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[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "The surface marking of the arch of aorta is as follows -" }, { "role": "assistant", "content": "The correct answer is Arch of Aorta surface marking\n\nRight end of sternal angle\nCentre of manubrium sterni\nSternal end of left second costal cartilage\n\nThese points when connected lies behind the lower half of manubrium sterni." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Apoptosis, Arteries, Atherosclerosis, Caspases, Cells, Cultured, Endothelial Cells, Endothelium, Vascular, Humans, Poly(ADP-ribose) Polymerases, Vascular Endothelial Growth Factor A." }, { "role": "user", "content": "Does vascular endothelial growth factor confer endothelial resistance to apoptosis through poly ( ADP-ribose ) polymerase? Context: Vascular endothelial growth factor (VEGF) inhibits the endothelial apoptosis that is induced by caspases during vascular remodeling; however, the underlying mechanisms have not been completely elucidated. We hypothesized that VEGF upregulates poly(ADP-ribose) polymerase-1 (PARP) as a caspase mediator, and sought to investigate the link between apoptosis inhibition by VEGF and PARP regulation in the human vasculature. Human endothelial cells (primary cells, macrovascular/microvascular lines) were incubated with 100 pg mL(-1) to 1 μg mL(-1) VEGF-A(165) in the absence or presence of PARP small interfering RNA (siRNA). Apoptosis induced by integrin inhibition was measured by flow cytometry, trypan blue exclusion, and nuclear morphology. PARP expression and activity were determined by real-time RT-PCR, Western blot, and ribosylation assay. VEGF receptors and signal transduction were analyzed by inhibitor experiments, enzyme assays, western blot, and immunofluorescence microscopy. Immunohistochemistry was applied to a vascular culture model and to 24 atherosclerotic and 10 normal human arteries. VEGF-A(165) induced resistance to apoptosis caused by caspase activation in endothelial cells in a time-dependent manner. VEGF, but not fibroblast growth factor-2 or transforming growth factor-β, time-dependently and dose-dependently induced PARP expression and activity, involving VEGF receptor-2 colocalized with neuropilin-1 as well as the signal transduction molecules c-Jun N-terminal kinase and Akt. The antiapoptotic effect of VEGF was abrogated by PARP siRNA. The relationship between local VEGF influence and endothelial PARP expression was confirmed in human arteries and the vascular culture model." }, { "role": "assistant", "content": " VEGF exerts its antiapoptotic effect on the endothelium through the regulation of PARP expression. PARP has been attributed an ambiguous role in apoptosis; here, we show that PARP promotes vascular endothelial integrity in VEGF-associated processes. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Mortality, Prognosis, Risk Factors, Survival Analysis, Young Adult." }, { "role": "user", "content": "Does repeated measurement of the intermountain risk score enhance prognostication for mortality? Context: The Intermountain Risk Score (IMRS), composed of the complete blood count (CBC) and basic metabolic profile (BMP), predicts mortality and morbidity in medical and general populations. Whether longitudinal repeated measurement of IMRS is useful for prognostication is an important question for its clinical applicability. Females (N = 5,698) and males (N = 5,437) with CBC and BMP panels measured 6 months to 2.0 years apart (mean 1.0 year) had baseline and follow-up IMRS computed. Survival analysis during 4.0±2.5 years (maximum 10 years) evaluated mortality (females: n = 1,255 deaths; males: n = 1,164 deaths) and incident major events (myocardial infarction, heart failure [HF], and stroke). Both baseline and follow-up IMRS (categorized as high-risk vs. low-risk) were independently associated with mortality (all p<0.001) in bivariable models. For females, follow-up IMRS had hazard ratio (HR) = 5.23 (95% confidence interval [CI] = 4.11, 6.64) and baseline IMRS had HR = 3.66 (CI = 2.94, 4.55). Among males, follow-up IMRS had HR = 4.28 (CI = 3.51, 5.22) and baseline IMRS had HR = 2.32 (CI = 1.91, 2.82). IMRS components such as RDW, measured at both time points, also predicted mortality. Baseline and follow-up IMRS strongly predicted incident HF in both genders." }, { "role": "assistant", "content": "Repeated measurement of IMRS at baseline and at about one year of follow-up were independently prognostic for mortality and incident HF among initially hospitalized patients. RDW and other CBC and BMP values were also predictive of outcomes. Further research should evaluate the utility of IMRS as a tool for clinical risk adjustment. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adaptor Proteins, Signal Transducing, Adult, Aged, Aged, 80 and over, DNA Mismatch Repair, Epithelial Cells, Female, Gene Expression Regulation, Neoplastic, Humans, Immunohistochemistry, Leukoplakia, Oral, Male, Microsatellite Instability, Middle Aged, Mouth Mucosa, Mouth Neoplasms, MutL Protein Homolog 1, Nuclear Proteins, Statistics, Nonparametric." }, { "role": "user", "content": "Is hMLH1 immunoexpression related to the degree of epithelial dysplasia in oral leukoplakia? Context: hMLH1 is a protein of the mammalian mismatch repair system responsible for genomic stability during repeated duplication. Relation between its altered expression linked to microsatellite instability has also been observed in oral leukoplakias (OL) and squamous cell carcinomas pointing to a possible role of hMLH1 in oral carcinogenesis. To our knowledge, this is the first study evaluating the immunoexpression of hMLH1 in OLs regarding their different degrees of epithelial dysplasia. Sixty-two specimens of OL were classified in four groups: 17 without dysplasia, 19 with mild dysplasia, 16 with moderate dysplasia, and 10 with severe dysplasia. Immunohistochemistry for hMLH1 was performed, and percentage of positive cells was assessed. In the statistical analysis, P values <0.005 were considered significant. hMLH1 immunoexpression showed decreasing indexes from lesions with lower degrees of dysplasia to lesions with more severe dysplasia. Statistical difference was found mainly between suprabasal layers and total indexes." }, { "role": "assistant", "content": "hMLH1 immunoexpression was inversely related to the OL degree of dysplasia. The total epithelial hMLH1 index seems to be of more clinical relevance than the evaluation stratified by layers. Our findings also suggest a role of such alterations in this pathway of DNA repair as an early event in oral carcinogenesis. 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": "Pralidoxime acts by ?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., Reactivating cholinesterase enzyme" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: STUDY DESIGN, OBJECTIVE, SETTING, METHODS. Meshes: Aged, Aged, 80 and over, Female, Humans, Locomotion, Magnetic Resonance Imaging, Meningioma, Neuronal Plasticity, Paraplegia, Spinal Cord Neoplasms." }, { "role": "user", "content": "Does the neuronal plasticity exist in elderly patients? Context: Case report. To report complete recovery after paraplegia in an elderly patient after removal of meningioma at C7-T1 level. Department of Neurosurgery, Reggio Calabria, Italy. An 82-year-old lady with 48 months of progressive weakness and numbness was admitted with complete paraplegia lasting 15 days. Investigations (magnetic resonance imaging (MRI)) demonstrated a meningioma at C7-T1. The tumour compressed the extremely thinned spinal cord. MRI after surgery showed no evidence of residual tumour and the spinal cord was of normal dimensions. The patient recovered fully and locomotion was restored." }, { "role": "assistant", "content": "Surgical decompression gave an excellent result. The result raises the possibility of neuronal plasticity." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, METHODS, METHODS, METHODS, RESULTS. Meshes: Adolescent, Age Factors, Child, Child, Preschool, Cochlear Implantation, Deafness, Hearing, Humans, Retrospective Studies, Severity of Illness Index, Speech Perception, Speech Production Measurement, Surveys and Questionnaires, Treatment Outcome." }, { "role": "user", "content": "Do the influence of residual high-frequency hearing on the outcome in congenitally deaf cochlear implant recipients? Context: To show that congenitally deaf children who receive a cochlear implant between 10 and 15 years of age find it significantly more difficult to learn the new signal, and that a history of sound detection at high frequencies with hearing aids is predictive of better outcomes in these children. A retrospective study using a within-subjects design. Children's Cochlear Implant Centre, Sydney (CCIC), Royal Prince Alfred Hospital, and the New Children's Hospital in Westmead are tertiary referral centers. Forty-five congenitally deaf patients were grouped according to their age (in years) at implantation into group 1 (aged 10-15), group 2 (aged <10), group 2a (aged 6-9), and group 2b (aged 3-5). Within each group, individuals with previous hearing between 2 and 4 kHz before receiving a cochlear implant were identified, and their mean results were compared with those in their respective age-matched groups. Surgical implantation, intensive weekly habilitation at the CCIC. Speech perception, speech production, and language measures were compared. Questionnaires and telephone interviews were conducted. Group 2 (age <10 years) consistently outperformed group 1 (10-15 years) on all outcome measures, and most of them learned to converse without lipreading. In group 1, children with previous aided hearing at high frequencies displayed exceptional gains in speech perception and speech production, with reduced dependence on lipreading. Previous high-frequency hearing does not benefit group 2." }, { "role": "assistant", "content": "Implant recipients aged 10 to 15 years experience more difficulty than younger children during the initial periods of device use. A history of high-frequency hearing before implantation in these individuals correlates with more rapid improvement. 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": "Gall stone causes intestinal obstruction when it gets impacted in which pa of the intestine commonly" }, { "role": "assistant", "content": "The correct answer is This type of obstruction tends to occur in the elderly secondary to erosion of a large gallstone through the gall bladder into the duodenum. Classically, there is impaction about 60 cm proximal to the ileocaecal valve. The patient may have recurrent attacks as the obstruction is frequently incomplete or relapsing as a result of a ball-valve effect. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1190" } ]

[ { "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": "Fluconazole differs from ketoconazole in that :" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Malignant glaucoma is seen in –a) Anterior chamber normalb) Misdirected aqueous flowc) Pilocarpine is the drug of choiced) Management is medical onlye) Atropine is also given" }, { "role": "assistant", "content": "The correct answer is In malignant glaucoma there is misdirection of aqueous posteriorly into the vitreous. It is characterized by markedly raised IOP and shallow or absent anterior chamber.\nTreatment includes :- i) Medical :- Atropine (DOC), phenylephrine, osmotic agents, (β-blockers, α-agonists, carbonic anhydrase inhibitors; ii) YAG laser hyaloidotomy; iii) Surgery :- pars plana vitrectomy." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Cytokines, Enzyme-Linked Immunosorbent Assay, Female, Health Status, Health Surveys, Humans, Interleukin-1, Interleukin-6, Male, Middle Aged, Sex Factors, Surveys and Questionnaires, Tumor Necrosis Factor-alpha." }, { "role": "user", "content": "Is self-rated health related to levels of circulating cytokines? Context: Self-rated health is a powerful and independent predictor of long-term health, but its biological basis is unknown. Because factors associated with poor self-rated health (eg, pain, daily discomforts, and low energy and fitness) resemble symptoms of a generalized cytokine-induced sickness response, we examined the relationship between circulating cytokines and self-rated health. In 265 consecutive primary health care patients (174 women and 91 men), we examined self-rated and physician-rated health, circulating levels of interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1ra), IL-6, and tumor necrosis factor (TNF)-alpha as determined from plasma samples using high-sensitivity enzyme-linked immunoassay. Self-rated health correlated with levels of IL-1beta (r = 0.27; p <.001), IL-1ra (r = 0.19; p <.05) and TNF-alpha (r = 0.46; p <.001) in women but not in men. Thus, poorer subjective health was associated with higher levels of inflammatory cytokines. Even when controlling for age, education, physical health, and diagnoses in multiple regression analyses, self-rated health was an independent and more robust predictor of cytokine levels than physician-rated health." }, { "role": "assistant", "content": "The present findings suggest that an individual's health perception may be coupled to circulating cytokines. Because epidemiological research established that self-rated health predicts morbidity and mortality, the biological correlates and mechanisms of self-rated health need to be understood. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, METHODS, METHODS, METHODS, RESULTS. Meshes: Aged, Aging, Cross-Sectional Studies, Exercise Test, Habits, Humans, Male, Mobility Limitation, Motor Activity, Muscle Strength, Walking." }, { "role": "user", "content": "Are habitual physical activity levels associated with performance in measures of physical function and mobility in older men? Context: To determine whether objectively measured physical activity levels are associated with physical function and mobility in older men. Cross-sectional. Academic research center. Eighty-two community-dwelling men aged 65 and older with self-reported mobility limitations were divided into a low-activity and a high-activity group based on the median average daily physical activity counts of the whole sample. Physical activity according to triaxial accelerometers; physical function and mobility according to the Short Physical Performance Battery (SPPB), gait speed, stair climb time, and a lift-and-lower task; aerobic capacity according to maximum oxygen consumption (VO(2) max); and leg press and chest press maximal strength and peak power. Older men with higher physical activity levels had a 1.4-point higher mean SPPB score and a 0.35-m/s faster walking speed than those with lower physical activity levels. They also climbed a standard flight of stairs 1.85 seconds faster and completed 60% more shelves in a lift-and-lower task (all P<.01); muscle strength and power measures were not significantly different between the low- and high-activity groups. Correlation analyses and multiple linear regression models showed that physical activity is positively associated with all physical function and mobility measures, leg press strength, and VO(2) max." }, { "role": "assistant", "content": "Older men with higher physical activity levels demonstrate better physical function and mobility than their less-active peers. Moreover, physical activity levels are predictive of performance in measures of physical function and mobility in older men. Future work is needed to determine whether modifications in physical activity levels can improve or preserve physical performance in later 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": "Odontoblasts release inflammatory chemokine ___________which is chemotactic for neutrophils." }, { "role": "assistant", "content": "The correct answer is Odontoblasts release inflammatory chemokine interleukin-8 which is chemotactic for neutrophils. Nerve growth factor and its receptor found in the odontoblasts are chemo attractants for neutrophils. Nitric oxide synthetase are important enzymes for vasodilatation and blood pressure regulation. These have been identified in odontoblasts and endothelial cells of the pulp. This finding suggests that they may have a role in mediating cell proliferation and vasodilatation" } ]

[ { "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 27-year-old G2P2002 is recovering in the hospital on postpartum day 3 after a low transverse C-section. During morning rounds, she reports a “pus-like” discharge and shaking chills overnight. She also endorses increased uterine cramping compared to the day before, but her postpartum course has otherwise been uneventful with a well-healing incision and normal vaginal bleeding. The patient’s prenatal care was complicated by HIV with a recent viral load of 400 copies/mL, type I diabetes well controlled on insulin, and a history of herpes simplex virus encephalitis in her first child. She did not have any genital lesions during the most recent pregnancy. Four days ago, she presented to the obstetric triage unit after spontaneous rupture of membranes and onset of labor. She made slow cervical change and reached full dilation after 16 hours, but there was limited fetal descent. Cephalopelvic disproportion was felt to be the reason for arrest of descent, so prophylactic ampillicin was administered and C-section was performed. A vaginal hand was required to dislodge the fetus’s head from the pelvis, and a healthy baby boy was delivered. On postpartum day 3, her temperature is 101.5°F (38.6°C), blood pressure is 119/82 mmHg, pulse is 100/min, and respirations are 14/min. Her incision looks clean and dry, there is mild suprapubic tenderness, and a foul yellow discharge tinged with blood is seen on her pad. Which of the following is the most significant risk factor for this patient’s presentation?" }, { "role": "assistant", "content": "C-section after onset of labor" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Aged, Aged, 80 and over, Coronary Angiography, Coronary Artery Disease, Cross-Sectional Studies, Female, Humans, Male, Metabolic Syndrome, Middle Aged, Prognosis, Prospective Studies." }, { "role": "user", "content": "Does metabolic syndrome predict significant angiographic coronary artery disease? Context: Metabolic syndrome (MS) is an independent predictor of acute cardiovascular events. However, few studies have addressed the relationship between MS and stable angiographic coronary artery disease (CAD), which has a different pathophysiological mechanism. We aimed to study the independent predictors for significant CAD, and to analyze the impact of MS (by the AHA/NHLBI definition) on CAD. We prospectively included 300 patients, mean age 64±9 years, 59% male, admitted for elective coronary angiography (suspected ischemic heart disease), excluding patients with known cardiac disease. All patients underwent assessment of demographic, anthropometric, and laboratory data and risk factors, and subsequently underwent coronary angiography. In the study population, 23.0% were diabetic, 40.5% had MS (and no diabetes) and 36.7% had neither diagnosis. Significant CAD was present in 51.3% of patients. CAD patients were older and more frequently male and diabetic, with increased triglycerides and glucose and lower HDL cholesterol. Abdominal obesity was also less prevalent. MS was not associated with the presence of CAD (OR 0.94, 95% CI 0.59-1.48, p=0.778). Of the MS components, the most important predictors of CAD were increased glucose and triglycerides. Abdominal obesity was associated with a lower risk of CAD. In a multivariate logistic regression model for CAD, independent predictors of CAD were age, male gender, glucose and triglycerides. Body mass index had a protective effect." }, { "role": "assistant", "content": "Although MS is associated with cardiovascular events, the same was not found for stable angiographically proven CAD. Age, gender, diabetes and triglycerides are the most influential factors for CAD, with abdominal obesity as a protective factor." } ]

[ { "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 drug having 40% absorption and hepatic extraction ratio of 0.6. What is the bioavailability of that drug?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., 16% Absoion of drug is 40% i. e. if 100 mg of drug is taken 40 mg will be absorbed. Hepatic extraction ratio is 0.6 i.e. out of the absorbed dose 60% will be removed by liver; so from the absorbed 40 mg 60% removed i. e. 24 mg removed. Thus finally the remaining 16 mg of the total dose taken reaches the systemic circulation. So bioavailability is 16% as 16mg of the total 100 mg finally reached the systemic circulation" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: 2-Methoxyestradiol, Animals, Cyclohexanes, Endothelium, Vascular, Estradiol, Hemangioendothelioma, Hemangiosarcoma, Male, Mice, Mice, Nude, Neovascularization, Pathologic, O-(Chloroacetylcarbamoyl)fumagillol, Sesquiterpenes." }, { "role": "user", "content": "Do the antiangiogenic agents TNP-470 and 2-methoxyestradiol inhibit the growth of angiosarcoma in mice? Context: Endothelial malignancies, such as angiosarcoma and hemangioendothelioma, are often resistant to chemotherapy and surgery, and may result in death. Improved means of therapy are needed for these disorders. We wanted to determine whether angiosarcoma can be treated with angiogenesis inhibitors in mice. Mice were inoculated with a cell line that gives rise to angiosarcoma and were treated with the angiogenesis inhibitors 2-methoxyestradiol and TNP-470. Response to therapy was monitored by measurement of tumors. TNP-470 caused an 84% reduction in tumor size, and 2-methoxyestradiol caused a 68% reduction in tumor size." }, { "role": "assistant", "content": "Angiogenesis inhibitors are highly effective in treatment of angiosarcoma in mice. Clinical trials of these agents in humans with angiosarcoma and hemangioendothelioma are 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: OBJECTIVE, METHODS, METHODS, METHODS, METHODS, RESULTS. Meshes: Bronchial Diseases, Bronchoscopy, Constriction, Pathologic, Critical Care, Emergencies, Female, Humans, Intensive Care Units, Intubation, Intratracheal, Laser Therapy, Lung Diseases, Lung Neoplasms, Male, Middle Aged, Respiration, Artificial, Respiratory Insufficiency, Retrospective Studies, Stents, Tracheal Stenosis, Tracheotomy, Ventilator Weaning." }, { "role": "user", "content": "Does therapeutic rigid bronchoscopy allow level of care changes in patients with acute respiratory failure from central airways obstruction? Context: To determine whether emergency rigid bronchoscopic intervention, including Nd-YAG laser resection or stenting, immediately affected the need for continued mechanical ventilation or intensive care level of support in critically ill patients with acute respiratory failure from malignant or benign central airways obstruction. Retrospective review of medical records of all patients with acute respiratory failure and malignant or benign tracheobronchial obstruction necessitating intubation, mechanical ventilation, or hospitalization in the ICU prior to referral for therapeutic bronchoscopy. University of California San Diego, a tertiary care institution specialized in airway management. Medical records of 32 patients with malignant or benign central airways obstruction requiring admission to the ICU prior to rigid bronchoscopic intervention between January 1994 and April 1996. Emergent rigid bronchoscopy with dilatation, Nd-YAG laser resection, or silicone stent insertion performed in the operating room under general anesthesia. Thirty-two patients with central airways obstruction requiring emergent hospitalization in the ICU were referred for therapeutic rigid bronchoscopy. Airway strictures were caused by benign disease in 18 patients, and by primary bronchogenic lung cancer in 14. Of the 19 patients who were mechanically ventilated, bronchoscopic intervention allowed immediate discontinuation of mechanical ventilation in 10 (52.6%). Twenty-five patients had indwelling artificial airways (12 endotracheal tubes, 13 tracheotomy tubes). Two, however, were considered tracheotomy-dependent because of neuromuscular disease. Of the remaining 23 patients, immediate extubation or decannulation was possible in seven (30.4%). Of seven patients with no indwelling airway, five (71.4%) were immediately transferred to a lower level of care after intervention. Of the 32 total patients, 20 (62.5%) were immediately transferred to a lower level of care immediately after intervention." }, { "role": "assistant", "content": "Emergency laser resection or stent insertion can favorably affect health-care utilization in patients with acute respiratory distress from central airways obstruction. Treatment may be lifesaving and allows successful withdrawal from mechanical ventilation, hospitalization in a lower level of care environment, relief of symptoms, and extended survival in critically ill patients. In patients with regionally advanced cancer, the palliative nature of this procedure postpones death by respiratory distress and may prompt consideration for institution of conservative comfort measures to reduce patient suffering. 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 4-year-old girl is brought to the physician for a well-child examination. She has been healthy apart from an episode of bronchiolitis as an infant. Her 6-year-old sister recently underwent surgery for ventricular septal defect closure. She is at the 60th percentile for height and weight. Her mother is concerned about the possibility of the patient having a cardiovascular anomaly. Which of the following is most likely to indicate a benign heart murmur in this child?" }, { "role": "assistant", "content": "A grade 2/6 continuous murmur heard at the right supraclavicular region" } ]

[ { "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 regarding SA-14-14-2 Japanese Encephalitis vaccine -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., Cell culture derived live attenuated" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Amiodarone, Dose-Response Relationship, Drug, Endothelium, Vascular, Hand, Humans, Male, Reference Values, Vasodilation, Vasodilator Agents, Veins." }, { "role": "user", "content": "Does amiodarone cause endothelium-dependent vasodilation in human hand veins in vivo? Context: Amiodarone, a class III antiarrhythmic agent, is a potent coronary vasodilator. However, direct evidence for its vasodilatory effects in human vasculature in vivo is not available. The aim of the study was to investigate the short-term effects of amiodarone in preconstricted human hand veins and to explore the underlying mechanisms. Thirty-one healthy male volunteers were studied with the use of the dorsal hand vein compliance technique. The hand veins of the subjects were preconstricted with the alpha 1-adrenergic receptor agonist phenylephrine, and amiodarone, inhibitors of nitric oxide formation (NG-monomethyl-L-arginine, L-NMMA), and adenosine triphosphate-dependent potassium channels (glyburide [INN, glibenclamide]) were infused in the presence or absence of a cyclooxygenase inhibitor (acetylsalicylic acid), and the venodilator effect was measured. Furthermore, amiodarone was infused in prostaglandin F2 alpha (dinoprost)-preconstricted hand veins. Amiodarone produced dose-dependent venodilation (51% +/- 3% maximum). Maximum amiodarone-induced venodilation was lower in dinoprost compared with phenylephrine-preconstricted veins. Pretreatment with acetylsalicylic acid reduced the amiodarone-induced venodilation by 40% +/- 6%. L-NMMA reduced the amiodarone-induced venodilation after pretreatment with acetylsalicylic acid by 72% +/- 3%. Glyburide decreased the venodilatory response of amiodarone by 31% +/- 11%, whereas only a slight but not statistically significant additional reduction in venodilation was detected after pretreatment with acetylsalicylic acid. Infusion of the solvents of commercially available amiodarone (polysorbate 80 and benzyl alcohol) did not cause vasodilation in phenylephrine-preconstricted veins." }, { "role": "assistant", "content": "Amiodarone dilates preconstricted human hand veins in vivo and acts as a venodilator through the cyclooxygenase pathway, activation of nitric oxide synthase, and blockade of alpha adrenergic mechanisms. 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 45-year-old male alcoholic with a history of poal hypeension presents with vomiting of blood (hematemesis) and hypotension. He denies any history of vomiting nonblood material or retching prior to vomiting blood. During workup he dies suddenly. Based on his history and physical findings, histologic sections from his esophagus would most likely reveal" }, { "role": "assistant", "content": "The correct answer is Most lesions of the esophagus present with similar symptoms, such as heaburn and dysphagia, but the most serious disease, which carries the risk of exsanguination, is bleeding esophageal varices. Varices occur in about two-thirds of all patients with cirrhosis, and in the majority of patients the etiology is alcoholic cirrhosis. The cirrhosis causes poal hypeension, which shunts blood into connecting channels between the poal and caval systems, such as the subepithelial plexus of veins in the lower esophagus. Varices produce no symptoms until they rupture and cause massive bleeding (hematemesis), which may lead to death. Other diseases, such as gastritis, esophageal laceration (Mallory-Weiss tears), or peptic ulcer disease, may cause hematemesis In contrast, columnar epithelium in the distal esophagus is seen with Barrett's esophagus; decreased ganglion cells in the myenteric plexus are seen with achalasia, a disorder that is characterized by aperistalsis, incomplete relaxation of the lower esophageal sphincter (LES) with swallowing, and increased resting tone of the LES, all of which lead to esophageal dilation and symptoms of progressive dysphagia. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition" } ]

[ { "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 common nerve in the neck from which schwannoma arises -" }, { "role": "assistant", "content": "The correct answer is Schwannomas or neurilemmomas arise from cranial and spinal nerve roots. An acoustic schwannoma or acoustic neuroma is an intracranial schwannoma located within the internal auditory canal originating from the vestibular poion of the acoustic nerve. Intraspinal schwannomas are found as intradural tumors in the thoracic region. In the peripheral nerves, they occur as a solitary nodule on any sheathed sensory, motor, or autonomic nerve. Multiple schwannomas are uncommon and occur in von Recklinghausen's disease. Textbook of pathology Harsha Mohan 6th edition page no 893" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: METHODS, RESULTS. Meshes: Cerebral Palsy, Cognition Disorders, Cohort Studies, Female, Follow-Up Studies, Humans, Infant, Newborn, Infant, Premature, Male, Positive-Pressure Respiration, Postpartum Period, Pregnancy, Pregnancy Outcome, Prospective Studies, Respiration, Artificial, Respiratory Insufficiency, Risk Factors." }, { "role": "user", "content": "Perinatal risk factors of adverse outcome in very preterm children: a role of initial treatment of respiratory insufficiency? Context: In Denmark, preterm children are treated with nasal CPAP as a first approach to respiratory support. A national prospective study of all infants with a birthweight below 1000 g or a gestational age below 28 wk born in 1994-1995 was initiated to evaluate this approach. Of the 269 surviving children 164 (61%) were not treated with mechanical ventilation in the neonatal period. A follow-up of the children at 5 y of age was conducted. Data from the neonatal period and the 5-y follow-up were analysed. In multivariate analyses including 250 children, a severely abnormal neonatal brain ultrasound scan was predictive of cerebral palsy (OR = 19.9, CI 95%: 6.1-64.8) and intellectual disability (OR = 6.2, CI 95%: 2.3-16.5). A high Clinical Risk Index for Babies (CRIB) score (OR = 2.4, CI 95%: 1.1-5.5) and chronic lung disease (OR = 2.8, CI 95%: 1.2-6.9) were predictive of intellectual disability. In univariate analyses mechanical ventilation was associated with cerebral palsy (OR=4.3, CI 95%: 1.7-10.8) and intellectual disability (OR = 2.2, CI 95%: 1.2-4.2), but the associations became insignificant in multivariate analyses including chronic lung disease and a severely abnormal ultrasound scan." }, { "role": "assistant", "content": "The associations between neonatal risk factors and adverse outcome in our cohort were very similar to those found in other cohorts with another initial treatment of respiratory insufficiency. We found no significant adverse effects of mechanical ventilation beyond what could be explained by associations with chronic lung disease and IVH 3-4/PVL." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Animals, Body Composition, Dietary Proteins, Digestive System Surgical Procedures, Intestine, Small, Mice, Mice, Inbred C57BL, Postoperative Period, Random Allocation, Short Bowel Syndrome, Weight Gain." }, { "role": "user", "content": "Does high-protein diet improve postoperative weight gain after massive small-bowel resection? Context: Short bowel syndrome (SBS) is a morbid clinical condition that results from massive small-bowel resection (SBR). After SBR, there is a dramatic weight loss in the acute postoperative period. Our aim was to determine the impact of a high-protein diet (HPD) on weight gain and body composition in mice after SBR. C57BL/6 mice underwent 50 % proximal SBR. Postoperatively, mice were randomly selected to receive standard rodent liquid diet (LD) (n = 6) or an isocaloric HPD (n = 9) for 28 days. Mice weights were recorded daily. Body composition analyses were obtained weekly. Student's t test was used for statistical comparisons with p < 0.05 considered significant. Mice that were fed HPD after SBR returned to baseline weight on average at postoperative day (POD) 8 versus mice that were fed LD that returned to baseline weight on average at POD 22. Total fat mass and lean mass were significantly greater by POD 14 within the HPD group. Both groups of mice demonstrated normal structural adaptation." }, { "role": "assistant", "content": "HPD results in greater weight gain and improved body composition in mice after SBR. This finding may be clinically important for patients with SBS since improved weight gain may reduce the time needed for parenteral nutrition. 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, METHODS. Meshes: Aged, Autoantigens, Biomarkers, Tumor, Colorectal Neoplasms, Female, Humans, Immunohistochemistry, Male, Membrane Proteins, Middle Aged, Prognosis, Proto-Oncogene Proteins c-myc, Survival Analysis." }, { "role": "user", "content": "Is cIP2A overexpression associated with c-Myc expression in colorectal cancer? Context: To improve the prognostic evaluation of colorectal cancer requires new molecular markers. Cancerous inhibitor of protein phosphatase 2A (CIP2A) serves as an oncoprotein by targeting PP 2A-mediated inhibition of c-Myc. A prognostic role for CIP2A has been demonstrated in gastric, lung and tongue cancers. CIP2A was overexpressed in 661 (87.9%) specimens. CIP2A overexpression was associated with tumor differentiation grade (p = 0.014), p53 immunopositivity (p = 0.042), EGFR immunopositivity (p = 0.007) and c-Myc nuclear immunopositivity (p = 0.018). In survival analysis, CIP2A failed to show any prognostic significance (p = 0.270, log-rank test). 863 consecutive colorectal cancer patients treated at Helsinki University Central Hospital in 1983–2001 were collected with 752 scored successfully for CIP2A immunohistochemical expression from tumor tissue microarrays. Associations with clinicopathologic variables and molecular markers were explored by the chi-square test, and the Kaplan-Meier method served for survival analysis." }, { "role": "assistant", "content": "Overexpression of CIP2A in colorectal cancer patients may be an important step in colorectal carcinogenesis. Based on our findings, CIP2A shows no association with patient prognosis in colorectal cancer, but is associated with nuclear c-Myc. 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: Cadmium, Cross-Sectional Studies, Female, Humans, Lung, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive, Respiratory Function Tests, Sex Characteristics." }, { "role": "user", "content": "Are blood cadmium levels associated with a decline in lung function in males? Context: Cadmium exposure was found to cause a decline in lung function among the general population, but these findings were limited to smokers and gender differences were not explored. To examine the relationship between cadmium and chronic obstructive pulmonary disease (COPD) according to gender and smoking status in Korea. Cross-sectional data from the Korean National Health and Nutrition Examination Survey from 2008 to 2011 were analyzed. COPD was defined by a pre-bronchodilator forced expiratory volume in 1s divided by forced vital capacity of <0.70. A logistic regression model was used to elucidate the association between blood cadmium levels and COPD according to gender and smoking status. Among 3861 eligible participants, 3622 were included in the analysis. The prevalence of COPD demonstrated an increasing trend in males (P for trend<0.001), but not in females (P for trend=0.67). After adjusting for covariates, a higher blood cadmium level, but within the normal range, was associated with COPD in males, including those who had never-smoked (P for trend <0.001 and P for trend=0.008). However, a higher blood cadmium level was not significantly associated with COPD in females, including those who had never smoked (P for trend=0.39 and P for trend=0.43)." }, { "role": "assistant", "content": "A higher blood cadmium level, within the normal range, was associated with COPD in males, including those who had never smoked. However, there was no significant association between blood cadmium levels and COPD in females. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adenocarcinoma, Analysis of Variance, Animals, Cell Line, Tumor, Female, Humans, Kaplan-Meier Estimate, Mice, Mice, SCID, Oncolytic Virotherapy, Oncolytic Viruses, Pancreatic Neoplasms, Rats, Receptors, CXCR4, Serotyping, Tumor Burden, Xenograft Model Antitumor Assays." }, { "role": "user", "content": "Does virotherapy using a novel chimeric oncolytic adenovirus prolong survival in a human pancreatic cancer xenograft model? Context: Pancreatic adenocarcinoma is an aggressive malignancy. Oncolytic adenoviruses (Ads) are modified genetically to target tumor cells while sparing normal cells. We modified the knob domain of the Ad serotype 5 with a serotype 3 knob domain and incorporated the CXCR4 promoter to regulate Ad E1A gene expression (Ad5/3-CXCR4-E1A). These modifications were made to efficiently infect and lyse pancreatic tumors. Human pancreatic cancer lines CFPAC-1, PANC-1, AsPC-1, and BxPC-3 were obtained from the American Type Culture Collection. Efficiency of Ad infection in the cells was determined by the use of an Ad construct expressing the green fluorescence protein (GFP) marker in place of the E1A gene (Ad5/3-CXCR4-GFP) and quantified by flow cytometry. Oncolytic activity in the pancreatic cancer cells was determined with the Ad5/3-CXCR4-E1A oncolytic Ad by a crystal violet staining method. To determine the oncolytic effect in vivo, pancreatic cancer cells were implanted on the flanks of 40 SCID mice (4 groups). Tumors were injected intratumorally for 3 days with Ad5/3-CXCR4-E1A, Ad5 wild-type (a positive control), or phosphate-buffered saline (a no virus control). Tumor size, overall survival, and body condition scale score were recorded. Statistical analyses included the Kaplan-Meier survival curve, the log-rank test, and one-way analysis of variance. The serotype 3 fiber-modified Ad with the CXCR4 promoter (Ad5/3-CXCR4-E1A) was most efficient in infecting and lysing pancreatic cancer cells compared with an Ad containing an unmodified fiber knob (Ad5-CXCR4-E1A). Treatment of pancreatic tumor xenografts in vivo with Ad5/3-CXCR4-E1A group resulted in smaller tumors (P = .001), greater body condition scale score (P = .01), and greater survival time (P = .04) than the other treatment groups." }, { "role": "assistant", "content": "Ad5/3-CXCR4-E1A treatment significantly prolonged survival in SCID mice pancreatic tumor xenografts. This novel construct represents a potential new therapy against pancreatic cancer. 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, Arachidonic Acid, Bone and Bones, Ceramides, Cystic Fibrosis, Fatty Acids, Fenretinide, Mice, Mice, Knockout, Osteoporosis." }, { "role": "user", "content": "Does fenretinide prevent the development of osteoporosis in Cftr-KO mice? Context: The most recently described phenotype associated with Cystic Fibrosis (CF) is reduced bone mineral density which results in osteopenia and osteoporosis. The etiology of the early onset of osteoporosis in CF patients has remained to be established. It has been suggested that inadequate nutritional absorption of essential fatty acids may play a role in the altered bone metabolism. In this study, we characterized the protective effect of fenretinide [N-(4-hydroxyphenyl) retinamide], a vitamin A derivative, on the early onset of osteoporosis in cystic fibrosis transmembrane conductance regulator knockout (Cftr-KO) mice. Using micro-computed-tomography we examined the effect of fenretinide on the bone composition and architecture in a Cftr-KO mouse model which was then confirmed with histological analyses. Plasma fatty acids were quantified using thin layer chromatography-ELISA method. Twice-weekly treatments with fenretinide, over four weeks dramatically increased trabecular bone volume compared to controls. This increase in bone volume was also related to an increased concentration of ceramide in the plasma resulting in the down regulation of phospholipid-bound AA in Cftr-KO mice." }, { "role": "assistant", "content": "To our knowledge, this is the first time that fenretinide's protective effect against osteoporosis has been demonstrated. The results of this study strongly suggest that fenretinide has potential to be used as a prophylaxis by preventing the early onset of osteoporosis. 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 PURPOSE, MATERIAL AND METHODS, RESULTS. Meshes: Aged, Antibiotics, Antineoplastic, Antineoplastic Agents, Antineoplastic Agents, Alkylating, Antineoplastic Combined Chemotherapy Protocols, Chemotherapy, Adjuvant, Chi-Square Distribution, Cisplatin, Dose Fractionation, Doxorubicin, Female, Follow-Up Studies, Humans, Life Tables, Longitudinal Studies, Melphalan, Middle Aged, Neoadjuvant Therapy, Neoplasm Invasiveness, Neoplasm Staging, Ovarian Neoplasms, Proportional Hazards Models, Prospective Studies, Radiotherapy Dosage, Radiotherapy, Adjuvant, Randomized Controlled Trials as Topic, Survival Rate." }, { "role": "user", "content": "Is there place for radiotherapy in the treatment of advanced ovarian cancer? Context: Irradiation of advanced ovarian cancer has been performed during the years 1976-1984 with six-field technique. Results of this treatment in a long follow-up have never before been evaluated. Seventy-five patients with stage IIb-IV of invasive ovarian cancer have been treated with a combination of surgery, radiotherapy and chemotherapy. The results of the treatment were compared with 98 patients treated during the year 1991-1992 with surgery and chemotherapy only. After controlling for the differences in background factors between the groups considered, there was still a significantly better survival rate for the patients treated with radiotherapy." }, { "role": "assistant", "content": "The results suggest that the role of radiotherapy in advanced ovarian cancer should be investigated in a prospective randomized trial." } ]

[ { "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": "Chronotropic effect means:-" }, { "role": "assistant", "content": "The correct answer is Effect Meaning Example Positive chronotropic Increase in hea rate Adrenaline Negative chronotropic Decrease in hea rate Acetylcholine Positive inotropic Increase in contractility Dobutamine Negative inotropic Decrease in contractility Verapamil Positive dromotropic Increase in AV conduction Dobutamine Negative dromotropic Decrease in AV conduction Vagal stimulation" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Amino Acid Sequence, Base Sequence, Cataract, Crystallins, Female, Genetic Linkage, Humans, Male, Molecular Sequence Data, Mutation, Pedigree, Polymerase Chain Reaction, RNA Splicing, Sequence Analysis, beta-Crystallin A Chain." }, { "role": "user", "content": "Is autosomal dominant zonular cataract with sutural opacities associated with a splice mutation in the betaA3/A1-crystallin gene? Context: Congenital cataracts constitute a morphologically and genetically heterogeneous group of diseases that are a major cause of childhood blindness. Autosomal Dominant Zonular Cataracts with Sutural Opacities (CCZS) have been mapped to chromosome 17q11-q12 near the betaA3A1-crystallin gene (CRYBA1). The betaA3A1-crystallin gene was investigated as the causative gene for the cataracts. The betaA3/A1-crystallin gene was sequenced in affected and control individuals. Base changes were confirmed and assayed in additional family members and controls using NlaIII restriction digestion of PCR amplified DNA sequences. Base changes were assessed for their effects on splicing by information analysis. The cataracts are associated with a sequence change in the 5' (donor) splice site of intron 3: GC(g->a)tgagt. The sequence change also creates a new NlaIII site. This base change cosegregates with the cataracts in this family, being present in every affected individual. Conversely, this base change was not seen in 140 chromosomes examined in 70 unaffected and unrelated individuals. Information theory mutational analysis shows that the base change lowers the information content of the splice site from 6.0 to -6.8 bits, so that splicing would not be expected to occur at the altered site." }, { "role": "assistant", "content": "Taken together, these observations suggest that the observed mutation might be causally related to the cataracts in this family. 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 40-year-old man presents with a 2-week history of recur- rent oral ulcers, genital ulcers, intermittent arthritic pain of the knees, and abdominal pain. Physical examination reveals shallow ulcerations of the mucosa of the glans penis, as well as oral aphthous ulcers and conjunctivitis. Which of the following is the most likely diagnosis?" }, { "role": "assistant", "content": "The correct answer is Behget disease is a systemic vasculitis characterized by oral aphthous ulcers, genital ulceration, and ocular inflammation, with occasional involvement of the nervous, gastrointestinal, and cardiovascular systems. The mucocutaneous lesions show a non-specific vasculitis of arterioles, capillaries, and venules. The cause of the necrotizing inflammation of small blood vessels is not known, but an association with specific HLA subtypes suggests an immune basis. Herpes (choice B) does not present with arthritis.Diagnosis: Behqet disease" } ]

[ { "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 21-year-old woman presents to the emergency department with complaints of intermittent bouts of lower abdominal and pelvic pain over the last week. The pain is primarily localized to the right side and is non-radiating. The patient is not sexually active at this time and is not currently under any medication. At the hospital, her vitals are normal. A pelvic examination reveals a tender palpable mass on the right adnexal structure. A pelvic CT scan reveals a 7-cm solid adnexal mass that was surgically removed with the ovary. Histological evaluation indicates sheets of uniform cells resembling a 'fried egg', consistent with dysgerminoma. Which of the following tumor markers is most likely elevated with this type of tumor?" }, { "role": "assistant", "content": "Lactate dehydrogenase (LDH)" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHOD, RESULTS AND DISCUSSION. Meshes: Art Therapy, Humans, Mental Disorders, Nursing Methodology Research, Program Evaluation, Psychiatric Nursing, Social Support." }, { "role": "user", "content": "Does prescribing participation in arts help to promote recovery for mental health clients? Context: Although recovery has become the focus of mental health policy in the UK, few models of practice show how mentalhealth nurses may promote recovery through participatory arts.AIM: To explore the experiences of people who engaged with an arts on prescription programme. This study used narrative inquiry and participants were interviewed three times over one year. Participants clearly benefited, especiallyin terms of having a \"safe place\" to come to, and from making new friends and experiencing peer support. It also enabled some to access education an d voluntarywork." }, { "role": "assistant", "content": "Engaging with community based arts activities may provide opportunities for clients to make friends, become more socially engaged and have a greater sense of belonging." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "An inconsolable mother brings her 2-year-old son to the emergency room after finding a large amount of bright red blood in his diaper, an hour ago. She states that for the past week her son has been having crying fits while curling his legs towards his chest in a fetal position. His crying resolves either after vomiting or passing fecal material. Currently, the child is in no apparent distress. Physical examination with palpation in the gastric region demonstrates no acute findings. X-ray of the abdominal area demonstrates no acute findings. His current temperature is 36.5°C (97.8°F), heart rate is 93/min, blood pressure is 100/64 mm Hg, and respiratory rate is 26/min. His weight is 10.8 kg (24.0 lb), and height is 88.9 cm (35.0 in). Laboratory tests show the following:\nRBC count 5 million/mm3\nHematocrit 36%\nHemoglobin 12 g/dL\nWBC count 6,000/mm3\nMean corpuscular volume 78 fL\nWhat is the most likely cause of this condition?" }, { "role": "assistant", "content": "Failure of the vitelline duct to close" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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": "Do cigarette smoke condensate and individual constituents modulate DNA methyltransferase expression in human liver cells? Context: Previous studies found higher expression levels of DNA methyltransferase 1 in liver samples from smokers compared to those from non-smokers. In contrast, expression levels of DNA methyltransferase 3a and DNA methyltransferase 3b were similar in smokers and non-smokers. This study extends these studies to establish a causal linkage to cigarette smoke exposure by examining whether DNA methyltransferase expression is modulated by cigarette smoke condensate. These experiments were conducted in an in vitro system using HepG2 human liver cells. The dose range of cigarette smoke condensate was 0.1-120 µg/mL. The duration of exposure was up to 72 h. In a 24-h exposure, DNA methyltransferase 1 expression was found to increase significantly in a dose-dependent manner (greater than threefold at 100 µg/mL cigarette smoke condensate). Expression levels of DNA methyltransferase 3a and DNA methyltransferase 3b were, however, not affected under these conditions. The effect of two cigarette constituents, nicotine and cotinine, on DNA methyltransferase 1 expression was also examined. Nicotine exposure significantly increased DNA methyltransferase 1 expression in a dose-dependent manner (greater than twofold at 50 µM). However, under these conditions, cotinine did not increase DNA methyltransferase 1 expression." }, { "role": "assistant", "content": "These results clearly provide additional support of the modulating effect of cigarette smoke on DNA methyltransferase 1 expression. Given the potential of alterations in DNA methyltransferase expression to affect cellular function, this pathway may play a critical role in cigarette smoke-induced toxicity. 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 AND METHODS, RESULTS. Meshes: Adult, Antiretroviral Therapy, Highly Active, Apolipoprotein A-I, Apolipoprotein C-III, Apolipoproteins B, Apolipoproteins C, Biomarkers, Cholesterol, HDL, Female, HIV Infections, HIV Protease Inhibitors, Humans, Lipoproteins, LDL, Lipoproteins, VLDL, Lopinavir, Male, Phospholipids, Pyrimidinones, Ritonavir, Statistics as Topic, Time Factors, Treatment Outcome, Triglycerides, Viral Load." }, { "role": "user", "content": "Decrease in LDL size in HIV-positive adults before and after lopinavir/ritonavir-containing regimen: an index of atherogenicity? Context: Hypertriglyceridemia (HTG) is frequently observed during highly active antiretroviral therapy (HAART) including protease inhibitor. Apolipoprotein (apo) CIII could be involved in this HTG by inhibition of triglyceride (TG) hydrolysis, which leads to the occurrence of small dense low density lipoprotein (sdLDL), a recognized cardiovascular risk factor. To characterize the influence of lopinavir/ritonavir-containing regimen on lipoprotein profile. 24 antiretroviral-experienced HIV infected adults (including 14 patients in therapeutic interruption of at least 2 months) and 14 HIV uninfected healthy controls were enrolled. Serum lipid parameters (total cholesterol (TC), HDL-C, LDL-C, TG, apoA1, apoB, apoCIII), lipoprotein composition and LDL size were determined before initiation of lopinavir/ritonavir-containing regimen, and at 1 and 3 months thereafter. At baseline an atherogenic lipid profile was evidenced, characterized by a moderate HTG associated to a smaller mean LDL size (25.16 vs 25.93 nm, P<0.001), an enrichment in TG of LDL (11.4 vs 6.0%, P<0.01) and a high prevalence of sdLDL (75 vs 7%, P<0.01) when compared to controls. After 1 month of lopinavir/ritonavir-containing regimen, a significant reduction of LDL size (24.81 vs 25.16 nm, P<0.05) and a significant increase in cholesterol total (5.53 vs 4.49 mmol/l, P<0.001), in TG (4.20 vs 2.01 mmol/l, P<0.001), in apoA1 (1.28 vs 1.11 g/l, P<0.001), in apoB (1.08 vs 0.94 g/l, P<0.01), in apoCIII (0.16 vs 0.10 g/l, P<0.001), in TG percentage in LDL (14.4 vs 11.4, P<0.05) and in TG percentage in HDL (10.2 vs 8.3, P<0.05) were observed." }, { "role": "assistant", "content": "Advanced stage of HIV infection is associated with an atherogenic lipid profile including a high prevalence of sdLDL. Lopinavir/ritonavir-containing regimen accentuates the reduction of LDL size. Since fibrates decrease TG and increase LDL size, they appear as a logical option to manage HAART-induced HTG." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, METHOD, RESULTS. Meshes: Adolescent, Adult, Aged, Antibiotic Prophylaxis, Antisepsis, Appendicitis, Cerebrospinal Fluid Shunts, Child, Child, Preschool, Enterococcus faecalis, Female, Gram-Positive Bacterial Infections, Humans, Infant, Infant, Newborn, Male, Middle Aged, Neurosurgical Procedures, Peritonitis, Retrospective Studies, Surgical Wound Infection." }, { "role": "user", "content": "Zero tolerance to shunt infections: can it be achieved? Context: To evaluate the rigid application of a technique of shunt placement aimed at the eradication of postoperative shunt infection in neurosurgical practice. All shunt procedures were performed or closely supervised by the senior author (MSC). The essentials were the use of intravenous peri- and postoperative antimicrobials, rigid adherence to classical aseptic technique, liberal use of topical antiseptic (Betadine), and avoidance of haematomas. Of 176 operations, 93 were primary procedures; 33 patients underwent revisions, some multiple. Only one infection occurred, seven months postoperatively, secondary to appendicitis with peritonitis. The infecting Streptococcus faecalis appeared to ascend from the abdominal cavity." }, { "role": "assistant", "content": "A rigidly applied protocol and strict adherence to sterile technique can reduce shunt infections to a very low level." } ]

[ { "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": "CSF with raised protein and low glucose is seen in all except:" }, { "role": "assistant", "content": "The correct answer is CSF with raised protein and low glucose is seen in:\n\nTuberculous meningitis (also lymphocytic)\nBacterial meningitis\nMalignant meningitis\n\nIn viral meningitis the glucose and protein content is normal" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Base Sequence, Cell Hypoxia, Cell Line, Chromatography, Affinity, DNA, Dexamethasone, Gene Expression Regulation, Glucocorticoids, Humans, Macrophage Migration-Inhibitory Factors, Molecular Sequence Data, Oligonucleotides, Protein Binding, Respiratory Mucosa, Signal Transduction, T-Lymphocytes, Transcriptional Activation." }, { "role": "user", "content": "Do hypoxia and glucocorticoid signaling converge to regulate macrophage migration inhibitory factor gene expression? Context: Macrophage migration inhibitory factor (MIF) is a proinflammatory mediator involved in the pathogenesis of rheumatoid arthritis. This study was undertaken to identify the MIF promoter elements responsible for regulating gene expression. Luciferase reporter gene assays were used to identify the MIF promoter sequence responsible for basal activity. Bioinformatic analysis was used to predict transcription factor binding sites, and electrophoretic mobility shift assay (EMSA) was used to demonstrate transcription factor binding. Chromatin immunoprecipitation (ChIP) was used to demonstrate transcription factor loading on the MIF promoter. We identified the minimal promoter sequence required for basal MIF promoter activity that was also capable of conferring glucocorticoid-dependent inhibition in a T lymphocyte model cell line. Deletion studies and EMSA revealed 2 elements in the MIF promoter that were responsible for basal promoter activity. The 5' element binds CREB/activating transcription factor 1, and the 3' element is a functional hypoxia-responsive element binding hypoxia-inducible factor 1alpha. Further studies demonstrated that the cis elements are both required for glucocorticoid-dependent inhibition. ChIP demonstrated glucocorticoid-dependent recruitment of glucocorticoid receptor alpha to the MIF promoter in lymphocytes within 1 hour of treatment and a concomitant decrease in acetylated histone H3." }, { "role": "assistant", "content": "Our findings indicate that hypoxia and glucocorticoid signaling converge on a single element regulating MIF; this regulatory unit is a potential interacting node for microenvironment sensing of oxygen tension and glucocorticoid action in foci of inflammation. 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, Antifibrinolytic Agents, Aspirin, Clopidogrel, Coronary Artery Bypass, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Platelet Aggregation, Platelet Aggregation Inhibitors, Platelet Function Tests, Prospective Studies, Ticlopidine, Tranexamic Acid." }, { "role": "user", "content": "Does tranexamic acid partially improve platelet function in patients treated with dual antiplatelet therapy? Context: Although the impact of tranexamic acid on platelet function remains controversial, tranexamic acid is part of clinical algorithms for the management of platelet dysfunction. The goal of our prospective, observational study was to examine the effects of tranexamic acid on platelet function in patients treated with dual antiplatelet therapy compared to those who ceased antiplatelet therapy for at least 7 days. Forty patients scheduled for cardiac surgery were enrolled in this study. Group 1 consisted of 20 patients who ceased antiplatelet therapy with aspirin and clopidogrel at least 7 days before surgery. Group 2 consisted of 20 patients who were treated with aspirin and clopidogrel until the day before surgery. Using the Multiplate device (Dynabyte, Munich, Germany), multiple electrode aggregometry (MEA) was performed following platelet stimulation with thrombin receptor activating peptide-6 (TRAP-6), arachidonic acid or ADP on blood collected 20 min before and after application of 2 g tranexamic acid. Compared with group 1, platelet aggregation was statistically significantly reduced in ASPItest and ADPtest in group 2, whereas there were no significant differences in the TRAPtest. In group 1, platelet aggregation did not differ significantly before and after tranexamic acid treatment. In contrast, in group 2, we observed a significant increase in arachidonic acid-induced [295 (280/470) arbitrary aggregation units × min [AU*min; median (25th/75th percentile) vs. 214 (83/409) AU*min, P = 0.01] and ADP-induced platelet aggregation [560 AU*min (400/760 AU*min) vs. 470 AU*min (282/550 AU*min), P = 0.013], whereas platelet aggregation following stimulation with TRAP-6 did not change significantly [980 (877/1009) AU*min, median (25th/75th percentile) after tranexamic acid vs. 867 (835/961) AU*min before tranexamic acid, P = 0.464]." }, { "role": "assistant", "content": "The results of this study indicate that tranexamic acid potentially corrects defects in arachidonic acid-induced and ADP-induced platelet aggregation imposed by dual antiplatelet therapy. However, platelet aggregation in response to arachidonic acid or ADP in the blood of patients who have not received aspirin and clopidogrel is unaffected by tranexamic acid. These results support the use of tranexamic acid to partially reverse platelet aggregation dysfunction due to antiplatelet therapy. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Adolescent, Adult, Biomarkers, Cell Degranulation, Female, Humans, Hypersensitivity, Immediate, Male, Mast Cells, Middle Aged, Nasal Mucosa, Prostaglandin D2." }, { "role": "user", "content": "Is prostaglandin D2 measurement in nasal secretions a reliable marker for mast cell activation in atopic patients? Context: Prostaglandin D2 (PGD2) is a very important mast cell product during the early-phase nasal allergic reaction. However, the quantification of PGD2 in nasal secretions has not yet been well established. Quantitative determination of PGD2 in nasal secretions of atopic patients (n = 17) after nasal allergen challenge (NAC) and in non-allergic healthy volunteers (n = 10). The nasal microsuction sampling technique was used to obtain the nasal secretions with an exactly known and minimally diluted volume. A sensitive and specific enzyme immunoassay was chosen to measure the more stable 11-methoxime derivative of PGD2, which was obtained after extraction in acetone/ethanol and conversion using methoxamine-HCl. The concentrations of PGD2 in nasal secretions obtained from 10 non-allergic healthy volunteers were used as reference values. There was no significant difference in the concentrations of PGD2 between men (median: 569 pg/mL) and women (median: 407 pg/mL), nor between the baseline concentrations from atopic patients (median: 410 pg/mL) and non-allergic controls (median: 477 pg/mL). In the atopic patient group, PGD2 did not significantly increase during the entire sampling period after NAC. The absence of PGD2 response contrasted with the nasal symptoms manifested by sneezing, increased nasal airway resistance, and the significant increases of the concentrations of histamine, tryptase, and leukotriene C4 (LTC4) 5 min after NAC." }, { "role": "assistant", "content": "This observation suggests that the measurement of PGD2 alone in the nasal secretions does not give reliable information on mast cell activation during a nasal allergic reaction. 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": "Drug of choice for substitution therapy in morphine dependence -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., Methadone Treatment of morphine or heroin poisoningo Treatment can be divided intoTreatment of toxicity (overdose)o Overdose is a medical emergency, and is treated with opioid antagonist to reverse the complications (respiratory depression) by antagonizing the action on opioid receptors. Intravenous naloxone is the antagonist of choince for morphine (heroin) poisoning. Oral naltrexone is used for maintenance therapy, once acute poisoning has been treated by iv naloxone. Intravenous nalmefene is another specific antagonist.Treatment of dependenceo Treatment of dependence include medically supervised withdrawal and detoxification, followed by maintenance therapy :(a) Detoxificationo Detoxification process include abrupt withdrawal of opioid followed by management of the emergent withdrawal symptoms, i.e., treatment of withdrawal syndrome. Detoxification can be done by any of the following :1 .Substitution of long-acting opioid agonism :- Methadone is the treatment of choice. Because of its agonistic activity on opioid receptors it suppresses withdrawal symptoms. L-alpha-acetyl- methadol/Levomethyl (LAAM) is the other opioid agonist which was used for this purpose. However it is no longer in use because some patients developed prolonged QT intervals (torsades de points).2. Substitution of partial agonist :- Buprenorphine can be used in place of methadone because of its partial agonistic activity on opioid receptor.3.Substitution by a2 agonists :- Clonidine acts as a sympatholytic agent due to its agonistic action on central presynaptic a, receptors which reduce nor-adrenergic activity. Therefore, clonidine reduces the adrenergic withdrawal symptoms. Lofexidine another a2 agonist, is an alternative to clonidine.4. . Clonidine plus naltrexone :- A more rapid detoxification can occur when clonidine is used along with naltrexone. Naltrexone, when given in opioid dependent patient, causes withdrawal symptoms because of its antagonistic action. These can be treated with clonidine. The addition of short acting Benzodiazepine (lorazepam or oxazepam) and NSAIDs, will help relieve withdrawlsymptoms not covered by clonidine. It should be kept in mind that naltrexone should not be used alone for detoxification (to treat withdrawl syptoms) as it precipitates or worsens the withdrawl syndrome.5.Other drugs :- Dextropropoxyphene, diphenoxylate(b) Maintenance therapyo Once detoxification phase is over (i.e., withdrawal symptoms have been managed), the patient is maintained on any of the following drugs to prevent relapse by reducing craving and preventing 'kick' or 'euphoria' produced by opioids (morphine or heroin). Drugs used are1. Methadone :- Reduces craving and 'kick/euphoria ' from morphine or heroin because their opioid receptors are already occupied.2. LAAM and buprenorphine :- Similarly reduce craving.3. Opioid antagonists (naltrexone) :- Naltrexone can be used orally to assist in the rehabilitation of ex-opioid abusers who are fully withdrawn (otherwise it induces an acute withdrawl syndrome). Naltrexone prevents relapse by discouraging substance seeking behavior -If a patient, who is on naltrexone maintenance therapy, takes an opioid, there is no 'kick' or 'euphoria' as opioid receptors are already blocked. Naltrexone can be used with clonidine as in detoxification." } ]

[ { "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": "ECG finding of Hyperkalemia:" }, { "role": "assistant", "content": "The correct answer is Ans.(d) Wide QRS complexRef: Harrison 19th ed. / 310ECG Findings of Hyperkalemia* The first ECG finding in hyperkalemia is tall tented T waves followed by slowing of depolarization of heart.* This results in prolonged PR interval with QRS widening.* Subsequently the P waves start becoming smaller.* Sine wave pattern leading to ventricular fibrillation/ diastolic arrest of heart." } ]

[ { "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": "Gas most suited for laproscopy is -" }, { "role": "assistant", "content": "The correct answer is Ans. is `d' i.e., Carbon dioxide" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Cardiopulmonary Resuscitation, Clinical Competence, Curriculum, Education, Medical, Undergraduate, Educational Measurement, Formative Feedback, Humans, Manikins, Northern Ireland, Students, Medical, Video Recording." }, { "role": "user", "content": "Does video feedback analysis improve CPR performance in phase 5 medical students? Context: The use of simulation in medical education is increasing, with students taught and assessed using simulated patients and manikins. Medical students at Queen's University of Belfast are taught advanced life support cardiopulmonary resuscitation as part of the undergraduate curriculum. Teaching and feedback in these skills have been developed in Queen's University with high-fidelity manikins. This study aimed to evaluate the effectiveness of video compared to verbal feedback in assessment of student cardiopulmonary resuscitation performance. Final year students participated in this study using a high-fidelity manikin, in the Clinical Skills Centre, Queen's University Belfast. Cohort A received verbal feedback only on their performance and cohort B received video feedback only. Video analysis using 'StudioCode' software was distributed to students. Each group returned for a second scenario and evaluation 4 weeks later. An assessment tool was created for performance assessment, which included individual skill and global score evaluation. One hundred thirty eight final year medical students completed the study. 62 % were female and the mean age was 23.9 years. Students having video feedback had significantly greater improvement in overall scores compared to those receiving verbal feedback (p = 0.006, 95 % CI: 2.8-15.8). Individual skills, including ventilation quality and global score were significantly better with video feedback (p = 0.002 and p < 0.001, respectively) when compared with cohort A. There was a positive change in overall score for cohort B from session one to session two (p < 0.001, 95 % CI: 6.3-15.8) indicating video feedback significantly benefited skill retention. In addition, using video feedback showed a significant improvement in the global score (p < 0.001, 95 % CI: 3.3-7.2) and drug administration timing (p = 0.004, 95 % CI: 0.7-3.8) of cohort B participants, from session one to session two." }, { "role": "assistant", "content": "There is increased use of simulation in medicine but a paucity of published data comparing feedback methods in cardiopulmonary resuscitation training. Our study shows the use of video feedback when teaching cardiopulmonary resuscitation is more effective than verbal feedback, and enhances skill retention. This is one of the first studies to demonstrate the benefit of video feedback in cardiopulmonary resuscitation teaching." } ]

[ { "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": "Best marker of SLE?" }, { "role": "assistant", "content": "The correct answer is Ans. (b) Anti-ds DNA antibodies(Ref: Harrison 18th/chapter 319)Anti dsDNA is specific for SLE, only in high titers;But still, anti ds DNA is the best marker for SLE because its prevalence in SLE is 70%;Whereas, Anti Sm antibody, which is specific for SLE, but is seen in only 25% patients with SLE" } ]

[ { "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 levels of microalbuminuria in a 60yr old asthmatic female is 280mg. which prophylactic drug is best in this scenario" }, { "role": "assistant", "content": "The correct answer is ARBs, ACE inhibitors stop the progression of diabetic nephropathy. ARBs have less adverse effects like cough and angioedema than ACE inhibitors, so preferable. Ref: Katzung 10th ed.Pg 281" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Acetyltransferases, Aminoglycosides, Anti-Bacterial Agents, Biotransformation, Humans, Microbial Sensitivity Tests, Mycobacterium Infections, Nontuberculous, Nontuberculous Mycobacteria." }, { "role": "user", "content": "Do aminoglycoside-modifying enzymes determine the innate susceptibility to aminoglycoside antibiotics in rapidly growing mycobacteria? Context: Infections caused by the rapidly growing mycobacterium (RGM) Mycobacterium abscessus are notoriously difficult to treat due to the innate resistance of M. abscessus to most clinically available antimicrobials. Aminoglycoside antibiotics (AGA) are a cornerstone of antimicrobial chemotherapy against M. abscessus infections, although little is known about intrinsic drug resistance mechanisms. We investigated the role of chromosomally encoded putative aminoglycoside-modifying enzymes (AME) in AGA susceptibility in M. abscessus. Clinical isolates of M. abscessus were tested for susceptibility to a series of AGA with different substituents at positions 2', 3' and 4' of ring 1 in MIC assays. Cell-free extracts of M. abscessus type strain ATCC 19977 and Mycobacterium smegmatis strains SZ380 [aac(2')-Id(+)], EP10 [aac(2')-Id(-)] and SZ461 [aac(2')-Id(+), rrs A1408G] were investigated for AGA acetylation activity using thin-layer chromatography (TLC). Cell-free ribosome translation assays were performed to directly study drug-target interaction. Cell-free translation assays demonstrated that ribosomes of M. abscessus and M. smegmatis show comparable susceptibility to all tested AGA. MIC assays for M. abscessus and M. smegmatis, however, consistently showed the lowest MIC values for 2'-hydroxy-AGA as compared with 2'-amino-AGA, indicating that an aminoglycoside-2'-acetyltransferase, Aac(2'), contributes to innate AGA susceptibility. TLC experiments confirmed enzymatic activity consistent with Aac(2'). Using M. smegmatis as a model for RGM, acetyltransferase activity was shown to be up-regulated in response to AGA-induced inhibition of protein synthesis." }, { "role": "assistant", "content": "Our findings point to AME as important determinants of AGA susceptibility in M. abscessus. 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: Diabetic Retinopathy, Endothelial Growth Factors, Female, Humans, Lymphokines, Male, Middle Aged, Platelet-Derived Growth Factor, Protein Isoforms, Vascular Endothelial Growth Factor A, Vascular Endothelial Growth Factors, Vitreous Body." }, { "role": "user", "content": "Are [ Cytokines in the vitreous fluid of patients with proliferative diabetic retinopathy -- vascular endothelial growth factor and platelet-derived growth factor elevated in proliferative diabetic retinopathy ]? Context: To determine the relation between vascular endothelial growth factor (VEGF) and platlet-derived growth factor (PDGF) in the vitreous fluids from patients with proliferative diabetic retinopathy (PDR). Concentrations of VEGF and PDGF in the vitreous fluids from 53 eyes, 31 eyes in 30 PDR patients and 22 eyes in 22 non diabetes mellitus(DM) patients serving as controls, were measured by enzyme-linked immunosolvent assay. The levels of VEGF and PDGF were compared between PDR and non DM patients. The relationship between these factors and clinical characteristics such as age, sex, protein concentration in the aqueous humor, HbA1c and duration of diabetes were investigated. Levels of both VEGF and PDGF in the PDR group were significantly higher than in non DM group (p < 0.01). A positive correlation was observed between the levels of VEGF and protein concentration in the aqueous humor (p < 0.01). However, levels of both VEGF and PDGF did not correlate with age, sex, or HbA1c." }, { "role": "assistant", "content": "Both VEGF and PDGF were shown to be correlated with the pathogenesis of PDR. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "Which of the positions best describes the location of celiac plexus -" }, { "role": "assistant", "content": "The correct answer is Celiac ganglia\n-        Located near to the origin of the celiac artery from the abdominal aorta.\n-        Mainly formed by two ganglia.\n-        Receives preganglionic sympathetic fibers from greater and lesser splanchnic nerves." } ]

[ { "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": "Arthritis involving DIP, PIP, 1st carpometacarpal with sparing of MCP and wrist joints is typical of -" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., Osteoarthritis JointImportant arthritis involving the jointDistal interphalangeal jointProximal interphalangeal jointMetacarpophalangeal joint1st Carpometacarpal jointWristOsteoarthritis, Psoriatic arthritis, Reactive arthritisOsteoarthritis, RA, SLE, Psoriatic arthritisRA. pseudogout, hemochromatosisOsteoarthritisRA, Pseudogout, gonococcal arthritis, juvenile arthritisSpared jointo Wrist and MTPo DIPOsteoarthritisRA" } ]

[ { "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": "High T3, high T4, low TSH and low radioiodine uptake is seen in" }, { "role": "assistant", "content": "The correct answer is Ans) c ( Subacute thyroiditis) Ref Bailey 25th ed pg 800Subacute thyroiditisAlso called Granulomatous or Dequervines thyroiditisCaused by viral infections. Presents with pain in the neck, fever, malaise, firm irregular enlargement of one or both thyroid lobes.ESR raised, absent thyroid auto antibodies, serum T4 high.Iodine 133 uptake low. It is self limiting.There may be a period of hypothyroidism before recovery.Specific treatment - Prednisolone 10- 20mg for 7 days.Grave's disease & toxic noduleHyperthyroidism with increased radioiodine uptakeHashimoto's thyroiditisMild hyperthyroidism initially but hypothyroidism inevitable. Decreased T3 & T4." } ]

[ { "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": "AH of the following are components of Epidemiological triad except -" }, { "role": "assistant", "content": "The correct answer is Epidemiological triad \nThe occurrence and manifestations of any disease, whether communicable or noncommunicable, are determined by the interaction of following three factors.\n\nThe agent \nThe host \nThe environment \n\nThese three factors together constitute the epidemiological triad. \nMere presence of these factors does not cause disease, interaction of these three is required for causation of a disease. \nThe triangle of epidemiology \nThe triangle of epidemiology shows the interaction and interdependence of agent, host, environment and time (It is different from epidemiological triad which does not contain time, but contain other three components). \nAdvanced model of the triangle of Epidemiology \nThis new model includes all facets of the communicable disease model. The term ‘agent’ is replaced by causative factors and this model shows the interaction of: - \n\nCausative factors; \nGroup of population and their characteristic;\nEnvironment behaviour, culture, physiological factors, ecological elements; and \nTime." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: PURPOSE, MATERIAL AND METHODS, RESULTS. Meshes: Advance Directive Adherence, Advance Directives, Aged, Aged, 80 and over, Cardiopulmonary Resuscitation, Female, Germany, Humans, Intensive Care Units, Life Support Care, Male, Middle Aged, Retrospective Studies, Terminal Care." }, { "role": "user", "content": "Are written advance directives helpful to guide end-of-life therapy in the intensive care unit? Context: The purpose of the study was to determine whether treatment preferences in patients' advance directives (ADs) are associated with life-supporting treatments received during end-of-life care in the intensive care unit (ICU). This is a retrospective cohort study, including patients who died in 4 ICUs of a university hospital in Germany. Patients with ADs were matched with 2 patients each without ADs using propensity scores. Sixty-four (13%) of 477 patients had ADs, written a median of 109 weeks before admission. Five categories of applicability conditions were identified, most of them difficult to interpret in the ICU (eg, \"advanced brain impairment\" or \"imminent death\"). Advance directives contained a number of treatment refusals. Specifically, 63 of 64 refused \"life-sustaining measures.\" Compared to patients without ADs, patients with ADs were less likely to receive cardiopulmonary resuscitation (9% vs 23%, P = .029) and more likely to have do-not-resuscitate orders (77% vs 56%, P = .007). Therapy-limiting decisions and ICU length of stay did not differ between those with or without ADs." }, { "role": "assistant", "content": "Patients with ADs are less likely to receive cardiopulmonary resuscitation but otherwise receive similar life-sustaining treatments compared to matched patients without ADs. More research is needed to explore reasons for potential noncompliance with patient preferences." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Experimental, Cells, Cultured, Cytokines, Dexamethasone, Fibroblasts, Gene Silencing, Glucocorticoids, Humans, Inflammation Mediators, Male, Mice, Mice, Inbred DBA, RNA, Small Interfering, Synovial Membrane, Transcription Factors, Transfection." }, { "role": "user", "content": "Is glucocorticoid-induced leucine zipper an endogenous antiinflammatory mediator in arthritis? Context: Glucocorticoid-induced leucine zipper (GILZ) is a glucocorticoid-induced protein, the reported molecular interactions of which suggest that it functions to inhibit inflammation. However, the role of endogenous GILZ in the regulation of inflammation in vivo has not been established. This study was undertaken to examine the expression and function of GILZ in vivo in collagen-induced arthritis (CIA), a murine model of rheumatoid arthritis (RA), and in RA synoviocytes. GILZ expression was detected in mouse and human synovium by immunohistochemistry and in cultured cells by real-time polymerase chain reaction and permeabilization flow cytometry. GILZ function was assessed in vivo by small interfering RNA (siRNA) silencing using cationic liposome-encapsulated GILZ or control nontargeting siRNA and was assessed in vitro using transient overexpression. GILZ was readily detectable in the synovium of mice with CIA and was up-regulated by therapeutic doses of glucocorticoids. Depleting GILZ expression in vivo increased the clinical and histologic severity of CIA and increased synovial expression of tumor necrosis factor and interleukin-1 (IL-1), without affecting the levels of circulating cytokines or anticollagen antibodies. GILZ was highly expressed in the synovium of patients with active RA and in cultured RA synovial fibroblasts, and GILZ overexpression in synovial fibroblasts inhibited IL-6 and IL-8 release." }, { "role": "assistant", "content": "Our findings indicate that GILZ functions as an endogenous inhibitor of chronic inflammation via effects on cytokine expression and suggest that local modulation of GILZ expression could be a beneficial therapeutic strategy. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Adolescent, Adult, Aged, Aged, 80 and over, Asian Continental Ancestry Group, Carcinoma, Carcinoma, Papillary, Female, Forkhead Transcription Factors, Genetic Association Studies, Genetic Loci, Genetic Predisposition to Disease, Homeodomain Proteins, Humans, Male, Middle Aged, Proto-Oncogene Proteins B-raf, Thyroid Cancer, Papillary, Thyroid Neoplasms, Transcription Factors." }, { "role": "user", "content": "Are the FOXE1 and NKX2-1 loci associated with susceptibility to papillary thyroid carcinoma in the Japanese population? Context: FOXE1 and NKX2-1 are two known genetic risk factors for the predisposition to sporadic papillary thyroid carcinoma (PTC) in Europeans, but their association in other ethnicities is still unknown. We aim to examine the association of the two genes with Japanese sporadic PTC, which exhibits high BRAF(V600E) mutation rate. 507 Japanese sporadic PTC cases and 2766 controls were genotyped for rs965513 (FOXE1) and rs944289 (NKX2-1). PTC cases were also examined for their BRAF(V600E) mutational status. The association of both rs965513 (p=1.27×10(-4), OR=1.69, 95% CI 1.29 to 2.21) and rs944289 (p=0.0121, OR=1.21, 95% CI 1.04 to 1.39) with the risk of sporadic PTC was confirmed. Subgroup analysis based on the BRAF mutational status showed strong association of rs965513 with BRAF(V600E)-positive cases (p=2.26×10(-4), OR=1.72, 95% CI 1.29 to 2.29), but not with BRAF(V600E)-negative cases (p=0.143, OR=1.52, 95% CI 0.87 to 2.65). However, there was no difference in the observed effect size between both subgroups. For rs944289, both subgroups showed marginal association (p=0.0585, OR=1.17, 95% CI 0.99 to 1.37 for BRAF(V600E)-positive cases; p=0.0492, OR=1.35, 95% CI 1.00 to 1.81 for BRAF(V600E)-negative cases)." }, { "role": "assistant", "content": "Both FOXE1 and NKX2-1 were associated with the increased risk of sporadic Japanese PTC. No clear associations were observed for either SNP with BRAF(V600E) status. 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, BACKGROUND, METHODS, RESULTS. Meshes: Aged, Familial Primary Pulmonary Hypertension, Female, Fluorescent Antibody Technique, Humans, Hypertension, Pulmonary, Immunohistochemistry, Lung, Male, NF-kappa B, Pulmonary Artery, Reverse Transcriptase Polymerase Chain Reaction." }, { "role": "user", "content": "Is nuclear factor κ-B activated in the pulmonary vessels of patients with end-stage idiopathic pulmonary arterial hypertension? Context: To assess activation of the inflammatory transcription factor NF-kappa B (NF-κB) in human idiopathic pulmonary arterial hypertension (PAH). Idiopathic PAH is a severe progressive disease characterized by pulmonary vascular remodeling and excessive proliferation of vascular cells. Increasing evidence indicates that inflammation is important in disease pathophysiology. NF-κB-p65 and CD68, CD20 and CD45 were measured by immunohistochemistry and confocal microscopy on lung specimens from patients with idiopathic PAH (n = 12) and controls undergoing lung surgery (n = 14). Clinical data were recorded for all patients including invasive pulmonary hemodynamics for the PAH patients. Immunohistochemical images were analyzed by blinded observers to include standard pulmonary vascular morphometry; absolute macrophage counts/mm(2) and p65-positivity (p65+) using composite images and image-analysis software; and cytoplasmic:nuclear p65+ of individual pulmonary arterial endothelial and smooth muscle cells (PASMC) in 10-20 pulmonary arteries or arterioles per subject. The expression of ET-1 and CCL5 (RANTES) in whole lung was determined by RT-qPCR. Macrophage numbers were increased in idiopathic PAH versus controls (49.0±4.5 vs. 7.95±1.9 macrophages/100 mm(2), p<0.0001): these macrophages demonstrated more nuclear p65+ than in macrophages from controls (16.9±2.49 vs. 3.5±1.25%, p<0.001). An increase in p65+ was also seen in perivascular lymphocytes in patients with PAH. Furthermore, NF-κB activation was increased in pulmonary arterial endothelial cells (62.3±2.9 vs. 14.4±3.8, p<0.0001) and PASMC (22.6±2.3 vs. 11.2±2.0, p<0.001) in patients with PAH versus controls, with similar findings in arterioles. Gene expression of both ET-1 mRNA ((0.213±0.069 vs. 1.06±0.23, p<0.01) and CCL5 (RANTES) (0.16±0.045 vs. 0.26±0.039, p<0.05) was increased in whole lung homogenates from patients with PAH." }, { "role": "assistant", "content": "NF-κB is activated in pulmonary macrophages, lymphocytes, endothelial and PASMC in patients with end-stage idiopathic PAH. Future research should determine whether NF-κB activation is a driver or bystander of pulmonary vascular inflammation and if the former, its potential role as a therapeutic target. 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, Carcinoma, Squamous Cell, Chemoradiotherapy, DNA-Binding Proteins, Endonucleases, Esophageal Neoplasms, Esophageal Squamous Cell Carcinoma, Esophagectomy, Female, Humans, Male, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Prognosis, Treatment Outcome." }, { "role": "user", "content": "Do eRCC1 expression and tumor regression predict survival in esophageal squamous cell carcinoma patients receiving combined trimodality therapy? Context: Combined trimodality therapy with neoadjuvant chemoradiation followed by surgery has shown promising results for locally advanced operable esophageal cancer. DNA repair proteins may affect treatment efficacy through repairing DNA damage induced by chemotherapy and radiation therapy. We evaluated the associations of XRCC1, ERCC1 and MGMT expression with histopathologic response and survival in patients with locally advanced operable esophageal squamous cell carcinoma (ESCC) who received neoadjuvant chemoradiation. Paraffin-embedded pre-treatment tissue samples, collected by endoscopic biopsy from patients treated with cisplatin-based neoadjuvant chemoradiation followed by surgery, were immunohistochemically stained for XRCC1, ERCC1 and MGMT expression. Of the 44 patients, major histopathologic response was noted in 26 (59.1%) patients. 68.8% of patients with ERCC1-negative tumors had major histopathologic response, compared to 53.6% of those who expressed positive ERCC1, though the difference was not statistically significant (P=0.361). The patients with ERCC1-negative tumor presented much better overall survival than those positive for ERCC1 expression (P=0.018). Patients with major histopathologic response had a 3-year survival rate of 96.2% versus those with minor response, with a 3-year survival rate of 41.5% (P=0.000). Multivariate analysis showed that ERCC1 expression and histopathologic response were independent predictive factors of overall survival in patients with locally advanced operable ESCC receiving neoadjuvant chemoradiation." }, { "role": "assistant", "content": "Patients with ERCC1-negative tumors show a benefit from neoadjuvant chemoradiation, ERCC1 expression and tumor regression are useful predictive markers in patients with locally advanced operable ESCC receiving neoadjuvant chemoradiation followed by surgery. 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, Antigens, Surface, Biomarkers, Tumor, Carcinoma, Squamous Cell, Cell Nucleus, Cyclooxygenase 2, Cytoplasm, ELAV Proteins, ELAV-Like Protein 1, Female, Humans, Immunoenzyme Techniques, Laryngeal Mucosa, Laryngeal Neoplasms, Lymph Nodes, Male, Middle Aged, RNA-Binding Proteins." }, { "role": "user", "content": "Is cytoplasmic HuR over-expression associated with increased cyclooxygenase-2 expression in laryngeal squamous cell carcinomas? Context: Cyclooxygenase-2 (COX-2) is an enzyme that catalyses the synthesis of prostaglandins and is over-expressed in a variety of premalignant and malignant conditions. The human embryonic lethal abnormal vision (ELAV)-like protein, HuR, is an mRNA stability protein that can regulate COX-2 expression. Because the regulation of gene expression through the post-transcriptional modification of the mRNA stability is an important mechanism in the control of cellular growth, this study investigated the expression and cellular localisation of the HuR protein and the relationships between COX-2 and HuR in laryngeal epithelium. The expression patterns of HuR and COX-2 in 39 laryngeal squamous cell carcinomas and paired samples of 38 normal and/or 30 dysplastic mucosa adjacent to an infiltrating carcinoma were analysed by immunohistochemistry and compared. An immunohistochemical evaluation of the specimens revealed high nuclear and cytoplasmic immunoreactivity for HuR in 39 (100%) and 26 (66.6%) of 39 lesions with laryngeal squamous cell carcinoma, 27 (90.0%) and one (3.3%) of 30 lesions with epithelial dysplasia, and 19 (50.0%) and 0 (0%) of 38 specimens with normal-appearing laryngeal epithelium, respectively. High levels of COX-2 expression were observed in 66.6% and 6.7% of laryngeal squamous cell carcinoma and epithelial dysplasia, respectively, but no COX-2 expression was detected in the normal epithelium. There was no significant correlation between HuR expression and the other clinicopathological parameters such as age, site, tumour size, or nodal status as well as histological differentiation. There was a statistically significant correlation between COX-2 immunoreactivity and the cytoplasmic HuR expression level in laryngeal squamous cell carcinoma." }, { "role": "assistant", "content": "Based on the fact that HuR in the cytoplasm indicates mRNA dysregulation of COX-2, our results suggest that their correlation plays an important role in the development and progression of laryngeal carcinoma. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adolescent, Africa, Eastern, Antibodies, Viral, Child, Child, Preschool, Diphtheria, Emigrants and Immigrants, Female, Healthcare Disparities, Hepatitis B Antibodies, Humans, Immunization Programs, Male, Mass Screening, Measles, Medical Audit, Prospective Studies, Rubella, Seroepidemiologic Studies, Tetanus, Victoria." }, { "role": "user", "content": "Do east African immigrant children in Australia have poor immunisation coverage? Context: To provide data on the immunisation status of recently arrived East African children and adolescents in Australia. A prospective audit was conducted at a hospital-based paediatric immigrant health clinic, in Melbourne, Australia, over the time period November 2000-January 2002. Study subjects were consecutive children and adolescents born in East Africa, arriving in Australia after January 1998. Vaccination status was ascertained by parent report and review of patient-held records where available, and by serological testing for immunity to hepatitis B, tetanus, diphtheria, rubella and measles. Among 136 participants, 132 (97%) had incomplete or unknown immunisation status based on parent report and vaccination records; written records were available for 5/136 (4%) of participants. Only 21/136 (15%) had serological immunity to all five of measles, rubella, tetanus, diphtheria and hepatitis B, despite a total of 395 visits to vaccine providers by participants since migration. A higher proportion of children had serological immunity to measles (90%) compared to the proportion with serological immunity to rubella (77%), tetanus (61%), diphtheria (45%) and hepatitis B (33%). The predictive value of parent-reported vaccination status for serological immunity was poor." }, { "role": "assistant", "content": "Paediatric East African immigrants in Victoria are very likely to be inadequately immunised and parent-reported vaccination status does not predict serological immunity. Full catch-up immunisation is recommended where immunisation status is unknown and written records are unavailable. Consideration should be given to policy and program development to provide timely and complete immunisation coverage in this group after arrival in Australia. 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: Age Factors, Animals, Animals, Newborn, Anxiety, Behavior, Animal, Fear, Hippocampus, Lithium Chloride, Memory, Mossy Fibers, Hippocampal, Nerve Growth Factors, Pilocarpine, Rats, Rats, Wistar, S100 Calcium Binding Protein beta Subunit, S100 Proteins, Status Epilepticus." }, { "role": "user", "content": "Are effects of early-life LiCl-pilocarpine-induced status epilepticus on memory and anxiety in adult rats associated with mossy fiber sprouting and elevated CSF S100B protein? Context: This study investigated putative correlations among behavioral changes and: (1) neuronal loss, (2) hippocampal mossy fiber sprouting, and (3) reactive astrogliosis in adult rats submitted to early-life LiCl-pilocarpine-induced status epilepticus (SE). Rats (P15) received LiCl (3 mEq/kg, i.p.) 12-18 h prior pilocarpine (60 mg/kg; s.c.). At adulthood, animals were submitted to behavioral tasks and after the completion of tasks biochemical and histological analysis were performed. In SE group, it was observed an increased number of degenerating neurons in the CA1 subfield and in the hilus of animals 24 h after SE. At adulthood, SE group presented an aversive memory deficit in an inhibitory avoidance task and the animals that presented lower latency to the step down showed a higher score for mossy fiber sprouting. In the light-dark exploration task, SE rats returned less and spent less time in the light compartment and present an increased number of risk assessment behavior (RA). There was a negative correlation between the time spent in the light compartment and the score for mossy fiber sprouting and a positive correlation between score for mossy fiber sprouting and number of RA. LiCl-pilocarpine-treated animals showed higher levels of S100B immunocontent in the CSF as well as a positive correlation between the score for sprouting and the GFAP immunocontent in the CA1 subfield, suggesting an astrocytic response to neuronal injury." }, { "role": "assistant", "content": "We showed that LiCl-pilocarpine-induced SE during development produced long-lasting behavioral abnormalities, which might be associated with mossy fiber sprouting and elevated CSF S100B levels at adulthood. 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": "At 42 weeks gestation, a long, thin neonate is born. He is apneic, pale with HR 94 bpm and covered with \"pea soup\" amniotic fluid. Which of the following is the first step in the resuscitation at delivery?" }, { "role": "assistant", "content": "The correct answer is Case of post-term neonate showing signs of chronic placental insufficiency (LBW for gest. age and wasted appearance). Higher risk of asphyxia and meconium aspiration. As per the latest guidelines on resuscitation of a neonate born through Meconium stained liquor, routine endotracheal intubation and tracheal suction of all neonates born through MSL is no longer recommended.. instead, the resuscitation should proceed as per the NRP, just ensuring that at least one person skilled in Endotracheal intubation should be available at the time of resuscitation.." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Do internal medicine residents ' perspectives and practice about resuscitate orders : survey analysis in the western region of Saudi Arabia? Context: The purpose of this study was to analyze the perceptions and practices of internal medicine residents in the western region of Saudi Arabia regarding the implementation of do not resuscitate (DNR) orders to improve future training practices among physicians. Medical residents involved in training programs in the western region of Saudi Arabia, including Jeddah, Makah, Medinah, and Taif, were invited to participate in a cross-sectional, anonymous, online survey regarding DNR orders. The 16-question survey was distributed to residents in all training programs in the region using surveymonkey.com, and the results were collected and tabulated. Of 364 residents, 157 completed the questionnaire, resulting in a 43% response rate. The study showed that most (66%) internal medicine residents in the western region of Saudi Arabia participate in DNR discussions with patients and family or surrogate decision-makers. In addition, 43% were observed by faculty members, and half of them (51.9%) reported feeling comfortable during these discussions. Furthermore, most residents believed that additional educational programs would enhance their competence in addressing issues related to DNR discussions." }, { "role": "assistant", "content": "This study highlights the need for a structured curriculum to teach skills relating to end-of-life issues such as DNR orders to residents in the Saudi Arabian medical system. The majority of residents surveyed believe they would benefit from additional training in DNR discussions. Therefore, an evidence-based curriculum providing instruction for improving discussions regarding DNR orders would improve physician confidence and effectiveness in caring for critically ill patients. 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": "The most common form of fetal traumatic injury incurred during breach extraction is:" }, { "role": "assistant", "content": "The correct answer is bih trauma intracranial haemorrhage due to uncontrolled delivery of the head and rupture of the veins of Galen or tentorial or falx tears Skull fractures Fracture dislocation of cervical veebra and atlantoaxial dislocation (refer pgno:377 sheila textbook of obstetrics 2 nd 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": "Inferior oblique muscle of eye is supplied by" }, { "role": "assistant", "content": "The correct answer is Ref BDC volume 3,6th edition pg 208NERVE SUPPLY:The superior oblique is supplied by trochlear nerveThe lateral rectus is supplied by abducent nerveThe superior rectus, medial rectus, inferior rectus and inferior oblique is supplied by occulomotor nerve" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response." }, { "role": "user", "content": "In a young female of reproductive age an absolute contraindication for prescribing oral contraceptive pills is:" }, { "role": "assistant", "content": "The correct answer is Ans-D i.e., Impaired liver function Repeat Q No 173 (Nov. 2004)Absolute contraindications include:A personal h/O thromboembolic venous, arterial or cardiac disease or severe or multiple risk factor for these. Transient cerebral ischaemic attacks without a headache.Infective hepatitis, until 3 months after liver function tests has become normal, and another liver disease including disturbances of hepatic excretion e.g. cholestatic jaundice, Dubin Johnson and Rotor syndromes.A migraine, if there is a typical aura, focal features or if it is severe and lasts > 72 hours despite t/t or is treated with an ergot derivative.Carcinoma of the breast or the genital tractOther conditions including SLE, porphyria, following the evacuation of a hydatidiform mole (until urine and plasma gonadotropin concentrations are normal), undiagnosed vaginal bleeding.Relative contraindications of OCP'sThe family history of venous thromboembolism, arterial disease or a known prethrombotic condition e.g. Factor V Leiden (pretreatment coagulation investigation is advised).Diabetes mellitus which may be precipitated or become more difficult to control (avoid if there are diabetic complications).Hypertension (avoid if B.P. exceeds 160/100)Smoking > 40 Cigarettes per day (15 Cigarettes/day enhances the risk of circulatory disease and constitutes an absolute contraindication for women over 35 years.Long-term immobility (e.g. due to Leg plaster, confinement to bed.Breastfeeding (until weaning or for 6 months after birth).Obesity" } ]

[ { "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 woman presents with fever, malaise, signs of jaundice, clay-colored stool, and dark urine. A liver biopsy reveals liver cell drop-out along with focal inflammation and ballooning degeneration of hepatocytes. A few intensely eosinophilic oval bodies are found. What are these microscopic bodies called" }, { "role": "assistant", "content": "The correct answer is Councilman bodies are intensely eosinophilic bodies that may be seen in liver biopsy specimens from individuals with viral hepatitis. These Councilman bodies are in fact necrotic hepatocytes that have undergone T-cell induced apoptosis. These apoptotic cells are cleared rapidly, and there may not be as many present in a liver biopsy specimen as were originally present." } ]

[ { "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 meningococcal epidemic?" }, { "role": "assistant", "content": "The correct answer is Ans. is 'a' i.e., A Meningococcal meningitis (cerebrospinal fever) It is an acute communicable disease caused by N. meningitidis. Out of 13 serogroups, group A, B and C are most impoant. Group A is associated with epidemics and group C mostly with localized outbreaks, while group B causes both epidemics and outbreaks. Group 29-E, W-135 and Y also frequently cause meningitis. Reservoir - Human nasopharynx is the only reservoir Source of infection - carriers are the most impoant source of infection, not the clinical cases. Age group - Children between 3 months to 5 years. Outbreaks of meningococcal meningitis occur more frequently in the dry and cold months of the year. Period of communicability - until meningococci are no longer present in discharges from nose and throat. Cases rapidly lose their infectiousness within 24 hours of specific treatment. Meningococcal meningitis is a very fatal disease. In untreated cases moality is 80%. The disease is fatal in 5-10% of cases even with prompt antimicrobial treatment in good health care facility." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, METHOD, RESULTS. Meshes: Adult, Aged, Anticholesteremic Agents, Coronary Disease, Decision Making, England, Family Practice, Female, Humans, Hyperlipidemias, Linear Models, Male, Middle Aged, Practice Patterns, Physicians', Primary Prevention, Risk Assessment, Risk Factors, Statistics, Nonparametric, Surveys and Questionnaires." }, { "role": "user", "content": "Hyperlipidaemia and primary prevention of coronary heart disease: are the right patients being treated? Context: In 1997, the Standing Medical Advisory Committee report suggested that patients with a coronary heart disease risk of 3% per year or greater should be considered appropriate for lipid-lowering medication. The report stated that cholesterol concentration alone is a poor predictor of absolute risk of coronary heart disease and recommended the Sheffield table as a method of estimating the coronary heart disease risk. To assess the impact of the Standing Medical Advisory Committee report on the management of patients with hyperlipidaemia in the primary prevention of coronary heart disease in primary care. A survey questionnaire giving the clinical details of 20 patients with various coronary heart disease risk factors was sent to 200 general practitioners in the West Midlands, UK. Forty-eight percent of the respondents used clinical assessment/perception as the sole means of risk assessment and 26% used the Sheffield table. In patients who did not require treatment, 40.1% of the decisions were inappropriate and, in patients who required treatment, 35.1% of the decisions were inappropriate. Overall, inappropriate decisions were made in 37.9% of the responses. Despite the clear advice in the Standing Medical Advisory Committee report on the importance of incorporating multiple risk factors in estimating absolute coronary heart disease risk, only total cholesterol and triglycerides were significant in influencing treatment decisions." }, { "role": "assistant", "content": "The Standing Medical Advisory Committee recommendations on the management of hyperlipidaemia in primary prevention of coronary heart disease are not widely used. Large savings could be made by correctly identifying and treating individuals at high risk. We recommend use of the full Framingham risk score in assessment of coronary heart disease risk in primary care." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: Adult, Aged, Cardiac Output, Exercise, Female, Humans, Kinetics, Male, Middle Aged, Myocardial Infarction, Oxygen Consumption, Stroke Volume." }, { "role": "user", "content": "Are oxygen uptake kinetics determined by cardiac function at onset of exercise rather than peak exercise in patients with prior myocardial infarction? Context: Resting cardiac function does not necessarily affect exercise capacity. However, to determine whether it affects early dynamics of oxygen uptake (VO2) during exercise, we measured VO2 during a constant work rate and during incremental exercise testing in patients with a history of myocardial infarction. VO2 kinetics and exercise capacity were compared between patients with relatively high left ventricular ejection fractions (LVEF > or = 35%, group 1) and those with lower ejection fractions (LVEF < 35%, group 2). Forty patients with a history of prior myocardial infarction (age, 57 +/- 10 years) were monitored during 6 minutes of moderate constant work rate testing (40 +/- 8 W) and during symptom-limited incremental exercise testing with a cycle ergometer. VO2 was calculated from respired gas analysis on a breath-by-breath basis. Cardiac output determinations were made with a computerized cadmium telluride detector every 10 seconds during exercise. The VO2 time constant during constant work rate exercise was slower in group 2 (58.0 +/- 7.6 seconds) compared with group 1 (45.8 +/- 10.5 seconds, P = .0002), indicating slower kinetics in group 2. The time constant for the rise in cardiac output during exercise was also slower in patients with lower EFs (63.0 +/- 12.8 versus 50.0 +/- 12.2 seconds). However, there were no differences in exercise capacity parameters, such as the VO2 or cardiac output at peak exercise, obtained during incremental exercise testing among the two groups." }, { "role": "assistant", "content": "The prolonged time constant of VO2, which is primarily determined during early parts of exercise, reflects delayed cardiac output response in patients with severely impaired LV function. The time constant of VO2 during submaximal constant work rate exercise can be used as a sensitive and discriminant measure of impaired cardiac reserve in these patients. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, OBJECTIVE, METHODS, RESULTS. Meshes: Asthma, Case-Control Studies, Cells, Cultured, Child, Chromosomes, Human, Pair 17, Cross-Sectional Studies, DNA Mutational Analysis, Female, Gene Expression Regulation, Genetic Predisposition to Disease, Genotype, Germany, Haplotypes, Humans, Interleukin-13, Interleukin-4, International Cooperation, Leukocytes, Mononuclear, Male, Membrane Proteins, Polymorphism, Single Nucleotide, Promoter Regions, Genetic, Th1-Th2 Balance, Th2 Cells." }, { "role": "user", "content": "Are polymorphisms related to ORMDL3 associated with asthma susceptibility , alterations in transcriptional regulation of ORMDL3 , and changes in TH2 cytokine levels? Context: Chromosome 17q21, harboring the orosomucoid 1-like 3 (ORMDL3) gene, has been consistently associated with childhood asthma in genome-wide association studies. We investigated genetic variants in and around ORMDL3 that can change the function of ORMDL3 and thus contribute to asthma susceptibility. We performed haplotype analyses and fine mapping of the ORMDL3 locus in a cross-sectional (International Study of Asthma and Allergies in Childhood Phase II, n = 3557 total subjects, n = 281 asthmatic patients) and case-control (Multicenter Asthma Genetics in Childhood Study/International Study of Asthma and Allergies in Childhood Phase II, n = 1446 total subjects, n = 763 asthmatic patients) data set to identify putative causal single nucleotide polymorphisms (SNPs) in the locus. Top asthma-associated polymorphisms were analyzed for allele-specific effects on transcription factor binding and promoter activity in vitro and gene expression in PBMCs after stimulation ex vivo. Two haplotypes (H1 and H2) were significantly associated with asthma in the cross-sectional (P = 9.9 × 10(-5) and P = .0035, respectively) and case-control (P = 3.15 × 10(-8) and P = .0021, respectively) populations. Polymorphisms rs8076131 and rs4065275 were identified to drive these effects. For rs4065275, a quantitative difference in transcription factor binding was found, whereas for rs8076131, changes in upstream stimulatory factor 1 and 2 transcription factor binding were observed in vitro by using different cell lines and PBMCs. This might contribute to detected alterations in luciferase activity paralleled with changes in ORMDL3 gene expression and IL-4 and IL-13 cytokine levels ex vivo in response to innate and adaptive stimuli in an allele-specific manner. Both SNPs were in strong linkage disequilibrium with asthma-associated 17q21 SNPs previously related to altered ORMDL3 gene expression." }, { "role": "assistant", "content": "Polymorphisms in a putative promoter region of ORMDL3, which are associated with childhood asthma, alter transcriptional regulation of ORMDL3, correlate with changes in TH2 cytokines levels, and therefore might contribute to the childhood asthma susceptibility signal from 17q21. 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": "Chloroquine cause exacerbation of :" }, { "role": "assistant", "content": "The correct answer is B i.e. Psoriasis" } ]

[ { "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": "Features of Torsade de pointes is-" }, { "role": "assistant", "content": "The correct answer is Torsades de pointes is a specific form of polymorphic ventricular tachycardia in patients with a long QT interval. It is characterized by rapid, irregular QRS complexes, which appear to be twisting around the ECG baseline. Ref Harrison 20th edition pg 1545" } ]

[ { "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 60-year old male has a long standing history of breathlessness. He has been a heavy smoker since the age of 20 years. Physical examination reveals an anxious male who is emaciated, puffing for breath but is not cyanosed. The chest is barrels shaped. The primary pathology of the lung in this patient is associated with which of the following pathogenetic mechanisms?" }, { "role": "assistant", "content": "The correct answer is From the history and clinical findings,the probable diagnosis is chronic obstructive pulmonary disease-emphysematous type.Severe alpha1 antitrypsin (protease inhibitor) deficiency is a proven genetic risk factor for COPD.The unopposed action of elastolytic proteases lead to destruction and enlargement of gas-exchanging air spaces,thus leading to the development of emphysema. Ref:Harrison's medicine-18th edition,page no:2152,2155." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Ankle Brachial Index, Blood Pressure, Brachial Artery, Follow-Up Studies, Humans, Hypertension, Japan, Male, Middle Aged, Odds Ratio, Predictive Value of Tests, Reference Values, Surveys and Questionnaires, Tibial Arteries." }, { "role": "user", "content": "Is brachial-ankle pulse wave velocity an independent predictor of incident hypertension in Japanese normotensive male subjects? Context: Cardiovascular morbidity and mortality are closely associated with hypertension, however, predictors of incident hypertension have not been fully established. We have conducted a study aimed at evaluating whether brachial-ankle pulse wave velocity (baPWV) is a predictor of incident hypertension. The relation between baPWV, a noninvasive index of aortic stiffness, and incident hypertension was evaluated in a cohort of 2278 Japanese normotensive male subjects with a follow-up of 3 years. Of the 2278 study participants, 151 (6.6%) had incident hypertension during the follow-up. After adjustment for variables, including age, gender, body mass index (BMI), smoking habit, alcohol consumption, diabetes mellitus, hyperlipidemia, family history of hypertension, heart rate, systolic blood pressure, low-density lipoprotein cholesterol, triglyceride, and fasting plasma glucose, multiple logistic regression analysis revealed that baPWV was a significant and independent predictor of incident hypertension with an adjusted odds ratio 1.45 (95% confidence interval 1.17-1.79, P < 0.01). In addition, baPWV values >1380 cm/s indicated a high risk for incident hypertension." }, { "role": "assistant", "content": "Among the Japanese normotensive male subjects participating in this study, BaPWV was a significant and independent predictor of incident hypertension. This result suggests that BaPWV could be a useful screening method to identify normotensive individuals who should be targeted for interventions aimed at preventing the incident hypertension. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Alcohol Drinking, Alcoholism, Animals, Behavior, Animal, Cholestenone 5 alpha-Reductase, Disease Models, Animal, Dose-Response Relationship, Drug, Enzyme Inhibitors, Finasteride, Male, Mice, Mice, Inbred C57BL, Pregnanolone, Receptors, GABA-A, Time Factors." }, { "role": "user", "content": "Does inhibition of 5alpha-reduced steroid biosynthesis impede acquisition of ethanol drinking in male C57BL/6J mice? Context: Allopregnanolone (ALLO) is a physiologically relevant neurosteroid modulator of GABA(A) receptors, and it exhibits a psychopharmacological profile that closely resembles the post-ingestive effects of ethanol. The 5alpha-reductase inhibitor finasteride (FIN), which inhibits biosynthesis of ALLO and structurally related neurosteroids, was previously demonstrated to reduce the maintenance of limited-access ethanol consumption. The primary aim of the current work was to determine whether FIN would reduce the acquisition of drinking in ethanol-naïve mice. Male C57BL/6J (B6) mice were acclimated to a reverse light/dark schedule, and were provided ad libitum access to chow and water. Following habituation to vehicle injections (VEH; 20% w/v beta-cyclodextrin; i.p.) administered 22-hour prior to drinking sessions with water only, mice were divided into 3 treatment groups: vehicle control (VEH), 50 mg/kg FIN (FIN-50), and 100 mg/kg FIN (FIN-100). Twenty-two hours after the first treatment, mice were permitted the inaugural 2-hour limited access to a 10% v/v ethanol solution (10E) and water. The acquisition of 10E consumption and underlying drinking patterns were assessed during FIN treatment (7 days) and subsequent FIN withdrawal (13 days) phases. FIN dose-dependently blocked the acquisition of 10E drinking and prevented the development of ethanol preference, thereby suggesting that the GABAergic neurosteroids may be important in the establishment of stable drinking patterns. FIN-elicited reductions in 10E intake were primarily attributable to selective and marked reductions in bout frequency, as no changes were observed in bout size, duration, or lick rates following FIN treatment. FIN-treated mice continued to exhibit attenuated ethanol consumption after 2 weeks post-treatment, despite a full recovery in brain ALLO levels. A second study confirmed the rightward and downward shift in the acquisition of ethanol intake following 7 daily FIN injections. While there were no significant group differences in brain ALLO levels following the seventh day of ethanol drinking, ALLO levels were decreased by 28% in the FIN-50 group." }, { "role": "assistant", "content": "Although the exact mechanism is unclear, FIN and other pharmacological interventions that modulate the GABAergic system may prove useful in curbing ethanol intake acquisition in at-risk individuals. 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, Breast Neoplasms, Cytotoxicity, Immunologic, Double-Blind Method, Female, Humans, Immunophenotyping, Killer Cells, Natural, Mastectomy, Middle Aged, Poly A-U, Receptors, IgG." }, { "role": "user", "content": "Does polyadenylic-polyuridylic acid enhance the natural cell-mediated cytotoxicity in patients with breast cancer undergoing mastectomy? Context: Surgical procedures suppress host antitumor defense mechanisms, which may increase the risk of metastatic tumor dissemination. We have evaluated the effects of the biologic response modifier polyadenylic-polyuridylic acid (PAPU) on natural cytotoxicity in patients with breast cancer undergoing operation. PAPU (150 mg) or placebo was given intravenously during the perioperative period (preoperative, days -1 and 0; postoperative, days 1, 3, 5, 7, and 14). The function (chromium release assay) and number (flow cytometry) of natural killer (NK) cells were measured before operation (days -2 and -1), on the day of operation (day 0), and after operation (days 1, 2, 4, 6, and 18). Surgical procedures suppressed NK cell cytotoxicity in the placebo group on postoperative days 1 (p < 0.001), 4, 6, and 18 (p < 0.05), whereas inhibition on postoperative day 2 failed to reach significance. PAPU abolished this immunosuppression after operation. The NK cell activity was elevated when compared with the control group; it was significant (p < 0.05) on postoperative days 1, 2, 4, 6, and 18. Surgical procedures also reduced circulating NK cell numbers during the first postoperative week in the placebo group; the decrease was statistically significant on day 4. The decrease in NK cell numbers in the PAPU group was insignificant." }, { "role": "assistant", "content": "PAPU prevented the decrease in the circulating number and cytotoxic activity of NK cells that occurred after operation and enhanced NK cell cytotoxicity. This may have important implications for patients with cancer undergoing major operation. 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: Bacterial Infections, Child, Disease Susceptibility, Erythrocytes, Extracellular Traps, Glucosephosphate Dehydrogenase, Glucosephosphate Dehydrogenase Deficiency, Granulocytes, Humans, Infant, Leukocyte Elastase, Male, NADP, Reactive Oxygen Species." }, { "role": "user", "content": "Does severe glucose-6-phosphate dehydrogenase deficiency lead to susceptibility to infection and absent NETosis? Context: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells in human subjects, causing hemolytic anemia linked to impaired nicotinamide adenine dinucleotide phosphate (NADPH) production and imbalanced redox homeostasis in erythrocytes. Because G6PD is expressed by a variety of hematologic and nonhematologic cells, a broader clinical phenotype could be postulated in G6PD-deficient patients. We describe 3 brothers with severe G6PD deficiency and susceptibility to bacterial infection. We sought to study the molecular pathophysiology leading to susceptibility to infection in 3 siblings with severe G6PD deficiency. Blood samples of 3 patients with severe G6PD deficiency were analyzed for G6PD enzyme activity, cellular oxidized nicotinamide adenine dinucleotide phosphate/NADPH levels, phagocytic reactive oxygen species production, neutrophil extracellular trap (NET) formation, and neutrophil elastase translocation. In these 3 brothers strongly reduced NADPH oxidase function was found in granulocytes, leading to impaired NET formation. Defective NET formation has thus far been only observed in patients with the NADPH oxidase deficiency chronic granulomatous disease, who require antibiotic and antimycotic prophylaxis to prevent life-threatening bacterial and fungal infections." }, { "role": "assistant", "content": "Because severe G6PD deficiency can be a phenocopy of chronic granulomatous disease with regard to the cellular and clinical phenotype, careful evaluation of neutrophil function seems mandatory in these patients to decide on appropriate anti-infective preventive measures. Determining the level of G6PD enzyme activity should be followed by analysis of reactive oxygen species production and NET formation to decide on required antibiotic and antimycotic prophylaxis. 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: Acetyl Coenzyme A, Biopsy, Carboxy-Lyases, Ceramides, Coenzyme A, Diglycerides, Fatty Acids, Gene Silencing, Glucose, Humans, Kinetics, Lipids, Muscle Fibers, Skeletal, Muscle, Skeletal, RNA, Messenger, RNA, Small Interfering, Transfection." }, { "role": "user", "content": "Does malonyl CoenzymeA decarboxylase regulate lipid and glucose metabolism in human skeletal muscle? Context: Malonyl coenzyme A (CoA) decarboxylase (MCD) is a key enzyme responsible for malonyl-CoA turnover and functions in the control of the balance between lipid and glucose metabolism. We utilized RNA interference (siRNA)-based gene silencing to determine the direct role of MCD on metabolic responses in primary human skeletal muscle. We used siRNA to silence MCD gene expression in cultured human myotubes from healthy volunteers (seven male and seven female) with no known metabolic disorders. Thereafter, we determined lipid and glucose metabolism and signal transduction under basal and insulin-stimulated conditions. RNA interference-based silencing of MCD expression (75% reduction) increased malonyl-CoA levels twofold and shifted substrate utilization from lipid to glucose oxidation. RNA interference-based depletion of MCD reduced basal palmitate oxidation. In parallel with this reduction, palmitate uptake was decreased under basal (40%) and insulin-stimulated (49%) conditions compared with myotubes transfected with a scrambled sequence. MCD silencing increased basal and insulin-mediated glucose oxidation 1.4- and 2.6-fold, respectively, compared with myotubes transfected with a scrambled sequence. In addition, glucose transport and cell-surface GLUT4 content was increased. In contrast, insulin action on IRS-1 tyrosine phosphorylation, tyrosine-associated phosphatidylinositol (PI) 3-kinase activity, Akt, and glycogen synthase kinase (GSK) phosphorylation was unaltered between myotubes transfected with siRNA against MCD versus a scrambled sequence." }, { "role": "assistant", "content": "These results provide evidence that MCD silencing suppresses lipid uptake and enhances glucose uptake in primary human myotubes. In conclusion, MCD expression plays a key reciprocal role in the balance between lipid and glucose metabolism. 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: Alkaline Phosphatase, Animals, Cells, Cultured, Chick Embryo, Coculture Techniques, Collagen Type I, Endothelial Progenitor Cells, Female, Femur, Gene Expression, Human Embryonic Stem Cells, Humans, Neovascularization, Physiologic, Osteogenesis, Vascular Endothelial Growth Factor A, Vascular Endothelial Growth Factor Receptor-1, Vascular Endothelial Growth Factor Receptor-2, von Willebrand Factor." }, { "role": "user", "content": "Do human endothelial and foetal femur-derived stem cell co-cultures modulate osteogenesis and angiogenesis? Context: A dynamic vasculature is a prerequisite for bone formation where the interaction of bone cells and endothelial cells is essential for both the development and the healing process of bone. Enhanced understanding of the specific mediators involved in bone cell and endothelial cell interactions offers new avenues for skeletal regenerative applications. This study has investigated the osteogenic and angiogenic potential of co-cultures of human foetal diaphyseal or epiphyseal cells with human umbilical vein endothelial cells (HUVEC) in the presence and absence of vascular endothelial growth factor (VEGF) supplementation. Early osteogenic activities of the co-cultures (± VEGF) were assessed by alkaline phosphatase (ALP) activity. Osteogenic and angiogenic gene expression was measured using quantitative polymerase chain reaction. An ex vivo organotypic embryonic chick (E11) femur culture model was used to determine the osteogenic effects of VEGF as determined using micro-computed tomography (μCT) and Alcian blue/Sirius red histochemistry and immunocytochemistry for expression of CD31. ALP activity and gene expression of ALP and Type-1 collagen was enhanced in foetal skeletal/HUVECs co-cultures. In foetal diaphyseal/HUVECs co-cultures, VEGF reduced the levels of ALP activity and displayed a negligible effect on von Willebrand factor (vWF) and VEGF gene expression. In contrast, VEGF supplementation was observed to significantly increase FLT-1 and KDR gene expression in co-cultures with modulation of expression enhanced, compared to VEGF skeletal monocultures. In the organotypic chick model, addition of VEGF significantly enhanced bone formation, which coincided with elevated levels of CD31-positive cells in the mid-diaphyseal region of the femurs." }, { "role": "assistant", "content": "These studies demonstrate a differential skeletal response of early foetal skeletal cells, when co-cultured with endothelial cells and the potential of co-culture models for bone repair. The differential effect of VEGF supplementation on markers of angiogenesis and osteogenesis in co-cultures and organ cultures, demonstrate the importance of the intricate temporal coordination of osteogenic and angiogenic processes during bone formation and implications therein for effective approaches to bone regenerative therapies. 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, DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, MAIN OUTCOME MEASURES, RESULTS. Meshes: Adult, Checklist, Child, Child, Preschool, Counseling, Educational Status, Female, Humans, Infant, Informed Consent, Male, Mental Recall, Otorhinolaryngologic Surgical Procedures, Parents, Patient Education as Topic, Prospective Studies, Risk, Surveys and Questionnaires." }, { "role": "user", "content": "Informed consent in pediatric surgery: Do parents understand the risks? Context: To investigate parent understanding of the risks of pediatric ear, nose, and throat surgery after counseling with and without the use of informational aids. Prospective, randomized trial. Academic tertiary care center. Parents of children undergoing ear, nose, and throat surgery. Parents were randomized to receive standard informed consent with or without detailed informational aids. Parents completed identical questionnaires testing their general procedure knowledge and their recall of 9 specific surgical risks both immediately after counseling and on the day of surgery. Thirty-four parents enrolled in and completed the study (18 in the control group and 16 in the test group). The mean time from informed consent to surgery was 6.3 days (range, 1-22 days). Parents in the test group scored significantly higher on identifying the 9 risks on both the preoperative questionnaire (mean score, 6.00 vs 4.44; P = .007, 2-tailed t test) and the postoperative questionnaire (6.25 vs 4.17; P<.001). There was a negative correlation (inverse relationship) between parent education score and risk recall, with parents with lower education levels scoring higher on both the preoperative (Pearson r = -0.36; P = .04) and the postoperative (r = -0.35; P = .04) surveys. The maternal parent recalled risks significantly better than the paternal parent, with surgical risk recall scores of 5.46 out of 9 vs 3.67 out of 9 (P = .02, 2-tailed t test)." }, { "role": "assistant", "content": "Parents of children undergoing ear, nose, and throat surgery recall far less than 100% of counseled risks. The use of detailed surgical risk counseling improves measured parental understanding of surgical risk. Parental educational level and maternal vs paternal parent may affect risk counseling recall." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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, Alleles, Cardiopulmonary Bypass, Electrocardiography, Female, Humans, Integrin beta3, Male, Middle Aged, Platelet Activation, Polymorphism, Genetic, Postoperative Complications, Thrombosis, Troponin I." }, { "role": "user", "content": "Are platelet PlA2 polymorphism and platelet activation associated with increased troponin I release after cardiopulmonary bypass? Context: The PlA2 polymorphism of platelet glycoprotein IIIa has been identified as a prothrombotic risk factor in a number of cardiovascular settings. The aim of this study was to determine whether the PlA2 polymorphism of platelet glycoprotein IIIa and degree of platelet activation were associated with more severe myocardial injury as indicated by troponin I release following cardiopulmonary bypass. The PlA2 genotype was determined in 66 patients undergoing elective coronary artery bypass grafting requiring cardiopulmonary bypass. Troponin I concentrations and the percentage of circulating, activated (CD62P+) platelets were measured at predetermined intervals perioperatively. Forty-six patients were Pl(A1,A1), and 20 were Pl(A1,A2) or Pl(A2,A2). Patients with at least one PlA2 allele had significantly greater postoperative troponin I concentrations than PlA1 homozygotes (P = 0.006, analysis of variance). Peak troponin I concentrations also correlated significantly with the increase in circulating, activated platelets (P = 0.02, Spearman rank correlation)." }, { "role": "assistant", "content": "The PlA2 allele of platelet glycoprotein IIIa is associated with higher troponin I concentrations following cardiopulmonary bypass surgery, suggesting that this platelet polymorphism contributes to perioperative myocardial 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: Age Factors, Child, Preschool, Cohort Studies, Denmark, Dermatitis, Atopic, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Pregnancy, Risk Factors, Severity of Illness Index, Staphylococcal Skin Infections, Staphylococcus aureus, Statistics as Topic." }, { "role": "user", "content": "Is neonatal colonization with Staphylococcus aureus associated with development of atopic dermatitis? Context: Staphylococcus aureus in atopic skin has been associated with exacerbation of eczema. Objectives To investigate a possible association between neonatal colonization with S. aureus and the risk of atopic dermatitis (AD) during the first 3 years of life. The study participants were 356 children born of mothers with asthma from the Copenhagen Prospective Study on Asthma in Childhood. Swabs from the vestibulum nasi and the perineum were cultured at 1 month and 1 year, from acute eczema, and from parents (vestibulum nasi and pharynx). AD development and severity were monitored prospectively. Of the neonates, 5.3% had positive swabs for S. aureus cultured from the vestibulum nasi (51.3%) and/or the perineum (11.3%). Forty-two per cent developed AD, but without association between colonization with S. aureus at 1 month of age and risk of developing AD at 3 years of age. There was a 70% concordance for S. aureus carriage between neonates and parents. At 1 year of age 11.3% children had swabs positive for S. aureus. Fourteen per cent of children tested at the 1-year visit developed AD after the visit but before 3 years of age, but again, there was no association between colonization with S. aureus and the risk of AD. In children seen at acute visits the severity of AD measured by scoring of atopic dermatitis (SCORAD) was significantly higher in children with a positive culture for S. aureus in lesions." }, { "role": "assistant", "content": "Colonization with S. aureus at 1 month of age is not associated with an increased risk of developing AD during the first 3 years of life. 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, RESULTS. Meshes: Alopecia, Animals, Carcinoma, Basal Cell, GATA3 Transcription Factor, Gene Expression Regulation, Developmental, Gene Silencing, Hair Follicle, Hedgehog Proteins, High Mobility Group Proteins, Immunohistochemistry, In Situ Hybridization, Mice, Mice, Transgenic, Microscopy, Electron, Scanning, SOX9 Transcription Factor, Signal Transduction, Skin Neoplasms, Stem Cells, Trans-Activators, Transcription Factors." }, { "role": "user", "content": "Is sox9 essential for outer root sheath differentiation and the formation of the hair stem cell compartment? Context: The mammalian hair represents an unparalleled model system to understand both developmental processes and stem cell biology. The hair follicle consists of several concentric epithelial sheaths with the outer root sheath (ORS) forming the outermost layer. Functionally, the ORS has been implicated in the migration of hair stem cells from the stem cell niche toward the hair bulb. However, factors required for the differentiation of this critical cell lineage remain to be identified. Here, we describe an unexpected role of the HMG-box-containing gene Sox9 in hair development. Sox9 expression can be first detected in the epithelial component of the hair placode but then becomes restricted to the outer root sheath (ORS) and the hair stem cell compartment (bulge). Using tissue-specific inactivation of Sox9, we demonstrate that this gene serves a crucial role in hair differentiation and that skin deleted for Sox9 lacks external hair. Strikingly, the ORS acquires epidermal characteristics with ectopic expression of GATA3. Moreover, Sox9 knock hair show severe proliferative defects and the stem cell niche never forms. Finally, we show that Sox9 expression depends on sonic hedgehog (Shh) signaling and demonstrate overexpression in skin tumors in mouse and man." }, { "role": "assistant", "content": "We conclude that although Sox9 is dispensable for hair induction, it directs differentiation of the ORS and is required for the formation of the hair stem cell compartment. Our genetic analysis places Sox9 in a molecular cascade downstream of sonic hedgehog and suggests that this gene is involved in basal cell carcinoma. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, RESULTS. Meshes: ." }, { "role": "user", "content": "Do functional MRI activation in white matter during the Symbol Digit Modalities Test? Context: Recent evidence shows that functional magnetic resonance imaging (fMRI) can detect activation in white matter (WM). Such advances have important implications for understanding WM dysfunction. A key step in linking neuroimaging advances to the evaluation of clinical disorders is to examine whether WM activation can be detected at the individual level during clinical tests associated with WM function. We used an adapted Symbol Digit Modalities Test (SDMT) in a 4T fMRI study of healthy adults. RESULTS from 17 healthy individuals revealed WM activation in 88% of participants (15/17). The activation was in either the corpus callosum (anterior and/or posterior) or internal capsule (left and/or right)." }, { "role": "assistant", "content": "The findings link advances in fMRI to an established clinical test of WM function. Future work should focus on evaluating patients with WM dysfunction. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, RESULTS. Meshes: Aged, Chronic Disease, Exercise Test, Exercise Therapy, Female, Heart Failure, Humans, Male, Middle Aged, Oxygen Consumption, Pulmonary Ventilation, Severity of Illness Index, Stroke Volume, Treatment Outcome, Ventricular Function, Left." }, { "role": "user", "content": "Does exercise training increase oxygen uptake efficiency slope in chronic heart failure? Context: The oxygen uptake efficiency slope (OUES) is a novel measure of cardiopulmonary reserve. OUES is measured during an exercise test, but it is independent of the maximally achieved exercise intensity. It has a higher prognostic value in chronic heart failure (CHF) than other exercise test-derived variables such as(Equation is included in full-text article.)or(Equation is included in full-text article.)slope. Exercise training improves(Equation is included in full-text article.)and(Equation is included in full-text article.)in CHF patients. We hypothesized that exercise training also improves OUES. We studied 34 New York Heart Association (NYHA) class II-III CHF patients who constituted an exercise training group T (N=20; 19 men/1 woman; age 60+/-9 years; left ventricular ejection fraction 34+/-5%) and a control group C (N=14; 13 men/one woman; age 63+/-10 years; left ventricular ejection fraction 34+/-7%). A symptom-limited exercise test was performed at baseline and repeated after 4 weeks (C) or after completion of the training program (T). Exercise training increased NYHA class from 2.6 to 2.0 (P<0.05),(Equation is included in full-text article.)by 14% [P(TvsC)<0.01], and OUES by 19% [P(TvsC)<0.01]. Exercise training decreased(Equation is included in full-text article.)by 14% [P(TvsC)<0.05]." }, { "role": "assistant", "content": "Exercise training improved NYHA class,(Equation is included in full-text article.)and also OUES. This finding is of great potential interest as OUES is insensitive for peak load. Follow-up studies are needed to demonstrate whether OUES improvements induced by exercise training are associated with improved prognosis. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Antigens, CD, Carbohydrate Conformation, Cell Line, Cricetinae, Female, Glycoproteins, Glycosylation, Membrane Glycoproteins, Mice, Placenta, Pregnancy, Pregnancy Proteins, Protein Binding, Protein Interaction Mapping, Protein Processing, Post-Translational, Recombinant Proteins, Tetraspanin 29, Transforming Growth Factor beta." }, { "role": "user", "content": "Is n-glycosylation required for binding of murine pregnancy-specific glycoproteins 17 and 19 to the receptor CD9? Context: Murine pregnancy-specific glycoproteins (PSGs) are encoded by 17 different genes. Different family members have different expression levels at different stages of embryonic development. It is currently unknown whether all members of this family of placentally secreted proteins have the same function and bind to the same receptor. Furthermore, the requirement of post-translational modifications for the activity of these highly glycosylated proteins remains undetermined. Recombinant PSG17 and PSG19 were generated and purified by affinity chromatography. An expression library was screened to identify the receptor for mouse PSG19. Binding to the receptor by proteins generated in different expression systems and mapping of the binding domain were analyzed by pull-down assays. Analysis of the carbohydrate composition of the receptor-binding domain was performed with the DIG glycan differentiation kit. PSG19 binds to the tetraspanin CD9, specifically to extra cellular loop 2 and can induce secretion of TGFbeta1 by a macrophage cell line. The receptor-binding domain of PSG17 and PSG19 is post-translationally modified by the addition of N-linked carbohydrates and, when expressed in CHO cells, terminal sialic acids are detected. PSGs produced in bacteria do not bind CD9." }, { "role": "assistant", "content": "PSG19, as previously determined for PSG17, binds to the second extracellular loop 2 of the tetraspanin CD9. The first immunoglobulin variable-like domain of PSG19 is sufficient for receptor binding and function. Analysis of receptor usage by the remaining 15 murine PSGs will most likely require that the proteins be generated in eukaryotic expression systems, as we have demonstrated that the addition of carbohydrates is essential for PSG-receptor interaction. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: ." }, { "role": "user", "content": "Do liver Label Retaining Cancer Cells Are Relatively Resistant to the Reported Anti-Cancer Stem Cell Drug Metformin? Context: Recently, we reported that liver Label Retaining Cancer Cells (LRCC) can initiate tumors with only 10 cells and are relatively resistant to the targeted drug Sorafenib, a standard of practice in advanced hepatocellular carcinoma (HCC). LRCC are the only cancer stem cells (CSC) isolated alive according to a stem cell fundamental function, asymmetric cell division. Metformin has been reported to preferentially target many other types of CSC of different organs, including liver. It's important to know if LRCC, a novel class of CSC, are relatively resistant to metformin, unlike other types of CSC. As metformin inhibits the Sorafenib-Target-Protein (STP) PI3K, and LRCC are newly described CSC, we undertook this study to test the effects of Metformin on Sorafenib-treated HCC and HCC-derived-LRCC. We tested various STP levels and phosphorylation status, associated genes' expression, proliferation, viability, toxicity, and apoptosis profiles, before and after treatment with Sorafenib with/without Metformin. Metformin enhances the effects of Sorafenib on HCC, and significantly decreased viability/proliferation of HCC cells. This insulin-independent effect was associated with inhibition of multiple STPs (PKC, ERK, JNK and AKT). However, Metformin increased the relative proportion of LRCCs. Comparing LRCC vs. non-LRCC, this effect was associated with improved toxicity and apoptosis profiles, down-regulation of cell death genes and up-regulation of cell proliferation and survival genes in LRCC. Concomitantly, Metformin up-regulated pluripotency, Wnt, Notch and SHH pathways genes in LRCC vs. non-LRCC." }, { "role": "assistant", "content": "Metformin and Sorafenib have enhanced anti-cancer effects. However, in contradistinction to reports on other types of CSC, Metformin is less effective against HCC-derived-CSC LRCC. Our results suggest that combining Metformin with Sorafenib may be able to repress the bulk of tumor cells, but as with other anti-cancer drugs, may leave LRCC behind leading to cancer recurrence. Therefore, liver LRCC, unlike other types of CSC, are relatively resistant to the reported anti-cancer stem cell drug metformin. This is the first report that there is a type of CSC that is not relatively resistant to the CSC-targeting drug. Our findings suggest that a drug targeting LRCC may be critically needed to target CSC and prevent cancer recurrence. These may significantly contribute to the understanding of Metformin's anti-cancer effects and the development of novel drugs targeting the relatively resistant LRCC. Final Decision: yes" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, Enzyme-Linked Immunosorbent Assay, Female, Flow Cytometry, Humans, Male, Middle Aged, Monocytes, Neutrophils, Phagocytosis, Reactive Oxygen Species, Young Adult." }, { "role": "user", "content": "Is impaired phagocytosis and reactive oxygen species production in phagocytes associated with systemic vasculitis? Context: Anti-neutrophil cytoplasmic antibodies associated vasculitides (AAV) is a group of autoimmune diseases, characterized by small vessel inflammation. Phagocytes such as neutrophils and monocytes are the main effector cells found around the inflamed vessel wall. Therefore, we wanted to investigate aspects of function and activation of these cells in patients with AAV. Flow cytometry was used to evaluate: the expression of activation markers (CD11c, CD62L, CD177 and C5aR); the number of recently released neutrophils from bone marrow, defined as CD10(-)D16(low) cells in peripheral blood; and the capacity of peripheral blood monocytes and polymorphonuclear leukocytes (PMN) to produce reactive oxygen species and to phagocytose opsonized bacteria. AAV patients (n = 104) showed an increase of CD10(-)CD16(low) neutrophils and total PMN in peripheral blood, suggesting a combination of increased bone marrow release and prolonged survival. An increased percentage of AAV PMN expressed CD177 but no other signs of activation were seen. A decreased production of reactive oxygen species was observed in AAV phagocytes, which was associated with disease activity. Moreover, granulocytes from patients with microscopic polyangiitis showed lower oxidative burst capacity compared to patients with granulomatosis with polyangiitis or eosinophilic granulomatosis with polyangiitis. In addition, decreased phagocytosis capacity was seen in PMN and monocytes." }, { "role": "assistant", "content": "Our results indicate that phagocytes from AAV patients have impaired function, are easily mobilized from bone marrow but are not particularly activated. The association between low reactive oxygen species formation in PMN and disease severity is consistent with findings in other autoimmune diseases and might be considered as a risk factor. 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, Aging, Depression, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Risk Factors, Schizophrenia, Schizophrenic Psychology, Suicidal Ideation." }, { "role": "user", "content": "Does age moderate the relationship between depressive symptoms and suicidal ideation in middle-aged and older patients with schizophrenia and subthreshold depression? Context: Suicidal deaths in middle-aged and older individuals with schizophrenia are a public health concern. Depression and schizophrenia are major risk factors for suicide. However, it is unknown whether age moderates the relationship between depression and suicidal ideation in patients with schizophrenia and subthreshold depression. Suicidal ideation was assessed with the InterSePT Scale for Suicidal Ideation and the Clinical Global Impression-Suicide Severity Scale in outpatients older than 39 years with schizophrenia and subthreshold depression (n = 213). Using linear regression, we examined whether depression (based on Calgary Depression Rating Scale scores), age, and \"age by depressive symptoms\" predicted suicidal ideation. Depressive symptoms predicted suicidal ideation. Neither age nor \"depressive symptoms by age\" predicted suicidal ideation." }, { "role": "assistant", "content": "In this population, age does not appear to moderate the relationship between depressive symptoms and suicidal behavior. Thus, assessing depressive symptoms as a risk factor is important at all ages in this population." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Animals, Blotting, Western, Carcinoma, Hepatocellular, Cell Proliferation, Cyclin D1, Gene Expression Regulation, Neoplastic, Hep G2 Cells, Humans, Liver Neoplasms, MafB Transcription Factor, Male, Mice, Inbred BALB C, Mice, Nude, Promoter Regions, Genetic, Protein Binding, RNA Interference, Reverse Transcriptase Polymerase Chain Reaction, Transplantation, Heterologous, Up-Regulation." }, { "role": "user", "content": "Does transcription Factor MafB promote Hepatocellular Carcinoma Cell Proliferation through Up-Regulation of Cyclin D1? Context: MafB, a member of the Maf transcription factor family, plays a key role in the regulation of pancreatic alpha and beta cell differentiation. However, its function in the control of cancer cell proliferation remains unknown. The mRNA and protein expression levels of MafB in hepatocellular carcinoma tissues and adjacent non-tumor normal specimens were determined by real-time RT-PCR and Western blot, respectively. Report assay was performed to determine whether the regulation of Cyclin D1 by MafB is at the transcriptional level. The binding of MafB to the Cyclin D1 promoter was determined by Chromatin Immunoprecipitation (ChIP) assays. To determine the potential oncogenic effects of MafB in vivo, HepG2 cells transfected with adenovirus containing empty vector or MafB were injected subcutaneously to the skin under the front legs of the nude mice. In the current study, we showed that MafB was markedly up-regulated in hepatocellular carcinoma (HCC) tissues and cells. Enforced overexpression of MafB enhanced, while its deficiency inhibited HCC cell proliferation. Mechanistically, Cyclin D1, an important regulator of cell cycle progression, was identified as a direct transcriptional target of MafB. Consistently, knockdown of Cyclin D1 largely attenuated the proliferative roles of MafB in HCC cells. Importantly, MafB overexpression significantly promoted cancer cell growth in mice." }, { "role": "assistant", "content": "Collectively, our results identified a novel HCC regulatory pathway involving MafB and Cyclin D1, the dysfunction of which drives proliferative character in HCC. 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": "Sickle cell anemia is associated with which type of RCC?" }, { "role": "assistant", "content": "The correct answer is RENAL CELL CARCINOMA MC type of RCC: Clear cell carcinoma MC type seen with dialysis associated cystic disease: Papillary carcinoma Exclusively associated with sickle cell treat: Medullary cell carcinoma Best prognosis: chromophobe carcinoma" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical 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: Bacteria, Bacteriophages, Biodiversity, Feces, Genome, Viral, Humans, Microbiota, Open Reading Frames." }, { "role": "user", "content": "Do chemostat culture systems support diverse bacteriophage communities from human feces? Context: Most human microbiota studies focus on bacteria inhabiting body surfaces, but these surfaces also are home to large populations of viruses. Many are bacteriophages, and their role in driving bacterial diversity is difficult to decipher without the use of in vitro ecosystems that can reproduce human microbial communities. We used chemostat culture systems known to harbor diverse fecal bacteria to decipher whether these cultures also are home to phage communities. We found that there are vast viral communities inhabiting these ecosystems, with estimated concentrations similar to those found in human feces. The viral communities are composed entirely of bacteriophages and likely contain both temperate and lytic phages based on their similarities to other known phages. We examined the cultured phage communities at five separate time points over 24 days and found that they were highly individual-specific, suggesting that much of the subject-specificity found in human viromes also is captured by this culture-based system. A high proportion of the community membership is conserved over time, but the cultured communities maintain more similarity with other intra-subject cultures than they do to human feces. In four of the five subjects, estimated viral diversity between fecal and cultured communities was highly similar." }, { "role": "assistant", "content": "Because the diversity of phages in these cultured fecal communities have similarities to those found in humans, we believe these communities can serve as valuable ecosystems to help uncover the role of phages in human microbial communities. 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": "Facial N. stimulation during testing of nerve is indicated by contraction of which of the following muscle?" }, { "role": "assistant", "content": "The correct answer is Orbicularis oris is a muscle of facial expression innervated by facial nerve. It acts as an orbital sphincter (closes eyelid). Palpebral poion gently closes and orbital poion tightly closes the eyelid.Muscles of facial expression supplied by facial nerve are:OccipitofrontalisProcerusOrbicularis oculiNasalisLevator labii superioris alaequi nasiAnterior auricular muscleSuperior auricular musclePosterior auricular muscleFacial nerve also supplies posterior digastric, stapedius and stylohyoid muscles. Masseter and temporalis are supplied by mandibular division of trigeminal nerve." } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: INTRODUCTION, METHODS, RESULTS. Meshes: Brazil, Democracy, Health Policy, Humans, Public Health, Public Policy." }, { "role": "user", "content": "Participatory health councils and good governance: healthy democracy in Brazil? Context: The Brazilian Government created Participatory Health Councils (PHCs) to allow citizen participation in the public health policy process. PHCs are advisory bodies that operate at all levels of government and that bring together different societal groups to monitor Brazil's health system. Today they are present in 98% of Brazilian cities, demonstrating their popularity and thus their potential to help ensure that health policies are in line with citizen preferences. Despite their expansive reach, their real impact on health policies and health outcomes for citizens is uncertain. We thus ask the following question: Do PHCs offer meaningful opportunities for open participation and influence in the public health policy process? Thirty-eight semi-structured interviews with health council members were conducted. Data from these interviews were analyzed using a qualitative interpretive content analysis approach. A quantitative analysis of PHC data from the Sistema de Acompanhamento dos Conselhos de Saude (SIACS) database was also conducted to corroborate findings from the interviews. We learned that PHCs fall short in many of the categories of good governance. Government manipulation of the agenda and leadership of the PHCs, delays in the implementation of PHC decision making, a lack of training of council members on relevant technical issues, the largely narrow interests of council members, the lack of transparency and monitoring guidelines, a lack of government support, and a lack of inclusiveness are a few examples that highlight why PHCs are not as effective as they could be." }, { "role": "assistant", "content": "Although PHCs are intended to be inclusive and participatory, in practice they seem to have little impact on the health policymaking process in Brazil. PHCs will only be able to fulfil their mandate when we see good governance largely present. This will require a rethinking of their governance structures, processes, membership, and oversight. If change is resisted, the PHCs will remain largely limited to a good idea in theory that is disappointing in 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": "Chalazion all are true EXCEPT:" }, { "role": "assistant", "content": "The correct answer is ANSWER: (B) Horizontal incision to be made to squeeze out contentsREF: Khurana 4th ed p. 347'Vertical incision is given on the conjunctiva to prevent injury to meibomian ducts and on the skin side horizontal incision is given\"" } ]

[ { "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 name of the sample group of individuals when followed for successive examination to evaluate the effect of oral preventive programmes is:" }, { "role": "assistant", "content": "The correct answer is None" } ]

[ { "role": "system", "content": "Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response. Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Cohort Studies, Confidence Intervals, Cross-Sectional Studies, Educational Status, Estrogen Replacement Therapy, Female, Follow-Up Studies, Humans, Menopause, Middle Aged, Odds Ratio, Patient Acceptance of Health Care, Portugal, Prevalence." }, { "role": "user", "content": "Have life prevalence of hormone replacement therapy and profile of users changed among women with self-reported menopause in the last two decades in Porto , Portugal? Context: To describe the prevalence of hormone replacement therapy (HRT) in a Portuguese population by menopause date, from 1985 to 2005. Participants were 382 postmenopausal women assessed as part of the ongoing follow-up evaluation of a cohort of Portuguese adults. Data were collected on education, lifetime use of oral contraceptives, menopause status, spontaneous or surgical menopause, and lifetime use of HRT. HRT use was analysed yearly and across 5-year menopause intervals, from 1985 to 2005. Overall, 40.1% of women who entered menopause between 1985 and 2005 reported having ever used HRT. No significant trend was observed throughout the 20-year period or across the 5-year intervals. Additionally, no trend was observed in HRT prevalence among women who either reported surgical or spontaneous menopause. Median education increased significantly among both HRT users and non-users; however, from 1990 onwards, HRT users were significantly more educated than non-users." }, { "role": "assistant", "content": "The prevalence of use of HRT and characteristics of users among Portuguese women living in Porto and entering menopause in the last 20 years have not changed substantially. Final Decision: no" } ]