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:
academic failure is a serious problem of the students , educational system , and society .
usually the students who have experienced academic downfall during their education do nt demonstrate desired theoretical or practical capability of their lessons .
academic downfall can also result in numerous emotional , social , behavioral , and psychological problems ; a study in the united states showed that the main reason for the suicide in students is downfall in education or profession .
considering the above - mentioned points , it can be said that academic downfall is one of the major problems of educational systems ; hence that every year it causes the dissipation of a large number of the labor force and economic sources and has serious consequences for students , their families , and society in general .
thus , taking the suitable steps to solve this problem is fundamental . in this study ,
the role of personality traits and mental health were considered as determinant factors in academic failure .
having good mental health and healthy personality , are necessary for each person in order to concentrate , learn , and study .
personal characteristics such as gender , age , degree of education and field of education are also important factors in this respect . in doing so , some pieces of research that have been conducted to determine the role of psychological factors in academic downfall are introduced .
, their study pointed out that the student with lower levels of achievement has a higher risk of psychological disorder .
bentez et al . in a study concluded that increased period of education comes along with the lack of health .
mc ilroy and bunting , king and bailly , they said that personal characters have a relationship with educational achievement of student .
chamorro - premuzic and furnham , gray and watson , duff and boyle , oconnor and paunonen , they said that loyalty and prepending are among the strongest and the most resistant 's characters related to educational achievement .
walt and pickworth reported that those students had higher achievement who had the following characteristic loyalty , emotional stability , social skills , self - disciplined , practical and were calm or anxious to an imagination .
, come to the conclusion that hopefulness and positive attribution style were the higher predictive factors in educational achievement .
in separate conducted studies , revealed that there is a significant relationship between age and academic performance .
hazavehei et al . , safdari - dehcheshmeh et al . , and zare et al .
in separate studies , concluded that academic performance of female students was better comparing to the males .
since mental health is regarded as a basic requirement for satisfactory performance in any field , including educational therefore investigation is so important that the national institute of mental health believes that those with mental health can satisfy their needs and have more compatibility with others .
mental health can also affect personality traits , the ability of social interaction , and adaptability to new situations .
it 's worth mentioning that educational status is one of the many needs that can be influenced by mental and individual features .
thus , considering the importance of medical sciences , the significant role of students personal and psychological state in their educational performance , and the consequences of academic downfall , this study aim to determine the role of personal and psychological factors in academic downfall among the students of medical sciences . concerning the variables of mental health and personality traits ,
studies carried out within the country and outside of the country have investigated the roles of different variables in educational performance .
for example , in order to determine personality traits , the following tests and questionnaires were used for different majors and semesters : cattell 16 personality factor ( 16 pf ) , izeng personality test , personality a and 5 , minnesota multiphasic personality inventory ( mmpi ) long and short form and in order to evaluate the mental health gho , symptom checklist-90 ( scl-90),  .
were used questionnaire , neo - personality inventory  revised ( neo - ff - r ) , minnesota long and short personality test forms mmpi and for testing students mental health , scl-90 , general health questionnaire ( ghq ) , and etc . , were used .
therefore , different results were obtained all of which indicate that some of the personality traits and mental health indicators influence students academic performance
. therefore , in this study , the effect of interaction between personal factors , personality characteristics and mental health indicators of students , in statistical model analyzes . the present study attempts to answer the following hypothesis : if personality factors , the status of metal health and demographic features have any role in predicting the educational performance of the students in the isfahan university of medical sciences .
the present descriptive - correlation study was conducted among 771 students who entered isfahan university of medical sciences between the years 2005 and 2007 .
the students educational and clinical files were used , and psychological interviews were performed by a clinical psychologist ( for communication and psychological support ) .
the psychological data were completed using ghq test ( known tool for the screening ) : somatic symptoms , anxiety - insomnia , social dysfunction , severe depression , and personality test minnesota short form ( mmpi ) ( this questionnaire forms , can be used in psychological and clinical research ) : hypochondriasis , depression , hysteria , psychopathic deviate , paranoia , psych asthenia , obsessive - compulsive disorder , schizophrenia , hypomania .
demographic characteristics included gender , age and education . in order to access the students grade point average students ( gpa ) and their scores in different subjects ,
an agreement was reached by the department of education , to use sama software ( 2003 , iran ) , which included all the students educational information .
it 's worth mentioning that the students information was confidentially analyzed in a group . using ( version 15 , spss inc . , chicago , il )
most of the participants in the present study were females ( 81.2% ) , 97% were single and 46.04% were bachelor students ( 27.62% undergraduate and 26.32% ph.d .
the average students standardized score in all the scales of personality tests was normal and in the range of 4752 .
in addition , the average students score in all the general health indices was normal .
the score of social performance had a higher average compared with others . in response to the following hypothesis analysis,[tables 13 ] .
the prediction of educational performance of the students at isfahan university of medical sciences based on personality indicators , mental health , and individual characteristics the investigation of the significance of the predictive coefficients in educational performance of the model the coefficients of variables of the predictors of educational performance if personality factors , the status of metal health and demographic features have any role in predicting the educational performance of the students in the isfahan university of medical sciences . according to the above results ,
the variables that are mentioned in the model could predict 11% of students educational performance ( students average scores have been considered ) as follows : education 4% , age 4% , gender 2% , depression ( as one of the aspects of mmpi test ) 1% , and hypochondria ( as one of the aspects of mmpi test ) 1% . as it has shown in table , the predictor coefficients of education , age , gender , depression , and hypochondria for educational performance is significant ( p < 0/0001 ) . according to the results shown in table 3 , five variables that could predict educational performance , in priority , are education , age , gender , depression , and hypochondria .
the analysis of the results showed that education , age , gender , depression , and hypochondria are the predictive variables of educational performance ( students average scores have been considered ) . according to the obtained results , among all the personality , general health , and demographic variables , only the variables of education , age , gender , depression , and hypochondria are significant predictors of students educational performance . concerning the prediction of students educational performance based on their age
, it should be said that the results of this study verify the results of the studies of duff and boyle no contradictory result were found .
concerning prediction of educational performance based on the depression ( as one of the aspects of mmpi test ) , it 's worth mentioning that the results of this study are verifying those of the following studies ; raoofi et al . , the results of predicting based on mental health are in agreement with the results of the following studies ; rafati et al .
these results were in contradiction to just one study by farahbakhsh et al . in 2007 , based on prediction of educational performance , according to mental health .
concerning the relationship and prediction of the educational performance based on hypochondria ( as a part of the mmpi ) , only kahrzaei et al .
confirmed the results of the present study ; but if the relationship between some of the personality features and educational performance is taken into account , the following studies could be mentioned as those that verify and recognized some personality traits as related factors in educational performance .
chamorro - premuzic and furnham , gray and watson , duff and boyle , walt and pickworth , leeson et al .
the results of the present study did not confirm the results of the study done by karamimatin according to which no significant relationship was observed between personality traits and educational performance .
the results of the regression test showed that the depression could predict 1% of the variance of academic performance .
depression occurs among students for many reasons , but the aim of this study is not saying about these reasons . when depression for whatever reason , was formed , academic performance of students most likely to be affected .
it is not needed to mention that academic achievement requires concentration , high morale , planning , perseverance , and many other factors that can be negatively influenced by depression .
although depressed students understand the importance of academic success and feel penitent if they experience academic failure , they are unable to compensate them academic downfall . in the present study , hypochondria
sometimes pressures , lack of satisfaction , and the guilty conscience appear as physical illnesses .
people are differently afflicted with different illnesses or disorders based on their potential , genetic background , and the skills that can be learned .
some of these disorders overlap the others , and some can cause the others . in general , fear of getting sick can reduce solace , concentration , and accomplishment . in fact , there is no disease , but it feels odor one may have wrong feelings about the severity of illness or pain . considering psycho - physics and the connection between body and mind , the effects of body on mind and vice versa can not be denied .
considering the prediction of educational performance based on gender , it should be mentioned that the results of the present study are in agreement with those of the following studies ; leeson et al . , and in contradiction to the following studies which have not found any relation in this area with those ; raoofi et al .
research , in which each variable was analyzed separately , all variables were analyzed in a more advanced model in this study .
most of the studies have confirmed that female students have more academic achievements than male students .
this difference has been probably caused by the following reasons .
 in terms of culture girls
are expected to be less concerned with diversity , mainly concentrate on their lessons and academic achievement , and spend less time on recreational , social , and political activitiesin our society boys are disappointed in academic achievements .
they feel that they should find a job as soon as possible due to the importance of financial issues and continue their education puts off their occupational success .
hence , they do nt have enough motivation to make any attempts and usually their aim is just to get an academic degree .
  in terms of culture girls
are expected to be less concerned with diversity , mainly concentrate on their lessons and academic achievement , and spend less time on recreational , social , and political activities in our society boys are disappointed in academic achievements .
they feel that they should find a job as soon as possible due to the importance of financial issues and continue their education puts off their occupational success .
hence , they do nt have enough motivation to make any attempts and usually their aim is just to get an academic degree .
courses have their own special characteristics to which the students should adapt , such as the obligation to study more , study more difficult lesson , spend more time studying ( those who do nt have enough time to study will be anxious about their lessons ) , length of the educational period , fatigue that causes limited recreational activities , and constant involvement with lessons that leads to low - spirit , lack of energy , or losing motivation .
being unsatisfied with the future career among students who are aware of the long period that they have to spend on education can affect academic performance , too .
the present study also revealed that the older the students get , the lower their academic performance will be ( as a result of research dastranj et al . , 2012 ) .
the influence of age on academic performance can be viewed from different perspectives : ( 1 ) as the students get older , they are faced with some problems like entering higher semesters , more difficult lessons , more assignments , and higher expectations of their supervisors .
this can lead to fatigue , impatience , or lack of motivation because of the long period of academic educations .
( 2 ) as the students get older , they approach the age at which they should accept more personal and social responsibilities , and they have to make important choices in marriage or , continuing education , job and , etc .
therefore , they have to spend some of their energy and concentration to choose the right path .
learning , gpa , and studying well are more important to the students in the first semesters .
first time failed in studies , and the first conditional state , or a low gpa can cause a lot of negative feelings in person , but as time passes , these conditions become something usual and are accepted more easily .
making friends with some people who are not committed to their education can worsen this situation .
we can say , if a student suffers from a physical or psychological problem , he / she has less opportunity in learning , education , and academic success .
this can lead to academic failure .
 performing check - up and consulting sessions for identifying students problems , especially males , older , and higher level students who are more vulnerable , according to this studycontinuous psychological intervention for the students who have a higher risk , following preventive measures in accordance to the compiled educational protocols and the target students characteristics .
  performing check - up and consulting sessions for identifying students problems , especially males , older , and higher level students who are more vulnerable , according to this study continuous psychological intervention for the students who have a higher risk , following preventive measures in accordance to the compiled educational protocols and the target students characteristics .

 performing check - up and consulting sessions for identifying students problems , especially males , older , and higher level students who are more vulnerable , according to this studycontinuous psychological intervention for the students who have a higher risk , following preventive measures in accordance to the compiled educational protocols and the target students characteristics .
  performing check - up and consulting sessions for identifying students problems , especially males , older , and higher level students who are more vulnerable , according to this
study continuous psychological intervention for the students who have a higher risk , following preventive measures in accordance to the compiled educational protocols and the target students characteristics .

Answer:
background : the issue of students academic failure is one of the most important educational , economic , and social issues .
 cognizance of the factors related to academic downfall is so efficient in its prevention and control and leads to protecting governmental assets and labor force . in order to achieve this goal , this study intends to determine the predictive factors of the students academic performance in isfahan university of medical sciences in terms of their personality profile , mental health , and their demographic characteristics.materials and methods : this study was a descriptive - correlation study on 771 students who entered isfahan university of medical sciences between 2005 and 2007 .
 the information was gathered through using the students educational and clinical files ( for measuring personality characteristics and mental health ) and sama software ( to get the mean scores ) .
 minnesota multiphasic personality inventory short form and general health questionnaire were used for collecting clinical data .
 the data were analyzed using spss 15 ( stepwise regression coefficient , variance analysis , student 's t - test , and spearman correlation coefficient).result : the results showed that the aforementioned students obtained a normal average for their personality profile and mental health indicators .
 of all the reviewed variables , education , age , gender , depression , and hypochondria were the predictive factors of the students educational performance.conclusion:it could be concluded that some of the personality features , mental health indicators , and personality profile play such a significant role in the students educational life that the disorder in any of them affects the students educational performance and academic failure .


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:
igg4-related diseases are systemic syndromes characterized by elevated serum levels of igg4 and igg4-positive lymphoplasmacytic infiltrative lesions in the body .
it was first observed that mikulicz 's disease correlated with igg4-related disease   and later determined that igg4-related disease can occur in any ocular adnexal tissues [ 25 ] .
here , we review the clinicopathological features , differential diagnosis , and treatments of orbital igg4-related disease on the basis of a meta - analysis of 42 patients including 3 case series studies .
the median age of patients with orbital igg4-related disease is 59 years ( range : 30 to 86 years ) with a 1  :  1 male - to - female ratio [ 35 ] .
notably , there is a 1  :  3 for bilateral lacrimal lesions similar to finding in mikulicz 's disease .
although orbital igg4-related disease can occur in men and women of any age , many patients have a history of allergic diseases such as asthma and allergic rhinitis .
the signs and symptoms of orbital igg4-related disease are chronic lid swelling ( figure 1 ) and proptosis ( figure 2 ) , but otherwise there are only mild signs , or no signs of inflammation or periocular pain .
ocular motility is restricted mildly if at all , despite the presence of one or more enlargements of the large extraocular muscles ( figure 1 ) .
there are generally no visual disturbances , although they may occur due to apical orbital lesions ( figure 2 ) .
imaging studies show infiltrative lesions in ocular adnexal tissues such as the lacrimal glands ( figure 1 ) [ 25 ] , extraocular muscles ( figure 1 ) [ 3 , 4 ] , infraorbital nerves ( figure 2 ) , optic nerve sheath , lacrimal sac , and even cavernous sinus ( figure 2 ) or the intracranial extension . in cases of orbital igg4-related disease
, 62% have bilateral lesions , 69% have lacrimal gland involvement , and 48% have bilateral lacrimal gland involvement [ 35 ] .
patients with orbital igg4-related disease sometimes have systemic igg4-related lesions in their submandibular glands ( 29% ) , lymph nodes ( 14% ) , pancreas ( 5% ) , or bile ducts ( 5% ) [ 35 ] .
igg4-related lesions in the thyroid and pituitary may also be present [ 7 , 8 ] .
chronic rhinosinusitis with orbital igg4-related lesions has similar histology ( figure 3 ) , although nonspecific chronic rhinosinusitis can be also associated with igg4-positive plasma cells in the lesions .
laboratory data of patients with orbital igg4-related disease show elevated serum levels of igg4 and ige , as well as hypergammaglobulinemia [ 25 ] .
high igg4 levels are associated with elevated levels of the soluble interleukin ( il-2 ) receptor .
sclerosing pancreatitis and cholangitis , considered as igg4-related diseases , have lymphocytes that signal for il-4 and il-10 in situ .
although an etiology for the igg4-related group of disease has been not determined yet , one plausible hypothesis for these serological and immunological abnormalities is that they result from in vivo activation of the immune system by activated th2 cells [ 3 , 10 ] .
the histology of orbital igg4-related disease includes different degrees of lymphoplasmacytic infiltration with dominant sclerosing lesions or reactive lymphoid follicle ( reactive lymphoid hyperplasia , figure 3 ) [ 25 ] .
rarely , orbital igg4-related disease may have an infiltration by lymphoplasmacytic cells and macrophages containing eosinophilic material .
igg4-related diseases in the body are characterized histologically by obliterative phlebitis ; however , it is rare in orbital igg4-related disease .
immunohistochemical analysis shows igg4-positive plasma cells ( figure 3 ) , which differentiate igg4-related disease from other inflammatory conditions arising from the ocular adnexa [ 3 , 4 ] .
for optimal treatment and resolution , orbital igg4-related disease must be differentiated from the following : idiopathic orbital inflammation , idiopathic orbital myositis , marginal zone b - cell lymphoma , antineutrophil cytoplasmic antibody- ( anca- ) mediated systemic vasculitis ( such as churg - strauss syndrome and wegener granulomatosis ) , and reactive lymphoid hyperplasia without igg4-positive plasma cells ( figure 4 ) .
they are characterized by sudden onset of orbital inflammation , periocular pain , swelling and redness of the eyelids , proptosis , ptosis , and ocular motility restrictions .
however , some cases of idiopathic orbital inflammation have atypical signs and symptoms , that is , they have lacked acute onset and inflammatory signs . in such cases ,
ocular adnexal marginal zone b - cell lymphomas make up the majority of lymphomas arising from the ocular adnexa .
they are characterized histologically by the presence of reactive follicles in up to 64% of cases , sclerosis in up to 20% of cases , and plasma cells in up to 35% of cases .
in addition , 9% of patients with ocular adnexal marginal zone b - cell lymphomas have infiltration of igg4-positive plasma cells and elevated serum level of igg4 .
evidence of light chain restrictions by in situ hybridization and immunoglobulin heavy chain gene rearrangements by southern blot analysis can differentiate between marginal zone b - cell lymphomas with igg4-positive plasma cells and igg4-related inflammatory disorder .
ocular adnexal lymphomas are reported to arise in igg4-related sclerosing dacryoadenitis , indicating a possible link between the two conditions .
the symptoms of patients with orbital lesions include periocular pain , which can differentiate these patients from those with orbital igg4-related disease
thus , anca - related vasculitis may not only include nonspecific inflammatory lesions , but also have abundant igg4-positive plasma cells .
finally , mikulicz 's disease includes symmetrical bilateral lacrimal gland enlargements and frequently correlates with igg4-related disease .
however , symmetrical bilateral lacrimal gland enlargements do not always indicate igg4-related lesions ( figure 4 ) .
treatments for patients with orbital igg4-related diseases may include systemic steroids , radiotherapy , or rituximab [ 35 ] .
studies of each of these treatments involved relatively few patients , making it difficult to evaluate the treatment outcomes via meta - analysis .
orbital igg4-related diseases resolve after systemic steroid therapy , but relapse is often observed following therapy discontinuation . in mikulicz 's disease , relapses of lesions are observed when steroids were discontinued .
therefore , it may be best to continue prednisolone at 5 to 10  mg / day or to combine prednisolone with an immunosuppressant such as azathioprine .
rituximab treatment leads to prompt clinical and serologic improvement in patients with refractory igg4-related diseases , although recurrence is also observed after rituximab treatment ends in some patients with orbital igg4-related disease .
orbital igg4-related disease has several unique characteristics that distinguish it from other orbital inflammatory conditions .
orbital igg4-related disease differs from other igg4-related diseases in the body in that it arises from nonglandular lesions and is not associated histologically with obliterative phlebitis .

Answer:
orbital igg4-related disease , which can occur in adults of any age , is characterized by igg4-positive lymphoplasmacytic infiltrations in ocular adnexal tissues .
 the signs and symptoms include chronic noninflammatory lid swelling and proptosis .
 patients often have a history of allergic disease and elevated serum levels of igg4 and ige as well as hypergammaglobulinemia .
 orbital igg4-related disease must be differentiated from idiopathic orbital inflammation and ocular adnexal marginal zone b - cell lymphoma to ensure appropriate and effective treatment .
 systemic steroid therapy decreases the size of the lesions , but relapse often occurs when systemic steroid therapy is discontinued .


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:
accidents and injuries are part of daily events , and many of these injuries are initially treated by untrained personnel due to lack of health care providers on the accident site .
therefore , implementing correct first aid measures is vital for victims in emergency cases and helps to improve the overall outcome of the first aid process in emergency situations .
the national first aid science advisory board defined first aid as making an assessment and implementing interventions that can be performed by a bystander ( or by the victim ) with minimal or no medical equipment .
several studies have been conducted around the world to evaluate the level of knowledge about first aid among different groups including university students .
some studies showed that a high percentage of students in different countries lack the appropriate first aid knowledge .
similarly , different studies showed that the immense majority of peoples had little or no first aid training .
many factors had been shown to be associated with better knowledge , including taking a first aid course during school , having a driving license , or having a higher level of education .
few reports assessing the first aid knowledge were carried out in arab countries and most of them reported that university students have poor levels of first aid knowledge . to the best of researcher 's knowledge and experience , no studies have been conducted about general first aid knowledge in jordan .
this gives the research a unique importance in building the cornerstone of the research background in the jordanian context .
therefore , first aid basics will equip persons around the injured person to reduce the danger posed by the accident and can make the difference between life and death in these situations .
hence , the current study has aimed at evaluating the level of knowledge about first aid process among university students in jordan .
this cross - sectional study was conducted among university students in the large public university in the north of jordan using simple random sampling and involved administering a questionnaire .
the study included 1500 students from the total 14 colleges at yarmouk university , jordan between september and december of 2014 .
inclusion criteria for participation involved : be an enrolled student at yarmouk university and be a jordanian citizen .
the newly drafted questionnaire was presented to a reviewer panel composed of three members for refinement and re - wording of questions to ensure that statements were understandable and meaningful to the participants , and to ensure that the questionnaire consistently measured what it was intended to measure .
reliability of the surveying instrument was determined by using the internal consistency method . after administering the questionnaire used in this study ,
cronbach 's alpha coefficients for all domains were produced and ranged from 0.77 to 0.91 indicating that the items within each domain are consistent in measuring the same attribute .
the final questionnaire was composed of four sections : demographic characteristics of students ( 7 items ) , general first aid knowledge ( 6 items ) , first aid knowledge in various emergency situations ( 17 items ) , and attitudes toward first aid education ( 2 items ) .
the total number of questionnaire items was 25 questions in addition to the 7 demographic characteristics . to ensure maximum representativeness ,
questionnaires were handed out to students during the general university requirement classes in which students from all faculties and specializations are registered after getting permission and obtained 15 min out to fill the questionnaire .
participants completed a multiple - choice questions and questions required short answers on their level of knowledge about first aid .
all data were analyzed using spss ( version 20 for windows ) ( spss statistics for windows , version 20.0 .
armonk , ny : ibm corp ) . frequency distribution and descriptive criteria were calculated .
the study was approved by the ethics committee at the faculty of medicine / yarmouk university , jordan and granted the number 30/2014 .
this cross - sectional study was conducted among university students in the large public university in the north of jordan using simple random sampling and involved administering a questionnaire .
the study included 1500 students from the total 14 colleges at yarmouk university , jordan between september and december of 2014 .
inclusion criteria for participation involved : be an enrolled student at yarmouk university and be a jordanian citizen .
the newly drafted questionnaire was presented to a reviewer panel composed of three members for refinement and re - wording of questions to ensure that statements were understandable and meaningful to the participants , and to ensure that the questionnaire consistently measured what it was intended to measure .
reliability of the surveying instrument was determined by using the internal consistency method . after administering the questionnaire used in this study ,
cronbach 's alpha coefficients for all domains were produced and ranged from 0.77 to 0.91 indicating that the items within each domain are consistent in measuring the same attribute .
the final questionnaire was composed of four sections : demographic characteristics of students ( 7 items ) , general first aid knowledge ( 6 items ) , first aid knowledge in various emergency situations ( 17 items ) , and attitudes toward first aid education ( 2 items ) .
the total number of questionnaire items was 25 questions in addition to the 7 demographic characteristics . to ensure maximum representativeness ,
questionnaires were handed out to students during the general university requirement classes in which students from all faculties and specializations are registered after getting permission and obtained 15 min out to fill the questionnaire .
participants completed a multiple - choice questions and questions required short answers on their level of knowledge about first aid .
all data were analyzed using spss ( version 20 for windows ) ( spss statistics for windows , version 20.0 .
armonk , ny : ibm corp ) . frequency distribution and descriptive criteria were calculated .
the study was approved by the ethics committee at the faculty of medicine / yarmouk university , jordan and granted the number 30/2014 .
a total of 1500 questionnaires were distributed to students of which 1116 ( 74.4% ) were returned . about 20% of the returned questionnaires were incomplete for which they had to be excluded , leaving a total of 883 questionnaires valid for statistical analysis .
of the 883 questionnaires included in the final analysis , 34.1% participants ( n = 301 ) were males and 65.9% ( n = 582 ) were females .
the average ( standard deviation ) age of members of the sample group was 19.9 ( 2.6 ) years .
most of the respondents were undergraduates ( 99.3% , n = 877 ) compared with only 0.7% ( n = 6 ) postgraduate students .
the majority of students were studying at literary colleges ( 59.3% ) , 31.4% of scientific colleges , 6.3% of physical education college , and the remaining 2.9% were studying in health sciences .
in the general knowledge domain , which asked about the correct civil defense call number , vital signs normal values or limits , and the normal blood sugar , students were more knowledgeable about normal body temperature and the civil defense call number .
the percentage of students who reported correct answers about vital signs and other general information are described in table 1 .
frequency and percentage of students who reported correct answers about vital signs and other general information as per gender about 80% of students gave correct responses of the normal body temperature , however , less than half of students knew the normal pulse rate ( 48.2% ) and normal blood sugar values ( 46.5% ) .
only a small percentage of students knew the respiration rate and normal blood pressure values .
the overall knowledge of first aid in different emergency situations has revealed that participants were more knowledgeable when asked about the position of patients in cardiopulmonary resuscitation ( cpr ) and care in case of bleeding ; however , they were least knowledgeable when asked about the correct position in coma situations and care of stabbing wounds .
participants correct responses about the care of victims in various emergency situations are shown and ranked in table 2 .
frequency and percentage of students who reported correct answers about the care of victims in various emergency situations as per gender only gender , faculty , and having previous first aid experience were significantly associated with first aid knowledge .
female students were more knowledgeable than male students in all aspects of first aid knowledge which revealed significant statistical associations .
table 3 describes the significant associations between the previous experience of students and correct responses of their level of first aid knowledge .
significant associations between previous experience of students and correct responses of their level of first aid knowledge having previous first aid experience was significantly associated with a better level of first aid knowledge among students when they were asked about vital signs ( body temperature , pulse , respiration , and blood pressure ) , correct position in case of coma , correct site of doing cardiac messages , how to check pulse in case of coma , burn care , and care in stabbing wounds . with respect to faculty background , several significant statistical associations have been revealed .
significant associations between faculty of students and percentages of correct responses of their level of first aid knowledge remarkably , health sciences students were more knowledgeable about first aid care in all emergency situations .
however , students from the scientific colleges were more knowledgeable than students from other colleges when asked about the correct emergency call civil defense number .
the last two questions in the questionnaire asked students whether the media in jordan offer enough information about the care or first aid for the situations mentioned in the questionnaire and whether students think that first aid course and training should be handled at secondary schools in jordan . about three - quarters of students thought that the media does not offer enough first aid information , and about 97% of students believed that first aid course and training should be handled at secondary schools .
no similar studies evaluating the level of first aid knowledge among university students in jordan exist so far .
results of the current study reveal the inability of the majority of the students surveyed to provide efficient first aid in emergency cases .
even with respect to simple questions ( e.g. , normal values of the pulse , respiration rate , the number of mouth - to - mouth ventilation or chest compressions in cpr ) , there are a large number of students , even among those trained in first aid , presenting serious lacks of basic first aid knowledge .
interestingly , students were less knowledgeable about the correct respiratory rate in an adult in 1 min .
only about 11% of the participants knew the correct respiratory rate . however , respiration is one of the most crucial vital signs of an individual .
similarly , al - khamees ( 2006 ) reported that university students in kuwait have poor levels of first aid knowledge .
this result is supported by the results of an indian study , which revealed that 11.5% of male students and 15.4% of female students had a good level of knowledge on first aid measures .
having previous first aid experience was strongly associated with better first aid knowledge of students .
furthermore , in greece , hatzakis et al . supports this result showing that trained industry workers on first aid were more knowledgeable than nontrained workers .
a similar trend was noted among university students in pakistan . moreover , a study conducted in austria demonstrated that the monstrous greater part of individuals had next to zero first aid preparing and that there was an immediate relationship between the level of emergency treatment preparing and the nature of first aid measures taken by the general population who attended accidents .
students from the health sciences and scientific colleges had better first aid knowledge compared to students of literary and sport colleges . in jordan , joining health sciences or scientific colleges requires students to get higher averages in the high school which indicates the better academic performance of those students .
this notion may explain the difference in knowledge between the health sciences and scientific colleges from one side and students from other colleges on the other side .
however , in fact , health sciences college is just starting at yarmouk university , and the last batch of students is still in the 1 year during which general university requirements are taught rather than core health sciences courses .
therefore , the low study year may explain this lack of knowledge among students of health sciences college . despite the relatively large sample size ( n = 883 ) ,
the researcher acknowledges the limitation of this study regarding reliable generalization of results to the whole population of university students in jordan as the total participants in this particular study were sampled from a single university .
despite the relatively large sample size ( n = 883 ) , the researcher acknowledges the limitation of this study regarding reliable generalization of results to the whole population of university students in jordan as the total participants in this particular study were sampled from a single university .
overall , first aid knowledge among students at yarmouk university was considered to be insufficient . to decrease the early mortality and morbidity of accidents and emergencies ,
first aid should be a standard component and separate course of educational programs introduced at secondary school and college levels as well as in the media .
furthermore , first aid course should be updated at regular intervals throughout different study levels .
the knowledge deficit of first aid measures among university students is evocative that only a minority of people have adequate emergency treatment preparing .
it is suggested that all adults should be able to administer first aid since everyone is expected to experience emergency situations at any time .

Answer:
background : this study has aimed to evaluate the level of knowledge about the first aid process among the university students in jordan.methods:the study population consisted of students of the 14 scientific and unscientific faculties at yarmouk university , jordan .
 data were obtained via questionnaires from 883 students.results:the majority of participants were females ( 65.9% ) with mean age ( standard deviation ) of 19.9 ( 2.6 ) years .
 only 29.2% of students had previous first aid experience .
 when asked , only 11% of students knew the normal respiration rate of an adult in 1 min .
 results revealed that female students , having previous first aid experience , and being a student of the health sciences and scientific colleges were the only factors had significant statistical associations with better level of first aid knowledge.conclusions:the students knowledge about first aid is not at an adequate level
 . it would be advisable that first aid course be handled as a separate and practical course at secondary school level .


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:
bariatric surgery is most often performed with the laparoscopic roux - en - y gastric bypass ( lrgb ) .
lrgb has favourable effects such as weight loss and correction of metabolic disturbances , but is also associated with serious complications .
it is a severe complication , which can lead to massive bowel necrosis that may result in short bowel syndrome ( sbs ) and sometimes death .
pregnant women , who have previously undergone lrbg , represent a diagnostic challenge when presenting with acute abdomen and internal hernia in this setting might be particularly risky . in this case , we present a 22-year - old woman , who had undergone lrgb and who suffered a massive internal hernia during pregnancy leading to short bowel syndrome .
in january 2012 , at 26 weeks of gestation , a 22-year - old woman was admitted to our surgical department due to sudden onset of upper abdominal pain .
the patient was otherwise healthy and had at the time she became pregnant lost 50  kg following a lrgb done two years and 11 months earlier .
following admission , an acute ultrasound showed gall bladder stones , and a mri scan showed no definite signs of internal hernia but could not demonstrate gallstones . due to severe pain
a trans - cystic balloon dilation of the papilla of vater was done as the cholangiogram demonstrated poor drainage caused by small gallstones in the common hepatic bile duct . on the 5th postoperative day
she was re - operated due to cholascos with renewed cystic duct ligation and drainage . on the following day , endoscopy was performed because of hematamesis , with the finding of blood in the jejunum , but no specific bleeding site was identified .
the clinical condition worsened and she was transferred to the intensive care unit ( icu ) with severe septicaemia and acute respiratory distress syndrome ( ards ) . on day 13 , a laparotomy was performed . an internal hernia through petersen 's space with necrosis of 1  m jejunum starting 10  cm below the pouch - enteric anastomosis
a vital premature girl of 1020  g was delivered by caesarean and the necrotic intestine was removed .
second and third look operations were performed the next days with further small bowel resections leaving her with a saliva fistula 10  cm below the pouch - enteric anastomosis , a jejunostomy 15  cm from the ligament of treitz and a blind closed ileum 35  cm from the ileo - coecal valve ( fig .
1 ) . after 3 months in the icu and surgical ward with several other complications , such as infectious complications , pneumothorax , thrombosis of the superior mesenteric vein as well as the iliac veins and a exposed bowel parquet covered with split skin ,
the patient had a good appetite and enjoyed the meals , but obviously she had no absorption of food due to the very short fistula below the pouch - enteric anastomosis . through a central venous line ( hickmann catheter ) she initially received 2200  kcal and later when she increased her daily activities this
was increased according to 2700  kcal given as smof kabiven ( fresenius ) added with vitamins and trace elements , and in addition 3  l of isotonic saline to maintain the fluid balance .
also in this phase complications occurred , and the hickmann catheter eventually had to be removed due to a yeast infection with candida albicans .
the nutrition was thereafter delivered through a peripherally inserted central venous catheter ( piccline ) . after four months of hospitalization
the patient was discharged with home parenteral nutrition . in november 2012 , ten month after the internal herniation , intestinal continuity was reconstructed , and a defect having a width of up to 12  cm in the anterior abdominal wall was closed with bilateral partial component separation technique ad modum ramirez .
the patient insisted on trying without parenteral nutrition , and 10 weeks later , she was doing well .
her weight had increased 2  kg since the operation , she had 12 bowel movements a day and blood values for haemoglobin and albumin had increased as well .
this patient suffered from massive small bowel internal hernia with extensive bowel resection leading to sbs dependent on parenteral nutrition during her pregnancy .
the patient was left with an intact duodenum , 15  cm of jejunum , 35  cm of ileum and her colon .
initially she was treated with 100% parenteral nutrition , but after reconstructive surgery with re - established intestinal continuity the amount of parenteral nutrition was rapidly reduced , and after six weeks she was weaned off parenteral nutrition .
several cases of internal hernias during pregnancies have been reported and three maternal deaths have been described .
describe severe internal hernias in pregnant women , involving the entire small intestine , parts of the colon and in renault et al .
she underwent extensive bowel resection leading to an acute intestinal failure associated with severe complications ( type 2 intestinal failure ) .
after treatment in a specialized intestinal failure unit , she underwent a long and complicated rehabilitation period and was discharged with a short bowel syndrome treated with home parenteral nutrition and fluids ( type 3 intestinal failure ) , and she survived . to our knowledge , no pregnant woman with lrgb has previously survived an internal herniation with such massive bowel necrosis as in this case , see table 1 .
the university of nebraska medical center describes in a series of papers that 5 out of 210 patient with postoperative sbs had previous gastric bypass operation , and thereafter they scrutinized 9 patients with sbs that had bariatric surgery performed . in a more recent paper , they reviewed 9 cases with massive bowel resection during pregnancy leading to small bowel syndrome .
it is believed to be caused by the growing uterus , which increases the intra - abdominal pressure , or postpartum as the uterus rapidly decreases in size .
the surveys of series of patients with previous bariatric surgery demonstrate that up to 16% of the patients develop internal herniation .
most bariatric surgeries have been performed in women of reproductive age , and as lrgb increases fertility , complications during pregnancy are to be expected . it is suggested that the changed anatomy during pregnancy disposes for herniation to occur . during pregnancy , the cause of abdominal pain can be difficult to diagnose , with potentially fatal consequences for both mother and foetus .
it is most important that relevant tools such as mri or ct scans are not postponed .
interpretation of mri and ct scan can be difficult especially in pregnant women , thus laparoscopy should be performed on a wide indication , when there is clinical suspicion of internal hernia and laparotomy performed if the anatomy is not clear . in the present paper
the literature provides other successful reconstructions after lrgb complicated with internal obstruction . a case report of a 44-year - old woman , who suffered from volvulus after lrgb , leaving her with an intact duodenum
the younger age of our patient leaves her with an even better chance to stay off parenteral nutrition .
since internal hernia is potentially life threatening for mother and foetus , both obstetricians and abdominal surgeons must be aware of this condition and surgery should be performed on a wide indication .
when bowel necrosis is found it should be resected and in case of extensive bowel resection the patient should start parenteral nutrition , and an evaluation should be made in centres specialized in intestinal failure .
all authors have contributed to acquisition of data , analysis and interpretation of data , writing , drafting the article and revising it critically for important intellectual content and approved of the final version .
written informed consent was obtained from the patient for publication of this case report and case series and accompanying images .
a copy of the written consent is available for review by the editor - in - chief of this journal on request .

Answer:
introductionbariatric surgery is most often performed with the laparoscopic roux - en - y gastric bypass .
 a complication to the laparoscopic roux - en - y gastric bypass is internal hernia , which occurs in up to 16% of the patients .
 since the laparoscopic roux - en - y gastric bypass is performed in women of fertile age , internal hernia may occur during pregnancy.presentation of casea 22-year old woman with a history of laparoscopic roux - en - y gastric bypass suffered from massive internal hernia during pregnancy with widespread bowel necrosis .
 extensive surgery was performed leaving the patient with an intact duodenum , 15  cm of jejunum , 35  cm of ileum and colon .
 parenteral nutrition was initiated and ten months after the internal hernia , intestinal continuity was re - established .
 ten weeks later the patient reached parenteral nutrition independence.discussioninternal hernia after laparoscopic roux - en - y gastric bypass can be difficult to diagnose , especially during pregnancy and might be severe and life threatening for both mother and child.conclusionobstetricians and abdominal surgeons must be aware of this condition .
 surgery should be performed on a wide indication . when bowel necrosis is found it should be resected and in case of extensive bowel resection the patient should be evaluated in centres specialized in intestinal failure .


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:
necrotising fasciitis ( nf ) is a serious soft tissue and life threatening infection , primarily involving the skin and superficial fascia , characterised by a rapid and extensive necrosis of the subcutaneous tissue .
most patients have associated comorbidities , such as diabetes , hiv infection or treatment with immunosuppressive drugs , but it can also affect previously healthy individuals .
infection is one of the common causes of morbidity and mortality in patients with systemic lupus erythematosus ( sle ) .
it is associated with immunosuppressive agents , renal failure , and increased disease activity . despite the increased propensity of sle patients to develop common and opportunistic infections , nf has rarely been reported . to our knowledge
, only 31 cases are described in the literature to date ( see table 1 ) .
nf has also been described in other rheumatic diseases including polymyositis , dermatomyositis , systemic sclerosis , rheumatoid arthritis and ankylosing spondylitis , but it appears that this association is more common in sle.1
 2 clinical features of nf in systemic lupus erythematosus a , asian ; aa , african  american ; aps , antiphospholipid syndrome ; art , arthritis ; avn , avascular necrosis ; aza , azathioprine ; cad , coronary artery disease ; cs , corticosteroid therapy ; cyc , cyclophosphamide ; d , died ; dm , diabetes mellitus ; f , female ; fg , fournier 's gangrene ; h , hispanic ; hcq , hydroxychloroquine ; lym , lymphocytes ; m , male ; mmf , mycophenolate ; mtx , methotrexate ; n , nephritis ; na , not available ; nf , necrotising fasciitis ; pe , pulmonary embolism ; rtx , rituximab ; s , survived ; sa , staphylococcus aureus ; ttp , thrombotic thrombocytopenic purpura ; wbc , white blood cells .
we describe the case of a nf caused by pseudomonas aeruginosa , complicated by recurrent sepsis and multiorgan failure in a young patient with a history of sle .
a 26-year - old asian woman with a complex history of sle , diagnosed at age 14 years when she presented with malar rash , arthralgia , mouth ulcers , pulmonary vasculitis , strongly positive anti - nuclear antibody and anti - dsdna antibodies .
subsequently , she had idiopathic detrusor overactivity with repeated urinary tract infection . linked to her corticosteroid treatment she developed avascular necrosis of her elbow ( at that time , on prednisolone 6  mg daily ) .
the patient was also treated with hydroxychloroquine ( hcq ) , azathioprine ( aza ) ( 100  mg from 1999 to 2009 ) and had 14 courses of cyclophosphamide ( cyc ) ( a cumulative dose of 14  g ) and two of rituximab ( rtx ) ( two 1  g intravenous infusions separated by 2  weeks ) , the last being given in march 2012 for a sle flare manifested by severe vasculitic rash . immediately prior to b - cell depletion , her c3 level was 0.33  g / l ( normal : 0.651.65 ) , cluster designation ( cd ) 19 count was 0.146/l ( 0.110.69 ) , and immunoglobulin g level was 23.4  g / l ( 716 ) . in may 2012
, she presented to her local hospital with painful swelling of her left lower limb , she denied a history of trauma , and her inflammatory markers and ultrasonography were normal , and she was discharged . within 12  h
she was found at home with a glasgow coma scale of 6 , and was admitted to the intensive care unit ( icu ) . on examination ,
the patient was in septic shock with hypotension ( systolic blood pressure 60  mm  hg ) , tachycardia ( 135/min ) , and respiratory failure ( sao2 70% ) .
laboratory results showed erythrocyte sedimentation rate 96  mm / h ( normal : 17 ) , c - reactive protein 281  mg / dl ( 05 ) , white blood cells 15  400/l ( 300010  000 ) ( 97% neutrophils ; 1.9% lymphocytes ) , haemoglobin 9.6  g / dl ( 11.515.5 ) , platelet 50  000/l ( 150  000400  000 ) , na 138  mmol / l ( 135145 ) , creatine kinase 474  iu / l ( 26140 ) , urea 16.8  mmol / l ( 1.78.3 ) , alamine transaminase 384  iu / l ( 1035 ) , total bilirubin 11  mg / dl ( 0.31.9 ) , albumin 17  g / l ( 3450 ) , creatinine 290  mol / l ( 4992 ) and proteinuria 2.30  g / l ( 00,10 ) .
her c3 level was 1.0  g / l ( 0.651.65 ) , cd19 count was 0.001/l ( 0.110.69 ) , and immunoglobulin g level was 9.32  g /
cultures of muscle tissue only grew p aeruginosa , resistant to piperazillin - tazobactam ; therefore , she was treated with meropenem , teicoplanin and clindamycin . as her clinical condition
however , 1  week later , she deteriorated , with thick yellowish sputum , fever , respiratory distress and the chest x - ray showed right consolidation .
ciprofloxacin and teicoplanin were empirically started , and the patient 's clinical condition gradually improved . a week
after this treatment had finished , the patient became worse with a new left lower lobe consolidation , so the antibiotic therapy was changed to ceftazidime .
her lupus flared with a marked malar rash over both cheeks , so her steroids ( prednisolone ) were increased to 20  mg per day and hcq was restarted .
she was in the icu from may to august 2012 , but made a remarkable recovery and was discharged home with a steroid - tapering regimen and hcq .
later , she developed two more sle flares , which were treated again with cyc and rtx , achieving good response . at 18 months
follow - up , there is no evidence of new recurrent or severe ongoing infections .
most patients with nf ranged from 38years to 44  years , with a male to female ratio of 23  :  1 , and apparently an increased incidence in african and asian countries.3 the true incidence is not known ( it is estimated to be approximately 0.4 cases per 100  000 ) , with a reported mortality from 20% to as high as 80%.35 the causative agents of nf vary and include two main categories , polymicrobial ( type 1 ) and infection of group a streptococcal ( type 2 ) .
patients with sle have an increased risk of infections , due to immunological dysfunction and the use of steroids and immunosuppressive agents.6 other factors , such as the presence of a variant form of the fc receptor are also believed to contribute to the risk of pneumococcal infection.7 nf due to pseudomonas has very rarely been reported.8
 9 the clinical presentation of patients with nf may be deceptively benign at onset , and it may not be possible to distinguish it clearly from minor soft tissue infections .
our patient was discharged from the original hospital before being admitted subsequently severely ill to university college hospital .
the lesion was rapidly progressive , probably due to her sle , and the prolonged steroid treatment and recent administration of cyc and rtx might have increased the risk of infection . during the initial period ,
exploration of the wound may be necessary even before the diagnosis is clear , particularly in a patient who is clearly toxic .
in addition to the present case , the other 31 cases of nf in sle patients that have been reported are summarised in table 1 .
the ages ranged from 12 years to 66  years , and 27 ( 84% ) were female .
most of the patients reported were asian ( 33% , 7 patients ) , 33% ( 7 patients ) hispanic and 19% ( 4 patients ) african  american .
the sites of infection included the upper or lower limb ( 60% , 17 patients ) , the face , neck or tongue ( 18% , 5 patients ) , the genital area ( 11% , 3 patients ) and the abdomen ( 11% , 3 patients ) .
nf type 1 was identified in 22 patients ( 71% ) and type 2 in 7 patients ( 23% ) , and when reported , the most common isolation was streptococcus ( 50% , 16 patients ) .
most of the patients presented with intense pain , poorly demarcated erythematous , swollen lesions over the limbs and systemic inflammatory response ; 28 patients ( 88% ) were receiving corticosteroids and 7 hcq ( 22% ) . additionally , use of other immunosuppressive drugs has been reported ( 5 cyc , 5 aza , 2 rtx , 1 mycophenolate , 1 methotrexate , 1 plasmapheresis ) before or at the time of infection .
other associated conditions have been identified , including nephritis ( 54% ; 15 patients of 28 reported ) , either during the current presentation or in the past , 13 ( 42% ) had active disease ( presumably those taking > 20  mg prednisolone or equivalent per day ) , 76% ( 13 of 17 reported ) had lymphopenia , 100% ( 12 out of 12 reported ) low serum albumin levels and 12 ( 37% ) had anaemia . interestingly , before the admission , 9 ( 28% ) reported a previous episode of infection : urinary , bartholin abcess , diarrhoea , respiratory tract infection , carious tooth , colitis , hepatitis c , cutaneous ulcers ( 2 ) , breast abscess and diverticulitis .
most patients responded to therapy , but 8 of the 32 patients died ( 25% ) , probably due to the infection or because of complications ( such as sepsis or pulmonary embolism ) .
the case presented here and the literature reviewed suggests that active disease , nephropathy , lymphopenia , anaemia , low serum albumin levels , immunosuppressive therapy and significant infections in the past , may constitute risk factors for the development of nf in patients with sle .
a high index of suspicion for the diagnosis is required , and surgical exploration should not be delayed , especially during the early stages , to improve the prognosis of this devastating complication .

Answer:
necrotising fasciitis ( nf ) is a rare infection of the subcutaneous tissue , known to be rapidly progressive and potentially fatal .
 patients with systemic lupus erythematosus ( sle ) may be predisposed to this condition , and early clinical recognition can be difficult .
 we report a case of necrotising fasciitis in a 26-year - old woman with sle .
 she presented with painful swelling of her left leg , then developed clinical features of septic shock .
 emergency debridement was performed .
 intraoperative findings revealed nf and cultures grew pseudomonas aeruginosa .
 the patient survived after a lengthy hospital admission , following several further debridements complicated by recurrent chest sepsis and multiorgan failure .
 we also review and discuss the published cases of nf in sle patients .


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

Paper text:
a level of pain that completely incapacitates one individual may cause only a minor annoyance in another .
characterizing the genetic factors affecting susceptibility to chronic pain could lead to novel treatment or prevention strategies , which are desperately needed . a recent paper by costigan et al .
the authors performed a multi - dimensional analysis using rat gene expression and human genetic association that identified a new genetic factor affecting susceptibility to chronic pain .
this study   was initiated by analysis of gene expression changes within rat dorsal root ganglia obtained after nerve damage was induced in three different models of chronic pain .
the mrna for a potassium channel alpha subunit ( kcns1 ) was constitutively expressed in sensory neurons , but was downregulated after three types of nerve injury in these models .
other studies have successfully identified a human genetic susceptibility factor on the basis of a candidate gene emerging from analysis of a rodent model .
costigan and colleagues   therefore examined snp alleles within the human homolog ( kcns1 ) in five independent cohorts ( two with chronic low back pain , two after limb amputation and one after mastectomy ) that have a high incidence of chronic pain . in four of
the five cohorts studied , there was a significant association of the val allele at a nonsynonymous snp ( rs734784 , val / ile ) with increased risk for chronic pain .
for example , homozygous val / val individuals had a 2.4-fold increased relative risk of failing to achieve pain improvement 1 year after back surgery .
the proportion of individuals without phantom limb pain after leg amputation was 45% in those without the val allele , but fell to 22% in val / val homozygotes . among healthy volunteers that were subjected to multiple experimental pain stimuli ,
although experimental studies demonstrating an allelic effect were not presented , which is a substantial limitation of this study , these results   make it likely that kcns1 alleles contribute to susceptibility to chronic pain .
although kcns1 by itself does not have potassium channel function when tested in heterologous expression systems , its expression has been shown to modulate the currents formed by other channels [ 3 - 5 ] .
voltage - gated potassium channels have important effects on neuronal function , including altering the resting membrane potential and the shape and frequency of the action potential
. similarly , gain - of - function mutations in the nav1.7 sodium channel cause syndromes associated with increased pain sensitivity .
chronic pain has a huge impact on our society , and its treatment is a major driver for the increasing cost of health care . an estimated 76 million people in the us have chronic pain , which costs the us public over $ 100 billion per year .
approximately 25% of chronic pain is neuropathic ( caused by nerve damage ) , which is characterized by spontaneous pain that is burning or stabbing in nature .
this can develop after limb amputation , mastectomy or lower back injury , or in individuals with a long history of diabetes .
although multiple kinds of treatment can be used , they often have limited efficacy , and chronic pain is often managed by administration of opioids ( morphine and related synthetic compounds , including hydrocodone ) .
the increased focus on pain management resulted in a six - fold increase in the per capita sales of prescription opioid medications in the us between 1997 and 2006 .
hydrocodone - acetaminophen is prescribed over 100 million times per year in the us , which is far more than any other medication , including lipid - lowering and blood - pressure - lowering agents .
this has led to a dramatic increase in the incidence of opioid misuse , emergency room visits due to opioid analgesic poisoning , and fatal opioid overdose .
prescription opioids have now surpassed marijuana as the drug that is most commonly abused among the newly initiated .
because of the enormity of this public health problem , we desperately need new approaches for the prevention or treatment of chronic pain conditions .
it is likely that genetic discoveries can lead to new approaches for chronic pain , because genetic discoveries have catalyzed new approaches for related clinical conditions .
for example , haplotype - based computational genetic analysis has identified causative genetic factors affecting analgesic medication   and inflammatory pain responses , and it has identified four genes affecting narcotic drug responses [ 11,14 - 16 ] in mice .
the latter genetic discovery generated a new treatment strategy for preventing narcotic drug withdrawal symptoms , which was shown to be effective in humans .
moreover , the variable response to multiple classes of analgesic medications among inbred mouse strains was shown to be due to genetic variation within a genetic locus ( kcnj9 ) that also encodes a potassium channel ( girk3 ) .
hopefully , characterizing the functional role of kcns1 in neuronal responses and pain perception , and the impact of the allelic differences , could lead to new approaches for treatment of chronic pain .
although the tractability of kcns1 ( or other potassium channels ) as a therapeutic target remains to be determined , small molecules targeting potassium channels have been produced ( reviewed in ) , and one has attenuated neuropathic pain in animal models . although the kcns1 val allele explains only a small percentage of the total variance ( 4.6 to 7.8% ) in the chronic pain endpoints in the cohorts studied , the identification of an initial genetic factor for chronic pain is an important achievement for two reasons .
first , it shows that genetic factors can be identified for this condition , and this study provides a template for subsequent studies .
second , it is likely that a greater percentage of the genetic susceptibility to chronic pain can be explained by combining this genetic factor with other subsequently identified factors .
moreover , pain is a subjective sensory symptom ; it is difficult to measure ; and there are substantial psychological and emotional components that contribute to the perception of pain .
it has recently been found that there are different subtypes of chronic pain , which are distinct from the causative disease ( diabetic neuropathy , radicular back pain and so on ) .
it is likely that genetic factors determine whether a chronic pain syndrome will develop and the specific subtype that emerges after exposure to a triggering cause .
thus , the impact of a single genetic factor could be much larger if a specific pain subtype is examined relative to that measured in a large cohort of individuals with different types of chronic pain .
beyond finding new drug targets , identification of genetic factors affecting susceptibility to chronic pain syndromes could be the lever that drives advances in this difficult clinical area .
a genetic risk factor could have a substantial impact on clinical practice because individuals at increased risk for developing a chronic pain syndrome could be identified before a surgical procedure or immediately after a traumatic incident . the genetic information could be used to develop proactive methods for prevention of chronic pain syndromes , enabling interventions to be targeted to the high - risk subset . because of the great inter - individual variation in the response to painful stimuli and to analgesic drugs , knowledge of genetic risk factors could enable better stratification of chronic pain patients or aid in the selection of the appropriate therapy . rather than focusing on the disease that is etiologically associated with the chronic pain ,
study   is hopefully one of the first of many subsequent genetic studies that could lead to entirely new ways to approach chronic pain syndromes .
clearly , the clinical and research communities have a long way to go before genetically targeted therapies for chronic pain become a reality .
however , kcns1 ( or other channels ) could perhaps become the next target for a new class of analgesics that are selectively used in the 20% of the population that are homozygous for the val alleles of kcns1 .
the day might soon come when we no longer think of ' chronic pain ' as a single clinical entity , but have the tools to characterize the specific ' channelopathy ' that underlies the clinical presentation and targeted treatments for each subgroup .
gp is a professor and mz is the director of statistical research in the department of anesthesia at stanford university medical school .

Answer:
a recent publication that combined rat gene expression data and a human genetic association study has identified the first genetic risk factor for chronic pain in humans . in four of
 the five cohorts studied , there was a significant association of an allele within a gene ( kcns1 ) encoding a potassium channel ( kv9.1 ) with an increased risk for chronic pain .
 identification of genetic risk factors for chronic pain could catalyze new advances in this difficult clinical area that has become a major public health problem .
 genomic - medicine - based advances for chronic pain could include the development of a mechanism - based classification system for chronic pain , new treatment options , improved methods for treatment selection and targeted prevention strategies for high - risk individuals .


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 20092010 , serum samples from patients with suspected dengue were received by the fdoh for dengue diagnostic testing ; the samples came from 16 of florida s 67counties .
specific , real - time rt - pcr ( 8) and igm anti - denv elisa ( 9 ) . samples with highly positive rt - pcr results were spread onto cultured ae .
albopictus c6/36 cells , and the presence of virus and genome were confirmed by immunofluorescence ( 10 ) and rt - pcr , respectively ( 11 ) .
isolates were further propagated and viral rna was extracted from culture supernatants by using the universal biorobot system ( qiagen , valencia , ca , usa ) .
the envelope glycoprotein ( e ) gene was amplified ( technical appendix ) , and the e gene open - reading frame ( 1,485 bp ) was sequenced .
multiple sequence alignments were performed by using the muscle module available in mega 5 ( www.megasoftware.net ) .
evolutionary history was inferred by using maximum likelihood and phylogenetic trees constructed by using neighbor - joining methods .
evolutionary distances were computed , and several e gene sequences from genbank were included in the phylogenetic tree to support tree topology by genotype ( technical appendix ) . in 2009 , five denv-1positive cases were identified by rt - pcr in key west .
subsequently , in 2010 , the fdoh tested 195 serum samples by real - time rt - pcr .
fifty - six ( 29% ) samples were positive for denv rna : denv-1 ( 37 [ 66% ] samples ) , denv-2 ( 13 [ 23% ] samples ) , denv-3 ( 3 [ 5% ] samples ) , and denv-4 ( 3 [ 5% ] samples ) .
monroe county submitted 73 serum samples , of which 31 ( 42% ) had results positive for recent dengue infection : denv-1 was detected in 22 by rt - pcr , and 9 had positive igm anti - denv elisa results .
none of the denv-1 patients from monroe county had a history of recent travel to a dengue - endemic region before the onset of symptoms .
fifteen other florida counties submitted serum samples : 13 counties submitted < 10 specimens , 1 submitted 2030 specimens , and 1 submitted > 60specimens .
denv-1 was found in 15 serum samples from 6 of these counties ; however , all the patients had a history of recent international travel .
we sequenced the e gene of 12 denv-1 strains isolated in florida during 20092010 to determine their genetic relatedness ; of the 12 strains , 8 were from key west and 1 each was from dade , broward , orange , and pinellas  counties .
in addition , 23 denv-1 e sequences published in genbank , including the 2010 key west isolates obtained from a blood donor and a mosquito pool ( 6,7 ) , were used to construct a maximum - likelihood phylogenetic tree .
this phylogenetic analysis showed that all the florida denv-1 isolates belong to the american  african genotype ( genotype v ) ( 12,13 ) together with other viruses isolated throughout the americas ( figure 1 ) .
maximum - likelihood phylogenetic tree of dengue virus type 1 , including isolates from key west , florida , usa , and representative isolates from 5 genotypes with global geographic distribution .
solid circles , 8 key west viruses ( monroe county ) isolated during 20092010 ; solid diamonds , isolates from other florida counties ( dade , pinellas , orange , and broward counties ) .
each taxon represents a single virus isolate and is labeled with the geographic origin and collection year .
thirty - six envelope glycoprotein gene sequences obtained from genbank were included to support tree topology and identify genotypes . all genotypes except the american  african genotype ( v ) have been collapsed .
key west denv-1 viruses grouped among central american viruses , which configure a distinct lineage separate from the caribbean viruses .
this divergence between the central american and caribbean lineages is well supported by high bootstrap values .
moreover , the key west and monroe county viruses grouped together and indicated a distinct sublineage supported by a high bootstrap value ( 99% ) , separating them from viruses isolated in dade , orange , pinellas , and broward counties that were more closely related to other central american viruses ( figure 1 ) .
one 2009 isolate ( iq425062 ) from a key west patient is related to this group , suggesting a separate introduction of denv-1 in key west .
the sequence similarity between the 2009 and 2010 key west strains was < 0.9% ; however , the evolutionary distance and taxa positions between the 2009 and 2010 strains presented in the phylogenetic tree suggests that the 2010 strains diverged from the 2009 strains .
the observed differences between e gene sequences for the key west strains ( 20092010 ) and the rest of the strains in this phylogeny were < 2.1% with the other florida strains , < 1.2% with central american strains , and < 4.8% with the rest of the american  african genotype .
evolutionary distances and the topology of the central american lineage suggest this lineage is the genetic origin of the florida denv-1 strain .
most viruses isolated in monroe county diverged from the central american lineage into a distinct sublineage  the key west denv-1 strain associated with the 20092010 outbreak .
the high level of genetic similarity among the viruses isolated in monroe county , their close evolutionary distances , and the lack of recent international travel for the case - patients suggest endemic transmission and microevolution of this denv .
conversely , the scattered and separate phylogenetic positioning of virus strains from patients with travel - associated cases from other florida counties indicates a different origin from the majority of key west isolates .
although the 2009 broward isolate ( jq425067 ) is positioned near the central american lineage , the low bootstrap value ( 53% ) does not support lineage ancestry .
the epidemiologic and phylogenetic evidence suggests that the 2010 cases appeared to be a continuation of the 2009 outbreak . unlike cases along the texas  mexico border ( 14 ) ,
in addition , denv-1 was detected in a blood donation from the monroe county in 2010 , further supporting local transmission of denv ( 7 ) .
collectively , these findings indicate that endemic denv-1 was transmitted in key west over a period of > 2 years .
table showing the dengue virus type 1 ( denv-1 ) envelope gene reverse transcription pcr and another showing denv-1 strains used in a study of the genetic relatedness of dengue viruses in key west , florida , usa , 20092010 .

Answer:
sequencing of dengue virus type 1 ( denv-1 ) strains isolated in key west / monroe county , florida , indicate endemic transmission for > 2 years of a distinct and predominant sublineage of the american  african genotype .
 denv-1 strains isolated elsewhere in florida grouped within a separate central american lineage .
 findings indicate endemic transmission of denv into the continental united states .


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:
rickettsia are obligatory , intracellular , small gram - negative bacteria associated with eukaryotic hosts .
they are traditionally divided into three groups : the spotted fever group , the typhus group and the scrub typhus group .
the spotted fever results from a large group of tick- , mite- and flea - borne zoonotic infections that are caused by closely related rickettsiae .
rickettsia conorii has been identified as the agent causing mediterranean spotted fever ( msf ) .
a variety of geographically distinct types of r. conorii have been described that cause variable clinical presentations different from typical msf .
a 27-year - old primigravida with a 16week history of amenorrhea and respiratory failure was transfered to a tertiary care center .
she had high - grade fever for 8 days prior to the transfer and had developed an erythymatous maculopapular rash on day 4 of the illness , involving the trunk initially , later extending to the palms and soles [ figure 1 ] .
erythematous maculopapular rash in a hand a persistant dry cough , not associated with hemoptysis , was noticed on day 5 .
she developed a progressively worsening dyspnea with bilateral ankle edema not associated with oliguria or orthopnea .
her condition deteriorated rapidly , warranting intubation for respiratory failure and transfer to a tertiary care center . on admission to the tertiary care center icu ,
the patient also had tachycardia ( 128 beats / min ) without any significant st segment changes on the ecg .
the blood urea measured 8.7 mmol / dl with a serum sodium of 140 meq / l and a pottasium of 5.0 meq / l .
full blood count showed neutrophilia of 78% in a total of 14.4  10 l. hemoglobin was 7.4 g / dl with a mild thrombocytopenia of 160,000 l .
the blood picture revealed normochromic normocytic anemia with no evidence of disseminated intravascular coagulation ( dic ) . the international normalized ratio ( inr ) was 0.96 .
the serum glutamate oxaloacetate transaminase ( sgot ) activity was 42 u / l and serum glutamate pyruvate transaminase ( sgpt ) activity was 28
the c - reactive protein ( crp ) level was 6 mg / dl and the antinuclear antibody ( ana ) was negative .
chest x - ray on day 1 at icu , showing diffuse bilateral opacities the patient was started on oral azithromycin , iv cefotaxime , iv hydrocortisone 50 mg 6 hourly .
the patient 's condition deteriorated rapidly on day 3 of icu stay and needed adrenaline , noradrenaline , dobutamine and vasopressin to maintain a blood pressure of 70/50 mmhg .
the urine output dropped and the urine microscopic examination revealed granular casts and dysmorphic red blood cells .
blood urea rose to 12.9 mmol / dl and the electrolytes showed pottasium level of 5.6 meq / l .
on the 4 day at the icu and 12 day of the disease , she devoloped anuria with further increase in blood urea and serum creatinine .
she was hemodynamically unstable with a blood pressure of 60 mmhg even with total inotrope support .
endocardium of the heart showed vegitations on a narrowed mitral valve [ figure 4 ] .
the kidneys were of normal size , but the cortico - medullary demarcations were less clear .
the grossly hemorrhagic lung the heart showing narrowing and vegetations at the mitral valve the histology of the lung showed gross hemorrhage and foci of pneumonia .
the vegetations of the heart were reported as fibrinous with entrapped white cells , but with no bacteria or fungi .
histology of the liver revealed centrilobular necrosis with a tendency to confluence , and a mild fatty change .
a final diagnosis of disseminated r. conorii infection with pulmonary hemorrhage , endocarditis and tubulointerstitial nephritis was made .
r. conorii is an obligate , intracellular , slow - growing , gram - negative bacterium belonging to the spotted fever group of rickettsiae .
unusual rickettsial strains related to r. conorii have been described as belonging to an  r. conorii complex  which includes the indian tick typhus rickettsia ( atcc vr-597 ) with r. conorii subsp .
it is transmitted to humans through the bite of dog ticks ( rhipicephalus sanguineus ) widely prevalent among the  old world  .
it is also known to be transmitted by haemaphysalis ticks , especially in pakistan and kenya .
the infection is transmitted via larvae and nymphs , and the tick bite is usually not felt .
the incubation period ranges from 3 to 15 days depending upon the route of rickettsial entry and the rickettsial load .
after introduction into the skin at the site of the tick bite or through the conjunctiva contaminated by blood or excretions from an infective tick , the primary multiplication occurs . in the skin , the localized multiplication of the rickettsiae in the endothelial cells of the capillaries leads to the formation of a raised red papule .
the inflammation and thrombosis of the affected capillaries lead to necrosis of the center of the papule and the formation of the typical red lesion with a black center , the  tache noire  .
this is followed by the spread of infection through lympho - hematogenous routes throughout the body , causing disseminated vascular lesions in multiple organs .
about 6% of the cases are severe , and fatal cases occur even in young , healthy adults , with a reported death rate of about 2.5% .
old age , alcoholism and glucose-6-phosphate dehydrogenase ( g6pd ) deficiency are known risk factors for severe disease .
the patient described here is from kotagla , a tea estate village in central sri lanka .
the patient reported a history of significant exposure to stray dogs , abundant in any sri lankan village , but not of any tick bites .
the absence of the tachy noire is significant in this case as the clinical diagnosis of msf ( caused by r. conorii subsp .
however , the absence of tache noire has been noted in israeli spotted fever caused by r. conorii subsp .
the fever starts after an incubation period of 7 days followed by a febrile period ( up to 40c , usually continuous ) associated with a maculopapular rash .
the papules of the rash are first noticed on the 3 to 5 day of illness , and they come out in crops and are palpable as small nodules in the skin . in severe cases ,
characteristically , the rash involves the palms of the hands , the soles of the feet and , to a lesser extent , the face . in this patient ,
the rash involved the palms and soles , sparing the face , and was of dusky cyanotic appearence with prominant macules .
the cough and the dyspnea reported in our patient were relatively rare in a case series of msf , with a representation of 10% and 21% , respectively .
renal insufficiency is a known complication in around 6% of the patients and is caused by tubulointerstitial nephritis .
myocarditis had been obseved in 11% of patients and might explain the severe tachycardia with poor response to inotropes in this patient .
the diagnosis of r. conorii infection in this patient is justfied as there is a compatible clinical picture along with a single titer of > 1/512 .
endocarditis is not described as a complication of r. conorii infection . identifying r. conorii as the causative organism of endocarditis in this patient
is supported by the absence of previous heart disease and lack of clinical features to suggest subacute bacterial endocarditis on admission and during prenatal clinics .
the vegetations isolated from this patient as well as the blood cultures did not reveal bacteria or fungi .
this patient was correctly started on oral azithromicin and intravenous chlorampenicol at the tertiary hospital .
a diagnostic scoring system with microbiological , epidemiologic , and clinical parameters has been proposed for msf and it had shown good sensitivity and specificity .
this case highlights the need of clinical suspicion of uncommon diseases based on the geographic and socioeconomic background of a patient .
relatively benign diseases may have severe manifestations resulting in fatality ; therefore , physicians should consider there factors for early diagnosis and intervention .

Answer:
rickettsial diseases are common in srilanka .
 the spotted fever group of rickettsiae presents in many ways , including very severe disease causing significant morbidity and mortality . a regional variation of the rickettsia conorii subspecies and differences in clinical presentations
 are reported .
 this case describes disseminated rickettsia conorii infection in a pregnant woman presenting with endocarditis .


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:
sarcomas are mesenchymal neoplasms with various lines of differentiation , i.e. , fibrocytic , myogenic , neurogenic , vascular , chondro - osseus , or undefined .
it is a spindle - cell tumor composed of collagen - rich and myxoid parts .
lgfs prefers subfascial soft tissue layers on the trunk and proximal extremities in younger adults but can also develop in internal organs .
pediatric cases have also been reported.[13 ] herein , we present a 48-year - old female patient who developed a lgfs on the lower leg .
the clinical presentation , histopathology , surgical treatment , and follow - up are discussed .
a 48-year - old woman was referred to our department because she had developed a slow - growing plaque below the left knee for 2 years .
on examination we found an otherwise healthy , slim , woman with a symptomless firm subcutaneous plaque of about 2 cm size on the anterior aspect of the left lower leg figure 1.there was some bluish discoloration and circumscribed ulceration but no erythema or warmth .
( a ) overview and ( b ) the ulcerated honeycomb - like plaque routine laboratory tests were unremarkable .
thoracic dual - energy x - ray and abdominal and lymph node ultrasound excluded a metastatic spread .
histology revealed a spindle - cell tumor , with mild atypia and fibroblast - like morphology [ figure 2 ] .
cells were arranged in a whorled or plexifiorm pattern , with alternating collagenous stroma and myxoid zones .
the tumor was surgically removed with a wide safety margin ( > 3 cm ) .
the defect was covered by a mesh graft transplant covered by vacuum - assisted closure ( vac ; kci international ) [ figure 3 ] .
compression stockings were prescribed to protect the transplant and prevent leg edema . a regular follow - up for at least 5 years
( a ) overview ( h&e , 4 ) and ( b ) detail ( h&e , 40 ) surgical procedure . ( a ) wide excision of suprafascial soft tissue ;
( b ) mesh graft transplantation ; and ( c ) placement of microporous white sponge for vacuum - assisted closure above the transplant
lgfs is a very rare and distinctive type of fibrosarcoma that was first described by evans in 1987 .
there is a discrepancy between the bland histologic features with sparse mitotic figures and absent or mild nuclear and cellular pleomorphism and the anaplasia . the hyalinizing spindle - cell tumor with giant rosettes
is considered a subtype of lgfs.[13 ] the tumor is further characterized by t(7;16)(q34;p11 ) translocation and fusion of fus and creb3l1 genes .
tumor cell phenotype is positive for vimentin , ema , cd99 , and bcl-2 , but negative for cd34 , sma , s-100 , desmin , keratins , neuron - specific enolase , and cd177 .
the differential diagnosis includes other types of sarcomas , myxoma , neurofibroma , peripheral sheath tumor , histocytoma , desmoid tumor , and others .
the diagnosis often is delayed - mainly because the patients do not seek treatment early .
( 2000 ) reported that in 15% of patients a histologic diagnosis was delayed by > 5 years . in our case
although the histopathologic features suggest a low - grade malignancy , local recurrence is seen in more than 50% of patients and metastasis occurs in 6% of patients .
tumor cell dormancy is responsible for very late metastasis in some patients , with 45 years being the longest period observed between primary surgery and metastasis .
complete surgery with wide margins ( > 3 cm ) is the most important procedure .
we used a combination of mesh graft transplantation and vacuum - assisted closure to cover the large defect .
it has been demonstrated recently that such a combination , with microporous sponge for vacuum - assisted closure , results in a significantly improved take rate .

Answer:
a 48-year - old female with an atypical plaque - like lesion of the lower leg is presented in this article .
 histologic investigation revealed a rare low - grade fibromyxoid sarcoma ( pt1a cn0 cm0 ; stage ia ) of suprafascial localization .
 staging of the patient did not reveal metastatic spread .
 the tumor was surgically removed with wide safety margins .
 the defect was closed using a mesh graft transplant and vacuum - assisted closure .
 healing was complete .
 regular follow - up for at least 5 years is recommended . besides the rareness of this tumor
 , this case is also remarkable because of the localization on the lower leg and the suprafascial soft tissue .