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[ { "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 33-year-old man comes to the physician 1 hour after he slipped in the shower and fell on his back. Since the event, he has had severe neck pain. He rates the pain as an 8–9 out of 10. On questioning, he has had lower back pain for the past 2 years that radiates to the buttocks bilaterally. He reports that the pain sometimes awakens him at night and that it is worse in the morning or when he has been resting for a while. His back is very stiff in the morning and he is able to move normally only after taking a hot shower. His temperature is 36.3°C (97.3°F), pulse is 94/min, and blood pressure is 145/98 mm Hg. Range of motion of the neck is limited due to pain; the lumbar spine has a decreased range of motion. There is tenderness over the sacroiliac joints. Neurologic examination shows no abnormalities. An x-ray of the cervical spine shows decreased bone density of the vertebrae. An MRI shows a C2 vertebral fracture as well as erosions and sclerosis of the sacroiliac joints bilaterally. The patient's condition is most likely associated with which of the following findings?" }, { "role": "assistant", "content": "Recurring eye redness and pain" } ]

[ { "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": "More false positive cases in a community signifies that the disease has: September 2004" }, { "role": "assistant", "content": "The correct answer is Ans. C i.e. Low prevalence" } ]

[ { "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, Body Weight, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Humans, Intra-Abdominal Fat, Japan, Male, Middle Aged, Non-alcoholic Fatty Liver Disease, Prevalence." }, { "role": "user", "content": "Is increased visceral adiposity with normal weight associated with the prevalence of non-alcoholic fatty liver disease in Japanese patients with type 2 diabetes? Context: To investigate the impact of increased visceral adiposity with normal weight (OB[-]VA[+]) on the prevalence of non-alcoholic fatty liver disease in patients with type 2 diabetes. This was a cross-sectional study of 140 Japanese patients with type 2 diabetes (mean age 65 ± 11 year; 44.6% women). Visceral fat area (VFA; cm(2) ) and liver attenuation index (LAI) were assessed by abdominal computed tomography. The patients were divided into four groups by VFA and body mass index (BMI; kg/m(2) ) as follows: BMI <25 kg/m(2) and VFA <100 cm(2) (OB[-]VA[-]), BMI ≥25 kg/m(2) and VFA <100 cm(2) (OB[+]VA[-]), BMI <25 kg/m(2) and VFA ≥100 cm(2) (OB[-]VA[+]), and BMI ≥25 kg/m(2) and VFA ≥100 cm(2) (OB[+]VA[+]). Multivariate linear regression and logistic regression analysis were carried out to determine the impact of OB(-)VA(+) on LAI. In the present study, 25.0% were OB(-)VA(+) patients, where the LAI levels were lower (1.09 ± 0.22) than those in OB(-)VA(-) patients (1.23 ± 0.15), and were equivalent to those in OB(+)VA(+) patients (1.03 ± 0.26). In multivariate linear regression analysis, OB(-)VA(+) was independently associated with LAI (standardized β-0.212, P = 0.014). In multivariate logistic regression analysis, OB(-)VA(+) was a significant predictor of LAI <0.9 (odds ratio 5.88, 95% confidence interval 1.03-33.52, P = 0.046)." }, { "role": "assistant", "content": "The present study provides evidence that increased visceral adiposity with normal weight is a strong predictor for the prevalence of non-alcoholic fatty liver disease in Japanese patients with type 2 diabetes. 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": "Pupil fails to dilate by giving cocaine in –" }, { "role": "assistant", "content": "The correct answer is In periphery cocaine blocks the uptake of Adrenaline and Noradrenaline in Adrenergic nerve ending resulting in higher concentration of sympathetic neurotransmitters (Sympathomimetic effect) :\nThe peripheral sympathomimetic action of cocaine produces following effect :\n\n\nMydriasis\nRise in B.P.\nLocal vasoconstriction\nTachycardia\n\n\nTherefore if the peripheral sympathetic system is paralysed it will lead to reverse of the above mentioned actions." } ]

[ { "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, PATIENTS AND METHODS, RESULTS. Meshes: Adult, Aged, Cohort Studies, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Male, Middle Aged, Multivariate Analysis, Prognosis, Prostate, Prostate-Specific Antigen, Prostatectomy, Prostatic Neoplasms, Tumor Burden." }, { "role": "user", "content": "Is statin use associated with prostate cancer aggressiveness? Context: To further examine the association between statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) and pathological features in a large group of patients undergoing radical prostatectomy (RP), as epidemiological studies have suggested that statins, in addition to their beneficial cardiovascular effects, might reduce the risk of aggressive prostate cancer. From 2003 to 2009, 1351 men with data on preoperative statin use had RP by one surgeon. The clinical and pathological tumour features were compared between 504 users of statins and 847 who were not users. Statin users were significantly older and had a higher mean body mass index than non-users. The preoperative serum prostate-specific antigen levels, tumour volume and percentage of cancer in the RP specimen were significantly lower in patients taking statins. Overall, statin users had a proportionately lower rate of adverse tumour pathology features, including a significantly lower risk of positive (cancerous) surgical margins." }, { "role": "assistant", "content": "Our results suggest that the use of statins might be associated with more favourable pathological features at RP. The long-term disease-specific outcomes and the underlying link between statins and prostate cancer require further investigation." } ]

[ { "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 10-year-old girl develops subcutaneous nodules over the skin of her arms and torso 3 weeks after a bout of acute pharyngitis. She manifests choreiform movements and begins to complain of pain in her knees and hips, particularly with movement. A friction rub is heard on auscultation of her chest. An abnormality detected by which of the following serum laboratory findings is most characteristic of the disease affecting this girl?" }, { "role": "assistant", "content": "The correct answer is Acute rheumatic fever can involve any or all layers of the heart. Because rheumatic fever follows a group A streptococcal infections, the antihyaluronidase, anti-DNase, and anti-streptolysin O (ASO) titers are often elevated. The strains of group A streptococci that lead to acute rheumatic fever are less likely to cause glomerulonephritis, so an elevated creatinine level is unlikely. The ANA level could be elevated in systemic lupus erythematosus, which is most likely to produce serous pericarditis. A positive rapid plasma reagin test suggests syphilis, but the clinical features here are not those of syphilis, and cardiovascular syphilis is one form of tertiary syphilis that develops decades after the initial infection. Cardiac troponins are markers for ischemic myocardial injury. Although their levels may be elevated because of the acute myocarditis that occurs in rheumatic fever, this change is not a characteristic of rheumatic heart disease." } ]

[ { "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: Algorithms, Cell Line, Tumor, Chromatin, Chromatin Immunoprecipitation, Cluster Analysis, Computational Biology, CpG Islands, Gene Expression Regulation, Gene Library, HeLa Cells, Hep G2 Cells, Histones, Humans, K562 Cells, Principal Component Analysis, Transcription Factors, Transcription Initiation Site." }, { "role": "user", "content": "Do chromatin states reveal functional associations for globally defined transcription start sites in four human cell lines? Context: Deciphering the most common modes by which chromatin regulates transcription, and how this is related to cellular status and processes is an important task for improving our understanding of human cellular biology. The FANTOM5 and ENCODE projects represent two independent large scale efforts to map regulatory and transcriptional features to the human genome. Here we investigate chromatin features around a comprehensive set of transcription start sites in four cell lines by integrating data from these two projects. Transcription start sites can be distinguished by chromatin states defined by specific combinations of both chromatin mark enrichment and the profile shapes of these chromatin marks. The observed patterns can be associated with cellular functions and processes, and they also show association with expression level, location relative to nearby genes, and CpG content. In particular we find a substantial number of repressed inter- and intra-genic transcription start sites enriched for active chromatin marks and Pol II, and these sites are strongly associated with immediate-early response processes and cell signaling. Associations between start sites with similar chromatin patterns are validated by significant correlations in their global expression profiles." }, { "role": "assistant", "content": "The results confirm the link between chromatin state and cellular function for expressed transcripts, and also indicate that active chromatin states at repressed transcripts may poise transcripts for rapid activation during immune response. 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: ." }, { "role": "user", "content": "Does computer navigation experience in hip resurfacing improve femoral component alignment using a conventional jig? Context: The use of computer navigation has been shown to improve the accuracy of femoral component placement compared to conventional instrumentation in hip resurfacing. Whether exposure to computer navigation improves accuracy when the procedure is subsequently performed with conventional instrumentation without navigation has not been explored. We examined whether femoral component alignment utilizing a conventional jig improves following experience with the use of imageless computer navigation for hip resurfacing. Between December 2004 and December 2008, 213 consecutive hip resurfacings were performed by a single surgeon. The first 17 (Cohort 1) and the last 9 (Cohort 2) hip resurfacings were performed using a conventional guidewire alignment jig. In 187 cases, the femoral component was implanted using the imageless computer navigation. Cohorts 1 and 2 were compared for femoral component alignment accuracy. All components in Cohort 2 achieved the position determined by the preoperative plan. The mean deviation of the stem-shaft angle (SSA) from the preoperatively planned target position was 2.2° in Cohort 2 and 5.6° in Cohort 1 (P = 0.01). Four implants in Cohort 1 were positioned at least 10° varus compared to the target SSA position and another four were retroverted." }, { "role": "assistant", "content": "Femoral component placement utilizing conventional instrumentation may be more accurate following experience using imageless computer navigation. 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: Animals, Biological Transport, Cell Differentiation, Cell Membrane, Cell Survival, Embryonic Stem Cells, Endosomal Sorting Complexes Required for Transport, Gene Expression Regulation, Humans, Mice, Mitosis, Neurons, Phagosomes, Protein Subunits." }, { "role": "user", "content": "Do eSCRT-III subunits Snf7-1 and Snf7-2 differentially regulate transmembrane cargos in hESC-derived human neurons? Context: Endosomal sorting complex required for transport (ESCRT) is involved in several fundamental cellular processes and human diseases. Many mammalian ESCRT proteins have multiple isoforms but their precise functions remain largely unknown, especially in human neurons. In this study, we differentiated human embryonic stem cells (hESCs) into postmitotic neurons and characterized the functional properties of these neurons. Moreover, we found that among the three human paralogs of the yeast ESCRT-III subunit Snf7, hSnf7-1 and hSnf7-2 are most abundantly expressed in human neurons. Both hSnf7-1 and hSnf7-2 are required for the survival of human neurons, indicating a non-redundant essential function. Indeed, hSnf7-1 and hSnf7-2 are preferentially associated with CHMP2A and CHMP2B, respectively, and regulate the turnover of distinct transmembrane cargos such as neurotransmitter receptors in human neurons." }, { "role": "assistant", "content": "These findings indicate that different mammalian paralogs of the yeast ESCRT-III subunit Snf7 have non-redundant functions in human neurons, suggesting that ESCRT-III with distinct subunit compositions may preferentially regulate different cargo proteins. 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 37-year-old man presents to his gastroenterologist due to a transaminitis found by his primary care physician (PCP). He reports currently feeling well and has no acute concerns. Medical history is significant for ulcerative colitis treated with 5-aminosalicylate. He recently went on a trip to Mexico and experienced an episode of mild diarrhea. The patient is 5 ft 4 in and weighs 220 lbs (99.8 kg). His temperature is 98°F (36.7°C), blood pressure is 138/88 mmHg, pulse is 90/min, and respirations are 18/min. Physical examination is unremarkable. Laboratory testing demonstrates:\n\nLeukocyte count: 7,200 /mm^3\nAlkaline phosphatase: 205 U/L\nAspartate aminotransferase (AST): 120 U/L\nAlanine aminotransferase (ALT): 115 U/L\nPerinuclear antineutrophil cytoplasmic antibody (pANCA): Positive\nAntimitochondrial antibody: Negative\n\nWhich of the following is most likely the diagnosis?" }, { "role": "assistant", "content": "Primary sclerosing cholangitis" } ]

[ { "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": "According to ADA guidelines, the diagnosis of diabetes is made when the fasting blood glucose is more than" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., 126 mg" } ]

[ { "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, METHODS, RESULTS. Meshes: Amniocentesis, Blindness, Codon, Nonsense, Eye, Fluorescein Angiography, Follow-Up Studies, Genetic Diseases, X-Linked, Gestational Age, Humans, Infant, Newborn, Laser Coagulation, Male, Nervous System Diseases, Retinal Degeneration, Retinal Detachment, Retinal Dysplasia, Spasms, Infantile, Vision, Ocular, Visual Acuity." }, { "role": "user", "content": "Does laser photocoagulation at birth prevent blindness in Norrie 's disease diagnosed using amniocentesis? Context: To report the first case of prophylactic laser treatment to prevent blindness in a patient who was diagnosed with Norrie's disease by genetic testing with amniocentesis. Case report. A 2-year-old white boy with Norrie's disease. A 37-week gestational age male with a family history of Norrie's disease was born via Cesarean section after the mother had undergone prenatal amniocentesis fetal-genetic testing at 23 weeks of gestation. A C520T (nonsense) mutation was found in the Norrie's disease gene. After examination under anesthesia confirmed the diagnosis on the first day of life, laser photocoagulation was applied to the avascular retina bilaterally. The patient was followed closely by ophthalmology, pediatrics, and occupational therapy departments. Functional outcome, as documented by Teller visual acuity and formal occupational therapy testing, and anatomic outcome, as documented by Retcam photography and fluorescein angiography. Complete regression of extraretinal fibrovascular proliferation was observed 1 month after laser treatment. No retinal detachment had occurred to date at 24 months. Teller visual acuity at 23 months of life was 20/100 in both eyes. The patient's vision and developmental milestones were age appropriate." }, { "role": "assistant", "content": "Pre-term genetic diagnosis with immediate laser treatment after birth may preserve vision in individuals affected with Norrie's disease. 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 previously healthy 35-year-old woman comes to the emergency department because of a sudden onset of difficulty breathing that began when she woke up that morning. She also reports a dry cough and chest pain that is worse with inspiration. She does not smoke, drink alcohol, or use illicit drugs. Her only medication is an oral contraceptive. Her temperature is 38°C (100.4°F), pulse is 90/min, respirations are 22/min, and blood pressure is 120/70 mm Hg. Oxygen saturation is 93% on room air. Physical examination is unremarkable. An ECG shows non-specific ST segment changes. An x-ray of the chest shows no abnormalities. In addition to oxygen supplementation, which of the following is the most appropriate next step in management?" }, { "role": "assistant", "content": "Measure fibrin degradation products" } ]

[ { "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, Angioplasty, Balloon, Coronary, Calcinosis, Cardiomyopathies, Coronary Angiography, Coronary Vessels, Cytokines, Female, Humans, Inflammation, Male, Middle Aged, Osteoprotegerin, Prospective Studies, Stents." }, { "role": "user", "content": "Is osteoprotegerin associated with angiographic coronary calcification? Context: Coronary artery calcification may play a significant role in the pathophysiology of plaque progression and healing. We hypothesized that osteoprotegerin, an inhibitor of osteoclastogenesis, may participate in the calcification of coronary plaques or the response to injury after coronary stenting. A prospective registry was performed in 2004. Blood samples from 100 patients undergoing percutaneous coronary intervention (PCI) were obtained before PCI and 24 h after PCI. The concentrations of osteoprotegerin (OPG), C-reactive protein, interleukin-6, and soluble CD40 ligand (sCD40L) were determined by ELISA. Quantitative coronary angiography was performed to define the presence of culprit lesion calcification (CLC). Comparisons among markers of inflammation and tertiles of OPG were stratified with respect to CLC. Patients with CLC (n = 28) compared with no CLC (n = 71) were older (P < 0.01), had lower creatinine clearance (P < 0.01), lower hemoglobin (P = 0.02), and were less likely to smoke (P = 0.04). Patients without CLC were over twice as likely to present with a marker-positive acute coronary syndrome. CLC was associated with less pre-PCI platelet-mediated inflammation as measured by sCD40L (4.65 vs. 7.15 pg/ml, P = 0.05), but not with lower levels of OPG. Inflammatory cytokines increased significantly after PCI for patients with and without CLC. For patients in the highest tertile of OPG at baseline, there was a reduction in OPG after PCI. Systemic osteoprotegerin levels are not associated with angiographic calcification of culprit plaques. For patients with elevated levels of OPG prior to PCI, there is a significant reduction after PCI consistent with a counterregulatory role for OPG." }, { "role": "assistant", "content": "Both calcified and non-calcified culprit plaques exhibited a similar inflammatory response to stent-mediated injury. After PCI, osteoprotegerin decreased while proinflammatory cytokines increased, which may be consistent with a counterregulatory role for osteoprotegerin. 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: Adult, Asthma, Cause of Death, Female, Follow-Up Studies, Humans, Hypercapnia, Lung Volume Measurements, Male, Middle Aged, Quality of Life, Risk Factors, Survival Rate, Switzerland." }, { "role": "user", "content": "Is extreme hypercapnia a long-term prognostic factor after near-fatal asthma : a 12-year follow-up study? Context: Some patients experiencing near-fatal asthma present with extreme hypercapnia (PaCO2 > or = 100 mm Hg), whereas others do not. The influence of this factor on short- and long-term outcome and quality of life in these patients is still unknown. A series of 39 consecutive patients who had had an episode of near-fatal asthma between 1978 and 1992 were followed up. Long-term outcome and quality of life of the 12 patients who had experienced extreme hypercapnia were compared with those of the 27 patients who had not. Four patients died, but only 1 from asthma. Three patients were lost to follow-up. The remaining 32 patients had a median observation period of 12.7 years. The hypercapnic patients did not significantly differ from the others in past asthma history, subsequent hospitalizations, medication needs, pulmonary function tests, quality of life and impairment/disability. In the event of subsequent near-fatal asthma attacks, they tended to present with hypercapnia levels similar to those observed during the first episode." }, { "role": "assistant", "content": "Extreme hypercapnia in near-fatal asthma tended to recur, but is not an aggravating long-term prognostic factor. Targeted surveillance of these high-risk patients should make it possible to reduce relapses and death rates from asthma. 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: Aged, Female, Hepatectomy, Human Growth Hormone, Humans, Insulin-Like Growth Factor Binding Protein 3, Insulin-Like Growth Factor I, Liver Cirrhosis, Male, Nitrogen, Proteins, Radioimmunoassay, Survival Analysis." }, { "role": "user", "content": "Do growth hormone/insulin-like growth factor 1 axis alterations contribute to disturbed protein metabolism in cirrhosis patients after hepatectomy? Context: Liver cirrhosis is accompanied by a fall in whole-body protein turnover and alterations of the growth hormone (GH)/insulin-like growth factor 1 (IGF-1) axis. However, the influence of liver cirrhosis on the GH/IGF-1 axis in the perioperative period, and the contribution of the GH/IGF-1 axis alteration in cirrhosis to postoperative nitrogen metabolism are not known. Plasma GH, IGF-1 and IGF binding protein 3 (IGF-BP3) levels were measured sequentially in patients undergoing hepatectomy with or without cirrhosis. Postoperative nitrogen excretion and whole-body protein turnover rate were also determined. Preoperative plasma IGF-1 level showed a negative correlation with indocyanine green retention rate. Cirrhosis patients undergoing hepatectomy had low IGF-1 and IGF-BP3 levels, despite extremely high GH levels in the perioperative period. Perioperative IGF-1 levels were lower in patients with postoperative complications than in those without complications. Postoperative nitrogen excretion was higher and whole-body protein turnover rate was lower in patients with cirrhosis than in those without cirrhosis. The post-operative IGF-1 level showed a positive correlation with whole-body protein turnover rate." }, { "role": "assistant", "content": "Postoperative hepatic IGF-1 production may be severely disturbed in patients with cirrhosis, and the impaired IGF-1 production contributes to the suppressed postoperative protein metabolism in cirrhosis. It may be appropriate to increase plasma IGF-1 level in patients with cirrhosis to enhance postoperative protein metabolism and improve the postoperative outcome. 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: Animals, Biological Evolution, Body Patterning, Cell Differentiation, Cell Movement, Cell Proliferation, Embryonic Development, Endoderm, Gastrointestinal Tract, Invertebrates, Mesoderm, Models, Biological, Mouth." }, { "role": "user", "content": "Does the study of Priapulus caudatus reveal conserved molecular patterning underlying different gut morphogenesis in the Ecdysozoa? Context: The digestive systems of animals can become highly specialized in response to their exploration and occupation of new ecological niches. Although studies on different animals have revealed commonalities in gut formation, the model systems Caenorhabditis elegans and Drosophila melanogaster, which belong to the invertebrate group Ecdysozoa, exhibit remarkable deviations in how their intestines develop. Their morphological and developmental idiosyncrasies have hindered reconstructions of ancestral gut characters for the Ecdysozoa, and limit comparisons with vertebrate models. In this respect, the phylogenetic position, and slow evolving morphological and molecular characters of marine priapulid worms advance them as a key group to decipher evolutionary events that occurred in the lineages leading to C. elegans and D. melanogaster. In the priapulid Priapulus caudatus, the gut consists of an ectodermal foregut and anus, and a mid region of at least partial endodermal origin. The inner gut develops into a 16-cell primordium devoid of visceral musculature, arranged in three mid tetrads and two posterior duplets. The mouth invaginates ventrally and shifts to a terminal anterior position as the ventral anterior ectoderm differentially proliferates. Contraction of the musculature occurs as the head region retracts into the trunk and resolves the definitive larval body plan. Despite obvious developmental differences with C. elegans and D. melanogaster, the expression in P. caudatus of the gut-related candidate genes NK2.1, foxQ2, FGF8/17/18, GATA456, HNF4, wnt1, and evx demonstrate three distinct evolutionarily conserved molecular profiles that correlate with morphologically identified sub-regions of the gut." }, { "role": "assistant", "content": "The comparative analysis of priapulid development suggests that a midgut formed by a single endodermal population of vegetal cells, a ventral mouth, and the blastoporal origin of the anus are ancestral features in the Ecdysozoa. Our molecular data on P. caudatus reveal a conserved ecdysozoan gut-patterning program and demonstrates that extreme morphological divergence has not been accompanied by major molecular innovations in transcriptional regulators during digestive system evolution in the Ecdysozoa. Our data help us understand the origins of the ecdysozoan body plan, including those of C. elegans and D. melanogaster, and this is critical for comparisons between these two prominent model systems and their vertebrate counterparts. 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 AND PURPOSE, METHODS, RESULTS. Meshes: Aged, Air Ambulances, Ambulances, Brain Ischemia, Emergency Medical Services, Female, Humans, Male, Stroke, Thrombolytic Therapy, Time Factors, Treatment Outcome." }, { "role": "user", "content": "Does helicopter emergency medical service transfer offer benefit to patients with stroke? Context: Helicopter transportation of patients with acute stroke who have received recombinant tissue-type plasminogen activator is commonly considered the best option. We evaluated if transportation by helicopter can reduce complications and improve clinical outcomes in patients with acute stroke. We conducted a review of consecutive patients with acute ischemic stroke transferred to our hospital after intravenous thrombolysis initiated at a referral center. A total of 122 patient transportations were analyzed, 94 by air and 28 by ground. Time from activation of the transport system to arrival at our hospital was significantly shorter with air transportation (53 versus 68 minutes, P=0.04). Two complications were noted in the air group and no complications were noted in the ground group (P=1.0). All other outcome measures were not significantly different between groups." }, { "role": "assistant", "content": "Air transfer of patients with acute ischemic stroke treated with thrombolysis does not seem to impart any benefit to patient outcomes when compared with ground transport. Therefore, ground transport should be considered for these patients unless they are being considered for emergency endovascular rescue therapy." } ]

[ { "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": "Growth factor needed for Salmonella" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "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: Antioxidants, Calorimetry, Diet, Diet, Diabetic, Dietary Carbohydrates, Dietary Fats, Dietary Proteins, Female, Humans, Male, Nutritional Physiological Phenomena, Reference Values." }, { "role": "user", "content": "Comparison of the diet of self-declared diabetics with non-diabetic patients in the SU.VI.MAX study: did the diabetics modify their nutritional behavior? Context: Dietary recommendations, a pillar in the treatment of diabetes, form part of official guidelines. However, it is not known how well these recommendations are followed in the diabetic population in France. The purpose of this study was to compare the habitual diet of self-declared diabetics with non-diabetics and to evaluate whether recommendations are being followed. The intakes of several nutrients and foods of 67 self-declared diabetic patients were compared to those of 4658 non-diabetics in the SU.VI.MAX study (a primary prevention trial evaluating the impact of antioxidant supplementation on chronic disease). All patients (aged 45 to 60 years) who had completed at least five 24-hr dietary records over the first 18 months of the SU.VI.MAX study were included. We excluded patients who had not declared a diagnosis of diabetes and those with plasma fasting glucose levels over 7 mmol/l. The diabetic patients who declared being diabetic reported lower carbohydrate intakes (185 +/- 10.4 vs 219 +/- 1.4 g/d for men [p=0.001], 137 +/- 9.6 vs 165 +/- 1.0 g/d for women [0.005]), with a 50% reduction in consumption of oligosaccharides. Lipid intakes were unchanged for men, but reduced for women (61 +/- 4.1 g/d vs 72 +/- 0.4 g/d [p=0.01] with a 20% reduction in saturated fatty acids. Protein consumption was higher in the diabetic than in the non-diabetic men, but comparable for the women. Energy intakes were only lower in the diabetic women (1458 +/- 81 vs 1665 +/- 9 Kcal/d for women [p=0.01]). Micronutrient intakes were similar to those of non-diabetics, but appeared to be inadequate, particularly for anti-oxidants. Diabetic men consumed more margarine and less alcohol than did the non-diabetics." }, { "role": "assistant", "content": "Diabetic patients who declared being diabetic did modify their nutritional behaviour, as they reduced their carbohydrate intake (both men and women), increased their protein intake (men only), and decreased their lipid and energy intakes (women only). However, carbohydrate intakes were unbalanced and there was excess protein intake. So patients who declared being diabetic are not as non-compliant in nutrition as commonly thought; they try to modify their diet, but often inappropriately. This may be explained by the fact that dietary advice stems from different sources and may be contradictory. A diabetic education program requires standardised training of health professionals and the provision of unequivocal information to the mass media and the general public." } ]

[ { "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: Actins, Animals, Cholesterol, Collagen, Desmin, Dietary Fats, Disease Progression, Fatty Acids, Nonesterified, Fibrosis, Immunohistochemistry, Lipid Peroxidation, Male, Malondialdehyde, Pancreas, Pancreatitis, Rats, Rats, Sprague-Dawley, Receptor, Platelet-Derived Growth Factor beta, Signal Processing, Computer-Assisted, Superoxide Dismutase, Time Factors, Transforming Growth Factor beta1, Triglycerides." }, { "role": "user", "content": "Do chronic high-fat diets induce oxide injuries and fibrogenesis of pancreatic cells in rats? Context: The mechanism of pancreatic damages induced by chronic high-fat diets (HFDs) remains unknown. The current study was to detect the involvement of free fatty acids (FFAs) and lipid peroxidation in pancreatic injuries in rats induced by a long-term HFD. Rats of HFD groups (n = 12) were fed with an HFD for 2, 4, 6, 10, and 18 weeks, respectively. Pancreatic malondialdehyde content and the concentration of FFA were measured. Histopathologic changes were observed by Sirius red staining for fibrosis and immunostaining of the pancreatic stellate cells for desmin, alpha-smooth muscle actin, platelet-derived growth factor receptor type beta, and transforming growth factor beta1. Pancreatic malondialdehyde content, the number of desmin and alpha-SMA positive cells significantly increased in all the HFD groups (P < 0.05). The levels of pancreatic FFA, platelet-derived growth factor receptor type beta, and transforming growth factor beta1 increased in rats of 2-, 4-, and 6-week HFD groups (P < 0.05). These enhancements were accompanied with sequential histopathology alterations that resulted from acute inflammatory response in the early stages of secondary pancreatic fibrosis." }, { "role": "assistant", "content": "The results indicate that chronic HFD increased pancreatic FFA and lipid peroxidation associated with pancreatic injuries and collagen synthesis by activated pancreatic stellate cells in rats. 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 taste sensation to anterior two thirds of the tongue is carried by:" }, { "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": "Lambert-Eaton Myasthenic Syndrome is associated with?" }, { "role": "assistant", "content": "The correct answer is Around 50% cases of Lambert Eaton Myasthenic syndrome have paraneoplastic association with small cell lung carcinoma.\nThe disease is also seen in association with other autoimmune diseases." } ]

[ { "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 drugs is most likely to cause myelosuppression" }, { "role": "assistant", "content": "The correct answer is Ganciclovir It is an analogue of acyclovir which is active against all herpes viruses including H. simplex, H. zoster, EBV and CMV against which it is most active. mech of action:- Ganciclovir is activated intracellularly by virus specific thymidine kinase and its triphosphate nucleotide preferentially inhibits viral DNA polymerase. This active metabolite attains much higher concentration inside CMV infected cells. The precursor cells in bone marrow are also quite sensitive to ganciclovir, and this may account for its bone marrow toxicity. Pharmacokinetics:- It has poor oral absorption, bioavailability of ganciclovir is low (<10%).Valganciclovir, the valyl prodrug, has ~ 8 times higher bioavailability, and is preferred, where available. Ganciclovir and its active metabolite are mostly excreted unchanged in urine.The plasma t 1/2 of ganciclovir is 2-4 hrs, but that of its triphosphate inside CMV infected cells is > 24 hrs. These factors account for its high activity against CMV infections. Systemic toxicity:- Toxicity of ganciclovir is high: bone marrowdepression, rash, fever, vomiting, neuropsychiatric disturbances. uses:- Use is restricted to prophylaxis and treatment of severe CMV infections (pneumonia/colitis/retinitis) in immunocompromised (AIDS, transplant recipient)patients. Treatment may be initiated with i.v. infusion of ganciclovir 10 mg/kg/day which can prevent blindness in AIDS patients with CMV retinitis. Ref:- kd tripathi; pg num:-801" } ]

[ { "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": "An example of high level disinfectant is" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "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, METHODS, RESULTS. Meshes: Absorptiometry, Photon, Adiposity, Adult, Body Composition, Body Mass Index, Breast, Cross-Sectional Studies, Diet, Energy Intake, Feeding Behavior, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Multivariate Analysis." }, { "role": "user", "content": "Is dietary energy density positively associated with breast density among young women? Context: Breast density is an established predictor of breast cancer risk, and there is considerable interest in associations of modifiable lifestyle factors, such as diet, with breast density. To determine whether dietary energy density (ED) is associated with percent dense breast volume (%DBV) and absolute dense breast volume (ADBV) in young women. A cross-sectional analysis was conducted with women who participated in the Dietary Intervention Study in Children Follow-Up Study. %DBV and ADBV were measured by magnetic resonance imaging. Diet was assessed by three 24-hour recalls. Dietary ED (kilocalories/gram) was calculated using three methods: food only, food and caloric beverages, and food and all beverages. One hundred seventy-two women (aged 25 to 29 years) who were enrolled in the Dietary Intervention Study in Children Follow-Up Study. Participants who reported breast augmentation or reduction surgery or were pregnant or lactating within 3 months before breast density assessment were excluded. ADBV and %DBV. Multivariable linear mixed effects models were used. Final models were adjusted for race, smoking status, education, parity, duration of sex hormone use, whole body percent fat, childhood body mass index z score, and energy from beverages. After adjustment, each 1 kcal/g unit increase in food-only ED was associated with a 25.9% (95% CI 6.2% to 56.8%) increase in %DBV (P=0.01). Childhood body mass index z score modified the association between food-only ED and %DBV such that a significant positive association was observed only in women who were heavier as children. Food-only ED was not associated with ADBV in all women, but a borderline significant positive association was observed in women who had higher childhood body mass index z scores." }, { "role": "assistant", "content": "This is the first report to suggest a potential role for dietary ED in breast density; the effects of long-term exposure to high-ED diets on breast cancer risk remain unknown. 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: Active Transport, Cell Nucleus, Adenocarcinoma, Aged, Cyclin D, Cyclins, Female, Humans, Immunohistochemistry, Male, Pancreatic Neoplasms, Phosphorylation, Proto-Oncogene Proteins c-akt, Receptor, Notch3, Receptors, Notch, STAT3 Transcription Factor, Survival Rate." }, { "role": "user", "content": "Is expression of nuclear Notch3 in pancreatic adenocarcinomas associated with adverse clinical features , and correlates with the expression of STAT3 and phosphorylated Akt? Context: Reactivation of the Notch signalling pathway occurs in a range of human malignancies. Previous research suggests that Notch3 is expressed in pancreatic adenocarcinomas, but neither cellular location nor association with clinical parameters has been described. The relationship between Notch3, clinical endpoints, and other proteins with potential to interact with Notch was therefore examined. An immunohistochemical study was performed on human pancreatic adenocarcinoma (n = 23) and normal pancreas (n = 12), to assess expression of Notch3, cyclin D1, pAkt, STAT3 and pSTAT3. Immunohistochemical data were then correlated with clinicopathological characteristics. Notch3 was significantly overexpressed in the cytoplasm of 73.9% of tumours. Nuclear expression was not observed in normal pancreatic ductal tissue, but was noted in 43.5% of tumours. No tumour expressing nuclear Notch3 was resectable. There were significant correlations between expression and intracellular location of Notch3 and each of STAT3, pSTAT3 and pAkt, but not cyclin D1." }, { "role": "assistant", "content": "The presence of Notch3 in tumour nuclei is likely to represent functional activation of the protein, and is clearly linked to a more aggressive tumour phenotype. The correlation with STAT3, pSTAT3 and pAkt expression has not previously been described and the concurrent intracellular localisation of these proteins suggests a functional relationship between them. 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": "An 18-year-old man is hospitalized after a suicide attempt, his 6th such attempt in the last 4 years. He was diagnosed with depression 5 years ago, for which he takes fluoxetine. He is currently complaining of severe and worsening left knee swelling and pain since he attempted suicide by jumping out of his second-story bedroom window. He sustained minor injuries at the time, primarily lacerations to his arms and knees, and he was admitted to the hospital’s psychiatric unit. His blood pressure is 110/72 mm Hg, heart rate is 88/min, and temperature is 38°C (100.4°F). On examination, the knee is erythematous and edematous, and it feels warm to the touch. The patient’s lab studies reveal a hemoglobin level of 11.9 g/dL, leukocyte count of 11,200/µL, and a platelet count of 301,000/µL. Arthrocentesis yields 15 mL of fluid with a leukocyte count of 61,000/µL, 93% neutrophils, and an absence of crystals under polarized light microscopy. A gram stain of joint fluid is negative; however, mucosal, blood and synovial fluid cultures are still pending. Which of the following is the most appropriate next step in the management of this patient?" }, { "role": "assistant", "content": "Administer intravenous antibiotics and repeat arthrocentesis" } ]

[ { "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": "Effective sign of neonatal resuscitation is:-" }, { "role": "assistant", "content": "The correct answer is Ans. (c) Heart rate increasedRef: Nelson Textbook of Pediatrics 20th Ed; Page No-845-46 and NEP guidelines 7th Ed 2016* Begin the resuscitation with antenatal counseling (when appropriate) and a team briefing and equipment check. Maintain normal body temperature of neonate during resuscitation, target temperature being 36.5-37.5degC in axilla.* Approx. 10% neonates need some assistance and upto 1% need active resuscitation.* Current evidence suggests that cord clamping should be delayed for at least 30-60 seconds for most vigorous term and pre-term neonates.* Most successful indicator of response to resuscitation is increase in heart rate. An electronic cardiac monitor is the preferred method for assessing heart rate.* Oxygen concentration method:# Resuscitation is gestational age at or above 35 weeks begins with 21% oxygen (room air)# In those < 35 weeks: Begin with 21 -30% oxygenationNewborn Resuscitation Algorithm# 100% 02 used whenever you give chest compression and wean 02 if HR improves* Stimulation can be done by: Rubbing the back trickling the sole once.* Mouth suctioned first, followed by nose. No role of routine tracheal suctioning.* To prevent hypoxic-ischemic tissue (brain, heart, and kidney) injury associated morbidity and mortality and reestablish adequate spontaneous respiration and cardiac output; neonatal resuscitation preferred.* The steps in neonatal resuscitation follow the TABCs:# T: Provide warmth, dry the baby and remove the wet linen.# A: Position the infant, clear the airway, and establish a patent airway by suctioning and if necessary, insert an endotracheal tube to ensure an open airway.# B: Tactile stimulation to initiate breathing or positive- pressure ventilation using either bag-and-mask or through an endotracheal tube as necessary.# C: Simulate and maintain the circulation of blood with chest compression and medications as indicated.* Flow-chart outlines the steps to follow for immediate neonatal evaluation and resuscitation.CPAP= continuous positive airway pressure; ET = endotracheal; HR= heart rate; IV= intravenous; PPV= positive pressure ventilation* If heart rate less than 60 beats/min with poor perfusion is an indication to begin chest compressions.* If the bradycardia exists, vascular access should be found; at that time resuscitative epinephrine should be administered in a repeatedly manner in every 3-5 min for persistent symptomatic bradycardia.* Atropine can also be given in such type of cases; if vagal tone increases (e.g., in the setting of head injury with raised intracranial pressure) or primary atrioventricular block is suspected.* Medications are rarely required but should be administered when the heart rate is <60 beats/min after 30 sec of combined ventilation and chest compressions or during asystole.* The umbilical vein can generally be readily cannulated and used for immediate administration of medications during neonatal resuscitation (See Extra mile).* If intravenous access is not available and/or for naloxone; the endotracheal tube is used for the administration of epinephrine* The dose of Epinephrine: 0.1-0.3mL/kgof a1:10,000 solution, given intravenously or intratracheally for asystole or for failure to respond to 30 sec of combined resuscitation. The dose may be repeated every 3-5 min.Extra MileGuidelines for Tracheal Tube Size and Depth of InsertionTube Size (mm internal diameter)Depth of Insertion from Upper Lip (cm)Weight (g)Gestation (week)2.56.5-7<1,000<2837-81,000-2,00028-343/3.58-92,000-3,00034-383.5/4.0>9>3,000>38" } ]

[ { "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: Angola, Animals, Cost of Illness, Cost-Benefit Analysis, Eflornithine, Humans, Melarsoprol, Treatment Outcome, Trypanocidal Agents, Trypanosomiasis, African." }, { "role": "user", "content": "Is eflornithine a cost-effective alternative to melarsoprol for the treatment of second-stage human West African trypanosomiasis in Caxito , Angola? Context: To compare the cost-effectiveness of eflornithine and melarsoprol in the treatment of human African trypanosomiasis. We used data from a Médecins Sans Frontières treatment project in Caxito, Angola to do a formal cost-effectiveness analysis, comparing the efficiency of an eflornithine-based approach with melarsoprol. Endpoints calculated were: cost per death avoided; incremental cost per additional life saved; cost per years of life lost (YLL) averted; incremental cost per YLL averted. Sensitivity analysis was done for all parameters for which uncertainty existed over the plausible range. We did an analysis with and without cost of trypanocidal drugs included. Effectiveness was 95.6% for melarsoprol and 98.7% for eflornithine. Cost/patient was 504.6 for melarsoprol and 552.3 for eflornithine, cost per life saved was 527.5 USD for melarsoprol and 559.8 USD for eflornithine without cost of trypanocidal drugs but it increases to 600.4 USD and 844.6 USD per patient saved and 627.6 USD and 856.1 USD per life saved when cost of trypanocidal drugs are included. Incremental cost-effectiveness ratio is 1596 USD per additional life saved and 58 USD per additional life year saved in the baseline scenario without cost of trypanocidal drugs but it increases to 8169 USD per additional life saved and 299 USD per additional life year saved if costs of trypanocidal drugs are included." }, { "role": "assistant", "content": "Eflornithine saves more lives than melarsoprol, but melarsoprol is slightly more cost-effective. Switching from melarsoprol to eflornithine can be considered as a cost-effective option according to the WHO choice criteria. 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 30 years old patient of head injury was brought to the emergency. NCCT was performed and the findings are given below. All of the following are true about this condition except:" }, { "role": "assistant", "content": "The correct answer is The given NCCT image showsbiconvex/lentiform hyperdensity, which is a characteristic feature of Epidural hematoma (EDH) Epidural Hematoma Due to rupture of middle meningeal aery Happens due to of Pterion (H shaped suture) Has lucid interval Treatment: Immediate surgical evacuation should be done - BURR HOLE Has good prognosis" } ]

[ { "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: Endoscopic Ultrasound-Guided Fine Needle Aspiration, Female, Humans, Lung Neoplasms, Lymph Node Excision, Lymph Nodes, Lymphatic Metastasis, Male, Metastasectomy, Neoplasm Staging, Patient Selection, Predictive Value of Tests, Prospective Studies, Risk Assessment, Risk Factors." }, { "role": "user", "content": "Is endobronchial ultrasound-guided transbronchial needle aspiration a sensitive method to evaluate patients who should not undergo pulmonary metastasectomy†? Context: Pulmonary metastasectomy is considered an effective treatment in selected patients with extrapulmonary cancer and oligometastatic disease. We know that the presence of mediastinal lymph node metastases reduces survival significantly, but the mediastinum is rarely evaluated before metastasectomy in these patients. We prospectively evaluated how endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) could identify metastases to the mediastinal lymph nodes in patients referred for pulmonary metastasectomy. All patients with extrapulmonary cancer and oligometastatic disease confined to the lungs on positron emission tomography-computed tomography, and who were considered eligible for pulmonary metastasectomy, routinely underwent EBUS-TBNA of the mediastinal lymph nodes. If EBUS-TBNA did not reveal malignant spread, the patient subsequently underwent pulmonary metastasectomy with systematic sampling of mediastinal lymph nodes for histological evaluation. One hundred and three eligible patients were referred for EBUS-TBNA during a 4-year period. The primary cancers were located in the colon/rectum (n = 64), kidney (n = 16) and other sites (n = 23). EBUS-TBNA sampled 248 lymph nodes and adequate cytology was obtained in 93 patients (90%). EBUS-TBNA found lymph node metastases in 17 patients (16.5%) and during subsequent pulmonary metastasectomy in the remaining 86 patients 1 (1.0%) had a lymph node metastasis. The sensitivity, specificity, NPV and PPV of EBUS-TBNA for diagnosis of mediastinal lymph node metastasis were 94.4, 100, 98.8 and 100%, respectively." }, { "role": "assistant", "content": "EBUS-TBNA is a sensitive minimally invasive modality for evaluation of mediastinal lymph node metastases in patients with oligometastatic pulmonary disease. It allows surgeons to select patients who will not benefit from pulmonary metastasectomy. 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": "Pleural pressure positive in" }, { "role": "assistant", "content": "The correct answer is During active expiration, the abdominal muscles are contracted to force up the diaphragm and the resulting pleural pressure can become positive. Positive pleural pressure may temporarily collapse the bronchi and cause limitation of air flow Ref: guyton and hall textbook of medical physiology 12 edition page number:316,317,318" } ]

[ { "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": "Most common foreign body in Children in Esophagus" }, { "role": "assistant", "content": "The correct answer is Ans. (a) CoinRef Bailey And Love 27th edition, Page 1073* Most common foreign body in esophagus in adult - Food bolus due to some underlying pathology causing narrowing* Most common foreign body in esophagus in children is coin* Most common site of foreign body impaction is cricopharynx" } ]

[ { "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: Disease Management, Female, Fetal Diseases, Humans, Hydronephrosis, Infant, Infant, Newborn, Kidney Pelvis, Male, Organ Size, Pregnancy, Prognosis, Radiography, Recurrence, Retrospective Studies, Ultrasonography, Prenatal, United States, Vesico-Ureteral Reflux." }, { "role": "user", "content": "Should prenatal hydronephrosis that resolves before birth be followed postnatally? Context: Prenatal ultrasonography has greatly enhanced detection of congenital genitourinary abnormalities. However, although persistent prenatal hydronephrosis (PPH) is typically imaged and followed postnatally, it remains unclear if prenatal hydronephrosis that resolves in utero (RPH) should be similarly managed. We determined postnatal abnormalities associated with RPH and compared these to those associated with PPH. We performed a retrospective review of all consecutive patients evaluated for prenatal hydronephrosis over 24 months. Patients were followed prenatally with serial ultrasounds and postnatally with ultrasonography and a voiding cystourethrogram. Of the consecutive 165 patients enrolled in the study, 72 had RPH. The average prenatal anterior-posterior renal pelvis length was significantly longer in patients with PPH (5.5 mm) than in those with RPH (4.9 mm) (p = 0.01). Recurrent postnatal hydronephrosis occurred in 44% of patients with RPH, with eventual resolution in 34% of those affected. In comparison, 29% of PPH cases resolved postnatally. Mean time to resolution was statistically shorter for PPH (116 days) than for RPH (175 days) (p = 0.01). Seven PPH patients required surgery, while no RPH patients needed intervention (difference was statistically significant)." }, { "role": "assistant", "content": "A significant number of RPH children had postnatal hydronephrosis. Despite a slower resolution time, no children with RPH required intervention. Although RPH may recur postnatally, the significantly lower chance of intervention being required suggests that these children may not require postnatal imaging." } ]

[ { "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: Acquired Immunodeficiency Syndrome, Adult, Africa South of the Sahara, Anti-HIV Agents, Antibodies, Neutralizing, Antigens, Viral, Autoantigens, CD4-Positive T-Lymphocytes, Drug Administration Schedule, Female, HIV-1, Humans, Immunity, Humoral, Lopinavir, Lymphocyte Activation, Male, Ritonavir, Stavudine, Viral Load." }, { "role": "user", "content": "Do antiretroviral therapy interruptions result in loss of protective humoral immunity to neoantigens in HIV-infected individuals? Context: Sustained antiretroviral therapy (ART)-mediated viral suppression restores responses to vaccination in HIV-1-infected individuals. As ART interruption occur frequently in resource-constrained settings, we studied their effects on the ability to mount humoral immune responses against a neoantigen. Treatment-naive HIV-1-infected individuals were treated with stavudine, lamuvidine and lopinavir/ritonovir. Individuals who maintained viral load less than 50  copies/ml and CD4 T-cell counts more than 450  cells/μl for 6 months received three doses of rabies vaccine, and were randomized to 72 weeks of continuous ART (arm 1) or sequential 2, 4 and 8-week ART interruptions (arm 2). An additional vaccine dose was administered at study end. Neutralizing antibody titers to rabies virus were assessed in plasma with a rapid fluorescent focus-inhibiting test. The proportion of participants achieving protective (>0.5 IU/ml) antibody titer after vaccination was similar (arm 1=92%; arm 2=91%), but over time the cumulative proportion of observations with protective titer was greater in arm 1 than arm 2 (P=0.0177). From week 26 after vaccination, antibody titers were lower in arm 2 than arm 1, and volunteers in arm 2 lost protective antibody titers at a greater rate (P=0.0029). After boosting, 100% of arm 1 and 95% arm 2 volunteers achieved protective antibody titer." }, { "role": "assistant", "content": "Our data indicate that individuals undergoing recurring ART interruption retain lower neutralizing antibody titers to a neoantigen, but maintain the ability to mount secondary responses upon boosting, suggesting that they might benefit from vaccine schedule intensification. 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: Adaptor Proteins, Signal Transducing, Animals, Antigens, Differentiation, Body Patterning, Cell Membrane, DNA-Binding Proteins, Dimerization, Drosophila, Drosophila Proteins, Embryo, Nonmammalian, Epistasis, Genetic, Immunity, Innate, Models, Biological, Mutation, Phenotype, Phosphoproteins, Receptors, Immunologic, Toll-Like Receptors, Transcription Factors, Zinc Fingers." }, { "role": "user", "content": "Is weckle a zinc finger adaptor of the toll pathway in dorsoventral patterning of the Drosophila embryo? Context: The Drosophila Toll pathway takes part in both establishment of the embryonic dorsoventral axis and induction of the innate immune response in adults. Upon activation by the cytokine Spätzle, Toll interacts with the adaptor proteins DmMyD88 and Tube and the kinase Pelle and triggers degradation of the inhibitor Cactus, thus allowing the nuclear translocation of the transcription factor Dorsal/Dif. weckle (wek) was previously identified as a new dorsal group gene that encodes a putative zinc finger transcription factor. However, its role in the Toll pathway was unknown. Here, we isolated new wek alleles and demonstrated that cactus is epistatic to wek, which in turn is epistatic to Toll. Consistent with this, Wek localizes to the plasma membrane of embryos, independently of Toll signaling. Wek homodimerizes and associates with Toll. Moreover, Wek binds to and localizes DmMyD88 to the plasma membrane. Thus, Wek acts as an adaptor to assemble/stabilize a Toll/Wek/DmMyD88/Tube complex. Remarkably, unlike the DmMyD88/tube/pelle/cactus gene cassette of the Toll pathway, wek plays a minimal role, if any, in the immune defense against Gram-positive bacteria and fungi." }, { "role": "assistant", "content": "We conclude that Wek is an adaptor to link Toll and DmMyD88 and is required for efficient recruitment of DmMyD88 to Toll. Unexpectedly, wek is dispensable for innate immune response, thus revealing differences in the Toll-mediated activation of Dorsal in the embryo and Dif in the fat body of adult flies. 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": "In which one of the following salivary gland tumors, the tumoris composed of \"intermediate cells\" histologically?" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "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: Analysis of Variance, Biomarkers, Case-Control Studies, Cholesterol, HDL, Cholesterol, LDL, Coronary Angiography, Coronary Disease, Cross-Sectional Studies, Female, Humans, Lipoprotein(a), Logistic Models, Male, Middle Aged, Saudi Arabia, Severity of Illness Index, Statistics, Nonparametric, Triglycerides." }, { "role": "user", "content": "Is lipoproteina ( a ) a feature of the presence , diffuseness , and severity of coronary artery disease in Saudi population? Context: To study lipoprotein(a) [Lp(a)] levels in Saudi patients with angiographically defined coronary artery disease and to see its relationship with its severity and diffuseness. This cross sectional study was carried out at King Khalid University Hospital, Riyadh, Saudi Arabia in 2006-2007. One hundred and forty-seven individuals with coronary artery disease (CAD) and 49 healthy individuals matched for age and body mass index were studied. Among CAD patients, 133 underwent angiography. Blood samples were analyzed for total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) and Lp(a). Coronary artery disease patients had higher Lp(a) levels than controls (25.78 +/- 25.09 mg/dl versus 14.57 +/- 11.81 mg/dl, p=0.0030). Patients without stenosis (10.97 +/- 8.06 mg/dl) and one vessel involvement (19.67 +/- 17.33 mg/dl) had significantly lower levels of Lp(a) compared to double (31.88 +/- 32.17 mg/dl) and triple (29.70 +/- 28.12 mg/dl) vessel disease. Lipoprotein(a) levels correlated significantly with coronary vessel score (r=0.234, p=0.033) and Gensini score (r=0.256, p=0.02). Smoking (odds ratio [OR]: 1.86; 95% confidence interval [CI]: 1.020-2.510; p=0.04), TG levels (OR: 2.04; 95% CI: 1.251-4.932; p=0.03) and Lp(a) levels (OR: 1.56; 95% CI: 1.033-3.687; p=0.025) significantly predicted CAD severity. High risk levels of Lp(a) >/= 30 mg/dL were present in 66.7% of CAD patients." }, { "role": "assistant", "content": "Lipoprotein(a) levels are significantly higher in Saudi patients with CAD compared to healthy individuals, and are associated with more severe and diffuse blockage of the coronary vessels. 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, MATERIALS AND METHODS, RESULTS. Meshes: Acute-Phase Proteins, Aged, Angina, Stable, Biomarkers, Coronary Disease, Cystatin C, Diabetic Nephropathies, Female, Glomerular Filtration Rate, Hepatitis A Virus Cellular Receptor 1, Humans, Kidney Function Tests, Lipocalin-2, Lipocalins, Male, Membrane Glycoproteins, Middle Aged, Prognosis, Proto-Oncogene Proteins, ROC Curve, Receptors, Virus." }, { "role": "user", "content": "Assessment of kidney function in diabetic patients. Is there a role for new biomarkers NGAL, cystatin C and KIM-1? Context: Assessment of kidney injury early detection in diabetic patients has great importance for therapy and prognosis. The aim of this study was to assess whether neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and kidney injury molecule-1 (KIM-1) could represent sensitive markers of kidney function/injury in patients with coronary heart disease and diabetes. The study comprised 121 consecutive patients with diabetes referred for coronary angiography due to coronary heart disease and a reference group consisting of 64 patients without diabetes. Cystatin C, serum and urinary NGAL values were significantly higher in diabetics than in non-diabetics. There was no significant difference in KIM-1 levels in both groups. Serum NGAL in diabetic group was associated with serum creatinine, fibrinogen, urinary NGAL, cystatin C and inversely related to kidney function assessed with 4 equations. After analysing levels of studied biomarkers in both groups, no significant difference in patients with estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73m² was found. The analysis of patients with eGFR over 60 ml/min/1.73m² showed significant differences in cystatin C and urinary NGAL levels. The area under the curve for serum NGAL, urinary NGAL and cystatin C was 0.60 (95% CI, 0.51 to 0.69), 0.59 (95% CI, 0.5 to 0.68), 0.62 (95% CI, 0.54 to 0.71), respectively, good cut-off values of studied biomarkers to detect diabetes were not found." }, { "role": "assistant", "content": "NGAL, cystatin C and KIM-1 are not more useful than eGFR in the assessment of kidney function in diabetic patients with coronary heart disease." } ]

[ { "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": "Flumazenil antagonize the effect of which drug:" }, { "role": "assistant", "content": "The correct answer is Ans. C. MidazolamFlumazenil is competitive antagonist of benzodiazepine receptor and is used for respiratory depression due benzodiazepines (midazolam)." } ]

[ { "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: Breast Neoplasms, Female, Fluorodeoxyglucose F18, Humans, Image Interpretation, Computer-Assisted, Middle Aged, Neoplasm Staging, Positron Emission Tomography Computed Tomography, Radiopharmaceuticals, Reproducibility of Results, Sensitivity and Specificity, Tumor Burden." }, { "role": "user", "content": "Is tumor Heterogeneity Assessed by 18F-FDG PET/CT Significantly Associated with Nodal Metastasis in Breast Cancer Patients? Context: The purpose of this study was to evaluate the association of tumor heterogeneity as assessed by positron emission tomography/computed tomography (PET/CT) with pathological factors of breast cancer, and the prediction of nodal metastasis through tumor heterogeneity. From January 2013 to December 2013, 102 patients with invasive ductal carcinoma of the breast were enrolled into this study. [18F]Fluorodeoxyglucose PET/CT was performed before surgery. The metabolic tumor volume (MTV) of each lesion was calculated and a series of standardized uptake value (SUV) thresholds (e.g. 40%, 50%, 60%, 70%, and 80% of SUVmax) was obtained. A threshold-volume (dV/dT) curve was acquired by plotting thresholds to MTV values automatically calculated with these thresholds. Tumor heterogeneity was calculated from the slope of the threshold-volume curve and defined as heterogeneity factor (HF). HF differed significantly according to T stage (p < 0.0001), N stage (p = 0.0131) and American Joint Committee on Cancer (AJCC) stage (p = 0.0006). Among the pathological parameters, dermal lymphatic involvement (p = 0.0039) showed the significant correlations with HF. Lymphovascular invasion (p = 0.0005) was the only independent factor for predicting nodal metastasis." }, { "role": "assistant", "content": "Tumor heterogeneity measured by 18F-FDG PET/CT is significantly associated with dermal lymphatic involvement. However, PET might not be able to predict nodal metastasis in breast cancer. 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": "A young patient's blood investigations shows evidence of Burkitt's lymphoma. Which of the following agent is associated with Burkitt's lymphoma?" }, { "role": "assistant", "content": "The correct answer is Epstein-Barr virus (EBV) is associated with Burkitt lymphoma, nasopharyngeal carcinoma, Hodgkin and non-Hodgkin lymphomas, and gastric carcinoma. EBV-associated posttransplant lymphoproliferative disorders are a complication for immunodeficient patients. Burkitt lymphoma is a tumor of the jaw in African children and young adults. It is speculated that EBV may be involved at an early stage in Burkitt lymphoma by immoalizing B cells. Ref: Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzner T.A. (2013). Chapter 33. Herpesviruses. In G.F. Brooks, K.C. Carroll, J.S. Butel, S.A. Morse, T.A. Mietzner (Eds), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e." } ]

[ { "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": "Most common cause of death in malignant melanoma is due to" }, { "role": "assistant", "content": "The correct answer is CNS metastasis is the most common cause of death in malignant melanoma." } ]

[ { "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: Adult, African Continental Ancestry Group, Blood Pressure, Cardiovascular System, Catecholamines, Cold Temperature, European Continental Ancestry Group, Female, Genetic Variation, Genotype, Heart Rate, Heterotrimeric GTP-Binding Proteins, Humans, Male, Protein Subunits, Receptors, Adrenergic, alpha-2, Stress, Psychological." }, { "role": "user", "content": "Do genetic variants in the alpha2C-adrenoceptor and G-protein contribute to ethnic differences in cardiovascular stress responses? Context: Cardiovascular responses to stressors are regulated by sympathetic activity, increased in black Americans, and associated with future cardiovascular morbidity. Our aim was to determine whether two functional variants in genes regulating sympathetic activity, a deletion in the alpha2C-adrenergic receptor (ADRA2C del322-325) and a G-protein beta3-subunit variant (GNB3 G825T), affect cardiovascular responses to physiologic stressors and contribute to their ethnic differences. We measured heart rate and blood pressure responses to a cold pressor test (CPT) in 79 healthy participants (40 blacks, 39 whites), aged 25.7+/-5.3 years, and determined genotypes for the ADRA2C and GNB3 variants. We examined the response variables (increase in heart rate and blood pressure) in multiple linear regression analyses adjusting first for baseline measures, ethnicity, and other covariates, and then additionally for genotypes. Black participants had a greater heart rate response to CPT than whites [mean difference, 9.9 bpm; 95% confidence interval (CI), 4.1 to 15.6; P=0.001]. Both the ADRA2C del/del (15.8 bpm; 95% CI, 8.0-23.7; P<0.001) and GNB3 T/T genotypes (6.8 bpm; 95% CI, 0.9-12.7; P=0.026) were associated with greater heart rate response. After adjusting for genotypes, the ethnic difference was abrogated (1.3 bpm; 95% CI, -5.4-8.0; P=0.70), suggesting that the genetic variants contributed substantially to ethnic differences." }, { "role": "assistant", "content": "Variation in genes that regulate sympathetic activity affects hemodynamic stress responses and contributes to their ethnic differences. This study elucidates how genetic factors may in part explain ethnic differences in cardiovascular regulation. 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, Attitude of Health Personnel, Clinical Competence, England, Female, Humans, Hypnosis, Irritable Bowel Syndrome, Male, Middle Aged, Physicians, Family, Primary Health Care, Referral and Consultation, Rural Population, State Medicine, Surveys and Questionnaires, Urban Population." }, { "role": "user", "content": "Do general practitioners believe that hypnotherapy could be a useful treatment for irritable bowel syndrome in primary care? Context: Irritable bowel syndrome is a common condition in general practice. It occurs in 10 to 20% of the population, but less than half seek medical assistance with the complaint. A questionnaire was sent to the 406 GPs listed on the West Sussex Health Authority Medical List to investigate their views of this condition and whether they felt hypnotherapy had a place in its management 38% of general practitioners responded. The achieved sample shared the characteristics of target sample. Nearly half thought that irritable bowel syndrome (IBS) was a \"nervous complaint\" and used a combination of \"the placebo effect of personal care,\" therapeutic, and dietary advice. There is considerable divergence in the perceived effectiveness of current approaches. Over 70% thought that hypnotherapy may have a role in the management of patients with IBS; though the majority (68%) felt that this should not be offered by general practitioners. 84% felt that this should be offered by qualified hypnotherapist, with 40% feeling that this should be offered outside the health service." }, { "role": "assistant", "content": "General practitioners vary in their perceptions of what constitutes effective therapy in IBS. They are willing to consider referral to a qualified hypnotherapist. 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": "Ankle edema caused by calcium channel blockers is prevented by" }, { "role": "assistant", "content": "The correct answer is Calcium channel blockers can lead to ankle edema caused by precapillary dilation of vessels.\nACE inhibitors or Angiotensin Receptor Blockers can Prevent the edema by causing postcapillary dilation of vessels." } ]

[ { "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 most common neurological disorder seen in CRF patients" }, { "role": "assistant", "content": "The correct answer is Ans. is 'b' i.e., Peripheral neuropathy" } ]

[ { "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, Cell Line, Epigenesis, Genetic, Gene Expression Regulation, Histones, Humans, Lymphocytes, Primates, RNA, Messenger, Sequence Analysis, RNA, Species Specificity." }, { "role": "user", "content": "Are epigenetic modifications associated with inter-species gene expression variation in primates? Context: Changes in gene regulation have long been thought to play an important role in evolution and speciation, especially in primates. Over the past decade, comparative genomic studies have revealed extensive inter-species differences in gene expression levels, yet we know much less about the extent to which regulatory mechanisms differ between species. To begin addressing this gap, we perform a comparative epigenetic study in primate lymphoblastoid cell lines, to query the contribution of RNA polymerase II and four histone modifications, H3K4me1, H3K4me3, H3K27ac, and H3K27me3, to inter-species variation in gene expression levels. We find that inter-species differences in mark enrichment near transcription start sites are significantly more often associated with inter-species differences in the corresponding gene expression level than expected by chance alone. Interestingly, we also find that first-order interactions among the five marks, as well as chromatin states, do not markedly contribute to the degree of association between the marks and inter-species variation in gene expression levels, suggesting that the marginal effects of the five marks dominate this contribution." }, { "role": "assistant", "content": "Our observations suggest that epigenetic modifications are substantially associated with changes in gene expression levels among primates and may represent important molecular mechanisms in primate evolution. 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: OBJECTIVES, DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, MAIN OUTCOME MEASURES, RESULTS. Meshes: Aged, Caregivers, Cost-Benefit Analysis, Dementia, Female, Friends, Health Status, Humans, Male, Psychological Tests, Psychometrics, Quality of Life." }, { "role": "user", "content": "Does befriending by trained lay workers improve psychological well-being and quality of life for carers of people with dementia, and at what cost? Context: To determine whether a social support intervention (access to an employed befriending facilitator in addition to usual care) is effective compared with usual care alone. Also to document direct and indirect costs, and establish incremental cost-effectiveness. The Befriending and Costs of Caring (BECCA) trial was a cost-effectiveness randomised controlled trial. Data on well-being and resource use were collected through interviews with participants at baseline and at 6, 15 and 24 months. This research was carried out in the English counties of Norfolk and Suffolk, and the London Borough of Havering. It was a community-based study. Participants were family carers who were cohabiting with, or providing at least 20 hours' care per week for, a community-dwelling relative with a primary progressive dementia. The intervention was 'access to a befriender facilitator' (BF). BFs, based with charitable/voluntary-sector organisations, were responsible for local befriending schemes, including recruitment, screening, training and ongoing support of befriending volunteers, and for matching carers with befrienders. The role of befrienders was to provide emotional support for carers. The target duration for befriending relationships was 6 months or more. Depression was measured by the Hospital Anxiety and Depression Scale (HADS) at 15 months postrandomisation. The health-related quality of life scale EQ-5D (EuroQol 5 Dimensions) was used to derive utilities for the calculation of quality-adjusted life-years (QALYs). A total of 236 carers were randomised into the trial (116 intervention; 120 control). At final follow-up, 190 carers (93 intervention; 97 control) were still involved in the trial (19% attrition). There was no evidence of effectiveness or cost-effectiveness from the primary analyses on the intention-to-treat population. The mean incremental cost per incremental QALY gained was in excess of 100,000 pounds, with only a 42.2% probability of being below 30,000 pounds per QALY gained. Where care-recipient QALYs were included, mean incremental cost per incremental QALY gained was 26,848 pounds, with a 51.4% probability of being below 30,000 pounds per QALY gained. Only 60 carers (52%) took up the offer of being matched with a trained lay befriender, and of these only 37 (32%) were befriended for 6 months or more. A subgroup analysis of controls versus those befriended for 6 months or more found a reduction in HADS-depression scores that approached statistical significance (95% CI -0.09 to 2.84)." }, { "role": "assistant", "content": "'Access to a befriender facilitator' is neither an effective nor a cost-effective intervention in the support of carers of people with dementia, although there is a suggestion of cost-effectiveness for the care dyad (carer and care recipient). In common with many services for carers of people with dementia, uptake of befriending services was not high. However, the small number of carers who engaged with befrienders for 6 months or more reported a reduction in scores on HADS depression that approached statistical significance compared with controls (95% CI -0.09 to 2.84). While providing only weak evidence of any beneficial effect, further research into befriending interventions for carers is warranted." } ]

[ { "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, Antineoplastic Agents, Cisplatin, Female, Genetic Variation, Hearing Loss, Sensorineural, Humans, Male, Middle Aged, Polymorphism, Single Nucleotide, Proteins." }, { "role": "user", "content": "Is genetic variation in Otos associated with cisplatin-induced ototoxicity? Context: Ototoxicity is an adverse drug reaction that may limit the effective use of cisplatin chemotherapy. Given the reported in vitro protective role of the gene Otos in response to cisplatin, this study aimed to explore the potential of Otos as a genetic modifier of ototoxicity. One hundred South African cisplatin-receiving cancer patients with baseline and follow-up audiometric data were screened for variation in exonic target regions of Otos using direct cycle sequencing. A total of 29 genetic variants were identified. The G alleles of Otos rs77124181 (c.-192-182C>G) and rs2291767 (c.-192-22A>G) were over-represented in ototoxicity-free patients (p = 0.022). Cumulative cisplatin dose and anatomical site of cancer were also associated with ototoxicity, while self-reported ethnicity associated with the ototoxic severity." }, { "role": "assistant", "content": "This study indicates a potentially protective role for the variant G alleles of SNPs rs77124181 and rs2291767 in Otos against the development of cisplatin-induced ototoxicity. 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, Apoptosis, Congenital Abnormalities, Diabetes Mellitus, Experimental, Embryonic and Fetal Development, Female, Mice, Mice, Inbred Strains, Mice, Knockout, Pregnancy, Pregnancy in Diabetics, Teratogens, Tumor Necrosis Factor-alpha." }, { "role": "user", "content": "Does tNF-alpha act to prevent occurrence of malformed fetuses in diabetic mice? Context: Activation of apoptosis in embryos is thought to be a key event in the pathogenesis of diabetes-induced embryopathies such as early embryonic death and inborn structural anomalies. TNF-alpha can activate apoptotic and anti-apoptotic signalling cascades, indicating its ability to contribute to and counteract diabetes-induced maldevelopment. To investigate how TNF-alpha regulates the response of embryos to diabetes-induced embryopathic stress, we used streptozotocin-induced diabetic TNF-alpha knockout mice. To evaluate the reproductive performance, mated diabetic female mice were examined on days 4 and 8 of pregnancy for the presence of blastocysts or embryos in uterine horns. To evaluate the teratogenic effect, the female mice were killed on day 18 of pregnancy and fetuses were examined for gross external anomalies. In addition, apoptotic nuclei were localised by the TUNEL assay and DNA-binding activity of the transcription factor NF-kappaB was evaluated by electrophoretic mobility shift assay in 10- and 11-day-old embryos respectively. Severely diabetic TNF-alpha(+/+) female mice had a much greater decrease in pregnancy rate but a lower incidence of malformed fetuses in litters than severely diabetic TNF-alpha(-/-) female mice. Also, the intensity of excessive apoptosis was higher, but the amount of active NF-kappaB complexes was lower in malformed TNF-alpha(-/-) embryos than in TNF-alpha(+/+) embryos." }, { "role": "assistant", "content": "TNF-alpha contributes to death of peri-implantation embryos and possibly protects postimplantation embryos exposed to diabetes-induced teratogenic stimuli via activation of NF-kappaB-mediated anti-apoptotic signalling. It seems that TNF-alpha prevents the birth of malformed offspring in severely diabetic mice. 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": "Tomato ketchup retina is seen in -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'b' i.e. Central retinal vein occlusion o Tomato ketchup or splash tomato fundus is seen in central retinal vein occlusion." } ]

[ { "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": "Killian's dehiscence is seen in" }, { "role": "assistant", "content": "The correct answer is Killian's dehiscence (also known as Killian's triangle, Laimer's triangle, and Killian-Laimer triangle) is a triangular area in the wall of the pharynx between the thyropharyngeus pa of the inferior constrictor of the pharynx and the cricopharyngeus muscle, also of the inferior constrictor muscle of the pharynx. It represents a potentially weak spot where a pharyngoesophageal diveiculum (Zenker's diveiculum) is more likely to occur" } ]

[ { "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": "Cavernous sinus thrombosis is due infection of" }, { "role": "assistant", "content": "The correct answer is Pterygoid plexus and the facial vein form the 2 major sources which carry the infections from the danger area of face to the cavernous sinus." } ]

[ { "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, METHODS, METHODS, RESULTS. Meshes: Adult, Down-Regulation, Embryo Implantation, Endometriosis, Endometrium, Female, Humans, Leukemia Inhibitory Factor, Ovulation, RNA, Messenger, Time Factors, Uterus." }, { "role": "user", "content": "Is leukemia inhibitory factor dysregulated in the endometrium and uterine flushing fluid of patients with adenomyosis during implantation window? Context: To determine whether the expression of leukemia inhibitory factor during the implantation window in endometrial tissue and uterine flushing fluid of patients with adenomyosis differs from that of healthy fertile women. Experimental study using endometrial tissue and uterine flushing fluid. Peking University First Hospital, People's Republic of China. There were 28 patients with adenomyosis and 27 control fertile women. Uterine flushing fluid and endometrial samples were collected during the implantation window, defined as 7 to 9 days after ovulation. Leukemia inhibitory factor levels in uterine flushing fluid were measured by enzyme-linked immunosorbent assay. Leukemia inhibitory factor messenger RNA expression in eutopic endometrium was quantified by real-time reverse transcriptase polymerase chain reaction. Leukemia inhibitory factor protein expression was evaluated with semiquantitative immunohistochemistry. Leukemia inhibitory factor levels were significantly lower in the uterine flushing fluid of patients with adenomyosis with a history of infertility. Leukemia inhibitory factor messenger RNA and protein also were significantly lower in patients with adenomyosis, compared with control. Leukemia inhibitory factor immunostaining intensity was significantly lower in patients with adenomyosis, compared with control." }, { "role": "assistant", "content": "Leukemia inhibitory factor is dysregulated in the endometrium and uterine flushing fluid of women with adenomyosis during the implantation window. 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": "Multienzyme complex in humans" }, { "role": "assistant", "content": "The correct answer is Fatty acid synthetase \n\nEnzymes used in the fatty acid synthesis are multienzyme complexes:-\n\n\nAcetyl-CoA carboxylase\nFatty acid synthase" } ]

[ { "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": "Locked in state is associated with ?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'b' i.e., Pons Locked in syndrome is caused by an insult to ventral pons (basis pontis). It is characterized by inability to speak and quadriplagia. There is complete paralysis of all voluntary muscles except for the eyes. The lesion essentially interrupts coicobulbars and coicospinal pathways. Somatosensory and ascending neuronal pathways responsible for arousal and wakfullness remain intact." } ]

[ { "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": "CD 95 is a marker of -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'b' i.e. Extrinsic pathway of apoptosiso CD 95 is a marker of extrinsic pathway of apoptosis." } ]

[ { "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: Apoptosis, Arthritis, Rheumatoid, Cell Survival, Cells, Cultured, Cyclin-Dependent Kinase Inhibitor p21, Dose-Response Relationship, Drug, Drug Combinations, Drug Synergism, Enzyme Inhibitors, Fibroblasts, Flow Cytometry, Fluorescent Antibody Technique, Indirect, Humans, Hydroxamic Acids, RNA, Messenger, Reverse Transcriptase Polymerase Chain Reaction, Signal Transduction, Synovial Membrane, fas Receptor." }, { "role": "user", "content": "Does trichostatin A cooperate with Fas-mediated signal to induce apoptosis in rheumatoid arthritis synovial fibroblasts? Context: To clarify the effects of trichostatin A (TSA), a histone deacetylase inhibitor, on the growth and survival of rheumatoid arthritis synovial fibroblasts (RA-SF). Cell viability was assessed using a WST-8 assay and direct cell counting. Apoptosis was detected by annexin V staining on a flow cytometer. Protein and mRNA expression was determined by Western blotting, flow cytometry, and RT-PCR. TSA suppressed cell growth of RA-SF in a dose-dependent manner, as determined by WST-8 assay and direct cell counting. Other histone deacetylase inhibitors also showed inhibitory effects on RA-SF proliferation. TSA upregulated p21(WAF1/CIP1) cell cycle inhibitor, suggesting that cell cycle arrest is involved in the reduction of cell numbers. In addition, TSA cooperated with Fas-induced pathway to induce cell death, determined by WST-8 assay and annexin V staining. TSA reduced FLICE inhibitory protein (FLIP) expression but not Bcl-2, Bcl-XL, and Fas expression, indicating that the synergistic effect may be through downregulation of FLIP." }, { "role": "assistant", "content": "TSA has antirheumatic effects on RA-SF and might be a potential therapeutic tool for the treatment of RA. 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: Adenocarcinoma, Mucinous, Adult, Antineoplastic Combined Chemotherapy Protocols, Appendectomy, Appendiceal Neoplasms, Biomarkers, Chemotherapy, Adjuvant, Chemotherapy, Cancer, Regional Perfusion, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Hyperthermia, Induced, Magnetic Resonance Imaging, Male, Middle Aged, Neoadjuvant Therapy, Neoplasm Recurrence, Local, Neoplasm Staging, Peritoneal Neoplasms, Prognosis, Retrospective Studies, Survival Rate." }, { "role": "user", "content": "Is surveillance MR imaging superior to serum tumor markers for detecting early tumor recurrence in patients with appendiceal cancer treated with surgical cytoreduction and HIPEC? Context: The purpose of this study was to determine if MRI surveillance is better than serum tumor makers in detecting early recurrence in patients with mucinous appendiceal neoplasm. A total of 50 patients with appendiceal neoplasm (DPAM 11, PMCA 39) underwent abdominal and pelvic MRI prior to surgical cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC). Patients then entered follow-up surveillance with serial MRI every 6 months and serial laboratory studies including CA 125, CEA, and CA19-9. Written reports for surveillance MRI exams were reviewed for tumor recurrence and compared with results of serial laboratory tests. Proof of tumor recurrence was by a consensus of surgery and histopathology, as well as clinical and imaging findings on serial examinations. During surveillance tumor recurrence was documented in 30 patients (60 %) with median time to recurrence of 13 months (range 3-56 months). MRI detected recurrent tumor in 28 patients, including 11 patients with normal laboratory values (sensitivity 0.93, specificity 0.95, accuracy 0.94, PPV 0.97, and NPV 0.90). Serial laboratory values showed tumor recurrence in 14 patients (sensitivity 0.48, specificity 1.00, accuracy 0.69, PPV 1.0, and NPV 0.57). Median survival was 50 months for 11 patients with earlier MRI detection of recurrence vs 33 months for the other 19 patients with recurrence." }, { "role": "assistant", "content": "Following cytoreductive surgery and HIPEC MRI detects tumor recurrence earlier and with greater accuracy than serial tumor markers alone. 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: Activating Transcription Factors, Adult, Aged, Antineoplastic Agents, Apoptosis, Cell Line, Tumor, Down-Regulation, Drug Resistance, Neoplasm, Female, Gene Expression Profiling, Humans, Male, Middle Aged, Paclitaxel, Pancreatic Neoplasms, Proto-Oncogene Proteins c-bcl-2, Up-Regulation, bcl-2-Associated X Protein." }, { "role": "user", "content": "Does interference with ATF5 function enhance the sensitivity of human pancreatic cancer cells to paclitaxel-induced apoptosis? Context: Past work has established that human glioblastomas and breast cancer cells invariably express the activating transcription factor 5 (ATF5) and that loss of function of ATF5 caused massive apoptotic death of all cancer cell lines tested. ATF5 expression and function in pancreatic cancer cells have not been investigated. Quantitative real-time/reverse transcription-polymerase chain reaction (QRT/RT-PCR), western blotting (WB), immunohistochemistry (IHC) and promoter reporter assay were used for gene expression analysis. MTT [3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay and FACS (fluorescence-activated cell sorting) analysis were used to monitor cell viability/apoptosis. ATF5 is highly expressed in pancreatic cancer cells as compared with non-tumor tissues. Both paclitaxel treatment and loss of function of ATF5 elicited apoptosis of SW1990 cells. Interference with ATF5 function in SW1990 cells resulted in down-regulation of BCL-2 and up-regulation of BAX, resulting in enhanced sensitivity to apoptosis induced by paclitaxel treatment." }, { "role": "assistant", "content": "ATF5 is highly expressed in pancreatic cancer cells. Targeting ATF5 significantly enhances paclitaxel-induced apoptosis in human pancreatic cancer cells. ATF5 could be an important therapeutic target for pancreatic cancer treatment. 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: OBJECT, METHODS, RESULTS. Meshes: Aged, Aged, 80 and over, Alendronate, Bone Density Conservation Agents, Bone Screws, Female, Humans, Lumbar Vertebrae, Magnetic Resonance Imaging, Male, Middle Aged, Osteogenesis, Prospective Studies, Radiography, Spinal Fusion, Treatment Outcome, Wound Healing." }, { "role": "user", "content": "Does alendronate disturb the healing process of posterior lumbar interbody fusion? Context: Bisphosphonate medications are widely used for the treatment of osteoporosis, but they might disturb the healing process of spinal fusion. The object of this prospective randomized controlled study was to evaluate the effect of bisphosphonate medication on spinal fusion through radiographic, clinical, and biological assessments. A total of 40 patients with osteoporosis who were candidates for single-level posterior lumbar interbody fusion were randomly assigned to the alendronate group (alendronate sodium 35 mg/week) or the control group (vitamin D, alfacalcidol 1 μg/day). Pedicle screw fixation and carbon polyetheretherketone cages were used for all the patients. Bone graft material was prepared as a mixture of local bone and β-tricalcium phosphate in a ratio of 2:1. Functional radiography and CT scans were used to evaluate fusion status and cage subsidence. The incidence of vertebral compression fractures (VCFs) occurring after surgery (subsequent VCFs) was assessed by means of MR imaging. Bridging bone formation was graded into 3 categories: Grade A (bridging bone through bilateral cages), Grade B (bridging bone through a unilateral cage), or Grade C (incomplete bony bridging). A solid fusion was defined as less than 5° of angular motion in flexion-extension radiographs and the presence of bridging bone through the cage (Grade A or B). Clinical outcome was evaluated by means of the Oswestry Disability Index. Bone metabolic markers (serum bone alkaline phosphatase, serum and urine Type I collagen cross-linked N-telopeptides) were measured to investigate the biological effects of alendronate on spinal fusion. Bridging bone formation (Grade A or B) was more frequently observed in the alendronate group at all postoperative assessment periods. At 1-year postoperative follow-up, a solid fusion was achieved in 95% of the patients in the alendronate group and 65% of those in the control group. Cage subsidence (>2 mm) was observed in 5% of the alendronate group and 29% of the control group. No vertebral fractures were observed in the alendronate group, whereas 24% of patients in the control group showed subsequent VCFs. There was no statistically significant between-groups difference in clinical outcomes, but poor clinical results in the control group were associated with pseudarthrosis and subsequent VCFs. Biochemical analysis of bone turnover demonstrated that alendronate inhibited bone resorption from the early phase of the fusion process and also suppressed bone formation after 6 months postoperatively." }, { "role": "assistant", "content": "Favorable mechanical circumstances provided by alendronate overcame its detrimental biological effect on the healing process of spinal fusion. The authors recommend that osteoporosis patients undergoing spinal fusion take bisphosphonates throughout the postoperative period." } ]

[ { "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: Cognition Disorders, False Positive Reactions, HIV Infections, Humans, Neuropsychological Tests." }, { "role": "user", "content": "Is it time to rethink how neuropsychological tests are used to diagnose mild forms of HIV-associated neurocognitive disorders? Context: Between 0 and 48% of normal HIV-uninfected individuals score below threshold neuropsychological test scores for HIV-associated neurocognitive disorders (HAND) or are false positives. There has been little effort to understand the effect of varied interpretations of research criteria for HAND on false-positive frequencies, prevalence and analytic estimates. The proportion of normal individuals scoring below Z score thresholds drawn from research criteria for HAND, or false-positive frequencies, was estimated in a normal Kenyan population and a simulated normal population using varied interpretations of research criteria for HAND. We calculated the impact of false-positive frequencies on prevalence estimates and statistical power. False-positive frequencies of 2-74% were observed for asymptomatic neurocognitive impairment/mild neurocognitive disorder and 0-8% for HIV-associated dementia. False-positive frequencies depended on the definition of an abnormal cognitive domain, Z score thresholds and neuropsychological battery size. Misclassification led to clinically important overestimation of prevalence and dramatic decreases in power." }, { "role": "assistant", "content": "Minimizing false-positive frequencies is critical to decrease bias in prevalence estimates and minimize reductions in power in studies of association, particularly for mild forms of HAND. We recommend changing the Z score threshold to ≤-1.5 for mild impairment, limiting analysis to 3-5 cognitive domains and using the average Z score to define an abnormal domain." } ]

[ { "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": "Matrix band is difficult to place on -- teeth" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "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: Adolescent, Adult, Caspase 1, Cytokines, Dermatitis, Atopic, Dinoprostone, Female, Humans, Interleukin-1, Interleukin-10, Interleukin-18, Interleukin-8, Lipopolysaccharide Receptors, Male, Middle Aged, Monocytes, RNA, Messenger." }, { "role": "user", "content": "Are expression of IL-18 mRNA and secretion of IL-18 reduced in monocytes from patients with atopic dermatitis? Context: IL-18 has been found to be an IFN-gamma-inducing factor that plays an important role in T(H)1 cell activation. Recently, IL-18 has also been found to enhance a T(H)2 cellular response in a specific setting. The aim of this study was to elucidate the role of monocytes and soluble factors, with special focus on IL-18, in the pathogenesis of atopic dermatitis (AD). The release of cytokines from PBMCs and purified monocytes was measured through use of ELISA; mRNA expression was evaluated by RT-PCR. The results from patients with AD were compared with those from healthy controls. IL-18 secretion was reduced in both unstimulated and lipopolysaccharide-stimulated monocytes from patients with AD. The mRNA expression of IL-18 and IL-1 beta-converting enzyme was significantly reduced in unstimulated monocytes from patients with AD (P <.03 and P <.01, respectively). Patients with AD had an elevated secretion of prostaglandin E(2) (PGE(2)) from unstimulated PBMCs (P <.001). The anti-PGE(2) antibody reversed the suppressive effect of PGE(2) on IL-18 secretion in unstimulated PBMCs from patients with AD." }, { "role": "assistant", "content": "Decreased IL-18 production, together with a significantly reduced IL-18 and ICE mRNA expression in unstimulated monocytes and elevated PGE(2) secretion from PBMCs, was associated with the pathogenesis of AD. 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: Animals, Apoptosis, Biliverdine, Cell Movement, Endothelial Cells, Hyperplasia, JNK Mitogen-Activated Protein Kinases, Muscle, Smooth, Vascular, Phosphorylation, Rats, Rats, Inbred Lew, Tunica Intima, Vascular Diseases." }, { "role": "user", "content": "Does biliverdin administration prevent the formation of intimal hyperplasia induced by vascular injury? Context: Autologous vein grafts and balloon angioplasty are still commonly used for arterial reconstructive procedures. Their success is limited by the development of intimal hyperplasia (IH). Biliverdin (BVD), one of the by-products of heme degradation, has been shown to have potent antioxidant and antiinflammatory effects. We hypothesized that BVD administration would protect vascular tissue against vascular injury. The effects of BVD administration against IH after vascular injury were analyzed in an arterialized vein graft model and a balloon injury model in rats. BVD treatment significantly suppressed the development of IH in both models compared with those without BVD. The mechanisms by which BVD treatment inhibits IH development might include decreasing c-Jun NH2 terminal kinase activation and preventing apoptosis of endothelial cells. BVD also suppressed vascular smooth muscle cell migration in vitro." }, { "role": "assistant", "content": "BVD administration prevented IH associated with arterialized vein graft vasculopathy or balloon angioplasty-induced vessel injury. These results suggest that a treatment regimen with exogenous BVD administration could provide an effective therapeutic adjunct to facilitate transfer of experimental treatments for vascular injury to the clinic. 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: METHODS, RESULTS. Meshes: Dental Alloys, Dental Stress Analysis, Friction, Humans, Materials Testing, Nickel, Orthodontic Appliance Design, Orthodontic Brackets, Orthodontic Wires, Stainless Steel, Stress, Mechanical, Surface Properties, Titanium." }, { "role": "user", "content": "Does the design of self-ligating brackets show different behavior in terms of friction? Context: All brackets had a 0.022-inch slot; the orthodontic archwires were 0.014-inch Ni-Ti, 0.016-inch Ni-Ti, 0.014 x 0.025-inch Ni-Ti, 0.018 x 0.025-inch Ni-Ti, 0.017 x 0.025-inch TMA, 0.019 x 0.025-inch stainless steel, and 0.019 x 0.025-inch Ni-Ti. Each bracket-archwire combination was tested 10 times. Coupled with 0.014-inch Ni-Ti and 0.016-inch Ni-Ti archwire, conventional brackets generated the greatest friction, while Damon MX and Vision LP brackets generated the lowest (P<.05). No significant difference was observed between Time3 brackets and Slide ligatures. Coupled with all the rectangular archwires, Victory Series brackets, Slide ligatures, and Vision LP self-ligating brackets generated significantly lower friction than Time3 and Damon MX self-ligating brackets (P<.05)." }, { "role": "assistant", "content": "These findings suggest that self-ligating brackets are a great family of brackets that, in vitro, can generate different levels of friction when coupled with thin, thick, rectangular, or round archwires. Clinical conclusions based on our results are not possible, due to the limitations of the experimental conditions." } ]

[ { "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 most common site for myocardial infarction is :" }, { "role": "assistant", "content": "The correct answer is Answer is B (Left ventricle) The most common site of myocardial infarction is the anterior wall of Left ventricle. Anterior wall MI 1. True Anterior Wall Occlusion of Left Anterior Descending aery (LAD) 2. Anteroseptal Infarction Occlusion of Left Anterior Descending aery (LAD) 3. Anterolateral infarction Occlusion of Left coronary aery thereby causing ischemia in region supplied by LAD aery and circumflex aery (lateral wall)" } ]

[ { "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: Adipokines, Adult, Biomarkers, Blood Pressure, C-Reactive Protein, Case-Control Studies, China, Enzyme-Linked Immunosorbent Assay, Female, Humans, Inflammation, Oxidative Stress, Placenta Growth Factor, Pre-Eclampsia, Pregnancy, Pregnancy Proteins, Pregnancy Trimester, Third, Reference Values, Regression Analysis, Statistics, Nonparametric, Vascular Endothelial Growth Factor Receptor-1." }, { "role": "user", "content": "Is plasma sFlt-1-to-PlGF ratio correlated with inflammatory but not with oxidative stress in Chinese preeclamptic women? Context: Considerable interest has been focused on angiogenic factors and angiogenic imbalance in the field of pre-eclampsia (PE), owing to its gaining role in the development of PE. This study was addressed to investigate the associations of sFlt-1-to-PlGF plasma ratios with oxidative stress assessed by the level of 8-isoprostane, and inflammation measured by the level of high-sensitive C-reactive protein (hs-CRP), and adipocytokines. A total of 83 patients with PE including 47 mild PE (MPE) and 36 severe PE (SPE) and 50 age-matched normotensive subjects in the third trimester of pregnancy were examined. Measurements included body mass index (BMI), systolic and diastolic blood pressure (BP) levels, plasma concentrations of hs-CRP, 8-isoprostane, adiponectin, and leptin. Subjects with PE had higher levels of sFlt-1/PlGF (P < 0.01), hs-CRP (P < 0.01), 8-isoprostane and leptin (both P < 0.01) and lower adiponectin (P < 0.01) than did normotensive control subjects. Significant positive correlations were found between plasma sFlt-1/PlGF and hs-CRP (r = 0.437, P < 0.01) or leptin (r = 0.656, P < 0.01). A weak inverse correlation emerged between sFlt-1/PlGF and adiponectin (r = -0.306, P < 0.01). When a multiple regression analysis was performed, with sFlt-1/PlGF as a dependent variable and all the other parameters as independent variables, sFlt-1/PlGF maintain a significant relationship with leptin (beta = 0.219, P < 0.05) and with hs-CRP (beta = 0.295, P < 0.01) as well as with systolic BP(beta = 0.446, P < 0.05)." }, { "role": "assistant", "content": "In Chinese preeclamptic women, plasma sFlt-1-to-PlGF ratio is correlated with inflammatory and adipocytokines but not with oxidative stress. 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, METHODS, RESULTS. Meshes: Acetylcholine, Administration, Topical, Adrenergic beta-Agonists, Aged, Dobutamine, Female, Hemodynamics, Humans, Male, Microcirculation, Middle Aged, Mouth Floor, Shock, Septic, Vasodilator Agents." }, { "role": "user", "content": "Are the effects of dobutamine on microcirculatory alterations in patients with septic shock independent of its systemic effects? Context: To evaluate the effects of dobutamine on microcirculatory blood flow alterations in patients with septic shock. Prospective, open-label study. A 31-bed, medico-surgical intensive care unit of a university hospital. Twenty-two patients with septic shock. Intravenous administration of dobutamine (5 mug/kg.min) for 2 hrs (n = 22) followed by the addition of 10 M acetylcholine (topically applied, n = 10). Complete hemodynamic measurements were obtained before and after dobutamine administration. In addition, the sublingual microcirculation was investigated with an orthogonal polarization spectral imaging technique before and after dobutamine administration and after topical application of acetylcholine. Dobutamine significantly improved capillary perfusion (from 48 +/- 15 to 67 +/- 11%, p = .001), but with large individual variation, whereas capillary density remained stable. The addition of topical acetylcholine completely restored capillary perfusion (98 +/- 1%, p = .001) and capillary density. The changes in capillary perfusion during dobutamine administration were not related to changes in cardiac index (p = .45) or arterial pressure (p = .29). Interestingly, the decrease in lactate levels was proportional to the improvement in capillary perfusion (y = 0.07 - 0.02x, r = .46, p = .005) but not to changes in cardiac index (p = .55)." }, { "role": "assistant", "content": "The administration of 5 mug/kg.min dobutamine can improve but not restore capillary perfusion in patients with septic shock. These changes are independent of changes in systemic hemodynamic variables. 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, METHODS, RESULTS. Meshes: Adult, Alcohol Drinking, Alcoholism, Australia, Cues, Epidemiologic Methods, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires, Treatment Outcome, United Kingdom." }, { "role": "user", "content": "Does level of impaired control predict outcome of moderation-oriented treatment for alcohol problems? Context: To examine the ability of the Impaired Control Scale (ICS) to predict outcome of moderation-oriented treatment for alcohol problems and to compare this predictive ability directly with that of a widely used measure of alcohol dependence, the Severity of Alcohol Dependence Questionnaire (SADQ). Prospective follow-up study. Out-patient treatment centres. A combined sample 154 problem drinkers taking part in two clinical trials of Moderation-oriented Cue Exposure in the UK and Australia. Clients were followed-up 6 (UK) and 8 (Australia) months after the end of treatment. Outcome was categorized by combining drinking behaviour at follow-up with changes on the Alcohol Problems Questionnaire from before treatment to follow-up. Controlling for research site, baseline scores on Part 2 of the ICS (substitution method) and the SADQ-C were entered in logistic regression analyses with three outcome dichotomies as dependent variables. Five per cent of clients were abstinent at follow-up, 13% non-problem drinkers, 25% much improved, 24% somewhat improved and 34% unimproved. Location of treatment and ICS2 scores were significant predictors of whether or not clients achieved a successful outcome (abstinence or non-problem drinking). Using a cut-point of 25 on the ICS, two-thirds of outcomes were classified correctly as either treatment successes or failures. SADQ-C score was not a significant predictor of treatment outcome." }, { "role": "assistant", "content": "The ICS predicts outcome of moderation-oriented treatment among moderately dependent problem drinkers recruited mainly via newspaper advertisements. The ICS should replace the SADQ as the basis for advice to clients in this population of problem drinkers regarding whether or not a moderation goal of treatment should be pursued. 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": "Which of the following causes distal myopathy:" }, { "role": "assistant", "content": "The correct answer is Ans: A (Myotonic dystrophy) Ref: Harrison's Principles of Internal Medicine. 18th ed, pg 3499.3500Explanation (See the following table)Myotonic Dystrophy:Facial muscle (hatchet face), neck.palatal, pharyngeal, distal muscle of hands and feet weaknessFrontal baldnessMyotonia of thenar muscle, tongue, wrist extensorCardiac conduction defects, cataract, insulin resistanceMyotonia treated with phenytoin/mexilitineDrug induced proximal weaknessAmiodaroneChloroquineHCQColchicineLipid lowering drugsGlucocorticoidsZidovudineAlcoholAmphetamined-PenicillamincClofibratteVincristineEndocrine causes:Hypo/hyperthyroidismHyper/hypoparathyroidismCushing's syndromeOsteomalaciaRenal osteodystrophyAdrenal insufficiencyConn's syndromeAcromegalyDMChannelopathies:Malignant hyperthermia- Calcium channelHypokalemic periodic paralysis- Calcium & sodium channelHyperkalemic periodic paralysis- Sodium channelParamyotonia congenita-Sodium channelMyotonia congenita! (Thompson's disease)- Chloride channelAnderson-Tawil syndrome- Potassium channelMitochondrial myopathies: MERFF, MELAS.CPEO, MNGIE. Kearns-Sayre syndromeDisorders of carbohydrate & lipid metabolism: Me Ardle disease, CPT deficiency- In general, myopathies follow a proximal distribution of weakness and muscle wasting (with the notable exception of myotonic muscular dystrophy)- Neuropathies are generally distal in distribution (with the notable exception of juvenile spinal muscular atrophy" } ]

[ { "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, Bipolar Disorder, Brain, Cell Count, Culture Techniques, Female, Humans, Hypertrophy, Male, Middle Aged, Neuroglia, Prefrontal Cortex, Retrospective Studies." }, { "role": "user", "content": "Do reductions in neuronal and glial density characterize the dorsolateral prefrontal cortex in bipolar disorder? Context: Bipolar disorder (BPD) is a mental illness in which depression and mania typically alternate, and both phases can present with psychotic features. The symptomatology of BPD, therefore, resembles major depressive disorder (MDD) and schizophrenia (SCHZ), posing diagnostic dilemmas. Distinct alterations in cellular architecture of the dorsolateral prefrontal cortex distinguish SCHZ and MDD, whereas the cellular neuropathology of BPD has not been studied. Dorsolateral prefrontal area 9 was analyzed using a three-dimensional morphometric method in postmortem brains from 10 BPD patients and 11 matched nonpsychiatric control subjects. Area 9 in BPD was characterized by reduced neuronal density in layer III (16%-22%) and reduced pyramidal cell density in layers III and V (17%-30%). A 19% reduction in glial density was found in sublayer IIIc coupled with enlargement and changes in shape of glial nuclei spanning multiple layers." }, { "role": "assistant", "content": "The morphologic signature of BPD, i.e., decreased neuronal and glial density in association with glial hypertrophy, is distinct from previously described elevations in neuronal density in SCHZ, instead resembling the reductions in cell density found in MDD. Thus, the neuropathologic distinctions between BPD and SCHZ are indicative of separate mental illnesses, each with a unique morphologic disturbance of specific neural circuits. 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: Contact Lenses, Cornea, Corneal Ulcer, Diagnosis, Differential, Diagnostic Techniques, Ophthalmological, Humans, Keratitis, Prospective Studies, Severity of Illness Index." }, { "role": "user", "content": "Can subtypes of contact lens-associated corneal infiltrative events be clinically differentiated? Context: A schema has recently been described for clinical differentiation among 4 symptomatic subtypes of contact lens-associated corneal infiltrative events (CIEs): microbial keratitis (MK), contact lens-induced peripheral ulcer (CLPU), contact lens-induced acute red eye (CLARE), and infiltrative keratitis (IK). The clinical utility of this schema has been challenged in the literature. The aim of this study is to determine whether it is possible to clinically differentiate among these conditions. Criteria for MK, CLPU, CLARE, and IK were applied to a data set of 111 contact lens-associated CIEs, spanning a wide range of clinical severities, presenting consecutively to a hospital clinic. A Venn diagram analysis was used to determine the extent to which these conditions can be clinically differentiated. Of the 111 CIEs, 20% could be classified unambiguously as MK, CLPU, CLARE, or IK, 56% could be classified as 1 of 2 conditions, 13% could be classified as 1 of 3 conditions, and 0% could be classified as 1 of 4 conditions. Eleven percent of CIEs could not be classified as any of the 4 conditions." }, { "role": "assistant", "content": "Although the etiology of CIEs is multifactorial, the considerable overlap between the clinical presentation of MK, CLPU, CLARE, and IK is such that it is not possible to clinically differentiate between them with any degree of certainty. A preferred approach might be to consider CIEs as part of a disease continuum whereby these events can manifest in various degrees of severity, depending as well on the point at which the condition is observed in the course of the natural history of the disease." } ]

[ { "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: Acute Disease, Aged, Aldosterone, Cohort Studies, Female, Heart Failure, Hospitalization, Humans, Longitudinal Studies, Male, Middle Aged, Multivariate Analysis, Patient Readmission, Prognosis, Proportional Hazards Models, Risk Factors, Stroke Volume." }, { "role": "user", "content": "Is serum aldosterone associated with mortality and re-hospitalization in patients with reduced ejection fraction hospitalized for acute heart failure : analysis from the EVEREST trial? Context: Post-discharge morbidity and mortality for acute heart failure (AHF) patients remains high. Although the adverse effects of neurohormonal activation are well known in chronic HF, the prognostic significance of serum aldosterone in patients hospitalized for AHF has not been well studied. A secondary analysis was carried out of the placebo arm (n = 1850) from the EVEREST trial which had aldosterone measured at baseline. All patients were hospitalized for worsening HF and had an LVEF <40%. The median follow-up was 9.9 months. The association between serum aldosterone levels at baseline and the independently adjudicated outcomes [all-cause mortality (ACM) and the combined outcome of cardiovascular mortality (CVM) and HF re-hospitalization] were explored with multivariable Cox models. Median aldosterone levels increased during the hospital stay from 11 ng/dL at baseline to 15 ng/dL at discharge (P < 0.001) and remained increased after discharge (16 ng/dL at 24 weeks, P < 0.001). After adjusting for potential confounders, higher baseline aldosterone levels were associated with an increased risk for ACM and CVM or HF re-hospitalization [hazard ratio (HR) 1.49, 95% confidence intrerval (CI) 1.11-1.99; and HR 1.40, 95% CI 1.11-1.78, respectively, in the highest quartile when compared with the lowest]." }, { "role": "assistant", "content": "In patients with LVEF <40% hospitalized for AHF and receiving standard therapy, serum aldosterone levels correlated with worse post-discharge outcomes. Aldosterone levels increase during AHF hospitalization and remain increased long after discharge. These results suggest that further modulation of the renin-angiotensin-aldosterone system in patients admitted with worsening HF might favourably improve post-discharge 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: Benchmarking, Clinical Competence, Florida, General Surgery, Hospitals, University, Humans, Injury Severity Score, Outcome Assessment (Health Care), Time Factors, Trauma Centers, Workforce, Wounds and Injuries." }, { "role": "user", "content": "Do trauma surgeon mortality rates correlate with surgeon time at institution? Context: Trauma centers have been created to bring traumatized patients together with experienced surgeons. We reviewed our outcomes to determine if mortality rates for high Injury Severity Scores (>or= 35) correlate with surgeon experience at our trauma center. Using our prospectively collected database, we compared our results with mean mortality for high-volume American College of Surgeon-certified trauma centers reporting to the National Trauma Data Bank. Mortality rates for our 11 trauma surgeons were correlated with years of experience as faculty surgeons at our institution during a 2-year period. Statistical analysis was done with chi-square or weighted linear regression; significance was defined as p < 0.05. Our trauma center mortality rates were significantly below the mean rates of National Trauma Data Bank at all levels of injury (chi-square, p < 0.05). Despite this success, there was a significant correlation between years of experience as a surgeon at our institution and improved outcomes for patients with an Injury Severity Score >or= 35 (weighted linear regression, p < 0.05). It took, on average, 7.9 years of experience at our trauma center to reach benchmark mortality rates." }, { "role": "assistant", "content": "Mortality rates for severely injured patients correlate significantly with surgeon experience at our institution. The training process does not end with fellowship or surgical residency, and surgeons new to an institution should be closely monitored and mentored to minimize mortality rates of severely injured patients. Even at a very high volume trauma center with overall results substantially better than mean expected survival, we can demonstrate that experience makes a difference. 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 storage triacylglycerol are hydrolysed by:" }, { "role": "assistant", "content": "The correct answer is Ans. D. Hormone sensitive lipase(Ref: Harper 31/e page 244)Pancreatic lipase to hydrolyse dietary TGsLipoprotein lipase to hydrolyse TGs in lipoprotein in the bloodLysosomal hydrolase to act on TGs in lysosomes" } ]

[ { "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, Antibodies, Neutralizing, Betacellulin, Cell Proliferation, Cells, Cultured, Diabetes Mellitus, Experimental, Gene Expression Regulation, Inhibin-beta Subunits, Insulin-Secreting Cells, Male, Nerve Growth Factor, RNA, Messenger, Rats, Wistar, Signal Transduction." }, { "role": "user", "content": "Does nerve growth factor neutralization suppress β-cell proliferation through activin A and betacellulin? Context: The aim of this study was to investigate the effects of nerve growth factor (NGF) neutralization on synthesis and secretion of activin A (Act-A) and betacellulin (BTC) from primary β cells and the importance of these relations for β-cell proliferation. β Cells were isolated from euglycemic and streptozotocin-induced (75 mg/kg) hyperglycemic rats and treated with NGF neutralization antibody. The gene expression levels of Act-A and BTC in the primary β cells were evaluated using quantitative real-time polymerase chain reaction. The cellular and secreted levels of Act-A and BTC proteins were estimated using Western blot analysis. Nerve growth factor neutralization (1) reduced β-cell proliferation, (2) decreased Act-A at gene expression and protein levels while increasing its secretion from β cells, and (3) increased BTC at gene expression level while mildly decreasing its cellular protein level and secretion from β cells. Nerve growth factor neutralization specifically affected β cells of hyperglycemic rats." }, { "role": "assistant", "content": "These findings indicate that NGF is an important regulator for the synthesis and secretion of Act-A and BTC from the β cells. Moreover, the results suggested that β-cell proliferation decreased through NGF neutralization is possibly related to decreased BTC and increased Act-A secretion from β cells of hyperglycemic rats. 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": "Repeated use of halothane causes" }, { "role": "assistant", "content": "The correct answer is A i.e. Hepatitis" } ]

[ { "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, Animals, Apoptosis, Base Sequence, Binding Sites, CDC2-CDC28 Kinases, Carcinoma, Carcinoma, Papillary, Carrier Proteins, Case-Control Studies, Cell Cycle Proteins, Cell Line, Tumor, Cell Proliferation, Cell Transformation, Neoplastic, Disease Models, Animal, Female, Gene Expression, Gene Expression Regulation, Neoplastic, Humans, Male, Mice, MicroRNAs, RNA Interference, Signal Transduction, Spheroids, Cellular, Thyroid Cancer, Papillary, Thyroid Neoplasms, Tumor Burden, Tumor Cells, Cultured, Xenograft Model Antitumor Assays." }, { "role": "user", "content": "Do miR-26a and its target CKS2 modulate cell growth and tumorigenesis of papillary thyroid carcinoma? Context: While many studies have shown that levels of miR-26a are lower in papillary thyroid carcinoma (PTC), the role and mechanism of miR-26a in PTC are unclear. We used database searches to select potential mRNA targets of miR-26a. Anti-miR-26a, miR-26a mimic, siRNA for CKS2 and their effects on cell growth, cell-cycle distribution and colony formation were evaluated. We also evaluate the over-expressed miR-26a in TPC-1 cells in severe combined immune-deficient mice. We used luciferase reporter assays, real-time PCR and western blot analysis to measure the expression and activity of miR-26a, CKS2, and related factors such as cyclin B1, cyclin A, cdk1, bcl-xl and Akt. Finally, we measured the relationship between the levels of miR-26a and CKS2 in PTC and normal thyroid tissues. Relative to normal thyroid tissues, miR-26a is consistently down-regulated in TPC specimens, and CKS2 was identified as a potential target. Up-regulated miR-26a expression or down-regulated CKS2 expression in TPC-1 and CGTH W3 cells lines caused G2 phase-arrest. Decreased miR-26a expression or increased CKS2 expression could have inverse function on PTC cell lines. CyclinB1, cyclinA, bcl-xl and AKt are indirectly regulated by miR-26a in a CKS2-dependent manner. Finally, CKS2 is overexpressed in PTC specimens relative to normal thyroid tissue, and a significant inverse correlation exists between miR-26a and CKS2 expression in clinical PTC specimens." }, { "role": "assistant", "content": "Our data indicate that miR-26a functions as a growth-suppressive miRNA in PTC, and that its suppressive effects are mediated mainly by repressing CKS2 expression. 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 pregnant patient with prosthetic valve should be switched to heparin (from warfarin) at -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'b' i.e., 36 weeks a) In pregnancy warfarin should be replaced by heparin prior to conception and continued throughout the first trimester (In early pregnancy , warfarin damages organogenesis in fetus). b) After the first trimester heparin should he replaced by warfarin and continued upto term (continued exposure to heparin cause osteoporosis). c) Warfarin should be discontinued near term and heparin can be substituted at this stage (warfarin exacerbates neonatal hypoprothrombinemia and its control is too imprecise to be safe in labour where as heparin can be discontiuned just before labour and its anticoagulant effect wears off in about 6 hrs)." } ]

[ { "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: Adult, Case-Control Studies, Cells, Cultured, Dendritic Cells, Down-Regulation, Female, Guanosine, Hepatitis B, Chronic, Humans, Interferon-alpha, Leukocytes, Mononuclear, Male, Middle Aged, Oligodeoxyribonucleotides, Toll-Like Receptor 7, Toll-Like Receptor 9, Viral Load." }, { "role": "user", "content": "Does downregulation of TLR7/9 lead to deficient production of IFN-α from plasmacytoid dendritic cells in chronic hepatitis B? Context: To investigate whether Toll-like receptor (TLR) 7 and TLR9-mediated interferon α (IFN-α) production in plasmacytoid dendritic cells (pDCs) is compromised in patients with chronic hepatitis B virus (HBV) infection. Peripheral blood mononuclear cells (PBMCs) were prepared from 32 chronic HBV patients and 13 healthy volunteers, and treated with loxoribine or cytidine phosphate guanosine (CpG) oligodeoxynucleotides (ODN). Interferon α in the supernatant was measured by sandwich ELISA. PDC frequency and the expression levels of TLR7 and TLR9 in pDCs were quantified by flow cytometry. The serum viral load of HBV was quantified using a highly sensitive real-time PCR kit. Compared to cells from healthy control group, PBMCs and pDCs from the HBV group showed significantly decreased production of IFN-α in response to ligand for TLR7 (loxoribine) and TLR9 (CpG ODN, P < 0.05). Mechanistically, the number of pDCs in peripheral blood, and the expression of pDC-associated TLR7 and TLR9 were significantly lower in HBV group than in the healthy control group (P < 0.05). In addition, the number of pDCs and the expression of TLR9 on pDCs were correlated inversely with the serum load of HBV." }, { "role": "assistant", "content": "Impaired IFN-α production from pDC may contribute to the immunopathogenesis of chronic HBV infection, which may be the result of a reduced amount of pDCs as well as decreased expression of TLR7 and TLR9 on pDCs. 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: Aged, Cholesterol, HDL, DNA-Binding Proteins, Diabetes Mellitus, Type 2, Female, Genetic Linkage, Ghrelin, Humans, Korea, Male, Middle Aged, Peptide Hormones, Phenotype, Polymorphism, Genetic, Promoter Regions, Genetic, Sequence Analysis, DNA, Transcription Factors, Transcriptional Activation." }, { "role": "user", "content": "Are polymorphisms in the ghrelin gene associated with serum high-density lipoprotein cholesterol level and not with type 2 diabetes mellitus in Koreans? Context: Ghrelin is known to play a role in glucose metabolism and in beta-cell function. There are controversies regarding the role of ghrelin polymorphisms in diabetes and diabetes-related phenotypes. The objective of this study was to examine polymorphisms of the ghrelin gene in a Korean cohort and investigate associations between them and susceptibility to type 2 diabetes and its related phenotypes. The ghrelin gene was sequenced to identify polymorphisms in 24 DNA samples. Common variants were then genotyped in 760 type 2 diabetic patients and 641 nondiabetic subjects. Genetic associations with diabetes-related phenotypes were also analyzed. Nine polymorphisms were identified, and four common polymorphisms [g.-1500C>G, g.-1062G > C, g.-994C > T, g.+408C > A (Leu72Met)] were genotyped in a larger study. The genotype distributions of these four common polymorphisms in type 2 diabetes patients were similar to those of normal nondiabetic controls. However, these four common polymorphisms were variably associated with several diabetes-related phenotypes, such as high-density lipoprotein (HDL) cholesterol, fasting plasma glucose, and homeostasis model assessment of insulin resistance. In particular, subjects harboring g.-1062C were associated with a lower serum HDL cholesterol level after adjusting for other variables (P = 0.0004 or 0.01 after Bonferroni correction for 24 tests)." }, { "role": "assistant", "content": "The aforementioned four common polymorphisms in the ghrelin gene were not found to be significantly associated with susceptibility to type 2 diabetes mellitus in the Korean population. However, the common polymorphism g.-1062G > C in the promoter region of the ghrelin gene was found to be significantly associated with serum HDL cholesterol levels. 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": "Phossy jaw is caused by -" }, { "role": "assistant", "content": "The correct answer is Phossy jaw or glass jaw :. It is osteomyelitis of jawbone (lower jaw) due to chronic white phosphorus poisoning. Initially there is toothache in caries tooth with swelling of gums. There is loosening of teeth, sloughing of gums followed by necrosis, sequestration and osteomyelitis of mandible. REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO 313" } ]

[ { "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 variation in instrument-based color coordinate of esthetic restorative materials by measurement method-A review? Context: Optical properties of an object are determined visually or instrumentally. Although instrumental measurement provides objective and quantitative color coordinates, these values vary by the measurement method such as specimen and background conditions, instrument settings and illuminant. The objective of this study was to review the influence of the measurement method on the instrumental color coordinates of esthetic dental restorative materials. Published reports on the measurement method dependent color variations of esthetic restorative materials were reviewed. Surface roughness influences the color coordinates differently by the surface roughness range and the measurement geometry. Specimen thickness and the kind of illuminant influence the color coordinates, and the influence of background varied by specimen thickness. Therefore, the specular component excluded (SCE) geometry that reflects the surface condition of specimens is suggested as the correct measurement geometry. Surface roughness, thickness and layering of specimens, and the kind of illuminant should be stipulated in each measurement. There should be a standard for the color and gloss of the background." }, { "role": "assistant", "content": "Variables in instrumental color measurements should be stipulated to obtain consistent and comparable color coordinates, and a general guideline for instrumental color measurement of dental materials should be established. 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: Adolescent, Child, Child, Preschool, Epilepsy, Family Health, Female, Genetic Heterogeneity, Genetic Linkage, Genetic Predisposition to Disease, Humans, Incidence, Infant, Infant, Newborn, KCNQ2 Potassium Channel, Male, Mutation, NAV1.1 Voltage-Gated Sodium Channel, Nerve Tissue Proteins, Newfoundland and Labrador, Phenotype, Retrospective Studies, Sodium Channels." }, { "role": "user", "content": "Is high incidence of pediatric idiopathic epilepsy associated with familial and autosomal dominant disease in Eastern Newfoundland? Context: To describe the incidence and epidemiology of pediatric idiopathic epilepsy (IE) in Newfoundland and Labrador. All children in Newfoundland and Labrador aged 0-15 years with IE were ascertained through the provincial neurology clinic at the Janeway Child Health Centre. Family history, medical history and blood samples were obtained from probands and relatives. Two genes, SCN1A and KCNQ2, were screened for mutations by direct sequencing. The mean annual incidence of IE for the population of children living in the Avalon region of Newfoundland from 2000 to 2004 was 107 per 100,000. This rate is approximately three-fold greater than rates reported in other developed countries. Of 117 families with IE eligible for study, 86 (74%) provided detailed pedigree data. Multiple different epilepsy phenotypes were identified. Fifty-five families (64%) had a positive family history. Eight of these had family histories compatible with autosomal dominant (AD) inheritance and these families lived in five different geographic isolates. DNA was obtained from 21 families (79 individuals). The two previously identified mutations in Newfoundland families with epilepsy were sequenced and excluded as pathogenic sites in all but one family which had a mutation in SCN1A." }, { "role": "assistant", "content": "The incidence of IE is high in the Avalon Peninsula of Newfoundland and the rate of familial disease is high throughout the province of Newfoundland and Labrador. The distribution of familial and AD IE in different geographic isolates, together with the clinical heterogeneity of disease suggests substantial genetic heterogeneity. It is likely that other novel mutations will be identified in this population. 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: Adult, Aged, Aged, 80 and over, Brain Ischemia, Carotid Stenosis, Endarterectomy, Carotid, Female, Follow-Up Studies, Humans, Intracranial Embolism, Male, Middle Aged, Predictive Value of Tests, Recurrence, Ultrasonography, Doppler." }, { "role": "user", "content": "Do doppler microembolic signals predict ischemic recurrences in symptomatic carotid stenosis? Context: To assess if Doppler microembolic signals (MES) associated with > or = 60% symptomatic extracranial carotid stenosis may predict ischemic recurrences before endarterectomy or angioplasty. All patients with > or = 60% carotid stenosis with symptoms in the preceding 2 months were prospectively considered. MES were identified using current criteria. All patients were followed-up until endarterectomy or angioplasty. We studied 50 patients, at a median of 7 days from their last symptom. Twenty patients showed MES (40.0%); median embolus rate was 4/h. During a median follow-up of 19 days 7 patients had recurrences (transient monocular blindness = 2; TIAs=4; stroke=1); 6 of them had shown MES. The association between recurrences and MES was significant (P=0.012)." }, { "role": "assistant", "content": "MES may identify patients with symptomatic carotid stenosis who are likely to suffer an ischemic recurrence before endarterectomy. This information may affect medical treatment and referral to the vascular surgeon. 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: Age Factors, Aged, Cognition, Humans, Magnetic Resonance Imaging, Male, Mental Processes, Middle Aged, Myelin Sheath, Nerve Fibers, Myelinated, Neuropsychological Tests, Time Factors." }, { "role": "user", "content": "Does myelin breakdown mediate age-related slowing in cognitive processing speed in healthy elderly men? Context: To assess the hypothesis that in a sample of very healthy elderly men selected to minimize risk for Alzheimer's disease (AD) and cerebrovascular disease, myelin breakdown in late-myelinating regions mediates age-related slowing in cognitive processing speed (CPS). The prefrontal lobe white matter and the genu of the corpus callosum myelinate later in brain development (late-myelinating white matter; LMWM) and are more vulnerable to breakdown due to the effects of normal aging. An in vivo MRI biomarker of myelin integrity (transverse relaxation rates; R(2)) of LMWM was obtained for 38 very healthy elderly adult men (mean age=66.3 years; SD=6.0; range=55-76). To evaluate regional specificity, we also assessed a contrasting early-myelinating region (splenium of the corpus callosum; SWM), which primarily contains axons involved in visual processing. CPS was assessed using the Trail Making Test. LMWM R(2) and CPS measures were significantly correlated (r=.515, p=.0009), but no significant association between R(2) and CPS was detected in the splenium (p=.409). LMWM R(2), but not SWM R(2), was a significant mediator of the relationship between age and CPS (p=.037)." }, { "role": "assistant", "content": "In this very healthy elderly sample, age-related slowing in CPS is mediated by myelin breakdown in highly vulnerable late-myelinating regions but not in the splenium. 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: Aged, Antihypertensive Agents, Biomarkers, Blood Pressure, Cardiovascular Diseases, Cerebrovascular Disorders, Female, Humans, Male, Middle Aged, Natriuretic Peptide, Brain, Peptide Fragments, Perindopril, Risk Factors." }, { "role": "user", "content": "Does perindopril-based blood pressure-lowering therapy reduce amino-terminal-pro-B-type natriuretic peptide in individuals with cerebrovascular disease? Context: The plasma amino-terminal-pro-B-type natriuretic peptide (NT-proBNP) level predicted congestive heart failure, myocardial infarction, and ischaemic stroke in participants of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a placebo-controlled study of the effects of blood pressure lowering on cardiovascular events among individuals with cerebrovascular disease. Active treatment comprised a flexible regimen based on perindopril, with the addition of indapamide at the discretion of treating physicians. Active treatment reduced cardiovascular events, and we therefore investigated whether active treatment modified NT-proBNP and other cardiovascular risk factors. We measured NT-proBNP and other cardiovascular risk factors at randomization and after 13 months of therapy in a subset of 357 PROGRESS participants. Baseline systolic and pulse pressures were higher in individuals with elevated baseline NT-proBNP levels. In comparison with placebo, active treatment reduced the blood pressure and NT-proBNP levels, and increased renin levels. Reduction of NT-proBNP levels by active treatment was most evident in individuals with baseline NT-proBNP levels in the highest quarter (> 26 pmol/l), with a median reduction of 16 pmol/l (interquartile range 0-51 pmol/l, P = 0.004), corresponding to a median decrease of 39% (interquartile range 0-69%). Active treatment reduced blood pressure similarly for individuals in each of the four quarters of baseline NT-proBNP. Active therapy had no effect on plasma lipid, C-reactive protein, homocysteine, or soluble vascular cell adhesion molecule 1 levels." }, { "role": "assistant", "content": "We conclude that plasma NT-proBNP level, in addition to predicting cardiovascular risk, may provide a measure of risk reduction by blood pressure-lowering therapy. 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: Adolescent, Analgesia, Patient-Controlled, Analgesics, Opioid, Anesthesia, General, Double-Blind Method, Drug Administration Schedule, Female, Humans, Hyperalgesia, Intraoperative Care, Male, Morphine, Orthopedic Procedures, Pain Measurement, Pain, Postoperative, Piperidines, Premedication, Prospective Studies, Remifentanil, Scoliosis." }, { "role": "user", "content": "Does pre-treatment with morphine prevent the development of remifentanil-induced hyperalgesia? Context: Remifentanil, an ultra short-acting opioid commonly used to supplement general anesthesia, is associated with the development of hyperalgesia that manifests clinically as an increase in postoperative analgesic requirement. This study involving adolescents undergoing scoliosis surgery evaluated whether pre-treatment with morphine prior to commencing remifentanil infusion would decrease the initial 24-hr morphine consumption and pain scores. Forty ASA I-II pediatric patients undergoing surgical correction of idiopathic scoliosis were recruited in a prospective, randomized, double-blind fashion to receive 150 microg x kg(-1) morphine or an equal volume saline prior to commencing remifentanil by infusion. The primary outcome was the initial 24-hr postoperative morphine consumption. Numeric rating scale (NRS) pain scores at rest and on coughing were recorded, as were scores for nausea, vomiting, and sedation and incidences of pruritus. The groups were demographically similar. No differences were observed between groups vis-à-vis the initial 24-hr morphine consumption, NRS pain scores, sedation, nausea, or vomiting." }, { "role": "assistant", "content": "Pre-treatment with 150 microg x kg(-1) morphine did not decrease the initial 24-hr morphine consumption in adolescents who received remifentanil by infusion for surgical correction of idiopathic scoliosis. 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: ." }, { "role": "user", "content": "Does not every diabetic child have type 1 diabetes mellitus? Context: Although it is type 1 diabetes mellitus of autoimmune origin that is most prevalent in childhood and adolescence, other forms of diabetes can also affect this population, resulting in different prognosis and treatment. Information was obtained by means of a bibliographic review, carried out by running searches for scientific articles in the MEDLINE and LILACS databases, in addition to classic publications on the subject, with the most representative being chosen. This article discusses the pathophysiological mechanisms, clinical presentation and treatment of the various forms of diabetes that affect the pediatric age group, such as type 1 diabetes mellitus , type 2 diabetes mellitus, maturity-onset diabetes of youth, neonatal diabetes, mitochondrial diabetes, diabetes of generalized lipodystrophy, diabetes secondary to other pancreatic diseases, diabetes secondary to other endocrine diseases, diabetes associated with infections and cytotoxic drugs and diabetes related to certain genetic syndromes." }, { "role": "assistant", "content": "Recognition of the primary pathophysiologic mechanism of the form of diabetes presented can guide specific treatment, optimizing metabolic control and minimizing complications over the long term. 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": "Superior oblique muscle performs action of -a) Intortionb) Extortion c) Elevationd) Medial rotation" }, { "role": "assistant", "content": "The correct answer is The primary action of superior oblique muscle is intorsion.The subsidiary actions are depression and abduction.\nDont get confuse by option d. Intorsion is also called medial rotation or internal rotation and extorsion is also called lateral rotation or external rotation.\n\nNote:-\nKhurana has mentioned medial rotation as adduction and lateral rotation as abduction. This is incorrect. I have checked it from various standard textbook of ophthalmology and also from internet. If you dont believe, read following statments:-\n\"Superior rectus causes elevation (upward movement), adduction and intorsion (medial rotation) of the eye\".— Clinical ophthalmology\n\"Contraction of superior oblique muscle causes depression, medial rotation and abduction\". — Oswald steward\n\"The rolling movement of eye towards the nose is called intorsion or medial rotation while rolling movement away from nose is called extorsion or lateral rotation\".  — Textbook of practical physiology" } ]

[ { "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, Analysis of Variance, Biomechanical Phenomena, Child, Child, Preschool, Cohort Studies, Female, Funnel Chest, Humans, Male, Radiography, Thoracic, Scoliosis, Thoracic Vertebrae, Thorax, Tomography, X-Ray Computed, Young Adult." }, { "role": "user", "content": "Do mechanical factors play an important role in pectus excavatum with thoracic scoliosis? Context: This study investigated the incidence, imaging characteristics and mechanical factors in scoliotic patients with pectus excavatum. A total of 142 scoliostic patients with pectus excavatum were evaluated prior to operation. The evaluation included a complete physical exam, phenotype and severity of the pectus excavatum, incidence and severity of scoliosis, and analysis of radiological images, including calculation of the Haller index. Twenty five out of 142 patients (17.61%) with pectus excavatum had scoliosis with a Cobb angle >10 degrees, and in 80.00% of the cases the spinal column was bent to the right. Seventeen patients had bent-to-the-right spines that involved the 6th to 10 th thoracic vertebrae. We found that 23 out of 25 patients with a Cobb angle more than 10° were teenagers and adults. The incidence of scoliosis was only 6.06% in the children under 11 years whereas it was 21.79% in the teenage group." }, { "role": "assistant", "content": "Mechanical forces appear to play a role in the coexistence of pectus excavatum and scoliosis. There is a relationship between age, severity (Haller index), asymmetry and scoliosis. The heart and mediastinum play a role in providing an outward force to the left of the sternum which may be an important reason for the coexistence of pectus excavatum and scoliosis, but the correlation needs further proof. 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": "Biopsy of the exposed surface of the palatine tonsil reveals the following type of tissue" }, { "role": "assistant", "content": "The correct answer is The palatine tonsil is situated at the oropharyngeal isthmus. Its oral aspect is covered with stratified squamous nonkeratinized epithelium, which dips into the underlying tissue to form the crypts. The lymphocytes lie on the sides of the crypts in the form of nodules. The tonsil has two surfaces medial and lateral. The medial surface is covered by stratified squamous epithelium continuous with that of the mouth. Ref: BD Chaurasia's HUMAN ANATOMY, Volume 3, 4th edition." } ]

[ { "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 38-year-old man presents to his physician with recurrent episodes of facial swelling and abdominal pain. He reports that these episodes started when he was approximately 16 years of age. His mother also has similar episodes of swelling accompanied by swelling of her extremities. The vital signs include: blood pressure 140/80 mm Hg, heart rate 74/min, respiratory rate 17/min, and temperature 36.6℃ (97.8℉). His physical examination is unremarkable. The laboratory work-up shows the following findings:\nTest Result Normal range\nC1 esterase inhibitor 22% > 60%\nComplement C4 level 9 mg/dL 14–40 mg/dL\nComplement C2 level 0.8 mg/dL 1.1–3.0 mg/dL\nComplement component 1q 17 mg/dL 12–22 mg/dL\nWhich of the following anti-hypertensive medications is contraindicated in this patient?" }, { "role": "assistant", "content": "Fosinopril" } ]

[ { "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: Angina Pectoris, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Myocardial Infarction, Prospective Studies, ROC Curve, Risk Assessment, Risk Factors, Thrombolytic Therapy, Treatment Outcome." }, { "role": "user", "content": "Can a modified thrombolysis in myocardial infarction risk score outperform the original for risk stratifying emergency department patients with chest pain? Context: The thrombolysis in myocardial infarction (TIMI) risk score has been shown to risk stratify patients with suspected acute coronary syndromes (ACS) effectively in the emergency department (ED) but cannot be used to guide patient disposition. We aimed to evaluate whether modifying the TIMI risk score to give greater weighting to ischaemic ECG changes and troponin elevations would enhance its risk stratification and thus potentially facilitate safe patient discharge after 12-h troponin testing. A prospective diagnostic cohort study was performed within the ED at Manchester Royal Infirmary, a university-affiliated teaching hospital with an annual ED census of approximately 145,000 patients. 804 patients who had presented to the ED with suspected cardiac chest pain were recruited. All patients underwent 12-h troponin T testing and were followed up by telephone and chart review after 30 days for the composite primary outcome of death, acute myocardial infarction (AMI) or urgent coronary revascularisation. The modified TIMI risk score outperformed the original (area under the receiver operator characteristic curve 0.87 versus 0.77, p<0.001). Using a cut-off of more than 2 points the score had a sensitivity of 96.4% for the prediction of 30-day events. The specificity of the score was only 51.0%, suggesting that in practice over 40% of patients would be ineligible for discharge even after troponin testing." }, { "role": "assistant", "content": "Modifications to the TIMI risk score can improve its performance in the risk stratification of patients presenting to the ED with chest pain. However, a lack of specificity may still limit its use for guiding patient disposition after troponin testing." } ]

[ { "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: Confounding Factors (Epidemiology), Delivery, Obstetric, Episiotomy, Female, Humans, Parity, Perineum, Pregnancy, Prevalence, Regression Analysis, Rupture, Vagina." }, { "role": "user", "content": "Is there a benefit to episiotomy at operative vaginal delivery? Context: Our purpose was to examine the association between maternal vaginal and perineal morbidity and episiotomy performed at operative vaginal delivery. We obtained data from 2041 consecutive operative vaginal deliveries and compared yearly rates of episiotomy, lacerations, and potential confounders with linear regression and stratified analyses. Between 1984 and 1994 the use of episiotomy for operative vaginal deliveries fell significantly (93.4% to 35.7%, R2 = 0.85, p = 0.0001). This change was associated with a rise in the rate of vaginal lacerations (16.1% to 40.0%, R2 = 0.80, p = 0.0002), a decrease in the rate of fourth-degree lacerations (12.2% to 5.4%, R2 = 0.62, p = 0.004), but no significant change in the rate of third-degree lacerations. These associations held in separate analyses stratified by parity and type of instrument used for delivery. The prevalence of other previously reported risks for perineal morbidity did not change during the study period." }, { "role": "assistant", "content": "At our institution a statistically and clinically significant reduction in the use of episiotomy for operative vaginal deliveries was not associated with a change in the rate of third-degree lacerations but was associated with an increase in the rate of vaginal lacerations and a decrease in the rate of fourth-degree lacerations." } ]

[ { "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, Antibodies, Monoclonal, Cell Death, Chemotaxis, Immunohistochemistry, Macrophage-1 Antigen, Neuroglia, Phagocytosis, Phosphotyrosine, Photoreceptor Cells, Rats, Rats, Mutant Strains, Retina, Retinal Degeneration." }, { "role": "user", "content": "Do microglial cells invade the outer retina as photoreceptors degenerate in Royal College of Surgeons rats? Context: Photoreceptor degeneration is accompanied by the invasion of phagocytic cells into the outer retina of Royal College of Surgeons (RCS) rats. Previous studies suggested that these mononuclear phagocytes were blood-borne macrophages and not retinal pigment epithelial cells nor Müller glia. Thus, immunospecific markers were used to identify these cells and to determine their distribution in the dystrophic retina. Retinas from RCS and control (RCS-rdy+) rats were processed for immunocytochemistry using antibodies against phosphotyrosine, which labels both microglial cells and peripheral macrophages, and ED2, which labels peripheral macrophages only. As a positive control to demonstrate ED2-labeling of peripheral macrophages that enter the retina during injury, experiments were performed using needle-punctured Long Evans rat retinas. In normal animals, process-bearing, phosphotyrosine-reactive cells were restricted to the inner retinal layers and the outer plexiform layer. In early dystrophic retinas, phosphotyrosine-reactive cells also were observed in the outer retinal layers. The number of phosphotyrosine-labeled cells in the outer retina increased substantially in later stages of dystrophy. ED2-reactive cells were observed in normal or dystrophic retinas only after needle puncture." }, { "role": "assistant", "content": "These findings suggest that phagocytic cells during the early stages of dystrophy in RCS rat retinas are derived from resident microglial cells, not from peripheral macrophages. The migration of microglial cells into the outer retina when photoreceptor cells begin to degenerate further suggests that they may play a major role in photoreceptor cell death in the dystrophic retina. 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": "Which renal stone is radiolucent?" }, { "role": "assistant", "content": "The correct answer is Ans. (c) Uric acidRef: Robbiris 8thed Table 20-12, Sabiston Textbook of Surgery, 18thed chapter 77," } ]