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[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Radioisotopes which is used in teletherapy: September 2011" }, { "role": "assistant", "content": "The correct answer is Ans. Co-60" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: AIMS, METHODS, RESULTS. Meshes: Adolescent, Biopsy, Fine-Needle, Child, Diagnosis, Differential, Female, Humans, Male, Medical Records, Retrospective Studies, Sensitivity and Specificity, Thyroid Gland, Thyroid Neoplasms, Thyroid Nodule, Ultrasonography." }, { "role": "user", "content": "Is ultrasonography useful in predicting thyroid cancer in children with thyroid nodules and apparently benign cytopathologic features? Context: To assess whether the presence of certain findings on thyroid ultrasonography (US) correctly diagnoses malignancy even when a fine-needle aspiration biopsy (FNAB) suggests a benign lesion. We reviewed the charts of 35 children and adolescents with a thyroid nodule who had had an US and a FNAB, and for whom final pathology was available. The global accuracy of FNAB was 83%, with a sensitivity of 75% and a specificity of 94%. 14 FNABs suggested malignancy (40%), only 1 of which was a false positive (7%). By contrast, 5 of the 21 FNABs suggesting benign lesions were false negatives (24%). These 5 cases had US findings suggestive of malignancy. When FNAB suggested a benign lesion, US had a good sensitivity (80%) but a poor specificity and accuracy (50 and 57%, respectively); its negative predictive value was 90% and its positive predictive value 36%." }, { "role": "assistant", "content": "US complements FNAB in the evaluation of thyroid nodules in children. A more aggressive approach is warranted in children with a thyroid nodule and a benign FNAB if US findings suggest malignancy." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Which of the following is not a cause of cataract" }, { "role": "assistant", "content": "The correct answer is Hypomagnesemia is least likely to cause cataract MISCELLANEOUS CATARACTS Diabetes- Snowflake/ snowstorm cataract Wilson's- Sunflower cataract, chalcosis. Bread crump appearance- Complicated cataract Coicosteroid cause posterior subcapsular cataract.(Note topical steroids cause glaucoma more; systemic cause cataract more). Oil drop cataract -galactosemia is reversible (deficiency of GPUT) Anterior lenticonus- Alpo Posterior Lenticonus- Lowe Syndrome Shield cataract- Atopic dermatitis. Radiation can cause PSC cataract. Hypocalcemic cataract - Tetanic cataract Myotonic dystrophy- Christmas tree cataract Persistent hyaloid aery&mittendorf dot -can be a cause of Posterior polar cataract." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Apoptosis, Cell Movement, Cell Proliferation, Curcumin, HeLa Cells, Humans, Matrix Metalloproteinase 9, Nitric Oxide Synthase Type II." }, { "role": "user", "content": "Does [ Curcumin inhibit HeLa cell invasion and migration by decreasing inducible nitric oxide synthase ]? Context: To investigate the inhibitory effects of curcumin against HeLa cell invasion and migration and explore the underlying mechanisms. HeLa cells were exposed to curcumin treatment at the concentrations of 0, 10, 25, 50, 100, 150 and 200 µmol/L for 24 h. MTT and TUNEL assays were used to assess the cell proliferation inhibition and apoptosis, respectively. Transwell assay was used to evaluate the invasiveness and migration of the treated cells, and RT-PCR and Western blotting were employed to detect the changes in the expression of inducible nitric oxide synthase (iNOS), and MMP-9 and E-cad, the 2 markers of cell invasion and migration, were detected by Western blotting. The capacity of NO production in HeLa cells was measured by Griess method. Curcumin inhibited the proliferation of HeLa cells by inducing cell apoptosis in a concentration-dependent manner. Curcumin inhibited the invasion and migration of HeLa cells by increasing E-cad expression and decreasing MMP-9 expression, and also decreased the expression level of iNOS and NO production in the cells." }, { "role": "assistant", "content": "Curcumin inhibits the invasion and migration of HeLa cells by decreasing the expression of iNOS. 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 23-year-old male presents to the emergency department. He was brought in by police for shouting on a subway. The patient claims that little people were trying to kill him, and he was acting within his rights to defend himself. The patient has a past medical history of marijuana and IV drug use as well as multiple suicide attempts. He is currently homeless. While in the ED, the patient is combative and refuses a physical exam. He is given IM haloperidol and diphenhydramine. The patient is transferred to the inpatient psychiatric unit and is continued on haloperidol throughout the next week. Though he is no longer aggressive, he is seen making \"armor\" out of paper plates and plastic silverware to defend himself. The patient is switched onto risperidone. The following week the patient is still seen gathering utensils, and muttering about people trying to harm him. The patient's risperidone is discontinued. Which of the following is the best next step in management?" }, { "role": "assistant", "content": "Clozapine" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Asthma, Case-Control Studies, Helicobacter Infections, Helicobacter pylori, Humans." }, { "role": "user", "content": "Is Helicobacter pylori infection associated with asthma risk? Context: Helicobacter pylori (H. pylori) infection has been thought to play a critical role in disorders such as gastric and lung cancer. A number of studies have been devoted to the relationship between H. pylori infection and asthma risk, which have generated inconclusive results. In this study we aimed to derive a more precise estimation of the relationship. Meta-analyses evaluating the association of H. pylori infection and asthma risk were conducted and subgroup analyses on ethnicity and source of controls as well as CagA status were further conducted. Eligible studies were identified for the period up to Jul 2012. A total of five case-control studies comprising 770 cases and 785 controls were lastly selected for analysis. The overall data failed to indicate a significant association of H. pylori infection and asthma risk (OR=1.01; 95%CI=0.82-1.24). Likewise, in the subgroup analysis regarding ethnicity, source of controls and CagA status, no associations could be observed." }, { "role": "assistant", "content": "The pooled data failed to suggest a marked association between H. pylori infection and asthma risk. Future studies are needed to confirm this conclusion." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All of the following statements about estrogen are TRUE EXCEPT:" }, { "role": "assistant", "content": "The correct answer is Estrogen decrease plasma LDL cholesterol while HDL and triglyceride levels are raised Estrogen's known effects on the cardiovascular system include a mix of positive and negative: Increases HDL cholesterol Decreases LDL cholesterol Promotes blood clot formation, and also causes some changes that have the opposite effect Dilates blood vessels so blood flow increases (Ref. Essentials of medical pharmacology TD Tripathi 7th edition page no.307)" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Arm Injuries, Arteries, Blood Vessel Prosthesis Implantation, Cohort Studies, Emergency Treatment, Humans, Iraq War, 2003-2011, Leg Injuries, Retrospective Studies, Suture Techniques, Treatment Outcome, United States, Veins." }, { "role": "user", "content": "Temporary vascular shunts as initial treatment of proximal extremity vascular injuries during combat operations: the new standard of care at Echelon II facilities? Context: Historically, penetrating injuries to the extremities account for up to 75% of wounds sustained during combat and 10% of deaths. Rapid vascular control and perfusion of injured extremities at forward deployed Echelon II surgical facilities is essential to limit loss of life and maximize limb preservation. We review our experience with the management of extremity vascular trauma and report the largest single Echelon II experience to date on temporary vascular shunting (TVS) for proximal extremity vascular injuries. Data on combat trauma patients presenting to a US Navy Echelon II forward surgical facility in Iraq were prospectively recorded during a 7-month period. Patients with suspected vascular injuries underwent exploration in the operating room. After vessel control, thrombectomy and instillation of heparinized saline, vascular injuries in the proximal extremity were temporarily shunted in a standardized fashion. Vascular injuries in the distal extremity were routinely ligated. After shunting, patients were transported to an Echelon III facility in the Iraqi Theater and underwent vascular reconstruction. They were followed through transfer to the Continental United States or discharge into the civilian Iraqi medical system. Shunt patency, limb salvage, and survival data were obtained by retrospective review of electronic medical records. Six hundred ten combat trauma patients were treated from August 16, 2006 to February 25, 2007. Thirty-seven patients (6.1%) sustained 73 injuries to major extremity vascular structures. Twenty-three proximal vascular shunts were placed in 16 patients with mean Injury Severity Score of 25 (range, 17-43) and mean mangled extremity severity score (MESS) of 8 (range, 5-10). Twenty-two of 23 shunts (95.6%) were patent upon arrival to the Echelon III facility and underwent successful autologous vein reconstruction. All shunt patients survived their injuries with 100% early limb preservation as followed through their first 30 days of medical care or discharge into the local medical community." }, { "role": "assistant", "content": "Complex combat injuries to proximal extremity vessels should be routinely shunted at forward-deployed Echelon II facilities as part of the resuscitative, damage control process." } ]

[ { "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": "Aschoff bodies are seen in" }, { "role": "assistant", "content": "The correct answer is Aschoff bodies are pathognomonic of Rheumatic heart disease." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Is murine Fig4 dispensable for muscle development but required for muscle function? Context: Phosphatidylinositol phosphates (PIPs) are low-abundance phospholipids that participate in a range of cellular processes, including cell migration and membrane traffic. PIP levels and subcellular distribution are regulated by a series of lipid kinases and phosphatases. In skeletal muscle, PIPs and their enzymatic regulators serve critically important functions exemplified by mutations of the PIP phosphatase MTM1 in myotubular myopathy (MTM), a severe muscle disease characterized by impaired muscle structure and abnormal excitation-contraction coupling. FIG4 functions as a PIP phosphatase that participates in both the synthesis and breakdown of phosphatidylinositol 3,5-bisphosphate (PI(3,5)P2). Mutation of FIG4 results in a severe neurodegenerative disorder in mice and a progressive peripheral polyneuropathy in humans. The effect of FIG4 mutation on skeletal muscle has yet to be examined. Herein we characterize the impact of FIG4 on skeletal muscle development and function using the spontaneously occurring mouse mutant pale tremor (plt), a mouse line with a loss of function mutation in Fig4. In plt mice, we characterized abnormalities in skeletal muscle, including reduced muscle size and specific force generation. We also uncovered ultrastructural abnormalities and increased programmed cell death. Conversely, we detected no structural or functional abnormalities to suggest impairment of excitation-contraction coupling, a process previously shown to be influenced by PI(3,5)P2 levels. Conditional rescue of Fig4 mutation in neurons prevented overt muscle weakness and the development of obvious muscle abnormalities, suggesting that the changes observed in the plt mice were primarily related to denervation of skeletal muscle. On the basis of the ability of reduced FIG4 levels to rescue aspects of Mtmr2-dependent neuropathy, we evaluated the effect of Fig4 haploinsufficiency on the myopathy of Mtm1-knockout mice. Male mice with a compound Fig4+/-/Mtm1-/Y genotype displayed no improvements in muscle histology, muscle size or overall survival, indicating that FIG4 reduction does not ameliorate the Mtm1-knockout phenotype." }, { "role": "assistant", "content": "Overall, these data indicate that loss of Fig4 impairs skeletal muscle function but does not significantly affect its structural development. 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: Case-Control Studies, Colon, Colorectal Neoplasms, GTPase-Activating Proteins, Gene Expression Regulation, Neoplastic, Humans, Intestinal Mucosa, Microarray Analysis, Protein Interaction Mapping, Proteome, Proteomics, Receptor Cross-Talk, Signal Transduction, Transcription Factor AP-1, Tumor Microenvironment." }, { "role": "user", "content": "Does aberrant gene expression in mucosa adjacent to tumor reveal a molecular crosstalk in colon cancer? Context: A colorectal tumor is not an isolated entity growing in a restricted location of the body. The patient's gut environment constitutes the framework where the tumor evolves and this relationship promotes and includes a complex and tight correlation of the tumor with inflammation, blood vessels formation, nutrition, and gut microbiome composition. The tumor influence in the environment could both promote an anti-tumor or a pro-tumor response. A set of 98 paired adjacent mucosa and tumor tissues from colorectal cancer (CRC) patients and 50 colon mucosa from healthy donors (246 samples in total) were included in this work. RNA extracted from each sample was hybridized in Affymetrix chips Human Genome U219. Functional relationships between genes were inferred by means of systems biology using both transcriptional regulation networks (ARACNe algorithm) and protein-protein interaction networks (BIANA software). Here we report a transcriptomic analysis revealing a number of genes activated in adjacent mucosa from CRC patients, not activated in mucosa from healthy donors. A functional analysis of these genes suggested that this active reaction of the adjacent mucosa was related to the presence of the tumor. Transcriptional and protein-interaction networks were used to further elucidate this response of normal gut in front of the tumor, revealing a crosstalk between proteins secreted by the tumor and receptors activated in the adjacent colon tissue; and vice versa. Remarkably, Slit family of proteins activated ROBO receptors in tumor whereas tumor-secreted proteins transduced a cellular signal finally activating AP-1 in adjacent tissue." }, { "role": "assistant", "content": "The systems-level approach provides new insights into the micro-ecology of colorectal tumorogenesis. Disrupting this intricate molecular network of cell-cell communication and pro-inflammatory microenvironment could be a therapeutic target in CRC patients. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Anterior pituitary develops from?" }, { "role": "assistant", "content": "The correct answer is Anterior lobe (adenohypophysis) of pituitary develops from Rathke's pouch (ectodermal diveiculum of the primitive oral cavity)." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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 Drinking, Animals, Basal Ganglia, Brain Chemistry, Darkness, Female, Gene Regulatory Networks, Male, Mice, Quantitative Trait Loci, Selection, Genetic." }, { "role": "user", "content": "Does selection for drinking in the dark alter brain gene coexpression networks? Context: Heterogeneous stock (HS/NPT) mice have been used to create lines selectively bred in replicate for elevated drinking in the dark (DID). Both selected lines routinely reach a blood ethanol (EtOH) concentration (BEC) of 1.00 mg/ml or greater at the end of the 4-hour period of access in Day 2. The mechanisms through which genetic differences influence DID are currently unclear. Therefore, the current study examines the transcriptome, the first stage at which genetic variability affects neurobiology. Rather than focusing solely on differential expression (DE), we also examine changes in the ways that gene transcripts collectively interact with each other, as revealed by changes in coexpression patterns. Naïve mice (N = 48/group) were genotyped using the Mouse Universal Genotyping Array, which provided 3,683 informative markers. Quantitative trait locus (QTL) analysis used a marker-by-marker strategy with the threshold for a significant logarithm of odds (LOD) set at 10.6. Gene expression in the ventral striatum was measured using the Illumina Mouse 8.2 array. Differential gene expression and the weighted gene coexpression network analysis (WGCNA) were implemented largely as described elsewhere. Significant QTLs for elevated BECs after DID were detected on chromosomes 4, 14, and 16; the latter 2 were associated with gene-poor regions. None of the QTLs overlapped with known QTLs for EtOH preference drinking. Ninety-four transcripts were detected as being differentially expressed in both selected lines versus HS controls; there was no overlap with known preference genes. The WGCNA revealed 2 modules as showing significant effects of both selections on intramodular connectivity. A number of genes known to be associated with EtOH phenotypes (e.g., Gabrg1, Glra2, Grik1, Npy2r, and Nts) showed significant changes in connectivity." }, { "role": "assistant", "content": "We found marked and consistent effects of selection on coexpression patterns; DE changes were more modest and less concordant. The QTLs and differentially expressed genes detected here are distinct from the preference phenotype. This is consistent with behavioral data and suggests that the DID and preference phenotypes are markedly different genetically. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Blood Flow Velocity, Female, Follow-Up Studies, Humans, Male, Middle Aged, Monitoring, Intraoperative, Ophthalmic Artery, Prospective Studies, Retinal Artery, Retinal Detachment, Scleral Buckling, Visual Acuity." }, { "role": "user", "content": "Do successful scleral buckling procedures decrease central retinal artery blood flow velocity? Context: Limited data suggest that scleral buckling procedures may decrease posterior segment blood flow. How this may affect functional outcome remains unknown. In a prospective, controlled study, color Doppler imaging was used to measure blood flow velocities in the central retinal and ophthalmic arteries of both eyes in patients with unilateral rhegmatogenous retinal detachments before and after primary scleral buckle repair. Encircling elements were used in all patients. Fellow eyes served as controls. Data from six consecutive patients did not show significant preoperative circulatory abnormalities in either artery compared with the controls. There was a statistically significant reduction in mean central retinal artery blood flow velocities of up to 53% in the immediate postoperative period. Ophthalmic artery blood flow velocities, however, did not significantly change after the procedure. Successful retinal reattachment with the expected visual improvement was achieved in all patients with this primary surgery." }, { "role": "assistant", "content": "Scleral buckling procedures with encircling elements decrease blood flow velocities in the central retinal artery but leave the ophthalmic artery unaffected. Good anatomic and functional results still can be achieved despite these hemodynamic changes. 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 10-year-old boy was admitted to the ward with complaints of fever for 2 weeks duration. After admission his fever pattern is recorded (shown below). In addition, he has ahritis and hepatosplenomegaly. What is the likely diagnosis?" }, { "role": "assistant", "content": "The correct answer is The depicted fever pattern is suggestive of Quotidian fever. Quotidian fever means the presence of daily fever spikes with temperature touching and going below baseline (37oC ) on occasions. Among the given options, this fever pattern is suggestive of Systemic onset JIA. In Systemic onset JIA, in addition to ahritis, Systemic features such as fever, evanescent rash, enlarged liver and spleen, lymphadenopathy, serositis and pericardial effusions can be seen" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Condoms, Confidence Intervals, Directive Counseling, Female, HIV Seronegativity, HIV Seropositivity, Health Knowledge, Attitudes, Practice, Humans, Male, Odds Ratio, Risk Reduction Behavior, Self Report, Sexual Partners, South Africa, Time Factors, Unsafe Sex, Young Adult." }, { "role": "user", "content": "Does hIV testing and counseling lead to immediate consistent condom use among South African stable HIV-discordant couples? Context: Effective behavioral HIV prevention is needed for stable HIV-discordant couples at risk for HIV, especially those without access to biomedical prevention. This analysis addressed whether HIV testing and counseling with ongoing counseling and condom distribution lead to reduced unprotected sex in HIV-discordant couples. Partners in Prevention HSV/HIV Transmission Study was a randomized trial conducted from 2004 to 2008 assessing whether acyclovir reduced HIV transmission from HSV-2/HIV-1-coinfected persons to HIV-uninfected sex partners. This analysis relied on self-reported behavioral data from 508 HIV-infected South African participants. The exposure was timing of first HIV testing and counseling: 0-7, 8-14, 15-30, or >30 days before baseline. In each exposure group, predicted probabilities of unprotected sex in the last month were calculated at baseline, month 1, and month 12 using generalized estimating equations with a logit link and exchangeable correlation matrix. At baseline, participants who knew their HIV status for less time experienced higher predicted probabilities of unprotected sex in the last month: 0-7 days, 0.71; 8-14 days, 0.52; 15-30 days, 0.49; >30 days, 0.26. At month 1, once all participants had been aware of being in HIV-discordant relationships for ≥1 month, predicted probabilities declined: 0-7 days, 0.08; 8-14 days, 0.08; 15-30 days, 0.15; >30 days, 0.14. Lower predicted probabilities were sustained through month 12: 0-7 days, 0.08; 8-14 days, 0.11; 15-30 days, 0.05; >30 days, 0.19." }, { "role": "assistant", "content": "Unprotected sex declined after HIV-positive diagnosis and declined further after awareness of HIV discordance. Identifying HIV-discordant couples for behavioral prevention is important for reducing HIV transmission risk. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Breast, Breast Neoplasms, Cell Line, Tumor, Female, Humans, Immunohistochemistry, Middle Aged, Prognosis, Receptors, Estrogen, Receptors, Transforming Growth Factor beta, Retrospective Studies, Smad4 Protein, Survival Rate." }, { "role": "user", "content": "Is smad4-expression decreased in breast cancer tissues : a retrospective study? Context: Although transforming growth factor beta (TGF-beta) typically inhibits proliferation of epithelial cells, consistent with a tumor suppressor activity, it paradoxically also exhibits pro-metastatic activity in the later stages of carcinogenesis. Since tumors often display altered TGF-beta signaling, particularly involving the Smad-pathway, we investigated the role of Smad4-expression in breast cancer. Smad4 expression was investigated by immunohistochemistry in formalin-fixed, paraffin-embedded tissue from 197 samples of primary breast cancer obtained between 1986 and 1998. The prognostic value of Smad4-expression was analyzed. Smad4 expression was found to be reduced in lobular and ductal breast carcinoma as compared to surrounding uninvolved lobular and ductal breast epithelia (p < 0.001, n = 50). Smad4-expression correlated positively with expression of TGF-beta-receptor I (p < 0.001, n = 197) and TGF-beta-receptor II (p < 0.001, n = 197), but showed no significant correlation with tumor size, metastases, nodal status, histological grade, histological type, or estrogen receptor expression. While not achieving statistical significance, there was a trend towards longer survival times in patients with Smad4 negative tumors." }, { "role": "assistant", "content": "According to the suggested role of Smad4 as a tumor suppressor we observed that expression of Smad4 is lower in human breast cancer than in surrounding breast epithelium. However, we also observed a trend towards longer survival times in Smad4-negative patients, indicating the complex role of TGF-beta signaling in tumor progression. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Animals, Autoimmune Diseases, Dependovirus, Eye, Gene Transfer Techniques, Genetic Therapy, Genetic Vectors, Interleukin-10, Interleukin-17, Interleukins, Mice, Retinitis." }, { "role": "user", "content": "Does aAV2-mediated subretinal gene transfer of mIL-27p28 attenuate experimental autoimmune uveoretinitis in mice? Context: Advances in gene transfer techniques have provided long-term, safe and stable transduction of retinal cells following subretinal injection with adeno-associated viral (AAV) vectors. In this study we investigated whether subretinal injection of AAV2-murine IL-27p28 vector was effective in inhibiting experimental autoimmune uveoretinitis (EAU) induced in B10RIII mice. An AAV2 vector encoding the murine IL-27p28 gene (rAAV2-CMV-mIL-27p28) was prepared and subretinally injected into B10RIII mice (4.35×10(8) vector genome (v.g.)). AAV2 vector mediating green fluorescent protein (rAAV2-CMV-GFP) served as a control (5×10(8) v.g.). The concentration of mIL-27p28 in homogenized eyes and serum was assayed by enzyme linked immunosorbent assay (ELISA) after subretinal injection. Human IRBP(161-180) peptide and Complete Freund's Adjuvant were injected into mice receiving either the rAAV2-CMV-mIL-27p28 or rAAV2-CMV-GFP vector. EAU was evaluated clinically and pathologically. The level of IL-17 and IL-10 in homogenized eyes was measured on day 12 and day 21 following immunization. Delayed type hypersensitivity (DTH) and IRBP(161-180)-specific proliferation of lymphocytes from the spleen and lymph nodes were assayed to examine the influence of the subretinal delivery of rAAV2-CMV-mIL-27p28 on the systemic immune response. IL-27p28 was detectable by ELISA within the eyes from two weeks following subretinal injection of the rAAV2-CMV-mIL-27p28 vector and showed a sustained high expression from day 14 to 9 months with a highest expression at 5 months. Subretinal injection of the vector significantly attenuated the severity of EAU disease clinically and pathologically in association with a significantly decreased IL-17 expression and an increased IL-10 expression. The IL-27p28 vector did not affect the systemic immune response, as determined by DTH and IRBP(161-180)-specific lymphocyte proliferation." }, { "role": "assistant", "content": "A high and stable expression of IL-27p28 was observed for at least 9 months following subretinal delivery of rAAV2-CMV-mIL-27p28. The amelioration of EAU disease severity was associated with a decreased IL-17 expression and an increased IL-10 expression. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Crosses, Genetic, DNA Primers, Diabetes Mellitus, Experimental, Diabetes Mellitus, Type 1, Diabetic Nephropathies, Female, Foam Cells, Kidney, Kidney Glomerulus, Macrophages, Male, Mice, Mice, Inbred C57BL, Mice, Inbred DBA, Mice, Knockout, Polymerase Chain Reaction, Receptors, Cytoplasmic and Nuclear." }, { "role": "user", "content": "Is diabetic nephropathy accelerated by farnesoid X receptor deficiency and inhibited by farnesoid X receptor activation in a type 1 diabetes model? Context: The pathogenesis of diabetic nephropathy is complex and involves activation of multiple pathways leading to kidney damage. An important role for altered lipid metabolism via sterol regulatory element binding proteins (SREBPs) has been recently recognized in diabetic kidney disease. Our previous studies have shown that the farnesoid X receptor (FXR), a bile acid-activated nuclear hormone receptor, modulates renal SREBP-1 expression. The purpose of the present study was then to determine if FXR deficiency accelerates type 1 diabetic nephropathy in part by further stimulation of SREBPs and related pathways, and conversely, if a selective FXR agonist can prevent the development of type 1 diabetic nephropathy. Insulin deficiency and hyperglycemia were induced with streptozotocin (STZ) in C57BL/6 FXR KO mice. Progress of renal injury was compared with nephropathy-resistant wild-type C57BL/6 mice given STZ. DBA/2J mice with STZ-induced hyperglycemia were treated with the selective FXR agonist INT-747 for 12 weeks. To accelerate disease progression, all mice were placed on the Western diet after hyperglycemia development. The present study demonstrates accelerated renal injury in diabetic FXR KO mice. In contrast, treatment with the FXR agonist INT-747 improves renal injury by decreasing proteinuria, glomerulosclerosis, and tubulointerstitial fibrosis, and modulating renal lipid metabolism, macrophage infiltration, and renal expression of SREBPs, profibrotic growth factors, and oxidative stress enzymes in the diabetic DBA/2J strain." }, { "role": "assistant", "content": "Our findings indicate a critical role for FXR in the development of diabetic nephropathy and show that FXR activation prevents nephropathy in type 1 diabetes. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "In dextroversion yoke muscle of right lateral rectus:" }, { "role": "assistant", "content": "The correct answer is Ans. a. Left medial rectusRef: Kanskis Clinical Ophthalmology 8th Ed; Page No-732-33Yoke muscles (Contralateral synergists) are pair of muscles (one from each eye) which contract simultaneously during version movements.For example right lateral rectus and left medial rectus acts as yoke muscle for dextroversion movement.Others pairs of yoke muscles are:Right SR and left IO: DextroelevationRight IR and left SO: Dextro depressionRight IO and left SR: LevoelevationRight SO and left IR : Levodepression" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Adenocarcinoma, Adult, Aged, Aged, 80 and over, Anaplastic Lymphoma Kinase, Biomarkers, Tumor, Carcinoma, Large Cell, Carcinoma, Squamous Cell, Cell Differentiation, DNA-Binding Proteins, Diagnosis, Differential, ErbB Receptors, Female, Humans, Immunohistochemistry, Lung Neoplasms, Male, Middle Aged, Mucins, Proto-Oncogene Proteins, Proto-Oncogene Proteins p21(ras), Receptor Protein-Tyrosine Kinases, Retrospective Studies, Transcription Factors, World Health Organization, ras Proteins." }, { "role": "user", "content": "Is pulmonary large cell carcinoma lacking squamous differentiation clinicopathologically indistinguishable from solid-subtype adenocarcinoma? Context: Pulmonary large cell carcinoma (LCC) includes tumors not readily diagnosed as adenocarcinoma (ADC) or squamous cell carcinoma on morphologic grounds, without regard to immunophenotype, according to the World Health Organization (WHO). This ambiguous designation may cause confusion over selection of mutation testing and directed therapies. Several groups have proposed the use of immunohistochemistry (IHC) to recategorize LCC as ADC or squamous cell carcinoma; however, it remains unclear if strictly defined LCCs are a clinicopathologically distinct lung tumor subset. To compare the pathologic, molecular, and clinical features of 2 morphologically similar tumors: solid-subtype ADC and LCC. Tumors were included on the basis of solid growth pattern; tumors with squamous or neuroendocrine differentiation were excluded. Solid ADC (n = 42) and LCC (n = 57) were diagnosed by using WHO criteria (5 intracellular mucin droplets in ≥2 high-power fields for solid ADC) and tested for KRAS, EGFR, and ALK alterations. Both solid ADC and LCC groups were dominated by tumors with \"undifferentiated\"-type morphology and both had a high frequency of thyroid transcription factor 1 expression. KRAS was mutated in 38% of solid ADCs versus 43% of LCCs (P = .62). One ALK-rearranged and 1 EGFR-mutated tumor were detected in the solid ADC and LCC groups, respectively. There were no significant differences in clinical features or outcomes; the prevalence of smoking in both groups was greater than 95%." }, { "role": "assistant", "content": "Other than a paucity of intracellular mucin, LCC lacking squamous or neuroendocrine differentiation is indistinguishable from solid-subtype ADC. We propose the reclassification of these tumors as mucin-poor solid adenocarcinomas. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: PURPOSE, METHODS AND MATERIALS, RESULTS. Meshes: Carcinoma, Non-Small-Cell Lung, Computer Simulation, Esophagus, Heart, Humans, Lung, Lung Neoplasms, Physical Phenomena, Physics, Radiation Protection, Radiotherapy Planning, Computer-Assisted, Radiotherapy, Conformal, Spinal Cord." }, { "role": "user", "content": "Inhomogeneous target-dose distributions: a dimension more for optimization? Context: To evaluate if the use of inhomogeneous target-dose distributions, obtained by 3D conformal radiotherapy plans with or without beam intensity modulation, offers the possibility to decrease indices of toxicity to normal tissues and/or increase indices of tumor control stage III non-small cell lung cancer (NSCLC). Ten patients with stage III NSCLC were planned using a conventional 3D technique and a technique involving noncoplanar beam intensity modulation (BIM). Two planning target volumes (PTVs) were defined: PTV1 included macroscopic tumor volume and PTV2 included macroscopic and microscopic tumor volume. Virtual simulation defined the beam shapes and incidences as well as the wedge orientations (3D) and segment outlines (BIM). Weights of wedged beams, unwedged beams, and segments were determined by optimization using an objective function with a biological and a physical component. The biological component included tumor control probability (TCP) for PTV1 (TCP1), PTV2 (TCP2), and normal tissue complication probability (NTCP) for lung, spinal cord, and heart. The physical component included the maximum and minimum dose as well as the standard deviation of the dose at PTV1. The most inhomogeneous target-dose distributions were obtained by using only the biological component of the objective function (biological optimization). By enabling the physical component in addition to the biological component, PTV1 inhomogeneity was reduced (biophysical optimization). As indices for toxicity to normal tissues, NTCP-values as well as maximum doses or dose levels to relevant fractions of the organ's volume were used. As indices for tumor control, TCP-values as well as minimum doses to the PTVs were used. When optimization was performed with the biophysical as compared to the biological objective function, the PTV1 inhomogeneity decreased from 13 (8-23)% to 4 (2-9)% for the 3D-(p = 0.00009) and from 44 (33-56)% to 20 (9-34)% for the BIM plans (p<0. 00001). Minimum PTV1 doses (expressed as the lowest voxel-dose) were similar for both objective functions. The mean and maximum target doses were significantly higher with biological optimization for 3D as well as for BIM (all p values<0.001). Tumor control probability (estimated by TCP1 x TCP2) was 4.7% (3D) and 6.2% (BIM) higher for biological optimization (p = 0.01 and p = 0.00002 respectively). NTCP(lung) as well as the percentage of lung volume exceeding 20 Gy was higher with the use of the biophysical objective function. NTCP(heart) was also higher with the use of the biophysical objective function. The percentage of heart volume exceeding 40 Gy tended to be higher but the difference was not significant. For spinal cord, the maximum dose as well as NTCP(cord) were similar for 3D plans (D(max): p = 0.04; NTCP: p = 0.2) but were significantly lower for BIM (D(max): p = 0.002; NTCP: p = 0.008) if the biophysical objective function was used." }, { "role": "assistant", "content": "When using conventional 3D techniques, inhomogeneous dose distributions offer the potential to further increase the probability of uncomplicated local control. When using techniques as BIM that would lead to large escalation of the median and maximum target doses, it seems indicated to limit target-dose inhomogeneity to avoid dose levels that are so high that the safety becomes questionable." } ]

[ { "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 interpretation cannot be associated with the given radiograph?" }, { "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, RESULTS. Meshes: Aged, Angina Pectoris, Biomarkers, Coronary Angiography, Coronary Disease, Exercise Test, Humans, Middle Aged, Myocardial Ischemia, Natriuretic Peptide, Brain, Prospective Studies, Severity of Illness Index, Thallium Radioisotopes, Tomography, Emission-Computed, Single-Photon." }, { "role": "user", "content": "Does n-terminal B-type natriuretic peptide predict extent of coronary artery disease and ischemia in patients with stable angina pectoris? Context: B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) are elevated in patients with acute coronary syndromes and are closely linked to prognosis. Because there is only a small amount of data available concerning NT-proBNP in patients with stable angina pectoris, we aimed to determine whether NT-proBNP is of additional diagnostic value in these patients. Ninety-four patients with stable angina pectoris were prospectively included. All patients underwent exercise testing and coronary angiography, and 91 patients received thallium-201 single-photon emission computed tomography myocardial scintigraphy. NT-proBNP was analyzed at rest and after exercise testing. NT-proBNP was elevated in patients with inducible myocardial ischemia shown by single-photon emission computed tomography (396 +/- 80 pg/mL vs 160 +/- 101 pg/mL; P <.01) closely linked to the extent of coronary artery disease (CAD) (no CAD, 148 +/- 29 pg/mL; 1- or 2-vessel disease, 269 +/- 50 pg/mL; 3-vessel disease 624 +/- 186 pg/mL; P <.01). In a multivariate analysis, NT-proBNP was an independent predictor for CAD. The area under the curve of the receiver operating characteristic curve was 0.72 for NT-proBNP to predict CAD. Using an optimized cut off level of 214 pg/mL, CAD can be predicted with high accuracy. The total test efficiency of exercise testing can be improved from 1.46 to 1.52 when combined with NT-proBNP measurement." }, { "role": "assistant", "content": "NT-proBNP is elevated in patients with stable angina pectoris and has a close correlation to disease severity. Combining the measurement of NT-proBNP with exercise testing, the test accuracy for predicting severe CAD can be improved. Our data show an incremental value of NT-proBNP in the diagnostic process of stable angina pectoris. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adolescent, Adult, Child, Electrodes, Implanted, Electroencephalography, Epilepsy, Female, Humans, Male, Middle Aged, Multivariate Analysis, Preoperative Care, Retrospective Studies, Seizures, Treatment Outcome, Young Adult." }, { "role": "user", "content": "Does differentiation of specific ripple patterns help to identify epileptogenic areas for surgical procedures? Context: High frequency oscillations (HFOs) at 80-500 Hz are promising markers of epileptic areas. Several retrospective studies reported that surgical removal of areas generating HFOs was associated with a good seizure outcome. Recent reports suggested that ripple (80-200 Hz) HFO patterns co-existed with different background EEG activities. We hypothesized that the coexisting background EEG pattern may distinguish physiological from epileptic ripples. Rates of HFOs were analyzed in intracranial EEG recordings of 22 patients. Additionally, ripple patterns were classified for each channel depending either as coexisting with a flat or oscillatory background activity. A multi-variate analysis was performed to determine whether removal of areas showing the above EEG markers correlated with seizure outcome. Removal of areas generating high rates of 'fast ripples (>200 Hz)' and 'ripples on a flat background activity' showed a significant correlation with a seizure-free outcome. In contrast, removal of high rates of 'ripples' or 'ripple patterns in a continuously oscillating background' was not significantly associated with seizure outcome." }, { "role": "assistant", "content": "Ripples occurring in an oscillatory background activity may be suggestive of physiological activity, while those on a flat background reflect epileptic activity. 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: Angiogenesis Inhibitors, Animals, Carcinoma, Renal Cell, Disease Models, Animal, Drug Therapy, Combination, Endostatins, Kidney Neoplasms, Mice, Neuropilin-1, Thrombospondins, Tumor Cells, Cultured." }, { "role": "user", "content": "Is combined antiangiogenic therapy superior to single inhibitors in a model of renal cell carcinoma? Context: Similar to cytotoxic drugs, a combination of antiangiogenic factors may lead to an improved treatment response and minimize resistance by targeting different pathways. Therefore, we investigated the effects of a combination of endogenous inhibitors using endostatin, soluble neuropilin-1 and thrombospondin-2 in a renal cell carcinoma model. Microencapsulated porcine aortic endothelial cells producing endostatin, soluble neuropilin-1 or thrombospondin-2 were tested in vitro and in a murine renal cell carcinoma alone or as a combination of the all 3 factors. Renca cells were applied subcutaneously for local therapy or injected intravenously in a metastatic model. Factors released from microbeads inhibited endothelial cell function but did not affect tumor cell proliferation in vitro. In vivo tumor growth was inhibited similarly by each angiogenic inhibitor alone (0.17, 0.18 and 0.18 gm in endostatin, soluble neuropilin-1 and thrombospondin-2 treated mice vs 1.3 gm in controls). The combination of all 3 inhibitors further decreased tumor weight (0.03 gm). In the metastatic model treatment with angiogenic inhibitors induced a significant reduction in the size and number of lung metastases with additive effects when factors were used in combination." }, { "role": "assistant", "content": "The combination of angiogenic inhibitors was superior to single factors, suggesting additive activity. These data support the strategy of combining angiogenic inhibitors to accomplish a complete angiogenic blockade. 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, MATERIALS AND METHODS, RESULTS. Meshes: Animals, Constriction, Pathologic, Cryptorchidism, Flow Cytometry, Male, Peripheral Vascular Diseases, Rats, Seminiferous Tubules, Spermatic Cord Torsion, Vas Deferens, Veins." }, { "role": "user", "content": "Do experimentally induced ipsilateral testicular torsion, vas deferens obstruction, intra-abdominal testis or venous obstruction damage the contralateral testis through a common mechanism? Context: To evaluate if various conditions affecting the ipsilateral testis which also damage the contralateral testis share a common pathway for their effects. The study comprised five groups of 10 adult rats which underwent surgery to produce (on their left sides); group 1, a sham operation (control); group 2, testicular torsion; group 3, vas deferens obstruction; group 4, an intra-abdominal testis; and group 5, venous obstruction. The ipsilateral and contralateral testes were harvested 4 weeks after surgery. The relative proportions of haploid cells, the mean seminiferous tubular diameter (MSTD), mean testicular biopsy scores (MTBS), and lactate and hypoxanthine levels were determined and compared. The proportions of haploid cells in the ipsilateral and the contralateral testes of groups 2-5 were significantly lower than those of the corresponding testes of the control group. The MSTD and MTBS of the ipsilateral testes in groups 2-5 were also significantly lower than the ipsilateral testes of controls and the contralateral testes within the same groups. While the MSTD and MTBS of the contralateral testes of groups 1 and 5 were not significantly different, those of the contralateral testes of groups 2-4 were significantly less than that of group 1. The lactic acid and hypoxanthine levels of the ipsilateral and contralateral testes were significantly increased in groups 2 and 3. While only the hypoxanthine level of group 5 increased significantly, both variables were not significantly different between the ipsilateral testes of groups 1 and 4." }, { "role": "assistant", "content": "These four treatments damaged both the ipsilateral and contralateral testes. As the lactic acid and hypoxanthine levels within the contralateral testis were greater than in the controls, testicular torsion and vas deferens obstruction seem to share a common pathway (which may be a reflex decrease in contralateral testicular blood flow) for their effects on the contralateral testis." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Blood Glucose, Butter, C-Peptide, China, Cross-Over Studies, Dietary Carbohydrates, Dietary Fats, Fatty Acids, Monounsaturated, Fatty Acids, Nonesterified, Fatty Acids, Unsaturated, Glycemic Index, Grape Seed Extract, Humans, Insulin, Lipids, Male, Meals, Olive Oil, Plant Oils, Postprandial Period, Single-Blind Method, Triglycerides." }, { "role": "user", "content": "Do dietary fat and carbohydrate quality have independent effects on postprandial glucose and lipid responses? Context: The magnitude of postprandial lipemia is influenced not only by the amount but also the type of fat and carbohydrate consumed. The aim of this study was to evaluate differences in postprandial glucose and lipid responses after a mixed meal containing low- or high-glycemic-index (GI) carbohydrate and three different types of fat varying in the degree of saturation in healthy subjects. A randomized, controlled, single-blinded crossover study was conducted in 20 healthy Chinese men. Subjects consumed in random order six experimental isocaloric meals that differed in carbohydrate and fat quality, and contained 40 g of either saturated fat (SFA, butter), monounsaturated fat (MUFA, olive oil) or polyunsaturated fat (PUFA, grapeseed oil), and 50 g of either low-GI (basmati rice) or high-GI (jasmine rice) carbohydrate. Glucose, insulin, c-peptide, triglycerides (TG) and non-esterified fatty acids (NEFA) were measured over 4 h. For all substrates evaluated, there were no significant interactions between fat and carbohydrate. The incremental area under the curve (iAUC) for TG was significantly lower after the SFA and PUFA meals compared with the MUFA meal, irrespective of GI. No significant difference was found for NEFA iAUC in all treatments. Glucose, insulin and c-peptide iAUCs were significantly lower after ingestion of low-GI than high-GI meals, independent of the type of fat." }, { "role": "assistant", "content": "A carbohydrate-rich meal (of either low or high GI) that contains butter or grapeseed oil results in lower postprandial TG concentrations relative to olive oil in healthy Chinese males. Glucose, insulin and c-peptide responses, however, are directly dependent on the GI of the meal and not on the degree of saturation of dietary fat. The trial was registered at clinicaltrials.gov as NCT02585427. 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": "Neuroendocrinal tumors (NET) can be best detected by :" }, { "role": "assistant", "content": "The correct answer is Ans. is 'd' i.e. Radio nucleotide scan * \"Somatostatin receptor scintigraphy (SRS type of radio nucleotide scan) is now the imaging modality of choice for localizing both primary and metastatic NET tumor.\" - HarrisonNeuroendocrine for NET) tumors refers to two types of tumor:Carcinoids & Pancreatic endocrine tumors (PETs) e.g. Insulinoma Gastrinoma VIPomas GRFomas Somatostatinoma etc.SRS is an investigating modality for localizing the NETs as are CT, MRI, Endoscopic U/SNote that it not a diagnostic investigation.Diagnosis of NETs, is made by detecting the peptides or amines (or their metabolites) secreted by the tumors, in urine or serum.For e.g. -In carcinoid tumor - Serotonin*5-HIAA (Best)*5-HTP*5-//T*Glucagonoma - Elevated plasma glucagon level*Somatostatinoma - Elevated plasma level of somatostatin*Investigating modalities for localization of NET tumors:CT ScanMRITransabdominal U/SSelective angiographySRSEndoscopic U/SSRS is the imaging modality of choice for localizing both primary and metastatic NET tumors.Insulinomas are an exception to this :They have low densities of SST receptors, therefore SRS is not effective modality for them.Best modality for localizing insulinomas is Endoscopic U/S.Also note that though SRS is the imaging modality of choice for localizing the NETs, it does not provide reliable information on tumor size (CT & MRI are much better)." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, European Continental Ancestry Group, Humans, Male, Mass Screening, Middle Aged, Prostatic Neoplasms." }, { "role": "user", "content": "Do mortality reductions produced by sustained prostate cancer screening have been underestimated? Context: The recently published European Randomized Study of Screening for Prostate Cancer (ERSPC) reported prostate specific antigen (PSA)-based screening to have reduced the prostate cancer death rate by only 20%. However, this is an underestimate caused by (i) including in the 20% the years before the impact of the first screen becomes manifest, and (ii) not having full information for the follow-up years where the effects of the screening are most apparent. This paper provides a re-analysis of the results using time-specific measures, which avoid the first of these sources of error. Mortality rate ratios for follow-up years 1-12 were derived from the yearly numbers of prostate cancer deaths and numbers of men being followed in each arm of the ERSPC. To reduce statistical noise, they were based on moving three-year intervals, and a smooth rate ratio curve was fitted to the yearly data, in order to measure the steady state reduction in mortality and to identify the time at which it reached this level. The re-analysis suggests that the sustained reduction in prostate cancer mortality may be more than 50%." }, { "role": "assistant", "content": "Re-analysis of the ERSPC data suggests that if screening is carried out for several years, and if follow-up is pursued until the reduction becomes manifest, the reduction in mortality will be 50-60%. An analysis that includes the 2007-2008 follow-up data is required to quantify more precisely the impact of this intervention. 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: Animals, Apoptosis, Bacterial Adhesion, Blotting, Western, Caco-2 Cells, Calcitriol, Cell Membrane Permeability, Cell Proliferation, Cells, Cultured, Colitis, Crohn Disease, Dextran Sulfate, Disease Models, Animal, Electric Conductivity, Escherichia coli, Escherichia coli Infections, Female, Fluorescent Antibody Technique, Gastrointestinal Tract, Humans, Immunoenzyme Techniques, Inflammation, Intestinal Mucosa, Mice, Mice, Inbred C57BL, RNA, Messenger, Real-Time Polymerase Chain Reaction, Reverse Transcriptase Polymerase Chain Reaction, Vitamin D Deficiency." }, { "role": "user", "content": "Does vitamin D deficiency predispose to adherent-invasive Escherichia coli-induced barrier dysfunction and experimental colonic injury? Context: Adherent-invasive Escherichia coli (AIEC) colonization has been strongly implicated in the pathogenesis of Crohn's disease. Environmental triggers such as vitamin D deficiency have emerged as key factors in the pathogenesis of inflammatory bowel diseases. The aim of this study was to investigate the effects of 1,25(OH)2D3 on AIEC infection-induced changes in vivo and in vitro. Barrier function was assessed in polarized epithelial Caco-2-bbe cells grown in medium with or without vitamin D and challenged with AIEC strain LF82. Weaned C57BL/6 mice were fed either a vitamin D-sufficient or -deficient diet for 5 weeks and then infected with AIEC, in the absence and presence of low-dose dextran sodium sulphate. Disease severity was assessed by histological analysis and in vivo intestinal permeability assay. Presence of invasive bacteria was assessed by transmission electron microscopy. Caco-2-bbe cells incubated with 1,25(OH)2D3 were protected against AIEC-induced disruption of transepithelial electrical resistance and tight-junction protein redistribution. Vitamin D-deficient C57BL/6 mice given a course of 2% dextran sodium sulphate exhibited pronounced epithelial barrier dysfunction, were more susceptible to AIEC colonization, and showed exacerbated colonic injury. Transmission electron microscopy of colonic tissue from infected mice demonstrated invasion of AIEC and fecal microbiome analysis revealed shifts in microbial communities." }, { "role": "assistant", "content": "These data show that vitamin D is able to mitigate the deleterious effects of AIEC on the intestinal mucosa, by maintaining intestinal epithelial barrier homeostasis and preserving tight-junction architecture. This study highlights the association between vitamin D status, dysbiosis, and Crohn's disease. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Does increased Copper in Individuals with Autism normalize Post Zinc Therapy More Efficiently in Individuals with Concurrent GI Disease? Context: To assess plasma zinc and copper concentration in individuals with autism. Plasma from 79 autistic individuals, and 18 age and gender similar neurotypical controls, were tested for plasma zinc and copper using inductively-coupled plasma-mass spectrometry. Autistic individuals had significantly elevated plasma levels of copper and Cu/Zn and lower, but not significantly lower, plasma Zn compared to neurotypical controls. Zn levels increased significantly in autistic individuals with and without GI disease after zinc therapy. Cu decreased significantly after zinc therapy in the GI disease group but not in the autistic group without GI disease. Autistic children significantly improved with respect to hyperactivity and stimming after zinc therapy in autistic children with GI disease. Autistic children without GI disease did not improve in these symptoms after the same therapy." }, { "role": "assistant", "content": "These results suggest an association between zinc and copper plasma levels and autism, and they suggest that zinc therapy may be most effective at lowering copper levels in autistic children with GI disease. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Age Factors, Aged, Aged, 80 and over, Female, Follow-Up Studies, Heart Failure, Humans, Male, Marital Status, Middle Aged, Multivariate Analysis, Quality of Life, Sex Characteristics, Stroke Volume, Surveys and Questionnaires, Time Factors, United States." }, { "role": "user", "content": "Are gender differences in quality of life minimal in patients with heart failure? Context: Prior investigators have suggested that quality of life differs in men and women with heart failure, especially in the physical functioning domain. The purpose of this study was to compare quality of life in men and women with heart failure to determine if differences exist after controlling for functional status, age, and ejection fraction. Data from a sample of 640 men and women (50% each) matched on New York Heart Association functional classification and age were used for this secondary analysis. Scores on the Minnesota Living with Heart Failure Questionnaire were compared at baseline and 3 months after enrollment using multivariate techniques with ejection fraction controlled. Treatment group (intervention versus control) was controlled statistically at 3 months because the original data were drawn from experimental and quasi-experimental studies in which an improvement in quality of life had been a goal of the intervention. The sexes differed on marital status, so this variable was controlled in analyses as well. In all analyses, quality of life was minimally worse in women compared with men (1-3 points at most). None of the differences reached statistical significance except for emotional quality of life at baseline (P =.03). By 3 months, both men and women reported significantly improved and comparable quality of life and there were no significant differences between them." }, { "role": "assistant", "content": "Quality of life is similar in men and women with heart failure when functional status, age, ejection fraction, and marital status differences are controlled. 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, Arthroscopy, Computer Simulation, Educational Measurement, Female, General Surgery, Humans, Knee Joint, Learning, Male, Minimally Invasive Surgical Procedures, Models, Anatomic, Orthopedics, Physicians, Psychomotor Performance, Spatial Behavior, Students, Medical, User-Computer Interface." }, { "role": "user", "content": "Does training in tasks with different visual-spatial components improve virtual arthroscopy performance? Context: We earlier showed that training in the Procedicus KSA Simulator improves the performance of tasks done later in the same simulator. However, it is still unclear how performance in a specific visual-spatial simulator context may change after training in other simulators with different visual-spatial components. In particular, the aim of this study was to test whether performance in the Procedicus Virtual Arthroscopy (VA) Knee Simulator would remain unchanged after a training session in three other simulators with different visual-spatial components. Twenty-eight medical students participated in a quasi-transfer study. They were randomly allocated to an experimental group ( n = 14) and a control group ( n = 14). Performance in the Procedicus VA Knee Simulator did not improve after training in other simulators with different visual-spatial components ( t-test p = NS). No significant correlation was found between the Procedicus VA Knee and the Minimally Invasive Surgical Trainer (MIST) simulators." }, { "role": "assistant", "content": "One hour of training in different visual-spatial contexts was not enough to improve the performance in virtual arthroscopy tasks. It cannot be excluded, however, that experienced trainees could improve their performance, because perceived similarity between different situations is influenced by many psychological factors, such as the knowledge or expertise of the person performing the transfer task. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Bronchiectasis, Exercise Tolerance, Female, Humans, Male, Pneumonectomy, Prospective Studies, Quality of Life, Respiratory Function Tests." }, { "role": "user", "content": "Does lung resection improve the quality of life of patients with symptomatic bronchiectasis? Context: Bronchiectasis is a significant cause of morbidity. Surgical resection is a treatment option, but its main outcomes regarding quality of life (QOL) and physiologic consequences have not been addressed previously, to our knowledge. We aimed to evaluate the effect of surgical procedures on QOL, exercise capacity, and lung function in patients with bronchiectasis in whom medical treatment was unsuccessful. Patients with noncystic fibrosis in whom medical treatment was unsuccessful and who were candidates for lung resection were enrolled in a prospective study. The main measurements before lung resection and 9 months afterward were QOL according to the Short Form 36 Health Survey and World Health Organization Quality of Life Questionnaires, lung function test results, and the results of maximal cardiopulmonary exercise testing on a cycle ergometer. Of 61 patients who were evaluated, 53 (50.9% male, age 41.3 ± 12.9 years) underwent surgical resection (83% lobectomies), and 44 completed the 9-month follow-up. At baseline, they had low QOL scores, mild obstruction, and diminished exercise capacity. After resection, 2 patients died and adverse events occurred in 24.5%. QOL scores improved remarkably at the 9-month measurements, achieving values considered normal for the general population in most dimensions. Functionally, resection caused mild reduction of lung volume; nevertheless, exercise capacity was not decreased. In fact, 52% of the patients improved their exercise performance. Multiple linear regression analysis showed that low QOL before resection was an important predictor of QOL improvement after resection (p = 0.0001)." }, { "role": "assistant", "content": "Lung resection promotes a significant improvement in the QOL of patients with noncystic fibrosis bronchiectasis without compromising their exercise capacity. 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": "Opiate withdrawal causes-" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., Mydriasis Morphine withdrawalo Manifestations of morphine withdrawal# Lacrimation# Anxiety & fear# Mydriasis# Diarrhea# Palpitation# Sweating# Restlessness# Insomnia# Dehydration# Rapid weight loss# Yawning# Gooseflash (Piloerection)# Abdominal colic# Rise in BP o Delirium and convulsions are not a characteristicfeatures (contrast barbiturates) and are seen only occasionally.o Treatment consists of withdraw! of morphine and substitution with oral methadone followed by gradual withdrawl of methodone.o Recently the NMDA antagonists and nitric oxide synthatase inhibitors have been found to block morphine tolerance and dependance." } ]

[ { "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": "Acute dilatation of stomach is not managed by -" }, { "role": "assistant", "content": "The correct answer is • This condition usually occurs in association with pyloroduodenal disorders or after surgery without nasogastric suction.\n• The stomach, which may also be atonic, dilates enormously.\n• Often the patient is also dehydrated and has electrolyte disturbances.\n• Failure to treat this condition can result in a sudden massive vomit with aspiration into the lungs.\nTreatment:\n• Nasogastric suction with a large-bore tube, fluid replacement and treatment of the underlying condition." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Cholecystokinin, Dietary Fats, Digestion, Duodenum, Enteral Nutrition, Enzyme Inhibitors, Fat Substitutes, Fatty Acids, Fatty Acids, Nonesterified, Female, Gastric Mucosa, Humans, Hunger, Lactones, Lipase, Male, Orlistat, Pressure, Sensation, Stomach, Sucrose, Triglycerides." }, { "role": "user", "content": "Does fat digestion modulate gastrointestinal sensations induced by gastric distention and duodenal lipid in humans? Context: It is unclear whether fat digestion is required for the induction of gastrointestinal sensations and whether different fats have different effects. We investigated the effect of fat digestion and of medium-chain triglycerides (MCTs; C < 12) and long-chain triglycerides (LCTs; C > 16) on gastrointestinal sensations. In a double-blind study, 15 healthy subjects were studied on 5 occasions during which LCT or MCT emulsions (2 kcal/min), with or without 120 mg tetrahydrolipstatin (THL, lipase inhibitor), or sucrose polyester (SPE, nondigestible fat) were infused intraduodenally in randomized order. After 30 minutes, the proximal stomach was distended in 1 mm Hg steps/min. Intensity of gastrointestinal sensations (on a 0-10 visual analog scale), plasma cholecystokinin (CCK) levels, and gastric volumes were assessed throughout. LCT and MCT increased gastric volume at baseline pressure compared with SPE, and LCT more than MCT. THL entirely abolished this effect (volumes [mL]: LCT, 213 +/- 19; LCT-THL, 39 +/- 3; MCT, 155 +/- 12; MCT-THL, 43 +/- 5; SPE, 44 +/- 5). Only LCT increased plasma CCK levels (pmol/L per 30 minutes: LCT, 21 +/- 2; LCT-THL, 9 +/- 1; MCT, 9 +/- 1; MCT-THL, 11 +/- 1; SPE, 9 +/- 1). During distentions, intragastric volumes were greater during infusion of LCT and MCT than during the respective THL conditions or SPE, but plasma CCK levels did not change. The intensity of sensations increased (hunger decreased) more with LCT than with MCT. During infusion of THL or SPE, the effects were smaller than during LCT or MCT." }, { "role": "assistant", "content": "Fat digestion is required for the modulation of gastrointestinal sensations during gastric distention. The effects of fat depend on the fatty acid chain length and are not entirely explained by release of CCK. 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: Adaptor Proteins, Vesicular Transport, Antigens, Bacterial, Cells, Cultured, Chaperonin 60, Corticotropin-Releasing Hormone, Female, Humans, Interleukin-1beta, Lipopolysaccharides, Luciferases, Myeloid Differentiation Factor 88, Obstetric Labor, Premature, Placenta, Pregnancy, Receptors, Immunologic, Reverse Transcriptase Polymerase Chain Reaction, Toll-Like Receptor 4, Transfection, Trophoblasts." }, { "role": "user", "content": "Does lipopolysaccharide stimulation of trophoblasts induce corticotropin-releasing hormone expression through MyD88? Context: We hypothesized that intrauterine infection may lead to placental corticotrophin-releasing hormone (CRH) expression via Toll-like receptor signaling. To test this hypothesis JEG3 cells were stimulated with lipopolysaccharide (LPS), chlamydial heat shock protein 60, and interleukin (IL)-1. CRH expression was assessed by reverse transcription polymerase chain reaction (RT-PCR). The signaling mechanisms that were involved were examined in transient transfection experiments with beta-galactosidase, CRH-luciferase, cyclic adenosine monophosphate (AMP) response element-luciferase, dominant-negative (DN)-myeloid differentiation primary response gene (MyD88) and DN-toll-IL-1-receptor domain containing adapter inducing interferon (TRIF) vectors. Luciferase activity was determined by luciferase assay. Beta-galactosidase assay was performed to determine transfection efficiency. LPS, chlamydial heat shock protein 60, and IL-1 stimulation led to CRH expression in the JEG3 cells. LPS-induced CRH expression was not due to the autocrine effect of LPS-induced IL-1 because the supernatant from LPS-conditioned JEG3 cells did not induce CRH expression in the naïve cells. DN-MyD88, but not DN-TRIF, blocked the LPS-induced CRH expression. The cAMP response element did not play a role in LPS-induced CRH expression." }, { "role": "assistant", "content": "Toll-like receptor signaling 4 may induce placental CRH expression through MyD88. 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": "All are true about human chorionic gonadotrophin except" }, { "role": "assistant", "content": "The correct answer is hcG inhibits apoptosis in nontrophoblastic tumors, thereby allowing rapid growth." } ]

[ { "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": "Severe hyperkalemia is seen in combination with:" }, { "role": "assistant", "content": "The correct answer is Ans. C. Losartan and amilorideACE inhibitors/ARBs result in hyperkalemia.Side effectsa. Hypotension may occur especially in patients who are hypovolemic as a result of diuretics, salt restriction, or gastrointestinal fluid loss.b. Hyperkalemia- mostly in patients with renal impairment, NSAIDs & K+ sparing diuretics.c. Cough is due to increased levels of bradykinin (ACE inhibitors)d. Dysgeusiae. Angioedema, Rashes, Urticariaf. Foetopathic effect- in utero development of the kidneys is angiotensin dependent.g. ACEI's or ARBs, are contraindicated given during the second or third trimesters" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Animals, Newborn, Catalase, Female, Fetus, Glutathione Peroxidase, Hernia, Diaphragmatic, Hernias, Diaphragmatic, Congenital, Humans, Infant, Newborn, Ligation, Lung, Pregnancy, Respiration, Artificial, Sheep, Superoxide Dismutase, Trachea." }, { "role": "user", "content": "Do tracheal ligation and mechanical ventilation improve the antioxidant enzyme status in the lamb model of congenital diaphragmatic hernia? Context: The antioxidant enzyme (AOE) system is the primary intracellular defense system of the lung against oxygen toxicity. The authors recently demonstrated depressed levels of catalase, glutathione peroxidase, and superoxide dismutase in congenital diaphragmatic hernia (CDH) lambs compared with controls. The aim of this study was to determine whether tracheal ligation (TL) or mechanical ventilation (recently shown to stimulate growth and surfactant metabolism, respectively) could induce an elevation in AOE activity. Four nonventilated lambs with surgically created CDH and TL and five CDH lambs ventilated for 4 hours were studied. Lung tissue was analyzed for AOE and the results compared with untreated CDH lambs. Both ventilation and TL failed to elevate AOE activity above that of untreated CDH lambs." }, { "role": "assistant", "content": "The data provide further evidence that TL does not improve lung metabolism or maturation. Mechanical ventilation, which often involves high oxygen delivery, is a necessary and often beneficial therapeutic modality. In the CDH neonate compromised not only by low baseline levels of the AOE, but also by an inability to induce enzyme synthesis in response to hyperoxia, mechanical ventilation may, by causing lung injury, be contributing to the high morbidity and mortality rate associated with CDH. 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, MATERIAL AND METHODS, RESULTS. Meshes: Cholangiopancreatography, Endoscopic Retrograde, Dilatation, Humans, Jaundice, Obstructive, Male, Middle Aged." }, { "role": "user", "content": "Is suprastenotic dilatation a mandatory symptom of impaired bile outflow? Context: To study the rate, nature, and symptoms of bile flow impairments running without developing suprastenotic dilatation. A total of 1082 patients undergoing endoscopic retrograde cholangiopancreatography for the differential diagnosis of jaundices were followed up. According to the diameter of the common bile duct, the patients were classified into cholangioectasia and non-cholangioectasia groups. The investigators studied the causes of bile evacuation disorders; the levels of bilirubin, hepatic transferases, and alkaline phosphatase; the duration and periodicity of obstructive jaundice; extended compression of suprastenotic dilatation; the occurrence of other symptoms; and the efficiency of additional procedures for the differential diagnosis of hepatic and obstructive jaundices. There was no suprastenotic dilatation in 11 cases: in noncircular amorphous internal hepatocholedochal blocks, in cicatrical stenoses of the hepatocholedoch, in excessive metastatic spread into the hepatic portal and parenchyma, extended stenosis of the common bile duct does not lead to intrahepatic cholangiectasia. In 9 cases, instrumental palpation and aspiration biopsy were used to visualize common bile duct stenosis in order to elucidate its nature, degree, and rigidity. Endobiliary stenting was employed for the differential diagnosis of jaundices." }, { "role": "assistant", "content": "No suprastenotic dilatation was seen in 0.8% of patients with organic bile flow impairment. In these cases, obstacles to bile flow may be suggested by clear-cut variations in the diameter of the hepaticocholedoch and its deformity. The absence of suprastenotic dilatation may be partly explained by excessive metastatic liver involvement and malignant hepatoduodenal ligament infiltration. When suprastenotic dilatation is absent, instrumental palpation and diagnostic and therapeutic stenting may be used for the differential diagnosis of obstructive and hepatic jaundices." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Not a pa of firearm -" }, { "role": "assistant", "content": "The correct answer is The synopsis of forensic medicine & toxicology ; Dr k.s narayan reddy ; 28 edition ; Pg no. 122,124,125 Refer the diagrams ." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Anesthesiology, Anti-Bacterial Agents, Antibiotic Prophylaxis, Decision Support Systems, Clinical, Documentation, Drug Administration Schedule, Electronic Mail, Feedback, Psychological, Guideline Adherence, Humans, Medical Records Systems, Computerized, Online Systems, Practice Guidelines as Topic, Program Development, Program Evaluation, Reminder Systems, Surgical Procedures, Operative, Surgical Wound Infection, Time Factors, Washington." }, { "role": "user", "content": "Does feedback mechanisms including real-time electronic alert to achieve near 100 % timely prophylactic antibiotic administration in surgical cases? Context: Administration of prophylactic antibiotics during surgery is generally performed by the anesthesia providers. Timely antibiotic administration within the optimal time window before incision is critical for prevention of surgical site infections. However, this often becomes a difficult task for the anesthesia team during the busy part of a case when the patient is being anesthetized. Starting with the implementation of an anesthesia information management system (AIMS), we designed and implemented several feedback mechanisms to improve compliance of proper antibiotic delivery and documentation. This included generating e-mail feedback of missed documentation, distributing monthly summary reports, and generating real-time electronic alerts with a decision support system. In 20,974 surgical cases for the period, June 2008 to January 2010, the interventions of AIMS install, e-mail feedback, summary reports, and real-time alerts changed antibiotic compliance by -1.5%, 2.3%, 4.9%, and 9.3%, respectively, when compared with the baseline value of 90.0% ± 2.9% when paper anesthesia records were used. Highest antibiotic compliance was achieved when using real-time alerts. With real-time alerts, monthly compliance was >99% for every month between June 2009 and January 2010." }, { "role": "assistant", "content": "Installation of AIMS itself did not improve antibiotic compliance over that achieved with paper anesthesia records. However, real-time guidance and reminders through electronic messages generated by a computerized decision support system (Smart Anesthesia Messenger, or SAM) significantly improved compliance. With such a system a consistent compliance of >99% was achieved. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adolescent, Adult, Denmark, Depression, Female, Humans, Incidence, Leadership, Male, Middle Aged, Prospective Studies, Severity of Illness Index, Sick Leave, Social Support, Surveys and Questionnaires, Work, Workplace." }, { "role": "user", "content": "Do positive psychosocial work factors protect against 2-year incidence of long-term sickness absence among employees with and those without depressive symptoms? Context: This study sought to examine the influence of protective work factors on long-term sickness absence among employees reporting different levels of depressive symptoms in a representative sample of the Danish workforce. Questionnaire data were collected from a random sample of members of the Danish workforce aged between 18 and 64 years using information from two surveys with baselines in 2000 and 2005. From the year 2000 baseline, questionnaires from 5510 employees (2790 males and 2720 females) were included; from the 2005 baseline, questionnaires from 8393 employees (3931 males and 4462 females) were included. Baseline data were collected on depressive symptoms, leadership, colleague support, and decision latitude. Information on 2-year incidence of sickness absence was derived from an official register. Stratified analyses on depressive symptom scores (none, moderate, and severe) indicate that quality of leadership was associated with reduced sickness absence to a somewhat stronger degree for those with moderate depressive symptoms (adjusted hazard ratio=0.88, 95% confidence interval=0.78-0.98) than for those without depressive symptoms and that high decision latitude was associated with reduced sickness absence to a somewhat larger degree for those without depressive symptoms (adjusted hazard ratio=0.91, 95% CI=0.85-0.97) than for those with depressive symptoms. However, quality of leadership and decision latitude did not interact significantly with depressive symptom status." }, { "role": "assistant", "content": "Quality of leadership may protect against long-term sick leave to a certain degree in those with moderate depressive symptoms. Possible interactions between psychosocial working conditions and depression status should be investigated in larger populations." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: RATIONALE AND OBJECTIVES, MATERIALS AND METHODS, RESULTS. Meshes: Absorptiometry, Photon, Blood Vessel Prosthesis, Coronary Angiography, Coronary Artery Disease, Equipment Failure Analysis, Humans, Phantoms, Imaging, Radiographic Image Enhancement, Reproducibility of Results, Sensitivity and Specificity, Stents, Tomography, X-Ray Computed." }, { "role": "user", "content": "Is coronary stent assessment improved with spectral analysis of dual energy CT? Context: The aims of this study were to distinguish stents from iodinated contrast on the basis of spectral characteristics on dual-energy computed tomographic (DECT) imaging and to determine whether DECT imaging might provide a more accurate measurement of true stent lumen. Three stainless steel stents and one cobalt chromium stent were scanned using a multidetector, single-source DECT scanner. Stents 2.5, 3.5, and 4.0 mm in diameter were filled with iodinated contrast, submerged in water, and scanned. Spectral analysis was performed to assess the separation of stents from iodinated contrast. Two independent reviewers measured stent lumen diameter and strut thickness on low-energy (L(0)), high-energy (L(1)), and combined-energy (L(c)) images. Dual-energy full-width half-maximum edge detection analysis was used to provide an independent assessment of stent luminal diameter and strut thickness. Two-dimensional graphical plots of computed tomographic attenuation for the L(0) and L(1) images did not demonstrate a sharp separation between the absorption characteristics of stents and iodinated contrast material. Stent lumens were underestimated by approximately 50% on L(c) images. Observer measurements on L(1) images demonstrated a 24% decrease in strut thickness and a 25% increase in stent luminal diameter compared to L(0) images (P<.0001). Full-width half-maximum measurements did not demonstrate significant changes in stent luminal diameters or strut thicknesses between L(0) and L(1) images." }, { "role": "assistant", "content": "Spectral analysis did not clearly distinguish stents from iodinated contrast with the DECT system used in this study. The larger stent lumens visualized by the high-energy components of the x-ray spectrum were not related to improved computed tomographic delineation of stent thickness." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVES, METHODS, RESULTS. Meshes: Adolescent, Adult, Biomarkers, Chorionic Gonadotropin, beta Subunit, Human, Down Syndrome, Female, Humans, Middle Aged, Nuchal Translucency Measurement, Predictive Value of Tests, Pregnancy, Pregnancy Trimester, First, Pregnancy-Associated Plasma Protein-A, Prenatal Diagnosis, Risk Adjustment, Ultrasonography, Prenatal, Uterine Hemorrhage." }, { "role": "user", "content": "Does vaginal bleeding influence first-trimester markers for Down syndrome? Context: To examine the effect of early vaginal bleeding on first-trimester screening markers for Down syndrome. A retrospective study was conducted on 1755 normal singleton fetuses that underwent first-trimester combined screening for Down syndrome on the basis of ultrasound and maternal serum markers. Fetal delta-nuchal translucency (NT), maternal serum pregnancy-associated plasma protein A (PAPP-A) and free beta-hCG were compared between pregnancies with (n = 252) and without (n = 1503) an episode of vaginal bleeding. Subgroup analysis for the intensity of bleeding (spotting n = 191; light n = 32; heavy n = 29) was performed. The median +/- SD (log(10)) for delta-NT, multiple of medians (MoM) PAPP-A and MoM free beta-hCG (corrected for maternal weight, smoking and ethnicity) was - 0.17 +/- 0.62, 1.10 +/- 0.28, 1.1 +/- 0.28 and - 0.15 +/- 0.51, 0.98 +/- 0.26, 0.94 +/- 0.3 in pregnancies with and without a history of early vaginal bleeding, which were not significantly different. Exclusion of patients with spotting from the vaginal bleeding group revealed significantly higher maternal serum free beta-hCG MoM values (median +/- SD (log(10))) compared to patients without bleeding, 1.29 +/- 0.27 vs 0.96 +/- 0.3(p = 0.011). Screen-positive (cut off of 1:350) rate after combined first-trimester screening was 28.1% in patients with light vaginal bleeding and 8.4% in patients without bleeding (p = 0.001)." }, { "role": "assistant", "content": "Light vaginal bleeding before first-trimester combined screening for Down syndrome leads to a higher screen-positive rate after combined first trimester screening, without a significant difference in serum levels of the screening markers." } ]

[ { "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 periapical abscess of a mandibular second molar space spreads most commonly to the" }, { "role": "assistant", "content": "The correct answer is None" } ]

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

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All are endoscopic modalities of treatment of chronic radiation proctitis, EXCEPT:" }, { "role": "assistant", "content": "The correct answer is The goal of endoscopic treatments of CRP is to achieve hemostasis.Modalities are 1. Heater probe 2. Neodymium:yttrium-aluminium garnet (Nd:YAG) laser 3. Potassium titanyl phosphate (KTP) laser 4. Bipolar electrocoagulation Ref:World J Gastroenterol 2011 November 7; 17(41): 4554-4562." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Animals, Capsaicin, Hot Temperature, Hyperalgesia, Mice, Mice, Inbred BALB C, Mice, Knockout, Pain, Reaction Time, Receptors, Neurokinin-1." }, { "role": "user", "content": "Are neurokinin-1 receptors involved in behavioral responses to high-intensity heat stimuli and capsaicin-induced hyperalgesia in mice? Context: The neurokinin-1 (NK-1) receptor and its ligand, substance P, are thought to play important roles in nociception and hyperalgesia. This study evaluated the role of the NK-1 receptor in processing noxious stimuli in normal and inflammatory states. Behavioral responses to heat and mechanical and chemical stimuli were studied in NK-1 receptor knockout mice and wild-type control mice. Thermal nociception was evaluated by measuring paw lick or jump latencies to hot plate (52, 55, and 58 degrees C) and paw withdrawal latencies to radiant heat applied to the hind paws. Mechanical nociception was measured by von Frey monofilament applications to the hind paws. Intraplantar capsaicin-induced (10 microg/20 microl) paw licking and mechanical and heat hyperalgesia were compared in NK-1 knockout and wild-type mice. Withdrawal responses to radiant heat (4.3+/-0.18 s for knockout and 4.4+/-0.8 s for wild-type mice) and von Frey monofilaments were similar in knockout and wild-type mice. In the hot plate test, increasing the hot plate temperature from 52 degrees C to 58 degrees C resulted in a decrease in the response latency in the wild-type mice (30.4+/-17.5 s to 15.2+/-6.8 s, P < 0.05), whereas in the knockout mice the response latencies remained constant (28.2+/-19.8 s to 29+/-15.1 s, not significant). Capsaicin-induced paw licking (14.5+/-12.8 s for knockout and 41.3+/-37.3 s for wild-type mice, P < 0.05) and mechanical and heat hyperalgesia were attenuated in the knockout mice." }, { "role": "assistant", "content": "NK-1 receptors contribute to the withdrawal responses to high-intensity heat stimuli and to capsaicin-induced mechanical and heat hyperalgesia. 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 bone bruise or contusion is best identified using: COMEDK 14" }, { "role": "assistant", "content": "The correct answer is Ans. MRI scan" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Comorbidity, Death, Sudden, Cardiac, Defibrillators, Implantable, Electric Countershock, Female, Heart Failure, Humans, Incidence, Italy, Male, Retrospective Studies, Risk Assessment, Survival Rate, Tachycardia, Ventricular, Treatment Outcome." }, { "role": "user", "content": "Is the association between ICD interventions and mortality independent of their modality : clinical implications? Context: Patients with severe structural heart disease have increased mortality after implantable cardioverter-defibrillator (ICD) shocks. Whether this is limited to ICD shock therapy only or extends also to no-shock therapies, such as antitachycardia pacing (ATP), is unclear. We investigated the impact of different ICD therapies on long-term mortality. We enrolled 573 patients who underwent ICD implantation at our institution from 2004 to 2011. The population was divided into 3 groups: no device interventions (group 1), ATP interventions (group 2), and shock interventions (group 3). The endpoint was the all-cause mortality. Over a follow-up period of 48 months (range 1-110), 447 (78%) had no device interventions, 71 (12%) had ATP therapy only, and 55 (10%) had at least one shock intervention. All-cause mortality occurred in 94 patients in group 1 (21%), 23 patients (43%) in group 2, and 21 patients (38%) in group 3. At multivariable Cox regression analysis, ATP intervention (HR: 1.8; 95% CI 1.1-3; P < 0.001), shock intervention (HR: 1.39; 95% CI 1.09-1.77; P = 0.008), age (HR: 1.05; 95% CI 1.02-1.07; P < 0.001), and LVEF (HR: 0.95; 95% CI 0.93-0.98; P = 0.001) were predictors of all-cause mortality. No significant difference in mortality was found between group 2 and 3." }, { "role": "assistant", "content": "Patients with ICDs who receive appropriate interventions are at increased risk of mortality. Such risk is not dependent on different types of ICD therapy, such as shocks or ATP. Our data suggest that sustained ventricular arrhythmias per se have a negative impact on prognosis rather than modality of ICD therapy. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "The latest drug of the choice in the management in trigeminal neuralgia 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": "Essential pentosuria can occur due to deficiency in metabolic pathway of" }, { "role": "assistant", "content": "The correct answer is Ans. a (Uronic acid) (Ref. Harper's Biochemistry-26th/pg. 105, 163, 170; 27th/pg. 177)Glucuronic acid is synthesized from glucose via the uronic acid pathway, of major significance for the excretion of metabolites and foreign chemicals (xenobiotics) as glucuronides. A deficiency in the pathway leads to essential pentosuria. Considerable quantities of L-xylulose appear in the urine because of absence of the enzyme necessary to reduce L-xylulose to xylitol. Parenteral administration of xylitol may lead to oxalosis, involving calcium oxalate deposition in brain and kidneys.URONIC ACID PATHWAY# In liver, uronic acid pathway catalyzes conversion of glucose to glucuronic acid, ascorbic acid, & pentoses.# It is also an alternative oxidative pathway for glucose, but--like the pentose phosphate pathway--it does not lead to the generation of ATP.# Glucose 6-phosphate is isomerized to glucose 1-phosphate, which then reacts with uridine triphosphate (UTP) to form uridine diphosphate glucose (UDPGlc) in a reaction catalyzed by UDPGlc pyrophosphorylase, as occurs in glycogen synthesis. UDPGlc is oxidized at carbon 6 by NAD-dependent UDPGlc dehydrogenase in a two-step reaction to yield UDP-glucuronate.Deficiencies in the enzymes of fructose and galactose metabolism lead to essential fructosuria and the galactosemias." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, AUCROC. Meshes: Aged, Asian Continental Ancestry Group, Creatinine, Cross-Sectional Studies, Cystatin C, Female, Glomerular Filtration Rate, Humans, Male, Mathematics." }, { "role": "user", "content": "Are cystatin C-based equations superior to creatinine-based equations for estimating GFR in Chinese elderly population? Context: Cystatin C has been proposed as a surrogate marker of kidney function. The elderly population accounts for the largest proportion of chronic kidney disease (CKD) patients. The aim of this study was to assess the diagnostic value of serum cystatin C and compare the applicability of cystatin C-based equations with serum creatinine (Scr)-based equations for estimating glomerular filtration rate (GFR). The estimated GFR (eGFR) values from six cystatin C-based equations (Tan, MacIsaac, Ma, Stevens1-3) and three Scr-based equations (CG, MDRD, CKD-EPI) were compared with the reference GFR (rGFR) values from 99mTc-DTPA renal dynamic imaging method. A total of 110 elderly Chinese (60-92 year, 71.05±7.62 year) were enrolled. Cystatin C had better diagnostic value than Scr (relationship coefficient with rGFR: cystatin C -0.847 vs. Scr -0.729, P<0.01; sensitivity: cystatin C 0.90 vs. Scr 0.55, P<0.01; cystatin C 0.857 vs. Scr 0.757, P<0.01). All the equations predicted GFR more accurately for rGFR≥60 ml/min/1.73 m2 than for rGFR<60 ml/min/1.73 m2. Most equations had acceptable accuracy. The cystatin C-based equations deviated from rGFR by -12.78 ml/min/1.73 m2 to -2.12 ml/min/1.73 m2, with accuracy varying from 64.6 to 82.7%. The Scr-based equations deviated from rGFR by -5.37 ml/min/1.73 m2 to -0.68 ml/min/1.73 m2, with accuracy varying from 77.3 to 79.1%. The CKD-EPI, MacIsaac and Ma equations predicted no bias with rGFR (P>0.05), with higher accuracy and lower deviation in the total group. The MacIsaac, CKD-EPI and Stevens3 equations could be optimal for those with normal and mildly impaired kidney function, whereas the Ma equation for those with CKD." }, { "role": "assistant", "content": "Cystatin C is a promising kidney function marker. However, not all cystatin C-based equations could be superior to the Scr-equations." } ]

[ { "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 average blood loss in ankylostomiasis per worm is -" }, { "role": "assistant", "content": "The correct answer is A duodenale ingests 0.15 -0.25 ml/ day. They also secrete anticoagulants at the site of attachment so that bleeding from these sites continue. Ref : panikers textbook of Medical parasitology 8th edition page 191" } ]

[ { "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": "Golden period of eye donation -" }, { "role": "assistant", "content": "The correct answer is The donor eyes should be removed as early aspossible (within 6 hours of death) and should bestored under sterile conditions. REF:Comprehensive ophthalmology,AK Khurana,4th edition,pg no.509." } ]

[ { "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": "Coliform test is for -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'b' i.e., Water Contomination Bacteriological indicators of w ater contaminationo Presence of following organism indicate fecal contamination of water.Coliform : by all practical point of view it is assumed that all coliform are fecal in origin unless a non-fecal origin can be proved.Fecal streptococci or enterococci :They regularly occur in feces. Finding of fecal streptococci in water is regarded as important confirmatory evidence of recent fecal contamination water.Clostridium perfringens: They also regularly occur in feces. Presence of spore of Cl. perfringens and absence of coliform group indicate remote contamination of water." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: PURPOSE, METHODS, RESULTS. Meshes: Adult, Case-Control Studies, Female, Humans, Middle Aged, Odds Ratio, Pregnancy, Premature Birth, Sleep Disorders, Intrinsic." }, { "role": "user", "content": "Disturbed sleep and preterm birth: a potential relationship? Context: Many women report disturbed sleep during pregnancy, but its impact on clinical outcomes remains unknown. This study examined subjective sleep quality and daytime sleepiness in relation to preterm birth. A convenience sample of 220 pregnant women completed the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Perceived Stress Scale (PSS) during the second trimester. Women who had preterm and full-term births were compared on these measures. The preterm birth rate of the sample was 14.6%. Sleep latency, the period from lights out to sleep onset, was significantly longer in the preterm group, which also reported a tendency to use more sleep medications, but had lower PSQI daytime dysfunction scores. Perceived stress did not differentiate preterm and full-term groups." }, { "role": "assistant", "content": "Disturbed sleep in pregnancy may be associated with preterm birth. Future studies should examine specific physiological factors that underlie this increased vulnerability." } ]

[ { "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 injury to the shown area can lead to fracture of which bone (FMGE June 2019)" }, { "role": "assistant", "content": "The correct answer is Anatomical snuff box: The given picture shows anatomical snuff box which is a depression formed at the posterolateral side of the wrist and metacarpal by the extensor tendons passing into the thumb. Base of the triangle is at the wrist and apex is directed into thumb. It is most apparent when thumb is extended. Boundaries: Lateral: Abductor pollicis longus and extensor pollicis brevis tendons. Medial :Extensor pollicis longus tendon Floor: Scaphoid and trapezium the distal ends of the tendons of the extensor carpi radialis longus and extensor carpi radialis brevis Scaphoid Fracture: The commonest carpal injury is a fracture across the waist of the scaphoid bone . It is uncommon to see other injuries. In approximately 10% of individuals, the scaphoid bone has a sole blood supply from the radial aery, which enters through the distal poion of the bone to supply the proximal poion. When a fracture occurs across the waist of the scaphoid, the proximal poion therefore undergoes avascular necrosis." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Aged, Cystadenocarcinoma, Serous, Female, Gene Expression Regulation, Neoplastic, High-Throughput Nucleotide Sequencing, Humans, Immunohistochemistry, In Situ Hybridization, Fluorescence, MAP Kinase Signaling System, Middle Aged, Molecular Targeted Therapy, Mutation, Ovarian Neoplasms, Phosphatidylinositol 3-Kinases, Receptor, ErbB-2, Retrospective Studies, TOR Serine-Threonine Kinases, Transcriptome, Uterine Neoplasms." }, { "role": "user", "content": "Is alteration in PI3K/mTOR , MAPK pathways and Her2 expression/amplification more frequent in uterine serous carcinoma than ovarian serous carcinoma? Context: To compare the molecular profile of a large cohort of uterine papillary serous carcinoma (UPSC) and ovarian serous carcinoma (EOC-S). 628 UPSC and 5335 EOC-S tumors were evaluated using a commercial multiplatform profiling service (CARIS Life Sciences, Phoenix, AZ). Specific testing performed included a combination of gene sequencing (Sanger, next generation sequencing), protein expression (IHC) and gene amplification (CISH or FISH). TP53 was the most commonly mutated gene in both UPSC and EOC-S (76% vs. 69%, P = 0.03). UPSC were more likely to have mutation in PIK3CA (29% vs. 2%, P < 0.001), FBXW7 (12% vs. 1%, P < 0.001), KRAS (9% vs. 5%, P < 0.001) PTEN (7% vs. 1%, P < 0.001), and CTNNB1 (2% vs. 0%, P < 0.001) compared to EOC-S. On the other hand, EOC-S were more likely to harbor mutation in BRCA1 (20% vs. 9% P = 0.17) and BRCA2 (18% vs. 6% P = 0.09). HER2 gene amplification (17% vs. 4%, P < 0.001) and Her2/neu expression (10% vs. 2%, P < 0.001) were more frequent in UPSC than EOC-S, respectively." }, { "role": "assistant", "content": "UPSC have a distinct mutation profile indicating higher activity of PI3K/AKT/mTOR, and MAPK pathways and Her2 expression/amplification but a trend toward lower frequency of alteration in homologous recombination pathway compared to EOC-S. Targeted PI3K/AKT/mTOR inhibitors should be evaluated in UPSC. 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 six-year-old boy presents to the emergency department with a painful limp. Clinical examination reveals tenderness in the femoral triangle and some limitation of hip movements. An X-ray was done which was normal. Which of the following should be the next course of action?" }, { "role": "assistant", "content": "The correct answer is Some of the guides have given option (MRI scan) as the answer by stating that this is a case of Perthe's disease. I do not agree with them.\nTwo most common causes of limp in a child between 4-10 years are :-\n\n\nTransient synovitis of hip\nPerthe's disease\n\n\nThe child in question has painful limp, tenderness in the femoral triangle and limitation of hip movement with normal X-ray. All of these can occur in both transient synovitis of hip and early stage of perthe's disease. However, the most favourable diagnosis here is transient synovitis because :-\n\n\n\nTransient synovitis of hip is the most common cause of painful limp in a child between 4-10 years.\nX-rays of transient synovitis are typically normal; however they may reveal subtle changes (widening of joint space). On the other hand x-rays are normal only in the initial stage of Perthe's; most of the time when patients present, the x-ray changes are there.\nChild with perthe's disease may present with painful limp, but maximum patients present when pain has subsided and only limp is there, i.e. painless limp (in chronic stage).\n\n\nTherefore, most probable diagnosis here is transient synovitis and management includes observation, bed rest and NSAIDs.\nAnd this is the protocol, which is followed in most of the hospitals. In a suspected case of transient synovitis, we give conservative treatment, i.e. bed rest, NSAIDs and observation. If the child does not improve in 3-5 days, then we think of further investigation.\nSo, according to me option 'a' is the best answer here. You can choose your answer according to your thought process." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: 2-Pyridinylmethylsulfinylbenzimidazoles, Adolescent, Adult, Aged, Aged, 80 and over, Anti-Ulcer Agents, Benzimidazoles, Costs and Cost Analysis, Drug Prescriptions, Drug Utilization Review, Female, Humans, Injections, Intravenous, Male, Middle Aged, Omeprazole, Peptic Ulcer Hemorrhage, Prospective Studies, Proton Pump Inhibitors, Sulfoxides, United States." }, { "role": "user", "content": "Use of intravenous proton pump inhibitors in community practice: an explanation for the shortage? Context: Since 2001, one intravenous proton pump inhibitor (pantoprazole) has been available in the United States. A drug shortage bulletin was issued for this agent in 2003.AIM: To evaluate the patterns of use of intravenous proton pump inhibitors (IV PPIs) in routine clinical practice. Prospective evaluation of IV PPI use in two community-based teaching hospitals. A computerized pharmacy ordering system was used to identify all patients for whom an IV PPI was ordered. Trained investigators obtained clinical data from patient records and these data were mapped to establish clinical criteria for the use of IV PPIs. Intravenous PPIs were prescribed in 238 patients over a 30-day period and a total of 1,631 doses were prescribed. Primary care providers prescribed 46% of prescriptions. Fifty-six percent of patients who received IV PPIs had no acceptable indication for their use. Of the 126 (81%) patients who were started on PPIs for the first time during their hospital stay, 102 were discharged on a PPI." }, { "role": "assistant", "content": "Intravenous PPIs are widely used for poor indications, which may contribute to the shortage of these agents." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, MATERIAL AND METHODS, RESULTS. Meshes: Adult, Age Factors, Female, Functional Laterality, Humans, Maternal Age, Pregnancy, Pregnancy Trimester, First, Pregnancy, Tubal, Young Adult." }, { "role": "user", "content": "Is there a relationship between age and side dominance of tubal ectopic pregnancies? Context: To determine whether there exists a relationship between age and side dominance of tubal ectopic pregnancies. One hundred twenty patients were retrospectively analyzed. The sides of the tubal ectopic pregnancies were recorded on the basis of laparoscopy or laparotomy findings. Five age groups were created: 20-24, 25-29, 30-34, 35-39, and>or = 40 years. Of the patients who were>30 years of age, 46 (69%) and 21 (31%) had tubal ectopic pregnancies on the right and left sides, respectively (p = 0.002). In the 35-39 years of age group, 17 of 20 patients (85%) had tubal ectopic pregnancies on the right, and 3 of 20 patients (15%) on the left side (p = 0.002). In the 30-34 years of age group, 26 of 39 patients (67%) and 13 of 39 patients (33%) had tubal ectopic pregnancies on the right and left sides, respectively (p = 0.037). In the>or = 40 years of age group, 3 of 8 patients (37%) had tubal ectopic pregnancy on the right side, while 5 patients (63%) on the left side (p = 0.48)." }, { "role": "assistant", "content": "Patients who are between the age of 30-40 years have a right-sided dominance of tubal ectopic pregnancy however studies that involve larger numbers of subjects are needed to make definitive conclusions about women older than 40 years of age." } ]

[ { "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 cross-sectional oral health survey was designed to assess both functional and psychosocial effects of dental disease on the elderly population of Buda, Texas (US). Printed surveys that consisted of 50 open-ended questions on dental disease history and dental hygiene were mailed to the selected members of a target population. However, the response rate was not satisfactory, as a large percentage of the selected study participants either did not return the survey or failed to answer all of the questions posed. The researchers opted for 2 strategies: prompt those who did not respond with a second letter that guaranteed complete confidentiality and broaden the pool of selected participants. Depending on the final response rate and the researchers’ statistical skills, the bias in the final publication will be more pronounced if...?" }, { "role": "assistant", "content": "...the difference between the observed and nonrespondent answers is increased." } ]

[ { "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": "Cystic fibrosis is associated with all except ?" }, { "role": "assistant", "content": "The correct answer is Ans. is d i.e., Renal failure o Thick viscid plugs of mucus may also be found in the small intestine of infants. Sometimes these cause small-bowel obstruction, known as meconium ileus. o Chronic sinopulmonary disease manifested by : Persistent colonization/infection with typical cystic fibrosis pathogens, including Staphylococcus aureus, non typeable Hemophilus influenzae, mucoid and nonmucoid Pseudomonas aeruginosa, Burkholderia cepacia; Chronic cough and sputum production, nasal polyps. o Azoospermia and infeility are found in 95% of the males who survive to adulthood; congenital bilateral absence of the vas deferens is a frequent finding in these 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, METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Chronic Disease, Dendritic Cells, Female, Flow Cytometry, Humans, Immunohistochemistry, Male, Middle Aged, Nasal Polyps, Real-Time Polymerase Chain Reaction, Rhinitis, Sinusitis, Young Adult." }, { "role": "user", "content": "Is the expression of dendritic cell subsets in severe chronic rhinosinusitis with nasal polyps altered? Context: Chronic rhinosinusitis with nasal polyps (CRSwNP) is characterized as a Th2-driven disease. Activated dendritic cells (DCs) are the main T-cell activators; their role in the chronic inflammatory process of nasal polyposis is still unclear. The regulation of DC subsets was analyzed in nasal polyp tissue from CRSwNP patients and compared to inferior turbinate tissue from healthy subjects. Tissue localization and expression of both plasmacytoid and myeloid DCs were assayed by means of immunohistochemistry and flow cytometry. Plasmacytoid DCs were also assayed by PCR, and tissue homogenates were assayed for various inflammatory markers. The number of plasmacytoid (pDCs) and myeloid (mDCs) dendritic cells was significantly increased in nasal polyp tissue when compared to non-inflamed nasal mucosa. The number of pDCs, but not mDCs, was down-regulated in more severe cases (nasal polyps with asthma) and varied with the cytokine milieu. The amount of pDCs was significantly decreased in IL5+IFNγ - nasal polyp tissue compared to tissues with high IFNγ levels (IL5+IFNγ+). Furthermore, levels of indoleamine 2,3-dioxygenase were increased in nasal polyp compared to inferior turbinate tissue and correlated negatively with the number of pDCs." }, { "role": "assistant", "content": "There is an altered balance of pDC and mDC numbers in nasal polyp tissue. pDCs seem to be more susceptible to an inflammatory cytokine milieu and may play a crucial role in disease severity. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, RESULTS. Meshes: Animals, Cardiac Output, Cardiography, Impedance, Dextrans, Disease Models, Animal, Extravascular Lung Water, Heart Failure, Hemodynamics, Norepinephrine, Pulmonary Edema, Pulmonary Wedge Pressure, Regression Analysis, Sensitivity and Specificity, Sheep, Telemedicine." }, { "role": "user", "content": "Is device-based impedance measurement a useful and accurate tool for direct assessment of intrathoracic fluid accumulation in heart failure? Context: Heart failure patients are often equipped with implanted devices and are frequently hospitalized due to volume overload. Reliable prediction of imminent fluid congestion has the potential to provide early detection of cardiac decompensation and therefore might be capable of enhancing therapy management. We investigated whether implant-based impedance (Z) measurement is closely correlated with directly assessed extravascular lung water and might thus be useful for patient monitoring. In sheep, pulmonary fluid congestion was induced. Continuous haemodynamic monitoring was performed and extravascular lung water index (EVLWI) assessed. An implanted device with a right ventricular lead measured Z using different electrode configurations. All animals developed gradual pulmonary fluid accumulation leading to inclining lung oedema: EVLWI did increase from 9.5 +/- 1 to 21.1 +/- 5.1 mL/kg (+127%). A concomitant decrease of Z by up to 23%, depending on the electrode configuration, was observed and regression analysis between Z and EVLWI yielded a significant inverse correlation." }, { "role": "assistant", "content": "Changes of Z show a strong inverse correlation with changes of directly measured EVLWI. This allows the application of Z as a measure of intrathoracic fluid status and has the potential to optimize patient care, especially in the context of evolving telemedicine concepts. 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 a vehicular injury is not caused by direct contact of vehicle ?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'c' i.e., Secondary injury Pedestrian injuries Following patterns of injuries are seen :? 1) Primary impact injuries : It is caused due to initial impact between vehicle and pedestrian. The height of the pedestrian often determines the site of impact and injuries, for example, they are usually found on head in children and on the trunk and legs in adults. Overall, the most common site is leg (85%), followed by head (50-80%) > arms > pelvis > chest or abdomen > neck and spine. 2) Secondary impact injuries : These are due to subsequent impact with the same vehicle, as may result from being lifted on to the vehicle after the initial impact:- Secondary impact injuries are also usually seen on the same side as the primary impact injuries (side facing the vehicle) when the body is thrown on the vehicle although they may be seen on other surfaces such as during ran over injuries. If the initial impact was below the centre of gravity (as occurs in adult and older child), it tends to lift the victim up onto bonnet/hood of vehicle (scooping up) or even on road behind the vehicle and cause severe head injuries, laceration (due to secondary impact or contact with windshield) and run over by passing vehicle. If the initial point of impact was at or above the centre of gravity (as occurs in children), he is directly thrown to ground (due to primary impact) and is run over by same car with consequent secondary impact under carriage injuries which may include burns from hot exhaust pipe and stains from grease oil etc. 3) Secondary injuries : These are caused by person violently falling on ground or on stationary object. These are found on pas opposite to primary impact or on head. Injuries due to contact with ground include abrasion and bruises over the face, hand, hips and legs, and laceration over the bony prominences. 4) Rolling/Runover (degloving injuries) : Caused by wheel of vehicle or rolling over the victim. Children are oftenly involved." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Abatacept, Adolescent, Adult, Age of Onset, Alleles, Antigens, CD, Antigens, Differentiation, Autoantibodies, C-Peptide, CTLA-4 Antigen, Child, Child, Preschool, Diabetes Mellitus, Type 1, European Continental Ancestry Group, Exons, Female, Glutamate Decarboxylase, HLA-DQ Antigens, HLA-DQ beta-Chains, HLA-DR Antigens, HLA-DRB1 Chains, Humans, Immunoconjugates, Infant, Islets of Langerhans, Isoenzymes, Italy, Male, Risk Factors." }, { "role": "user", "content": "Autoantibody negative new onset type 1 diabetic patients lacking high risk HLA alleles in a caucasian population: are these type 1b diabetes cases? Context: In Caucasians, a small number of Type 1 diabetic patients do not show evidence of humoral islet autoimmunity at disease onset, at least with common screening procedures. In African- and Hispanic-American diabetic children at time of diagnosis, many show no evidence of autoimmunity but have an atypical clinical form of the disease. According to the recent American Diabetes Association classification, this subgroup of autoantibody negative patients is referred to as Type 1b diabetic subjects. In the present study, a homogeneous Caucasian Type 1 diabetic clinic-based cohort has been evaluated at diagnosis using a large panel of diabetes-related antibodies and then characterized for various genetic features in order to identify newly diagnosed Type 1 diabetics who are potentially autoantibody negative, i.e. possibly referrable to as idiopathic Type 1b diabetes. Newly diagnosed Type 1 diabetic patients of Italian origin (n=141, mean age 12.0+/-7.6 years) were tested for anti-islet cell, anti-insulin, anti-65 kDa isoform of glutamic acid decarboxylase and anti-amino acid residues 256-979 of the tyrosine-phosphatase IA-2 molecule autoantibodies (Step 1). Only those patients found to be autoantibody negative were tested for anti-disialo-ganglioside GD3, anti-thyroid peroxidase, anti-thyroglobulin, anti-21-OH hydroxylase, anti-gastric parietal cell and anti-transglutaminase antibodies (Step 2). Sera negative for the presence of these six autoantibodies as well were characterized in terms of HLA DRB1, DQB1 and CTLA-4. Six out of 141 subjects (3.5%) were autoantibody negative in the first step of the study and five out of six in the second. These five autoantibody negative patients underwent genetic analysis. Three of them had at least one Type 1 diabetes-related high risk HLA haplotype (3/141, 2.1%) while the remaining two cases showed neutral (DR5-DQB1*0301/DR5-DQB1*0301) or strongly protective (DR2-DQB1*0602/DR2-DQB1*0602) HLA genotypes, respectively (2/141, 1. 4%)." }, { "role": "assistant", "content": "Clinically defined Type 1 diabetic patients with no sign of autoimmunity do exist in a Caucasian population. These patients (2 out of 141) that cannot be classified as Type 1a diabetic patients lack clinical characteristics of Type 1b diabetes and have to be reconsidered for a more appropriate ADA classification. These data suggest the need of further large population-based studies to understand if Type 1b diabetes really occurs in a Caucasian population. The patient with a strongly protective HLA genotype is particularly interesting considering that among Caucasians only a few sporadic cases with Type 1 diabetes and DQB1*0602, have been reported, none of whom was homozygous at DQB1 locus." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Adipose Tissue, Blood Glucose, Body Water, Fatty Liver, Female, Hepatitis, Humans, Hypoglycemic Agents, Male, Middle Aged, Pioglitazone, Thiazolidinediones, Weight Gain." }, { "role": "user", "content": "Does pioglitazone treatment increase whole body fat but not total body water in patients with non-alcoholic steatohepatitis? Context: Non-Alcoholic Steatohepatitis (NASH) is a chronic liver disease frequently associated with insulin resistance and type 2 diabetes mellitus (T2DM). Pioglitazone reverses the metabolic and histological abnormalities of patients with impaired glucose tolerance or T2DM and NASH, but also leads to weight gain. To understand the nature of weight gain associated with pioglitazone treatment in NASH we analyzed 35 patients who completed tests for determination of whole body fat (WBF) and total body water (TBW). Twenty-one patients received pioglitazone and 14 placebo in a double-blind, randomized fashion for a period of 6 months. WBF and TBW were measured before and after treatment using DXA, a water dilution technique and bioimpedance. Pioglitazone increased body weight (from 93.6+/-4.2 to 96.1+/-4.5 kg, p<0.003) and WBF measured with DXA (from 32.9+/-2.1 to 35.4+/-2.5 kg, p<0.002) while no changes were seen with placebo. Total body water was not altered significantly either after pioglitazone (from 45.4+/-2.3 to 45.6+/-2.7 l, p=NS) or placebo. Muscle hydration and extracellular water were unchanged both by pioglitazone and placebo treatments." }, { "role": "assistant", "content": "Six months of pioglitazone treatment in patients with NASH is associated with weight gain that is attributable to an increase in adipose tissue mass and not to water retention. 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: Adaptor Proteins, Signal Transducing, Antineoplastic Agents, Autophagy, Caspase 8, Cell Line, Tumor, Cell Survival, Drug Resistance, Neoplasm, Flow Cytometry, Humans, Immunoblotting, Immunohistochemistry, Male, Microscopy, Confocal, Microscopy, Electron, Transmission, Prostatic Neoplasms, Sequestosome-1 Protein, TNF-Related Apoptosis-Inducing Ligand, Tissue Array Analysis." }, { "role": "user", "content": "Does autophagic flux determine cell death and survival in response to Apo2L/TRAIL ( dulanermin )? Context: Macroautophagy is a catabolic process that can mediate cell death or survival. Apo2 ligand (Apo2L)/tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) treatment (TR) is known to induce autophagy. Here we investigated whether SQSTM1/p62 (p62) overexpression, as a marker of autophagic flux, was related to aggressiveness of human prostate cancer (PCa) and whether autophagy regulated the treatment response in sensitive but not resistant PCa cell lines. Immunostaining and immunoblotting analyses of the autophagic markers p62 [in PCa tissue microarrays (TMAs) and PCa cell lines] and LC3 (in PCa cell lines), transmission electron microscopy, and GFP-mCherry-LC3 were used to study autophagy induction and flux. The effect of autophagy inhibition using pharmacologic (3-methyladenine and chloroquine) and genetic [(short hairpin (sh)-mediated knock-down of ATG7 and LAMP2) and small interfering (si)RNA-mediated BECN1 knock-down] approaches on TR-induced cell death was assessed by clonogenic survival, sub-G1 DNA content, and annexinV/PI staining by flow cytometry. Caspase-8 activation was determined by immunoblotting. We found that increased cytoplasmic expression of p62 was associated with high-grade PCa, indicating that autophagy signaling might be important for survival in high-grade tumors. TR-resistant cells exhibited high autophagic flux, with more efficient clearance of p62-aggregates in four TR-resistant PCa cell lines: C4-2, LNCaP, DU145, and CWRv22.1. In contrast, autophagic flux was low in TR-sensitive PC3 cells, leading to accumulation of p62-aggregates. Pharmacologic (chloroquine or 3-methyladenine) and genetic (shATG7 or shLAMP2) inhibition of autophagy led to cell death in TR-resistant C4-2 cells. shATG7-expressing PC3 cells, were less sensitive to TR-induced cell death whereas those shLAMP2-expressing were as sensitive as shControl-expressing PC3 cells. Inhibition of autophagic flux using chloroquine prevented clearance of p62 aggregates, leading to caspase-8 activation and cell death in C4-2 cells. In PC3 cells, inhibition of autophagy induction prevented p62 accumulation and hence caspase-8 activation." }, { "role": "assistant", "content": "We show that p62 overexpression correlates with advanced stage human PCa. Pharmacologic and genetic inhibition of autophagy in PCa cell lines indicate that autophagic flux can determine the cellular response to TR by regulating caspase-8 activation. Thus, combining various autophagic inhibitors may have a differential impact on TR-induced cell death. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Autophagosomes, Autophagy, Becaplermin, Benzofurans, Cell Cycle, Cell Proliferation, Cells, Cultured, Male, Muscle, Smooth, Vascular, Myocytes, Smooth Muscle, Oxadiazoles, Proto-Oncogene Proteins c-sis, Rats, Triazoles, beta Catenin." }, { "role": "user", "content": "Does dl-3-n-butylphthalide suppress PDGF-BB-stimulated vascular smooth muscle cells proliferation via induction of autophagy? Context: Vascular smooth muscle cells (VSMCs) played an important role in vascular remodeling. dl-3-n-butylphthalide (NBP) was extracted as a pure component from seeds of Apium graveolens Linn (Chinese celery) for protecting neurons activity, but the role of NBP on VSMCs was not clearly clarified. Cell proliferation was measured by MTS and flow cytometry. Western blot analysis and transmission electron microscopy were performed to analyze the relative protein expression and autophagosome. Moreover, the autophagic inhibitor and β-catenin inhibitor were used to evaluate the effects of NBP on autophagy and the function of β-catenin on cell proliferation respectively. NBP significantly suppressed platelet derived growth factor-BB (PDGF-BB)-stimulated VSMC proliferation, and the inhibitory effects of NBP on proliferation were caused by inducing autophagy. In addition, the inhibitory effects of NBP on proliferation were associated with the β-catenin signaling pathway. Moreover, β-catenin overexpression reversed the induction effect of NBP on autophagy and the β-catenin inhibitor JW74 enhanced these effects." }, { "role": "assistant", "content": "Our findings demonstrated that NBP protected VSMC from PDGF-BB-stimulated proliferation by inducing autophagy through suppression of the β-catenin signaling pathway, confirming the induction of autophagy might be a therapeutic strategy for use in the proliferative cardiovascular 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, RESULTS. Meshes: Colitis, Ulcerative, Cytokines, Escherichia coli, Gene Expression Regulation, Humans, Inflammation, Interferon-beta, Leukocytes, Macrophages, Monocytes, Oligonucleotide Array Sequence Analysis, Toll-Like Receptor 4, Toll-Like Receptors, Transcription, Genetic, Treatment Outcome." }, { "role": "user", "content": "Is delayed resolution of acute inflammation in ulcerative colitis associated with elevated cytokine release downstream of TLR4? Context: Ulcerative colitis (UC) is widely viewed as a leukocyte-mediated disorder. Although strong evidence implicates an exuberant response to microbial components in its pathogenesis, no intrinsic immune defect has been identified and the underlying pathogenic mechanisms remain obscure. The acute immune response to bacterial injection was determined in UC patients with quiescent disease and directly compared to healthy control subjects. Monocyte-derived macrophages were used to investigate bacterial recognition mechanisms in vitro. An exuberant and protracted acute inflammatory response to bacteria was evident in patients with UC, which coincides with increased systemic levels of CXCL10. Macrophages stimulated with bacteria and Toll-like receptor (TLR) ligands revealed a specific defect in the TLR4 response in UC. The defect resulted in the over-expression of a number of pro-inflammatory molecules under transcriptional control of the adaptor TIR-domain containing adaptor inducing interferon-beta (TRIF)." }, { "role": "assistant", "content": "These findings highlight a dysregulated innate immune response with over-expression of molecules associated with leukocyte recruitment and activation that may eventuate in the hallmark chronic immune-mediated inflammation of UC. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: METHODS, RESULTS. Meshes: Adolescent, Adult, Cardiac Surgical Procedures, Echocardiography, Transesophageal, Female, Heart Septal Defects, Ventricular, Hemodynamics, Humans, Male, Postoperative Complications, Reoperation, Risk, Suture Techniques, Treatment Outcome." }, { "role": "user", "content": "Does direct visualization of peripatch areas in beating heart eliminate the risk of residual ventricular septal defect in adult patients? Context: In 87 patients who were operated because of isolated VSD (Group I), VSD was closed under cardioplegic arrest and right atriotomy or right ventriculotomy were closed in the beating heart after aortic cross-clamp removal. The VSD patch was watched out for residual shunt and additional sutures were placed if it existed. Results of this technique have been compared with the other 216 (Group II) in which all procedures of the VSD closure were performed under cardioplegic arrest. Transosephageal echocardiography (TEE) was performed for evidence of residual shunting intraoperatively and postoperatively in all patients. In group I, additional sutures were placed for residual shunt in 14 patients (16.1%), and insignificant residual shunt was detected in only one (1.1%) patient at early postoperative period (p<0.05, according to group II). In group II, there was hemodynamically insignificant residual shunt in 31 patients (14.5%), and 9 patients (4.2%) were reoperated for significant shunt (p<0.05)." }, { "role": "assistant", "content": "Transatrial or transventricular inspection to peripatch areas in the beating heart is a safe technique to detect a residual shunt, an observation that may eliminate reoperation." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Aged, Animals, Arginine, Arterial Pressure, Biomarkers, Female, Humans, Hypertension, Pulmonary, Indoleamine-Pyrrole 2,3,-Dioxygenase, Male, Mice, Middle Aged, Nitric Oxide, Pulmonary Circulation, Purines, Reproducibility of Results, Statistics as Topic, Tricarboxylic Acids, Vascular Resistance, Ventricular Dysfunction, Right." }, { "role": "user", "content": "Does metabolic Profiling of Right Ventricular-Pulmonary Vascular Function reveal Circulating Biomarkers of Pulmonary Hypertension? Context: Pulmonary hypertension and associated right ventricular (RV) dysfunction are important determinants of morbidity and mortality, which are optimally characterized by invasive hemodynamic measurements. This study sought to determine whether metabolite profiling could identify plasma signatures of right ventricular-pulmonary vascular (RV-PV) dysfunction. We measured plasma concentrations of 105 metabolites using targeted mass spectrometry in 71 individuals (discovery cohort) who underwent comprehensive physiological assessment with right-sided heart catheterization and radionuclide ventriculography at rest and during exercise. Our findings were validated in a second cohort undergoing invasive hemodynamic evaluations (n = 71), as well as in an independent cohort with or without known pulmonary arterial (PA) hypertension (n = 30). In the discovery cohort, 21 metabolites were associated with 2 or more hemodynamic indicators of RV-PV function (i.e., resting right atrial pressure, mean PA pressure, pulmonary vascular resistance [PVR], and PVR and PA pressure-flow response [ΔPQ] during exercise). We identified novel associations of RV-PV dysfunction with circulating indoleamine 2,3-dioxygenase (IDO)-dependent tryptophan metabolites (TMs), tricarboxylic acid intermediates, and purine metabolites and confirmed previously described associations with arginine-nitric oxide metabolic pathway constituents. IDO-TM levels were inversely related to RV ejection fraction and were particularly well correlated with exercise PVR and ΔPQ. Multisite sampling demonstrated transpulmonary release of IDO-TMs. IDO-TMs also identified RV-PV dysfunction in a validation cohort with known risk factors for pulmonary hypertension and in patients with established PA hypertension." }, { "role": "assistant", "content": "Metabolic profiling identified reproducible signatures of RV-PV dysfunction, highlighting both new biomarkers and pathways for further functional characterization. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Antibodies, Fungal, Antigens, Fungal, Biomarkers, Tumor, Candida, Disease Progression, Female, Follow-Up Studies, Fungal Proteins, Humans, Immunoglobulin G, Kidney Neoplasms, Male, Middle Aged, Neoplasm Metastasis, Neoplasm Staging, Prognosis, Survival Analysis." }, { "role": "user", "content": "Do serum IgG against Candida predict survival in patients with metastatic renal cell carcinoma? Context: In contrast to hematologic malignancies, little is known about the role of fungi in the development and progression of solid tumors. This prompted us to analyze and correlate serum levels of different fungal IgG with survival of patients with metastatic renal cell carcinoma. Serum IgG to Candida sp., Saccharomyces cerevisiae and Aspergillus fumigatus were measured in a cross-sectional study in 64 patients with advanced disease. Univariate and multivariate analyses were chosen to study serum IgG as prognostic indicators. Median follow-up was 29.0 months (range 0.3-122). Median overall survival of patients, which tested negative for Candida IgG, was significantly increased (median not reached, >29 months) compared with Candida IgG positive patients (17.8 months, P = 0.002). Median survival of Saccharomyces IgG negative patients was 33.1 months as opposed to 19.4 months in Saccharomyces IgG positive patients, although this difference was not significant (P = 0.281). No difference in overall survival was found between Aspergillus IgG positive patients (28.0 months) and Aspergillus IgG negative patients (29.1 months) (P = 0.181). Cox backward-stepwise regression confirmed Candida IgG as the strongest predictor of survival in metastatic renal cell carcinoma patients (risk ratio 3.27, P = 0.001, [95% CI 1.86-5.73])." }, { "role": "assistant", "content": "Our findings suggest that IgG antibodies directed against yeast fungi and particularly against Candida but not against mold fungi have prognostic relevance. 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": "Objective of calibrating examiner before survey is to:" }, { "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": "Patient of exudative retinopathy of coats presents with leukocoria, needs to be differentiated from -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., Retinoblastoma EXUDATIVE RETINOPATHY OFCOATSo Coats' disease is a severe form of retinal telengiectasia (idiopathic congenital vascular malformation), which typically affects one eye of boys in their first decade of life.o In early stages it is characterised by large areas of intra and subretinal yellowish exudates and haemorrhages associated with overlying dilated and tortuous retinal blood vessels and a number of small aneurysms near the posterior pole and around the disc.o It may present with visual loss, strabismus or leukocoria (whitish pupillary reflex) and thus needs to be differentiated from retinoblastoma. The condition usually progresses to produce exudative retinal detachment and a retrolental mass.o In late stages complicated cataract, uveitis and secondary' glaucoma occur, which eventually end in phthisis bulbi.Treatmento Photocoagulation or cryotherapy may check progression of the disease if applied in the early stage. However, once the retina is detached the treatment becomes increasingly difficult and success rate declines to 33 percent." } ]

[ { "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 structure helps in maintaining the centralized location of the spinal cord in the subarachnoid space?" }, { "role": "assistant", "content": "The correct answer is Denticulate ligaments are lateral extensions of the pia mater which attaches to the arachnoid and dura mater. It helps in maintaining the centralized location of the spinal cord in the subarachnoid space. These ligaments are found between the ventral and dorsal roots, and project through the arachnoid mater in order to attach to the dura mater in a series of sawtooth projections. Filum terminale is an extension of the pia mater beyond the tip of the spinal cord which attaches to the coccyx in the veebral canal. Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 1. Back." } ]

[ { "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 true about ulcerative colitis" }, { "role": "assistant", "content": "The correct answer is Classically, ulcerative colitis begins in the rectum, and in continuity extends upwards into the sigmoid colon, descending colon, transverse colon, and sometimes may involve the entire colon. The colonic contents may rarely backflow into the terminal ileum in continuity, causing 'back-wash ileitis' in about 10% of cases. Grossly, the characteristic feature is the continuous involvement of the rectum and colon without any uninvolved skip areas compared to Crohn's disease. TEXTBOOK OF PATHOLOGY 6TH EDITION HARSH MOHAN PAGE NO:567,568 IMAGE REF: GENERAL AND SYSTEMIC PATHOLOGY RAMDAS 2ND EDITION, PAGE 509" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Animals, Chemotaxis, Leukocyte, Chronic Disease, Cytokines, Dermatitis, Allergic Contact, Enzyme-Linked Immunosorbent Assay, Female, Histamine Agonists, Histamine Antagonists, Immunohistochemistry, Mice, Mice, Inbred C57BL, Picryl Chloride, Receptors, G-Protein-Coupled, Receptors, Histamine, Receptors, Histamine H4." }, { "role": "user", "content": "Does histamine H ( 4 ) receptor antagonist ameliorate chronic allergic contact dermatitis induced by repeated challenge? Context: The present study observed effects of the histamine H(4) receptor on chronic allergic contact dermatitis induced by repeated challenge in mice. Acute contact dermatitis was induced by single epicutaneous challenge of 2,4,6-trinitro-1-chlorobenzene (TNCB) to the ear. Chronic allergic contact dermatitis was developed by repeated epicutaneous challenge using TNCB on the dorsal back skin. H(4) receptor antagonist JNJ7777120 was administered to wild-type mice, while H(4) receptor agonist 4-methylhistamine was administered to histidine decarboxylase (HDC) (-/-) mice that synthesized no histamine. HDC (-/-) mice did not differ phenotypically from HDC (+/+) mice, and H(4) receptor antagonist/agonist did not have clinical effects in terms of acute contact dermatitis reactions. H(4) receptor antagonist ameliorated skin eczematous lesions induced by repeated TNCB challenge in HDC (+/+) mice. On the contrary, H(4) receptor agonist exacerbated skin lesions exclusively in HDC (-/-) mice. Application of H(4) receptor agonist induced migration of mast cells and eosinophils in skin lesions, and H(4) receptor antagonist suppressed these changes. H(4) receptor was immunohistochemically detected on mast cells in eczematous lesions. Levels of interleukin (IL)-4, -5, and -6 in lesions were decreased, whereas levels of interferon-gamma and IL-12 were increased by H(4) receptor antagonistic activity. Serum Immunoglobulin E levels rapidly increased with repeated challenge, but decreased with H(4) receptor antagonist." }, { "role": "assistant", "content": "Because chronic allergic contact dermatitis is developed by H(4) receptor stimulation, H(4) receptor antagonists might represent new candidate drugs for treating chronic allergic contact dermatitis. 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 defective in renal glucosuria?" }, { "role": "assistant", "content": "The correct answer is SGLT-2 is defective in Renal glucosuria." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "In which type of nerve fibres is conduction blocked maximally by pressure" }, { "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": "Phase 3 of paurition is :" }, { "role": "assistant", "content": "The correct answer is Phases of Paurition Paurition, the bringing foh of young, encompasses all physiological processes involved in bihing :Phase 1 = Prelude to paurition Phase 2 (Activation) = Preparation for labor Phase 3 (Stimulation) =Processes of labor Phase 4 (Involution) =Paurient recovery The clinical stages of labor, which are the first, second, and third stages together make up phase 3 of paurition. Please note: The phases of paurition should not be confused with the clinical stages of labor" } ]

[ { "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": "Excision of head of radius in a child should not be done because" }, { "role": "assistant", "content": "The correct answer is C i.e. It causes subluxation of inferior radioulnar joint" } ]

[ { "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 9-year-old boy with cystic fibrosis (CF) presents to the clinic with fever, increased sputum production, and cough. The vital signs include: temperature 38.0°C (100.4°F), blood pressure 126/74 mm Hg, heart rate 103/min, and respiratory rate 22/min. His physical examination is significant for short stature, thin body frame, decreased breath sounds bilateral, and a 2/6 holosystolic murmur heard best on the upper right sternal border. His pulmonary function tests are at his baseline, and his sputum cultures reveal Pseudomonas aeruginosa. What is the best treatment option for this patient?" }, { "role": "assistant", "content": "Inhaled tobramycin for 28 days" } ]

[ { "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 32-year-old man with a history of alcohol binge drinking and polysubstance use is found down in his hotel room with bottles of alcohol, oxycodone, alprazolam, amphetamine-dextroamphetamine, and tadalafil. When EMS arrives, he appears comatose with pinpoint pupils and oxygen saturation of 80% on room air. He is intubated at the scene and airlifted to the nearest intensive care unit. Body temperature is 95 degrees F (35 degrees C). Creatine phosphokinase is 12,000 U/L. MRI of the brain demonstrates extensive infarcts consistent with acute hypoxic ischemic injury. Which of the following is the likely culprit for his overdose?" }, { "role": "assistant", "content": "Opioids" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Alanine Transaminase, Alveolar Bone Loss, Animals, Antigens, Aspartate Aminotransferases, Biomarkers, Disease Models, Animal, Female, Glutathione, Immunohistochemistry, Liver Diseases, Malondialdehyde, Pericytes, Periodontal Index, Periodontitis, Peroxidase, Proteoglycans, Rats, Rats, Wistar." }, { "role": "user", "content": "Is decrease of Pericytes Associated With Ligature-Induced Periodontitis Liver Disease in Rats? Context: The damages caused by periodontitis have affected not only periodontal tissues, but have also increased the severity of different illnesses such as: rheumatoid arthritis, diabetes and liver diseases. The aim of this study was to investigate the association between induced periodontitis and the damages caused through its systemic effects on the liver. Twenty rats were divided into two groups: control and periodontitis. The following parameters were evaluated: Gingival Bleeding Index (GBI), Probing Pocket Depth (PPD), Myeloperoxidase (MPO) activity, Alveolar Bone Loss (ABL) for periodontal tissues; histopathological examination of gingival and liver tissues; immunohistochemistry to positive cell for neural/glial antigen 2 (NG2) expressed in hepatic pericytes, glutathione (GSH) and malondialdehyde (MDA) concentrations in liver; serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). GBI, PPD, MPO, ABLs and histopathological examinations demonstrated the development of periodontitis. There was a significant increase in microvesicular steatosis accompanied by a marked reduction in NG2+ pericytes in the periodontitis compared to control group. The periodontitis group had significantly lower GSH and higher MDA concentration in the liver compared with the control group." }, { "role": "assistant", "content": "Our study results link the systemic effects of induced periodontitis with changes in hepatic tissues such as microvesicular steatosis, likely caused by an increase in oxidative stress and lipid peroxidation. Our findings implicate decrease of pericytes is associated with ligature-induced periodontitis liver disease in rats. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Apolipoproteins B, Blood Pressure, Body Mass Index, Carotid Arteries, Diabetes Mellitus, Type 2, Female, Gene Frequency, Genetic Predisposition to Disease, Heterozygote, Humans, Insulin Receptor Substrate Proteins, Insulin Resistance, Lipids, Male, Middle Aged, Mutation, Phosphoproteins, Prospective Studies, Risk Factors, Tunica Intima, Tunica Media." }, { "role": "user", "content": "Is intima media thickness of carotid arteries reduced in heterozygous carriers of the Gly972Arg variant in the insulin receptor substrate-1 gene? Context: The Gly972Arg mutation in the IRS-1 gene has been found to be associated with insulin resistance and type II diabetes. A recently published study described an association between the Arg allele and an increased risk for coronary artery disease. In the present study we asked whether the presence of the codon 972 mutation in the IRS-1 gene is associated with higher IMT values of the carotid arteries. To address this question, genotypes of the codon 972 polymorphism were determined in 1018 healthy unrelated individuals aged 40-65 years. Three homozygous carriers of the mutation were excluded for statistical analysis. In all subjects, intima media thickness (IMT) and B-scores of carotid arteries as well as a large number of metabolic parameters were determined. Heterozygous carriers of the Arg972 allele exhibited significantly lower IMT and B-score values than noncarriers. Total cholesterol, LDL-cholesterol and serum levels of apolipoprotein B were significantly lower in the carriers. Furthermore, a significant interaction between Gly972Arg-carrier status and mean daytime 24-h systolic blood pressure with regard to IMT could be observed; carriers with a systolic blood pressure above the median had lower IMT values than carriers with a systolic blood pressure equal or below the median. All these effects were more pronounced in females and remained significant after adjustment for sex, age, BMI, systolic blood pressure and serum apolipoprotein B levels. No significant differences between the carriers and the noncarriers could be found for BMI, insulin sensitivity or frequency of type II diabetes." }, { "role": "assistant", "content": "The results of our study demonstrate that the presence of the Arg972 allele is associated with lower IMT values of the carotid arteries. This finding is partly explained by lower serum levels of apolipoprotein B in carriers. The protective effect of the Gly972 Arg mutation seems to be stronger in the presence of a higher systolic blood pressure. Our data contradict previous findings suggesting an increased risk for insulin resistance, type II diabetes and atherosclerotic vascular disease in carriers of the mutation. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Cholecystectomy, Cholecystectomy, Laparoscopic, Cholecystitis, Acute, Emergency Medical Services, Feasibility Studies, Female, Humans, Male, Middle Aged, Prospective Studies, Time Factors." }, { "role": "user", "content": "Does urgent laparoscopic cholecystectomy in the management of acute cholecystitis : timing influence conversion rate? Context: The optimal treatment of acute cholecystitis is urgent laparoscopic cholecystectomy. Most reports suggest that a delay of 72 or 96 h from onset of symptoms leads to a higher conversion rate. This study assessed the conversion rate in relation to the timing of urgent laparoscopic cholecystectomy for acute cholecystitis. During a 12 month period, 112 patients received laparoscopic cholecystectomy for acute cholecystitis at a tertiary care university hospital in central Taiwan. Data were collected prospectively. The overall conversion rate was 3.6% (4/112). Of 62 procedures performed within 72 h from onset of symptoms, 2 were converted, as compared with 2 of 50 procedures after 72 h. Of 76 procedures performed within 96 h from onset of symptoms, 3 were converted, as compared with 1 of 36 procedures after 96 h. There were no mortalities or common bile duct injuries." }, { "role": "assistant", "content": "The conversion rate for urgent laparoscopic cholecystectomy among patients with acute cholecystitis can be as low as 3.6%. The timing of urgent laparoscopic cholecystectomy has no impact on the conversion rate. 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: OBJECTIVES, DESIGN, SETTING, PARTICIPANTS, INTERVENTION, MEASUREMENTS, RESULTS. Meshes: Activities of Daily Living, Aged, Aged, 80 and over, Drug Utilization, Drug Utilization Review, Female, Guideline Adherence, Humans, Male, Nursing Homes, Practice Guidelines as Topic, Quality Assurance, Health Care." }, { "role": "user", "content": "Does incorporating medications in the surveyors' interpretive guidelines reduce the use of potentially inappropriate medications in nursing homes? Context: To quantify the association between including specific medications deemed potentially inappropriate in the surveyors' interpretive guidelines for nursing homes and the prevalence of use. Quasi-experimental. One thousand one hundred forty-one nursing homes in four U.S. states. Residents living in one of the included nursing homes in operation during 1997 (before Beers; n=130,250) and 2000 (after Beers; n=164,889). Inclusion of specific medications deemed potentially inappropriate in the surveyors' interpretive guidelines for nursing homes. Logistic regression models adjusting for clustering effects of residents residing in homes provided estimates of the relationship between the survey process and use of any medications targeted as potentially inappropriate as part of the survey process, as well as those deemed inappropriate but not included. The use of any potentially inappropriate medication decreased from 42.5% in 1997 to 39.8% in 2000. After adjustment for resident characteristics, residents were less likely to receive any potentially inappropriate medication (odds ratio (OR)=0.85, 95% confidence interval (95% CI)=0.84-0.87), those considered high-severity drugs (those with a high likelihood of a clinically significant adverse event) (OR=0.67, 95% CI=0.65-0.69), or Beers' medications not included in the surveyors' guidelines (OR=0.76, 95% CI=0.74-0.79) in 2000 than in 1997 after the changes to the drug regulations and interpretive guidelines." }, { "role": "assistant", "content": "Targeting specific drugs in the surveyor's interpretive guidelines as a method to reduce potentially inappropriate medication use may not produce desired gains in medication-use quality improvement. Alternative strategies for nursing homes should be evaluated." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Cross-Sectional Studies, Energy Metabolism, Female, Humans, Logistic Models, Male, Metabolic Syndrome, Motor Activity, Nutrition Surveys, Ontario." }, { "role": "user", "content": "Is vigorous intensity physical activity related to the metabolic syndrome independent of the physical activity dose? Context: Current physical activity guidelines imply that, by comparison with moderate physical activity (MPA), the benefits of engaging in vigorous physical activity (VPA) are attributed to the greater energy expenditure dose per unit of time and do not relate to intensity per se. The purpose of this study was to determine whether VPA influences the metabolic syndrome (MetS) independent of its influence on the energy expenditure dose of moderate-to-vigorous physical activity (MVPA). Participants consisted of 1841 adults from the 2003-06 National Health and Nutrition Examination Survey, a representative cross-sectional study. MPA and VPA were measured objectively over 7 days using Actigraph accelerometers. MetS was determined using an established clinical definition. Associations between physical activity and the MetS were determined using logistic regression and controlled for relevant covariates. Analyses revealed that VPA remained a meaningful predictor of the MetS after controlling for the total energy expenditure dose of MVPA such that the relative odds of the MetS was 0.28 (95% confidence interval 0.17-0.46) in the group with the highest VPA compared with the group with no VPA. VPA had a greater influence on the MetS than an equivalent energy expenditure dose of MPA. For instance, between 0 and 500 MET min/week of MPA the adjusted prevalence of the MetS decreased by 15.5%, whereas between 0 and 500 MET min/week of VPA the prevalence decreased by 37.1%." }, { "role": "assistant", "content": "These cross-sectional findings suggest that VPA per se has an important role in cardiometabolic disease prevention. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adenocarcinoma, Antineoplastic Agents, Apoptosis, Breast Neoplasms, Carcinoma, Hepatocellular, Cell Line, Tumor, Cell Proliferation, Ciprofloxacin, Colonic Neoplasms, DNA Topoisomerases, Type II, Female, Humans, Hydrazones, Liver Neoplasms, Membrane Potential, Mitochondrial." }, { "role": "user", "content": "Does piperonal ciprofloxacin hydrazone induce growth arrest and apoptosis of human hepatocarcinoma SMMC-7721 cells? Context: To investigate the cytotoxic effects of piperonal ciprofloxacin hydrazone (QNT4), a novel antibacterial fluoroquinolone derivative, against human hepatocarcinoma SMMC-7721 cells. Human hepatocarcinoma cells (SMMC-7721), human breast adenocarcinoma cells (MCF-7) and human colon adenocarcinoma cells (HCT-8) were tested. The effects of QNT4 on cell proliferation were examined using MTT assay. Cell apoptosis was determined using Hoechst 33258 fluorescence staining, TUNEL assay and agarose gel electrophoresis. The topoisomerase II activity was measured using agarose gel electrophoresis with the DNA plasmid pBR322 as the substrate. Mitochondrial membrane potential (Δψm) was measured using a high content screening imaging system. Protein expression of caspase-9, caspase-8, caspase-3, p53, Bcl-2, Bax, and cytochrome c was detected with Western blot analysis. Treatment with QNT4 (0.625-10 μmol/L) potently inhibited the proliferation of the cancer cells in time- and dose-dependent manners (the IC(50) value at 24 h in SMMC-7721 cells, MCF-7 cells and HCT-8 cells was 2.956±0.024, 3.710±0.027, and 3.694±0.030 μmol/L, respectively). Treatment of SMMC-7721 cells with QNT4 (0.2146, 2.964, and 4.600 μmol/L) for 24 h dose-dependently increased the percentage of apoptotic cells, elicited characteristic DNA \"ladder\" bands, and decreased the mitochondrial membrane potential. QNT4 dose-dependently increased topoisomerase II-mediated DNA breaks while inhibiting DNA relegation, thus keeping the DNA in fragments. Treatment of SMMC-7721 cells with QNT4 significantly increased cytochrome c in the cytosol, and decreased cytochrome c in the mitochondrial compartment. QNT4 (3-7.39 μmol/L) significantly increased the protein expression of p53, Bax, caspase-9, caspase-3, and the cleaved activated forms of caspase-9 and caspase-3 in SMMC-7721 cells. In contrast, the expression of Bcl-2 was decreased, while caspase-8 had no significant change." }, { "role": "assistant", "content": "QNT4 induced the apoptosis of SMMC-7721 cells via inhibiting topoisomerase II activity and modulating mitochondrial-dependent pathways. 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": "\"Apple core\" sign seen in" }, { "role": "assistant", "content": "The correct answer is i.e. (Carcinoma descending colon): (1181-Love & Bailly 25th)* Barium enema showing a carcinoma of the sigmoid colon. It may have a 'apple core' appearance i.e. a short irregular stenosis with sharp shoulders at each end.* Carcinoma of the left colon appears as a fixed filling defect with an annular \"apple core\" configuration lesion of the right colon may appears as - constriction or an intraluminal mass (663 - CSDT13th)CEA levels are high in 70% of patients with cancer of large intestine but less than half of patients with localize disease are CEA positive. CEA does not therefore serve as a useful screening procedure, nor is it an accurate diagnostic test for colorectal cancer in a curable stage. CEA is helpfid in detecting recurrence after curative surgical resection; if high CEA levels return to normal after operation and then rise progressively during the follow up period, recurrence of cancer is likely (663-CSDT 13th)* Apple jelly nodules are seen in Lupus vulgaris*** Claw appearance on barium enema - Intussusception* Napkin - Ring sign - carcinoma colonRisk Factors for the Development of Colorectal cancer* Diet: Animal fat, High caloric diet, High saturated fat consumption* Hereditary syndromes (Autosomal dominant inheritance* Polyposis coli* Nonpolyposis syndrome (Lynch syndrome)* Inflammatory bowel syndrome (UC & CD)* Streptococcus bovis bacteremia* Uretero sigmoidostomy* DM and obesity* Tobacco use* Sedentary life style* High red meat consumption* High content of refined carbohydrate* There is narrowing of terminal ileum due to irritability This along with shortened rigid caecum is called as \"Sterilin sign\" seen in Crohn's disease and Ileocaecal TuberculosisCROHN'S DISEASE or REGIONAL ENTERITISULCERATIVE COLITIS* Terminal ileum is the Most common site*** Granularity & asymmetrical involvement with skip lesion* Ulcer - Apthous ulcer and fissure ulcer* Cobblestone pattern** (Serpiginous transverse ulcer seperated by areas of edema)* Rigidity of mesenteric border and pseudosacculation of anti mesenteric border (Omega sign)* Wide gapping of bowel loops due to thickening of bowel wall* Stricture : long segment (String sign of cantor)*** Collar button ulcer* Double Tracking (longitudinal submucosal ulceration over several centimeter)* Symmetrical involvement of colon* Rectum involvement in 95% of cases*** Thumbprinting** due to mucosal oedema* Blunting of haustral fold (Pipestem appearance)*** Inflammatory polyp*** Back wash ileitis. In UG when whole colon involved, the inflammation extends 1-2 cm into terminal ileum in 10-20% cases called Backwash ilitis* Gaseless abdomen in X-ray***" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Animals, Blotting, Western, Immobilization, Immunohistochemistry, Male, RNA, Messenger, Raphe Nuclei, Rats, Rats, Sprague-Dawley, Stress, Psychological, Tryptophan Hydroxylase." }, { "role": "user", "content": "Does immobilization stress elevate tryptophan hydroxylase mRNA and protein in the rat raphe nuclei? Context: Stress triggers adaptive and maladaptive changes in the central nervous system, including activation of the hypothalamic-pituitary-adrenal axis, and can trigger mood disorders and posttraumatic stress disorder. We examined the effect of immobilization stress (IMO) on gene expression of tryptophan hydroxylase (TPH), the rate-limiting enzyme in serotonin biosynthesis, and the role of cortisol in that response. Regular and adrenalectomized Sprague-Dawley rats were exposed to various repetitions of IMO. Tryptophan hydroxylase messenger ribonucleic acid (mRNA) was determined by competitive reverse transcriptase polymerase chain reaction, and TPH protein was examined by immunoblot and immunocytochemistry. Elevation of TPH mRNA by IMO was tissue-specific and dose-dependent. A single IMO elicited a threefold rise in TPH mRNA in median raphe nucleus (MRN), but repeated (3x) IMOs were needed for similar response in dorsal raphe nucleus (DRN). Repeated daily IMO, up to 7 days, triggered a robust induction (6-10-fold) in TPH mRNA, accompanied by corresponding rise in TPH protein levels in raphe nuclei but not in the pineal gland. The rise in TPH immunoreactivity was widespread throughout the DRN and MRN. Bilateral adrenalectomy did not prevent the IMO-triggered increase in TPH immunoreactive protein in the raphe nuclei." }, { "role": "assistant", "content": "This study reveals adrenal glucocorticoid-independent induction of TPH gene expression in raphe nuclei in response to immobilization 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: Adult, Cost-Benefit Analysis, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Gastric Bypass, Humans, Male, Obesity, Morbid, Paris, Retrospective Studies, Treatment Outcome." }, { "role": "user", "content": "Is medication cost significantly reduced after Roux-en-Y gastric bypass in obese patients? Context: This study aims to determine the influence of Roux-en-Y gastric bypass (RYGB) on medication-related costs. The study analyzed the types, dosages, and costs of drugs and medical devices prescribed before and after surgery (1, 3, 6, and 12 months and yearly thereafter) in patients who underwent RYGB between June 2004 and May 2010 and had an outpatient visit between December 2009 and May 2010 at Pitié-Salpêtrière University Hospital, Paris, France. The cohort included 143 patients (78 % female; mean age, 42.9 years; mean BMI, 48.6 kg/m(2)). Total prescription costs were significantly lower (-32 %, p < 0.001) 1 year after RYGB compared with preoperative costs. However, the cost for medications to prevent RYGB side effects (in particular nutritional deficiencies) displayed a 36-fold increase in the first month postsurgery, but then decreased progressively over time. Importantly, the cost related to the treatment of the two most frequent obesity-related diseases significantly decreased 1 year after surgery. Indeed, prescription costs for treatment of type 2 diabetes (T2D) and obstructive sleep apnea (OSA) (namely CPAP therapy considered as the gold standard treatment) were reduced 1 year after surgery by 85 and by 63 % (both p < 0.001), respectively. We also observed a trend toward a decrease in the prescription costs of other obesity-related diseases, although it did not reach significance in our cohort." }, { "role": "assistant", "content": "Considering medication to treat both obesity-related diseases and prevention of secondary effects of bariatric surgery, we observed that overall postoperative medication costs were significantly reduced one year after surgery, especially for T2D and OSA. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: UNLABELLED. Meshes: Adolescent, Animals, Beverages, Body Height, Body Mass Index, Body Weight, Carbonated Beverages, Child, Cross-Sectional Studies, Dairy Products, Diet, Mediterranean, Energy Drinks, Energy Intake, Female, Humans, Male, Mathematical Computing, Motor Activity, Nutrition Surveys, Obesity, Spain, Surveys and Questionnaires, Waist Circumference." }, { "role": "user", "content": "Are caloric beverage drinking patterns differentially associated with diet quality and adiposity among Spanish girls and boys? Context: The present study assesses the impact of beverage consumption pattern on diet quality and anthropometric proxy measures for abdominal adiposity in Spanish adolescents. Data were obtained from a representative national sample of 1,149 Spanish adolescents aged 10-18 years. Height, weight, and waist circumferences were measured. Dietary assessment was performed with a 24-h recall. Beverage patterns were identified by cluster analysis. Adherence to the Mediterranean diet was measured by the KIDMED index. Three beverage clusters were identified for boys--\"whole milk\" (62.5 %), \"low-fat milk\" (17.5 %) and \"soft drinks\" (20.1 %)-and for girls--\"whole milk\" (57.8 %), \"low-fat milk\" (20.8 %) and juice (21.4 %), accounting for 8.3, 9.6, 13.9, 8.6, 11.5 and 12.9 % of total energy intake, respectively. Each unit of increase in the KIDMED index was associated with a 14.0 % higher (p = 0.004) and 11.0 % lower (p = 0.048) probability of membership in the \"low-fat milk\" and \"soft drinks\" cluster in girls and boys, respectively, compared with the \"whole milk\" cluster. Boys in the \"soft drinks\" cluster had a higher risk of 1-unit increase in BMI z score (29.0 %, p = 0.040), 1-cm increase in waist circumference regressed on height and age (3.0 %, p = 0.027) and 0.1-unit increase in waist/height ratio (21.4 %, p = 0.031) compared with the \"whole milk\" cluster." }, { "role": "assistant", "content": "A caloric beverage pattern dominated by intake of \"soft drinks\" is related to general and abdominal adiposity and diet quality in Spanish male adolescents. Final Decision: yes" } ]