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[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Acidosis, Adult, Apgar Score, Baltimore, Birth Weight, Blood Gas Analysis, Case-Control Studies, Delivery, Obstetric, Female, Fetal Blood, Fetal Hypoxia, Gestational Age, Humans, Hydrogen-Ion Concentration, Infant, Newborn, Length of Stay, Longitudinal Studies, Medical Records, Obstetric Labor Complications, Pregnancy, Retrospective Studies, Seizures." }, { "role": "user", "content": "Is evidence of intrapartum hypoxia-ischemia present in the majority of cases of neonatal seizures? Context: To determine the extent to which neonatal seizures are associated with intrapartum hypoxia-ischemia. In this case-control study, all neonates diagnosed with seizures at a single institution from 1988 to 1999 were compared to a control group without seizures matched in a 2:1 fashion for gestational age at delivery, birth weight and mode of delivery. Data were abstracted from the maternal and neonatal charts. Parametric variables were compared using an independent samples t test, and non-parametric variables were compared using a Fisher exact test, with p < 0.05 being considered significant. There were 13 cases of neonatal seizures identified, of which one was chromosomally abnormal and excluded from further analysis. For the cases, the mean gestational age at delivery was 34.8 +/- 6.9 weeks, with four preterm and eight term deliveries. The mean birth weight for the cases was 2684 +/- 1369 g (range 590-4350 g). For both cases and controls, 83% were delivered vaginally and 17% by Cesarean section. For term neonates with seizures, the mean length of stay was 11.6 +/- 5.0 days, as compared to 2.5 +/- 0.9 days in the control group (p < 0.001). A 1-min Apgar score of < 7 was found in six of 12 (50%) cases and seven of 24 (29%) controls, and a 5-min Apgar score of < 7 was found in four of 12 (33%) cases and four of 24 (17%) controls (non-significant). In the controls, the mean base excess was -2.8 +/- 2.6 mEq/l, and the mean umbilical arterial pH was 7.28 +/- 0.09. In the case group, two infants born at 24 weeks did not have an umbilical arterial blood gas obtained; in the remaining cases, the mean base excess was -7.6 +/- 6.9 mEq/l (p = 0.02), and the mean cord pH was 7.17 +/- 0.23 (p = 0.065), with only three of ten (30%) having a pH < 7.00 (p = 0.02)." }, { "role": "assistant", "content": "Clinically significant acidosis was found in only 30% of neonates who developed seizures, and only one of 12 cases (8%) could possibly have met the criteria of the American College of Obstetricians and Gynecologists for neurological morbidity linked to intrapartum asphyxia. The majority of cases of neonatal seizures were not associated with evidence of intrapartum hypoxia-ischemia. 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": "Unstable spine injury occurs in" }, { "role": "assistant", "content": "The correct answer is Mode of injuries in Lower Cervical Spine Fractures (C3 - C7)Mode of injuriesPattern of fractureVeical (Axial) compression Burst fracture (Veebral height is decreased in toto)Pure flexion Wedge compression fracture (Decreased anterior height of veebrae)Combined axial compression & flexion Teardrop fracture (Antero inferior fragment of the veebral body is sheared off)Distraction - Flexion /Flexion rotation (MC unstable spine injury)Unilateral or bilateral subluxation & dislocation Flexion sprains Jumped facetsFloating veebra Avulsion injury of spinous process Clay shoveler's fracture Axial compression extension type Second most common type Distraction extension injury Disruption of anterior ligamentous complex followed by posterior soft tissue complex (Refer: Rockwood and Green's Fractures in Adults, 7th edition,pg no: 1498,1413,1435,1485)" } ]

[ { "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, Androgen Antagonists, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Grading, Neoplasm Recurrence, Local, Neoplasm Staging, Prognosis, Prostatic Neoplasms, Radiotherapy, Retrospective Studies, Salvage Therapy, Survival Rate." }, { "role": "user", "content": "Is less advanced disease at initiation of salvage androgen deprivation therapy associated with decreased mortality following biochemical failure post-salvage radiation therapy? Context: The optimal clinical context for initiation of salvage androgen deprivation therapy (SADT) following the biochemical recurrence of localized prostate cancer remains controversial. We chose to investigate if disease burden at time of SADT initiation is associated with clinical outcomes following biochemical failure (BF) post-salvage radiation therapy (SRT). Medical records of 575 patients receiving SRT at a single institution from 1986-2010 were retrospectively reviewed. Of 250 patients experiencing BF post-SRT, 172 had a calculable prostate-specific antigen doubling time (PSADT) prior to SADT initiation. These patients comprise the analyzed cohort and were divided into four groups based on characteristics at SADT initiation: those with PSADTs >3 months without distant metastasis (DM) (group 1 [less advanced disease], n=62), those with PSADTs <3 months without DM (group 2 [more advanced disease], n=28), those with DM (group 3 [more advanced disease], n=32), and those not receiving SADT during follow-up (group 4, n=50). Endpoints included prostate cancer-specific mortality (PCSM) and overall mortality (OM). Kaplan-Meier methods were used to estimate survival, and Cox proportional hazards models were used for multivariate analysis. Median follow-up post-SRT was 7.9 years. Patients starting SADT with more advanced disease were at significantly increased risk for PCSM (hazard ratio [HR]:2.8, 95% confidence interval [CI]: 1.4-5.6, p=0.005) and OM (HR:1.9, 95% CI: 1.0-3.5, p=0.04) compared to those receiving SADT with less advanced disease. PCSM and OM did not significantly differ between groups 1 and 4 or groups 2 and 3. Of note, patients in group 4 had very long PSADTs (median = 27.0 months) that were significantly longer than those of group 1 (median = 6.0 months) (p<0.001). Multivariate analysis including groups 1-3 found a pre-SADT PSADT <3 months to be the most significant predictor of PCSM (HR:4.2, 95% CI: 1.6-11.1, p=0.004) and the only significant predictor of OM (HR:2.9, 95% CI: 1.3-6.7, p=0.01)." }, { "role": "assistant", "content": "Less advanced disease at initiation of SADT is associated with decreased PCSM and OM following BF post-SRT; however, observation may be reasonable for patients with very long PSADTs. A PSADT <3 months prior to SADT initiation significantly predicts an increased risk of PCSM and OM in this patient demographic. 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, Aged, 80 and over, Aneurysm, Dissecting, Aortic Aneurysm, Aortic Aneurysm, Thoracic, Aortic Diseases, Blood Pressure, Carotid Arteries, Female, Heart Rate, Humans, Male, Middle Aged, Reference Values, Regression Analysis, Reproducibility of Results, Vascular Resistance." }, { "role": "user", "content": "Is augmentation index elevated in aortic aneurysm and dissection? Context: The augmentation index, the ratio of the ejection pressure from the heart to the reflection pressure from the arterial system, has recently been recognized as one of the indexes of left ventricular afterload. We studied it in patients with aortic aneurysm and dissection, using carotid artery diameter waveform obtained from an echo-tracking system. Forty-six patients were divided into the following three groups based on pathology: group A, 21 patients with thoracic aortic aneurysm; group B, 15 patients with chronic aortic dissection; and group C, 10 patients without any aortic diseases. Using an echo-tracking system on the carotid artery, we measured stiffness parameter beta, arterial compliance, and the augmentation index. There was no significant difference in stiffness parameter beta and arterial compliance among the three groups. The augmentation index was significantly higher in groups A and B than group C (22 +/- 10%, 22 +/- 13% vs 8 +/- 17%; p = 0.012). Female (p = 0.028) and heart rate (p = 0.005) were significantly associated with the augmentation index and the significance of aortic diseases was marginal (p = 0.056)." }, { "role": "assistant", "content": "The carotid augmentation index is elevated in patients with aortic aneurysm and dissection. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Base Sequence, Bayes Theorem, Female, Genetic Variation, Genotype, Hepatitis B, Hepatitis B Vaccines, Hepatitis B virus, Humans, Male, Molecular Sequence Data, Netherlands, Vaccination." }, { "role": "user", "content": "Does selective hepatitis B virus vaccination have reduced hepatitis B virus transmission in the Netherlands? Context: In the Netherlands, a selective hepatitis B virus (HBV) vaccination programme started in 2002 for men having sex with men, drug users, commercial sex workers and heterosexuals with frequent partner changes. We assessed the programme's effectiveness to guide policy on HBV prevention. We analysed reports of acute HBV infection in the Netherlands between 2004 and 2010 requesting serum from patients for HBV-genome S- and C-region sequencing. We used coalescence analyses to assess genetic diversity of nonimported genotype-A cases over time. 1687 patients with acute HBV infection were reported between 2004 and 2010. The incidence of reported acute HBV infection decreased from 1.8 to 1.2 per 100,000 inhabitants, mostly due to a reduction in the number of cases in men who have sex with men. Men were overrepresented among cases with an unknown route of transmission, especially among genotype A2 cases mainly associated with transmission through male homosexual contact. The genetic diversity of nonimported genotype-A strains obtained from men who have sex with men decreased from 2006 onwards, suggesting HBV incidence in this group decreased." }, { "role": "assistant", "content": "The selective HBV-vaccination programme for behavioural high-risk groups very likely reduced the incidence of HBV infection in the Netherlands mainly by preventing HBV infections in men who have sex with men. A considerable proportion of cases in men who did not report risk behaviour was probably acquired through homosexual contact. Our findings support continuation of the programme, and adopting similar approaches in other countries where HBV transmission is focused in high-risk adults. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: UNLABELLED. Meshes: Acetaldehyde, Case-Control Studies, Chromatography, Gas, Dose-Response Relationship, Drug, Ethanol, Furosemide, Gestational Age, Humans, Infant, Infant, Newborn, Infant, Premature, Iron Compounds, Sodium Potassium Chloride Symporter Inhibitors." }, { "role": "user", "content": "Do essential medicines containing ethanol elevate blood acetaldehyde concentrations in neonates? Context: Neonates administered ethanol-containing medicines are potentially at risk of dose-dependent injury through exposure to ethanol and its metabolite, acetaldehyde. Here, we determine blood ethanol and acetaldehyde concentrations in 49 preterm infants (median birth weight = 1190 g) dosed with iron or furosemide, medicines that contain different amounts of ethanol, and in 11 control group infants (median birth weight = 1920 g) who were not on any medications. Median ethanol concentrations in neonates administered iron or furosemide were 0.33 (range = 0-4.92) mg/L, 0.39 (range = 0-72.77) mg/L and in control group infants were 0.15 (range = 0.03-5.4) mg/L. Median acetaldehyde concentrations in neonates administered iron or furosemide were 0.16 (range = 0-8.89) mg/L, 0.21 (range = 0-2.43) mg/L and in control group infants were 0.01 (range = 0-0.14) mg/L. There was no discernible relationship between blood ethanol or acetaldehyde concentrations and time after medication dose." }, { "role": "assistant", "content": "Although infants dosed with iron or furosemide had low blood ethanol concentrations, blood acetaldehyde concentrations were consistent with moderate alcohol exposure. The data suggest the need to account for the effects of acetaldehyde in the benefit-risk analysis of administering ethanol-containing medicines to neonates. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Aged, 80 and over, Female, Heart Rate, Humans, Indoles, Long QT Syndrome, Male, Middle Aged, Ondansetron, Postoperative Complications, Postoperative Period, Preoperative Care, Quinolizines, Serotonin 5-HT3 Receptor Antagonists, Young Adult." }, { "role": "user", "content": "Do perioperative doses of ondansetron or dolasetron lengthen the QT interval? Context: To test the primary hypothesis that ondansetron or dolasetron extends the rate-corrected QT electrocardiographic interval (QTc) greater than 60 milliseconds or increases the fraction of patients with QTc greater than 500 milliseconds in patients having noncardiac surgery, and the secondary hypothesis that QTc prolongation is worse in diabetic patients. We extracted data from the Cleveland Clinic's Perioperative Health Documentation System between March 25, 2006, and September 30, 2010, and additional perioperative medications from Cleveland Clinic pharmacy's Epic Cost of Goods Sold (COGS) system. We searched for patients who had a preoperative electrocardiogram within 1 month of surgery and postoperatively within 2 hours. We excluded patients given an antiemetic drug other than ondansetron or dolasetron perioperatively, and those given amiodarone. A total of 1429 patients given serotonin-3 receptor (5HT3R) antagonists and 1022 controls met the enrollment criteria. Seventeen percent of patients given 5HT3R antagonists (n=242) and 22% of controls (n=220) had postoperative QTc exceeding 500 milliseconds. Mean ± SD presurgical and postsurgical QTc, respectively, were 438±37 milliseconds and 464±41 milliseconds for 5HT3R antagonist patients and 443±40 milliseconds and 469±47 milliseconds for control patients. Univariable mean ± SD perioperative increases in QTc were 26±39 and 26±48 milliseconds in the 2 groups. After adjusting for confounding variables, there were no differences in the mean increase in QTc in patients who were and were not given 5HT3R antagonists: -0.1 milliseconds (97.5% CI, -5.2 to 5.0 milliseconds; multivariable P=.97). The QTc was prolonged, but not significantly, in diabetic patients given 5HT3R antagonists (P=.16)." }, { "role": "assistant", "content": "The average QTc prolongation from baseline was only 6%. Perioperative use of ondansetron or dolasetron was not associated with extended QT prolongation, and these results did not vary by diabetic status. Perioperative use of 5HT3R antagonists does not produce potentially dangerous perioperative electrocardiographic changes and does not seem to warrant a drug safety warning from the Food and Drug Administration. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: METHODS, RESULTS. Meshes: Adolescent, Chorionic Gonadotropin, Female, Humans, Methotrexate, Predictive Value of Tests, Pregnancy, Pregnancy, Tubal, Retrospective Studies, Rupture, Spontaneous, Sensitivity and Specificity, Young Adult." }, { "role": "user", "content": "Tubal rupture in ectopic pregnancy: is it predictable? Context: Demographic data and medical data were extracted from patient charts for 211 cases who had diagnosis of tubal ectopic pregnancy. Women with tubal rupture were compared to those without rupture. Expectant management, single dose methotrexate and primary surgical treatment were applied to 83 cases (39%), 93 cases (44%) and 35 cases (17%), respectively. The tubal rupture occurred in 14.7% of the study population. If the EP mass diameter is<2 cm, no tubal rupture was found. hCG values at admission were found to be predictive for rupture. On admission, hCG level of 1855 IU/L had 93.5%, sensitivity and 29% positive predictive value for tubal rupture." }, { "role": "assistant", "content": "In tubal ectopic pregnancy cases, hCG level on admission and size of ectopic pregnancy mass can predict tubal rupture." } ]

[ { "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": "Dithionite test is done for assessing -" }, { "role": "assistant", "content": "The correct answer is Ans. is `d' i.e., Hb S Dithionite test is a rapid screening tube test for the detection of HbS." } ]

[ { "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, Biopsy, Endoscopy, Digestive System, Eosinophilic Esophagitis, Eosinophils, Esophagus, Female, Food, Food, Formulated, Humans, Male, Mast Cells, Middle Aged, Patient Compliance, Patient Selection, Prospective Studies, Treatment Outcome, Weight Loss." }, { "role": "user", "content": "Does elemental diet induce histologic response in adult eosinophilic esophagitis? Context: Elemental diets have not been studied in adults with eosinophilic esophagitis (EoE). The goal of this trial was to assess the efficacy of an elemental diet in adults with EoE. A total of 18 adults with EoE were given an elemental diet for 4 weeks, or just 2 weeks if their response was complete. Symptoms and histologic findings, based on biweekly biopsies, were monitored. Six subjects were rebiopsied 2-7 days after resuming a normal diet. After therapy, esophageal tissue eosinophil content decreased from 54 to 10 per maximal high power field (P=0.0006). There was complete or nearly complete response (≤10 eosinophils) in 72% of subjects. Mast cell content, parabasal layer thickness, and endoscopic furrows and exudates also significantly decreased. Of the 29 qualified subjects, 11 (38%) failed to adhere to the diet. Several subjects had significant weight loss. Symptoms and endoscopic fixed strictures did not improve. After the subjects resumed a normal diet, the eosinophil content increased substantially in 3-7 days." }, { "role": "assistant", "content": "While symptoms did not improve and dietary compliance was problematic, there was substantial histologic improvement after 4 weeks on the elemental diet. EoE in adults is substantially triggered by foods. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Bumetanide, Cell Membrane Permeability, Erythrocyte Membrane, Erythrocytes, Female, Humans, Male, Middle Aged, Myocardial Ischemia, Ouabain, Potassium, Sodium-Potassium-Exchanging ATPase, Spectrophotometry, Atomic." }, { "role": "user", "content": "Is erythrocyte passive potassium flux increased in patients with ischemic coronary disease ( ICD ) and in subjects with family history of ICD? Context: It has been proposed that ischemic coronary disease (ICD) associated potassium loss could be due to modifications of potassium permeability. We investigated whether a positive family history of ICD can influence this parameter. We have compared potassium permeability in erythrocytes from ICD patients and from positive family history subjects (FICD) with control subjects. All patients and subjects were carefully selected for the absence of hypertension and dysmetabolic pathologies. ICD group: 24 patients (19 males, 5 females; ages 43 to 69) all affected by ischemic coronary disease, under no drug treatment; FICD group: 18 subjects (all males, ages 27 to 42) with a verified positive ICD family history, without hypertensive family history and cardiovascular pathology; control group: 16 subjects (11 males, 5 females; ages 28 to 48) without positive family history of ICD. Passive potassium efflux (PPE) was spectrophotometrically measured in K-free medium containing ouabain and bumetanide. The kinetic constant was calculated by dividing PPE by the erythrocyte potassium concentration. No statistically significant differences were noted between the intracellular potassium content of the three groups. However, (1) the passive potassium permeability of the ICD group was significantly higher (kK=0.055 +/- 0.021 h(-1), n=24) than that of the control group (kK=0.023 +/- 0.008 h(-1), n= 16; p<0.00001), (2) the FICD group was higher (kK=0.036 +/- 0.012 h(-1), n=18) than the control group (p<0.001), and (3) the ICD group was higher than the FICD group (p<0.001)." }, { "role": "assistant", "content": "Our results suggest an inheritability of ICD, paralleling the familial aggregation of the pathology. Erythrocyte potassium permeability could represent an early marker of ischemic coronary disease and be used as a prophylactic tool. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Carcinoma, Chemotherapy, Adjuvant, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Neoadjuvant Therapy, Perineum, Radiation Injuries, Rectal Neoplasms, Retrospective Studies, Risk Factors, Surgical Wound Infection, Wound Healing." }, { "role": "user", "content": "Does primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection have a high incidence of wound failure? Context: Neoadjuvant radiation therapy has been used increasingly to downstage rectal cancer and decrease local recurrence. Despite its efficacy, preoperative radiation therapy may inhibit healing and contribute to wound complications. This study was designed to evaluate perineal wound complications after abdominoperineal resection. The clinical records of a consecutive series of patients who underwent abdominoperineal resection for rectal carcinoma between 1988 and 2002 were reviewed. Demographic data, disease stage, and use of preoperative radiation therapy were recorded. Major wound complications included delayed wound healing (>1 month), wound infection requiring drainage/debridement, or reoperation. A total of 160 patients underwent abdominoperineal resection with primary closure of the perineal wound (mean age, 63 +/- 12 years); 117 (73 percent) patients received preoperative radiation therapy; 114 received radiation therapy for rectal cancer (radiation therapy + chemotherapy = 107, radiation therapy alone = 7); 3 received radiation therapy for other pelvic malignancies. Median radiation dose was 5,040 (range, 900-5,400) cGY. Overall wound complication rate was 41 percent. Major wound complication rate was 35 percent. Delayed healing was the most common complication (24 percent), followed by infection (10 percent). Radiation therapy increased the risk of any wound complication (47 vs. 23 percent; P = 0.005), risk of a major wound complication (41 vs. 19 percent; P = 0.021), and risk of infection (14 vs. 0 percent; P = 0.015). Risk of wound complications did not correlate with age, gender, disease stage, smoking, or diabetes." }, { "role": "assistant", "content": "Wound complications are frequent after abdominoperineal resection and primary closure of the perineum. Preoperative radiation therapy doubles the rate of total and major perineal wound complications. Alternatives to primary perineal closure should be considered, particularly after radiation therapy. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adjuvants, Anesthesia, Amino Acids, Animals, Animals, Newborn, Body Temperature Regulation, Cell Respiration, Cells, Cultured, Fentanyl, Liver, Oxygen Consumption, Probability, Rats, Rats, Wistar, Reference Values, Sensitivity and Specificity." }, { "role": "user", "content": "Do amino acids counteract the inhibitory effect of fentanyl on hepatocyte oxidative metabolism? Context: Hypothermia is common after major surgery in newborns and can be triggered by intraoperative fentanyl analgesia. Recent studies have found that fentanyl inhibits hepatocyte mitochondrial oxidative metabolism, which is proportional to thermogenesis. In adults it has been shown that amino acids have a thermogenic effect, although the biochemical basis of this phenomenon is not known. The aim of this study was to test the hypothesis that amino acids counteract the inhibition of neonatal hepatocyte oxygen consumption by fentanyl. Hepatocytes were isolated from suckling rats, and O2 consumption was measured polarographically. In experiment A hepatocytes were incubated with (1) palmitate alone (control), (2) palmitate plus fentanyl, (3) palmitate plus fentanyl plus amino acids, and (4) palmitate plus amino acids. In experiment B the effects of essential and nonessential amino acids were tested separately. In experiment C, to investigate whether the effect of amino acids is intramitochondrial, hepatocytes were incubated with amino acids plus inhibitors of mitochondrial respiration. In experiment A, fentanyl significantly inhibited O2 consumption (P = .006). This inhibition was reversed by amino acids (P < .001). In experiment B, both essential and nonessential amino acids reversed the effect of fentanyl (P < .001). In experiment C, there was no difference in O2 consumption in the presence of myxothiazol among the groups indicating that amino acids affect intramitochondrial O2 consumption." }, { "role": "assistant", "content": "(1) Amino acids abolish the inhibitory effect of fentanyl on hepatocyte oxidative metabolism. (2) Amino acids affect intramitochondrial O2 consumption and therefore thermogenesis. (3) Perioperative administration of amino acids in neonates may help to prevent hypothermia and its deleterious effects. 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 is not a non-radiographic methods of determining the working length:" }, { "role": "assistant", "content": "The correct answer is NON-RADIOGRAPHIC METHODS\nTactile Sense\nIf the coronal portion of the canal is not constricted, an experienced clinician may detect an increase in resistance as the file approaches the apical 2-3 mm. This detection is by a tactile sense. it is ineffective in root canals with an immature apex and is highly inaccurate if the canal is constricted throughout its entire length of if it has excessive curvature. This method should be considered as a supplementary method. If the canals are not preflared, determination of the apical constriction by tactile sensation would be possible in only one-third of the cases\nApical Periodontal Sensitivity\nBased on the patients’, responses, dentists observe the ‘eye twitching’ sign. This is no more an acceptable method. Leads to too shorter determination of working length, in cases of inflamed tissues and overestimation in cases of non-vital teeth with periapical pathology\nPaper Point Method\nPaper points in the root canals with immature apex are the most reliable means determining the working lengths. This method is gently pass the blunt end of the paper point into the canal after profound anaesthesia is achieved. The moisture or blood on the portion of the paper point that passes beyond the apex may be an estimation of working length. This method cannot be used in weeping canals. This is a supplementary method. Paper points with millimetre marking have been introduced, recently." } ]

[ { "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": "Leprosy bacillus is cultured by using:-" }, { "role": "assistant", "content": "The correct answer is Leprosy: Oldest disease known. Caused by Mycobacterium leprae. Mode of transmission: Air droplets, skin contact, transplacental, breast feeding, insect bite, tattoo, corneal/organ transplantation. Mycobacterium leprae has no aificial culture media. Leprae bacilli are cultured by: Foot pad of mice. 9-banded armadillo. Other options: Bordet gengou medium: Bordetella Peussis. LJ medium: Mycobacterium Tuberculosis. Loeffler's serum slope: Corynebacterium Diphtheria." } ]

[ { "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": "Preganglionic fibres to the submandibular ganglion arise from?" }, { "role": "assistant", "content": "The correct answer is Sensory root is from the lingual nerve. It is suspended by two roots of lingual nerve Sympathetic root is from the sympathetic plexus around the facial aery. This plexus contains postganglionic fibres from the superior cervical ganglion of sympathetic trunk. These fibres pass express through the ganglion and are vasomotor to the submandibular gland Secretomotor root is from superior salivatory nucleus through nervus intermedius chorda tympani which is abranch of cranial nerve VII. Chorda tympani joins lingual nerve.The parasympathetic fibres get relayed in the submandibular ganglion Ref BDC volume 3,sixth edition pg 310" } ]

[ { "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: Activities of Daily Living, Adult, Anti-Inflammatory Agents, Elbow Joint, Female, Fractures, Bone, Humans, Hyaluronic Acid, Injections, Intra-Articular, Joint Dislocations, Male, Medical Records, Middle Aged, Osteoarthritis, Pain, Pain Measurement, Range of Motion, Articular, Retrospective Studies, Time Factors, Treatment Failure." }, { "role": "user", "content": "Is intra-articular injection of hyaluronic acid effective for the treatment of post-traumatic osteoarthritis of the elbow? Context: In this study we evaluated the effect and safety of intra-articular injection of hyaluronic acid in 19 consecutive elbows with post-traumatic osteoarthritis. In 18 patients (10 male and 8 female patients; mean age, 45.6 years [SD, 15.0 years]), 3 injections of sodium hyaluronate were given within 4 weeks at regular intervals. Evaluation took place just before the first injection, as well as after 3 and 6 months, and consisted of the Elbow Function Assessment Score, the Functional Rating Index of Broberg and Morrey, and the Modified Andrews Elbow Scoring System. Pain was also assessed by means of visual analog scales. Viscosupplementation resulted in slight, short-term pain relief and a very limited decrease in activity impairment at evaluation after 3 months. After 6 months, no beneficial effects were noticed in any of the 19 injected elbows. Other parameters were not influenced by treatment with viscosupplementation at any time. Systemic or local adverse effects did not occur." }, { "role": "assistant", "content": "Because the use of viscosupplementation for the treatment of post-traumatic osteoarthritis of the elbow provides only slight, short-term pain relief and a very limited decrease in activity impairment and the other parameters were not modified, we believe that viscosupplementation is not suitable for this indication. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: METHODS, RESULTS. Meshes: Adult, Biopsy, Female, Genotype, Hepacivirus, Hepatitis C, Chronic, Humans, Interferon-alpha, Laparoscopy, Liver Cirrhosis, Male, Middle Aged, RNA, Viral, Reproducibility of Results, Retrospective Studies, Treatment Outcome." }, { "role": "user", "content": "Is laparoscopy an advantage in the diagnosis of cirrhosis in chronic hepatitis C virus infection? Context: In this retrospective study, diagnostic laparoscopy with laparoscopic liver biopsy was performed in 72 consecutive patients with chronic HCV infection. The presence or absence of cirrhosis was analyzed macroscopically by laparoscopy and microscopically by liver biopsy specimens. Clinical and laboratory data and outcome of interferon-alfa treatment were compared between cirrhotic and noncirrhotic patients. Laparoscopically, cirrhosis was seen in 29.2 % (21/72) and non-cirrhosis in 70.8 % (51/72) of patients. Cirrhotic patients were significantly older with a significant longer duration of HCV infection than noncirrhotic patients. Laboratory parameters (AST, y-GT, y-globulin fraction) were measured significantly higher as well as significantly lower (prothrombin index, platelet count) in cirrhotic patients than in non-cirrhotic patients. Histologically, cirrhosis was confirmed in 11.1 % (8/72) and non cirrhosis in 88.9 % (64/72). Patients with macroscopically confirmed cirrhosis (n=21) showed histologically cirrhosis in 38.1 % (8/21) and histologically non-cirrhosis in 61.9 % (13/21). In contrast, patients with macroscopically non-cirrhosis (n=51) showed histologically non cirrhosis in all cases (51/51). Thirty-nine of 72 patients were treated with interferon-alfa, resulting in 35.9 % (14/39) patients with sustained response and 64.1 % (25/39) with non response. Non-responders showed significantly more macroscopically cirrhosis than sustained responders. In contrast, there were no significant histological differences between non-responders and sustained responders." }, { "role": "assistant", "content": "Diagnostic laparoscopy is more accurate than liver biopsy in recognizing cirrhosis in patients with chronic HCV infection. Liver biopsy is the best way to assess inflammatory grade and fibrotic stage. The invasive marker for staging, prognosis and management, and treatment outcome of chronic HCV-infected patients need further research and clinical trials. Laparoscopy should be performed for recognition of cirrhosis if this parameter is found to be of prognostic and therapeutic relevance in patients with chronic HCV infection." } ]

[ { "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 one of the following provides hemodynamic stability and prolongs survival in congestive heart failure?" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Anger, Chronic Disease, Female, Humans, Middle Aged, Recurrence, Smoking, Smoking Cessation, Young Adult." }, { "role": "user", "content": "Does anger Expression Style predict the Domain of the First Smoking Relapse After a Quit Attempt? Context: Risk for smoking relapse may be associated with context-dependent social and behavioral cues. However, lack of research examining the role of trait negative mood such as anger in this relationship and assessment of objective indices related to smoking status (e.g., biochemical measures) may limit existing findings. We examined the roles of trait anger, habitual anger expression behavior, and the situation in which the first incident of smoking lapse following a quit attempt occurs. One-hundred and five smokers interested in cessation (mean age, SD: 34.7 ± 11.8) set a quit day and attended multiple post-quit assessments where they were asked to provide biochemical measures including exhaled carbon monoxide (CO) and self-report measurements, including smoking status. Eighty-eight participants (40 women) returned to smoking over the 12-month study period. Self-reported smoking status was verified by exhaled CO measurements. Thirty-one percent of participants who relapsed reported the first lapse occurring at home, 15% at work, 14% at a restaurant or a bar, and 8% in a car. Multinomial logistic regression models found that high levels of anger-out were associated with smoking relapse in situations other than work or home (p <.05)." }, { "role": "assistant", "content": "These results expand prior work suggesting habitual anger expression style may moderate associations between situational factors and risk for smoking relapse, highlighting the need to incorporate findings in treatment methods. Absence of gender differences suggests the situational factors explored here affect relapse independent of gender. 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: Adenocarcinoma, Adenocarcinoma of Lung, Aged, Carcinoma, Large Cell, Carcinoma, Neuroendocrine, Carcinoma, Non-Small-Cell Lung, Carcinoma, Small Cell, Female, High-Throughput Nucleotide Sequencing, Humans, Lung Neoplasms, Male, Middle Aged, Mutation, Small Cell Lung Carcinoma." }, { "role": "user", "content": "Does next-Generation Sequencing of Pulmonary Large Cell Neuroendocrine Carcinoma reveal Small Cell Carcinoma-like and Non-Small Cell Carcinoma-like Subsets? Context: Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a highly aggressive neoplasm, whose biologic relationship to small cell lung carcinoma (SCLC) versus non-SCLC (NSCLC) remains unclear, contributing to uncertainty regarding optimal clinical management. To clarify these relationships, we analyzed genomic alterations in LCNEC compared with other major lung carcinoma types. LCNEC (n = 45) tumor/normal pairs underwent targeted next-generation sequencing of 241 cancer genes by Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT) platform and comprehensive histologic, immunohistochemical, and clinical analysis. Genomic data were compared with MSK-IMPACT analysis of other lung carcinoma histologies (n = 242). Commonly altered genes in LCNEC included TP53 (78%), RB1 (38%), STK11 (33%), KEAP1 (31%), and KRAS (22%). Genomic profiles segregated LCNEC into 2 major and 1 minor subsets: SCLC-like (n = 18), characterized by TP53+RB1 co-mutation/loss and other SCLC-type alterations, including MYCL amplification; NSCLC-like (n = 25), characterized by the lack of coaltered TP53+RB1 and nearly universal occurrence of NSCLC-type mutations (STK11, KRAS, and KEAP1); and carcinoid-like (n = 2), characterized by MEN1 mutations and low mutation burden. SCLC-like and NSCLC-like subsets revealed several clinicopathologic differences, including higher proliferative activity in SCLC-like tumors (P < 0.0001) and exclusive adenocarcinoma-type differentiation marker expression in NSCLC-like tumors (P = 0.005). While exhibiting predominant similarity with lung adenocarcinoma, NSCLC-like LCNEC harbored several distinctive genomic alterations, including more frequent mutations in NOTCH family genes (28%), implicated as key regulators of neuroendocrine differentiation." }, { "role": "assistant", "content": "LCNEC is a biologically heterogeneous group of tumors, comprising distinct subsets with genomic signatures of SCLC, NSCLC (predominantly adenocarcinoma), and rarely, highly proliferative carcinoids. Recognition of these subsets may inform the classification and management of LCNEC patients. Clin Cancer Res; 22(14); 3618-29. ©2016 AACR. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Aged, Antiviral Agents, Drug Therapy, Combination, Female, Genotype, Hepacivirus, Hepatitis C, Chronic, Humans, Interferon-alpha, Logistic Models, Male, Mass Spectrometry, Middle Aged, Multivariate Analysis, Proteome, Ribavirin, Sensitivity and Specificity, Taiwan, Treatment Outcome, Viral Load." }, { "role": "user", "content": "Does serum proteome predict virological response in chronic hepatitis C genotype 1b patients treated with pegylated interferon plus ribavirin? Context: Whether serum proteome changes can predict treatment response in chronic hepatitis C remains unclear. We investigated the association between serum proteome changes and virological responses in chronic hepatitis C virus genotype 1b (HCV-1b) patients treated with pegylated interferon (PegIFN) plus ribavirin (RBV). One hundred and thirty-six HCV-1b patients who had completed a course of PegIFN plus RBV for 24 weeks, had a 24-week follow-up, and had pretreatment serum available were enrolled. These patients were divided into training and validation groups. We used matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS) for peptide profiling and ClinPro Tools version 2.0 bioinformatics software for data analysis. Seventy-four patients (54%) had a sustained virological response (SVR), whereas 62 did not. We identified three protein peaks in pretreatment sera where the expression levels significantly differed between SVR and non-SVR (p < 0.05). Using the class prediction tool composed of the three protein peaks, we were able to correctly predict SVR in 95% of validation group patients with sensitivity = 95%, specificity = 56.3%, positive predictive value = 73.1%, and negative predictive value = 90%. We also identified a set of 20 protein peaks where the expression levels significantly differed in pretreatment sera between patients with nonresponse (NR) and virological response (SVR plus relapse; p < 0.05). Using the class prediction tool composed of these 20 protein peaks, we were able to correctly predict virological NR in 82% of validation group patients with sensitivity = 100%, specificity = 82%, positive predictive value = 92.6%, and negative predictive value = 100%." }, { "role": "assistant", "content": "Pretreatment serum proteome allows prediction of SVR and NR to PegIFN plus RBV treatment in HCV-1b patients. 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 does not handle the free radicals in the lens" }, { "role": "assistant", "content": "The correct answer is Lens has two major antioxidant Vitamin C and Vitamin E also it has two detoxifying enzymes that is catalase and superoxide dismutase Refer: Khurana 6th edition page number 219" } ]

[ { "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 sensitive indicator of iron deficiency anemia" }, { "role": "assistant", "content": "The correct answer is Ans. (c) Serum ferritin(Ref: Robbins 9th/pg 649-652)Among the options provided, most sensitive marker in iron deficiency anemia is Serum ferritin.Serum ferritin reflects the storage of Iron which is decreased even in the pre-latent stage of Iron deficiency Anemia and is the most sensitive marker." } ]

[ { "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": "Transfer of a poion of the DNA from one bacterium to another by bacteriophage is known as" }, { "role": "assistant", "content": "The correct answer is ." } ]

[ { "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: Abortion, Spontaneous, Adult, Amniocentesis, Amniotic Fluid, Case-Control Studies, Chemokine CCL2, Female, Humans, Odds Ratio, Pregnancy, Pregnancy Outcome, Pregnancy Trimester, Second, ROC Curve, Reference Values, Retrospective Studies, Risk Factors." }, { "role": "user", "content": "Is elevated monocyte chemotactic protein-1 in amniotic fluid a risk factor for pregnancy loss? Context: Pregnancy loss after mid-trimester amniocentesis occurs in 0.5-1% of cases and is frequently attributed to the procedure. Accumulating evidence implicates a pre-existing, but clinically silent, intra-amniotic inflammation in the etiology of adverse pregnancy outcome after mid-trimester amniocentesis. Monocyte chemotactic protein-1 (MCP-1) is a potent chemokine produced by a wide variety of cells during the course of an inflammatory response. This study was designed to assess if the amniotic fluid concentration of this chemokine identifies patients at risk for spontaneous abortion and/or fetal death. A retrospective case-control study of women who had a mid-trimester amniocentesis was designed. Cases (n = 10) consisted of patients who had a spontaneous pregnancy loss after the procedure, while the control group (n = 84) consisted of patients who had a normal pregnancy outcome after mid-trimester amniocentesis. MCP-1 was measured by a specific enzyme immunoassay (sensitivity, 18.3 pg/ml). The Kolmogorov-Smirnov test was utilized to assess normal distribution of the data. Logarithmic transformation was applied to achieve normality. Statistical analysis was performed using Student's t test. A receiver operating characteristic (ROC) curve analysis was used to select a cut-off to dichotomize amniotic fluid concentrations of MCP-1. MCP-1 was detectable in all amniotic fluid samples. Patients who had a mid-trimester amniocentesis and a subsequent pregnancy loss had a higher mean amniotic fluid log MCP-1 concentration than those with a normal pregnancy outcome (pregnancy loss, mean 2.95 +/- 0.19 pg/ml vs. normal outcome, mean 2.78 +/- 0.19 pg/ml; p = 0.01). A cut-off of > 765 pg/ml was selected by ROC curve analysis (area under the curve, 0.74; p = 0.01). An amniotic fluid concentration of MCP-1 above this level was strongly associated with pregnancy loss (odds ratio, 7.35; 95% confidence interval, 1.7-31.1), a sensitivity of 70%, and a specificity of 76%." }, { "role": "assistant", "content": "A subset of women who had a pregnancy loss after a mid-trimester amniocentesis had higher concentrations of the chemokine MCP-1 than those who had a normal pregnancy outcome. Subclinical intra-amniotic inflammation is a risk factor for pregnancy loss after mid-trimester amniocentesis. This observation may have medicolegal and clinical implications. An elevated MCP-1 concentration in amniotic fluid of patients with a pregnancy loss after a mid-trimester amniocentesis indicates that a pathological condition was present at the time of the procedure. 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: Bilirubin, Haptoglobins, Heart, Artificial, Hemoglobins, Hemolysis, Hemopexin, Humans, L-Lactate Dehydrogenase, Phosphopyruvate Hydratase, Platelet Count, Retrospective Studies." }, { "role": "user", "content": "Does neuron-specific enolase correlate to laboratory markers of haemolysis in patients on long-term circulatory support? Context: Neuron-specific enolase (NSE) is used as a diagnostic tool in neuropathies, cerebral diseases or traumata and for some tumours. Furthermore, it is also expressed by erythrocytes and platelets and has been linked to haemolysis ex vivo as a laboratory issue. Chronic haemolysis is frequently associated with mechanical circulatory support by ventricular assist device (VAD) or total artificial heart (TAH). Therefore, we compared NSE with indicators of haemolysis in VAD and TAH patients. We included 599 data sets of 97 patients who underwent VAD or TAH implantation. NSE, haptoglobin (HAPT), haemopexin (HPX), free haemoglobin (frHB), lactate dehydrogenase activity (LDH), platelet counts and total bilirubin (TBIL) in plasma were analysed. Further, all major cerebral events were assessed. NSE correlated to frHB (rs = 0.553) and to LDH (rs = 0.695). An inverse correlation was found with HAPT (rs = -0.484) and HPX (rs = -0.398). Thirty-two patients suffered neurological events. Within the time frame of 1 day before to 4 days after a neurological event, correlations of NSE to HAPT (rs = -0.540) and HPX (rs = -0.611) in negative and to frHB (rs = 0.757), LDH (rs = 0.862) and TBIL (rs = 0.549) in positive direction were established (all P < 0.05). Furthermore, haemolysis was graded into three groups for severe, moderate or no or only slight haemolysis. NSE values differed correspondingly between these groups (P < 0.001)." }, { "role": "assistant", "content": "NSE correlates to laboratory parameters indicative of haemolysis in VAD and TAH patients. Our data suggest an influence of intravascular haemolysis on NSE. Therefore, the parameter should be used with caution when it is used to assess cerebral damage. 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: Acute Disease, Adult, Aged, Biomarkers, Cohort Studies, Female, Furosemide, Heart Failure, Humans, Infusions, Intravenous, Male, Middle Aged, Natriuretic Peptide, Brain, Prospective Studies, Sodium Potassium Chloride Symporter Inhibitors, Treatment Outcome." }, { "role": "user", "content": "Is insufficient natriuretic response to continuous intravenous furosemide associated with poor long-term outcomes in acute decompensated heart failure? Context: Treatment of acute decompensated heart failure (ADHF) with loop diuretics, such as furosemide, is frequently complicated by insufficient urine sodium excretion. We hypothesize that insufficient natriuretic response to diuretic therapy, characterized by lower urine sodium (UNa) and urine furosemide, is associated with subsequent inadequate decongestion, worsening renal function, and adverse long term events. We enrolled 52 consecutive patients with ADHF and measured serum and urine sodium (UNa), urine creatinine (UCr), and urine furosemide (UFurosemide) levels on a spot sample taken after treatment with continuous intravenous furosemide, and followed clinical and renal variables as well as adverse long-term clinical outcomes (death, rehospitalizations, and cardiac transplantation). We observed similar correlations between UNa:UFurosemide ratio and UNa and fractional excretion of sodium (FENa) with 24-hour net urine output (r = 0.52-0.64, all P < .01) and 24-hour weight loss (r = 0.44-0.56; all P < .01). Interestingly, FENa (but not UNa or UNa:UFurosemide) were influenced by estimated glomerular filtration rate (eGFR). We observed an association between lower UNa:UFurosemide with greater likelihood of worsening renal function (hazard ratio [HR] 3.01; P = .02) and poorer adverse clinical outcomes (HR 1.63, P = .008) after adjusting for age and eGFR. Meanwhile, both diminished weight loss and net fluid output over 24 hours of continuous intravenous furosemide were observed when UNa:UFurosemide ratios were <2 mmol/mg or when UNa <50 mmol." }, { "role": "assistant", "content": "In patients with ADHF receiving continuous furosemide infusion, impaired natriuretic response to furosemide is associated with greater likelihood of worsening renal function and future adverse long-term outcomes, independently from and incrementally with decreasing intrinsic glomerular filtration. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Antineoplastic Combined Chemotherapy Protocols, Breast Neoplasms, Cyclophosphamide, Epirubicin, Female, Humans, Middle Aged, Paclitaxel, Pilot Projects." }, { "role": "user", "content": "Is prolonged dose-dense epirubicin and cyclophosphamide followed by paclitaxel in breast cancer feasible? Context: We conducted a pilot study of dose-dense epirubicin/cyclophosphamide (EC) x 6 --> paclitaxel (P) x 6 with pegfilgrastim. A previous dose-dense trial of FEC (5-fluorouracil [5-FU]/EC) x 6 with filgrastim --> by weekly paclitaxel alternating with docetaxel x 18 was not feasible because of pneumonitis (with dose-dense FEC) and pericardial/pleural effusion (taxane phase). Dose-dense EC (without the 5-FU) is not associated with pneumonitis, and dose-dense paclitaxel (alone) is feasible. Primary objective was feasibility. Patients with resectable breast cancer were enrolled, regardless of surgery status, tumor size, or nodal status. Treatment regimen consisted of every-2-week EC (100/600 mg/m2) x 6 --> by 2-weekly P (175 mg/m2) x 6 with pegfilgrastim 6 mg on day 2. Between November 2004 and May 2005, 38 patients were enrolled. The median age was 47 years (range, 30-72 years); 33 of 38 (87%) were treated in the adjuvant setting and 27 of 33 (81%) had involved nodes (range, 1-46); 5 of 38 (13%) were treated pre-operatively; 33 of 38 (87%) completed all chemotherapy as planned; the remaining patients (13%) had treatment modifications for toxicity. Febrile neutropenia occurred in 6 of 38 patients (16 %) and only during EC. There were 12 hospitalizations in 9 of 38 patients (24%) enrolled." }, { "role": "assistant", "content": "Dose-dense every-2-week EC x 6 --> P x 6 with pegfilgrastim is feasible based on our prospective definition. 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 a common cause of abdominal wall hernias" }, { "role": "assistant", "content": "The correct answer is Hernia development is more common in pregnancy due to hormonally induced laxity of pelvic ligaments. It is also more common in the elderly due to the degenerative weakness of muscles and fibrous tissue. An inguinal hernia is less common in obese patients with hernia risk being negatively related to body mass index (BMI) contrary to widespread belief. Hernia is more common in smokers." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Adaptor Proteins, Vesicular Transport, Adult, Age Factors, Aged, Animals, Aorta, Apoptosis, Cells, Cultured, Gene Expression, Gene Silencing, Humans, Immunohistochemistry, Intracellular Space, Middle Aged, Muscle, Smooth, Vascular, Myocytes, Smooth Muscle, Nerve Growth Factor, Protein Transport, Rats, Tunica Intima, Young Adult." }, { "role": "user", "content": "Is sortilin expression essential for pro-nerve growth factor-induced apoptosis of rat vascular smooth muscle cells? Context: Sortilin, a member of the Vps10p-domain receptor family, has been demonstrated a key regulator in mediating cellular response to pro-neurotrophins. In the present study, we investigated the role of sortilin in the apoptotic pathway of vascular smooth muscle cells. Immunohistochemistry revealed that sortilin was barely detectable in human and rat normal young vessels, while its expression was increased in human fibroatheromatous plaques. Sortilin immunodetection was also marked in the neointima of the rat aorta fifteen days after ballooning.In vitro, rat aortic intimal cells expressed higher sortilin levels than normal media SMCs; sortilin was distributed in the cytoplasm and in correspondence of the cell membrane. After 48 h, pro-nerve growth factor (proNGF) induced the strong dose-dependent increase of intimal cell apoptosis and the accumulation of sortilin protein. ProNGF was a more potent apoptotic inducer than equimolar or even higher concentration of NGF, whereas brain derived neutrotrophic factor was ineffective. Targeted interfering RNA-mediated sortilin reduction counteracted proNGF-induced apoptosis without affecting p75(NTR) expression. ProNGF-induced apoptosis was associated to NF-κB down-regulation and bax increase. Inhibition of NF-κB activity increased intimal cell apoptosis that did not further increase with the addition of proNGF." }, { "role": "assistant", "content": "Our results indicate that sortilin expression characterizes human atheromatous lesions and rat aortic post-injury neointima, and suggest that sortilin represents an important regulator of proNGF-induced SMC apoptosis and arterial remodeling. 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, OBJECTIVE, METHODS, RESULTS. Meshes: Absorptiometry, Photon, Adult, Body Composition, Body Mass Index, Bone Density, Contraceptive Agents, Female, Desogestrel, Female, Femur Neck, Follow-Up Studies, Humans, Intrauterine Devices, Copper, Intrauterine Devices, Medicated, Lumbar Vertebrae, Male, Prospective Studies." }, { "role": "user", "content": "Do body composition and bone mineral density in users of the etonogestrel-releasing contraceptive implant? Context: There is scarce information about bone mineral density (BMD) and body composition (BC) among users of the etonogestrel (ENG)-releasing implant. To evaluate BC and BMD in ENG-releasing implant users as compared to copper intrauterine device (Cu-IUD)-users. A prospective study was conducted on 75 users of both contraceptive methods. BMD was evaluated at femoral neck (FN) and lumbar spine (LS) (L1-L4) and BC at baseline and at 12 months after insertion. The mean (±SD) age was 30.4 ± 6.8 and 29.8 ± 8.4 years and body mass index (kg/m(2)) was 24.9 ± 4.1 and 24.6 ± 3.5 in ENG-releasing implant- and Cu-IUD-users, respectively. ENG-releasing implant users did not show significant differences on BMD at the LS and FN at 12 months of use. Furthermore, ENG-implant users had an increase in body weight at 12 months (p < 0.001) and an increase of 2 % in the percentage of body fat, when compared with Cu-IUD users. There was a significant increase in lean mass in ENG-implant users at 12 months (p = 0.020)." }, { "role": "assistant", "content": "No significant changes of BMD were seen after the first year of use among the ENG-releasing implant-users, albeit an increase of weight and fat mass was seen when compared to Cu-IUD users. 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 these has dense irregular connective tissue?" }, { "role": "assistant", "content": "The correct answer is Dense irregular connective tissue: This type of tissue contains a dense woven network of collagenous (and some elastic) fibers in a viscous matrix. It is found in - Joint capsules Muscle fascia Dermis of skin" } ]

[ { "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, Area Under Curve, Female, Humans, Hypertension, Pulmonary, Male, Middle Aged, Myocardial Perfusion Imaging, Pulmonary Artery, Retrospective Studies, Tomography, Emission-Computed, Single-Photon, Tomography, X-Ray Computed." }, { "role": "user", "content": "Does main pulmonary artery diameter from attenuation correction CT scan in cardiac SPECT accurately predicts pulmonary hypertension? Context: To establish the value of the main pulmonary artery (MPA) diameter assessed from unenhanced computer tomography (CT) scans used for attenuation correction (AC) of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) to predict pulmonary hypertension (PHT). In contrast-enhanced chest CT scans an MPA diameter of 29 mm or greater is an established predictor of PHT. However, it is unknown, whether measurements from an unenhanced CT scan for AC may be used as predictor of PHT. 100 patients underwent SPECT MPI for assessment of coronary artery disease. PHT was defined as a right ventriculo-atrial gradient of 30 mm Hg or greater by Doppler echocardiography. We compared MPA diameter from CT to SPECT findings (right ventricular hypertrophy/enlargement, septal wall motion abnormality/perfusion defect, and D-shape) to determine the best predictor of PHT. PHT was found in 37 patients. An MPA diameter of 30 mm or greater yielded a sensitivity, specificity, accuracy, positive, and negative predictive value of 78%, 91%, 86%, 83%, and 88%, respectively. This yielded an area under the ROC curve of 0.85." }, { "role": "assistant", "content": "MPA diameter from low-dose unenhanced multi-slice CT reliably predicts PHT, providing an important added clinical value from AC for SPECT MPI. 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: Abnormalities, Drug-Induced, Adolescent, Adult, Anticonvulsants, Attitude to Health, Epilepsy, Female, Folic Acid, Guideline Adherence, Health Services Research, Humans, Information Dissemination, Medical Audit, Medical Records Systems, Computerized, Patient Education as Topic, Practice Guidelines as Topic, Pregnancy, Pregnancy Complications, Quality Assurance, Health Care, Quality Indicators, Health Care, Sex Factors, Surveys and Questionnaires, Women's Health." }, { "role": "user", "content": "Management of women with epilepsy: Are guidelines being followed? Context: Several international guidelines for the management of women with epilepsy (WWE) have been developed since 1989. We aimed to determine whether guidelines for the management of WWE are followed and whether active implementation of such guidelines makes a difference to clinical practice. The study covered a 2-year period of \"passive dissemination\" of guidelines followed by a 2-year period of \"active implementation.\" Documentation reflecting adherence to the guidelines was abstracted retrospectively from electronic medical records on 215 WWE aged 16-42 years. Data abstracted from case notes included counselling on contraception and pregnancy-related issues; follow-up during pregnancy; advice on supplementation of folic acid, calcium, and vitamin D; and serum folate measurements. A questionnaire assessing the knowledge of WWE issues was completed by 112 (71%) of 157 patients. Documentation that WWE issues had been addressed was found in approximately one third of medical case records with no measurable effect of active implementation. Only the follow-up during pregnancy seemed to have improved. Serum folate measurements in 51 women treated with enzyme-inducing antiepileptic drugs (AEDs) revealed folate deficiency in 11 (22%). Respondents to the questionnaire recalled having received information from their neurologists on the interaction between AEDs and oral contraceptives (46%), need to plan pregnancy (63%), and folic acid requirement (56%)." }, { "role": "assistant", "content": "Judged by a review of documentation in case notes, active implementation of guidelines had no measurable effect on clinical practice. However, the follow-up during pregnancy seemed to have improved. Patients' knowledge of WWE issues compared favorably with published studies. Better strategies are needed to secure successful implementation of guidelines." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Angioplasty, Balloon, Coronary, C-Reactive Protein, Carbon, Coronary Restenosis, Coronary Stenosis, Female, Fibromuscular Dysplasia, Humans, Ions, Male, Middle Aged, Prospective Studies, Prosthesis Design, Prosthesis Failure, Stents." }, { "role": "user", "content": "Does a carbon ion-implanted surface reduce the restenosis rate of coronary stents? Context: Neointimal hyperplasia and resulting restenosis limit the long-term success of coronary stenting. Heavy metal ions induce an inflammatory and allergic reaction, and result in in-stent restenosis. However, a carbon ion-implanted surface might prevent heavy metal ions from diffusing into surrounding tissue. 140 lesions in 140 patients with coronary lesions underwent implantation of carbon-implanted surface stents (Arthos(inert) stent group, n=70) or control stents (Arthos stent group, n=70). The primary end point was the in-stent restenosis and the secondary end point was the value of hs-CRP at 48 h and 6 months after coronary stenting. Clinical and angiographic follow-ups were performed at 6 months. The rate of in-stent restenosis was lower in the Arthos(inert) stent group (15.9%, 10/63) than in the Arthos stent group (20.9%, 13/62), but there were no significant differences between both groups (p=0.56). The value of hs-CRP at 48 h was lower in the Arthos(inert) stent group (13.9+/-13.4 mg/dl) than in the Arthos stent group (24.5+/-26.0 mg/dl) with significant differences (p=0.04). However, the differences between two groups were not statistically significant at 6 months (p=0.76)." }, { "role": "assistant", "content": "As compared with a standard coronary stent, a carbon ion-implanted stent shows no considerable benefit for the prevention of in-stent restenosis within the range of this study. Despite all the limitations of this study, a positive effect of a carbon ion-implanted stent in reducing inflammatory reaction after coronary revascularization seems likely." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All are true about congenital lymphedema except?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'None' Primary lymphedema has been classified on the basis of the age at onset and presence of familial clustering. a) Congenital lymphedema - has onset before the 1st year of life (according to Schwaz and Bailey onset is - congenital lymphedema can involve a single lower extremity, multiple limbs, the genitalia or the face (it is more likely to be bilateral & involve whole leg) the familial version of congenital lymphedema is k/a Milroy's ds. b) Lymphedema praecox primary lymphedema with onset b/w the age of 1 and 35 yrs is called lymphedema praecox this is the most common form of primary lymphedema accounting for 90% of cases praecox is far more common in women (10:1) - praecox lymphedema more likely to be unilateral and usually extends only to the knees (i.e. involves foot & calf) the familial version of lymphedema praecox is k/a Meige's ds. c) Lymphedema tarda primary lymphedema with onset after the age of 35 yrs is called lymphedema tarda" } ]

[ { "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: Cell Line, Tumor, Cell Movement, Cell Nucleus, Claudins, Cytoplasm, Electrophoresis, Polyacrylamide Gel, Gene Knockdown Techniques, Humans, Lung, Lung Neoplasms, Matrix Metalloproteinase 9, Membrane Proteins, Microscopy, Confocal, Reverse Transcriptase Polymerase Chain Reaction, Sp1 Transcription Factor, Transfection." }, { "role": "user", "content": "Does claudin-2 knockdown decrease matrix metalloproteinase-9 activity and cell migration via suppression of nuclear Sp1 in A549 cells? Context: Claudin expression is altered in lung cancer, but the pathophysiological role of claudin is not well understood. We examined the effect of claudin-2 expression on cell migration using human adenocarcinoma A549 cells. The mRNA level was measured by real time polymerase chain reaction. To knockdown claudin-2 expression, we made the cells expressing doxycycline-inducible claudin-2 shRNA vector. The protein level was examined by Western blotting. Cell migration was measured by wound-healing assay. The enzymatic activity of MMP-9 was assessed by gelatin zymography. In A549 cells, claudin-2 expression was higher than in normal lung tissue. Claudin-2 knockdown did not affect the expression of other junctional proteins including claudin-1, occludin and E-cadherin. Claudin-2 knockdown decreased cell migration concomitant with a decrease in the mRNA level and enzymatic activity of MMP-9. The expression level of Sp1 in the nuclei was decreased by claudin-2 knockdown. In contrast, the expression levels of c-Fos, c-Jun and NF-kB p65 in the nuclei were not changed by claudin-2 knockdown. The knockdown of Sp1 expression by siRNA decreased cell migration, and the mRNA expression, enzymatic activity, and promoter activity of MMP-9." }, { "role": "assistant", "content": "Claudin-2 may increase the mRNA level and enzymatic activity of MMP-9 mediated by the elevation of nuclear distribution of Sp1, resulting in the up-regulation of A549 cell migration. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Aminolevulinic Acid, Cystectomy, Female, Fluorescence, Humans, Light, Male, Middle Aged, Neoplasm Recurrence, Local, Prospective Studies, Radionuclide Imaging, Urethra, Urinary Bladder Neoplasms." }, { "role": "user", "content": "Hexaminolevulinate-induced fluorescence versus white light during transurethral resection of noninvasive bladder tumor: does it reduce recurrences? Context: To evaluate the effect of hexaminolevulinate (HAL)-induced fluorescence during resection of noninvasive bladder cancer on tumor recurrence compared with resection under white light. Between 2008 and 2010, 102 consecutive patients with suspected bladder cancer were randomized to undergo transurethral resection with either conventional white light or combination of white light and HAL-induced fluorescence. Difference in tumor recurrence rate and recurrence-free survival between the 2 groups was evaluated. Subgroup analysis on recurrence-free survival was performed for different tumor parameters. Cystoscopy at 3 months revealed tumor recurrence in 6 of 45 (13.3%) patients of the white light group compared with only 1 of 41 patients of the HAL group (2.4%) (P<.001). The recurrence-free rates in white light patients at 12 and 18 months were 56.3% and 50.6%, respectively, compared with 91% and 82.5% in HAL patients (P = .0006). In subgroup analyses, recurrence-free survival was similar between the 2 groups when solitary tumors were treated (P = .3525). However, the HAL group had a favorable recurrence-free survival compared with the white light group when multifocal tumors (P<.001), primary tumors (P = .0237), recurrent tumors (P = .0189), nonaggressive (papillary urothelial neoplasm of low malignant potential and low grade) tumors (P = .0204), or aggressive (high grade and carcinoma in situ) tumors (P = .0134) were treated." }, { "role": "assistant", "content": "HAL significantly aids resection of non-muscle-invasive bladder cancer with the result of reduction in tumor recurrence rates." } ]

[ { "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: ." }, { "role": "user", "content": "Do the SFT-1 and OXA-1 respiratory chain complex assembly factors influence lifespan by distinct mechanisms in C. elegans? Context: C. elegans mitochondrial (Mit) mutants have disrupted mitochondrial electron transport chain function, yet, surprisingly, they are often long-lived, a property that has offered unique insights into the molecular mechanisms of aging. In this study, we examine the phenotypic consequences of reducing the expression of the respiratory chain complex assembly factors sft-1 (homologous to human SURF1) and oxa-1 (homologous to human OXA1) by RNA interference (RNAi). Mutations in human SURF1 are associated with Leigh syndrome, a neurodegenerative condition of the brain caused by cytochrome oxidase (COX) deficiency. Both SURF1 and OXA1 are integral proteins of the inner mitochondrial membrane, functioning in the COX assembly pathway. RNAi of both of these genes in C. elegans is associated with increased longevity, but the mechanism by which lifespan is extended is different in each case. sft-1(RNAi) animals display lifespan extension that is dependent on the daf-16 insulin-like signaling pathway, and associated with sensitivity to oxidative stress. oxa-1(RNAi) animals, in contrast, exhibit increased longevity that is at least partially independent of daf-16, and associated with a reduced developmental rate and increased resistance to oxidative stress." }, { "role": "assistant", "content": "This study further delineates the consequences of mitochondrial dysfunction within a whole organism that will ultimately help provide new models for human mitochondrial-associated diseases. The difference in phenotype observed upon down-regulation of these two COX assembly factors, as well as phenotypic differences between these factors and other respiratory chain components analyzed thus far, illustrates the complex inter-relationships that exist among energy metabolism, reproduction and aging even in this simplest of metazoan model organisms. 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": "How many muscle fibers are there in one motor unit in eye?" }, { "role": "assistant", "content": "The correct answer is No of muscle fibers ina motor unit are usually less than 10 Motor unit is the no of muscle fibers innervated by single neuron Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:85,86,87" } ]

[ { "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": "Methionine is synthesised in human body from -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'b' i.e., Homocysteine* Homocysteine in the presence of methionine synthase and methyl B12, gets converted to methionine." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Antibodies, Monoclonal, Aorta, Abdominal, Aortic Aneurysm, Abdominal, CD18 Antigens, Disease Models, Animal, Disease Progression, Flow Cytometry, Injections, Intraperitoneal, Leukocyte Count, Leukocytes, Leukocytes, Mononuclear, Neutrophils, Pancreatic Elastase, Rats, Rats, Inbred SHR, Rats, Inbred WKY." }, { "role": "user", "content": "Does anti-CD 18 monoclonal antibody slow experimental aortic aneurysm expansion? Context: Inflammation has been implicated as a contributing factor in the expansion of abdominal aortic aneurysms (AAA). To test this hypothesis, we examined the effects of a monoclonal antibody (MAB) to the leukocyte CD18 adhesion molecule on the expansion of experimental AAA. Aneurysms were induced by perfusion of an isolated segment of the infrarenal aorta with elastase in 22 normotensive (WKY) and 17 genetically hypertensive (WKHT) rats. Animals of both strains were randomly allocated to control or MAB-treated groups (MAB, 5 microgram/100 gm body weight intraperitoneally, daily, beginning on the operative day for a total of four doses). The activity of the MAB against rat leukocytes had first been determined by in vitro immunofluorescence flow cytometry. Aortic size was directly measured initially and on day 14. At that time, a segment of aorta was stained with hematoxylin and eosin and mononuclear leukocytes and neutrophils were counted in each of 10 microscopic fields (400X). The initial aortic size in all animals was 1.11+/-0.15 mm. All groups developed aneurysms significantly larger than the initial aortic size (p<0.01). However, the MAB-treated animals had significantly smaller aneurysms than the untreated controls (mm): WKY: 3.63+/-1.26, WKY-MAB: 2.08+/-0.30, WKHT: 4.54+/-1.86, WKHT-MAB: 2.37+/-0.40, p<0.0001. There also were significantly fewer monocytes in the MAB-treated normotensive rats: WKY:35.5+/-29.9, WKHT:40.6+/-28.8, WKY-MAB: 8.9+/-8.5, WKHT-MAB: 32.3+/-25.7, p=0.03. Neutrophil counts did not differ significantly between the groups." }, { "role": "assistant", "content": "Treatment with anti-CD18 monoclonal antibody slows the expansion of AAA in this experimental model. The associated inflammatory process at day 14, as indicated by monocyte infiltration, is reduced, but this effect may be opposed by the presence of hypertension. Further evaluation of the role of leukocytes and adhesion molecules in the expansion of AAA is warranted. 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": "Human brain is more intelligent than monkey's brain due to" }, { "role": "assistant", "content": "The correct answer is Association areas, which are related to intelligence and higher functions, are about 85% of the human brain. These are smaller in other animals." } ]

[ { "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, Cardiomyopathy, Dilated, Case-Control Studies, Contrast Media, Female, Fibrosis, Gadolinium, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Middle Aged, Myocardium, Time Factors, Ventricular Function, Left." }, { "role": "user", "content": "Does shorter difference between myocardium and blood optimal inversion time suggest diffuse fibrosis in dilated cardiomyopathy? Context: To find evidence of diffuse fibrosis in dilated cardiomyopathy (DCM) patients by comparing measurements on clinical late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) studies between DCM and healthy subjects. LGE-CMR and the Look-Locker images from 20 DCM patients and 17 healthy controls were analyzed. Blood signal-to-noise ratio (SNR), myocardium SNR, and blood-to-myocardium contrast-to-noise ratio (CNR) were measured on the LGE-CMR images. The optimal inversion time (TI) to null blood and myocardium was determined on the Look-Locker images. The postcontrast T(1) was estimated using a phantom study that correlated optimal TI and heart rate to T(1). The blood SNR was lower, myocardium SNR was higher, and the blood-to-myocardium CNR was lower (6.6 +/- 0.7 vs. 10.3 +/- 0.9, P = 0.004) on DCM LGE-CMR images as compared to controls. The blood-myocardium optimal TI difference (DeltaTI) was lower (38 +/- 2 msec vs. 55 +/- 3 msec, P < 0.001) in DCM, and the estimated blood-myocardium T(1) difference (DeltaT(1)) (116 +/- 6 msec vs. 152 +/- 8 msec, P = 0.001) was also lower." }, { "role": "assistant", "content": "DCM patients have reduced blood-myocardium DeltaTI and DeltaT(1), and lower CNR as compared to controls, suggesting the presence of diffuse fibrosis. This may impact the interpretation of LGE data. 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 poison retards putrefaction-" }, { "role": "assistant", "content": "The correct answer is Carbolic acid retards putrefaction. Poisons which retard putrefaction are carbolic acid, arsenic, strychnine and zinc chloride." } ]

[ { "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, Body Mass Index, Chorionic Gonadotropin, Embryo Transfer, Estradiol, Female, Fertilization in Vitro, Follicle Stimulating Hormone, Humans, Insulin, Middle Aged, Oocytes, Ovary, Ovulation Induction, Polycystic Ovary Syndrome, Sperm Injections, Intracytoplasmic, Triptorelin Pamoate." }, { "role": "user", "content": "Does plasma insulin level affect ovarian response to exogenous administration of follicle-stimulating hormone in women without polycystic ovary syndrome? Context: Raised insulin levels have been shown to contribute to ovarian overproduction of androgens. Hyperinsulinemia, usually associated with polycystic ovary syndrome (PCOS), brings about greater ovarian endocrine and morphological responses to ovulation induced by follicle-stimulating hormone (FSH). This indicates that elevated levels of insulin play a role in the endocrine and paracrine control of the ovaries. The aim of the present study was to investigate whether basal insulin levels influence ovarian response to FSH in healthy women (non-PCOS) undergoing assisted reproduction by in vitro fertilization-embryo transfer (IVF-ET). The study included 36 consecutive women, 27-45 years old, undergoing IVF-ET for tubal-factor or male-factor infertility. Serum insulin levels were determined on the day of administration of gonadotropin-releasing hormone analog (GnRHa) and on the first day of FSH administration. Mean insulin levels were 6 +/- 3 and 7 +/- 3 microU/ml on the day of GnRHa and FSH administration, respectively. No correlations were found between basal insulin level, days of treatment, total FSH dose, estradiol level and the number of oocytes retrieved." }, { "role": "assistant", "content": "The results of the present study show that normal levels of insulin do not seem to influence ovarian response to FSH in non-PCOS women. In all patients included in our study, serum insulin levels did not correlate with IVF stimulation data (days of stimulation, total FSH dose) nor with IVF-ET outcome. Thus the study demonstrates that, in patients who are not insulin-resistant, insulin does not correlate with ovarian response to FSH administration." } ]

[ { "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, Antibodies, Viral, Antigens, Viral, Chickens, Influenza A virus, Influenza Vaccines, Protein Binding, Vaccines, Synthetic, Viral Matrix Proteins." }, { "role": "user", "content": "Do vaccination induced antibodies to recombinant avian influenza A virus M2 protein or synthetic M2e peptide bind to the M2 protein on the virus or virus infected cells? Context: Influenza viruses are characterized by their highly variable surface proteins HA and NA. The third surface protein M2 is a nearly invariant protein in all Influenza A strains. Despite extensive studies in other animal models, this study is the first to describe the use of recombinant M2 protein and a peptide coding for the extracellular part of the M2 protein (M2e) to vaccinate poultry. Four groups of layer chickens received a prime-boost vaccination with recombinant M2 protein, M2e, a tetrameric construct from M2e peptide bound to streptavidin and a control tetrameric construct formulated with Stimune adjuvant. We determined the M2-specific antibody (Ab) responses in the serum before vaccination, three weeks after vaccination and two weeks after booster, at days 21, 42 and 56 of age. The group vaccinated with the M2 protein in combination with Stimune adjuvant showed a significant Ab response to the complete M2 protein as compared to the other groups. In addition an increased Ab response to M2e peptide was found in the group vaccinated with the M2e tetrameric construct. None of the vaccinated animals showed seroconversion to AI in a commercial ELISA. Finally no Ab's were found that bound to M2 expressed on in vitro AI infected MDCK cells." }, { "role": "assistant", "content": "Although Ab's are formed against the M2 protein and to Streptavidin bound M2e peptide in a tetrameric conformation these Ab's do not recognize of M2 on the virus or on infected cells. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Alkaloids, Antineoplastic Agents, Apoptosis, Berberine Alkaloids, Chelidonium, Humans, Jurkat Cells, Phenanthridines." }, { "role": "user", "content": "Is proapoptotic activity of Ukrain based on Chelidonium majus L. alkaloids and mediated via a mitochondrial death pathway? Context: The anticancer drug Ukrain (NSC-631570) which has been specified by the manufacturer as semisynthetic derivative of the Chelidonium majus L. alkaloid chelidonine and the alkylans thiotepa was reported to exert selective cytotoxic effects on human tumour cell lines in vitro. Few clinical trials suggest beneficial effects in the treatment of human cancer. Aim of the present study was to elucidate the importance of apoptosis induction for the antineoplastic activity of Ukrain, to define the molecular mechanism of its cytotoxic effects and to identify its active constituents by mass spectrometry. Apoptosis induction was analysed in a Jurkat T-lymphoma cell model by fluorescence microscopy (chromatin condensation and nuclear fragmentation), flow cytometry (cellular shrinkage, depolarisation of the mitochondrial membrane potential, caspase-activation) and Western blot analysis (caspase-activation). Composition of Ukrain was analysed by mass spectrometry and LC-MS coupling. Ukrain turned out to be a potent inducer of apoptosis. Mechanistic analyses revealed that Ukrain induced depolarisation of the mitochondrial membrane potential and activation of caspases. Lack of caspase-8, expression of cFLIP-L and resistance to death receptor ligand-induced apoptosis failed to inhibit Ukrain-induced apoptosis while lack of FADD caused a delay but not abrogation of Ukrain-induced apoptosis pointing to a death receptor independent signalling pathway. In contrast, the broad spectrum caspase-inhibitor zVAD-fmk blocked Ukrain-induced cell death. Moreover, over-expression of Bcl-2 or Bcl-xL and expression of dominant negative caspase-9 partially reduced Ukrain-induced apoptosis pointing to Bcl-2 controlled mitochondrial signalling events. However, mass spectrometric analysis of Ukrain failed to detect the suggested trimeric chelidonine thiophosphortriamide or putative dimeric or monomeric chelidonine thiophosphortriamide intermediates from chemical synthesis. Instead, the Chelidonium majus L. alkaloids chelidonine, sanguinarine, chelerythrine, protopine and allocryptopine were identified as major components of Ukrain. Apart from sanguinarine and chelerythrine, chelidonine turned out to be a potent inducer of apoptosis triggering cell death at concentrations of 0.001 mM, while protopine and allocryptopine were less effective. Similar to Ukrain, apoptosis signalling of chelidonine involved Bcl-2 controlled mitochondrial alterations and caspase-activation." }, { "role": "assistant", "content": "The potent proapoptotic effects of Ukrain are not due to the suggested \"Ukrain-molecule\" but to the cytotoxic efficacy of Chelidonium majus L. alkaloids including chelidonine. 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": "Imiquimod is used in treatment of anogenital was acts mainly as:-" }, { "role": "assistant", "content": "The correct answer is Topical immunomodulation with imiquimod 5% cream is used for treatment of: genital was superficial basal cell carcinoma actinic keratoses Acts on Toll-like receptor 7 (TLR-7). This is a cell surface receptor found on cells of monocyte lineage. Interaction of TLR-7 with ligands activates a signalling pathway, leading to release of large amounts of interferon-a, IL-12, TNF-a and other potent cytokines. S/E: irritation, discomfo and occasionally erosion at the point of application with a small risk of causing vitiligo-like depigmentation." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, RESULTS. Meshes: Adult, Cell Division, Colon, Colonic Neoplasms, Epithelial Cells, Female, Growth Hormone, Hormone Replacement Therapy, Humans, Male, Middle Aged, Risk Factors." }, { "role": "user", "content": "Does one year growth hormone replacement therapy alter colonic epithelial cell proliferation in growth hormone deficient adults? Context: Increased colonic epithelial cell proliferation has been found in various conditions associated with increased risk of colorectal cancer including acromegaly. In a placebo-controlled study we determined the effect of growth hormone (GH) replacement therapy in GH deficient adults on the colonic epithelial proliferation rate. Sixteen GH deficient adults were randomised to low dose GH therapy (1 U (0.5 mg) subcutaneously per day, n = 5), high dose GH therapy (2 U daily, n = 5) or placebo (n = 6) during 6 months. Thereafter, all patients were treated with 2 U of GH daily during a 6-months open extension period. Plasma Insulin-like growth hormone I (IGF-I) and IGF binding protein 3 (IGF BP3) concentrations were measured using commercial RIA kits. The colonic epithelial proliferation rate, expressed as overall crypt labelling index (LI) using 5-bromo-2'-deoxyuridine (BrdU) immunostaining, was determined at baseline, after 6 months treatment and at the end of the 6 months open extension period. IGF-I rose from 8.9 +/- 6.7 to 34.6 +/- 20.0 nmol/l after 6 months in 8 GH treated patients (P < 0.01 from baseline; P < 0.01 from change with placebo). In the extension study, plasma IGF-I was also increased in the patients who previously received placebo (P < 0.02, n = 5). LI was evaluable in 14 biopsies at baseline, in 16 after 6 months and in 14 after 12 months. Overall crypt LI did not change in 8 GH treated patients after 6 months (P > 0.40 from baseline; P > 0.80 from change with placebo). In the extension study, overall crypt LI was also unchanged in those patients who received GH after placebo (n = 5, P > 0.40) and in those who continued GH replacement (n = 9, P > 0.60; P > 0.80 from change in initially placebo treated patients). Separate evaluation of the LI at the basal, mid and luminal portions of the colonic crypts also did not reveal any effect of GH treatment on BrdU labelling." }, { "role": "assistant", "content": "Six to 12 months of GH replacement therapy, aimed to increase plasma IGF-I into the (high) physiological range, does not adversely affect colonic epithelial cell proliferation as a biomarker for the risk of development of colorectal cancer. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, RESULTS. Meshes: Age Factors, Animals, Calcium Channels, L-Type, Cells, Cultured, Heart Ventricles, Mice, Microscopy, Scanning Probe, Myocytes, Cardiac, Patch-Clamp Techniques, Rats, Sodium Channels, Ventricular Function." }, { "role": "user", "content": "Does super-resolution scanning patch clamp reveal clustering of functional ion channels in adult ventricular myocyte? Context: Compartmentation of ion channels on the cardiomyocyte surface is important for electric propagation and electromechanical coupling. The specialized T-tubule and costameric structures facilitate spatial coupling of various ion channels and receptors. Existing methods such as immunofluorescence and patch clamp techniques are limited in their ability to localize functional ion channels. As such, a correlation between channel protein location and channel function remains incomplete. To validate a method that permits routine imaging of the topography of a live cardiomyocyte and study clustering of functional ion channels from a specific microdomain. We used scanning ion conductance microscopy and conventional cell-attached patch clamp with a software modification that allows controlled increase of pipette tip diameter. The sharp nanopipette used for topography scan was modified into a larger patch pipette that could be positioned with nanoscale precision to a specific site of interest (crest, groove, or T-tubules of cardiomyocytes) and sealed to the membrane for cell-attached recording of ion channels. Using this method, we significantly increased the probability of detecting activity of L-type calcium channels in the T-tubules of ventricular cardiomyocytes. We also demonstrated that active sodium channels do not distribute homogenously on the sarcolemma instead, they segregate into clusters of various densities, most crowded in the crest region, that are surrounded by areas virtually free of functional sodium channels." }, { "role": "assistant", "content": "Our new method substantially increases the throughput of recording location-specific functional ion channels on the cardiomyocyte sarcolemma, thereby allowing characterization of ion channels in relation to the microdomain where they reside. 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": "Coronary blood flow is maximum during?" }, { "role": "assistant", "content": "The correct answer is ANSWER: (D) I so volumetric relaxationREF: Ganongs 22nd ed page 621CORONARY BLOOD FLOW:Coronary blood flow, like blood flow in other vessels, is dependent on a pressure gradient, principally driven by mean arterial pressure. However, because aortic pressure can vary widely and because the heart beats continuously, the pressure gradient and, hence coronary blood flow fluctuate depending on the state of contraction. During systole, especially on the left side of the heart, the pressure within the coronary artery secondary to extravascular compression from the squeezing effect of the contracting myocardium virtually eliminates antegrade coronary blood flow. The coronary blood flow\" goes to zero just prior to ventricular ejection, corresponding to isovolumic contraction and increased extravascular compression. Conversely, coronary blood flow through the left side is maximal during blood flow through the right side, however, is maximal during peak systole, because developed pressure and consequently extravascular compression within the RV are considerably less than in the LV, thus allowing for antegrade flow during both systole and diastole" } ]

[ { "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": "Brown tumour is found in" }, { "role": "assistant", "content": "The correct answer is (Hyper parathyroidism) (990- CMDT-08) (1765-H17th)Hyper parathyroidism causes a loss of cortical bone and again of trabecular bone. Osteitis fibrosa cystica may present as pathologic fracture or as \"brown tumours \" or cysts of Jaw.More commonly, patients have bone pain and arthralgia" } ]

[ { "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, Cystectomy, Epidemiologic Methods, Female, Humans, Lymph Nodes, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Recurrence, Local, Prognosis, Treatment Outcome, Urinary Bladder Neoplasms, Urothelium." }, { "role": "user", "content": "Is lymphovascular invasion an independent predictor of oncological outcomes in patients with lymph node-negative urothelial bladder cancer treated by radical cystectomy : a multicentre validation trial? Context: To validate the association of lymphovascular invasion (LVI) with disease recurrence and cancer-specific survival (CSS) in a multicentre cohort of patients treated with radical cystectomy (RC) for urothelial bladder cancer (UBC). We collected pathological and clinical data on 1099 lymph node-negative patients treated with RC at six German institutions. LVI was defined as the presence of tumour cells within an unequivocal endothelium-lined space in haematoxylin and eosin-stained sections. LVI was present in 295 (26.8%) patients; the presence of LVI correlated significantly with increasing tumour stage, i.e. pT1, 65 (29.4%); pT2, 88 (31.5%); pT3 110 (31.8%); and pT4 32 (38.1%) (P= 0.002) and grade (P < 0.001). In univariable analysis the presence of LVI was significantly associated with reduced recurrence-free survival (P= 0.008) and reduced CSS (P= 0.039). On multivariable Cox regression analysis tumour stage (P < 0.001), age (>75 vs >or=75 years; P= 0.018) and LVI (P < 0.001) were identified as independent predictors of CSS." }, { "role": "assistant", "content": "Our large multicentre study confirms the independent prognostic value of LVI in patients with node-negative UBC. LVI can be regarded as a surrogate variable for lymphatic micrometastasis in node-negative UBC. Assessment of LVI might improve the selection of patients who are likely to benefit from adjuvant therapy after RC. The identification of factors involved in the process of LVI could reveal new therapeutic targets for UBC. 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": "Rideal Walker test is used to determine the efficiency of the" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A term infant has initial Apgar scores of 8 and 10 at 1 and 5 minutes. On auscultation of the chest, a heart murmur is audible. There is hepatosplenomegaly. Cataracts of the crystalline lens are noted. The infant is at the 30th percentile for height and weight. Echocardiography shows a patent ductus arteriosus. Which of the following events is the most likely risk factor for the findings in this infant?" }, { "role": "assistant", "content": "The correct answer is Rubella infection in the first trimester, when organogenesis is occurring (3 to 9 weeks' gestation), can lead to embryopathy with cardiac, ocular, skin, central nervous system, and hepatic abnormalities. Rubella is rare with routine vaccinations. Folate deficiency is most likely to be associated with neural tube defects. Dispermy is rare and can lead to triploidy, a condition that rarely results in a live birth. Erythroblastosis fetalis leads to fetal anemia with congestive heart failure and hydrops, but not to malformations. In the past, thalidomide use was a cause of malformations (almost invariably prominent limb deformities). Nondisjunctional events during meiosis in the maternal ova account for trisomies and monosomies, many of which have associated cardiac defects, including ventricular septal defect (e.g., trisomy 21). This mechanism is unlikely in paternal sperm, however, which are constantly being produced in large numbers throughout life." } ]

[ { "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": "Early Neonatal periods lasts upto:" }, { "role": "assistant", "content": "The correct answer is Early neonatal period Late neonatal period <7 days or <168 hours of bih 7th - <28th days of bih" } ]

[ { "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 24-year-old man is admitted to the hospital after a street fight. Radiographic examination reveals an inferior (blow-out) fracture of the orbit. Orbital structures would most likely be found inferiorly in which of the following spaces?" }, { "role": "assistant", "content": "The correct answer is The maxillary sinus is located inferior to the orbit. Any trauma to the inferior bony wall of the orbit will likely displace the orbital structures in the compartment to the space below the orbit (maxillary sinus). The ethmoid sinus is located superiorly and medially to the orbit, whereas the frontal sinus is located superiorly to the orbit. The nasal cavity is toward the midline and is not inferior to the orbit. The sphenoid sinus is deeper into the facial region but is not inferior to the orbit." } ]

[ { "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 65-year-old man comes to a follow-up appointment with his surgeon 2 months after undergoing hip replacement surgery. His major concern at this visit is that he is still limping since the surgery even after the post-operative pain has subsided. Specifically, when he stands on his right leg, he feels that he has to lean further to the right in order to maintain balance. When standing on his left leg, he feels that he is able to step normally. Damage to which of the following nerves would most likely present with this patient's symptoms?" }, { "role": "assistant", "content": "Superior gluteal nerve" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Fibromuscular wall is seen in -" }, { "role": "assistant", "content": "The correct answer is The extrahepatic biliary tree and gallbladder share a similar microscopic anatomy, consisting of a fibromuscular wall lined by mucin producing columnar epithelium similar to that seen in intrahepatic bile ducts." } ]

[ { "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 are causes of pancytopenia with cellular bone marrow except:" }, { "role": "assistant", "content": "The correct answer is Answer is B (Dyskeratosis congenita) Dyskeratosis congenita is associated with Pancytopenia and a hypocellular marrow." } ]

[ { "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": "Thermafil is" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 4-year-old boy presents with a history of recurrent bacterial infections, including several episodes of pneumococcal sepsis. His 2 maternal uncles died after having had similar complaints. Lab investigations reveal an undetectable level of all serum immunoglobulins. Which of the following is the most likely diagnosis of this patient?" }, { "role": "assistant", "content": "Bruton agammaglobulinemia" } ]

[ { "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, Breeding, Case-Control Studies, Dog Diseases, Dogs, Exons, Female, Genetic Loci, Genome-Wide Association Study, Genotype, Male, Netherlands, Patella, Patellar Dislocation, Polymorphism, Single Nucleotide, Sequence Analysis, DNA." }, { "role": "user", "content": "Does genome-wide survey indicate involvement of loci on canine chromosomes 7 and 31 in patellar luxation in Flat-Coated Retrievers? Context: Patellar luxation is an orthopedic disorder in which the patella moves out of its normal location within the femoral trochlea of the knee and it can lead to osteoarthritis, lameness, and pain. In dogs it is a heritable trait, with both environmental and genetic factors contributing to the phenotype. The prevalence of patellar luxation in the Dutch Flat-Coated Retriever population is 24%. In this study, we investigated the molecular genetics of the disorder in this population. Genome-wide association analysis of 15,823 single nucleotide polymorphisms (SNPs) in 45 cases and 40 controls revealed that patellar luxation was significantly associated with a region on chromosome CFA07, and possibly with regions on CFA03, CFA31, and CFA36. The exons of the genes in these regions, 0.5 Mb combined, were analyzed further. These exons from 15 cases and a pooled sample from 15 controls were enriched using custom genomic hybridization arrays and analyzed by massive parallel DNA sequencing. In total 7257 variations were detected. Subsequently, a selection of 144 of these SNPs were genotyped in 95 Flat-Coated Retrievers. Nine SNPs, in eight genes on CFA07 and CFA31, were associated with patellar luxation (P <10-4). Genotyping of these SNPs in samples from a variety of breeds revealed that the disease-associated allele of one synonymous SNP in a pseudogene of FMO6 was unique to Flat-Coated Retrievers." }, { "role": "assistant", "content": "Genome-wide association analysis followed by targeted DNA sequencing identified loci on chromosomes 7 and 31 as being involved in patellar luxation in the Flat-Coated Retriever breed. 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, METHODS, RESULTS. Meshes: Anxiety, Cohort Studies, Female, Hospitals, Teaching, Hospitals, Urban, Humans, Male, Middle Aged, Music, Patients, Prospective Studies, Surveys and Questionnaires, Transportation of Patients." }, { "role": "user", "content": "Does music reduce patient anxiety during interfacility ground critical care transport? Context: Interfacility ground critical care transport (CCT) of patients by ambulance may be stressful. This study evaluated whether playing music during CCT reduces patient anxiety and whether objective evidence is manifested by a change in vital signs. Urban teaching hospital. In this prospective cohort study, music was played for eligible adult patients during CCT while recording vital signs. A questionnaire was subsequently mailed to patients to rate whether the ambulance transport was stressful, the impact music had on transport, whether music changed their anxiety, whether music made them comfortable and relaxed, and whether they would prefer music to be played on future transports. Vital signs were compared between respondents who perceived transport as stressful and those who did not. One hundred two patients were enrolled; 23 respondents (22.5%) constituted the study group. Four patients (17.4%) reported CCT as stressful (average response, 4.75). Nineteen (82.6%) rated CCT as not stressful (average response, 1.63). Subjectively, patients reported a positive impact of music on transport, with improved comfort and relaxation but only a minimal decrease in anxiety. No statistically significant change in vital signs was observed between cohorts; too few patients were enrolled to generate power to detect any difference." }, { "role": "assistant", "content": "Music therapy is a simple adjunct for use during CCT that may increase patient comfort and alleviate anxiety. The small number of patients in this preliminary report limits the strength of any conclusions. Larger studies are needed. 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 7-year-old boy is brought to the physician for a follow-up examination after the removal of a tooth. During the procedure, he had prolonged bleeding that did not resolve with pressure and gauze packing and eventually required suture placement. His older brother had a similar episode a year ago, but his parents and two sisters have never had problems with prolonged bleeding. Physical examination shows no abnormalities. Genetic analysis confirms an X-linked recessive disorder. Which of the following is most likely deficient in this patient?" }, { "role": "assistant", "content": "Factor VIII" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, PATIENTS AND METHODS, RESULTS. Meshes: Adrenergic alpha-Antagonists, Aged, Humans, Logistic Models, Male, Prostatic Hyperplasia, Quality of Life, Sexual Behavior, Sulfonamides, Time Factors, Treatment Outcome, Urinary Retention." }, { "role": "user", "content": "Does the time of administration (morning or evening) affect the tolerability or efficacy of tamsulosin? Context: To determine whether the time of dosing (morning or evening) affects the tolerability or efficacy of tamsulosin in the treatment of lower urinary tract symptoms. Data were analysed from an open-label, observational study in which patients were treated with 0.4 mg tamsulosin once daily for 12 weeks. Treatment effects were determined using the Benign Prostatic Hyperplasia Impact Index, the quality-of-life question of the International Prostate Symptom Score, a similarly phrased question about sexual satisfaction, the maximum urinary flow rate, the postvoid residual urine volume, and the overall efficacy and tolerability. The results were analysed statistically for differences between dosing times, using analysis of covariance for the quantitative variables and logistic regression for the qualitative variables. While no specific recommendation about the dosing time was given in the trial, the retrospective analysis showed that 4420 and 2087 patients received tamsulosin in the morning and evening, respectively. Both groups had similar values for all variables before treatment. The efficacy and tolerability of tamsulosin treatment was also similar in both groups; there were small advantages for morning dosing, which were statistically significant because there were many patients." }, { "role": "assistant", "content": "In contrast to other alpha-blockers, night-time dosing is not necessary to improve the tolerability or efficacy of tamsulosin." } ]

[ { "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, Body Mass Index, Body Weight, Cholesterol, HDL, Diet Records, Diet, Fat-Restricted, Dietary Fats, Exercise, Fatty Acids, Female, Food, Humans, Lipids, Lipoproteins, Patient Compliance, Soybean Oil, alpha-Linolenic Acid." }, { "role": "user", "content": "Do low linolenate and commercial soybean oils diminish serum HDL cholesterol in young free-living adult females? Context: A mutant soybean line (A16) low in linolenic acid content (2% of oil by weight) was developed to increase oil oxidative stability. It was unknown whether serum lipid and lipoprotein concentrations in humans would be affected should A16 soybean oil (A16 oil) replace commercial soybean oil in diets. This study was conducted to examine the hypothesis that in free-living normolipidemic women, the consumption of A16 oil at approximately 10% of energy intake (en%) would not affect serum lipids and lipoproteins differently than would the consumption of the same amount of a commercial soybean oil with 7% of linolenic acid content. Fifteen free-living female college students consumed the soybean oil daily with regular meals for 9 weeks in different orders, with each test oil being eaten for 3 weeks. During the study, 13 en% was provided by each test oil and a total of 35 en% was from dietary fat. Serum concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL cholesterol), low-density lipoprotein cholesterol (LDL cholesterol) and triacylglycerides (TAG) were measured. Serum total fatty acid patterns were analyzed as well. Each of the three test oils decreased serum total cholesterol, LDL cholesterol and TAG concentrations from the baseline values. The feeding of A16 and commercial soybean oils decreased serum HDL cholesterol significantly compared with coconut oil (p < 0.05). Dietary inclusion of coconut oil increased serum myristic acid significantly more than did either soybean oil (p < 0.01). Serum arachidonic acid concentrations were significantly greater with A16 consumption than with commercial soybean oil consumption (p < 0.001)." }, { "role": "assistant", "content": "A16 and commercial soybean oils both diminished serum HDL cholesterol. Although the fatty acid composition differed between the two soybean oils, A16 oil and commercial oil had similar effects on serum concentrations of lipoproteins and lipids. With increased oxidative stability, A16 oil is a good alternative to commercial soybean oil. 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: Adult, Behcet Syndrome, Biomarkers, Blood Sedimentation, Case-Control Studies, Female, Humans, Leukocyte Count, Male, Middle Aged, Neutrophils, Nitric Oxide, alpha 1-Antitrypsin, alpha-Macroglobulins." }, { "role": "user", "content": "Increased nitric oxide production in patients with Behçet's disease: is it a new activity marker? Context: The origin of Behçet's disease (BD) is unclear. One of the prominent features of BD is vasculitis and thrombosis as a result of endothelial dysfunction. Because nitric oxide (NO) is synthesized by endothelium, we considered it as an interesting target of investigation in BD. Our purpose was to define the level of NO in the serum of patients with BD and its relation with disease activity. As an indicator for NO, serum total nitrite levels (end product of NO) were measured by Griess reaction in 52 consecutive patients with BD and compared with 32 age- and sex-matched healthy staff volunteers. Serum NO levels of active and inactive patients were compared. The overall serum nitrite levels in patients with BD (40.25 +/- 10.51 micromol/L) were significantly higher (P<.001) than those in healthy volunteers (25.09 +/- 5.33 micromol/L). The difference in serum total nitrite levels among patients with active BD (46.74 +/- 10.62 micromol/L) and inactive BD (33.24 +/- 3.73 micromol/L) was significant (P<.001). Significant differences were observed in serum nitrite levels between patients in the inactive period of BD and the control group (P<.001)." }, { "role": "assistant", "content": "Increased NO production might be responsible for the overall inflammatory process of BD. NO seems to be related to disease activity." } ]

[ { "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: Animals, Dihydro-beta-Erythroidine, Dose-Response Relationship, Drug, Evoked Potentials, Auditory, Hippocampus, Mecamylamine, Mental Processes, Mice, Mice, Inbred DBA, Nicotine, Receptors, Nicotinic, Schizophrenia." }, { "role": "user", "content": "Does alpha4beta2 nicotinic receptor stimulation contribute to the effects of nicotine in the DBA/2 mouse model of sensory gating? Context: Nicotine improves the deficiencies of sensory gating function in schizophrenic patients and in dilute brown non-Agouti (DBA/2) mice. This effect of nicotine has been attributed to activation of the alpha7 nicotinic acetylcholine receptor (nAChR) subtype. The aim of this study was to determine whether the activation of another nAChR subtype, the central nervous system (CNS) prominent alpha4beta2 receptor, also contributes to the effects of nicotine on sensory gating in DBA/2 mice. Unanesthetized DBA/2 mice were treated either with nicotine, the alpha4beta2 antagonist dihydro-beta-erythroidine, the noncompetitive nAChR antagonist mecamylamine, or a combination of an antagonist and nicotine. Thereafter, gating was assessed by recording hippocampal evoked potentials (EP), which were elicited by pairs of auditory clicks. The EP response to the second click, or test amplitude (TAMP), was divided by the EP response to the first click, or condition amplitude (CAMP), to derive gating T:C ratios. Nicotine significantly (p<0.05) lowered T:C ratios by 42%, while significantly increasing CAMP by 55%. After a pretreatment with dihydro-beta-erythroidine, nicotine still significantly lowered T:C ratios by 28%; however, the nicotine-induced increase of CAMP was blocked. Mecamylamine blocked the effect of nicotine on both T:C ratios and CAMP." }, { "role": "assistant", "content": "Activation of alpha4beta2 receptors by nicotine increases CAMP. However, under conditions where alpha4beta2 receptors are blocked, nicotine still lowers T:C ratios and may improve sensory gating, possibly through the activation of other nAChR subtypes such as alpha7. These effects of nicotine on auditory EPs may be indicative of a profile that would improve information processing in schizophrenia and other CNS diseases. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "The 6-year-old drowsy child came in an emergency with a history of vomiting, loose motion for 3 days. On examination, he had a sunken eye, hypothermia, the skin on pinching taken time to revert diagnosis -" }, { "role": "assistant", "content": "The correct answer is A child with severe dehydration will have at least two of the following four signs: sensorium is abnormally sleepy or lethargic, sunken eyes, drinking poorly or not at all, and a very slow skin pinch,\nA child with some signs of dehydration will have two of the following: restlessness or irritability, sunken eyes, drinking eagerly or slow r skin pinch.\nA child with either one or none of these signs is classified as having no signs of dehydration." } ]

[ { "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, Animals, Newborn, Autophagy, Disease Models, Animal, Male, Mice, Mice, Inbred C57BL, Mitochondria, Heart, Myocardial Reperfusion Injury, Myocytes, Cardiac, Rats, Signal Transduction, TNF Receptor-Associated Factor 2." }, { "role": "user", "content": "Does tumor necrosis factor receptor-associated factor 2 mediate mitochondrial autophagy? Context: Tumor necrosis factor (TNF) signaling protects against ischemia/reperfusion-induced cardiomyocyte death, in vitro, ex vivo, and in vivo. TNF-receptor-associated factor 2 (TRAF2), an E3 ubiquitin ligase, coordinates cytoprotective signaling downstream of both TNF receptors, via unclear mechanisms. Noting that TRAF2 is recruited to mitochondria, and that autophagic removal of ubiquitin-tagged damaged mitochondria is cytoprotective, we tested the hypothesis that TRAF2 mediates mitochondrial autophagy. TRAF2 localizes to the mitochondria in neonatal rat cardiac myocytes, and TNF treatment transcriptionally upregulates TRAF2 abundance in the mitochondrial subfraction. TRAF2 colocalizes with ubiquitin, p62 adaptor protein, and mitochondria within LC3-bound autophagosomes; and exogenous TRAF2 enhances autophagic removal of mitochondria. TRAF2 knockdown with adenoviral shRNA transduction induces accumulation of depolarized mitochondria in resting neonatal rat cardiac myocytes, as well as in those treated with TNF or uncoupling agent carbonyl cyanide m-chlorophenyl hydrazone, suggesting an essential role for TRAF2 in homeostatic and stress-induced mitochondrial autophagy. TRAF2 also colocalizes and interacts with PARKIN, a previously described E3 ubiquitin ligase and mitophagy effector, on depolarized mitochondria in neonatal rat cardiac myocytes. Exogenous expression of TRAF2, but not its E3 ligase-deficient mutants, is sufficient to partially restore mitophagy in the setting of PARKIN knockdown, suggesting redundancy in their ubiquitin ligase roles. TRAF2 abundance increases in the mitochondrial subfraction of ischemia/reperfusion-modeled hearts; and exogenous TRAF2, but not its E3 ligase-deficient mutants, reduces depolarized mitochondria and rescues cell death in neonatal rat cardiac myocytes subjected to hypoxia/reoxygenation." }, { "role": "assistant", "content": "Taken together, these data indicate an essential role for TRAF2 in concert with PARKIN as a mitophagy effector, which contributes to TRAF2-induced cytoprotective signaling. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Does serum α-hydroxybutyrate ( α-HB ) predict elevated 1 h glucose levels and early-phase β-cell dysfunction during OGTT? Context: Serum α-hydroxybutyrate (α-HB) is elevated in insulin resistance and diabetes. We tested the hypothesis that the α-HB level predicts abnormal 1 h glucose levels and β-cell dysfunction inferred from plasma insulin kinetics during a 75 g oral glucose tolerance test (OGTT). This cross-sectional study included 217 patients at increased risk for diabetes. 75 g OGTTs were performed with multiple postload glucose and insulin measurements over a 30-120 min period. OGTT responses were analyzed by repeated measures analysis of variance (ANOVA). Multivariable logistic regression was used to predict 1 h glucose ≥155 mg/dL with α-HB added to traditional risk factors. Mean±SD age was 51±15 years (44% male, 25% with impaired glucose tolerance). Fasting glucose and insulin levels, but not age or body mass index (BMI), were significantly higher in the second/third α-HB tertiles (>3.9 µg/mL) than in the first tertile. Patients in the second/third α-HB tertiles exhibited a higher glucose area under the receiver operating characteristics curve (AUC) and reduced initial slope of insulin response during OGTT. The AUC for predicting 1 h glucose ≥155 mg/dL was 0.82 for a base model that included age, gender, BMI, fasting glucose, glycated hemoglobin (HbA1c), and insulin, and increased to 0.86 with α-HB added (p=0.015), with a net reclassification index of 52% (p<0.0001)." }, { "role": "assistant", "content": "Fasting serum α-HB levels predicted elevated 1 h glucose during OGTT, potentially due to impaired insulin secretion kinetics. This association persisted even in patients with an otherwise normal insulin-glucose homeostasis. Measuring serum α-HB could thus provide a rapid, inexpensive screening tool for detecting early subclinical hyperglycemia, β-cell dysfunction, and increased risk for diabetes. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Conditions that increase aldosterone secretion without affecting glucocorticoid secretion includes :" }, { "role": "assistant", "content": "The correct answer is Conditions that increase aldosterone secretion.\nGlucocorticoid secretion also increased Surgery Anxiety Physical trauma\nHemorrhage Glucocorticoid secretion unaffected High potassium intake Low sodium intake Constriction of inferior vena cava in thorax Standing Secondary hyperaldosteronism (in some cases of congestive heart failure, cirrhosis, and hephrosis)" } ]

[ { "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: Computational Biology, DNA, Algal, Databases, Genetic, Diatoms, Evolution, Molecular, Models, Genetic, Phytophthora, Plastids, Rhodophyta, Symbiosis." }, { "role": "user", "content": "Are algal genes in nonphotosynthetic protists evidence of historical plastid endosymbioses? Context: How photosynthetic organelles, or plastids, were acquired by diverse eukaryotes is among the most hotly debated topics in broad scale eukaryotic evolution. The history of plastid endosymbioses commonly is interpreted under the \"chromalveolate\" hypothesis, which requires numerous plastid losses from certain heterotrophic groups that now are entirely aplastidic. In this context, discoveries of putatively algal genes in plastid-lacking protists have been cited as evidence of gene transfer from a photosynthetic endosymbiont that subsequently was lost completely. Here we examine this evidence, as it pertains to the chromalveolate hypothesis, through genome-level statistical analyses of similarity scores from queries with two diatoms, Phaeodactylum tricornutum and Thalassiosira pseudonana, and two aplastidic sister taxa, Phytophthora ramorum and P. sojae. Contingency tests of specific predictions of the chromalveolate model find no evidence for an unusual red algal contribution to Phytophthora genomes, nor that putative cyanobacterial sequences that are present entered these genomes through a red algal endosymbiosis. Examination of genes unrelated to plastid function provide extraordinarily significant support for both of these predictions in diatoms, the control group where a red endosymbiosis is known to have occurred, but none of that support is present in genes specifically conserved between diatoms and oomycetes. In addition, we uncovered a strong association between overall sequence similarities among taxa and relative sizes of genomic data sets in numbers of genes." }, { "role": "assistant", "content": "Signal from \"algal\" genes in oomycete genomes is inconsistent with the chromalveolate hypothesis, and better explained by alternative models of sequence and genome evolution. Combined with the numerous sources of intragenomic phylogenetic conflict characterized previously, our results underscore the potential to be mislead by a posteriori interpretations of variable phylogenetic signals contained in complex genome-level data. They argue strongly for explicit testing of the different a priori assumptions inherent in competing evolutionary hypotheses." } ]

[ { "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 36-year-old man is brought to the emergency department because of facial spasm and an inability to speak for 2 hours. He has had no loss of consciousness or rhythmic movements. He has a history of schizophrenia and was recently put on clozapine for resistant symptoms. He appears to be aware of his surroundings. At the hospital, his blood pressure is 135/85 mm Hg, the pulse is 86/min, the respirations are 16/min, and the temperature is 36.7°C (98.1°F). Physical examination shows the superior deviation of both eyes to the right side, trismus, and spasm of the neck muscles with a deviation of the head to the left. He follows directions without hesitation. The remainder of the physical examination shows no abnormalities. The most appropriate next step is to administer which of the following?" }, { "role": "assistant", "content": "Diphenhydramine" } ]

[ { "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 cholangiogram shows?" }, { "role": "assistant", "content": "The correct answer is Ans. (a) Klastskin TumorThe image shows the endoscope in the middle and the biliary tree. You can notice the contrast in gall bladder (9deg clock) and cystic duct where it is meeting the common hepatic duct. However the left and right hepatic ducts are not visible indicating a tumor causing obstruction to flow of contrast." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Most common cause of inseional tendonitis of tendoachilles is -" }, { "role": "assistant", "content": "The correct answer is ACHILLES TENDINITIS: Athletes, joggers and hikers often develop pain and swelling around the tendo Achillis, due to local irritation of the tendon sheath or the paratenon.Clinical features :The condition may come on gradually, or rapidly following a change in spoing activity (or a change of spos footwear). Less commonly there is a history of direct trauma to the Achilles tendon. The area above the heel may look inflamed and function is inhibited because of pain in the heel-cord, especially at pushoff. The tendon feels thickened in the watershed area about 4 cm above its inseion. In chronic cases an ultrasound scan may be helpful in confirming the diagnosis. REF:Apley&;s system of ohopaedics- 9th edn- pg no 613 ." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, METHODS, METHODS, METHODS, RESULTS. Meshes: DNA Primers, Endometriosis, Enzyme-Linked Immunosorbent Assay, Female, Humans, Interleukin-10, Interleukin-6, Leiomyoma, NF-kappa B, Ovarian Neoplasms, RNA, Messenger, Receptors, Interleukin-10, Reverse Transcriptase Polymerase Chain Reaction, Stromal Cells, Transcription Factors, Transcription, Genetic, Tumor Necrosis Factor-alpha, Uterine Neoplasms." }, { "role": "user", "content": "Does interleukin-10 attenuate TNF-alpha-induced interleukin-6 production in endometriotic stromal cells? Context: To determine whether high levels of interleukin (IL)-10 can attenuate the production of tumor necrosis factor (TNF)-alpha-induced proinflammatory cytokines in endometriotic stromal cells. Prospective study. Department of Ob/Gyn, Tottori University, Japan. Thirty-five patients with ovarian endometrioma and ten patients with uterine myoma. Endometriotic stromal cells were obtained from chocolate cyst linings of ovaries. Endometrial stromal cells obtained from patient with uterine myoma. Expression of IL-10 gene in endometriotic or endometrial stromal cells was determined by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). We performed immunohistochemical staining to find the presence of IL-10 and IL-10 receptors 1 and 2. We examined the effects of TNF-alpha and IL-10 on the expression of IL-6 or IL-8 by real-time RT-PCR and ELISA. We examined the activation of intracellular signal transduction molecules in endometriotic stromal cells by Western blotting. Addition of IL-10 suppressed the expressions of IL-6 induced by TNF-alpha and IL-10 induced the phosphorylation of STAT3 in endometriotic stromal cells. TNF-alpha induced the expression of phosphorylated ERK1/2, JNK1/2, and I kappaB. Adding IL-10 suppressed the phosphorylation of these signal molecules." }, { "role": "assistant", "content": "Interleukin-10 attenuates TNF-alpha-induced IL-6 synthesis via NF-kappaB and MAPK pathways in endometriotic cells.. Interleukin-10 may play a significant role in the pathogenesis of endometriosis. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Animals, Bacterial Toxins, Bone and Bones, C-Reactive Protein, Disease Models, Animal, Exotoxins, Female, Humans, Leukocidins, Methicillin-Resistant Staphylococcus aureus, Mice, Neutrophils, Osteomyelitis, Rabbits, Staphylococcal Infections, Virulence Factors." }, { "role": "user", "content": "Does panton-valentine leukocidin enhance the severity of community-associated methicillin-resistant Staphylococcus aureus rabbit osteomyelitis? Context: Extensive spread of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in the United States, and the concomitant increase in severe invasive staphylococcal infections, including osteomyelitis, in healthy children, has led to renewed interest in Panton-Valentine leukocidin (PVL). However, the pathogenetic role of PVL in staphylococcal infections remains controversial, possibly because it depends on the site of infection. We compared the course of experimental rabbit osteomyelitis due to the PVL-positive CA-MRSA strain USA 300 (LAC) and its PVL-negative isogenic derivative (LACDeltapvl), using a low and a high inoculum (8x10(5) and 4x10(8) CFU). With the low inoculum, bone infection was less frequent on day 7 (D7) and day 28 (D28) with LACDeltapvl than with LAC (respectively 12/19 and 18/19 animals, p = 0.042). With the high inoculum of both strains, all the animals were infected on D7 and the infection persisted on D28 in almost every case. However, tibial bacterial counts and the serum CRP concentration fell significantly between D7 and D28 with LACDeltapvl but not with LAC. Respectively 67% and 60% of LAC-infected rabbits had bone deformation and muscle/joint involvement on D7, compared to 0% and 7% of LACDeltapvl-infected rabbits (p = 0.001 and p = 0.005 respectively). Between D0 and D28, the anti-PVL antibody titer increased significantly only with the high inoculum of LAC." }, { "role": "assistant", "content": "PVL appears to play a role in the persistence and rapid local extension of rabbit osteomyelitis, in keeping with the greater severity of human bone infections due to PVL-positive S. aureus. The possible therapeutic implications of these findings are discussed. 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 these is not an antigen presenting cell?" }, { "role": "assistant", "content": "The correct answer is Ans. (a) Bipolar cellsRef: Robbiris pathology 9th ed. /191-192: Pocket companion to Robbin 'spathology 8th edition /119T cells cannot be activated by soluble antigens. Therefore presentation of processed antigen by antigen presenting cells is required for activation of T cells.Important Antigen Presenting Cells are* Macrophage* B cells* Dendritic cells (most potent APCs)* Langerhans cellsBipolar cell is a type of neuron which has two extensions. Bipolar cells are specialized sensory neurons for the transmission of special senses. As such, they are part of the sensory pathways for smell, sight, taste, hearing and vestibular functions." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Biomarkers, Tumor, Breast Neoplasms, Disease-Free Survival, Female, Follow-Up Studies, Humans, Hyaluronan Receptors, Middle Aged, Prognosis." }, { "role": "user", "content": "Is cD44v6 a prognostic factor in primary breast cancer? Context: CD44 is an adhesion molecule and represents a highly variable family of isoforms. The isoform CD44v6 has been associated with metastasis formation and poor prognosis in animal models and human colon cancer. Results of studies in primary breast cancer are relatively small and contradictory. The immunohistochemical expression of CD44v6 was studied in a series of 338 patients with primary breast tumours, uniformly staged and treated in a single center with a long median follow-up of 128 months. The prognostic significance of CD44v6 as well as the correlation with several clinicopathological features were analysed. Two hundred nineteen of 338 (64.8%) of the breast cancer were CD44v6-positive (> 5% of tumour cells with positive staining). CD44v6 expression had no value for prognosticating disease-free or overall survival at this or any other cut-off point." }, { "role": "assistant", "content": "CD44v6 expression is not a prognostic factor in primary breast cancer. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Animals, Apoptosis, Apoptosis Regulatory Proteins, Autophagy, Autophagy-Related Protein 7, Beclin-1, Cell Line, Tumor, Cell Survival, Chloroquine, ErbB Receptors, Glioblastoma, Humans, Membrane Proteins, Mice, Mice, Inbred BALB C, Neoplasm Transplantation, Phosphatidylinositol 3-Kinases, Piperidines, Proto-Oncogene Proteins c-akt, Proto-Oncogene Proteins c-ret, Quinazolines, Receptors, Vascular Endothelial Growth Factor, Signal Transduction, TOR Serine-Threonine Kinases, Ubiquitin-Activating Enzymes, Xenograft Model Antitumor Assays." }, { "role": "user", "content": "Does autophagy inhibition induce enhanced proapoptotic effects of ZD6474 in glioblastoma? Context: Autophagy is a lysosomal degradation pathway that can provide energy through its recycling mechanism to act as a cytoprotective adaptive response mediating treatment resistance in cancer cells. We investigated the autophagy-inducing effects of ZD6474, a small-molecule inhibitor that blocks activities of vascular endothelial growth factor receptor (VEGFR), epidermal growth factor receptor (EGFR), and RET tyrosine kinases. We investigated the effects of ZD6474 on autophagy in glioblastomas cells. The ZD6474 mechanism of action was determined by western blot. We then examined the impacts of the inhibition of autophagy in combination with ZD6474 on cell apoptosis in vitro. Furthermore, we evaluated the synergistic anticancer activity of combination treatment with an autophagy inhibitor (chloroquine) and ZD6474 in U251 glioblastoma cells xenograft model. ZD6474-induced autophagy was dependent on signalling through the phosphoinositide 3-kinase/Akt/mammalian target of rapamycin (PI3K/Akt/mTOR) pathway. ZD6474-induced autophagy was inhibited by both knockdown of the ATG7 and Beclin 1 gene, essential autophagy genes, and pharmacologic agents (chloroquine and 3-methyalanine) treatment. Both treatments also dramatically sensitised glioblastoma cells to ZD6474-induced apoptosis, decreasing cell viability in vitro. Furthermore, in a xenograft mouse model, combined treatment with ZD6474 and chloroquine significantly inhibited U251 tumour growth, and increased the numbers of apoptotic cells compared with treatment with either agent alone." }, { "role": "assistant", "content": "Autophagy protects glioblastoma cells from the proapoptotic effects of ZD6474, which might contribute to tumour resistance against ZD6474 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: OBJECTIVE, RESULTS. Meshes: Adult, Brachial Artery, Case-Control Studies, Endothelium, Vascular, Family Health, Female, Humans, Hypertension, Male, Regression Analysis, Risk Factors, Ultrasonography, Vasodilation." }, { "role": "user", "content": "Is endothelium-dependent vasodilation impaired in healthy offspring of hypertensive parents? Context: Impaired endothelium-dependent vasodilation has been demonstrated in asymptomatic normotensive offspring of hypertensive parents in Caucasians and Chinese population. The study was designed to determine whether impaired endothelium-dependent vasodilation is present in Indian normotensive offspring with hypertensive parents. We conducted this study in non smoker, healthy, young volunteers with a positive (n = 45) or a negative parental history (n = 30) of essential hypertension in a case-control, blinded design. The subjects underwent a thorough clinical and routine laboratory evaluation. A high resolution ultrasound was used to assess endothelium-dependent brachial artery flow-mediated dilation by a single observer blinded to the family histories. The brachial artery diameters at baseline and after occlusion release, flow mediated dilatation %, brachial intima-media thickness/lumen diameter were obtained and compared between the two groups using student's t-test. There was no significant difference between the two groups in age, sex, body mass index, blood pressure and total cholesterol levels. However, there was a statistically significant impairment of flow mediated dilatation amongst subjects with parental history of hypertension compared to controls (6.87 SD 8.14 % vs 11.31 SD 5.17%, p < 0.01). Multiple regression analysis revealed no association of FMD with age, blood pressure, BMI or total cholesterol in those with or without parental hypertension." }, { "role": "assistant", "content": "Our study demonstrated impaired brachial artery flow mediated dilatation amongst normotensive offspring with parental hypertension compared to controls. This suggests that endothelial dysfunction possibly precedes clinical hypertension and might have a role in the pathogenesis of essential hypertension. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, METHODS, METHODS, METHODS, RESULTS. Meshes: Blood Glucose, Diabetes Mellitus, Type 2, Female, Glycemic Index, Humans, Hyperglycemia, Male, Middle Aged, Virginia, Walking." }, { "role": "user", "content": "Is postprandial walking better for lowering the glycemic effect of dinner than pre-dinner exercise in type 2 diabetic individuals? Context: In prior studies of exercise done before or after breakfast and lunch, postprandial activity generally reduces glycemia more than pre-meal. This study sought to examine the effects of exercise before or after an evening meal. Examined the differing effects of a single bout of pre- or postprandial moderate exercise or no exercise on the glycemic response to an evening (dinner) meal in individuals with type 2 diabetes. Community-dwelling participants tested at a research university in Virginia. Twelve men and women subjects (mean age of 61.4+/-2.7 years) with type 2 diabetes treated with diet and/or oral medications. Three trials conducted on separate days consisting of a rest day when subjects consumed a standardized dinner with a moderate glycemic effect and 2 exercise days when they undertook 20 minutes of self-paced treadmill walking immediately before or 15 to 20 minutes after eating. Blood samples taken every 30 minutes over a 4-hour period and later assayed for plasma glucose; from these data both absolute and relative changes in glucose levels were determined, as well as the total glucose area under the curve (AUC) of the 4-hour testing period. Initial samples were additionally assayed for glycated hemoglobin and lipid levels. Twenty minutes of self-paced walking done shortly after meal consumption resulted in lower plasma glucose levels at the end of exercise compared to values at the same time point when subjects had walked pre-dinner. Total glucose AUC over 4-hours was not significantly different among trials." }, { "role": "assistant", "content": "Postprandial walking may be more effective at lowering the glycemic impact of the evening meal in individuals with type 2 diabetes compared with pre-meal or no exercise and may be an effective means to blunt postprandial glycemic excursions. 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 person with multiple injuries develops fever, restlessness, tachycardia, tachypnea and periumbilical rash. The likely diagnosis is:" }, { "role": "assistant", "content": "The correct answer is Ans. is 'b' i.e. Fat embolism The classical picture of mental disturbances, tachycardia, tachypnea and periumbilical rash in a multiple injury patient suggests a diagnosis of fat embolism.Fat embolism is a common phenomenon after fractures of long bones. In most instances, fat embolism is clinically inapparent. A small percentage of these patients develop clinical features similar to those of ARDS known as Fat Embolism syndrome.The source of fat emboli is probably the bone marrow, and the condition is more commonly seen in patients with multiple fractures.Symptoms are evident 1 to 3 days after the injury, and includes slight rise in temperature, increased pulse rate, breathlessness, mild mental confusion or restlessness and petechiae. In its most severe form, which may be fatal, this syndrome is characterized by respiratory failure, mental changes deteriorating to coma, thrombocytopenia, and widespread petechiae.Diagnosis:In a case with multiple fractures, early diagnosis may be possible by strong suspicion. In addition to the classis clinical features, signs of retinal artery emboli may be present. Sputum and urine may reveal the presence of fat globules.Chest x-rays reveal diffuse opacity of the lungs, which may progress to a \"whiteout\" typical of acute respiratory distress syndrome.Low blood P02 values may indicate respiratory failure.Management:Severe fat embolism syndrome can probably be avoided by the use of high doses of oxygen immediately after injury and by the prompt stabilization of long-bone fractures.In mild cases, treatment is supportive with high inspired oxygen tensions supplemented if necessary by mechanical ventilation.In severe cases recovery is unpredictable and the mortality rate high.Air embolism can cause similar clinical picture but is rarely seen after trauma.Causes of air embolism are:The primary cause of venous air embolism is surgical procedures, especially neurosurgical procedures performed in the upright, sitting position. Anytime the operative site is more than 5 cm above the right atrium, VAE is a risk. Other surgical procedures that can lead to the infusion of air include obstetric/gynecologic procedures (cesarean section), craniofacial surgery, dental implant surgery, vascular procedures, liver transplantation, and orthopedic procedures (eg, hip replacement, arthroscopy). The frequency of reported VAE in surgical procedures ranges from 10% in cervical laminectomy up to 80% in posterior fossa surgery.Iatrogenic creation of a pressure gradient for air entry. Eg. Spinal needles in lumbar punctures (case report), peripheral intravenous lines, central venous catheters etc.Mechanical insufflation or infusion as during arthroscopic procedures, CO2 hysteroscopy, laparoscopy, urethral insufflation, and orogenital sexual activity during pregnancy.Positive-pressure ventilation, which can occur during mechanical ventilation and SCUBA diving.Blunt and penetrating trauma to the chest, abdomen, neck, and face can lead to the entry of air and ultimately to VAE.Small amounts of air do not produce symptoms because the air is broken up and absorbed from the circulation. Although classical teaching states that more than 5 mL/kg of air (IV) is required for significant injury (including shock and cardiac arrest), patient complications secondary to as little as 20 mL of air (the length of an unprimed IV infusion set) have been reported. Further, as little as 0.5 mL of air in the left anterior descending coronary artery has been shown to lead to ventricular fibrillation." } ]

[ { "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, Astragalus Plant, Carcinoma, Hepatocellular, Diethylnitrosamine, Dose-Response Relationship, Drug, Gene Expression, Hep G2 Cells, Humans, Liver, Liver Neoplasms, Male, Neoplasm Invasiveness, Phosphorylation, Plant Extracts, Plasminogen Activator Inhibitor 1, Rats, Rats, Sprague-Dawley, Salvia miltiorrhiza, Signal Transduction, Smad Proteins, Transforming Growth Factor beta, Up-Regulation." }, { "role": "user", "content": "Do compound Astragalus and Salvia miltiorrhiza extracts suppress hepatocarcinogenesis by modulating transforming growth factor-β/Smad signaling? Context: Previous studies showed Compound Astragalus and Salvia miltiorrhiza extract (CASE), extract from Astragalus membranaceus and Salvia miltiorhiza, significantly suppresses hepatocellular carcinoma (HCC) in rats induced by diethylinitrosamine (DEN), and in vitro experiments further demonstrated that CASE's anti-HepG2 cell invasion is associated with transforming growth factor-β (TGF-β). We hypothesized that CASE's suppression of HCC is modulated by TGF-β/Smad signaling, and we conducted this in vivo study to test this hypothesis. Rats were divided into the normal control, the DEN group, and three CASE (60, 120, and 240 mg/kg) treatment groups. The expression of phosphorylation(p) Smad both at C-terminal and linker region, plasminogen activator inhibitor 1, and Smad4 and Smad7 of liver tissues were measured and compared across the five groups. The positive staining of pSmad2L and pSmad3L increased both in hepatoma nodule areas and adjacent relatively normal liver tissues in rats treated with DEN, while the positive staining of pSmad2C and pSmad3C increased only in relatively normal liver tissues adjacent to hepatoma tissues. The elevated expression of pSmad2C, pSmad2L, pSmad3L, Smad4, and plasminogen activator inhibitor 1 proteins were suppressed by CASE in a dose-dependent manner. CASE treatment also significantly reduced the intranuclear amounts of pSmad2L and pSmad3L, and upregulated the elevation of pSmad3C positive cells and protein expression in a dose-dependent manner." }, { "role": "assistant", "content": "The results suggest that CASE significantly suppresses HCC progression by mediating TGF-β/Smad signaling, especially by modulating Smad3 phosphorylation both at the C-terminal and linker region. 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": "Nerve not carrying taste sensation from tongue" }, { "role": "assistant", "content": "The correct answer is Trigmenial nerve does not carry taste sensation from tongue. Taste from tongue is medicated by chorda tympani nerve, a branch of facial nerve." } ]

[ { "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: UNASSIGNED. Meshes: Breast Neoplasms, Cell Line, Tumor, Cell Transformation, Neoplastic, DNA Damage, DNA Polymerase beta, DNA Repair, Estrogens, Female, Genetic Predisposition to Disease, Germ-Line Mutation, Guanine, High-Throughput Nucleotide Sequencing, Humans, Polymorphism, Single Nucleotide." }, { "role": "user", "content": "Does estrogen drive Cellular Transformation and Mutagenesis in Cells Expressing the Breast Cancer-Associated R438W DNA Polymerase Lambda Protein? Context: Repair of DNA damage is critical for maintaining the genomic integrity of cells. DNA polymerase lambda (POLL/Pol λ) is suggested to function in base excision repair (BER) and nonhomologous end-joining (NHEJ), and is likely to play a role in damage tolerance at the replication fork. Here, using next-generation sequencing, it was discovered that the POLL rs3730477 single-nucleotide polymorphism (SNP) encoding R438W Pol λ was significantly enriched in the germlines of breast cancer patients. Expression of R438W Pol λ in human breast epithelial cells induces cellular transformation and chromosomal aberrations. The role of estrogen was assessed as it is commonly used in hormone replacement therapies and is a known breast cancer risk factor. Interestingly, the combination of estrogen treatment and the expression of the R438W Pol λ SNP drastically accelerated the rate of transformation. Estrogen exposure produces 8-oxoguanine lesions that persist in cells expressing R438W Pol λ compared with wild-type (WT) Pol λ-expressing cells. Unlike WT Pol λ, which performs error-free bypass of 8-oxoguanine lesions, expression of R438W Pol λ leads to an increase in mutagenesis and replicative stress in cells treated with estrogen. Together, these data suggest that individuals who carry the rs3730477 POLL germline variant have an increased risk of estrogen-associated breast cancer." }, { "role": "assistant", "content": "The Pol λ R438W mutation can serve as a biomarker to predict cancer risk and implicates that treatment with estrogen in individuals with this mutation may further increase their risk of breast cancer. Mol Cancer Res; 14(11); 1068-77. ©2016 AACR. 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: Cold Temperature, Gene Expression Profiling, Gene Expression Regulation, Plant, Gene Regulatory Networks, Hydrogen Peroxide, Oligonucleotide Array Sequence Analysis, Oryza, Oxidation-Reduction, Oxidative Stress, Plant Proteins, Promoter Regions, Genetic, RNA, Plant, Signal Transduction, Transcription Factors." }, { "role": "user", "content": "Does transcriptional regulatory network triggered by oxidative signals configure the early response mechanisms of japonica rice to chilling stress? Context: The transcriptional regulatory network involved in low temperature response leading to acclimation has been established in Arabidopsis. In japonica rice, which can only withstand transient exposure to milder cold stress (10 degrees C), an oxidative-mediated network has been proposed to play a key role in configuring early responses and short-term defenses. The components, hierarchical organization and physiological consequences of this network were further dissected by a systems-level approach. Regulatory clusters responding directly to oxidative signals were prominent during the initial 6 to 12 hours at 10 degrees C. Early events mirrored a typical oxidative response based on striking similarities of the transcriptome to disease, elicitor and wounding induced processes. Targets of oxidative-mediated mechanisms are likely regulated by several classes of bZIP factors acting on as1/ocs/TGA-like element enriched clusters, ERF factors acting on GCC-box/JAre-like element enriched clusters and R2R3-MYB factors acting on MYB2-like element enriched clusters.Temporal induction of several H2O2-induced bZIP, ERF and MYB genes coincided with the transient H2O2 spikes within the initial 6 to 12 hours. Oxidative-independent responses involve DREB/CBF, RAP2 and RAV1 factors acting on DRE/CRT/rav1-like enriched clusters and bZIP factors acting on ABRE-like enriched clusters. Oxidative-mediated clusters were activated earlier than ABA-mediated clusters." }, { "role": "assistant", "content": "Genome-wide, physiological and whole-plant level analyses established a holistic view of chilling stress response mechanism of japonica rice. Early response regulatory network triggered by oxidative signals is critical for prolonged survival under sub-optimal temperature. Integration of stress and developmental responses leads to modulated growth and vigor maintenance contributing to a delay of plastic injuries. 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": "Cotton's Fracture involves:" }, { "role": "assistant", "content": "The correct answer is ANSWER: (A) AnkleREF: http;//en.wikipedia.org/wiki/List_of_eponymous_fracturesSee APPENDIX-68 for \"Alphabetical list of eponymous fractures\" APPENDIX - 68Alphabetical List of Eponymous FracturesFractureDescriptionMechanism of injuryAviators fractureFracture neck of talusDorsiflexionBumper fracturecompression fracture of lateral condyle of tibial (always intra articular)Forced valgus of knee when struck from side by car bumperBoxer's fractureFracture of distal 5th metacarpalPunching solid objectBos worth fractureFracture of distal fibula with posterior dislocation of the proximal fibula behind the tibiaSevere external rotation of the footBennett's fractureIntra-articular fracture of base of first metacarpalAxial load along metacarpal in a partially flexed thumb (Abductor pollids longus pull)Barton's fractureIntra articular distal radius fracture invoking the articular surface with dislocation of the radio carpal jointFall on outstretched handBankart's fractureFracture of anterior glenoid associated with anterior shoulder dislocationExternal rotation and abduction of shoulderColies' fractureDistal radius fracture with dorsal angulation, impaction and radial driftFall on outstretched handCotton's fractureTrimalleolar fracture of ankle Clay shoveller's fractureStress avulsion fracture of Spinous process of C6, C7 or T1Forced hyper flexion of neckCh opart's fracture- dislocationFoot dislocation through talonavicular and calcaneocuboid joints with associated fractures, usually after ankle twisting. Treated in a non-weight bearing cast for 6-8 weeks Chauffeur's fractureIntra-articular fracture of radial styloidForced ulnar deviation of the wrist causing avulsion of the radial styloidChance fractureHorizontal fracture of vertebral bodyHyper flexion of spine, seen in car accidents when lap belts xvere usedDuverney fractureIsolated fracture of the iliac wingDirect traumaEssex-LoprestifractureComminuted radial head fracture xvith interosseous membrane disruption and distal radioulnar joint subluxationFall from heightGosselin fractureV-shaped distal tibia fracture extending into the tibial plafond Galeazzi fractureRadius shaft fracture with dislocation of distal radioulnar jointBlow to forearmHolds worth fractureUnstable spinal fracture-dislocation at the thoracolumbar junction Hume fractureOlecranon fracture with anterior dislocation of radial head Hill-Sachs fractureImpacted posterior humeral head fracture occurring during anterior shoulder dislocation Hangman s fractureFracture of both pedicles of C2Distraction and extension of neck (judicial hanging)Jones fractureFracture of base of 5th metatarsal extending into intermetatarsal jointInversion of ankle (pronator brevis pull)Jefferson fractureBurst fracture of 1st cervical vertebraCompression of neckLisfranc fractureFracture dislocation of midfootForced plantar flexion of foot or dropping heavy weight on footLe Forts fracture of the ankleVertical fracture of distal fibula with avulsion of medial malleolus Le Fort fracturesSeries of facial fracturesDirect trauma to faceMoores fractureDistal radius fracture with ulnar dislocation and entrapment of styloid process under annular ligament Monteggia fractureProximal ulna fracture with dislocation of radial headBlow to forearmMarch fractureStress fracture of 2n<1 /3rd metatarsal shaftHeavy or unaccustomed exerciseMalgaignesfractureVertical pelvic fracture through both pubic rami and the ilium or sacroiliac joint with vertical displacementHigh energy impact to pelvis (front to back)MaisonneuvefractureSpiral fracture of proximal fibulaExternal rotation of anklePipkin fracture- dislocationPosterior dislocation of hip with avulsion fracture of fragment of femoral head by the ligamentum teresImpact to the knee with the hip flexed (dashboard injury)Pilon fractureComminuted fracture of distal articular fracture with fibular fracture Pott's fractureBimalleolar fracture of the ankleEversion of ankleRolando fractureIntra articular T or Y shaped Comminuted fracture of base of V metacarpalAxial load along the metacarpal causing splitting of the proximal articular surfaceRunner's fractureStress fracture of distal fibula 3-8 cm above the lateral malleolusRepeated axial stress on fibulaStieda fractureAvulsion fracture of the medial femoral condyle at the origin of the medial collateral ligament Smith's fractureDistal radius fracture with volar displacementFall on outstretched hand with wrist in flexed positionShepherd s fractureFracture of the lateral tubercle of the posterior process of the talus Segond fractureLateral tibial plateau avulsion fracture with anterior cruciate ligament tear| Internal rotation of the kneeSalter-HarrisfracturesFractures involving a growth platevariousTitlaux fractureSalter-Harris III fracture of the tibiaForced lateral rotation of footToddlers fractureUndisplaced spiral fracture of distal tibia in children under 8 years oldLow-energy trauma t often rotational" } ]

[ { "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": "When evaluating an ABG from a client with a subdural hematoma, the nurse notes the PaCO2 is 30 mm Hg. Which of the following responses best describes this result?" }, { "role": "assistant", "content": "The correct answer is A normal PaCO2 value is 35 to 45 mm Hg. CO2 has vasodilating properties; therefore, lowering PaCO2 through hyperventilation will lower ICP caused by dilated cerebral vessels.\n\nOption B: Oxygenation is evaluated through PaO2 and oxygen saturation.\nOption D: Alveolar hypoventilation would be reflected in an increased PaCO2." } ]

[ { "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 35-year-old male presented with nasal discharge, facial pain and fever which persisted with several courses of antibiotics and antihistaminics over a period of 3 months. On nasal endoscopy mucopurulent discharge from middle meatus and inflamed sinus openings seen. His NCCT nose and PNS is given below. He should be best managed by:" }, { "role": "assistant", "content": "The correct answer is (b) Functional endoscopic sinus surgery(Ref. Scott Brown, 8th ed., Vol 1; 1072)NCCT shows left maxillary sinus (asterisk) haziness s/o sinusitis." } ]

[ { "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": "Collar Button Ulcer is a feature of -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'd' i.e., Ulcerative colitis o Repeat from previous sessions" } ]

[ { "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: Animals, Anti-Anxiety Agents, Behavior, Animal, Drug Tolerance, Ganglionic Stimulants, Male, Motor Activity, Nicotine, Raphe Nuclei, Rats, Receptors, Serotonin, Receptors, Serotonin, 5-HT1, Substance Withdrawal Syndrome." }, { "role": "user", "content": "Is the dorsal raphé nucleus a crucial structure mediating nicotine 's anxiolytic effects and the development of tolerance and withdrawal responses? Context: Smokers frequently report that they obtain anxiety-reducing (anxiolytic) effects from smoking, and this may be one factor which contributes to nicotine dependence. The aim of this study was to investigate the role of the dorsal raphé nucleus (DRN) in mediating the acute anxiolytic effect of nicotine, the development of tolerance to this effect and the anxiogenic response observed on withdrawal from chronic nicotine. The social interaction test of anxiety was used to investigate the effects of a range of doses of (-)-nicotine (2.5-4000 ng) following DRN infusion, and whether co-administration of the specific 5-HT1A receptor antagonist WAY 100635 could antagonise the anxiolytic action of nicotine. We then examined the effects of intra-DRN nicotine (2.5-7 ng) following six daily injections of subcutaneous (s.c.) (-)-nicotine (0.1 mg/kg). Finally, we examined whether s.c. or intra-DRN (-)-nicotine could antagonise the anxiogenic response seen 72 h after the termination of 7 days of nicotine treatment. Acute nicotine administration into the DRN produced dose-related effects: low doses (2.5-10 ng) induced an anxiolytic effect, intermediate doses were behaviourally silent (100-1000 ng), and an anxiogenic effect was seen following administration of a high dose (4 micrograms). The anxiolytic effect of (-)-nicotine (5 ng) was reversed by co-administration of a behaviourally inactive dose of WAY 100635 (200 ng). Following 6 days of treatment with s.c. 0.1 mg/kg per day (-)-nicotine, tolerance developed to its anxiolytic action in the DRN. Rats withdrawn for 72 h following this chronic treatment showed an anxiogenic response which was reversed by (-)-nicotine injected s.c. (0.1 mg/kg) or into the DRN (5 ng)." }, { "role": "assistant", "content": "The present findings therefore suggest that the DRN plays an important role in mediating the acute effects of nicotine on anxiety, as measured in the social interaction test, and that the anxiolytic effect is mediated by activation of somatodendritic 5-HT1A autoreceptors. The DRN is also concerned with mediating the development of tolerance to nicotine's anxiolytic effects and because there is an anxiogenic response 72 h after withdrawal from chronic nicotine, this suggests that an oppositional, compensatory mechanism is mediating the tolerance. 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: Acid-Base Equilibrium, Acute Kidney Injury, Adenine, Adult, Aged, Aged, 80 and over, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Cohort Studies, Creatinine, Female, Follow-Up Studies, HIV Infections, HIV-1, Humans, Kidney, Male, Middle Aged, Organophosphonates, Reverse Transcriptase Inhibitors, Tenofovir." }, { "role": "user", "content": "Are minor changes in calculated creatinine clearance and anion-gap associated with tenofovir disoproxil fumarate-containing highly active antiretroviral therapy? Context: Tenofovir disoproxil fumarate (Tenofovir DF, TDF), the first nucleotide reverse transcriptase inhibitor approved for the treatment of HIV disease, has been associated with renal dysfunction in isolated cases. The aim of this study was to assess changes in renal parameters in individuals receiving TDF- and non-TDF-containing highly active antiretroviral therapy (HAART). All individuals on HAART attending our clinic were included in the analysis. Time-weighted changes in serum creatinine, calculated creatinine clearance (CCrCl) and anion-gap were assessed for individuals on TDF- and non-TDF HAART. Of 948 individuals on HAART, 290 (31%) and 618 (65%) were on TDF- and non-TDF HAART, with 40 (4%) having ceased TDF HAART. Baseline values for serum creatinine, CCrCl and anion-gap were similar for those on TDF- and non-TDF HAART. In a multivariate analysis, statistically significant differences were observed in time-weighted change from baseline in anion-gap and CCrCl between individuals on TDF- and non-TDF HAART [mean difference in change between groups: anion-gap 0.78 mmol/L (standard error, 0.19) and CCrCl-6.80 (standard error 2.2); P = 0.005 and P = 0.032, respectively] after adjusting for baseline anion-gap and CCrCl, respectively. Two cases of TDF-associated renal failure were observed." }, { "role": "assistant", "content": "Overt renal failure with TDF HAART is rare. However, subtle but statistically significant changes in anion-gap and CCrCl were observed which were associated with TDF HAART. These parameters may be of use in monitoring individuals on HAART. 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, DESIGN, RESULTS. Meshes: Biopsy, Fine-Needle, Carcinoma, Female, Goiter, Nodular, Humans, Male, Middle Aged, Pennsylvania, Prospective Studies, Risk Factors, Thyroid Gland, Thyroid Nodule." }, { "role": "user", "content": "Is fine-needle aspiration (FNA) of multiple thyroid nodules justified? Context: The clinical management of patients with solitary thyroid nodule is well established; however, the evaluation of patients with multiple thyroid nodules is controversial. The aim of this study was to assess if there is a correlation between the risk of malignancy and number of thyroid nodules. The study cohort included 2,884 patients (2,410 females and 474 males) with 3,274 thyroid nodules that underwent FNA under ultrasound guidance between November 1997 and April 2004. Multiple thyroid nodules were aspirated in 360 patients; 2 in 332 (291 females, 41 males), 3 nodules in 26 (23 females, 3 males), and 4 nodules in 2 patients (1 female, 1 male). Subsequent information regarding the histological diagnosis was obtained in the cases that underwent surgical excision. The average age for patients with single or multiple nodules was the same (51 yr). The FNA specimens were diagnosed as benign (n = 1,663, 51%), neoplasm (n = 880, 27%), suspicious for neoplasm or papillary carcinoma (n = 234, 7%), malignant (n = 187, 6%), and non-diagnostic (n = 310, 9%). Surgical excision was performed in 1,135 patients: 993 patients with single nodules and 142 patients with multiple nodules. The surgical pathology diagnosis was benign in 656 nodules (52%) and malignant in 596 nodules (48%). In the malignant category 153 tumors were papillary microcarcinoma (<1 cm). Excluding these cases, the malignancy rate was 39% in patients with single nodules, 41% with two nodules, and 21% with three nodules." }, { "role": "assistant", "content": "The cancer risk is similar for patients with one or two nodules over 1 cm and decreases with three or more thyroid nodules." } ]

[ { "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 57-year-old man is brought to the emergency department by a social worker from the homeless shelter. The man was acting strangely and then found unresponsive in his room. The social worker says she noticed many empty pill bottles near his bed. The patient has a past medical history of multiple hospital admissions for acute pancreatitis, dehydration, and suicide attempts. He is not currently taking any medications and is a known IV drug user. His temperature is 99.2°F (37.3°C), blood pressure is 107/48 mmHg, pulse is 140/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is notable for a man with a Glasgow coma scale of 6. Laboratory values are ordered as seen below.\n\nHemoglobin: 10 g/dL\nHematocrit: 30%\nLeukocyte count: 5,500/mm^3 with normal differential\nPlatelet count: 147,000/mm^3\n\nSerum:\nAlbumin: 1.9 g/dL\nNa+: 139 mEq/L\nCl-: 100 mEq/L\nK+: 4.3 mEq/L\nHCO3-: 25 mEq/L\nBUN: 29 mg/dL\nGlucose: 65 mg/dL\nCreatinine: 1.5 mg/dL\nCa2+: 10.2 mg/dL\nProthrombin time: 27 seconds\nPartial thromboplastin time: 67 seconds\nAST: 12 U/L\nALT: 10 U/L\n\nWhich of the following is the most effective therapy for this patient's underlying pathology?" }, { "role": "assistant", "content": "Liver transplant" } ]

[ { "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, Female, Follow-Up Studies, Health Surveys, Humans, Male, Mental Disorders, Middle Aged, Mortality, Somatoform Disorders, State Medicine, United Kingdom." }, { "role": "user", "content": "Does somatic illness explain the association between common mental disorder and elevated mortality? Context: Common mental disorder (psychological distress) is associated with an increased risk of disease-specific mortality. Given that physical illness is related to both exposure and outcome, it may explain this relation through confounding or mediation. The authors used a 20-year follow-up of the UK Health and Lifestyle Survey (6127 men and women) in which common mental disorder was ascertained at baseline using the 30 item General Health Questionnaire and physical illness using a range of enquiries. Study members were an average of 45.2 years (SD 17.0) at study induction. In age-adjusted analyses, a 1 SD increase in common mental disorder score was associated with an elevated risk of mortality outcomes coronary heart disease (CHD) in men (HR 1.11, 95% CI 0.96 to 1.27), CHD in women (1.33, 1.16 to 1.51); plus, in men and women combined, stroke (1.13, 0.96 to 1.30), respiratory disease (1.31, 1.15 to 1.48), lung cancer (1.11, 0.92 to 1.33), 'other' cancer (1.14, 1.03 to 1.26) and all causes (1.18, 1.12 to 1.23). Controlling for prior physical illness effectively eliminated the common mental disorder-mortality relation in all analyses with the exception of CHD in women." }, { "role": "assistant", "content": "That physical illness largely explains the link between common mental disorder and mortality in the present cohort is compatible with either a confounding or mediation explanation." } ]