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:
obesity is a complex heterogeneous disease that is caused by genes , environmental factors , and the interaction between the two .
obesity is also a multifactorial condition , and many endocrine and inflammatory pathways are involved in its development and in obesity - related diseases .
excess weight in obesity may come from muscles , bone , fat , and/or body water , but obesity specifically refers to having an abnormally high proportion of total body fat .
the world health organization defines  overweight  as a body mass index ( bmi ) of 25 or more and  obesity  as a bmi of 30 or more .
the prevalence of obesity has been stated as being near epidemic size [ 13 , 57 ] , and obesity has been associated with type ii diabetes , hypertension , coronary artery disease , stroke , and many forms of cancer [ 8 , 9 ] .
therefore , it is important that the underlying pathophysiology of obesity - related diseases is understood .
obesity results from the combined effects of genes , lifestyle , and the interactions of these factors , and both familial and nonfamilial factors play an important role in its development . a genetic predisposition to obesity
has been reported as a major risk factor for individuals .   with the increasing prevalence of obesity , studies on candidate genes for obesity
most obesity - predisposing genes encode the molecular components of physiological systems related to energy balance .
leptin is a protein product of the ob gene and is expressed and secreted by adipose tissue in amounts proportional to the body weight content ; studies on its receptor have greatly advanced the comprehension of the mechanism for regulating body weight and energy homeostasis .
the lipostat system , mediated by leptin and its hypothalamic receptor , reduces food intake and increases thermogenesis [ 10 , 12 ] . the leptin ( lep ) and leptin receptor ( lepr ) genes have been evaluated for polymorphisms that could potentially be related to the pathophysiology of obesity and its complications . although the polymorphisms in these genes have been evaluated [ 1315 ] , the association of these polymorphisms with obesity is still controversial
. therefore , we investigated whether the lep gene g2548a polymorphism and lepr gene 668a / g ( q223r ) polymorphism might be involved in the pathogenesis of obesity .
this study included 127 obesity patients ( 93 women , 34 men ) and 105 controls ( 62 women , 43 men ) provided from the department of internal medicine , gazi osmanpaa university in tokat , turkey .
informed consent was in accordance with the study protocol , and all patients and controls signed a written consent form .
all patients received a complete clinical evaluation , and all individuals in the control group were healthy and were selected by excluding the diagnosis of obesity .
genomic dna was isolated from white blood cells by a kit procedure ( invitrogen life technologies , carlsbad , ca , usa ) and stored at 20c .
lep g2548a and lepr 668a / g polymorphisms were analyzed by polymerase chain reaction based restriction fragment length polymorphism ( pcr - based rflp ) methods . the pcr protocol consisted of an initial melting step of 2
min at 94c , followed by 35 cycles of 30  s at 94c , 30  s at 55c ( for lep ) , 30  s at 60c ( for lepr ) , and 30  s at 72c , and a final elongation step of 5  min at 72c .
amplification was carried out using primers forward 5-ttt cct gta att ttc ccg tga g-3 and reverse 5-aaa gca aag aca ggc ata aaa a-3 for the lep gene and forward 5-tcc tct tta aag cct atc cag tat tt-3 and reverse 5-agc tag caa ata ttt ttg taa gca at-3 for the lepr gene .
pcr was performed with a 25  l reaction mixture containing 2550  ng/l dna , 1  l of 10  pmol/l of each primer , 1  l of dntp mixture ( 5  mm dntp , 1  l 2.5  mm mgcl2 , 1  u taq dna polymerase ) , 2.5  l 10x pcr buffer ( mg free , invitrogen life technologies , carlsbad , ca , usa ) , and dh2o .
amplified products were digested with hhai at 37c for lep and mspi at 37c for lepr , and the resulting fragments were separated by 2% agarose gel electrophoresis .
the fragments were stained with ethidium bromide and visualized through a vilber - lourmat gel quantification and documentation system ( quantum - st4 ; vilber lourmat bp 66 , torcy , france ) .
analysis of the data was performed using spss 16.0 ( spss , chicago , il , usa ) and openepi info ( http://www.openepi.com ) .
the frequencies of the alleles and genotypes ( hardy - weinberg equilibrium ) in patients and controls were compared with  analysis , and 95% confidence intervals were calculated .
a p value less than 0.05 ( two - tailed ) was regarded as statistically significant .
the mean age and bmi were 44.86  1.51 , 35.45  4.56 and 34.25  15.43 , 21.57  1.89 in patients and control groups , respectively .
the mean age of obesity patients with bmi > 35  kg / m and bmi < 35  kg / m was 45.01  1.38 and 44.7  1.65 , respectively , while the mean bmi of these patients was 38.68  3.11 ( bmi > 35  kg / m ) and 32.06  1.56 ( bmi < 35  kg / m ) .
patients and controls were genotyped for both the g2548a polymorphism in the lep gene promoter and the 668a / g polymorphism in the lepr gene .
the distribution of the lep g2548a and lepr 668a / g polymorphisms of the patients and control groups are presented in tables 2 and 3 .
we found no statistically significant difference in the genotype frequencies of the lep gene polymorphism in patients and control groups ( p > 0.05 ) .
the lepr genotypes differed between the obesity patients and controls , but this was not statistically significant after the bonferroni correction ( p = 0.05 ) .
allele frequencies in the lepr gene showed no statistically significant association ( p > 0.05 ) ( table 3 ) . the lepr gene a allele was 61.4% in patients and 69.5% in the control group , while the g allele frequency was 38.5% in patients and 30.4% in the control group . in the combined analysis of the lep and lepr genes ,
the lep / lepr gg / gg combined genotype was found to increase the risk of obesity compared to the controls ( p < 0.05 ) ( table 4 ) . in the combined genotype analysis based on the mean bmi of obesity patients
, there was no association of the lep / lepr combined genotype and obesity between patients with a bmi  35  kg / m and patients with a bmi near 30  kg / m ( p > 0.05 ) ( table 4 ) .
human obesity is a complex trait determined by the interaction of multiple genes and environmental factors .
obesity may arise as a result of increased energy intake , decreased energy expenditure , or increased partitioning of nutrients into fat , either alone or in combination .
the prevalence of obesity and being overweight continues to increase worldwide , not only causing serious personal health problems but also imposing a substantial economic burden on societies .
genetic influences are difficult to elucidate , and identification of the involved genes is not easily achieved .   in the present study
, we analyzed the frequencies of lep g2548a and lepr 668a / g polymorphisms in obesity patients in a turkish population .
there was no statistically significant difference between the groups with respect to the lep genotype distribution ( p > 0.05 ) and allele frequencies ( p > 0.05 ) .
suggested that the lep g2548a variant may influence gene expression of leptin and leptin secretion by adipose tissue .
noted that the lep g2548a polymorphism may influence a bmi increase by means of its effects on leptin secretion ; however , they identified a significant and independent association between the lep 2548gg carrier status and higher leptin levels .
an association of the lep g2548a polymorphism and increased bmi was reported in overweight europeans and in taiwanese subjects with obesity   and the combined lep 759c / t and lep g2548a genotype may be a determinant of obesity .
the results of our study do not support the results of these studies but do support those of other studies that showed no association between the lep g2548a polymorphism and obesity - related phenotypes [ 11 , 14 , 15 , 21 ] .
we found that lepr genotypes show a difference , but not statistically significant , between obesity patients and controls .
we attribute this lack of significance to the low number of patients included in our study , but finding obese patients that have no other disease is difficult .
some researchers have proposed that the polymorphisms of the leptin receptor gene ( especially lepr 668a / g polymorphism ) may contribute to common forms of human obesity [ 11 , 14 , 2224 ] .
our results with respect to the lepr polymorphism are in agreement with the results of these studies .
our results showed a statistically significant difference between groups with respect to the distribution of the lep / lepr gg / gg combined genotype .
obesity results from both gene - gene and gene - environment interactions , and in our study we examined the gene - gene interactions of the lep / lepr genes and their link to obesity .
demonstrated that the haplotype association of the lep g2548a and lepr q223r variants was related to a 58% increase in obesity risk , and they considered the interactions between lep and lepr gene polymorphisms to intensively influence modulation of energy homeostasis . in agreement with the findings of our study ,
boumaiza et al . reported that the lep g2548a and lepr q223r polymorphisms and haplotype combination were associated with a metabolic syndrome and obesity risk in tunisian subjects .
the g2548a and 3hvr variants of the lep gene have been noted as being in linkage disequilibrium , and i / g combined genotypes are associated with obesity .
in addition , the interactions between the polymorphisms of the lep and lepr genes have been shown to increase the risk of non - hodgkin 's lymphoma and influence insulin plasma concentrations and blood pressure levels .
our findings indicate that the lep g2548a polymorphism is not a relevant obesity marker and that the lepr 668a / g polymorphism may be related to obesity in a turkish population . additionally , the lep / lepr gg / gg combined genotype was found to increase the risk of obesity in patients compared to controls
. however , the association of these polymorphisms with obesity is still controversial , and further research with larger patient populations is necessary .

Answer:
objective . obesity is a complex heterogeneous disease that is caused by genes , environmental factors , and the interaction between the two .
 the leptin ( lep ) and leptin receptor ( lepr ) genes have been evaluated for polymorphisms that could potentially be related to the pathophysiology of obesity and its complications . the aim of this study was to investigate the role of lep g2548a and lepr   668a / g polymorphisms in the pathogenesis of obesity .
 subjects . the study included 127 patients with obesity and 105 healthy controls . polymerase chain reaction and restriction fragment length analysis for lep g2548a and lepr
 668a / g polymorphisms were applied .
 results .
 there was no statistically significant difference in the genotype frequencies of the lep gene polymorphism between patients and control groups ( p > 0.05 ) .
 we found a difference in the lepr genotypes between patients and controls , but this was not statistically significant ( p = 0.05 ) .
 additionally , we found an increased risk of obesity in the lep / lepr gg / gg combined genotype ( p < 0.05 ) . conclusion .
 our findings indicate that the lep g2548a polymorphism is not a relevant obesity marker and that the lepr 668a / g polymorphism may be related to obesity in a turkish population .
 further researches with larger patient population are necessary to ascertain the implications of lep and lepr polymorphisms in obesity .


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:
lung cancer is one of the leading causes of cancer - related deaths in the world .
although it is well known that smoking is the primary risk factor for lung cancer , lung cancer develops in less than 20% of people who smoke throughout their life . moreover , lung cancer is a multi - cellular and multistage process involving a number of genetic changes in oncogenes , suggesting that genetic factors may play an important role in its development .
the glutathione s - transferases ( gsts ) are a gene superfamily of phase ii metabolic enzymes that detoxify free radicals , particularly in tobacco smoke , products of oxidative stress , and carcinogens such as benzopyrene and other polycyclic aromatic hydrocarbons .
phenotype assays have confirmed this lack of function by demonstrating a strong concordance between phenotype and genotype .
previous studies have suggested that individuals with null genotypes of gstm1 may be unable to eliminate electrophilic carcinogens efficiently and have a high risk of lung cancer .
however , the results from previous reported studies in asians were inconclusive [ 333 ] .
therefore , we conducted a meta - analysis to explore the effect of gstm1 null genotype on lung cancer risk in asians .
we searched the pubmed and embase to identify published case - control studies investigating the associations of gstm1 null genotype with risk of lung cancer in asians .
glutathione s - transferases or  gstm1 and  lung cancer , without restriction on language .
additional studies were identified by a manual search of references of original studies or review articles .
the inclusion criteria were : ( 1 ) original papers containing independent data ; ( 2 ) studies should provide the sample size , odds ratios ( ors ) , and 95% confidence intervals ( cis ) , as well as the genetic distribution or the information needed to infer the results ; and ( 3 ) case - control or cohort studies .
the major exclusion criteria for studies were : ( 1 ) overlapping data ; ( 2 ) insufficiently useful data ; and ( 3 ) case - only studies or family - based studies ; ( 4 ) reviews , abstracts , or commentaries ; ( 5 ) not relevant to lung cancer or gstm1 ; and ( 6 ) not conducted in asians .
two independent researchers extracted raw data according to the inclusion criteria . the following information was collected from each study using a data extraction form : the surname of the first author , year of publication , country of origin , sex of subjects , histology , smoking status , number of cases and controls , adjustment , and ors and the corresponding 95% confidence intervals ( cis ) of lung cancer risk . for the gstm1 gene , we estimated the risk effect of the null genotype on lung cancer compared with the non - null genotypes in the recessive model ( null vs. heterozygous + wild type ) .
the strength of the association between the gstm1 gene and lung cancer risk was measured by ors with 95% cis .
the ors with corresponding 95% cis from individual studies were pooled using fixed or random effects models , according to the heterogeneity .
when the p value for cochran s q statistic was less than 0.1 , and a significant heterogeneity existed across the included studies , the random effects model ( dersimonian and laird method ) was used for meta - analysis , or the fixed - effects model ( mantel - haenszel method ) was used .
sensitivity analysis was further performed by excluding a single study to assess the impact of an individual study on the pooled estimate .
funnel plots and egger s regression test were used to assess the potential publication bias .
data analysis was performed using stata 12 ( statacorp lp , college station , texas , usa ) .
we searched the pubmed and embase to identify published case - control studies investigating the associations of gstm1 null genotype with risk of lung cancer in asians .
glutathione s - transferases or  gstm1 and  lung cancer , without restriction on language .
additional studies were identified by a manual search of references of original studies or review articles .
the inclusion criteria were : ( 1 ) original papers containing independent data ; ( 2 ) studies should provide the sample size , odds ratios ( ors ) , and 95% confidence intervals ( cis ) , as well as the genetic distribution or the information needed to infer the results ; and ( 3 ) case - control or cohort studies .
the major exclusion criteria for studies were : ( 1 ) overlapping data ; ( 2 ) insufficiently useful data ; and ( 3 ) case - only studies or family - based studies ; ( 4 ) reviews , abstracts , or commentaries ; ( 5 ) not relevant to lung cancer or gstm1 ; and ( 6 ) not conducted in asians .
the following information was collected from each study using a data extraction form : the surname of the first author , year of publication , country of origin , sex of subjects , histology , smoking status , number of cases and controls , adjustment , and ors and the corresponding 95% confidence intervals ( cis ) of lung cancer risk .
for the gstm1 gene , we estimated the risk effect of the null genotype on lung cancer compared with the non - null genotypes in the recessive model ( null vs. heterozygous + wild type ) .
the strength of the association between the gstm1 gene and lung cancer risk was measured by ors with 95% cis .
the ors with corresponding 95% cis from individual studies were pooled using fixed or random effects models , according to the heterogeneity .
when the p value for cochran s q statistic was less than 0.1 , and a significant heterogeneity existed across the included studies , the random effects model ( dersimonian and laird method ) was used for meta - analysis , or the fixed - effects model ( mantel - haenszel method ) was used .
sensitivity analysis was further performed by excluding a single study to assess the impact of an individual study on the pooled estimate .
funnel plots and egger s regression test were used to assess the potential publication bias .
data analysis was performed using stata 12 ( statacorp lp , college station , texas , usa ) .
a total of 31 studies were retrieved based on the search criteria for lung cancer susceptibility related to the gstm1 polymorphism [ 333 ] .
the evaluations of the association between gstm1 polymorphism and lung cancer risk are summarized in table 2 .
the null genotype of gstm1 was associated with a significantly increased risk of lung cancer when compared with present genotype ( or=1.43 ; 95% ci , 1.301.58 ; figure 2 ) .
the combination of adjusted ors for lung cancer was 1.38 ( 95% ci , 1.231.54 ) . when stratified by sex , significantly elevated risks were observed in men ( or=1.38 ; 95% ci , 1.061.78 ) and women ( or=1.30 ; 95% ci , 1.031.64 ) . in the subgroup analysis according to histology , significantly increased risks were observed in adenocarcinoma ( or=1.27 ; 95% ci , 1.051.55 ) and squamous cell carcinoma ( or=1.40 ; 95% ci , 1.101.78 ) , but not in small - cell lung cancer ( or=1.22 ; 95% ci , 0.811.83 ) .
subgroup analysis based on the smoking status showed that increased risks were found in non - smokers ( or=1.49 ; 95% ci , 1.251.79 ) and smokers ( or=1.78 ; 95% ci , 1.432.23 ) . as shown in figure 3 ,
the results showed that the pooled ors tended to be stable . a single study involved in the meta - analysis
was deleted each time to reflect the influence of the individual data set on the pooled ors , and the corresponding pooled ors were not materially altered ( figure 4 ) .
funnel plot and egger s test were used to assess the publication bias of the literature .
the shape of the funnel plot did not reveal any evidence of obvious asymmetry ( figure 5 ) .
a total of 31 studies were retrieved based on the search criteria for lung cancer susceptibility related to the gstm1 polymorphism [ 333 ] .
the evaluations of the association between gstm1 polymorphism and lung cancer risk are summarized in table 2 .
the null genotype of gstm1 was associated with a significantly increased risk of lung cancer when compared with present genotype ( or=1.43 ; 95% ci , 1.301.58 ; figure 2 ) .
the combination of adjusted ors for lung cancer was 1.38 ( 95% ci , 1.231.54 ) . when stratified by sex , significantly elevated risks were observed in men ( or=1.38 ; 95% ci , 1.061.78 ) and women ( or=1.30 ; 95% ci , 1.031.64 ) . in the subgroup analysis according to histology , significantly increased risks were observed in adenocarcinoma ( or=1.27 ; 95% ci , 1.051.55 ) and squamous cell carcinoma ( or=1.40 ; 95% ci , 1.101.78 ) , but not in small - cell lung cancer ( or=1.22 ; 95% ci , 0.811.83 ) .
subgroup analysis based on the smoking status showed that increased risks were found in non - smokers ( or=1.49 ; 95% ci , 1.251.79 ) and smokers ( or=1.78 ; 95% ci , 1.432.23 ) . as shown in figure 3 ,
the results showed that the pooled ors tended to be stable . a single study involved in the meta - analysis
was deleted each time to reflect the influence of the individual data set on the pooled ors , and the corresponding pooled ors were not materially altered ( figure 4 ) .
funnel plot and egger s test were used to assess the publication bias of the literature .
the shape of the funnel plot did not reveal any evidence of obvious asymmetry ( figure 5 ) .
the present meta - analysis , including 5347 lung cancer cases and 6072 controls from 31 case - control studies , explored the association of gstm1 null genotype with lung cancer risk .
we demonstrated that the null genotype of gstm1 was associated with a significantly increased lung cancer risk in asians .
furthermore , in the stratified analysis by sex , we found that both men and women with gstm1 null genotype had increased lung cancer risk .
more studies are needed to assess the association between gstm1 null genotype and lung cancer risk in males and females .
cigarette smoking is a pro - inflammatory stimulus and an important risk factor for lung cancer .
our results showed significant associations between gstm1 polymorphism and lung cancer risk among smokers and non - smokers .
we also found that patients with gstm1 null genotype had increased non  small - cell lung cancer ( adenocarcinoma and squamous cell carcinoma ) risk .
however , we failed to find a significant relationship between gstm1 null polymorphism and small - cell lung cancer risk .
this result suggested that gstm1 null polymorphism may play an important role in the development of non - small - cell lung cancer .
gsts are biotransformation enzymes , and they are phase ii enzymes with both catalytic activities and non - catalytic functions .
previous studies have shown that individuals with the gstm1 null genotype have a decreased capacity to detoxify certain carcinogens .
thus , it is biologically plausible that the gstm1 null genotype may increase risk of lung cancer .
first , the methodological issues for meta - analysis such as one - way sensitivity analysis and cumulative meta - analysis were well investigated .
results from one - way sensitivity analysis and cumulative meta - analysis suggested high stability and reliability of our results and significant heterogeneity was not observed in this meta - analysis . moreover , funnel plots and egger s tests were used to find potential publication bias .
second , lack of the original data from the eligible studies limited the evaluation of the effects of the gene - gene and gene - environment interactions in the development of lung cancer .
third , only published studies were included in this meta - analysis ; therefore , publication bias may have occurred even though the statistical test did not show it .
in conclusion , this meta - analysis suggests that an increased risk of lung cancer was associated with the null polymorphism of gstm1 in asians .

Answer:
backgroundseveral molecular epidemiological studies have been conducted to examine the association between glutathione s - transferase m 1 ( gstm1 ) null genotype and lung cancer in asians ; however , the conclusions remained controversial .
 we therefore performed an extensive meta - analysis on 31 published case - control studies with a total of 5347 lung cancer cases and 6072 controls.material/methodspubmed and embase were searched to identify case - control studies investigating the associations of gstm1 null genotype with risk of lung cancer in asians .
 odds ratios ( ors ) with 95% confidence intervals ( cis ) were used to assess the strength of association between lung cancer risk and polymorphism of gstm1.resultsgstm1 null genotype was significantly associated with lung cancer risk ( or=1.43 ; 95% ci , 1.301.58 ) .
 this result remained statistically significant when the adjusted ors were combined ( or=1.38 ; 95% ci , 1.231.54 ) . in the subgroup analysis by sex
 , there were significant associations in women and men .
 when stratifying for histology , this genotype showed increased adenocarcinoma risk and squamous cell carcinoma risk . in the subgroup analysis stratified by smoking status , lung cancer risk was increased in both smokers and non-smokers.conclusionsthis study suggests that gstm1 null genotype is a risk factor for lung cancer in asians .


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 43-year - old woman diagnosed with intravenous leiomyomatosis at another hospital was transferred to our hospital .
she had suffered from palpitation , dizziness , dyspnea , and chest pain for two weeks prior to admission into another hospital , and had experienced syncope three times on the day of admission to our hospital .
no cardiac murmur was noted , and laboratory findings were unremarkable with the exception of anemia ( hemoglobin : 9.7
g / l ) . cardiac and pelvic magnetic resonance imaging ( mri ) taken at the previous hospital revealed multiple low attenuation masses in the uterus , involving both ovaries , the left gonadal vein , the left internal iliac vein , and the left renal vein , which extended into the inferior vena cava ( ivc ) , and to the right atrium ( ra ) ( fig .
1 ) . a trans - thoracic echocardiogram revealed a 4.81.8-cm hypermobile and echogenic mass in the ra connected to the mass in the ivc .
emergency one - stage operation was planned with a gynecologist , and upon being transferred to the operation room , the patient had a sudden onset of dyspnea and unstable blood pressure .
rapid endotracheal intubation was performed to maintain blood oxygen saturation . in transesophageal echocardiography ( tee ) , the echogenic mass in the ra and ivc was not seen .
we suggested that the mass detached from the ra and migrated to the right ventricle or the pulmonary artery .
we discovered an echogenic linear mass in the pulmonary artery between the arterial bifurcation and both main pulmonary arterial branches ( fig .
trans - abdominal hysterectomy and left salphingo - oophorectomy were performed through median laparotomy , and the mass in the left gonadal and internal iliac veins was completely removed ( fig .
another mass in the pulmonary artery was also removed under conventional cardiopulmonary bypass without circulatory arrest ( fig .
the ra was opened to confirm that there was no remnant mass in the ra and the ivc .
the patient 's postoperative course was uneventful , and she has received follow - up care for two years without any evidence of tumor recurrence .
intravenous leiomyomatosis is a benign intravascular proliferation of smooth muscle cells originating from the intrauterine venules and reaching the right heart .
the uncommon benign tumor usually arises from either the uterine venous wall or uterine leiomyoma , and although it is histologically benign , it can cause fatal cardiovascular complications such as cardiac failure , pulmonary embolization , or sudden death . in previously reported cases describing intracardiac involvement , the tumor extended to the right atrium in 30% of cases , and to the right ventricle in 70% of cases .
extension or embolization into the pulmonary artery or lung metastasis is a very rare complication constituting less than 5% of the reported cases .
however , when it occurs , the course of the patient can be fatal , and urgent surgical correction is imperative .
ariza and colleagues described the first successful two - stage removal of an intracaval mass , with delayed laparotomy after resection of the intracardiac portion of a tumor in 1982 .
since then , a staged operation has been performed in many cases ( radical resections of intracavocardiac tumors and intrapelvic components in separate operations ) , but more recently , a one - stage approach by median sternotomy with cardiopulmonary bypass with or without hypothermic circulatory arrest , and a separate laparotomy has been performed successfully .
the advantages of the one - stage resection include avoiding risks of tumor embolism , tumor progression , or hemodynamic complications in the interval between the two stages of two - staged operations .
in addition , because both abdominal and thoracic cavities are opened , the tumor can be removed completely , and vascular reconstruction and bleeding control may be more easily performed .
however , in hemodynamically unstable patients , the longer operative time may not be appropriate , and a two - stage operation may be beneficial . since incomplete resection of the tumor may causes recurrence , gathering detailed preoperative information regarding tumor localization , size , and extent by using abdominal ultrasound , echocardiogram , computed tomography , magnetic resonance imaging , and venography is required .
transesophageal echocardiography should also be performed to detect possible changes in the location and size of the tumor , as occurred in this case . in conclusion ,
intracardiac leiomyomatosis should be considered in a female patient presenting with an extensive mass in the right side of the heart , and urgent surgical removal should be performed to avoid possible fatal complications , even if the patient is asymptomatic . as the tumor may move or detach from the central venous system even during operation , intraoperative tee

Answer:
a 43-year - old woman was diagnosed with an intravenous leiomyomatosis at a previous hospital and transferred to our hospital to undergo surgical treatment .
 emergency one - stage operation for coincidental removal of intra - abdominal , right atrial , and intravenous masses were planned . upon arriving at the operating room
 , she suffered a sudden onset of severe dyspnea and showed hemodynamic instability .
 intraoperative tee showed pulmonary embolization of a right atrial mass .
 removal of the pulmonary artery mass and the intra - abdominal mass , and the cardiopulmonary bypass were performed without any complications .


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:
knee osteoarthritis is known to cause not only restrictions in joint functions , but also
 major problems , such as the wear of articular cartilage and pain due to inflammatory damage
 to the surrounding tissues1 , 2 .
if the pain due to osteoarthritis persists chronically ,
 cytokines will increase in the spinal cord due to inflammatory stimulation coming from
 peripheral regions , and the increase in cytokines will induce inflammatory responses to
 cause damage to spinal cord nerve cells . if pain signals continuously extend from the
 peripheral joint regions to the spinal cord , spinal cord nerve cell damage will increase to
 develop chronic pain along with neuropathic pain , such as hyperalgesia3 . in this case , to regenerate the synapses of damaged spinal
 cord nerve cells , growth - associated protein-43 ( gap-43 ) , which is a substance related to
 nerve regeneration , increases in the posterior horn of the spinal cord4 . among the many methods of treating osteoarthritis patients , exercise
not only reinforces
 the regenerative capacity of articular cartilage and improves the collagen synthesis
 network , but it also strengthens the muscles and ligaments around the knee joints5 . in addition , exercise is known to not only
 suppress the production of pre - inflammatory cytokines , such as il-6 , il-8 , and tnf- , and
 increase the secretion of il-10 , which has anti - inflammatory effects to reduce inflammatory
 responses in the joints and the spinal cord , but it also increases the expression of
 neurotrophic factors , increased neurotrophic factor expression could promote the gap-43
 expression , thereby enhancing the nerve regeneration capacity3 , 6 , 7 . as such
, the purpose of exercise treatment for osteoarthritis
 patients is to not only enhance joint functions , but also relieve pain , thereby enhancing
 quality of life .
therefore , the present study was conducted to examine the effects of
 exercise on the recovery of spinal cord nerve cells damaged due to pain signals , which are a
 major symptom of osteoarthritis .
experimental procedures were performed in accordance with the protocols established by the
 institution of animal care and use committee ( iacuc ) at the daegu university , based on the
 nih guidelines for the care and use of laboratory animals ( nih , 1996 ) .
adult male
 sprague - dawley rats ( 810 weeks of age , weight 250300  g , n=40 ) were used and housed at a
 controlled temperature at 25  2 c with 12  h light / dark cycle and free access to
 food and water .
induction of osteoarthritis by monosodium iodoacetate ( mia , sigma , st louis , mo , america )
 was performed briefly , 3  mg mia in 50ul saline was injected through the patella tendon into
 the right knee joint8 .
injected rats were randomly divided into 4
 groups : sham control group without mia injection ( sg ) , control group with injected mia ( cg ) ,
 oa without exercise ( neg ) , oa with exercise ( eg ) .
three weeks after oa induction , exercise group was habituated on motor - driven treadmill at
 a speed of 10 m / min for 2 days to reduce their stress .
the exercise group was submitted to
 4-week training program on a treadmill for 5 days / week , 30  min / day , 16 m / min velocity which
 corresponded to approximately 6070% vo2 max .
spinal cord were removed , postfixed for 30  min , then rinsed and stored in 0.2  m phosphate
 buffer ( pb ) overnight .
spinal cord were sectioned with a microtome in serial section of 30
 um , collected on slides and sections were performed immunohistochemistry .
briefly , sections
 were rinsed 5  min and incubated for 1hr rt in tbs ( tris - buffered saline ) containing 5%
 donkey serum ( sigma aldrich , wien , austria ) , 1% bsa ( bovine serum albumin , sigma - aldrich ) .

the sections were incubated for immunohistochemistry with the primary antibody ( rabbit
 polyclonal gap-43 , 1:500 , chemion international , usa ) overnight at 4c .

subsequently , the sections were rinsed 5  min , after which the abc complex ( vector
 laboratories ) was applied to each section for 1hr at room temperature , antibody binding was
 visualized using a commercially available dab substrate solution ( vector laboratories ) . for
 quantitative analysis of positive immunoreactivity
was measured using computer - assisted
 image analysis and is reported here as the proportional area of tissue occupied by
 immunohistochemically stained .
data was calculated by pixel and were analyzed using spss for
 windows version 18.0 . and expressed as mean  standard deviation ( sd ) .
in this study , a results of measuring the expression of gap-43 , gap-43 was observed in all
 groups , showed that the significant difference in each group ( table 1table 1.the comparison of expression of ngf in spinal cord between four groups unit ;
 pixelexpressions of gap-43 ( mean  sd)group ( n=40)sg ( n=10)cg ( n=10)neg ( n=10)eg ( n=10)8,306.6  541.711,558.2  881.618,213.5  603.322,986.4  1239.6sg : sham group ; cg : control group ; neg : no exercise group ; eg : exercise group ; mean
 sd : mean  standard deviation . significant difference from sg .
, significantly higher gap-43 expression were
 found in neg and eg groups . in particular , it was confirmed that the highest expression of
 gap-43 in the group which performed treadmill exercise .
sg : sham group ; cg : control group ; neg : no exercise group ; eg : exercise group ; mean
 sd : mean  standard deviation .
if the
 pain signals generated by the knee joint are continuously delivered to the spinal cord ,
 cytokines , which are an inflammation - inducing substance , will increase in the spinal cord to
 cause inflammatory responses in the spinal cord so that nerve cells are damaged and the
 sensory neurons in the spinal dorsal horn become sensitive , resulting in the occurrence of
 neuropathic pain , such as hyperalgesia4 , 9 . when the central nervous system s nerve cells have been damaged , activities for the
 protection and regeneration of the damaged region increase .
astrocytes , which are neuroglia
 cells , proliferate , neurotrophic factors , such as ngf , brain - derived neurotrophic factor
 ( bdnf ) , and neurotrophic-3 ( nt-3 ) , increase , and these neurotrophic factors lead to
 increases in the expression of gap-43 , which acts directly in the secretion of
 neurotransmitters and axonal regeneration10 , 11 . in the present study , to examine whether exercise affects the expression of gap-43 , which
 plays important roles in nerve cell regeneration and recovery in osteoarthritic white rats
 spinal cords , rats were induced to perform treadmill exercises , and the state of the
 expression of gap-43 in the posterior horn of the spinal cord was examined through
 immunohistochemical staining . upon examining the state of the expression of gap-43 , it could
 be seen that gap-43 increased in the cg compared to the sg , and this can be judged as
 indicating spinal cord nerve cell damage due to osteoarthritis , as presented in a study
 conducted by orita et al .
in addition , orita et al . observed the gap-43 expression in the spinal cord , which did not
 clearly increase at the early stage of the onset of osteoarthritis , but it remarkably
 increased from 14 days after the onset , and the lesion progressed to 28 days after the onset
 when the experiment terminated .
this is consistent with the results of the present study ,
 indicating that the gap-43 expression significantly increased in the neg compared to in the
 cg .
therefore , gap-43 seems to have increased over time through natural healing to heal the
 damaged nerve cells . the significantly higher expression could be seen in the eg , which
 performed exercise , compared to the neg .
based on the results of an analysis of previous
 studies , this result can be judged as indicating that the damaged nerve cells were actively
 being recovered as gap-43 increased thanks to exercise .
when the above - mentioned results were viewed comprehensively , it could be seen that
 exercise increased the gap-43 expression in the spinal cord to promote the regeneration of
 spinal cord nerve cells damaged due to chronic osteoarthritis .
also , the increase in the
 regeneration of nerve cells damaged due to inflammatory responses is thought to have
 positive effects on treatment for pain relief .

Answer:
[ purpose ] the purpose of the study was to investigate the effects of exercise on the
 recovery of spinal cord nerve cells damaged due to pain signals which are a major symptom
 of osteoarthritis .
 [ subjects and methods ] adult male sprague - dawley rats ( n=40 ) were used
 and induction of osteoarthritis by monosodium iodoacetate .
 injected rats were randomly
 divided into 4 groups : sham control group without mia injection ( sg ) , control group with
 injected mia ( cg ) , oa without exercise ( neg ) , oa with exercise ( eg ) .
 sham control group
 was injected normal cell line instead of mia .
 the exercise group was submitted to 4-week
 training program on a treadmill for 5 days / week , 30  min / day , 16 m / min velocity , then
 spinal cord were removed and measured the gap-43 expression by immunohistochemistry
 analysis . [ results ] in this study , a results of measuring the expression of gap-43 .
 gap-43
 was observed in all groups , showed that the significant difference in each group .

 [ conclusion ] it could be seen that exercise increased the gap-43 expression in the spinal
 cord to promote the recovery of spinal cord nerve cells damaged due to chronic
 osteoarthritis .


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

Paper text:
the selective melatonin receptor agonism effect of ramelteon is useful for insomnia.1 ) here we wanted to present a refractory chronic migraine case , who had significant improvements in migraine after using ramelteon .
the precipitating factors were the stress , increase in physical activities and sudden cold weather .
the moderate or severe pain intensity was aggravated by or causing avoidance of increased physical activity .
the residual symptom between the migraine episodes were the head tense feeling , but not achieveing headache severity .
the computed tomography revealed no significant findings of other causes for headache , such as tumor or hemorrhage .
she ever received many kinds of medications , such as aspirin , nonsteroidal anti - inflammatory drugs , triptans , ergots , anticonvulsants and glucocorticoids .
however , the severity of migraine still remained moderate ( migraine disability assessment test [ midas ] scores , 19 ) and the associated symptoms were moderate headache , dizziness , nausea , and sensitivity to sound .
the migraine also exacerbated her insomnia problems , with fragmented sleep and inadequate sleep duration as 12 hours ( insomnia severity index [ isi ] score , 23 ) .
she did nt have any comorbid mental disorder except insomnia . due to the fear of abuse potential related to hypnotics
after 2 weeks treatment of ramelteon 8 mg / day , her sleep duration prolonged to 45 hours with less fragmentation .
in addition , her migraine severity started to decline ( midas scores , 11 ) .
after 6 months of ramelteon 8 mg / day treatment , the migraine severity continued to relieve ( midas scores , 6 ) with stable sleeping quality ( isi score , 14 ) .
in this case , we found significant improvements in migraine severity and insomnia after the use of ramelteon . since the patient did nt have insomnia before the first onset of migraine .
therefore we could speculate that the ramelteon had significant effects in migraine in such mild prolongation of sleep duration .
the melatonin might relieve the headache via the following possible mechanisms , such as anti - inflammatory effect , free radical scavenging , reduction of pro - inflammatory cytokine , membrane stabilization , nitric oxide synthase activity and dopamine release inhibition , gaba and opioid analgesia potentitation , glutamate neurotoxicity protection , neurovascular regulation,2 ) cytoprotection and antiallodynic action.3 ) the pineal gland , the primary source of serotonin and melatonin , might also play a significant role in the analgesic effect.4 ) however , the clinical trial of melatonin administration showed no significant improvements in migraine severity,5 ) which suggested the modulation of melatonin receptor might be a better option for the analgesic effects .
the modulation of serotonin system by the ramelteon would also relieve the pain sensation.2 ) in addition , the chemical structure of ramelteon was similar with that of indomethacin , which is a kind of non - steroidal anti - inflammatory medicine.2 ) in the study of animal model , the antinociceptive and antiallodynic actions of melatonin have been observed in different kinds of pathways , such as intrathecally or intracerebroventricular routes .
the use of ramelteon , a kind of mt1 and mt2 agonist , could also relieve the pain even lack of free radical scavenger effects.3 ) the state - of - art treatment of refractory chronic migraine also includes the ramelteon due to selective m1 receptor agonism.6 ) from the successful experience in this case , we can consider the use of ramelteon for refractory chronic migraine with insomnia .

Answer:
the selective melatonin receptor agonism effect of ramelteon is useful for insomnia .
 here we wanted to present a refractory chronic migraine case , who had significant improvements in migraine after using ramelteon .
 the possible mechanism for the ramelteon in the migraine relief might be related to melatonin effects .


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:
adult surgeons have applied it to all spectra of surgical diseases including inguinal hernia repair . with advancements in anesthesia and refinements in laparoscopic instruments ,
it has become conceivable that application of laparoscopy in pediatric surgical diseases including hernia repair is the next step .
unresolved debate still exists regarding the benefit of using laparoscopy over conventional open inguinal hernia repair even between laparoscopic surgeons .
although inguinal hernia repair is widely performed in every pediatric surgery department , the use of laparoscopy has not gained wide acceptance due to the benefits of conventional open repair regarding lower morbidity , good cosmesis , and lower rates of recurrence .
different techniques are being used to tighten up the hernia opening , which vary from a single stitch to a purse string procedure using laparoscopy . several published comparative studies and large laparoscopic series aim to clarify the feasibility of laparoscopy in pediatric inguinal hernia repair and compare laparoscopy versus conventional repair .
the aim of the current study was to compare various aspects of a recently reported laparoscopic flip - flap technique with the conventional open inguinal hernia repair in a short - term follow - up .
a retrospective cohort study was performed including all children who underwent congenital inguinal hernia repair in the pediatric surgery department of alwasl hospital from july 2004 to october 2004 by either the new laparoscopic flip - flap technique described by yip et al or conventional open repair .
another 2 flank ports were introduced under direct laparoscopic guidance , and insufflations ranged from 8 mm hg to 10 mm hg . an incision over the peritoneum alongside
the anterior and lateral edge of the hernia entry side was made ; a peritoneal flap big enough to cover the hernia opening was raised .
the anterior and lateral half circumference of the sac was detached from the surrounding soft tissue , and the opening of the hernia sac spontaneously collapsed .
a 4  0 polyprolene suture was then introduced into the peritoneal cavity through the anterior abdominal wall .
the needle was retrieved through the working port , and the wounds were then closed with absorbable sutures .
the medical records of these patients were reviewed , and patients were divided into 2 groups according to the type of surgery done : group a comprised those who underwent the new laparoscopic technique , and group b comprised those who underwent conventional open repair .
the following data were collected and analyzed : demographics , hernia site , operative time , intraoperative complications , time of postoperative hospital stay , and postoperative recurrence .
another 2 flank ports were introduced under direct laparoscopic guidance , and insufflations ranged from 8 mm hg to 10 mm hg .
an incision over the peritoneum alongside the anterior and lateral edge of the hernia entry side was made ; a peritoneal flap big enough to cover the hernia opening was raised .
the anterior and lateral half circumference of the sac was detached from the surrounding soft tissue , and the opening of the hernia sac spontaneously collapsed .
a 4  0 polyprolene suture was then introduced into the peritoneal cavity through the anterior abdominal wall .
the needle was retrieved through the working port , and the wounds were then closed with absorbable sutures .
the medical records of these patients were reviewed , and patients were divided into 2 groups according to the type of surgery done : group a comprised those who underwent the new laparoscopic technique , and group b comprised those who underwent conventional open repair .
the following data were collected and analyzed : demographics , hernia site , operative time , intraoperative complications , time of postoperative hospital stay , and postoperative recurrence .
all patients were male , and the age ranged from 4 months to 7 years ( mean , 44 months ) .
group a included 15 patients ( mean age , 39 months ) , while group b comprised 18 patients ( mean age , 44 months ) .
five patients had bilateral hernias in group a versus 7 patients in group b ( all of them had bilateral repairs ) .
operative time for group a ranged from 40 minutes to 55 minutes ( mean , 47.5 ) , in group b , operative time ranged from 20 minutes to 35 minutes ( mean , 27.5 ) .
the calculated time excluded time consumed for any technical problems with the laparoscopic instruments . in group
a , intraoperative complications included 1 case ( 7% ) of vas deferens injury during mobilization of the flaps , and in 3 other cases ( 20% ) the flaps were torn during suturing , which necessitated multiple sutures to close the defect .
the range of postoperative hospital stay was from 3 hours to 8 hours ( mean , 5.5 ) .
postoperative follow - up of 3 months revealed recurrence in 4 cases in group a ( 27% ) , and no recurrences were encountered in group b.
failure to close the processus vaginalis accounts for nearly all the inguino scrotal abnormalities seen in infancy and childhood .
the concurrence rate of recurrent inguinal hernia after uncomplicated inguinal hernia conventional open repairs is generally reported at 0.5% to 1% , increasing for premature infants and complicated inguinal hernia . with advances in minimally invasive surgery
, inguinal hernias have been treated routinely by the laparoscopic method in some centers . however , from the technical point of view , the procedure remains in its early evolution .
recurrence for laparoscopic pediatric inguinal hernia repair is approximately 4% , which is higher than recurrence for conventional open repair .
several technical modifications have been reported aiming to reduce the high recurrence rate after laparoscopic repair .
chan and tam advised normal saline injection at the extraperitoneal space to separate the vas deferens and testicular vessels from the peritoneum .
care still is needed to prevent hematoma formation with this procedure , thus avoiding recurrence .
schier initially performed laparoscopic hernia repair only in girls for fear of damaging the vas deferens and testicular vessels in boys .
after refining his technique by using interrupted stitches to close the internal ring , thus avoiding this risk , he included boys for this operation .
a space can lead to recurrence , whereas too narrow a space near the vas deferens or testicular vessels can cause obstruction .
prasad et al recently described the use of a 1.7-mm needle laparoscope , and a special curved stainless steel awl introduced percutaneously anteralateral to the internal ring for childhood hernia repair .
this method still has the difficulty of separating the vas deferens and testicular vessels from the peritoneum , and the risk of damaging these important structures persists .
yep et al published a new laparoscopic technique in which the hernia opening was repaired with a peritoneal flip - flap anchored with a single tension - free intracorpo - real suture .
the valve mechanism of the flip - flap helped to avoid scrotal collection and prevent hernia recurrence .
the operative time was shorter in the open group than in the laparoscopic group , and the learning curve did not change the time which is comparable to that of the open technique due to the meticulous dissection required to create the flaps ; however , even this caution did not guard against tearing of the flaps in 3 cases .
intraoperative complications in the open repair were nil in comparison with complications in the laparoscopic group in which one case of vassal injury occurred during creation of the flaps , and in 3 cases the flaps were torn during stitch fixation , which required closure of the internal ring by multiple stitches .
postoperative hospital stay was nearly the same in both groups , and all the patients were discharged the same day .
meanwhile , the postoperative analgesic requirements also did not differ in both groups , and this may be attributed to our policy of routine preemptive analgesia with nonsteroidal anti - inflammatory medication .
we did not encounter any postoperative recurrence in the open group in the 3-month follow - up , while 4 cases of recurrence occurred in the laparoscopic group . from our experience ,
intraoperative complications and postoperative recurrence in the laparoscopic flip - flap technique were a major problem discouraging wide use of this new technique in comparison with the satisfactory results obtained by conventional open repair from all aspects including good cosmetic appearance and lower rate of recurrence .
although the incidence of contralateral hernia remains controversial , the advantage of using laparoscopy for inguinal hernia repair to diagnose the contralateral side should be associated with comparable results to that of the conventional open repair .
moreover , until we have satisfactory outcomes for laparoscopic hernia repair in children , the open repair remains the gold standard for pediatric surgeons , and other options for managing the contralateral side are still available through either observation and repair of a contralateral hernia only if it later becomes apparent , routine contralateral groin exploration , and laparoscopy to evaluate the contralateral groin for a potential hernia that could be used through the inguinal incision or by using a mini - telescope through the umbilicus .
our preliminary experience showed unsatisfactory outcomes with the laparoscopic flip - flap hernia repair in children . in spite of the advancement in the application of laparoscopy in pediatric surgery ,
future studies with more numbers and long - term follow - up should be conducted .

Answer:
background and objectives : inguinal hernia repair is one of the most frequently performed pediatric surgical operations .
 several pediatric laparoscopic inguinal hernia repair techniques have been introduced .
 but debate is unresolved regarding the feasibility of laparoscopy for treating pediatric inguinal hernias.methods:a retrospective cohort study enrolled 33 patients who underwent congenital inguinal hernia repair by either the new laparoscopic flip - flap technique or conventional open repair .
 patients were divided into 2 groups according to the type of surgery : group a included those who underwent the new laparoscopic technique , and group b included those who underwent conventional open repair.results:group a comprised 15 patients ( mean age , 39 months ) , and group b comprised 18 ( mean age , 44 months ) .
 mean operative time was 47.5 minutes for group a versus 27.5 minutes for group b. intraoperative complications for group a included 1 case ( 7% ) of vas deferens injury , and 3 cases ( 20% ) in which the flaps were torn during suturing . in group b
 , no intraoperative complications were encountered . in both groups ,
 the mean postoperative hospital stay was 5.5 hours .
 postoperative follow - up of 3 months revealed recurrence in 4 patients in group a ( 27% ) , while there were no recurrences in group b.conclusion:our preliminary experience shows unsatisfactory outcomes with laparoscopic flip - flap hernia repair in children . in spite of advancement in the application of laparoscopy in pediatric surgery ,
 conventional open hernia repair is still the gold standard for children , in our experience .
 future studies with more numbers and long - term follow - up should be conducted .


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:
hydatid disease ( echionococcosis ; hydatidosis ) is a parasitic disease , endemic in many sheep raising countries ( australia , south america , mediterranean countries , russia , middle east , and central asia ) .
adult cestodes of echinococcus granulosus inhabit the small intestine of a definitive host ( dogs , foxes , and wolves ) and produce infective eggs . through the feces , either cestode segments or free eggs
these are ungulates ( sheep , goats , pigs , and horses ) but in some cases accidental ingestion of eggs , usually shed by dogs , could lead to human cystic echinococcosis ( ce ) .
contaminated food , water , or hand - to - mouth transmission are usual modes of infection in humans [ 2 - 4 ] . so far ,
once ingested by the intermediate host , in its intestinal tract , parasite eggs transform into the oncosphere .
oncospheres penetrate the intestinal wall , enters the portal vein , and reaches the liver where they usually are trapped and become the hydatid cyst .
liver involvement has been described as the most common location of ce , varying from 59% to 78% of all cases [ 1,5 - 8 ] .
some larvae pass the liver and reach the lungs where they develop into pulmonary hydatidosis .
lung involvement is present in 15 - 27% of all cases [ 1,5 - 8 ] .
not so often , larvae may pass these filters and form cysts in the brain , skeletal muscles , bones , kidneys , spleen , or other tissues .
theoretically , they can occur at any site except the teeth , nails , and hairs .
epidemiological studies have been conducted in some countries , while in serbia , montenegro , bih , and albania no information is available about the precise incidence in humans .
the aim of this retrospective study was to investigate the skeletal manifestations of hydatid disease in serbia , it 's demographic distribution , site involvement , complications , and bone tissue comorbidities .
the study was conducted by reviewing the medical database of institute for pathology ( faculty of medicine in belgrade ) which is a reference institution in serbia for bone pathology .
materials in the study comprised all the cases with histologically verified bone hydatidosis during the period between 1971 and 2010 in the territory of serbia .
data obtained from medical records included the age at the moment of diagnosis , sex , localization of hydatid cyst , copresence of hydatid cyst in localizations other than the bone tissue , presence of skeletal complications , bone comorbidities , and diagnosis based on radiographies . in order to standardize the data ,
the radiological assessment was made on standard radiography , having in mind the length of the study period and diagnostic procedures available for that time .
changes in the bone structure were classified as tumefaction ( sharply or unshapely demarcated area of altered bone structure ) , cysts ( sharply demarcated lytic bone lesion with geographical borders ) , or fractures ( in cases where fracture line occured ) . in some patients , altered bone structure was able to be classified as cyst or tumefaction preceding the pathological fracture , while in other cases , no alteration of the bone structure was radiologically visible aside of the fracture line .
the age of the patients at the time of diagnosis was from 7 to 77 years .
the mean age of all patients was 40.918.8 years . in order to explore the age distribution of ce ,
we grouped patients into 5 age categories : i ( 1 - 18 years ) , ii ( 19 - 36 years ) , iii ( 37 - 54 years ) , iv ( 55 - 73 years ) , and v ( > 73 years ) . in group
the mean age of adult patients ( more than 18 years old ) was 44.716.6 years .
a total of 24 male patients presented 58.5% of all cases , while 17 female patients presented 41.5% .
the spine was the most commonly involved site with the predominance of the thoracic segment .
analysis of standard radiographies revealed that fracture was by far the predominant radiological diagnosis , followed by tumefaction and cyst ( table 2 ) .
pain was the symptom in 41.5% of patients , while some patients demonstrated complications such as paraplegia ( 22.0% ) , pathologic fracture ( 48.8% ) , and scoliosis ( 9.8% ) .
the pathological fracture was most frequently found in the spine ( 75.0% ) followed by the femur ( 20.0% ) and tibia ( 5.0% ) . however
in addition to the bone involvement , 2 patients demonstrated extraskeletal hydatid cysts : 1 in the liver and 1 in the lungs .
bone tissue comorbidities refer to bone tuberculosis in a patient with spinal hydatid disease ( 2.4% ) and to presence of fistula detected in 2 patients ( 4.9% ) , 1 with spinal and 1 with pelvic hydatidosis .
serbia is recognized as an endemic country for ce , but so far , no epidemiological study has been conducted . since echionococcosis is subjected to an obligatory disease for reporting , the data on the number of reported patients were available through the annual report on infectious diseases on the territory of republic of serbia published by serbian institute for public health , serbia . in the study period , a total of 727 patients with ce
the frequency was relatively high compared to the reports from other endemic countries , being 0.5 - 4.0% .
this frequency can be explained at least partially by a larger total number of patients   due to careless reporting of echionococcosis by physicians , which was even noted in the official annual reports from 1978 to 1989 of serbian institute for public health , serbia .
studies in other endemic countries showed that the prevalence of ce increases with age , resulting that the most of the patients belong to the adult population .
the mean age at the moment of diagnosis , including all localizations , was from 33 to 52 years [ 13 - 18 ] . in our study ,
the mean age of the patients with skeletal manifestation of ce was 40.918.8 years , but among the adults the mean age was 44.716.6 .
higher frequency in aged people could be due to the fact that older people have more chances to be infected with e. granulosus during life , and also , the clinical signs of ce are more probable to appear later in life , as the disease progresses . as it was reported in previous studies [ 15,19 - 21 ] , no significant difference between sex was found . in our study ,
12.2% of patients were under 18 years , with the mean age being 13.04.2 years .
it was consistent with the results of a previous report on the frequency of echinococcosis among children in serbia .
although boys to girls ratio was 1.5:1.0 , no significant difference in the positive rate between sex was found . some other studies reported slight predominance of boys , which could probably be explained by their outdoor playing , closer contact with animals , and low level of personal hygiene , compared to girls .
symptoms associated with bone ce are not specific and often missing , making the diagnosis difficult and sometimes overlooked .
our results showed that 19.5% of patients did not report any symptoms and did not develop any complications .
these asymptomatic patients are not surprising in consideration that hydatid disease is anywhere in the body and often discovered as an incidental finding .
radiological diagnosis of osseous hydatid disease is also difficult because of non - specific findings .
radiography usually reveals single or multiple osteolytic lesions and in some cases shows cortical thinning , osteosclerosis ( fig .
intraosseous foci of hydatid disease predominate in spongious bone tissues and consist of small , separate , and thin - walled cysts .
while these cysts expand , they destroy the surrounding trabeculae and can reach a considerable size . due to cyst enlargement and consequent cortical thinning
, pathological fractures may occur . in the case of connective tissue proliferation and bone sclerosis ,
presentation of ce can be unclear , consisting of mixed radiological signs   ( table 2 ) .
therefore , preoperative diagnosis of skeletal hydatid disease is difficult , and conclusive diagnosis is often made intraoperatively and by histological verification [ 26 - 28 ] .
histological examination of the cyst wall usually reveals an outer chitinous ( or fibrous laminar ) and an inner germinal layer , surrounded by either granulation tissue or fibrous capsule ( fig .
osseous ce is almost invariably related to primary infection and is not the result of extension from neighboring soft tissue lesions . however , some authors report that around 30 - 45% of bone hydatidosis is co - present with the hydatid cysts in other localizations .
we have reported just in 4.9% of cases the presence of hydatid disease in the liver or lungs ; however , there is no statement in our database about the radiological surveys for the possible diagnoses of hepatic or pulmonary hydatidosis .
therefore , it is impossible to exclude the presence of secondary cysts without a whole body scan . in patients with bone ce ,
spine is the most commonly affected site with the frequency of appearance 35 - 50% [ 24,29 , 33 - 36 ] .
our findings ( table 1 ) are in concordance with the ones reported by other authors , with the exception of the cervical region .
it is considered to be relatively silent , slowly progressive disease with a latent period of many years .
early symptoms appear when the small cyst expands and produces significant mechanical compression on surrounding vital structures . at this stage ,
intermittent pain can be present as a symptom . as the disease progresses and the cyst enlarges , patient starts suffering from persistent backache , gradually leading to severe neurologic deficit and varying degrees of weakness of limbs .
pain was present in 50% of patients with spinal hydatidosis in our study ( table 3 ) with the frequency of appearance similar to the ones reported by other authors .
paraplegia is the most serious complication of vertebral hydatidosis appearing in up to 75% of patients with spinal ec .
this compressive effect of spinal ce was present in 37.5% of patients in our study ( table 3 ) .
paraplegia is a neurological complication , occurring as a result of invasive intradural and extradural growth of the cyst .
cysts invade the spinal canal either by direct compression or by ischemic changes in the spinal cord .
radicular pain usually precedes paraparesis by few weeks , progressing rapidly to paraplegia in the thoracic spine , but slowly in the lumbar spine .
our results show that , in some patients , paraplegia can be developed as a compressive effect not just of the cyst , but of the spinal pathological fracture that ce can lead to , as well .
all these data indicate that once formed in the spinal column , hydatid cyst is likely to result in paraplegia during the progression of the disease . in long - term hydatidosis , apart from pain and paraplegia , some cases can result in secondary infections and fistula formation .
. their presence can resolve the disease in the term of surgical treatment , while bacterial superinfection can lead to sterilization of the parasite , limiting the bone destruction .
interestingly , in our study , 1 male patient was reported with bone ce and tuberculosis super - infection . despite ce
shows the spinal tropism causing severe complications , the therapy of spinal ce is still poor .
they are applied in order to retard the recurrences and control the disease but radical surgery is still the keystone .
data from the literature reported that the recurrence rate of bone ce , even after several operations , varied from 30% to 100% .
moreover , the mortality rate of spinal ce is unacceptably high , varying 14 - 58% . when ce is affecting long bones , it is generally the metaphyseal region , extending later to the diaphyses and nearby bones .
the incidence of long bone involvement in our study ( table 1 ) was similar to the results reported by other authors .
therapy is surgical resection , performed if lesion is segmental , otherwise , amputation or disarticulation are the only solutions .
our results ( table 1 ) did not differ from the ones obtained by other authors .
it 's progression is infiltrating and diffuse and may lead to pain , swelling , and stiffness of the hip joint .
this disease is hematogenously seeded along the trabeculae and through the medullar canal , leading to extensive bone lesions .
our results reported that these lesions were mostly complicated with pathological fracture ( 48.8% of all cases ) .
our results reported primary involvement of the spine ( 75% ) , with the predominance of lumbar over thoracic segment . in patients with bone ce
, bone tissue destruction develops through 3 mechanisms ; as the consequence of the cystic lesion expansion and its compression on surrounding tissues , ischemic processes through compression and obstruction of nutrient vessels , and cellular processes like osteoclast proliferation around the compressed bone tissue . in the absence of pericyst formation ,
the wall of the cyst is thin and can not overcome the rigid bone nature .
therefore , the cyst can not assume it typical , spherical shape , and it enlarges irregularly along the path of least resistance . in patients with skeletal ce ,
bone destruction lead to its thinning , extension into soft tissues and , as the worse case , can lead to fracture .
therefore , some authors suggest that all the pathological fractures in endemic countries should be considered as a possible case of ce .

Answer:
although serbia is recognized as an endemic country for echinococcosis , no information about precise incidence in humans has been available .
 the aim of this study was to investigate the skeletal manifestations of hydatid disease in serbia .
 this retrospective study was conducted by reviewing the medical database of institute for pathology ( faculty of medicine in belgrade ) , a reference institution for bone pathology in serbia .
 we reported a total of 41 patients with bone cystic echinococcosis ( ce ) during the study period .
 the mean age of 41 patients was 40.918.8 years . in 39% of patients ,
 the fracture line was the only visible radiological sign , followed by cyst and tumefaction .
 the spine was the most commonly involved skeletal site ( 55.8% ) , followed by the femur ( 18.6% ) , pelvis ( 13.9% ) , humerus ( 7.0% ) , rib ( 2.3% ) , and tibia ( 2.3% ) .
 pain was the symptom in 41.5% of patients , while some patients demonstrated complications such as paraplegia ( 22.0% ) , pathologic fracture ( 48.8% ) , and scoliosis ( 9.8% ) .
 the pathological fracture most frequently affected the spine ( 75.0% ) followed by the femur ( 20.0% ) and tibia ( 5.0% ) . however
 , 19.5% of patients did n't develop any complication or symptom . in this study
 , we showed that bone ce is not uncommon in serbian population .
 as reported in the literature , therapy of bone ce is controversial and its results are poor . in order to improve the therapy outcome , early diagnosis ,
 before symptoms and complications occur , can be contributive .


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:
cyclodialysis cleft is a rare clinical finding , but one that can have significant ocular complications , including decreased vision , shallowing of the anterior chamber , corneal edema , hypotony , choroidal effusions , maculopathy , vascular tortuosity , and optic disc edema .
while it can be caused by surgical manipulation of the eye , it is more frequently a consequence of trauma.1 traumatic injury to the eye results in separation of the ciliary body from the scleral spur , which creates an aberrant outflow pathway for aqueous humor through the suprachoroidal space and often leads to hypotony .
cyclodialysis cleft has been reported to occur in 3.4% of cases of ocular injury or globe rupture.2 additionally , one large review of 291 cases involving cyclodialysis suggested that hypotony occurs 9% of the time.3 medical treatment with atropine ophthalmic drops and laser therapy to promote reattachment of the ciliary body to the scleral spur are options for repair of this entity , but larger and more chronic cyclodialyses often require surgical repair.4,5 because of their rarity , reports on surgical repair techniques in the literature are limited .
we share a novel , simple surgical approach to management of a case of chronic traumatic cyclodialysis cleft with a successful outcome .
a 70-year - old caucasian male followed at the martinsburg veterans affair hospital ophthalmology clinic , martinsburg , west virginia , usa , since 2002 was found consistently to have intraocular pressure ( iop ) asymmetry , with the right eye iop ranging from 615 mmhg and usually having an iop 04 mmhg lower than the left eye .
he was monitored for primary open - angle glaucoma and was on latanoprost eye drops in the left eye for field defects in that eye . in april 2008 ,
the patient s history was significant for trauma to the right eye with a piece of wood over 30 years ago , which was thought to be the cause of the cleft .
while the patient had hypotony , he maintained good visual acuity , ranging from 20/25 to 20/40 , and was therefore observed for approximately 3 years until december 2011 . at this visit ,
his visual acuity dropped to 20/150 and he clinically developed descemet s folds with a shallow anterior chamber and an iop of 02 mmhg .
on dilated fundus exam , he had a shallow choroidal hemorrhage and effusion in the far nasal periphery .
the patient was initially treated medically with atropine and prednisolone acetate 1% ophthalmic drops for approximately 2 months , without improvement in iop and with persistence of choroidal hemorrhage and effusion .
postoperatively , the choroidal effusion resolved , but the patient s iop did not improve . on repeat gonioscopy
therefore , the patient was taken for additional surgical repair of the persistent cleft by the same technique , this time with successful closure .
on postoperative day 1 following the second surgery , the patient complained of severe eye pain and nausea , and was found to have an lop of 58 mmhg .
the patient was treated with topical anti - glaucoma drops and oral acetazolamide , with reduction in the iop to the mid - teens and resolution of his pain . on exam
, there was no distortion of the pupil by sutures and the anterior chamber appeared deep ( figure 1 ) .
the patient was subsequently tapered off the oral acetazolamide and topical drops , with stabilization of the pressure in the mid - teens and maintenance of 20/70 visual acuity at 1 year postoperatively .
final visual acuity was limited by subsequent progression of ocular comorbidities in that eye , including cataract and proliferative diabetic retinopathy .
a nasal conjunctival peritomy was performed , and dissection down to bare sclera was carried out and continued superotemporally to encompass the region of the cyclodialysis cleft .
a 10 - 0 nylon suture on cs175 - 6 needle ( ethicon ) , which is a 7.0 mm -circle needle , was selected for cyclopexy .
interrupted 10 - 0 nylon sutures were radially passed through the corneal side of the limbus , then through the iris root and ciliary body , and carried out through the sclera on the opposite side of the limbus ( figure 3 ) . to ensure that ciliary body was incorporated into each pass ,
the sutures were tugged on intraoperatively and the iris root was evaluated for movement with mechanical pull
. additionally , as more sutures were placed , the eye appeared to become more firm .
we found the needle type to have a curvature and size that was very helpful for the angle and length of the pass required .
a nasal conjunctival peritomy was performed , and dissection down to bare sclera was carried out and continued superotemporally to encompass the region of the cyclodialysis cleft .
a 10 - 0 nylon suture on cs175 - 6 needle ( ethicon ) , which is a 7.0 mm -circle needle , was selected for cyclopexy .
interrupted 10 - 0 nylon sutures were radially passed through the corneal side of the limbus , then through the iris root and ciliary body , and carried out through the sclera on the opposite side of the limbus ( figure 3 ) . to ensure that ciliary body was incorporated into each pass ,
the sutures were tugged on intraoperatively and the iris root was evaluated for movement with mechanical pull .
additionally , as more sutures were placed , the eye appeared to become more firm .
we found the needle type to have a curvature and size that was very helpful for the angle and length of the pass required .
multiple approaches to cleft closure have been described in the literature , including medical management , laser photocoagulation , cryotherapy , trans - scleral diathermy , gas tamponade , and anterior scleral buckle , along with various surgical repair techniques.6 while different surgical approaches have been described , many are technically challenging , particularly in the hypotonous eye . in this case report
, we discuss the repair of a chronic traumatic cyclodialysis with indirect surgical cyclopexy , which we found to be technically easier and less invasive than other reported techniques , but equally successful .
compared to the direct cyclopexy described in a review by ioannidis and barton,6 our indirect technique eliminated the need for direct visualization of the ciliary body , thereby reducing technical difficulty along with bleeding and wound dehiscence risk . additionally , compared to cyclopexy described by mccannel,7 our approach eliminated the additional need for clear corneal stab incision with retrieval of suture , which can also be difficult in a soft , hypotonous eye and may prolong surgical time . while our technique was successful , it required two operations to achieve successful cleft closure with improvement in iop .
our first attempt failed , likely due to the spacing of our sutures in one particular quadrant , which we determined were too far apart .
additionally , we used a needle with less curvature and length initially . we found that spacing the sutures approximately 1 mm apart achieved good apposition of ciliary body to scleral spur and , ultimately , closure of the cleft with restoration of physiologic iop .
the length and curvature of the cs175 - 6 ( ethicon , cincinnati , ohio , usa ) needle also assisted with passage of each suture through the targeted tissues .
the patient s postoperative iop spike after the second surgery was suggestive of successful closure of the cleft.1 additionally , successful closure was later confirmed by gonioscopy .
another challenge to our case was the chronicity of the injury which was sustained 30 years prior to presentation as per the patient s self - reported history .
there was concern that , even with successful anatomic closure , iop and visual function may not be restored due to chronic ischemic changes to the ciliary body . however , our repair achieved both anatomic and functional success , suggesting that even chronic cyclodialysis clefts can be effectively repaired .
delgado et al reported a similar finding in a case of hypotony maculopathy secondary to cyclodialysis that was resolved with cleft closure 7 years later.8 cyclodialysis is a vision - threatening ocular injury that can often be difficult to treat medically .
surgical repair is often necessary but can be technically difficult and challenging , particularly because of how rarely it is encountered in clinical practice .
we present a simple , less - invasive approach to surgical cleft closure that was successful anatomically and functionally .
additionally , we demonstrate clinical success with cleft closure in an eye with chronic hypotony .

Answer:
cyclodialysis cleft is a rare clinical finding and therefore , reports on surgical repair techniques in the literature are limited .
 additionally , hypotony can make repair technically challenging .
 we share a novel , simple surgical approach to management of a case of chronic traumatic cyclodialysis cleft with a successful outcome .


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

Paper text:
migraine is a disabling neurological disorder considered by the world health organization as the 19th leading cause of all years lived with disability among both males and females of all ages , and as the 12th leading cause of years lived with disability among females of all ages .
apart from pain , the disability caused by migraine is aggravated by accompanying symptomatology , such as gastro - intestinal symptoms , the most common being nausea and vomiting , to such an extent that their presence is one of the diagnostic criteria for migraine .
a telephone interview survey of 500 self - reported migraine sufferers found that nausea occurred in more than 90  % of all migraineurs ; nearly one - third of these had nausea during every attack .
vomiting occurred in almost 70  % of all migraineurs ; nearly one - third of these vomited in the majority of attacks .
indeed , 30.5  % of those who had nausea , reported that it interfered with their ability to take their oral migraine medication . the american study ii stated that 73  % of the migraineurs studied reported to have suffered from nausea during attacks and that 29  % had vomited .
one of the most interesting approaches to nausea adopted by traditional chinese medicine and , in particular , by acupuncture is the stimulation of the acupoint pc6 neiguan .
indeed , there is documented evidence as to the efficacy of stimulating this point to alleviate chemotherapy - induced nausea and vomiting ( cinv ) , postoperative nausea and vomiting ( ponv ) and motion sickness , both with acupuncture and acupressure . however , to the best of our knowledge , there are no studies in indexed medical literature as to the efficacy of treating pc6 acupoint for gastrointestinal symptoms in migraine attacks and particularly for nausea . therefore , our preliminary study aimed at verifying if pressure applied to the point pc6 was effective on the presence of nausea during migraine attacks .
a total of 40 female patients were enrolled into this study , after having given their informed consent , and all were suffering from migraine without aura , diagnosed according to the criteria established by the international classification of headache disorders ( ichd - ii ) .
the patients were examined at the women s headache center , department of gynaecology and obstetrics of turin university .
inclusion criteria were : at least two migraine attacks per month for a 1-year period before enrollment ; no more than 15  days of pain per month .
none of the patients were on prophylactic therapy , but were allowed to continue taking their usual symptomatic treatment .
the patients medical history had to include the presence of nausea as accompanying symptomatology of their migraine , documented by a diary noting at least 1  month of attacks with nausea , prior to the inclusion in the study .
subjects taking antiemetics to control their nausea , whether as a single product or present as a compound in a combination product for the control of migraine , were excluded from the study .
the patients enrolled were asked to fill in a dedicated diary recording the details of the length and intensity of the migraine attacks along with the accompanying symptomatology , paying particular attention to the presence of nausea . a device known as the sea - band
the sea - bands are elastic wristbands with a 1  cm protruding round plastic button ; these devices apply continual pressure to the pc6 acupuncture point with the aim of decreasing , or completely eliminating nausea ( fig .  1 ) .
the pc6 point , also called neiguan , is located on the anterior surface of the forearm , 3 fingers widths up from the first wrist crease and between the tendons of the flexor carpi radialis and palmaris longus .
the sea - bands were applied bilaterally on both wrists on the neiguan point , starting from the onset of the migraine attack and left in place for no less than 4  h , or for the whole attack period.fig .
1the localization of the point pc6 neiguan and the correct positioning of the sea - bands the localization of the point pc6 neiguan and the correct positioning of the sea - bands the patients were asked to document a total of six migraine attacks : three without the use of the sea - band wristbands ( phase c , control ) and three with the application of the sea - bands ( phase sb ) .
the sequence of the treatment given for the attacks ( with , or without sea - bands ) was chosen at random according to a scheme provided by the computer and was applied to each single patient .
the section of the diary provided that covered the symptom of nausea was detailed to include information as to the time of symptom onset and symptom resolution , the intensity of nausea at the onset ( t0 ) , at 30 ( t1 ) , 60 ( t2 ) , 120 ( t3 ) and 240 ( t4 ) minutes evaluated on a scale from 0 to 10 , where 0 indicated no nausea and 10 the maximum sensation of nausea .
diary analysis was carried out by an impartial operator who did not know in which attacks the sea - bands were used or not . in this preliminary study ,
the average values of nausea in phases c and sb were calculated at different times throughout the study and a statistical evaluation of the differences between the values obtained in t0 , t1 , t2 , t3 and t4 in the two groups studied was performed using a non - parametric friedman test for repeated measures .
moreover , a non - parametric wilcoxon test for paired data was always performed for each level of the variable   time to evaluate the difference between phase c and phase sb .
this test also took into consideration the average intensity of the three attacks in each of the two phases .
all values given in the following text are reported as arithmetic means ( sem ) .
all analyses were performed using the statistical package for the social sciences ( spss ) software program .
only 32 patients ( mean age 39.65  years , range 1961 ) completed the study .
four patients were lost to follow - up , three handed over a diary with incomplete , unreliable data and one patient did not suffer from any migraine attacks in the 3-month observation period .
the friedman test for repeated measures showed a highly statistically significant reduction in the intensity of nausea in the sb group ( p  <  0.001 ) during treatment ( at t1 , t2 , t3 and t4 ) .
the wilcoxon test for paired data showed that the nausea intensities were significantly higher in phase c than in phase sb ( fig .
2 ) : after 30  min ( t1 c 5.55    0.36 vs. t1 sb 4.6    0.40 , p  =  0.006 ) , 60  min ( t2 c 4.93    0.33 vs. t2 sb 3.11    0.40 p
<  0.001 ) , 120  min ( t3 c 3.48    0.35 vs. t3 sb 1.89    0.31 p
<  0.001 ) and 240  min ( t4 c 2.05    0.28 vs. t4 sb 0.93    0.23 p  <  0.001 ) .
there was no difference between groups at t0 ( t0 c 5.96    0.38 vs. t0 sb 6.36    0.35 ; p  =  0.276).fig .
2average values of nausea score before treatment ( t0 ) , after 30  min ( t1 ) , after 60  min ( t2 ) , after 120  min ( t3 ) , after 240  min ( t4 ) , in phase sb ( black columns ) and in phase c ( white columns ) .
non - parametric wilcoxon test for paired data at t0 , t1 , t2 , t3 and t4 : at t0 p  =  0.276 , n.s . ; at t1 * p  =  0.006 ; at t2 , t3 and t4 * * p  <  0.001 average values of nausea score before treatment ( t0 ) , after 30  min ( t1 ) , after 60  min ( t2 ) , after 120  min ( t3 ) , after 240  min ( t4 ) , in phase sb ( black columns ) and in phase c ( white columns ) .
non - parametric wilcoxon test for paired data at t0 , t1 , t2 , t3 and t4 : at t0 p  =  0.276 , n.s . ; at t1 * p  =  0.006 ; at t2 , t3 and t4 * *
p  <  0.001 the number of patients who reported having had at least a 50  % reduction in the nausea score was : 0/32 at 30  min in phase c and 7/32 in phase sb ( chi square test : p  =  0.16 rr 0.43 ; ci 95  % 0.320.58 ) ; 1/32 at 60  min in phase c and 15/32 in phase sb ( chi square test : p  <  0.001 rr 0.37 , ci 95  % 0.250.56 ) ; 11/32 at 120  min in phase c and 23/32 in phase sb ( chi square test : p  =  0.003 rr 0.44 , ci 95  % 0.240.80 ) ; 21/32 at 240  min in phase c and 27/32 in phase sb ( chi square test : p  =  0.083 rr 0.55 , ci 95  % 0.251.1 ) .
moreover , when the consistency of the treatment ( response in at least two out of three treated attacks ) is taken into consideration , it was reached : in 9 patients ( 28  % ) at 60  min ; in 13 ( 40  % ) at 120  min and in 19 ( 59  % ) at 240  min .
noteworthy , the nausea was significantly reduced by acupressure in 3/3 attacks : in 5/32 patients ( 15  % ) at 60  min ; in 10/32 ( 31  % ) at 120  min and in 17/32 ( 53  % ) at 240  min .
some studies have reported that nausea was present in 73 to more than 90  % of the subjects studied and that almost one - third of these experienced nausea during every attack . moreover
, 30.5  % of the subjects who reported nausea indicated that its severity even interfered with their ability to take their oral migraine medication [ 3 , 4 ] .
traditional chinese medicine and especially acupuncture , stimulates some points that can be considered extremely valid from the point of view of nausea and/or vomiting control .
in particular , the treatment of the acupoint pc6 neiguan may be applied to this aim , even with the application of acupressure alone , as has been validated by various studies .
international literature reports numerous studies on the efficacy of stimulating the acupuncture point pc6 and its capacity to reduce nausea under various clinical conditions . a cochrane review on ponv concluded by stating that , compared with sham treatment , acupoint stimulation significantly reduces nausea ( rr 0.71 , 95  % ci 0.610.83 ) and the need for rescue antiemetics ( rr 0.69 , 95  % ci 0.570.83 ) . from a cochrane review on cinv
, it emerged that acupressure is effective for both mean and worst acute nausea severity , and , therefore , acupressure is able to offer a no - cost , convenient , self - administered intervention for chemotherapy patients to reduce acute nausea .
on the basis of the data obtained in this study , the application of acupressure for the control of nausea during a migraine attack seems to be justified .
indeed , the application of the sea - bands on the acupoint pc6 neiguan was observed to be effective in the control of nausea .
the average nausea scores drop in the sb phase from 6.36    0.35 in t0 , to 4.60    0.39 in t1 , to 3.11    0.40 in t2 , to 1.88    0.31 in t3 and to 0.92    0.22 in t4 . at each time step taken into consideration after the application of the sea - bands , there was a statistically significant improvement over the non - treated phases .
moreover , there was a high percentage of responders to the treatment : i.e. 46.8  % at 60  min ; 71.8  % at 120  min ; 84.3  % at 240  min with a consistent response over time .
even when the fact that our study is both preliminary and open is taken into consideration , the results obtained seem to be encouraging and advocate the continuous application of pc6 acupressure in all migraine attacks with the accompanying symptom of nausea .
further controlled studies are , of course , required to validate the findings of this study .

Answer:
migraine is a disabling neurological disorder , aggravated by accompanying symptomatology , such as nausea .
 one of the most interesting approaches to nausea adopted by traditional chinese medicine is the stimulation of the acupoint pc6 neiguan .
 actually there are no studies in medical literature as to the efficacy of treating pc6 acupoint for gastrointestinal symptoms in migraine attacks .
 our study aimed at verifying if pressure applied to the acupoint pc6 was effective on nausea during migraine .
 forty female patients suffering from migraine without aura were enrolled , if nausea was always present as accompanying symptomatology of their migraine .
 the patients were treated randomly for a total of six migraine attacks : three with the application of a device , the sea - band wristband , which applies continual pressure to the pc6 acupoint ( phase sb ) , and three without it ( phase c ) .
 the intensities of nausea at the onset , at 30 , 60 , 120 and 240  min were evaluated on a scale from 0 to 10 .
 the values were always significantly lower in phase sb than in phase c. also the number of patients who reported at least a 50  % reduction in the nausea score was significantly higher in phase sb than in phase c at 30 , 60 and 120  min . moreover , the consistency of the treatment ( response in at least two out of three treated attacks ) was reached in 28  % patients at 60  min ; in 40  % at 120  min and 59  % at 240  min .
 our results encourage the application of pc6 acupressure for the treatment of migraine - associated nausea .