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:
third molar impaction is the most commonly observed tooth impaction in modern communities , as the third molars are the last teeth to erupt .
third molars have been reported to account for 18 - 32% of impactions . while most studies have reported no gender differences in caucasians ,
the purpose of this study was to investigate the prevalence , distribution , position , and depth of impacted third molars ( itms ) in turkish orthodontic patients from a single academic institution .
we retrospectively reviewed the panoramic radiographs , intraoral photographs , and dental casts of 207 patients ( 62 men and 145 women ; age , 20 - 39 years ; mean age , 22.7  3.29 years ) who had undergone orthodontic treatment .
patients with conditions such as cleidocranial dysplasia , and down 's syndrome were excluded from the study . if an itm was present , its angle and depth of impaction were recorded .
if the third molar was not fully erupted to its normal functional position or the eruption process was not complete with regard to angular position or lack of space , then it was deemed as impacted .
the angulation of impaction was measured with reference to the angle formed between the intersected longitudinal axes of the second and third molars .
the following classification system was adopted : 0-10 , vertical ; 11-79 , mesioangular or distoangular ; 80-100 , horizontal , and the remaining cases were classified as cases of inverted or buccolingual impaction .
the level of impaction was considered in relation to alveolar bone and the cementoenamel junction of the itm : level a , not buried in bone ; level b , partially buried in bone ( if any part of the cementoenamel junction was lower than the bone level , the tooth was considered to be partially buried in bone ) ; and level c , completely buried in bone .
statistical analysis was performed using ncss ( number cruncher statistical system ) 2007 statistical software ( utah , usa ) .
groups were compared using pearson 's chi - square test and fisher 's exact test .
in our orthodontic patient population , itms were evident in 112 patients ( 54.1% ) .
prevalence of itm was not found to be significantly different between men and women ( 61.3% , n = 38 vs. 51.0% , n = 74 , respectively ) , ( p = 0.23 ) .
the proportion of itms was approximately equally represented in the maxilla and the mandible for both genders . of the 300 itms ,
there was no significant difference between the distribution of maxillary and mandibular itms in men and women ( p = 0.97 ) .
in addition , there was no significant difference in the frequency of third molar impaction between the right and left sides within each arch ( p > 0.05 ) .
the distribution of itms on the right and left sides was equal ( 50% ) in the mandible . in the maxilla , the distribution was 51.35% for the right side and 48.65% for the left side .
distribution of itms by arch and gender the distribution of patients by number of itms is shown in table 2 .
the most common type was impaction of all 4 third molars and 2 third molars .
there were no significant differences between the distribution of the number of itms in male and female patients ( p > 0.05 ) .
distribution of patients by total number of itms the occurrence of the different angulations of impaction in the mandible is shown in table 3 , and their occurrence in the maxilla is shown in table 4 .
the most common angulations were mesioangular ( 65.1% ) and horizontal ( 25.7% ) in the mandible , while they were distoangular ( 64.2% ) and vertical ( 23.6% ) in the maxilla .
the distribution of the mesioangular and horizontal angulations of impaction in the mandible were significantly different between the men and women ( p < 0.05 ) [ table 3 ] . in the mandible , the mesioangular position was more common among women than among men , while this association was vice versa with respect to horizontal position .
on the other hand , there was no significant difference in the frequency of different angulation types of impaction between the sexes in the maxilla .
distribution of angulations of mandibular itms distribution of angulations of maxillary itms the distribution of impaction levels is shown in table 5
there were no significant differences between level b and level c impactions in the maxilla ( p = 0.75 ) , or in the mandible ( p = 0.79 ) in men and women .
the relative proportion of the different levels of impaction was significantly different between the 2 arches .
there was significantly more level c impaction in the maxilla ( 46% ) than in the mandible ( 32% ) ( p = 0.02 ) .
there was no significant difference between level b and level c impactions in the maxilla or the mandible , in men ( p = 0.45 ) , or women ( p = 0.21 ) .
distribution of levels of impacted third molars in the maxilla and mandible in our patient population , 86 patients presented with bilateral impaction ( 76.8% of all subjects with itms ) [ table 6 ] . the frequencies of maxillary and mandibular bilateral impaction were similar ( 30.2% , and 24.4% , respectively ) .
seventy - one percent of the mandibular bilateral impaction cases and 82% of the maxillary bilateral impaction cases presented with the same angle classification and the same level of impaction [ table 7 ] .
bilateral impaction with the same angulation ( 82% ) was significantly more frequent than bilateral impaction with different angulation ( 30% ) at the same level of impaction in the maxilla ( p = 0.00 ) .
there was no significant relationship between the impaction levels with regard to mandibular bilateral impactions ( p = 0.12 ) .
there was also no significant relationship between the bilateral impaction angulations in the maxilla and the mandible ( p = 0.38 ) .
distribution of bilateral impaction by arch distribution of bilateral impaction by angulation and level in the maxilla and mandible
to achieve more reliable results in this study , 20 years was deemed to be the lower age limit on the basis of literature regarding the growth and eruption time of the third molars .
in addition , due to possible angulation changes of third molars even after 30 years of age , the upper age limit was 39 in our patient population .
although all of the patient records and file information were carefully investigated , it is still possible that some third molars may have been extracted . for determination of the angular position of an itm ,
this useful system has also been used before by other researchers . in many other studies ,
the angulation of itms was usually determined using visual impression based on winter 's classification . due to ethnic variations
, differences in diet , and genetic heredity , variations in jaw - tooth sizes and facial growth can occur .
thus , some differences are evident in the prevalence of itms in studies of different populations . in addition
, differences in diagnostic criteria , sample sizes , and statistical methods may also lead to differences in results . in our study ,
many other studies have reported much lower frequencies of itms . in another turkish population study ,
it was concluded that the prevalence of itms was 35.9% , and this proportion was lower than was observed in our study . on the other hand , saglam and
tuzum reported the frequency of lower third molar impaction to be 42.4% and that of upper third molar impaction to be 40.5% in a sample of turkish patients aged between 16 and 75 .
there were some methodological differences between these studies with regard to factors such as age limits .
some other prevalence studies have also reported higher itm frequencies , between 65.6% and 76.0% , in american , chinese , indian , and swedish populations .
we observed no significant gender differences with regard to the frequency of third molar impactions ( p = 0.23 ) .
however , some other studies , including another investigating a turkish orthodontic patient population , have reported a significantly greater frequency of itms in women ( p < 0.05 ) . in our study , the proportions of impacted mandibular ( 50.7% ) and maxillary ( 49.3% ) third molars were almost equal .
in contrast , in most other studies , itms were observed more frequently in the mandible than in the maxilla , although some studies have also indicated the opposite .
because of the different classification systems used in different studies , including classification determined solely by visual impression alone , it is difficult to make reliable comparisons of the reported itm angulations . in this study
, we found that mesioangular impaction of mandibular third molar and distoangular impaction of maxillary third molar were the most common ( 65.1% , and 64.2% , respectively ) .
most other researchers have also reported that mesioangular inclination was the most common , in the mandible . however , hugoson and kugelberg reported vertical impaction to be the most common ( 50.0% ) in the mandible . in their study ,
in which they used a different classification system , celikoglu et al . reported that in a turkish population vertical impaction was the most common in the maxilla ( 58.9% ) . in our research ,
study result , and they used the same criteria in their study ( level b , 80% ) .
however , they included all third molars , impacted or otherwise , in their study .
thus , our result is not directly comparable to that reported by hugoson and kugelberg , or other study results . in this study , we only evaluated impacted third molars , and our reference was the amount of crown buried in bone .
the frequency of level a impaction was reported as only 5% by quek et al . in our research
however , level a was observed in only 1 patient and thus was not analysed statistically .
there was significantly more level c impaction in the maxilla ( 46% ) than in the mandible ( 32% ) ( p = 0.02 ) and this result is comparable with that of quek et al .
dachi and howel have indicated that the prevalence of unilateral and bilateral impaction of third molars was almost the same .
have reported that bilateral occurrence of third molar impaction was more common than unilateral impactions .
our study also showed that bilateral impaction of itms was more frequent . in this study
however , quek et al . indicated that the majority of bilateral third molar impactions were in the mandible .
they also reported that half of the bilateral impactions presented with the same classification of angle and level of impaction in the mandible , while this percentage was 71% in our research .
our study showed that third molar impaction was present in 54.1% of a group of turkish orthodontic patients aged between 20 and 39 years , with no significant gender differences , and this frequency is the highest , thus far , to be reported in a turkish population .
mesioangular and distoangular inclinations were the most common in the mandible and the maxilla , respectively . of all itms ,

Answer:
objective : we aimed to investigate the prevalence , distribution , angular position , and depth of third molar impaction in a turkish orthodontic patient population.materials and methods : we retrospectively reviewed the panoramic radiographs , intraoral photographs , and dental casts of 207 patients ( 62 men and 145 women ; age 20 - 39 years ) who had undergone orthodontic treatment at a university department of orthodontics for impacted third molars ( itms ) .
 a comprehensive chart review of all subjects was conducted .
 patient and treatment - related data were recorded in a digital database for comparative analysis.results:the prevalence of itms was 54.1% , and no statistically significant gender differences were evident ( 61.3% in men and 51.0% in women ; p = 0.23 ) .
 the frequency of maxillary itms was 49.3% ( 148 of 300 teeth ) while that of mandibular itms was 50.7% ( 152 of 300 teeth ) . the most frequently observed angulations of impaction were mesioangular for the mandible ( 65.1% ) , and distoangular for the maxilla ( 64.2% ) .
 of all the itms analysed , 61% were partially buried in bone and 39% were completely buried.conclusions:third molar impaction was evident in 54.1% of a group of turkish orthodontic patients aged 20 - 39 years , and there was no statistically significant gender bias .
 mesioangular and distoangular inclinations were the most common in the mandible and the maxilla , respectively .


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:
without appropriate management , herpes simplex encephalitis ( hse ) is a potentially fatal disease ( 1 ) . the mortality and morbidity rates remain high , even when an early diagnosis is made based on the detection of the herpes simplex virus ( hsv ) in the cerebrospinal fluid ( csf ) by a polymerase chain reaction ( pcr ) , and despite the advent of acyclovir therapy ( 2 ) . in particular , the acute - phase mortality and long - term outcome in patients with severe hse remain major concerns ( 3 ) .
although the severity and poor outcomes of hse are mostly associated with acute - phase complications ( 2,3 ) , these important adverse events are not well understood because of the low frequency of the condition and the paucity of reported cases .
this lack of understanding may contribute to a lack of awareness by clinicians and , consequently , to the poor outcomes of patients with hse .
we herein report the case of a patient with hse that was complicated by cerebral hemorrhage ( the diagnosis of which was delayed ) , which developed at the end of 2 weeks of acyclovir therapy .
a 71-year - old woman was admitted to our hospital in a state of unconsciousness following fever and headache .
she experienced epigastric discomfort and dizziness 8 days before admission and gradually lost her appetite .
two days later , she developed a fever of 38.2c , headache , and nausea .
she was evaluated twice by the outpatient service of our hospital for fever and was prescribed acetaminophen both times . however , in addition to the persistence of fever and headache , there was an acute worsening of her state of consciousness on the day of admission , and she was transported to our emergency department by ambulance .
the patient was placed under observation for 4 years at another hospital due to the presence of an unruptured aneurysm of the right middle cerebral artery .
the patient was a non - smoker and did not regularly consume alcohol . on physical examination ,
her glasgow coma scale ( gcs ) score was e1v1m4 , her body temperature was 38.8c , her blood pressure was 116/66 mmhg , her pulse rate was 80/min , and her respiratory rate was 16/min with an o2 saturation of 99% ( with a flow rate of 3 l / min ) .
her pupils were round and equally dilated ( size , 3 mm ) . a head and neck examination revealed no anemia , icterus , or other abnormalities .
the results of a cardiovascular examination were normal , and auscultation revealed normal lung sounds .
a neurological examination revealed no neck stiffness and normal deep tendon reflexes ; however , slightly rigid muscle tone and bilateral pathological babinski reflexes were observed .
laboratory investigations revealed a normal white blood cell count ( 7,350/l ) , a slightly elevated c - reactive protein ( 0.36 mg / dl ) level , elevated lactate dehydrogenase ( 313
iu / l ) levels , hyponatremia ( 128 meq / l ) , hypokalemia ( 2.9 meq / l ) , hypochloremia ( 88 meq / l ) , and a normal blood glucose level ( 126 mg / dl ) .
a urinalysis revealed no abnormal findings . a chest x - ray and electrocardiogram revealed no abnormalities .
the right anterior medial temporal lobe and insular cortex displayed high signal intensity on t2-weighted and diffusion - weighted brain magnetic resonance imaging ( fig .
1a - c ) , and the patient 's aneurysm , which was already known to exist , was observed at the bifurcation of the distal m1 segment of the middle cerebral artery using magnetic resonance angiography ( fig .
1d ) . a csf analysis detected moderate lymphocytic leukocytosis ( 170/l ) , a moderately increased protein level ( 77 mg / dl ) , and a slightly decreased glucose level ( 53 mg / dl ) .
gram staining of the patient 's csf was negative , and blood and csf cultures showed no bacterial growth . a pcr of the csf to detect hsv-1 and hsv-2 revealed the presence of hsv-1 dna .
axial t2-weighted images ( a , b ) and an axial diffusion - weighted image ( c ) show an area of high signal intensity in the right anterior medial temporal lobe and insular cortex .
magnetic resonance angiography ( d ) shows an aneurysm at the bifurcation of the distal m1 segment of the right cerebral artery .
the patient was treated with acyclovir ( 10 mg / kg , intravenously , three times per day [ ideal body weight ] ) , glycerol ( 200 ml , intravenously , twice a day ) , and additional supportive therapies .
although the patient vomited on the day of admission , her symptoms disappeared within the first 2 days .
her consciousness gradually recovered to gcs e4v4m6 , and her temperature returned to 37.3c on day 11 after admission .
however , she vomited during the night on day 12 , and her gcs slightly worsened to e3v4m6 , and she displayed a slightly elevated body temperature of 37.6c on day 13 .
an exacerbation of hse was considered , and a csf analysis including a pcr for hsv-1 was performed , which revealed mild bloody fluid with moderate lymphocytic leukocytosis ( 178/l ) and a markedly increased protein level ( 350 mg / dl ) .
brain computed tomography imaging performed on day 14 revealed cerebral hemorrhage in the right medial temporal lobe and right basal frontal area , with a right lateral ventricular rupture ( fig .
although magnetic resonance angiography revealed an increase in the size of right cerebral arterial aneurysm ( fig .
2d ) , no evidence of subarachnoid hemorrhage was observed by computed tomography or magnetic resonance imaging .
acyclovir therapy was terminated based on the results of the second pcr for hsv , which was negative .
there was no recurrence of encephalitis or intracranial hemorrhage . computed tomography and magnetic resonance imaging at the time of cerebral hemorrhage .
axial computed tomography shows acute cerebral hemorrhage in the right medial temporal lobe ( a ) and the right basal frontal area ( b ) . a right lateral ventricular rupture
magnetic resonance angiography ( d ) shows an increase in the size of the right cerebral arterial aneurysm at the bifurcation of the distal m1 segment of the right cerebral artery .
we herein report a case of cerebral hemorrhage that developed in a patient who was undergoing acyclovir treatment for hse . although the patient made a near - complete recovery , the diagnosis of the cerebral hemorrhage was delayed .
initially , an acute exacerbation of hse was considered , as intracranial vascular disease was not included in the differential diagnosis .
this case suggests that acute - phase complications of hse need to be better understood to avoid missing the onset of adverse events that can be managed successfully if they are diagnosed early .
the patient 's cerebral hemorrhage appears to have been associated with hse due to the following reasons .
first , the site of hemorrhage was consistent with the region in which hse - associated inflammation was observed .
second , the timing of the onset of hemorrhage was typical for hse - related cerebral hemorrhage ( 4 ) . although the precise cause of cerebral hemorrhage in hse patients remains unclear , based on the pathological findings in similar cases , we hypothesize that the rupture of the small vasculitic vessels of the brain due to hsv - induced inflammation was a possible mechanism of our patient 's bleeding ( 5,6 ) .
in addition to cerebral hemorrhage ( 4 ) , seizures ( 2,3 ) , increased intracranial pressure ( 3,7 - 10 ) , stroke ( 11,12 ) , subarachnoid hemorrhage ( 13 ) , and central diabetes insipidus ( 14 ) have been reported as complications during the acute phase of hse ( this includes the period of acyclovir therapy ) .
although the prevalence of these complications is not well known , seizures and increased intracranial pressure , which have been reported in one in three and one in five hse cases , appear to be among the most common ( 2,3 ) .
cerebral hemorrhage and increased intracranial pressure have mostly been observed during acyclovir therapy , within 2 weeks after admission ( 3,4,7 - 10 ) ; the condition of patients may decline in this period due to hse and not because of complications , which can pose a challenge for the differential diagnosis .
furthermore , the symptoms of these two complications , which include deteriorated consciousness , headache , hemiparesis , hemiplegia , and third nerve palsy , are similar to those of hse ( 3,4,7 - 10 ) .
thus , the possibility of a diagnostic delay may be higher in patients with cerebral hemorrhage and increased intracranial hypertension than in those with other complications .
however , these two complications frequently require surgical intervention ( 3,4,7 - 10 ) . because both complications can be detected by computed tomography ( as in our case )
, clinicians should consider repeat computed tomography to allow for the early detection of these potential complications in patients who display a worsening clinical condition despite the administration of acyclovir treatment .
acute - phase complications in patients with herpes encephalitis . * in intensive care unit patients in conclusion
, the diagnosis of cerebral hemorrhage during the early phase of hse may be delayed because of the similarity of its symptoms to the primary disease and due to the worsening of encephalitis .
clinicians should consider cerebral hemorrhage and other acute - phase complications and re - perform imaging studies in hse patients who do not show any improvement during acyclovir treatment .

Answer:
herpes simplex encephalitis ( hse ) can be complicated by adverse events in the acute phase .
 we herein present the case of a 71-year - old woman with hse complicated by cerebral hemorrhage .
 she presented with acute deterioration of consciousness and fever and was diagnosed with hse based on the detection of herpes simplex virus-1 in the cerebrospinal fluid by a polymerase chain reaction . the cerebral hemorrhage developed during acyclovir therapy ; however , its diagnosis was delayed for 2 days . after the conservative treatment of the cerebral hemorrhage , the patient made a near - complete recovery .
 cerebral hemorrhage should be considered as an acute - phase complication of hse .


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:
males and females of c57bl/6-tg(ubc - gfp)30scha / j , c57bl/6j , b6.129p2(c)mecp2/j , b6.129p2-lyz2/j ( lysm ) , b6.129p2-mecp2/j , mecp2 , and c57bl/6j mice were purchased from jackson laboratories ( bar harbor , me ) ; b6.cg-mecp2 mice were a generous gift from dr .
andrew pieper , ( southwestern medical school , dallas , tx ) and were maintained in our lab on c57bl/6j background .
all procedures complied with regulations of the institutional animal care and use committee ( acuc ) at the university of virginia .
four week - old mice were subjected to lethal split - dose -irradiation ( 300 rad followed 48 hours later by 950 rad ) .
four hours after the second irradiation , mice were injected with 510 bone marrow cells .
after irradiation , mice were kept on drinking water fortified with sulfamethoxazole for two weeks in order to limit infection by opportunistic pathogens .
full methods and any associated references are available in the online version of the paper at www.nature.com/nature .
males and females of c57bl/6-tg(ubc - gfp)30scha / j , c57bl/6j , b6.129p2(c)mecp2/j , b6.129p2-lyz2/j ( lysm ) , b6.129p2-mecp2/j , mecp2 , and c57bl/6j mice were purchased from jackson laboratories ( bar harbor , me ) ; b6.cg-mecp2 mice were a generous gift from dr .
andrew pieper , ( southwestern medical school , dallas , tx ) and were maintained in our lab on c57bl/6j background .
all procedures complied with regulations of the institutional animal care and use committee ( acuc ) at the university of virginia .
four week - old mice were subjected to lethal split - dose -irradiation ( 300 rad followed 48 hours later by 950 rad ) .
four hours after the second irradiation , mice were injected with 510 bone marrow cells .
after irradiation , mice were kept on drinking water fortified with sulfamethoxazole for two weeks in order to limit infection by opportunistic pathogens .
full methods and any associated references are available in the online version of the paper at www.nature.com/nature .

Answer:
rett syndrome is an x - linked autism spectrum disorder .
 the disease is characterized in the majority of cases by mutation of the mecp2 gene , which encodes a methyl - cpg - binding protein 15 .
 although mecp2 is expressed in many tissues , the disease is generally attributed to a primary neuronal dysfunction 6 . however , as shown recently , glia , specifically astrocytes , also contribute to rett pathophysiology .
 here we examined the role of another form of glia , microglia , in a murine model of rett syndrome .
 transplantation of wild type bone marrow into irradiation - conditioned mecp2-null hosts resulted in engraftment of brain parenchyma by bone marrow - derived myeloid cells of microglial phenotype , and arrest of disease development .
 however , when cranial irradiation was blocked by lead shield , and microglial engraftment was prevented , disease was not arrested .
 similarly , targeted expression of mecp2 in myeloid cells , driven by lysmcre on an mecp2-null background , dramatically attenuated disease symptoms . thus , via multiple approaches , wild type mecp2-expressing microglia within the context of an mecp2-null male mouse arrested numerous facets of disease pathology ; lifespan was increased ; breathing patterns were normalized ; apneas were reduced ; body weight was increased to near wild type , and locomotor activity was improved .
 mecp2+/ females also exhibited significant improvements as a result of wild type microglial engraftment .
 these benefits mediated by wild type microglia , however , were diminished when phagocytic activity was inhibited pharmacologically using annexin v to block phosphatydilserine residues on apoptotic targets , thus preventing recognition and engulfment by tissue - resident phagocytes .
 these results suggest the importance of microglial phagocytic activity in rett syndrome .
 our data implicate microglia as major players in rett pathophysiology , and suggest that bone marrow transplantation might offer a feasible therapeutic approach for this devastating disorder .


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:
reverse shoulder prosthesis is an excellent surgical option for patients with certain shoulder pathologies , of which rotator cuff arthropathy is one .
one area where we are gaining a greater understanding is that of managing acromial pathology .
recent studies are showing that not all acromial pathology is a contraindication to reverse shoulder arthroplasty ; in both pre- and post - operative patients , small lateral fractures of the acromion can be treated non - operatively or fixed surgically with a tension band technique .
overall , results comparable to that of reverse arthroplasty can be achieved with either of these treatment options .
however , fractures at the base of the acromion or of the scapular spine present a different problem . in these types of fractures , a larger length of deltoid muscle is detached , and therefore defunctioned . in reverse shoulder arthroplasty , in order to achieve a stable shoulder , the deltoid must be tensioned a great deal .
this in turn causes a deforming force and distraction at the fracture site , making for a poor healing potential . also , as the reverse shoulder prosthesis relies on the deltoid muscle to move the arm , if the deltoid is detensioned or improperly tensioned , this will lead to poor functional capacity .
we present a case of treatment of a fracture at the base of the acromion using a 90/90 plating construct that healed in a good position .
a 71-year - old right - handed woman presented with a 2-year history of right shoulder pain and dysfunction , which began abruptly when lifting a heavy load . at the initial evaluation ,
her range of motion was limited , particularly in active abduction as she achieved only 45 degrees in this plane . a cuff arthropathy ( hamada grade 3 )
was diagnosed and the decision was taken to proceed with reverse shoulder arthroplasty . to complete the pre - operative assessment ,
a ct scan was performed which confirmed there was no acromial pathology involved . a reverse shoulder prosthesis and a biceps tenodesis
was carried out ( delta xtend , depuy , warsaw , in , usa ) through a deltopecoral approach [ figure 1 ] .
the patient 's right arm was immobilized in a sling and the range of motion exercises were started 6 weeks after arthroplasty [ figure 1a ] .
five months after surgery , she sustained a blow to the right shoulder but sought medical attention 1 month later , at her scheduled follow - up visit .
radiographs showed a displaced fracture at the base of the acromion [ figure 1 ] .
this showed that both the humeral and glenoid components were well fixed and the only pathology was the fracture .
antero - posterior radiographs showing the patient 's right shoulder immediately after reverse shoulder arthroplasty ( a ) and after fracture , 5 months later ( b ) .
the post - operative image shows no pre - existing acromial pathology she was taken to the operating room and her previous incision was extended into a  sabre  incision to better expose the acromion .
two small fragment ( 3.5 mm ) locking plates ( synthes , west chester , pa , usa ) were used in a 90/90 configuration ; one was a fragment specific clavicular plate and the other a reconstruction plate .
the fragment specific clavicular plate was applied on the superior edge of the scapular spine in a compression mode .
a second reconsrtuction plate was applied from the posterior acromion to the posterior cortex of the scapular spine , in the infraspinatus fossa .
fixation was solid , but in order to protect the construct , the patient was placed in an abduction brace for 6 weeks .
eighteen months after fracture fixation , the patient was satisfied with the clinical result [ figure 2 ] .
she was capable of 125 degrees of abduction , 160 degrees of forward flexion , 85 degrees of external rotation in adduction , and 60 degrees of internal rotation .
her quickdash score was 29.5 ( compared to 82.5 pre - op ) and constant score was 69 on the affected side compared to 85 on the left side , for a  good  functional outcome .
a medline search using the key words [ acromion fracture ] , [ scapula fracture ] , [ reverse arthroplasty ] was performed .
we then sought to classify and separate the cases by location ; there were 30 cases of fractures at the base of the acromion , and scapular spine . when our case is added , we have a total of 31 cases .
results are summarized in table 1 . in brief , of the 30 more proximal cases , 21 were treated non - operatively in a sling , 7 were treated with open reduction and open fixation and one with revision of the prosthesis . of those treated non - operatively , and for whom results are published , fourteen had a non - union , four had a malunion and in two cases , it was unclear whether union was achieved . for patients receiving fixation of the fracture , there was one non - union , two repeat fixations , and one patient required removal of the fixation .
the patient who had a revision of the prosthesis had a malunion of the acromion .
results of the literature review . in the fracture location column , the fracture description provided by the authors is presented .
although recent studies have shown that good outcomes may be achieved with non - surgical management of lateral acromial fractures , the same does not hold true for basal acromial fractures .
the likely reason for this is that with fractures at the base of the acromion , a large length of the deltoid is defunctioned and the deltoid muscle is essential to the functioning of the reverse shoulder prosthesis .
previously described techniques , such as tension band fixation achieved poor functional results for fractures at the base of the acromion .
we postulate that this is because the fixation method is insufficient to withstand the forces generated by the deltoid muscle  a tension band can neutralize forces parallel to the axis of the band but in the case of the deltoid , force vectors are generated in different directions .
it also allows for compression along the fracture site and resists motion in all directions .
good screw purchase can be achieved by angling the screws either toward the scapular spine or the coracoid .
the locking option enables good fixation and improves cut - out strength in osteopenic or osteoporotic bone .
in addition to the stable fixation achieved with this technique , we further recommend immobilization of the affected shoulder using a sling and an abduction pillow to detension the deltoid , thus at least partially removing the distractive forces at the fracture site . also essential to achieving a good functional result
we thus also recommend a program of range of motion exercises followed by strengthening exercises to maximize functional capabilities . based on results from previous studies ,
fractures of the tip were those of the most lateral or anterior portion of the acromion .
fractures of the body of the acromion are those medial to the tip of the acromion and lateral to the beginning of the scapular base .
the scapular base is the lateral border of the scapular spine , which is smooth and round . in our nomenclature ,
fractures at the scapular base are termed fractures at the base of the acromion as functionally , this zone connects the acromion to the rest of the scapula and this term avoids confusion with any more medially occurring fractures .
coronal ( a ) and axial ( b ) representations of the proposed classification scheme for acromial fractures associated with revere arthroplasty we propose the above mentioned classification system as it provides a nomenclature for acromial fractures that is descriptive and is based on the anatomy and functionality of the scapula . as the results from the review of the literature indicate , the more medial the fracture , the worse the prognosis with non - operative treatment .
thus , this classification system may be used to predict outcomes and determine treatment offered .
it differs from other classification systems ( crosby ) in that it further subclassifies more medial fractures , which are the more ominous fractures . as more research is carried out in this field

Answer:
fractures of the acromion and scapula are known to occur after reverse shoulder arthroplasty .
 we present a case of a fracture at the base of the acromion 5 months after arthroplasty treated successfully with dual plating of the acromion .
 eighteen months after fracture fixation , the patient had 160 degrees of active forward flexion , a quickdash of 29.5 , a constant score of 69 and she was satisfied with the result . a concomitant review of the literature produced , in addition to our patient , 56 cases .
 these were used to produce a classification system , based on bony and functional anatomy as follows .
 tip fractures are of the most lateral or anterior portion of the acromion , those of the body of the acromion are medial to the tip but lateral to the beginning of the scapular base
 . fractures at the scapular base are termed fractures of the base of the acromion and those more medial to that , fractures of the scapular spine .
 the functional results of these case series demonstrated poorer functional outcomes for more medial fractures .
 as future research in this domain increases , clarity on the nomenclature of these fractures will allow for prognostication and treatment based on fracture location as well as comparison between studies .


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 19-year - old patient was admitted for low back pain and radiating pain in the posterior aspect of the left leg which had begun 2 months prior .
she was treated with nonsteroidal anti - inflammatory drugs , physical therapy , and an epidural block in the local hospital .
she mainly complained of pain in the left leg , with a score of 6/10 on the visual analogue scale ( vas ) , and a result of 50 degrees in a passive straight leg - raising test .
there were no sensory - motor abnormalities , and the tests for reflexes showed normal responses .
magnetic resonance imaging ( mri ) revealed central herniation of the l4-l5 intervertebral disc , which compressed the dural sac ( fig .
discectomy was suggested , as the patient complained of consistent and severe pain , the mri findings showed severe spinal stenosis , and there were no responses to conservative treatment .
therefore , we decided to treat her with percutaneous epidural neuroplasty with a racz catheter on the left l5 spinal nerve root . after obtaining her informed consent ,
prophylactic antibiotics ( ceftezole 1 g ) were administered intravenously after negative skin test confirmation .
routine monitoring equipment - including an electrocardiogram , blood pressure monitor , and pulse oximeter - were applied , and she was placed in the prone position on the fluoroscopy table .
a pillow was inserted under the abdomen to correct the anteflexion of the lumbar vertebrae , the legs were abducted , and the feet were inverted . following sterile preparation and draping , the location of the sacral hiatus was confirmed by fluoroscopy , and a local infiltration of 1% lidocaine was performed in the insertion area ( 1 inch right lateral and 2 inches caudal from the sacral hiatus ) .
the tip of the needle was placed between the s3 and s4 vertebrae , whose locations were confirmed by fluoroscopy with a c - arm . after confirming negative aspiration of the blood or cerebrospinal fluid ( csf ) , 10 ml of water - soluble contrast media were injected for the epidurogram .
the racz catheter was inserted through the needle and was advanced towards the left l5 nerve root under continuous fluoroscopy ( fig .
2 ) . 1,500 units of hyaluronidase in 10 ml of normal saline were then injected . additional dye ( 2 ml ) was injected to confirm the contours of the nerve root , and 9 ml of 0.2% ropivacaine and 1 ml of 4 mg dexamethasone were injected following negative aspiration .
the patient did not complain of severe pain , paresthesia , or unusual responses during the procedure .
after 1 hour , the patient complained of sudden motor weakness in the right lower limb , on the site opposite to where the neuroplasty was conducted .
the great toe dorsiflexion was marked as motor grade i , and the ankle dorsiflexion as motor grade ii .
paresthesia and a dull sensation in the right l4-l5 dermatome had developed , but the patient did not complain of pain . at first
, we suspected a temporary motor weakness caused by ropivacaine , and the symptoms were observed for one hour .
an urgent mri was performed , but no epidural hematoma or suspicious lesions were found ( fig .
around 4 hours after the neuroplasty , the motor and sensory weakness had not improved ; emergency surgery was therefore performed .
discectomy of the l4-l5 intervertebral disc was conducted . during the surgery , central and left paracentral protrusions of the disc
were found , and swelling of the right l5 nerve root was also discovered . after the surgery
the motor strength and sensory function of the right leg had returned to normal . in the 10-day follow - up period
, there were no signs of motor or sensory abnormalities , and the patient was therefore discharged without any discomfort .
bleeding , infections , or nerve damage can generally develop after epidural neuroplasty , but motor and sensory weaknesses are rare complications
. acute monoplegia following epidural adhesiolysis has previously been reported in a patient with failed - back syndrome and foraminal stenosis of the l4-l5 levels . however , to the best of our knowledge , there has been no report of acute motor weakness in the opposite lower extremity after percutaneous epidural neuroplasty .
first , motor weakness can be caused by direct nerve injury from the epidural needle or racz catheter during the procedure .
however , this was unlikely in this case , as there were no complaints of acute severe pain , sensory abnormality , or abnormal responses during the procedure .
this was also unlikely in this case , as these injections cause bilateral or patchy blocks of the motor and sensory functions .
fourth , although nerve damage from hypertonics can be a reason , we did not use hypertonic saline .
finally , injection of a large volume of fluid into the epidural space may cause a transient neurological deficit .
rocco et al .   reported that epidural injections after spinal surgery may cause complications such as cauda equine syndrome or nerve root damage as the epidural space after surgery is limited , and the injected drugs may increase the pressure and cause nerve damage either directly or by ischemia , due to decreased blood flow .
they presented acute right monoplegia which had occurred after epidural adhesiolysis of the bilateral l5 nerve root in a patient with failed - back surgery syndrome , with spontaneous recovery after 5 weeks .
they suggested that the large volume of fluid injection might have been the reason for the transient neurological deficit , as a compartment loculated by the fluids might have compressed the nerve .
they also suggested careful injection under observation of the excretion of the contrast dye through the neural foramen in order to prevent nerve injuries caused by compression from a large volume of injected drugs .
in particular , if the spinal stenosis is severe , the epidural injection may increase the pressure in the epidural space , and even a mild edema around the nerve root may cause a neurologic deficit by compression of the nerve root .
we hypothesized that the large volume of fluid injected during the epidural neuroplasty and the severe spinal stenosis might have been the reason for the opposite motor weakness in this case , as per the previous reported case .
the patient in the present study presented severe spinal stenosis , with a herniated disc occupying more than 2/3 of the spinal canal .
the epidurogram during the neuroplasty showed a better spread of the contrast dye in the left side , and a filling defect on the right side .
moreover , the central protrusion may have increased the pressure on the right side of the epidural space , and the closed compartment may have caused loculation , leading to barotrauma in the right l5 nerve root .
in addition , swelling of the l5 nerve root was observed during the surgery , and the motor and sensory functions returned to normal immediately after the surgery , suggesting that the latter had a decompressive effect .
however , further evaluations , including measurement of the pressure and radiologic tests , are required to prove this theory . in conclusion
, we presented a rare case of unilateral motor weakness following epidural neuroplasty , on the side opposite to the lesions .
the injection of a large amount of fluid during neuroplasty in a patient with spinal stenosis may cause compressive nerve damage .

Answer:
recently , percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc .
 a 19-year - old female patient suffering from left radicular pain caused by an l4-l5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left l5 nerve root using a racz catheter .
 after the procedure , the patient complained of acute motor weakness in the right lower leg , on the opposite site to where the neuroplasty was conducted .
 emergency surgery was performed , and swelling of the right l5 nerve root was discovered .
 the patient recovered her motor and sensory functions immediately after the surgery .
 theoretically , the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space , which may cause injury of the opposite nerve by barotrauma from a closed compartment .
 practitioners should be aware of this potential complication .


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 prostate is the site of two common diseases in aging men , benign prostatic hyperplasia and prostate cancer ( pca ) .
epidemiological studies show that , in the united states , pca accounts for 28.7% of new non - skin cancers and 12.7% of cancer - related deaths.1 androgen deprivation therapy ( adt ) retards pca progression in 60%80% of patients but may cause cardiovascular complications and alterations in body composition , lipoprotein metabolism , and sexual function . in general , adt may result in a decreased quality of life .
furthermore , studies in men demonstrate that low serum testosterone ( t ) levels are associated with several cardiovascular risk factors,2,3 such as lower high density lipoprotein cholesterol , higher triglyceride concentrations , hyperinsulinemia , and increased abdominal adiposity .
these factors are all characteristic of the metabolic insulin resistance syndrome . in addition , many patients treated with adt experience rapid bone loss that increases the risk of debilitating osteoporotic fractures.46 reports indicate that total and free levels of serum t decline in aging men and that abdominal visceral fat is inversely associated with t levels . resting energy expenditure ( ree ) , which accounts for 60%70% of total daily energy expenditure ,
decreases with age , physical inactivity , sympathetic nervous system and endocrine status.7,8 to our knowledge , the effects of adt on ree have not been fully explored in controlled trials .
the goal of this prospective study was to determine the effects of adt on body composition and resting metabolic rate in patients with metastatic pca .
sixteen men , aged 63 to 96 years ( mean age 71 ) , with untreated metastatic pca were enrolled in this study . prior to orchiectomy , all patients were evaluated clinically and by laboratory analysis to establish a baseline . after a careful medical history had been taken from each patient , we assessed several exclusion criteria , namely , cognitive alterations , depression and emotional liability .
laboratory examinations included tests of fsh - lh serum concentrations , and an evaluation of body mass index , fat / lean body mass , bone mineral density , carbohydrate / lipid oxidation , and resting energy expenditure .
following orchiectomy , the same evaluation was carried out monthly and after 12 months , the period chosen for final analysis . to evaluate body composition
, all patients underwent densitometry testing ( dual - energy x ray absorptiometry - dexa).9 the ree , fat and carbohydrate oxidation levels were measured using indirect calorimetry , with a delta - trac metabolic monitor.10 body composition analyses and indirect calorimetry were carried out at baseline and after 12 months following the orchiectomy procedure . written consent was obtained from all patients , and this protocol was approved by the ethics committee at our institution .
we used the non - parametric two - sided wilcoxon t - test , and p<0.05 was considered significant to appropriately compare time differences for each variable.11
we used the non - parametric two - sided wilcoxon t - test , and p<0.05 was considered significant to appropriately compare time differences for each variable.11
statistically significant differences in body composition pre and post orchiectomy were seen in terms of weight , body mass index ( bmi ) and lean body mass ( lbm ) .
total fat body mass ( fbm ) exhibited a tendency to increase but failed to reach significance .
no significant changes were observed in bone mineral density ( bmd ) and ree , but we identified a statistically significant change in terms of increased carbohydrate oxidation ( choox ) and a decrease in lipid oxidation ( lipidox ) .
aging is associated with sarcopenia ( loss of muscle mass ) , with an average 12 kg loss of lbm between the ages of 25 and 70 years and an increase in fbm of 18%36% during the same period.2 testosterone levels exhibit a positive correlation with lbm and a negative correlation with fbm .
this has led to the hypothesis that adt may help mitigate age - related alterations in body composition .
our study reports two major findings : 1 ) adt was associated with decreased body weight and with decreased lbm ; 2 ) adt led to increased choox and decreased lipidox .
androgens modulate body composition , including lipid and protein metabolism.12 smith et al,13 galvo et al,14 levy et al,15 and van londen et al16 observed significant changes in metabolic and body composition parameters after 6 months of induced hypogonadism in all patients .
the researchers observed a significant increase in fbm ( 20.29.4 to 21.99.6 kg,13 13.82.3%,14 1.172.3 % , 15 and 2167.15 g,16 respectively ) and a significant decrease in lbm ( 63.28.0 to 62.35.4 kg,13 2.4  0.4%,14 1.152.20%;15 and 1785.81 g,16 respectively ) with no significant changes in total body weight , lipid readings or glucose metabolism .
they also reported a positive correlation between the changes in fbm and insulin concentrations ( r=0.56 ; p=0.013 ) .
these results are in agreement with other studies that demonstrated a relationship between t and abnormalities in carbohydrate and lipid metabolism.17 in healthy male populations , low t concentrations are negatively correlated with the degree of central abdominal obesity . in hypogonadal males , there is a tendency toward increased visceral adiposity and reduced muscle mass that can be reversed by androgen replacement.18 the underlying mechanisms for these observations are not well defined , but androgen receptors are known to be present on visceral adipocytes .
it is likely that t is directly involved in the mobilization of free fatty acids.19 we observed significant changes in metabolic and body composition in our patients after adt .
we identified significant decreases in total body weight , bmi and lbm ( 2.5 kg , p = 0.01 ; 0.8 kg / cm , p = 0.02 , 11.7 kg , p = 0.002 , respectively ) .
fbm was found to increase ( 7.15 kg , p = 0.06 ) with no significant change in bone mineral density ( bmg ) .
there were no changes in ree , but we did identify a significant increase in choox and a decrease in lipidox ( 52.62% , 4.10% respectively ) . in one study , suppression of t levels after 10 weeks of gnrh agonist administration was found to reduce ree in young men .
in this study , researchers were unable to determine whether the effect was directly mediated by a reduction in t levels or if it was due to a subsequent reduction in t aromatization to estrogen.20 we were unable to show alterations in ree in our study , possibly due to the size of our study sample .
the altered concentrations of gonadotropins following orchiectomy may be linked with the effects of this procedure on the pituitary gland .
it is important to consider that adt not only acts on pca but also affects metabolism , including hematogenesis , bone , fat , protein , and sarcho - metabolism . despite pca being one of the leading causes of death , a substantial proportion of aging patients die of unrelated causes that are due to comorbidities , often in the context of metabolic syndrome .
to our knowledge , this is the first prospective study to examine changes in body composition , resting energy expenditure , and consequences involving the oxidation of carbohydrates and lipids in the context of adt .
a study on a larger group of patients would be of great interest once a limited number of patients included from only one centre may be considered a limitation in this study .
after 12 months of androgen deprivation therapy , elderly males with metastatic prostate cancer exhibit declines in lean body mass and lipid oxidation , together with an increase in carbohydrate oxidation .

Answer:
introductiontestosterone is needed for normal male development , muscle strength , bone mineralization , hematopoietic function , and sexual and reproductive functions .
 the main purpose of androgen deprivation therapy in prostate cancer is to reduce tumor progression , but therapy is often accompanied by significant adverse effects.objectivethis study aimed to determine the effects of androgen deprivation therapy on body composition and resting metabolic rate in patients with prostate cancer.patients and methodsa prospective study was performed to evaluate the body composition of 16 elderly males ( aged 6396 ; median age 71 ) with prostate cancer scheduled for orchiectomy , one year before and after surgery .
 body composition was measured by dexa , and energy expenditure , fat and carbohydrate oxidation were measured by indirect calorimetry.resultsbody weight ( p=0.01 ) , lean mass ( p=0.004 ) , and lipid oxidation ( p=0.001 ) decreased significantly .
 carbohydrate oxidation ( p=0.02 ) , fsh ( p=0.0001 ) and lh ( p=0.0001 ) levels increased significantly .
 changes in fat mass ( p=0.06 ) and bone mineral density ( p=0.48 ) were not significant.conclusionsafter 12 months of androgen deprivation therapy , elderly men with metastatic prostate cancer exhibit a decline in lean body mass and lipid oxidation , together with increased carbohydrate oxidation .


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:
orthodontic anchorage is a basic procedure necessary for a successful treatment . for
 this reason ,
clinicians seek to better understand various orthodontic devices , such as
 headgear , transpalatal arch , lingual arch , and nance 's button .
these devices allow a
 certain degree of movement of the anchorage unit and are dependent , to varying degrees ,
 on patient compliance . in severe cases or in cases of non - cooperative patients ,
 treatment could be compromised .
recently , skeletal anchorage has increased in popularity
 due to the benefit of direct transfer of the point of anchorage from the teeth to the
 skeleton . however , since
 these mini - implants have been used in orthodontics , a small displacement during
 treatment has been detected .
the mini - implant displacement allows contact between the
 screw and the dental root , causing damage to the root or the periodontal ligament ,
 potentially leading to mobility or loss of the mini - implant .
unfortunately , there is not much information available on the displacement or adverse
 effects of mini - implants .
recently , hsieh , et al . ( 2008 ) found that even endosseous titanium implants may not
 necessarily serve as a rigid orthodontic anchorage at all force levels .
( 2004 ) investigated cephalometric
 tracings and found a noteworthy extrusion and tipping forward of mini - implants after
 en - masse retraction of anterior teeth . recently
, tomographic studies have evaluated the
 position of mini - implants in both jaws , though without relating them to longitudinal
 control . to the best of our knowledge ,
general dentistry and orthodontics constantly use radiographs with the main purpose of
 assessing the validity of treatment methods . zanda ( 2007 ) described a new film holder for occlusal film that showed
 effective reproducibility of occlusal radiographic images in dry skulls ( figure 1 ) , making it possible to take an occlusal
 radiographic sequence at different times .
( 2005 ) used dry human skulls to analyze the reliability
 in determining tooth position in posterior - anterior films .
using markers inserted in the
 bands of molars and premolars from hyrax expanders allow identifying each one in each
 side on posterior - anterior films .
occlusal x - ray film holder and skull positioned for standardized occlusal
 radiograph the purpose of the present study was to evaluate the reliability and accuracy of a
 radiographic analysis method for identifying the location of mini - implants inserted in
 the posterior region of the maxilla in dry human skulls .
three human skulls were obtained from the anatomy department of the dental school of the
 university center of maranho , brazil .
all skulls had preserved maxilla and mandible and
 sufficient teeth on the posterior area of the maxilla for the successful placement of
 mini - implants . the cortical bone condition and
the maxillary interadicular space were
 evaluated using radiographic images between the second premolars and the first molars .
 according to the same technical criteria used for patients ,
six self - drilling
 mini - implants ( 1.6x1x7 mm ; osas , dewimed , tuttlingen , germany ) were placed between the
 second premolars and the first molars at a 45 angle relative to the tooth 's long
 axis .
once the study began , the main purpose was to test the reliability of different
 operators for the proposed method in this research .
therefore , clinical operators with
 various levels of professional experience were invited to take the occlusal radiographs .

three operators were selected : an orthodontist , an implantodontist and an undergraduate
 dental student .
each operator performed three occlusal radiographs taken at three
 intervals of 15 days in each of the three skulls .
the set of three radiographs of each
 skull was identified externally according to an identification number for the skull , the
 operator and the time .
a total of 27 randomized occlusal radiographs were obtained using insight io-41 film
 ( size 5.7 cm x 7.6 cm ; kodak ) with 1.5 s exposure time at 10 ma and 70 kv .
the occlusal
 radiographs were taken with a correct alignment between the cylinder localizer from the
 x - ray machine and the ring from the occlusal radiographic position self - drilling film .

each operator took the occlusal radiograph for each of the skulls with the occlusal
 films inserted in the zanda ( 2007 )
 film holder and fit the film in more number of posterior teeth of the maxilla .
all radiographs and a ruler with same lateral size were digitized using a scanner
 ( be@rpaw 2400ta plus , scanner a4 ) ( figure 2 ) .
the
 radiographs were measured using macbiophotonics imagej software originally applied in
 biologic researches for microscopic image capture .
after the mini - implant positions , the points were defined and
 measured using a cartesian coordinate system ( figure
 3 ) .
the cartesian system was composed by the following measures : occlusal radiographs with mini - implants placed occlusal radiographs and measurements line a : a straight line traced over the maximum number point of the midpalatal suture ;   line b : a line perpendicular to the intersection of line a at the virtual point
 representative of the incisive foramen ; distance xd : for the mini - implant on the right side , the minimum distance from the head
 of the mini - implant to line a ; distance yd : for the mini - implant on the right side , the minimum distance from the head
 of the mini - implant to line b ; distance x ' d : for the mini - implant on the right side , the minimum distance from the tip
 of the mini - implant to line a ; distance y ' d : for the mini - implant on the right side , the minimum distance from the tip
 of the mini - implant to line b ; distance xe : for the mini - implant on the left side , the minimum distance from the head
 of the mini - implant to line a ; distance ye : for the mini - implant on the left side , the minimum distance from the head
 of the mini - implant to line b ; distance x ' e : for the mini - implant on the left side , the minimum distance from the tip
 of the mini - implant to line a ; distance y ' e : for the mini - implant on the left side , the minimum distance from the tip
 of the mini - implant to line b. the means and standard deviations of the distances on each side were calculated
 considering the operator and the skull ( table
 1 ) .
the intra - operator reliability for the measurements was estimated using the
 interclass correlation coefficient ( icc ) .
analysis of variance ( anova ) was used to test
 the effect of different image times and different operators . mean and standard deviation ( sd ) for each measurement and operator ( op )
statistical analysis indicated a significantly high , positive correlation between the
 maxillary occlusal radiography taken by the different operators ( table 2 ) .
intra - operator reliability for mini - implant measurements expressed as interclass
 correlation coefficient ( icc ) ( n=3 ) the icc test verified the measurements of each variable made by each operator on each
 skull that localize the head and the tip of the mini - implant ( x , y , x ' and y ' ) .

intra - operator correlations were above 0.87 for all the operators and each of the skulls
 ( table 2 ) .
this value seems to indicate a
 similar variation , indicating an excellent reproducibility through a positive and high
 correlation . in terms of the effect of time
, the operator and its interactions showed no
 statistically significant differences in any of the variables analyzed by anova ( table 3 ) .
the goal of the present study was to test the reliability and accuracy of the
 radiographic occlusal position developed by zanda ( 2007 ) used as a device to verify the stability of
 posteroanteriorly and lateromedially positioned orthodontic mini - implants .
the
 hypothesis was that this method can be used as a replicate for maxillary occlusal
 radiographs for location of mini - implant placement in the posterior region of the
 maxilla . since the introduction of the cephalostat as a standard for taking cephalometric
 radiographs ,
the cephalostat has been traditionally used to determine the direction and
 amount of skeletal and dental changes .
several devices have also been developed and
 improved with longitudinal research in orthodontic patients .
some studies have reported
 that film holders and markers of anatomic structures contribute to the improvement in
 radiographic images . also creating more information about the position of structures
 during orthodontic treatments .
based on these presumptions , our study
 used a model of an occlusal x - ray film holder to obtain the most uniform radiographic
 series . additionally , the selected anatomic structures used as references to determinate
 the measurements were chosen because they are known to be stable during treatment .
this study showed that the use of the occlusal x - ray film holder is sufficiently
 accurate for investigations of mini - implant stability and an alternative to
 cephalometric analyses for determinate mini - implant displacement .
furthermore , the
 numerical information on the displacement of the mini - implants can be correlated with
 the amount of dental movement determined by the retraction .
( 2004 ) reported that mini - implants do
 not remain stable at forces higher than 400 g. these findings suggest that studies are
 necessary to quantify mini - implant displacement caused by treatment , especially by means
 of the innumerable variables related to the use of this transitional anchorage
 device .
our findings show that future clinical studies will be able to evaluate the direction of
 the displacement of the mini - implants .
also , different types of this skeletal anchorage
 device could be compared considering the thickness , the design and the length with the
 suffered displacement .
computed tomography ( ct ) scans are not routinely used to improve the quality of
 craniofacial measurements in orthodontics .
the present data prove that the method
 presented here is valid and can be performed at a much lower cost compared to ct .
this
 means that clinicians and researchers can better understand this innovative modality of
 anchorage using an easily attainable and low - cost material .
another important benefit of
 this method is a lower exposure of patients to radiation to detect the stability of the
 mini - implants .
we believe that clinical studies on this topic are very important for
 further acknowledgment of transitory anchorage device .
however , there is a great deal of
 responsibility in deciding to prescribe radiographs , especially ct scans ; it is
 complicated and depends on the effects on the orthodontic therapy management .
human skulls were used for safety reasons due to the potential exposure of patients to
 ionizing radiation .
the adopted model simulates similar conditions used for patients ,
 with a reduced x - ray exposure time .

additionally , the anatomic structures used to obtain all measurement tracings are easily
 identified , as well as their presence in the same plane and height as the indicated
 inserted mini - implant in the posterior maxillary area .
, we believe that the selected areas are not influenced by
 soft tissue thickness and do not compromise the visualization of the anatomic structures
 used and the installed mini - implants . the number of dry skulls used in this type of study has revealed variations in other
 studies .
the number of
 skulls used in the present study was sufficient to verify the influence of individual
 anatomic variations in the statistical analysis .
it should be noted that we opted for a
 research design that did not evaluate the anatomic aspects in relation to accuracy and
 reliability .
the aim of the
 study was to analyze operator 's reproducibility on separate occasions .
the intraclass
 correlation proved that , with the skull change and , consequently , the occurrence of
 anatomic variations , a high and significant correlation was found among the different
 measurements of each skull .
the agreement in the operators ' measurements ( table 3 ) shows that this method is useful for research and for
 clinical evaluation . for clinical use
, it is indicated to attach the film to the film
 holder ( figure 1 ) and after adaption inside of the
 mouth , ask for the patient to occlude . only with the dental occlusion is possible to
 achieve stability to use this intraoral radiographic technique .
zanda ( 2007 ) found variations in the
 reliability of measurements far from the occlusal plane , whereas the present study
 showed no statistically significant differences .
in the present study , this
 reproducibility was found because the mini - implants and the anatomic structures used the
 same plane into the maxilla , both are at the same tall of palatal plane .
variables
 describing the position of the head and the tip of the mini - implant were in the same
 plane .
also , the midpalatal suture was chosen as a reliable reference for the
 determination of a measurement for each variable .
it should be mentioned that the method
 presented here only identifies mini - implant localization on the posterior region of the
 maxilla .
this implies that , in future studies , an additional use for this method in
 another site of the maxilla or mandible may be the identification of a more reliable
 anatomic structure for each studied region .
the results of the present study demonstrate that this radiographic method was highly
 reproducible among operators and accurate for the identification of measurements . also ,
 no differences were observed based on the time and the operator using this method .
these
 results support the use of this standardized method for occlusal radiographs for
 mini - implant identification on the posterior maxilla .

Answer:
objectivethe purpose of this study was to evaluate the reliability and accuracy of a
 radiographic analysis method for the location of mini - implants inserted in the
 posterior region of the maxilla .
 material and methodstwo self - drilling mini - implants were installed between the second premolar and the
 first molar on the right side and left side in three dry skulls .
 three operators
 performed three occlusal radiographs , using an occlusal x - ray film holder , at
 three different times in each of the three skulls .
 resultsthe interclass correlation coefficient showed a significantly high , positive
 correlation ( p<0.05 ) , indicating an excellent reliability between operators .

 the analysis of variance showed no significant differences in time and among the
 operators .
 conclusionbased of these findings , it may be concluded that this methodology can be used by
 several operators in longitudinal clinical studies on orthodontic mini - implants at
 the anterior - posterior and lateral - medial locations or longitudinal
 displacement .


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 an infection caused by various fungal species of trichophyton , epidermophyton , and microsporum genera , together known as dermatophytes belonging to order onygenales .
terbinafine was added to this list of antifungals in the early 1990s and has since then shown good efficacy in widespread tinea infections .
it is the only orally available allylamine antifungal . with a favorable mycological and pharmacokinetic profile ,
terbinafine is considered to be a first - line drug for the treatment of tinea corporis and cruris .
squalene epoxidase is an enzyme responsible for synthesis of ergosterol , an important component of fungal cell membrane .
this ultimately results in fungal cell wall disintegration allowing terbinafine to exert its fungicidal action .
the side effects include gastrointestinal side effects such as nausea , vomiting , and abdominal pain .
the drug has shown consistent efficacy against dermatophytes achieving more than 90% cure rates at a dose of 250 mg / day when administered for 2 weeks . however , recently , we have observed decreased efficacy terbinafine in patients with tinea infections .
this study is aimed at documenting these cases of terbinafine therapy failure in patients of tinea corporis and/or tinea cruris .
we also tried to see the correlation of this resistance with the species involved as well as the percentage of body surface area involved .
the study was carried out in northern part of india during spring and summer season with an average humidity of 70% and an average temperature of 28c .
patients diagnosed to have tinea corporis and/or tinea cruris on clinical examination and involving more than 1% body surface area were taken up for the study .
the diagnosis was made by clinical examination followed by 10% koh smear and culture in all the patients .
only culture positive patients were included in the study and culture negative patients were excluded from the study .
patients who had taken any treatment , had any previous history of intolerance to the drug under study , had any abnormality in the laboratory investigation or who were immune compromised , pregnant or lactating , were excluded from the study .
moreover , patients with a history of tinea infections in family , friends , or close contacts were also excluded from the study .
a total of 100 patients satisfying all the inclusion criteria were included in the study .
culture was performed simultaneously on sabouraud 's dextrose agar ( sda ) medium with chloramphenicol and sda with chloramphenicol and cycloheximide .
all the enrolled patients were put on oral terbinafine 250 mg once daily for 2 weeks . no antacids or antihistamines were prescribed , and the patients were advised to take the medication at bedtime . no topical antifungals or antifungal steroid combination agents were allowed during the study . clinical examination and fungal culture
were repeated at the end of treatment period to document clinical and mycological cure , respectively .
residual pigmentation was present in some cases but was not taken as suggestive of incomplete cure .
patients who had a persistent clinical disease on clinical examination were given alternate oral treatments and were excluded from further analysis .
cases , in whom the disease was seen to be cured clinically , were advised to go for repeat cultures from the initial involved sites only .
in addition , these clinically cured patients were asked to come for follow - up every 2 weeks .
relapse was defined as the appearance of lesions seen clinically and confirmed on culture subsequently .
in this study , a total of 100 culture positive patients of tinea corporis and/or tinea cruris in age group of 1662 years were included in this study .
the disease was found to be more common in males , the male : female ratio being 1.63:1 ( 62 males and 38 females ) .
the majority of patients , i.e. , 63% were in the age group 2030 years .
the most common causative organisms grown on culture were trichophyton rubrum and trichophyton tonsurans [ table 1 ] .
the percentage distribution of various causative organisms involved at the end of oral terbinafine therapy , only 70 cases out of 100 were clinically cured while the rest ( 30/100 ) had signs of persistent infection at the treated site ( persisters ) . on repeat fungal culture ,
five cases out of the seventy clinically cured patients had a positive culture with the same organism that was grown initially .
thus , out of a total of 100 cases enrolled , only 65% could achieve both clinical and mycological cure after 2-week terbinafine therapy ( cured ) . over the 12-week follow - up ,
clinical relapse was seen in 22 of the 65 clinico - mycologically cured patients ( relapse ) .
relapse was confirmed on culture as the repeat cultures grew primary pretreatment isolates in all cases .
thus , at the end of 12 weeks , there were only 43 cases out of the total 100 cases enrolled who were able to maintain a long - term clinical and mycological cure after 2 weeks of oral terbinafine treatment [ table 2 ] .
percentage of causative organisms viz - a - viz the cured , persisters and relapse groups majority of the relapses ( 16/22 ) were seen after 8 weeks of completion of treatment .
this was followed by 3 more cases at the end of 4-week while further 2 , 6 , 3 , and 7 patients relapsed at 6 , 8 , 10 , and 12 weeks , respectively .
the mean percentage body surface area involvement in the cured , persistent , and relapse groups was 3.23  1.2% , 3.65  1.73% , and 3.182  1.46% , respectively .
thus , there was no significant difference in the body surface area involvement when compared with the cured and the persistent disease groups ( mann  whitney u - test , p : 0.3908 ) .
furthermore , there was no significant difference between the cured and the relapse group as far as the body surface area involvement is concerned ( mann  whitney u - test , p : 0.5952 ) .
dermatophytosis , being among the most common dermatologic conditions , does not spare people of any race or age . according to the world health organization , about 20% of the world population are affected by cutaneous dermatophytic infections .
dermatophytes are related fungi capable of causing skin infection of the type known as ringworm or dermatophytosis .
the ringworm species belong to three asexual genera : microsporum , trichophyton , and epidermophyton , which attack the keratinized tissue and cause a wide spectrum of clinical manifestations , of which the most predominant type of infection is tinea corporis followed by tinea cruris , tinea pedis , and onychomycosis .
tinea corporis accounts for about 70% of the dermatophytic infection . in this study , which was limited to cases with tinea corporis and/or tinea cruris we found tinea cruris with corporis was the predominant type seen in 52% of cases followed by tinea corporis only ( 28% ) and tinea cruris only ( 20% ) . in this study ,
. and kumar et al . reported male : female ratio 1.86:1 and 1.36:1 , respectively , in patients with tinea infection .
the predominance of males is usually thought to be a result of increased physical activity and thus increased perspiration .
the patients belonged to the age group of 1462 years , with the mean age being 29.06  10.76 years .
the maximum number of patients , i.e. , 63% was in the age group 2030 years .
in a recent study by surendran et al . from south india , a similar age statistics was seen .
moreover , multiple authors from various parts of india have reported comparable data on age distribution .
tinea corporis and tinea cruris are most commonly caused by trichophyton species of which t. rubrum is most common infectious agent in the world accounting for around 50% of tinea corporis cases . in this study ,
the most common causative organism isolated after culture was t. rubrum , followed by t. tonsurans , trichophyton mentagrophytes , trichophyton verrucosum , and microsporum gypseum in that order . within the genus trichophyton ,
even one study from northeast india reported t. tonsurans as the most common etiological agent in dermatophytosis .
diagnosis of tinea corporis and/or tinea cruris is mostly done clinically . to avoid a misdiagnosis , important for successful treatment , identification of dermatophyte requires both a fungal culture on sabouraud 's agar media and a mycological examination , consisting of a 1015% koh preparation , from skin scrapings . in our patients , koh slide test was positive in 94% of cases .
however , much lower percentages of culture positivity in dermatophytosis have been reported by some authors .
the treatment is based on the infection site , an area involved etiological agent , and penetration ability of the drug .
although topical antifungals may be sufficient for treatment of tinea corporis and/or tinea cruris , lesions which are widespread or fail to respond to topical therapy need systemic therapy . among the several systemic antifungal drugs used to treat dermatophytosis ,
terbinafine 's fungicidal action , combined with its excellent pharmacokinetic properties , makes it an ideal systemic drug for the purpose .
it exhibits its action on fungi by inhibiting the enzyme squalene epoxidase , thus causing an ergosterol deficiency which is important for fungal cell wall integrity .
terbinafine is particularly effective against the species in trichophyton , microsporum , and epidermophyton genera , which in fact are the most common causative agents for tinea infections .
historically griseofulvin was considered the drug of choice for tinea infections for a pretty long time .
however , reports of higher relapse rates with griseofulvin pushed terbinafine to the forefront in treatment of tineacorporis and cruris . over the years
terbinafine slowly gained a first line drug status in the treatment of tinea infections particularly tineacorporis and cruris where clinical and mycological cure rates were reported to be around 90% .
even with an intermittent pulse dose therapy cure rates of around 90% have been reported with terbinafine .
however , these results are in contrast to what we experienced in our patients of tinea cruris and corporis treated with oral terbinafine .
we found a clinical efficacy of only 43% in our patients followed for a 12-week .
such a low clinical efficacy might be a result of the appearance of resistant strains of dermatophytes .
although resistance to terbinafine in dermatophytosis is very uncommon in clinical practice , it has been reported in clinical isolates which result from sequence variation in the gene for squalene epoxidase .
these mutations ultimately decrease the affinity of the terbinafine binding domain resulting in decreased susceptibility to the drug . the low clinical efficacy
as observed in this study could not be attributed to extensive body surface area involvement as there was no statistically significant difference between the cured , persistent and the relapsed cases . again
numerous authors have reported excellent results with oral terbinafine therapy in immunocompromised individuals who interestingly have extensive area involvement .
even 1 week short course oral therapy with terbinafine has shown good results in such individuals with extensive skin area involvement .
however , primary resistance to terbinafine in clinical t. rubrum strains has been reported long back .
thus , we need to seriously consider the appearance of resistance to terbinafine in dermatophytes as an upcoming challenge in dermatological practice .
our results demand further studies to characterize the resistant strains isolated , at a molecular and biochemical level and further test the susceptibility to various antifungals so that an alternate treatment could be proposed .
the main limitation of the study was the absence of calculation of mic in cases with failed cure and relapse .
incomplete cure is very common after a 2-week course of oral terbinafine therapy and recommendations about the daily dose and duration of oral therapy need to be changed and updated accordingly .
this article highlights the presence of resistance to terbinafine in our cases of tinea infections .
this article makes the dermatologists aware of the growing resistance to terbinafine and stimulates further microbiological studies in this respect .
this article highlights the presence of resistance to terbinafine in our cases of tinea infections .
this article makes the dermatologists aware of the growing resistance to terbinafine and stimulates further microbiological studies in this respect .
this article highlights the presence of resistance to terbinafine in our cases of tinea infections .
this article makes the dermatologists aware of the growing resistance to terbinafine and stimulates further microbiological studies in this respect .

Answer:
background : the incidence of recurrent tinea infections after oral terbinafine therapy is on the rise.aim:this study aims to identify the appearance of incomplete cure and relapse after 2-week oral terbinafine therapy in tinea corporis and/or tinea cruris.materials and methods : a total of 100 consecutive patients clinically and mycologically diagnosed to have tinea corporis and/or tinea cruris were included in the study .
 the enrolled patients were administered oral terbinafine 250 mg once daily for 2 weeks .
 all clinically cured patients were then followed up for 12 weeks to look for any relapse / cure.results : the common dermatophytes grown on culture were trichophyton rubrum and trichophyton tonsurans in 55% and 20% patients , respectively . at the end of 2-week oral terbinafine therapy ,
 30% patients showed a persistent disease on clinical examination while 35% patients showed a persistent positive fungal culture ( persisters ) at this time .
 these culture positive patients included all the clinically positive cases .
 rest of the patients ( 65/100 ) demonstrated both clinical and mycological cure at this time ( cured ) . over the 12-week follow - up ,
 clinical relapse was seen in 22 more patients ( relapse ) among those who had shown clinical and mycological cure at the end of terbinafine therapy .
 thus , only 43% patients could achieve a long - term clinical and mycological cure after 2 weeks of oral terbinafine treatment .
 majority of the relapses ( 16/22 ) were seen after 8 weeks of completion of treatment .
 there was no statistically significant difference in the body surface area involvement or the causative organism involved between the cured , persister , or relapse groups.conclusions:incomplete mycological cure as well as relapse is very common after standard ( 2-week ) terbinafine therapy in our patients of tinea cruris / corporis .


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:
beyond its role of cellular energy currency and phosphate donor , atp plays a potent signaling role through its extracellular release and activation of cell surface purinergic receptors .
fast responses to atp are mediated through activation of p2x receptors , a family ( p2x1p2x7 ) of atp - activated ligand - gated ion channels and metabotropic effects through the activation of p2y receptors ( p2y12 , p2y4 , p2y6 , p2y1114 ) which couple to heterotrimeric g proteins . human leukocytes including monocytes , mast cells , neutrophils and central microglia express a diverse repertoire of p2y receptors though p2x1 , p2x4 and p2x7 are the dominant p2x subtypes present .
activation of purinergic receptors in leukocytes is coupled to the production and secretion of cytokines and other pro - inflammatory molecules including prostaglandin e2 .
purinergic receptors are associated with inflammation , with some receptors inhibited either directly ( p2y12 ) or indirectly through the activity of anti - thrombotic , in the case of platelet p2y12 , or anti - inflammatory agents , in the case of the action of statins on monocyte p2x4 .
atp can act as a non - peptide damage - associated molecular pattern ( damp ) release from injured cells and tissues . in this fashion
the release of cellular atp is unregulated and released due to cell lysis or puncture .
cell surface purinergic receptors are activated by this atp damp signal which serves to initiate an inflammatory response and promote wound healing .
however , atp can be released from cells physiologically and act as a critical signal for painful , inflammatory processes .
do release other nucleotides including utp and udp - sugars but our focus here is atp release . mechanisms of atp release during physiological processes remain diverse and controversial .
investigation into how cellular stress stimulates atp release in non - leukocytes suggests roles for connexin and pannexin hemichannels , maxi- and volume - regulated anion channels and efflux through the p2x7 receptor , though release routes and signal transduction mechanism underlying atp release in leukocytes remain poorly defined .
in neutrophils atp is released in response to activation of fmlp receptor by bacterially derived n - formylmethionine .
the precise release mechanism is unclear but occurs at the leading edge of migrating neutrophils .
released atp and its subsequent metabolism to adenosine at the cell surface activate p2y2 and a3 receptors serving to direct cell orientation and promote migration in response to chemotactic signals .
bacterially derived lipopolysaccharide can stimulate central microglia to secrete atp which in - turn activates neighboring astrocytes and modulates excitatory neurotransmission .
this raises the possibility that atp can act in a feed forward loop possibly amplifying responses to itself or other external cues which couple to atp secretion .
furthermore , such constitutive secretion leads to activation of cell surface gq - coupled p2y receptors which elevate intracellular calcium levels through release of calcium .
this mode of constitutive secretion generates a constant pericellular atp cloud or  halo  which appears to be important in regulating intracellular calcium homeostasis following p2y receptor activation . in cells of hematopoietic lineage such as monocyte / macrophage , nk killer and mast cells , secretory lysosomes have evolved as bifunctional organelles which combine classical degradative properties with secretion .
the mechanism of lysosomal atp transport remains undefined though a nucleotide transporter ( v - nut ) has been characterized for other atp containing vesicles .
the signal transduction coupling external cues such as cytokines , chemokines and bacterially derived molecules to atp release is poorly defined .
what are the release machines in leukocytes and do they differ from other cell types ? it is expected that therapeutic intervention in agonist stimulated atp release is a potentially novel route to pharmacological modulation of innate immune responses but also in chronic inflammatory disease where normal inflammatory responses are heighten and act deleteriously .

Answer:
release and reception of extracellular atp by leukocytes plays a critical role in immune responses to infection , injury and cardiovascular disease .
 leukocytes of both the innate , adaptive immune and central nervous system express a repertoire of cell surface receptors for atp ( p2x and p2y receptors ) and its metabolites .
 atp acts as a damage - associated molecule pattern ( damp ) released by injured or dying cells .
 detection of released atp by neighboring leukocytes initiates inflammation and wound healing .
 however , recent evidence from our group and others suggests atp release by leukocytes themselves serves to regulate homeostatic mechanisms and coordinate responses to external pro - inflammatory cues .
 examples include the homeostatic control of intracellular calcium and regulation of migratory guidance during chemotactic response to external cues .
 though there has been some progress in elucidating atp release mechanisms of some mammalian cells types , release conduits and coupling signal transduction machinery remain larger elusive for leukocytes .
 our recent studies suggest a role for secretory lysosomes in releasing atp in monocytes . though poorly defined ,
 targeting atp release mechanisms in leukocytes have great anti - inflammatory potential .