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[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Adenosine Triphosphate, Animals, B-Lymphocytes, Cyclin-Dependent Kinase 5, Cytosol, Diabetes Mellitus, Type 2, Exocytosis, Genetic Variation, Glucose, Insulin, Mice, Mice, Knockout, Mitochondria, Nerve Tissue Proteins, Patch-Clamp Techniques, Potassium." }, { "role": "user", "content": "Does deletion of CDKAL1 affect mitochondrial ATP generation and first-phase insulin exocytosis? Context: A variant of the CDKAL1 gene was reported to be associated with type 2 diabetes and reduced insulin release in humans; however, the role of CDKAL1 in β cells is largely unknown. Therefore, to determine the role of CDKAL1 in insulin release from β cells, we studied insulin release profiles in CDKAL1 gene knockout (CDKAL1 KO) mice. Total internal reflection fluorescence imaging of CDKAL1 KO β cells showed that the number of fusion events during first-phase insulin release was reduced. However, there was no significant difference in the number of fusion events during second-phase release or high K(+)-induced release between WT and KO cells. CDKAL1 deletion resulted in a delayed and slow increase in cytosolic free Ca(2+) concentration during high glucose stimulation. Patch-clamp experiments revealed that the responsiveness of ATP-sensitive K(+) (K(ATP)) channels to glucose was blunted in KO cells. In addition, glucose-induced ATP generation was impaired. Although CDKAL1 is homologous to cyclin-dependent kinase 5 (CDK5) regulatory subunit-associated protein 1, there was no difference in the kinase activity of CDK5 between WT and CDKAL1 KO islets." }, { "role": "assistant", "content": "We provide the first report describing the function of CDKAL1 in β cells. Our results indicate that CDKAL1 controls first-phase insulin exocytosis in β cells by facilitating ATP generation, K(ATP) channel responsiveness and the subsequent activity of Ca(2+) channels through pathways other than CDK5-mediated regulation. 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 42-year-old man comes to the physician for the evaluation of episodic headaches involving both temples for 5 months. The patient has been taking acetaminophen, but it has not provided relief. He has also had double vision. Ophthalmic examination shows impaired peripheral vision bilaterally. Contrast MRI of the head shows a 14 x 10 x 8-mm intrasellar mass. Further evaluation is most likely to show which of the following findings?" }, { "role": "assistant", "content": "Impotence" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Cell Line, Tumor, Genes, erbB-2, Humans, Inflammasomes, Interleukin-1beta, Neuregulin-1, Pulmonary Alveoli." }, { "role": "user", "content": "Does inflammasome Inhibition suppress Alveolar Cell Permeability Through Retention of Neuregulin-1 ( NRG-1 )? Context: Neuregulin (NRG)-1-human epidermal receptor (HER)-2 signaling pathway is a key regulator of IL-1β-mediated pulmonary inflammation and epithelial permeability. The inflammasome is a newly discovered molecular platform required for caspase-1 activation and maturation of IL-1β. However, the role of the inflammasome in NRG-1-HER2 signaling-mediated alveolar cell permeability is unknown. The inflammasome was activated or inhibited in THP-1 cells; supernatants from these cells were added to A549 cells and human small airway epithelial cells (HSAEC). The protein expression of NRG-1 and phospho-HER2 (pHER2) were measured by Western blot analysis and epithelial permeability was measured using Lucifer yellow dye. Results reveal that alveolar permeability in A549 cells and HSAEC is increased when treated with supernatants of inflammasome-activated THP-1 cells. Alveolar permeability is significantly suppressed when treated with supernatant of inflammasome-inhibited THP-1 cells. Inflammasome-mediated permeability is decreased when A549 cells and HSAEC are pretreated with IL-1β receptor antagonist (IL-1βRA). In addition, HER2 kinase inhibitor AG825 or NRG-1 inhibitor TAPI inhibits inflammasome-mediated permeability in A549 cells and HSAEC demonstrating critical roles of IL-1β, NRG-1, and HER2 in inflammasome-mediated alveolar permeability." }, { "role": "assistant", "content": "These findings suggest that inflammasome-induced alveolar cell permeability is mediated by NRG-1/HER2 signaling through IL-1β regulation. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Which is the most common cause of Cushing syndrome" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adenocarcinoma, Adenosine Triphosphate, Apoptosis, Autophagy, Blotting, Western, Calcium, Caspase 3, Cells, Cultured, Colon, Epithelial Cells, Flow Cytometry, Fluorescent Antibody Technique, Humans, Ileal Neoplasms, L-Lactate Dehydrogenase, Macrophages, Necrosis, Nitric Oxide, Reactive Oxygen Species." }, { "role": "user", "content": "Does extracellular ATP induce cell death in human intestinal epithelial cells? Context: Extracellular ATP is an endogenous signaling molecule released by various cell types and under different stimuli. High concentrations of ATP released into the extracellular medium activate the P2X7 receptor in most inflammatory conditions. Here, we seek to characterize the effects of ATP in human intestinal epithelial cells and to evaluate morphological changes in these cells in the presence of ATP. We treated human intestinal epithelial cells with ATP and evaluated the effects of this nucleotide by scanning and transmission electron microscopy analysis and calcium measurements. We used flow cytometry to evaluate apoptosis. We collected human intestinal explants for immunohistochemistry, apoptosis by the TUNEL approach and caspase-3 activity using flow cytometry analyses. We also evaluated the ROS production by flow cytometry and NO secretion by the Griess technique. ATP treatment induced changes characteristic of cell death by apoptosis and autophagy but not necrosis in the HCT8 cell line. ATP induced apoptosis in human intestinal explants that showed TUNEL-positive cells in the epithelium and in the lamina propria. The explants exhibited a significant increase of caspase-3 activity when the colonic epithelial cells were incubated with IFN-gamma followed by ATP as compared to control cells. In addition, it was found that antioxidants were able to inhibit both the ROS production and the apoptosis induced by ATP in epithelial cells." }, { "role": "assistant", "content": "The activation of P2X7 receptors by ATP induces apoptosis and autophagy in human epithelial cells, possibly via ROS production, and this effect might have implications for gut inflammatory conditions. 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": "Gastric carcinoma is most common in which one of the listed geographic locations?" }, { "role": "assistant", "content": "The correct answer is There are marked differences in the incidence of various types of cancer in different parts of the world. The highest rates for gastric carcinoma are found in Japan, Chile, China, and Russia, while it is much less common in the United States, the United Kingdom, Canada, and France." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Female, Hospitalization, Humans, Influenza Vaccines, Influenza, Human, Intensive Care Units, Logistic Models, Male, Middle Aged, Pneumonia, Seasons, Severity of Illness Index, United States, Vaccination." }, { "role": "user", "content": "Does Influenza Vaccination Modify Influenza Severity? Context: Some studies suggest that influenza vaccination might be protective against severe influenza outcomes in vaccinated persons who become infected. We used data from a large surveillance network to further investigate the effect of influenza vaccination on influenza severity in adults aged ≥50 years who were hospitalized with laboratory-confirmed influenza. We analyzed influenza vaccination and influenza severity using Influenza Hospitalization Surveillance Network (FluSurv-NET) data for the 2012-2013 influenza season. Intensive care unit (ICU) admission, death, diagnosis of pneumonia, and hospital and ICU lengths of stay served as measures of disease severity. Data were analyzed by multivariable logistic regression, parametric survival models, and propensity score matching (PSM). Overall, no differences in severity were observed in the multivariable logistic regression model. Using PSM, adults aged 50-64 years (but not other age groups) who were vaccinated against influenza had a shorter length of ICU stay than those who were unvaccinated (hazard ratio for discharge, 1.84; 95% confidence interval, 1.12-3.01)." }, { "role": "assistant", "content": "Our findings show a modest effect of influenza vaccination on disease severity. Analysis of data from seasons with different predominant strains and higher estimates of vaccine effectiveness are needed." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Allergens, Amino Acid Sequence, Antimicrobial Cationic Peptides, Chitinases, DNA Primers, Enzyme-Linked Immunosorbent Assay, Female, Food Hypersensitivity, Humans, Immunoglobulin E, Latex, Latex Hypersensitivity, Male, Middle Aged, Molecular Sequence Data, Musa, Persea, Plant Lectins, Protein Structure, Tertiary, Sequence Homology, Amino Acid, Skin Tests, Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization." }, { "role": "user", "content": "Are isolated hevein-like domains , but not 31-kd endochitinases , responsible for IgE-mediated in vitro and in vivo reactions in latex-fruit syndrome? Context: Individuals with natural rubber latex allergy often have immediate reactions to plant-derived foods and fresh fruits, such as avocado and banana. IgE of these patients has been shown to bind endochitinases containing an N-terminal hevein-like domain (HLD). However, evidence on 31-kd endochitinase-induced reactions in vivo is lacking. We sought to assess the clinical significance of 31-kd endochitinases and isolated HLDs in latex-fruit syndrome. The 31-kd endochitinases and corresponding HLDs were purified or produced from avocado, banana, latex, and wheat germ. Skin prick test reactivities against purified proteins were examined in 15 patients with natural rubber latex allergy. The binding efficiency of IgE to purified proteins was studied by using an inhibition ELISA. Experimentally resolved or modeled structures of the proteins were compared to clarify the molecular basis of clinical reactions. Eleven (73%) patients had skin prick test reactions to isolated HLDs of avocado and banana, but only 1 (7%) patient reacted to their corresponding 31-kd endochitinases. HLDs from avocado and banana inhibited binding of IgE to prohevein (Hev b 6.01) in 59% and 38% of patients, respectively, whereas corresponding percentages for 31-kd endochitinases were 17% and 20%, respectively. Isolated HLDs of wheat germ agglutinin and 18-kd wheat germ agglutinin did not significantly inhibit IgE binding to hevein." }, { "role": "assistant", "content": "The isolated HLD molecules alone, but not when linked to endochitinases, seem to be responsible for IgE-mediated clinical reactions in latex-fruit syndrome. Careful selection of relevant allergens in their proper molecular form is therefore crucial in forming a reliable diagnosis of latex-fruit syndrome. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, METHODS, RESULTS. Meshes: Albuminuria, Animals, Antineoplastic Agents, Azotemia, Cisplatin, Dog Diseases, Dogs, Female, Male, Neoplasms." }, { "role": "user", "content": "Is microalbuminuria associated with cisplatin-induced azotemia in dogs? Context: Cisplatin is an effective antineoplastic agent but its use is limited by renal toxicity. Microalbuminuria is a marker of renal damage and might be an indicator of cisplatin-induced azotemia. Microalbuminuria is not associated with azotemia in dogs treated with cisplatin. This study used 32 client-owned dogs. This was a prospective observational study in which cancer-bearing dogs were treated with cisplatin chemotherapy. Cisplatin-induced azotemia was defined as an increase of serum creatinine concentration above the reference range. Serum creatinine concentration, other routine tests of renal function, and microalbuminuria were measured after each cisplatin treatment. Variables potentially associated with azotemia were compared by use of Fisher's exact test and Wilcoxon's rank-sum test. Cisplatin-induced azotemia occurred in 10 (31%) dogs after 1-5 treatments. At each of the first 3 treatments, the proportions of dogs with microalbuminuria were similar between dogs with and without azotemia." }, { "role": "assistant", "content": "Microalbuminuria measured after each treatment was not associated with azotemia through the first 3 treatments. Testing for microalbuminuria as a marker for cisplatin-induced renal damage is insensitive and not recommended. 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: Administration, Topical, Alendronate, Alveolar Bone Loss, Alveolar Process, Animals, Anti-Bacterial Agents, Bone Resorption, Doxycycline, Drug Carriers, Drug Combinations, Drug Synergism, Gelatin Sponge, Absorbable, Male, Mandible, Microradiography, Rats, Rats, Wistar, Surgical Flaps, Tetracycline." }, { "role": "user", "content": "Does combined local application of tetracycline and bisphosphonate reduce alveolar bone resorption in rats? Context: Recent animal studies have shown that a combination of chemically-modified tetracyclines together with bisphosphonates, when delivered systemically, are synergistically effective in suppressing periodontal bone loss. In the present study, we explored the combined efficacy of local delivery of alendronate and tetracyclines in reducing alveolar bone loss. Eighty-six (86) male Wistar rats were used in these experiments. The flap was elevated using a special periosteal elevator, on both sides of the mandible, as described previously. A gelfoam pellet containing the drugs was applied between the alveolar bone and the mucoperiosteal flap, according to the experimental protocol. The rats were divided into 5 treatment groups: 1) alendronate; 2) doxycycline hyclate 10% (DOXY); 3) tetracycline hydrochloride 1% (TET); 4) alendronate + DOXY; and 5) alendronate + TET. In the operated control sites (C), saline was applied. The rats were sacrificed 21 days following the flap procedure. Sections of the mandibles (1.5 mm), in a buccal-lingual direction, underwent microradiography and were analyzed for bone loss. DOXY alone was most effective in reducing bone loss. Alendronate was also effective in reducing bone loss as shown in previous reports. TET did not reduce bone loss significantly when used alone. In combination with alendronate TET was synergistically effective. The combined local treatment of alendronate + DOXY showed no additive effect." }, { "role": "assistant", "content": "In the present study, we found that tetracyclines can be most effective in reducing alveolar bone loss when applied locally. The combined local treatment of alendronate and tetracycline may have a synergistic effect. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, METHODS, RESULTS. Meshes: Animals, Bromocriptine, Cells, Cultured, Culture Media, Conditioned, Humans, Macrophage Activation, Macrophages, Peritoneal, Male, Mice, Mice, Inbred C3H, Mycobacterium bovis, Prolactin, Sperm Motility." }, { "role": "user", "content": "Does bromocriptine reverse the inhibitory effect of macrophages on human sperm motility? Context: To determine the effects of PRL suppression on the activation of murine peritoneal macrophages and their subsequent effects on human sperm motility. Laboratory study. Mice were treated with subcutaneous implants of 2.5 mg bromocriptine pellets 7 days before bacillus of calmette and guerin (BCG), a strain of Mycobacterium bovis, injection for activation of macrophages. Bromocriptine treatment, which significantly suppressed circulating PRL levels, continued through the day of peritoneal macrophage collection. Macrophages were subsequently cultured for 4 days and culture supernatant was collected. Human sperm were incubated for 4 hours in the presence of culture medium or culture supernatant from control and treated mice. Motion analysis was performed at 0, 2, and 4 hours. A significant decrease in human sperm motility was observed in the presence of culture supernatant from activated murine peritoneal macrophages. After 4 hours of incubation, sperm motility decreased from 69% +/- 3% in the nonactivated macrophage control group to 37% +/- 6% in the BCG- activated macrophage group. The suppressive effect of soluble products of activated macrophages on human sperm motility was reversed when mice were rendered hypoprolactinemic with bromocriptine. Motility after 4 hours was 56% +/- 3% in the BCG-bromocriptine group. Simultaneous administration of bromocriptine and PRL (100 ng per mouse daily) restored the inhibitory effect of soluble products of activated macrophages on sperm motility (36% +/- 5% motile)." }, { "role": "assistant", "content": "PRL may modulate the deleterious effects of activated macrophages on human sperm motility, thereby suggesting novel and useful methods for the modification of the immune response in early reproduction. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Do children with cancer and blood diseases experience positive physical and psychological effects from massage therapy? Context: Previous research has shown positive effects from massage therapy (MT) for premature infants and for children with asthma, arthritis, and other illnesses. Although these effects have been demonstrated, MT research on children with cancer and blood disease is needed. The present study, conducted at the Cancer Center, Shands Hospital, at the University of Florida, Gainesville, measured the physical and psychological effects of MT on pediatric oncology and hematology patients. The participants were 30 children with cancer or blood disease, ages 6 months to 17 years. This randomized, non-blinded prospective study used measures of physical health and mental wellbeing that were completed before, during, and after four MT sessions were implemented. Descriptive statistics, one-way between-subjects analysis of variance, and an independent-samples t-test were used to analyze the data. The treatment group received 20-minute sessions of Swedish MT once daily for approximately 4 days (inpatients), or once weekly for approximately 4 weeks (outpatients); the control group received no MT. Between-groups analyses indicated significant psychological improvements for the MT group on state anxiety (F(1,58) = 16.79, p < 0.000), trait anxiety (F(1,58) = 3.95, p < 0.000), and emotional state (F(1,238) = 42.39, p < 0.001)]. Between-groups analyses indicated significant physical improvements for the MT group on muscle soreness (F(1,238) = 38.96, p < 0.001), discomfort (F(1,238) = 50.16, p < 0.001), respiratory rate (F(1,237) = 22.47, p < 0.000)], and overall progress (t(28) = 25.55, p < 0.000). No significant differences were found between groups on parent-completed ratings of their child's physical or psychological health, pulse rate, or blood pressure." }, { "role": "assistant", "content": "In children with cancer and blood diseases, MT can reduce psychological and physical distress and can have a positive effect on quality of life. 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": "Gene therapy is given in aEUR'" }, { "role": "assistant", "content": "The correct answer is Severe combined immunodeficiency [Ref KDT 6m/e p. 843, 8441 Gene therapy Gene therapy refers to introduction of functional genetic material usually D.N.A. into target cells to replace or supplement defective genetic material. In contrast to all other therapies or drugs, gene therapy impas, new functions to a cell. Gene defects result in.fallure to synthesize a functional protein or in the synthesis of a dysfunctional protein. Equipping the cell with a normal copy of the defective gene would overcome the deficieny at the site where it is needed on a long term. Approaches in gene therapy :? Gene therapy tries to either modify or transfer the genes. Gene modification This involves correction of the defective poion of a genomic sequence or removal of the whole defective gene and its replacement by a normal copy. Gene transfer This involves introduction of genes without removing or altering the existing ones. Gene transfer is carried out in the following ways? i) Injection of naked D.N.A. ii) Transfer of generic material using virus as a carrier with D.N.A. incorporated into its genome. iii) Transfer of D.N.A. encapsulated within a liposome Applications of Gene therapy (where genetherapy is being considered) :? Cystic fibrosis (inseion of CFTR gene into respiratory epithelial cells) Severe combined immunodeficiency disease (introducing genes for adenosine deaminase) Growth hormone deficiency Familial hypercholesterelimia Lysch Nyhan syndrome Parkinsonism Alzhiemer's disease, Huntington's chorea. Familial amyotrophic lateral sclerosis, Gaucher's disease Stroke, head injury, multiple sclerosis Duchenne muscular dystrophy Prevention of restenosis of grafted coronary vessel Anemia Sickle cell anemia Haemophilia HIV infection Cancers Current status of Gene therapy (www.Fda.gov/Biologic.s bloodvaccines/cellular gene therapy) The food and drug administration has not yet approved any human gene therapy product for sale. - Current gene therapy is experimental and has not proven very successful in clinical trials. - Clear cut success in gene therapy has been achieved in Severe combined immunodeficiency (adenosine deaminase deficiency). - But there were repos that children treated with gene therapy in severe combined immunodeficiency developed leukemia. - Based on current data, the efficacy of gene transfer, .for severe combined immunodeficiency is convincing there have been no complications in the six children treated on this protocol, but longer term follow up will be required to determine whether this approach is sufficiency safe to he used in place of pegylated form of the enzyme adenosine deaminase." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Arrhythmias, Cardiac, Electrocardiography, Heart Conduction System, Heart Ventricles, Humans, Hypothyroidism, Long QT Syndrome, Thyroxine." }, { "role": "user", "content": "Does [ Subclinical hypothyroidism influence ventricular repolarization measured by QTc interval ]? Context: Thyroid disorders exert a major effect on cardiac function and on ECG. Few studies examined the effect of thyroid hormones on ventricular repolarization, measured by corrected QT interval (QTc). Prolonged QTc is associated with increased risk of arrythmias and cardiac mortality. The aim of this study was to examine the influence of subclinical hypothyroidism on ventricular repolarization measured by corrected QTc in standard 12-lead electrocardiogram. The examined group consisted of 32 patients with hypothyroidism, the controls were 39 healthy individuals. The mean corrected QTc was 0.434, SD +/- 0.0296 seconds and 0.414, SD +/- 0.0208 in the examined groups and in controls, respectively (p < 0.01). QTc did not correlate with free thyroxine concentrations (p = 0.4064). In the group with subclinical hypothyroidism we did not observe a significant difference in heart rate (74.3 vs. 73.7, SD +/- 13.58, NS)." }, { "role": "assistant", "content": "Corrected QT intervals were significantly prolonged in patients with subclinical hypothyroidism. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVES, DESIGN, SETTING, PARTICIPANTS, MAIN OUTCOME MEASURES, RESULTS. Meshes: Adolescent Medicine, Data Collection, Internship and Residency, Pediatrics, Preventive Medicine, United States." }, { "role": "user", "content": "Adolescent medicine training in pediatric residency programs: are we doing a good job? Context: To determine how pediatric residency programs are responding to the new challenges of teaching adolescent medicine (AM) to residents by assessing whether manpower is adequate for training, whether AM curricula and skills are adequately covered by training programs, what types of teaching methodologies are used to train residents in AM, and the needs for new curricular materials to teach AM. A 3-part 92-item survey mailed to all US pediatric residency training programs. Pediatric residency programs. Residency program directors and directors of AM training. AM divisional structure, clinical sites of training, presence of a block rotation, and faculty of pediatric training programs; training materials used and desired in AM; perceived adequacy of coverage of various AM topics; competency of residents in performing pelvic examinations in sexually active teens; and manpower needs. A total of 155/211 (73.5%) of programs completed the program director and the AM parts of the survey. Ninety-six percent of programs (size range, 5-120 residents) had an AM block rotation and 90% required the AM block; those without a block rotation were more likely to be larger programs. Only 39% of programs felt that the number of AM faculty was adequate for teaching residents. Almost half of the programs reported lack of time, faculty, and curricula to teach content in substance abuse. Besides physicians, AM teachers included nurse practitioners (28%), psychologists (25%), and social workers (19%). Topics most often cited as adequately covered included sexually transmitted diseases (81.9%), confidentiality (79.4%), puberty (77.0%), contraception (76.1%), and menstrual problems (73.5%). Topics least often cited as adequately covered included psychological testing (16.1%), violence in relationships (20.0%), violence and weapon-carrying (29.7%), and sports medicine (29.7%). Fifty-eight percent of 137 respondents thought that all or nearly all of their residents were competent in performing pelvic examinations by the end of training; there was no difference between perceived competence and the residents' use of procedure books. Seventy-four percent used a specific curriculum for teaching AM; materials included chapters/articles (85%), lecture outlines (76.1%), slides (41.9%), videos (35.5%), written case studies (24.5%), computerized cases (6.5%), and CD-ROMs (3.2%). Fifty-two percent used Bright Futures, 48% used the Guidelines for Adolescent Preventive Services, and 14% used the Guide to Clinical Preventive Services for teaching clinical preventive services. Programs that used Bright Futures were more likely to feel that preventive services were adequately covered in their programs than those who did not (78% vs 57%). A majority of programs desired more learner-centered materials." }, { "role": "assistant", "content": "Although almost all pediatric programs are now providing AM rotations, there is significant variability in adequacy of training across multiple topics important for resident education. Programs desire more learner-centered materials and more faculty to provide comprehensive resident education in AM." } ]

[ { "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": "Daily additional requirement of protein in lactation is-" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e. 25 gm The additional requirement of protein is : pregnancy -15 gm Lactation - 25 gm" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Case-Control Studies, Female, Heart Atria, Humans, Liver Cirrhosis, Male, Middle Aged, Natriuretic Peptide, Brain, Peptide Fragments." }, { "role": "user", "content": "Are nT pro BNP plasma level and atrial volume linked to the severity of liver cirrhosis? Context: Plasma levels of NT-pro-BNP, a natriuretic peptide precursor, are raised in the presence of fluid retention of cardiac origin and can be used as markers of cardiac dysfunction. Recent studies showed high levels of NT pro BNP in patients with cirrhosis. We assessed NT pro-BNP and other parameters of cardiac dysfunction in patients with cirrhosis, with or without ascites, in order to determine whether the behaviour of NT pro BNP is linked to the stage of liver disease or to secondary cardiac dysfunction. Fifty eight consecutive hospitalized patients mostly with viral or NAFLD-related cirrhosis were studied. All underwent abdominal ultrasound and upper GI endoscopy. Cardiac morpho-functional changes were evaluated by echocardiography and NT-pro-BNP plasma levels determined upon admission. Twenty-eight hypertensive patients, without evidence of liver disease served as controls. Fifty eight cirrhotic patients (72% men) with a median age of 62 years (11% with mild arterial hypertension and 31% with type 2 diabetes) had a normal renal function (mean creatinine 0.9 mg/dl, range 0.7-1.06). As compared to controls, cirrhotic patients had higher NT pro-BNP plasma levels (365.2±365.2 vs 70.8±70.6 pg/ml; p<0.001). Left atrial volume (LAV) (61.8±26.3 vs 43.5±14.1 ml; p = 0.001), and left ventricular ejection fraction (62.7±6.9 vs. 65.5±4%,; p = 0.05) were also altered in cirrhotic patients that in controls. Patients with F2-F3 oesophageal varices as compared to F0/F1, showed higher e' velocity (0.91±0.23 vs 0.66±0.19 m/s, p<0.001), and accordingly a higher E/A ratio (1.21±0.46 vs 0.89±0.33 m/s., p = 0.006)." }, { "role": "assistant", "content": "NT-pro-BNP plasma levels are increased proportionally to the stage of chronic liver disease. Advanced cirrhosis and high NT-pro-BNP levels are significantly associated to increased LAV and to signs of cardiac diastolic dysfunction. NT pro-BNP levels could hence be an useful prognostic indicators of early decompensation of cirrhosis. 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": "Septic tank is used for:" }, { "role": "assistant", "content": "The correct answer is Ans: a (Excreta disposal) Ref: Park 19ed, p. 615(A quite simple one! 1 think no explanation is needed. Let's discuss other important related points.)Methods of excreta disposalUNSEWERED AREA1) Service type( conservatory system)2) Non service type (sanitary latrines)Borehole latrineDugwell or pit latrineWater seal type, eg: RCA type. PRA1 typeSeptic tankAqua privy3) Latrine suitable for camps and temporary useShallow trench latrineDeep trench latrinePit latrineBorehole latrineSewered areasWater cairi age system and sewage treatmenta) Primary treatmentScreeningRemoval of gritPlain sedimentationb) Secondary treatmentTrickling filterActivated sludge processc) Other methodsSea outfallRiver outfallSewage fanningOxidation pond*Trickling filter- zoological layer- smaller cities* Activated sludge process - aeration tank is the heart- for larger cities" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "A 25-year-old girl presents with papules, erythema and telangiectasiae over the face as shown below. She also gives a history of flushing and burning sensation on exposure to sun and on any emotional disturbance. The most likely diagnosis is:" }, { "role": "assistant", "content": "The correct answer is Ans. (b) Rosacea." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Biomarkers, Blood Urea Nitrogen, Calcitriol, Diabetes Mellitus, Experimental, Diabetic Nephropathies, Down-Regulation, Fibrosis, Humans, Kidney, Male, Microtubule-Associated Proteins, Minor Histocompatibility Antigens, Protective Agents, Random Allocation, Rats, Transforming Growth Factor beta1." }, { "role": "user", "content": "Are protective effects of calcitriol on diabetic nephropathy mediated by down regulation of TGF-β1 and CIP4 in diabetic nephropathy rat? Context: To explore the protective effects of calcitriol on diabetic nephropathy by modulating the expressions of transforming growth factor-beta 1 (TGF-β1) and Cdc42 interacting protein-4 (CIP4). Streptozotocin-induced diabetic nephropathy rats (n=36) were randomly divided into control group (control-H, control-M, control-L) and calcitriol group (calcitriol-H, calcitriol-M, calcitriol-L). The expression of TGF-β1 gradually decreased in control-H, control-M and control-L subgroups by injection of different virus vectors. Peanut oil and calcitriol were given to control and calcitriol group, respectively. The expressions of TGF-β1 and CIP4 in kidney, the pathology, and the renal function and lipid profiles were compared between control and calcitriol treatment groups. In the control group, the higher level of TGF-β1 was associated with more severe glomerular pathology (P<0.05). There is a positive correlation between the expression of CIP4 and TGF-β1. Control-H subgroup had significant more severe kidney disease, higher levels of cholesterol, triglyceride, blood glucose, blood urea nitrogen (BUN) and creatinine (Cr) than control-M and control-L subgroups. After calcitriol treatment, the expression of TGF-β1 and CIP4 were significantly decreased compared to the corresponding control subgroups (all P<0.05). Renal fibrosis and pathological changes were markedly improved. The levels of cholesterol, triglyceride, blood glucose, BUN and Cr were significantly reduced (P<0.05)." }, { "role": "assistant", "content": "Calcitriol may protect diabetic nephropathy from fibrosis via inhibition of TGF-β1 and CIP4. 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, UNASSIGNED, UNASSIGNED. Meshes: ." }, { "role": "user", "content": "Do statins exert multiple beneficial effects on patients undergoing percutaneous revascularization procedures? Context: Statins are an essential component of the therapeutic approach of patients with atherosclerotic disease. Statin use is also associated with improved peri-operative and long-term outcomes in these patients. We aimed to define the role of statin treatment in patients undergoing percutaneous revascularization procedures. We searched Medline for studies assessing the effect of statin treatment on percutaneous interventions. Early statin treatment is associated with improved outcomes in patients undergoing percutaneous coronary intervention procedures. Current evidence implies that statin treatment may also play a beneficial role in the management of patients undergoing percutaneous renal artery revascularization and endovascular abdominal aortic aneurysm repair, carotid angioplasty/stenting and endovascular peripheral arterial interventions." }, { "role": "assistant", "content": "Preliminary data suggest that statins exert multiple beneficial actions in patients undergoing percutaneous interventions. Future randomized trials are expected to further evaluate the beneficial effects of statins in these procedures. 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": "Medication which may prevent rapid progression of cochlear Otosclerosis is:" }, { "role": "assistant", "content": "The correct answer is (c) Fluorides(Ref. Cummings, 6th ed., 2218)In active otosclerosis cases, i.e. when Schwartz sign is present medical management with sodium fluoride (Na F) decreases the progression by accelerating the maturation and inhibiting proteolytic enzymes.As per the pathogenesis of otosclerosis steroids, antibiotics and vitamins have no role in the management of otosclerosis." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Age of Onset, Aged, Alleles, Alzheimer Disease, Apolipoproteins E, Aromatase, Cognition Disorders, DNA, Estrogens, Female, Fertility, Gene Frequency, Genetic Variation, Genotype, Humans, Neuropsychological Tests, Parity, Polymorphism, Single Nucleotide, Pregnancy, Regression Analysis." }, { "role": "user", "content": "Does genetic variation of CYP19 ( aromatase ) gene influence age at onset of Alzheimer 's disease in women? Context: There is evidence for a higher prevalence of Alzheimer's disease (AD) in women, but whether this is due to their longer life expectancy or to biological gender-specific risk factors is unclear. One likely contributing factor is the reduced estrogen neuroprotective action following menopause. In this context, an AD risk gene could be CYP19, encoding aromatase, an enzyme involved in estrogen biosynthesis. We analyzed the role of 3 CYP19 single-nucleotide polymorphisms (rs12907866, rs17601241, rs4646) in AD development and their possible influence on quantitative traits reflecting disease severity (age at onset and cognitive decline) in 319 patients and 110 controls. No association was observed between the CYP19 single-nucleotide polymorphisms and AD risk. Yet CYP19 genetic variation did seem to contribute to AD development in women as the rs4646 genotypes carrying the T allele were associated with an earlier onset age (p = 0.01) independently of a similar effect determined by the APOE e*4 allele (p = 0.005). Also, being present only in parous women (p = 0.01), the effect of rs4646 genotypes on onset age appeared to depend on past fertility." }, { "role": "assistant", "content": "Together with gender-specific factors such as parity, genes controlling estrogen metabolism may play a relevant role in AD susceptibility in women. 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: Arabidopsis, Evolution, Molecular, Fungi, Gene Duplication, Humans, Oxidative Phosphorylation, Oxidoreductases, Phylogeny." }, { "role": "user", "content": "Does phylogenomics of the oxidative phosphorylation in fungi reveal extensive gene duplication followed by functional divergence? Context: Oxidative phosphorylation is central to the energy metabolism of the cell. Due to adaptation to different life-styles and environments, fungal species have shaped their respiratory pathways in the course of evolution. To identify the main mechanisms behind the evolution of respiratory pathways, we conducted a phylogenomics survey of oxidative phosphorylation components in the genomes of sixty fungal species. Besides clarifying orthology and paralogy relationships among respiratory proteins, our results reveal three parallel losses of the entire complex I, two of which are coupled to duplications in alternative dehydrogenases. Duplications in respiratory proteins have been common, affecting 76% of the protein families surveyed. We detect several instances of paralogs of genes coding for subunits of respiratory complexes that have been recruited to other multi-protein complexes inside and outside the mitochondrion, emphasizing the role of evolutionary tinkering." }, { "role": "assistant", "content": "Processes of gene loss and gene duplication followed by functional divergence have been rampant in the evolution of fungal respiration. Overall, the core proteins of the respiratory pathways are conserved in most lineages, with major changes affecting the lineages of microsporidia, Schizosaccharomyces and Saccharomyces/Kluyveromyces due to adaptation to anaerobic life-styles. We did not observe specific adaptations of the respiratory metabolism common to all pathogenic species. 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": "There are some undesirable but unavoidable pharmacodynamic effects of a drug, which are known as:" }, { "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: INTRODUCTION, METHODS, RESULTS. Meshes: Adult, Australia, Cesarean Section, Clinical Competence, Family Relations, Female, Health Facility Size, Health Knowledge, Attitudes, Practice, Health Personnel, Health Services Accessibility, Hospitals, Maternity, Humans, Patient Preference, Patient Safety, Professional-Patient Relations, Qualitative Research, Rural Health Services, Social Support, Tasmania, Transportation, Workplace." }, { "role": "user", "content": "Small rural maternity units without caesarean delivery capabilities: is it safe and sustainable in the eyes of health professionals in Tasmania? Context: In Australia, over 50% of small rural maternity units have been closed in the past two decades. Workforce shortages, safety and quality concerns and cost considerations are the three interrelated reasons that have led to these closures. Women and families face many challenges when these critical services are absent from their local communities. In an effort to continue to provide maternity services in rural areas, small maternity units without caesarean delivery capabilities have been established in a few rural communities in Tasmania. However, they have divided the opinions of Tasmanian health professionals. This article is part of a larger study which focused on maternity services for rural women and reports the views of the health professionals on this model of care. A qualitative study using semi-structured interviews was conducted with 20 maternity health providers across Tasmania to explore their experiences and views on the model of offering small rural maternity units without obstetric services. The data were analysed in NVivo v9 (<a href='http://www.qsrinternational.com' target='_blank'>www.qsrinternational.com) using grounded theory. Three main themes are grounded from interview data: (1) women's difficulties in rural areas; (2) women's expectations; and (3) maternity units without caesarean delivery capabilities. The results reveal that low-intervention style birthing services in rural areas could reduce women's difficulties that include access issues, disruption, anxiety and travel related issues, and address women's expectations in term of access to local services. However, this model is less likely to meet women's safety expectations, especially in emergency situations." }, { "role": "assistant", "content": "The findings of this study offer insights for policy-makers and state government with regard to the future planning of this model of care. It is recommended that safety and sustainability issues should be considered when this model of care is to be implemented in other rural communities." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Aging, Animals, Apoptosis, Biological Transport, Carrier Proteins, Cell Proliferation, Cholesterol, Cytokines, Gene Knockout Techniques, Intestinal Mucosa, Intestines, Liver, Lung, Mice, Organ Specificity, Peroxidase, Pseudomonas aeruginosa, Sepsis, Spleen, Survival Analysis, Triglycerides." }, { "role": "user", "content": "Does intestine-specific deletion of microsomal triglyceride transfer protein increase mortality in aged mice? Context: Mice with conditional, intestine-specific deletion of microsomal triglyceride transfer protein (Mttp-IKO) exhibit a complete block in chylomicron assembly together with lipid malabsorption. Young (8-10 week) Mttp-IKO mice have improved survival when subjected to a murine model of Pseudomonas aeruginosa-induced sepsis. However, 80% of deaths in sepsis occur in patients over age 65. The purpose of this study was to determine whether age impacts outcome in Mttp-IKO mice subjected to sepsis. Aged (20-24 months) Mttp-IKO mice and WT mice underwent intratracheal injection with P. aeruginosa. Mice were either sacrificed 24 hours post-operatively for mechanistic studies or followed seven days for survival. In contrast to young septic Mttp-IKO mice, aged septic Mttp-IKO mice had a significantly higher mortality than aged septic WT mice (80% vs. 39%, p = 0.005). Aged septic Mttp-IKO mice exhibited increased gut epithelial apoptosis, increased jejunal Bax/Bcl-2 and Bax/Bcl-XL ratios yet simultaneously demonstrated increased crypt proliferation and villus length. Aged septic Mttp-IKO mice also manifested increased pulmonary myeloperoxidase levels, suggesting increased neutrophil infiltration, as well as decreased systemic TNFα compared to aged septic WT mice." }, { "role": "assistant", "content": "Blocking intestinal chylomicron secretion alters mortality following sepsis in an age-dependent manner. Increases in gut apoptosis and pulmonary neutrophil infiltration, and decreased systemic TNFα represent potential mechanisms for why intestine-specific Mttp deletion is beneficial in young septic mice but harmful in aged mice as each of these parameters are altered differently in young and aged septic WT and Mttp-IKO mice. 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: Alanine Transaminase, Angiostatins, Animals, Antineoplastic Agents, Aspartate Aminotransferases, Blotting, Western, Cattle, Cell Division, Coculture Techniques, Endothelium, Vascular, Eye Enucleation, Humans, Liver Function Tests, Liver Neoplasms, Melanoma, Experimental, Mice, Mice, Nude, Peptide Fragments, Plasminogen, Tumor Cells, Cultured, Uveal Neoplasms." }, { "role": "user", "content": "Does angiostatin produced by certain primary uveal melanoma cell lines impede the development of liver metastases? Context: To evaluate the ability of human uveal melanomas to produce angiostatin in vitro and the effect of angiostatin on the development of liver metastases in vivo. Human uveal melanoma cell lines (OCM1, OCM3, MEL202, MEL285, 92-1, OM431, and OMM1) were assayed for their ability to produce angiostatin in vitro by an angiostatin bioassay and by Western blot analysis. The OCM3 and OMM1 tumor cells were inoculated either in the posterior or the anterior segment of nude mice. One group of mice in each experiment underwent enucleation and hepatic metastases were assayed by histopathologic and liver function analysis. OCM1, OCM3, and 92-1 cell lines significantly inhibited bovine endothelial cell proliferation in vitro and generated 38-Kd angiostatin molecules. Enucleation of eyes containing OCM3 in the posterior segment resulted in a higher number of metastatic foci (26.5) in that group compared with the nonenucleated group of mice (11.17). After enucleation, elevated levels of serum aspartate transaminase and alanine aminotransferase were observed in mice bearing OCM3 in either anterior or posterior segments. The enucleation of eyes containing OMM1 (nonangiostatin-producing cells) had no significant effect on liver metastasis." }, { "role": "assistant", "content": "By removing a source of angiostatin, enucleation of melanoma-containing eyes may unwittingly exacerbate the metastatic potential of uveal melanomas. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Aged, 80 and over, C-Reactive Protein, Calcitonin, Calcitonin Gene-Related Peptide, Emergency Service, Hospital, Female, Glomerular Filtration Rate, Humans, Immunoassay, Inflammation, Male, Prospective Studies, Protein Precursors, Reference Values." }, { "role": "user", "content": "Are decisional procalcitonin thresholds adapted to elderly patients admitted to the emergency room? Context: Diagnosis of sepsis in elderly is challenging. We investigated whether procalcitonin concentrations in elderly differed from values for the general population. Procalcitonin measurement was assessed prospectively in 307 apyretic patients ≥75 years visiting the emergency department. Median age was 86 years [IQR81-90] and 222 (72%) were female. Procalcitonin concentration was 0.057 µg/L [0.040-0.092]; 99th percentile was 0.661 µg/L. Patients with procalcitonin concentrations above decisional thresholds had lower glomerular filtration rate and higher C-reactive protein concentrations." }, { "role": "assistant", "content": "Baseline procalcitonin levels are increased in elderly. Elevated values are common and associated to low-grade inflammation and lower eGFR. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, METHODS, RESULTS. Meshes: Aged, Aging, Alcohol-Related Disorders, Anxiety, Chronic Disease, Comorbidity, Depression, Disease Progression, Female, Humans, Longitudinal Studies, Male, Quality of Life, Stress Disorders, Post-Traumatic, United States, Wounds and Injuries." }, { "role": "user", "content": "Is pTSD a chronic , fluctuating disorder affecting the mental quality of life in older adults? Context: Examine the longitudinal course of posttraumatic stress disorder (PTSD) in older adults and its influence on mental health quality of life (MHQoL). Evaluation performed at baseline, and 3 and 6 months postrandomization as part of a longitudinal trial. A total of 1,185 participants, with a mean (±SD) age of 73.53 (±5.98) years, at seven primary care sites (including five Veterans Affairs clinics), were divided into four groups, namely, no trauma (n = 661), trauma only (n = 319), partial PTSD (n = 114), and PTSD (n = 81), based on reports of trauma and associated PTSD symptoms. The prevalence of comorbid depression, anxiety, and alcohol use disorders, assessed using the Diagnostic and Statistical Manual, Fourth Edition, criteria and changes in MHQoL, as assessed by the Short Form-36 mental component score. At baseline, the PTSD group had higher frequencies of comorbid depression and anxiety disorders and worse MHQoL than the other groups. Both chronic (participants diagnosed with PTSD at all three assessments) and fluctuating (participants moving to or from one of the other groups) trajectories of course were observed during the follow-up period, which appeared to be separate from that of the comorbid disorders. Even after accounting for those comorbid disorders, PTSD had an independent association with poorer MHQoL at multiple time points, especially in men, whereas trauma without PTSD symptoms (trauma only) had better MHQoL." }, { "role": "assistant", "content": "PTSD had chronic and fluctuating courses, with negative effects on MHQoL, while partial PTSD might represent a transitional state, underscoring the need to better identify and treat PTSD at any phase in later life. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, DESIGN, PATIENTS, RESULTS. Meshes: Adult, Aged, Anal Canal, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Middle Aged, Rectal Fistula, Retrospective Studies, Surgical Flaps, Suture Techniques, Treatment Outcome, Wound Healing, Young Adult." }, { "role": "user", "content": "Is the outcome of transanal advancement flap repair affected by the complexity of high transsphincteric fistulas? Context: Transanal advancement flap repair for the treatment of high transsphincteric fistulas fails in 1 of every 3 patients. Until now no definite risk factors for failure have been identified. The question is whether the more complex fistulas, such as those with horseshoe extensions and associated abscesses, have a less favorable outcome. Aim of the present study was to indentify whether more complex fistulas have a less favorable outcome. This study is a retrospective case series review. Between 1995 and 2007 a series of 162 patients underwent endoanal MR imaging before transanal advancement flap repair. Two investigators, without prior knowledge of the surgical findings, reviewed all MR images. Lateral fistulas were identified in 5 patients. Because of the small number, these patients were excluded from further analysis. Posterior fistulas were identified in 119 patients (76%). These fistulas had 3 types of extensions: a direct course (36%), a classic horseshoe extension (23%), or an intersphincteric horseshoe extension (41%). The corresponding healing rates were 37%, 81%, and 73%. Anterior fistulas were observed in 23% of the patients. These fistulas had 2 types of extensions: a direct course (61%) or a classic horseshoe extension (39%). The corresponding healing rates were 60% and 52%. The healing rate of fistulas with a direct course was significantly lower than the healing rate of fistulas with a classic or intersphincteric horseshoe extension. Associated abscesses were found in 47% of the posterior fistulas and 5% of the anterior fistulas. Once adequately drained, these abscesses did not affect the outcome of transanal advancement flap repair." }, { "role": "assistant", "content": "The complexity of high transsphincteric fistulas does not affect the outcome of transanal advancement flap repair." } ]

[ { "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 regions has the lowestatmospheric humidity?" }, { "role": "assistant", "content": "The correct answer is Humidity or moisture is always present in the atmosphere. The amount of moisture which air can hold depends upon its temperature. If air is cooled excessive moisture precipitates for a paicular temperature. This is called the dew point." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Angiogenesis Inhibitors, Animals, Antibodies, Monoclonal, Humanized, Bevacizumab, Cell Hypoxia, Cell Line, Tumor, Female, Humans, Mice, Mice, Nude, Neoplasm Metastasis, Neoplasms, Neovascularization, Pathologic, Ovarian Neoplasms, Vascular Endothelial Growth Factor A." }, { "role": "user", "content": "Does short-term anti-vascular endothelial growth factor treatment elicit vasculogenic mimicry formation of tumors to accelerate metastasis? Context: Antiangiogenic therapy is one of the most significant advances in anticancer treatment. The benefits of antiangiogenic therapies of late-stage cancers have been investigated but are still too limited. We used an ovarian cancer model to test the effect of short-term bevacizumab treatment on metastasis as measured by bioluminescence. Western blotting and CD34-PAS dual staining were performed to assess hypoxia-inducible transcription factor-1α (HIF-1α) expression and vasculogenic mimicry(VM) formation. Cell viability was examined by a CCK8 assay. Bevacizumab demonstrated antitumor effects in models of ovarian cancer, but also accelerated metastasis together, with marked hypoxia and VM formation in mice receiving short-term therapy. Bevacizumab treatment did not affect SKOV3 cell viability and the amount of VM in three-dimensional culture." }, { "role": "assistant", "content": "These results suggest that antiangiogenic therapy may potentially influence the progression of metastatic disease, which has been linked to the hypoxic response and VM formation. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Case-Control Studies, DNA Damage, Deoxyguanosine, Diabetes Mellitus, Type 2, Female, Folic Acid, Humans, Male, Micronucleus Tests, Middle Aged, Oxidative Stress." }, { "role": "user", "content": "Do dNA and oxidative damages decrease after ingestion of folic acid in patients with type 2 diabetes? Context: Type 2 diabetes mellitus (T2DM) is a chronic degenerative disease that promotes autoxidation of sugars, leading to the production of reactive oxygen species. This damage occurs especially at the level of cellular proteins, carbohydrates, lipids and DNA, thus playing an important role in the pathogenesis of late complications of T2DM. We investigated the effect of folic acid on DNA and oxidative damage in patients with T2DM. We studied 30 individuals diagnosed with T2DM and 30 control individuals without disease. Individuals with T2DM were prescribed 5 mg of folic acid, taken orally three times daily for 1 month. Samples were taken 15 and 30 days after treatment. DNA damage was determined using the micronucleus test in oral mucosa and oxidative stress by quantifying 8-hydroxy-2'-deoxyguanosine (8-OHdG) as well as by quantifying total lipid peroxides. Individuals with T2DM had a higher number of micronuclei as well as higher levels of 8-OHdG and lipid peroxides than the control group (p = 0.001). Individuals with T2DM showed a significant reduction in the number of micronuclei and the concentration of 8-OHdG and lipid peroxides over time with folic acid intake." }, { "role": "assistant", "content": "A positive correlation exists between oxidative stress produced by T2DM and DNA damage, so the use of an antioxidant such as folic acid in DM2 therapy is advisable for delaying complications due to T2DM-induced oxidative stress and DNA damage. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, African Americans, Age Factors, Asian Americans, Chi-Square Distribution, Colitis, Ulcerative, Crohn Disease, Hospitalization, Humans, Indians, North American, Middle Aged, Minority Groups, Prevalence, United States." }, { "role": "user", "content": "Are hospitalizations increasing among minority patients with Crohn 's disease and ulcerative colitis? Context: Rates of inflammatory bowel disease (IBD) appear to be increasing among nonwhite populations outside the United States, but national data describing the incidence and prevalence of IBD are not available for minority patients. The aim of this study was to examine time trends of hospital discharge among minority patients with IBD. Nationally representative data describing hospital discharges were obtained from the National Hospital Discharge Survey for the years 1994 to 2006. Race-specific annual proportions of hospitalizations including a discharge diagnosis of ulcerative colitis and Crohn's disease were calculated. Trends in proportions were assessed for statistical significance using the extended Mantel-Haenszel chi-square test for trend. The proportion of hospitalizations including a discharge diagnosis of IBD increased significantly from 1994 to 2006 among the total population and among Asian, black, and white patients separately. Increases were statistically significant when analysis was performed for Crohn's disease and ulcerative colitis combined and separately. Marked increases were seen among Asians." }, { "role": "assistant", "content": "The proportion of hospitalizations including a discharge diagnosis of IBD increased significantly among minority and nonminority patients from 1994 through 2006. The causes underlying these changes are not certain and should be further investigated. 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, Antigens, Nuclear, Carcinoma, Papillary, Cell Division, Female, Humans, Ki-67 Antigen, Male, Middle Aged, Neoplasm Recurrence, Local, Nuclear Proteins, Receptor, ErbB-2, Tumor Suppressor Protein p53, Urinary Bladder Neoplasms." }, { "role": "user", "content": "Is proliferative activity the most significant predictor of recurrence in noninvasive papillary urothelial neoplasms of low malignant potential and grade 1 papillary carcinomas of the bladder? Context: Recurrence of transitional cell carcinoma of the bladder cannot be predicted accurately by traditional criteria alone. This study examined the value of cell proliferative activity, morphometry, and expression of p53, c-erbB-2, and bcl-2 oncogenes in predicting recurrence of superficial papillary urothelial neoplasms of low malignant potential (LMP) and Grade 1 (G1) papillary carcinomas of the bladder. Sixty-two patients (mean age, 62 years) with newly diagnosed superficial pTa bladder tumors (19 LMP, and 43 G1) were analyzed retrospectively. All patients underwent transurethral resection (TUR). Median follow-up was 69 months. Serial sections from formalin-fixed, paraffin-embedded material at initial TUR were stained with monoclonal antibodies (MoAbs) DO7, CB11, and bcl-2-124. Cell proliferation was assessed by MIB-1 MoAb, the quantity of argyrophilic nucleolar organizer region-associated proteins (AgNORs), and mitotic count. Of the 62 patients, 42 (67.7%) had one or more recurrences. Recurrence rates were higher in MIB-1 (P < 0.0001) and p53 immunopositive cases (P = 0.02), when the mitotic count was greater than 5 (P = 0.004), and in G1 carcinomas (P = 0.04). In univariate analysis, the disease-free period was shorter for MIB-1 (P < 0.0001) and p53 immunopositive (P = 0.0001) cases, for cases with high AgNOR quantity (P = 0.04), mitotic count greater than 5 (P = 0.01), and in G1 carcinomas (P = 0.002). In multivariate analysis, only MIB-1 immunoreactivity retained independent prognostic significance." }, { "role": "assistant", "content": "Despite the small cohort, the results confirm the prognostic value of cell proliferation and p53 expression in patients with bladder neoplasms. The results also indicate that MIB-1 immunopositivity is the most significant predictor of recurrence and disease-free survival in superficial LMP and G1 papillary bladder carcinomas. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Biopsy, Humans, Male, Middle Aged, Prospective Studies, Prostatic Neoplasms, Rectum, Reoperation." }, { "role": "user", "content": "Does office based transrectal saturation biopsy improve prostate cancer detection compared to extended biopsy in the repeat biopsy population? Context: Multiple studies have shown significant prostate cancer detection for repeat biopsy. However, the best approach regarding core number and location remains controversial. Transrectal saturation biopsy is believed to increase cancer detection but to our knowledge no studies comparing it to 12 to 14-core extended biopsy have been published. We compared saturation and extended repeat biopsy protocols after initially negative biopsy. A total of 1,056 men underwent prostate biopsy after initially negative biopsy. The extended biopsy group included 393 men with 12 to 14-core repeat biopsy. The saturation biopsy group included 663 men with 20 to 24-core repeat biopsy. We analyzed demographics and prostate cancer between the 2 groups. We compared prostate cancer detection in patients with previous atypical small acinar proliferation and/or high grade prostatic intraepithelial neoplasia as well as the risk of detecting clinically insignificant tumors. Prostate cancer was detected in 315 of the 1,056 patients (29.8%). Saturation biopsy detected almost a third more cancers (32.7% vs 24.9%, p=0.0075). In patients with a benign initial biopsy saturation biopsy achieved significantly greater prostate cancer detection (33.3% vs 25.6%, p=0.027). For previous atypical small acinar proliferation and/or high grade prostatic intraepithelial neoplasia there was a trend toward higher prostate cancer detection rate in the saturation group but it did not attain statistical significance (31.2% vs 23.3%, p=0.13). Of 315 positive biopsies 119 (37.8%) revealed clinically insignificant cancer (40.1% vs 32.6%, p=0.2)." }, { "role": "assistant", "content": "Compared to extended biopsy, office based saturation biopsy significantly increases cancer detection on repeat biopsy. The potential for increased detection of clinically insignificant cancer should be weighed against missing significant cases. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Most common cause of abdominal mass in neonates is?" }, { "role": "assistant", "content": "The correct answer is b. Multicystic dyspiastic kidney(Ref: Nelson's 20/e p 2513)Multicystic dyspiastic kidneyQ is the most common cause of abdominal mass in a neonate." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Which of the following drugs has both antihelminth and antiprotozoal activity ?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., Nitazoxanide Nitazoxanide This is the salicylamidecogener of the antihelminthniclosamide, introduced for the treatment of giardiasis and cryptosporidiosis and is also active against other protozoa and helminthes including E. histolytica, T. vaginalis, Ascaris and H. nana. It is a prodrug which onn absorption is conveed into active for tizoxanide. Tizoxanide is an inhibitor of PFOR enzyme that is the essential pathway of electron transpo energy metabolism in anaerobic organisms." } ]

[ { "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 56-year-old male patient develops an accentric hard breast lump over the past few months and a biopsy proves this to be breast carcinoma. Of all breast cancers, the rate of occurrence in males is which of the following?" }, { "role": "assistant", "content": "The correct answer is Cancer of the breast in males constitutes <1% of total cases. It tends to present at a more advanced stage in men than in women, because it is often overlooked. It may easily be confused with the more commonly occurring condition of gynecomastia. Careful clinical radiological follow-up studies are indicated." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, RESULTS. Meshes: Antibodies, Monoclonal, Cell Line, Drug Evaluation, Preclinical, HIV Antibodies, HIV Fusion Inhibitors, HIV Infections, HIV-1, Humans, Immunization, Passive, Leukocytes, Mononuclear, Neutralization Tests, Virus Replication." }, { "role": "user", "content": "Is hIV sensitivity to neutralization determined by target and virus producer cell properties? Context: Using clinical isolates from a recent passive immunization trial with antibody 2G12, we probed the capacity of frequently used neutralization formats - the primary peripheral blood mononuclear cell (PBMC)-based and the TZM-bl cell-based assay systems - to predict in-vivo activity of 2G12. Antibodies and entry inhibitors of established efficacy were used to neutralize HIV-1 isolates in different in-vitro assay setups. Single round infection with Env-pseudotyped and multiple round infection with replication-competent virus was studied on PBMCs and a variety of engineered cell lines. Six out of 12 isolates with high sensitivity to 2G12 in the replication-competent PBMC assay lacked sensitivity to the monoclonal antibody in the env-pseudotype TZM-bl assay. Outcome of passive immunization with 2G12 corroborated the PBMC-assay in-vitro data, as escape mutations to 2G12 emerged, proving the monoclonal antibody's impact on HIV in vivo. Failure to inhibit pseudotype infection of TZM-bl was not due to sequence differences or the pseudotype infection per se, as infection of PBMCs with the identical pseudotyped viruses was sensitive to 2G12 inhibition. Similar shifts in efficacy, though less extreme, were noted for other neutralizing antibodies and inhibitors. Exploration of causes for the observed differences between assay systems revealed that both target cell and virus producer properties influence sensitivity of virus entry to inhibition." }, { "role": "assistant", "content": "Our observation that neutralization assay systems employing engineered reporter cell lines can miss in-vivo relevant neutralizing activities strongly argues that preclinical assessment should not be restricted to a single assay type. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Age Distribution, Aged, Aged, 80 and over, Body Surface Area, Body Weight, Burns, Discriminant Analysis, Humans, Incidence, Injury Severity Score, Mass Screening, Middle Aged, Multivariate Analysis, Obesity, Morbid, Predictive Value of Tests, Pulmonary Embolism, Retrospective Studies, Risk Factors, Thromboembolism, Time Factors, Venous Thrombosis." }, { "role": "user", "content": "Are thermally injured patients at significant risk for thromboembolic complications? Context: The incidence of thromboembolic complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE) in thermally injured patients is considered sufficiently uncommon that routine prophylactic measures are not warranted. Nevertheless, the incidence of DVT/PE may be increasing. The records of 1,300 patients admitted to our unit from January 1990 to June 1995 were reviewed. Twenty-three patients developed a clinically significant DVT, eight patients developed a PE, and two patients developed both a DVT and a PE, for an overall DVT/PE incidence of 2.9%. Four of 10 PEs were felt to be fatal. The DVT/PE patients were older (mean age, 42.6 vs. 28.7; p < 0.001) and had larger burns (37% vs. 18%, p < 0.001) than patients without evidence of DVT/PE. Body weight appeared to also influence DVT/PE rates, with obese patients (>30% over ideal body weight) having a higher incidence than patients with low or normal body weight (7.2 vs. 2.7%, p < 0.015). Age and total body surface area (TBSA) burn had a synergistic effect on DVT/PE risk, with the sum of age and TBSA burn exerting the strongest independent effect when discriminant function analysis was performed (p < 0.001)." }, { "role": "assistant", "content": "One can identify a population at increased risk of DVT/PE on the basis of the sum of age and TBSA burn, but prospective screening trials that assess all risk factors for DVT/PE should be performed before routine prophylaxis is used in thermally injured patients. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Acceleration, Animals, Craniocerebral Trauma, Diffusion Magnetic Resonance Imaging, Disease Models, Animal, Injections, Intravenous, Male, Polyethylene Glycols, Rats, Solvents." }, { "role": "user", "content": "Does intravenous polyethylene glycol successfully treat severe acceleration-induced brain injury in rats as assessed by magnetic resonance imaging? Context: Polyethylene glycol (PEG) is a nontoxic molecule with known efficacy as a cell membrane sealant, improving histological and behavioral outcomes in trauma models. Diffusion-weighted (DW) magnetic resonance imaging (MRI) is the most sensitive method of detecting in vivo diffuse axonal injury (DAI), where a decreased apparent diffusion coefficient (ADC) of water reflects cytotoxic edema. We use DW-MRI to assess severe DAI in rats treated with a single acute postinjury injection of PEG. Rats were divided into uninjured, injured saline-treated, and injured PEG-treated groups. Injury groups received a severe brain injury using an impact-acceleration weight-drop model. Saline or PEG was administered acutely as a single intravenous dose to injured saline-treated and injured PEG-treated groups, respectively. DW-MRI analysis was performed at postinjury day 7 with a 9.4-T magnet. ADC was calculated for cortex, corpus callosum/hippocampus, and thalamus in each group. An expected decrease in ADC, representing cytotoxic edema, was observed in the injured saline-treated group. The injured PEG-treated group demonstrated no decrease in ADC relative to the uninjured rats, and the difference between ADC in saline and PEG-treated groups reached significance for all 3 zones of assessed brain. Differences were seen grossly between injured saline-treated and injured PEG-treated groups on representative color-mapped ADC images." }, { "role": "assistant", "content": "A single intravenous dose of PEG dramatically limits sequelae of severe acceleration-induced brain injury--in this case, assessed by cytotoxic edema on DW-MRI--by intervening at the primary injury level of neuronal membrane disruption. This outcome is unprecedented, as no prior treatments for DAI have demonstrated similar efficacy. DAI treatment with intravenous PEG may have future clinical relevance and warrants further investigation. 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, OBJECTIVE, BACKGROUND, METHODS, RESULTS. Meshes: 1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine, Animals, Anterior Horn Cells, Axons, Behavior, Animal, Cauda Equina, Disease Models, Animal, Hypesthesia, Injections, Spinal, Intracellular Signaling Peptides and Proteins, Lumbar Vertebrae, Male, Motor Skills, Motor Skills Disorders, Nerve Degeneration, Neuroprotective Agents, Pain Threshold, Polyradiculopathy, Protein Kinase Inhibitors, Protein-Serine-Threonine Kinases, Rats, Rats, Sprague-Dawley, Research Design, Schwann Cells, Spinal Stenosis, Time Factors, rho GTP-Binding Proteins, rho-Associated Kinases." }, { "role": "user", "content": "Does rho kinase inhibitor improve motor dysfunction and hypoalgesia in a rat model of lumbar spinal canal stenosis? Context: Immunohistochemical and behavioral study using a rat cauda equina compression model. To investigate, after cauda equina compression by spinal canal stenosis (SCS), Rho activation in the spinal cord and cauda equina, and the effect of intrathecal administration of a Rho kinase inhibitor on hypoalgesia and motor dysfunction. Compression of the cauda equina caused by SCS is a common clinical disorder associated with sensory disturbance and intermittent claudication. Cauda equina compression is thought to reduce blood flow and result in nerve degeneration caused by various cytokines. Rho, a member of the small GTPases, is a signal transmitter. It promotes Wallerian degeneration, decreases blood flow in the spinal cord and brain, and increases expression of several cytokines. Currently, Rho kinase inhibitor is used clinically to treat progressive nerve damage due to cerebrovascular disorders. However, its effect for SCS has not been evaluated. Forty-two 6-week-old male Sprague-Dawley rats (200-250 g) were used. For the SCS model (n = 27), a small piece of silicon was placed under the lamina of the fourth lumbar vertebra. In the sham-operated group, laminectomies were performed at L5 only (n = 15). We examined mechanical sensitivity and motor function using von Frey hairs and a treadmill, and immunohistochemically localized Rho in the spinal ventral neurons, axons, and Schwann cells in the cauda equina. We also examined the effects of intrathecally administered Rho kinase inhibitor for hypoalgesia or motor dysfunction caused by SCS. We observed motor dysfunction and hypoalgesia and activated Rho-immunoreactive cells in spinal ventral neuroreported to induce neurite and axonal outgrowth in the spinal cord and brain after nervous system injury. In addition, 1 report showed that Rho kinase was involved in Wallerian degeneration that was rescued by Rho kinase inhibitor. Furthermore, it is thought that Rho is involved in TNF-alpha and interleukin (IL) production in the central nervous system, and the production was inhibited by administering Rho kinase inhibitor in the central nervous system. Regardns, axons, and Schwann cells in the cauda equina. Intrathecal administration of Rho kinase inhibitor improved mechanical hypoalgesia and motor dysfunction caused by SCS." }, { "role": "assistant", "content": "Activated Rho may play an important role in nerve damage in the cauda equina in SCS. Rho kinase inhibitor may be a useful tool in determining the pathomechanism of cauda equina syndrome caused by SCS. 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 following is not a features of Alzheimer's disease" }, { "role": "assistant", "content": "The correct answer is Lewy bodies are commonly found in Parkinsonism." } ]

[ { "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": "False about following skin condition is?" }, { "role": "assistant", "content": "The correct answer is Ans. A. More common in maleMelasma is due to the abnormal deposition of melanin pigment in facial skin. It is most common in females on the forehead, malar cheeks, upper lip, and chin. It seems to be associated with pregnancy and oral contraceptives. It is believed that light plays a role in its appearance. Treatment may require the application of a topical bleaching cream containing hydroquinone, tretinoin, or azelaic acid. Occasionally, certain laser treatments may be of benefit." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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 systematic review of fall in older adults with cancer? Context: Older adults frequently experience falls, at great cost to themselves and society. Older adults with cancer may be at greater risk for falls and have unique risk factors. We undertook a systematic review of the available medical literature to examine the current evidence regarding factors associated with falls in older adults with cancer. PubMed, Embase, CINAHL, CENTRAL, DARE, Cochrane Database of Systematic Reviews and clinical trials.gov were searched using standardized terms for concepts of oncology/cancer, people 60 and older, screening, falls and diagnosis. Eligible studies included cohort or case-control studies or clinical trials in which all patients, or a subgroup of patients, had a diagnosis of cancer and in which falls were either the primary or secondary outcome. We identified 31 studies that met our inclusion criteria. Several studies suggest that falls are more common in older adults with a diagnosis of cancer than those without. Among the 11 studies that explored factors associated with outpatient falls, some risk factors for falls established in the general population were also associated with falls in older adults with cancer, including dependence in activities of daily living and prior falls. Other factors associated with falls in a general population, such as age, polypharmacy and opioid use, were not predictive of falls among oncology populations. Falls among older adults with cancer in the inpatient setting were associated with established risk factors for falls in people without cancer, but also with factors unique to an oncology population, such as brain metastases." }, { "role": "assistant", "content": "Falls in older adults with cancer are more common than in the general population, and are associated with risk factors unique to people with cancer. Further study is needed to establish methods of screening older adults with cancer for fall risk and ultimately implement interventions to reduce their risk of falls. Identifying which older adults with cancer are at greater risk for falls is a requisite step to ultimately intervene and prevent falls in this vulnerable population. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Aged, 80 and over, Biomarkers, Chi-Square Distribution, Creatinine, Critical Illness, Emergency Service, Hospital, Female, Hospital Mortality, Hospitals, Teaching, Hospitals, Urban, Humans, Infection, Lactic Acid, Leukocyte Count, Male, Patient Admission, Pennsylvania, Predictive Value of Tests, ROC Curve, Regression Analysis, Retrospective Studies, Selection Bias, Single-Blind Method." }, { "role": "user", "content": "Is emergency department lactate associated with mortality in older adults admitted with and without infections? Context: Serum lactate values in the emergency department (ED) have been associated with mortality in diverse populations of critically ill patients. This study investigates whether serum lactate values measured in the ED are associated with mortality in older patients admitted to the hospital, both with and without infections. This is a retrospective cohort study performed at two urban teaching hospitals. The study population includes 1,655 older ED patients (age>or=65 years) over a 3-year period (2004-2006) who had serum lactate measured prior to admission. The presence or absence of infection was determined by review of International Classification of Diseases Ninth Revision (ICD-9) admission diagnosis codes. Mortality during hospitalization was determined by review of inpatient records. Mortality at 30 and at 60 days was determined using a state death registry. In patients with infections, increasing serum lactate values of >or=2.0 mmol/L were linearly associated with relative risk (RR) of mortality during hospitalization (RR=1.9 to 3.6 with increasing lactate), at 30 days (RR=1.7 to 2.6), and at 60 days (RR=1.4 to 2.3) when compared to patients with serum lactate levels of <2.0 mmol/L. In patients without infections, a similar association was observed (RR=1.1 to 3.9 during hospitalization, RR=1.2 to 2.6 at 30 days, RR=1.1 to 2.4 at 60 days). In both groups of patients, serum lactate had a greater magnitude of association with mortality than either of two other commonly ordered laboratory tests, leukocyte count and serum creatinine." }, { "role": "assistant", "content": "Higher ED lactate values are associated with greater mortality in a broad cohort of admitted patients over age 65 years, regardless of the presence or absence of infection. 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 regarding the pudendal nerve, except" }, { "role": "assistant", "content": "The correct answer is Pudendal nerve is a somatic nerve and is not the main supply of pelvic viscera (D). It is the nerve of perineum carrying root value S-2, 3 & 4 (B) and is a mixed nerve with both the sensory and motor (A) components." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: 6-Ketoprostaglandin F1 alpha, Administration, Oral, Adult, Blood Pressure, Cyclosporine, Dinoprostone, Endothelins, Female, Heart Rate, Humans, Immunosuppressive Agents, Inulin, Kidney Diseases, Kidney Transplantation, Male, Metabolic Clearance Rate, Nitrates, Nitric Oxide, Nitrites, Prostaglandins, Renal Artery, Renal Circulation, Thromboxane B2, Vascular Resistance, Vasoconstrictor Agents, p-Aminohippuric Acid." }, { "role": "user", "content": "Pathophysiology of cyclosporine-induced nephrotoxicity in humans: a role for nitric oxide? Context: The causes for the nephrotoxicity of cyclosporine A (CsA) have not been fully elucidated. Intrarenal vasoconstriction induced by several different mediators, both in humans and experimental animals, have been proposed. We studied prostaglandin metabolites, endothelin and nitric oxide in kidney transplant patients receiving their first CsA dose. Prostaglandin metabolites in the urine and endothelin and nitric oxide (NO2/NO3 in urine and plasma were measured in 14 patients before and 3 and 6 h after oral ingestion of CsA (10 mg/kg b.w.). Clearances for inulin and p-aminohippuric acid (PAH) were measured before and in two separate 3-hour periods after CsA. Blood pressure, heart rate, and CsA blood levels were also determined. Clearances of inulin and PAH decreased progressively after CsA dosage while renal vascular resistance increased. Nitric oxide plasma levels decreased in nearly all patients from 21.0 +/- 2.8 to 19.1 +/- 2.6 (p = 0.003) and then rose slightly to 19.5 +/- 2.5 micromol/l (p = 0.1) 3 and 6 h after CsA ingestion, respectively. Urinary excretion of NO2/NO3 decreased nonsignificantly from 269 +/- 38.8 to 259 +/- 27.7 and 254 +/- 41.6 micromol/min (p = 0.5 and 0.5). At the same time, urinary prostaglandin E2 and 6-keto-prostaglandin F(1 alpha) excretion rate declined significantly [from 1,187 +/- 254 to 1,186 +/- 351 and 730 +/- 148 pg/min (p = 0.27 and 0.02) and from 697 +/- 115 to 645 +/- 134 and 508 +/- 58.2 pg/min (p = 0.34 and 0.05)]. Urinary thromboxane B2 and plasma and urinary endothelin first increased and then decreased nonsignificantly. Mean arterial pressure rose from 107 +/- 2.5 to 110 +/- 2.6 and 114 +/- 3.4 mm Hg (p = 0.1 and 0.05)." }, { "role": "assistant", "content": "The pathophysiology of CsA-induced acute renal vasoconstriction involves several different mechanisms including a decrease of the vasodilating prostaglandins E2 and 6-keto-prostaglandin F(1 alpha) and possibly nitric oxide." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Biomarkers, Tumor, Female, Glycoproteins, Humans, Male, Middle Aged, Mucin-1, Reference Values." }, { "role": "user", "content": "Are serum levels of CA15-3 , KL-6 and BCA225 positively correlated with each other in the general population? Context: Carbohydrate antigen 15-3 (CA15-3), Kerbs von den Lungen (KL-6) and breast cancer antigen 225 (BCA225) are widely used tumor markers for breast and lung cancer respectively. We analyzed 460 Japanese volunteers for 99 items on blood examination including 27 serum tumor markers. Correlations between 27 tumor markers and the other items were statistically analyzed. Positive correlations were identified between CA15-3 vs. KL-6, CA15-3 vs. BCA225, and KL-6 vs. BCA225, with correlation coefficients of 0.84, 0.86, and 0.79, respectively." }, { "role": "assistant", "content": "This is the first report to show a positive correlation among these markers in the general population. All of these are recognized as belonging to the mucin family, and this might be the reason for the positive correlation. 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 65 year old male with a history of smoking and alcohol abuse complains of poor appetite and difficulty swallowing both solid and liquid foods over the course of the last 4 months. He has lost 10 Kg and occasionally vomits blood. A mass is detected in his esophagus and is subsequently biopsied. What is the most likely histological appearance of the biopsy?" }, { "role": "assistant", "content": "The correct answer is The most common esophageal cancer is squamous cell in origin. The esophageal mucosa consists of stratified, nonkeratinized, squamous epithelium. Smoking and alcohol increase the risk for the development of esophageal carcinoma. Suspect cancer when there are signs like rapid weight loss in a sho period of time and symptoms such as dysphasia, hematemesis, and anorexia." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Acute Disease, Animals, HMGB1 Protein, Interleukin-1, Interleukin-10, Male, Myocardial Reperfusion Injury, Myocardium, Rats, Rats, Sprague-Dawley, Vascular Endothelial Growth Factor A." }, { "role": "user", "content": "Does exogenous high-mobility group box 1 improve myocardial recovery after acute global ischemia/reperfusion injury? Context: High-mobility group box 1 (HMGB1) is a mediator of inflammation with dose-dependent effects. In the setting of regional myocardial infarction, a high-dose HMGB1 treatment decreases myocardial function, whereas low-dose HMGB1 improves function; however, it is unknown what role HMGB1 has in the setting of global ischemia/reperfusion (I/R) injury. We hypothesized that a low-dose HMGB1 treatment would improve myocardial functional recovery and decrease infarct size after global I/R injury in association with increased levels of cardioprotective paracrine factors and decreased inflammation. Adult rat hearts were isolated and perfused using the Langendorff method and were subjected to global I/R and treatment with either the vehicle, 200-ng HMGB1, or 1-μg HMGB1. The treatment was administered during 1 min at the start of reperfusion, and myocardial function was measured for 60 min of reperfusion. At the end of reperfusion, the hearts were sectioned and incubated in triphenyltetrazolium chloride to assess myocardial infarct size or homogenized to measure levels of inflammatory cytokines and growth factors. Postischemic treatment with 200-ng HMGB1 significantly improved myocardial functional recovery after global I/R in association with decreased infarct size and decreased interleukin-1 (IL-1), IL-6, IL-10, and vascular endothelial growth factor (VEGF) levels. In addition, 1-μg HMGB1 decreased myocardial inflammation but did not result in subsequent improvement in functional recovery." }, { "role": "assistant", "content": "In the setting of global I/R, 200-ng postischemic HMGB1 treatment improves myocardial function and decreases infarct size in association with suppressed myocardial inflammation. These results suggest a potential role for exogenous HMGB1therapy in the acute postischemic period. 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. Meshes: Adolescent, Adult, Aged, Albuminuria, Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Male, Middle Aged, Treatment Outcome." }, { "role": "user", "content": "Does baseline albuminuria predict the efficacy of blood pressure-lowering drugs in preventing cardiovascular events? Context: Albuminuria has been proven to be associated with cardiovascular morbidity and mortality. Such an association has been found not only in subjects with diabetes and hypertension, but also in the general population. It could therefore be expected that especially subjects with higher albuminuria levels may benefit from blood pressure-lowering agents to improve their cardiovascular outcome." }, { "role": "assistant", "content": "This study indicates that the efficacy of blood pressure-lowering agents to prevent cardiovascular events is dependent of the level of albuminuria before start of such treatment. The higher baseline albuminuria, the better the relative and absolute risk reduction for cardiovascular events with blood pressure-lowering drugs. The data also suggest a possible better cardiovascular protective effect of renin-angiotensin intervening agents compared with other blood pressure-lowering agents. 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": "Incidence can be calculated by -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., Prospective study" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Anoikis, Antibodies, Monoclonal, Apoptosis, Caspase 3, Caspases, Cell Adhesion, Cell Survival, Cells, Cultured, Collagen Type IV, DNA Fragmentation, Electrophoresis, Extracellular Matrix, Female, Fibronectins, Hepatocytes, Immunohistochemistry, Integrin beta1, Liver, Oligopeptides, Rats, Rats, Inbred BN." }, { "role": "user", "content": "Does hepatocyte survival depend on beta1-integrin-mediated attachment of hepatocytes to hepatic extracellular matrix? Context: A major drawback of allogeneic hepatocyte transplantation is the lack of sustained survival of the transplanted cells in the recipient liver parenchyma. The purpose of this study was to determine the effect of the presence or absence of hepatic extracellular matrix (ECM) molecules on hepatocyte survival and function following hepatocyte isolation for transplantation purposes, and the role of beta1-integrin molecules therein. Hepatocytes, either untreated or treated with anti-beta1 integrin antibodies or RGD peptides, were seeded on wells precoated with collagen type I, type IV, laminin, fibronectin or polyhydroxyethylmehacrylate. The extent of attachment and apoptosis was evaluated. When hepatocytes were added into wells precoated with either fibronectin, or collagen type IV, rapid spreading and prolonged survival occurred, in contrast to hepatocytes that were seeded in wells precoated with collagen type I or polyhydroxyethylmehacrylate. Pretreatment of the cells with anti-beta1-integrin antibodies resulted in reduction of cell attachment to laminin, fibronectin, collagen I, and collagen IV. Synthetic RGD (arginine-glycine-aspartate)-peptides and anti-beta1 antibodies inhibited apoptosis of cultured hepatocytes." }, { "role": "assistant", "content": "Our findings indicate that embedding of hepatocytes within their normal liver ECM surroundings maintains their survival. When detached from their natural surrounding hepatocytes enter into apoptosis, unless treated with anti-beta1-integrin antibodies or RGD peptides. This knowledge will allow improvement of hepatocyte transplantation efficiency. 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": "FDA indications of inhaled NO is" }, { "role": "assistant", "content": "The correct answer is \"Inhaled nitric oxide has been approved by FDA for use in newborns with persistent pulmonary hypeension and has become the first line therapy for this disease. In this disease state, NO inhalation has been shown to reduce, significantly, the necessity for extracorporeal oxygenation\".(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 257)" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Aryl Hydrocarbon Hydroxylases, Biological Factors, Coronary Vessels, Cytochrome P-450 Enzyme System, Fluorescent Antibody Technique, Hydrocortisone, Microscopy, Confocal, Organ Culture Techniques, Steroid 16-alpha-Hydroxylase, Steroid Hydroxylases, Swine, Vasodilation." }, { "role": "user", "content": "Is cytochrome P450 2C expression and EDHF-mediated relaxation in porcine coronary arteries increased by cortisol? Context: In addition to nitric oxide (NO) and prostacyclin, endothelium-dependent dilation is mediated by the endothelium-derived hyperpolarizing factor (EDHF) which, in the coronary circulation, has been characterised as a metabolite of arachidonic acid synthesised by an cytochrome P450 (CYP) epoxygenase homologous to CYP 2C8/9. As the promotor regions of CYP 2C8 and 2C9 contain consensus sequences for glucocorticoid response elements, we determined the effect of cortisol on EDHF-mediated relaxations as well as on the expression of CYP 2C in isolated segments of porcine coronary artery. Bradykinin-induced NO-mediated relaxation of KCl-constricted arterial rings was slightly attenuated following exposure to cortisol. However, EDHF-mediated relaxations of U46619-constricted arterial rings assessed in the presence of the cyclo-oxygenase inhibitor diclofenac and the NO synthase inhibitor N(omega)nitro-L-arginine (0.3 mM), were significantly enhanced (maximum relaxation: 66+/-7%, P<0.05 vs. control rings: 36+/-8%). Cortisol treatment (0.1 microM, 24 h) did not affect the endothelium-independent relaxation elicited by sodium nitroprusside and acute incubation with cortisol (0.1 microM, 30 min) did not alter either NO- or EDHF-mediated responses. The expression of CYP 2C (quantified by RT-PCR, Western blot analysis and confocal microscopy) was enhanced in porcine coronary endothelial cells following incubation with cortisol for 18-24 h." }, { "role": "assistant", "content": "These results demonstrate the concomitant upregulation of EDHF-mediated relaxations and CYP 2C expression by long-term treatment with cortisol. These observations support the concept that an epoxygenase homologous to CYP 2C8/9 plays a crucial role in the generation of EDHF-mediated responses in the coronary endothelium. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Most abundant free nucleotide in a mammalian cell ?" }, { "role": "assistant", "content": "The correct answer is Most abundant free nucleotide in a mammalian cell is ATP" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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. Meshes: ." }, { "role": "user", "content": "Does therapeutic restoration of cytolytic and suicidal cell molecular machineries favour disease healing? Context: Several drugs have recently been demonstrated to successfully treat diseases by activating cytolytic or suicidal cell molecular machineries. On the other hand, in healthy subjects cytolytic and suicidal machineries are able to maintain tissue homeostasis, thus preventing the onset of a number of diseases. These machineries include both the cytolysis, exerted by cytotoxic T lymphocytes, of cells 'altered' by infectious or neoplastic antigens (altered cell cytolysis [AlCC]), and the suicide of antigen-activated T cells when in antigen-excess (activated cell suicide [AcCS])." }, { "role": "assistant", "content": "These drugs may therefore, in our opinion, restore AlCC or AcCS, and, as aconsequence, favour disease healing. Thus, such a restoration could prove helpful for treating disorders caused by failure of such machineries. 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: Humans, Hyperbaric Oxygenation, Incidence, Infant, Newborn, Infant, Very Low Birth Weight, Intensive Care Units, Neonatal, Laser Therapy, Neonatal Screening, Ophthalmologic Surgical Procedures, Oximetry, Practice Guidelines as Topic, Practice Patterns, Physicians', Prospective Studies, Retinopathy of Prematurity, Survival Rate." }, { "role": "user", "content": "Can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? Context: A wide variability in the incidence of severe retinopathy of prematurity (ROP) is reported by different centers. The altered regulation of vascular endothelial growth factor from repeated episodes of hyperoxia and hypoxia is 1 important factor in the pathogenesis of ROP. Strict management of O(2) delivery and monitoring to minimize these episodes may be associated with decreased rates of ROP. The objective of this study was to compare the incidence of and need for surgery for severe ROP (stages>or=3) in infants of 500 to 1500 g birth weight before and after the implementation of a new clinical practice of O(2) management in a large level 3 neonatal intensive care unit (NICU). An oxygen management policy that included strict guidelines in the practices of increasing and weaning of fraction of inspired oxygen (FIO(2)) and the monitoring of O(2) saturation parameters in the delivery room, during in-house transport of infants to the NICU, and throughout hospitalization was implemented in April 1998. The main objectives were to monitor oxygenation levels more precisely and to avoid hyperoxia and repeated episodes of hypoxia-hyperoxia in very low birth weight infants. Included in the policy were equipment for monitoring, initiation of monitoring at birth, avoidance of repeated increases and decreases of the FIO(2), minimization of \"titration\" of FIO(2), modification of previously used alarm limits, and others. After an educational process, each staff member signed an agreement stating understanding of and future compliance with the guidelines. Examinations were performed by experienced ophthalmologists following international classification and American Academy of Pediatrics recommendations. ROP data from January 1997 to December 2002 for infants of 500 to 1500 g were analyzed as usual and also have been reported to Vermont Oxford Network since 1998. The incidence of ROP 3 to 4 at this center decreased consistently in a 5-year period from 12.5% in 1997 to 2.5% in 2001. The need for ROP laser treatment decreased from 4.5% in 1997 to 0% in the last 3 years." }, { "role": "assistant", "content": "We observed a significant decrease in the rate of severe ROP in very low birth weight infants in association with an educational program provided to all NICU staff and the implementation and enforcement of clinical practices of O(2) management and monitoring. Although several confounders cannot be excluded, it is likely that differences in these clinical practices may be, at least in part, responsible for the documented intercenter variability in rates of ROP." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Analgesics, Opioid, Animals, Benzamides, Carbon Dioxide, Cross-Over Studies, Double-Blind Method, Female, Humans, Male, Morphine, Morpholines, Naloxone, Narcotic Antagonists, Rats, Rats, Sprague-Dawley, Receptors, Serotonin, 5-HT4, Respiratory Insufficiency, Serotonin Receptor Agonists." }, { "role": "user", "content": "Does the 5-hydroxytryptamine 4 receptor agonist mosapride antagonize morphine-induced respiratory depression? Context: On the basis of experiments in rats, serotonin 4 receptor (5-hydroxytryptamine 4 [5-HT4]) agonists have been proposed as a novel therapeutic strategy for the selective treatment of respiratory depression caused by opioids while leaving analgesic effects unaffected. The effects in rats have been seen with the 5-hydroxytryptamine 4a (5-HT4a) agonist BIMU8, which is currently not available for use in humans. In a proof-of-applicability study, the clinically recommended dose of 5 mg mosapride, currently the only 5-HT4 agonist available for clinical use, was given in a placebo-controlled manner 3 times daily for 5 days to 12 healthy men and women. During the actual experiments, a further 15 mg mosapride was administered. After baseline measurements of respiratory depression, by use of a carbon dioxide rebreathing method, and of pain, by use of electrical and chemical pain stimuli, 30 mg morphine per 70 kg body weight was administered intravenously within 2 hours. After assessment of respiratory depression and pain, 2 mg naloxone was intravenously administered within 20 minutes, followed by a third assessment of respiratory depression and pain. In ancillary experiments 10 rats received 100 mg/kg mosapride orally or placebo 50 minutes before intraperitoneal injection of 10 mg/kg morphine, followed 20 minutes later by injection of naloxone, and the respiratory frequency was monitored. With placebo coadministration, the slope of the relationship between expiratory volume and CO2 concentration in the inspired air was significantly reduced, from 1.11 +/- 0.46 L/mm Hg CO2 at baseline to 0.39 +/- 0.25 L/mm Hg CO2 at the end of the morphine infusion (P < .001). Coadministration of mosapride had no effect on respiratory depression induced by morphine (slope of 0.39 +/- 0.19 L/mm Hg CO2, P > .7). In contrast, naloxone significantly reversed the slope to 0.78 +/- 0.36 L/mm Hg CO2 (P = .001). Morphine produced significant effects on electrical and chemical pain stimuli, which were partially reversed by naloxone, but mosapride did not affect the analgesic effects of morphine. In rats mosapride similarly failed to prevent a slowing of the breathing frequency after morphine administration but naloxone reversed the respiratory depression." }, { "role": "assistant", "content": "Our results show that, with mosapride, opioid-induced respiratory depression cannot be prevented, and because other 5-HT4 agonists are not currently available for clinical use, a cure for opioid-induced respiratory depression as promised by the previous successful experiments in laboratory animals is not yet available in clinical practice. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Plazomicin was approved by FDA recently for" }, { "role": "assistant", "content": "The correct answer is it is ia new or nect generation aminoglycoside i.e neo glycoside, bactericidal in nature ,inhibiting the protein syunthesis, acting on both gram negetive and positive bacteria." } ]

[ { "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 components included for Pareek's method of socio-economic classification for rural areas include the following Except" }, { "role": "assistant", "content": "The correct answer is BG Prasad classification proposed a scale based on per capita monthly income and has been used extensively in India. In rural areas Pareek classification based on nine characteristics viz. caste, occupation, education, level of social paicipation of the head of the family, landholding, housing, farm power, material possession and total members in the family is widely used. Modified Kuppuswamy scale is commonly used to measure the socio-economic status in the urban communities. The scale includes the education, occupation of head of the family and income per month from all sources Ref:" } ]

[ { "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": "Initiation of lactation is affected by :" }, { "role": "assistant", "content": "The correct answer is Ans is a, b and c Prolactin; HPL; and Progesterone Lactation can be divided into 3 stages : Stage I : Mammogenesis - Mammary growth and development Hormones responsible : Growth Main hormone Suppoing hormones Ductal growth Oestrogen Growth hormone and glucocoicoids Alveolar growth Progesterone Prolactin, prednisolone and other (in the oestrogen primed breast) growth promoting factors Stage ii : Lactogenesis : Initiation of milk secretion Main hormone responsible : Prolactin Although prolactin levels continue to rise as pregnancy advances, placental sex steroids block prolactin induced secretory activity of-the glandular epithelium. Therefore, lactation is not initiated until plasma estrogens progesterone, and human placental lactogen (hPL) level fall after delivery.\" Suppoing hormones : * Estrogens Progestins Human placental Lactogen Stage Galactopoiesis or Maintenance of established milk secretion is mainly by sucklingdeg. Hormones responsible : Prolactindeg * Oxytocindeg Growth hormonedeg * Thyroxine/Parathyroid hormonedeg Coisoldeg * Insulindeg" } ]

[ { "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 cutaneous manifestation of TB:" }, { "role": "assistant", "content": "The correct answer is Lupus pernio is a skin manifestation of Sarcoidosis.\n \nSarcoidosis does not involve kidney.\n \nSarcoidosis mimics like Berylliosis." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: INTRODUCTION, METHODS, RESULTS. Meshes: Aged, Antimetabolites, Antineoplastic, Azacitidine, Female, Humans, Leukemia, Myeloid, Acute, Male, Proportional Hazards Models, Statistics as Topic, Survival Rate, United States." }, { "role": "user", "content": "Converging or Crossing Curves: Untie the Gordian Knot or Cut it? Context: Among patients with acute myeloid leukemia (AML), the DACO-016 randomized study showed reduction in mortality for decitabine [Dacogen(®) (DAC), Eisai Inc., Woodcliff Lake, NJ, USA] compared with treatment choice (TC): at primary analysis the hazard ratio (HR) was 0.85 (95% confidence interval 0.69-1.04; stratified log-rank P = 0.108). With two interim analyses, two-sided alpha was adjusted to 0.0462. With 1-year additional follow-up the HR reached 0.82 (nominal P = 0.0373). These data resulted in approval of DAC in the European Union, though not in the United States. Though pre-specified, the log-rank test could be considered not optimal to assess the observed survival difference because of the non-proportional hazard nature of the survival curves. We applied the Wilcoxon test as a sensitivity analysis. Patients were randomized to DAC (N = 242) or TC (N = 243). One-hundred and eight (44.4%) patients in the TC arm and 91 (37.6%) patients in the DAC arm selectively crossed over to subsequent disease modifying therapies at progression, which might impact the survival beyond the median with resultant converging curves (and disproportional hazards). The stratified Wilcoxon test showed a significant improvement in median (CI 95%) overall survival with DAC [7.7 (6.2; 9.2) months] versus TC [5.0 (4.3; 6.3) months; P = 0.0458]." }, { "role": "assistant", "content": "Wilcoxon test indicated significant increase in survival for DAC versus TC compared to log-rank test." } ]

[ { "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": "VEGF is involved in all of the process of angiogenesis except:" }, { "role": "assistant", "content": "The correct answer is VEGFs, mainly VEGF-A, stimulates both migration and proliferation of endothelial cells, thus initiating the process of capillary sprouting in angiogenesis. It promotes vasodilation by stimulating the production of NO and contributes to the formation of the vascular lumen.\nNewly formed vessels are leaky because of incomplete interendothelial junctions and because VEGF, the growth factor that drives angiogenesis, increases vascular permeability.\nTGF-β suppresses endothelial proliferation and migration, and enhances the production of ECM proteins.\nRobin’s Textbook of pathology 10th ed  Page 91" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Anthropometry, Birth Weight, Body Composition, Cohort Studies, Dietary Carbohydrates, Dietary Proteins, Female, Humans, Infant, Newborn, Male, Maternal Nutritional Physiological Phenomena, Obesity, Organ Size, Placenta, Pregnancy, Pregnancy Trimester, Third, Seasons, Surveys and Questionnaires, Tasmania." }, { "role": "user", "content": "Is higher maternal dietary protein intake in late pregnancy associated with a lower infant ponderal index at birth? Context: A high ponderal index at birth has been associated with later obesity and it has been suggested that intervention to prevent obesity and its sequela should consider the antenatal period. In this context, we investigated the association between maternal nutrition and birth anthropometry. We analyzed data on 1040 mother-infant pairs collected during the Tasmanian Infant Health Survey (TIHS), Tasmania, 1988-1989. Maternal dietary intake during pregnancy was measured by food frequency questionnaire (FFQ) applied soon after birth. Outcomes of interest were birth weight, birth length, head circumference, ponderal index, head circumference -to-ponderal index ratio, placenta-to-birth weight ratio and head circumference-to-birth length index. In multiple regression model, an increase of 10 g of absolute protein intake/day was associated with a reduction in birth weight of 17.8 g (95% CI: -32.7, -3.0; P=0.02). Protein intake was also associated negatively with ponderal index (beta=-0.01; 95% CI: -0.02, -0.00; P=0.01). A 1 % increase in carbohydrate intake resulted in a 1% decline in placental weight relative to birth weight. Higher protein intake in the third trimester was associated with a reduced ponderal index among large birth weight infants but not low birth weight infants." }, { "role": "assistant", "content": "This raises the possibility that any effect of high protein in altering infant anthropometry at birth may involve changes in body composition and future work to examine how a high-protein diet influences body composition at birth is warranted. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adaptation, Physiological, Disability Evaluation, Gait Disorders, Neurologic, Humans, Linear Models, Male, Middle Aged, Recovery of Function, Stroke, Stroke Rehabilitation." }, { "role": "user", "content": "Does a novel and simple test of gait adaptability predict gold standard measures of functional mobility in stroke survivors? Context: Although there is evidence that stroke survivors have reduced gait adaptability, the underlying mechanisms and the relationship to functional recovery are largely unknown. We explored the relationships between walking adaptability and clinical measures of balance, motor recovery and functional ability in stroke survivors. Stroke survivors (n=42) stepped to targets, on a 6m walkway, placed to elicit step lengthening, shortening and narrowing on paretic and non-paretic sides. The number of targets missed during six walks and target stepping speed was recorded. Fugl-Meyer (FM), Berg Balance Scale (BBS), self-selected walking speed (SWWS) and single support (SS) and step length (SL) symmetry (using GaitRite when not walking to targets) were also assessed. Stepwise multiple-linear regression was used to model the relationships between: total targets missed, number missed with paretic and non-paretic legs, target stepping speed, and each clinical measure. Regression revealed a significant model for each outcome variable that included only one independent variable. Targets missed by the paretic limb, was a significant predictor of FM (F(1,40)=6.54, p=0.014,). Speed of target stepping was a significant predictor of each of BBS (F(1,40)=26.36, p<0.0001), SSWS (F(1,40)=37.00, p<0.0001). No variables were significant predictors of SL or SS asymmetry." }, { "role": "assistant", "content": "Speed of target stepping was significantly predictive of BBS and SSWS and paretic targets missed predicted FM, suggesting that fast target stepping requires good balance and accurate stepping demands good paretic leg function. The relationships between these parameters indicate gait adaptability is a clinically meaningful target for measurement and treatment of functionally adaptive walking ability in stroke survivors. 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 newborn is brought to the emergency department by his parents with violent vomiting. It started about 3 days ago and has slowly gotten worse. He vomits after most feedings but seems to keep some formula down. His mother notes that he is eager to feed between episodes and seems to be putting on weight. Other than an uncomplicated course of chlamydia conjunctivitis, the infant has been healthy. He was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. The physical exam is significant for a palpable mass in the right upper quadrant. What is the first-line confirmatory diagnostic test and associated finding?" }, { "role": "assistant", "content": "Abdominal ultrasound; elongated pyloric channel and muscle hypertrophy" } ]

[ { "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": "Commonest type of veex presentation :" }, { "role": "assistant", "content": "The correct answer is Left occipito transverse" } ]

[ { "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": "IUGR is caused by all except" }, { "role": "assistant", "content": "The correct answer is Intrauterine growth restriction(IUGR) refers to those fetuses that have failed to achieve their own growth potential. Causes include: * Foetal causes like chromosomal abnormality, congenital malformation and congenital infections. * Placental causes (uteroplacental insufficiency)caused by preeclampsia, collagen vascular disease, APLA syndrome, inherited thrombophilias, diabetes with vasculopathy, multiple pregnancies, placental and cord abnormalities. * Maternal causes like poor weight gain, smoking, alcohol, cocaine, anticonvulsant drugs, chronic maternal diseases causing severe hypoxia like chronic renal failure, severe anemia, congenital cyanotic hea disease. Reference : page 201 Textbook of Obstetrics Sheila Balakrishnan 2nd edition" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "9th cranial nerve supplies which of the following?" }, { "role": "assistant", "content": "The correct answer is The stylopharyngeus arises from the styloid process It passes through the gap between the superior and middle constrictors to run downwards on the inner surface of the middle and inferior constrictors The pharynx is supplied by the pharyngeal plexus of nerves which lies chiefly on the middle constrictor.The plexus is formed by: 1.The pharyngeal branch of vagus nerve carrying fibres of the cranial accessory nerve 2.The pharyngeal branches of glossopharyngeal nerve 3.The pharyngeal branches of superior cervical sympathetic ganglion Ref BDC volume3,sixth edition pg 233" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Active Transport, Cell Nucleus, Animals, Animals, Newborn, Atrial Natriuretic Factor, Cell Line, Chromatin Immunoprecipitation, Estradiol, Estrogen Receptor alpha, Female, Fluorescent Antibody Technique, Gene Expression Regulation, Humans, Mice, Mice, Knockout, Mutagenesis, Site-Directed, Mutation, Myocytes, Cardiac, Natriuretic Peptide, C-Type, Promoter Regions, Genetic, Protein Binding, Protein Interaction Domains and Motifs, Protein Interaction Mapping, Protein Precursors, RNA, Messenger, Rats, Rats, Sprague-Dawley, Transcription, Genetic, Transfection, Two-Hybrid System Techniques." }, { "role": "user", "content": "Does 17β-Estradiol-induced interaction of ERα with NPPA regulate gene expression in cardiomyocytes? Context: 17β-Oestradiol (E2) and its receptors (ERα and ERβ) are important regulators of physiological and pathological processes in the cardiovascular system. ER act in concert with other regulatory factors mediating oestrogenic effects. However, the underlying mechanisms modulating ER transcriptional activity are not fully elucidated. To gain better understanding of E2-induced ERα action in the human heart, we aimed to identify and functionally analyse interaction partners of ERα. Using yeast two-hybrid assays with a human heart cDNA library, we identified atrial natriuretic peptide precursor A (NPPA), a well-known cardiac hypertrophy marker, as a novel ERα interaction partner interacting in an E2-dependent manner. Mutation analyses and immunofluorescence data indicated that the LXXLL motif within NPPA is necessary for its E2-induced interaction with ERα, its action as a co-repressor of ERα, and its translocation into the nucleus of human and rat cardiomyocytes. Expression analysis and chromatin immunoprecipitation assays in a human left ventricular cardiomyocyte cell line, AC16, showed that NPPA interacts with E2/ERα, suppressing the transcriptional activity of ERα on E2-target genes, such as NPPA, connexin43, αactinin-2, nuclear factor of activated T-cells, and collagens I and III." }, { "role": "assistant", "content": "We characterize for the first time an E2-regulated interaction of NPPA with ERα in cardiomyocytes, that may be crucial in physiological and/or pathological cardiac processes, thereby representing a potential therapeutic target. 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": "Open Vial Policy apply to which vaccine" }, { "role": "assistant", "content": "The correct answer is The WHO multi-dose l policy states that ls of liquid DTP, TT, HepB and OPV opened in a fixed clinic may be used at more than one immunization session provided that: A) The expiry date has not passed. B) The vaccines are stored under appropriate cold chain conditionsPark pg no: 117" } ]

[ { "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": "Ideal management of a 37 weeks pregnant elderly primigravida with placenta prae and active bleeding: September 2007" }, { "role": "assistant", "content": "The correct answer is Ans. B: Caesarean Section An initial assessment to determine the status of the mother and fetus is required. It is now considered safe to treat placenta prae on an outpatient basis if the fetus is at less than 30 weeks of gestation, and neither the mother nor the fetus are in distress. Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother are in distress. Blood volume replacement (to maintain blood pressure) and blood plasma replacement (to maintain fibrinogen levels) may be necessary. In cases of fetal distress, associated complicating factors like malpresentation, elderly primigravidae, pregnancy with a previous caesarean section and contracted pelvis, a caesarean section is indicated. Caesarean section is contraindicated in cases of disseminated intravascular coagulation. Placenta prae increases the risk of puerperal sepsis and postpaum haemorrhage because the lower segment to which the placenta was attached contracts less well post-delivery" } ]

[ { "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": "Real time PCR is used for -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'd' i.e., For quantitative dectection of PCR materialVarious types of PCR1) Multiplex PCR:# To find out the deletion mutation in a patient DNA.# In this type of PCR, multiple pairs of oligonucleotide primer are synthesized to amplify the entire gene or selected region of the gene.# After this, agrose gel electrophoresis reveals any deletion mutation compared to normal gene product.2) Reverse transcriptase PCR:# In this type of PCR, RNA is the starting material on which the reverse transcriptase enzyme acts to convert it to the DNA which is subsequently used for PCR.# DNA polymerase derived from thermus thermophillus organism has got additional reverse transcriptase activity and hence is preferred for reverse transcriptase type of PCR.3) Real time PCR:# In this type of PCR, a fluorescent dye known as \"SYBR Green is used to tag the primer, this helps in quantitative detection of PCR material.4) Invert PCR:# In this type of PCR, the flanking region of the DNA is converted to target region and target region is convered to flanking region.# This is done for those DNA fragments for which the sequence of outer flanking region for the construction of primer is not known.5) Nested PCR :# In this type of PCR, specificity of amplification is enhanced by using new set of primer in each phase of the PCR# New set of primer is complimentary to the template DNA sequence which is downstream to the first primer, i.e. nested between the original set of primer." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Abdominal Pain, Aged, Carcinoma, Pancreatic Ductal, Female, Humans, London, Male, Middle Aged, Outcome Assessment (Health Care), Pancreatic Neoplasms, Prognosis, Referral and Consultation, Survival Analysis, Waiting Lists, Weight Loss." }, { "role": "user", "content": "Do clinical presentation and waiting time targets affect prognosis in patients with pancreatic cancer? Context: The prognosis of patients with pancreatic cancer remains poor despite recent advances in treatment. It is not known whether delays in referring, diagnosing and treating these patients and the way they present can affect their survival. In our study we investigated the impact of clinical presentation (jaundice, abdominal pain, weight loss) and delays in management of these patients on their treatment and survival. Data on all patients with pancreatic cancer referred to the Pancreatic Unit (1997-2002) were collected prospectively and analysed using SPSS 16((R).) The delay in diagnosis and treatment for each patient was measured by estimating the time from the beginning of symptoms to the date of the referral letter (T1), the time from the referral date to the date of first review at the Unit (T2) and the time from date of review to the date of diagnosis/treatment (T3). Treatments were defined as 1) pancreatic resections, 2) gastric and biliary bypass and 3) biliary stents. The term 'operability' was used to describe patients thought to have a potentially removable tumour and had an operation and 'resectability' applied to the patients whose tumour was actually removed at the operation. Follow-up time and survival were recorded by reviewing the patient's notes, hospital electronic databases and by contacting patients General Practitioners. There were a total of 355 patients with pancreatic cancer. Median age at diagnosis was 64 (i.q.r. 56-71) years and median follow-up was 8 (i.q.r. 4-14) months. The overall 1, 3 and 5 years patient's survival was 26%, 5% and 4% respectively. 1, 3 and 5 years survival of inoperable patients was 24%, 2% and 0% and for operable patients was 35%, 13% and 9% respectively. The median survival time for those patients that underwent operation was significantly higher than those that did not (12 vs 6 months, p < 0.001). The overall median time from initial symptoms to diagnosis/treatment (T1 + T2 + T3) was 102 (i.q.r. 56-182) days, T1 was 65 (i.q.r. 31-143), T2 17 (i.q.r. 8-28) and T3 11 (i.q.r. 6-21) days. The time delay from symptoms to referral (T1) had minimal clinical relevance to survival, with a hazard ratio of only 1.001 (95% CI 0.001-0.002, p = 0.043) per day. Of all 355 patients, 305 (86%) were reviewed and treated within 62 days from the GP referral (T2 + T3). There was no significant difference in operability, resectability and survival of patients that were diagnosed/treated before or after 62 days from referral (T2 + T3) (median months 6.5 and 7.9 respectively, p = 0.134). Patients presenting with jaundice were referred (T1, median 56 vs 103) and diagnosed/treated (T2 + T3, median 96 vs 130) days (p < 0.001) sooner, had a higher operability rate (33% vs 21%, p = 0.035) but not a significantly higher resectability rate of (37% vs 29%) (p = 0.608). Isolated or combined mode of clinical presentation had no significant effect on survival (p = 0.965). On multivariate regression analysis, prognostic factors of survival were a resectable tumour and the time from the beginning of symptoms to referral." }, { "role": "assistant", "content": "This study showed that pre-hospital delays in referring patients to a specialist unit, but not hospital related 62 days target, had an no impact on operability, resectability and survival. Clinical presentation also had no impact on the survival. We confirmed that pancreatic resection is the most important factor in determining the length of survival in patients with pancreatic cancer. Our study implies that the successful implementation of the 62 days National Cancer Waits Target across the UK is unlikely to have an impact on prognosis in patients with pancreatic cancer. Focusing on early referral to specialist Pancreatic Units might be more effective. 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, METHODS, RESULTS. Meshes: Administration, Oral, Analysis of Variance, Breast Neoplasms, Cross-Over Studies, Female, Gonadal Hormones, Humans, Isoflavones, Middle Aged, Milk Proteins, Phytoestrogens, Postmenopause, Probiotics, Soybean Proteins." }, { "role": "user", "content": "Does short-term soy and probiotic supplementation markedly affect concentrations of reproductive hormones in postmenopausal women with and without histories of breast cancer? Context: Observational studies suggest that dietary isoflavones reduce breast cancer risk, and this may be caused in part by effects on endogenous hormone concentrations. Because intestinal bacteria metabolize isoflavones, it was hypothesized that consumption of probiotic bacteria would enhance the biologic effects of isoflavones, including effects on endogenous hormones. Twenty (20) postmenopausal breast cancer survivors and 20 healthy postmenopausal women completed four 42-day diet periods in a randomized, crossover design. They received one of the following: isolated soy protein; isolated milk protein; soy + probiotic capsules; or milk + probiotic capsules. Each protein supplement provided 0.38 g protein/(kg body weight/day) (26.6 +/- 4.5 g protein/day) and soy protein provided 0.64 mg isoflavones/(kg body weight/day) (44.4 +/- 7.5 mg isoflavones/day). Probiotic capsules provided 10(9) colony-forming units Lactobacillus acidophilus (strain DDS-1), Bifidobacterium longum, and 15-20 mg fructo-oligosaccharide. Plasma samples were collected at baseline and after each diet for analysis of estrogens, follicle-stimulating hormone (FSH), androgens, and sex hormone?binding globulin (SHBG). Hormone levels were not affected by soy, probiotic supplements, or equol producer status, and neither cancer status nor equol producer status altered the effects of soy or probiotics. Furthermore probiotics did not alter the effects of soy consumption. Soy protein tended to decrease SHBG compared to milk protein diets (p = 0.05), although both proteins significantly decreased SHBG relative to baseline (p = 0.0001 and p = 0.03)." }, { "role": "assistant", "content": "These data suggest that short-term, moderate consumption of isoflavone-containing soy protein and consumption of these particular probiotic capsules do not significantly alter reproductive hormone concentrations in breast cancer survivors or controls, regardless of equol producer status. Final Decision: no" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Adenosine, Atrial Flutter, Catheter Ablation, Female, Heart Atria, Heart Conduction System, Humans, Male, Middle Aged, Recurrence, Retrospective Studies, Treatment Outcome, Tricuspid Valve." }, { "role": "user", "content": "Does adenosine facilitate dormant conduction across cavotricuspid isthmus following catheter ablation? Context: Recurrence of trans-isthmus conduction following catheter ablation of common right atrial flutter (AFL) has been reported to be as high as 15%-31% at 3 months with invasive follow-up. Intravenous adenosine has previously been shown to facilitate acute, transient reconnection of pulmonary veins following catheter ablation of atrial fibrillation. To determine whether intravenous adenosine can facilitate dormant trans-isthmus conduction after achieving bidirectional conduction block (BDB) with catheter ablation. Thirty-two patients underwent radiofrequency catheter ablation of cavotricuspid isthmus (CTI) for common right AFL at 2 institutions. Once persistent BDB was achieved for 30 minutes and during isoproterenol infusion, 18 mg of intravenous adenosine was injected during coronary sinus pacing. Evidence for transient reconduction across the isthmus was observed. Additional ablation lesions were performed, and adenosine infusion was repeated to reassess for dormant conduction. Thirty-two (men 81%, hypertension 72%, coronary artery disease 15%, congestive heart failure 25%, diabetes mellitus 30%, left atrial size 42 ± 11 mm, left ventricular ejection fraction 51% ± 10%) patients underwent ablation of CTI. BDB was achieved in 30 of the 32 patients. Following adenosine infusion, transient reconduction was observed in 7 of the 30 patients (23%) for 10-45 seconds. Following additional ablation lesions, persistent BDB could be achieved in all 7 patients without evidence for reconduction with repeat adenosine infusion. During a mean follow-up of 19 ± 12 months, only 1 of 30 patients (3%) had clinical recurrence of AFL. None of the patients with transient reconduction after adenosine developed symptomatic recurrence of AFL." }, { "role": "assistant", "content": "Adenosine infusion can facilitate dormant conduction across CTI following catheter ablation. Persistent BDB can be achieved with additional ablation. Adenosine challenge with additional ablation may improve long-term clinical outcome. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Aged, Diabetes Mellitus, Type 2, Fasting, Female, Glucose Tolerance Test, Humans, Insulin, Insulin Resistance, Liver, Male, Metabolic Syndrome, Middle Aged, Risk, Triglycerides, Waist Circumference." }, { "role": "user", "content": "Is hepatic insulin clearance closely related to metabolic syndrome components? Context: Insulin clearance is decreased in type 2 diabetes mellitus (T2DM) for unknown reasons. Subjects with metabolic syndrome are hyperinsulinemic and have an increased risk of T2DM. We aimed to investigate the relationship between hepatic insulin clearance (HIC) and different components of metabolic syndrome and tested the hypothesis that HIC may predict the risk of metabolic syndrome. Individuals without diabetes from the Metabolic Syndrome Berlin Brandenburg (MeSyBePo) study (800 subjects with the baseline examination and 189 subjects from the MeSyBePo recall study) underwent an oral glucose tolerance test (OGTT) with assessment of insulin secretion (insulin secretion rate [ISR]) and insulin sensitivity. Two indices of HIC were calculated. Both HIC indices showed lower values in subjects with metabolic syndrome (P < 0.001) at baseline. HIC indices correlate inversely with waist circumference, diastolic blood pressure, fasting glucose, triglycerides, and OGTT-derived insulin secretion index. During a mean follow-up of 5.1 ± 0.9 years, 47 individuals developed metabolic syndrome and 33 subjects progressed to impaired glucose metabolism. Both indices of HIC showed a trend of an association with increased risk of metabolic syndrome (HICC-peptide odds ratio 1.13 [95% CI 0.97-1.31], P = 0.12, and HICISR 1.38 [0.88-2.17], P = 0.16) and impaired glucose metabolism (HICC-peptide 1.12 [0.92-1.36], P = 0.26, and HICISR 1.31 [0.74-2.33] P = 0.36), although point estimates reached no statistical significance." }, { "role": "assistant", "content": "HIC was associated with different components of metabolic syndrome and markers of insulin secretion and insulin sensitivity. Decreased HIC may represent a novel pathophysiological mechanism of the metabolic syndrome, which may be used additionally for early identification of high-risk subjects. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Aged, Antineoplastic Combined Chemotherapy Protocols, Asian Continental Ancestry Group, Camptothecin, Colorectal Neoplasms, Diarrhea, Feasibility Studies, Female, Fluorouracil, Genotype, Glucuronosyltransferase, Humans, Kaplan-Meier Estimate, Leucovorin, Middle Aged, Neoplasm Staging, Neutropenia, Organoplatinum Compounds, Retrospective Studies, Thrombocytopenia, Treatment Outcome." }, { "role": "user", "content": "Is regimen selection for first-line FOLFIRI and FOLFOX based on UGT1A1 genotype and physical background feasible in Japanese patients with advanced colorectal cancer? Context: We examined the feasibility of regimen selection for first-line irinotecan, 5-fluorouracil and leucovorin or oxaliplatin, 5-fluorouracil and leucovorin in Japanese patients with advanced colorectal cancer based on UDP-glucuronosyltransferase 1A1 genotype as well as physical status of patients related to diarrhea. As first-line irinotecan, 5-fluorouracil and leucovorin is a little bit superior to oxaliplatin, 5-fluorouracil and leucovorin with respect to efficacy and toxicity, patients without risk factors of irinotecan-induced toxicity were first assigned to irinotecan, 5-fluorouracil and leucovorin. Patients with UDP-glucuronosyltransferase 1A1 28/ 28, 6/ 6, 28/ 6 or 28/ 27 and those with ascites, peritoneal dissemination or diarrhea first received oxaliplatin, 5-fluorouracil and leucovorin to avoid the irinotecan-induced neutropenia and diarrhea, respectively. We retrospectively evaluated the feasibility of this strategy by assessing toxicity and total progression-free survival in first- and subsequent second-line therapies in all patients studied. In the first-line irinotecan, 5-fluorouracil and leucovorin (n = 61), Grade 4 neutropenia, febrile neutropenia and Grade 3 diarrhea occurred in 8.2, 3.3 and 3.3% of patients, respectively. In the first-line oxaliplatin, 5-fluorouracil and leucovorin (n = 26), Grade 4 neutropenia, febrile neutropenia, Grade 3 thrombocytopenia and Grade 3 neuropathy were observed in 11.5, 3.8, 3.8 and 7.7% of patients, respectively. In the second-line oxaliplatin, 5-fluorouracil and leucovorin (n = 38), Grade 3 diarrhea occurred in 2.6% of patients. In the second-line irinotecan monotherapy (n = 11), Grade 4 or febrile neutropenia occurred in 18% of patients and Grade 3 diarrhea in 9.1% of patients. In second-line S-1 (n = 9), Grade 3 anemia occurred in 2 patients. Median total progression-free survival in all 87 patients was 11.5 months." }, { "role": "assistant", "content": "Present regimen selection strategy would be feasible, since it causes less toxicity and similar efficacy comparing to previous studies. Determination of appropriate reduced dose in the second-line irinotecan monotherapy or other standard second-line therapy for patients with high-risk to irinotecan-induced toxicity might make this strategy more effective. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND AND OBJECTIVES, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Clinical Competence, Colectomy, Colonic Diseases, Female, General Surgery, Humans, Internship and Residency, Laparoscopy, Learning Curve, Male, Middle Aged, Rectal Diseases, Retrospective Studies." }, { "role": "user", "content": "Laparoscopic colectomy: does the learning curve extend beyond colorectal surgery fellowship? Context: As minimally invasive colon and rectal resection has become increasingly prevalent over the past decade, the role that fellowship training plays has become an important question. This analysis examines the learning curve of one fellowship-trained colorectal surgeon in his first 100 cases. This was a prospectively collected retrospective analysis of the first 100 laparoscopic colon and rectal resections performed between July 2007 and July 2008 by a colorectal (CRS) fellowship trained surgeon at a Veteran's Administration (VA) and county hospital. Included were all emergent and nonemergent laparoscopic cases. Mean age was 63(range, 36 to 91). The 100 resections included 42 right, 6 left, 32 sigmoid, 13 rectal, and 7 total abdominal colectomies. Indications were 55% cancer, 20% unresectable polyp, 18% diverticular, 4% inflammatory, and 3% other. Overall mortality was 3%. Overall morbidity including wound infection was 24%. Early and late groups were similar in age, ASA score, and indication. Conversion rate was 4%. No statistical difference was seen in mortality, morbidity, EBL, LOS, margin, lymph nodes, or conversions between the first and second 50 cases (P<0.05). Right and sigmoid colectomy operative time decreased by 40.0% and 19.6%, respectively." }, { "role": "assistant", "content": "Prior investigators have demonstrated a significant learning curve for laparoscopic colorectal surgery. In the first 100 cases, there is no difference in mortality or morbidity between early and late cases. Alternatively, operative times decreased with experience. Laparoscopic training during CRS fellowship surpasses the learning curve in regard to safety and outcome, whereas operative efficiency improves over the first year of practice." } ]

[ { "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 26-year-old man is brought to the emergency room by his roommate after he was found attempting to commit suicide. His roommate says that he stopped him before he was about to jump off the balcony. He has been receiving treatment for depression for about a year. 6 months ago, he had come to the hospital reporting decreased interest in his daily activities and inability to concentrate on his work. He had stopped going out or accepting invitations for any social events. He spent several nights tossing and turning in bed. He also expressed guilt for being unable to live up to his parents’ expectations. His psychiatrist started him on fluoxetine. He says that none of the medications have helped even though the dose of his medication was increased on several occasions, and he was also switched to other medications over the course of the past year. He has mentioned having suicidal thoughts due to his inability to cope with daily activities, but this is the first time he has ever attempted it. Which of the following would this patient be a suitable candidate for?" }, { "role": "assistant", "content": "Electroconvulsive therapy" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Arthritis, Chemotaxis, Collagen, Interleukin-1, Lipopolysaccharides, Male, Mice, Mice, Inbred DBA, Phagocytes, Synovial Membrane, Tumor Necrosis Factor-alpha." }, { "role": "user", "content": "Do phagocytic lining cells determine local expression of inflammation in type II collagen-induced arthritis? Context: To investigate the in vivo role of phagocytic synovial lining cells in the local expression of inflammation in type II collagen-induced arthritis (CIA) in DBA/1J mice. On various days before arthritis induction (day 7, 5, or 2), phagocytic lining cells were selectively depleted from the synovial layer by injecting multilamellar liposomes containing clodronate (dichloromethylene diphosphonate) directly into the knee joints. As controls, either PBS or PBS-laden liposomes were injected. CIA was induced by immunizing mice with heterologous bovine type II collagen in Freund's complete adjuvant. Arthritis onset was synchronized by a single intraperitoneal injection of lipopolysaccharide; arthritis was evaluated in hematoxylin and eosinstained knee joint sections. Chemotactic activity in synovial washout samples was detected in a Transwell chemotactic assay. Interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF alpha) protein levels were measured in NOB-1 and L929 bioassays, respectively. IL-1 messenger RNA (mRNA) in synovial specimens was measured by reverse transcriptase-polymerase chain reaction. IL-1 was also detected immunohistologically in knee joint sections. In clodronate-laden liposome-treated, lining-depleted knee joints, there was significantly decreased inflammation compared with controls. Cell influx into the synovium was markedly decreased. Expression of IL-1 mRNA in the synovium was significantly reduced. IL-1 was detected only in some cells in the deeper synovial layer, in contrast to controls, in which large numbers of cells in the deeper synovial layer were stained. In synovial washouts from lining-depleted knee joints, biologically active IL-1 levels were reduced by 40% at 6 hours after arthritis induction. Most strikingly, chemotactic activity was highly decreased in these synovial washout samples. When IL-1 or TNF alpha was injected into the knee joints of immunized mice in which arthritis was not yet expressed, arthritis was not induced in the lining-depleted joints, whereas marked cell influx was found in control joints." }, { "role": "assistant", "content": "Our data indicate that phagocytic lining cells play a crucial role in the local expression of inflammation in systemically induced CIA. Phagocytic lining cells probably form an important source of chemotactic factors which are set free upon activation by IL-1 or TNF alpha. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Area Under Curve, Double-Blind Method, Estradiol, Excitatory Amino Acid Antagonists, Excitatory Amino Acids, Facial Pain, Female, Follow-Up Studies, Glutamic Acid, Gonadal Steroid Hormones, Humans, Injections, Intra-Articular, Ketamine, Male, Pain Measurement, Pain Threshold, Progesterone, Range of Motion, Articular, Receptors, N-Methyl-D-Aspartate, Sex Factors, Temporomandibular Joint Disorders, Testosterone, Young Adult." }, { "role": "user", "content": "Is glutamate-induced temporomandibular joint pain in healthy individuals partially mediated by peripheral NMDA receptors? Context: To determine if glutamate injected into the healthy temporomandibular joint (TMJ) evokes pain through peripheral N-methyl-D-aspartate (NMDA) receptors and if such pain is influenced by sex or sex steroid hormones. Sixteen healthy men and 36 healthy women were included and subjected to two randomized and double-blind intra-articular injections of the TMJ. Experimental TMJ pain was induced by injection of glutamate (1.0 mol/L) and NMDA block was achieved by co-injection of the NMDA antagonist ketamine (10 mmol/L). The TMJ pain intensity in the joint before and during a 25-minute postinjection period was continuously recorded on an electronic visual analog scale (0 to 10). Estradiol, progesterone, and testosterone levels in serum were analyzed. Glutamate-induced pain showed a median (25/75 percentile) duration of 8.3 (5.2/12.2) minutes. The peak pain intensity was 6.1 (4.2/8.2), the time to peak was 50 (30/95) seconds, and the area under the curve was 59 (29/115) arbitrary units. The women reported higher maximum pain intensity than the men and shorter time to peak. The sex hormone levels were not significantly related to the glutamate-induced TMJ pain. NMDA block significantly reduced the glutamate-induced TMJ pain, mainly in the women. There were no significant correlations between sex hormone levels and the effects of NMDA block for any pain variable." }, { "role": "assistant", "content": "Glutamate evokes immediate pain in the healthy human TMJ that is partly mediated by peripheral NMDA receptors in the TMJ. 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: Adiponectin, Adult, Aged, Asian Continental Ancestry Group, Biomarkers, Cholesterol, Diagnosis, Differential, Fatty Liver, Humans, Lipoproteins, Male, Metabolic Syndrome, Middle Aged, Non-alcoholic Fatty Liver Disease, Risk Factors, Triglycerides." }, { "role": "user", "content": "Is plasma adiponectin a more specific marker of fatty liver than a marker of metabolic syndrome in Japanese men? Context: The association of plasma cardiovascular risk markers and metabolic syndrome (MetS) with non-alcoholic fatty liver disease (NAFLD) has not been well defined. Japanese men (n = 809) had standard anthropometric measurements done, and had their liver fat quantitated by ultrasound. Three groups were identified: (1) normal controls without significant disease, (2) preliminary-metabolic syndrome (pre-MetS) cases and (3) MetS cases. Plasma adiponectin, high sensitivity-C reactive protein (hs-CRP), HOMA-IR, lipids, lipoproteins and liver enzymes were evaluated among the three groups. The prevalence of fatty liver was 13% in controls, 39% in pre-MetS and 62% in MetS. Plasma adiponectin and high density lipoprotein cholesterol (HDL-C) were significantly decreased, and HOMA-IR, hs-CRP, TG, remnant lipoproteins (RLPs) and small dense-LDL-C (sd LDL-C) were significantly increased in subjects with fatty liver compared to those without fatty liver. Multivariate analyses of serum parameters associated with fatty liver revealed that adiponectin and hs-CRP were more strongly associated with the presence of fatty liver than waist circumference. However, HOMA-IR, HDL-C, TG, RLP-C, RLP-TG and sd LDL-C were more strongly associated with waist circumference than with fatty liver. Factor analysis revealed that adiponectin and HDL-C were linked to liver enzymes, lipoproteins and HOMA-IR associated with fatty liver, but not with waist circumference." }, { "role": "assistant", "content": "Adiponectin was found to be a more specific diagnostic marker for the presence of fatty liver regardless of MetS status, and was inversely correlated with liver enzyme concentrations. However, RLPs were found to be more specifically associated with the presence of MetS. 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, Cell Membrane Permeability, Disease Models, Animal, Dose-Response Relationship, Drug, Erythropoietin, Follow-Up Studies, Ileum, Infusions, Intravenous, Peptide Fragments, Rats, Rats, Sprague-Dawley, Resuscitation, Shock, Hemorrhagic, Treatment Outcome." }, { "role": "user", "content": "Does recombinant human erythropoietin improve gut barrier function in a hemorrhagic shock and resuscitation rat model? Context: Gut injury and bacterial translocation develop and persist after limited periods of hemorrhagic shock. Erythropoietin (EPO) can exert hemodynamic, anti-inflammatory, and tissue protective effects. We tested the hypothesis that EPO given at the time of resuscitation with saline will reduce functional ileal injury 24 hours after shock. Sprague-Dawley rats (n = 6 per group) were randomized to sham surgery or hemorrhagic shock maintained at mean arterial pressure 40 mm Hg for 60 minutes and then treated with either saline resuscitation (three times the volume of shed blood) or saline + recombinant human EPO (rHuEPO) resuscitation. Intravenous rHuEPO (1,000 U/kg) was given at the start of saline resuscitation, and at 24 hours ileal function was evaluated using quantitative cultures of mesenteric lymph nodes to assess for bacterial translocation (colony-forming units per gram of tissue [CFU/g]), determination of portal vein plasma endotoxin levels and histopathological evaluation using semi-thin plastic sections of the distal ileum. In a second series of animals, fluorescein isothiocyanate-dextran 4000 (FD-4) was used to assess mucosal permeability of the distal ileum to macromolecules. At 24 hours, the saline group had morphologic evidence of intestinal injury when compared with the sham group, and the degree of mucosal injury was less in the saline + rHuEPO when compared with the saline group, which demonstrated significantly reduced bacterial translocation to the mesenteric lymph nodes (383 CFU/g ± 111 CFU/g vs. 1130 CFU/g ± 297 CFU/g; p < 0.05) and decreased terminal ileum permeability to FD-4 (3.08 μg/mL ± 0.31 μg/mL vs. 5.14 μg/mL ± 0.88 μg/mL; p < 0.05). No significant difference was found in the portal vein endotoxin levels between the two groups. Histopathological evaluation demonstrated a trend for decreased enterocyte disarray or disruption and vacuolization in the saline + rHuEPO versus saline group." }, { "role": "assistant", "content": "Using rHuEPO at time of saline resuscitation resulted in decreased bacterial translocation and permeability to macromolecules 24 hours after shock. These observations suggest that rHuEPO can mediate a protective effect on intestinal mucosal barrier function during ischemic injury. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Aged, Biomarkers, Tumor, Breast Neoplasms, Carcinoma, Ductal, Breast, Case-Control Studies, Cell Nucleus, Early Detection of Cancer, Female, Humans, Immunohistochemistry, Middle Aged, Osteopontin, Poland, Prognosis, Survivors, Sweden." }, { "role": "user", "content": "Is nuclear osteopontin-c a prognostic breast cancer marker? Context: Although Osteopontin has been known as a marker for cancer progression, the elevated production of this cytokine is not specific for cancer. We have identified the splice variant Osteopontin-c as being absent from healthy tissue but associated with about 75% of breast cancer cases. However, in previous studies of Osteopontin-c, follow-up information was not available. Here we have analysed 671 patients, comprising a cohort of 291 paraffin blocks plus a population-based case-control study of 380 arrayed breast tumor tissues. We find that high staining intensity of nuclear Osteopontin-c is strongly associated with mortality in patients with early breast cancer. Cytosolic staining for exon 4, reflective of Osteopontin-a and -b also predicts poor outcome. By contrast, total Osteopontin does not correlate with prognosis. These diverse assessments of Osteopontin also do not correlate with each other, suggesting distinct expression patterns for the variant forms. Consistent with its role in tumor progression, not tumor initiation, Osteopontin-c is not correlated with proliferation markers (Ki-67, cyclin A, cyclin B, cyclin E and cyclin D), neither is it correlated with ER, PR or HER2." }, { "role": "assistant", "content": "The addition of Osteopontin-c immunohistochemistry to standard pathology work-ups may have prognostic benefit in early breast cancer diagnosis. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Adolescent, Adult, Brain Stem, Child, Disability Evaluation, Disease Progression, Female, Follow-Up Studies, Gadolinium, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis, Predictive Value of Tests, Prognosis, Proportional Hazards Models." }, { "role": "user", "content": "Do infratentorial lesions predict long-term disability in patients with initial findings suggestive of multiple sclerosis? Context: The number and volume of abnormalities on baseline brain magnetic resonance images in patients with initial findings suggestive of multiple sclerosis are known to predict outcome in terms of disability. However, no long-term data exist on specific locations or types of lesions. To assess the long-term predictive value of baseline magnetic resonance imaging parameters, including location of lesions and gadolinium-enhancing and hypointense lesions in patients with initial findings suggestive of multiple sclerosis for the occurrence of clinically relevant disability as defined by an Expanded Disability Status Scale score of 3. After a median follow-up period of 8.7 years, the medical records of 42 patients were reviewed and assessed for time until patients received an Expanded Disability Status Scale score of 3. Magnetic resonance imaging parameters were dichotomized according to maximum accuracy and then used to calculate hazard ratios using the Cox model for proportional hazard ratios. Conversion to clinically definite multiple sclerosis was observed in 26 patients (62%), of whom 14 (54%) progressed to an Expanded Disability Status Scale score of 3. Two or more infratentorial lesions best predicted long-term disability (hazard ratio, 6.3). Gadolinium-enhancing and hypointense T1-weighted lesions did not show prognostic value." }, { "role": "assistant", "content": "Infratentorial lesions are related to long-term prognosis for patients with initial findings suggestive of multiple sclerosis and thus may help to identify patients at high risk for earlier occurrence of clinically relevant disability. 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 52 year old lady with a vesicovaginal fistula after abdominal hysterectomy is not responding to conservative management. Most useful and impoant next investigation is:" }, { "role": "assistant", "content": "The correct answer is The most valuable investigation in an established case of a vesicovaginal fistula should be cystoscopy. Ref: Female Pelvic Health and Reconstructive Surgery By Carlin and Leong, 1st Edition; Minute Obstetrics and Gynecology consult, 2008, Page 210; Urogynecology and Female Pelvic Reconstructive Surgery : Just the Facts By Sam Siddighi, Jeffrey S. Hardesty, Page 190." } ]

[ { "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": "Estrogen receptors are seen in" }, { "role": "assistant", "content": "The correct answer is The estrogen receptor (ER) is a ligand-activated enhancer protein that is a member of the steroid/nuclear receptor superfamily.Two genes encode mammalian ER: ERa and ERb.ER binds to specific DNA sequences called estrogen response elements (EREs) with high affinity and transactivates gene expression in response to estradiolRef: DM Vasudevan, 7th edition, page no: 57" } ]

[ { "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": "True about amoebic liver abscess is" }, { "role": "assistant", "content": "The correct answer is Most of the patients are young men( may be due to heavy alcohol consumption) Not associated with diabetes Cultures of amoebic abscess are usually sterile or negative Ref: Sabiston 20th edition" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "The most commonly affected component of the lateral collateral ligament complex in an \"ankle sprain\" is the -" }, { "role": "assistant", "content": "The correct answer is * The lateral collateral ligament is commonly sprained, mostly so the anterior talo - fibular component. Ref: Maheshwari 9th /e p.157" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "After her first urinary tract infection (UTI), a 1-year-old girl has a voiding cystourethrogram with findings shown below. Which of the following is the most appropriate treatment option?" }, { "role": "assistant", "content": "The correct answer is The radiograph shows reflux into the ureters and into the kidney, with dilation of the renal pelvis, making the diagnosis of vesicoureteral reflux (VUR). The higher the reflux into the renal system, especially if the renal pelvis is dilated, the more likely it is for renal damage to occur; the grading system is based upon these radiographic observations. Grade I VUR is reflux of urine into an undilated ureter. Reflux into the ureter and collecting system without dilatation is called grade II. Grade III lesions have dilatation of the ureter and collecting system without blunting of the calyces. Grade IV lesions are characterized by blunting of the calyces, and grade V lesions demonstrate even more dilatation and tortuosity of the ureter. While somewhat controversial, low-grade lesions (grade I and grade II) usually are conservatively managed with close observation, daily low-dose antibiotics, and urinalyses and cultures every 3 to 4 months. Grade V lesions (and some grade IV lesions) require surgical reimplantation of a ureter if the findings persist. Lesions in between these two extremes are treatment dilemmas. Neither a diet low in protein nor early toilet training would likely affect the VUR." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Astrocytoma, Blotting, Western, Brain Neoplasms, Cell Division, Extracellular Matrix, Furin, Humans, Immunoenzyme Techniques, In Vitro Techniques, Injections, Subcutaneous, Metalloendopeptidases, Mice, Mice, SCID, Neoplasm Invasiveness, Neoplasm Transplantation, Rats, Receptor, IGF Type 1, Subtilisins, Trachea, Transfection, Transforming Growth Factor beta, Tumor Cells, Cultured, alpha 1-Antitrypsin." }, { "role": "user", "content": "Does inhibition of furin-mediated processing result in suppression of astrocytoma cell growth and invasiveness? Context: Astrocytoma arises in the central nervous system as a tumor of great lethality, in part because of the invasive potential of the neoplastic cells that are able to release extracellular matrix-degrading enzymes. Furin convertase activates several precursor matrix metalloproteases involved in the breakdown of the extracellular matrix. In the present study inhibition of furin was achieved by gene transfer of alpha(1)-antitrypsin Portland (PDX) cDNA. This furin inhibitor was transfected into two tumorigenic astrocytoma cell lines. The inhibitory effect was evaluated using in vivo tumorigenicity, invasion, and proliferation assays, as well as by investigating impairment of furin substrate processing. Expression of PDX prevented the s.c. growth of the transfected cells. Invasion assays demonstrated that PDX-transfected cells exhibited a reduced invasive ability in vitro and in vivo. Furthermore, s.c. growth of PDX transfectant xenotransplants showed a significant reduction in size that coincided with a significant decrease of the in vitro doubling time and of the in vivo cell proliferation ability. Additional studies showed that the furin substrates insulin-like growth factor IR, transforming growth factor beta and membrane type 1-matrix metalloprotease were not activated in PDX-expressing astrocytoma cells." }, { "role": "assistant", "content": "PDX expression in astrocytoma cells demonstrated a direct mechanistic link between furin inhibition, and decreased astrocytoma proliferation and invasive ability. Because furin inhibition inhibits both invasiveness and cell growth in astrocytoma, furin should be considered a promising target for glioblastoma 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": "Lingual flange in the posterior region is determined by:" }, { "role": "assistant", "content": "The correct answer is Lingual flange in the anterior region is determined by genioglossus, in molar region by mylohyoid in posterior region it is determined by palatoglossus and superior constrictor.\nLabial border is determined by buccinator and masseter." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "All of the following are post-translational effects of histone except" }, { "role": "assistant", "content": "The correct answer is Histones are the Most Abundant Chromatin ProteinsHistones are a small family of closely related basic proteins. Nucleosomes contain four major types of histones: H2A, H2B, H3, and H4.These four core histones are subject to at least six types of covalent modification or posttranslational modifications (PTMs): acetylation, methylation, phosphorylation, ADP-ribosylation, monoubiquitylation, and sumoylation. These histone modifications play an impoant role in chromatin structure and function.Ref: Harper&;s Biochemistry; 30th edition; Chapter 35 DNA Organization, Replication, & Repair" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Brain, Cell Line, Cricetinae, Encephalitis Virus, Japanese, Encephalitis, Japanese, Female, Gene Expression Profiling, Gene Expression Regulation, Humans, Mice, Mice, Inbred BALB C, RNA, Messenger, Spleen." }, { "role": "user", "content": "Does japanese encephalitis virus infection induce changes of mRNA profile of mouse spleen and brain? Context: Japanese encephalitis virus (JEV) is a mosquito-borne flavivirus, leading to an acute encephalitis and damage to the central nervous system (CNS). The mechanism of JEV pathogenesis is still unclear. DNA microarray analyses have been recently employed to detect changes in host gene expression, which is helpful to reveal molecular pathways that govern viral pathogenesis. In order to globally identify candidate host genes associated with JEV pathogenesis, a systematic mRNA profiling was performed in spleens and brains of JEV-infected mice. The results of microarray analysis showed that 437 genes in spleen and 1119 genes in brain were differentially expressed in response to JEV infection, with obviously upregulated genes like pro-inflammatory chemokines and cytokines, apoptosis-related proteases and IFN inducible transcription factors. And the significant pathways of differentially expressed genes are involved in cytokine-cytokine receptor interaction, natural killer cell mediated cytotoxicity, antigen processing and presentation, MAPK signaling, and toll-like receptor signaling, etc. The differential expression of these genes suggests a strong antiviral response of host but may also contribute to the pathogenesis of JEV resulting in encephalitis. Quantitative RT-PCR (RT-qPCR) assay of some selected genes further confirmed the results of microarray assay." }, { "role": "assistant", "content": "Data obtained from mRNA microarray suggests that JEV infection causes significant changes of mRNA expression profiles in mouse spleen and brain. Most of differentially expression genes are associated with antiviral response of host, which may provide important information for investigation of JEV pathogenesis and therapeutic method. Final Decision: yes" } ]