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:
voluntary exercise has been found to mitigate harmful consequences of stress on the brain and to prevent the expression of depression and anxiety - like behavior .increased activity of brain - derived neurotrophic factor ( bdnf ) signaling is suggested to be an important factor mediating the benefits seen after running.in agreement , stress and depression have been found to decrease bdnf expression [ 2 , 3 ] .
corticotrophin - releasing factor ( crf ) is the major hypothalamic mediator of stress and is also involved in the etiology of depression and anxiety - like behavior [ 4 , 5 ] and has been found to be downregulated in the mouse hypothalamus following exercise [ 6 , 7 ] .
crf acts through the seven transmembrane , g - protein - coupled receptor crf receptor 1 ( crfr1 ) , initiating the release of cortisol in humans and corticosterone in rodents from the adrenal gland .
the cloning of a second crf receptor ( crfr2 ) [ 911 ] , existing as two primary splice variants ( crfr2 and crfr2 ) , was followed by the discovery of three additional crf family members , the urocortin 1 ( ucn1 ) , urocortin 2 ( ucn 2 ) [ 13 , 14 ] , and urocortin 3 ( ucn 3 ) . in general , there is a limited overlap in the distribution of crf and the crf receptor subtypes and of the urocortins , suggesting separate but complementary functional roles .
the physiological roles of crfr2 in the brain are still somewhat elusive , but most reports in the literature suggest involvement in dampening the body 's response to stress .
thus , mice deficient in crfr2 ( crfr2 / ) exposed to restraint stress show rapid and elevated acth levels compared to control animals , and behavioral studies show an increase in anxiety - like behaviors , possibly due to increased crf mrna levels in the central nucleus of the amygdala .
however , studies using agonists and antagonists against crfr2 indicate that the attenuation of depression and anxiety - like behavior in relation to activated crfr2 is complex .
thus , the effects has been found to be diverse , site specific , and depending on the stress level and experimental model as well as being different between genders .
the lateral septum ( ls ) , a brain area important in the shaping of coping responses to stress and found to modulate the activity in the amygdala , exhibits the highest density of crf2 in the brain .   here
, we have studied crfr2 and bdnf in the female mouse ls using quantitative real - time reverse transcriptase polymerase chain reaction ( qrt - pcr ) in an exercise paradigm .
brain punch biopsies from young female mice exposed to voluntary exercise and nonexercised age- and sex - matched controls were analyzed for expression levels of transcript for bdnf and crfr2 in ls .
in addition , crf mrna was studied in the central nucleus of amygdala ( cea ) , as this is a key site for the integration of central stress circuits .
finally , we monitored the exercise - induced effects on morning corticosterone and leptin levels in plasma as well as the weight of abdominal fat mass .
the experiment was performed in 20 nave , 5-week - old c57/bl6 female mice ( scanbur , sollentuna , sweden ) . all experimental procedures in animals
were approved by the animal care and use committee at linkping university and in accordance with the european communities council directive guidelines .
the mice were housed individually under standard conditions with free access to water and food under a 12-h light and 12-h dark cycle ( lights on at 07:00 am ) .
the experimental groups ( n = 10 ) had access to a wheel (  :  13  cm ) for three weeks , and the housing of the control group ( n = 10 ) remained unchanged .
vaginal smears were used to assess the stage in the estrous cycle and all females were in the estrous phase at the end point of the experiment .
the amount of running was on average 8,000 revolutions per day with peaks during the proestrus phase . for analysis of gene expression by qrt - pcr
, the mice were euthanized after three weeks at 9.00 am by means of decapitation .
blood was immediately withdrawn from the right ventricle by heart puncture , collected in edta containers ( sarstedt ab , landskrona , sweden ) and centrifuged at 7,000  g ( 4c ; 10  min ) .
the brains were dissected out , sliced , and put on ice , and punch biopsies were collected under a microscope using an air - powered punching machine following a microdissection protocol .
total rna was extracted using rneasy lipid tissue mini kit ( qiagen , sollentuna , sweden)including dnase treatment  and rna was reversely transcribed to cdna ( applied biosystems , foster city , calif , usa ) .
quality control of rna extraction was performed on each brain area using the agilent rna 6000 nano assay protocol ( http://www.agilent.com/chem/labonachip/ ) according to their protocol .
real - time rt - pcr was performed on an applied biosystems 7900 fast real - time pcr system using taqman fast universal pcr master mix according to the manufacturer 's instructions ( applied biosystems , stockholm , sweden ) .
the taqman gene expression assays used were : bdnf = mm 01334042-m1 ;   crfr2 = mm 00438303-m1 ; b - actin = mm 00607939-s1 and gapdh = mm 99999915-s1 as endogenous controls .
each gene was normalized with the corresponding average of b - actin and gapdh expression in the same animal and expressed as the fold difference in relation to the control group .
morning corticosterone was measured by means of an enzyme immunoassay ( oc - teia ) , according to the manufacturer 's instruction ( ids nordic , herlev , denmark ) .
assay sensitivity was 0.55  ng / ml . leptin concentration was measured by means of bead - based xmap luminex technology ( austin , tex , usa ) , using a commercially available kit ( electrabox , tyres , sweden ) according to the manufactures protocol .
data were acquired as mean fluorescence intensity , collected by the star station software program ( applied cytometry systems , dinnington , sheffield , uk ) .
data were analyzed with anova followed by student 's t - test to ascertain which group differed significantly from controls .
here , we report a 3-fold increase in bdnf gene - expression levels in the ls following three weeks of voluntary running ( p < 0.05 ) ( figure 1 ) . to our knowledge , this is the first demonstration that bdnf mrna levels in the female ls are markedly increased following long - term exercise .
bdnf has a multitude of actions on neurons , and dysfunction of this neurotrophin may modulate mood .
exercise has been found to induce bdnf - mediated increase of neurogenesis , and increased bdnf gene - expression and protein following acute or long - term exercise results in mood benefits and enhanced memory [ 3 , 21 ] .
however , studies of exercise - induced effects on bdnf in other brain areas and circuits other than hippocampus are limited .
in addition , we studied the effect after voluntary exercise on crfr2 , since the ls harbors substantial levels of crfr2   and since this receptor has been reported to mediate coping responses during the recovery phase after stress [ 4 , 22 ] . in the present study ,
crfr2 gene - expression was , however , not altered after three weeks exercise nor was cea expression of crf mrna although we found a trend towards an increase in crfr2 ( figure 1 ) .
plasma concentrations of morning corticosterone were decreased by approximately 18% compared to the control group ( 15,3  1,6  ng / ml ; 12,6  2,4  ng / ml , p < 0.01 ) ( figure 2 ) , which may suggests that it is possible that a part of the hpa - axis is inhibited by voluntary long - term exercise . however
we used female mice , since anxiety and depression are twice as common in females , and there is accumulating evidence that the crf system also outside hypothalamus is differently regulated when comparing female and male rodents .
the amount of voluntary running in females is closely correlated to the levels of sex hormones .
we observed what others also have found that the average frequency of running where higher during the proestrus phase when there is a peak in estrogen levels .
we chose to collect the brains the day at estrus when estrogen levels are low , since it is known that bdnf is regulated by this sex hormone itself at least in the hippocampus .
thus , bdnf - synthesizing neurons express estrogen receptors , and the bdnf gene contains an estrogen responsive element , suggesting possible interactions between estrogen and bdnf regulation [ 25 , 26 ] .
our working hypothesis was that since acute exercise initiates the activation of the hpa - axis , crfr2 might be activated to counteract the crf / crfr1 system in the amygdala through the ls .
thus , the activation of the crf system in the amygdala is tightly correlated to stress and anxiety - like behavior . however , neither crfr2 nor crf mrna were changed after three weeks running . taken together , if crfr2 and ls are involved in the strategies of stress coping , it seems that long - term voluntary exercise is a situation when ls crfr2 and cea crf are not activated .
< 0.05 ) ( figure 2 ) , in parallel with a 30% reduction in fat mass ( p < 0.001 ) .
food intake and water consumption was not measured in the present study , but previous studies of mice using the same experimental model showed no difference in food intake in exercised animals versus controls , and no difference between groups in total body weight , similar to what we observed .
leptin is a 16  kda protein hormone and a product of the obese gene that has been found to be correlated with the lipid content of the cells and plays an important role in regulating food intake and energy expenditure .
it has been shown in both humans and mice that weight loss is associated with a decrease in plasma leptin .
as already mentioned , we did not observe any changes in total body weight but a decrease in perigonadal fat pads .
a decrease in abdominal fat in combination with no weight loss is probably due to an increase in muscle weight after long - term exercise .
it is possible that the decrease of plasma leptin in the present study is correlated to the decrease in perigonadal fat .
however , further studies are needed , since the mechanisms responsible for regulating leptin expression and protein are complex and not fully understood at least not in females . in summary , these data show for the first time that long - term voluntary exercise increases bdnf gene expression but not crfr2 in the ls or crf in the cea in young healthy female mice .
although our data show that the bdnf gene is activated by exercise in the ls , the limitation is that we did not measure bdnf protein levels .
however , it is possible that exercise may promote ls neuronal survival through increased bdnf , but this needs to be further elucidated .
in addition , to what extent this is related to an effect on depressive and anxiety - like behavior remains to be analyzed and would be an intriguing future perspective .

Answer:
voluntary physical activities are known to modulate anxiety and depressive / like behaviors in both animals and humans .
 brain derived neurotrophic factor ( bdnf ) , has been reported to be elevated following exercise .
 bdnf , as well as type 2 corticotrophin releasing factor receptor ( crfr ) 2 , has been shown to mediate anxiety - like behavior . in the present study we examined the effects of long - term voluntary exercise on the transcripts for bdnf and crfr2 in the lateral septum ( ls ) and for crf in the central amygdala ( cea ) in female mice .
 thus , increased activity of crf in the cea is associated with anxiety - like behavior .
 quantitative rt - pcr was employed to measure levels of mrna in punch biopsies from ls and cea .
 in addition , measurements of the concentration of corticosterone and leptin in plasma were employed . in the ls
 , we found a three - fold increase of bdnf mrna ( p < 0.05 ) but no significant change in crfr2 mrna . no changes in crf in the amygdala were observed but we found a decrease in the levels of plasma corticosterone .
 plasma leptin and the weight of perigonadal fat pads were decreased following exercise . in conclusion , these data show that bdnf gene expression in the ls is influenced by long - term exercise in females but not crfr2 .


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:
it is surprising that a medline search reveals less than 10 articles on topics concerning adult thalassemia .
there is a severe resource data crunch at a time when information needs to be readily available to the physicians , the emphasis being on  evidence - based medicine .
 this study aims to evaluate the clinical profile of thalassemia major patients surviving into adulthood so as to orient the physicians and the general practitioners to adult thalassemia patients .
the study included all adult patients of thalassemia ( > 18 years old ) who are attending the adult thalassemia care unit ( department of medicine ) for their management .
the department of pediatrics at our institute , which happens to be a tertiary institute , runs a thalassemia day care unit , wherein about 250 patients regularly receive transfusion and all patients who attain 18 years of age are referred to adult thalassemia care unit ( department of medicine ) for management , from where these data are being reported .
all patients were evaluated clinically and investigated for complete blood counts , serum urea , creatinine , bilirubin ( total and direct ) , alanine and aspartate transaminases , alkaline phosphatase , total protein and albumin , fasting and postprandial plasma glucose , serum ferritin , and thyroid hormone levels .
all the patients were receiving packed cell transfusions for at least 15 years with the aim to keep the hemoglobin levels at about 10 g / dl .
unpaired student 's t - test was used to ascertain difference in clinical features between male and female thalassemia patients .
a total of 19 thalassemia patients were above the age of 18 years and were availing regular transfusion services at fortnightly intervals .
as is evident from the table , the height in both the male and female subjects was quite lower than the usual height in indian adults .
only three males and one female had a height exceeding 150 cm , the maximum height achieved by a male subject being 168 cm and for the female 151 cm .
the average height in male thalassemics was significantly higher than that in females ( unpaired t - test , p=0.023 ) . despite the fact , the height was below average , the bmi was < 18.5 in eight thalassemia patients ( 42.1% ) and only one ( 5.3% ) had a bmi>25 i.e. 25.44 .
clinical features of thalassemia patients nearly half of the patients ( 47.4% ) had undergone splenectomy by the time they reached their adulthood . interestingly ,
72% males had undergone splenectomy as compared to 12.5% female thalassemics ( unpaired t - test , p=0.005 ) .
average hemoglobin was similar in both male and female subjects but six ( 31.6% ) had their hemoglobin levels < 8 g / dl .
average leukocyte counts were higher in males ( unpaired student 's t - test , p=0.0058 ) .
moreover , two ( 18.2% ) males and four ( 50% ) females had total leukocyte counts < 4000/mm .
surprisingly , no patient had achieved the recommended serum ferritin levels of < 1000 ng / ml .
in fact , serum urea , creatinine , total proteins , and albumin levels were within the normal range for all patients .
four patients ( 21.1% ) had serum bilirubin levels > 1.5 mg/ dl with a predominant indirect hyperbilirubinemia .
one patient was positive for both hepatitis b and c virus infections and three others were only positive for hcv and one other harbored hiv infection . in total five ( 26.3% ) patients were harboring at least one of the three infections .
four ( 21.1% ) of the patients were receiving a combination of two iron - chelating drugs - deferiprone and desferrioxamine , while the remaining were receiving only deferiprone .
average dose of deferiprone being administered to each patient was 958 mg / kg body weight daily in divided doses .
thalassemia is an autosomal recessive disorder and thalassemia major manifests as severe anemia in infancy or childhood and used to be incompatible with life in the absence of regular red cell transfusions .
however , hematopoietic stem cell transplantation ( hsct ) has offered a prospect of cure with a normal life expectancy and quality of life , relief from life - long blood transfusions and its attendant complications .
short of hsct , thalassemia major patients need a two - pronged therapy in the form of  transfusion
it is only thalassemia minor / trait which may be diagnosed in adulthood and does not carry a great clinical significance being asymptomatic in majority of individuals .
however , with increasing number of thalassemia major patients surviving through their adolescence into adulthood , adult physicians should brace themselves to face the challenge of dealing with thalassemia in their adult patients .
 what adult thalassemics will be like  has been presented in this article . in spite of improvements in transfusion practices and availability of effective iron chelators , the life of thalassemia patients
the complications relate to inadequate transfusions , inadequate chelation , transfusion - transmitted viral infections , allosensitization , iron overload and its consequences of endocrine , cardiac , hepatic disturbance ; iron - chelator - related drug toxicities ; osteoporosis and psychosocial problems.[24 ] lack of proper and trained medical expertise , periodic requirement of safe and adequate packed red cell concentrates high cost of in - line leukocyte - depleting filters and iron - chelator drugs ; and poor compliance with blood transfusions , periodic monitoring , and regular chelation pose other major hurdles for the thalassemics .
inadequate transfusions are a rule rather than the exception in india resulting in hypersplenism and greater rates of splenectomy .
a total of 31.6% patients had hemoglobin levels < 8 g / dl and 47.4% adult thalassemics had undergone splenectomy in the present study .
however , this finding could not be corroborated because of lack of similar published studies .
the high total leukocyte counts observed in males can be explained as a consequence to splenectomy .
the low average height , weight , and the bmi in both males and females are signs of growth failure commonly seen in inadequately chelated beta - thalassemics .
normal serum protein and albumin levels rule out protein energy malnutrition as a cause of growth failure .
serum ferritin levels were high in all patients , a testimony to inadequate chelation in this group .
this is despite the fact that all thalassemics were receiving iron chelation , either deferiprone alone or in combination with desferrioxamine .
even the average dose of deferiprone while being used as monotherapy was 95 mg / kg / day ( range being 85114 mg / kg / day ) against the recommended dose of 75 mg / kg / day in divided doses . in fact
, one study citing that deferiprone was not found sufficiently effective at the recommended dose of 75 mg / kg / day , tried a high dose of 100 mg / kg / day for 2 years and found it to be safe and effective .
however , in the present study in adult thalassemics , deferiprone is not effectively chelating even at this high dose , so a higher dose may need to be tried or patients shifted to alternative iron chelators like deferasirox .
repeated blood transfusions are associated with the serious risk of transmission of chronic viral infections , which were observed in 26.3% of the cases in the present series .
antibodies to hepatitis c virus were observed in 21% cases and the same figure has been reported from indian thalassemics .
average serum transaminase values are higher than normal in the present study and can be attributable to chronic viral hepatitis .
the absence of diabetes , hypothyroidism , cardiac arrhythmias in the present cohort can possibly be explained by the young age ( early adulthood ) , since these are a consequence of iron overload and the prevalence therefore increases with the number of blood transfusions and so with the age .
indeed , one indian study did not report diabetes or impaired glucose tolerance in chronically transfused patients of thalassemia major between 8 and 15 years of age .
however , cardiac involvement can not be entirely ruled out since it requires echocardiography and mri to see for the functional and structural effects of iron overload , respectively .
osteoporosis and osteopenia are extremely frequent in thalassemia affecting from 52% to 96% of patients and the prevalence rises with age .
echocardiography , mri , and dexa scan were not performed for the thalassemia patients in the preceding 1 year and could not be done as part of the study in view of cost constraints .
this study presents a profile of the adult thalassemia subjects and provides insight into the problems and complications faced by them despite several medical advances .
the onus of dealing with these lies squarely with the adult physician and it is imperative for one and all to be aware of these .

Answer:
background : effective transfusion and chelation have prolonged the quality and longevity of life in thalassemics , who now survive into adulthood . hence , adult physicians need to be aware of their clinical and laboratory profile and the problems faced by them.aim:the present study was aimed to evaluate the clinical profile of adult thalassemics.materials and methods : adult ( > 18 years ) thalassemia major patients ( n=19 ) were evaluated clinically and fasting pretransfusion blood samples were analyzed for complete blood counts , kidney and liver function tests , plasma glucose , serum ferritin , and thyroid hormone levels.results:average age was 21.652.47 years ( range 1928 years ) , 42.1% had body mass index ( bmi ) < 18.5 .
 splenectomy had been performed in 47.4% before reaching adulthood , males significantly outnumbered females ( 72% vs. 12.5% ) . hemoglobin levels < 8 g / dl were observed in 31.6% and none had serum ferritin levels in the recommended range suggesting inadequacy of both transfusion and chelation .
 indirect hyperbilirubinemia was observed in 21.1% patients although kidney functions , serum protein , and albumin were normal in all patients .
 electrocardiographic abnormalities , diabetes mellitus or hypothyroidism were absent .
 five patients ( 26.3% ) had contracted transfusion - transmitted viral infections
 21.1% and 5.3% respectively had antibodies to hepatitis c virus and hiv , while 5.3% were positive for australia antigen .
 all patients were receiving chelation therapy
 deferiprone alone ( 78.9% ) or along with desferrioxamine ( 21.1% ) .
 average dose of deferiprone being used was 958 mg / kg.conclusion : adult thalassemia major patients present with a distinct clinical profile having low bmi , generalized hyperpigmentation , most are splenectomized , have low hemoglobin , inadequate chelation and harbor transfusion - transmitted infections .
 adult physician needs to be aware of this profile .


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:
it is well established that the transition of vascular smooth muscle cells ( vsmcs ) from a differentiated phenotype to a dedifferentiated state plays a critical role in the pathogenesis of atherosclerosis .
the phenotypic modulation in vsmcs is accompanied by accelerated migration , proliferation and production of extracellular matrix components .
eventually , these cellular events result in the formation of atherosclerotic lesions . however , the molecular mechanisms involved in phenotypic control are still unclear
. micrornas ( mirnas ) are a class of endogenous , small , non - coding rnas that pair with sites can in 3 ' untranslated regions in mrnas of protein - coding genes to downregulate their expression .
more importantly , one mirna is able to regulate the expression of multiple genes because it can bind to its mrna targets as either an imperfect or a perfect complement .
thus , a mirna can be functionally as important as a transcription factor . as a group , mirnas
it is therefore not surprising that mirnas are involved in the regulation of all major cellular functions .
recently , the role of mirnas in cardiac cell differentiation has been described . in this study , kwon et al . demonstrated that mir-1 plays important roles in modulating cardiogenesis and in maintenance of muscle - gene expression by targeting transcripts encoding the notch ligand delta .
the biological roles of mir-145 in diverse cancer cells have been recently identified ( reviewed in ) . in a recent article reported by xu et al .
, mir-145 was found to be a critical switch for embryonic stem cell differentiation by repressing some core pluripotency factors . whether mirnas participate in the phenotypic control of vsmcs was unknown until recently . in this respect ,
three independent groups have reported exciting new discoveries regarding the critical role of the vsmc - enriched mirna , mir-145 , in vsmc phenotypic modulation [ 8 - 10 ] .
they identified that mir-145 plays a role not only in the differentiation of multipotent neural crest stem cells into vsmcs , but also in the differentiation of adult vsmcs .
other mirnas that may participate in the phenotypic modula tion of vsmcs are mir-143 and mir-221 [ 9 - 12 ] .
this minireview summarizes the current research progress regarding the roles of mir-145 in the vsmc phenotype and the potential therapeutic opportunities of mirnas in atherosclerotic vascular disease .
ji et al .   demonstrated that mir-145 is the most abundant mirna in arteries . its expression is significantly downregulated in rat balloon - injured arteries with neointimal lesion growth .
a recent nature article by cordes et al .   showed that mir-145 expression was also decreased in mouse carotid arteries after ligation injury .
more interestingly , transcripts of mir-145 were down regulated to nearly undetectable levels in atherosclerotic lesions containing neointimal hyperplasia .
our own unpublished data also revealed that mir-145 is largely downregulated in atherosclerotic mouse and human arteries , although the downregulation is less pronounced compared with that from cordes ' study .
if the selected atherosclerotic tissue had fewer vsmcs , the expression level of mir-145 could be lower .
recently , cheng et al .   found that mir-145 is the most abundant mirna in differentiated vsmcs .
also , its expression is quickly downregulated in subcultured dedifferentiated vsmcs and in dedifferentiated vsmcs induced by stimulation with platelet - derived growth factor ( pdgf ) .
our unpublished data also indicate that mir-145 expression in vsmcs isolated from balloon - injured rat carotid arteries and atherosclerotic apoe - knockout mouse aortas is significantly decreased compared with that in vsmcs isolated from normal control arteries .
.   found that , during the development of arteries , the expression of mir-145 is associated with the state of vsmc differentiation .
mir-145 expression is notably absent in the aorta and pulmonary arteries during later cardiogenesis , during which vsmcs and arteries are developing .
in contrast , high transcript levels of mir-145 in vsmcs of the arteries are demonstrated postnatally , after vsmcs and arteries have completed their development .
cordes et al .   demonstrated that mir-145 was necessary and sufficient to induce differentiation of multipotent neural crest stem cells into vsmcs .
in addition , cheng et al .   identified for the first time that mir-145 is a critical modulator for the vsmc phenotype both in vitro and in vivo .
vsmc differentiation marker genes such as sm -actin , calponin , and sm - mhc were downregulated by mir-145 downregulation , and upregulated by mir-145 upregulation . the regulatory effect of mir-145 on the vsmc phenotype
was further verified by cordes and colleagues . in contrast , another co - expressed mirna , mir-143 , had no significant effect on marker genes for vsmc differentiation , although it had a strong effect on vsmc proliferation .
.   demonstrated that the expres sion of the mir-143/145 cluster is confined to vsmcs during development .
they found that mir-143 and mir-145 are required for vsmc acquisition of the contractile phenotype because the vsmcs from mir-143/145-deficient mice are locked in the synthetic state .
the regulatory effects of mirnas on the vsmc phenotype are not limited to mir-143 and mir-145 .
two recent studies revealed that mir-221 is also related to the vsmc phenotype that affects vsmc proliferation and migration .
it is well known that phenotypic modulation of vsmcs is an initial cellular event in the development of atherosclerotic vascular disease . to determine the therapeutic potential of mir-145 in vascular disease ,
.   demonstrated that restoration of mir-145 in rat balloon - injured carotid arteries via adenovirus - mediated gene transfer significantly inhibited neointimal lesion growth .
in contrast , knockout of mir-143 and mir-145 resulted in the formation of neointima in mouse arteries .
the roles of mir-145 in the vsmc phenotype and atherosclerotic vascular disease are summarized in figure 1 .
expression modulation of mir-145 in the vascular walls and the potential roles of mir-145 in vascular smooth muscle cell phenotype and atherosclerosis .
its expression is significantly downregulated in developing arteries and in adult arteries containing intimal hyperplasia .
the downregulated mir-145 in adult arteries will increase vsmc dedifferentiation and result in the development of atherosclerotic lesions .
mirna - based therapy may have some advantages compared with that for other molecular targets because one endogenous mirna can target its multiple target genes .
although the recent studies have demonstrated that targeting mirnas , and mir-145 in particular , may represent a new therapy for atherosclerosis , there is still a long road before mirna - based technology can be translated to clinical therapy .
first , the critical mirnas responsible for the development of atherosclerosis must be further identified , especially in human atherosclerotic arteries .
second , the detailed cellular and molecular mechanisms of these critical mirnas in the prevention and treatment of atherosclerosis should be studied .
third , in addition to the biological effects of these mirnas on vsmcs , their effects on other atherosclerosis - related cellular events should be identified .
fourth , although methods are available to downregulate a mirna in vivo , technology for upregulating a mirna in the vascular walls in vivo requires development . finally , the potential side - effects of mirna - based therapy should be studied before application in the clinic .
mirna : microrna ; mir-145 : microrna-145 ; pdgf : platelet - derived growth factor ; vsmc : vascular smooth muscle cell .
this work was supported by a national institutes of health grant hl080133 and a grant from the american heart association 09grnt2250567 .

Answer:
micrornas ( mirnas ) represent a class of small , non - coding rnas that negatively regulate gene expression via degradation or translational inhibition of their target mrnas .
 recent studies have identified that mir-145 is the most abundant mirna in normal arteries and vascular smooth muscle cells ( vsmcs ) , and its expression is significantly downregulated in dediffer - entiated vsmcs and atherosclerotic arteries .
 mir-145 plays a critical role in modulating vsmc phenotype .
 because phenotypic modulation of vsmcs is an initial cellular event in the development of atherosclerosis , mirnas , and mir-145 in particular , may represent new therapeutic targets for atherosclerosis .


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:
migraine is a chronic disease of the brain that enhances morbidity with complains like photophobia , headache attacks , phonophobia , and nausea . in the second edition of the headache classification by the international headache society ,
migraine is among the primary headaches and migraine without aura , migraine with aura , migraine cursors in childhood , retinal migraine , and migraine complications are grouped as potential migraines . according to the results of the turkish headache database ,
the number of female patients is 4 times that of male patients . there were 84% of the adults who were migraine without aura patients , and 14% who were migraine with aura patients .
although most of these patients have been found to have comorbidity with other diseases , eye diseases were excluded from those studies ; however , photophobia is reported to be the most frequent accompanying symptoms .
the vision system is reported to play a role , especially in migraine with aura headaches .
one of 5 patients with a headache is directed to the department of eye diseases , mostly because almost all migraine with aura patients have visual auras .
the relationship between migraine and refractive errors has been studied for more than 100 years ; however , conflicting results have emerged from those studies [ 79 ] . in this study , we compared the auto - refractometric values of migraine patients with and without visual aura , with those patients without migraine complaints .
we prospectively compared the patients who consulted the neurology policlinic between june 2013 and march 2014 with a headache complaint and diagnosed with migraine in accordance with the ichd-2 criterion with the individuals of the same gender and age group with no headache complaint .
this study adhered to the tenets of the declaration of helsinki and was carried out with the approval of the institution .
the patients were given full detailed eye examinations and findings were noted . out of these patients , those over age 18 years who had 20/20 uncorrected vision and who did not have ocular pathology in their examination were included in the study .
the patients were divided into 3 groups : group 1 : 86 eyes of 43 migraine patients without aura ; group 2 : 38 eyes of 19 migraine patients with aura ; and group 3 : 60 eyes of 30 patients without headache . the same ophthalmologist examined the patients in the period with no headache .
the corrected and uncorrected vision of right eye and left and bilateral eye of all the patients were individually measured .
those patients whose uncorrected vision did not have 20/20 value for both eyes separately and bilaterally were excluded from the study .
the 3-dimensional vision and eye movements of the patients were evaluated by the worth 4-point test and those patients who failed this test were excluded from the study .
biomicroscopic and fundus examinations of the patients were carried out and the intraocular pressure values were measured with goldmann applanation tonometry ; those patients with ocular pathology were excluded from the study . before the eye examination ,
following the eye examinations , 45 minutes after the patients were given 1% cyclopentolate hcl drips 3 times with 5 minutes intervals , their auto - refractometry values were recorded again .
the intended purpose of using the cyclopentolate with mydriatic and cycloplegic effect was that with the cycloplegic effect , ciliary muscles contraction was hindered and refractivity of the lenses increases through cambering ; in other words , accommodation was hindered .
thus , we aimed to provide more accurate refractivity values for the eye structures . in the study ,
spherical equivalents ( se ) and cycloplegic spherical equivalents ( cse ) from the auto - refractometrical values of the patients were used .
spherical equivalent is equal to the sum of the sphere value and half the cylindrical value , which were measured by the auto - refractometer device .
data were analyzed using spss ( statistical package for social sciences ) for windows 17.0 software . for quantitative data to compare the groups with normal distribution of parameters ,
we prospectively compared the patients who consulted the neurology policlinic between june 2013 and march 2014 with a headache complaint and diagnosed with migraine in accordance with the ichd-2 criterion with the individuals of the same gender and age group with no headache complaint .
this study adhered to the tenets of the declaration of helsinki and was carried out with the approval of the institution .
the patients were given full detailed eye examinations and findings were noted . out of these patients , those over age 18 years who had 20/20 uncorrected vision and who did not have ocular pathology in their examination were included in the study .
the patients were divided into 3 groups : group 1 : 86 eyes of 43 migraine patients without aura ; group 2 : 38 eyes of 19 migraine patients with aura ; and group 3 : 60 eyes of 30 patients without headache .
the corrected and uncorrected vision of right eye and left and bilateral eye of all the patients were individually measured .
those patients whose uncorrected vision did not have 20/20 value for both eyes separately and bilaterally were excluded from the study . the 3-dimensional vision and eye movements of the patients
were evaluated by the worth 4-point test and those patients who failed this test were excluded from the study .
biomicroscopic and fundus examinations of the patients were carried out and the intraocular pressure values were measured with goldmann applanation tonometry ; those patients with ocular pathology were excluded from the study . before the eye examination ,
45 minutes after the patients were given 1% cyclopentolate hcl drips 3 times with 5 minutes intervals , their auto - refractometry values were recorded again .
the intended purpose of using the cyclopentolate with mydriatic and cycloplegic effect was that with the cycloplegic effect , ciliary muscles contraction was hindered and refractivity of the lenses increases through cambering ; in other words , accommodation was hindered .
thus , we aimed to provide more accurate refractivity values for the eye structures . in the study ,
spherical equivalents ( se ) and cycloplegic spherical equivalents ( cse ) from the auto - refractometrical values of the patients were used .
spherical equivalent is equal to the sum of the sphere value and half the cylindrical value , which were measured by the auto - refractometer device .
data were analyzed using spss ( statistical package for social sciences ) for windows 17.0 software . for quantitative data to compare the groups with normal distribution of parameters ,
forty - three ( 69% ) out of the total of 62 patients had migraine without aura and 19 of them ( 31% ) had aura migraine .
age , gender distribution , and auto - refractometrical values of the migraine and control patients are given in table 1 .
although the cycloplegic spherical equivalents results of the right eyes were not statistically significant , statistical significance was found in the tukey test between the migraine patients with aura and the control group ( p=0.05 ) .
the right and left eyes of the patients were evaluated together and a significant correlation was found between the groups . it was also found through the tukey test that the source of significance was patients with aura ( p=0.010 ) .
when the refractive value differences between both eyes were evaluated , no significant difference was found in se and cse measurements ( p=0.411 and 0.536 ) . to evaluate
the impact of cycloplegia in patients , se and cse values were obtained and differences between these values were evaluated . in the post
hoc tukey test , it was found that the change in group 2 patients was significantly lower than the change in group 3 patients ( p=0.024 ) .
the differences between cse and se in all eyes in both groups are given in table 3 .
ninety - nine percent of migraine patients with aura had visual symptoms . it was observed that since visual auras such as photopsy , scintillating scotoma , and hemianosmic changes in the foreground , especially in migraine with aura , the potential ocular problems in migraine pathogenesis have to be taken into account and the patients consulting with headaches were referred to ophthalmologists .
we give eye examination to the migraine patients referred to our policlinics from the department of neurology and evaluated their examination findings .
there are studies stating that migraine - related findings and refraction defects can trigger migraine .
it was reported that migraine may impact the eyelids , conjunctiva , iris , pupil , optical nerve , retina , and extraocular muscles .
the relationship between the refractive errors and migraine has been researched since the beginning of the 20 century .
although these studies especially emphasized that anisometropia and astigmatism were the triggers of migraine , the value of their results were limited because they were not controlled studies and no statistical evaluation was made [ 79 ] .
emphasized that blurry vision generated by astigmatism could create a hyperexcitability on the visual cortex and this could be a triggering factor for migraine .
when the migraine patients in our study were compared with the same age and gender groups , the spherical equivalents were found to be the same , but the cycloplegic spherical equivalents were significantly lower . when the migraine patients are divided into groups with and without aura and evaluated this way , while se values of the patient group with aura were similar to the control group , their cse values were significantly lower .
compatible with this finding , it was found that the changes in migraine patients with aura between the measurements before and after eye drops ( 1% cyclopentolate hcl ) were significantly lower .
similar to our study , there are studies demonstrating that the refractive errors were not different in migraine patients and it was also suggested in these studies that binocular vision was important .
however , even though we found no significant difference in refractive values between the 2 eyes in our study , all the patients involved in the study had 3-dimensional and uncorrected 20/20 vision .
the fact that the cycloplegic refraction values , especially in patients with aura , were found to be lower in comparison to healthy individuals could be an indication that these patients did not make sufficient accommodation .
since these patients could have blurry vision and difficulty focusing , it should be noted that this could be the trigger of a headache . on the other hand ,
no anisocoria was found in any of our patients ; however , we failed to measure the pupil diameters since we did not have a pupillometer .
it is possible that lack of accommodation in addition to isochoric and mydriatic pupils may create an attack with the increase in the amount of light entering the retina .
it was found in the previous studies that visual stimulus triggered a migraine in more than 1/3 of the patients and that the migraines triggered by light decreased in patients who were given colored lenses during the migraine attack .
bright light was a triggering factor in 87% of the migraine patients with aura , and this rate was 76% in migraine patients without aura .
the general characteristic of this condition is that with the third cranial nerve the most affected , it is accompanied by ocular cranial nerve palsy together with the migraine - like headaches in the form of attacks . in these situations ,
in which the pathophysiology is not fully understood in 75% of the patients , there was contrast increase and thickening in the mri - scanned nerves during the attacks , and it was thought that there might be an accompanying migraine or independent neuropathy . in another study , in a spect - scanned nerve area ,
a low level of blood flow was detected and it was thought that a temporary ischemic attack might follow .
in addition , ciliary ganglion cells or migraine - related elongated mydriasis might have occurred as a result of temporary dysfunctioning of postganglionic and parasympathetic fibers during a migraine attack .
the researchers who coined the term sillier ganglioplegic for this particular situation stated that this might be another result of ophthalmoplegic migraine pathogenesis . according to this hypothesis
, the cause of ophthalmoplegic migraine may also cause elongated mydriasis by clinging to the parasympathetic fibers . in the same study , it was stated that , in theory , the pain stemming from the sillier ganglions may find its way to the ophthalmic region of the trigeminal nerve and may create a bilateral headache .
based on this study , it is possible to conclude that innervation deterioration in the sillier ganglions into the sillier muscle in these patients may cause insufficient accommodation .
however , it was not possible to evaluate these hypotheses in our study since there were insufficient numbers of migraine patients with aura ; they were evaluated during the remission period and no mri tests were carried out .
we are of the opinion that the main causes of these conflicting results are misdiagnosis of headaches , changes in the diseases classification due to the new diagnostic techniques , evaluation of all the migraine patients together , and the lump - sum evaluation of all the eye impairments and visual levels .
to keep our study free of such handicaps , we only evaluated the patient with uncorrected 20/20 vision , dividing them into groups with and without aura .
we found that the cycloplegic spherical equivalent values of our patients with aura were lower than in control patients .
however , given the fact that our findings were obtained from the eye examinations of the patients during the remission period , it is not possible to determine whether migraine with aura is the trigger or the result of those attacks .
however , the number of migraine patients with aura is less than those without aura and it is very difficult to detect by the patient s ophthalmologist during the attack period . in order to be more conclusive about this particular issue
, the neurologist and ophthalmologist should be in communication and there is a need for more comprehensive studies with larger number of participants .

Answer:
backgroundthe aim of this study was to compare spherical equivalents ( se ) and spherical equivalents with cycloplegic ( cse ) values of migraine patients with and without visual aura , with those patients without migraine complaints.material/methodswe included patients over the age of 18 years , who had 20/20 uncorrected vision , and who did not have ocular pathology in their examination .
 the patients were divided into 3 groups : group 1 : 86 eyes of 43 migraine patients without aura , group 2 : 38 eyes of 19 migraine patients with aura , and group 3 : 60 eyes of 30 patients without migraine .
 spherical equivalents and spherical equivalents with cycloplegic from the auto - refractometrical values of the patients were compared.resultsthe mean age of the migraine and control patients was 34.28.3 and 33.610.8 years , respectively .
 forty - three ( 69% ) of 62 migraine patients had migraine without aura and 19 ( 31% ) had migraine with aura .
 the right and left eyes of the patients were evaluated together and a significant correlation was found between the groups . to evaluate
 the impact of cycloplegia in patients , se and cse values were obtained and differences between these values were evaluated .
 it was found that the change in group 2 patients was significantly lower than the change in group 3 patients ( p=0.024).conclusionswe found that the cycloplegic spherical equivalents values of our patients with aura were lower than control patients .
 we need further studies to reveal whether migraine with aura is the trigger or the result of those attacks .


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:
because many prenatal disorders involve more than one organ , an important clue of prenatal diagnosis is to look for multiple anomalies .
therefore , finding a specific lesion commands detailed examination of the fetus to rule out a possible involvement of other organs .
this approach is clinically important as identifying multiple lesions may impact on diagnosis , prognosis , and pregnancy / postnatal management .
the aim of the present work was to report on two cases in which digestive tract occlusion or perforation was found to be associated with brain hemorrhage . in one fetus , finding this association modified the prognosis and the outcome of pregnancy , while in the other , it influenced the postnatal management .
a 39yearold pregnant woman was referred to our multidisciplinary center of fetal medicine at 26 weeks of gestation for reevaluation of fetal intestinal dilatation and ascites .
an amniocentesis performed at 21 weeks due to mother age was normal for a female fetus . on ultrasound ( us ) , a meconial pseudocyst in the left flank of the fetus , ascites , and slight bowel dilatation ( 7 mm ) were found ( fig .
the doppler study was normal for the umbilical artery and ductus venosus but it showed slight daily changes in the resistive index of the medial cerebral artery from 0.84 to 0.75 .
performed at 31 weeks , a sudden increase in bowel dilatation ( 15 mm ) was observed .
the mri performed on the next day , confirmed the presence of meconial pseudocyst , small bowel dilatation , and unused microcolon which likely developed in the context of perforation secondary to small bowel atresia .
because the mri reference scan showed an abnormal hyperintense t1 cerebral lesion , a focused brain mri was performed the week after , at 32 weeks .
this examination demonstrated intraventricular hemorrhage and extensive intraparenchymal frontoparietal ischemic lesions , consistent with the diagnosis of grade 4 brain hemorrhage ( fig .
these lesions had most probably been overlooked at least on the us scan performed on the day before the first mri . a 26week and 4day axial us abdominal scan of the fetus 1 showing the meconial pseudocyst ( between crosses ) and the ascites ( arrow ) . a 31week t2 weighted mri coronal slice of the brain of the same fetus showing the periventricular parenchymal ischemic lesions ( arrow ) , the hemosiderin deposits in the subependymal region ( arrow head ) , and the ex vacuo dilatation of the frontal horn of the lateral ventricle : grade 4 hemorrhage .
after multidisciplinary discussion and complete information of the parents , they elected termination of pregnancy at 34 weeks because of the risk of cerebral palsy and poor abdominal prognosis .
a 25yearold pregnant woman came to our fetal medicine center for routine second trimester us at 22 weeks .
the amniocentesis revealed neither genetic anomalies nor infection . on subsequent us performed at 25 weeks , an intraventricular brain hemorrhage ( fig .
, we observed a progressive dilatation of the bowel loops and resolution of the effusions .
the colon that should be clearly visible on third trimester us was never seen suggesting proximal bowel atresia .
a comprehensive mri performed at 31 weeks investigated both regions , the fetal brain mri confirmed the grade 2 hemorrhage without parenchymal lesions and the abdominal mr sequences demonstrated a distal small bowel atresia with unused microcolon ( fig .
the loops dilatation increased to 30 mm diameter with heterogeneous content and slight abdominal effusion suggesting parietal damage .
a caesarian delivery was performed on the same day giving birth to a 2620 g baby girl with good apgar score .
the neonatal surgery confirmed an isolated distal small bowel atresia , with proximal intact loops , the atretic segment was resected , and a double ileostomy was done .
a 25week axial us scan of the head of the fetus 2 showing subependymal hemorrhage ( arrow ) and the hyperechogenic wall of the lateral ventricle ( arrow head ) : grade 2 hemorrhage .
a 31week t2 weighted mri coronal scan of the fetus 2 showing normal fluid filled proximal loops ( arrow ) and dilated intermediate and distal loops attesting of the distal small bowel occlusion .
we report on two cases of prenatal diagnosis of digestive tract occlusion or perforation that were found to be associated with brain hemorrhage ; this significantly impacted on prognosis in one case and on postnatal management in the other .
different theories have been proposed to explain digestive tract atresia : for example , lack of vacuolization of the solid cord stage of intestinal development or ischemic insult to the midgut due to mesenteric vascular accident 1 , 2 .
the atresia can be isolated but may also be associated with meconium ileus , apple peel atresia , volvulus , or abdominal wall defect 3 , 4 .
cystic fibrosis should be excluded as it is an associated condition in 740% of cases 5 , 6 .
concomitant extraintestinal anomalies are less frequent , though one study reported extra abdominal malformations like congenital heart disease , down 's syndrome , anorectal and vertebral anomalies , neural tube defect , microcephaly , and vesicoureteral reflux 7 . to our knowledge , the association of meconial peritonitis or ileal atresia with brain hemorrhage has never been described prenatally .
a vascular insult responsible of the gut atresia could be associated with blood flow disturbance leading to cerebral hypoperfusion and subsequent injury 8 , 9 . in case 1 ,
the appearance of the brain ischemic lesion on mri at 31 weeks was compatible with vascular insult going back to a few weeks earlier .
experimental studies in fetal sheep 10 have shown that cerebrovascular immaturity may impair the ability to maintain constant cerebral blood flow over a wide range of changes in arterial blood pressure ; this might also apply to human foetuses .
periventricular and subependymal regions that corresponded to the affected zones in our two fetuses are of greater susceptibility because of high metabolism and watershed vascular regions 11 .
another hypothesis explaining the rare association of meconial peritonitis and brain hemorrhage may be an intravascular meconial dissemination leading to endovascular occlusions by squamous cells
. a neonatal case has been published associating meconium peritonitis , periventricular leukomalacia , and pulmonary hypertension leading to neonatal death secondary to respiratory insufficiency .
necropsy disclosed disseminated intravascular occlusions by squamous cells 12 . a case of twintotwin transfusion syndrome has also been reported ; one twin presented meconium peritonitis and intravascular disseminated coagulation that led to intrauterine death of the other twin .
these two possible pathogenic mechanisms could cause vascular disruption of the blood supply in multiple organs and hence explain the association we describe in the present report .
these two rare cases associating digestive tract occlusion or perforation and brain hemorrhage give us the opportunity to emphasize the need for careful screening of the fetal brain in such acute abdominal conditions . because brain lesions may be delayed , neonatologists and pediatricians should also be vigilant and prescribe transfontanellar us whenever a newborn has a history of bowel ischemia and/or perforation .

Answer:
key clinical messagewe report two prenatal cases of an exceptional association of digestive tract atresia or perforation with brain hemorrhage .
 this combination worsens the prognosis leading to termination of pregnancy in one case .
 we outline the importance of a careful fetal brain examination on imaging in cases of prenatal  acute  abdominal insults .


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:
during 20042007 , as part of a broader biodiversity survey and inventory program , we sampled birds from mostly forested sites in guangxi and guizhou provinces in the southern part of the people s republic of china ( figure ) .
sampling was conducted by mist netting and selective harvesting with shotguns ; all birds in the study were apparently healthy and behaving normally at the time of collection . because initial sampling was focused on endoparasite communities , samples from 20042005 consisted of complete gastrointestinal tracts frozen in liquid nitrogen . in 20062007
southeastern asia , showing 5 sites in the people s republic of china where land birds were collected and tested for influenza a virus .
prevalence values were 4% ( n = 103 ) in dashahe in 2006 ; 6% ( n = 194 ) in kuan kuoshui in 2006 ; 0.3% ( n = 328 ) in shuipu in 2007 ; 3% ( n = 184 ) in jing xi , in 2004 ; and 0% ( n = 130 ) in shiwandashan in 2005 .
a total of 184 samples were collected from jing xi municipality in guangxi ( 21.122n , 105.964e ) in 2004 , 130 from shiwandashan nature reserve in guangxi ( 21.840n , 107.880e ) in 2005 , 103 from dashahe nature reserve in guizhou ( 29.167n , 107.575e ) in 2006 , 194 from kuan kuoshui nature reserve in guizhou ( 28.226n , 107.160e ) in 2006 , and 328 from shuipu village , guizhou province ( 25.485n , 107.882e ) in 2007 ( figure ) .
samples were tested for influenza a virus by real - time reverse transcription  pcr ( 6 ) in 2 diagnostic laboratories ( southeast poultry research laboratory , us department of agriculture , athens , ga , usa , and national wildlife health center , us geological survey , madison , wi , usa ) .
of 939 samples tested , 24 were positive for influenza a viruses ( prevalence 2.3% , table ; complete summary in appendix table ) .
if migratory behavior ( species classified as migratory or nonmigratory on the basis of descriptions by mackinnon and phillipps ) , was considered , 11 ( 4.8% ) of 231 samples from species showing marked seasonal migrations were influenza positive .
however , only 13 ( 1.8% ) of 708 samples from nonmigratory species were positive .
the cumulative binomial probability that such a high number ( 11 ) of positive samples would result among the 231 migratory - species samples , were the true prevalence to be 1.8% , is low ( p = 0.0013 ) .
thus , migratory species appear to have higher influenza infection rates . in terms of general habitat use ( 7 ) , open - country species were slightly more prone to be influenza positive ( 8 [ 2.9% ] of 274 samples ) than forest species ( 16 [ 2.4% ] of 665 samples ) , but the difference was not significant ( cumulative binomial probability , p>0.05 ) .
interactions between migratory behavior and habitat use were not significant ( contingency test , p>0.05 ) .
although all infections detected were among songbirds ( passeriformes ) , the sampling also concentrated on songbirds ( 94.3% ) .
thus , we could not test adequately the hypothesis that influenza prevalence was equivalent between songbirds and other birds .
an obvious question is whether the influenza a viruses we detected belong to the highly pathogenic subtype h5n1 strain currently circulating across much of asia .
pcr ( 6 ) , although this result does not exclude the possibility that h5 viruses were among the positive samples .
the preservation status of samples we tested prevented virus isolation or full , strain - level characterization of influenza viruses .
the subtype h5n1 strain of influenza virus has spread rapidly and has been detected across much of central and southern eurasia . although movements of wild birds have been implicated in this spread ( 8) , other studies question ( 9,10 ) or contradict ( 11 ) this idea .
an important part of the argument centers on the question of the occurrence of the virus in wild birds without obvious illness , which can be difficult to interpret given the low prevalence of influenza .
for instance , a recent study based on sampling > 13,000 migratory birds in china detected the subtype h5n1 strain of influenza virus only 8 times ( 12 ) , and similar results have been obtained elsewhere ( 2 ) .
our study , although not successful in characterizing influenza viruses to specific strains , nonetheless shows that influenza a virus infection occurs in more bird species than previously assumed and that influenza a infections can be found in birds that behave normally and show no sign of illness .
although a review of avian influenza virus ecology ( 1 ) discussed the occurrence of influenza viruses across all groups of birds ( and other vertebrates ) , subsequent studies have assumed that waterbirds are the primary reservoir ( 8,13,14 ) . in this study ,
although waterbirds could have higher prevalences , we have demonstrated broad occurrence of influenza viruses in diverse taxa of passeriformes ( songbirds ) in southeast asia .
this result suggests that land birds may also be a major reservoir of influenza viruses .
we have taken a step toward a more complete understanding of influenza virus ecology among wild birds .
our partial survey of influenza virus distributions across the rich avifaunas of the southern region of china demonstrated frequent infections .
we suggest that to be effective future surveillance efforts will need to include the full diversity of wild birds .

Answer:
water birds are considered the reservoir for avian influenza viruses .
 we examined this assumption by sampling and real - time reverse transcription
 pcr testing of 939 asian land birds of 153 species .
 influenza a infection was found , particularly among migratory species .
 surveillance programs for monitoring spread of these viruses need to be redesigned .


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:
chronic suppurative otitis media ( csom ) is an inflammatory disease of the middle ear and mastoid air cell system , which can result in irreversible changes not only in the middle ear structures but also in the inner ear.1 ) dysfunction of the eustachian tube and the bacterial infection are important factors in the multifactorial pathogenesis of csom . in order to eradicate inflammation ,
prevent recurrence and restore middle ear structures and hearing , both medical and surgical treatment modalities are important in csom .
it has been emphasized that selection of appropriate antibiotics should be based on the bacteriologic studies to identify the pathogens and determine sensitivities.2,3 ) recent bacteriologic studies of the middle ear discharge in csom in korea have reported increasing prevalence of methicillin - resistant staphylococcus aureus ( mrsa).2,4,5 ) in addition , staphylococcus aureus ( s. aureus ) and pseudomonas species were most predominant from the postoperative otorrhea cultures.3 ) higher rates of postoperative otorrhea and reperforation after tympanomastoid surgeries were reported in csom patients with mrsa cultured from preoperative ear discharge.6 ) in addition to intrinsic mrsa infection of the mastoid air cell system , nasal colonization of mrsa may pose increased risk of postoperative infection . nasal colonization rate of mrsa and it is a known predictor of postoperative surgical site infection.7,8 ) previous studies have identified bacterial pathogens from the middle ear and the mastoid air cells , or nasopharynx as a bacterial reservoir in csom.4,5,9 - 12 ) however , few studies have focused on the effect of nasal mrsa colonization in the otologic surgery .
the aims of this study are to examine the prevalence of nasal mrsa colonization in patients undergoing otologic surgeries and to determine the association between mrsa colonization and the pathogens identified from perioperative culture studies .
the study included 66 consecutive patients ( 25 males and 41 females ) undergoing tympanomastoid surgeries from may 2010 to december 2011 at the yonsei university college of medicine gangnam severance hospital .
patients with intracranial or extratemporal complications of csom , known history of external radiation , known history of corticosteroid therapy preoperatively , or those undergoing emergency operations were excluded .
the mean age at operation was 51.715.7 years ( range 34 - 74 years ) , and the right ear was operated in 34 ears , the left in 32 ears . upon the initial visit in the outpatient department , the external auditory canal was cleaned , and the middle ear discharge was collected with collected with cotton swabs through sterile otoscopes , taking care not to touch the external auditory canal skin . to assess nasal colonization of s. aureus ,
the nasal samples were obtained by cotton swab from the anterior vestibular of the nares by the physician . during the operation , intraoperative culture specimens were taken in cases with overt discharge in the middle ear cavity . during postoperative period of 1 month ,
postoperative culture specimens were again taken in cases with otorrhea through the external auditory canal .
all culture samples were in stuart transport medium and transported to the laboratory , where the samples were inoculated onto blood agar , macconkey 's agar , and chocolate agar plates .
all plates were incubated at 37-c aerobically under 5% ( v / v ) co2 and examined 24 and 48 hours later .
susceptibility testing was performed using disk diffusion . identified pathogen species and antimicrobial susceptibility were compared between nasal swab and perioperative ( preoperative , intraoperative and postoperative otorrhea ) cultures .
statistical analysis was performed with fisher 's exact testusing spss statistical software ( version 15.0 ; spss inc . ,
among the 67 patients undergoing operation for csom , nasal swab confirmed bacterial colonization in 37 ( 55.2% ) patients ( table 1 ) . clinically importantly , nasal cavity colonization of s. aureus was noted in 10/67 ( 14.9% ) of patients , and 4/67 ( 6.0% ) patients were positive for mrsa .
also , methicillin - sensitive staphylococcus aureus ( mssa ) was identified in 9/37 ( 23.4% ) and methicillin - resistant coagulase - negative staphylococcus ( mrcns ) in 11/67 ( 13.4% ) of patients .
preoperative ear culture studies identified pathogens in 39/67 ( 58.2% ) of the patients : the most commonly identified species was staphylococcus [ mrcns 26.9% , methicillin - sensitive coagulase - negative staphylococcus ( mscns ) 1.5% , mrsa 13.4% and mssa 11.9% ] .
mrsa was found in 3/40 ( 4.5% ) ears , mssa in 2 ears ( 3.0% ) , mrcns in 2 ears ( 3.0% ) and mscns in 1 ear ( 1.5% ) .
after the surgery , 11 of the 67 patients developed otorrhea within 1 month postoperatively .
the postoperative culture studies identified mrsa in 3/11 ( 27.3% ) and acinetobacter species in 1/11 ( 9.1% ) and fungus in 2/11 ( 18.1% ) patients ( table 2 ) .
preoperative ear culture results and nasal swab culture results showed significant difference ( p=0.001 ) , as well as intraoperative middle ear cultures and postoperative otorrhea culture results showed significant difference ( p=0.023 ) .
however , no significant difference was noted between preoperative ear and postoperative otorrhea culture results ( p=0.493 ) .
then we compared the culture results according to the presence of bacterial growth and reports of no growth ( fig .
no significant difference was noted between preoperative ear culture , and nasal swab culture results ( p=0.055 ) , between preoperative ear and postoperative otorrhea culture results ( p=0.068 ) , or nasal swab and postoperative otorrhea culture results ( p=0.094 ) .
lastly , the culture results were compared according to the presence of antibiotic resistance ( fig .
no significant difference was noted between the antibiotic - susceptible and resistant strains identified between preoperative ear culture and nasal swab cultures ( p=0.098 ) , or between preoperative ear and postoperative otorrhea cultures ( p=0.053 ) .
then we analyzed the correlation of isolated organisms from the nasal swab and other cultures in patients with nasal colonization of antibiotic - resistant strains ( fig .
4 ) . among 4 patients with identified with nasal mrsa colonization , preoperative ear cultures were also positive for mrsa in 3 patients ( 75.0% ) .
however , intraoperative culture identified mrsa in only one patient , and none of the patients developed mrsa infection postoperatively .
preoperative ear cultures reported mrsa in 1 , mrcns in 1 , and mscns in 7 , ciprobay - resistant pseudomonas in 1 , and no growth in 2 patients .
increasing incidence of antibiotic - resistant bacterial strains in csom patients poses a challenge to not only the selection of appropriate antibiotics therapy , but also to prevent the emergence of resistance to glycopeptides , the main drugs chosen for mrsa .
it has been reported that patients who are colonized with s. aureus are the main source of s. aureus in hospitals , and that nasal carriage of mrsa increases the risk of postoperative infection . since the rate of methicillin resistance is higher in korean csom patients compared to other countries , we examined the rate of nasal mrsa colonization .
the rate of nasal carriage of mrsa in csom patients was higher than among healthy individuals reported as 0.2 - 2.8% of the united states population.7 ) although this study was limited to small number of patients , the finding may suggest that in addition to nosocomial infection , community - acquired mrsa infection may contribute partially to the relatively higher rate of mrsa in csom patients in korea . on the other hand ,
the rates of bacterial isolation from preoperative ear discharge , intraoperative middle ear discharge , or postoperative otorrhea cultures in our patients were lower .
also , the perioperative culture studies frequently reported no growth of pathogens . given that the patients were prescribed with antibiotics prior to surgery , it may signify that current antibiotics are effective in infection control during the tympanomastoid surgery . furthermore , the interpretation of the culture results from postoperative otorrhea is limited since antibiotics were routinely used postoperatively in all patients and culture samples were taken from the external auditory canal in cases with overt otorrhea or from wet surface of the grafted tympanic membrane immediately after removal of the packing material at 2 weeks postoperatively . the culture results can only reflect that mrsa infection that could not be controlled by routine antibiotics , which may be clinically significant .
mrsa has been identified not only in csom patients,2,3,5,13 ) but also in patients with external otitis.14 )
 s. aureus has been implicated in biofilm formation complicating cochlear implants.15 - 17 ) nasal mrsa colonization deserves attention since transmission from nasal carriage to surgical site infections or bacteremia is possible , and it is associated with increased morbidity and mortality .
previous studies have reported that elimination of nasal mrsa colonization reduces the risk of postoperative infections.8,18,19 ) application of 2% mupirocin calcium ointment to the nares has been proven to be effective , and chlorhexidine - based solutions is used to reduce the density of skin colonization of mrsa preoperatively.18 - 20 ) a recent study compared the rates of mrsa infection in otolaryngology surgeries , before and after implementation of preoperative screening and treatment of nasal mrsa carriage.21 ) further studies are warranted to investigate the possible benefit of preoperative treatment of mrsa colonized patients undergoing middle ear surgeries .
the rate of nasal mrsa colonization among patients with csom was higher than among the general community .
further studies are warranted to investigate the possible benefit of preoperative treatment of mrsa colonized patients undergoing middle ear surgeries .

Answer:
background and objectivesmethicillin - resistant staphylococcus aureus ( mrsa ) is one of major pathogens in patients with chronic suppurative otitis media ( csom ) .
 in addition to intrinsic mrsa infection of the mastoid air cell system , nasal colonization of mrsa , a known predictor of postoperative surgical site infection , may pose increased risk of postoperative complications .
 the purpose of this study is to describe microbiology of preoperative nasal swab screening and localized middle ear specimens in patients undergoing otologic surgeries.subjects and methodsforty - nine consecutive patients with csom who underwent middle ear surgery were included .
 preoperative nasal swabs for mrsa , and preoperative and intraoperative middle ear swabs were collected and compared for pathogens.resultspreoperative nasal swab screening confirmed mrsa colonization in 3/49 patients ( 6.1% ) and methicillin - resistant coagulase - negative staphylococcus ( mrcns ) in 9/49 patients ( 18.4% ) .
 correlation with preoperative culture results and nasal swab screening results were compatible in 2/4 patients with positive nasal swab for mrsa and 1/9 patients with positive nasal swab for mrcns .
 postoperative conversion to mrsa was observed in 3 patients.conclusionsthe rate of nasal mrsa colonization among patients with csom was higher than among the general community .
 preoperative mrsa colonization was associated with mrsa from middle ear specimens .
 further studies are warranted to investigate the possible benefit of preoperative treatment of mrsa colonized patients undergoing middle ear surgeries .


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 patients in the african - heritage ( n = 9 ) and caucasian - heritage ( n = 11 ) groups had similar distributions of sex , age , and duration of diabetes ( male 75 vs. 70% , p = 0.89 ; mean  sd age 53.3  7.2 vs. 55.2  4.6 years , p = 0.50 ; and duration 10.3  10.7 vs. 6.8  6.4 years , p = 0.37 , respectively ) .
systolic blood pressure and diastolic blood pressure were 124.4 vs. 122.1 mmhg ( p = 0.75 ) and 77.0 vs. 76.1 mmhg ( p = 0.81 ) , respectively .
the patients were nave to antihypertensive therapy , and equal numbers in each group received metformin ( n = 6 ) and insulin ( n = 2 ) .
a1c and urinary albumin were measured by high - pressure liquid chromatography ( ha 8 - 121 ; biomen , berkshire , u.k . ) and immunoturbidimetry , respectively .
microalbuminuria was excluded on the basis of three consecutive albumin - to - creatinine ratios <3 mg / mmol in sterile , early - morning urine samples and a urinary albumin excretion rate < 30 mg / day .
renal plasma flow ( rpf ) was measured by the constant infusion method ( 6,7 ) .
a bolus dose of 8 mg / kg paraminohippurate ( merck , sharp & dohme , hoddesdon , u.k . ) was given with a 20 mg / min infusion .
after a 90-min equilibration period , the concentration of the infusate was multiplied by the infusion flow rate and divided by the mean of duplicate plasma samples at this and subsequent time points .
plasma paraminohippurate was assayed after deproteinizing the samples with 6% trichloroacetic acid for 10 min at 70c and sequentially adding sodium nitrite , ammonium sulfamate , and n-1-naphthylethylenediamine using a cobas mira ( roche , lewes , u.k . ) .
after initial equilibration , an amino acid mixture ( vamin ; pharamcia & upjohn , milton keynes , u.k . ) was infused ( 0.043 ml  kg  min ) .
rpf was assessed 80 min later , and then l - nmma ( clinalfa , laufelfingen , switzerland ) was begun at the nonpressor dose of 20 g  kg  min .
both infusions were continued for a further 20 min , after which a final rpf measurement was made . during the studies ,
blood pressure was monitored automatically ( dinamap ; critikon , basingstoke , u.k . ) , and whole blood was sampled from a venflon in a hand vein to measure glucose by the oxidase method ( one touch ; lifescan , high wycombe , u.k . ) every 10 min .
mean arterial pressure ( map ) was calculated as the diastolic blood pressure plus one - third of the pulse pressure .
renal blood flow ( rbf ) was calculated by dividing the rpf by 1 hematocrit and renal vascular resistance ( rvr ) by dividing map by rbf .
the study was approved by the ethics committee of the whittington hospital national health service trust .
analyses between or within the groups were performed using spss for windows ( version 10 ; spss , chicago , il ) .
continuous variables were compared with parametric or nonparametric tests and associations tested with spearman 's rank correlation test or pearson 's x test according to their distribution .
categorical variables were compared using a  test with continuity correction or fisher 's exact test .
clearance and rpf measurements were corrected for a body surface area of 1.73 m. data are expressed as means  sd unless otherwise stated .
analyses between or within the groups were performed using spss for windows ( version 10 ; spss , chicago , il ) .
continuous variables were compared with parametric or nonparametric tests and associations tested with spearman 's rank correlation test or pearson 's x test according to their distribution .
categorical variables were compared using a  test with continuity correction or fisher 's exact test .
clearance and rpf measurements were corrected for a body surface area of 1.73 m. data are expressed as means  sd unless otherwise stated .
comparative baseline measurements of rpf and systolic and diastolic blood pressures were similar between the african - heritage and caucasian - heritage groups ( rpf 533.7  174.7 vs. 565.3  260.8 ml / min per 1.73 m , p = 0.78 ; systolic 124.9  23.7 vs. 121.6  12.3 mmhg , p = 0.29 ; and diastolic 77.1  9.5 vs. 76.3  5.7 mmhg , p = 0.81 , respectively ) .
there were no differences in creatinine clearance or median urinary albumin excretion rate ( 93.7  19.9 vs. 98.9  19.5 ml / min per 1.73 m , p = 0.57 , and 12.6 [ 4.125.0 ] vs. 14.0 [ interquartile range 8.524.1 ] mg / day , p = 0.79 ) .
averaged blood glucose was similar ( 6.7  0.9 vs. 7.4  0.9 mmol / l ; p = 0.14 ) .
a1c was lower in the african - heritage than in the caucasian - heritage group ( 6.8  0.69 vs. 8.0  0.94% ; p = 0.005 ) .
the l - nmma infusion was associated with significant changes in systolic blood pressure in the african - heritage group ( fig .
relative to the baseline and post  amino acid measurements , there was a mean rise of 10.0 mmhg ( 95% ci 2.317.9 ; p = 0.017 ) and 7.3 mmhg ( 1.013.7 ; p = 0.03 ) , respectively , in the african - heritage group and 4.3 mmhg ( 1.8 to 10.4 ; p = 0.23 ) and 2.4 mmhg ( 3.5 to 8.3 ; p = 0.38 ) in the caucasian - heritage group .
final blood pressure was higher in the african - heritage group ( 137.5  9.0 vs. 123.4  14.2 mmhg ; p < 0.05 ) and was associated with a fall in rbf ( 46.0 ml / min per 1.73 m ; p < 0.05 ) and a rise in rvr ( from 0.12  0.06 to 0.14  0.04 mmhg ml / min per 1.73 m ; p = 0.036 ) .
the changes in rvr correlated with map ( r = 0.77 ; p = 0.004 ) .
in this study , patients without hypertension or renal disease of african heritage had an increased sensitivity to the renal vasoconstrictive effect of no synthase ( nos ) inhibition .
these data suggest that a reduction in no bioavailability may adversely affect autoregulatory processes that could potentially increase vulnerability to renal damage ( 8) .
we used the amino acid infusion to optimize renal blood flow and suppress tubuloglomerular feedback as a contributor to vasoconstriction .
therefore , the reduction in renal blood flow that we observed was probably due to an effect of nos inhibition on the renovascular smooth muscle .
early in the course of diabetes , no production is necessary to forestall a rise in blood pressure .
hypertension is associated with the generation of no - quenching free radicals and is a prerequisite for the development of renal disease ( 1012 ) .
furthermore , the renal expression of nos in patients with diabetes is related to the degree of vasculopathy ( 13 ) .
it could therefore be considered that upregulation of no production in patients of african heritage is related to a mechanism that opposes an enhanced vasoconstrictor tendency .
although consistent with experimental studies , these outcomes require caution before being generalized . confirmatory studies in patients with and without diabetes with greater power and the evaluation of the role of vasoconstrictive cytokines , angiotensin

Answer: objective  we compared the renal and systemic vascular ( renovascular ) response to a reduction of bioavailable nitric oxide ( no ) in type 2 diabetic patients without nephropathy and of african and caucasian heritage.research design and methods  under euglycemic conditions , renal blood flow was determined by a constant infusion of paraminohippurate and changes in blood pressure and renal vascular resistance estimated before and after an infusion of l-ng-monomethyl-l-arginine.resultsin the african - heritage group , there was a significant fall in renal blood flow ( 46.0 ml / min per 1.73 m2 ; p < 0.05 ) and rise in systolic blood pressure ( 10.0 mmhg [ 95% ci 2.317.9 ] ; p = 0.017 ) , which correlated with an increase in renal vascular resistance ( r2 = 0.77 ; p = 0.004).conclusions  the renal vasoconstrictive response associated with no synthase inhibition in this study may be of relevance to the observed vulnerability to renal injury in patients of african heritage .


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 retrospective chart review was performed for cases of infectious scleritis seen from january 2007 to august 2011 .
the diagnostic criteria for a case of infectious scleritis included the presence of single or multiple inflamed anterior scleral nodules or ulcerations , which revealed a causative organism on microbiological culture .
microbial cultures were considered significant if growth of the same organism was present on more than one solid medium or if there was a confluent growth on inoculation on one solid medium or if growth of one medium was consistent with direct microscopy findings .
data regarding patient demographics , predisposing factors , causative organisms , and clinical features for all 12 patients was extracted .
all patients except one were followed up for a period of at least 6 months and , therefore , the treatment and outcome details were analyzed for 11 patients .
data was analyzed by the chi - square test using spss version 11.0.1 to determine the prognostic factors .
twelve eyes of 12 patients were identified to have culture - positive infectious scleritis . demographic data and clinical features
preceding surgical procedures performed included manual small - incision cataract surgery ( 4 ) , pterygium excision ( 1 ) , and trabeculectomy ( 1 ) .
none of the patients had a history of fever , joint pain , respiratory illness , skin rashes , etc .
, one patient ( case 2 ) had progeria , another had chronic liver disease ( case 6 ) , and 2 patients had diabetes ( case 8 and 10 ) .
patients with multifocal scleritis were associated with growth of either gram - negative bacilli ( gnb ) or nocardia on culture an example of which is shown in fig .
2a and b. demographics , clinical features , organisms , management , and outcomes of infectious scleritis ( a ) multifocal scleral abscesses owing to pseudomonas sp .
( b ) healed scleritis with minimal scleral thinning 2 months after treatment with topical fortified antibiotics and dexamethasone ( case 11 ) ( a ) nocardia asteroides : gram stain showing filamentous forms fragmented into bacillary and coccoid forms ( magnification = 1000 ) .
( b ) nocardia asteroides : orange coloured , centrally heaped , dry colony all patients received topical antimicrobials based on the culture and sensitivity report .
seven patients were also treated with topical steroids due to severe intra - ocular inflammation .
in addition to medical treatment , 5 patients underwent various surgical procedures in an attempt to decrease the load of infective organism or to preserve the globe as shown in table 1 and fig .
of these , only 2 patients had a good final visual acuity ( better than 6/18 ) on the last follow - up visit .
six months after corneo - scleral patch graft following infectious scleritis post - cataract surgery ( case 8) we determined the prognostic factors of infectious scleritis using the chi - square test .
a poor visual acuity at presentation ( less than counting fingers at 1 m ) usually resulted in a worse visual outcome ( p = 0.005 ) .
the causes of poor visual acuity at last follow - up include corneal scarring following keratitis ( 1 ) , failed corneal graft ( 1 ) , secondary angle closure glaucoma and optic atrophy ( 1 ) , choroidal detachment ( 1 ) , and endophthalmitis ( 5 ) .
the visual outcome was not dependant on any particular organism ( p = 0.099 ) or the presence of multifocal abscesses ( p = 0.209 ) .
the addition of surgical intervention did not result in a significantly better visual outcome than medical management alone ( p = 0.209 ) , but resulted in a higher rate of globe preservation ( p = 0.045 ) .
a clinical suspicion of infectious scleritis in all cases of scleral inflammation following trauma has been emphasized previously .
however , in our series , 4 cases were preceded by cataract surgery and only 1 by pterygium surgery .
another case series of indian eyes also showed maximum number of their cases had cataract surgery prior to an episode of infectious scleritis .
this may be due to the large number of scleral - tunnel small incision cataract surgeries performed in india as compared to clear corneal phacoemulsification performed in developed countries .
pseudomonas aeruginosa is the leading cause of microbial scleritis in reported literature . in our series , 33.33% had gnb , 25% had nocardia , and 25% had fungal infection .
one of the fungi was identified to be rhodotorula spp , which we have reported elsewhere . in cases of scleritis following trauma
where infection is suspected but routine microbial culture is negative , polymerase chain reaction tests may be used to confirm the diagnosis .
if these tests are also negative , the possible diagnosis of surgically induced necrotizing scleritis ( sins ) should be considered .
sins is a believed to be a delayed - type hypersensitivity response to any form of surgical trauma . up to 90% of patients who develop sins
may have an undiagnosed systemic vasculitis and , therefore , a detailed systemic investigation is warranted .
this is often seen as late as 9 months after the surgical intervention and , after ruling out an infectious cause , requires treatment with intensive systemic immunosuppression .
when infectious scleritis occurs long after surgery , it has been hypothesized to be due to an underlying sins with secondary microbial infection , which can make diagnosis and treatment difficult .
these patients may benefit from a systemic evaluation to rule out an autoimmune vasculitis , which will require appropriate management .
some presented with scleritis and developed secondary intraocular spread , which has been described in other reports .
others had scleritis , uveitis , and endophthalmitis at presentation ( e.g. , case 7 where the sclera in the area of the bleb was necrotic with vitreous inflammation ) . the wide use of anti - metabolites at the time of trabeculectomy increases risk of scleral melt and inflammation , which may have resulted in secondary infection and endophthalmitis .
pseudomonas is most often associated with this presentation , which has been attributed to an intra - scleral dissemination facilitated by its proteolytic products and motility .
our series had 6 cases of multifocal scleral abscesses , 3 of which were due to p. aeruginosa , 2 due to nocardia , and 1 due to klebsiella sp .
a review of past literature suggests that multifocal scleritis can be caused by several organisms and may be related to factors such as the load of infection , rather than specific organisms .
the visual acuity at presentation is the most important prognostic factor determining the final visual acuity , and this has been seen in other studies .
this suggests that early diagnosis should help preserve the patient 's remaining vision if effective treatment is initiated .
there is a lot of discrepancy among researchers regarding the effect of surgical debridement on the outcome of infectious scleritis .
a large series showed that despite adjuvant surgery in 46 of 56 eyes , approximately 50% lost functional vision .
however , unlike other studies , we did not find any difference in the final vision between the medically and surgically treated groups . in conclusion ,
manual small incision cataract surgery is a common predisposing factor to infectious scleritis in developing countries .
the visual acuity at presentation is the most important prognostic factor determining the final visual outcome .
aggressive surgical intervention improves the chance of globe preservation but does not improve the visual outcome .

Answer:
in this retrospective case series , we studied the predisposing factors , causative organisms , clinical spectrum , and outcomes of 12 cases of culture - proven infectious scleritis .
 nine of 12 patients had a history of preceding trauma ( surgical or accidental ) .
 past surgical history included small - incision cataract surgery ( 4 ) , pterygium surgery ( 1 ) , and trabeculectomy ( 1 ) .
 six patients had multifocal scleral abscesses due to pseudomonas , klebsiella , or nocardia . only 2 patients retained useful vision ( > 6/18 ) . a poor visual acuity at presentation usually resulted in a worse visual outcome ( p = 0.005 ) .
 four eyes developed phthisis .
 the addition of surgical intervention did not result in a significantly better visual outcome than medical management alone ( p = 0.209 ) , but resulted in a higher globe preservation rate ( p = 0.045 ) .
 therefore , we concluded that infection must be ruled out in cases of scleritis with preceding history of trauma , and aggressive surgical intervention improves the anatomical outcome but does not change the visual outcome .