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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: BACKGROUND, RESULTS. Meshes: Active Transport, Cell Nucleus, Antineoplastic Agents, Cell Line, Tumor, Cell Movement, Cell Nucleus, Fucus, Gene Expression Regulation, Neoplastic, Humans, Lung Neoplasms, Matrix Metalloproteinase 2, Mitogen-Activated Protein Kinase 1, Mitogen-Activated Protein Kinase 3, NF-kappa B, Neoplasm Invasiveness, Neoplasm Metastasis, Phosphatidylinositol 3-Kinases, Polysaccharides, Proto-Oncogene Proteins c-akt, Signal Transduction, TOR Serine-Threonine Kinases." }, { "role": "user", "content": "Does fucoidan from seaweed Fucus vesiculosus inhibit migration and invasion of human lung cancer cell via PI3K-Akt-mTOR pathways? Context: Recently there has been an increased interest in the pharmacologically active natural products associated with remedies of various kinds of diseases, including cancer. Fucoidan is a polysaccharide derived from brown seaweeds and has long been used as an ingredient in some dietary supplement products. Although fucoidan has been known to have anti-cancer activity, the anti-metastatic effects and its detailed mechanism of actions have been poorly understood. Therefore, the aims of this study were to demonstrate the anti-metastatic functions of fucoidan and its mechanism of action using A549, a highly metastatic human lung cancer cell line. Fucoidan inhibits the growth of A549 cells at the concentration of 400 µg/ml. Fucoidan treatment of non-toxic dose (0-200 µg/ml) exhibits a concentration-dependent inhibitory effect on the invasion and migration of the cancer cell via decreasing its MMP-2 activity. To know the mechanism of these inhibitory effects, Western blotting was performed. Fucoidan treatment down-regulates extracellular signal-related kinase 1 and 2 (ERK1/2) and phosphoinositide 3-kinase (PI3K)-Akt-mammalian target of rapamycin (PI3K-Akt-mTOR) pathways. Furthermore, fucoidan decreases the cytosolic and nuclear levels of Nuclear Factor-kappa B (p65)." }, { "role": "assistant", "content": "The present study suggests that fucoidan exhibits anti-metastatic effect on A549 lung cancer cells via the down-regulation of ERK1/2 and Akt-mTOR as well as NF-kB signaling pathways. Hence, fucoidan can be considered as a potential therapeutic reagent against the metastasis of invasive human lung cancer cells. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Anti-Bacterial Agents, Asteraceae, Bacterial Proteins, Methicillin-Resistant Staphylococcus aureus, Microbial Sensitivity Tests, Penicillin-Binding Proteins, Plant Extracts, Plant Leaves, Polymerase Chain Reaction, Sesquiterpenes." }, { "role": "user", "content": "Does antimicrobial activity of the constituents of Smallanthus sonchifolius leave against methicillin-resistant Staphylococcus aureus? Context: Methicillin-resistant Staphylococcus aureus (MRSA) has been a serious problem as its infection is associated with higher mortality and increase cost worldwide. In the present study, the antibacterial activity of enhydrin, polymatin B, allo-schkuhriolide from the leaves of Smallanthus sonchifolius was investigated. Enhydrin, polymatin B, allo-schkuhriolide from the leaves of Smallanthus sonchifolius were tested for antimicrobial activity using micro dilution broth method against 2 strains of ATCC 33591, ATCC 25923 and 15 strains of clinical isolates MRSA. The antibacterial activity of Smallanthus sonchifolius can safely be attributed to enhydrin as polymatin B, and allo-schkuhriolide are not showing any activity against Staphylococcus aureus strains. The enhydrin showed good antibacterial activity against all tested strains (MIC = 125-500 microg/ml)." }, { "role": "assistant", "content": "These results suggest that only enhydrin can be considered as an antibacterial drug against MRSA. 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": "Dilutionalhyponatremia is seen in -" }, { "role": "assistant", "content": "The correct answer is In Addison's disease in more advanced stages of adrenal destruction,serum sodium, chloride and bicarbonate levels are reduced,serum potassium level is elevated. Hyponatremia is due to both loss of sodium into urine and to movement into intracellular compament.(Harrison 17 pg 2264).-" } ]

[ { "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: Activities of Daily Living, Aged, Aged, 80 and over, Aging, Behavior Therapy, Cognition Disorders, Comorbidity, Dementia, Female, Humans, Incidence, Longitudinal Studies, Macular Degeneration, Male, Motor Activity, Risk Factors, Social Behavior, Vision, Low." }, { "role": "user", "content": "Is activity loss associated with cognitive decline in age-related macular degeneration? Context: The objective of this study was to determine whether relinquishing cognitive, physical, and social activities is associated with an increased risk of cognitive decline in patients with age-related macular degeneration (AMD). We conducted a 3-year longitudinal study of 206 nondemented patients with AMD. Twenty-three subjects (14.4%) declined cognitively. Age, sex, education, decline in visual acuity, and number of dropped activities were associated with cognitive decline; each additional dropped activity increased the risk by 58%. Subjects who relinquished three activities were 3.87 times (95% confidence interval, 1.95-7.76) more likely to become demented than subjects who relinquished no activities; those who relinquished five activities were 9.54 times (95% confidence interval, 3.05-30.43) more likely. A multivariate model demonstrated that number of dropped activities was a powerful predictor of cognitive decline after controlling for relevant risk factors, particularly for subjects younger than 80 years of age." }, { "role": "assistant", "content": "Relinquishing valued activities is associated with an increased risk of cognitive decline in older patients with vision loss caused by AMD. These data suggest the importance of promoting optimal cognitive and physical health in patients with AMD and perhaps other chronic diseases. 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: Adolescent, Adult, Aged, Analgesics, Anxiety, Combined Modality Therapy, Depression, Double-Blind Method, Drug Administration Schedule, Ergot Alkaloids, Female, Headache Disorders, Secondary, Humans, Male, Medical Records, Middle Aged, Migraine Disorders, Norway, Prednisolone, Prospective Studies, Substance Withdrawal Syndrome, Tension-Type Headache, Treatment Failure, Tryptamines." }, { "role": "user", "content": "Does prednisolone reduce withdrawal headache : a randomized , double-blind study? Context: Medication overuse headache is a condition where abrupt drug withdrawal is considered the treatment of choice. To study whether prednisolone given orally the first 6 days after medication withdrawal reduces headache intensity during the same period. From August 2003 through November 2005, we included patients aged 18 to 70 years with probable medication overuse headache. The study was randomized, double-blind, and placebo controlled. The patients were hospitalized for 3 days to start medication withdrawal. They were randomly assigned to receive prednisolone 60 mg on days 1 and 2, 40 mg on days 3 and 4, and 20 mg on days 5 and 6 (Group A) or placebo tablets for 6 days (Group B). Headache intensity was recorded in a diary for a month before withdrawal (baseline) and throughout the study period of 28 days. The primary endpoint was a calculated mean headache (MH), based on number of days with headache and mean intensity the first 6 days after withdrawal. We included 26 men and 74 women. Sixty-five had migraine, 13 had tension-type headache, and 22 had both migraine and tension-type headache. Baseline headache days were 25.4 (CI 24.3 to 26.4). Baseline MH was 1.6 (CI 1.41 to 1.69). Fifty-one received Regimen A, and 49 received Regimen B. Baseline features were similar. During the first 6 days after withdrawal, headache was similar in Groups A and B (MH 1.48 [CI 1.28 to 1.68] vs 1.61 [CI 1.41 to 1.82], p = 0.34)." }, { "role": "assistant", "content": "Prednisolone has no effect on withdrawal headache in unselected patients with chronic daily headache and medication overuse. 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: PURPOSE, METHODS, RESULTS. Meshes: Adolescent, Ambulatory Surgical Procedures, Anterior Cruciate Ligament, Anterior Cruciate Ligament Reconstruction, Child, Efficiency, Female, Hospitals, Humans, Male, Operative Time, Surgicenters, Young Adult." }, { "role": "user", "content": "Do Surgical Times and Efficiency Differ Between Inpatient and Ambulatory Surgery Centers That are Both Hospital Owned? Context: The aim of this study was to examine the differences in primary anterior cruciate ligament reconstruction (ACLR) surgical time and operation room (OR) work efficiency between inpatient and ambulatory facilities within the same institution. Patients studied included those who underwent primary ACLR at either the inpatient hospital or the ambulatory facility by a single orthopaedic surgeon on elective surgery days. Time variables were calculated for ACLR to compare the 2 facilities. The OR work efficiency was calculated as the percentage of work that was completed before mid-day that was determined by the midpoint of the surgical day at each facility. Two hundred twenty-seven ACLR surgeries were performed on 187 elective surgery days, 153 surgeries at the inpatient facility and 74 at the outpatient facility. The mean age at the time of surgery was 14.9±2.2 years. The ACLR surgeries at the ambulatory facility were of shorter duration than those at the inpatient facility (P<0.0001). One OR was most commonly utilized and 2 to 3 surgeries were performed on most surgery days at both facilities. Seven nurses served as alternating circulators at the ambulatory facility compared with 41 nurses serving in the same capacity at the inpatient facility. The median turnover time was longer at the inpatient facility compared with the ambulatory facility. OR work efficiency (work done before mid-day) was 72.5% at the ambulatory facility and 49.5% at the inpatient facility, P<0.0001. If 2 ACLR surgeries were performed consecutively, the surgery day lasted for 6 hours at the hospital-owned ambulatory surgery center compared with 9 hours at the inpatient hospital." }, { "role": "assistant", "content": "Despite the common variables of the same surgeon performing the same surgery at facilities owned by the same institution primarily working in a single OR, differences exist in OR procedure time and work efficiency." } ]

[ { "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 intravascular volume depletion in infant -" }, { "role": "assistant", "content": "The correct answer is “A significant misconception is that shock occurs only with low B.P. (hypotension).\nThrough various compensatory mechanisms, hypotension is often a late ending.\nTachycardia, with or without tachy apnea may be the 1 st or only sign of early compensated shock”. Shock is an acute dramatic syndrome characterized by the inadequate\ncirculatory supply of oxygen so that the metabolic demands of vital organs and tissues are not met. Shock has been categorized into a series of the recognizable stage: -\nCompensated Uncompensated Irreversible An initial insult triggers shock, thus disrupting blood flow to end organs leading to inadequate tissue perfusion.\nThe body9s compensatory mechanism is initiated to maintain perfusion to vital organs. If treatment is not introduced during this period,\ndecompensated shock develops causing tissue damage that leads to multisystem organ dysfunction and death. Compensatory shock\n\nIn the early phases of shock, multiple compensatory physiologic mechanisms act to maintain blood pressure and preserve tissue perfusion.\n\nBlood pressure remains normal, initially, because of peripheral vasoconstriction and increased systemic vascular resistance.\nThus hypotension occurs late and is more a characteristic of the uncompensated stage of shock Patients in compensated shock have relatively normal cardiac output and normal blood\npressures but they have an alteration in microcirculation that increases flow to some organs and reduce flow to other.\nIn infants, compensatory increases in cardiac output are achieved primarily by “tachycardia” rather than by an increase in stroke volume.\nHeart rates of 190-210/min are common in infants with compensated shock. On the other hand in older patients, cardiac contractility (stroke volume) and (heart rate) increase to improve cardiac output" } ]

[ { "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: Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, Breast Neoplasms, Carcinoma, Intraductal, Noninfiltrating, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Middle Aged, Radiotherapy, Risk Factors, Sick Role, Stress Disorders, Traumatic." }, { "role": "user", "content": "Do physical symptoms/side effects during breast cancer treatment predict posttreatment distress? Context: Studies suggest that the period following completion of treatment can be distressing for cancer patients. One potentially important predictor of distress is physical symptoms/side effects during treatment. A longitudinal, observational design was used to examine whether the number of physical symptoms/side effects experienced during treatment was a correlate of cancer-related distress and general distress 4 months after treatment completion, as measured by the Impact of Events Scale and the Mental Health subscale of the Short Form-36, respectively. Participants were 151 women who had completed chemotherapy and/or radiotherapy for ductal carcinoma in situ or stage 1 or 2 breast cancer. Hierarchical multiple regression was conducted with relevant sociodemographic, clinical, and psychiatric variables entered as controls. Greater physical symptoms/side effects predicted greater total cancer-related distress, intrusive thoughts, and general distress. Physical symptoms/side effects did not significantly predict avoidance. Follow-up analyses indicated that the relationship between physical symptoms/side effects and general distress was mediated by both total cancer-related distress and intrusive thoughts." }, { "role": "assistant", "content": "These results suggest that patients who experience greater physical symptoms/side effects during treatment are at greater risk for later cancer-related distress and, in turn, general distress. Future research should evaluate whether early intervention with these patients is effective in preventing or reducing distress in the posttreatment period. 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": "Six year old-child was brought to the hospital with obstructed hernia. On exploration, bowel was found gangrenous. Which of the following is true about anastomosis?" }, { "role": "assistant", "content": "The correct answer is Intestinal anastomoses: Interrupted and continous single-layer suture techniques are adequate and safe. --Bailey 27th edition pgno: 98 However, Halsted oured a one-layer extramucosal closure, and this was subsequently advocated by Matheson as it was felt to cause the least tissue necrosis or luminal narrowing. This technique has now become widely accepted, although it is essential that this is not confused with a seromuscular suture technique. The extramucosal suture must include the submucosa as this has a high collagen content and is the most stable suture layer in all sections of the gastrointestinal tract. - Bailey 27th edition pgno: 98" } ]

[ { "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 20-year-old woman presents with nausea, fatigue, and breast tenderness. She is sexually active with two partners and occasionally uses condoms during intercourse. A β-hCG urinary test is positive. A transvaginal ultrasound reveals an 8-week fetus in the uterine cavity. The patient is distressed by this news and requests an immediate abortion. Which of the following is the most appropriate step in management?" }, { "role": "assistant", "content": "Explain the risk and potential harmful effects of the procedure." } ]

[ { "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": "Cyst coming from an unerupted permanent tooth is" }, { "role": "assistant", "content": "The correct answer is Dentigerous cyst is most commonly arises from lower third molar teeth." } ]

[ { "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: Analysis of Variance, Animals, Chromones, Guinea Pigs, Leukotriene Antagonists, Nasal Mucosa, Ovalbumin, Random Allocation, Steroids." }, { "role": "user", "content": "Is remodeling of nasal mucosa by allergen exposure in guinea pigs suppressed by steroid and pranlukast? Context: It is unclear whether remodeling exists in allergic rhinitis in man. The aim of this study was to establish a guinea pig model of allergic rhinitis with remodeling and to examine the effects of dexamethasone and pranlukast on nasal mucosa remodeling. In the first experiment, three groups of ovalbumin-sensitized Hartley guinea pigs received intranasal challenges with ovalbumin for 1, 8, 12 weeks, respectively. In the second experiment, to examine the effect of dexamethasone and pranlukast, the animals were divided into 4 groups: negative control group; ovalbumin-sensitized group; ovalbumin + dexamethasone group; and ovalbumin + pranlukast group. During 12 weeks of intranasal exposure to ovalbumin, the latter two groups received daily intraperitoneal injections of dexamethasone and pranlukast, respectively. In the first experiment, in contrast to the negative control group, the ovalbumin-sensitized group exhibited significant goblet cell hyperplasia, epithelial damage and deposition of extracellular matrix in the nasal septal mucosa and conchae. In the second experiment, these changes were significantly inhibited by dexamethasone and pranlukast, respectively." }, { "role": "assistant", "content": "We have established a model of upper airway remodeling in guinea pigs. The tissue remodeling was inhibited by early intervention with the antiallergic-inflammatory agents dexamethasone and pranlukast. 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, Carotid Artery Diseases, Carotid Intima-Media Thickness, Cohort Studies, Female, Forkhead Box Protein O1, Forkhead Transcription Factors, Genetic Association Studies, Genetic Predisposition to Disease, Humans, Male, Polymorphism, Single Nucleotide, Sirtuin 1." }, { "role": "user", "content": "Are genetic polymorphisms at SIRT1 and FOXO1 associated with carotid atherosclerosis in the SAPHIR cohort? Context: SIRT1 and FOXO1 interact with each other in multiple pathways regulating aging, metabolism and resistance to oxidative stress and control different pathways involved in atherosclerotic process. It is not known, if genetic polymorphisms (SNPs) at the SIRT1 and FOXO1 have an influence on carotid atherosclerosis. Intima-media thickness (IMT) was measured on the common and internal carotid arteries. Morphological alterations of the carotid arteries and size of these alterations were included in the B-score grading on a five point scale. Eleven SNPs at SIRT1 and FOXO1 gene loci were genotyped in the SAPHIR cohort (n = 1742). The association of each SNP with common carotid IMT, internal carotid IMT and B-score was analyzed using linear regression models. A significant association was found between common carotid IMT and two SNPs at FOXO1 - rs10507486, rs2297627 (beta = -0.00168, p = 0.0007 and beta = -0.00144, p = 0.0008 respectively) and at least a trend for rs12413112 at SIRT1 (beta = 0.00177, p = 0.0157) using an additive model adjusting for age and sex. Additional adjustment for traditional cardiovascular risk factors and markers (BMI, smoking status, hypertension, total cholesterol, HDL-cholesterol, hsCRP) even improved the strength of this association (p = 0.0037 for SIRT1 and p = 0.0002 for both SNPs at FOXO1). Analysis for internal carotis IMT and B-score did not reveal any significant association. One haplotype in FOXO1 showed a moderate effect on common carotid IMT and B-score in comparison to the reference haplotype of this gene. Several SNPs within SIRT1 showed differential effects for men and women with higher effect sizes for women: rs3740051 on all three investigated phenotypes (interaction p-value < 0.0069); rs2236319 on common and internal carotid IMT (interaction p-value < 0.0083), rs10823108, rs2273773 on common carotid IMT and rs1467568 on B-score (interaction p-value = 0.0007). The latter was significant in women only (betawomen = 0.111, pwomen = 0.00008; betamen = -0.009, pmen = 0.6464)." }, { "role": "assistant", "content": "This study demonstrated associations of genetic variations at the SIRT1 and FOXO1 loci with carotid atherosclerosis and highlighted the need for further investigation by functional studies. 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": "Consider the following four events of development of fetus: 1. Centers of ossification for calcaneum 2. Centers of ossification for lower end of femur 3. Centers of ossification for talus 4. Centers of ossification for cuboid What is the order in which they appear from lower to higher gestation?" }, { "role": "assistant", "content": "The correct answer is 16 weeks of IUL Sex can be recognized; lanugo hair is visible on body 20 weeks Nails are distinct and soft, vernix caseosa appears on the body. Fine hair on scalp, meconium at the beginning of large intestine. Center of ossification for calcaneum appears 24 weeks Eyebrow and eye lashes appear meconium is seen in upper pa of large intestine 28 weeks Eyelids are open, pupillary membrane disappears Meconium present in entire large intestine. Center of ossification for talus appears 32 weeks Scalp hair is thick. Left testes in scrotum, right testes near the external inguinal ring. 36 weeks Scalp is covered with dark hair; lanugo hair is seen only in shoulders; vernix caseosa is present over the flexures of joints. scrotum contains both testes. Meconium is near the end of large intestine. Ossification centers for lower end of femur (36-37 weeks), cuboid and capitate appear at bih" } ]

[ { "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: Adrenergic alpha-2 Receptor Agonists, Animals, Blood Flow Velocity, Dexmedetomidine, Guinea Pigs, Injections, Subcutaneous, Male, Receptors, Adrenergic, alpha-2, Vasoconstriction." }, { "role": "user", "content": "Does locally injected dexmedetomidine induce vasoconstriction via peripheral α-2A adrenoceptor subtype in guinea pigs? Context: Recent research shows that locally injected dexmedetomidine enhances the local anesthetic potency of lidocaine via the α-2A adrenoceptor subtype in guinea pigs. However, little is known about the effect of locally injected dexmedetomidine on the peripheral vascular response. This study aimed to evaluate the effect of locally injected dexmedetomidine on the peripheral vascular response, measuring skin blood flow in the injected area in guinea pigs. Dexmedetomidine was intracutaneously injected at a volume of 0.1 mL into the backs of guinea pigs, and further injected combined with yohimbine, a selective antagonist of α-2 adrenoceptors, or prazosin, a selective antagonist of α-1 adrenoceptors and an antagonist of both α-2B and α-2C adrenoceptor subtypes. Skin blood flow was measured until 60 minutes after injection using a laser-Doppler flowmeter. Furthermore, systemic arterial blood pressure and pulse of the guinea pigs were monitored via a catheter inserted into the carotid artery throughout every experiment. Dexmedetomidine at a concentration of 1 μM significantly decreased the skin blood flow in a dose-dependent manner with no changes in the mean blood pressure and pulse. Yohimbine completely antagonized the effect of dexmedetomidine, but prazosin did not." }, { "role": "assistant", "content": "The results reveal that locally injected dexmedetomidine at a concentration of 1 μM induced peripheral vasoconstriction without a systemic cardiovascular response via the peripheral α-2A adrenoceptor subtype. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 48-year-old woman with a history of type 2 diabetes mellitus presents to her primary care physician with complaints of headaches, fatigue, dry cough, and frequent episodes of bronchospasm. She was diagnosed with moderate nonproliferative diabetic retinopathy by an ophthalmologist last month. Her blood pressure measured in the clinic is 158/95 mmHg. A 24-hour urine collection is obtained and reveals 9.5 g of protein. On physical examination, the patient has diffuse wheezing, jugular venous distention, and 2+ pitting pretibial edema. Labs are notable for a potassium level of 5.2 mEq/L. Which of the following medications is most likely contributing to this patient’s current presentation?" }, { "role": "assistant", "content": "Lisinopril" } ]

[ { "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: Antigens, CD34, Duodenum, Female, Heme Oxygenase-1, Humans, Hypertension, Portal, Kruppel-Like Transcription Factors, Liver Cirrhosis, Male, Mechanotransduction, Cellular, MicroRNAs, Middle Aged, Neovascularization, Pathologic, Platelet Endothelial Cell Adhesion Molecule-1, Protein Processing, Post-Translational, RNA, Messenger, Splanchnic Circulation, Vascular Endothelial Growth Factor A." }, { "role": "user", "content": "Is angiogenesis within the duodenum of patients with cirrhosis modulated by mechanosensitive Kruppel-like factor 2 and microRNA-126? Context: The mechanism involved in neovascularization in splanchnic circulation and the main trigger that induces angiogenesis in patients with cirrhosis are not fully recognized. To explore the involvement of flow sensitive lung Kruppel-like factor (KLF2), microRNA-126 (miR-126), angiopoietin-2 (Ang-2) and heme oxygenase-1 (HO-1) in modulation of vascular endothelial growth factor (VEGF) signalling that have a critical effect on growth of new blood vessels. Duodenal biopsies from 22 patients with cirrhosis and 10 controls were obtained during routine endoscopy. The process of angiogenesis was evaluated by a measurement of CD31 concentration, immunodetection of CD34 protein and estimation of capillary densities. Messenger RNA (mRNA) and protein expressions were analysed by real-time PCR, Western blot or ELISA respectively. Markers of angiogenesis (both, CD31 and CD34) were significantly enhanced in cirrhotic patients. In comparison to healthy controls, levels of Ang-2 and KLF-2 mRNAs as well as Ang-2, KLF-2, HO-1, VEGF protein expressions were considerably increased. Levels of sCD163, a surrogate marker of portal hypertension, correlated with levels of Ang-2, (P = 0.021) and VEGF (P = 0.009). The expression of miR-126, a KLF2-mediated regulator of the VEGF signalling was enhanced in cirrhotic patients." }, { "role": "assistant", "content": "Our results demonstrate, for the first time in humans, that neovascularization is induced in duodenal tissue of patients with cirrhosis and proangiogenic factors such as KLF-2, Ang-2, miR-126 and VEGF can contribute to the angiogenesis induced by hemodynamic forces. Thus, cirrhosis-induced blood flow and pressure within splanchnic vessels may be important hemodynamic triggers that initiate the angiogenic signalling cascade. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVES, DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS, RESULTS. Meshes: Aged, Aged, 80 and over, Clinical Competence, Female, Geriatrics, Hospitalization, Humans, Male." }, { "role": "user", "content": "Are geriatricians more efficient than other physicians at managing inpatient care for elderly patients? Context: To compare outcomes and measures of efficiency for hospitalized elderly adults managed by geriatricians with those managed by other physicians. Secondary data analysis using a system that integrates clinical and financial information for inpatient and outpatient services delivered throughout the University of Pittsburgh Medical Center (UPMC). Propensity scores were developed based on participant sociodemographic and clinical characteristics and used to match participants based on the attending physician's specialty (geriatrician, n = 701; nongeriatrician, n = 11,549). Multivariate analyses using generalized estimating equations methods were performed. Two UPMC hospitals in Pittsburgh, Pennsylvania. Patients aged 65 and older admitted in 2002 in a medical diagnosis-related group (DRG). Outcomes (inpatient mortality, 30-day mortality, readmission) and efficiency measures (length of stay, total costs, and surplus, which is the difference between hospital costs and payment received for an admission). Elderly adults managed by geriatricians were significantly older (P<.001) and more likely to be male (P<.001) and had more diagnoses (P<.001). Propensity scores successfully balanced characteristics managed by the two groups. Patients of geriatricians had shorter length of stay (P<.001), lower costs per admission (P<.001), and greater surplus (P<.001) with no differences in outcomes. In multivariate analyses, there were not significant differences in outcomes, but patients of geriatricians had significantly shorter length of stay and lower costs per admission and generated more surplus for the hospitals." }, { "role": "assistant", "content": "Geriatricians were more efficient than other physicians in managing hospitalized elderly adults with medical DRGs frequently managed by geriatricians. This efficiency did not compromise patient outcomes." } ]

[ { "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": "Regarding medical treatment of ectopic pregnancy, all are true except:" }, { "role": "assistant", "content": "The correct answer is Ans. A. Initial beta HCG is an indicator for the number of doses requiredThe best candidate for medical therapy in unruptured tubal ectopic is the woman who is asymptomatic, motivated, and compliant. With medical therapy, some classic predictors of success include a low initial serum beta hCG level, small ectopic pregnancy size, and absent fetal cardiac activity. Of these, initial serum beta hCG level is the single best prognostic indicator of successful treatment with single-dose methotrexate but is not a valid indicator of the number of doses needed for successful resolution.CBC,LFT,KFT is performed before giving methotrexate because of potential side effects - liver involvement, stomatitis, gastroenteritis, bone marrow depression and is excreted mainly by renal mechanism" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "In cholangiography CBD stone appears as ?" }, { "role": "assistant", "content": "The correct answer is Ans is a ie Meniscus sign" } ]

[ { "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: Amino Acids, Animals, Caseins, Cats, Diet, Female, Gastric Emptying, Male, Models, Biological, Phenylalanine, Whey Proteins." }, { "role": "user", "content": "Are phenylalanine flux and gastric emptying affected by replacement of casein with whey protein in the diet of adult cats consuming frequent small meals? Context: Decreasing the rate of protein emptying from the stomach may improve efficiency of utilization of dietary amino acids for protein deposition. Some studies in rats and humans have shown casein to be more slowly released from the stomach than whey protein. To test if casein induces a slower rate of gastric emptying in cats than whey protein, L-[1-(13)C]phenylalanine (Phe) was dosed orally into 9 adult cats to estimate gastric emptying and whole-body Phe flux. Concentrations of indispensable amino acids in plasma were not significantly affected by dietary protein source. First-pass splanchnic extraction of Phe was not different between diets and averaged 50% (SEM = 3.8%). The half-time for gastric emptying averaged 9.9 min with casein and 10.3 min with whey protein, and was not significantly different between diets (SEM = 1.7 min). Phenylalanine fluxes were 45.3 and 46.5 μmol/(min · kg) for casein- and whey-based diets, respectively (SEM = 4.7 μmol/(min · kg))." }, { "role": "assistant", "content": "In adult cats fed frequent small meals, the replacement of casein with whey protein in the diet does not affect supply or utilization of amino acids. These two milk proteins appear to be equally capable of meeting the dietary amino acid needs of cats. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Arthritis, Rheumatoid, Behcet Syndrome, Female, Homocysteine, Humans, Immunoenzyme Techniques, Male, Middle Aged, Reference Values, Smoking, Vascular Diseases, Vitamin B 12." }, { "role": "user", "content": "Is there an association of plasma homocysteine levels with vascular involvement in patients with Behçet's syndrome? Context: To assess whether or not plasma homocysteine levels play a part in vascular involvement in Behçet's syndrome (BS). 74 consecutive BS patients fulfilling the criteria of the International Study Group for BS, 35 healthy control (HC) and 14 rheumatoid arthritis (RA) patients on methotrexate (MTX) were studied. BS patients were then classified as those with and without vascular involvement. Fasting plasma homocysteine, folate, and vitamin B12 concentrations were measured by enzyme immunoassay and chemiluminescent immunoassay methods respectively. Plasma homocysteine levels were found to be higher in the BS patients than in the healthy control (16.08 +/- 7.5 vs. 12.9 +/- 6.3 micromol/L, p<0.03). The homocysteine levels in the RA group on MTX were higher compared with both the BS and HC groups (28.7 +/- 9.9; p<0.0001). No remarkable difference pertaining to homocysteine levels was found between BS patients with or without thrombosis (p<0.86). Hyperhomocysteinemia was also detected in 11 out of 22 (50%) of the patients with vascular involvement, which proved to be of no significant difference in comparison with those without vascular involvement (20/52, 38%; chi2 = 0.26, p>0.05). Active BS smokers exhibited a higher concentration of homocysteine in contrast to non-smoker BS sufferers (20 +/- 8.4 vs 14.1 +/- 6.1 micromol/l; p<0.004). Smoking was determined to have a positive correlation with vascular involvement (r = 0.26, p<0.046), as well as with homocysteine levels (r = 0.31, p<0.012) in BS. Upon logistic regression analysis, smoking was found to have a significant relationship with vascular involvement (odds ratio 3.12 [95% CI 2.02-4.22] p = 0.04). There was no significant difference between the study groups with respect to their B12 vitamin and folate levels. We were unable to make any correlation between homocysteine and vitamin B12 or folate in any of the groups (p>0.05)." }, { "role": "assistant", "content": "No association was found between homocysteine levels and vascular involvement in our BS patients. We determined that smoking seems to pose a risk for vascular involvement in BS patients." } ]

[ { "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: Alginates, Analysis of Variance, Calcium Sulfate, Composite Resins, Dental Alloys, Dental Impression Materials, Dental Marginal Adaptation, Dental Models, Ethers, Gold Alloys, Humans, Inlays, Materials Testing, Microscopy, Pliability, Polymers, Polyvinyls, Silicones, Siloxanes, Surface Properties, Viscosity." }, { "role": "user", "content": "Does margin adaptation of indirect composite inlays fabricated on flexible die? Context: Indirect composite restorations can be made in 1 appointment using a flexible die. Interactions between different impression materials and flexible die materials may affect the accuracy of fit and margin adaptation of the restoration. This study compared the margin adaptation of composite inlays made using the following 5 impression/flexible die material combinations; condensation silicone/polyvinyl siloxane (CS/PVS), wash viscosity polyvinyl siloxane/medium or heavy viscosity polyvinyl siloxane (PVS/PVS), irreversible hydrocolloid impression/medium viscosity polyvinyl siloxane (IH/PVS), wash viscosity polyvinyl siloxane impression/polyether (PVS/PE), with composite inlays made using a control system of a wash viscosity polyvinyl siloxane impression and a type IV stone die. For each test and control system, 10 impressions were made of a class II composite inlay preparation in a metal master die. One die was made from each impression and one composite inlay was made and finished on each die (a total of 60 inlays). Inlays were placed on the master die and the margin opening at the buccal, distal, and gingival sites was recorded with a measuring microscope (x40 magnification). The overall mean +/- SD margin openings of inlays made from the systems were as follows: PVS wash/PVS heavy viscosity 149.5 +/- 107. 4 microm; PVS wash/PVS medium viscosity 87.4 +/- 63.0 microm; IH/PVS medium viscosity 76.7 +/- 48.9 microm; CS/PVS 73.3 +/- 48.7 microm, PVS wash viscosity/PE 64.0 +/- 44.3 microm, PVS wash viscosity/stone 53.9 +/- 48.3 microm. Composite inlays made using the PVS wash viscosity/PVS heavy viscosity system had significantly larger distal, gingival, and overall mean margin openings than all other inlays (ANOVA and Fisher PLSD test; P =.05). The separating medium required between some impression and die materials did not work consistently. Composite inlays fabricated on dies made of material different than the impression material had mean buccal, distal, gingival, and overall margin openings < or =100 microm." }, { "role": "assistant", "content": "Composite inlays made on the CS/PVS, IH/PVS medium viscosity, PVS wash viscosity/PE flexible dies, and control PVS wash viscosity/stone dies had statistically similar (P =.05) mean buccal, distal, gingival, and overall mean margin openings that were < or =100 microm. Composite inlays made on dies that were made of the same type of material as the impression material (PVS/PVS) had mean gingival margin openings >100 microm that were significantly larger than all other systems tested (P =.05). 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": "Characteristic symptom of aconite poisoning: Al 10" }, { "role": "assistant", "content": "The correct answer is Ans. Tingling and numbness" } ]

[ { "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: Animals, Apolipoproteins E, Chymases, Gene Expression, Humans, Indoleacetic Acids, Male, Mast Cells, Mice, Mice, Inbred C57BL, Mice, Knockout, Naphthalenes, Plaque, Atherosclerotic, Protease Inhibitors, RNA, Messenger, Receptors, LDL." }, { "role": "user", "content": "Does mast cell chymase inhibition reduce atherosclerotic plaque progression and improves plaque stability in ApoE-/- mice? Context: mast cells have been shown to accumulate in the adventitia of human atherosclerotic plaques and were recently demonstrated by us to contribute to plaque progression and instability. In this study, we investigated whether selective inhibition of mast cell chymases would affect the lesion development and stability. the protease inhibitor RO5066852 appeared to be a potent inhibitor of chymase activity in vitro and ex vivo. With this inhibitor, we provide three lines of evidence that chymase inhibition can prevent many pro-atherogenic activities. First, oral administration of RO5066852 reduced spontaneous atherosclerosis in the thoracic aorta of apoE(-/-) mice. Second, chymase inhibition prevented the accelerated plaque progression observed in apoE(-/-) mice that were exposed to repetitive episodes of systemic mast cell activation. Furthermore, RO5066852 enhanced lesional collagen content and reduced necrotic core size. Third, RO5066852 treatment almost completely normalized the increased frequency and size of intraplaque haemorrhages observed in apoE(-/-) mice after acute perivascular mast cell activation in advanced atherosclerosis." }, { "role": "assistant", "content": "our data indicate that chymase inhibition can inhibit pro-atherogenic and plaque destabilizing effects which are associated with perivascular mast cell activation. Our study thus identifies pharmacological chymase inhibition as a potential therapeutic modality for atherosclerotic plaque stabilization. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Does safety and persistence of non-animal stabilized hyaluronic Acid fillers for nasolabial fold correction in 30 Indian patients? Context: Correction of nasolabial creases through minimally invasive procedures is increasingly being sought by patients. Injecting non-animal stabilized hyaluronic acid filler is a highly effective method to achieve an optimal and persistent cosmetic result To evaluate the efficacy, persistence and safety of Restylane and Perlane (Q-Med, Sweden) for correction of nasolabial folds in Indian patients Thirty Indian patients with mild, moderate and severe nasolabial folds (based on Wrinkle Assessment Scale) were recruited in the study after informed consent for correction of their folds with Restylane or Perlane or both. Injections were administered in a single sitting after global assessment of the patient's face using Wrinkle assessment scale (WAS).Optimal filling was performed by using appropriate techniques and its safety and efficacy assessed independently by the investigator as well as by patients at immediately, 3, 6 and 9 months post-procedure. Any adverse reactions were noted. Twenty two females and 8 males (age range 45-55 years, mean age 52 years) were recruited in the study. An optimum cosmetic correction was obtained in all patients. The efficacy increased with time and was greatest at 3 months after the treatment. Grade 2 improvement was maintained at 9 months in mild and moderate folds, and grade 3 improvement for severe folds. Minor post injection side effects like erythema at puncture site, needle marks and bruising were seen." }, { "role": "assistant", "content": "Restylane and Perlane are safe and effective dermal fillers for correction of nasolabial creases and offer immediate effect. 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": "What is the ideal site to make a burr hole in a patient of head injury with rapidly deteriorating sensorium & progressive dilatation of pupil with no localizing sign?" }, { "role": "assistant", "content": "The correct answer is Burr hole surgery should be done by taking into consideration side of pupillary dilatation 1. One sided pupillary dilatation: Burr hole on that side 2. Both sided pupillary dilatation: Burr hole on the side of first dilated pupil/ side with obvious external trauma. 3. No localizing sign: Burr hole on the side of dominant hemisphere i.e left temporal." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Aged, 80 and over, Cholangiography, Cholecystectomy, Laparoscopic, Cholelithiasis, Feasibility Studies, Female, Gallstones, Humans, Intraoperative Period, Male, Middle Aged." }, { "role": "user", "content": "Is routine intraoperative cholangiography feasible and efficient during laparoscopic cholecystectomy? Context: This is the evaluation of the feasibility and results of routine laparoscopic intraoperative cholangiography. A multicentric prospective study in 315 consecutive patients undergoing elective or urgent laparoscopic cholecystectomy. The success rate was 94%. Mean duration of intraoperative cholangiography was 12 min. Sixteen of 18 failures were related to a narrow cystic duct. One cystic duct avulsion (ligated under laparoscopy) and 2 false positive cholangiograms (1 transcystic exploration, 1 conversion) were noted. Intraoperative cholangiography revealed aberrant bile ducts possibly at risk to injury from dissection in four patients (1.3 per cent). Intraoperative cholangiography disclosed unsuspected stones in 10 patients (4%). Forty-five patients had a preoperative suspicion of choledocholithiasis: choledocholithiasis were found at intraoperative cholangiography in 3 of 13 patients who had preoperative endoscopic sphincterotomy for stone extraction, in 1 of 11 patients with normal preoperative endoscopic cholangiography, and in 11 of 21 patients undergoing surgery alone (57%)." }, { "role": "assistant", "content": "If complete clearance of choledocholithiasis is to remain the objective of surgical treatment of biliary lithiasis including laparoscopic cholecystectomy, then routine intraoperative cholangiography is feasible and efficient. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adenocarcinoma, Adult, Aged, Aged, 80 and over, Carcinoma, Pancreatic Ductal, Down-Regulation, Dystroglycans, Female, Gene Expression Regulation, Neoplastic, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Pancreatic Neoplasms, Real-Time Polymerase Chain Reaction." }, { "role": "user", "content": "Does reduced α-dystroglycan expression correlate with shortened patient survival in pancreatic cancer? Context: Deregulation of cell-matrix interactions is considered an important factor in malignant transformation. Dystroglycan forms the interface between the basement membrane and the cell membrane in epithelia by its two subunits, α- and β-dystroglycan. Aberrant expression of dystroglycan has been observed in various human cancers. Here we assessed the expression of dystroglycan in pancreatic ductal adenocarcinoma (PDAC) and analyzed its association with clinical parameters. mRNA levels of dystroglycan were determined by real-time quantitative PCR in tissue samples from 60 patients with PDAC, from 48 patients with CP, and from 18 healthy donors. Furthermore, pancreatic cancer specimens of 53 patients were analyzed by immunohistochemistry using specific α- and β-dystroglycan antibodies. The staining was semiquantitatively evaluated and correlated to patient survival using the Kaplan-Meier method. On the mRNA level, dystroglycan was down-regulated in PDAC compared with the normal pancreas. In normal pancreatic tissues, α- and β-dystroglycans were mainly expressed on the basolateral cell membrane of acinar and ductal cells, while islet cells showed a cytoplasmatic staining. In contrast, in PDAC tissues, this membrane staining pattern was lost and replaced by a cytoplasmatic staining, suggesting impairments in the membrane translocation of both dystroglycans. Semiquantitative analysis revealed a significant inverse correlation of α- (but not β-) dystroglycan staining and postoperative survival (P=0.039)." }, { "role": "assistant", "content": "Reduced expression and altered localization of dystroglycan is common in PDAC, potentially contributing to the aggressive behavior of this disease. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "After 28 weeks of gestation true is/are :" }, { "role": "assistant", "content": "The correct answer is Ans. is a, b and d i.e. Viable: >1000 gm: and Type II pneumocytes present" } ]

[ { "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, DESIGN, SETTING, PATIENTS, MEASUREMENTS AND RESULTS. Meshes: Age Factors, Blood Pressure Determination, Female, Humans, Hypertension, Male, Medical Records, Middle Aged, Retrospective Studies." }, { "role": "user", "content": "Do we adequately use the sphygmomanometer for improving the prevention of arterial hypertension in primary care? Context: To assess the monitoring of arterial pressure (AP) in non-hypertensive patients at a health centre and to compare the results of two types of consultations. A retrospective observation study over 5 years. Urban health care. After the exclusion of hypertensive patients, 337 medical records, which were active over the period under assessment, were chosen by systematic sampling of the adult population. Consultation types were: CT1 (stable staff, MIR training, habitual development of the PAPPS); CT2 (staff not stable, training uneven, without systematic development of the PAPPS). Records were considered indicated when they contained symptoms suggestive of AHT or when AP had been measured because the patients had been included in a health programme; the rest of the records were considered not indicated. Data were analysed using the Chi-squared test. 152 of the 337 records belonged to CT1 and 185 to CT2. In 151 records there was no measurement of AP: 50 belonging to CT1 and 101 to CT2. 508 measurements of AP were performed, 274 in CT1 and 234 in CT2. Of the 151 cases where measurements were not indicated (64 in CT1 and 87 in CT2." }, { "role": "assistant", "content": "The percentage of patients without any monitoring is high (44.8%), similar to the percentage of AP measurements not indicated, which would imply the need to rationalise use of the sphygmomanometer in the consulting-room. CT1 consultations seem to have the most rational measurements of AP." } ]

[ { "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": "Renal osteodystrophy differs from nutritional and metabolic rickets due to the presence of:" }, { "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": "For comparison grading of pain the scale used is -" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Aged, 80 and over, Biopsy, Needle, Carcinoma, Merkel Cell, Cause of Death, Combined Modality Therapy, Female, Humans, Immunohistochemistry, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Recurrence, Local, Neoplasm Staging, Probability, Prognosis, Registries, Retrospective Studies, Risk Assessment, Skin Neoplasms, Survival Analysis, Treatment Outcome." }, { "role": "user", "content": "Merkel cell carcinoma: does tumor size or depth of invasion correlate with recurrence, metastasis, or patient survival? Context: The objective of this retrospective study and literature review was to compare the clinical and histologic criteria including tumor size and depth of invasion with outcomes in patients with Merkel cell carcinoma. The state cancer registry provided patients (n = 46) diagnosed with Merkel cell carcinoma from 1992 through 2002. Pathology slides were reviewed by the author for tumor size, depth of invasion, Clark level, and margin status. Further clinical information and survival data were gathered from patient records. Statistical analysis was performed using t tests and Kaplan-Meier survival curves. Patients were excluded from specific analysis based on misdiagnosis, unavailability of pathology slides, absent medical records, or those lost to follow up. Disease-free survival rates were 52%, 39%, and 9% at 1, 2, and 5 years, respectively. The average disease-free interval was 18.4 months (range, 1-80 months). No correlation was found between tumor size (P = .49), depth (P = .41), or Clark level (P = .82) to overall survival. A trend was found comparing tumor size or depth of invasion with local recurrence (P = .07) but with no correlation to regional recurrence (P = .93 and P = .60) or distant metastasis (P = .16 and P = .24). Overall recurrence was found in 60.7% of patients with local recurrence occurring in 18.1%, regional recurrence 40.9%, and distant recurrence 47.8%. Comparing patients with positive versus negative margins at initial excision, local recurrence was found in 33.3% versus 9.09% (P = .19), regional recurrence 66.6% versus 27.2% (P = .08), and distant metastasis 66.6% versus 45.4% (P = .36), respectively." }, { "role": "assistant", "content": "No correlation was found between tumor size or depth of invasion to patient survival or metastasis. However, there was a trend toward increased local and regional recurrence rates when comparing size and depth and in specimens with positive tumor margins. These outcomes are consistent with those reported in recent literature and further characterize the unpredictable nature of this disease. An aggressive approach should be taken, including wide local excision with negative tumor margins and lymph node dissection; however, larger multistate reviews are needed for additional support." } ]

[ { "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, Estriol, Female, Humans, Immunoenzyme Techniques, Pilot Projects, Pregnancy, Pregnancy Trimester, First, Saliva, Sensitivity and Specificity." }, { "role": "user", "content": "Is salivary estriol detectable in very early pregnancy? Context: Estriol (E3) is produced by the placenta and is important for early pregnancy maintenance. In blood, E3 can be detected from the 8th week of pregnancy. Under the influence of the hypothalamic-pituitary-adrenal (HPA) axis hormone ACTH, E3 levels increase sharply after the 10th week. Although E3 can be reliably analyzed in saliva, till now information about the concentrations during the first trimester is missing. The aim of this study was to verify whether the sensitivity of a newly developed enzyme immunoassay is sufficient for the determination of salivary E3 (sE3) in very early pregnancy. Saliva samples were collected at home, once weekly in 25 healthy pregnant women from the 6th week of gestation to the end of the first trimester. sE3 was detectable from the beginning of the 6th pregnancy week (M = 3.17 pg/ml, SD = 2.13). A steep significant increase between the 7th and the 8th week (p = 0.029) and again between the 10th and the 11th week (p = 0.001) was apparent." }, { "role": "assistant", "content": "Low concentrations of sE3 can be measured during very early pregnancy and may serve as a promising, easily assessable marker for future research on the mechanisms of healthy pregnancy." } ]

[ { "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, PURPOSES, METHODS, RESULTS. Meshes: Adult, Arthroplasty, Replacement, Knee, Female, Femur, Humans, Knee Joint, Male, Osteoarthritis, Knee, Radiography, Range of Motion, Articular, Tibia." }, { "role": "user", "content": "Is the medial wall of the intercondylar notch useful for tibial rotational reference in unicompartmental knee arthroplasty? Context: It is difficult to implant components in the correct rotational position in the narrow operating field in a unicompartmental knee arthroplasty. Although no rotational reference has been confirmed for unicompartmental knee arthroplasty, the AP axis of the tibia may serve as a reference for unicompartmental knee arthroplasty and TKA. However, it is difficult to identify the AP axis during unicompartmental knee arthroplasty, especially with the tibia first-cut technique.QUESTIONS/ We explored whether the medial wall of the intercondylar notch could be useful for the tibial rotational reference as an alternative to the AP axis in unicompartmental knee arthroplasty. We scanned the knees of 24 healthy Asian patients (45 knees) at a flexion angle of 90º using open MRI, then measured the angle between the AP axis and the medial wall of the notch. We determined whether the origins of the ACL and PCL were located lateral to the line on the medial wall of the notch and whether the mediolateral dimension of the bone cut surface of the medial tibial plateau was wide enough relative to the AP dimension to use the commercially available unicompartmental knee arthroplasty tibial components when the tibia was cut parallel to the medial wall of the notch. At 90º flexion the medial wall of the notch was externally rotated 0.1º ± 4.4º relative to the AP axis. In all knees, the ACL and PCL were located lateral to the line on the medial wall of the notch. The mediolateral dimension of the bone cut surface was wide enough to use the commercially available tibial components." }, { "role": "assistant", "content": "At 90º flexion the medial wall of the intercondylar notch is almost parallel to the AP axis of the tibia at and we believe a reasonable candidate for a rotational reference of tibial placement in unicompartmental knee arthroplasty. This landmark would need to be confirmed in other populations and in patients with osteoarthritis." } ]

[ { "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, Breast Neoplasms, Carcinoma, Ductal, Breast, Carcinoma, Lobular, Female, Humans, Magnetic Resonance Imaging, Mammography, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Preoperative Care, Prognosis, Prospective Studies, Retrospective Studies, Sensitivity and Specificity, Ultrasonography, Mammary." }, { "role": "user", "content": "Use of preoperative magnetic resonance imaging for invasive lobular cancer: good, better, but maybe not the best? Context: Invasive lobular cancer (ILC) of the breast is difficult to diagnose clinically and radiologically. It is hoped that preoperative magnetic resonance imaging (MRI) can improve evaluation of extent of disease. Patients diagnosed with ILC at a single institution from 2001 to 2008 who underwent clinical breast examination (CBE), mammography, ultrasound, and MRI were studied retrospectively. Concordance between tumor size on imaging/CBE and pathologic size was defined as size within ± 0.5 cm. Pearson correlation coefficients (R) were calculated for each modality. Local recurrence and re-excision rates were compared with those patients with ILC who did not undergo preoperative MRI. Seventy patients with ILC had all imaging modalities, including CBE, performed preoperatively. The sensitivity for detection of ILC by MRI was 99%. MRI-based tumor size was concordant with pathologic tumor size in 56% of tumors. MRI overestimated tumor size by>0.5 cm in 31% of tumors. Correlation of tumor size on imaging with final pathology was better for MRI (R = 0.75) than for mammography (R = 0.65), CBE (R = 0.63), or ultrasound (R = 0.45, all P<0.01). Preoperative MRI was associated with lower reoperation rates for close/positive margins (P>0.05)." }, { "role": "assistant", "content": "For ILC, MRI has better sensitivity of detection and correlation with tumor size at pathology than CBE, mammography, or ultrasound. However, 31% of cases are overestimated by MRI, and correlation remains only at 0.75. The select use of MRI for preoperative estimation of tumor size in ILC is supported by our data, but the need for improvement and refinement of imaging remains." } ]

[ { "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: Filtration, Humans, Leukocytes, Platelet Transfusion, Plateletpheresis." }, { "role": "user", "content": "Does white cell subsets in apheresis and filtered platelet concentrate? Context: White cell (WBC)-reduced platelet concentrates (PCs) are defined by their absolute WBC count, a criterion which provides no information regarding the various WBC subsets contained in the PC. These heterogeneous cells are known to mediate different physiologic and pathophysiologic functions and account for distinct adverse transfusion responses. This study describes a method which allows the detection and quantification of these subsets and characterizes their presence in a variety of platelet components. Random-donor pooled PCs (RD PCs) and single-donor apheresis PCs (SD PCs) were studied. RD PCs consisting of 6 units of 2- to 3-day old PCs were randomly assigned to be filtered with one of four WBC-reduction filters from three different manufacturers (n=34). The residual WBCs were pelleted by centrifugation and isolated on a density gradient. The various WBC subsets were quantified by flow cytometry in unfiltered and filtered PCs using fluorescence and two-angle light scatter. SD PCs obtained with two manufacturer's systems and three processing protocols (n=30) were studied in like manner. WBC counts for non-WBC-reduced PCs averaged 3 x 10(8) in RD PCs and ranged from 8.6 to 9.6 x 10(6) per SD PC. Residual WBC counts in filtered PCs ranged from 2.3 x 10(4) to 2.2 x 10(5) and those in WBC-reduced SD PCs averaged 2.2 x 10(5) per unit. The data demonstrate significant phenotypic differences among PCs produced with various procedures. All SD PCs and two of four filtered RD PCs contained five WBC populations including granulocytes and monocytes, while RD PCs filtered with the remaining manufacturer's devices contained only lymphocytes." }, { "role": "assistant", "content": "The data confirm that distinct phenotypic differences exist among PCs prepared with different devices and/or procedures. It is suggested that as for non-generic pharmaceuticals, the clinical benefits of these various PCs should be individually proved. 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: Antineoplastic Combined Chemotherapy Protocols, Biomarkers, Tumor, Female, Follow-Up Studies, Humans, Lymphocytes, Male, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Neutrophils, Prognosis, Proportional Hazards Models, Stomach Neoplasms, Survival Rate." }, { "role": "user", "content": "Does blood neutrophil-lymphocyte ratio predict survival for stages III-IV gastric cancer treated with neoadjuvant chemotherapy? Context: Accurate predictors of survival for patients with advanced gastric cancer treated with neoadjuvant chemotherapy are currently lacking. In this study, we aimed to evaluate the prognostic significance of the neutrophil-lymphocyte ratio (NLR) in patients with stage III-IV gastric cancer who received neoadjuvant chemotherapy. We enrolled 46 patients in this study. The NLR was divided into two groups: high (>2.5) and low (≤2.5). Univariate analysis on progression-free survival (PFS) and overall survival(OS) was performed using the Kaplan-Meier and log-rank tests, and multivariate analysis was conducted using the Cox proportional hazards regression model. We analyzed whether chemotherapy normalized high NLR or not, and evaluated the prognostic significance of normalization on survival. The univariate analysis showed that PFS and OS were both worse for patients with high NLR than for those with low NLR before chemotherapy (median PFS 16 and 49 months, respectively, P = 0.012; median OS 21 and 52 months, P = 0.113). PFS and OS were also worse for patients with high NLR than for those with low NLR before surgery (median PFS 12 and 35 months, P = 0.019; median OS 21 and 52 months, P = 0.082). Multivariate analysis showed that both NLR before chemotherapy and surgery were independent prognostic factors of PFS. Neoadjuvant chemotherapy normalized high NLR in 11 of 24 patients, and these 11 patients had better median PFS and OS than the 13 patients who had high NLR both before chemotherapy and before surgery (PFS: 35.0 and 10.0 months, P = 0.003; OS: 60 and 16 months, P = 0.042)." }, { "role": "assistant", "content": "NLR may serve as a potential biomarker for survival prognosis in patients with stage III-IV gastric cancer receiving neoadjuvant chemotherapy. 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: Acetates, Airway Remodeling, Animals, Disease Models, Animal, GATA3 Transcription Factor, Mice, Mice, Inbred BALB C, Mice, Transgenic, Quinolines, Receptors, Leukotriene, Reverse Transcriptase Polymerase Chain Reaction, Th2 Cells." }, { "role": "user", "content": "Does blockade of cysteinyl leukotriene-1 receptors suppress airway remodelling in mice overexpressing GATA-3? Context: We demonstrated previously that GATA-3 overexpression markedly enhanced allergen-induced airway inflammation and airway remodelling, including subepithelial fibrosis, and smooth muscle cell hyperplasia, in transgenic mice. Because cysteinyl leukotrienes (cysLTs) have been shown to be involved in such structural changes, the effects of a specific cysLT1 receptor antagonist, montelukast, were evaluated in a mouse model of chronic asthma. GATA-3-overexpressing mice and wild-type Balb/c mice were sensitized and repeatedly challenged by ovalbumin (OVA) or saline. The effects of montelukast on the development of airway remodelling were compared between the two mouse genotypes. CysLTs in the lung were increased after repeated allergen challenges, and significantly enhanced in GATA-3-overexpressing mice. The enhanced cysLT levels were accompanied by the development of eosinophilia, smooth muscle cell hyperplasia, and increased stromal cell-derived factor-1 gene expression with a small increase in pro-collagen gene expression in OVA-challenged GATA-3-overexpressing mice, but not in wild-type mice. Montelukast significantly decreased lung cysLT levels and inhibited the GATA-3-overexpression-related airway remodelling, potently preventing smooth muscle cell hyperplasia, but partially suppressed the increased pro-collagen gene expression and eosinophilic inflammation. Increases in the levels of IL-4, IL-5, IL-13, and eotaxin in bronchial lavage and TGF-β gene expression in the lungs were induced by OVA in both mouse genotypes. Montelukast treatment also significantly reduced these levels to the levels seen after saline challenges in GATA-3-overexpressing mice." }, { "role": "assistant", "content": "Montelukast efficaciously prevented airway inflammation and remodelling in a GATA-3-overexpression antigen challenge mouse model by decreasing the cysLT-driven Th2 cytokine cycle of amplification of airway pathologies. 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": "Theophyline levels in blood are increased by:" }, { "role": "assistant", "content": "The correct answer is Cimetidine" } ]

[ { "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 seen in WV involvement of CNS -" }, { "role": "assistant", "content": "The correct answer is Inclusion bodies [Ref : Bobbin's Thie p. 13751 Involvement of C.N.S. is a common and impoant manifestation of AIDS. In addition to the lymphoid system the nervous system is a major target of HIV infection. Macrophages and microglia cells in the central nervous system that belongs to the monocyte and macrophages lineages are the predominant types in the brain that are infected with HIV. It is widely believed that HIV is carried into the brain by infected monocytes. Ninety percent of patients demonstrate some form of neurological involvement at autopsy. C.N.S. involvement in AIDS usually produces AIDS dementia complex. The pathology associated with AIDS related congnitive motor complex sometimes called subacute encephalitis is located mainly in subcoical areas with relative sparing of cerebral coex. Between 10 and 20% of I-UV-infected patients present with neurologic signs as their first clinical manifestation of infection. In some, no other signs of AIDS develop. Between 50 and 70% of all AIDS patients eventually develop some features of what is called AIDS dementia or the AIDS related cognitive-motor complex. -This term is used to describe the characteristic pattern of cognitive, motor, and behavioral dysfunction, including mood disturbances, seen in AIDS patients. At autopsy, between 60 and 90% of AIDS patients brains show some .form of pathology. Pathologic changes directly due to HIV infection (subacute encephalitis) The pathology associated with the AIDS-related cognitive-motor complex, sometimes called subacute encephalitis, is located mainly in subcoical areas, with relative sparing of cerebral coex. Microscopic changes include : - Diffuse white matter pallor - Perivascular infiltrates of lymphocytes and macrophages - Foci of necrosis, gliosis, and/or demyelination Microglial nodules, macrophages and multinucleated cells Remember, Vasculitis is characteristically absent in CNS involvement in AIDS. The virus enters the brain, probably primarily by way of nacrophages, as HIV has been localized in CNS, mainly in macrophages, microglia and multinucleated giant cells. The virus is able to reproduce in the brain. Vacuolar myelopathy - Is sometimes seen in the spinal cord. This change consists of white matter vacuolation in posterior and lateral columns, and is mainly due to swelling within mhyelin sheaths. Peripheral nervous system pathology - PNS damage is seen in some HIV-infected patients. Inflammatory demyelinating neuropathy is the primary PNS pathology." } ]

[ { "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 group of anticancer drugs temozolomide belong to:" }, { "role": "assistant", "content": "The correct answer is Temozolomide is used to treat specific types of brain cancer (eg, glioblastoma multiforme, anaplastic astrocytoma) in patients whose tumors have returned or whose tumors have just been diagnosed. It belongs to the group of medicines known as antineoplastics (cancer medicines). Mechanism of Action Imidazotetrazine derivative prodrug; active metabolite MTIC methylates guanine-rich areas of DNA that initiate transcription, which lead to DNA double strand breaks and apoptosis Absorption Rapidly and completely absorbed after oral administration Peak Plasma Time: 1 hr (empty stomach); 2.25 hr (high-fat meal) Bioequivalence: 100%; IV infusion (when administered over 90 min) is bioequivalent to same dose of oral capsule Mean peak plasma concentration and AUC decreased by 32% and 9%, respectively when administered after a high-fat breakfast Distribution Protein Bound: 15% Vd: 0.4 L/kg Metabolism Metabolite: Hydrolyzed at physiologic pH to 3-methyl-(triazen-1-yl) imidazole-4-carboxamide (MTIC); MTIC fuher hydrolyzed to to 5-amino-imidazole-4-carboxamide (AIC), which is known to be an intermediate in purine and nucleic acid biosynthesis, and to methylhydrazine, which is believed to be the active alkylating species Elimination Half-life: 1.8 hr Clearance: 5.5 L/hr/m2 Excretion: primarily urine (~38%) REFERENCE: www.medscape.com, www.mayoclinic.org" } ]

[ { "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, DESIGN, SETTING, PARTICIPANTS, METHODS, INSTRUMENTS, MAIN OUTCOME MEASURES, RESULTS. Meshes: Adolescent, Adult, Anecdotes as Topic, Female, Humans, Infant, Newborn, Male, Mothers, Paternal Age, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Pregnancy in Adolescence, Prenatal Care, Prevalence, Psychology, Adolescent, Risk Factors, Self Disclosure, Spouse Abuse, Stress Disorders, Post-Traumatic, Surveys and Questionnaires, United States." }, { "role": "user", "content": "Domestic violence and trauma care in teenage pregnancy: does paternal age make a difference? Context: To determine whether teenagers partnered with adult men were more likely to report domestic violence and trauma-related care during pregnancy than teenagers partnered with male peers. Nonexperimental, descriptive comparative design. Postpartum unit in a large, urban teaching hospital. English-speaking teenagers who recently delivered a live infant. Semistructured interviews lasting from 30 minutes to 2 hours. The Abuse Assessment Screen, the Danger Assessment Scale. Domestic violence and trauma-related care during pregnancy. Teenagers with adult partners were not more likely to report domestic violence or seek trauma-related care during pregnancy than teenagers with peer-age partners." }, { "role": "assistant", "content": "Researchers, policy makers, and health care providers should continue to address violence occurring among pregnant teenagers by identifying subgroups who may be at increased risk of abuse." } ]

[ { "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, PURPOSES, METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Aged, 80 and over, Bone Plates, Child, Female, Fracture Fixation, Internal, Fracture Healing, Humans, Incidence, Male, Middle Aged, Postoperative Complications, Pubic Symphysis, Pubic Symphysis Diastasis, Radiography, Retrospective Studies, United Kingdom, Young Adult." }, { "role": "user", "content": "Is fixation failure after plate fixation of the symphysis pubis clinically important? Context: Plate fixation is a recognized treatment for pelvic ring injuries involving disruption of the pubic symphysis. Although fixation failure is well known, it is unclear whether early or late fixation failure is clinically important.QUESTIONS/ We therefore determined (1) the incidence and mode of failure of anterior plate fixation for traumatic pubic symphysis disruption; (2) whether failure of fixation was associated with the types of pelvic ring injury or pelvic fixation used; (3) the complications, including the requirement for reoperation or hardware removal; and (4) whether radiographic followup of greater than 1 year alters subsequent management. We retrospectively reviewed 148 of 178 (83%) patients with traumatic symphysis pubis diastasis treated by plate fixation between 1994 and 2008. Routine radiographic review, pelvic fracture classification, method of fixation, incidence of fixation failure, timing and mode of failure, and the complications were recorded after a minimum followup of 12 months (mean, 45 months; range, 1-14 years). Hardware breakage occurred in 63 patients (43%), of which 61 were asymptomatic. Breakage was not related to type of plate, fracture classification, or posterior pelvic fixation. Five patients (3%) required revision surgery for failure of fixation or symptomatic instability of the symphysis pubis, and seven patients (5%) had removal of hardware for other reasons, including late deep infection in three (2%). Routine radiographic screening as part of annual followup after 1 year did not alter management." }, { "role": "assistant", "content": "Our observations suggest the high rate of late fixation failure after plate fixation of the symphysis pubis is not clinically important." } ]

[ { "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 a selective cyclooxygenase-2 inhibitor ?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'c' i.e., Nabumitone o Amongst the given options no drug is selective COX-2 inhibitor. o But Nabumiton is a prefrential COX-2 inhibitor i.e. it has relative COX-2 selectivity --> it inhibits COX-2 more than COX-I. o Other prefrential COX-2 inhibitors are nimesulide and meloxicam." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Animals, Conditioning (Psychology), Electric Stimulation, Evoked Potentials, Somatosensory, Female, Humans, Lasers, Gas, Male, Neural Inhibition, Pain, Pain Measurement, Rats, Tooth, Young Adult." }, { "role": "user", "content": "Does heterotopic CO2 laser stimulation inhibit tooth-related somatosensory evoked potentials? Context: The diffuse noxious inhibitory control (DNIC) effect is the neurophysiological basis for the phenomenon that heterotopic \"pain inhibits pain\" in remote areas of the body. The effect of DNIC is mediated by spino-bulbo-spinal loops and a final postsynaptic inhibitory mechanism. The DNIC effect depends on intensity, duration, quality, and application site of conditioning stimulation and stimulated nerve fiber-type. DNIC induced by CO(2) laser conditioning stimulation has, however, not yet been investigated, and the present study was designed to examine this. As the indicator of test stimulation, the late component of somatosensory evoked potentials (SEPs) induced by electrical tooth stimulation and pain intensity were examined under CO(2) laser conditioning stimulation. As the conditioning stimuli, CO(2) laser energy (lambda = 10.6 microm, spot size Ø = 2 mm) was applied to the dorsum of the left hand. The maximum reductions in SEP amplitude and pain intensity evaluated using a visual analog scale were 34.7% and 28.7%, respectively during CO(2) laser conditioning stimulation. No aftereffect was observed." }, { "role": "assistant", "content": "The present study revealed that CO(2) laser radiation attenuated the late component of SEPs induced by electrical tooth stimulation, triggering the DNIC effect but with no aftereffect. 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 most susceptible to ionizing radiation?" }, { "role": "assistant", "content": "The correct answer is Tissues that have high sensitivity are lymphoid organs, bone marrow, testes, intestines, mucous membranes. \nTissues with intermediate sensitivity are fine vasculature, growing cartilage & cartilage,  salivary glands, lungs, kidneys and liver. \nTissues with low sensitivity include optic lens, mature erythrocytes, muscle cells and neurons." } ]

[ { "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: Alcohol Oxidoreductases, BRCA1 Protein, Carcinoma, Ovarian Epithelial, Cell Line, Tumor, Cell Survival, Epigenesis, Genetic, Female, Gene Expression Profiling, Gene Expression Regulation, Neoplastic, Gene Knockdown Techniques, Humans, Methionine, Neoplasms, Glandular and Epithelial, Nerve Tissue Proteins, Ovarian Neoplasms, Phthalazines, Piperazines, Poly(ADP-ribose) Polymerase Inhibitors, Poly(ADP-ribose) Polymerases, Promoter Regions, Genetic." }, { "role": "user", "content": "Is bRCA1 expression epigenetically repressed in sporadic ovarian cancer cells by overexpression of C-terminal binding protein 2? Context: Ovarian cancer is the leading cause of mortality from gynecological malignancy despite advancements in novel therapeutics. We have recently demonstrated that the transcriptional co-repressor C-terminal binding protein 2 (CtBP2) is overexpressed in epithelial ovarian carcinoma. Reverse-transcribed cDNA from CtBP2 wild-type and knockdown ovarian cancer cell lines was hybridized to Affymetrix Gene 1.0 ST microarrays, and differentially expressed genes were studied. Immunohistochemical analysis of CtBP2 and BRCA1 staining of ovarian tissues was performed. Chromatin immunoprecipitation (ChIP) and luciferase assays were carried out. The effect of the drugs 4-methylthio-2-oxobutyric acid (MTOB) and poly(ADP-ribose) polymerase (PARP) inhibitor Olaparib on CtBP2 wild-type and knockdown cell lines was examined using methylthiazol tetrazolium assays and an xCELLigence System. Eighty-five genes involved in DNA repair, mitotic checkpoint, nucleosome assembly, and the BRCA1 network were differentially regulated by CtBP2 expression. ChIP and luciferase reporter assays using a BRCA1 promoter-regulated luciferase construct indicated that the CtBP2 complex binds the BRCA1 promoter and represses BRCA1 transcription. Immunohistochemistry illustrated a significant inverse CtBP2 and BRCA1 expression in a panel of malignant ovarian tumor tissues. The CtBP2 inhibitor MTOB suppressed ovarian cancer cell survival in a CtBP2-dependent manner. Ovarian cancer cells with CtBP2 knockdown did not display increased sensitivity to the PARP inhibitor Olaparib." }, { "role": "assistant", "content": "CtBP2 is an ovarian cancer oncogene that may play a significant role in epigenetically silencing BRCA1 function in sporadic epithelial ovarian cancer. CtBP2-specific inhibitors, such as MTOB, may be effective adjunct therapies in the management of patients with CtBP2-positive ovarian carcinoma. 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: Analgesia, Anti-Inflammatory Agents, Non-Steroidal, Biopsy, Needle, Humans, Injections, Intravenous, Ketorolac, Office Visits, Pain, Prospective Studies, Ultrasonography, Interventional." }, { "role": "user", "content": "Does intravenous ketorolac significantly reduce the pain of office transrectal ultrasound and prostate biopsies? Context: Campbell's' Urology, 8th edition, indicates that office transrectal ultrasound (TRUS) and prostate biopsies require no anesthesia. This is however in contradistinction from the experience of patients who have had the procedure. A study was conducted to evaluate whether 60 mg of intravenous Ketorolac before the procedure makes it more tolerable. A prospective study was performed involving 24 patients who were randomized into two groups. One group was given 60 mg of Ketorolac intravenously before the procedure and the control group received no analgesia. The two groups were comparable in age and the indications for the TRUS and prostate biopsies. The number of biopsy cores tolerated and taken was significantly less in the control group than in the group that was given intravenous Ketorolac. The degree of pain in the group that had intravenous Ketorolac was significantly less than in the no analgesia group." }, { "role": "assistant", "content": "TRUS with prostate biopsies is a painful procedure. Intravenous Ketorolac significantly reduces the pain involved in the procedure and allows patients to tolerate it better for a more complete procedure. 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": "Dental fluorosis not associated with skeletal flourosis are seen at:" }, { "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, Aged, Aged, 80 and over, Antineoplastic Agents, Carcinoma, Hepatocellular, Female, Humans, Liver Neoplasms, Male, Middle Aged, Niacinamide, Phenylurea Compounds." }, { "role": "user", "content": "Is intra-patient sorafenib dose re-escalation safe and tolerable in patients with advanced hepatocellular carcinoma? Context: Although sorafenib improves survival in patients with hepatocellular carcinoma (HCC), doses have to be reduced in quite a few patients because of adverse events. We investigated whether intra-patient sorafenib dose re-escalations were safe and tolerable in patients with advanced HCC. Of the 73 advanced HCC patients treated with sorafenib, 42 achieved a tolerable dose with a dose reduction. We evaluated safety and tolerability in patients who attempted intra-patient dose re-escalations from the reduced dose. Thirteen of 42 patients increased the sorafenib dose from the reduced dose. Ten patients had a tolerable dose of 400 mg on alternate days, and 3 patients had a tolerable dose of 400 mg daily. Dose-limiting toxicity (DLT), defined as toxicity resulting in a dose reduction, was observed in 8 of 13 patients as a hand-foot skin reaction (HFSR), and DLT was noted in 2 of 13 patients as an increase in alanine aminotransferase/aspartate aminotransferase levels. Seven of 13 patients did not exhibit DLT after dose re-escalations. Although 6 patients exhibited DLT, the cause of the adverse event was HFSR in all cases. The median escalation dose ratio, which was calculated as the ratio of the real cumulative dose to the cumulative dose when continued at the tolerable dose after dose re-escalation, was 1.84." }, { "role": "assistant", "content": "The results of the present study indicated that intra-patient sorafenib dose re-escalations were safe and tolerable. Further prospective analyses are needed to determine in more detail the safety and efficacy of intra-patient sorafenib dose re-escalations." } ]

[ { "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, Apoptosis Regulatory Proteins, Calcium-Calmodulin-Dependent Protein Kinases, Carcinoma, Non-Small-Cell Lung, Combined Modality Therapy, CpG Islands, DNA Methylation, Death-Associated Protein Kinases, Humans, Lung Neoplasms, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, O(6)-Methylguanine-DNA Methyltransferase, Promoter Regions, Genetic, Receptors, Retinoic Acid." }, { "role": "user", "content": "Can aberrant promoter hypermethylation of CpG islands predict the clinical outcome of non-small cell lung cancer after curative resection? Context: Aberrant methylation of CpG islands acquired in tumor cells in promoter regions is one cause for the loss of gene function. We examined whether aberrant DNA hypermethylation could be used to predict the clinical outcomes of patients with primary nonsmall cell lung cancer (NSCLC) after curative resection. We tested 61 patients with NSCLC using methylation-specific polymerase chain reaction (MSP) and searched for promoter hypermethylation of the genes p16INK4a, retinoic acid receptor beta-promoter (RARbetaP2), death-associated protein kinase (DAPK), and O6-methylguanine-DNA-methyltransferase (MGMT). The clinical data, the presence of DNA hypermethylation, and clinical outcomes were analyzed. Hypermethylation in the tumor samples was detected in 67% (41 of 61) for p16(INK4a), 49% (30 of 61) for RARbetaP2, 30% (18 of 61) for DAPK, and 62% (38 of 61) for MGMT. Thirty patients (49%) developed recurrence within 33 months; 16 in the remaining lung, 10 in other organs, and 4 in both. We found no correlation between the specific DNA hypermethylation and any of the clinicopathological characteristics of the patients. DNA hypermethylation was not associated with a different survival or recurrence rate. However, the aberrant hypermethylation of RARbetaP2 seemed to be related to the location of cancer recurrence. Although advanced T stage and preoperative chemotherapy were statistically significant in univariate analysis, unmethylation of DAPK (p = 0.030) and hypermethylation of RARbetaP2 (p = 0.014), as well as advanced T stage (p = 0.075) and preoperative chemotherapy (p = 0.025), were significant risk factors in multivariate analysis for early recurrence in the remaining lung." }, { "role": "assistant", "content": "The P2 hypermethylation of the RARbeta gene and unmethylation of DAPK seem to be important factors in predicting early cancer recurrence in the remaining lung and could be used as a prognostic marker in NSCLC. However, the clinical implications of this finding need further investigation." } ]

[ { "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, Areca, Female, Health Surveys, Humans, Hyperglycemia, Linear Models, Male, Metabolic Syndrome, Middle Aged, Obesity, Prevalence, Risk Factors, Taiwan." }, { "role": "user", "content": "Is betel-quid use associated with the risk of the metabolic syndrome in adults? Context: Betel-quid use has been associated with obesity and hyperglycemia in previous studies. The aim was to test whether betel-quid use contributes to the metabolic syndrome, as defined by the National Cholesterol Education Program Adult Treatment Panel III. Associations between betel-quid use and the metabolic syndrome, obesity, hypertriacylglycerolemia, low HDL cholesterol, hyperglycemia, and high blood pressure after adjustment for sex, age, smoking, alcohol drinking, physical activity, and dietary intakes were studied in nonpregnant adults aged 20-64 y (n = 1986) from the Nutrition and Health Survey in Taiwan (1993-1996). The prevalence of the metabolic syndrome was not significantly different between the men and women (10.1% compared with 9.7%), whereas the prevalence of betel-quid use was higher in the men than in the women (31% compared with 2.3%; P < 0.001). The daily rate of betel-quid use was associated with the metabolic syndrome [odds ratio (OR) associated with a betel-quid consumption rate of 10 times/d: 1.31; 95% CI: 1.12, 1.55; P = 0.003], abdominal obesity (OR: 1.42; 95% CI: 1.2, 1.7; P = 0.001), hypertriacylglycerolemia (OR: 1.33; 95% CI: 1.02, 1.73; P = 0.037), and high blood pressure (OR: 1.2; 95% CI: 1.01, 1.4; P = 0.04). However, the daily rate of betel-quid use was not associated with low HDL cholesterol or hyperglycemia." }, { "role": "assistant", "content": "The daily rate of betel-quid use is independently and positively associated with the metabolic syndrome in adults. 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": "Fluid of choice in child with burn < 24 hour is" }, { "role": "assistant", "content": "The correct answer is Ans. is 'c' i.e., Ringer lactate Fluid resuscitation in burn injury Parkland formulaa a. Initial 24 hours: Ringer's lactated (RL) solution 4 ml/kg/% burn for adults and 3 ml/kg/% burn for children. RL solution is added for maintenance for children: 4 ml/kg/hour for children weighing 0-10 kg 40 ml/hour +2 ml/hour for children weighing 10-20 kg 60 ml/hour + 1 ml/kg/hour for children weighing 20 kg or higher This formula recommends no colloid in the initial 24 hours. b Next 24 hours: Colloids given as 20-60% of calculated plasma volume. No crystalloids. Glucose in water is added in amounts required to maintain a urinary output of 0.5-1 ml/hour in adults and 1 ml/hour in children." } ]

[ { "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 region begins closure of the neural tube?" }, { "role": "assistant", "content": "The correct answer is After the notochord induces the formation of the neural plate, the lateral edges of the plate fold dorsally to form the neural groove. The lips of the neural groove grow toward the midline and fuse to form the neural tube. This closure of the neural tube occurs first in the cervical region and progresses cranially and caudally simultaneously. Failure of the neural tube to close results in a variety of congenital abnormalities that include anencephaly and spina bifida with myeloschisis." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Aged, 80 and over, Alleles, Child, Collagen Type III, DNA Mutational Analysis, Ehlers-Danlos Syndrome, Female, Genetic Variation, Humans, Male, Middle Aged, Mutation, Mutation, Missense, RNA Splicing, Treatment Outcome, Young Adult." }, { "role": "user", "content": "Is survival affected by mutation type and molecular mechanism in vascular Ehlers-Danlos syndrome ( EDS type IV )? Context: We sought to characterize the natural history of vascular Ehlers-Danlos syndrome in individuals with heterozygous COL3A1 mutations. We reviewed clinical records for details of vascular, bowel, and organ complications in 1,231 individuals (630 index cases and 601 relatives). Missense and splice-site mutations accounted for more than 90% of the 572 alterations that we had identified in COL3A1. Median survival was 51 years but was influenced by gender (lower in men) and by the type of mutation." }, { "role": "assistant", "content": "Although vascular Ehlers-Danlos syndrome appears to be genetically homogeneous, allelic heterogeneity is marked, and the natural history varies with gender and type of mutation in COL3A1. These findings indicate that when counseling families, confirmation of the presence of a COL3A1 mutation and its nature can help evaluate the risks of complications. These data are also important ingredients in both the selection and allocation of individuals to appropriate arms in clinical trials to assess the effects of interventions. 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": "Inferior wall MI -" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, METHODS, METHODS, METHODS, METHODS, RESULTS. Meshes: Abortion, Spontaneous, Epididymis, Female, Humans, Male, Oligospermia, Pregnancy, Pregnancy Rate, Retrospective Studies, Sperm Injections, Intracytoplasmic, Sperm Motility, Spermatozoa, Testis, Tissue and Organ Harvesting." }, { "role": "user", "content": "Does testicular sperm result in elevated miscarriage rates compared to epididymal sperm in azoospermic patients? Context: Several sperm retrieval techniques are available for use on azoospeermic men. Comparisons between spermatozoa retrieved from the testicles and epididymis in relation to pregnancy and miscarriage rates are not well established. To compare pregnancy and miscarriage rates using sperm retrieved from the testes and epididymis using intracytoplasmic sperm injection. Furthermore, we evaluated the fertilization and pregnancy rates according to the status of the spermatozoa retrieved (motile or immotile). Retrospective study. A private center for assisted fertilization. One hundred and eight consecutive patients who presented with azoospermia were included in our study, on whom a total of 144 retrieval procedures were performed. Of the 144 retrieval procedures, 104 were testicular sperm aspirations (TESA) and 40 were epididymal sperm aspirations (PESA). PESA was the first approach in obstructive patients (n = 68), whereas TESA was used when the former failed. For non-obstructive patients (n = 40), TESA was the method of retrieval. Pregnancy and miscarriage rates according to spermatozoa characteristics (motile or immotile). The number of cycles performed using spermatozoa retrieved from the testicles and epididymis was 81 and 30, respectively. Motile spermatozoa had higher fertilization (2PN) and pregnancy rates compared to immotile spermatozoa (p < 0.05). Also, motile spermatozoa had lower miscarriage rates compared to immotile spermatozoa (p < 0.0001). No differences were seen in pregnancy rates with testicular spermatozoa (n = 28) compared to epididymal spermatozoa (n = 13) (p = 0.1). However, the miscarriages rates were higher in spermatozoa retrieved from the testicles (n = 12) compared to epididymis retrievals (n = 1) (p = 0.01)." }, { "role": "assistant", "content": "Although pregnancy rates were similar when the intracytoplasmic sperm injection was performed with spermatozoa retrieved from the testicles and epididymis, the use of testicular spermatozoa yields a significantly higher miscarriage rate. It is possible that the higher miscarriage rate seen in patients using spermatozoa retrieved from the testicles is linked to high genetic sperm abnormalities. 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": "Sphincter of Oddi consists of -" }, { "role": "assistant", "content": "The correct answer is Sphincter of Oddi consists of three sets of sphincters :-\n\n\nSphincter choledochus (Sphincters of Boyden).\nSphincter pancreaticus. \nSphincter of Oddi (proper)." } ]

[ { "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": "Mostly death in PEM is due to all except?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'c' i.e., Worm infestation" } ]

[ { "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": "Ciliary movement rate of nasal mucosa is:" }, { "role": "assistant", "content": "The correct answer is Nasal mucosa contains goblet cells responsible for secretion of mucosa. The cilia of nasal mucosa beat constantly at speed of 5-10 mm/minute and are in contact with serous layer of mucus which entraps the foreign bodies, allergens and carry it to nasopharynx. Beat frequency = 10 Hz Movement is metachronus (i.e. all cilia at right angle to the direction of flow are in the direction of flow while those in the direction of flow are slightly out of phase). Mucociliary clearance time = 5-20 mins. The pH of mucous blanket of nose is 7." } ]

[ { "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, Cell Line, Cell Survival, Collagen Type I, Female, Fibroblasts, Humans, Isoflavones, Matrix Metalloproteinase 1, Matrix Metalloproteinase 2, Mice, Mice, Inbred BALB C, Mice, Nude, Phosphorylation, Phytoestrogens, Procollagen, Signal Transduction, Smad2 Protein, Smad5 Protein, Transcription, Genetic, Transforming Growth Factor beta." }, { "role": "user", "content": "Does daidzein stimulate collagen synthesis by activating the TGF-β/smad signal pathway? Context: The objective of this study was to investigate the effects of daidzein on collagen metabolism and its underlying mechanism in cultured skin fibroblast and nude mouse skin. Skin fibroblasts were exposed to different concentrations of daidzein (0.5-50 μg/mL) for 24 h or 48 h, respectively. Female nude mice were treated topically with 200 μg/mL daidzein once a day for 6 weeks. Cell viability and cell cycle were determined by MTT and flow cytometer. The transcriptional activity of collagen type I was evaluated and the expression of procollagen, matrix metalloproteinase-1 (MMP1) and MMP2 were measured by real-time polymerase chain reaction. A Western blot analysis was applied to detect the levels of phosphorylated-Smad2 and Smad3. In the daidzein-treated cells the expression of type I procollagen increased markedly while the expressions of MMP1, and MMP2 was significantly inhibited. Additionally, the mouse skin showed more collagen deposition after daidzein treatment. The levels of transforming growth factor (TGF)-β, phosphorylated-smad2 and smad3 were also higher in the daidzein treated skin fibroblasts than in the controls." }, { "role": "assistant", "content": "The results showed that daidzein treatment can increase skin collagen synthesis and inhibit collagen degradation in vitro and in vivo. It seems that TGF-β/smad signalling pathways play an important role in daidzein-induced collagen accumulation. 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 38-year-old woman presents to the clinic complaining of fatigue and recurrent stomach pain for the past 3 years. She reports an intermittent, dull ache at the epigastric region that is not correlated with food intake. Antacids seem to help a little, but the patient still feels uncomfortable during the episodes. She reports that she has been getting increasingly tired over the past week. The patient denies fevers, chills, nausea, vomiting, melena, hematochezia, or diarrhea but does endorse intermittent abdominal bloating. Her past medical history is significant for type 1 diabetes that is currently managed with an insulin pump. Physical examination demonstrates pale conjunctiva and mild abdominal tenderness at the epigastric region. Laboratory studies are shown below:\n\nLeukocyte count: 7,800/mm^3\nSegmented neutrophils: 58%\nBands: 4%\nEosinophils: 2%\nBasophils: 0%\nLymphocytes: 29%\nMonocytes: 7%\nHemoglobin: 10 g/dL\nPlatelet count: 170,000/mm^3\nMean corpuscular hemoglobin concentration: 36 g/dL\nMean corpuscular volume: 103 µm^3\nHomocysteine: 15 mmol/L (Normal = 4.0 – 10.0 mmol/L)\nMethylmalonic acid: 0.6 umol/L (Normal = 0.00 – 0.40 umol/L)\n\nWhat substance would you expect to be decreased in this patient?" }, { "role": "assistant", "content": "Intrinsic factor" } ]

[ { "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, Blood Glucose, Blotting, Western, C-Peptide, Diabetes Mellitus, Experimental, Diabetes Mellitus, Type 2, Diet, High-Fat, Disease Models, Animal, Gene Expression, Gluconeogenesis, Glucose Transporter Type 2, Humans, Insulin, Insulin Resistance, Male, Mice, Inbred BALB C, PPAR gamma, Reverse Transcriptase Polymerase Chain Reaction, Signal Transduction, Triglycerides, Tumor Suppressor Protein p53, Up-Regulation." }, { "role": "user", "content": "Does overexpression of p53 improve Blood Glucose Control in an Insulin Resistant Diabetic Mouse Model? Context: This paper aimed to assess the physiological effects of p53 on glucose homeostasis in vivo. A recombinant adenoviral p53 (rAd-p53) vector was administered to insulin-resistant diabetic mice. Intraperitoneal glucose tolerance test was performed in all groups of mice. Changes in fasting blood glucose, serum triglycerides, C-peptide, and insulin concentrations in treated and untreated mice were measured. Analyses of the target genes related to glucose metabolism were performed. Treatment with the rAd-p53 improved glucose control in a dose- and time-dependent manner and lowered significantly the fasting blood glucose, the serum triglycerides, and improved tolerance test of glucose as compared to control. Lowered blood glucose was associated with up-regulation of genes in the glycogenesis pathways, and down-regulation of genes in the gluconeogenesis pathways in the liver. Overexpressions of GLUT2, GK, PPAR-γ, and insulin receptor precursor were also observed in the liver and the pancreas of treated animals." }, { "role": "assistant", "content": "Activation of p53-mediated glucose metabolism led to insulin-like antidiabetic effect in the mouse model especially by changing hepatic insulin sensitivity in the diabetic mouse model. 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": "Primigravida with full term, complains of faintness on lying down and she feels well when turns to side or sitting position. This is due to:" }, { "role": "assistant", "content": "The correct answer is Ans. is b, i.e. IVC compressionRef. Dutta Obs 9/e, p 49SUPINE HYPOTENSION SYNDROME (POSTURAL HYPOTENSION): During late pregnancy, the gravid uterus produces a compression effect on the inferior vena cava when the patient is in supine position. In 90% cases this, however, results in opening up of the collateral circulation by means of paravertebral and azygos veins. In some cases (10%), when the collateral circulation fails to open up, the venous return of the heart may be seriously curtailed. This results in production of hypotension, tachycardia and syncope called as supine hypotensive syndrome. The normal blood pressure is quickly restored by turning the patient to lateral position. That is why pregnant females are advised to lie in lateral positions best being left lateral." } ]

[ { "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, Biomarkers, Tumor, Breast Neoplasms, Disease-Free Survival, Female, Humans, Lymph Nodes, Lymphatic Metastasis, Mastectomy, Menopause, Middle Aged, Neoplasm Staging, Prognosis, Young Adult." }, { "role": "user", "content": "Is number of negative lymph nodes associated with disease-free survival in patients with breast cancer? Context: The aim of this study was to evaluate the prognostic value of the number of negative lymph nodes (NLNs) in breast cancer patients after mastectomy. 2,455 breast cancer patients who received a mastectomy between January 1998 and December 2007 were retrospectively reviewed. The prognostic impact of the number of NLNs with respect to disease-free survival (DFS) was analyzed. The median follow-up time was 62.0 months, and the 5-year and 10-year DFS was 87.1% and 74.3%, respectively. The DFS of patients with >10 NLNs was significantly higher than that of patents with ≤10 NLNs, and the 5-year DFS rates were 87.5% and 69.5%, respectively (P < 0.001). Univariate Cox analysis showed that the NLN count (continuous variable) was a prognostic factor of DFS (hazard ratio [HR] = 0.913, 95% confidence interval [CI]: 0.896-0.930, P < 0.001). In multivariate Cox analysis, patients with a higher number of NLNs had a better DFS (HR = 0.977, 95% CI: 0.958-0.997, P = 0.022). Subgroup analysis showed that the NLN count had a prognostic value in patients at different pT stages and pN positive patients (log-rank P < 0.001). However, it had no prognostic value in pN0 patients (log-rank P = 0.684)." }, { "role": "assistant", "content": "The number of NLNs is an independent prognostic factor of DFS in breast cancer patients after mastectomy, and patients with a higher number of NLNs have a better DFS. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, METHODS, METHODS, RESULTS. Meshes: Chi-Square Distribution, Critical Care, Critical Illness, Drug Administration Schedule, Enteral Nutrition, Erythromycin, Female, Follow-Up Studies, Gastrostomy, Humans, Injections, Intravenous, Intensive Care Units, Male, Middle Aged, Nutritional Requirements, Probability, Pylorus, Sensitivity and Specificity, Treatment Outcome." }, { "role": "user", "content": "Is gastric feeding with erythromycin equivalent to transpyloric feeding in the critically ill? Context: To determine whether adding erythromycin to a gastric feeding regimen could render it as effective in meeting nutritional needs as transpyloric feeding. Randomized, controlled study. University hospital medical, surgical, and neurologic care intensive care units. Critically ill patients, requiring a projected 96 hrs of enteral feeding, who had no specific indication for tube location (gastric or transpyloric). Eighty patients were randomized. Patients were randomized to gastric feeding with erythromycin (200 mg iv) given every 8 hrs or feeding through a transpylorically placed feeding tube. Goal rate and feeding advancement were determined by protocol. During the 96-hr period, the gastric group received 74% of their goal calories and the transpyloric group received 67%. The only day on which gastric feedings were superior was the first study day, where the gastric group attained 55% of their goal, compared with 44% in the transpyloric group. This 1-day difference was the result of an initial failure of tube placement in some subjects. Exclusion of these patients did not change overall results. Nutritional indexes, length of stay in the intensive care unit, ventilator dependence, and survival were not different between the two groups." }, { "role": "assistant", "content": "Gastric feeding with erythromycin as a prokinetic is equivalent to transpyloric feeding in meeting the nutritional goals of the critically ill. 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: Administration, Oral, Animals, Bacterial Proteins, Choice Behavior, Drinking Behavior, GABAergic Neurons, Gene Knock-In Techniques, Hippocampus, Luminescent Proteins, Male, Mice, Inbred C57BL, Mice, Transgenic, Nicotine, Nicotinic Agonists, Perforant Pathway, Receptors, Nicotinic, Saccharin, Self Administration, Tobacco Use Disorder, Up-Regulation, Ventral Tegmental Area." }, { "role": "user", "content": "Is chronic nicotine pretreatment sufficient to upregulate α4* nicotinic receptors and increase oral nicotine self-administration in mice? Context: Understanding the underlying causes of nicotine addiction will require a multidisciplinary approach examining the key molecular, cellular and neuronal circuit functional changes that drive escalating levels of nicotine self-administration. In this study, we examined whether mice pretreated with chronic nicotine, at a dosing regimen that results in maximal nicotinic acetylcholine receptor (nAChR) upregulation, would display evidence of nicotine-dependent behaviour during nicotine self-administration. We investigated oral self-administration of nicotine using a two-bottle choice paradigm in which one bottle contained the vehicle (saccharine-sweetened water), while the other contained nicotine (200 μg/ml) in vehicle. Knock-in mice with YFP-tagged α4 nAChR subunits (α4YFP) were implanted with osmotic pumps delivering either nicotine (2 mg/kg/hr) or saline for 10 days. After 10 days of pretreatment, mice were exposed to the nicotine self-administration paradigm, consisting of four days of choice followed by three days of nicotine abstinence repeated for five weeks. Mice pre-exposed to nicotine had upregulated α4YFP nAChR subunits in the hippocampal medial perforant path and on ventral tegmental area GABAergic neurons as compared to chronic saline mice. Compared to control saline-pretreated mice, in a two bottle-choice experiment, nicotine-primed mice ingested a significantly larger daily dose of nicotine and also exhibited post-abstinence binge drinking of nicotine." }, { "role": "assistant", "content": "Chronic forced pre-exposure of nicotine is sufficient to induce elevated oral nicotine intake and supports the postulate that nAChR upregulation may be a key factor influencing nicotine self-administration. 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: Adiposity, Biomarkers, Blood Glucose, Body Height, Body Mass Index, Body Weight, Breast Feeding, Cardiovascular Diseases, Child, Preschool, Cholesterol, HDL, Cholesterol, LDL, Female, Follow-Up Studies, Humans, Infant, Insulin, Linear Models, Maternal Nutritional Physiological Phenomena, Metabolic Syndrome, Mexico, Obesity, Pregnancy, Prospective Studies, Randomized Controlled Trials as Topic, Risk Factors, Triglycerides, Waist Circumference." }, { "role": "user", "content": "Is breastfeeding status at age 3 months associated with adiposity and cardiometabolic markers at age 4 years in Mexican children? Context: The effect of breastfeeding (BF) on cardiometabolic risk factors is not well characterized. The objective was to assess the association of BF status at 3 mo and duration with adiposity and cardiometabolic markers at 4 y. We studied 727 children with prospectively collected BF information and anthropometric measurements at 4 y, of whom 524 provided a nonfasting blood sample. BF status at 3 mo was classified as exclusive or predominant (EBF-PreBF), partial (PaBF), or nonbreastfeeding (NBF). Total duration of any BF was classified as <3 mo, 3- 6 mo, >6 to 12 mo, and >12 mo. We modeled associations of BF with body mass index (BMI; in kg/m(2)), serum total cholesterol and low-density lipoprotein (LDL) cholesterol, triglycerides (TGs), and insulin at 4 y. Children who were NBF or PaBF at 3 mo had higher BMI [0.46 (95% CI: 0.16, 0.76) and 0.31 (95% CI: 0.07, 0.54), respectively] than the EBF-PreBF group (P < 0.01). NBF children had higher total cholesterol (8.02 mg/dL; 95% CI: 1.39, 14.64; P = 0.02) than children who were EBF-PreBF. LDL cholesterol (5.04 mg/dL; 95% CI: -0.72, 10.81) and TGs (12% change; 95% CI: -0.01, 0.24) showed similar patterns. An inverse association between EBF-PreBF and insulin, mediated through abdominal circumference, was documented (P < 0.05). Children breastfed <3 mo had higher BMI (0.44; 95% CI: 0.11, 0.77) at 4 y than children breastfed for >12 mo." }, { "role": "assistant", "content": "EBF and PreBF at 3 mo were associated with lower adiposity and serum total cholesterol in children at 4 y. In addition, BF >12 mo was associated with lower adiposity. These data confirm the importance of exclusive BF and prolonged BF for later cardiometabolic health. 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": "Most reliable investigation in bladder rupture 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": "Lithium should be Stopped how many days before surgery" }, { "role": "assistant", "content": "The correct answer is Lithium should be stopped around 48-72 hrs before surgery." } ]

[ { "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": "Effect of PIH on GFR is-" }, { "role": "assistant", "content": "The correct answer is In normal pregnancy – changes which occur in renal system are-:" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "In sickle cell trait, number of bands found in Hb-" }, { "role": "assistant", "content": "The correct answer is In hemoglobin electrophoresis, various types of hemoglobin move at varying speed.\nIn Sickle cell trait (heterozygous state), there are two types of hemoglobin : - HbS (40%) and HbA (60%). So, on electrophoresis, two different bands are produced.\nIn homozygous state, almost all hemoglobin is HbS. So, a single band is produced.\n\nLaboratory findings of sickle cell anemia\n\nModerate to severe anemia.\nPeripheral smear will show\nSickle cells\nTarget cells\nHowell-Jolly bodies because of autosplenctomy.\nA positive sickling test with a reducing substance like sodium metabisulfite." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, RESULTS. Meshes: Animals, Bromodeoxyuridine, Cell Proliferation, Cells, Cultured, Drug Synergism, Enzyme Inhibitors, Epidermal Growth Factor, ErbB Receptors, Humans, Interleukin-6, Janus Kinase 2, MAP Kinase Signaling System, Mice, Mice, Inbred ICR, Mitogen-Activated Protein Kinase 1, Mitogen-Activated Protein Kinase 3, Mitogen-Activated Protein Kinases, Neurons, Phosphorylation, STAT3 Transcription Factor, Spinal Cord, Stem Cells." }, { "role": "user", "content": "Does interleukin-6 induce proliferation in adult spinal cord-derived neural progenitors via the JAK2/STAT3 pathway with EGF-induced MAPK phosphorylation? Context: In a previous study, we observed cell proliferation 3 days after spinal cord injury, and levels of interleukin-6 (IL-6) and epidermal growth factor (EGF) had significantly increased in the region of the injury. The purpose of the new study described here was to evaluate the roles of IL-6 and EGF after traumatic damage to the spinal cord having isolated neural progenitor cells (NPC) from adult mice. Evidence provided by the trypan blue dye exclusion assay, 5-bromodeoxyuridine immunoreactivity and Western blot analysis indicated that IL-6 and EGF induced proliferation of these spinal cord-derived NPCs via phosphorylation of Janus-activated kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) and mitogen-activated protein kinases (MAPK), respectively. Combined treatment with IL-6 and EGF accelerated proliferation of cells synergistically and phosphorylation of STAT3 and extracellular signal-regulated kinase 1/2 (Erk1/2). Furthermore, AG490 and AG1478, JAK2 inhibitor and EGFR inhibitor, respectively, prevented the IL-6- and EGF-induced proliferation of the cells. Interestingly, IL-6-activated MAPKs but EGF did not influence JAK2/STAT3 activation; AG490 specifically inhibited IL-6-induced Erk1/2 phosphorylation without affecting IL-6-induced phosphorylation of Raf and MEK1/2. These results indicate that IL-6 is directly involved in Erk1/2 activation via JAK2 and that Erk1/2 provides a signal bridge between the IL-6-induced JAK2/STAT3 pathway and EGF-induced MAPK pathway." }, { "role": "assistant", "content": "Our study is the first demonstration of IL-6- and EGF-stimulated proliferation of spinal cord progenitor cells via JAK2/STAT3 and MAPK signalling pathways. These pathways play key roles in repopulation and regeneration of spinal cord tissue after injury. It may represent novel therapeutic targets for pharmacological intervention in central nervous system disease, including spinal cord injury. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, STUDY DESIGN, RESULTS. Meshes: Adult, Disease Progression, Endometriosis, Female, Humans, Longitudinal Studies, Pelvic Pain, Prospective Studies, Rectal Diseases, Severity of Illness Index, Ultrasonography, Vaginal Diseases." }, { "role": "user", "content": "Is rectovaginal endometriosis a progressive disease? Context: The purpose of this study was to observe the natural history of untreated asymptomatic rectovaginal endometriosis. This was a prospective, observational study. Eighty-eight patients with untreated asymptomatic rectovaginal endometriosis were followed for 1 to 9 years. Pain symptoms and clinical and transrectal ultrasonographic findings were evaluated before and every 6 months after diagnosis. Two patients had specific symptoms that were attributable to rectovaginal endometriosis that was associated with an increase in lesion size and underwent surgery. In 4 other patients, the size of the endometriotic lesions increased, but the patients remained symptom free. The estimated cumulative proportion of patients with progression of disease and/or appearance of pain symptoms that were attributable to rectovaginal endometriosis after 6 years of follow up was 9.7%. For the remaining patients, the follow-up period was uneventful, with no detectable clinical nor echographic changes of the lesions and with no appearance of new symptoms." }, { "role": "assistant", "content": "Progression of the disease and appearance of specific symptoms rarely occurred in patients with asymptomatic rectovaginal endometriosis." } ]

[ { "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, Arrhythmias, Cardiac, Atrial Fibrillation, Biopsy, Case-Control Studies, Child, Echocardiography, Electrocardiography, Heart Atria, Hepatolenticular Degeneration, Humans, Liver, Middle Aged." }, { "role": "user", "content": "Is p wave dispersion prolonged in patients with Wilson 's disease? Context: To investigate the P wave dispersion as a non-invasive marker of intra-atrial conduction disturbances in patients with Wilson's disease. We compared Wilsonos disease patients (n = 18) with age matched healthy subjects (n = 15) as controls. The diagnosis was based on clinical symptoms, laboratory tests (ceruloplasmin, urinary and hepatic copper concentrations). P wave dispersion, a measurement of the heterogeneity of atrial depolarization, was measured as the difference between the duration of the longest and the shortest P-waves in 12 lead electrocardiography. All the patients were asymptomatic on cardiological examination and have sinusal rhythm in electrocardiography. Left ventricular and left atrial diameters, left ventricular ejection fraction and left ventricular mass index were similar in both groups. The Wilson's disease patients had a significantly higher P wave dispersion compared with the controls (44.7 +/- 5.8 vs 25.7 +/- 2.5, P < 0.01)." }, { "role": "assistant", "content": "There was an increase in P wave dispersion in cardiologically asymptomatic Wilson's disease patients which probably represents an early stage of cardiac involvement. 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: Apoptosis, Caspase 3, Caspases, Drug Synergism, Enzyme Inhibitors, Enzyme Precursors, Flavonoids, Humans, Imidazoles, Inhibitor of Apoptosis Proteins, JNK Mitogen-Activated Protein Kinases, MAP Kinase Kinase 1, MAP Kinase Signaling System, Mitogen-Activated Protein Kinase Kinases, Mitogen-Activated Protein Kinases, Protein-Serine-Threonine Kinases, Proteins, Pyridines, Tumor Necrosis Factor-alpha, U937 Cells, p38 Mitogen-Activated Protein Kinases." }, { "role": "user", "content": "Do mEK and p38MAPK inhibitors potentiate TNF-alpha induced apoptosis in U937 cells? Context: TNF-alpha is one of the key inflammatory cytokines and it modulates various events through several pathways. U937 myelomonocytic leukemia cells are sensitive to TNF-alpha and about 20% of these cells undergo apoptosis within 6 hours after treatment. Co-treatment of these cells with actinomycin D or cycloheximide enhances TNF-alpha induced apoptosis, suggesting that some TNF-alpha-derived signals can augment apoptosis. We investigated whether mitosis-activating protein kinases (MAPKs) had an influence on TNF-alpha induced apoptosis. U937 cells were treated by TNF-alpha with or without MEK or p38MAPK inhibitors. Apoptosis was assessed morphologically by fluorescence microscopy and caspase-3 was studied by immunoblotting. Expression of apoptosis-inhibitory proteins was studied by RT-PCR whilst the activation of JNKs was investigated by detecting their phosphorylation. TNF-alpha treatment induced apoptosis in about 23% of the cells, while pretreatment with a MEK inhibitor (PD98059) caused 69% of the cells to undergo apoptosis. The inhibition of p38MAPK by SB203580 scarcely enhanced apoptosis, although another p38MAPK inhibitor (PD169316) induced apoptosis in 37% of the cells. Simultaneous pretreatment of cells with PD98059 and PD169316 resulted in the highest level of TNF-alpha induced apoptosis and 90% of the cells underwent apoptosis after 6 hours. In cells pretreated with PD98059 plus PD169316, caspase-3 was completely cleaved at 6 hours and early induction of c-IAP2/HIAP 1 mRNA was not observed. JNKs showed rapid and extensive phosphorylation in these cells." }, { "role": "assistant", "content": "TNF-alpha induced apoptosis was potentiated by the inhibition of either MEK alone, or MEK plus p38MAPK, suggesting that the MAPK pathway may be a promising target for cancer 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: PURPOSE, MATERIALS AND METHODS, RESULTS. Meshes: Acute Kidney Injury, Aged, Anticoagulants, Canada, Citrates, Contraindications, Critical Care, Female, Heparin, Humans, Male, Middle Aged, Prospective Studies, Renal Replacement Therapy, Sodium Chloride." }, { "role": "user", "content": "Is regional citrate superior to systemic heparin anticoagulation for continuous renal replacement therapy? Context: Continuous renal replacement therapy (CRRT) is commonly used in the care of critically ill patients although the optimal means of anticoagulation is not well defined. We report our regional CRRT protocol that was developed using the principles of quality improvement and compare the effect of regional citrate with systemic heparin anticoagulation on filter life span. Prospective observational cohort study in a Canadian adult regional critical care system. A standardized protocol for CRRT has been implemented at all adult intensive care units in the Calgary Health Region since August 1999. All patients with acute renal failure treated with CRRT during October 1, 2002, to September 30, 2003, were identified and followed up prospectively until hospital discharge or death. Eighty-seven patients with acute renal failure requiring CRRT were identified, 54 were initially treated with citrate, 29 with heparin, and 4 with saline flushes. Citrate and heparin were used in 212 (66%) and 97 (30%) of filters for 8776 and 2651 hours of CRRT, respectively. Overall median (interquartile range) filter life span with citrate was significantly greater than heparin (40 [14-72] vs 20 [5-44]hours, P<.001). The median time to spontaneous filter failure was significantly greater with citrate compared with heparin (>72 vs 33 hours, P<.001). Citrate anticoagulation resulted in greater completion of scheduled filter life span (59% vs 10%, P>.001). Citrate anticoagulation was well tolerated with no patient requiring elective discontinuation for hypernatremia, metabolic alkalosis, or hypocalcemia." }, { "role": "assistant", "content": "Regional citrate anticoagulation was associated with prolonged filter survival and increased completion of scheduled filter life span compared with heparin. These data support small studies suggesting that citrate is a superior anticoagulant for CRRT and suggest the need for a future definitive randomized controlled trial." } ]

[ { "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: Antisocial Personality Disorder, Child, Child Behavior Disorders, Child, Preschool, Female, Humans, Longitudinal Studies, Male, Television, Violence." }, { "role": "user", "content": "Is violent television viewing during preschool associated with antisocial behavior during school age? Context: The effect of violent television programming on preschoolers' behaviors is poorly understood. The objective of this study was to test the hypothesis that exposure to violent television viewing when children are 2 to 5 years of age would be associated with antisocial behavior at ages 7 to 10. Data were derived from the Panel Study of Income Dynamics. Our primary outcome was being in the 88th percentile of the Behavioral Problem Index antisocial subdomain. Our primary predictor was exposure to violent screen content. Data were available for 184 boys and 146 girls at both time periods. Adjusting for baseline Behavioral Problem Index scores and age, parental education, maternal depression, and cognitive and emotional support, violent television programming was associated with an increased risk for antisocial behavior for boys but not for girls. Neither educational nor nonviolent programming was associated with increased risk for boys or girls." }, { "role": "assistant", "content": "Viewing of violent programming by preschool boys is associated with subsequent aggressive behavior. Modifying the content that is viewed by young children may be warranted. 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: Adrenergic alpha-Antagonists, Age Factors, Animals, Autoradiography, Body Weight, Cocaine, Dopamine Uptake Inhibitors, Female, Idazoxan, Male, Pregnancy, Prenatal Exposure Delayed Effects, Prosencephalon, Rats, Rats, Sprague-Dawley, Receptors, Adrenergic, alpha-2, Sexual Maturation, Tritium." }, { "role": "user", "content": "Does prenatal cocaine exposure alter alpha2 receptor expression in adolescent rats? Context: Prenatal cocaine exposure produces attentional deficits which to persist through early childhood. Given the role of norepinephrine (NE) in attentional processes, we examined the forebrain NE systems from prenatal cocaine exposed rats. Cocaine was administered during pregnancy via the clinically relevant intravenous route of administration. Specifically, we measured alpha2-adrenergic receptor (alpha2-AR) density in adolescent (35-days-old) rats, using [3H]RX821002 (5 nM). Sex-specific alterations of alpha2-AR were found in the hippocampus and amygdala of the cocaine-exposed animals, as well as an upregulation of alpha2-AR in parietal cortex." }, { "role": "assistant", "content": "These data suggest that prenatal cocaine exposure results in a persistent alteration in forebrain NE systems as indicated by alterations in receptor density. These neurochemical changes may underlie behavioral abnormalities observed in offspring attentional processes following prenatal exposure to cocaine. 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": "According to Dummer classification Type III 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": "An old man was brought to OP by his son telling that his father is having habit of washing his hands 'n' number of times and repetition of other daily routines as well. Characteristic of obsession are all, EXCEPT:" }, { "role": "assistant", "content": "The correct answer is According to the DSM-IV, obsessive-compulsive disorder (OCD) is characterized by recurrent obsessions or compulsions that are ego-dystonic and time-consuming and that interfere with normal functioning. Compulsions or compulsive behavior may result when patients engage in repetitive behavior in an attempt to reduce anxiety or cope with these obsessive thoughts. Obsessions refer to thoughts, ideas, or images which recur and are distressing or unwanted. Ref: Handbook of Neuropsychology and Aging edited by Paul David Nussbaum, 1997, Page 83." } ]

[ { "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: Actins, Animals, Cell Differentiation, Cells, Cultured, Down-Regulation, Epithelial-Mesenchymal Transition, Glucose, Glycogen Synthase Kinase 3, Lithium Chloride, Membrane Proteins, Mice, Podocytes, RNA Interference, RNA, Messenger, RNA, Small Interfering, Receptors, Calcitriol, Signal Transduction, Snail Family Transcription Factors, Transcription Factors, Up-Regulation, beta Catenin." }, { "role": "user", "content": "Are gSK-3β and vitamin D receptor involved in β-catenin and snail signaling in high glucose-induced epithelial-mesenchymal transition of mouse podocytes? Context: Epithelial-mesenchymal transition (EMT) is recognized to play an important role in diabetic nephropathy (DN). To analyze the roles of glycogen synthase kinase 3β (GSK-3β), β-catenin and Snail signaling in high glucose (HG)-induced mouse podocytes EMT. Differentiated podocytes were divided into: the normal glucose group (NG: glucose 5.6mM), the HG groups (12.5HG: 12.5mM; 25HG: 25mM; and 50HG: 50mM of glucose), and the osmotic control group (NG+M: glucose 5.6mM and mannitol 44.4mM). GSK-3β, β-catenin and Snail were assessed using semi-quantitative RT-PCR, western blot and immunofluorescence. β-catenin and Snail pathways were assessed after down-regulating GSK-3β expression using an inhibitor (LiCl) or a small-interfering RNA (siRNA). HG increased GSK-3β, β-catenin and Snail expressions, and promoted EMT, as shown by decreased nephrin expression (epithelial marker), and increased α-SMA expression (mesenchymal marker). GSK-3β inhibitor and GSK-3β siRNA decreased β-catenin and Snail expressions, and reversed HG-induced EMT. Immunofluorescence showed that GSK-3β and β-catenin did not completely overlap; β-catenin was transferred to the nucleus in the 25HG group. VDR seems to be involved in HG-induced β-catenin nuclear translocation." }, { "role": "assistant", "content": "Down-regulating GSK-3β expression decreased β-catenin and Snail expression and reversed HG-induced podocytes EMT. Thus, modulating GSK-3β might be a target to slow or prevent DN. © 2014 S. Karger AG, Basel. 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 16-year-old girl undergoes an emergent appendectomy after presenting to the emergency department with appendicitis. She is given a mixture of nitrous oxide and sevoflurane for induction of anesthesia and intubated for a secure airway during surgery. A few minutes after induction, she is found to have increased end-tidal carbon dioxide and tachycardia. Furthermore, the surgeon notices that her abdomen is extremely rigid before making his incision. Finally, she is found to have hyperkalemia despite having normal serum potassium during preoperative laboratory studies. Defective function of which of the following proteins is most likely responsible for this patient's findings?" }, { "role": "assistant", "content": "Ryanodine receptor" } ]

[ { "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, Azathioprine, Crohn Disease, Demography, Female, Humans, Ileocecal Valve, Intestinal Obstruction, Kaplan-Meier Estimate, Male, Mesalamine, Middle Aged, Recurrence, Smoking, Treatment Outcome, Young Adult." }, { "role": "user", "content": "Is azathioprine more effective than mesalazine at preventing recurrent bowel obstruction in patients with ileocecal Crohn 's disease? Context: Patients with subocclusive Crohn's disease (CD) who received azathioprine (AZA) therapy had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. We investigated whether AZA also was effective for prevention of recurrent bowel obstruction. Rates of recurrent bowel occlusion were compared between patients treated with AZA and those treated with mesalazine. We assessed the time interval-off intestinal obstruction as well as the occlusion-free survival for both groups. There was a significantly lower cumulative rate of patients with recurrent subocclusion in the AZA group (56%) compared with the mesalazine group (79%; OR 3.34, 95% CI 1.67-8.6; P=0.003), with the number needed to treat in order to prevent 1 subocclusion episode of 3.7 favoring AZA. The occlusion-free time interval was longer in the AZA group compared with the mesalazine group (28.8 vs. 18.3 months; P=0.000). The occlusion-free survival at 12, 24, and 36 months was significantly higher in the AZA group (91%, 81%, and 72%, respectively) than in the mesalazine group (64.7%, 35.3%, and 23.5%, respectively; P<0.05 for all comparisons)." }, { "role": "assistant", "content": "In an exploratory analysis of patients with subocclusive ileocecal CD, maintenance therapy with AZA is more effective than mesalazine for eliminating or postponing recurrent intestinal obstruction during 3 years of 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: BACKGROUND, METHOD, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Atrophy, Biopsy, Capsule Endoscopy, Celiac Disease, Duodenum, Female, Gastroscopy, Humans, Intestinal Mucosa, Male, Middle Aged, Prospective Studies, Sensitivity and Specificity." }, { "role": "user", "content": "Capsule endoscopy: an alternative to duodenal biopsy for the recognition of villous atrophy in coeliac disease? Context: Villous atrophy present on a duodenal biopsy remains the 'gold standard' diagnostic test for coeliac disease. However, endoscopic biopsy may cause morbidity and discomfort. Our aim was to evaluate wireless capsule endoscopy as an alternative test for the recognition of villous atrophy. Twenty-one patients with a positive endomysial antibody referred for endoscopy and duodenal biopsy were also offered a wireless capsule endoscopy to evaluate their small bowel. Concurrently, other patients (n=23) referred for a wireless capsule endoscopy acted as controls. Wireless capsule endoscopy reports were assessed for the presence of villous atrophy by one blinded investigator. Twenty endomysial antibody positive patients subsequently had villous atrophy on duodenal biopsy. The controls all had normal duodenal biopsies (with a negative endomysial antibody) and no evidence of villous atrophy noted on their wireless capsule endoscopy. Of the 20 endomysial antibody positive patients with confirmed villous atrophy on biopsy, 17 had villous atrophy also detected by wireless capsule endoscopy. The sensitivity, specificity, positive and negative predictive values for wireless capsule endoscopy recognising villous atrophy were 85%, 100%, 100%, 88.9%, respectively." }, { "role": "assistant", "content": "Wireless capsule endoscopy may be an option to recognise villous atrophy in patients with a positive endomysial antibody who are unwilling, or unable to have a gastroscopy. However, a negative test should be followed by a biopsy if coeliac disease is to be excluded." } ]

[ { "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: Amyotrophic Lateral Sclerosis, Arm, Double-Blind Method, Follow-Up Studies, Humans, Leg, Muscle Contraction, Muscle, Skeletal, Nerve Growth Factors, Physical Examination, Placebos, Quality Control, Randomized Controlled Trials as Topic, Research Design, Respiratory Muscles, Statistics as Topic, Treatment Outcome, Vital Capacity." }, { "role": "user", "content": "Can we eliminate placebo in ALS clinical trials? Context: Previous studies concluded that the decline in strength in patients with amyotrophic lateral sclerosis (ALS) is a linear function. If so, a patient's natural history might serve as the control, instead of placebo, in a clinical trial. A placebo-controlled ALS clinical trial included a natural history phase, followed by a 6-month treatment phase. Each patient's forced vital capacity (FVC) score and maximal voluntary isometric contraction (MVIC) raw scores were measured monthly, standardized, and averaged into megascores. For 138 patients, the arm, leg, FVC, arm+leg combination, and arm+leg+FVC combination megascore slopes during the natural history phase and during the placebo phase were compared. The mean slope of megascores during the natural history phase and the mean slope during the placebo phase were not different for the arm, leg, and arm+leg megascores, but were different for the FVC and arm+leg+FVC combination megascores." }, { "role": "assistant", "content": "Natural history controls may be useful in ALS exploratory trials that use arm megascore slope as the primary outcome measure. However, there are distinct limitations to the use of natural history controls, so that Phase 3 ALS clinical trials require placebo controls." } ]

[ { "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: Adolescent, Cardiotonic Agents, Dobutamine, Echocardiography, Stress, Echocardiography, Transesophageal, Female, Humans, Linear Models, Male, Myocardial Contraction, Natriuretic Peptide, Brain, Transposition of Great Vessels, Ventricular Dysfunction, Right, Young Adult." }, { "role": "user", "content": "Is reduced contractile reserve of the systemic right ventricle under Dobutamine stress associated with increased brain natriuretic peptide levels in patients with complete transposition after atrial repair? Context: To compare B-type natriuretic peptide (BNP) levels with response of systemic right ventricular function to Dobutamine stress. Sixteen patients aged 25.6 +/- 3.7 years (eight each after Senning or Mustard repair of complete transposition) were studied. Transoesophageal imaging was performed in the catheterization laboratory under general anaesthesia before and at the end of a 10 min infusion of 5 microg/kg/min of Dobutamine. The BNP levels were measured at rest. Myocardial Doppler data were acquired before and at peak stress in a four-chamber view. The BNP (pg/mL) values of 67.3 +/- 47.5 (14-189) were elevated. There was no correlation between BNP and IVA, strain, or systolic and diastolic velocities at rest. Dobutamine stress led to a significant increase in IVA, s-velocity, and strain but no significant change in e-velocity. A correlation was found between increase in IVA under Dobutamine and BNP levels (r = 0.57, P < 0.02)." }, { "role": "assistant", "content": "Elevated BNP levels correlate with response of systolic right ventricular function assessed by IVA to Dobutamine stress. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Aged, Aged, 80 and over, Blood Glucose, Cause of Death, Cerebral Hemorrhage, Comorbidity, Diabetes Mellitus, Female, Fibrinolytic Agents, Glycated Hemoglobin A, Hematoma, Humans, Hypertension, Incidence, International Normalized Ratio, Japan, Kaplan-Meier Estimate, Kidney Failure, Chronic, Kidney Function Tests, Male, Middle Aged, Mortality, Recurrence, Renal Dialysis, Retrospective Studies, Risk, Risk Factors, Severity of Illness Index, Single-Blind Method, Stroke, Tomography, X-Ray Computed." }, { "role": "user", "content": "Does maintenance hemodialysis independently increase the risk of early death after acute intracerebral hemorrhage? Context: It is unknown whether the clinical features and outcomes of intracerebral hemorrhage (ICH) patients who undergo maintenance hemodialysis (HD) at the time of ICH are similar to those of general ICH patients. We retrospectively examined the medical records of ICH patients admitted to the Stroke Center of Kawasaki Medical School Hospital within 7 days of ICH onset between April 2004 and June 2011. Patients were classed as HD or non-HD, and clinical characteristics were compared between the two groups. ICH volume was measured on admission CT and follow-up CT scan (< 24 h after admission). Hematoma enlargement was defined as a hematoma that increased by more than 33% of its initial volume. Early death was defined as all-cause death within 14 days of ICH onset. The factors associated with early death were determined using multivariate logistic regression analysis. Five hundred and seven patients (320 males; 69.0 years old, interquartile range 59.0-79.0) were enrolled in the study. Thirty-six (7.2%) were receiving maintenance HD at the time of ICH and formed the HD group, and the remaining 471 patients formed the non-HD group. Use of antithrombotic agents prior to ICH was more common in the HD group than in the non-HD group (41.7 vs. 21.9%; p = 0.012). Brainstem (30.6 vs. 11.3%; p = 0.003) and lobar (19.4 vs. 6.6%; p = 0.013) hematoma locations were more common in the HD group than in the non-HD group. Enlargement of ICH volume was more common in the HD group than in the non-HD group (25.8 vs. 10.2%; p = 0.015). Early death was more common in the HD group than in the non-HD group (33.3 vs. 9.3%; p < 0.001). On the multivariate logistic regression analysis adjusted for age, sex and renal dysfunction, National Institutes of Health Stroke Scale score > 20 [odds ratio (OR) 27.40, 95% confidence interval (CI) 9.69-77.44; p < 0.001], ICH volume > 30 ml (OR 9.53, 95% CI 3.82-23.77; p < 0.001), HD (OR 6.42, 95% CI 1.39-29.76; p = 0.017), the use of antithrombotic agents (OR 3.04, 95% CI 1.22-7.56; p = 0.017) and glucose > 150 mg/dl (OR 2.51, 95% CI 1.01-6.26; p = 0.047) were independent factors associated with early death." }, { "role": "assistant", "content": "Maintenance HD is independently associated with early death in ICH patients. 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: Adult, Aged, Defibrillators, Implantable, Electric Countershock, Emotions, Female, Health Status Disparities, Humans, Interpersonal Relations, Longitudinal Studies, Male, Middle Aged, Patient Satisfaction, Prospective Studies, Quality of Life, Sex Factors, Social Behavior, Social Responsibility, Surveys and Questionnaires, Time Factors, Treatment Outcome." }, { "role": "user", "content": "Is sex associated with differences in individual trajectories of change in social health after implantable cardioverter-defibrillator? Context: Social health is a dimension of quality of life, and refers to people's involvement in, and satisfaction with social roles, responsibilities, and activities. The implantable cardioverter-defibrillator is associated with changes in overall quality of life, but little is known about sex differences in individual trajectories of change in social health. We prospectively measured changes in 3 subscales of the SF-36v2 generic health questionnaire (role physical, role emotional, and social functioning), 2 Patient-Reported Outcomes Measurement Information System short forms (satisfaction with participation in social roles and satisfaction with participation in discretionary social activities), and the Florida Patient Acceptance Survey before and at 1, 2, and 6 months after implantation. Individual growth models of temporal change were estimated. The scores of the 6 indicators improved with time. The unconditional model demonstrated significant (fixed effects: P<0.05; covariance parameters: P<0.10) residual variability in the individual trajectories. In the conditional model, men and women differed significantly in their rates of change in the scores of 3 of the 6 measures. Although men's mean scores exceeded women's mean scores on all indicators at baseline (range of relative mean difference: 11.0% to 17.8%), the rate of women's change resulted in a reversal in relative standing at 6 months after implantation, with the mean scores of women exceeding the men's by 4.5% to 5.6%." }, { "role": "assistant", "content": "Men and women differed in their trajectories of change in social health, both in terms of their starting points (ie, baseline scores) and their rates of change. 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 disorder associated with impulse to consume alcohol is called" }, { "role": "assistant", "content": "The correct answer is Dipsomania: An irresistible desire for alcoholic drinks at periodic intervals. Kleptomania: An irresistible desire to steal aicles of little value. Pyromania: An irresistible desire to set fire to things. Mutilomania: An irresistible desire to mutilate animals. Sexual impulses: Compulsive urge to perform sexual intercourse which may often be in a perveed way." } ]

[ { "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, Attention Deficit Disorder with Hyperactivity, Child, Diagnostic Errors, Female, Humans, Intelligence Tests, Male, Middle Aged, Neuropsychological Tests, Severity of Illness Index." }, { "role": "user", "content": "Does order of Conners ' CPT-II administration within a cognitive test battery influence ADHD indices? Context: To study the effect of administration sequence on Conner's continuous performance test (CPT-II) scores in clients requesting psychological assessment. It was hypothesized that when administered at the end rather than beginning of a test battery, the test scores will show higher symptom severity. If present, order effects may cause the over- or underdiagnosing of ADHD. Participants were recruited at a Midwestern university's training clinic (16 men, 9 women; mean age = 22.4, SD = 10.2). The CPT-II was administered twice to each client: once at the beginning of the testing session and once at the end of their appointment. The clients completed at least a full Wechsler intelligence battery in between the CPT-II administrations. Clients' ADHD index score (interpreted as percent confidence in an ADHD diagnosis) is more impaired at Time 2 (M = 53.3, SD = 29.0) compared to Time 1 (M = 39.4, SD = 22.5): t (24) = 3.93, p < .05, Cohen's d = .79. The number of T-scores above 60 on the subscales also changed from Time 1 (M = 1.92, SD = 1.73) to Time 2 (M = 3.12, SD = 2.05): t(24) = 3.47, p < .01, Cohen's d = .71." }, { "role": "assistant", "content": "If the CPT-II is administered later in a sequence of tests, it is more likely to yield scores in the impaired range. Order effects are more pronounced in individuals diagnosed with ADHD. Recommendations include the adoption of a standardized administration sequence, further research to investigate the nature of order effects, and a strategic use of order effects in ADHD assessment. 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": "Methionine is synthesized from ?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e.,Cysteine Methionine is a sulphar containing amino acid and is synthesized from cysteine.The precursor is homoserine, a product of reduction of aspaic acid.Homoserine is phosphorylated (by ATP) and the phosphate is then displaced by sulfhydryl group of cysteine to form cystathionine.Cleavage of alanine group from cystathionine yields homocysteine, which is methylated to yield 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: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Abdomen, Feasibility Studies, Female, Hernia, Inguinal, Humans, Laparoscopy, Male, Middle Aged, Reoperation, Retrospective Studies." }, { "role": "user", "content": "Is totally extraperitoneal laparoscopic inguinal hernia repair a safe option in patients with previous lower abdominal surgery? Context: History of inguinal hernia repair changed over the decades from repair by tissue approximation to the insertion of synthetic mesh and the introduction of laparoscopic repair. Despite accounting for 15-20% of hernia operations worldwide, many surgeons considered previous lower abdominal surgery as a contraindication to performing totally extraperitoneal (TEP) repair. The aim of this study was to assess the feasibility of TEP in primary and recurrent inguinal hernias in patients with previous lower abdominal surgery. This study was a retrospective review of patients who underwent TEP inguinal hernia repair from January 2001 to July 2005. Variables studied included patient demographics, type of hernia, type of previous surgery, conversion to open repair, postoperative complications, and overnight admission. One hundred eight patients (107 males, 1 female), with a median age of 55 years (range 87-24), underwent TEP repair. Ninety-four patients had primary inguinal hernias, and 13 patients had recurrent inguinal hernias. Seventeen patients had a previous lower abdominal surgery (13 primary and 4 recurrent inguinal hernias). There was 1 conversion to open repair and 1 case of postoperative bleeding that required an exploration-both in the group with no previous surgery. Postoperative complications were minimal. All cases were performed as day cases; however, patients with recurrent hernia stayed longer in the hospital than those with primary hernia (P = 0.006)." }, { "role": "assistant", "content": "TEP repair is feasible in patients with previous lower abdominal surgery. TEP was planned as a day-case procedure; however, patients with recurrent hernias needed a planned admission, as an overnight stay was required. 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 22-year-old woman comes to the physician for a routine health maintenance examination. She has no history of serious illness. Pelvic examination shows a pink, 2 x 2-cm, fluctuant swelling at the right posterior vaginal introitus. The swelling is most likely derived from which of the following structures?" }, { "role": "assistant", "content": "Greater vestibular glands" } ]

[ { "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": "Space maintenance is an example of" }, { "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, SETTING AND PARTICIPANTS, RESULTS, LIMITATIONS. Meshes: Adult, African Americans, Aged, Aged, 80 and over, Biomarkers, Biopsy, Bone Diseases, Female, Humans, Hypercalcemia, Hyperparathyroidism, Kidney Failure, Chronic, Male, Middle Aged, Osteogenesis, Parathyroid Hormone, Peritoneal Dialysis, Practice Guidelines as Topic, Predictive Value of Tests, Renal Dialysis." }, { "role": "user", "content": "Can the combination of calcium and parathormone levels above K/DOQI guidelines be used as a marker of adynamic bone disease in African Americans? Context: Patients of African American descent are at risk for the development of adynamic bone disease at parathyroid hormone levels 50% above the K/DOQI guidelines. Since a low bone formation rate is associated with hypercalcemia, attempts to reach one K/DOQI guideline may result in serum calcium levels above another K/DOQI guideline. Calcium levels above K/DOQI guidelines therefore may signal a need to stop parathyroid suppression. Bone biopsies were performed at the East Alabama Medical Center, in Opelika AL, USA on eight patients (four Caucasians, four African Americans) whose parathormone levels and serum calcium levels both exceeded K/DOQI guideline recommendations. All patients had mild to severe hyperparathyroid bone disease. No variable studied was predictive of the finding. Small sample size and the unavailability of the original Nichols Diagnostic Institute radioimmunoassay for parathormone." }, { "role": "assistant", "content": "We did not find hypercalcemia predictive of adynamic bone in patients of African American descent at levels of parathormone where low bone formation rates have been documented to occur. Since no parameter predicted bone histology, perhaps bone biopsies will be necessary to distinguish hyperparathyroidism from adynamic bone disease in African Americans with ESRD, hypercalcemia, and moderately elevated levels of PTH. Further studies are needed to determine appropriate therapy." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Non specific esterase is positive in all the categories of AML except -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'd' i.e., M6 o FAB classification divides AML into eight types M 0 to M7. o This scheme takes into account : ? i) The degree of maturation (MO to M3) ii) The lineage of leukemic blast (M4 to M7). Class Blast cells o Myeloperoxidase negative Mo minimally differentiatedAML o Auer rods negative o Express myeloid lineage antigen o 3 % blasts myeloperoxidase positive M AML without differentiation o Auer rods positive o Full range of myeloid maturation MZ AML with maturation o Myeloperoxidase positive o Auer rods positive" } ]

[ { "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, Biomarkers, Biomarkers, Tumor, Carcinoma, Hepatocellular, Female, Humans, Liver Cirrhosis, Alcoholic, Liver Neoplasms, Male, Middle Aged, Osteopontin, ROC Curve, Severity of Illness Index." }, { "role": "user", "content": "Is plasma osteopontin a biomarker for the severity of alcoholic liver cirrhosis , not for hepatocellular carcinoma screening? Context: Implementation of surveillance programs for at-risk populations and identification of biomarkers for early hepatocellular carcinoma (HCC) detection are a major public health goal. Recently, osteopontin (OPN) has attracted attention as a promising biomarker, with some potential advantages compared to alpha-fetoprotein (AFP), but its role in the context of alcoholic cirrhosis has never been assessed. The aims of this study are to assess the utility of plasma OPN in the diagnosis of HCC in alcoholic cirrhotic patients and to investigate whether increased values are due to the tumor or underlying liver disease severity. A total of 90 consecutively alcoholic cirrhosis patients, observed between Jun 2013 and May 2014 at a Liver Disease Unit, were included and divided into two groups: 45 without (group I) and 45 with HCC (group II). Plasma levels of OPN (ELISA, Immuno-Biological Laboratories, Gunma, Japan) and AFP (IMMULITE® 2000 AFP, Siemens Healthcare Diagnostics, Tarrytown, New York) were assessed. The diagnostic accuracy of each marker was evaluated using Receiver-Operating Characteristic (ROC) curve analysis (AUC) and its 95 % Confidence Interval (CI). Plasma OPN levels in group I patients (1176.28 +/-744.59 ng/mL) weren't significantly different from those of group II (1210.75 +/-800.60 ng/mL) (p = 0.826). OPN levels significantly increased with advancing BCLC tumor stage and with advancing Child-Pugh class, in both groups. Comparing the two groups, AUC for OPN and AFP were 0.51 (95 % CI: 0.39-0.63) and 0.79 (95 % CI: 0.70-0.89), respectively. Based on the ROC analysis, there were no satisfactory cut-off values for OPN that would distinguish patients with from those without tumour." }, { "role": "assistant", "content": "Despite having a correlation with BCLC stage, the same was observed with progressive deterioration of underlying liver function in terms of Child-Pugh class and MELD score, and isn't a useful diagnostic biomarker for HCC in alcoholic cirrhotic patients, particularly in the early stages. AFP confirms the performance evidenced in other studies, being superior to OPN. Searching more specific biomarkers for early diagnosis of HCC in alcoholic cirrhosis is still warranted. Final Decision: yes" } ]