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[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Female, Gastric Mucosa, Helicobacter Infections, Helicobacter pylori, Humans, Immunohistochemistry, Lymphocyte Antigen 96, Male, Reverse Transcriptase Polymerase Chain Reaction, Toll-Like Receptor 4." }, { "role": "user", "content": "Does helicobacter pylori infection affect Toll-like receptor 4 expression in human gastric mucosa? Context: Toll-like receptor 4 (TLR4), which requires a helper molecule, MD-2, is a main receptor for lipopolysaccharide (LPS) from gram-negative bacteria. The expression of TLR4 in H. pylori infection in human gastric mucosa, however, is unclear. The aim of this study was to determine the effect of H. pylori infection on the TLR4 and MD-2 expression in human gastric mucosa. Biopsy samples from the antrum and corpus were obtained from 45 patients (25 patients without H. pylori infection including 5 patients with successful eradication of H. pylori, and 20 patients with H. pylori infection). These samples were used for TLR4, MD-2 mRNA expression study and immunohistochemical study. In patients without H. pylori infection, the expressions of TLR4 and MD-2 were bigger in the corpus mucosa than in the antral mucosa. In patients with H. pylori infection, the expressions of TLR4 and MD-2 significantly increased in the antral and corpus mucosa. Immunohistochemical study revealed similar results as the TLR4 mRNA expression. After the eradication of H. pylori, the expressions of TLR4 and MD-2 were the same levels in both sites as those in patients without H. pylori infection." }, { "role": "assistant", "content": "The results indicated that H. pylori infection significantly increased TLR4 and MD-2 expressions in the antral and corpus mucosa. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Fundus of stomach is supplied by which of the following artery:" }, { "role": "assistant", "content": "The correct answer is Ans. B Splenic arteryRef: Clinically Oriented Anatomy by Keith, Moore, 5th ed. pg. 252-253* The stomach has a rich arterial supply arising from the celiac trunk and its branches.* Most blood is supplied by anastomoses formed along the lesser curvature by the right and left gastric arteries, and along the greater curvature by the right and left gastro- omental arteries.* Fundus of the stomach is supplied by splenic artery mainly.* Branches of splenic artery:# Posterior gastric# Short gastric arteries# Left gastroepiploic artery* Out ot the three, the fundus of stomach is supplied by short gastric artery and left gastroepiploic artery. But major contribution is by short gastric arteries.* This was a controversial question, but given these choices the best answer is splenic artery." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Man is the terminal end for -" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "FALSE about Cvtochrome-P450" }, { "role": "assistant", "content": "The correct answer is (B) Peroxidase converts H202 at the expense of electron acceptors # Cytochrome-P450 are located on the smooth endoplasmic reticulum of cells throughout the body, but the highest concentrations are found in the liver (hepatocytes) and small intestine> Catalase is a hemoprotein containing four heme groups. In addition to possessing peroxidase activity, it is able to use one molecule of H2O2 as a substrate electron donor and another molecule of H202 as an oxidant or electron acceptor> Transfer of a single electron to 02 generates the potentially damaging superoxide anion free radical (02\"-), the destructive effects of which are amplified by its giving rise to free radical chain reactions." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Cardiopulmonary Bypass, Enzyme Activation, Erythrocytes, Humans, Hypotension, Nitric Oxide, Nitric Oxide Synthase Type III, Vasodilation." }, { "role": "user", "content": "Does extracorporeal circulation activate endothelial nitric oxide synthase in erythrocytes? Context: Extracorporeal circulation used in cardiopulmonary bypass and hemodialysis is often associated with severe hypotension, which is an important predictor for mortality and morbidity. One pathophysiological hypothesis includes nitric oxide (NO) generation. Recently, a functional NO synthase (endothelial type NO synthase [eNOS]), was found to be expressed in human red blood cells. However, to date, activation of red blood cell eNOS has not been shown. We hypothesized that eNOS in circulating red blood cells might be activated during extracorporeal circulation and thus contribute to hypotension through vasodilation upon NO release. We collected blood samples from 28 patients electively subjected to cardiac surgery during cardiopulmonary bypass (0, 20, 40, 60, and 80 minutes of cardiopulmonary bypass; taken for routine blood gas analyses). Red blood cells were immunohistochemically stained against activated eNOS. The degree of activation was assessed by television densitometry (gray units). We found significant red blood cell eNOS activation during cardiopulmonary bypass in a time dependent fashion. The eNOS activation occurred by dissociation of the enzyme from the cellular membrane into the cytosol (translocation). The correlation between activated eNOS and bypass duration was highly significant." }, { "role": "assistant", "content": "Red blood cells might contribute to hypotension through vasodilation upon NO release during extracorporeal circulation and could serve as new therapeutic targets in clinical practice. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Biomarkers, Female, Hemoglobins, Humans, Mass Spectrometry, Pre-Eclampsia, Pregnancy, Protein Array Analysis, Proteomics." }, { "role": "user", "content": "Does discriminatory proteomic biomarker analysis identify free hemoglobin in the cerebrospinal fluid of women with severe preeclampsia? Context: Preeclampsia is an idiopathic multisystem disorder specific to human pregnancy. This study used proteomic analysis of cerebrospinal fluid (CSF) to identify protein biomarkers characteristic of preeclampsia and related to its severity. CSF was collected from women diagnosed clinically with severe preeclampsia (sPE: n = 7), mild preeclampsia (mPE: n = 8), and normotensive controls (CRL: n = 8). Samples were subjected to proteomic analysis using surface-enhanced laser desorption/ionization time-of-flight (SELDI-TOF) mass spectroscopy. A discriminative proteomic biomarker profile was extracted by applying Mass Restricted analysis, and a Preeclampsia Proteomic Biomarker (PPB) score developed based on the presence or absence of four discriminatory protein peaks in individual CSF SELDI tracings. In-gel tryptic digests, Western blot analysis, on-chip immunoassays, ELISA, and spectral analysis were used to identify the biomarkers composing the PPB score. PPB score distinguished patients with a clinical diagnosis of sPE from mPE and CRLs. (PPB median [range]: sPE: 4 [0-4] vs mPE: 1 [0-1] vs CRL: 0 [0-0]; P < 0.001). PPB scores were unaffected by parity, magnesium seizure prophylaxis, CSF leukocyte counts, and total protein content. Proteomic identification techniques matched the discriminatory protein peaks to the alpha- and beta-hemoglobin chains. ELISA confirmed that women diagnosed clinically with sPE had significantly higher CSF hemoglobin concentrations than women with mPE or CRL (median [range]: sPE: 6.6 [0.0-10.3] microg/mL vs mPE: 0 [0-1.3] microg/mL vs CRL: 0 [0-0] microg/mL; P < 0.001)." }, { "role": "assistant", "content": "Proteomic analysis of CSF can accurately distinguish sPE from both mPE and CRL. Patients with sPE have nanomolar amounts of free hemoglobin in their CSF. Further studies are needed to confirm these observations and determine their physiologic implications. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Chinese letter configuration is seen in ?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'd' i.e. C diphtheriae C. diphtheriae is gram positive, non motile, nonsporing, noncapsulated. Babes Ernest or volutin granules Also known as metachromatic granules or polar bodies. Composed of polymetaphosphate. Usually stained with Loeffler's methylene blue. Special stains for demonstration are Albe's, Neisser 's and Ponder 's." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Blood Pressure, Chemokine CXCL12, Familial Primary Pulmonary Hypertension, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Prognosis, Proportional Hazards Models, Pulmonary Artery." }, { "role": "user", "content": "Is elevated plasma CXCL12α associated with a poorer prognosis in pulmonary arterial hypertension? Context: Recent work in preclinical models suggests that signalling via the pro-angiogenic and pro-inflammatory cytokine, CXCL12 (SDF-1), plays an important pathogenic role in pulmonary hypertension (PH). The objective of this study was to establish whether circulating concentrations of CXCL12α were elevated in patients with PAH and related to mortality. Plasma samples were collected from patients with idiopathic pulmonary arterial hypertension (IPAH) and PAH associated with connective tissue diseases (CTD-PAH) attending two pulmonary hypertension referral centres (n = 95) and from age and gender matched healthy controls (n = 44). Patients were subsequently monitored throughout a period of five years. CXCL12α concentrations were elevated in PAH groups compared to controls (P<0.05) and receiver-operating-characteristic analysis showed that plasma CXCL12α concentrations discriminated patients from healthy controls (AUC 0.80, 95% confidence interval 0.73-0.88). Kaplan Meier analysis indicated that elevated plasma CXCL12α concentration was associated with reduced survival (P<0.01). Multivariate Cox proportional hazards model showed that elevated CXCL12α independently predicted (P<0.05) earlier death in PAH with a hazard ratio (95% confidence interval) of 2.25 (1.01-5.00). In the largest subset by WHO functional class (Class 3, 65% of patients) elevated CXCL12α independently predicted (P<0.05) earlier death, hazard ratio 2.27 (1.05-4.89)." }, { "role": "assistant", "content": "Our data show that elevated concentrations of circulating CXCL12α in PAH predicted poorer survival. Furthermore, elevated circulating CXCL12α was an independent risk factor for death that could potentially be included in a prognostic model and guide therapy. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Lens subluxation occurs in all except:" }, { "role": "assistant", "content": "The correct answer is Ans. Congenital rubella" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 64-year-old female presents to her primary care physician for an annual checkup. She states that her health is adequate, but she has not been doing well since her husband died last year. She is able to get by but admits to having trouble caring for herself, cooking, cleaning, and paying her bills. The patient complains of diffuse muscle aches and pains. She has a past medical history of anxiety and seasonal affective disorder. She is not currently taking any medications. On physical exam, you note a gaunt woman with a depressed affect. You note that her body mass index (BMI) and height have both decreased since her last annual visit. On physical exam, her cardiac, pulmonary, and abdominal exams are within normal limits. Lab work is drawn and is as follows:\n\nSerum:\nNa+: 135 mEq/L\nK+: 3.7 mEq/L\nCl-: 100 mEq/L\nHCO3-: 23 mEq/L\nUrea nitrogen: 7 mg/dL\nGlucose: 70 mg/dL\nCreatinine: 0.8 mg/dL\nCa2+: 8.0 mg/dL\nMg2+: 1.5 mEq/L\nParathyroid hormone: 855 pg/mL\nAlkaline phosphatase: 135 U/L\nPhosphorus: 2.6 mg/dL\n\nHemoglobin: 14 g/dL\nHematocrit: 36%\nPlatelet count: 187,000/mm^3\nLeukocyte count: 4,700/mm^3\n\nWhat is the most likely diagnosis?" }, { "role": "assistant", "content": "Osteomalacia" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Carbon Dioxide, Cell Line, Tumor, Epithelium, Female, Humidity, Hypothermia, Induced, Laparoscopy, Mice, Inbred BALB C, Models, Animal, Neoplasm Transplantation, Nitrous Oxide, Oxygen, Peritoneal Cavity, Pneumoperitoneum, Artificial, Tissue Adhesions." }, { "role": "user", "content": "Does conditioning of the abdominal cavity reduce tumor implantation in a laparoscopic mouse model? Context: The addition of 4 % O2 and 10 % N2O to the CO2 pneumoperitoneum (PP), together with slight cooling and humidification (conditioning), contributes to reducing adhesions by preventing mesothelial damage. We investigated the effect of peritoneal damage during laparoscopy on tumor implantation. In Experiment 1, different tumor cell concentrations were injected into control mice without PP and into mice with 60-min dry CO2PP (mesothelial damage). In Experiment 2, tumor cells were injected into control mice (group I) and in mice with mesothelial damage (group II). In groups III to VI, mesothelial damage was decreased by adding humidification, humidification + 10 % N2O, humidification + 10 % N2O + 4 % O2, and conditioning, respectively. In Experiment 1, the tumors increased with the number of cells injected and with mesothelial damage in the abdominal cavity (p = 0.018) and abdominal wall (p < 0.0001). Experiment 2 confirmed that 60 min of dry CO2PP increased the number of tumors in the abdominal cavity and wall (p = 0.026 and p = 0.003, respectively). The number of tumors was decreased in the abdominal cavity by conditioning (p = 0.030) and in the abdominal wall using humidified CO2 (p = 0.032) or conditioning (p = 0.026)." }, { "role": "assistant", "content": "Tumor implantation was enhanced by peritoneal damage (60 min of dry CO2PP and desiccation), but this was prevented by conditioning. If confirmed in humans, conditioning would become important for oncologic surgery. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Female, Genetic Predisposition to Disease, Genotype, Humans, Male, Middle Aged, Polymorphism, Genetic, Suicide, Attempted, Tryptophan Hydroxylase, Turkey, Young Adult." }, { "role": "user", "content": "Is tPH1 A218 allele associated with suicidal behavior in Turkish population? Context: Serotonergic dysfunction is implicated in depression, psychiatric disorders and suicidal behaviors. The first and rate-limiting step in the synthesis of serotonin is catalyzed by tryptophan hydroxylase (TPH) which is encoded by TPH1 and THP2 genes. Genetic association studies have revealed contradictory results about the effect of the TPH1 A218C (rs1800532) polymorphism on suicidal behavior in different populations. In this study, we investigated A218C polymorphism in 109 suicide attempters and 98 healthy controls. Socio-demographic characteristics of participants were obtained through questionnaire. DNA was extracted from peripheral blood and genotyping was performed by Real Time PCR. Fisher's exact test was used to evaluate the significance of the difference among the independent variables. Hardy-Weinberg equilibrium was tested using Pearson's goodness-of-fit chi-squared test. The frequency of A allele was significantly higher in suicide attempters than controls (46.33% vs. 35.71%, p=0.0357). However, there were no differences in genotype frequencies of this locus between participants having attempted suicide and controls (p>0.05). Among males, frequencies of CC genotype and C allele were found to be significantly higher in controls (p=0.0125, p=0.0298). With regard to the female subjects and female controls, no significant association was detected between suicidal behavior and genotype/allele frequencies (p>0.05)." }, { "role": "assistant", "content": "Our results provide evidence that A allele of TPH1 A218C polymorphism may be associated with suicidal behavior in Turkish population. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Not an indication for cholecystectomy for gallstones disease" }, { "role": "assistant", "content": "The correct answer is Indications of prophylactic Cholecystectomy Cardiac transplant recepients Lung transplant recipients Chronic TPN requirements Recepients of biliopancreatic diversion (bariatric patient) Children with hemoglobinopathy (sickle cell, thalassemia and spherocytosis) Asymptomatic gallstone >=3cm Stone associated with the polyp Family history of GB cancer and asymptomatic stones Cholelithiasis encountered during elective abdominal procedures Non functioning GB Typhoid carrier with positive bile culture Trauma to GB Procelain GB Ref: Sabiston 20th edition Pgno :1494" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: METHODS, OBJECTIVE, BACKGROUND, METHODS, RESULTS. Meshes: Biomechanical Phenomena, Bone Screws, External Fixators, Humans, Joint Instability, Models, Anatomic, Neck, Odontoid Process, Range of Motion, Articular, Skull, Spinal Fractures, Spinal Fusion, Thorax." }, { "role": "user", "content": "Do biomechanics of halo-vest and dens screw fixation for type II odontoid fracture? Context: An in vitro biomechanical study of halo-vest and odontoid screw fixation of Type II dens fracture. The objective were to determine upper cervical spine instability due to simulated dens fracture and investigate stability provided by the halo-vest and odontoid screw, applied individually and combined. Previous studies have evaluated posterior fixation techniques for stabilizing dens fracture. No previous biomechanical study has investigated the halo-vest and odontoid screw for stabilizing dens fracture. A biofidelic skull-neck-thorax model was used with 5 osteoligamentous whole cervical spine specimens. Three-dimensional flexibility tests were performed on the specimens while intact, following simulated dens fracture, and following application of the halo-vest alone, odontoid screw alone, and halo-vest and screw combined. Average total neutral zone and total ranges of motion at C0/1 and C1/2 were computed for each experimental condition and statistically compared with physiologic motion limits, obtained from the intact flexibility test. Significance was set at P < 0.05 with a trend toward significance at P < 0.1. Type II dens fracture caused trends toward increased sagittal neutral zone and lateral bending range of motion at C1/2. Spinal motions with the dens screw alone could not be differentiated from physiologic limits. Significant reductions in motion were observed at C0/1 and C1/2 in flexion-extension and axial rotation due to the halo-vest, applied individually or combined with the dens screw. At C1/2, the halo-vest combined with the dens screw generally allowed the smallest average percentages of intact motion: 3% in axial rotation, 17% in flexion-extension, and 18% in lateral bending." }, { "role": "assistant", "content": "The present reduction in C1/2 motion observed, due to the halo-vest and dens screw combined is similar to previously reported immobilization provided by the polyaxial screw/rod system and transarticular screw fixation combined with wiring. The present biomechanical data may be useful to clinicians when choosing an appropriate treatment for those with Type II dens fracture. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Confluent areas of pancreatic parenchyma that do not demonstrate enhancement after the administration of intravenous (IV) contrast material is known as:" }, { "role": "assistant", "content": "The correct answer is Pancreatic necrosis is defined as confluent areas of pancreatic parenchyma that do not demonstrate enhancement after the administration of (IV) contrast material. Pseudocyst is with a well defined wall with fluid inside. Walled off pancreatic necrosis happens after 4 weeks of acute pancreatic necrosis. Acute peripancreatic fluid collection is outside the pancreas. Ref: ACR Appropriateness Criteria,Acute Pancreatitis." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Alleles, Anxiety Disorders, Brain-Derived Neurotrophic Factor, Cross-Sectional Studies, Female, Genetic Association Studies, Genetic Predisposition to Disease, Humans, Male, Methionine, Polymorphism, Single Nucleotide, Valine, Young Adult." }, { "role": "user", "content": "Is the Met allele of BDNF Val66Met polymorphism associated with increased BDNF levels in generalized anxiety disorder? Context: Generalized anxiety disorder (GAD) is a common psychiatric disorder characterized by long-term worry, tension, nervousness, fidgeting, and symptoms of autonomic system hyperactivity. The neurobiology of this disorder is still unclear, although it has been shown consistently that the environment and the genetic profile could increase its risk. We examined whether a polymorphism in the brain-derived neurotrophic factor (BDNF) gene, which plays a role in neuroplasticity and memory, could increase the vulnerability to this disorder. In our study, 816 participants from a population-based study were genotyped by qPCR for the BDNF functional variant rs6265 (Val66Met) and the BDNF serum levels were measured by ELISA. Our results showed a significant association between the Met allele and risk for GAD (P=0.014), but no differences were observed in the serum levels of BDNF according to diagnosis (P=0.531) or genotype distribution (P=0.197). However, after stratification according to the GAD diagnosis, the Met allele was associated significantly with an increase in serum BDNF levels compared with the Val/Val genotype in GAD participants (F=3.93; P=0.048). The logistic regression analysis confirmed the independent association of Met allele as a risk factor for development of GAD after adjusting for confounder variables (β=0.528; 95% confidence interval: 0.320-0.871; P=0.012)." }, { "role": "assistant", "content": "These results suggest that BDNF could be involved in the neurobiology of GAD and might represent a useful marker associated with the disease. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Calcium Signaling, Cyclic AMP, Cyclic AMP Response Element-Binding Protein, Cyclic AMP-Dependent Protein Kinases, Dose-Response Relationship, Drug, Glucose, In Vitro Techniques, Insulin, Insulin-Secreting Cells, KATP Channels, Male, Mice, Mice, Inbred C57BL, Phosphorylation, Protein Kinase Inhibitors, Receptors, G-Protein-Coupled, Signal Transduction, Taurochenodeoxycholic Acid." }, { "role": "user", "content": "Does the bile acid TUDCA increase glucose-induced insulin secretion via the cAMP/PKA pathway in pancreatic beta cells? Context: While bile acids are important for the digestion process, they also act as signaling molecules in many tissues, including the endocrine pancreas, which expresses specific bile acid receptors that regulate several cell functions. In this study, we investigated the effects of the conjugated bile acid TUDCA on glucose-stimulated insulin secretion (GSIS) from pancreatic β-cells. Pancreatic islets were isolated from 90-day-old male mice. Insulin secretion was measured by radioimmunoassay, protein phosphorylation by western blot, Ca(2+) signals by fluorescence microscopy and ATP-dependent K(+) (KATP) channels by electrophysiology. TUDCA dose-dependently increased GSIS in fresh islets at stimulatory glucose concentrations but remained without effect at low glucose levels. This effect was not associated with changes in glucose metabolism, Ca(2+) signals or KATP channel activity; however, it was lost in the presence of a cAMP competitor or a PKA inhibitor. Additionally, PKA and CREB phosphorylation were observed after 1-hour incubation with TUDCA. The potentiation of GSIS was blunted by the Gα stimulatory, G protein subunit-specific inhibitor NF449 and mimicked by the specific TGR5 agonist INT-777, pointing to the involvement of the bile acid G protein-coupled receptor TGR5." }, { "role": "assistant", "content": "Our data indicate that TUDCA potentiates GSIS through the cAMP/PKA pathway. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Does a managed protocol for treatment of deceased potential donors reduce the incidence of cardiac arrest before organ explant? Context: To assess the effect of the application of a managed protocol for the maintenance care of deceased potential multiple organ donors at two hospitals. A before (Phase 1)/after (Phase 2) study conducted at two general hospitals, which included consecutively potential donors admitted to two intensive care units. In Phase 1 (16 months), the data were collected retrospectively, and the maintenance care measures of the potential donors were instituted by the intensivists. In Phase 2 (12 months), the data collection was prospective, and a managed protocol was used for maintenance care. The two phases were compared in terms of their demographic variables, physiological variables at diagnosis of brain death and the end of the process, time to performance of brain death confirmatory test and end of the process, adherence to bundles of maintenance care essential measures, losses due to cardiac arrest, family refusal, contraindications, and the conversion rate of potential into actual donors. Student's t- and chi-square tests were used, and p-value < 0.05 was considered to be significant. A total of 42 potential donors were identified (18 in Phase 1 and 24 in Phase 2). The time interval between the first clinical assessment and the recovery decreased in Phase 2 (Phase 1: 35.0±15.5 hours versus Phase 2: 24.6±6.2 hours; p = 0.023). Adherence increased to 10 out of the 19 essential items of maintenance care, and losses due to cardiac arrest also decreased in Phase 2 (Phase 1: 27.8 versus 0% in Phase 2; p = 0.006), while the convertion rate increased (Phase 1: 44.4 versus 75% in Phase 2; p = 0.044). The losses due to family refusal and medical contraindication did not vary." }, { "role": "assistant", "content": "The adoption of a managed protocol focused on the application of essential measures for the care of potential deceased donors might reduce the loss of potential donors due to cardiac arrest. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Antineoplastic Agents, Apoptosis, Carcinoma, Curcumin, Disease Models, Animal, Female, Humans, Mice, Mice, Nude, NF-kappa B, Neoplasm Transplantation, Neovascularization, Pathologic, Ovarian Neoplasms, Platelet Endothelial Cell Adhesion Molecule-1." }, { "role": "user", "content": "Does curcumin inhibit tumor growth and angiogenesis in ovarian carcinoma by targeting the nuclear factor-kappaB pathway? Context: Curcumin, a component of turmeric, has been shown to suppress inflammation and angiogenesis largely by inhibiting the transcription factor nuclear factor-kappaB (NF-kappaB). This study evaluates the effects of curcumin on ovarian cancer growth using an orthotopic murine model of ovarian cancer. In vitro and in vivo experiments of curcumin with and without docetaxel were done using human ovarian cancer cell lines SKOV3ip1, HeyA8, and HeyA8-MDR in athymic mice. NF-kappaB modulation was ascertained using electrophoretic mobility shift assay. Evaluation of angiogenic cytokines, cellular proliferation (proliferating cell nuclear antigen), angiogenesis (CD31), and apoptosis (terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling) was done using immunohistochemical analyses. Curcumin inhibited inducible NF-kappaB activation and suppressed proliferation in vitro. In vivo dose-finding experiments revealed that 500 mg/kg orally was the optimal dose needed to suppress NF-kappaB and signal transducers and activators of transcription 3 activation and decrease angiogenic cytokine expression. In the SKOV3ip1 and HeyA8 in vivo models, curcumin alone resulted in 49% (P = 0.08) and 55% (P = 0.01) reductions in mean tumor growth compared with controls, whereas when combined with docetaxel elicited 96% (P < 0.001) and 77% reductions in mean tumor growth compared with controls. In mice with multidrug-resistant HeyA8-MDR tumors, treatment with curcumin alone and combined with docetaxel resulted in significant 47% and 58% reductions in tumor growth, respectively (P = 0.05). In SKOV3ip1 and HeyA8 tumors, curcumin alone and with docetaxel decreased both proliferation (P < 0.001) and microvessel density (P < 0.001) and increased tumor cell apoptosis (P < 0.05)." }, { "role": "assistant", "content": "Based on significant efficacy in preclinical models, curcumin-based therapies may be attractive in patients with ovarian carcinoma. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Ursodiol reduces the size of common bile duct gallstones by wof mechanisms" }, { "role": "assistant", "content": "The correct answer is GALLSTONE DISSOLVING DRUGS Cholesterol (CH) remains dissolved in bile with the help of bile salts (salts of cholic acid and chenodeoxycholic acid conjugated with glycine and taurine) because bile salts are highly amphiphilic. A high CH : bile salt ratio ours crystallization of CH in bile; these crystals act as nidi for stone formation. Chenodeoxycholic acid (Chenodiol) and Ursodeoxycholic acid (Ursodiol) decrease CH content of bile, enabling solubilization of CH from stone surface. Ursodiol:- It is a hydroxy epimer of chenodiol, is more effective and needs to be used at lower doses. Complete dissolution of CH stones has been achieved in upto 50% cases. It is also much better tolerated. Calcification of some gall stones may be induced. Ref:- kd tripathi; pg num:-671" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Administration, Oral, Animals, Anti-Allergic Agents, Cytokines, Dermatitis, Atopic, Dose-Response Relationship, Drug, Drug Evaluation, Preclinical, Histamine, Humans, Mast Cells, Mice, Mice, Inbred ICR, Mitogen-Activated Protein Kinases, NF-kappa B, Passive Cutaneous Anaphylaxis, Plant Extracts, Rats, p-Methoxy-N-methylphenethylamine." }, { "role": "user", "content": "Does sopoongsan inhibit mast cell-mediated anaphylactic reactions and inflammatory cytokine secretion? Context: Mast cells are key effector cells in the early-phase allergic inflammation and in diverse immunological and pathological processes. Sopoongsan (SPS), a traditional Korean medicine, has been used as therapeutics for allergic diseases such as atopic dermatitis (AD). The precise effect in experimental models of SPS, however, remains unknown. In this report, we investigated the effect of SPS on mast cell-mediated anaphylactic reactions and cytokine production in in vivo and in vitro murine models. Compound 48/80-induced histamine and ear swelling were measured with the various concentrations of SPS. The amount of dye was determined colorimetrically after antidinitrophenyl IgE antibody-induced passive cutaneous anaphylaxis reaction. Secretion of tumor necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8) and IL-6 in supernatants from HMC-1 cells was measured by a sandwich enzyme-linked immunosorbent assay. The expression level of nuclear factor (NF)-kappaB/Rel A in the nucleus and the activation of mitogen-activated protein kinases (MAPKs) were examined by Western blot analysis. SPS inhibited the degranulation and histamine release from the rat peritoneal mast cells activated by compound 48/80. Compound 48/80-induced ear swelling was significantly reduced. SPS also showed an inhibitory effect of passive cutaneous anaphylaxis reaction. Significantly reduced levels (p < 0.05) of TNF-alpha, IL-8 and IL-6 were observed in the human mast cell line with SPS and SPS components. In addition, SPS inhibited an increase of NF-kappaB and extracellular signal-regulated kinase 1/2 activity." }, { "role": "assistant", "content": "These findings suggest that SPS has an inhibitory effect on atopic allergic reaction and this might be useful for the clinical application to treat allergic diseases such as AD. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "'Peg cells' are seen in which of the following pa of the female genital tract?" }, { "role": "assistant", "content": "The correct answer is There are three types of cells present in the epithelium of fallopian tubes, they are ciliated epithelial cells, nonciliated secretory cells and intercalated or peg cells called stem cells. Peg cells can differentiate into either of the other two types of cells. Peg cells: They are abundant during the premenstrual and menstrual periods. They have long slender, rod like nuclei and small amount of cytoplasm squeezed by adjoining cells. They represent secretory cells in transitional stages. Fallopian tubes usually measures between 8-14cm and is divided into an interstitial poion, isthmus, ampulla and infundibulum. Ref: Textbook of Pathology By V. Krishna page 930, Syllabus of Gynecologic Pathology with Clinical Correlations By Tung Van Dinh page 82" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Pin point pupils are seen in all of the following conditions except: September 2005" }, { "role": "assistant", "content": "The correct answer is Ans. D: Datura poisoning If the patient has bilateral pinpoint pupils consider the following possible etiologies: Opiate use/abuse/overdose such as Heroin, Fentanyl, Codeine, Methadone and Morphine stimulate the parasympathetic side of the autonomic nervous system and cause pupil constriction. Miosis in combination with depressed respirations are the hallmark signs of opiate overdose. Pontine Hemorrhage The pons is a knob-like structure located at the front of the brainstem. Intracranial hemorrhage in the area of the pons will typically cause bilateral pupil constriction. Intracranial hemorrhage can have both traumatic and atraumatic origins. Consider pontine hemorrhage in the presence of high mechanism head trauma and patients with a history of vascular disease, strokes and abnormal bleeding. Organophosphate / Chemical / Nerve Agent Exposure Organophosphate chemicals are the most common chemicals causing parasympathetic over-stimulation and, therefore, pinpoint pupils. These compounds are effective pesticides used in agriculture. They are widely used because they break down easily in the environment unlike their cousin DDT. Malathion and parathion are examples of organophosphate pesticides. These chemicals kill insects by disrupting their nervous system function. They can be absorbed through the skin, inhaled and ingested. Once absorbed they shut down acetylcholiesterase production and put the parasympathetic system into overdrive. This will create the classic SLUDGE presentation, characterized by excessive salivation, lacrimation (tears), urination, defecation and emesis. And two other telltale signs muscle cramps and pinpoint pupils. Pupils are widely dilated with loss of accommodation for near vision is seen in datura poisoning." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Disability Evaluation, Electroencephalography, Electromyography, Evoked Potentials, Female, Fingolimod Hydrochloride, Humans, Immunosuppressive Agents, Magnetic Resonance Imaging, Male, Multiple Sclerosis, Physical Stimulation, Statistics, Nonparametric, Transcranial Magnetic Stimulation." }, { "role": "user", "content": "Do multimodal evoked potentials follow up in multiple sclerosis patients under fingolimod therapy? Context: Clinical trials have shown the therapeutic effect of fingolimod in reducing disease activity in relapsing-remitting multiple sclerosis (RR-MS), but its influence on nervous conduction assessed by evoked potentials (EPs) has not been previously investigated. EP data of 20 patients examined 12months prior to initiation of fingolimod (t=-1), at treatment initiation (t=0) and 1year later (t=+1) were compared. Each EP (VEP, MEP, SEP) and EP sum score, a global evoked potential score as the sum score of the each EP score was evaluated and correlated with Expanded Disability Status Scale (EDSS). During pre-treatment period (1year) EDSS worsened while one year after fingolimod treatment EDSS remained stable. From t-1 to t0 VEP, SEP, MEP and EP sum score worsened while from t0 to t+1 VEP, SEP and EP sum score improved, and MEP score remain stable. VEP and SEP were related to EDSS at baseline (t=-1), while MEP and total EP sum score were related to EDSS at all time points." }, { "role": "assistant", "content": "Fingolimod is able to improve visual and somatosensory evoked potential in RR-MS patients even if clinical disability scale remains stable. VEP and SEP could give eloquent information on pathway underweighted in EDSS. EPs are useful to evaluate fingolimod effects in clinical practice. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "With regard to paranasal sinuses, true is" }, { "role": "assistant", "content": "The correct answer is Paranasal sinuses are rudimentary in newborn. Sphenoid sinus drains into sphenoethmoidal recess and not into middle meatus. Sphenoid sinus is supplied by posterior ethmoidal nerve." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Why are the following vaccine ls coloured?" }, { "role": "assistant", "content": "The correct answer is Light sensitive vaccines: - These vaccine lose their potency if exposed to bright light - Thus, these vaccines are packed in dark brown glass for protection - BCG, Measles, JE, Rotavirus are light sensitive vaccines" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, RESULTS. Meshes: Acetylcholine, Adenosine Triphosphate, Animals, Blotting, Western, Cell Communication, Cell Line, Choline O-Acetyltransferase, Humans, Immunohistochemistry, Male, Mice, Mice, Inbred C57BL, Mice, Knockout, Myocardial Ischemia, Myocardium, Reactive Oxygen Species." }, { "role": "user", "content": "Does a non-neuronal cardiac cholinergic system play a protective role in myocardium salvage during ischemic insults? Context: In our previous study, we established the novel concept of a non-neuronal cardiac cholinergic system--cardiomyocytes produce ACh in an autocrine and/or paracrine manner. Subsequently, we determined the biological significance of this system--it played a critical role in modulating mitochondrial oxygen consumption. However, its detailed mechanisms and clinical implications have not been fully investigated. We investigated if this non-neuronal cardiac cholinergic system was upregulated by a modality other than drugs and if the activation of the system contributes to favorable outcomes. Choline acetyltransferase knockout (ChAT KO) cells with the lowest cellular ACh levels consumed more oxygen and had increased MTT activity and lower cellular ATP levels compared with the control cells. Cardiac ChAT KO cells with diminished connexin 43 expression formed poor cell-cell communication, evidenced by the blunted dye transfer. Similarly, the ChAT inhibitor hemicholinium-3 decreased ATP levels and increased MTT activity in cardiomyocytes. In the presence of a hypoxia mimetic, ChAT KO viability was reduced. Norepinephrine dose-dependently caused cardiac ChAT KO cell death associated with increased ROS production. In in vivo studies, protein expression of ChAT and the choline transporter CHT1 in the hindlimb were enhanced after ischemia-reperfusion compared with the contralateral non-treated limb. This local effect also remotely influenced the heart to upregulate ChAT and CHT1 expression as well as ACh and ATP levels in the heart compared with the baseline levels, and more intact cardiomyocytes were spared by this remote effect as evidenced by reduced infarction size. In contrast, the upregulated parameters were abrogated by hemicholinium-3." }, { "role": "assistant", "content": "The non-neuronal cholinergic system plays a protective role in both myocardial cells and the entire heart by conserving ATP levels and inhibiting oxygen consumption. Activation of this non-neuronal cardiac cholinergic system by a physiotherapeutic modality may underlie cardioprotection through the remote effect of hindlimb ischemia-reperfusion. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 48-year-old patient with congestive heart failure is brought into the emergency room after an attempted suicide. He was found by his daughter whom he lives with while trying to suffocate himself. He had recently moved in with his daughter after his house went into foreclosure. The daughter lives in a small two-bedroom apartment that was recently baby proofed for her daughter. She cares for him and tries to help him with all of his medical appointments and taking his medications on time. He is noted to still consume moderate amounts of alcohol. She is concerned her father might try this again because his aunt died from suicide. Which of the circumstances is protective for this patient?" }, { "role": "assistant", "content": "Having a support system" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, MATERIALS AND METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Emergency Service, Hospital, Female, Humans, Infant, Male, Middle Aged, Patient Care Team, Predictive Value of Tests, Prospective Studies, Quality Assurance, Health Care, Sensitivity and Specificity, Trauma Centers, Trauma Severity Indices, Triage, Wounds and Injuries." }, { "role": "user", "content": "Should high-energy traumas always result in a trauma team call? Context: This study was performed to evaluate the trauma triage system currently used by the general hospital of Viborg County, Denmark. According to the trauma triage system, an isolated high-energy trauma leads to a trauma team call. The aim of the study was to determine whether a high-energy trauma patient with no symptoms of injury is a sufficient indication to lead to a trauma team call. The study was based on prospective registration of traumatised patients admitted to the hospital during the period from 1 March 2000 to 28 February 2003. A ROC curve analysis was used to validate the ability of the trauma points to predict severe injury by isolated high-energy traumas. The study included 514 trauma patients, 304 of whom had suffered high-energy traumas. The positive predictive value of a trauma team call was 45% of severe injury. Among the subgroup of patients with no immediate symptoms, the positive predictive value was 15%. The ROC curve analysis found the optimum cut point to be a high-energy trauma with at least one symptom of injury. The sensitivity was 70% and the specificity 52%." }, { "role": "assistant", "content": "The study suggests that a high-energy trauma patient showing no symptoms of injury is not a sufficient indication to lead to a trauma team call. This has caused a change in the scoring system. A trauma team call based on a high-energy trauma now implies that the patient shows signs of at least one symptom of injury." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, METHODS, METHODS, RESULTS. Meshes: Abdomen, Adenomatous Polyposis Coli, Adolescent, Adult, Aged, Child, Child, Preschool, Europe, Female, Fibromatosis, Abdominal, Genes, APC, Genetic Predisposition to Disease, Humans, Infant, Male, Middle Aged, Multivariate Analysis, Mutation, Retrospective Studies, Risk Factors, Young Adult." }, { "role": "user", "content": "Are family history , surgery , and APC mutation risk factors for desmoid tumors in familial adenomatous polyposis : an international cohort study? Context: Ability to identify patients with familial adenomatous polyposis who have a high risk of developing desmoid tumors may affect decisions in clinical practice. Our aim was to assess several risk factors for desmoid tumor development in an international cohort of patients with familial adenomatous polyposis and to evaluate the clinical relevance of risk factors. This was a retrospective cohort study. Polyposis registries in The Netherlands, France, Denmark, Finland, and Italy provided information on familial adenomatous polyposis patients with desmoid tumors. We used univariate and multivariable analyses of data from registries in The Netherlands, France, Denmark, and Finland to test whether gender, APC mutation site, previous colorectal surgery, colorectal cancer, and family history for desmoid tumors contribute to risk of developing desmoid tumors at any location, or specifically at an intra-abdominal location. The effect of family history was tested with a generalized linear mixed model. : Of 2260 patients with familial adenomatous polyposis from 912 families in The Netherlands, France, Denmark, and Finland, 220 patients (10%) had desmoid tumors (101 men). In 387 patients with desmoid tumors (including 167 patients from the Italian registry), the median age at diagnosis of the first desmoid tumor was 31 years (range, 4 months-74 years). Desmoid locations were intra-abdominal (53%), abdominal wall (24%), extremities (9%), and unknown sites or combinations of sites (14%). Multivariable analysis of risk factors for desmoids at any location showed surgery (OR, 2.58; P = .0004), an APC mutation 3' of codon 1444 (OR, 3.0; P < .0001), and a positive family history (P < .0001) to be independently associated with desmoid development. When only intra-abdominal location was analyzed, APC mutation site was not associated with desmoid development." }, { "role": "assistant", "content": "Selection bias may have occurred. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Among the following, the best indicator for acute malnutrition in the under-fives is" }, { "role": "assistant", "content": "The correct answer is Wasting (deficit in weight-for-height) indicates a deficit in tissue and fat mass and may result either from failure to gain weight or from actual weight loss.It usually signifies acute onset malnutrition. Page 101,Ghai essential pediatrics 6th edition" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: MATERIALS AND METHODS, RESULTS. Meshes: Adolescent, Adult, Epidemiologic Methods, Female, Fractures, Bone, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Radiography, Scaphoid Bone, Sensitivity and Specificity." }, { "role": "user", "content": "Can follow-up radiography for acute scaphoid fracture still be considered a valid investigation? Context: Fifty sets of radiographs (initial and follow-up) were independently assessed by four expert observers for the presence or absence of a scaphoid fracture. Magnetic resonance imaging (MRI), performed in all cases, was used as the gold standard to determine the sensitivity, specificity, positive and negative predictive values of the observers' assessment of the follow-up radiograph. In addition, the reliability among observers of the follow-up radiograph was determined by reliability variance analysis. Of the 50 sets of radiographs, 35 patients had a scaphoid fracture and 15 were normal, as established from MRI report. For individual observer's assessment of the follow-up radiograph, sensitivities of 11, 9, 43 and 49%; specificities of 93, 93, 87 and 80%; positive predictive values of 80, 75, 88 and 85%; and negative predictive values of 31, 30, 39 and 40%. A reliability coefficient of more than 60% is needed for a diagnostic test to be considered reliable. Overall, the inter-observer reliability coefficient was 33%, with pair-wise inter-observer coefficients ranging from 18-53%." }, { "role": "assistant", "content": "With poor sensitivity, poor negative predictive value and poor reliability, follow-up radiography cannot be considered a valid diagnostic examination for the detection of scaphoid fracture in patients with normal initial radiographs." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Which of the following drug prevent these renal stones?" }, { "role": "assistant", "content": "The correct answer is The renal stones are hexagonal in shape so, cystine stonesCarbonic anhydrase inhibitors are useful for cystinuria.Ref: Goodman Gillman 12th ed. Pg: 680" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Administration, Oral, Aged, Angioplasty, Balloon, Coronary, Cardiovascular Diseases, Coronary Artery Disease, Diabetes Mellitus, Type 2, Drug Administration Schedule, Female, Hong Kong, Humans, Isosorbide Dinitrate, Male, Middle Aged, Myocardial Infarction, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Vasodilator Agents." }, { "role": "user", "content": "Is long-term oral nitrate therapy associated with adverse outcome in diabetic patients following elective percutaneous coronary intervention? Context: To assess the impact of long-term oral nitrate therapy on clinical outcome following percutaneous coronary intervention (PCI) in patients with type II diabetes. The incidence of major adverse cardiovascular events (MACEs) following elective PCI for stable coronary artery disease was evaluated in 108 patients with type II diabetes (age 64.6±10.5 years, 67.7% men). Major adverse cardiovascular events were defined as the need for revascularization, non-fatal myocardial infarction or cardiovascular death. Multivariate Cox regression analysis was used to evaluate the predictive value of MACEs by clinical characteristics and the prescription of long-term nitrate therapy. Isosorbide mononitrate (ISMN) was prescribed to 46 patients with an average dose of 44.3±15.2 mg/day. After a mean follow up of 25.3±25 months, 16 patients developed MACEs. Patients who received ISMN were more likely to suffer from MACEs (26.1% vs. 6.5%, P=0.01), mainly driven by a higher rate of acute coronary syndrome (13.0 vs 0%, P=0.01). Average daily dose of nitrate and other cardiovascular medication was not associated with MACEs. Multivariate Cox regression analysis revealed that prescription of only ISMN (Hazard Ratio 3.09, 95% CI 1.10-10.21, P=0.04) was an independent predictor for the development of MACEs." }, { "role": "assistant", "content": "Long-term oral nitrate therapy was associated with MACEs following elective coronary artery revascularization by PCI in patients with type II diabetes. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Alveolar Epithelial Cells, Animals, Bronchoalveolar Lavage Fluid, Cell Membrane, Female, In Vitro Techniques, Inspiratory Capacity, Lung, Microscopy, Confocal, Necrosis, Poloxamer, Pulmonary Surfactants, Random Allocation, Rats, Rats, Sprague-Dawley, Ventilator-Induced Lung Injury." }, { "role": "user", "content": "Does poloxamer 188 facilitate the repair of alveolus resident cells in ventilator-injured lungs? Context: Wounded alveolus resident cells are identified in human and experimental acute respiratory distress syndrome models. Poloxamer 188 (P188) is an amphiphilic macromolecule shown to have plasma membrane-sealing properties in various cell types. To investigate whether P188 (1) protects alveolus resident cells from necrosis and (2) is associated with reduced ventilator-induced lung injury in live rats, isolated perfused rat lungs, and scratch and stretch-wounded alveolar epithelial cells. Seventy-four live rats and 18 isolated perfused rat lungs were ventilated with injurious or protective strategies while infused with P188 or control solution. Alveolar epithelial cell monolayers were subjected to scratch or stretch wounding in the presence or absence of P188. P188 was associated with fewer mortally wounded alveolar cells in live rats and isolated perfused lungs. In vitro, P188 reduced the number of injured and necrotic cells, suggesting that P188 promotes cell repair and renders plasma membranes more resilient to deforming stress. The enhanced cell survival was accompanied by improvement in conventional measures of lung injury (peak airway pressure, wet-to-dry weight ratio) only in the ex vivo-perfused lung preparation and not in the live animal model." }, { "role": "assistant", "content": "P188 facilitates plasma membrane repair in alveolus resident cells, but has no salutary effects on lung mechanics or vascular barrier properties in live animals. This discordance may have pathophysiological significance for the interdependence of different injury mechanisms and therapeutic implications regarding the benefits of prolonging the life of stress-activated cells. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adenosine, Aminoimidazole Carboxamide, Animals, Disease Models, Animal, Myocardial Infarction, Myocardial Ischemia, Myocardial Reperfusion, Myocardium, Rabbits, Ribonucleosides, Time Factors, Ventricular Fibrillation." }, { "role": "user", "content": "Does acadesine extend the window of protection afforded by ischaemic preconditioning in conscious rabbits? Context: Ischaemic preconditioning protects myocardium from infarction if the reperfusion interval between the brief and prolonged ischaemic intervals is less than 1 h. In anaesthetised rabbits acadesine (5-amino-4-imidazolecarboxamide riboside, AICAR), an adenosine enhancer which increases tissue adenosine during ischaemia, prolongs the window of protection to 2 h. The aim of this study was to try to determine the maximum extension of this window of protection, using chronically instrumented, unsedated rabbits. Rabbits were instrumented with a balloon occluder around a major branch of the left coronary artery for reversible coronary occlusion. Five to seven days after surgery all animals underwent a 30 min coronary occlusion. Animals were randomised to one of seven groups: (1) No additional treatment (control); (2) Ischaemic preconditioning with 5 min regional ischaemia followed by 10 min reperfusion before the 30 min coronary occlusion; (3) and (4) Ischaemic preconditioning followed by 2 or 4 h of reperfusion before the 30 min occlusion, respectively; (5) Treatment with acadesine (2.5 mg.kg-1.min-1 intravenously for 5 min and then 0.5 mg.kg-1.min-1 beginning 45 min before and continuing until 30 min after release of the 30 min occlusion) without ischaemic preconditioning; (6) and (7) Treatment with the higher dose of acadesine for 5 min beginning 35 min before the 5 min ischaemic period, and then the lower dose continuing until 30 min after release of the 30 min coronary occlusion in rabbits with 4 or 6 h reperfusion intervals, respectively. Rabbits with ischaemic preconditioning with 10 min reperfusion preceding the 30 min coronary occlusion (group 2) had only 5.6(SEM 1.1)% infarction of the ischaemic zone. Ischaemic preconditioning followed by 2 h reperfusion (group 3) offered continued protection [18.2(2.2)% infarction] as compared to control animals [37.7(2.6)% infarction]. However, protection waned if ischaemic preconditioning was followed by 4 h reperfusion (group 4) [36.7(3.0)% infarction]. Additionally, treatment with acadesine alone did not modify infarct size (group 7) [39.5(4.0)%], but acadesine largely restored the protection of ischaemic preconditioning despite a 4 h reperfusion interval (group 5) [20.4(3.0)% infarction, P < 0.01 v control]. However, when reperfusion was extended to 6 h (group 6) acadesine could no longer restore protection [36.2(0.9)% infarction]." }, { "role": "assistant", "content": "The protection afforded by a 5 min ischaemic preconditioning period lasts from 2 to 4 h in the awake, unsedated rabbit, and acadesine can extend the duration of this window of protection to at least 4 h but not to 6 h. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Creatinine, Female, Graft Rejection, Humans, Kidney Failure, Chronic, Kidney Transplantation, Male, Regression Analysis, Risk, Risk Factors, Thyrotropin, Thyroxine, Treatment Outcome, Triiodothyronine." }, { "role": "user", "content": "Is pretransplantation serum FT3 concentration in kidney recipients useful to identify higher risk of graft failure? Context: Free triiodothyronine (FT3) is a marker of comorbidity in end-stage renal disease and in many acute and chronic diseases. The objective of the present study was to investigate the effects of pretransplantation FT3 concentration on graft function. Between 2003 and 2008, the study enrolled 86 patients who underwent renal transplantation. Twenty-six patients were women, and 60 were men, with overall mean (SD) age of 38 (10) years. In all patients, serum FT3, free thyroxine, and thyroid-stimulating hormone concentrations were determined before transplantation. Demographic data and laboratory values were evaluated at 2 years posttransplantation. The overall graft survival rate at 2 years was 82.1%. Pretransplantation serum FT3 concentration was inversely correlated with 2-year serum creatinine concentration (r=-0.29; P=.01) and proteinuria (r=-0.37; P<.00). Linear regression analysis demonstrated that serum FT3 (r2=0.63; 95% confidence interval, 0.52-0.74; P=.00) was a statistically significant risk factor for increased serum creatinine concentration. No correlation was observed for thyroid-stimulating hormone or free thyroxine and posttransplantation data." }, { "role": "assistant", "content": "Patients with end-stage renal disease with low pretransplantation serum FT3 concentration are at greater risk of subsequent graft failure. Measurement of pretransplantation serum FT3 concentration could be a clinically useful method of identifying patients at increased risk of graft failure. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, STUDY DESIGN, RESULTS. Meshes: Aged, Female, Female Urogenital Diseases, Germany, Humans, Middle Aged, Retrospective Studies, Sexual Behavior, Sexuality." }, { "role": "user", "content": "Sexuality in German urogynecological patients and healthy controls: is there a difference with respect to the diagnosis? Context: To evaluate sexual function among German urogynecological patients compared to a control group without urogynecological symptoms, using the validated German version of the Australian pelvic floor questionnaire. Retrospective study including 313 women divided into five subgroups: women with stress urinary incontinence (SUI), overactive bladder (OAB), mixed incontinence (MI), pelvic organ prolapse (POP) and healthy controls. The self-administered questionnaire is divided into three domains: bladder, pelvic organ prolapse, and sexual function. It also includes severity, bothersomeness and condition-specific quality of life. Only completely filled out questionnaires were included. The Mann-Whitney U-test was used as a non-parametric test to calculate significances for ordinal data. A p-value<.05 was taken as significant. 16/59 (27.1%) women in the control group were not sexually active compared to 19/60 (31.7%) in the SUI group, 51/98 (52.0%) in the mixed-incontinence group, 19/43 (44.2%) in the OAB group, and 24/53 (45.3%) in the prolapse group. Coital incontinence was present significantly more often in women with SUI (15/41, 36.6%) or mixed incontinence (20/44, 45.5%) than among the controls (1/49, 2.1%). Hence, concerning sexuality, women with urogynecological symptoms were all significantly more affected than the healthy controls." }, { "role": "assistant", "content": "The German version of the Australian pelvic floor questionnaire is a feasible tool to evaluate not only symptoms of urinary incontinence and pelvic organ prolapse but also sexual dysfunction. A substantial proportion of our urogynecological patients suffer immensely from problems with their sexuality, and it is therefore our responsibility as physicians to provide assistance and improve our education in this field." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Aged, 80 and over, Anemia, Aplastic, Cross-Sectional Studies, Deoxyribonucleases, Type II Site-Specific, Female, Fetal Hemoglobin, Hemoglobinuria, Paroxysmal, Humans, Locus Control Region, Male, Middle Aged, Polymerase Chain Reaction, Polymorphism, Genetic." }, { "role": "user", "content": "Is xmnI polymorphism associated with fetal hemoglobin levels in hypoplastic syndromes? Context: Acquired fetal hemoglobin (HbF) elevation has been implicated as a prognostic factor in dyserythropoietic disorders. Our objectives were to examine acquired HbF increases in aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH) patients, and to evaluate whether there is an association between the presence of XmnI and 5' hypersensitive site locus control region (LCR-HS2) polymorphisms and the HbF levels. Cross-sectional study at the Hematology and Blood Transfusion Service of Universidade Federal de São Paulo - Escola Paulista de Medicina. We studied a group of 37 patients with AA and/or PNH. Polymerase chain reaction (PCR) and enzymatic digestion were utilized to analyze XmnI polymorphisms; and PCR, cloning and automated sequencing for the HS2 polymorphisms. The mean HbF level was 2.32%, but there was no significant difference in HbF level between the AA and PNH groups (p = 0.46). HbF levels of less than 1.0% showed a significant correlation with absence of the XmnI (+) polymorphism (p = 0.02). The presence of the XmnI allele was greater in the AA group (p = 0.007)." }, { "role": "assistant", "content": "XmnI polymorphism absence reduction is associated with acquired HbF elevation. Further studies are required to confirm these observations and make treatment, prognosis and survival comparisons. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Residual chlorine required for normal supply water system:" }, { "role": "assistant", "content": "The correct answer is Ans: a (0.5 mg/1) Ref: Park, 19 ed, p. 575The minimum recommended concentration of free chlorine is 0.5 mg/L at the end of one hour.Tests used for both free and combined chlorine after chlorination are:Orthotoludine test - free and combined chlorine simultaneouslyOrthotoludine arsenite test - tests both separatelyBreak point chlorinationThe point at which the residual chlorine appears and when all combined chlorine have been completely destroyed is the breakpoint and corresponding dosage is breakpoint dosage.Other methods for water disinfectionOzonizationUltraviolet irradiationNote:In disinfection of wells using bleaching powder, contact period of one hour is allowed before the water is drawn for use.Chlorine demand: It is the dose of bleaching powder required for disinfection of water. It is estimated by Horrocks apparatus; The test uses 2.5 grains bleaching powder for 1000 litres.Ideally once every weekIn epidemics it is done once every dayContact period: bacteria/ virus- 1 hourNo effect on spores/ protozoal cyst / ova- needs superchlorinationVirus (exception- polio/ hepatitis A)BRIDGE:1 mg/L of free residual chlorine destroys Hep- A virus in 30 mins.Indicator used in Horrocks apparatus is starch - iodide solution." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Nipple confusion means?" }, { "role": "assistant", "content": "The correct answer is Ans. (a) Baby fed with a bottle finding it difficult and confusing to suckle at breastRef: OP Ghai 8th ed./153* A problem that may beset a bottlefed baby in which it forgets how to nurse on mother' nipple* Breastfeeding requires far more vigorous mouth and tongue motions and greater muscle coordination than bottlefeeding.* On bottle nipples or even pacifiers, a newborn can forget how to nurse properly.* This confusion can lead to diminished or discontinued nursing. Nipple confusion is usually not a concern after the early weeks, once the baby is nursing well." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Dose-Response Relationship, Radiation, Humans, Lung Neoplasms, Models, Statistical, Prognosis, Radiation Injuries, Radiation Tolerance, Retrospective Studies, Tomography, X-Ray Computed." }, { "role": "user", "content": "Do cT characteristics allow identification of patient-specific susceptibility for radiation-induced lung damage? Context: There is a huge difference in radiosensitivity of lungs between patients. The present study aims to identify and quantify patient-specific radiosensitivity based on a single pre-treatment CT scan. 130 lung cancer patients were studied: 60 stereotactic ablative radiotherapy (SABR) treatments and 70 conventional treatments (20 and 30 patients from external datasets, respectively). A 3month-follow-up scan (CT3M) was non-rigidly registered to the planning CT scan (CT0). Changes in Hounsfield Units (ΔHU=HU3M-HU0) inside lung subvolumes were analyzed per dose bin of 5Gy. ΔHU was modeled as a function of local dose using linear and sigmoidal fits. Sigmoidal fit parameters ΔHUmax (saturation level) and D50 (dose corresponding to 50% of ΔHUmax) were collected for all patients. Sigmoidal fits outperformed linear fits in the SABR groups for the majority of patients. Sigmoidal dose-responses were also observed in both conventional groups but to a lesser extent. Distributions of D50 and ΔHUmax showed a large variation between patients in all datasets. Higher baseline lung density (p<0.001) was prognostic for higher ΔHUmax in one SABR group. No prognostic factors were found for D50." }, { "role": "assistant", "content": "Baseline CT characteristics are prognostic for radiation-induced lung damage susceptibility. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Aged, 80 and over, Animals, Athletic Injuries, Child, Female, Horses, Humans, Male, Middle Aged, Risk." }, { "role": "user", "content": "Do equestrian injury prevention efforts need more attention to novice riders? Context: Equestrian injury is commonly seen at trauma centers and the severity of injury is often high. We sought to determine the risk, incidence, and the influence of skill and experience on injury during horse-related activity (HRA). Members of horse clubs and individual equestrians in a three-state region (Oregon, Washington, and Idaho) were recruited via mailings and community advertisements to take a survey regarding their horse contact time and injuries over their entire riding career. Serious injury (SI) was defined by hospitalization, surgery, or long-term disability. There were 679 equestrians with a median age of 44 years who reported a median of 20 hours of HRA per month with a mean of 24 years (1 to 75 years) experience. The cumulative risk of any injury (AI) was 81% and of SI was 21%. The incidence of AI and SI were 1.6 +/- 0.1 (SE) and 0.26 +/- 0.02 per 10,000 hours, respectively. The incidence, per 10,000 hours, of AI was 7.6 +/- 2.7, 2.4 +/- 0.2, 1.5 +/- 0.1, and 1.0 +/- 0.1 at novice, intermediate, advanced, and professional levels, respectively (p < 0.001, analysis of variance [ANOVA]) and of SI was 1.03 +/- 0.52, 0.38 +/- 0.06, 0.21 +/- 0.03, and 0.19 +/- 0.04 at the respective skill levels (p < 0.001, ANOVA). There was a sharp decline in incidence of injury between 18 and 100 hours of experience. Helmet use was 74%, 61%, 58%, and 59% at the respective skill levels (NS, chi)." }, { "role": "assistant", "content": "One in five equestrians will be seriously injured during their riding career. Novice riders experienced a three-fold greater incidence of injury over intermediates, a five-fold greater incidence over advanced riders, and nearly eight-fold greater incidence over professional equestrians. Approximately 100 hours of experience are required to achieve a substantial decline in injury. These findings suggest that equestrian injury prevention efforts need more attention and should focus on novice equestrians. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Contraindication for bag and mask ventilation among the following is:" }, { "role": "assistant", "content": "The correct answer is Ans: a (Meconium aspiration) Ref: O.P. Ghai, ed, p. 141\"Bag and mask ventilation is contraindicated in suspected or confirmed diaphragmatic hernia, in non vigorous babies bom through meconium stained liquor, bag and mask ventilation is done only after tracheal suctioning.\"" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Brucella abortus, Brucellosis, Case-Control Studies, Cytokines, Female, Glyceraldehyde-3-Phosphate Dehydrogenase (Phosphorylating), Humans, Leukocytes, Mononuclear, Lymphocyte Subsets, Male, Middle Aged, Recombinant Proteins, Ribosomal Proteins, Th1 Cells." }, { "role": "user", "content": "Does brucella abortus L7/L12 recombinant protein induce strong Th1 response in acute brucellosis patients? Context: Because of high morbidity of the brucellosis in humans and the potential use of the microorganism as an agent of biologic warfare, protection of effective vaccines and specific diagnostic reagents become necessary to eradicate brucellosis. In this study we aimed to investigate the cytokine responses and changes in peripheral blood lymphocyte subgroups of acute brucellosis patients in response to L7/L12 and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) recombinant proteins derived from Brucella abortus. levels of IFN-γ, IL-4 and IL-10 secreted from PBMCs of 25 acute brucellosis patients and 15 healthy controls, stimulated with Phytohemagglutinin (PHA), L7/L12 or GAPDH were measured by ELISA. Furthermore alterations in lymphocyte subgroups in response to these Brucella antigens were determined by flow cytometry. Extracellular IFN-γ levels were found to be elevated after stimulation with L7/L12 in patients with acute brucellosis, whereas no significant changes were found in IL-4 and IL-10 levels. Similar data was also obtained with GAPDH, but the stimulation of IFN-γ production was not observed in all patients and was not as strong as that observed for L7/L12. Moreover, when the distribution of lymphocytes subgroups (CD3+, CD3+ CD4+, CD3+ CD8+, CD4+ CD25+, CD3+ CD69+ and CD3+ CD152+) was evaluated, it was found that the stimulation with L7/L12 and GAPDH only led to an increase in the percentage of CD3+ CD69+ lymphocytes." }, { "role": "assistant", "content": "These data indicate that Brucella abortus L7/L12 or GAPDH induce a Th1 type immune response in acute brucellosis patients. Additionally, these recombinant proteins, especially L7/L12, may be used in new vaccine preparations and diagnostic tests. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "PDA true is all except ?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'd i.e., More common in term baby During fetal life, most of the pulmonary aerial blood is shunted through the ductus aeriosus into the aoa . Functional closure of the ductus normally occurs soon after bih, but if the ductus remains patent when pulmonary vascular resistance falls, aoic blood is shunted into the pulmonary aery. The aoic end of the ductus is just distal to the origin of the left subclan aery, and the ductus enters the pulmonary aery at its bifurcation Female patients with PDA outnumber males 2 : 1. PDA is also associated with maternal rubella infection during early pregnancy. It is a common problem in premature infants, where it can cause severe hemodynamic derangements and several major sequelae" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Traumatic eye with late presentation of hyperaemic sclera with unilateral proptosis is due to:" }, { "role": "assistant", "content": "The correct answer is Severe blunt trauma to the orbit can occasionally cause a retrobulbar hematoma. When a retrobulbar hematoma is large enough, it can cause an abrupt increase in intraocular pressure, causing decreased blood flow to the optic nerve and loss of vision. The conscious patient will complain of pain, proptosis, and decreasing vision. A CT scan of the orbit will demonstrate retrobulbar hemorrhage. An intraocular pressure >40 mm Hg is a consideration for emergency canthotomy. No matter what the intraocular pressure, if retrobulbar hematoma is suspected or confirmed, request emergency ophthalmology consultation. Ref: Walker R.A., Adhikari S. (2011). Chapter 236. Eye Emergencies. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Adult, Air Pollutants, Air Pollution, Arteries, Brachial Artery, Cross-Over Studies, Double-Blind Method, Female, Humans, Inhalation Exposure, Male, Ozone, Particle Size, Ultrasonography, Vasoconstriction, Vasodilation." }, { "role": "user", "content": "Does inhalation of fine particulate air pollution and ozone cause acute arterial vasoconstriction in healthy adults? Context: Fine particulate air pollution and ozone are associated with increased cardiovascular events. To help explain the mechanism behind these observations, we investigated the effect of air pollution exposure on vascular function. Twenty-five healthy adults underwent a randomized, double-blind, crossover study comparing the vascular response to the 2-hour inhalation of approximately 150 microg/m(3) of concentrated ambient fine particles (CAP) plus ozone (120 ppb) versus the response to the inhalation of filtered air. High-resolution vascular ultrasonography was used to measure alterations in brachial artery diameter, endothelial-dependent flow-mediated dilatation (FMD) and endothelial-independent nitroglycerin-mediated dilatation (NMD). Exposure to CAP plus ozone caused a significant brachial artery vasoconstriction compared with filtered air inhalation (-0.09+/-0.15 mm versus +0.01+/-0.18 mm, P=0.03). There were no significant differences in FMD (+0.29+/-4.11% versus -0.03+/-6.63%, P=0.88), NMD (+3.87+/-5.43% versus +3.46+/-7.92%, P=0.83), or blood pressure responses between exposures." }, { "role": "assistant", "content": "Short-term inhalation of fine particulate air pollution and ozone at concentrations that occur in the urban environment causes acute conduit artery vasoconstriction. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Antidepressive Agents, Second-Generation, Asian Continental Ancestry Group, CLOCK Proteins, Circadian Rhythm, Cytochrome P-450 CYP2D6, Depressive Disorder, Disorders of Excessive Somnolence, Female, Genotype, Humans, Japan, Male, Middle Aged, Paroxetine, Polymorphism, Genetic, Serotonin Plasma Membrane Transport Proteins." }, { "role": "user", "content": "Is severe sleepiness and excess sleep duration induced by paroxetine treatment a beneficial pharmacological effect , not an adverse reaction? Context: Severe sleepiness and excess sleep duration, \"Hypersomnia\", induced by paroxetine treatment are generally considered adverse drug reactions, however, our experience indicates that patients with depressive disorder who experience \"Hypersomnia\" during paroxetine treatment have good clinical response. The aim of this study was to determine if \"Hypersomnia\" during paroxetine treatment is a beneficial pharmacological effect or an adverse drug reaction, and to investigate the impact of genetic polymorphisms on individual differences in the occurrence of \"Hypersomnia\" induced by paroxetine. A consecutive series of 46 Japanese patients with depressive disorder were treated with paroxetine. Patients who complained of great drowsiness or who slept for more than 12-h per day over seven days were identified as having experienced \"Hypersomnia\". For the clinical improvement rates and genotype distribution of the circadian locomotor output cycles kaput (CLOCK), serotonin transporter and cytochrome P450 2D6 (CYP2D6), the group that showed \"Hypersomnia\" induced by paroxetine treatment and the group that did not show \"Hypersomnia\" were compared statistically. Patients who experienced \"Hypersomnia\" (17.4%) showed a significantly higher response rate at two weeks than did patients who did not experience \"Hypersomnia\" (p=0.0127). No significant association between the occurrence of \"Hypersomnia\" and genetic polymorphisms was found." }, { "role": "assistant", "content": "We cannot exclude the risk of false positive errors due to the relatively small sample sizes. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: UNLABELLED. Meshes: Aged, Analysis of Variance, Biomarkers, Tumor, Carcinoma, Hepatocellular, Cell Communication, Cell Movement, Female, Hepatic Stellate Cells, Humans, Liver Neoplasms, Male, Middle Aged, Monocytes, Multivariate Analysis, Neoplasm Recurrence, Local, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Reproducibility of Results, Survival Analysis, Tumor Cells, Cultured, Tumor Microenvironment." }, { "role": "user", "content": "Does hepatic stellate cell and monocyte interaction contribute to poor prognosis in hepatocellular carcinoma? Context: Hepatocellular carcinoma (HCC) patients suffer from a poor survival rate and a high incidence of postoperative recurrence. The hepatic microenvironment plays a significant role in the initiation, progression, and recurrence of HCC; however, the causal mechanisms of these phenomena are unclear. Given the predominant underlying fibrotic and cirrhotic conditions of the liver prone to HCC and its recurrence, alterations of components of the inflammatory milieu have been suggested as factors that promote HCC development. In particular, activated hepatic stellate cells (A-HSCs), which play a key role in liver fibrosis and cirrhosis, have been suggested as contributors to the HCC-prone microenvironment. Here, we have identified and validated an A-HSC-specific gene expression signature among nontumor tissues of 319 HCC patients that is significantly and independently associated with HCC recurrence and survival. Peritumoral, rather than tumor tissue-related, A-HSC-specific gene expression is associated with recurrence and poor survival. Analyses of A-HSC-specific gene signatures and further immunohistochemical validation in an additional 143 HCC patients have revealed that A-HSCs preferentially affect monocyte populations, shifting their gene expression from an inflammatory to an immunosuppressive signature. In addition, the interaction between A-HSCs and monocytes induces protumorigenic and progressive features of HCC cells by enhancing cell migration and tumor sphere formation." }, { "role": "assistant", "content": "A-HSCs play a significant role in promoting HCC progression through interaction with and alteration of monocyte activities within the liver microenvironment; thus, disrupting the interactions and signaling events between the inflammatory milieu and components of the microenvironment may be useful therapeutic strategies for preventing HCC tumor relapse. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Chronic Disease, Disease Models, Animal, Lung Transplantation, Male, Pneumonia, Aspiration, Postoperative Complications, Rats, Rats, Inbred F344, Rats, Wistar." }, { "role": "user", "content": "Does chronic aspiration of gastric fluid accelerate pulmonary allograft dysfunction in a rat model of lung transplantation? Context: Emerging clinical evidence suggests that gastroesophageal reflux disease is associated with pulmonary allograft dysfunction. In this study, we used a model of rat lung transplantation to test the hypothesis that chronic aspiration of gastric contents accelerates pulmonary allograft dysfunction. We evaluated the effects of chronic aspiration on pulmonary isografts (strain F344) and pulmonary allografts (strain WKY to strain F344). Chronic aspiration consisted of 0.5 mL/kg of filtered gastric contents injected weekly into the left lung for 4 to 8 weeks beginning 1 week after transplantation. Seven days after the last aspiration, animals were killed, and grafts were evaluated grossly and by histologic and immunochemical analyses, including Masson trichrome staining for collagen and immunostaining for CD68+ and CD8+ cells. Serum cytokine concentrations were determined by bead-based immunoassays or enzyme-linked immunosorbent assay. Allografts without aspiration (n = 12) demonstrated a relatively normal architecture with diffuse International Society for Heart and Lung Transplantation grade 3 acute rejection; occasional grade 4 rejection was noted. In contrast, allografts with chronic aspiration (n = 7) demonstrated severe grade 4 acute rejection with significant monocyte infiltration, fibrosis, and loss of normal alveolar anatomy. Grossly, 8 (67%) of 12 allografts without aspiration seemed to inflate and perfuse normally, whereas all allografts exposed to chronic aspiration were firm and shrunken, without the ability to ventilate (P = .013; Fisher exact test). Aspiration was associated with increases in graft-infiltrating macrophages and CD8+ T cells and higher levels of serum transforming growth factor beta." }, { "role": "assistant", "content": "Chronic aspiration of gastric contents promotes accelerated allograft failure and may promote a profibrotic environment. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Do n-terminal proBrain natriuretic peptide levels predict short-term poststroke survival? Context: To investigate the significance of N-terminal proBrain natriuretic peptide (NT-proBNP) in predicting the outcome of acute stroke in relation to other cardiovascular variables and stroke severity. Prospective study of previously independent acute ischemic and hemorrhagic stroke patients admitted to the acute stroke ward. Measurements of NT-proBNP in acute phase in addition to standard assessment of cardiovascular and neurological details. Concentrations and significance of NT-proBNP in patients who were dead versus alive at 120 days after acute stroke and Cox regression analysis with stroke severity measured as Scandinavian Stroke Scale (SSS) and other cardiovascular disease to predict mortality. One hundred fourteen patients were recruited, median age 74 years. At 120 days, 13 patients had died. Deceased patients had a significantly higher concentration of NT-proBNP as compared to alive patients (P < .001). All patients who had died had NT-proBNP concentration above the median for the whole group. Cox regression analysis revealed that NT-proBNP was the most significant independent variable predicting mortality (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.35 to 4.41, P = .003) followed by the SSS (OR 0.95, 95% CI 0.90 to 0.98, P = .005). Higher NT-proBNP and lower SSS predicted mortality. There was a significant negative correlation of NT-proBNP with SSS score (r = -0.24, P = .02). There were no significant difference in NT-proBNP concentrations between ischemic and hemorrhagic strokes (P < .346). At 6 weeks, the dependent patients had higher concentrations of NT-proBNP than independent patients." }, { "role": "assistant", "content": "NT-proBNP, an index of cardiac impairment, has an independent prognostic value in acute stroke patients over other cardiovascular variables and stroke severity. This may provide a channel for interventional therapy in acute stroke. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 42-year-old man presents with unremitting diarrhea that has lasted for 2 weeks. He describes his bowel movements as watery, non-bloody, foul-smelling, and greasy. He also has cramping abdominal pain associated with the diarrhea. He says that his symptoms started right after he returned from a father-son camping trip to the mountains. His son has similar symptoms. His vital signs include: pulse 78/min, respiratory rate 15/min, temperature 37.2°C (99.0°F), and blood pressure 120/70 mm Hg. A stool sample is obtained and microscopic analysis is significant for the findings shown in the image below. Which of the following pathogens is most likely responsible for this patient’s condition?" }, { "role": "assistant", "content": "Giardia lamblia" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "E. coli has the ability to regulate its enzymes to break down various sources of energy when available. It prevents waste by the use of the lac operon, which encodes a polycistronic transcript. At a low concentration of glucose and absence of lactose, which of the following occurs?" }, { "role": "assistant", "content": "Increased cAMP levels result in binding to the catabolite activator protein" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Does a systematic review of diagnostic utility of selective nerve root block? Context: Transforaminal epidural injections, or selective nerve root blocks, are used for a myriad of different spinal disorders. A clear consensus on the use of selective nerve root injections as a diagnostic tool does not currently exist. Additionally, the effectiveness of this procedure as a diagnostic tool is not clear. The objective was to evaluate the accuracy of selective nerve root injections in diagnosing spinal disorders. The study involved a systematic review of diagnostic studies about selective nerve root blocks for the diagnosis of spinal pain. A systematic review of the literature for clinical studies was performed to assess the accuracy of selective nerve root injections in diagnosing spinal disorders. Methodologic quality evaluation was performed utilizing AHRQ and QUADAS criteria. The methodology of the studies was graded and the evidence was classified into five levels: conclusive, strong, moderate, limited, or indeterminate. There is limited evidence on the effectiveness of selective nerve root injections as a diagnostic tool in spinal disorder. There is insufficient research into this area for strong support, but the available literature is supportive of selective nerve root injections as a diagnostic test in equivocal radicular pain. The current analysis provides moderate evidence of transforaminal epidural injections in the preoperative evaluation of patients with negative or inconclusive imaging studies." }, { "role": "assistant", "content": "Selective nerve root injections may be helpful as a diagnostic addition in evaluating spinal disorders with radicular features, but the role of this diagnostic test needs to be further clarified by additional research and consensus on technique. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, RESULTS. Meshes: Adult, Cardiomyopathy, Hypertrophic, Death, Sudden, Cardiac, Defibrillators, Implantable, Epidemiologic Methods, Female, Heart Septum, Humans, Male, Tachycardia, Ventricular, Ventricular Outflow Obstruction." }, { "role": "user", "content": "Does surgical septal myectomy decrease the risk for appropriate implantable cardioverter defibrillator discharge in obstructive hypertrophic cardiomyopathy? Context: To determine the impact of surgical myectomy on ventricular arrhythmias in obstructive hypertrophic cardiomyopathy (HCM). Left ventricular outflow tract obstruction (LVOTO) correlates with adverse outcomes, including sudden cardiac death (SCD) in patients with HCM. Surgical myectomy is the primary treatment strategy for relief of symptoms owing to LVOTO and has been hypothesized to decrease the potential for ventricular tachyarrhythmias. We reviewed the Mayo Clinic HCM database for those patients with HCM who had received implantable cardioverter defibrillator (ICD) and grouped the patients into myectomy and non-myectomy groups. Retrospective analysis of the incidence of SCD and appropriate ICD discharge was performed in addition to the analysis of ICD interrogation records. A total of 125 patients defined by these parameters were followed at the Mayo Clinic between 1992 and 2005. New York Heart Association functional class, anti-arrhythmic drug usage, wall thickness, and reasons for ICD implantation were similar between the groups; 118 patients underwent ICD implantation for primary prevention and seven for secondary prevention after sustained ventricular arrhythmias. There were no SCDs during this follow-up period in either group, whereas 12 (17%) patients in the non-myectomy group and only one (2%) patient in the myectomy group sustained appropriate ICD discharges. The average annualized event rate was 4.3% per year in the non-myectomy group, compared with 0.24% per year following myectomy (P = 0.004)." }, { "role": "assistant", "content": "These data suggest that surgical myectomy, primarily performed to relieve outflow tract obstruction and severe symptoms in HCM, is associated with a marked reduction in the incidence of appropriate ICD discharge and risk for SCD. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 69-year-old man is brought to the emergency department by his wife because of fever, cough, diarrhea, and confusion for 2 days. He recently returned from a cruise to the Caribbean. He has a history of chronic obstructive pulmonary disease. He has smoked one pack of cigarettes daily for 40 years. His temperature is 39.1°C (102.4°F), pulse is 83/min, and blood pressure is 111/65 mm Hg. He is confused and oriented only to person. Physical examination shows coarse crackles throughout both lung fields. His serum sodium concentration is 125 mEq/L. Culture of the most likely causal organism would require which of the following mediums?" }, { "role": "assistant", "content": "Charcoal yeast extract agar" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: PURPOSE, MATERIALS AND METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Contrast Media, Female, Gadolinium DTPA, Hepatocytes, Humans, Image Processing, Computer-Assisted, Liver Neoplasms, Magnetic Resonance Imaging, Male, Middle Aged, Observer Variation, Radiology, Reproducibility of Results, Sensitivity and Specificity, Time Factors." }, { "role": "user", "content": "Gadoxetic acid disodium-enhanced hepatocyte phase MRI: can increasing the flip angle improve focal liver lesion detection? Context: To determine whether hepatocyte phase gadoxetic acid disodium (EOB)-enhanced MRI using a high flip angle (FA) improves focal liver lesion (FLL) detection compared with using a standard low FA. Sixty-two consecutive patients with 159 FLLs underwent EOB-enhanced MRI during the hepatocyte phase at 5, 10, 15, and 20 min, with both low (10°) and high (30°) FAs. Two blinded radiologists independently and randomly reviewed the two image sets using a four-point rating scale. Sensitivities and specificities were calculated and lesion-to-liver contrast ratio (LLC) on all hepatocyte phase images was measured. The sensitivities with high FA for small (≤10 mm) malignant FLLs were significantly higher than those with low FA, at all time points, for both readers (P ≤ 0.05). Meanwhile, the specificities of the two protocols for the detection of all FLLs at all time points during the hepatocyte phase were high and same (98.2%) for both readers, without any significant differences (P = 1.00). LLCs with high FA were significantly higher than those with low FA at all time points (P ≤ 0.001)." }, { "role": "assistant", "content": "Hepatocyte phase EOB-enhanced MRI with increasing FA can significantly increase LLC and improve the detection of FLLs, particularly small malignant lesions." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Long thoracic nerve supplies which of the following muscles?" }, { "role": "assistant", "content": "The correct answer is Ans. a (Serratus anterior) (Ref. BDC Vol. I, 4th ed., 67)LONG THORACIC NERVE OF BELL# Derived from ventral rami of C5, C6, and C7 - close to their emergence from intervertebral foramina;# It runs downward and passes either in front of or behind middle scalene muscle;# It reaches upper slip of serratus anterior muscle and descends on outer surface of this muscle, giving branches into it;# Scapular Winging: may occur from long thoracic nerve injury or from spinal accessory nerve injury (which deinnervates the trapezius)Sr.NerveMuscle GroupFunctional Deficit or Sign1.Long thoracicSerratus anterior# Winging of scapula2.SuprascapularSupraspinatus and Infraspinatus# Difficulty in initiating arm abduction3.AxillaryDeltoid and Teres minor# Inability to fully abduct arm4.RadialExtensors of forearms, wrist proximal phalanges and thumb# Loss of arm extension, loss of foreams extension, supination, abduction, loss of wrist extension (wrist drop), loss of proximal phalangeal extension and thumb extension.# Saturday night palsy.5.Musculocuta- neousFlexors of arm and forearm# Weak arm and forearm flexion, weak forearm supination.6.MedianWrist and hand flexors# Paralysis of flexor, pronator, and thenar muscles, inability to fully flex the index and middle fingers (Sign of benediction),# \"Pointing index finger\",# Labourer's nerve,# Ape-thumb deformity.7.UlnarWrist and hand flexors# Musician nerve# Inability to extend the distal and middle phalanges (Clawhand);# Loss of thumb abduction; Froment sign positive;# Tardy ulnar palsy (cubitus varus in condylar humerus fracture)Also know:Palsy of Median nerveMNEMONIC: SLAPFeaturesSign of benedictionLabourer's nerveApe-thumb deformityPointing index fingerUlnar nerveFACTFroment signAbduction of thumb lostClaw handTardy palsy due to cubitus varus" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Animals, Anti-Inflammatory Agents, Non-Steroidal, Enzyme Activation, Ganglia, Spinal, Hyperalgesia, Imidazoles, Injections, Spinal, Male, Neurons, Peptides, Cyclic, Phosphorylation, Protein Kinase Inhibitors, Pyrazoles, Pyridines, Rats, p38 Mitogen-Activated Protein Kinases." }, { "role": "user", "content": "Does activation of p38 mitogen-activated protein kinase in the dorsal root ganglion contribute to pain hypersensitivity after plantar incision? Context: The phosphorylation of p38 mitogen-activated protein kinase (MAPK) in the dorsal root ganglion (DRG) promotes primary afferent sensitization. The role of p38MAPK signaling in the DRG in the pathogenesis of plantar incision hyperalgesia has not been investigated. Levels of phosphorylated p38MAPK (p-p38MAPK) obviously increased in the DRG after plantar incision. Unmyelinated and myelinated DRG neurons that express p-p38MAPK contained small to medium cell bodies, suggesting that p-p38MAPK expression is induced in neurons with C- and Aδ-fibers. The p-p38MAPK inhibitors FR167653 or SB203580 inhibited incision-induced mechanical hypersensitivity and spontaneous pain behavior. The systemic administration of tumor necrosis factor-α (TNF-α) inhibitor prevented subsequent incision-induced activation of p38MAPK in the DRG and alleviated mechanical hypersensitivity after the incision." }, { "role": "assistant", "content": "p38MAPK signaling in the DRG plays a crucial role in the development of primary afferent sensitization and pain behavior caused by plantar incision. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Is total antioxidant status in lung cancer associated with levels of endogenous antioxidants and disease stage rather than lifestyle factors - preliminary study? Context: Decreased total antioxidant capacity (TAC) has been reported in different neoplasms, including lung cancer. However, no study concerning the relationship between endogenous antioxidants, lifestyle factors, and TAC has been conducted among lung cancer patients. The purpose of the study was to investigate the associations between endogenous antioxidants, severity of disease, lifestyle factors, and TAC in lung cancer patients. The study was conducted among 59 lung cancer patients. The levels of total antioxidant status (ATBS method), endogenous antioxidants, and C-reactive protein were measured in patients' sera automatically. Dietary habits of the subjects were evaluated based on the Food Frequency Questionnaire (FFQ) on the day of admission to hospital. We found a positive correlation between serum albumin, uric acid (UA), and TAC and a negative correlation between CRP and TAC. Moreover, TAC was significantly positively associated with disease stage. We did not find any significant relationship between the frequency of selected food consumption and TAC in lung cancer patients, except for a positive correlation between the frequency of refined cereal products consumption and TAC level. Smoking status did not correlate with TAC." }, { "role": "assistant", "content": "Total antioxidant status of lung cancer patients results from their disease stage and levels of endogenous antioxidants rather than from lifestyle factors. The lack of influence of diet and smoking on the TAC presumably result from disturbed homeostasis in which cancer, while developing, could determine the redox state to a greater extent than lifestyle factors. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: CD18 Antigens, Cells, Cultured, Cytotoxicity, Immunologic, Humans, Multiple Trauma, Neutrophil Activation, Neutrophils, Pancreatic Elastase, Respiratory Burst, Resuscitation, Saline Solution, Hypertonic, Systemic Inflammatory Response Syndrome." }, { "role": "user", "content": "Is hypertonic saline attenuation of polymorphonuclear neutrophil cytotoxicity : timing everything? Context: The potential to modulate the inflammatory response has renewed interest in hypertonic saline (HTS) resuscitation of injured patients. However, the effect of the timing of HTS treatment with respect to polymorphonuclear neutrophil (PMN) priming and activation remains unexplored. We hypothesized that HTS attenuation of PMN functions requires HTS exposure before priming and activation. Isolated PMN were incubated in HTS (180 mM Na+) before L-alpha-phosphatidylcholine, beta-acetyl-gamma-O-alkyl (PAF)/N-formylmethionyl-leucyl-phenylalanine (fMLP) priming/activation, after priming, or after priming/activation. Superoxide production was measured by the reduction cytochrome c, elastase release by cleavage of AAPV-pNA, and beta2-integrin expression by flow cytometry. HTS before priming or activation decreased beta2-integrin expression, superoxide production, and elastase release. In contrast, HTS after priming/activation augmented superoxide production and elastase release." }, { "role": "assistant", "content": "The timing of HTS is a key variable in the attenuation of PMN cytotoxic functions. Maximal attenuation of cytotoxicity is achieved before priming, whereas HTS exposure after activation augments cytotoxicity. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, RESULTS. Meshes: Administration, Intranasal, Administration, Topical, Animals, Disease Models, Animal, Follow-Up Studies, Glucocorticoids, Male, Nasal Decongestants, Nasal Mucosa, Prospective Studies, Rabbits, Rhinitis." }, { "role": "user", "content": "Does topical glucocorticoid reduce the topical decongestant-induced histologic changes in an animal model nasal mucosa? Context: To investigate the histologic consequences of simultaneous nasal glucocorticosteroid and xylometazoline HCl administration in the rabbit nasal mucosa. Prospective randomized study. Twenty New Zealand male rabbits were randomly placed into three groups: group I, control (n = 6); group II, xylometazoline HCl (n = 8); or group III, xylometazoline HCl-fluticasone furoate (n = 6). Group I received no treatment. Groups II and III received two intranasal puffs of xylometazoline HCl 0.5 mg/mL twice daily or two puffs of xylometazoline HCl 0.5 mg/mL twice daily plus one puff of 27.5 μg fluticasone furoate twice daily to each nostril (110 μg), respectively. At the end of 3 weeks, the rabbits were sacrificed. The mucosa of the nasal cavities was excised. Specimen sections (5 μm) were stained with hematoxylin and eosin, mucicarmine, and Gomori one-step trichrome and were examined under a light microscope. The presence of edema, congestion, inflammatory cell infiltration, nasociliary loss, epithelial and nerve-ending degeneration, and goblet cell increase were evaluated semiquantitatively (grades 0-3). Statistically significant differences were detected between groups II and III in terms of edema, congestion, inflammatory cell infiltration, nasociliary loss, and epithelial degeneration (P = .006, P = .049, P = .015, P = .014, and P = .049, respectively). Nerve-ending degeneration, goblet cell increase, and quantitative goblet and neutrophil cell counts did not yield statistically significant differences between groups II and III (P = .137, P = .580, P = .770, and P = .616, respectively)." }, { "role": "assistant", "content": "The combined simultaneous intranasal administration of xylometazoline HCl and fluticasone furoate appears to be beneficial in minimizing the long-term usage-associated congestion, edema, inflammatory cell infiltration, epithelial degeneration, and nasociliary loss in the rabbit model nasal mucosa. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Flupiine is" }, { "role": "assistant", "content": "The correct answer is Flupiine is a centrally acting non-opioid analgesic. It is unique as a non-opioid, non-NSAID, Nonsteroidal analgesic. It is a centrally acting, non-opioid analgesic with N-methyl D aspaate (NMDA) receptor antagonist propey which has been shown to be effective in the management of postoperative pain." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, CD28 Antigens, CD8-Positive T-Lymphocytes, Female, HIV, HIV Infections, Hepacivirus, Hepatitis C, Humans, Interferon-gamma, Male, Middle Aged." }, { "role": "user", "content": "Does hIV coinfection impair CD28-mediated costimulation of hepatitis C virus-specific CD8 cells? Context: During human immunodeficiency virus (HIV) infection, reduced proportions of CD8 cells express CD28, the key costimulatory molecule for lymphocyte activation. However, it is unclear whether reduced CD28 expression affects immune responses to non-HIV antigens, potentially contributing to susceptibility to opportunistic infection. We measured CD4- and CD8-specific interferon- gamma responses to hepatitis C virus (HCV) peptide pools in subjects with chronic HCV monoinfection (n=14), in subjects with chronic HCV/HIV coinfection (n=15), and in healthy control subjects (n=10) by enzyme-linked immunospot assay in the presence and absence of CD28 costimulation. Anti-CD28 agonist increased the cumulative frequency of HCV-specific CD4 cell responses in the subjects with HCV monoinfection and in those with HCV/HIV coinfection. In contrast, anti-CD28 agonist increased the breadth and cumulative frequency of HCV-specific CD8 cell responses only in the subjects with HCV monoinfection. Additionally, in the presence of anti-CD28 agonist, the proportion of subjects responding, the cumulative frequency, and the breadth of reactive CD8 cells were greater among the subjects with HCV monoinfection than among those with HCV/HIV coinfection. Finally, the HCV/HIV-coinfected subjects had lower proportions of CD8 cells that expressed CD28." }, { "role": "assistant", "content": "These results indicate that, during HCV/HIV coinfection, memory-effector CD8 cells have reduced responsiveness to CD28 costimulation. This appears to reflect a global effect that HIV has on the activation or differentiation state of CD8 cells that are responsive to other microbial pathogens. This functional defect has implications for the pathogenesis of HCV/HIV coinfection. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Coronary Artery Bypass, European Continental Ancestry Group, Female, Healthcare Disparities, Humans, Male, Myocardial Infarction, New Zealand, Oceanic Ancestry Group, Percutaneous Coronary Intervention, Sex Factors." }, { "role": "user", "content": "Ethnic differences in coronary artery revascularisation in New Zealand: does the inverse care law still apply? Context: In 2002 striking differences in cardiac revascularisation rates were reported between New Zealand Māori, Pacific and European ethnicities. This paper examines whether this inequity still exists, taking into account ethnic differences in need. Age-standardised time trends in intervention rates for coronary artery bypass grafts (CABG), percutaneous coronary intervention (PCI) and ST elevation myocardial infarction (STEMI) were calculated by ethnicity. Ethnic-specific trends were also calculated in the ratio of observed to expected CABG and PCI interventions based on the rate of hospitalisation with a diagnosis of STEMI. On a per capita basis, standardised CABG intervention rates were significantly higher for Pacific (both sexes) and female Māori than Other throughout 2000-2012, and were significantly higher for Māori males than Other in 2009-12. Population based PCI rates were significantly lower for male Māori from 2000-2012, while for female Māori they were significantly lower in 2000-2004 but significantly higher in 2009-12. However, and despite some improvement since 2000-2004, Māori and Pacific intervention numbers for PCI in 2009-2012 were still 22%-32% lower than expected for the rate of STEMI hospitalisation they experience. Overall revascularisation ratios were significantly lower than expected for Māori (both sexes) and Pacific females." }, { "role": "assistant", "content": "Large increases in the PCI population intervention rates in Māori and Pacific over the period 2000-2012 have not been sufficient to eliminate inequalities in relation to need, except perhaps for Pacific men." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Monoamniotic monochorionic twins are formed when division occurs: (Repeat)" }, { "role": "assistant", "content": "The correct answer is Ans: C (>8 days) Ref: Dutta Textbook of Obstetrics 5th ed pg 200 Explanation: Dizygotic Twins 80% (fraternal, binocular) fertilization of 2 ova by 2 sperms during single ovarian cycle Monozygotic twins 20% (identical, uniovular) Twinning may occur at different periods after Fertilisation Division within 72 hrs --Diamniotie Diehorionic (30%) - DAD Division 4-8 days Diamniotic Monochorionic (66%) - DAM Division > 8 days--Monoaniniotic Monochorionic (3%) - MAM Division > 2 weeks--conjoined twins <1% Siamese twins Thoracopagus Pyophagus Craniophagus Ischiophagus Remember: DAD - DAM - MAM" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Body Weight, Dietary Proteins, Male, Mice, Mice, Inbred C57BL, Mice, Knockout, Receptors, G-Protein-Coupled, Weight Gain." }, { "role": "user", "content": "Is gPRC6a required for the effects of a high-protein diet on body weight in mice? Context: The G-protein coupled receptor family C group 6 member A (GPRC6A) is activated by proteinogenic amino acids and may sense amino acids in the gastrointestinal tract and the brain. The study investigated whether GPRC6A was necessary for the effects of low- and high-protein diets on body weight and food intake in mice. The role of GPRC6A in mediating the effects of a low-protein diet on body weight was investigated in GPRC6a knockout (GPRC6a-KO) and wild-type (WT) mice fed a control diet (18% protein) or a low-protein diet (6% protein) for 9 days. The role of GPRC6A in mediating the effects of a high-protein diet on body weight was investigated in GPRC6a-KO and WT mice fed a control diet (18% protein) or a high-protein diet (50% protein) for 5 weeks. A high-protein diet reduced body weight gain and food intake compared with a control diet in both WT and GPRC6a-KO mice. A low-protein diet decreased body weight gain in GPRC6a-KO mice." }, { "role": "assistant", "content": "GPRC6A was not necessary for the effects of a low- or high-protein diet on body weight and likely does not play a role in protein-induced satiety. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Carrier Proteins, Caspase Inhibitors, Cell Death, Diet, High-Fat, Endothelial Cells, Eye Diseases, Inflammasomes, Inflammation, Male, Microcirculation, NF-kappa B, NLR Family, Pyrin Domain-Containing 3 Protein, Obesity, Oxidative Stress, Rats, Rats, Wistar, Receptors, Cytoplasmic and Nuclear, Retina." }, { "role": "user", "content": "Is thioredoxin-interacting protein required for endothelial NLRP3 inflammasome activation and cell death in a rat model of high-fat diet? Context: Obesity and hypertension, known pro-inflammatory states, are identified determinants for increased retinal microvascular abnormalities. However, the molecular link between inflammation and microvascular degeneration remains elusive. Thioredoxin-interacting protein (TXNIP) is recognised as an activator of the NOD-like receptor pyrin domain containing-3 (NLRP3) inflammasome. This study aims to examine TXNIP expression and elucidate its role in endothelial inflammasome activation and retinal lesions. Spontaneously hypertensive (SHR) and control Wistar (W) rats were compared with groups fed a high-fat diet (HFD) (W+F and SHR+F) for 8-10 weeks. Compared with W controls, HFD alone or in combination with hypertension significantly induced formation of acellular capillaries, a hallmark of retinal ischaemic lesions. These effects were accompanied by significant increases in lipid peroxidation, nitrotyrosine and expression of TXNIP, nuclear factor κB, TNF-α and IL-1β. HFD significantly increased interaction of TXNIP-NLRP3 and expression of cleaved caspase-1 and cleaved IL-1β. Immunolocalisation studies identified TXNIP expression within astrocytes and Müller cells surrounding retinal endothelial cells. To model HFD in vitro, human retinal endothelial (HRE) cells were stimulated with 400 μmol/l palmitate coupled to BSA (Pal-BSA). Pal-BSA triggered expression of TXNIP and its interaction with NLRP3, resulting in activation of caspase-1 and IL-1β in HRE cells. Silencing Txnip expression in HRE cells abolished Pal-BSA-mediated cleaved IL-1β release into medium and cell death, evident by decreases in cleaved caspase-3 expression and the proportion of live to dead cells." }, { "role": "assistant", "content": "These findings provide the first evidence for enhanced TXNIP expression in hypertension and HFD-induced retinal oxidative/inflammatory response and suggest that TXNIP is required for HFD-mediated activation of the NLRP3 inflammasome and the release of IL-1β in endothelial cells. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Blood Flow Velocity, Brain Ischemia, Carbon Dioxide, Carotid Artery Diseases, Carotid Stenosis, Cerebrovascular Circulation, Humans, Prognosis, Proportional Hazards Models, Regression Analysis, Risk Assessment, Risk Factors, Stroke, Time Factors, Ultrasonography, Doppler, Transcranial." }, { "role": "user", "content": "Does cerebrovascular reactivity predict stroke in high-grade carotid artery disease? Context: To assess the usefulness of transcranial Doppler CO2 reactivity (CO2R) for prediction of ipsilateral ischemic stroke in carotid artery stenosis and occlusion with a meta-analysis of prospective studies based on individual patient data. We searched Medline, Biosis Previews, Science Citation Index, The Cochrane Library, and EMBASE for studies in which patients with severe carotid artery stenosis or occlusion underwent Doppler CO2R testing (inhalation of CO2 or breath-holding) and were prospectively followed for ipsilateral ischemic stroke. Individual data from 754 patients from 9 studies were included. We used percentage cerebral blood flow velocity increase (pCi) during hypercapnia as the primary CO2R measure, and defined impaired reactivity as pCi <20% increase. In a multiple regression model, impaired CO2R was independently associated with an increased risk of ipsilateral ischemic stroke (hazard ratio [HR] 3.69; confidence interval [CI] 2.01, 6.77; p < 0.0001). Risk prediction was similar for recently symptomatic vs asymptomatic patients. Using continuous values of pCi, a significant association between decreasing pCi and increasing risk of ipsilateral stroke was found: HR of 1.64 (95% CI 1.33, 2.02; p < 0.0001) per 10% decrease in pCi. For patients with asymptomatic internal carotid artery stenosis only (n = 330), a comparable stroke risk prediction was found: increasing HR 1.95 (95% CI 1.26, 3.04; p = 0.003) per 10% decrease in pCi." }, { "role": "assistant", "content": "This analysis supports the usefulness of CO2R in risk prediction for patients with severe carotid artery stenosis or occlusion, both in recently symptomatic and asymptomatic patients. Further studies should evaluate whether treatment strategies in asymptomatic patients based on CO2R could improve patient outcomes. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adolescent, Adult, Ambulatory Care Facilities, Continuity of Patient Care, Cross-Sectional Studies, Female, Finland, Humans, Male, Maternal Health Services, Maternal-Child Health Centers, Models, Organizational, Parents, Patient Satisfaction, Pregnancy, Surveys and Questionnaires, Young Adult." }, { "role": "user", "content": "Does the organizational model of the maternity health clinic have an influence on women's and their partners' experiences? Context: In high-income countries, great disparities exist in the organizational characteristics of maternity health services. In Finland, primary maternity care is provided at communal maternity health clinics (MHC). At these MHCs there are public health nurses and general practitioners providing care. The structure of services in MHCs varies largely. MHCs are maintained independently or merged with other primary health care sectors. A widely used organizational model of services is a combined maternity and child health clinic (MHC&CHC) where the same public health nurse takes care of the family from pregnancy until the child is at school age. The aim of this study was to determine how organizational model, MHC independent or combined MHC&CHC, influence on women's and their partners' service experiences. A comparative, cross-sectional service evaluation survey was used. Women (N = 995) and their partners (N = 789) were recruited from the MHCs in the area of Turku University Hospital. Four months postpartum, the participants were asked to evaluate the content and amount of the MHC services via a postal questionnaire. Comparisons were made between the clients of the separate MHCs and the MHCs combined to the child health clinics. Women who had used the combined MHC&CHCs generally evaluated services more positively than women who had used the separate MHCs. MHC's model was related to several aspects of the service which were evaluated \"good\" (the content of the service) or \"much\" (the amount of the service). Significant differences accumulated favoring the combined MHC&CHCs' model. Twelve aspects of the service were ranked more often as \"good\" or \"much\" by the parents who had used the combined MHC&CHC, only group activities regarding delivery were evaluated better by women who had used the separate MHCs." }, { "role": "assistant", "content": "Based on the women's and partners' experiences an organizational model of the combined MHC&CHC where the same nurse will take care of family during pregnancy and after birth of the child was preferred. This model also provides greater amount of home visits and peer support than the separate MHC." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Asia, Cryptococcus neoformans, Drug Resistance, Fungal, Fluconazole, Flucytosine, Genetic Variation, Genotype, HIV Infections, Humans, Microsatellite Repeats, Polymerase Chain Reaction, Serotyping." }, { "role": "user", "content": "Is resistance of Asian Cryptococcus neoformans serotype A confined to few microsatellite genotypes? Context: Cryptococcus neoformans is a pathogenic yeast that causes cryptococcosis, a life threatening disease. The prevalence of cryptococcosis in Asia has been rising after the onset of the AIDS epidemic and estimates indicate more than 120 cases per 1,000 HIV-infected individuals per year. Almost all cryptococcal disease cases in both immunocompromised and immunocompetent patients in Asia are caused by C. neoformans var. grubii. Epidemiological studies on C. neoformans in pan-Asia have not been reported. The present work studies the genetic diversity of the fungus by microsatellite typing and susceptibility analysis of approximately 500 isolates from seven Asian countries. Genetic diversity of Asian isolates of C. neoformans was determined using microsatellite analysis with nine microsatellite markers. The analysis revealed eight microsatellite complexes (MCs) which showed different distributions among geographically defined populations. A correlation between MCs and HIV-status was observed. Microsatellite complex 2 was mainly associated with isolates from HIV-negative patients, whereas MC8 was associated with those from HIV-positive patients. Most isolates were susceptible to amphotericin B, itraconazole, voriconazole, posaconazole, and isavuconazole, but 17 (3.4%) and 10 (2%) were found to be resistant to 5-flucytosine and fluconazole, respectively. Importantly, five Indonesian isolates (approximately 12.5% from all Indonesian isolates investigated and 1% from the total studied isolates) were resistant to both antifungals. The majority of 5-flucytosine resistant isolates belonged to MC17." }, { "role": "assistant", "content": "The findings showed a different distribution of genotypes of C. neoformans var. grubii isolates from various countries in Asia, as well as a correlation of the microsatellite genotypes with the original source of the strains and resistance to 5-flucytosine. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Dwarfism is caused by all EXCEPT" }, { "role": "assistant", "content": "The correct answer is Thyroid hormones are essential for normal growth and development. If thyroid deficiency occurs in children, any time before the fusion of the epiphyses of the long bones, it leads to growth retardation or arrest. Loss in height that occurs due to this, may be recovered after the administration of thyroid hormone. This is called \"catch-up growth\". GH deficiency before pubey leads to dwarfism. Castration or extirpation of testes, before pubey, would result in permanent sterility. Absence of testosterone leads to failure of usual pubeal changes to occur, and accessory organs of reproduction do not develop. There is some delay in the closure of epiphyses of long bones, due to absence of testosterone. However, it does not result in dwarfism." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "MCH located on -" }, { "role": "assistant", "content": "The correct answer is (A) (Chromosome number 6) (136 Baveja 4lh) (106 D. Greenwood 18th)MAJOR HISTOCOMPATIBILITY COMPLEX (MHO* The MHC in human is known as human leucocyte antigen (HLA) complex.* The HLA complex of genes is located on short arm of chromosome 6.* They are arranged over a region of between 2000 and 4000 kilobases is size, containing sufficient DNA for more than 200 genes.HLA Complex (MHC complex)||||Class IClass 11Class III* Comprising A, B and C loci* 'D' region - DR, DQ, DPComplement region encodes* Responsible for* Responsible for* C2&C4# Graft rejection# Graft versus host response* Properdin factor B# Cell mediated cytolysis# Mixed leucocyte reaction* Heat shock protein* Found on the surface of all nucleated cells and platelets* Found only on cells of the immune system* TNF a and b* Enzyme 21 hydroxylaseIndications of HLA typing:* Tissue typing prior to transplantation.* Paternity determination.* Disease and HLA - associationHLA - B27 - Ankylosing spondylitis.HLA - DR4 - Rheumatoid arthritis" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Raji cell assay are used to quantitate-" }, { "role": "assistant", "content": "The correct answer is A sensitivie and simple procedure for the detection and quantitation of soluble complement (C)- fixing immune complexes in sera of patients with various disease states has been developed by utilizing C receptors on Raji cells. These cells lack membrane-bound immunoglobulin but have receptors for IgG Fc, C3b, C3d, and possibly with other C proteins. Uptake experiments showed that both aggregated human gamma globulin (AHG) and 7S IgG bound to receptors for IgG Fc; however, AHG reacted with C bound to cells only receptors for C and this binding was much more efficient than IgG Fc receptors. published in journal of clinical investigations. >." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Corpus callosum involvement on MRI is usually seen in which of the following conditions? NOT RELATED-MEDICINE" }, { "role": "assistant", "content": "The correct answer is ." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Posterior communicating aery connects" }, { "role": "assistant", "content": "The correct answer is Posterior communicating aery connects the internal carotid aery with posterior cerebral aery.(Ref: Vishram Singh textbook of clinical neuroanatomy second edition pg 172)" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Acupuncture Therapy, Anesthesia, Animals, Blood Pressure, Capsaicin, Electric Stimulation, Injections, Subcutaneous, Male, Paraventricular Hypothalamic Nucleus, Peroneal Nerve, Pressoreceptors, Rats, Rats, Sprague-Dawley." }, { "role": "user", "content": "Does electrical stimulation of deep peroneal nerve mimicking acupuncture inhibit the pressor response via capsaicin-insensitive afferents in anesthetized rats? Context: To assess the inhibitory modulation of blood pressure by stimulation of the deep peroneal nerve (DPN) and to determine the involvement of nociceptive fibers in the modulation. All the animals were divided into six groups (A-F). The rats in groups A and B received no pretreatment. The rats in groups C and D received subcutaneous injection of capsaicin or control vehicle, respectively, near the DPN for 2 days. Those in groups E and F had the DPN exposed to capsaicin or control vehicle, respectively, for 20 min. Subsequently, pressor responses were induced by stimulation of paraventricular nucleus (PVN) either electrically (groups A and C C-F) or chemically via injection of glutamate (group B). After two stable pressor responses (baseline), all groups were subject to 5-min DPN stimulation followed by PVN stimulation for 10 s. Arterial blood pressure, heart rate, and electrocardiogram were recorded. The pressor response was calculated as the difference in the mean arterial pressure (MAP) before and after PVN stimulation, and changes from baseline in pressor response after DPN stimulation were compared between the groups. Increases of MAP of 22.88±2.18 mm Hg and 20.32±5.25 mm Hg were induced by electrical (group A) or chemical (group B) stimulation of the PVN, respectively. These pressor responses were inhibited by stimulation of the DPN, and the MAP was reduced to 12.00±2.10 mm Hg in group A (n=6, P<0.01) and 7.00±2.85 mm Hg in group B (n=6, P<0.01). Subcutaneous injection of capsaicin (125 mg/kg) near the DPN in group C (n=7) had no effect on the inhibitory effect of DPN stimulation compared with the group D (n=9), and neither did blockade of nociceptive fibers with capsaicin in group E (n=6) compared with group F (n=8)." }, { "role": "assistant", "content": "Stimulation of the DPN mimicking acupuncture has an inhibitory effect on the pressor response, and the effect is mediated by capsaicin-insensitive afferent fibers in the DPN. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Alkyl and Aryl Transferases, Bone Density Conservation Agents, Cell Proliferation, Cholesterol, Diphosphonates, Humans, Imidazoles, Male, Prostatic Neoplasms, Protein Prenylation, Tumor Cells, Cultured, Zoledronic Acid." }, { "role": "user", "content": "Does zoledronic acid treatment impair protein geranyl-geranylation for biological effects in prostatic cells? Context: Nitrogen-containing bisphosphonates (N-BPs) have been designed to inhibit osteoclast-mediated bone resorption. However, it is now accepted that part of their anti-tumor activities is related to interference with the mevalonate pathway. We investigated the effects of zoledronic acid (ZOL), on cell proliferation and protein isoprenylation in two tumoral (LnCAP, PC-3,), and one normal established (PNT1-A) prostatic cell line. To assess if inhibition of geranyl-geranylation by ZOL impairs the biological activity of RhoA GTPase, we studied the LPA-induced formation of stress fibers. The inhibitory effect of ZOL on geranyl geranyl transferase I was checked biochemically. Activity of ZOL on cholesterol biosynthesis was determined by measuring the incorporation of 14C mevalonate in cholesterol. ZOL induced dose-dependent inhibition of proliferation of all the three cell lines although it appeared more efficient on the untransformed PNT1A. Whatever the cell line, 20 microM ZOL-induced inhibition was reversed by geranyl-geraniol (GGOH) but neither by farnesol nor mevalonate. After 48 hours treatment of cells with 20 microM ZOL, geranyl-geranylation of Rap1A was abolished whereas farnesylation of HDJ-2 was unaffected. Inhibition of Rap1A geranyl-geranylation by ZOL was rescued by GGOH and not by FOH. Indeed, as observed with treatment by a geranyl-geranyl transferase inhibitor, treatment of PNT1-A cells with 20 microM ZOL prevented the LPA-induced formation of stress fibers. We checked that in vitro ZOL did not inhibit geranyl-geranyl-transferase I. ZOL strongly inhibited cholesterol biosynthesis up to 24 hours but at 48 hours 90% of this biosynthesis was rescued." }, { "role": "assistant", "content": "Although zoledronic acid is currently the most efficient bisphosphonate in metastatic prostate cancer management, its mechanism of action in prostatic cells remains unclear. We suggest in this work that although in first intention ZOL inhibits FPPsynthase its main biological actitivity is directed against protein Geranylgeranylation. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Bernard-Soulier Syndrome, Blood Platelets, Bone Marrow Cells, Cell Differentiation, Cell Membrane, Cell Movement, Endothelium, Vascular, Humans, Megakaryocytes, Membrane Proteins, Mice, Mice, Transgenic, Microscopy, Electron, Platelet Glycoprotein GPIb-IX Complex, Platelet Membrane Glycoproteins." }, { "role": "user", "content": "Is absence of GPIbalpha responsible for aberrant membrane development during megakaryocyte maturation : ultrastructural study using a transgenic model? Context: The glycoprotein Ib/IX/V complex (GPIb-IX-V) mediates platelet attachment to von Willebrand factor in exposed subendothelium. Molecular defects in the genes for GPIbalpha, GPIbbeta, and GPIX give rise to the Bernard-Soulier syndrome, in which thrombocytopenia and giant platelets suggest that this receptor also is involved in platelet production. To study how giant platelets are produced in vivo, we used a model of GPIbalpha-deficient mice (GPIbalpha(null)) and mice rescued with the human GPIbalpha transgene (GPIbalpha(null;hTg)). Using electron microscopy and immunogold labeling, we examined megakaryocytopoiesis in the bone marrow of these mice and developed a method to quantify the membranes of megakaryocytes (MK) and proplatelets by computer analysis. Abnormal membrane development in the perinuclear zone was found in immature MK of GPIbalpha(null) mice. This led to a poorly developed demarcation membrane system and other ultrastructural changes. As a result, well-organized platelet territories were rarely seen within the cytoplasm of mature MK. Membrane quantification confirmed that MK of GPIbalpha(null) mice had a reduced internal membrane pool. Whereas these MK normally crossed the endothelial barrier, their migration was accompanied by the production of unusually large MK fragments or proplatelets in the vascular sinus with an approximately 50% decrease in internal membrane content compared to wild-type. In the rescued GPIbalpha(null;hTg) model, GPIbalpha was normally localized in MK, and there was a total correction of the ultrastructural defects." }, { "role": "assistant", "content": "GPIbalpha is essential for membrane development and distribution in maturing MK. Its absence leads to abnormal partitioning of the membrane systems and abnormal proplatelet production. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Adolescent, Adult, Aged, Antiviral Agents, Apoptosis, Cardiovascular Diseases, Cell Line, Endothelial Cells, Endothelium, Vascular, Female, Flow Cytometry, Humans, Interferon-beta, Male, Middle Aged, Parvoviridae Infections, Parvovirus B19, Human, Risk Factors, Treatment Outcome, Young Adult." }, { "role": "user", "content": "Does interferon beta modulate endothelial damage in patients with cardiac persistence of human parvovirus b19 infection? Context: In a phase 1 study, we investigated whether interferon beta reduced endothelial damage in patients with cardiac persistence of human parvovirus B19 (B19V) infection. In vitro, B19V infected cultivated endothelial cells (ECs), which led to a reduction in their viability (P = .007). Interferon beta suppressed B19V replication by 63% (P = .008) in ECs and increased their viability (P = .021). Circulating mature apoptotic ECs (CMAECs [CD45(-)CD146(+) cells expressing von Willebrand factor and annexin V]) and circulating progenitor cells (CPCs [CD34(+)KDR(+) cells]) were quantified by flow cytometry in 9 symptomatic patients with cardiac B19V infection before and after 6 months of interferon beta therapy (16 MU) and were compared to levels in 9 healthy control subjects. Endothelial dysfunction was measured using flow-mediated dilatation of the forearm. Patients with B19V persistence had significantly higher (P = .04) levels of CMAECs than did control subjects, which normalized after treatment (mean +/- standard deviation, 0.06% +/-0.08% vs 0.01% +/- 0.006%; P = .008). Similar improvement was shown for flow-mediated dilatation (P = .04) in the treatment group only (P = .017 for the comparison with untreated patients with B19V persistence n = 5). There were significantly higher numbers of CPCs in patients with B19V persistence before therapy (mean +/- standard deviation, 0.04% +/- 0.05% vs 0.01% +/- 0.004%; P = .02; than in control subjects, which normalized after treatment (P = .03)." }, { "role": "assistant", "content": "Thus, we present (for the first time, to our knowledge) a modulation of virally induced chronic endothelial damage-specifically, EC apoptosis and endothelial regeneration. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: PURPOSE, METHODS, RESULTS. Meshes: Abdominal Injuries, Adolescent, Adult, Aged, Aged, 80 and over, Algorithms, Angiography, Female, Glasgow Coma Scale, Hematologic Tests, Humans, Injury Severity Score, Male, Middle Aged, Multiple Trauma, Predictive Value of Tests, Prospective Studies, Tomography, Spiral Computed, Trauma Centers, Wounds, Nonpenetrating." }, { "role": "user", "content": "Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography? Context: The purpose of this study was to determine whether admission non-computed tomography (CT) criteria can exclude intra-abdominal injury in stable patients sustaining blunt abdominal trauma. Seven hundred fourteen hemodynamically stable patients with suspicion of blunt abdominal trauma were included in the study. Admission data for clinical examination, sonography, routine laboratory studies, chest/pelvic radiographic findings, and Glasgow Coma Scale (GCS) score were recorded. Each patient underwent helical abdominal CT. Injuries were considered major if they required surgery or angiographic intervention. At the authors' institution, angiography is routinely performed if there is a splenic injury of American Association for the Surgery of Trauma grade II or higher or a liver injury of American Association for the Surgery of Trauma grade III or higher. Statistical analysis was performed to determine the value of isolated and combined clinical, radiologic, and laboratory parameters in depicting an intra-abdominal injury with regard to CT results and clinical follow-up. The best combination of criteria to identify a major abdominal injury was obtained when sonography, chest radiography, and three laboratory parameters (serum glutamic oxaloacetic transaminase, white blood cell count, and hematocrit) were normal: 22% (129 of 589) of patients without major injuries fulfilled these criteria. The only combination of criteria that completely excluded intra-abdominal injury was obtained when clinical criteria combined with a Glasgow Coma Scale score>13, bedside radiologic studies, and laboratory data were all normal, but only 12% (68 of 578) of patients without abdominal injury fulfilled these criteria." }, { "role": "assistant", "content": "After blunt abdominal trauma, admission non-CT criteria can at best identify 12% of patients without intra-abdominal injuries and 22% of patients without major injuries." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Coronary Artery Bypass, Endoscopy, Female, Humans, Male, Middle Aged, Retrospective Studies, Robotics, Sex Factors, Treatment Outcome." }, { "role": "user", "content": "Robotic totally endoscopic coronary artery bypass grafting in men and women: are there sex differences in outcome? Context: According to several studies, women are at higher risk for mortality and experience less relief of angina after coronary artery bypass graft surgery (CABG) than men. Sex-related differences in patients undergoing totally endoscopic coronary bypass grafting (TECABG) have not been investigated thus far. The aim of the present study was to evaluate the impact of sex on the outcome of patients undergoing TECABG. The data of 500 consecutive patients (364 male, 136 female) undergoing TECABG using the da Vinci telemanipulation system (Intuitive Surgical, Sunnyvale, CA) from 2001 to 2011 at two institutions were investigated regarding sex-related differences in short-term and long-term outcome. In all, 334 single, 150 double, 15 triple, and 1 quadruple TECABG procedures were carried out. Female patients were significantly older (63 years [range, 26 to 90] versus 59 years [range, 31 to 85], p = 0.001) and had higher European System for Cardiac Operative Risk Evaluation score levels (3 [range, 0 to 11] versus 2 [range, 0 to 13], p<0.001). Male patients received slightly more grafts (1 [range, 1 to 4] versus 1 [range, 1 to 3], p = 0.028), female patients were more likely to undergo beating heart surgery (20% versus 28%, p = 0.042). In-hospital mortality was 3 of 364 men (0.8%) and 2 of 136 women (1.5%; p = 0.513). Comparison of long-term-survival revealed 1-, 3- and 5-year survival rates of 96%, 96%, and 95% in men and 96%, 96%, and 96% in women, respectively, without any significant difference. Analysis of freedom from major adverse cardiac and cerebrovascular events revealed 1-, 3-, and 5-year rates of 86%, 84%, and 82% in men and 85%, 81%, and 81% in women, respectively, without any significant difference." }, { "role": "assistant", "content": "Our data show that women undergoing TECABG have outcomes similar to those of men." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Depressive Disorder, Major, Humans, Mental Disorders, Migraine Disorders, Outpatients, Pain, Psychometrics, Quality of Life." }, { "role": "user", "content": "Does migraine predict physical and pain symptoms among psychiatric outpatients? Context: No study has been performed to compare the impacts of migraine and major depressive episode (MDE) on depression, anxiety and somatic symptoms, and health-related quality of life (HRQoL) among psychiatric outpatients. The aim of this study was to investigate the above issue. This study enrolled consecutive psychiatric outpatients with mood and/or anxiety disorders who undertook a first visit to a medical center. Migraine was diagnosed according to the International Classification of Headache Disorders, 2nd edition. Three psychometric scales and the Short-Form 36 were administered. General linear models were used to estimate the difference in scores contributed by either migraine or MDE. Multiple linear regressions were employed to compare the variance of these scores explained by migraine or MDE. Among 214 enrolled participants, 35.0% had migraine. Bipolar II disorder patients (70.0%) had the highest percentage of migraine, followed by major depressive disorder (49.1%) and only anxiety disorder (24.5%). Patients with migraine had worse depression, anxiety, and somatic symptoms and lower SF-36 scores than those without. The estimated differences in the scores of physical functioning, bodily pain, and somatic symptoms contributed by migraine were not lower than those contributed by MDE. The regression model demonstrated the variance explained by migraine was significantly greater than that explained by MDE in physical and pain symptoms." }, { "role": "assistant", "content": "Migraine was common and the impact of migraine on physical and pain symptoms was greater than MDE among psychiatric outpatients. Integration of treatment strategies for migraine into psychiatric treatment plans should be considered. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Acute Lung Injury, Analysis of Variance, Animals, Blotting, Western, Immunoenzyme Techniques, Interleukin-1, Lipopolysaccharides, Lymphotoxin-alpha, Male, Mice, Mice, Inbred Strains, Random Allocation, Reverse Transcriptase Polymerase Chain Reaction, Shock, Hemorrhagic, Toll-Like Receptor 4." }, { "role": "user", "content": "Is tLR4 essential in acute lung injury induced by unresuscitated hemorrhagic shock? Context: Acute lung injury (ALI) and acute respiratory distress syndrome in patients with hemorrhagic shock (HS) or resuscitation is associated with the expression of TLR4. However, the role of TLR4 in ALI induced by unresuscitated HS remains obscure. The lung pathologic change was observed by hematoxylin and eosin staining. Interleukin-1beta and tumor necrosis factor-alpha were analyzed by enzyme-linked immunosorbent assay. Polymorphonuclear leukocyte sequestration and lung leak were analyzed by pulmonary myeloperoxidase activity and Evans blue dye. The expressions of TLR4 mRNA and protein were analyzed by reverse transcription-polymerase chain reaction and Western blot, respectively. TLR4 distribution was analyzed by immunohistochemistry. Lung neutrophil accumulation and microvascular permeability were significantly increased after unresuscitated HS, meanwhile, lung interleukin-1beta and tumor necrosis factor-alpha were gradually augmented. TLR4 mRNA, TLR4 distribution and TLR4 protein were also significantly increased in TLR4 wt mice, however, no above-mentioned changes appeared in TLR4 mutant mice." }, { "role": "assistant", "content": "TLR4 is strongly associated with the pathogenesis of ALI induced by unresuscitated HS, which may serve as a useful therapeutic target. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "The penicillin G preparation with the longest duration of action is:" }, { "role": "assistant", "content": "The correct answer is Benzathine penicillin has the longest duration of action." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Burns, Chemical, Cell Movement, Cell Proliferation, Cell Survival, Cells, Cultured, Collagen Type III, Corneal Opacity, Dexamethasone, Disease Models, Animal, Drug Combinations, Drug Synergism, Enzyme Inhibitors, Enzyme-Linked Immunosorbent Assay, Eye Burns, Glucocorticoids, Human Umbilical Vein Endothelial Cells, Male, Mice, Mice, Inbred C57BL, Neovascularization, Pathologic, Protein Kinase Inhibitors, Sodium Hydroxide, Wound Healing, rho-Associated Kinases." }, { "role": "user", "content": "Does inhibition of Rho-Associated Kinase prevent Pathological Wound Healing and Neovascularization After Corneal Trauma? Context: To investigate the effect of AMA0526, a specific inhibitor of rho-associated protein kinase (ROCK), on corneal neovascularization (NV) and scarring in different in vitro and in vivo experimental models. The effect of AMA0526 on cell viability, proliferation, and migration of human umbilical vein endothelial cells was determined. Its in vivo topical effect on NV was investigated in the corneal micropocket mouse model (bevacizumab as a control). The vessel length, clock hours, and NV area were measured on photographs. The effect of AMA0526 on pathological wound healing was investigated in the alkali burn mouse model (dexamethasone as a control). Corneas were scored for corneal opacity (CO) and NV after burn injury. Immunohistochemistry was performed to study inflammation, blood vessel density, and collagen III deposition after 7 days. ROCK inhibition significantly inhibited vascular endothelial cell proliferation and migration in vitro in a dose-dependent manner. In the micropocket model, NV was significantly reduced by AMA0526 (37% reduction, P < 0.05) comparable to bevacizumab. CO and NV were reduced after AMA0526, compared with the vehicle (P < 0.05 at all time points from day 3) after chemical burn. AMA0526 resulted in decreased inflammatory cell infiltration (26% reduction, P < 0.01), angiogenesis (47% reduction, P < 0.01), and collagen III deposition (27% reduction, P = 0.009) in the alkali burn model. AMA0526 administration showed results similar to those of dexamethasone with an additional antifibrotic effect." }, { "role": "assistant", "content": "The ROCK inhibitor, AMA0526, efficiently inhibited angiogenesis in vitro, reduced CO and NV, and controlled the complete process of wound healing in vivo. These results warrant further investigation of the therapeutic potential of AMA0526 for corneal NV and scarring. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Microorganisms that enter freshly laid eggs are" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., Salmonella . Salmonella can enter through the shell if eggs are left on contaminated chicken feed or feces and grow inside." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Use of Buspirone is -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., Anxiolytico Buspirone is a 5HT1A agonist useful for the treatment of anxiety,o Unlike benzodiazepines, it is non-sedative anti-anxiety drug.o Due to delay in the onset of its action, it is used for the treatment of chronic anxiety and is ineffective in acute panic attacks.o Buspirone lacks anticonvulsant and muscle relaxant property'." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 48 year old woman, P2L2 with menorrhagia, diagnosed with adenomyosis, is not responding to medical management with NSAIDs and hormonal therapy. Next step in management should be?" }, { "role": "assistant", "content": "The correct answer is Any menorrhagia in woman of perimenopausal age group should be evaluated with an endometrial biopsy , preferably hysteroscopy guided, even if a diagnosis of adenomyosis is made on USG, to rule out malignancy Treatment options for adenomyosis Medical: NSAIDs, GnRH analogues, danazol Mirena IUCD (LNG IUCD) Hysterectomy: most definitive treatment" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Prepatent period&; in lymphatic filariasis is defined as the time interval between inoculation of infective larvae and -" }, { "role": "assistant", "content": "The correct answer is <p> lymphatic filariasis:- Pre patent period-Time interval between inoculation of infective larvae and first appearance of detectable microfilaria. Clinical incubation period-Time interval from invasion of infective larva to development of clinical manifestation. 8-16 months. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.272}</p>" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Aged, Base Sequence, Child, Child, Preschool, Chromosome Mapping, Chromosomes, Human, Pair 12, Cohort Studies, DNA Mutational Analysis, Female, Genetic Predisposition to Disease, Genetic Testing, Genotype, Hereditary Sensory and Autonomic Neuropathies, Humans, Infant, Intracellular Signaling Peptides and Proteins, Male, Middle Aged, Minor Histocompatibility Antigens, Mutation, Nerve Tissue Proteins, Pedigree, Peripheral Nerves, Phenotype, Prevalence, Protein-Serine-Threonine Kinases, Quebec, WNK Lysine-Deficient Protein Kinase 1." }, { "role": "user", "content": "Do two mutations in the HSN2 gene explain the high prevalence of HSAN2 in French Canadians? Context: Hereditary sensory and autonomic neuropathy type 2 (HSAN2; MIM 201300) is a rare recessive neuropathy typically diagnosed in the first decade. The 1973 study of a French Canadian family led to the definition of HSAN2. To demonstrate that the apparent higher prevalence of HSAN2 in Quebec is due to the presence of two HSN2 mutations and that carriers of different mutations appear to have a similar phenotype. Through attending physicians, the authors recruited French Canadian patients with HSAN2. Exclusion of linkage to the known HSAN loci and linkage to the HSAN2 was performed using standard methods. Sequencing of the HSN2 gene was used to uncover the causal mutations. A large cluster of HSAN2 patients comprising 16 affected individuals belonging to 13 families was identified. The mode of inheritance is clearly autosomal recessive. All patients originated from southern Quebec, and 75% are from the Lanaudière region. Whereas linkage to the HSAN1, 3, and 4 loci was excluded, linkage to the 12p13.33 HSAN2 locus was confirmed. Sequencing of the HSN2 gene uncovered two French Canadian mutations and a novel nonsense mutation in a patient of Lebanese origin, all predicted to lead to truncations of the HSN2 protein. The comparison of clinical variables between patients with different genotypes does not suggest any difference in phenotype." }, { "role": "assistant", "content": "Two founder mutations are responsible for the apparently higher prevalence of HSAN2 in French Canadians. Genotype-phenotype correlation does not suggest any significant clinical variability. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Blood Loss, Surgical, Blood Transfusion, Colectomy, Colorectal Neoplasms, Feasibility Studies, Female, Humans, Kaplan-Meier Estimate, Laparoscopy, Length of Stay, Male, Middle Aged, Neoplasm Recurrence, Local, Patient Safety, Prospective Studies, Recovery of Function, Treatment Outcome." }, { "role": "user", "content": "A single surgeon's experience with 54 consecutive cases of multivisceral resection for locally advanced primary colorectal cancer: can the laparoscopic approach be performed safely? Context: Laparoscopic resection for colorectal cancer has become popular. However, no previous studies have compared the laparoscopic and open approaches for colorectal cancer adherent to adjacent organs. This study analyzed the short- and long-term survival outcomes after laparoscopic multivisceral resection of the locally advanced primary colorectal cancer compared with open procedure in an effort to address appropriate patient selection. From a prospectively collected database, 54 patients with locally advanced primary colorectal cancer who had undergone multivisceral resection from March 2001 to September 2009 were identified. Laparoscopic and open surgeries were selectively performed for 38 and 16 patients, respectively. The two groups had similar demographics, with no differences in age, sex, and comorbidity. However, five emergency or urgency operations were included in the open group. No differences existed between the two groups in terms of tumor node metastasis (TNM) staging, histologic tumor infiltration rates, or curative resection rates. Three patients (7.9%) in the laparoscopic group required conversion to open procedure. In the laparoscopic group, the operation time was longer (330 vs. 257 min; p = 0.018), the volume of blood loss was less (269 vs. 638 ml; p = 0.000), and the time until return of bowel movement was shorter (3.7 vs. 4.7 days; p = 0.029) than in the open group. The perioperative morbidity rates were similar in the two groups (21.1% vs. 43.7%; p = 0.107), and no perioperative mortality occurred in either group. The mean follow-up period after curative resection was 40 months in the laparoscopic group and 35 months in the open group. The two groups showed similar rates for local recurrence (7.7% vs. 27.3%; p = 0.144) and distant metastasis (15.4% vs. 45.5%; p = 0.091). The overall 5-year survival rate was 60.5% for the laparoscopic group and 47.7% for the open group (p = 0.044, log-rank test). In terms of TNM stages, the overall 5-year survival rate for pathologic stage 3 disease was 58.3% for the laparoscopic group and 25% for the open group (p = 0.022, log rank test), but no difference was noted for the stage 2 patients (p = 0.384)." }, { "role": "assistant", "content": "No adverse long-term oncologic outcomes of laparoscopic resection were observed in this study. Although inherent limitations exist in this nonrandomized study, laparoscopic multivisceral resection seems to be a feasible and effective treatment option for colorectal cancer for carefully selected patients. Patients with colon cancer should be much more carefully selected for laparoscopic multivisceral resection than patients with rectal cancer because anatomic uncertainty can make oncologic en bloc resection incomplete." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Giant dendritic ulceration on cornea is seen in case of:" }, { "role": "assistant", "content": "The correct answer is Ans. (c) HSV infectionRef: A.K. Khurana 6th ed. /108* Viral keratitis causes corneal ulceration. It is caused most commonly by Herpes simplex, Herpes Zoster and Adenoviruses.* Dendritic & geographical corneal ulcers are seen in herpes simplex ocular disease.* Dendritic ulcer (branching ulcer with knobbed ends), resembles no other condition, and is pathognomic of herpes simplex ocular infection.* The use of steroids in dendritic ulcer hastens the formation of geographical ulcer so it is contraindicated." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Nohern blot is used for the separation of which of the following?" }, { "role": "assistant", "content": "The correct answer is Nohern blotting is used to estimate the gene expression estimating the expression of mRNA." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVES, METHODS, RESULTS. Meshes: Aged, Aged, 80 and over, Cardiac Pacing, Artificial, Cardiomyopathy, Dilated, Female, Heart Failure, Humans, Male, Middle Aged, Nitric Oxide, Stroke Volume." }, { "role": "user", "content": "Does cardiac resynchronization therapy improve nitric oxide concentration in exhaled gas? Context: Cardiac resynchronization therapy (CRT) is widely known to improve cardiac function in patients with chronic heart failure, especially those with increased intraventricular conduction delay. However, whether vascular endothelial cell function is improved remains unknown. Capability of nitric oxide (NO) production is a good marker to evaluate endothelial cell function. Therefore, NO output was measured in exhaled air in patients with chronic heart failure after CRT. Six patients with chronic heart failure and dilated cardiomyopathy (mean age 62.0 +/- 11.3 years, left ventricular ejection fraction 22.8 +/- 11.6%) received CRT. Pacing leads were lodged at the right atrium, the apex of the right ventricle and at the mid portion of the postero-lateral branch of the coronary sinus. One month after CRT, endtidal NO concentration was evaluated with and without pacing using the chemiluminescence method. Left ventricular ejection fraction improved from 22.8% to 28.8% after the procedure. Endtidal NO was significantly (p = 0.038) increased from 64.7-13.2 ppb without pacing to 69.1-14.1 ppb with pacing. Respiratory rate (with pacing: 19.7-5.7 n/min, without pacing: 20.3-4.8 n/min), tidal volume (with pacing: 523.2-122.7 ml, without pacing: 516.2-160.3 ml) and minute ventilation were not changed." }, { "role": "assistant", "content": "CRT did not affect respiratory rate, tidal volume or minute ventilation, so increased endtidal NO did not result from enhanced production from tracheal and/or bronchial epithelial cells. Therefore, endtidal NO increased because chronic heart failure increased pulmonary perfusion and so raised vascular shear stress. CRT for patients with dilated cardiomyopathy can improve vascular endothelial cell function." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Aged, Balkan Nephropathy, Balkan Peninsula, Bulgaria, CpG Islands, DNA Methylation, Endemic Diseases, Female, Genetic Predisposition to Disease, Genome, Human, Humans, Male, Middle Aged, Prevalence, Risk Factors, Serbia." }, { "role": "user", "content": "Does whole genome methylation array analysis reveal new aspects in Balkan endemic nephropathy etiology? Context: Balkan endemic nephropathy (BEN) represents a chronic progressive interstitial nephritis in striking correlation with uroepithelial tumours of the upper urinary tract. The disease has endemic distribution in the Danube river regions in several Balkan countries.DNA methylation is a primary epigenetic modification that is involved in major processes such as cancer, genomic imprinting, gene silencing, etc. The significance of CpG island methylation status in normal development, cell differentiation and gene expression is widely recognized, although still stays poorly understood. We performed whole genome DNA methylation array analysis on DNA pool samples from peripheral blood from 159 affected individuals and 170 healthy individuals. This technique allowed us to determine the methylation status of 27 627 CpG islands throughout the whole genome in healthy controls and BEN patients. Thus we obtained the methylation profile of BEN patients from Bulgarian and Serbian endemic regions. Using specifically developed software we compared the methylation profiles of BEN patients and corresponding controls and revealed the differently methylated regions. We then compared the DMRs between all patient-control pairs to determine common changes in the epigenetic profiles.SEC61G, IL17RA, HDAC11 proved to be differently methylated throughout all patient-control pairs. The CpG islands of all 3 genes were hypomethylated compared to controls. This suggests that dysregulation of these genes involved in immunological response could be a common mechanism in BEN pathogenesis in both endemic regions and in both genders." }, { "role": "assistant", "content": "Our data propose a new hypothesis that immunologic dysregulation has a place in BEN etiopathogenesis. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "The right lobe of liver consists of which of the following segments" }, { "role": "assistant", "content": "The correct answer is Caudate lobe Segment 1 Left lobe II, III, IV Right lobe V, VI, VII, VIII Ref: Sabiston 20th edition Pgno : 1421" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Does coil type affect angiographic follow-up outcomes of cerebral aneurysm coiling : a systematic review and meta-analysis? Context: Previous studies varied in their conclusions about the superiority of second-generation coils compared with bare platinum. In this systematic review and meta-analysis, we assessed differences in reported unfavorable angiographic outcomes of cerebral aneurysms treated with coil embolization as a function of coil type. This systematic review covered 1999-2011 through the use of Ovid MEDLINE and EMBASE. Search terms were \"subarachnoid hemorrhage,\" \"intracranial aneurysms,\" \"endovascular treatment,\" and \"coiling.\" Inclusion criteria were studies reporting >50 aneurysms with imaging follow-up. We defined \"unfavorable angiographic outcome\" as either \"recanalization,\" <90% occlusion, or \"incomplete occlusion\" at follow-up. Rates of unfavorable outcomes were pooled through the use of random effects models and compared across various coil types. Multivariate random effects meta-regression models were used to further explore the differences in outcomes related to coil type. We included 82 studies, comprising 90 patient cohorts, among which, 65 (72%) used bare platinum coils, 8 (8.9%) used Matrix, 11 (12%) used HydroCoil, and 6 (6.7%) used Cerecyte. The overall unfavorable outcome rate was 19% (95% CI: 17%,21%). Unfavorable outcome rates were 20% (95% CI: 17%, 22%) for bare platinum coils, 23% (95% CI: 16%, 29%) for Matrix, 15% (95% CI: 9%, 21%) for HydroCoil, and 15% (95% CI: 7%, 23%) for Cerecyte, respectively. The difference in unfavorable outcome rates among the various coil types was not statistically significant after adjusting for baseline characteristics, including aneurysm size, rupture status, and follow-up duration." }, { "role": "assistant", "content": "The rate of unfavorable angiographic outcomes was not statistically different across the major approved coil types. The quality of the evidence, however, remains low because of high heterogeneity, small sample size, and potential publication bias. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All are true about Bullous keratopathy except -" }, { "role": "assistant", "content": "The correct answer is It is seen in fuch's dystrophy.Stage of bullous keratopathy,this stage follows long-standing stromal oedema and is characterised by marked epithelial oedema with formation of bullae, which when rupture cause pain, discomfo and irritation with associated decreased visual acquity.Reference:Comprehensive ophthalmology,AK Khurana,4th edition,page no.119" } ]