up exercise with isokinetic feedback using an accelerometer . an isokinetic accelerometer feedback device was attached on the lateral right side of the trunk . another function provided a changing color ( red or green ) bar on a screen if the speed was too high or too low with regard to the speed threshold . capacitive components of an accelerometer are commonly used to convert mechanical motion into an electrical signal . in the present study , the analog signal was converted to a digital signal with an a / d converter ( ni usb - 6009 , national instruments ; austin , tx , usa ) . the accelerometer detected linear motion and provided visual feedback through graphic software via a user - friendly interface using labview ( national instruments ) . we used the mean value of three successful performances of the isokinetic feedback exercise . participants were allowed 5 min of practice for each condition to familiarize themselves with performing push - ups at the appropriate velocity of movement . the spss software ( ver . 12.0 ; differences in the upper and lower sa under the three conditions were tested by repeated measures one - way anova . the major effects were determined using bonferroni s correction , and significance was set at p 0.05 . the middle and lower sa muscle activities under condition 2 ( middle , 28.313.2 % ; lower , 24.512.9 % ) were significantly decreased when compared with those under conditions ( middle , 40.118.6 % ; lower , 32.614.8 % ) and 3 ( middle , 45.918.6 % ; lower , 34.715.1 % ) ( p 0.05 ) . the middle sa activity under condition 3 was significantly increased when compared with that under condition 1 ( p 0.05 ) . in this study , we investigated the effect of different exercise speeds and isokinetic feedback on the middle and lower serratus anterior muscles during push - up exercises . our results showed that the middle and lower sa muscle activities under condition 2 were significantly decreased compared with those under conditions 1 and 3 . we consider that the speedy push - up exercise might not have activated the sa sufficiently . finally , performing the push - up exercise quickly changed the amount of loading during it . the middle sa under condition 3 with isokinetic feedback showed the highest activation among the conditions . this study suggests that an isokinetic feedback device produced balance in the ascending and descending phases . a push - up exerciseconsists of an eccentric - descending phase and a concentric - ascending phase . according to a previous report , the descending phase showed significantly decreased middle sa and lower sa activities than the ascending phase7 . during the descending phase of the push - up , thus , the subject feels the descending phase as a comfortable phase . for this reason , most subjects performing push - ups under condition 1 performed a fast ascending phase during the 3 - s standard push - up exercise when compared with the descending phase . according to a previous report , the descending phase ( eccentric contraction ) has been suggested to elicit fatigue in the targeted muscles8 , 9 . some researchers have shown that the middle and lower parts of the serratus anterior muscle are important for stabilizing scapular movement , and that activating the middle and lower parts of the serratus anterior muscle may be an effective form of intervention4 , 5 , 7 . based on the result of this study , it can be suggested that the proper selection of push - up exercise speed may be necessary for selective strengthening of the sa and that isokinetic feedback information obtained using an accelerator can help in selective strengthening of the middle sa .\noutput:\n" }, { "from": "agent", "value": "[ purpose ] this study assessed the use of different exercise speeds and isokinetic feedback on the middle and lower serratus anterior muscles during push - up exercises . [ subjects ] ten male workers voluntarily consented to participate in the study . [ methods ] the subjects performed push - up exercises under three conditions . surface electrodes were placed on the dominant right side of the middle and lower serratus anterior muscles . [ results ] the middle and lower sa muscle activities under condition 2 were significantly decreased when compared with those under conditions 1 and 3 . the middle sa activity under condition 3 was significantly increased when compared with that under condition 1 . [ conclusion ] this study suggests that proper selection of push - up exercise speed may be necessary for selective strengthening of the sa and that isokinetic feedback information obtained using an accelerator can help in selective strengthening of the middle sa ." } ]

[ { "from": "human", "value": "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***\nthe input is a biomedical literature\n\n***output***\nthe output is the summary of an input biomedical literature in six sentences\n\n***documentation***\n\n***examples***\n\ninput: empty follicle syndrome ( efs ) is characterized by failure to obtain oocytes from mature follicles after ovulation induction for assisted reproduction treatment . ndukwe et al concluded that efs is a drug - related phenomenon caused by very low serum hcg levels . adnexal torsion is the fifth most common gynecologic surgical emergency with a prevalence of 2.7 % . pena et al demonstrated in a recent study that ovulation induction was associated with ovarian torsion in 19 % of patients . the purpose of this report is to describe a case of empty follicle syndrome associated with ovarian torsion . tubal patency had been demonstrated with hysterosalpingography . the day 3 fsh level was 2.6 iu / ml , and lh level was 2.1 iu / ml . the long protocol of pituitary desensitization was commenced and maintained with daily injection of 0.1 mg of triptorelin ( arvekap , ipsen ) administered on day 21 of the preceding menstrual cycle , for 2 weeks . ovulation induction was achieved with daily subcutaneous injections of 300 iu of recombinant human fsh ( gonal f , serono ) . on day 13 of stimulation , sonography of the left ovary showed 10 follicles of 19 mm in mean diameter and 5 smaller follicles ( 16 mm in mean diameter ) ; the right ovary had 12 follicles of 19 mm in mean diameter and 6 smaller follicles . a dose of 5,000 iu of hcg was administered intramuscularly on day 13 , and oocyte retrieval was scheduled at 36 hours later on day 15 . late in the afternoon on day 14 , the patient had a sudden onset of lower left abdominal pain with nausea . a physical examination revealed lower abdominal tenderness especially on the left side and signs of peritonitis on day 15 . no oocytes were retrieved from the left ovary ; 18 oocytes were obtained from the right ovary . the patient 's clinical symptoms resolved 2 days later , and transcervical transfer of 4 embryos , created from retrieved oocytes of the right ovary , was performed on day 18 . acute adnexal torsion is an uncommon but serious complication of controlled superovulation in assisted reproduction programs . adnexal torsion may involve twisting of the ovary , fallopian tube , or both . if complete ovarian torsion remains undiagnosed and untreated , it can lead to necrosis with peritonitis , loss of the ovary , infertility , and even death . early diagnosis and immediate surgical intervention are , therefore , essential if adnexal organs and function are to be preserved . abnormal flow detected by doppler sonography is highly predictive of adnexal torsion and , therefore , useful in the diagnosis of ovarian torsion . however , when normal flow is detected by doppler sonography , it does not necessarily exclude ovarian torsion ; in fact , torsion is missed in 60 % of cases , and diagnosis in these cases is delayed . in our casesince successful conservative management of adnexal torsion by laparoscopy was described by mage et al , this technique has been extensively used even when diagnosis is delayed and the adnexa appear ischemic and hemorrhagic with subsequent good functional results . in a recent study , robson and kerin described a case of acute adnexal torsion before oocyte retrieval in an in vitro fertilization cycle . they noticed a great difference in the characteristics of the follicular fluid obtained from the 2 ovaries ; in all the follicles from the affected ovary , fluid was heavily bloodstained , and in all the follicles from the contralateral ovary , it was clear . in our study we aspirated 12 follicles , and no oocytes were obtained from the affected left ovary . we also noticed that the follicular fluid from the left affected ovary was dark and bloodstained as compared with the clear - colored follicular fluid from the right ovary . efs is defined as the failure to retrieve oocytes from mature follicles following ovulation induction for assisted reproductive treatments . evidence has been provided to suggest that efs is more likely to represent a defect in the in vivo bioactivity of hcg rather than being an intrinsic patient problem , although awonuga has demonstrated its occurrence in the presence of normal hcg concentrations . in our opinion , evidence suggests that efs may be a multifactorial problem with common manifestations and the lack of oocyte retrieval during the operation . it is known from pathological findings that venous and lymphatic stasis occur early in torsion and arterial flow is decreased at this stage . it seems that our case was one of ovarian torsion that resulted in decreased blood flow to the affected ovary , which in turn might have resulted in reduced concentration of hcg to that ovary inducing dys - functional folliculogenesis . venous and lymphatic stasis in torsion may also have contributed to intrinsic ovarian dys - function and dysfunctional folliculogenesis . in conclusion , to the best of our knowledge this is the first published report of empty follicular syndrome from a torsed ovary .\noutput:\n" }, { "from": "agent", "value": "we report a very rare case of ovarian torsion following controlled ovarian stimulation for in vitro fertilization in which no oocytes were obtained at the time of ovum retrieval from the left torsed ovary . the patient was a 33 - year - old nulligravida female undergoing controlled ovarian stimulation . on day 14 , the patient complained of lower left abdominal pain with nausea . transvaginal oocyte retrieval from the right ovary was performed . the patient subsequently underwent laparoscopy 6 hours following oocyte retrieval . a portion of the left ovary was observed . the ovary was detorsed at the time of laparoscopy followed by peritoneal lavage ." } ]

[ { "from": "human", "value": "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***\nthe input is a biomedical literature\n\n***output***\nthe output is the summary of an input biomedical literature in six sentences\n\n***documentation***\n\n***examples***\n\ninput: diabetes is the fourth leading cause of disease - related death and almost 80 % of diabetes - related deaths occur in developing countries . optimal glycemic control , in particular hba1c level less than 7 % with effective management of dyslipidemia and hypertension can reduce development of diabetes - related complications . delay in initiating / or optimizing appropriate anti - diabetic therapy including insulin could be a possible cause of the increase in complications . improving management practices and clinical outcomes in type 2 diabetes ( impact ) was a prospective , open - label , 26 - week , comparative , multi - center study to compare efficacy and safety of the indian insulin guideline ( iig ) group versus routine clinical practice ( rcp ) group in type 2 diabetes patients . a total of 4695 patients ( 22.7 % ) ( iig , 4113 [ 22.6 % ] ; rcp , 582 [ 23.5 % ] ) had macrovascular complications and 8640 patients ( 41.8 % ) ( iig , 7486 [ 41.2 % ] ; rcp , 1154 [ 46.6 % ] ) had microvascular complications . of 4695 patients with macrovascular complications , 2850 patients ( 60.7 % ) had coronary heart disease followed by 1457 patients ( 31.0 % ) with peripheral vascular disease . of all the microvascular complications recorded , 5627 patients ( 65.1 % ) had peripheral neuropathy followed by 3313 patients ( 38.3 % ) with retinopathy . the rates of complications were high in patients with type 2 diabetes at the time of being initiated on insulin therapy in india .\noutput:\n" }, { "from": "agent", "value": "introduction : diabetes is the fourth leading cause of disease - related death and almost 80 % of diabetes - related deaths occur in developing countries . optimal glycemic control , in particular hba1c level less than 7 % with effective management of dyslipidemia and hypertension can reduce development of diabetes - related complications . delay in initiating / or optimizing appropriate anti - diabetic therapy including insulin could be a possible cause of the increase in complications.method : improving management practices and clinical outcomes in type 2 diabetes ( impact ) was a prospective , open - label , 26 - week , comparative , multi - center study to compare efficacy and safety of the indian insulin guideline ( iig ) group versus routine clinical practice ( rcp ) group in type 2 diabetes patients . a total of 20,653 subjects from 885 centers across india were enrolled.results : a total of 4695 patients ( 22.7 % ) ( iig , 4113 [ 22.6 % ] ; rcp , 582 [ 23.5 % ] ) had macrovascular complications and 8640 patients ( 41.8 % ) ( iig , 7486 [ 41.2 % ] ; rcp , 1154 [ 46.6 % ] ) had microvascular complications . of 4695 patients with macrovascular complications , 2850 patients ( 60.7 % ) had coronary heart disease followed by 1457 patients ( 31.0 % ) with peripheral vascular disease . of all the microvascular complications recorded , 5627 patients ( 65.1 % ) had peripheral neuropathy followed by 3313 patients ( 38.3 % ) with retinopathy.conclusion : the rates of complications were high in patients with type 2 diabetes at the time of being initiated on insulin therapy in india ." } ]

[ { "from": "human", "value": "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***\nthe input is a biomedical literature\n\n***output***\nthe output is the summary of an input biomedical literature in six sentences\n\n***documentation***\n\n***examples***\n\ninput: the treatment regimen includes multi - agent chemotherapy ( three phases : induction therapy , intensification therapy , maintenance therapy ) and central nervous system directed radiotherapy . immune suppression caused due to disease , and its therapy makes these children more prone to infections with severe stomatologic complications . the most common complications are mucositis , xerostomia , bleeding , dysgeusia and infections leading to pain , discomfort and interfere with the course and prognosis of the neoplasm . the study was planned to study the oral manifestations in pediatric population with acute leukemias during the induction phase only . to study the oral manifestation of acute leukemia during induction chemotherapy.to analyze the level of oral hygiene and find its correlation with induction outcome ( short come outcomes in the form of increased febrile neutropenic episodes , induction deaths , number of admissions ) . to study the oral manifestation of acute leukemia during induction chemotherapy . to analyze the level of oral hygiene and find its correlation with induction outcome ( short come outcomes in the form of increased febrile neutropenic episodes , induction deaths , number of admissions ) . to study the oral manifestation of acute leukemia during induction chemotherapy.to analyze the level of oral hygiene and find its correlation with induction outcome ( short come outcomes in the form of increased febrile neutropenic episodes , induction deaths , number of admissions ) . to study the oral manifestation of acute leukemia during induction chemotherapy . to analyze the level of oral hygiene and find its correlation with induction outcome ( short come outcomes in the form of increased febrile neutropenic episodes , induction deaths , number of admissions ) . this was a cross - sectional noninvasive study . thirty three patients both sexes age range ( 5 - 15 years ) in pediatric oncology unit with diagnosis of acute lymphoblastic leukemia and acute myeloblastic leukemia were the subjects for the study . single clinician ( dental surgeon ) performed oral examination of children at the 1 week of induction and 4 week of induction of chemotherapy . patients who have completed first induction phase or those who were on maintenance therapy were excluded from the study . the parents / responsible guardians were informed and explained about the aim and character of the study . patients were evaluated for , oral hygiene by using oral hygiene index - simplified ( ohi - s ) [ table 1a , b ] , dental caries by usingdef index and decayed missing filled teeth ( dmft ) index , [ table 2 ] and gingival findings by usingthe patients were also scrutinized for any other findings or lesions in the oral cavity , i.e. , lesion including site and size of the lesion , candidiasis , any other infections as herpes simplex virus , varicella zoster virus , cytomegalovirus , acute necrotizing and ulcerative gingivitis . gingival index of loe and silness debris index : debris is defined as soft , foreign matter consisting of bacterial plaque and food debris . the criteria include : the same examination was again carried out in the 4 week of the induction phase . all the scores and observations were recorded in a diagnostic chart along with the brief patient 's history and complete blood count on the day of observation . these reports were collected and co - related with short term outcomes such as febrile / neutropenic episodes / morbidity / mortalities with the help of routine blood culture reports . the changes in the oral health status were being observed during first week and fourth week and were analyzed with wilkoxon 's signed rank test . the indices scores were converted in to percentage scale . for this pilot study , acut - off criteria has been set as 50 % for oral hygiene , gingival and def / dmft index . debris index : debris is defined as soft , foreign matter consisting of bacterial plaque and food debris . the criteria include : the same examination was again carried out in the 4 week of the induction phase . all the scores and observations were recorded in a diagnostic chart along with the brief patient 's history and complete blood count on the day of observation . these reports were collected and co - related with short term outcomes such as febrile / neutropenic episodes / morbidity / mortalities with the help of routine blood culture reports . the changes in the oral health status were being observed during first week and fourth week and were analyzed with wilkoxon 's signed rank test . the indices scores were converted in to percentage scale . for this pilot study , acut - off criteria has been set as 50 % for oral hygiene , gingival and def / dmft index . a total of 23 male and 10 female patients with acute leukemia were studied prospectively . we found that the dental status namely the gingival and periodontal tissues were affected in this period due to lack of good oral hygiene and overall poor health status following chemotherapy [ table 1 ] .15 out of 30 ( 50 % ) subjects showed increase in ohi - s , loe and silness gingival index . a significant change was observed in these indices ( p = 0.002 ; 0.003 , respectively ) . there were no extractions or dental filling done ; the decay factor was mainly noticed in this period . dental finding pre - and post - induction phase table 5 shows hematological finding pre - and post - induction phase . no significant difference was noted in hemoglobin , total leucocytic count , or absolute neutrophil count ( p = 0.4 ; 0.11 ; 0.53 respectively ) , but highly significant difference was seen in platelet count p 0.05 . hematological finding pre - and post - induction phase in this study , no interruptions in induction chemotherapy was reported due to dental infections . three patients expired due to debilitating general health , but not due to induction therapy . palatal aphthous ulcer was observed in a child and it was 1.5 cm diameter in size . in another subject angular cheilitis was noted . all the remaining subjects presented no clinical signs of oral lesion . as a regular protocol the suspected foci of infection was cultured and it was found to be candida in angular cheilitis . in the second case of aphthous ulcer neutropenia was noticed as a cause . leukemia is a disease resulting from the malignant transformation of stem cells whose proliferation starts in the bone marrow . oral complaints precipitated by the side - effects of the antineoplastic agents are primarily those of discomfort , sensitivity of teeth and pain , ulceration , gingival hemorrhage , dryness and impaired taste sensation . maintenance of oral hygiene is the basic preventive aid from all kinds of oral infections . patients are advised against any vigorous mechanical dental cleansing aid ( tooth brush / floss / interdental cleaning aids ) to avoid triggering of any bleeding episodes . an alkaline saline rinse of warm water flavored with salt and sodium bicarbonate is recommended for oral cleansing . gingiva reacts differently to even slight amount of plaque if subject is on anti - neoplastic therapy for blood dyscrasias . in the present study , it was observed that the ohi - s count was increased in 50 % of individuals . this change in ohi - s definitely affects other oral hard and soft - tissues . inflammation in the gingiva is most common and probably earliest presentation of changes in oral tissues due to plaque . the increased scores of gi in 50 % of individuals clearly highlight the problems associated oral hygiene maintenance in these patients . the gingival inflammation , if not treated leads to periodontal problems and may eventually lead to loss of teeth in adult patients . dmft / def index was found to be increased in 10 patient 's , i.e. , 33 % of study population . since no active dental treatmentis advocated ( advisable ) to any patient undergoing induction therapy , the difference in dmft was only in d , i.e. , decay component of the dmft . although the induction therapy drugs are not directly responsible for the decay process , the change in oral environment due to excess plaque accumulation and / or change in quality and quantity of saliva due to drugs might have played important role in increased in caries process . in most of the patient 's erythematous oral mucosa , burning sensation of mouth was common , since mucositis was not primary objective of this study , the findings were not noted . one subject demonstrated an aphthous ulcer on palatal mucosa but it responded well to the symptomatic therapy . in another subject , angular cheilitis was seen . the angular cheilitis is generally a clinical sign of an inflammatory response to fungal infection . there was no statistical significant difference was observed in terms of short term outcomes of leukemia therapy due to dental problem . in this study , it was observed that the oral health status worsened following first induction chemotherapy in acute leukemic pediatric patients . there was a significant increase in level of ohi , gingival index and def / dmft . lesions like aphthous ulcer and angular cheilitis were noticed in two of the subjects while other subjects did not have any oral complications . these finding suggest that there is a need to institute optimum oral health , during and in between induction phases . further study is study with larger sample size is needed to conclude the role of oral hygiene in the induction outcome of pediatric patients receiving treatment for acute leukemia .\noutput:\n" }, { "from": "agent", "value": "background : treatment of acute leukemia 's - a common childhood malignancy , involves intensive and powerful multi - drug chemotherapeutic regime . oral lesions are a common complication in these patients affecting oral health status.aim : this study was conducted to evaluate and assess the oral health status of newly diagnosed leukemic pediatric patients during induction phase and its correlation to outcome of induction therapy.material methods : oral examinations was done in 33 children between the age group of 5 - 15 years with acute lymphoblastic leukemia ( all ) and acute myloblastic leukemia ( aml ) , who were undergoing chemotherapy . oral hygiene index - simplified , ( ohi - s ) decayed missing filled teeth index ( def / dmft ) , loe and sillness index for gingiva , and complete blood count at first and fourth week of induction phase were recorded for each patient . the changes in the oral health status were analyzed with wilcoxon signed rank test.results : during an induction phase it was observed that level of ohi - s ( p = 0.002 ) , loe and sillness index ( p = 0.003 ) , def / dmft index ( p = 0.076 ) , platelet count ( p = 0.00 ) increased significantly and no significant difference was noted in hemoglobin ( p = 0.4 ) and total leucocytes count ( p = 0.11 ) . conclusion : it was observed that , although oral health status had significantly worsened , the induction outcome was not affected ." } ]

[ { "from": "human", "value": "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***\nthe input is a biomedical literature\n\n***output***\nthe output is the summary of an input biomedical literature in six sentences\n\n***documentation***\n\n***examples***\n\ninput: a 49 - year - old woman visited our clinic with a complaint of a left upper - eyelid mass . the patient did not have any history of other cutaneous lesions or antecedent trauma . on examination , appearance of the mass was with a smooth surface and dark brown , violet color . unfortunately , we did nt have a photo - documentation facility at that time in the hospital so we could not present preoperative photothe wound was repaired primer suturing with 6 - 0 vicryl . on the macroscobic examination , size and characteristic ofthe mass was 0.60.40.2 cm and at soft temper nodular structure . histopathological examination of the mass showed with numerous capillary lumina lined by endothelial cells , without nuclear atypism [ fig . 1 ] . histopathologic features of proliferative vessels lined by increased endothelial cells without nuclear atypism of patient with capillary hemangioma of the left upper eyelid ( h and e , 200 ) the patient was assessed at postoperative 1 week . the wound had healed and the sutures were removed . the previously noted under - skin vessels were still clinically evident at postoperative 1 week . these vessels became less obvious and got light violet color at postoperative 6 month control , and mass had not recurred again . after histopathological diagnoses , we realized that it was a rare case , and we sent the patient to the education and research hospital for photo - documentation and advanced systemic examination [ figs . 2 and 3 ] . postoperative 1 week , with dark purple under - skin vessels ( arrow ) and healing of the wound ( asterisk ) postoperative 6 month , excellent wound healing ( asterisk ) and getting lighter on vessels colors ( arrow ) the most common congenital vascular tumors of the periorbital region are capillary hemangiomas ; and involution of this entity usually occur in the first decade . acquired capillary hemangioma of the eyelid and periocular region is a very rare conditions . one was in a pregnant woman , and the other was in a 12 - year - old girl . hormonal changes during puberty and pregnancy can cause the development of vascular lesions and also trauma , and irritative agents may cause inciting factors for capillary hemangiomas . the acquired form of capillary hemangioma looks like a mature type of congenital capillary hemangioma . in immature stages of the lesion , when immature lesion getting mature , the vascular lumina becomes dilated the endothelial cells get more flattened , stroma becomes edematous and hyalinized , and blood flow establishes . the main differential diagnoses for ach are , pyogenic granuloma , angiosarcoma , and acquired tufted angioma of the eyelids . clinically , tenderness , hypertrichosis , and induration are useful signs in differentiating tufted angioma from hemangioma . histopathologically , angiomatous lobules of tufted angioma are composed of relatively bloodless and poorly canalized capillaries which are lined by plump endothelial cells . angiomatous lobules of juvenile hemangiomas are more massive , and lesions tend to have involvement of deeper periocular structures at later stages . congenital capillary hemangiomas usually regress spontaneously , especially immunohistochemically bcl - 2 negative lesions more prone to spontaneous involution . the vessels around the mass which were obvious became less manifest at postoperative 6 month [ figs . 2 and 3 ] . to the best of our knowledge , this is the first ach of the eyelid case whose age was over 40 , and the first case of a woman who was not pregnant .\noutput:\n" }, { "from": "agent", "value": "a 49 - year - old woman developed a dark brown nodular mass in the lower eyelid . the lesion had grown fast for 2 months and then had remained stable in size . excisional biopsy was performed . histopathological examination of an excisional biopsy specimen pointed to proliferative vessels lined by increased endothelial cells without nuclear atypism . the nodular mass evaluated as a capillary hemangioma ." } ]

[ { "from": "human", "value": "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***\nthe input is a biomedical literature\n\n***output***\nthe output is the summary of an input biomedical literature in six sentences\n\n***documentation***\n\n***examples***\n\ninput: - amyloid ( a ) peptide is the main cause of alzheimer 's disease ( ad ) . a has two major types , a40 and a42 , which are derived from a ubiquitous type i transmembrane proteinamyloid precursor protein ( app ) by a two - step secretase ( - and - secretase ) pathway . the amyloid cascade hypothesis predicts that the aggregated a peptides in the brain have an early and essential role in the neuronal degeneration that leads to dementia . the aggregation of a occurs following a conformational conversion from either - helix or random coil to - sheet in a time - dependent manner , indicating that the formation of - sheet structure is the key step for the peptide aggregation . the formation of a aggregates is modulated by several factors , including metal ions . in amyloid plaques of ad - affected brain , remarkably high concentration of metals , such as cu ( 400 m ) , zn ( 1 mm ) and fe ( 1 mm ) , has been found . in vitro studies , micromolar levels of cu , zn and fe have been shown to sufficiently induce protease - resistant aggregation and precipitation of a . copper ions are bound to the three his residues of a located at the n - terminus , which forms a 3n1o square - planar motif as verified by epr spectroscopy . copper - selective chelators can dissolve a deposits extracted from ad postmortem brain specimens and reduce the level of free radical . curtain and his colleagues previously reported that the addition of cu to oligomeric a40 in a negatively charged lipid membrane can induce a peptides reinserted into lipid membranes , convert a conformation from - strand into - helix , and cause the lipid peroxidation . their result is the first study to show that instead of - sheet , a in - helical form can also generate free radicals in the presence of cu ions . recently , our group has characterized the conformation of a in the presence of cu ions into three structural states , stable helix , unstable helix , and random coil , in 40 % , 25 % , and 5 % tfe , respectively , . therefore , this provides us a possibility to re - examine the relationship between a conformation , and cu - driven free radical generation . in the present study , we examined the correlation between cu binding affinity , h2o2 formation , and a40 conformation . it was found that both cu binding affinity and h2o2 formation are well correlated with the conformation of a40 . in general , cu ions can be bound to the different structural forms of a40 . the copper - binding affinity of a40 in random coiled form is about 3-fold higher than that of a40 in stable helical form . for h2o2 formation , our result shows in the first time that the generation of h2o2 can also be induced by cu and the stable helical form of a40 . in contrast , in random coiled form , the formation of h2o2 is inhibited by a40 . the synthesis of full - length a40 peptide was performed in an abi - 433a solid - phase peptide synthesizer using the fmoc protocol . cleavage and deprotection of the synthesized peptide were performed by treatment with a mixture of trifluoroacetic acid / distilled water / phenol / thioanisole / ethanedithiol . then the peptide was extracted with 1 : 1 ( v : v ) ether : h2o containing 0.1 % 2 - mercaptoethanol . the synthesized a peptides were purified on a reverse - phase c - 18 hplc with a linear gradient from 0 % to 100 % acetonitrile , and the molecular weight of a40 peptides and purity was verified by an maldi - tof mass spectroscopy . one mg of purified monomeric a40 peptide was dissolved in 1 ml 100 % trifluoroethanol ( tfe ) as stock solution . a final a peptide concentration of 30 m in either 5 % or 40 % tfe was prepared from fresh peptide stock solution diluted in phosphate buffer , ph 7.4 , with or without the same concentration of cu . a thousand m of cu stock solution was prepared by dissolved cucl2 salt in distilled h2o purged by n2 in a sealed flask and freshly diluted into the designed concentration before it was used . all measurements were performed in quartz cells with a path length of 0.1 cm . data were collected at wavelengths from 190 to 260 nm in 0.2 nm increments . the reported cd spectra were corrected using phosphate buffer , ph 7.4 for the baseline . an equal molar 300 m of a and cu in 30 % glycerol phosphate buffer , ph 7.4 , and 5 % and 40 % of tfe was employed for spin counting purposes . epr spectra were obtained at x - band using a bruker emx er073 spectrometer equipped with a bruker te102 cavity and an advanced research system continuous - flow cryostat ( 4.2300 k ) . during epr experiments , the sample temperature was maintained at 10 k. the microwave frequency was measured with a hewlett - packard 5246l electronic counter . tyrosine fluorescence spectroscopy was used to investigate the binding affinity for copper bound to a. a peptide stock solution was diluted in phosphate buffer , ph 7.4 to a final peptide concentration of 10 m with designed concentration of cu . all measurements were performed in a 96 - well plate using a microplate reader ( flexstation 3 , md ) . the excitation and emission wavelengths were selected at 278 and 305 nm , respectively . reported data were the average obtained from three individual samples and three repeated measurements of each sample . the binding affinity was calculated using the following equation : ( 1 ) fxf0 = ixii0i = 11 + ka [ cu2 + ] n , where i0 and ix are the fluorescence intensity for free and a / cucomplex , respectively , i is the fluorescence intensity at saturation state , [ cu ] is the copper concentration , and n is the copper binding number . the related parameters were fitted using nonlinear curve fitting program micro - origin v6 .0 ( microcal software , inc . , nothampton , ma ) . in the initial fitting stage , the simplex method , which was set to 100 cycle runs , the final fitting parameters were obtained when the value of was less than 0.05 and the parameters and errors for the parameters reached the convergent and steady state . the production of h2o2 was analyzed using the dichlorofluorescein diacetate ( dcfh - da ) assay . dichlorofluorescein diacetate was dissolved in 100 % dimethyl sulfoxide , deacetylated with 50 % v / v 0.05 m naoh for 30 min , and then neutralized ( ph 7.4 ) to a final concentration of 200 m as stock solution . the reactions were carried out in dulbecco 's pbs , ph 7.4 , in a 96 - well plate ( 100 l / well ) containing different concentration of a40 , 30 m cucl2 , tfe ( 5 % and 40 % ) , deacylated dcf ( 20 m ) , and horseradish peroxidase ( 5 m ) at 37c . for negative control , an extra of 1.0 mm catalase ( aspergillus niger ) was used to quench h2o2 . fluorescence readings were recorded on a microplate reader ( md , flexstation 3 ) , with the excitation and emission wavelengths selected at 485 and 530 nm , respectively . uv / vis turbidity assay was used to detect the aggregation process of a. 200 l of 30 m a40 in phosphate buffer , ph 7.4 containing either 5 % or 40 % tfe was freshly prepared from stock solution . fresh prepared samples with or without 30 m cu placed in a 96 - well plate were incubated at 37c . turbidity was measured using a microplate reader ( md , flexstation 3 ) at a wavelength of 450 nm . the aim of this study is to examine the relationship between a40 conformation and other physical and chemical properties such as aggregation , cu - binding affinity , and free radical formation . in the present study , we applied 5 % and 40 % tfe to mimic the conformation of a40 in random coil and stable helix , respectively , . therefore , the effect of tfe on cu binding affinity and free radical generation has to be evaluated . as depicted in supplemental data ( see supplementary material available online at doi : 10.4061 / 2011 / 607861 ) , the main effect of tfe on the system is only to quench the dcf fluorescence intensity . neither was the solubility of cu ions nor the formation of h2o2 affected by tfe . first of all , we characterized the structural state of a40 with and without cu in either 5 % or 40 % tfe using circular dichroism ( cd ) spectroscopy . figures 1 ( a ) and 1 ( b ) show the cd spectra for a40 and a40 / cu in 5 % and 40 % tfe , respectively . it can be seen that , in 5 % tfe , the pattern of cd spectrum for a40 in the presence of cu showed a dramatic change compared to that for a40 only , while the cd spectra of a40 with or without cu in 40 % tfe did not show any significant change . the secondary structure of a40 in 5 % tfe changes from 63 % random coil , 34 % - sheet and 3 % helix in cu - free state to 45 % random coil , 50 % - sheet and 5 % helix in cu - bound state , representing that there is a structural conversion from random coil into - sheet . on the other hand , the conformation of a40 with or without cu in 40 % tfe remains stable in which the secondary structure is 74 % helix , 14 % - sheet , and 12 % random coil in cu - free state and 73 % helix , 15 % - sheet , and 12 % random coil in cu - bound state , indicating that there is no conformational conversion of a40 in 40 % tfe while adding cu ions . it has been shown that cu ions are able to accelerate the aggregation of a40 . hence , we characterized the aggregation process of a40 / cu and a40 in 5 % and 40 % tfe . the aggregation process of a40 / cu and a40 in 5 % and 40 % tfe was analyzed by turbidity assay as shown in figure 2 . in general , in both 5 % and 40 % tfe , a40 in the presence of cu was aggregated much faster than that in the absence of cufurthermore , the aggregation rate in 5 % tfe for both a40 / cu and a40 was much faster than that in 40 % tfe . the aggregation process in 5 % tfe for a40 / cu and a40 showed a typical sigmoidal profile . on the other hand , the aggregation process in 40 % tfe for a40 with and without cu mostly stayed in the nucleation or the early elongating stage within 24 hrs . the aggregation process for a40 and a40 / cu in 5 % and 40 % tfe echoes with the result obtained in the analyses of secondary structure in which the aggregation ability is correlated with the ability of conformational formation of - sheet . in the present study , we showed that the conformational states for a40 / cu and a40 in 5 % are dramatically different , while no such conformational change can be observed between a40 / cu and a40 in 40 % tfe . although cu ions have been shown to be bound to a in aqueous solution , then , whether cu ions are bound to a40 in 40 % tfe is needed to be investigated since the structural state for a40 / cu and a40 in 40 % tfe shows no difference . to address this issue , epr spectroscopy was applied to explore the interaction between cu and a40 in 40 % tfe . as shown in figure 3 , the epr spectra of a / cu both in 5 % and 40 % tfe showed two major groups of hyperfine peaks , while no hyperfine peak could be observed in the epr spectrum for cu alone , indicating that cu ions were bound to a40 in both 5 % and 40 % tfe . the pattern of hyperfine peaks for a40 / cu in 5 % and 40 % tfe is similar , but the position of hyperfine peaks in 40 % tfe shifts to low magnetic field . the related epr parameters of g , a , and g are 2.28 , 156.8 , and 2.06 for a40 / cu in 5 % tfe , respectively . the g and g values in 5 % tfe are very close to those in the literature measured in aqueous condition , representing that the binding geometry of a40 / cu in 5 % tfe should adopt a similar 3n1o coordination . on the other hand , the related epr parameters of g , a , and g are 2.40 , 119.6 , and 2.09 for a40 / cu in 40 % tfe , indicating that the copper - binding geometry is different from the 3n1o mode andthis further indicates that the binding affinity of cu to a40 in random coiled form may be stronger than that to a40 in stable helical form . as shown in epr studies , cu can be bound to different structural forms of a40 with a different binding affinity . in order to further elucidate the binding property of cu , we applied the tyrosine fluorescence spectroscopy to determine the cu - binding constant , since tyrosine 10 is the only fluorophore in a amino acid sequence and locates at the binding pocket , in which the binding of cuto a40 may cause the change of tyrosine fluorescence . the titration curves of cu concentration versus tyrosine fluorescence intensity in 5 % and 40 % tfe are shown in figures 4 ( a ) and 4 ( b ) , respectively . the binding constants , ka , were estimated using the equation as described in the experimental section with molar ratio of a : cu = 1 : 1 , that is , n = 1 . the calculated ka values are 0.14 m ( r 0.97 ) and 0.05 m ( r 0.96 ) for a / cu in 5 % and 40 % tfe , respectively . the ka of a40 / cu in 5 % tfe is around 3-fold higher than that in 40 % tfe , suggesting that cu is bound to random coiled form of a40 more strongly than to stable helical form of a40 which is consistent with the epr studies . it has been demonstrated that a40 coordinated with cu can cause the reduction of cu and then induce the formation of h2o2 from o2 in a catalytic manner . to examine the relationship between free radical formation and a40 conformation , figures 5 ( a ) and 5 ( b ) show the plots of dcf fluorescence intensity versus a concentration in 5 % and 40 % tfe as incubated at 37c for 1 hr . in general , results clearly show that the formation of h2o2 is also correlated with a40 conformation . in 5 % tfe , the level of h2o2 was reduced to zero when the a40 / cu molar ratio 1 , indicating that the formation of h2o2 is inhibited when a40 adopts the random coiled form . unexpectedly but interestingly , unlike the formation of h2o2 which was inhibited in 5 % tfe , the level of h2o2 in 40 % tfe was increased with an increase of a40 concentration and was much higher than those of either cu or a40 alone , suggesting that the formation of h2o2 was induced when a40 was in the stable helical form . according to amyloid cascade hypothesis , aggregated a is the main toxic species to cause the alzheimer 's disease . the various forms of a aggregate have been shown to coordinate with redox active transition metals , such as cu and fe , and induce the generation of reactive oxygen species . however , the correlation of copper - binding affinity , copper - driven aggregation , and free radical formation with a40 conformation still needs to be elucidated . for ion interaction , our results demonstrate for the first time that cu ions can interact with both random coiled and stable helical forms of a40 . as a larger a value and binding constant obtained for a40 in 5 % tfe , the cu - binding affinity for random coiled form of a40 is much stronger than that for stable helical form of a40 . the possible explanation may be attributed to the different flexibility of a40 conformation in 5 % and 40 % tfe . as shown in cd spectra , the conformation of a40 in 5 % tfe is relatively flexible and can easily convert structure from random coil into - sheet while coordinating with cu . on the other hand , the overall conformation of a40 with or without cu is relatively rigid and remains in stable helix in 40 % tfe , and only the local geometry of cu - binding site is distorted while interacting with cu ions as indicated by the shift of g value . therefore , the interaction between cu and a40 is strong in 5 % tfe and relatively weak in 40 % tfe . the binding affinity for stable helical form of a40 is almost 3-fold lower than that for random coiled form of a40 . the cu - binding affinity can further be used to account for the differences for cu - driven aggregation between random coiled and stable helical forms of a40 . it is well known that the formation of - sheet plays a key step for the aggregation of a40 . as shown in the present study , the conformation of a40 in 5 % tfe is much easier than that in 40 % tfe to convert into - strand structure by cu ions . thus , in the presence of cu , the random coiled form of a40 ( in 5 % tfe ) aggregates faster and more severe than the stable helical form of a40 ( in 40 % tfe ) . unlike the cascade hypothesis that only - sheet form of aggregated a can produce free radical , we demonstrate that helical form of a40 can also induce the formation of h2o2 . from the aggregation assay , this helical form of a40 may possibly exist as a monomer during the early incubation period . then , this further implies that monomeric a40 in stable helical form by coordinating with cu can induce the formation of h2o2 . in contrast , a40 in random coiled form shows to inhibit the formation of h2o2 during the early incubation period . the inhibition of h2o2 formation becomes more significant with an increase of a40 concentration , and the formation of h2o2 further is completely inhibited when the molar ratio of a / cu molar ratio 1 . our observation is consistent with a recent study by viles and his colleagues , in which they showed that , at a / cu molar ratio = 1 , the formation of h2o2 is inhibited by both monomeric and fibrillar a peptides . taken together , it may suggest that helical structure may play a key factor for the generation of h2o2 by a40 / cu . in summary , our present results demonstrate that both ion interaction and copper - driven free radical formation are well correlated with a40 conformation . when a40 adopts a stable helical structure , the cu binding affinity is weaker , and the free radical is produced . on the other hand , when a40 adopts a random coil in 5 % tfe , the cu binding affinity is stronger , and the formation of h2o2 is inhibited .\noutput:\n" }, { "from": "agent", "value": "the neurotoxicity of a is associated with the formation of free radical by interacting with redox active metals such as cu2 + . however , the relationship between ion - interaction , ion - driven free radical formation , and a conformation remains to be further elucidated . in the present study , we investigated the correlation of cu2 + interaction and cu2 + - driven free radical formation with a40 conformation . the cu2 + - binding affinity for a40 in random coiled form is 3-fold higher than that in stable helical form . unexpectedly but interestingly , we demonstrate in the first time that the stable helical form of a40 can induce the formation of h2o2 by interacting with cu2 + . on the other hand , the h2o2 generation is repressed at a / cu2 + molar ratio 1 when a40 adopts random coiled structure . taken together , our result demonstrates that a40 adopted a helical structure that may play a key factor for the formation of free radical with cu2 + ions ." } ]

[ { "from": "human", "value": "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***\nthe input is a biomedical literature\n\n***output***\nthe output is the summary of an input biomedical literature in six sentences\n\n***documentation***\n\n***examples***\n\ninput: dependence on addictive drugs spread all over the world and the side effects of addiction , it is necessary to study the function of drugs in animal trials especially in placenta . many behavioral problems in addicted mother s infants indicated the effects of opioids on embryo ( 1 , 2 ) . the majority of studies focused on the embryo , whereas they neglected to study the placenta as an important organ . disruptive effects of consumption of opioids in human samples and laboratory animals were well conducted . the research showed that consumption of opiate materials by pregnant mothers cause delay in embryonic development and malfunctions , such as spinabifida ( 1 , 3 ) . in accordance to previous studies , high blood corticosteron concentration of pregnant mother attenuate placenta and embryo . the capacity of placenta for displacement and releasing food materials depends on the placenta s shape , size and transferring factors . as morphine is small and imploring molecule , it can easily pass through blood barrier and placenta and then become effective on embryonic cells ( 4 - 6 ) . as placenta in mammalsis the most important part to exchange materials between embryonic and maternal blood , the size of the placenta is directly related to food material transporting ( simple and active transport ) ( 2 , 4 , 6 ) . the morphine effects were presented with mio , kappa and delta opioids receptors and activating of these receptors caused several changes , including decrease in the camp , an increase in output of - k + ion and a decrease in input of ca - ion ( 7 , 8 ) . on the other hand , the ca - ion has important role in secretion of estrogen and progesterone hormone from placenta , stableness and embryonic development ( 9 , 10 ) . by progress of pregnancy , placenta can act as a gland that secrets progesterone , estrogen and other enzymes that are needed for embryonic development and considered as an alternative for ovary secretion hormones ( 6 , 11 ) . therefore , morphine can interfere and causes dysfunction in placental secretion operating and delay in placental development ( 5 , 10 ) . several experiments have shown that morphine administration cause the decrease of placenta weight in rabbits ( 12 , 13 ) . on the other hand , because the placenta is a protective barrier , it can prevent the input or output of some materials . placental barrier as a protective mechanism is often considered against pathogenic factors ( 2 , 14 , 15 ) . disorders in the development of placenta cause placental disability in exchanging endocrine and protective acts in embryo function ( 6 ) . the importance of mother s blood corticosteron concentration in placenta development and the effects of morphine on delay of placental development are the major reasons for the present research that consider the oral morphine administrations effect on the placenta of addictive mothers on 10 and 14 days of pregnancy . the animals were housed 2 / cage to a temperature of ( 2410c ) and controlled environment with a 12 - h light / dark cycle and were provided with food and water . this experimental study was accomplished with financial support of baqyiatallah ( a.s . ) university of medical sciences as a thesis project . all experiments were conducted in accordance with standard ethical guidelines and approved by the local ethical committee ( the baqiyatallah ( a.s . ) university of medical sciences committee on the use and care of animals , 86/143 , apr 15 , 2007 ) . in this study , prepared morphine sulphate from iran temad co , was used orally . twenty - four female wistar rats were divided into four equal groups consisting of six animals each . the female rats were mated into 2 groups with one adult male rat . after pregnancy ( with the observation of vaginal plug and existence of sperm in vagina ) , they were separated from male rats the next morning and kept in the same coed - groups . thereafter ( 0 day of pregnancy ) , experimental group received a daily dose of 0.05 mg / ml morphine ( 5 mg per 1000 ml potable water from city pipeline for 12 rats ) ( 15 ) . also , 1 ml bloods were collected from retro - orbital sinus at 13 days of pregnancy . finally plasma corticosterone was assessed by rat corticosterone elisa kit ( eia - 4164 ; drg instruments gmbh , germany ) in both experimental groups . in 10 and 14 days of pregnancy , the animals were anesthetized with chloroform and placenta were removed and transferred to 10 % formalin solution for 10 days , then , placenta were put in tissue processing molding , then blocks were sagittaly sectioned with 5um thickness and serially by microtome ( 15 , 16 ) . these slices were put on slides and stained with hematoxylin and eosin methods ( h & d ) . after staining , slides were studied microscopically . differences between all groups were calculated by a one - way analysis of variance ( anova ) and post - hoc duncan test by using the spss / pc computer program ( version 9.1 ) . statistical significance between the two measurementsresult were considered statistically significant when p 0.05 . the thickness of portion placenta , blood cisterns surface , and number of cells in the experimental and control groups was measured with motic software . the system used included a microscope connected to a computer and a monitor with software which could take photos from slides . subsequently , the number of cells on each layer was counted randomly and compared with that of the experimental groups . our results showed that the oral morphine consumption in pregnant rats increased the placenta concentration of corticosteron at day 13 of pregnancy in comparison with control group . in addition morphine administration in pregnant rats placenta showed , thickness of maternal part has increased in 10 and 14 days placentae ( table i ) . in contrast , significant decrement in thickness of placenta in embryonic part was shown ( table i ) . also , increment in cells number of placenta in maternal and embryonic part in experimental groups was assessed ( table i ) , thereby decrement in blood pools surface of placenta in maternal and embryonic part in 10day experimental groups was shown in this study ( table i ) . indicates effect of administration of oral morphine on placenta and plasma corticosterone concentration in rats result were considered statistically significant when p 0.05 . effect of administration of oral morphine on the10 , 14 days of placenta portions thickness and cell number and lacuna area development furthermore , plasma corticosterone concentration in rats which received oral morphine on the 13 day of pregnancy and comparison of control and experimental groups . changes in thickness of the placenta portion in experimental ( b1 ) and control ( a1 ) group in the 10 - day old placenta by 40 ( two arrowheads ) . morphologic changes on 10 - day old placenta in experimental group ( b2 ) indicates placenta cells and blood lacuna of placenta shuch as indicates placenta cells and blood lacuna in control group ( a2 ) in 10 days placenta with zoom 100 , ( a one head arrow ) . the changes of thickness in placenta layer in 14 - day old placenta in experimental ( b3 ) and control ( a3 ) groups zoomed 40 ( two heads arrow ) . the changes of the blood cisterns and the number of placenta portion cells in 14 - day old placenta in experimental ( b4 ) and control ( a4 ) groups , zoomed 100 ( one head arrow ) . results of the present study showed that morphine consumption during pregnancy can cause delay in the development of embryonic and maternal portion of placenta . on pregnant mother , concentration of corticosteron at blood plasma will increase at second period of pregnancy so we measured corticosteron concentration at 13 days after pregnancy ( 17 , 18 ) . in agreement with this subject , our data also indicated the oral morphine administration increased blood plasma corticosteron concentration on addictive pregnant mothers ( table i ) . increase in corticosteron density of the blood plasma of the pregnant female mice can justify the side effects in embryos of these mothers . in addition the results of these studies were consistent with previous ones , which indicated that cortisol administration could delay differentiation of placental cells ( 1 , 5 ) . regarding the fact that embryonic development is the result of placental natural function and due to the essential function ofthat is the hormone secretion and material exchange , any disorder in normal function of fetal and maternal portion of placenta can cause abnormality on embryo growth ( 3 , 16 , 19 ) . morphologic studies have shown that if physiologic changes of spiral veins occur during pregnancy , trophoblast cells will attack placenta and blood flow will increase at this site and finally placental villi disrupting will appear ( 6 , 20 , 21 ) . morphologic and morphometric results have shown the oral morphine effect on both embryonic and maternal parts of placenta ( table i ) . also our study indicated that oral morphine administration in pregnant mouse caused corticosteron secretion in experimental group ( 5 , 10 , 17 ) . fowden and forhead declared , the increase of placing embryo and placenta in exposure of glococorticoides cause attenuation of embryo and placenta , and this will directly change the cell cycle from mitotic to differentiated state ( 5 , 6 , 10 ) . also corticosteron induces proliferation of cytotrophoblast cells of maternal and fetal portion of placenta ( 6 , 17 , 22 ) by stimulation of procytotrophoblastic cells to shortening of interphase ( 5 , 17 , 23 ) , so cells do not have enough time for growth , protein synthesize , replication , and enough growth , and finally cause disorder in normal function of placental fetal cells ( 6 , 7 , 23 ) , in contrast lead to late differentiation of placental cell and embryonic development ( 5 , 7 , 10 , 19 ) . results of present research together with above data showed high level of corticosteron by morphine administration raised maternal portion thickness and number of these cells in placenta of day 10 and 14 of pregnancy . in addition morphine consumption has decreased more placenta fetal portion in contrast to maternal portion and this increment cause severs abnormality at embryo ( table i ) . the previous studies indicated oral morphine administration in the 9 day of pregnancy attenuate neural tube and neural plate evolution and development of frontal cortex in embryo were reduced in the 17 day of pregnancy ( 15 , 16 , 24 , 25 ) . the major role of placenta is material exchange between maternal blood and placenta and secretory substances such as steroids , peptides , cytokine and glycoproteins release from mother blood and enter to embryo by placenta . otherwise because consumption and production of nutrition material were determined by placenta any disorder in functionality of fetal placental portion ( 5 , 6 , 11 ) cause delay in development of embryo and placenta . during pregnancy inparallel with vessel angiogenesis , thickness of fetal placenta portion will decrease , so material exchanges become more and finally morphine uptake increases and decrease in thickness of fetal placenta portion is the effect of this increment ( 14 , 20 , 23 ) . so , speed of morphine transition and disruptive effects have direct ratio with decrease of fetal layer thickness . in present research , effect of morphine resulted decrease in abnormal thickness in embryonic unit of experimental group compared to control group in 10 and 14 day old placenta , and decrease of blood cisterns surface , also number of cell in both 10 and 14 day old placenta in experimental group compared to control group are consistent with increase of corticosteron concentration ( table i ) . the other researches of morphine effect on placenta fetal portions of both groups indicated , morphine causes decrease in blood cisterns area and these data not only are consistent with koulin s and doppler s researches , but also they are valuable to research in human . in other researches , it was shown ; that the morphine consumption orally and by injection indicated the same effect ( 20 , 26 , 27 ) . the effective factors on blood vessel contraction are corticosteron and opioides receptors on the membrane of placental cells ( 2 , 3 , 7 ) , that located on placental villi and be contracted by morphine stimulation and resulted decrease in blooding , embryonic hypoxia and delay in embryonic development ( 20 , 28 ) embryonic portion of placenta basically give rise to cyncytiotrophoblast cells and these cells play important role in embryonic development through secretory function , like estrogen and progesterone hormone ( 10 , 17 ) and disorder in the secretion of these cells cause delay in placental and embryonic development ( 6 , 19 ) and can aggravate embryonic abortion . according to studies , morphine administration caused embryonic abortion and decrease in babies weight in pregnant rabbits ( 12 ) . in total , these results indicated oral morphine consumption causes the unusual increment in plasma corticosteron density and delay in placenta fetal and maternal portion development in wistar rat but it was not identified if present study results are due to morphine or corticosteron effect or both of them . although behavioral disorders in infants or embryonic abortion from addictive pregnant mothers need to be studied more .\noutput:\n" }, { "from": "agent", "value": "background : previous studies have shown that morphine consumption during pregnancy may delay embryo development or cause abnormal nervous system function . objective : the present study focused on the effect of maternal morphine consumption on development of placenta and blood corticosteron concentration in addictive pregnant mothers . materials and methods : 24 female rats , 170 - 200 g weight , were used . the experimental groups after pregnancy received an oral dose of 0.05 mg / ml of morphine by tap water while the control group received only tap water . on 10th and 14th day of pregnancy , rats were anesthetized and placenta removed surgically , 1 ml blood was collected from each pregnant mother from retro - orbital sinus , the concentration of blood corticosteron was determined by corticosteron elisa kit after centrifugation . the fixed tissue was processed , sectioned and stained with hematoxylin and eosin . placenta was studied microscopically according to the thickness of layers , area of blood cisterns , and the number of cells . results : comparing the plasma corticosteron concentration of the treatment and the control groups , not only a severe increase in the treatment group was detected , but also the thickness of maternal and embryonic portions of the placenta at day 10th and 14th of gestation was different significantly ( p0 .05 ) . furthermore , an increase in number of cells in maternal and embryonic portion of placenta and a decrease in blood cistern area were demonstrated in both the experimental and the control groups . conclusion : the effects of morphine , including an increase in blood concentration of corticosteron , in dependent pregnant mothers were seen . development of placenta in the experimental group was delayed ." } ]

[ { "from": "human", "value": "***task***\nthe task is to summarize an input biomedical literature in six sentences\n\n***input***\nthe input is a biomedical literature\n\n***output***\nthe output is the summary of an input biomedical literature in six sentences\n\n***documentation***\n\n***examples***\n\ninput: sugar - sweetened beverages ( ssb ) are drinks sweetened with various forms of sugars that add calories and include , but are not limited to , soda , fruit ades and fruit drinks , and sports ( sd ) and energy drinks ( ed ) . on average , ssb intake contributes approximately 300 kilocalories to the daily intake of adolescents 1219 years old in the united states . regular consumption of these caloric drinks can increase the risk for obesity and dental caries . in particular , sports and energy drinks ( seds ) are relatively new products that are increasingly marketed to adolescents . furthermore , purchase and consumption of these drinks by adolescents appear to be common . in 2010 , the proportion of high school students who consumed sds and eds at least once per day was 16 % and 5 % , respectively . sds contain carbohydrates , minerals , and electrolytes and are often marketed for the purpose of rehydration . however , drinking water alone provides adequate replenishment in most instances other than prolonged vigorous exercise . both sds and edshave been associated with increased dental erosion , due to their acidity and the presence of citric acid . eds carry additional consequences due to their stimulatory and performance enhancing effects , derived from ingredients such as caffeine , taurine , guarana , and carbohydrate sweeteners . unlike caffeinated soda drinks , eds do not have restrictions on their caffeine concentration nor are they required to have undergone safety testing or placement of appropriate warning labels . as a result , the caffeine content found in eds can range from 50 mg to 505 mg per can , which can be as much as that found in 1412 - ounce cans of a typical soda . consumption of eds may put adolescents at risk of adverse effects of caffeine ( elevated heart rate , anxiety , and sleep disturbances ) and in one study their consumption was associated with coconsumption of alcohol . a significant proportion of us adolescents regularly consume eds , ranging from 28 % of 12 - to 14 - year - olds to 34 % of 18 - to 24 - year - olds . the problem extends to other countries , as evidenced by one study in germany that found 23 % of adolescents regularly consuming eds at 1 can per week and 3 % consuming 1 to 7 cans per week . furthermore , a recent study of us poison center data described the disproportionate exposure of children and young adults to eds ; among cases involving nonalcoholic eds , over 50 % occurred with children under 6 years of age while 68 % of cases involving alcoholic eds occurred with young adults under 20 years of age . health care providers can play an important role in addressing the issue of sed consumption , through counseling and educating adolescent patients and their families on associated health risks . in 2011 , the american academy of pediatrics ( aap ) recommended routine counseling of children and adolescents for sed consumption ; the aap emphasized that water should be the principle source of hydration rather than sd and that due to the potential health risks of caffeine , any consumption of ed by children should be discouraged . while counseling practices related to seds have not been well described , numerous studies have examined counseling practices for general ssb or adolescent obesity . one cross - sectional survey found that 38 % of youth participants had discussed ssb with their physicians and 69 % of youths reported that they would change their obesity - related behaviors if it were recommended by their physicians . in a separate survey study , youths were more likely to report positive perceptions of a health care provider if they discussed one or more sensitive health topics , which included mood , drugs and alcohol , sexuality , and family issues although body weight was not included . a better understanding is needed on how provider characteristics are associated with counseling practices , specifically with regard to sed consumption . the purpose of this study is to examine the prevalence and frequency of sed counseling among health care providers , where counseling is defined as discussions during which patients are advised to limit consumption of sds and to avoid any consumption of eds . furthermore , this study also examines whether provider characteristics are associated with regular sed counseling . data was obtained from docstyles 2011 , a web - based panel survey developed by porter novelli . the survey is designed to provide insight into health care provider attitudes and counseling behaviors regarding a variety of adult and pediatric health issues and to assess their use of health information resources . in addition , the survey includes questions on the provider 's height and weight , as well as other questions describing their demographics , health behaviors , and practice characteristics . the centers for disease control and prevention human subjects review determined that these analyses were exempt from human subjects review because this is a secondary data analysis using data without identifiers . this study is based on responses from family / general practitioners ( fgps ) , internists , pediatricians , and nurse practitioners in docstyles 2011 . for the complete docstyles 2011 survey , physicians and other health care providers were randomly selected from epocrates ' honor panel and epocrates ' allied health panel , respectively . epocrates ' honors panel is an opt - in panel of over 190,000 medical practitioners , verified by checking each physician against the american medical association 's ( ama ) master file . participants for this study were randomly selected through a probability sampling method to meet preestablished quotas for each health care provider type ( 1,000 primary care physicians , 250 pediatricians , 250 obstetricians / gynecologists , 250 retail pharmacists , 250 nurse practitioners , and 200 registered dietitians ) and for the physician sample to match the ama master file in terms of age , gender , and region . the total sample is not intended to be representative of the national population of health care providers . porter novelli compared the physician participants , stratified by specialty , to the ama master file for gender , age , and region of the country and found the average age to be lower compared to national averages . the present study was limited to fgps ( n = 544 ) , internists ( n = 85 ) , pediatricians ( n = 239 ) , and nurse practitioners ( n = 178 ) who regularly see patients 17 years old ( n = 1046 ) . only these individuals were eligible to respond to the questions regarding counseling of adolescents on sed consumption , per survey protocol . after exclusion of respondents due to ambiguous or inconsistent responses , the final analytic sample was 1014 . the authors were unable to assess the comparability of this analytic sample with the ama master file because the study was restricted to those who see pediatric patients and are of particular specialties . comparison data were not available for nurse practitioners . the analysis of health care provider counseling of adolescents on sed is based on the three questions listed in figure 1 . individuals who responded with both drink types or sports drinks only were asked question 2 , which inquires about frequency of counseling to limit sd consumption . individuals who responded with both drink types or energy drinks only were asked question 3 , which inquires about frequency of counseling to not drink eds . regular sd counseling was defined as those individuals who regularly ( always or often ) counseled on reducing sd consumption with the comparison group being those who counseled less frequently ( sometimes , rarely , or never ) or did not provide any counseling . lastly , regular comprehensive sed counseling was defined as individuals who counseled on both drink types and counseled regularly for both ; the comparison group included everyone who provided counseling less frequently or did not provide counseling . in all three outcomes , individuals who responded with not sure in question 1 ( n = 32 ) or sports drinks / energy drinks are not typically discussed in questions 2 ( n = 2 ) and 3 ( n = 7 ) were excluded due to ambiguity or inconsistency of answers . to investigate factors associated with sed counseling , personal and medical practice - related characteristics of each participant were analyzed . personal characteristics include age ( 45 years versus 45 years ) , sex , race and ethnicity ( non - hispanic white versus all others ) , weight status determined by body mass index ( bmi ) calculated from self - reported height and weight ( normal / underweight bmi 25 , overweight 25 bmi 30 and obese bmi 30 ) , number of days per week they ate 5 cups of fruit or vegetables henceforth called high intake ( 4 days versus 4 days ) , and number of days they exercised or kept their heart rate up for 30 minutes ( 5 days versus 5 days ) . medical practice - related characteristics included type of specialty , practice setting ( individual versus group versus hospital or clinic ) , affiliation with a teaching hospital , years of practice ( 10 years versus 10 years ) , number of total patients per week ( 100 versus 100 ) , and perceived financial status of their patients ( very poor to poor , poor to low middle , low middle to middle , middle to upper middle , and upper middle to affluent ) . the overall prevalence among health care providers giving regular counseling to adolescent patients regarding sds , eds , or both was assessed . chi - square analysis was used to examine differences in the prevalence of regular sed counseling among participants with different personal and medical practice - related characteristics . multivariate logistic regression was conducted to determine characteristics independently associated with the three outcomes of interest : regular sd counseling , regular ed counseling , and regular comprehensive sed counseling . the significance level was p 0.05 and the selection criterion for bivariate inclusion in the multivariate model was p 0.20 . all analyses were conducted using sas 9.2 statistical software ( sas institute inc . ) . approximately three - fourths of providers were non - hispanic whites , with a relatively even distribution in sex and age ( table 1 ) . thirty - seven percent of providers were overweight and 15 % were obese , 55 % reported high fruit and vegetable intake ( at least 5 cups per day , 4 days per week ) , and 29 % engaged in 30 minutes or more of physical activity 5 days per week . nearly 60 % had been practicing for greater than ten years and approximately half ( 46 % ) had teaching privileges . the majority ( 66 % ) ofthe participants worked in a group practice , 57 % had five or less physicians in their practice , and 58 % saw 100 patients per week . overall , 41 % of participants provided regular ( always or often ) sd counseling compared to 55 % for ed counseling ( table 1 ) . female providers exhibited a higher prevalence of regular counseling , at 47 % and 61 % for sds and eds , respectively , compared to 35 % and 49 % by male providers . pediatricians had the highest prevalence of regular sd counseling at 55 % compared to internists who had the lowest prevalence at 30 % . for regular ed counseling , nurse practitioners had the highest prevalence at 65 % compared to internists at 43 % . multivariate modeling found that regular sd counseling was independently associated with being female ( adjusted odds ratio ( aor ) : 1.41 [ 95 % confidence interval ( 95 % ci ) : 1.071.88 ] ) , high fruit and vegetable intake ( aor : 1.63 [ 95 % ci : 1.242.13 ] ) , type of provider , and group practices compared to individual practices ( aor : 0.66 [ 95 % ci : 0.470.93 ] ) ( table 2 ) . in the model , compared to pediatricians as the reference group , fgps ( aor : 0.46 [ 95 % ci : 0.330.64 ] ) , internists ( aor : 0.33 [ 95 % ci : 0.180.59 ] ) , and nurse practitioners ( aor : 0.55 [ 95 % ci : 0.360.83 ] ) all had significantly lower odds of providing regular sd counseling . similar to sd counseling , multivariate modeling found that regular ed counseling was independently associated with being female ( aor : 1.40 [ 95 % ci : 1.061.84 ] ) , high fruit and vegetable intake ( aor : 1.68 [ 95 % ci : 1.302.16 ] ) , internists as compared to pediatricians ( aor : 0.56 [ 95 % ci : 0.330.96 ] ) , and group practices compared to individual practices ( aor : 0.68 [ 95 % ci : 0.480.95 ] ) ( table 2 ) . other provider types did not significantly differ from pediatricians in the adjusted model . with regard to either regular sd counseling or ed counseling , no statistically significant differences were found with regard to race / ethnicity , bmi , years of practice , teaching privileges , number of physicians per practice , number of patients seen per week , or the provider 's perception of their patient population 's socioeconomic level ( table 2 ) . the third outcome of this study is regular comprehensive sed counseling , which had an overall prevalence of 34 % ( table 1 ) . the prevalence of counseling was higher in female providers at 41 % compared to male providers at 28 % . among the types of health care providers , pediatricians and nurse practitioners had the highest prevalence of comprehensive sed counseling at 43 % and 42 % , respectively , compared to fgps at 29 % and internists at 23 % . multivariate modeling found regular comprehensive sed counseling to be independently associated with being female ( aor : 1.44 [ 95 % ci : 1.071.93 ] ) , high fruit and vegetable intake ( aor : 2.05 [ 95 % ci : 1.542.73 ] ) , fgps ( aor : 0.58 [ 95 % ci : 0.410.82 ] ) and internists ( aor : 0.37 [ 95 % ci : 0.200.70 ] ) compared to pediatricians , and group practices ( aor : 0.59 [ 95 % ci : 0.420.84 ] ) compared to individuals practices ( table 2 ) . we found that one - third of health care providers in this study reported comprehensive sed counseling , indicating that the majority of health care providers who see adolescent patients were not providing both sd and ed counseling regularly . stratification by provider type found that pediatricians had the highest prevalence of regular comprehensive sed counseling ( 43 % ) . this is lower than the ssb counseling rate of 65 % reported by pediatricians in the 2006 aap periodic survey of fellows . however , differences may be attributed to the topic counseled upon ( sed versus ssb ) and how frequent counselingin addition to pediatricians , nurse practitioners also exhibited high counseling rates ; these two provider types comprised the two highest prevalences of sd only , ed only , and comprehensive sed counseling . the finding that pediatricians typically exhibited the highest rates of sed counseling is congruent with previous studies , which have also have found that pediatricians more frequently assessed weight status and provided behavioral counseling than family / general practitioners . nurse practitioners were more likely to provide sed counseling than fgps and internists in this study . one possible reason for this difference may be that , in this study , fgps and internists tend to see fewer pediatric patients per week ( fgps / internists : 23.3 pediatric patient versus nurse practitioners : 29.4 versus pediatricians : 105.0 ) and may have less experience counseling adolescents . another reason , though not investigated in this study , is the amount of time nurse practitioners have to spend with each patient and the complexity of cases they manage . regardless of the cause of the disparities , fgps and internists likely play significant roles in the health maintenance of adolescent patients . gaps in counseling practices can be addressed through changes in the training and continuing education of providers . currently , the differences in provider access and familiarity of aap counseling recommendations are unknown . this study also found that the prevalence of regular sd counseling and of regular ed counseling significantly differed overall , at 41 % and 55 % , respectively . specifically , this difference varied by provider type , with internists exhibiting the greatest discrepancy ( 21 % higher for ed counseling ) in comparison to pediatricians ( 1 % higher for ed counseling ) . these findings suggest that there are provider - specific differences in how the health risks of these two drink types are perceived and managed . we found that being female , having high fruit and vegetable intake , being a pediatrician , and operating in an individual practice compared to a group practice were associated with greater odds of providing regular comprehensive sed counseling . some variables identified in previous studies to be related to physician counseling behaviors such as race / ethnicity and bmi were not found to be associated in this study . compared to bleich et al . , this study contained a similar proportion of overweight / obese providers at 52 % , with the difference being a focus on adolescent patients with whom providers may be more motivated to counsel on obesity - related topics . given the relatively low rates of regular sed counseling , increasing provider awareness of the health effects of sed is the first step in addressing this issue . secondly , studies have found that various factors affect how inclined and confident a clinician is in terms of providing health behavior counseling . one study found that physicians with normal bmis were more likely to discuss weight loss and were more confident in offering diet and exercise suggestions . another study found that clinicians who personally struggle with making healthy choices , such as avoiding calorically dense foods and beverages , may find it more difficult to counsel patients on that topic . our data supports that hypothesis , with providers of high fruit and vegetable intake having higher prevalence of sed counseling . encouraging health care providers to lead healthy lives may contribute to higher prevalences of sed counseling . ideally , providers can be role models for healthy behavior and create a supportive environment in their clinic or hospital setting and in the community - at - large for patients and families . other studies have found that another barrier to offering effective health counseling is a lack of training or confidence in behavioral counseling . techniques such as motivational counseling , the 5 a 's heuristic , and multistage models provide frameworks from which effective changes can be encouraged . investigators have developed and examined curricula for medical students and residents , comprised of lectures and opportunities to practice counseling techniques that resulted in subjective increases in confidence in providing health behavior counseling . lastly , physicians can also learn from effective community - based interventions and adapt them for their patients . for example , physicians can consider explaining caloric information to adolescent patients in terms of physical activity equivalents , a promising intervention used for youth in baltimore . first , the sample was drawn from an opt - in database , which is subject to selection bias and may not be representative of health care providers nationally . second , the responses regarding counseling behaviors are subjective and susceptible to recall bias ; thus , reported prevalence may not reflect actual practices . third , there is limited evidence for or against the assignment of the sometimes response to the not regular counseling group ; however , the data was also analyzed withsometimes assigned to the regular counseling group and the results were not significantly different . finally , the survey did not assess barriers that prevented sd and / or ed counseling from being offered . with the prevalence of regular comprehensive sed counseling at 34 % , increased efforts must be applied to educate adolescent patients and not overlook the associated health risks of high consumption of these beverages . additional research is required to assess physician opinions and barriers that stand in the way of providing regular counseling . research and training can help teach health care providers of various disciplines pertinent information and effective counseling techniques for patients and parents .\noutput:\n" }, { "from": "agent", "value": "objective . to examine the proportion of health care providers who counsel adolescent patients on sports and energy drink ( sed ) consumption and the association with provider characteristics . methods . this is a cross - sectional analysis of a survey of providers who see patients 17 years old . the proportion providing regular counseling on sports drinks ( sds ) , energy drinks ( eds ) , or both was assessed . chi - square analyses examined differences in counseling based on provider characteristics . multivariate logistic regression calculated adjusted odds ratios ( aor ) for characteristics independently associated with sed counseling . results . overall , 34 % of health care providers regularly counseled on both seds , with 41 % regularly counseling on sds and 55 % regularly counseling on eds . on adjusted modeling regular sed counseling was associated with the female sex ( aor : 1.44 [ 95 % ci : 1.071.93 ] ) , high fruit / vegetable intake ( aor : 2.05 [ 95 % ci : 1.542.73 ] ) , family / general practitioners ( aor : 0.58 [ 95 % ci : 0.410.82 ] ) and internists ( aor : 0.37 [ 95 % ci : 0.200.70 ] ) versus pediatricians , and group versus individual practices ( aor : 0.59 [ 95 % ci : 0.420.84 ] ) . modeling for sd - and ed - specific counseling found similar associations with provider characteristics . conclusion . the prevalence of regular sed counseling is low overall and varies . provider education on the significance of sed counseling and consumption is important ." } ]