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[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: PURPOSE, METHODS, RESULTS. Meshes: Attitude of Health Personnel, General Surgery, Internship and Residency, Professional Practice, Surveys and Questionnaires, United States." }, { "role": "user", "content": "Are you a surgical role model? Context: Multiple papers have examined the recent decline in the number of surgical residency applicants. Many have concluded that a lack of role models in surgery is at least partially responsible for this decline. However, to date, the definition of a surgical role model does not exist. This paper defines a surgical role model based on criteria determined by surgery residents. Fourth- and fifth-year surgical residents from 1 residency program were asked to collaboratively define 9 characteristics that make a surgical role model. The 9 criteria as defined by the residents were didactic teaching, teaching rounds, attendance at didactic activities, demonstrates skills and decision making in the operating room with confidence and virtuosity, allows [resident] to do procedures according to ability, allows autonomy to make independent decisions, provides feedback, stimulates critical thinking with use of literature, and assists [resident]to find and complete research for publication. Each resident in the program was then given a questionnaire and asked to evaluate each of the 49 teaching attendings on each of the 9 criteria, on a 3-point scale. Finally, residents evaluated each attending based on professionalism and mutual respect on a scale of I Don't Want To Emulate Him/Her, OK, or Role Model. These categories were also assigned a number (1, 2, and 3, respectively). Pearson correlation and stepwise multiple regression were used to determine the relationship between \"Role Model\" and the 9 criteria. The unit of analysis was the mean rating given each attending on each of the 10 scales. A total of 847 questionnaires were analyzed. Each of the 9 criteria correlated significantly with the Role Model rating (all p<0.01). The average correlation was 0.73 (range, 0.64 to 0.78). Of the 9 criteria, 4 correlated best with the Role Model, as shown in. The stepwise regression indicates that 3 of the 9 criteria are uniquely associated with the Role Model variable. These 3 criteria are stimulates critical thinking with use of literature, allows autonomy to make independent decisions, and attendance at didactic activities." }, { "role": "assistant", "content": "All of the 9 criteria are important factors in residents' perception of the Role Model characteristics of attending faculty. A parsimonious, operational definition of the surgical attending role model is one who stimulates the resident to think, gives the resident the opportunity to think and act independently, and is available to the resident." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVES, METHODS, RESULTS. Meshes: Case-Control Studies, Cesarean Section, Female, Humans, Leiomyoma, Middle Aged, Pregnancy, Retrospective Studies, Risk Factors, Uterine Hemorrhage, Uterine Neoplasms." }, { "role": "user", "content": "Is a history of cesarean section a risk factor for abnormal uterine bleeding in patients with uterine leiomyoma? Context: To determine whether a history of cesarean section was a risk factor for abnormal uterine bleeding in patients with uterine leiomyomas, and to identify other risk factors for this symptom. We analyzed retrospectively, the medical records of patients who underwent hysterectomies due to the presence of uterine leiomyomas during a 6-year period (2009 and 2014) at Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey. Uterine leiomyoma was diagnosed based on histopathological examination of hysterectomy specimens. Demographic characteristics, and laboratory and histopathological findings were compared between patients with uterine leiomyoma with and without abnormal uterine bleeding. In total, 501 (57.9%) patients had abnormal uterine bleeding and 364 (42.1%) patients had other symptoms. A history of cesarean section was more common in patients with abnormal uterine bleeding than in those with other symptoms (17.6% versus 9.3%, p=0.001; odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.3). The presence of a submucosal leiomyoma (OR: 2.1; 95% CI: 1.5-3.1) and coexistent adenomyosis (OR: 1.6; 95% CI: 1.1-2.4) were also associated with abnormal uterine bleeding." }, { "role": "assistant", "content": "A history of cesarean section was an independent risk factor for abnormal uterine bleeding in patients with uterine leiomyomas; submucosal leiomyoma and coexisting adenomyosis were also independent risk factors." } ]

[ { "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, Aromatase, Estradiol, Female, Follicle Stimulating Hormone, Gene Frequency, Genetic Association Studies, Gonadotropins, Homozygote, Humans, Luteinizing Hormone, Microsatellite Repeats, Oocytes, Ovarian Follicle, Ovary, Polymorphism, Genetic, Reproductive Techniques, Assisted." }, { "role": "user", "content": "Do aromatase ( CYP19 ) gene variants influence ovarian response to standard gonadotrophin stimulation? Context: The association of cytochrome P450 aromatase gene CYP19(TTTA) ( n ) polymorphism with ovarian response to FSH stimulation was explored. Three hundred women undergoing medically assisted reproduction and 300 women with at least one spontaneous pregnancy participated in the study. CYP19(TTTA) ( n ) polymorphism was genotyped, while serum hormones were determined. During oocyte retrieval, the follicular size, the follicle and oocyte numbers were recorded. Six CYP19(TTTA) ( n ) alleles with 7 to 12 repeats were revealed. Women homozygous for long CYP19(TTTA) ( n ) alleles presented with lower serum FSH levels at the third day of the menstrual cycle (p < 0.001) and higher large follicle numbers (p < 0.01), compared to women homozygous for short CYP19(TTTA) ( n ) alleles. The CYP19(TTTA) ( 7 ) allele was associated with higher serum FSH levels (p < 0.003), with lower total follicle (p < 0.02) and large follicle numbers (p < 0.03), while CYP19(TTTA) ( 7 ) allele-carriers presented more frequently with small follicles than CYP19(TTTA) ( 7 ) allele-non carriers (p < 0.01)." }, { "role": "assistant", "content": "CYP19 genetic variants were associated with ovarian reserve and response to standard gonadotrophin stimulation of women undergoing in vitro fertilization. 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: Androstadienes, Antimetabolites, Antineoplastic, Ataxia Telangiectasia Mutated Proteins, Cell Cycle Proteins, Cell Line, Tumor, DNA-Binding Proteins, Deoxycytidine, Extracellular Signal-Regulated MAP Kinases, Gene Expression Regulation, Neoplastic, Humans, JNK Mitogen-Activated Protein Kinases, MicroRNAs, Pancreatic Neoplasms, Phosphatidylinositol 3-Kinases, Protein-Serine-Threonine Kinases, Tumor Suppressor Proteins, Up-Regulation, Wortmannin." }, { "role": "user", "content": "Is human SMG-1 involved in gemcitabine-induced primary microRNA-155/BIC up-regulation in human pancreatic cancer PANC-1 cells? Context: Human primary microRNA-155/B-cell integration cluster (BIC) transcript is the precursor of microRNA-155. The overexpression of them has been widely observed in the progression of various types of tumors. Our objective was to investigate the effect of anticancer agents on the expression of BIC and possible signal pathways that involved in. Quantitative real-time reverse transcriptase polymerase chain reaction was used to measure the expression of BIC. Chemical inhibitors against c-Jun N-terminal kinase 1, mitogen-activated protein kinase/extracellular signal-regulated kinase kinase 1/2, protein kinase C, checkpoint kinase 1, and phosphatidylinositol 3 kinase (PI3K) were used for the evaluation of involved signal pathways. RNA interference was used to knock down the expression of ataxia-telangiectasia mutated, ataxia-telangiectasia and Rad3 related, and suppressor of morphogenesis in genitalia-1 (SMG-1), and Western blot was carried out to evaluate the knockdown effect. B-cell integration cluster expression was induced by a representative anti-pancreatic cancer drug, gemcitabine, in human pancreatic cancer PANC-1 cells. The mitogen-activated protein kinase/extracellular signal-regulated kinase kinase 1/2 and c-Jun N-terminal kinase inhibitors, but not the checkpoint kinase 1 and protein kinase C inhibitors, suppressed the up-regulation of BIC. B-cell integration cluster up-regulation was also significantly inhibited by the PI3K inhibitor wortmannin. RNA interference studies showed that wortmannin-sensitive SMG-1 but not ataxia-telangiectasia mutated or ataxia-telangiectasia and Rad3 related was involved in the up-regulation." }, { "role": "assistant", "content": "Our results show that multiple pathways can be involved in the up-regulation of BIC. Furthermore, we demonstrate for the first time that PI3K SMG-1 is required for gemcitabine-induced up-regulation of BIC transcript. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Analysis of Variance, Blood Flow Velocity, Coronary Angiography, Coronary Circulation, Coronary Stenosis, Echocardiography, Female, Humans, Male, Middle Aged, Myocardial Contraction, Myocardial Infarction, Myocardial Reperfusion, Observer Variation." }, { "role": "user", "content": "Does persistence of systolic coronary flow reversal predict irreversible dysfunction after reperfused anterior myocardial infarction? Context: To investigate serial assessments of systolic coronary flow reversal in the infarct related artery for predicting poor left ventricular functional recovery after reperfused acute myocardial infarction. Regional hospital. 49 patients with anterior acute myocardial infarction had transthoracic Doppler echocardiography to record coronary flow velocity in the left anterior descending coronary artery immediately after successful primary coronary angioplasty (day 0), and at 48 hours, one week, and three weeks. Coronary flow velocity at each time point; regional wall motion score index (RWMSI) at day 0 and at three weeks. Irreversible dysfunction was defined as a decrease in RWMSI to < 0.22. Measurements of coronary flow velocity could be made in 45 patients. Patients were divided into three groups: no systolic flow reversal (group 1, n = 27), systolic flow reversal observed only on day 0 (group 2, n = 8), and systolic flow reversal persisting until 48 hours (group 3, n = 10). Although baseline RWMSI was similar among the three groups, the value at three weeks was significantly higher in group 3 than in the other two groups. In predicting irreversible dysfunction, the persistence of systolic flow reversal up to 48 hours had a higher positive predictive value (100%) than the presence of systolic flow reversal on day 0 (67%, p < 0.04). The negative predictive value of systolic flow reversal at 48 hours (83%) was comparable in accuracy to the presence of systolic flow reversal on day 0 (85%, NS)." }, { "role": "assistant", "content": "In reperfused anterior acute myocardial infarction, serial assessment of coronary flow velocity in the left anterior descending coronary artery is feasible using transthoracic Doppler echocardiography, and the persistence of systolic flow reversal at 48 hours is a more specific marker of irreversible dysfunction than peak creatine kinase or diastolic deceleration time. 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: Adult, Aged, Anastomosis, Surgical, Carcinoma, Squamous Cell, Esophageal Neoplasms, Esophageal Stenosis, Esophagectomy, Gastric Fundus, Humans, Middle Aged, Oxygen, Oxygen Consumption, Postoperative Period, Surgical Wound Dehiscence, Wound Healing." }, { "role": "user", "content": "Is tissue oxygen tension during esophagectomy a predictor of esophagogastric anastomotic healing? Context: The genesis of anastomotic leakage and late stenosis of esophagogastrostomy is still unknown, although minimal blood flow and tissue hypoxia of the gastric tube are discussed as main reasons. However, the changes in tissue oxygen tension (PtO2) on esophagogastric anastomoses have not yet been evaluated in the perioperative course. Submucosal tissue oxygen tension (PtO2) was measured in 33 patients with cervical esophagogastrostomy during resection of esophageal carcinoma and reconstruction by a gastric tube. Measurements were taken close to the projected resection line and latter anastomosis using a Clark-type oxygen electrode. Mean baseline PtO2 was 55.1 +/- 10.4 mmHg. Following the ligature of the vasa gastricae brevis and the left gastroepiploic artery (46.1 +/- 9.7 mmHg), the left gastric artery (34.8 +/- 9.8 mmHg), and the pull up of the gastric tube, PtO2 decreased to 25.8 +/- 9.4 mmHg. Anastomotic leakage occurred in 6 patients and late stenosis in 10 patients. During the operation there was no significant evidence of decreased PtO2 levels in these two groups. Postoperative PtO2 levels showed a significant increase in patients with anastomotic leakage." }, { "role": "assistant", "content": "A disorder in oxygen consumption may cause a significant increase of PtO2 in anastomotic tissue, which is associated with anastomotic leakage." } ]

[ { "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: INTRODUCTION, METHODS, RESULTS. Meshes: Foot, Foot Diseases, Humans, Melanoma, Negative-Pressure Wound Therapy, Recovery of Function, Skin Neoplasms, Skin Transplantation, Transplant Donor Site, Wound Closure Techniques." }, { "role": "user", "content": "Closure of Melanoma Defects on the Sole of the Foot Using Glaborous Skin: The End of the Flap? Context: Plantar melanomas are a challenge to reconstruct after wide excision. Non-glaborous skin grafts have resulted in tissue loss, hyperkeratosis, marginal scarring, and poor functional outcomes, leading many to utilize various flaps for reconstruction that are technically demanding and associated with increased failure rates. Glaborous skin is better suited to withstand compressive and shear forces, and provides a more robust graft for plantar defects. Data were collected prospectively. Wide excision to the plantar fascia and sentinel lymph node biopsies were performed as indicated. The defect was treated with negative pressure dressings until granulation tissue was flush with surrounding skin. Two 8/1000 inch grafts were harvested from the ipsilateral non-weight-bearing instep. The epidermis/papillary dermis was replaced on the donor site and the deeper glaborous dermal graft was secured to the defect. This technique is demonstrated in the multimedia file. Primary endpoints were graft take, complication rates, and functional outcomes. Consecutive plantar melanomas of the foot were prepared for glaborous grafting. Mean Breslow thickness was 3.9 mm (range 1.25-10; n = 5), and the average width of the defect was 6.2 cm. Mean follow-up was 304 days. The graft take was 100 %, and pre- and post-surgery results are displayed in the media file and Fig. 1. There were no recipient site complications, incidences of significant hypo- or hyperpigmentation, or hypertrophic scarring at either site. One patient experienced a donor site hematoma without delayed healing or hypertrophic scarring. There were no other donor or recipient site complications. Cosmesis was excellent, with minimal to no residual contour irregularity. Functional outcomes demonstrated a 100 % return to baseline activities without orthotics, including snowboarding and windsurfing." }, { "role": "assistant", "content": "Glabrous dermal grafting of plantar defects after melanoma resection is extremely reliable, affords excellent cosmesis, has minimal to no donor site morbidity, and results in excellent functional outcomes. Flaps are now rarely performed for these patients at our institution. Fig. 1 Plantar melanoma defect before and after split-thickness glaborous skin grafting using the current technique." } ]

[ { "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, HYPOTHESIS, METHODS, RESULTS. Meshes: Aged, Biomarkers, Chi-Square Distribution, Coronary Artery Disease, Female, Heart Failure, Humans, Hyperuricemia, Linear Models, Male, Middle Aged, Multivariate Analysis, Prognosis, Proportional Hazards Models, Randomized Controlled Trials as Topic, Retrospective Studies, Risk Assessment, Risk Factors, Up-Regulation, Uric Acid." }, { "role": "user", "content": "Is serum uric acid level an independent predictor of heart failure among patients with coronary artery disease? Context: Uric acid (UA) is elevated in patients with the metabolic syndrome, and there is a possible association with coronary events. Its association with future risk of heart failure (HF) is not clear. Our objective was to evaluate the association between levels of UA and risk of HF in patients with stable coronary artery disease (CAD). Serum UA is associated with HF in CAD patients. A retrospective cohort analysis among 2939 participants of the bezafibrate infarction prevention study, assessing long-term risk of HF incidence over an 8-year of follow-up in relation to baseline UA. Among patients with high levels of UA, there was a larger proportion of men, systolic hypertension, diabetes mellitus, metabolic syndrome, elevated total cholesterol, chronic renal failure, and previous coronary revascularization procedures. The rate of myocardial infarction during the follow-up was 10.9%, 10.3%, and 11.6% in the 1st, 2nd and 3rd tertiles of UA, respectively (P = 0.68). Age-adjusted hazard ratios for HF were 1.16 (95% confidence interval [CI]: 0.94-1.45) and 1.28 (95% CI: 1.04-1.59) in the 2nd and 3rd tertiles, respectively, as compared to the 1st tertile. After adjusting for multiple confounders and myocardial infarction, the hazard ratio for developing HF was 1.18 (95% CI: 0.95-1.47) and 1.25 (95% CI: 1.00-1.56) in the 2nd and 3rd tertiles of UA levels, respectively." }, { "role": "assistant", "content": "UA levels are associated with future risk of HF in patients with stable CAD, but this association is attenuated after adjusting for traditional CAD risk factors." } ]

[ { "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": "Is termination of Nociceptive Bahaviour at the End of Phase 2 of Formalin Test Attributable to Endogenous Inhibitory Mechanisms , but not by Opioid Receptors Activation? Context: Formalin injection induces nociceptive bahaviour in phase I and II, with a quiescent phase between them. While active inhibitory mechanisms are proposed to be responsible for initiation of interphase, the exact mechanisms which lead to termination of nociceptive response in phase II are not clear yet. Phase II is a consequence of peripheral and central sensitization processes, which can lead to termination of the noxious stimuli responses; 45-60 minutes after formalin injection via possible recruitment of active inhibitory mechanisms which we have investigated in this study. To test our hypothesis, in the first set of experiments, we evaluated nociceptive response after two consecutive injection of formalin (50µL, 2%), with intervals of 5 or 60 minutes. In the next set, formalin tests were carried out in companion with injection of Naloxone Hydrochloride, a non-selective antagonist of opioid receptors, pre-formalin injection and 30 and 45 minutes post formalin injection. While normal nociceptive behaviour was observed in the group receiving one injection of formalin, a diminished response was observed in phases I and II of those receiving consequent injection of formalin, 60 minute after first injection. While second injection of formalin, 5 minute after first injection, had no effect. Administration of naloxone (1mg/kg) decreased nociception in phase 2A; but had no effect on delayed termination of formalin test." }, { "role": "assistant", "content": "The results of this study suggest the existence of an active inhibitory mechanism, other than the endogenous opioids, that is responsible for termination of nociceptive behaviour at the end of formalin test. 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": "Do autologous anti-SOX2 antibody responses reflect intensity but not frequency of antigen expression in small cell lung cancer? Context: Anti-SOX2 antibody responses are observed in about 10 to 20% of small cell lung cancer (SCLC) patients. The aim of this study was to determine whether such responses reflect a particular pattern of SOX2 protein expression in the tumor and whether this pattern associates with clinical outcome. Paraffin embedded tumor tissues, obtained from SCLC patients who had no evidence of paraneoplastic autoimmune degeneration, were evaluated for SOX2 expression by immunohistochemistry for both intensity and extent of staining. Sera from the same patients were tested for autologous antibodies against recombinant SOX2 by enzyme-linked immunosorbent assay (ELISA). Correlates between overall survival and various clinical parameters including SOX2 staining and serology were determined. SOX2 protein expression was observed in tumor tissue in 89% of patients. Seventeen patients (29%) were seropositive for SOX2 antibodies and, in contrast to SOX2 staining, the presence of antibody correlated with limited disease stage (p = 0.05). SOX2 seropositivity showed a significant association with the intensity of SOX2 staining in the tumor (p = 0.02) but not with the frequency of SOX2 expressing cells." }, { "role": "assistant", "content": "Anti-SOX2 antibodies associate with better prognosis (limited stage disease) while SOX2 protein expression does not; similar to reports from some earlier studies. Our data provides an explanation for this seemingly contrasting data for the first time as SOX2 antibodies can be observed in patients whose tumors contain relatively few but strongly staining cells, thus supporting the possible presence of active immune-surveillance and immune-editing targeting SOX2 protein in this tumor type. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adolescent, Adult, Cross-Sectional Studies, Female, Health Services, Health Status Indicators, Humans, Interpersonal Relations, Male, Mental Health, Middle Aged, Multivariate Analysis, Psychometrics, Regression Analysis, Residence Characteristics, Scotland, Self Concept, Social Behavior Disorders, Social Class, Social Environment, Social Problems, Surveys and Questionnaires, Urban Population, Vulnerable Populations." }, { "role": "user", "content": "Is concern about young people's anti-social behaviour associated with poor health? Context: Young people in disadvantaged neighbourhoods are often the focus of concerns about anti-social behaviour (ASB). There is inconsistent evidence to support the hypothesis that perceptions of ASB (PASB) are associated with poor health. We ask whether perceptions of young people's ASB are associated with poor health; and whether health, demographic and (psycho)social characteristics can help explain why PASB varies within disadvantaged neighbourhoods (Glasgow, UK). Regression analysis of survey data exploring associations between perceiving teenagers hanging around to be a serious neighbourhood problem and SF-12v2 mental and physical health scores (higher = better), including adjustment for demographic characteristics. Further analysis explored associations with self-reported measures of health service use, psychosocial characteristics of homes and neighbourhoods and social contacts. 6008 adults participated (50% response) and 22% (n = 1,332) said teenagers were a serious neighbourhood problem (the most frequently reported local problem). Demographic characteristics associated with perceiving serious teenager problems included regular health service use, age (inverse relationship), financial problems and living with children. Lower SF-12v2 physical health scores were associated with perceiving teenager problems after adjustment for demographic variables (OR 0.98; 95%CI 0.97,0.99; p =<0.001), whilst adjusted findings for mental health scores were less conclusive (OR 0.99; 95%CI 0.98,1.00; p = 0.103). Further analysis suggested that perceiving teenager problems was more strongly associated with a number of self-reported psychosocial factors: e.g. lacking social support,<weekly family contacts, poor neighbourhood safety, low trust in neighbours, neighbourhood perceived to be a barrier to self-esteem, and neighbourhood decline." }, { "role": "assistant", "content": "Given the evidence we found of weak and small associations between PASB and health, we caution against assuming that tackling concern about teenagers' ASB will lead to substantial public health gains in disadvantaged areas. Although the findings do not present a compelling case for making PASB a public health priority, it is still important to address concerns about young people's ASB. Reasons for doing so may include improving social cohesion, reducing fear and isolation, and improving the general quality of people's lives - particularly in neighbourhoods burdened by multiple disadvantages. Future research should evaluate interventions that attempt to reduce PASB in disadvantaged areas. Findings from this study could help inform the targeting of such interventions." } ]

[ { "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: Breast Neoplasms, Cost-Benefit Analysis, Decision Making, Delivery of Health Care, Female, Humans, Markov Chains, Models, Economic, Quality-Adjusted Life Years, Surveys and Questionnaires." }, { "role": "user", "content": "Cost-Value Analysis and the SAVE: A Work in Progress, But an Option for Localised Decision Making? Context: Cost-value analysis aims to address the limitations of the quality-adjusted life-year (QALY) by incorporating the strength of public concerns for fairness in the allocation of scarce health care resources. To date, the measurement of value has focused on equity weights to reflect societal preferences for the allocation of QALY gains. Another approach is to use a non-QALY-based measure of value, such as an outcome 'equivalent to saving the life of a young person' (a SAVE). This paper assesses the feasibility and validity of using the SAVE as a measure of value for the economic evaluation of health care technologies. A web-based person trade-off (PTO) survey was designed and implemented to estimate equivalent SAVEs for outcome events associated with the progression and treatment of early-stage breast cancer. The estimated equivalent SAVEs were applied to the outputs of an existing decision analytic model for early breast cancer. The web-based PTO survey was undertaken by 1094 respondents. Validation tests showed that 68 % of eligible responses revealed consistent ordering of responses and 32 % displayed ordinal transitivity, while 37 % of respondents showing consistency and ordinal transitivity approached cardinal transitivity. Using consistent and ordinally transitive responses, the mean incremental cost per SAVE gained was £ 3.72 million." }, { "role": "assistant", "content": "Further research is required to improve the validity of the SAVE, which may include a simpler web-based survey format or a face-to-face format to facilitate more informed responses. A validated method for estimating equivalent SAVEs is unlikely to replace the QALY as the globally preferred measure of outcome, but the SAVE may provide a useful alternative for localized decision makers with relatively small, constrained budgets-for example, in programme budgeting and marginal analysis." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All of the following skin infections are caused by S aureus, EXCEPT:" }, { "role": "assistant", "content": "The correct answer is Erysipelas is caused almost exclusively by Streptococcus pyogenes. It is characterized by abrupt onset of fiery red, swelling of face or extremities. It has well defined margins along the nasolabial fold, and has rapid progression with intense pain. It usually affects the face and legs. Bacterial infections and associated organisms: Infection Organism Folliculitis S. aureus, Pseudomonas aeruginosa Furuncle/Carbuncle S. aureus Abscess Polymicrobial , S. aureus in one quaer Erysipelas Streptococcus pyogenes Cellulitis S. aureus, Streptococcus pyogenes Ecthyma S. aureus, Streptococcus pyogenes Impetigo S. aureus, Streptococcus pyogenes Ref: Skin Infections: Diagnosis and Treatment edited by John C. Hall page 19." } ]

[ { "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": "H. pylori is found in?" }, { "role": "assistant", "content": "The correct answer is Mucous layer REF: Jawett's 24' edition chapter 18 H pylori grows optimally at a pH of 6.0-7.0 and would be killed or not grow at the pH within the gastric lumen. Gastric mucus is relatively impermeable to acid and has a strong buffering capacity. On the lumen side of the mucus, the pH is low (1.0-2.0) while on the epithelial side the pH is about 7.4 H pylori is found deep in the mucous layer near the epithelial surface where physiologic pH is present. H pylori also produce a protease that modifies the gastric mucus and fuher reduces the ability of acid to diffuse through the mucus. H pylori produce potent urease activity, which yields production of ammonia and fuher buffering of acid. The mechanisms by which H pylori causes' mucosal inflammation and damage are not well defined but probably involve both bacterial and host factors. The bacteria invade the epithelial cell surface to a limited degree" } ]

[ { "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, Aged, Antibiotics, Antineoplastic, Antineoplastic Agents, Hormonal, Antineoplastic Agents, Phytogenic, Biomarkers, Tumor, Docetaxel, Endometrial Neoplasms, Epirubicin, Female, Humans, Lung Neoplasms, Paclitaxel, Tamoxifen, Taxoids." }, { "role": "user", "content": "Is docetaxel effective in the treatment of metastatic endometrial cancer? Context: Systemic treatment of endometrial carcinoma with distant metastases is currently performed, inter alia, with anthracyclines, platinum, paclitaxel, if osfamid or progestins. This is the first report presenting experience in treatment of metastatic endometrial carcinoma with docetaxel. A 69-year-old women with adenocarcinoma of the endometrium was treated with primary combined radiotherapy. Two years later disseminated bilateral pulmonary metastases were detected and the patient was submitted to chemotherapy with epirubicin. After three cycles of chemotherapy with epirubicin examinations revealed metastatic progression. Thus, chemotherapy was changed to docetaxel. After three cycles of chemotherapy with docetaxel examinations revealed remission of the described pulmonary metastases more than 50%. A further three cycles of chemotherapy with docetaxel lead to continuing shrinkage of the detectable metastases to less than 25% of the original size. Because of various side effects, like increasing fatigue and asthenia, uncomfortable acral paresthesia and allergic skin reactions, the patient refused to continue chemotherapy." }, { "role": "assistant", "content": "We conclude that docetaxel may be an active agent in patients with metastatic endometrial cancer, but care should be taken to minimize side-effects. 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, DESIGN, SETTINGS, PATIENTS, MAIN OUTCOME MEASURES, RESULTS, LIMITATIONS. Meshes: Adenocarcinoma, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, Chemoradiotherapy, Adjuvant, Dose Fractionation, Female, Fluorouracil, Humans, Leucovorin, Male, Middle Aged, Neoadjuvant Therapy, Neoplasm Recurrence, Local, Neoplasm Staging, Prospective Studies, Rectal Neoplasms, Time Factors, Watchful Waiting." }, { "role": "user", "content": "Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management? Context: No immediate surgery (Watch and Wait) has been considered in select patients with complete clinical response after neoadjuvant chemoradiation to avoid postoperative morbidity and functional disorders after radical surgery. The purpose of this study was to demonstrate the long-term results of patients who had a complete clinical response following an alternative chemoradiation regimen and were managed nonoperatively. This is a prospective study. This study was conducted at a single center. Seventy consecutive patients with T2-4N0-2M0 distal rectal cancer were studied. Neoadjuvant chemoradiotherapy included 54 Gy and 5-fluorouracil/leucovorin delivered in 6 cycles every 21 days. Patients were assessed for tumor response at 10 weeks from radiation completion. Patients with incomplete clinical response were referred to immediate surgery. Patients with complete clinical response were not immediately operated on and were monitored. The primary outcomes measured were the initial complete clinical response rates after 10 weeks and the sustained complete clinical response rates after 12 months from chemoradiotherapy. One patient died during chemoradiotherapy because of cardiac complications. Forty-seven (68%) patients had initial complete clinical response. Of these, 8 developed local regrowth within the first 12 months of follow-up (17%). Thirty-nine sustained complete clinical response at a median follow-up of 56 months (57%). An additional 4 patients (10%) developed late local recurrences (>12 months of follow-up). Overall, 35 patients never underwent surgery (50%). This study is limited by the short follow-up and small sample size." }, { "role": "assistant", "content": "Extended chemoradiation therapy with additional chemotherapy cycles and 54 Gy of radiation may result in over 50% of sustained (>12 months) complete clinical response rates that may ultimately avoid radical rectal resection. Local failures occur more frequently during the initial 12 months of follow-up in up to 17% of cases, whereas late recurrences are less common but still possible, leading to 50% of patients who never required surgery. Strict follow-up may allow salvage therapy in the majority of these patients (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A113.)." } ]

[ { "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": "Rinne's test is negative in -" }, { "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: PURPOSE, METHODS, RESULTS. Meshes: Adenocarcinoma, Adult, Aged, Anastomosis, Surgical, Antineoplastic Agents, Cetrimonium Compounds, Colorectal Neoplasms, Disease-Free Survival, Female, Humans, Intraoperative Care, Male, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Seeding, Therapeutic Irrigation." }, { "role": "user", "content": "Does rectal washout during anterior resection prevent local tumor recurrence? Context: Colorectal cancer is one of the leading causes of cancer deaths in the industrialized nations. Left-sided tumors, especially rectal, rectosigmoid, and sigmoid, account for more than half of these tumors. Among many colorectal surgeons, the practice of rectal washout with cytocidal agents before anastomosis is common. It is widely believed that this practice prevents implantation of free malignant cells. It is unclear whether this translates into a reduction in the incidence of local recurrence. This study was designed to evaluate the effectiveness of cytocidal rectal washout in reducing the incidence of local recurrence. Case notes and histology reports of all patients who underwent curative anterior resection for adenocarcinoma of the rectum and rectosigmoid between 1992 and 1994 were reviewed. A total of 141 patients were deemed suitable for the study. Of these, 90 patients underwent rectal washout using cetrimide before anastomosis. Fifty-one patients did not have rectal washout before anastomosis. Local recurrences between the two groups were compared. The two study groups were identical in all respects. Overall, the local recurrence rate for all comers was 5 percent (n = 7). Among the washout group, the local recurrence rate was 4.4 percent (n = 4) compared with 5.9 percent (n = 3) among the no washout group." }, { "role": "assistant", "content": "Because of the size of the study, we were unable to demonstrate the benefit or lack thereof of cytocidal agents in reducing local recurrence." } ]

[ { "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 valvular hea diseases is most commonly associated with sudden death:" }, { "role": "assistant", "content": "The correct answer is Answer is A (Aoic Stenosis) Aoic Stenosis is the most common valvular disease associated with sudden death. The most common valve disease causing sudden death is aoic stenosis. In children subvalvular and supravalvular aoic stenosis may cause sudden death whereas in adults both congenitally bicuspid and trileaflet valves are the cause. Aoic stenosis accounts for approximately 2 percent of sudden death in adults' The classic symptoms of the valvular type of aoic stenosis (regardless of type) include external dyspnoea, syncope, angina, and sudden cardiac death. The onset of symptoms is an ominous sign. The presence of angina does not necessarily indicate coexisting coronary disease; rather, it is related to increased left ventricular filling pressure causing subendocardial ischemia." } ]

[ { "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: Adenoma, Carcinoma, Female, Humans, Hypothyroidism, Male, Middle Aged, Neck, Parathyroid Neoplasms, Retrospective Studies." }, { "role": "user", "content": "Parathyroid adenomas: is bilateral neck exploration necessary? Context: The traditional surgical treatment for primary hyperparathyroidism is bilateral neck exploration with identification of all parathyroid glands. Multiple investigators who recommend initial unilateral neck exploration based on more advanced localization studies have recently challenged this approach. We reviewed our experience with primary hyperparathyroidism to determine if localization study-aided unilateral neck exploration is sufficient for a cure. Retrospective chart review of patients with primary hyperparathyroidism. Sixty-eight patients underwent surgery for primary hyperparathyroidism. Forty-four patients were treated with localization study-aided unilateral neck exploration, and 24 patients were treated with bilateral neck exploration without preoperative localization studies. The most successful preoperative localization study was the technetium 99m sestamibi (T99mS) scan which correctly identified the location of adenomas in all cases in which it was used (n = 15). All patients were treated with unilateral neck exploration and were cured. This success was matched only by surgical exploration (n = 24)." }, { "role": "assistant", "content": "Unilateral neck exploration based on the results of a T99mS scan can be used as an initial approach for primary hyperparathyroidism if the scan identifies a solitary lesion. The second gland on the same side of the lesion should be biopsied, and if it is normal, the opposite side of the neck may be left undisturbed. If the second gland is not normal, or if the T99mS scan shows multiple lesions, bilateral neck exploration should be performed." } ]

[ { "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 karyotype of a patient with androgen insensitivity Syndrome is" }, { "role": "assistant", "content": "The correct answer is Karyotype-46 ,XY. Normal genitK appearance -SRY deletion ,SF1 defect,Gonadal dysgenesis ,Severe StAR defect ,Complete androgen insensitivity syndrome. Genital ambiguity -Testicular dysgenesis ,Steroidogenic defects,Paial androgen insensitivity syndrome ,Aromatase deficiency. * Chromosomal study: Karyotype is 46, XY. * In infants and children, stimulation by hCG before measurement of hormones needed. * Serum testosterone is normal (or higher) * Serum E2 level is high normal for males * Serum LH level is normal or slightly elevated * FSH is normal. * USG: --Ovaries, uterus, upper 2/3rd of vagina and tubes are absent Reference: OP Ghai ,essential.paediatrics ,8 th edition, page no- 538,table 17.32 ." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, RESULTS. Meshes: Animals, Anti-Arrhythmia Agents, Calcium Signaling, Dose-Response Relationship, Drug, Flecainide, HEK293 Cells, Humans, Ion Channel Gating, Male, Membrane Potentials, Myocytes, Cardiac, Potassium Channels, Rats, Sprague-Dawley, Ryanodine Receptor Calcium Release Channel, Sarcoplasmic Reticulum, Tachycardia, Ventricular, Time Factors, Transfection, Voltage-Gated Sodium Channel Blockers." }, { "role": "user", "content": "Does the mechanism of flecainide action in CPVT involve a direct effect on RyR2? Context: Flecainide, a class 1c antiarrhythmic, has emerged as an effective therapy in preventing arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT) refractory to β-adrenergic receptor blockade. It has been proposed that the clinical efficacy of flecainide in CPVT is because of the combined actions of direct blockade of ryanodine receptors (RyR2) and Na(+) channel inhibition. However, there is presently no direct evidence to support the notion that flecainide blocks RyR2 Ca(2+) flux in the physiologically relevant (luminal-to-cytoplasmic) direction. The mechanism of flecainide action remains controversial. To examine, in detail, the effect of flecainide on the human RyR2 channel and to establish whether the direct blockade of physiologically relevant RyR2 ion flow by the drug contributes to its therapeutic efficacy in the clinical management of CPVT. Using single-channel analysis, we show that, even at supraphysiological concentrations, flecainide did not inhibit the physiologically relevant, luminal-to-cytosolic flux of cations through the channel. Moreover, flecainide did not alter RyR2 channel gating and had negligible effect on the mechanisms responsible for the sarcoplasmic reticulum charge-compensating counter current. Using permeabilized cardiac myocytes to eliminate any contribution of plasmalemmal Na(+) channels to the observed actions of the drug at the cellular level, flecainide did not inhibit RyR2-dependent sarcoplasmic reticulum Ca(2+) release." }, { "role": "assistant", "content": "The principal action of flecainide in CPVT is not via a direct interaction with RyR2. Our data support a model of flecainide action in which Na(+)-dependent modulation of intracellular Ca(2+) handling attenuates RyR2 dysfunction in CPVT. 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": "Neutrophil Extracellular Traps" }, { "role": "assistant", "content": "The correct answer is Neutrophil Extracellular Traps (Robbins 9th edition- New Topic):\nNETs are extracellular fibrillar networks that provide a high concentration of antimicrobial substances at sites of infection and prevent the spread of  microbes by trapping them in the fibrils. They are produced by neutrophils in  response to infectious pathogens and  inflammatory mediators." } ]

[ { "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": "Acquired extra – cranial infection that causes aqueductal Stenosis is –" }, { "role": "assistant", "content": "The correct answer is Aqueductal stenosis -\nCauses of acquired aqueductal stenosis\n\nNeonatal meningitis                       o Intrauterine viral infections\nSubarachnoid hemorrhage              o Mumps meningoencephalitis" } ]

[ { "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: Animals, Calcium, Calcium Channel Agonists, Calcium Channels, Cell Line, Chlorophenols, Cresols, HEK293 Cells, Humans, Membrane Proteins, Neoplasm Proteins, ORAI1 Protein, ORAI2 Protein, Rats, Ryanodine Receptor Calcium Release Channel, Stromal Interaction Molecule 1." }, { "role": "user", "content": "Does the ryanodine receptor agonist 4-chloro-3-ethylphenol block ORAI store-operated channels? Context: Depletion of the Ca(2+) store by ryanodine receptor (RyR) agonists induces store-operated Ca(2+) entry (SOCE). 4-Chloro-3-ethylphenol (4-CEP) and 4-chloro-m-cresol (4-CmC) are RyR agonists commonly used as research tools and diagnostic reagents for malignant hyperthermia. Here, we investigated the effects of 4-CEP and its analogues on SOCE. SOCE and ORAI1-3 currents were recorded by Ca(2+) imaging and whole-cell patch recordings in rat L6 myoblasts and in HEK293 cells overexpressing STIM1/ORAI1-3. 4-CEP induced a significant release of Ca(2+) in rat L6 myoblasts, but inhibited SOCE. The inhibitory effect was concentration-dependent and more potent than its analogues 4-CmC and 4-chlorophenol (4-ClP). In the HEK293 T-REx cells overexpressing STIM1/ORAI1-3, 4-CEP inhibited the ORAI1, ORAI2 and ORAI3 currents evoked by thapsigargin. The 2-APB-induced ORAI3 current was also blocked by 4-CEP. This inhibitory effect was reversible and independent of the Ca(2+) release. The two analogues, 4-CmC and 4-ClP, also inhibited the ORAI1-3 channels. Excised patch and intracellular application of 4-CEP demonstrated that the action site was located extracellularly. Moreover, 4-CEP evoked STIM1 translocation and subplasmalemmal clustering through its Ca(2+) store-depleting effect via the activation of RyR, but no effect on STIM1 redistribution was observed in cells co-expressing STIM1/ORAI1-3." }, { "role": "assistant", "content": "4-CEP not only acts as a RyR agonist to deplete the Ca(2+) store and trigger STIM1 subplasmalemmal translocation and clustering, but also directly inhibits ORAI1-3 channels. These findings demonstrate a novel pharmacological property for the chlorophenol derivatives that act as RyR agonists. 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 25-year-old woman develops a sore, red, hot, swollen left knee. She has no history of trauma and no familial history of joint disease .Aspirin is effective in relieving symptoms of acute inflammation in this patient because it inhibits which of the following enzymes?" }, { "role": "assistant", "content": "The correct answer is Arachidonic acid is metabolized by cyclooxygenases (COX-1, COX-2) and lipoxygenases (5-LOX) to generate prostanoids and leukotrienes, respectively. The early inflammatory prostanoid response is COX-1 dependent. COX-2 becomes the major source of prostanoids as inflammation progresses. Inhibition of COX is one mechanism by which nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, indomethacin and ibuprofen, exe their potent analgesic and anti-inflammatory effects. NSAIDs block both COX-1 & COX-2 induced formation of prostaglandins, thereby mitigating pain and inflammation." } ]

[ { "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, Aggregatibacter actinomycetemcomitans, Analysis of Variance, Cells, Cultured, Chemokine CCL2, Chemokine CCL3, Chemokine CCL4, Chemokine CCL5, Chemokines, CC, Chemotaxis, Leukocyte, Dental Plaque, Enzyme-Linked Immunosorbent Assay, Humans, Lipopolysaccharides, Macrophage Inflammatory Proteins, Mouth, Neutrophils, Osteoblasts, Porphyromonas gingivalis." }, { "role": "user", "content": "Do periodontal pathogens stimulate CC-chemokine production by mononuclear and bone-derived cells? Context: Chemokines are chemotactic cytokines that stimulate recruitment of leukocytes. Monocyte chemoattractant protein-1, macrophage inflammatory protein-1alpha, and RANTES (regulated on activation, normal T cell expressed, and secreted) are 3 well-characterized CC-chemokines that regulate mononuclear cell recruitment. The recruitment of inflammatory cells is of particular importance in the oral cavity because of the likelihood that cells will be challenged with bacteria either during acute infection or following surgical procedures. Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans are putative periodontal pathogens that may be harbored in subgingival and supragingival plaque. The capacity of the host to respond to these bacteria by the elaboration of chemoattractants may represent an important defense mechanism. In the present study, we examined CC-chemokine production by human mononuclear cells and bone-derived cells in response to P. gingivalis, A. actinomycetemcomitans and lipopolysaccharides (LPS) stimulation in vitro. The chemokines produced were measured by ELISA. The results demonstrate that P. gingivalis and A. actinomycetemcomitans induce high levels of MIP-1alpha in mononuclear cells. P. gingivalis and A. actinomycetemcomitans stimulated high levels of MCP-1 in bone-derived cells and induced moderate levels of RANTES production in both mononuclear and osteoblastic cells. In mononuclear cells, LPS induced high levels of MIP-1alpha and RANTES and moderate levels of MCP-1; in osteoblasts LPS only induced MCP-1." }, { "role": "assistant", "content": "The capacity of bacteria to induce a given chemokine depends upon the cell type stimulated. That different cell types would exhibit differences in the CC-chemokines produced under the same stimulus provides a mechanism to explain tissue-specific recruitment of leukocytes. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Adolescent, Bayes Theorem, Child, DNA, Bacterial, Feces, Female, Humans, Irritable Bowel Syndrome, Male, Metabolomics, Microbiota." }, { "role": "user", "content": "Does simultaneous fecal microbial and metabolite profiling enable accurate classification of pediatric irritable bowel syndrome? Context: We previously showed that stool samples of pre-adolescent and adolescent US children diagnosed with diarrhea-predominant IBS (IBS-D) had different compositions of microbiota and metabolites compared to healthy age-matched controls. Here we explored whether observed fecal microbiota and metabolite differences between these two adolescent populations can be used to discriminate between IBS and health. We constructed individual microbiota- and metabolite-based sample classification models based on the partial least squares multivariate analysis and then applied a Bayesian approach to integrate individual models into a single classifier. The resulting combined classification achieved 84 % accuracy of correct sample group assignment and 86 % prediction for IBS-D in cross-validation tests. The performance of the cumulative classification model was further validated by the de novo analysis of stool samples from a small independent IBS-D cohort." }, { "role": "assistant", "content": "High-throughput microbial and metabolite profiling of subject stool samples can be used to facilitate IBS diagnosis. 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-year-old woman presents with generalized fatigue, joint pain, and decreased appetite. She says that symptoms onset a year ago and have not improved. The patient’s husband says he has recently noticed that her eyes and skin are yellowish. The patient denies any history of smoking or alcohol use, but she admits to using different kinds of intravenous illicit drugs during her college years. The patient is afebrile and vital signs are within normal limits. Physical examination is unremarkable, except for moderate scleral icterus. A polymerase chain reaction (PCR) of a blood sample is positive for a viral infection that reveals a positive-sense RNA virus, that is small, enveloped, and single-stranded. The patient is started on a drug that resembles a purine RNA nucleotide. She agrees not to get pregnant before or during the use of this medication. Which of the following is the drug that was most likely given to this patient?" }, { "role": "assistant", "content": "Ribavirin" } ]

[ { "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, Aorta, Cell Movement, Cell Proliferation, DNA (Cytosine-5-)-Methyltransferase 1, DNA (Cytosine-5-)-Methyltransferases, DNA Methylation, Diet, High-Fat, Estrogen Receptor alpha, Gene Expression Regulation, Enzymologic, Gene Knockdown Techniques, Humans, Lipopolysaccharides, Male, MicroRNAs, Myocytes, Smooth Muscle, Rats, Rats, Sprague-Dawley." }, { "role": "user", "content": "Does microRNA-152 mediate DNMT1-regulated DNA methylation in the estrogen receptor α gene? Context: Estrogen receptor α (ERα) has been shown to protect against atherosclerosis. Methylation of the ERα gene can reduce ERα expression leading to a higher risk for cardiovascular disease. Recently, microRNAs have been found to regulate DNA methyltransferases (DNMTs) and thus control methylation status in several genes. We first searched for microRNAs involved in DNMT-associated DNA methylation in the ERα gene. We also tested whether statin and a traditional Chinese medicine (San-Huang-Xie-Xin-Tang, SHXXT) could exert a therapeutic effect on microRNA, DNMT and ERα methylation. The ERα expression was decreased and ERα methylation was increased in LPS-treated human aortic smooth muscle cells (HASMCs) and the aorta from rats under a high-fat diet. MicroRNA-152 was found to be down regulated in the LPS-treated HASMCs. We validated that microRNA-152 can knock down DNMT1 in HASMCs leading to hypermethylation of the ERα gene. Statin had no effect on microRNA-152, DNMT1 or ERα expression. On the contrary, SHXXT could restore microRNA-152, decrease DNMT1 and increase ERα expression in both cellular and animal studies." }, { "role": "assistant", "content": "The present study showed that microRNA-152 decreases under the pro-atherosclerotic conditions. The reduced microRNA-152 can lose an inhibitory effect on DNA methyltransferase, which leads to hypermethylation of the ERα gene and a decrease of ERα level. Although statin can not reverse these cascade proatherosclerotic changes, the SHXXT shows a promising effect to inhibit this unwanted signaling pathway. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Does sagittal abdominal diameter show better correlation with cardiovascular risk factors than waist circumference and BMI? Context: Obesity (abdominal adiposity) is a risk factor for cardiovascular diseases and the most used methods to measure the adiposity are body mass index (BMI), waist circumference (WC), and sagittal abdominal diameter (SAD). To correlate BMI, WC, and SAD with biochemical parameters and blood pressure in adults. A non-experimental exploratory/descriptive and cross sectional study was developed and it was assessed 133 subjects (59 men and 74 women) aging between 18 and 87 years. It was registered the patients' weight (kg), height (m), BMI (kg/m(2)), WC (cm) and SAD (cm), and these parameters were correlated with glycemia, triglycerides, total cholesterol, HDL-c, LDL-c and blood pressure. After adjustment for gender and age, it was observed a positive correlation between SAD and systolic arterial blood pressure (r = 0.20), glycemia (r = 0.20), triglycerides (r = 0.32), LDL (r = 0.26), total cholesterol (TC) (r = 0.33), and a negative correlation with HDL-c (r = -0.21) (p < 0.05). It was observed a positive correlation between WC and systolic arterial blood pressure (r = 0.14), triglycerides (r = 0.31), total cholesterol (r = 0.21), and a negative correlation with HDL-c (r = -0.24) (p < 0.05). BMI showed a positive correlation with systolic arterial blood pressure (r = 0.22), total cholesterol (r = 0.20), and triglycerides (r = 0.23) (p < 0.05)." }, { "role": "assistant", "content": "SAD correlated with almost all the cardiovascular risk factors analyzed and it might be considered the best predictor of abdominal fat and cardiovascular risk. 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": "Byssinosis is caused due to inhalation of:" }, { "role": "assistant", "content": "The correct answer is Byssinosis is caused due to inhalation of cotton fibre dust over long periods of time. It leads to pneumoconiosis causing chronic lung disease. Ref: Park 21st edition, page 747. Chapter: Occupational health." } ]

[ { "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: Antihypertensive Agents, Body Surface Area, Ciliary Body, Female, Glaucoma, Open-Angle, Humans, Intraocular Pressure, Latanoprost, Male, Middle Aged, Ocular Hypertension, Ophthalmic Solutions, Prospective Studies, Prostaglandins F, Synthetic, Ultrasonography." }, { "role": "user", "content": "Is the efficacy of latanoprost independent of the width of the ciliary body face? Context: To assess the relation between the intraocular pressure-lowering efficacy of latanoprost 0.005% and the area of the ciliary body face exposed to the anterior chamber as assessed by ultrasound biomicroscopy. Untreated, latanoprost-naive patients with ocular hypertension or open-angle glaucoma were enrolled in this prospective clinical trial. A radial, perpendicular ultrasound biomicroscopy image at the 6-o'clock position detailing Schwalbe line, scleral spur, and iris insertion was obtained. The distances between these structures were then measured and their relations to the intraocular pressure-lowering effect of latanoprost at 1, 2, 3, and 6 months were analyzed. Fifty-four eyes (54 patients) were enrolled. The mean age of participants was 60.2 +/- 13.9 years, and mean pretreatment intraocular pressure was 26.4 +/- 3.8 mm Hg. The mean intraocular pressure reduction from baseline was 7.1 mm Hg (26.9%), 7.3 (27.7%), 7.8 (29.5%), and 7.7 (29.2%) at 1, 2, 3 and 6 months, respectively. The mean distance between the scleral spur and the iris insertion was 0.14 +/- 0.08 mm (range, 0.04-0.33 mm). There was a significant correlation between intraocular pressure reduction at 1 month and trabecular meshwork height, suggesting that intraocular pressure reduction was associated with increasing trabecular meshwork height (P < 0.05). No other correlation could be found regarding intraocular pressure reduction." }, { "role": "assistant", "content": "Although latanoprost lowers intraocular pressure by enhancing uveoscleral outflow, its efficacy is independent of the height of the ciliary face. 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: Adult, Aged, Attitude to Health, Female, Humans, Incidence, Middle Aged, Patient Compliance, Patient Education as Topic, Retrospective Studies, Rural Population, Serbia, Socioeconomic Factors, Uterine Cervical Neoplasms, Vaginal Smears, Women's Health." }, { "role": "user", "content": "Do women in rural areas of Serbia rarely apply preventive measures against cervical cancer? Context: We analyzed secondary data of the 2006 National Health Survey of the population of Serbia focused on characteristics of adult females aged 25 to 65 years (5.314 in total) taking into consideration that programme of the organized screening will include female population aged over 25 years. Respondents from rural areas have gynecological examination less than once a year in comparison with those from urban areas (OR = 0.60, 95% CI 0.54-0.68). Less women from rural areas did Pap test during the last 12 months in comparison with respondents from urban areas (OR = 0.55, 95% Cl 0.48-0.64). Respondents from urban areas less often do the Pap test on doctor's advice in comparison with those from rural one (OR = 0.55, 95% CI 0.42-0.62)." }, { "role": "assistant", "content": "This study shows that women in rural areas rarely implement preventive gynecological measures againt cervical cancer in comparison with those in urban areas. Implementation of preventive measures among rural women is conditioned by lower levels of education and lower socioeconomic status." } ]

[ { "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, Antimetabolites, Antineoplastic, Disease Models, Animal, Drug Delivery Systems, Fluorouracil, Gene Transfer Techniques, Genes, p16, Genetic Therapy, Humans, Mice, Mice, Nude, Neoplasm Transplantation, Neoplasms, Experimental, Promoter Regions, Genetic, Thymidine Kinase, Thymidylate Synthase, Tumor Cells, Cultured, Xenograft Model Antitumor Assays." }, { "role": "user", "content": "Do [ Double promoters induct suicide gene target killing of 5-FU drug-fast cancer cells ]? Context: To study target killing of 5-FU drug-fast cancer cells with thymidylate synthase (TS) and p16 gene promoters inducting TK gene expression. TS promoter was inserted to 5' end and p16 promoter inserted to 3' end of TK cDNA sequence, constructing recombinant plasmid of pXJ41. Human rectal cancer cell lines of HR-8348 and normal peripheral blood mononuclear cells (PBMC) were transfected with the recombinant plasmid. Plating efficiency was counted and survival rates of cells were tested with MTT method. And suppression rates of xenograft tumors in nude mice were examined. Recombinant pXJ41 with double promotors and TK gene was transfected into HR-8348, and positive expression of TS and TK was observed. The expression of TK gene was consistent with TS expression. Plating efficiency was 9/300, 92/300 in transfected HR-8348 and contrast cells respectively (t = 33.885, P < 0.01). Cancer cell growth rate reduced markedly in the transfected group. The suppression rate of xenograft tumor growth was 74.5%. With the recombinant pXJ41 to transfect PBMC, p16 expression was positive, but TK and TS expressions were negative. No damnification was observed in PBMC." }, { "role": "assistant", "content": "TS and p16 double promoters are capable of inducting TK target killing of 5-FU drug-fast cancer cells, thus protecting normal cells and improving safety of gene therapy. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "For a population of ______ in plains, A female health worker is alloted" }, { "role": "assistant", "content": "The correct answer is Female health worker is alloted at subcenter level.\nSubcenter in plains is for 5000 population.\nSubcenter in hilly/tribal areas is for 3000 population." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Adolescent, Adult, Analysis of Variance, Attention, Biophysics, Discrimination Learning, Female, Humans, Linear Models, Male, Neuropsychological Tests, Reaction Time, Signal Detection, Psychological, Time Factors, Transcranial Magnetic Stimulation, User-Computer Interface, Young Adult." }, { "role": "user", "content": "Is enhancement of object detection with transcranial direct current stimulation associated with increased attention? Context: We previously found that Transcranial Direct Current Stimulation (tDCS) improves learning and performance in a task where subjects learn to detect potential threats indicated by small target objects hidden in a complex virtual environment. In the present study, we examined the hypothesis that these effects on learning and performance are related to changes in attention. The effects of tDCS were tested for three forms of attention (alerting, orienting, and executive attention) using the Attention Network Task (ANT), which were compared with performance on the object-learning task. Participants received either 0.1 mA (N = 10) or 2.0 mA (N = 9) tDCS during training and were tested for performance in object-identification before training (baseline-test) and again immediately after training (immediate test). Participants next performed the Attention Networks Task (ANT), and were later tested for object-identification performance a final time (delayed test). Alerting, but not orienting or executive attention, was significantly higher for participants receiving 2.0 mA compared with 0.1 mA tDCS (p < 0.02). Furthermore, alerting scores were significantly correlated with the proportion of hits (p < 0.01) for participants receiving 2.0 mA." }, { "role": "assistant", "content": "These results indicate that tDCS enhancement of performance in this task may be related in part to the enhancement of alerting attention, which may benefit the initial identification, learning and/or subsequent recognition of target objects indicating potential threats. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adolescent, Adult, Enzyme Activation, Fatty Acids, Female, Flushing, Humans, Intracellular Space, Male, Niacin, Phospholipases A2, Psychotic Disorders, Risk, Skin, Young Adult." }, { "role": "user", "content": "Does niacin Skin Sensitivity be Increased in Adolescents at Ultra-High Risk for Psychosis? Context: Most studies provide evidence that the skin flush response to nicotinic acid (niacin) stimulation is impaired in schizophrenia. However, only little is known about niacin sensitivity in the ultra-high risk (UHR) phase of psychotic disorders. We compared visual ratings of niacin sensitivity between adolescents at UHR for psychosis according to the one year transition outcome (UHR-T n = 11; UHR-NT n = 55) with healthy controls (HC n = 25) and first episode schizophrenia patients (FEP n = 25) treated with atypical antipsychotics. Contrary to our hypothesis niacin sensitivity of the entire UHR group was not attenuated, but significantly increased compared to the HC group, whereas no difference could be found between the UHR-T and UHR-NT groups. As expected, niacin sensitivity of FEP was attenuated compared to HC group. In UHR individuals niacin sensitivity was inversely correlated with omega-6 and -9 fatty acids (FA), but positively correlated with phospholipase A2 (inPLA2) activity, a marker of membrane lipid repair/remodelling." }, { "role": "assistant", "content": "Increased niacin sensitivity in UHR states likely indicates an impaired balance of eicosanoids and omega-6/-9 FA at a membrane level. Our findings suggest that the emergence of psychosis is associated with an increased mobilisation of eicosanoids prior to the transition to psychosis possibly reflecting a \"pro-inflammatory state\", whereas thereafter eicosanoid mobilisation seems to be attenuated. Potential treatment implications for the UHR state should be further investigated. 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 is not an insulin analogue ?" }, { "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, BACKGROUND, METHODS, RESULTS. Meshes: Aged, Echocardiography, Doppler, Female, Heart Failure, Diastolic, Humans, Male, Middle Aged, Stroke Volume, Systole, Time Factors, Ventricular Function, Left." }, { "role": "user", "content": "Is left ventricular systolic function abnormal in diastolic heart failure : re-assessment of systolic function using cardiac time interval analysis? Context: The purpose of this study was to re-assess the left ventricular (LV) systolic function in diastolic heart failure (DHF) using Doppler echocardiography. Systolic function in DHF is defined as the preserved LV ejection fraction (EF). EF may not fully reflect the systolic function in DHF, especially in the presence of abnormalities during the isovolumetric contraction time (ICT). We examined LV systolic and diastolic function in 80 consecutive patients with DHF, 30 patients with asymptomatic diastolic dysfunction (ADD), and 30 normal subjects (Control). The LV and left atrial volumes, LV EF, LV ICT, and isovolumetric relaxation time (IRT), early diastolic mitral flow velocity, systolic mitral annular velocity (S'), and early diastolic mitral annular velocity were obtained. LV ICT in DHF (69+/-30 ms) was significantly increased compared to those with ADD (37+/-23 ms) and Control (35+/-26 ms) (P<0.0001). ICT in ADD was equal to that in Control. The LV end-diastolic volume index in DHF (49+/-14 ml/m(2)) was significantly increased compared to those with ADD (42+/-12 ml/m(2)) and Control (43+/-8 ml/m(2)) (P<0.05). S' in DHF (5.9+/-1.4 cm/s) and ADD (6.7+/-1.1 cm/s) was significantly decreased compared to that in Control (8.7+/-2.5 cm/s)." }, { "role": "assistant", "content": "Our results revealed that the major differences between ADD and DHF were global and longitudinal LV systolic dysfunction and LV enlargement. This study suggests that LV systolic dysfunction plays an important role in the development of DHF. 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, Adult, Aged, Alleles, Base Sequence, Case-Control Studies, Child, Child, Preschool, Confidence Intervals, Female, Genetic Predisposition to Disease, Glomerulonephritis, Heterozygote, Humans, Male, Middle Aged, Molecular Sequence Data, Odds Ratio, Polymerase Chain Reaction, Polymorphism, Genetic, Probability, Purpura, Schoenlein-Henoch, Receptors, Interleukin-1, Reference Values, Severity of Illness Index, Vasculitis, Leukocytoclastic, Cutaneous." }, { "role": "user", "content": "Is interleukin 1 receptor antagonist gene polymorphism associated with severe renal involvement and renal sequelae in Henoch-Schönlein purpura? Context: To assess the influence of interleukin 1 receptor antagonist gene polymorphism (IL1RN) in the incidence of Henoch-Schönlein purpura (HSP) and cutaneous leukocytoclastic angiitis (CLA) and to determine if implications exist with severe systemic complications of HSP, in particular with severe renal involvement and permanent renal dysfunction (renal sequelae). Patients from Northwest Spain with primary cutaneous vasculitis classified as HSP or hypersensitivity vasculitis (HV) according to proposed criteria were studied. Patients with HV were included if they had a biopsy proven small size blood vessel leukocytoclastic vasculitis limited to skin and also fulfilled the Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitis definitions for CLA. All patients were required to have had at least 2 years' followup. Patients and ethnically matched controls were genotyped for IL-1 receptor antagonist intron 2 VNTR polymorphism. We examined 96 Caucasian patients (58 HSP and 38 CLA) and 109 controls. No allele or genotype differences between the whole group of HSP or CLA patients and controls were observed. We found a significant association between carriage of IL-1 receptor antagonist allele 2 (ILRN*2) and severe renal involvement, manifested as nephrotic syndrome and/or renal insufficiency (p = 0.016), and permanent renal involvement (renal sequelae) (p = 0.012)." }, { "role": "assistant", "content": "In unselected patients with cutaneous vasculitis, carriage of ILRN*2 alleles influences disease severity rather than susceptibility. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Aged, Biomarkers, Central Venous Pressure, Critical Illness, Extravascular Lung Water, Female, Hemodynamics, Hospitals, University, Humans, Intensive Care Units, Male, Middle Aged, Osmolar Concentration, Pulmonary Edema, Retrospective Studies, Risk Factors, Serum Albumin, Stroke Volume, Thermodilution." }, { "role": "user", "content": "Are global end-diastolic volume , serum osmolarity , and albumin risk factors for increased extravascular lung water? Context: The transpulmonary thermodilution technique allows the determination of cardiac preload (global end-diastolic volume index) and quantification of pulmonary edema (extravascular lung water index [EVLWI]). Pulmonary edema commonly develops in critically ill patients; however, the underlying pathophysiology, that is, hydrostatic (cardiac) or permeability-induced (noncardiac), often remains unclear. In this study, hemodynamic and serum parameters of osmolarity and oncotic pressure were analyzed to identify risk factors for increased EVLWI. A retrospective, single-center analysis in an intensive care unit of a university hospital was performed. No interventions were made for the study. Forty-two critically ill patients were included, and 126 simultaneous hemodynamic measurements and serum determinations were analyzed by logistic regression and Spearman rank correlation coefficient analysis. Global end-diastolic volume index (P = .001), serum albumin (P = .006), and serum osmolarity (P = .029) were significant factors for increased EVLWI (defined as >10 mL/kg)." }, { "role": "assistant", "content": "Hypervolemia, hypoalbuminemia, and high plasma osmolarity are associated with increased EVLWI. 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 gene expression profiling reveal potential prognostic biomarkers associated with the progression of heart failure? Context: Heart failure (HF) is the most common cause of morbidity and mortality in developed countries. Here, we identify biologically relevant transcripts that are significantly altered in the early phase of myocardial infarction and are associated with the development of post-myocardial infarction HF. We collected peripheral blood samples from patients with ST-segment elevation myocardial infarction (STEMI): n = 111 and n = 41 patients from the study and validation groups, respectively. Control groups comprised patients with a stable coronary artery disease and without a history of myocardial infarction. Based on plasma NT-proBNP level and left ventricular ejection fraction parameters the STEMI patients were divided into HF and non-HF groups. Microarrays were used to analyze mRNA levels in peripheral blood mononuclear cells (PBMCs) isolated from the study group at four time points and control group. Microarray results were validated by RT-qPCR using whole blood RNA from the validation group. Samples from the first three time points (admission, discharge, and 1 month after AMI) were compared with the samples from the same patients collected 6 months after AMI (stable phase) and with the control group. The greatest differences in transcriptional profiles were observed on admission and they gradually stabilized during the follow-up. We have also identified a set of genes the expression of which on the first day of STEMI differed significantly between patients who developed HF after 6 months of observation and those who did not. RNASE1, FMN1, and JDP2 were selected for further analysis and their early up-regulation was confirmed in HF patients from both the study and validation groups. Significant correlations were found between expression levels of these biomarkers and clinical parameters. The receiver operating characteristic (ROC) curves indicated a good prognostic value of the genes chosen." }, { "role": "assistant", "content": "This study demonstrates an altered gene expression profile in PBMCs during acute myocardial infarction and through the follow-up. The identified gene expression changes at the early phase of STEMI that differentiated the patients who developed HF from those who did not could serve as a convenient tool contributing to the prognosis of heart failure. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Apoptosis, Cell Line, Tumor, Cell Proliferation, Cell Survival, Estradiol, Female, Humans, Mitogens, Ovarian Neoplasms." }, { "role": "user", "content": "Are estradiol metabolites potent mitogenic substances for human ovarian cancer cells? Context: The etiology of ovarian cancer appears to be associated with a long-term influence of estrogens. However, evidence is accumulating that certain estradiol metabolites may play a decisive role in the carcinogenesis of estrogen-dependent diseases. In the present study we examined the effect of estradiol metabolites on the proliferation and apoptosis of human ovarian cancer cells in comparison to the effect of their parent substance. The ovarian cancer cell line OVCAR-3 was used for the experiments. 17Beta-estradiol (E2), 2-hydroxyestradiol (2-OHE2), 4-hydroxyestradiol (4-OHE2) and 16alpha-hydroxyestrone (16-OHE1) were incubated for seven days in the concentration range of 0.01 nM to 10 nM. Proliferation and apoptosis were measured by commercially available assay kits. E2 enhanced proliferation rate and concomitantly reduced apoptotic rate of the ovarian cancer cells at physiological concentrations. 2-OHE2 had no significant effect, whereas 4-OHE2 elicited similar effects on proliferation and apoptotic rate as E2. The greatest proliferative and antiapoptotic effect was observed for 16-OHE1, the values being significantly different to the effects of E2." }, { "role": "assistant", "content": "The pattern of endogenous estradiol metabolism may play a role in defining ovarian cancer risk. This may be of importance in certain predisposed women who are treated with hormone therapy in postmenopause. 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": "Megalolomes in nucleated cell are seen in" }, { "role": "assistant", "content": "The correct answer is (D) All of the above" } ]

[ { "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 accurate technique for taking intraoral radiograph:" }, { "role": "assistant", "content": "The correct answer is Paralleling Technique\n\nThis is the most accurate technique for taking intraoral radiographs. \nThe image receptor should be positioned parallel to the long axis of the teeth, while the X-ray beam is directed perpendicular to the image receptor. Ideally, image receptor holders that enable one to aim easily and correctly should be used.\nThis means that the aiming device must firmly grip the image receptor and that there is an extraoral component that allows the X-ray beam to be positioned correctly in both the vertical and horizontal planes. \nIt can produce either elongation or foreshortening of the image, if the vertical angulation is incorrect or overlapping of proximal surfaces, if the horizontal angulation is incorrect. \n\nMcDonald's 10th Ed P:23" } ]

[ { "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": "Nerve which hooks around wharton's duct 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: OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Biomarkers, Tumor, Carcinoma, Squamous Cell, Disease Progression, Female, Humans, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Predictive Value of Tests, Retrospective Studies, Survival Rate, Tongue Neoplasms, Vascular Endothelial Growth Factor A, Vascular Endothelial Growth Factor C." }, { "role": "user", "content": "Does vascular endothelial growth factor C ( VEGF-C ) expression predict metastasis in tongue cancer? Context: We evaluated predictive factors for cervical lymph node metastasis of tongue squamous cell carcinoma (SCC). We present a retrospective analysis of 90 patients with T1-2 N0 SCC who underwent primary excision as initial treatment without preoperative radiotherapy or chemotherapy. We examined the clinicopathologic factors (gender, age, clinical stage, surgical margin, grade of differentiation, lymphatic invasion, tumor depth of invasion, pattern of invasion [POI]) and immunohistochemical factors (vascular endothelial growth factor [VEGF]-A and VEGF-C expression) to predict the probability of lymph node metastasis. The local progression-free 5-year survival rate was 100%. Tumor depth of invasion (≥4 mm, P = .022), POI (score >4, P = .000), and VEGF-C expression (P = .008) were associated with the lymph node metastasis of tongue SCC in a multiple logistic regression analysis (odds ratios [ORs]: 5.075, 17.383, and 9.533, respectively)." }, { "role": "assistant", "content": "The local control rate of tongue SCC in the early stages has significantly improved as a result of development of surgical techniques. On the other hand, we believe that tumor depth of invasion (≥4 mm), POI, and VEGF-C expression all need to be considered in the preoperative and postoperative planning stages for tongue 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: BACKGROUND, METHODS, RESULTS. Meshes: Angiography, Hepatic Artery, Humans, Kidney, Laparoscopy, Living Donors, Magnetic Resonance Angiography, Nephrectomy, Reproducibility of Results, Retrospective Studies, Tissue and Organ Harvesting." }, { "role": "user", "content": "Can magnetic resonance angiogram be a reliable alternative for donor evaluation for laparoscopic nephrectomy? Context: While hand-assisted laparoscopic donor nephrectomy (HLDN) is less invasive, which can encourage kidney donation, it requires more exact information about the renal vascular anatomy because of its limited visual field during nephrectomy. MRA is also an attractive choice because of its minimal invasiveness; further, it is an outpatient-based procedure, it uses non-nephrotoxic contrast material and it has no radiation. The aim of our study was to evaluate the effectiveness of gadolinium enhanced three-dimensional MRA (GdE-3D MRA) in a group of potential live donors who were candidates for HLDN. From September 2002 to December 2004, 40 potential live renal donors were evaluated prospectively with GdE-3D MRA, and this imaging modality was performed before the gold standard, the intra-arterial digital subtraction angiogram (IA-DSA), was carried out. All the images were reviewed in a blinded manner by the attending vascular radiologist. The MRA findings were compared with the DSA findings and the surgical findings as the reference methods. We evaluated the accuracy of MRA for imaging the renal architectures, and especially for imaging the renal accessory arteries and the early branching arteries that are important determinants for selection of the donor kidney. Both the MRA and DSA images showed consistent findings with the surgical findings in 92.5% of the 40 donors. There were no discrepant cases in depicting the main renal artery. MRA showed 100% specificity for imaging both the renal accessory arteries and the early branching arteries, when compared with the surgical findings. The kappa values for the MRA and DSA for the accessory arteries were all 0.66 compared with the intraoperative findings. MRA also depicted one huge renal cyst in one donor and many small renal cysts in the other donors that could not be imaged by DSA. There were no adverse events during the MRA procedure. None of the findings missed by MRA resulted in deleterious consequences at laparoscopic nephrectomy for the donor and graft." }, { "role": "assistant", "content": "Our limited experience with GdE-3D MRA for imaging the renal structures in kidney donor evaluation for HLDN has been quite satisfactory." } ]

[ { "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, Anti-Bacterial Agents, Anti-Infective Agents, Bacterial Infections, Chronic Disease, Ciprofloxacin, Double-Blind Method, Humans, Levofloxacin, Male, Middle Aged, Ofloxacin, Prostate-Specific Antigen, Prostatitis." }, { "role": "user", "content": "Does treatment of chronic bacterial prostatitis with levofloxacin and ciprofloxacin lower serum prostate specific antigen? Context: We compared baseline and post-therapy prostate specific antigen (PSA) in patients with chronic bacterial prostatitis who were treated with levofloxacin or ciprofloxacin. Subset analysis was done using a randomized, multicenter, double-blind, active control trial of 500 mg levofloxacin daily for 28 days vs 500 mg ciprofloxacin twice daily in 28 days in men with chronic bacterial prostatitis. Of the 377 men in the intent to treat population, including 197 treated with levofloxacin and 180 treated with ciprofloxacin, 35 on levofloxacin and 37 on ciprofloxacin with baseline PSA greater than 4 ng/ml were included in this analysis. Excluded from analysis were 2 levofloxacin treated patients with extremely high PSA at baseline (62 and 103 ng/ml, respectively). Mean baseline PSA +/- SD in the patients analyzed was 8.33 +/- 4.46 ng/ml, which decreased to 5.36 +/- 3.82 ng/ml after therapy. There was no significant difference in the mean change in PSA between the levofloxacin and ciprofloxacin groups. Approximately 42% of patients with increased baseline PSA had a post-therapy PSA of 4 ng/ml or less. Of patients who were microbiologically evaluable and had normalized PSA after therapy levofloxacin eradicated the pathogen in 90.9% (10 of 11). However, of patients in whom post-therapy PSA remained increased the microbiological eradication rate was 69.2% (9 of 13). Similarly 93.3% of the ciprofloxacin group (14 of 15 patients) with normalized post-therapy PSA experienced microbiological eradication compared with 61.5% (8 of 13) with continued increased PSA after therapy." }, { "role": "assistant", "content": "Approximately 20% of patients diagnosed with chronic bacterial prostatitis had increased PSA. A significant decrease in PSA was observed in these patients after treatment with levofloxacin or ciprofloxacin. An association was observed between bacterial persistence and the likelihood that PSA would return to normal. 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": "Follicular conjunctivitis are found in all except:" }, { "role": "assistant", "content": "The correct answer is Ans. 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: Adult, Bronchial Hyperreactivity, Bronchial Provocation Tests, Exhalation, Female, Humans, Male, Methacholine Chloride, Middle Aged, Nitric Oxide, Smoking, Surveys and Questionnaires." }, { "role": "user", "content": "Is bronchial responsiveness related to increased exhaled NO ( FE ( NO ) ) in non-smokers and decreased FE ( NO ) in smokers? Context: Both atopy and smoking are known to be associated with increased bronchial responsiveness. Fraction of nitric oxide (NO) in the exhaled air (FE(NO)), a marker of airways inflammation, is decreased by smoking and increased by atopy. NO has also a physiological bronchodilating and bronchoprotective role. To investigate how the relation between FE(NO) and bronchial responsiveness is modulated by atopy and smoking habits. Exhaled NO measurements and methacholine challenge were performed in 468 subjects from the random sample of three European Community Respiratory Health Survey II centers: Turin (Italy), Gothenburg and Uppsala (both Sweden). Atopy status was defined by using specific IgE measurements while smoking status was questionnaire-assessed. Increased bronchial responsiveness was associated with increased FE(NO) levels in non-smokers (p = 0.02) and decreased FE(NO) levels in current smokers (p = 0.03). The negative association between bronchial responsiveness and FE(NO) was seen only in the group smoking less <10 cigarettes/day (p = 0.008). Increased bronchial responsiveness was associated with increased FE(NO) in atopic subjects (p = 0.04) while no significant association was found in non-atopic participants. The reported interaction between FE(NO) and smoking and atopy, respectively were maintained after adjusting for possible confounders (p-values<0.05)." }, { "role": "assistant", "content": "The present study highlights the interactions of the relationship between FE(NO) and bronchial responsiveness with smoking and atopy, suggesting different mechanisms behind atopy- and smoking-related increases of bronchial responsiveness. 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: Acetylcysteine, Areca, Arecoline, Blotting, Western, Catechin, Dose-Response Relationship, Drug, GTP-Binding Proteins, Humans, Immunohistochemistry, Oral Submucous Fibrosis, Reactive Oxygen Species, Transglutaminases." }, { "role": "user", "content": "Does elevated transglutaminase-2 expression mediate fibrosis in areca quid chewing-associated oral submucocal fibrosis via reactive oxygen species generation? Context: Transglutaminase-2 (TGM-2) protein is involved in the cross-linking of matrix proteins resulting in several fibrotic disorders and can be induced by reactive oxygen species (ROS). Little is known about its role in the development of oral submucocal fibrosis (OSF). Hence, we hypothesize that TGM-2 may have a role in the pathogenesis of areca quid chewing-associated OSF and arecoline, a major areca nut alkaloid, could regulate TGM-2 via ROS generation. Forty OSF specimens from areca quid chewing-associated OSF and ten normal buccal mucosa biopsy samples without areca quid chewing were analyzed by immunohistochemistry. The expression of TGM-2 from fibroblasts cultured from OSF and normal buccal mucosa was evaluated by Western blot. The effect of arecoline on normal buccal mucosa fibroblasts (BMFs) was used to elucidate whether TGM-2 expression could be affected by arecoline by using 2', 7'-dichlorofluorescein diacetate assay and Western blot. In addition, glutathione precursor N-acetyl-L-cysteine (NAC) and epigallocatechin-3 gallate (EGCG) were added to find the possible regulatory mechanisms. TGM-2 expression was significantly higher in OSF specimens than normal specimens (p < 0.05). Fibroblasts derived from OSF were found to exhibit higher TGM-2 expression than BMFs in protein levels (p < 0.05). Arecoline significantly upregulated the intracellular ROS generation in a dose-dependent manner (p < 0.05). TGM-2 protein induced by arecoline was found in BMFs in a dose-dependent manner (p < 0.05). Treatment with NAC and EGCG markedly inhibited TGM-2 expression induced by arecoline (p < 0.05)." }, { "role": "assistant", "content": "Our results suggest that TGM-2 expression is significantly upregulated in OSF tissues from areca quid chewers. Arecoline-upregulated TGM-2 expression may be mediated by ROS generation. 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": "Out of 10 relatives exposed to a primary case, of measles, 6 developed measles. Secondary attack rate of measles-" }, { "role": "assistant", "content": "The correct answer is Ans. is 'b' i.e., 6/10 Secondary attack rate (SAR)o SAR is defined as \"the number ofexposed persons developing the disease within the range of incubation period, following exposure to primary caseSAR=No of exposed persons developing disease withinthe range of the incubation period-----------------------Total number of exposed/susceptible contactx 100 SAR =610x 100" } ]

[ { "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": "Cataract is caused by all except:" }, { "role": "assistant", "content": "The correct answer is B i.e. MRI" } ]

[ { "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: Animals, Baroreflex, Hypertension, Male, Oxidative Stress, Physical Conditioning, Animal, Rats, Rats, Inbred SHR, Rats, Inbred WKY." }, { "role": "user", "content": "Is baroreflex sensitivity improvement associated with decreased oxidative stress in trained spontaneously hypertensive rat? Context: Baroreflex sensitivity (BRS) impairment has been associated with endothelial dysfunction and oxidative stress. Because exercise training could improve endothelial function in spontaneously hypertensive rats (SHR), the effect of moderate exercise training on oxidative stress and BRS was investigated. Groups were divided into sedentary and trained Wistar-Kyoto rats (S-WK, n = 7 and T-WK, n = 6) and SHR (S-SHR and T-SHR, n = 9 each). Exercise training was performed on a treadmill (5 days/week, 60 min, 10 weeks), and the lactate threshold (20 m/min) was used to determine moderate intensity. Exercise training reduced mean arterial pressure in WK and SHR (S-WK 127 +/- 4, T-WK 105 +/- 5, S-SHR 169 +/- 4 versus T-SHR 140 +/- 4 mmHg; P < 0.01). Baroreflex bradycardic (S-WK -1.89 +/- 0.15, T-WK -2.11 +/- 0.37, S-SHR -0.80 +/- 0.09 versus T-SHR -1.29 +/- 0.10 bpm/mmHg; P < 0.0001) and tachycardic (S-WK 2.57 +/- 0.19, T-WK 2.73 +/- 0.21, S-SHR 1.18 +/- 0.07 versus T-SHR 2.02 +/- 0.10 bpm/mmHg; P < 0.0001) responses were significantly different between groups. Lipoperoxidation in erythrocytes (S-WK 11 320 +/- 739, T-WK 10 397 +/- 765, S-SHR 20 511 +/- 1627 versus T-SHR 10 211 +/- 589 counts per second (cps)/mg haemoglobin; P < 0.0001) and aortas (S-WK 12 424 +/- 2219, T-WK 7917 +/- 726, S-SHR 26 957 +/- 1772 versus T-SHR 17 777 +/- 1923 cps/mg protein; P < 0.0001) was reduced in T-SHR compared with S-SHR. Inverse correlations were observed between both bradycardic and tachycardic responses and lipoperoxidation in erythrocytes (r = 0.56 and r = -0.77, respectively; P < 0.01) and aortas (r = 0.77 and r = -0.80, respectively; P < 0.0001)." }, { "role": "assistant", "content": "Our results indicate that exercise training decreases oxidative stress, which is related to an improvement in BRS in SHR. Final Decision: yes" } ]