Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
a 54-year - old male patient with a height of 170 cm and weight of 77 kg visited a private hospital due to a headache and weakness in left muscle that started the day before his hospital visit . during the examination ,
the patient showed decreased consciousness , and internal hemorrhaging in the cerebral ventricle was observed in the ct scan , hence he was transferred to our hospital .
when he arrived at the emergency room , the patient was semi - conscious and had difficulty in breathing , and his glassgow coma scale ( gcs ) showed severe head trauma with a total score of 8 or lower . the head ct scan revealed worsened stage of hemorrhage in the cerebral ventricle , so he was immediately intubated and transferred to the icu . a day after entering the icu ,
the hemorrhaging in the patient was still worsened according to the ct scan and he was in a semi - comatose state ; therefore , an extra ventricular drainage ( evd ) was done to decrease the pressure in the brain and hematoma aspiration was also carried out .
in addition , an emergency tracheostomy was done at the same time since long term mechanical ventilation was expected .
preoperative vitals were a blood pressure of 150/80 mmhg , a heart rate of 100/min , a respiration rate of 24/min , a body temperature of 38 , and a spo2 of 97% . after administering 0.2 mg of glycopyrrolate
after complete loss of consciousness , muscle relaxation was achieved with 8 mg of vecuronium .
alfentanil at a concentration of 1.0 mg was administered to minimize hemodynamic changes when replacing the tube and at the same time anesthesia was maintained with o2 supply of 1 l / min , air supply of 2 l / min , and 2.0 vol% of sevoflurane . considering the difficulty in maintaining airway characteristics in head surgery , the previously intubated polyvinylchloride ( pvc ) plain tube was replaced with a reinforced tube .
the patient 's vitals immediately after intubation were blood pressure of 130/70 mmhg , a heart rate of 95/min , and a spo2 of 98% .
starting from the evd , the operation proceeded smoothly and the tracheostomy was done in 2 hours and 30 minutes .
ten minutes after starting the tracheostomy , the fio2 increased to 1.0 . while adjusting for bleeding around the tracheal cartilage with monopolar coagulation before inserting the tracheostomy tube , a fire of about 15 cm in size suddenly started perpendicular to the direction of the trachea .
the supply of sevoflurane and 100% o2 was immediately stopped after the initiation of fire and manual ventilation was done at a fio2 of 0.2 .
normal saline was used to extinguish the fire and soon the condition was brought under control .
the endotracheal tube ( reinforced tube ) was taken out , tracheostomy tube was intubated to maintain manual ventilation , and spo2 was again increased to 98% .
vitals before and after the tracheostomy were stable except for the temporary decrease in spo2 .
the condition of the tube after extubation was as follows : the part directly above the cuff had holes due to melting from the heat ; the coil inside the tube had melted , and there was overall charring ( fig .
the operation was completed without occurrence of any further incident , and since the patient was still in a semi - coma state , he was transferred to the icu while maintaining bag ventilation through the tracheostomy tube . in the abga
conducted directly after being transferred to the icu , the ph was 7.406 ; the pco2 was 33.6 mmhg ; the po2 was 121 mmhg ; the hco3 was 20.7 mmhg , and oxygen saturation was 97.8% .
there were no observable changes in the chest x - rays both , before and after the operation ( fig .
the patient showed no improvement in consciousness during continuous mechanical ventilation ; therefore , 5 days after the surgery , the patient was transferred to another hospital as per the wishes of the guardian .
there were no irregularities in the chest x - ray images and clinical symptoms after being monitored for 4 months post - surgery ( fig .
intra - tracheal tube fire is rare and yet a critical emergency that can cause fatal complications . despite numerous studies on the cause and prevention of fire ,
of course , when a fire occurs , the type of operation and the cause for the fire are different .
it can occur during operations using lasers , in tracheostomies , and there exists reported incidents for double - lumen tubes .
the three important factors that contribute to the occurrence of intra - tracheal fires are oxygen , fuel , and heat .
the high concentration of oxygen is the main cause of fire , but there are reports of fires occurring at 50% oxygen concentrations and can even occur in 25% oxygen environments , which is similar to the atmosphere .
therefore , caution is needed especially in tracheostomy since 100% highly concentrated oxygen is typically used , which is characteristic of the operation . for fuel , the intra - tracheal tube itself is the problem since tubes generally consist of pvc material . in tracheostomy ,
the risk of fire is increased since fire - resistant tubes are not used , unlike in other laser operations .
our present case also employed a reinforced tube , since tracheostomy was done after the neurosurgery , which is believed to be one of the reasons for the fire .
there are reports of heat occurring in all modes of cutting , coagulation , and blending .
therefore , when doing a tracheostomy , the use of electrocautery is minimized or a bipolar is used , but the bipolar can also cause sparks while coming into contact with tissue ; so it can not be considered as a completely safe alternative .
our case also considered these points and tried to minimize the use of electrocautery during the operation .
however , it is believed that the reinforced wire was exposed due to damage to the tube cover during the process of cutting into the mesh . there was immediate occurrence of hemorrhage before inserting the tube , and while urgently trying to control the bleeding , the electrocautery and reinforced wire are believed to have reacted to initiate the fire .
although there are a number of reports on intra - tracheal tube fires and numerous reports on the review , prevention , and countermeasures of tube fires , currently there are no accurate protocols established regarding this situation . however , when similar cases and reports are put together , there are some common suggestions and advice , which can be organized as follows : 1 ) use a tube of sufficient length so the tip of the tube can reach directly above the carina to minimize the possibility of damaging the balloon during tracheostomy , 2 ) avoid using flammable gases for anesthesia , 3 ) fill the balloon with normal saline , 4 ) maintain the safest minimum level of fio2 when using nitrous oxide or helium , 5 ) remove the by - products of the electrocautery ( smoke , burnt tissue ) through a sufficient amount of suction before performing the tracheostomy , 6 ) insert the tube deeply before the tracheostomy , 7 ) the surrounding area needs to have sufficient hemostasis before proceeding and avoid using electrocautery for the tracheostomy , and 8) when there is hemorrhage after a tracheostomy , carry out ligature of the hemorrhage with the tube and cuff in place , or use bipolar electrocautery .
there are also reports , which state that peep ventilation can decrease the risk of fire . whereas , rhee et al .
reported that by filling the balloon with normal saline and mucous lidocaine , tube fires can be prevented that can occur in laser operations as well as maintain the shape of the balloon and ventilation when there are punctures in the air balloon due to fire and other incidents .
additionally , maintaining the aridness of the operating room to prevent fires and preparing containers and ambu bags with normal saline in case of fire emergencies are also considered as important factors .
the above - mentioned methods may prevent fire emergencies , but necessary countermeasures to combat the occurrence of fire must also be devised
. the anesthesiologist needs to first check the state of the patient , quickly separate the pipe streaming anesthetic gas from the tube , and attempt ventilation with atmospheric air . at the same time , there needs to be cooperation amongst the surgeons to extinguish the fire .
dealing with a tube that has been on fire is another part that should not be ignored .
there is controversy regarding immediate extubation after the incidence of a tube fire . in the past ,
immediate extubation was recommended considering the chemical risks due to the evolution of toxic substances from the burnt tube and the damage to the trachea .
however , chee and benumof   argue that immediate extubation is not always the best option , considering that the damage from the fire is minimal in most of the cases of fire reported until now ; most of the patients undergoing tracheostomies have difficulties in maintaining their airways due to edema , which is the leading cause of morbidity and the increase in the death rate in accidents involving anesthesia is hypoventilation and hypoxia . in our case , immediate extubation and intubation of the endotracheal tube were done , but in post - operative examinations , there were no problems with the trachea itself and there was no chemical damage .
it is most important to consider the risk benefit on a case - by - case basis rather than setting a general rule regarding the timing of the extubation . in conclusion , it is important in tracheostomies to understand that though occurrence of fires are rare , they are still possible along with other risk factors and the surgeons must be attentive in terms of preventing the occurrence of fires .
caution needs to be taken , since tube fires can occur in unexpected areas such as the reinforced wire in our case . in addition
, when a tube fire does occur , it is very important to minimize additional damage or burns in the respiratory tract through appropriate and fast responses , and to determine a suitable time for extubation according to the specific situation .

Answer:
every operation could have a fire emergency , especially in the case of a tracheostomy .
 when a flammable gas meets a source of heat , the danger of fire is remarkable .
 a tracheal tube filled with a high concentration of oxygen is also a great risk factor for fire .
 intra - tracheal tube fire is a rare , yet critical emergency with catastrophic consequences .
 thus , numerous precautions are taken during a tracheostomy like , use of a special tube to prevent laser damage , ballooning of the tube with normal saline instead of air , and dilution of fio2 with helium or nitrogen . since the first recorded cases on tube fires , most of the fires were initiated in the balloon and the tip . in the present case report
 , however , we came across a fire incidence , which originated from the wire .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
onchocerciasis is the second leading infectious cause of blindness in the world , after trachoma . for centuries
black fly , the disease is prevalent in 19 african countries , and endemic in now just six american foci . in total ,
37 million people are thought to have active disease , with nearly all such cases in africa where over 100 million people live at risk of new infection .
this old world disease originated in africa and spread to new world via the slave trade , where it formerly existed in 13 discrete geographic foci within latin america . over 500,000 individuals live with a significant visual impairment from the disease , with an additional 270,000 individuals who have suffered from complete vision loss .
the simulian vector is infected when biting infected humans , and after maturation of larva within the fly , can then re - infect others during subsequent blood - meals .
these flies breed within and live around fast - flowing rivers ( hence the name  river - blindness  ) , and generally only persons living in and around these areas are at risk for infection after repeated biting
. transmission efficiency of most simulian species is quite low relative to other diseases ( e.g. , anopheles mosquito with malaria ) , although variable between regions , such that travelers are generally not at risk for this infection unless living long - term in endemic areas .
once deposited within the skin , infective stage larvas maturate and trigger the development of fibrous subcutaneous nodule in which they will mate and reproduce .
annually , female adult worms can release hundreds of thousands of microfilariae ( mf ) that migrate freely through skin with the potential for reaching and invading the eye . in the skin , mf cause pruritis and dermatitis , and eventually can lead to skin atrophy and discoloration (  leopard skin  ) . in the eye
the ocular pathology of this disease occurs in both anterior and posterior segments of the eye .
anteriorly , mf travel through scleral and subconjunctival tissues to reach the cornea whereby they attempt to penetrate and migrate through the cornea . within the corneal stroma ,
bacteria , an intracellular , rickettsia - like bacteria that lives symbiotically with mf and adult onchocerca worms .
interestingly , these organisms are extremely important to the lifecycle and reproduction of onchocerca , and without them , female adult worms can not reproduce . within the cornea , as with other tissues , release of wolbachia elicits an immune response and inflammation .
this process clinically appears in the cornea as a punctate keratitis ( pk ) , lesions that gradually resolve over 23 months as the mf are degraded by immune cells .
the prevalence of pk has served as the cornerstone for evaluating the progress of mass ivermectin therapy during recent elimination campaigns in the americas .
repeated mf - associated corneal insults eventually lead to sclerosing keratitis ( opacification and scarring of the cornea ) , a major cause of onchocercal - related visual loss . a large proportion of visual morbidity and blindness caused by this disease , however , is due to posterior pole lesions that persist even after ivermectin therapy.[1416 ] in the posterior segment of the eye , mf invade retinal tissues causing chronic chorioretinitis , inflammation , scarring , and in some cases optic atrophy and glaucoma .
it is likely that dying mf in these tissues trigger an inflammatory response there , one that is potentially promoted by cross reactivity between o. volvulus antigen ( ov39 ) and human retinal pathogen ( hr44 ) found in the optic nerve and neural epithelial layers of the retina.[1719 ] interestingly , onchocercal chorioretinitis continues despite ivermectin therapy and extermination of the parasite from the eye , potentially as a result of an autoimmune response provoked by the parasite .
diagnosing onchocerciasis relies on demonstration of characteristic eye pathology ( visible mf in the cornea or anterior chamber ) or demonstration of mf within the skin . on the individual level , visible mf in the anterior segment
are specific to onchocerciasis ; however , it is often difficult to observe mf in the anterior chamber , and punctuate keratitis lesions are fleeting and can be nonspecific for onchocerciasis if the degraded mf is not visible within the lesion . at lower levels of microfiladermia ,
skin - snips , a superficial ( dermal ) biopsy of 13 mg , examined microscopically for mf are invasive and suffer from poor sensitivity in patients with low levels of microfiladermia .
pcr examination of skin snips improves this situation , although sensitivity is still low in such persons , making this tool less useful in endemic areas where ivermectin has been used to treat this disease for years .
skin patch testing with diethylcarbamazine ( dec ) has been shown as a good alternative to skin snip evaluations in africa .
this test relies upon dec killing of mf within the dermis and subsequent provocation of a hypersensitivity reaction ( i.e. , localized mazzoti reaction ) .
advantages over skin snip evaluation ( noninvasive , better patient acceptance ) , although can be operationally difficult ( patches can fall off , patients must return in 24 h for test reading ) . the sensitivity and specificity of the dec patch test
is not yet clear , although recent studies using newer formulations suggest its utility in monitoring for infection within mass onchocerciasis treatment programs in africa .
serologic antibody tests using recombinant antigens , such as the ov-16 , can be useful , but can not distinguish between past and active infection.[2629 ] in addition , the sensitivity of this assay is questionable , with at least one study showing that a large percentage of those with active eye disease living in endemic areas have negative ov-16 results .
a highly specific antigen detection test capable of diagnosing active infection has been reported in the literature , but to date , has received little evaluation .
the development of a highly specific and sensitive test capable of determining active onchocercal infection remains an imperative for public health campaigns seeking to control and eliminate this parasite .
the development of a safe and effective macrofilaricidal drug has been long sought for this disease . for years ,
ivermectin , a macrocyclic lactone , has been the mainstay of therapy ; however , ivermectin kills only the mf . in effect
, ivermectin serves as a birth control device for adult worms , in that female worms are temporarily sterilized for an average of 6 months , preventing the release of mf during that time .
consequently , periodic single dose oral treatment prevents the onset of new ocular and dermal lesions and reduces transmission as the vector is less exposed to mf during its feeding on human skin .
ocular barrier , thus avoiding intraocular killing of mf and subsequent intraocular damage due to inflammation .
however , new therapies targeting the endosymbiotic wolbachia within the adult worms have now been proven to be effective in causing long - term ( and potentially permanent ) sterilization of adult worms and early worm death .
doxycycline treatment ( 100mg / day ) for 6 weeks with a single dose of ivermectin has become the treatment of choice for individuals based on recent clinical trial data , although 4 week courses of doxycycline or rifampin are also effective [ table 1 ] . from a public health perspective , however , the mass treatment of affected populations with doxycycline is difficult given the length of necessary therapy and the potential for re - infection in endemic areas .
however , these therapies may be of particular use in areas of co - endemicity with loiasis where mass distribution of ivermectin is complicated by potential adverse events in patients co - infected with loiasis . studies evaluating the efficacy of antibiotic therapy directed at onchocercal endosymbiotic wolbachia bacteria
the development of a safe and effective macrofilaricidal drug has been long sought for this disease . for years ,
ivermectin , a macrocyclic lactone , has been the mainstay of therapy ; however , ivermectin kills only the mf . in effect
, ivermectin serves as a birth control device for adult worms , in that female worms are temporarily sterilized for an average of 6 months , preventing the release of mf during that time .
consequently , periodic single dose oral treatment prevents the onset of new ocular and dermal lesions and reduces transmission as the vector is less exposed to mf during its feeding on human skin .
ocular barrier , thus avoiding intraocular killing of mf and subsequent intraocular damage due to inflammation .
however , new therapies targeting the endosymbiotic wolbachia within the adult worms have now been proven to be effective in causing long - term ( and potentially permanent ) sterilization of adult worms and early worm death .
doxycycline treatment ( 100mg / day ) for 6 weeks with a single dose of ivermectin has become the treatment of choice for individuals based on recent clinical trial data , although 4 week courses of doxycycline or rifampin are also effective [ table 1 ] . from a public health perspective , however , the mass treatment of affected populations with doxycycline is difficult given the length of necessary therapy and the potential for re - infection in endemic areas .
however , these therapies may be of particular use in areas of co - endemicity with loiasis where mass distribution of ivermectin is complicated by potential adverse events in patients co - infected with loiasis .
two large public health campaigns currently operate worldwide with goals of either elimination or control of this parasite .
the cornerstone of these campaigns is the mass distribution of ivermectin , delivered semi - annually or annually , and donated in perpetuity for this cause by merck .
when ivermectin is delivered as such in the long - term , sustained fashion to large percentages of at risk populations ( e.g. , > 85% is the goal in latin america ) , dermal mf levels fall such that new eye lesions and transmission are prevented .
the african programme for onchocerciasis control ( apoc ) currently strives to eliminate onchocerciasis as a
public health concern  by delivering ivermectin to populations where dermal mf prevalence of 40% .
recent studies in mali and senegal indicate a tremendous reduction in microfilaridermia and a profound reduction in the prevalence of black fly infection indicating that elimination is feasible in at least some african foci . in the americas ,
the onchocerciasis elimination program for the americas ( oepa ) strives to completely eliminate the disease by treating 85% of at risk persons with ivermectin every 6 months . as of 2010 ,
7 of the 13 endemic foci have been declared free of onchocerciasis , treatment with ivermectin therapy has stopped , and surveillance for disease recrudescence will continue for 3 years prior to a declaration of disease elimination in these foci .
currently , active eye disease only exists within several foci within venezuela and brazil , where treatment coverage has been more recently increased and it is anticipated that elimination of eye disease in these areas will follow in subsequent years .
as anti - wolbachia therapy has been shown to be effective in clinical trials , its optimal use within these public health campaigns is not yet clear . within latin america ,
conceivably , anti - wolbachia therapy could be used in limited circumstances either to  mop - up  or
catch - up  in regions that continue to have active disease or where ivermectin coverage has been less than complete . as elimination with ivermectin looms near in latin america , however , it is not clear that such alternative therapies will ever be needed .
within africa , at least one large scale community directed treatment program using doxycycline has been reported . as with latin america , a role for mass doxycycline therapy there has not yet been clearly defined , and might differ by region based on vector competence , parasite pathogenicity , public health capacity , and the ability to deliver 46 weeks of such therapy in mass fashion .
lastly , anti - wolbachia would theoretically become very important in either region should the parasite develop resistance to ivermectin . although ivermectin resistance has not definitively been reported , it remains a concern and anti - wolbachia therapy offers an alternative should such an event occur .
in latin america , oepa has declared the year 2015 as a goal for the final year of mass treatment with ivermectin for onchocerciasis , and in africa great reductions in disease have been documented with mass ivermectin therapy . although current progress with these mass ivermectin drug campaigns is encouraging , improved diagnostics and further development and evaluation of anti - wolbachia and other drug therapies will improve the chances that these large regional public health initiatives will achieve long - term success .

Answer:
for decades , onchocerciasis ( or river blindness ) was one of the most common infectious causes of blindness in the world .
 primarily an infection of africa , with limited distribution in the new world , disease due to the nematode onchocerca volvulus is rapidly diminishing as a result of large public health campaigns targeting at risk populations in africa and the americas . existing and newly - developed treatment strategies
 offer the chance to eliminate onchocercal ocular morbidity in some parts of the world .
 this article reviews these treatment strategies , current clinical and epidemiologic aspects of onchocerciasis , and the next steps toward elimination .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
percutaneous nephrolithotomy ( pcnl ) is a widely accepted treatment for urinary calculi > 2 cm or resistant to other modalities .
complications of this procedure are well reported ; however , to our knowledge no mention has occurred in the literature of a retained nephrostomy tube after pcnl .
thus , we will present the management of a retained council tip catheter after pcnl .
a 76-year - old gentleman underwent a pcnl for a 2.2x1.4-cm lower pole calculus via an uneventful upper pole puncture .
incomplete stone fragmentation was obtained using the ultrasonic lithotripter ; therefore , a 24-french council tip nephrostomy tube was placed , the balloon was inflated with 3 ml of sterile water , and the patient was scheduled for a second look nephroscopy when a holmium laser was available .
one week later at the second look nephroscopy , attempts to deflate the catheter balloon were unsuccessful .
after transection of the balloon port valve , attempted passage of a 0.038 movable core bentson guidewire down the balloon port was unsuccessful .
an antegrade nephrostogram outlined the catheter balloon within the renal pelvis ( figure 1 ) . with the c - arm in a vertical orientation ,
an 18-gauge chiba needle ( cook , bloomington in ) was advanced through a puncture site directly over the balloon under fluoroscopic guidance .
the balloon was successfully punctured by the chiba needle with clear efflux through the needle .
contrast was then instilled through the chiba needle to evaluate the integrity of the balloon and exclude the possibility of retained balloon fragments from a ruptured balloon ( figure 2b ) .
flexible nephroscopy was performed to evaluate for balloon fragments , which were not identified , and to remove the lower pole stone .
( a ) chiba needle ( white arrow ) has punctured and drained the catheter balloon .
( b ) contrast injected via chiba needle has filled the catheter balloon ( dark arrow ) and confirmed its integrity .
a retained urethral catheter due to balloon malfunction is a well - recognized urologic complication .
many solutions to this problem have been attempted , including overinflation until rupture , puncture of the balloon via a wire through the balloon port , and puncture of the balloon under ultrasound guidance via a suprapubic or transvaginal route . given this infrequent but known complication of balloon - type cystostomy catheters , it is not surprising that a similar complication occurred in our patient .
our familiarity with the use of the chiba needle and 3-dimensional fluoroscopy for percutaneous renal access facilitated percutaneous puncture of the catheter balloon .
if equipment or experience limits the urologist 's ability to perform this technique , collaboration with an interventional radiologist using conventional c - arm or ultrasound for guidance should be considered .
prevention of a retained catheter due to a balloon - port malfunction requires use of sterile water instead of saline and limiting the time of catheter placement .
malecot tubes have been utilized for nephrostomy drainage , but these tubes are not without difficulties . tissue bridge formation over flanges of the tube has occurred , requiring endoscopic removal .
tubeless pcnl would avoid these issues entirely ; however , the tubeless technique is contraindicated in the face of significant postoperative bleeding , urinary extravasation , ureteral obstruction , or anticipated need for a second - look nephroscopy .
pigtail catheters following pcnl may represent a good alternative for drainage and access , while minimizing the risk of catheter malfunction or retention .

Answer:
percutaneous nephrolithotomy is a widely accepted treatment for urinary calculi , but it is not without complications . we present the case of a 76-year - old male with a retained council tip catheter after percutaneous nephrolithotomy .
 fluoroscopic guidance was used to perform percutaneous puncture of the catheter balloon , and the catheter was removed without complication .
 advantages of various nephrostomy tube designs and additional measures to prevent this type of complication are discussed .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:

 lipoma is a rare tumor but can be found at various sites in the abdominal cavity ( fig .
2 ) . if it is of a large size , it can compress adjacent tissues or organs and become heterogeneous . in such cases ,
imaging is incapable of distinguishing it from liposarcoma.lipoblastoma is a type of a benign tumor with embryonic fat .
it is usually found in the extremities and torso whereas abdominal cavity belongs to its rather rare sites . in us , such tumors are echogenic .
lipoblastomatosis is a form of this tumor characterized by aggressive localized growth.hibernoma is a benign tumor , mainly composed of brown fat , in whose cells the numbers of mitochondria responsible for enhanced metabolic activity are impressive .
these tumors are rarely encountered in the retroperitoneal space but are also echogenic with well - or ill - defined margins .
their characteristic feature is evident flow in color doppler.other benign tumors with a fat component , such as myolipoma , angiomyolipoma and myelolipoma , apart from teratoma ( which is usually benign ) , tend to be homogeneous with echogenicity increased to various degrees ( fig . 3 , 4 ) .
only gonadal germ cell tumors , such as teratoma and dermoid cyst that arise from several germ layers , frequently have irregular echotexture due to the presence of fluid sebum , hair , soft tissues and bony elements .
that is why they are encountered in solid , cystic or solid - cystic forms ( fig .
mature fat tissue can also be found in choristoma which , however , is not a neoplasm .
lipoma is a rare tumor but can be found at various sites in the abdominal cavity ( fig .
2 ) . if it is of a large size , it can compress adjacent tissues or organs and become heterogeneous .
it is usually found in the extremities and torso whereas abdominal cavity belongs to its rather rare sites . in us , such tumors are echogenic .
hibernoma is a benign tumor , mainly composed of brown fat , in whose cells the numbers of mitochondria responsible for enhanced metabolic activity are impressive .
these tumors are rarely encountered in the retroperitoneal space but are also echogenic with well - or ill - defined margins .
other benign tumors with a fat component , such as myolipoma , angiomyolipoma and myelolipoma , apart from teratoma ( which is usually benign ) , tend to be homogeneous with echogenicity increased to various degrees ( fig . 3 , 4 ) .
only gonadal germ cell tumors , such as teratoma and dermoid cyst that arise from several germ layers , frequently have irregular echotexture due to the presence of fluid sebum , hair , soft tissues and bony elements .
that is why they are encountered in solid , cystic or solid - cystic forms ( fig .
mature fat tissue can also be found in choristoma which , however , is not a neoplasm .
two views show lipoma ( arrows ) as a slightly echogenic lesion in the supraperitoneal fat three lipomas ( l ) in the small bowel mesentery , which in computed tomography showed density ranging from 57 to 74 hounsfield units two views show angiomyolipoma ( l ) located entirely in the adipose capsule of the right kidney .
an arrow points to the site of regrowth in the form of the beak sign myelolipoma in the right suprarenal field ( arrow ) as a visible hyperechoic mass a heterogeneous mass arising from the retroperitoneal space is a mature teratoma with slight calcifications ( arrows )
liposarcoma is the only malignancy deriving from adipose tissue that is relatively frequently encountered in the retroperitoneal space ( it constitutes nearly 1/3 of sarcomas at this site and 1015% of all neoplasms of this type ) . according to the who , these tumors can be divided into five histological subtypes depending on the grade of their differentiation ( well - differentiated , dedifferentiated , myxoid , round cell , pleomorphic ) , which is relevant in prognosis .
its presence can be indicated only by uneven margins and heterogeneous enhancement upon contrast agent administration .
poorly differentiated subtypes account for even 40% of local relapses , and metastases are observed in 17% of cases . as has already been mentioned , well - differentiated liposarcoma is difficult to distinguish from lipoma also in sonography .
one of the differential criteria can be tumor 's reaction to compression with a transducer ( fig .
more aggressive forms of this tumor , however , tend to be unevenly delineated , present heterogeneous echotexture and infiltrate adjacent tissues ( fig .
myxoid liposarcoma is characterized by a cystic structure and should be distinguished e.g. from lymphangioma , teratoma or cystic mesothelioma .
no lesion compressibility when pressure is applied with the transducer ( arrow ) heterogeneous retroperitoneal liposarcoma infiltrates into adjacent tissues ( arrows ) mesenteric liposarcoma with pathological vascularity finally , immature teratoma must be mentioned .
it is a primary germinal tumor that can contain adipose tissue and occurs at similar sites .
they are characterized by the predominance of a solid component , and the only sign suggesting a malignancy is poorly circumscribed margins . a chance for malignant transformation
cystic lesions can correspond to mesenteric cysts , lymphatic or vascular angiomatosis and even a cystic form of peritoneal mesothelioma , which is considered a benign lesion ( fig .
the differential diagnosis of these pathologies should include ovarian cystic tumors , endometrial cysts and cystic tumors growing beyond organs , e.g. of the pancreas , kidneys or liver .
solid tumors found at these sites include : leiomyoma and rhabdomyoma , angiomas as well as stromal , neurogenic and desmoid tumors ( fig .
desmoid tumors , also called fibromatosis , are an interesting group of benign tumors that exhibit local aggressiveness and have considerable tendency to recur ( in approximately 50% of cases ) .
all lesions were hypoechoic with slightly irregular echo patterns , 59% of cases were well - defined and 41% had irregular margins .
the differential diagnosis should include sarcomas , mainly the two types that are most frequently found in soft tissues : histiocytic fibrosarcoma and liposarcoma , i.e. lesions characterized by higher echogenicity .
it is of note that desmoid tumors frequently coexist with familial adenomatous polyposis , which is estimated at 918% of cases . of all imaging modalities ,
some authors recommend punch or even surgical biopsy in the event of doubts . in this case ,
mesenteric lymphangioma as a multilocular lesion without flow ( arrow ) retroperitoneal neuroblastoma in a 13-year - old ( arrows ) .
aorta , v  inferior vena cava desmoid , poorly vascularized tumor ( d ) in the small bowel mesentery
these changes are rarely encountered but they represent a rich spectrum of mainly mesenchymal neoplasms : fibrosarcoma , malignant fibrous histiocytoma , hemangiopericytoma , leiomyosarcoma , rhabdomyosarcoma and gastrointestinal stromal tumors ( fig .
an epithelioid malignant neoplasm encountered at this site is malignant peritoneal mesothelioma , a lesion that almost exclusively develops in males in the fifth and sixth decade of life .
it can assume two morphological forms : irregular peritoneal infiltration without ascites ( dry appearance ) ( fig .
13 ) and nodular thickening of the peritoneum and greater omentum with ascites ( wet appearance ) .
lesions of this type must be distinguished from papillary serous carcinoma of the peritoneum ( a rare neoplasm found in elderly women ) , abdominal carcinomatosis , in which ascites prevails over implants , and peritoneal tuberculosis , in which there are no tumorous lesions ( but ascites is present , the greater omentum is thickened with preserved smooth surface and the mesenteric lymph nodes are enlarged ) .
lymphomas , however , are characterized by considerable abdominal lymphadenopathy , rare and slight ascites and no omental involvement .
rhabdomyosarcoma with rich vascularity in the retroperitoneal space ( arrows ) two views present poorly vascularized malignant mesothelioma of the greater omentum ( m )
this is the most numerous group with prevailing carcinoma foci , mainly deriving from abdominal organs , such as pancreas , stomach , large bowel or ovaries .
these lesions spread by direct extension , via the lymphatic system or blood stream and through the peritoneal cavity . their echotexture can vary .
14 ) and thickened parietal peritoneum ( its normal thickness is up to 1.5 mm ) ( fig .
echogenic lesions that only slightly differ from the surrounding tissues are the hardest to find ( fig .
peritoneal sites at which carcinoma implants tend to develop are : the recto - uterine pouch , right iliac fossa , right paracolic gutter and the region of the upper sigmoid mesentery .
moreover , ovarian carcinoma cells frequently migrate to the supra- and subhepatic area ( fig .
well - designed prospective studies have proven ultrasound imaging to be highly useful in detecting abdominal carcinomatosis .
it occurred that lesions in the greater omentum were the easiest to detect ( 91% ) whereas those in the small bowel mesentery were the hardest to find ( 67% ) .
moreover , ultrasound guidance enables one to obtain diagnostically valuable material for cytological and histological analysis in the vast majority of such cases .
metastasis of malignant melanoma ( m ) from the interscapular space to the small bowel mesentery peritoneal carcinomatosis of ovarian carcinoma . thickened hypoechoic parietal peritoneum with signs of vascular flow ( arrows ) two views show a hyperechoic implant of ovarian carcinoma in the gastrocolonic ligament ( arrows ) ovarian carcinoma implants in the pouch of morison ( arrows ) another rare neoplasm encountered in fatty bodies of the abdominal cavity is non - hodgkin lymphoma .
the involvement of the small bowel mesentery , with prominent , large mesenteric lymph nodes , is observed to occur in a half of patients with this neoplasm .
these lymph nodes , together with the superior mesenteric vessels , create a so - called  sandwich  image ( fig .
it is usually a small neuroendocrine neoplasm located in the small bowel . sometimes , the first morphological sign of its existence is the presence of mesenteric abnormalities in the form of enlarged lymph nodes or a hypoechoic mass .
mesenteric thickening or contraction , which can lead to small bowel obstruction , is more rarely a predominant element of the image . any doubts in the assessment of these lesions require verification in computed tomography and , sometimes , magnetic resonance imaging . ultrasound imaging , however , enables precise , percutaneous sampling for cytological and histological analysis , which is worth remembering and applying .
sandwich  sign in the small bowel mesentery ( arrows ) created by enlarged lymph nodes surrounding the superior mesenteric vessels  a manifestation of non - hodgkin lymphoma extranodal location of follicular lymphoma in the small bowel mesentery ( arrow ) lesions in the lymph nodes , which are relatively frequently affected by various neoplastic and non - neoplastic processes , have been presented only briefly since these issues are too broad to be included in this review .
authors do not report any financial or personal connections with other persons or organizations , which might negatively affect the contents of this publication and/or claim authorship rights to this publication .

Answer:
this article focuses on various cancerous lesions that are found beyond organs in the intra - abdominal fat and can be visualized with ultrasonography .
 these lesions are divided into five groups .
 the first group includes primary benign tumors containing adipocytes , such as lipoma , lipoblastoma , hibernoma and other lesions with an adipose tissue component , such as myolipoma , angiomyolipoma , myelolipoma and teratoma .
 the second group comprises primary malignant adipocytecontaining tumors , including liposarcoma and immature teratoma .
 the third group contains primary benign tumors without an adipocyte component that are located in intra - abdominal fat .
 this is a numerous group of lesions represented by cystic and solid tumors .
 the fourth group encompasses primary malignant tumors without an adipocyte component that are located in intra - abdominal fat .
 these are rare lesions associated mainly with sarcomas : fibrosarcoma , malignant fibrous histiocytoma , hemangiopericytoma and leiomyosarcoma .
 an epithelioid tumor at this site is mesothelioma .
 the last but not least group includes secondary malignant tumors without an adipocyte component located in intra - abdominal fat .
 this is the most numerous group with prevailing carcinoma foci . for each of these groups ,
 the authors present ultrasound features of individual lesions and discuss their differential diagnosis . in the vast majority of cases ,
 the material for cytological and histological analysis can be obtained during ultrasound - guided procedures .
 this is the advantage of this imaging modality .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
the leucine - rich , glioma inactivated 1 ( lgi1 ) gene was identified at the brake point of a reciprocal chromosome translocation t(10;19)(q24;q13 ) in the glioblastoma cell line t98 g .
lgi1 protein includes domains presumably involved in protein - protein interaction such as the leucine - rich repeats flanked by cysteine rich regions and the seven - bladed beta - propeller domain [ 24 ] .
lgi1 gene is predominantly expressed in brain , and it is associated with autosomal dominant lateral temporal epilepsy ( adlte ) [ 5 , 6 ] . although the specific function of lgi1 remains to be defined , it was suggested to form complexes with kv1.1 potassium channels , essential regulators of synaptic transmission in brain and also to be a ligand of the trans - membrane receptor adam22 , a protein highly expressed in brain whose function is still uncertain [ 7 , 8 ] .
the loss of lgi1 expression in most high - grade gliomas supported the function of tumor suppressor gene . in agreement with this hypothesis the reexpression of lgi1 in glioma cells , lacking endogenous lgi1 , impaired cell growth and migration capacity .
these phenotypic changes were linked with the downregulation of matrix metalloproteinase ( mmp ) genes by lgi1-mediated inhibition of the erk / mapk pathway . a role of lgi1 in the development of malignant brain tumors
was substantiated by the discovery of somatic missense mutations in lgi1 gene associated with high- and low - grade gliomas .
the ability of lgi1 to suppressor growth of neuroblastoma cells was suggested by the results of lgi1 overexpression , which was shown to impair proliferation and to induce apoptosis through the inhibition of the pi3k / akt pathway [ 12 , 13 ] .
further support to the tumor suppressor function of lgi1 was provided by a comprehensive study on malignant esophageal tumors ( barrett's - related adenocarcinomas ) showing that expression of lgi1 was consistently downregulated .
the aim of this study was to establish whether lgi1 was capable to suppress growth of cancer cells different from glioblastoma and neuroblastoma .
for this purpose we performed stable expression of lgi1 in hela cell , which is derived from a human cervical adenocarcinoma and expresses the human papillomavirus proteins e6/e7 ( hpv-18 ) .
essentially these viral proteins sustain cell proliferation and survival through the inactivation of tumor suppressors p53 and prb , which are implicated in cell cycle arrest and induction of apoptosis [ 16 , 17 ] . for these features conferring remarkably vigorous growth
the results showed that expression of lgi1 inhibited the rate of hela cell proliferation and increased cellular death .
furthermore lgi1 altered expression of key regulators of apoptosis such as the antiapoptotic b - cell lymphoma 2 gene ( bcl2 ) and of the proapoptotic b - cell lymphoma 2-associated x protein gene ( bax ) .
the lethal effect produced by lgi1 expression in hela cells suggests that the proposed role of tumor suppressor might be extended to adenocarcinoma - derived cells .
hela cells ( atcc number : ccl-2 ) were cultured in dulbecco 's modified eagle medium ( dmem , low glucose ) with 10% heat inactivated fetal calf serum ( fcs ) . for transfection cells ( 1.5  10 )
transfection with plasmid pclgi1 including the human lgi1 cdna ( 2075 bp ) or with empty vector pcdna3 ( 10 g / ml each ; invitrogen , groningen , the netherlands ) was performed by the dna ca - phosphate coprecipitation .
cells were cultured for 48 hours after transfection ; then they were replated at low density .
total rna was isolated from subconfluent cells by the geneelute mammalian total rna kit ( sigma chemical co. , st louis , mo , usa ) .
the cdna synthesis was performed by the reverse transcriptase improm - ii starting from random primer examer ( promega , madison , wi usa ) .
for quantification of lgi1 mrna , a cdna segment of ( 236 bp ) was amplified with primers : 5-tgtaaactgaaatggctagtggaa , and 5-agtaaaaggctgagcgatgactac .
amplification of a bcl2 segment ( 258 bp ) was carried out with primers : 5-ggtcatgtgtgtggagagcgt , and 5-acttcacttgtggctcagataggc . a bax fragment ( 539 bp )
a portion of the glyceraldehyde-3-phosphate dehydrogenase ( gapdh , 909 bp ) was amplified using primers : 5-gaccccttcattgacctcaactaca and 5-ggtcttactccttggaggccatgt ( clontech , palo alto , ca usa ) . for the semiquantitative rt - pcr analysis
different number of pcr cycles ( < 25 ) and serial cdna dilutions were employed to establish conditions of linear amplification .
the pcr products were separated by agarose gel electrophoresis ; then the net intensity of ethidium bromide stained bands was determined using the kodak 1 d image analysis software .
the following antibodies ( santa cruz biotechnology , santa cruz , ca usa ) were used to probe blots : antibody c-19 directed to the c - terminal peptide of lgi1 ( 60 kda ) , affinity purified polyclonal antibody ( bax 21 ) against bax protein ( 23 kda ) , and monoclonal antibodies to bcl-2 and gapdh proteins ( 28 kda and 36 kda , respectively . the immunoreactions were revealed by the ecl reagent ( pharmacia amersham biotech , little chalfont , uk ) and quantified by the kodak 1 d image analysis software by evaluating the net intensity of the bands . an elisa immunoassay based on brdu incorporation was employed to measure cell proliferation according to the instruction procedures ( roches diagnostic , germany ) .
cells were plated in quadruplicate on 96 well cluster plates ( 100 cells / mm ) and cultured for 24 hours .
absorbance at ( 450690 nm ) was measured using a plate reader . to determine the fraction of dead cells , the lactate dehydrogenase ( ldh ) released in the medium and that present in intact cells was measured using the cytotox non - radioactive cytotoxicity assay ( promega , madison , wi usa ) .
cells were plated on 96-well plates ( 100 cells / mm ) and cultured for 24 hours .
one half of the culture medium was transferred to a fresh well to determine ldh spontaneously released by dead cells .
then the conversion of tetrazolium salt ( int ) into the red formazan product by ldh activity was measured ( absorbance 490 nm ) .
the fraction of dead cells was calculated as follows : % cytotoxicity = [ spontaneously released ldh  2  100]/total ldh . the apo - one homogeneous caspase-3/7 assay ( promega )
cells were seeded on 96-well plates ( 100 cells / mm ) , and the caspase-3/7 substrate z - devd - r110 was added 24 hours later .
the reaction was carried on for 6 hours , and the measurement of fluorescence was then performed by a plate spectrofluorimeter ( 485 nm excitation wavelength , 530 nm emission wavelength ) .
ldh assays were performed on replicated cell samples to determine the number of living cells , which was used to normalize caspase activity .
experimental data were expressed as the mean  sd . to determine the significance of variations , values were analyzed by student 's t - test ; levels of p < .05 were considered to be significant .
stable transfection of hela cells with lgi1 cdna was performed to establish whether expression of lgi1 might affect cell viability .
the level of lgi1 expression was evaluated in three cell clones designated he - lgi1 - 1 , he - lgi1 - 2 , and he - lgi1 - 3 , respectively ( figure 1 ) .
the results of the quantification of lgi1 mrna was quite in agreement with the estimated values of lgi1 protein ( table 1 ) .
although lgi1 protein was detected in whole cells sample , the possibility that it might be secreted as it occurred in 293 t cells   can not be excluded , since it might be bound to the cell surface .
the endogenous expression of lgi1 in nontransfected hela cells and in cell clones stably transfected with empty vector was undetectable by rt - pcr and western blotting ( see he - pcdna3 ; figure 1 and table 1 ) .
the absence of lgi1 expression in human uterine tumors and in normal uterine tissue is supported by the analysis of expressed sequence tags ( ests ) reported by unigene and is in agreement with lack of lgi1 expression in mouse uterus .
the brdu incorporation procedure was employed to evaluate the influence of lgi1 expression on the rate of hela cell proliferation .
all cell clones expressing lgi1 exhibited a lower proliferation rate in comparison with control cells transfected with empty vector ( figure 2 ) , which were similar to nontransfected hela cells ( not shown ) .
with he - lgi1 - 1 cell clone , in which lgi1 expression is very little , decrease of cell proliferation was on average 30% . with he - lgi1 - 2 cells , expressing the highest lgi1 levels the decrease was 80% , whereas it was 70% with helgi1 - 3 cells , showing intermediate levels of lgi1 expression ( figure 2 ) .
the results showed that the inhibitory effect of lgi1 on cell proliferation was proportional with the levels of lgi1 expression . to establish whether expression of lgi1 also might affect survival of hela cells we measured the amount of ldh spontaneously released in the medium as a consequence of cell death .
the fraction of dead cells was significantly greater in cell clones expressing lgi1 in comparison with control cells ( figure 3 ) .
in particular , the percentage of he - lgi1 - 1 dead cells was on average 7% , slightly but significantly greater than that of he - pcdna3 cells , which was 5% .
the lethal effect was much greater with he - lgi1 - 2 and he - lgi1 - 3 , whose fractions of dead cells were on average 26% and 21% , respectively .
the decline of cell survival was clearly correlated with the levels of lgi1 expression , likewise inhibition of cell proliferation . since
significant effects were obtained with cell clone helgi1 - 1 expressing very low levels of lgi1 , it can be suggested that the impairment of cell proliferation and survival was a consequence of the proper lgi1 activity rather than the outcome of artificial overexpression .
furthermore , these effects on cells of epithelial origin exclude the requirement of interactions with proteins specifically expressed in brain for the ability of lgi1 to contrast cell growth and survival . to gain information on the process of hela cell death caused by the expression of lgi1 we measured the activity of the apoptosis effectors caspase-3 and -7 in the experimental conditions employed to monitor cell death ( figure 4 ) .
the relative fluorescence emitted by the specific caspase-3/7 substrate upon cleavage was particularly enhanced with he - lgi1 - 2 ( 7.4-fold ) and he - lgi-3 cells ( 4.2-fold ) , whereas a modest increase was measured with he - lgi1 - 1 ( figure 3 ) .
the results supported the possibility that expression of lgi1 might trigger apoptosis of hela cells . to substantiate the induction of apoptosis of hela cell expressing lgi1 we measured the level of the antiapoptotic bcl2 and of the proapoptotic bax gene expression , since the relative proportion of these proteins plays a central role in the control of cell survival .
a significant decrease of bcl2 mrna and protein was measured in cell clones expressing lgi1 in comparison with control cells , whereas the expression of bax was consistently increased ( figure 1 ; table 1 ) . in particular , the upregulation of bax expression was proportional with the levels of lgi1 , with a maximum increase of 4.6-fold of bax protein in he - lgi1 - 2   ( table 1 ) .
the results showed that the antiapoptotic bcl2 gene was downregulated and that of its opponent proapoptotic bax was upregulated as a consequence of lgi1 expression .
a decreased ratio of bcl2/bax favors the release of apoptogenic molecules from mitochondria , which activate the intrinsic pathway of apoptosis in various cancer cells , including hela [ 2126 ] .
thus lgi1 might increase the susceptibility of hela cells to spontaneous apoptosis , similarly to what occurred in neurobalstoma cells .
apparently lgi1 was capable to counteract efficiently the oncogenicity of hpv , specifically of the viral protein e6 , which prevents apoptosis by stimulating the ubiquitin - mediated degradation of p53 , a transcriptional regulator capable to enhance the expression of bax and to repress that of bcl2 [ 16 , 2729 ] .
thus the balance of these apoptotic factors imposed by e6 to sustain cell survival might be destabilized by lgi1 in favor of apoptosis .
although the mechanism of cell death induced by lgi1 has not been completely elucidated , it seems possible that lgi1 might interfere with central survival pathways such as the pi3k / akt , as it occurred in neuroblastoma cells , because the prosurvival effects of this pathway includes transcriptional regulation of bcl2 and bax genes [ 30 , 31 ] . in conclusion
, this study supports the possibility that lgi1 might act as tumor suppressor of adenocarcinoma - derived cells , in line with the downregulation of lgi1 reported in barrett's - related adenocarcinomas and with previous studies on glioblastoma and neuroblastoma cells [ 914 ] .

Answer:
the lgi1 gene was suggested to function as tumor suppressor for its ability to reduce malignant features of glioblastoma cells . in support to this proposal were the findings that overexpression of lgi1 in neuroblastoma cells inhibited proliferation and induced apoptosis . in this study
 we performed stable lgi1 expression in hela cells to examine whether the noxious effect of lgi1 might be extended to cancer cells of diverse origin .
 hela cell clones stably expressing lgi1 exhibited a significant impairment of proliferation and a consistent increase of cell death when compared with control cells lacking expression of lgi1 .
 expression of lgi1 increased the activity of apoptosis effectors caspase-3/7 ; furthermore it downregulated the antiapoptotic bcl2 gene and upregulated the proapoptotic bax gene expression , suggesting that the cause of hela cells death might be an increased susceptibility to apoptosis induced by lgi1 .
 the results suggested that lgi1 is capable to restrain growth and survival of adenocarcinoma cells such as hela .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
neonatal period ( the first 28 days after birth ) , which is the period of various physiological adaptations to the extrauterine life , is a vulnerable time .
more than 10 million children die before the age of 5 years , 8 million of whom die before the age of 1 year and more than half of these deaths occur in the first 4 weeks after birth .
about 98% of the neonatal deaths occur in developing countries . according to the world health organization ( who )
, the rate of deaths is 30 times more in the countries with the highest rate compared to the countries with the lowest rate . according to the reports of ministry of health and medical education
, the index of neonatal death in iran is 16 - 20 deaths out of 1000 survived births , which is higher than that in developed countries . who has urged iran to halve its neonatal death rate by 2015 .
risk factors in studying neonatal death are categorized into three groups : prenatal , intrapartum , and postnatal factors . all over the world , infection , preterm delivery , and birth asphyxia contribute to about 87% of neonatal deaths . in most societies , congenital malformations and premature birth
babies with low birth weight ( lbw ) and extremely lbw account for 6 - 7% and 1% of babies death , respectively .
these causes , however , are the second and third reasons , respectively , which are responsible for one half of the neonatal deaths .
prematurity is responsible for about 60 - 80% of neonatal deaths all over the world in babies without congenital anomalies . in many cases ,
neonatal diseases are caused by respiratory problems , of which hyaline membrane disease ( hmd ) can be mentioned as the foremost .
about 1.3% of all neonatal deaths are caused by hmd or its complications in premature newborns .
have mentioned five main causes of neonatal death , including prematurity , internal bleeding , septicemia , respiratory distress syndrome , and congenital anomalies , while gheibi et al .
have reported prematurity ( 68% ) , hmds ( 51% ) , asphyxia ( 13% ) , sepsis ( 13% ) , and congenital cardiac malformations ( 8% ) as the most important causes of neonatal death .
the baby 's gender has also been considered as an important factor in his or her death .
one of the most important issues in babies death is suitable management and timely referral of newborn babies with high - risk levels and being hospitalized in neonatal intensive care unit ( nicu ) .
nicu is a critical section in a hospital , dealing with infections ( e.g. septicemia , pneumonia , surgical infections , and other infections ) that are difficult to control . in the usa ,
management , appropriate care , and supportive cares are the important factors in preventing babies death .
rostami et al . have reported that the rescue chances of the babies who have received preventive nasal continuous positive airflow pressure ( ncpap ) are three times higher than the other babies . considering that an analytical and comprehensive study has not been done about the role of neonatal risk factors and the therapy given for hospitalized neonatal death in west azerbaijan ,
the study is case  control study , wherein the case group included 250 died babies who were hospitalized in the nicu during 2007 - 2009 .
the control group also included 250 newborn babies who were hospitalized in the same unit and were discharged alive and healthy after they were given appropriate treatment . only the newborn babies from shahid motahhari therapy - training center
were selected in order to homogenize the sample and eliminate some threatening factors ( factors involved in referral , death , etc . ) .
data collection was carried out through a researcher - designed questionnaire which was designed based on other studies and scholars points of view .
inclusion criteria included the babies complete profiles , and the criteria for exclusion included their incomplete profiles .
the questionnaire contained six sections ( mother 's and baby 's demographic information , causes of hospitalization , during - treatment complications , therapeutic actions , and causes of death ) for alive babies and five sections for dead ones .
chi - square test , odds ratio ( or ) , and logistic regression were applied to analyze how the variables were related .
based on single - variable analysis , neonatal risk factors affecting the newborn babies hospitalized in the nicu are as follows : 51.6% of case babies and 18.3% of control babies had first - minute apgar score of less than 6 , which proved to have a significant correlation with babies death ( p < 0.001 ) .
about 9.6% of babies of case group and 2.4% of babies in the control group had during - birth asphyxia which proved to have a significant correlation with neonatal death ( p = 0.001 ) [ table 1 ] .
the distribution of independent variables by independent variables ; p value based on chi - square test in this study , one of the factors causing death of babies hospitalized in the nicu was hmd ; 77.6% of case babies and 44.8% of control babies suffered from this disease ( p < 0.001 ) .
fourteen percent of case babies and 2% of control babies had sepsis which showed a significant relation with babies death ( p < 0.001 ) . moreover ,
58.8% of case babies and 71.5% of control babies were born through cesarean section which also proved to have a significant effect ( p < 0.001 ) [ table 1 ] .
congenital anomalies have been recognized as one of the significant risk factors of death of babies hospitalized in the nicu .
eight percent of case babies and 2.8% of control babies were reported to have congenital anomalies ( p < 0.001 ) [ table 1 ] . regarding therapeutic actions
, the results of the study also showed that having ncpap played a significant role in decreasing death of babies hospitalized in the nicu ( p < 0.001 ) .
there was also a significant relation between supportive cares and neonatal death ( p < 0.001 ) .
increased number of pregnancies also had a significant effect on neonatal death ( p < 0.001 ) [ table 1 ] .
variables like lbw , baby 's gender , blood group , history of preterm labor , and consanguinity had no significant role in the death of neonates hospitalized in the nicu . in order to gauge the key effects of the mentioned factors ,
the adjusted or calculated from advanced logistic regression model was measured through advance selection method .
the results showed that the or of neonatal death was 4.02 times greater for neonates with first - minute apgar score of less than 6 compared to those with first - minute apgar score of 6 and more , for asphyxia , the or was 6.16 , for hmd it was 4.08 , and for sepsis it was 6.42 . applying ncpap and
multiparity led to a decrease in the death of neonates hospitalized in the nicu [ table 1 ] .
in the present study , the most important neonatal risk factors affecting neonatal death were found to be sepsis , birth asphyxia , hmd , first - minute apgar score of less than 6 , congenital anomalies , and delivery method . in our study ,
the most common risk factor for neonatal deaths was sepsis which raised the risk of death by infection to 6.42 times more than the other causes .
, sepsis and its complications were reported to be the first cause of death , but in the investigations of nayeri et al . and amin et al . , sepsis had higher ratings .
this may be due to the factor that premature babies are prone to infection , but it should be more investigated because of the high number of deaths resulting from it .
this spread of sepsis has been reported to be in 1 - 10 cases out of 1000 live births , but 10 - 50% of deaths occur because of it . the second risk factor in the present study was at birth asphyxia , which is in line with tariq and kundi 's study which mentioned sepsis and neonatal asphyxia as the main causes of death , but in the studies carried out by sereshtedari et al . , it was the cause of the 16% deaths in 18 provinces of the country , in bangladesh approximately 26% of neonatal deaths are caused by asphyxia .
the other serious clinical problem is respiratory difficulty , and in this study , it manifested as respiratory distress and hmd . in our study , it was the third risk factor of infant death .
the study of abdul in malaysia showed that this problem with sepsis is the most important cause of infants death .
there is also a second leading cause of infant death in tariq and kundi 's study , and respiratory distress syndrome which were studied by kumar et al . in india ,
jehan et al . in pakistan , naghavi in 18 provinces of iran , javanmardi et al . in isfahan , amani et al . in ardebil , and in the studies of nayeri et al . in tehran and sereshtedari
one of the causes of infant death , low apgar score at birth , is increasingly mentioned in many studies to be a risk factor .
low apgar score at birth could be correlated to factors such as neonatal infections , birth asphyxia , meconium aspiration , respiratory distress syndrome , and other causes which may result in infant mortality . in our study , ncpap was applied in the control group two times more than in the case group , which resulted in a decrease of babies death by 0.43 .
in their study , rostami et al . also reported that applying preventive ncpap to newborn babies will increase their survival chances by three times .
congenital anomalies was found to be in the second position in the studies of sharifi , hematyar and yarjo , javanmardi et al . in esfahan , and naghavi 's study in 18 provinces .
it was mentioned as the second and first cause in the studies of sareshtedati et al . and
's study , congenital anomalies and infection were mentioned as the leading factors of infant death .
the rate of abnormalities in our study compared with other studies , which shows that it is a less important factor in the incidence of neonatal death .
this may be due to high morbidity and mortality caused by other factors such as immaturity , lack of attention and careful examination at the time of birth , lack of screening for neonatal abnormalities , and not performing autopsy in dead neonates .
death rate in babies with lbw is about 40 times higher than in babies with normal weight . unlike these studies
this finding is in correlation with that of nayeri et al . in the present study ,
normal vaginal delivery was higher in the case group than that in the control group .
this finding shows that cesarean section can be better when there is an emergency case or prematurity .
although emergency cesarean section is performed to save the lives of the mother and baby , the selection is not always uncomplicated . in a study , it has been reported that two - third of babies who died were born through cesarean section . in our study , despite the high level of infant mortality in males , there was no significant relation between gender and the cause of death .
an important risk factor that was investigated in this study was the number of pregnancies .
the results of this investigation showed that death rate decreased as the number of pregnancies increased .
number of births higher than 5 , pregnancy number above 3 , and high rate of birth were mentioned as effective factors causing babies death in studies conducted by shirvani and khosravi , chaman et al .
, and titaley et al . , respectively . appropriately carrying out care and supportive cares can be effective factors in preventing babies death . in our study ,
51.6% of case babies and 2.3% of control babies had received supportive care from birth .
higher death rate in case babies can be due to bad physical conditions and other threatening factors .
the results of the study show that incorrect methods of transfer can increase the death rate . in this study , special attention was devoted to increasing the care standards in order to decrease the death rate . according to the results of the study that took into consideration factors such as age , occupation , consanguinity , blood group , preterm delivery background , and sex in two groups with equal distribution , it can be concluded that factors related to accompanying diseases and care during delivery play a significant role in neonatal death .
therefore , regarding the fourth goal of millennium development , decreasing babies death to two - fourths by 2015 in countries with high rate of mortality , it seems to be better to spot pregnancies with high risk of babies death through pre - delivery care and to transfer mothers who are likely to bear premature or sick babies to centers that have nicus . in cases where it is impossible to specify whether a delivery is risky before birth ,
the subsequent hospitalization problems can be prevented by providing appropriate conditions of transfer and therapeutic actions in intensive care units .
the major risk factors in this study ( sepsis , asphyxia during birth , hmd , congenital anomaly , and apgar score less than 6 in the first minute of birth ) are considered as the major complications of preterm labor and preterm infants .
so , strict preventive programs should be undertaken for premature preterm labor and preterm infants ; taking care of the infants in four stages ( before conception , during pregnancy , during delivery , and thereafter ) can be highly effective as well .

Answer:
background : a newborn is highly fragile whose death can be caused by embryonic , intrapartum , and postpartum factors . identifying the causes of death is the first step to be taken in order to decrease the death rate .
 the present study was aimed at finding out how neonatal factors and therapeutic actions affect death of newborn babies.materials and methods : the is a case - control study where the case group included 250 dead neonates who were hospitalized in the neonatal intensive care unit during 2007 - 2009 .
 the control group also included 250 newborn neonates who were hospitalized in the same unit and were discharged alive and healthy after they were treated appropriately .
 researcher - designed questionnaires including demographic characteristics of mothers and infants , causes of hospitalization , treatment and its complications , and causes of death were used to collect the required data .
 chi - square test , odds ratio ( or ) , and logistic regression were applied to analyze how the variables were related .
 p < 0.05 were considered significant .
 statistical analyses were carried out using software spss 16.0.results:the results of advanced logistic regression model showed that first - minute apgar less than 6 ( or = 4.02 ) , existence of birth asphyxia ( or = 6.16 ) , hyaline membrane disease ( or = 4.08 ) , and sepsis ( or = 6.42 ) increased the death rate of neonates hospitalized in the intensive care unit , and applying nasal continuous positive airway pressure and multiparity decreased the death rate of newborn babies .
 there was no significant correlation between variables such as low birth weight , consanguinity , blood group , pr eterm labor history , and baby 's gender , and the death rate of neonates.conclusions:the results of the study show that factors such as low apgar score , asphyxia , hyaline membrane disease , sepsis , prematurity and congenital anomalies , and method of delivery have a positive effect on the death of neonates .
 they also prove that suitable management and carrying out appropriate therapeutic actions and intensive care decrease the death rate of newborn babies .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
a newly diagnosed acromegaly patient aged 45-year - old woman was referred to our clinic for an ophthalmologic examination from the endocrinology department of our hospital .
serum igf-1 level was 750 ng / ml ( reference ranges of igf-1 in ages 4685 : 94166 ng / ml ) .
complete ophthalmological examination including cct with ultrasonic pachymetry ( tomey corporation , nagoya , japan ) , and standard threshold perimetry with the humphrey visual field analyzer 24 - 2 program ( carl zeiss meditec , inc . ,
dublin , ca , usa ) were performed . after informed consent was obtained from the patient , basal tear samples were collected atraumatically from the inferior tear meniscus of both eyes using glass capillary tubes or micropipettes .
tear samples were diluted in phosphate - buffered saline , placed in microtubes , and stored at 70c until further examination .
tear igf-1 concentrations were measured using a commercial enzyme - linked immunosorbent assay kit ( quantikine , r and d systems , minneapolis , mn , usa ) according to the manufacturer 's instructions .
tear igf-1 level was 0.63 ng / ml . best - corrected visual acuities were 1.0 in both eyes .
optic disc examination revealed normal in both eyes ( cup - to - disc ratio was 0.3 in both eyes ) .
cct was 615 m in the right eye and 612 m in the left eye .
iop levels were 24 mm hg in the right eye and 23 mm hg in the left eye .
after the patient was referred to a neurosurgery by the endocrinology clinic for an operation , he underwent transsphenoidal adenectomy for the pituitary adenoma .
the patient 's serum igf-1 values had fallen to 125 ng / ml . besides tear igf-1 values were 0.32 ng / ml .
cct was 585 m in the right eye and 575 m in the left eye .
iop levels were 20 mm hg in the right eye and 19 mm hg in the left eye .
another newly diagnosed acromegaly patient aged 55-year - old woman was referred from endocrinology clinic for an ophthalmologic examination .
serum igf-1 level of the patient was 1340 ng / ml . tear igf-1 level was 0.98 ng / ml .
cct was 595 m in the right eye and 590 m in the left eye .
iop levels were 22 mm hg in the right eye and 21 mm hg in the left eye .
optic disc examination were also normal in both eyes ( cup - to - disc ratio was 0.4 in both eyes ) .
the patient also was referred to the neurosurgery department for an operation , and she also underwent pituitary surgery .
three months after surgery the patient 's complete ophthalmological and visual field examination revealed normal .
serum igf-1 value had fallen to 389 ng / ml . besides tear igf-1 value was 0,25 ng / ml .
cct values were 565 m in the right eye and 560 m in the left eye .
iop levels were 18 mm hg in the right eye and 17 mm hg in the left eye .
a newly diagnosed acromegaly patient aged 45-year - old woman was referred to our clinic for an ophthalmologic examination from the endocrinology department of our hospital .
serum igf-1 level was 750 ng / ml ( reference ranges of igf-1 in ages 4685 : 94166 ng / ml ) .
complete ophthalmological examination including cct with ultrasonic pachymetry ( tomey corporation , nagoya , japan ) , and standard threshold perimetry with the humphrey visual field analyzer 24 - 2 program ( carl zeiss meditec , inc . ,
dublin , ca , usa ) were performed . after informed consent was obtained from the patient , basal tear samples were collected atraumatically from the inferior tear meniscus of both eyes using glass capillary tubes or micropipettes .
tear samples were diluted in phosphate - buffered saline , placed in microtubes , and stored at 70c until further examination .
tear igf-1 concentrations were measured using a commercial enzyme - linked immunosorbent assay kit ( quantikine , r and d systems , minneapolis , mn , usa ) according to the manufacturer 's instructions .
tear igf-1 level was 0.63 ng / ml . best - corrected visual acuities were 1.0 in both eyes .
optic disc examination revealed normal in both eyes ( cup - to - disc ratio was 0.3 in both eyes ) .
cct was 615 m in the right eye and 612 m in the left eye .
iop levels were 24 mm hg in the right eye and 23 mm hg in the left eye .
after the patient was referred to a neurosurgery by the endocrinology clinic for an operation , he underwent transsphenoidal adenectomy for the pituitary adenoma .
the patient 's serum igf-1 values had fallen to 125 ng / ml . besides tear igf-1 values were 0.32 ng / ml .
cct was 585 m in the right eye and 575 m in the left eye .
iop levels were 20 mm hg in the right eye and 19 mm hg in the left eye .
another newly diagnosed acromegaly patient aged 55-year - old woman was referred from endocrinology clinic for an ophthalmologic examination .
serum igf-1 level of the patient was 1340 ng / ml . tear igf-1 level was 0.98 ng / ml . best - corrected visual acuities were 1.0 in both eyes .
cct was 595 m in the right eye and 590 m in the left eye .
iop levels were 22 mm hg in the right eye and 21 mm hg in the left eye .
optic disc examination were also normal in both eyes ( cup - to - disc ratio was 0.4 in both eyes ) .
the patient also was referred to the neurosurgery department for an operation , and she also underwent pituitary surgery .
three months after surgery the patient 's complete ophthalmological and visual field examination revealed normal .
serum igf-1 value had fallen to 389 ng / ml . besides tear igf-1 value was 0,25 ng / ml .
cct values were 565 m in the right eye and 560 m in the left eye .
iop levels were 18 mm hg in the right eye and 17 mm hg in the left eye .
in acromegaly , normalization of igf - i in serum has been used to follow - up the success of surgical and medical therapies .
van setten et al . reported that the igf-1 level was elevated not only in the serum , but also in the subretinal fluid and aqueous humor in a patient with acromegaly .
this study inspired us to hypothesize that the eyes might be another target organ for the effects of excess gh and igf-1 , hence in our study we measured tear igf-1 levels and evaluated the relationship with cct and iop before and after treatment in two acromegaly patients .
ciresi et al . emphasized that high gh may have stimulatory effects on the cornea , as well as on other target organs .
bramsen et al . divided 27 pituitary adenoma patients into two groups as those with and without acromegaly and reported higher cct values in the group with acromegaly .
in contrast , polat et al . reported no statistically significant difference regarding median right and left corneal thicknesses and mean cct values between acromegaly and control groups .
they divided 30 patients with acromegaly into two groups as those with active and inactive .
we think that possible growth effect of tear igf-1 may have an impact on cct .
we found a higher cct , iop , and tear igf-1 values in the active phase of the disease .
the activity of the disease may have an impact on ocular parameters such as cct , iop , and tear igf-1 values .
however , longitudinal studies including larger populations and controls are needed to confirm this relationship .

Answer:
the aim of the study was to compare the central corneal thickness ( cct ) , intraocular pressure ( iop ) , and tear insulin - like growth factor-1 ( igf-1 ) levels of 2 patients with acromegaly before and after the surgical treatment of the disease .
 ccts , iop levels , and tear igf-1 values showed a decrease after the treatment in 2 patients . as we found higher cct , iop , and tear igf-1 levels in the active phase of the disease in two acromegaly patients , detailed information about the activity of the disease may be important before the examination of these patients .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:

 women with psychiatric diseases are treated with antipsychotic medication(s ) with limited evidence to support the safety of their use during pregnancy.olanzapine , a second - generation antipsychotic , is a us food and drug administration pregnancy category  c drug with no unequivocal evidence of harm to the fetus.we report the first case of tracheo - esophageal fistula as a possible teratogenic effect of olanzapine exposure .

women with psychiatric diseases may become pregnant and are treated with antipsychotics without any proven evidence of safety . due to ethical issues , pregnant women
are rarely included in clinical trials , leading to a dearth of data available on the safety of antipsychotic drugs in this population .
there have been reports of congenital anomalies in newborns of mothers exposed to antipsychotic medications during pregnancy [ 14 ] .
olanzapine , a second - generation antipsychotic , is a us food and drug administration ( fda ) pregnancy category  c drug [ 3 , 5 ] with no unequivocal evidence of harm to the fetus .
a literature search revealed that maternal exposure to olanzapine appears to be associated with lumbar meningomyelocele , dysplastic kidney , hip dysplasia , atrioventricular canal defect , club foot , microcephaly , ventricular septal defect , absent fingers , craniosynostosis , cleft lip , encephalocele , aqueductal stenosis , etc .
the possibility of further teratogenic effects of olanzapine can not be ruled out . in this case report , we report the first case of tracheo - esophageal fistula ( tef ) as a possible teratogenic effect of olanzapine exposure .
we report the case of a 29-year - old married woman with bipolar disorder with mixed episodes who had been treated with olanzapine in the psychiatric outpatient department of our institute ( lady hardinge medical college , new delhi , india ) for the last 7  years who delivered a full - term female baby with tef in september 2013 .
one week after her marriage in february 2008 , the patient developed psychotic symptoms such as excessive talking , episodes of crying and laughing , and forgetting things frequently .
following initial unsuccessful local treatment , she was taken to the psychiatry department of a tertiary care hospital .
after initial management of acute symptoms there , she continued her treatment from our institute , where she was prescribed olanzapine ( oleanz 10  mg tablet orally once daily ) . in december 2008 , she had a miscarriage at 4  months gestation , following which she stopped taking the medication of her own choice . a careful history / enquiry from the parents failed to reveal any data available regarding congenital malformation of the aborted fetus . in 2009
, she conceived again ( it is noteworthy that the patient was not taking olanzapine during this pregnancy ) and delivered a full - term healthy female child in january 2010 .
eight months after delivery of this baby the patient had a recurrence of psychotic symptoms for which she was prescribed the same treatment . in december 2012 , she conceived a third time but due to persistent psychiatric symptoms , olanzapine was continued throughout the pregnancy by the treating psychiatrist , who considered there to be a favorable benefit : risk ratio for the patient at that time .
she received regular antenatal care and was compliant with all prescriptions and instructions , including prophylactic folic acid and two doses of tetanus toxoid .
there was no history of maternal alcohol intake , smoking , or exposure to other potential teratogenic drugs or exogenous hormones throughout the pregnancy .
all baseline hematological ( hemoglobin 13.8 g / dl , total leukocyte count 6000/l , platelets 2.3 lac/l , etc . ) and biochemical investigations ( random blood sugar 98 mg / dl , blood urea 27 mg / dl , etc . )
tests for trisomy 21 and 18 ( nuchal translucency scan and dual marker tests ) and rubella were negative .
, she delivered a full - term female baby by vaginal delivery . immediately after delivery ,
the baby experienced respiratory distress and excessive salivation , for which she was admitted to the neonatal intensive care unit . on examination ,
a red rubber catheter could not be negotiated beyond 10  cm in the esophagus .
other concomitant anomalies including vertebral , anal , renal , limb ( components of vacterl [ vertebral defects , anal atresia , cardiac defects , tracheo - esophageal fistula , renal anomalies , and limb abnormalities ] ) , eye , ear , and nasal defects were ruled out .
the tef was repaired using esophageal  esophageal anastomosis with a drainage tube in the fifth intercostal space . on the second post - operative day
for this reason , cervical esophagotomy was performed and a gastrostomy was inserted for feeding purposes .
the baby was discharged in a stable condition with advice for full breast milk feeding through gastrostomy , some required medications ( multivitamin syrup , calcium , anti - emetic and antibiotics ) for an appropriate duration , and regular vaccination . however , although the baby was well until this point , she was re - hospitalized at 11  months of age because of diarrhea and unfortunately died on 19 august 2014 , probably because of widespread infection ( no definitive record of the last hospitalization is available and a post - mortem was not performed).fig .
1chest x - ray posteroanterior view of the newborn baby , who was born to a mother with antenatal exposure to olanzapine , suggestive of tracheo - esophageal fistula
  chest x - ray posteroanterior view of the newborn baby , who was born to a mother with antenatal exposure to olanzapine , suggestive of tracheo - esophageal fistula
a number of drugs are clearly known to be associated with teratogenicity , such as thalidomide and isotretinoin , but the majority of drugs do not have conclusive data concerning their effect on fetal development and growth . due to strict ethical constraints , at - risk populations ( including pregnant women ) are not included in most clinical trials , limiting the availability of data on the use of drugs ( including antipsychotics ) in these populations , and thus spontaneous reporting of suspected adverse drug effects constitutes an essential tool for generating data on the safety of drugs , especially in the population of pregnant women . according to a retrospective analysis of data from the lilly safety database , of the 610 prospectively identified pregnancies exposed to olanzapine with an available outcome
, there were 401 ( 66% ) normal births , 60 ( 9.8% ) premature births , 57 ( 9.3% ) spontaneous abortions , 49 ( 8% ) perinatal complications , 27 ( 4.4% ) congenital anomalies ( cleft lip , encephalocele , and aqueductal stenosis ) , and 16 ( 2.6% ) other outcomes ( post - perinatal condition , ectopic pregnancy , post - term birth , and still birth ) .
other reported congenital anomalies with olanzapine included meningocele , ankyloblepharon , hip dysplasia , acheiria , atrioventricular canal defect , and unilateral club foot [ 1 , 68 ] . a link between teratogenicity and antipsychotics
is also supported by the fact that these drugs readily cross the placental barrier [ 1 , 4 , 9 ] , with 23.8% placental passage for quetiapine and 72.1% for olanzapine [ 2 , 4 , 9 ] .
newport  et al . measured placental passage of medication from mother to fetus by measuring levels in the umbilical cord serum and found that olanzapine has the highest rate of placental passage , compared with haloperidol , risperidone , and quetiapine [ 3 , 9 ] .
the overall incidence of esophageal atresia / tef ranges from one in every 2500 to 4500 live births .
however , a careful literature search revealed a paucity of data on the incidence of tef in children born to women with psychiatric disease and the problem of confounding by indication can not be ruled out .
it has been proposed that antipsychotics interfere with the action of calmodulin , which has an important role in organogenesis .
esophageal atresia and abnormalities of pharyngeal glands have also been proposed as being related to neural crest cells .
the drugs ( olanzapine in this case ) associated with such anomalies may be hypothesized to cause neural crest cell damage during early fetal development as a causative factor . although the neural crest cell damage - related esophageal abnormalities in many cases are also associated with cardiovascular anomalies , these were absent in the present case .
we tried to establish the causality between the adverse outcome ( tef ) and use of olanzapine during pregnancy according to the who - umc ( world health organization
uppsala monitoring centre ) adverse drug reaction causality assessment scale and the naranjo causality assessment scale .
causality is  probable ( score + 5 ) as per the naranjo scale , whereas it is
one of the important reasons for lower scores of causality is the non - applicability of many questions in these scales .
the current case report of tef associated with antenatal olanzapine exposure demonstrates the need for large clinical studies to generate more conclusive data concerning use of this drug during pregnancy .
on the basis of the present case and the literature , it is suggested that antenatal olanzapine exposure may be related to the development of tef in newborns .
however , the present case report can only be considered as preliminary evidence and further observational prospective studies of women with antenatal exposure to olanzapine should be conducted to explore the strength of association between tef and olanzapine .
knowledge of the teratogenic potential of a drug is essential to prevent / reduce the morbidity and mortality associated with a congenital anomaly ( tef in this case ) .
such post - marketing reports are effective tools to disclose the adverse effects of drugs , which are difficult to detect in clinical trials and may factually change the safety status of a drug .
written informed consent was obtained from the infant s father for publication of this case report .

Answer:
there is a dearth of evidence on the safety of the use of antipsychotics during pregnancy .
 olanzapine , a pregnancy category  c drug , has no unequivocal evidence of harm to the fetus . against this backdrop
 , we report the first case of a tracheo - esophageal fistula ( tef ) in a newborn following maternal antenatal exposure to olanzapine .
 a 29-year - old woman with acute psychotic disorder had been treated with olanzapine for the last 7  years . her first pregnancy , while taking olanzapine , resulted in a miscarriage at 4  months gestation , following which she discontinued olanzapine .
 she reconceived after a few months and delivered a full - term normal child .
 however , due to the recurrence of psychiatric illness after her second pregnancy , she was prescribed olanzapine again , which was continued throughout her third pregnancy .
 the outcome of the third pregnancy was a full - term female baby with a tef .
 the baby was managed surgically and discharged with satisfactory vital signs .
 unfortunately , however , the baby did not survive beyond 11  months of age .
 causality between antenatal maternal olanzapine exposure and tef in the newborn was determined to be
 probable ( score + 5 ) as per the naranjo causality assessment scale .
 greater knowledge of this potential teratogenicity caused by olanzapine is needed to reduce morbidity and mortality in newborns .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
currarino syndrome ( cs ) is a hereditary pathology that is characterized by a triad of malformations : sacrococcygeal bone defect , presacral mass , and anorectal malformation .
radiologic imaging modalities such as ultrasonography ( us ) , computed tomography ( ct ) , and magnetic resonance imaging ( mri ) play a vital part in diagnosis and follow - up of this pathology . in this report , we aim to present the magnetic resonance imaging ( mri ) findings of a case with complete cs recognized in adulthood .
a 20-year - old male patient who underwent anal atresia operation in childhood was referred to our department for evaluation of anal sphincter status with transrectal us .
calibration of one - third of the inferior rectum was observed to be very thin , while one - third of the superior and middle segments of the rectum was seen to be dilated .
the left half of s2 and s3 vertebrae , more distal sacral vertebrae , and coccyx were not seen .
we also detected anterior meningocele related to spinal canal that originated from the neural foramen of s2 and s3 vertebrae .
the lesion was isointense with cerebrospinal fluid in all of the sequences and its size was 4.5  3.5 cm .
20-year - old man with anal atresia operation history in childhood diagnosed with currarino syndrome .
( a ) t2-weighted sagittal magnetic resonance image shows calibre of one - third of inferior rectum is very thin ( thick white arrows ) , while superior and middle segments of the rectum are dilated ( arrowheads ) . also , the images demonstrate anterior meningocele ( asterisk ) at the posterior of the rectum related to spinal canal that originated from the neural foramen of s2 and s3 vertebrae .
( b ) fat - saturated t2-weighted axial magnetic resonance image shows partial cleft at l5 vertebra corpus ( thin white arrow ) and dilated rectum in front of it . on ( c )
t1-weighted and ( d ) fat - saturated t2-weighted axial magnetic resonance images , left half of the sacrum is not seen . in this part , spinal canal relationship of anterior meningocele ( asterisk ) and its indentation to the adjacent rectum is also observed .
( e ) t2-weighted coronal magnetic resonance images demonstrate the contiguity of the sacral defect and anterior meningocele ( asterisk ) more clearly ( r = rectum , b = bladder ) .
currarino syndrome is a rare inherited disorder that is characterized by sacrococcygeal bone defect , presacral mass , and anorectal malformation .
the complete form of this syndrome shows all three abnormalities and is rarer than the incomplete form which includes one or two of the disease components mentioned above .
although the patients with this syndrome may present with complex conditions like recurrent urinary system infections or meningitis , chronic constipation is the most common finding .
some of the cases are asymptomatic and can be diagnosed during adulthood only on x - rays and us examinations that are performed for different reasons .
in addition to rectal digital examination , x - rays , us , ct , and mri are very helpful in the diagnosis of the syndrome .
sacrococcygeal bone defect is a prerequisite for the diagnosis of cs and its spectrum changes from mild lateralization of the coccyx to multilevel hypoplasia of the sacral segments (  scimitar sacrum  ) . in our case
, there was partial cleft at l5 vertebra corpus and s1 vertebra was partially deformed . also ,
the left half of s2 and s3 vertebrae , more distal sacral vertebrae , and coccyx were absent .
rectal and/or anal stenosis which may be fistulized to ascending spinal canal is the most common anorectal malformation which is seen in cs .
anal atresia or ectopy , imperforated anus , rectal duplication , and rectourethral , rectovaginal , and rectovesical fistulas may be also associated with the syndrome . in our patient ,
there was heterogeneity of the cutaneous and subcutaneous soft tissue around the anus secondary to earlier anal atresia operation .
enteric cyst , lipoma , hamartoma , dermoid and epidermoid cysts may be seen as well .
us , ct , and mri are frequently used for diagnosing the mass lesion and determining its nature .
mri is an invaluable technique to recognize accompanying additional pathologies like tethered cord , syringomyelia , and intradural lipoma . in our patient
, we detected a 4.5  3.5 cm size anterior meningocele related to the spinal canal .
cloacal malformation with anal atresia , double vagina , rectovesical fistula , urogenital sinus , neurogenic bladder , vesicoureteral reflux , and multicystic kidney are other related pathologies of cs .
mri is a very useful imaging modality to diagnose cs and accurately detect all the three components .
besides , it can show the different aspects of other cloacal malformations including the uterus , vagina , maldeveloped puborectalis , and external anal sphincter .
although these anomalies are not surgically correctable , early detection almost always provides better prognosis and helps in patient management .
another major advantage of mri over other imaging modalities is the ability to detect associated anomalies of anorectal malformations , especially of the spinal cord , spine , and urogenital system .
kassir et al . , also reported that mri is a specific and sensitive non - invasive diagnostic tool in patients with anorectal malformations .
mri provides excellent information about the postoperative anatomy of anorectal malformations . due to its superior soft tissue characterization , multiplanar imaging ability , and lack of ionizing radiation exposure
these unique features make mri a very appropriate modality in follow - up of patients treated for anorectal abnormalities .
the treatment strategy changes based on the type of pathology . the management of the anorectal anomaly and presacral mass may be performed with single - stage surgical procedure .
if the mass is a meningocele , a staged operation must be preferred due to the risk of meningitis .
cs should be obviously considered in patients with sacrococcygeal bone defect , presacral mass , and anorectal malformation .
mri may be used safely in diagnosis of the syndrome , in detecting the accompanying mass lesions and other pathologies , and in the follow - up investigations after treatment in patients with cs .

Answer:
currarino syndrome is a hereditary pathology that is characterized by sacrococcygeal bone defect , presacral mass , and anorectal malformation .
 sacrococcygeal bone defect is almost always a part of the syndrome .
 the complete form of this entity displays all three abnormalities and is very uncommon . in this report ,
 we present the magnetic resonance imaging findings of a case with complete form of currarino syndrome recognized in adulthood .