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:
clubbing of digits , periosteal new bone formation along the shafts of the tubular bones of the extremities and synovial effusions characterize hypertrophic osteoarthropathy ( hoa ) .
primary hoa is a rare syndrome , not associated with other systemic diseases , and usually occurs in childhood , whereas secondary hoa is associated with various underlying pulmonary and non - pulmonary causes , such as bronchogenic carcinoma and right - to - left cardiac shunts . although various intrathoracic malignancies have been associated with the development of hoa , it has been extremely rare for hoa to occur in a patient with a malignant neoplasm of the thymus .
since the first case was reported in 1939 , a few cases have been reported worldwide .
recently , we experienced a case of hoa with a thymic carcinoma , and herein report the case with a review of the literature .
a 63-year - old woman was referred to our hospital because she had a chief complaint of both leg pains .
the pain was noted several months ago without any prior history , such as trauma and it was wax and wane and slowly progressing .
she did not have any other systemic symptoms , such as weight loss or fever .
her past and family history was not contributory except for the diagnosis of hypertension one year before and antihypertensive medication thereafter .
physical examination at presentation was normal except for tenderness of both the lower extremities and clubbing of the fingers ( figure 1 ) .
laboratory investigation showed no abnormal findings except for mild anemia ( hgb 10.2 g / dl ) .
the plain radiograph of both lower legs showed cortical thickening along the shaft of the tibia and the bone scan revealed diffusely increased uptake along the cortex of both lower extremities ( figure 2 ) .
the radiologic findings were not consistent with bone metastasis but with hypertrophic osteo arthropathy ( hoa ) . in order to find the possibility of the secondary hoa
, we performed a chest radiograph , which revealed a left mediastinal bulging mass ( figure 3 ) .
the chest ct scan confirmed the presence of a soft tissue density mass in the anterior mediastinum with pericardial effusion ( figure 4 ) . for a pathologic confirmation
microscopic examination showed irregular nests of poorly differentiated malignant cells with hyperchromatic and irregular nuclei ( figure 5 ) . according to the microscopic examination
hypertrophic osteoarthropathy ( hoa ) begins as periostitis followed by new bone formation , which is seen as a solid lamination involving the proximal and distal diaphyses of the tibia , fibula , radius , ulna and , less frequently , the femur , humerus , metacarpals , metatarsals and phalanges .
as the process of new bone formation progresses , these changes extend to involve metaphyses .
initial radiological finding is a radiolucent area between the new bone formation and subjacent cortex . in the long - standing process ,
para - cortical increase of uptake is a characteristic finding of the bone scan study .
proliferation of connective tissue occurs in the nail bed and volar pad of the digits , giving rise to clubbing .
clubbing is almost always a feature of hoa but can occur as an isolated manifestation .
this isolated manifestation of clubbing may represent an early stage of hoa , so it may have the same clinical significance as hoa .
secondary hoa occurs in association with a variety of underlying disorders , including heart , lungs , pleura , gastrointestinal tract and liver .
although several theories have been suggested for the pathogenesis of hoa , its underlying mechanism is still controversial .
. then , most platelets are produced in the lungs , especially , in pulmonary capillaries , by physical fragmentation of cytoplasms of megakaryocytes , because they are large and can not pass unchanged through the normal lung vasculature , which is narrow . in patients with disorders associated with right - to - left shunts , such as cyanotic congenital heart disease and severe liver cirrhosis ( where the pulmonary circulation is abnormal due to the development of arteriovenous connections in the lungs ) , these megakaryocytes and large platelet particles may bypass the lung and reach the distal extremities , leading to the interaction with endothelial cells .
this interaction in the distal portion of extremities would then result in degranulation and the production of platelet - derived growth factor ( pdgf ) and other factors , causing proliferation of connective tissue and periosteum .
hoa has been associated with many different benign and malignant intrathoracic tumors and occurs in 510% of patients with intrathoracic malignancies including lung cancer and pleural tumors .
the most frequently associated cancer is non - small cell lung cancer . in these situations ,
the tumor itself may supply a vascular shunt from right to left without being filtered through pulmonary capillaries .
megakaryocytes are larger in lung cancer than normal and may have increased pdgf synthetic activity .
the relatively frequent association of hoa with lung cancers suggests that some additional factors may be involved in the development of hoa in lung cancer .
growth hormone secretion by bronchogenic carcinoma was suggested for the underlying mechanism of the occurrence of hoa and clubbing .
reported an elevated serum growth hormone level and growth hormone - releasing hormone ( ghrh)-producing cells in a non - small lung cancer patient with hoa . recently , vascular endothelial growth factor ( vegf ) has been implicated in the pathogenesis of hoa .
silveira et al . reported that plasma levels of vegf were significantly higher in patients with primary hoa and in those with lung cancer associated with hoa , compared with healthy control .
in addition , serum vegf levels were higher in patients with lung cancer and hoa compared with lung cancer patients without hoa .
thymic carcinoma is a rare epithelial neoplasm of the thymus that has a poor prognosis . in the past ,
invasive thymoma has a similar cytological feature to benign thymoma but thymic carcinoma exhibits malignant cytological features .
there has been no explanation for the mechanism of the coexistence of thymic carcinoma and hoa .
reported that serum levels of vegf and basic fibroblast growth factor ( bfgf ) were significantly elevated in patients with thymic carcinoma compared with those in healthy volunteers .
therefore , the results suggested that serum vegf and bfgf might serve as markers for thymic carcinoma and these angiogenic factors could be associated with the invasiveness of thymic carcinoma . on the other hand , lauriola et al
thus , we measured the serum level of vegf in the patient by using human vegf elisa ( enzyme - linked immunosorbent assay ) kit ( amersham pharmacia biotech , buckinghamshire , uk ) .
serum vegf level was elevated in the patient ( 1,120 pg / ml ) compared with the mean value of healthy volunteers ( 388  68.9 pg / ml ) .
we also measured the serum level of the growth hormone in the patient . although it might not have significance because provocation and suppression tests were not done , the serum level of the growth hormone ( 5.6
ug / l ) was not increased compared with a normal control value ( < 10 ug / l ) .
however , further study is warranted to evaluate the mechanism of hoa and the relationship between hoa and thymic carcinoma .
the patient was initially treated with external radiation therapy because of poor resectability and increased operative risk .
, new metastatic brain lesion was observed in a brain mri that was performed when the patient complained of neurologic symptoms .
brain metastasis was known to be rare in thymic carcinoma , so it was also an unusual presentation of thymic carcinoma .
because high serum vegf has been known to relate with metastasis and invasiveness of cancer and poor clinical outcome , brain metastasis might be associated with elevated serum vegf in the patient .
considering the possible relationship between serum vegf and the development of hoa , it may be suggested that hoa could be a poor prognostic sign in thymic carcinoma . in summary , we experienced a rare case of poorly differentiated thymic carcinoma associated with hoa and suggest a possible association between thymic carcinoma and hoa .

Answer:
hypertrophic osteoarthropathy is characterized by clubbing and periosteal new bone formation along the shaft of the long bones of the extremities .
 although various intrathoracic malignancies have been associated with the development of hoa , it has been extremely rare for hoa to occur in a patient with a thymic carcinoma .
 recently , we experienced a 63-year - old woman diagnosed as a thymic carcinoma with hypertrophic osteoarthropathy .
 she had both digital clubbing and cortical thickening in her lower extremities identified radiologically .
 we herein describe this case with a review of the literature .


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 vertebrate immune system employs a wide variety of antigen - specific receptors - the immunoglobulins and t - cell receptors - to recognize and neutralize foreign invaders .
the receptor diversity necessary to recognize an almost limitless universe of potential pathogens is created by a site - specific dna rearrangement process termed v(d)j recombination .
this unique reaction assembles the receptor genes from separate v , d and j gene segments , a process ostensibly restricted to lymphocytes at a certain stage of their development . in this view
, the prediction is that the germline dna of a given organism should contain unrearranged receptor genes ; rearranged versions of the genes should exist only in lymphocytes .
this prediction was satisfied by examination of germline and lymphocyte dna samples from a variety of familiar vertebrates , including mice , humans , birds , and common farm animals .
the fly in the ointment , however , appeared with an analysis of receptor genes in the germline of evolutionarily distant organisms - the cartilaginous fishes . in these primitive vertebrates ,
many of the immunoglobulin genes are actually found pre - rearranged in the germline ( reviewed in ) .
this suggests that the v(d)j recombinase may actually be an evolutionary force , a notion that is strongly supported by recent studies in the nurse shark .
the evolutionary consequences of these site - specific germline gene rearrangements may reach far beyond the immune system .
the recombination machinery recognizes dna sequences called recombination signal sequences ( rsss ) adjacent to each gene segment .
each rss consists of conserved heptamer and nonamer motifs separated by 12- or 23-nucleotide ' spacer ' sequences .
the recombinase is made up of two proteins , rag-1 and rag-2 , which , in conjunction with the non - specific dna - bending proteins , hmg-1 or hmg-2 , recognize the rss and catalyze site - specific dna cleavage ( see   for review ) .
cleavage requires both rag-1 and rag-2 , and co - expression of these proteins is thought to be limited to developing lymphocytes ( , and reviewed in ) . as illustrated in figure 1 , the rag proteins introduce a double - strand dna break precisely between the v , d or j coding sequence and the rss , generating two types of dna ends : blunt signal ends ( which terminate in the rss ) and covalently sealed ( hairpin ) coding ends ( which terminate in the v , d or j element ) . after cleavage ,
the two signal ends are joined , producing a signal joint . prior to joining the coding ends ,
the hairpins must be opened ; joining generates a coding joint that may have lost or gained nucleotides .
the precise details of the end - processing and joining reactions remain obscure , and are not important for this story ; it is clear , however , that multiple , non - lymphoid - specific dna repair proteins are involved .
one detail that is important is that the opening of the hairpins frequently occurs ' off center ' , leading to palindromic single - stranded tails . joining of these ends can give rise to a characteristic signature in the completed junction : a palindromic , or p nucleotide , insertion .
another type of junctional insertion , n ( non - templated ) nucleotides , are added randomly by the enzyme terminal deoxynucleotidyl transferase .
thus , coding joints formed by v(d)j recombination have several distinguishing characteristics , including variable loss of nucleotides and the frequent presence of either n nucleotides , p nucleotides , or both .
v(d)j recombination bears many striking parallels to the movement of certain transposable elements , both in its general form and in important mechanistic details of the reaction ( reviewed in ) .
in fact , recent biochemical experiments have shown that purified rag proteins can catalyze transposition in the test tube , integrating a dna fragment bearing signal ends into a target duplex ( figure 2 ) .
this reaction does not require specific dna sequences in the target and , like many transposition reactions , creates a characteristic ' footprint ' : upon integration , three to five nucleotides of target dna are duplicated on either side of the transposon .
it should be noted that there is , as yet , no firm evidence that rag - mediated transposition events can occur in living cells .
early on , it was suggested that the v(d)j recombination system might have arisen by the fortuitous integration of a transposable element into an ancestral antigen - receptor gene .
this hypothesis was strengthened by the discovery that the rag genes are tightly linked , and by the finding that the rag proteins can act as a transposase .
thus , a plausible model for the acquisition of the v(d)j recombination system during vertebrate evolution is the integration of a transposable element carrying the linked rag genes into a primordial antigen - receptor gene in an ancestral jawed vertebrate , approximately 450 million years ago ( reviewed in ) .
presumably , this initial integration event created the first rearranging antigen - receptor gene ; subsequent gene duplication events then created the multiple immunoglobulin and t - cell receptor loci . to learn more about the evolutionary origins of the combinatorial immune system ,
several laboratories have characterized antigen - receptor loci from a wide variety of species , including the cartilaginous fishes - the living jawed vertebrates most phylogenetically distant from mammals .
the immunoglobulin loci of sharks and skates contain some fairly typical antibody genes , with multiple v , d and j elements .
surprisingly , however , many of the immunoglobulin genes are already partially or fully rearranged in the germline ( see   for review ) .
recently , pre - rearranged immunoglobulin genes were also found in a teleost fish , the channel catfish .
one possibility is that they are descendants of the ancestral antigen - receptor gene , before integration of the putative transposable element .
a second possibility is that these genes arose from rag - mediated dna rearrangement events that occurred in the germline , an operation that violates the precept that the rag recombinase is functional only in developing lymphocytes . a recent paper by lee et al
.   addresses these questions by examining immunoglobulin genes in the nurse shark . the nurse shark ns4 immunoglobulin light chain gene family provided very useful information , as there are several highly homologous genes present both in pre - rearranged and unrearranged forms .
these features allowed the authors to evaluate sequences in sufficient detail to ascertain whether the genes bear characteristic features of v(d)j recombination or footprints of transposition .
their analysis revealed that the pre - rearranged genes did indeed contain tell - tale signs of coding joints formed by v(d)j recombination , including both n nucleotides and p nucleotides , which strongly suggest a hairpin intermediate .
the presence of these features in several junctions suggests several independent germline v(d)j recombination events , although analysis of multiple unrelated individuals suggests that these events are not frequent .
importantly , analysis of the unrearranged ns4 genes failed to detect the target site duplications that are hallmarks of transposon insertions .
thus , while the pre - rearranged ns4 genes appear to have been derived from unrearranged genes by germline v(d)j recombination , there is as yet no evidence to support the hypothesis that the unrearranged genes were derived from the pre - rearranged genes by insertion of a transposable element ; this is discussed in a recent review by lewis and wu .
the recent studies of the nurse shark ns4 genes strongly suggest that v(d)j recombination events can occur in the germline .
moreover , phylogenetic analysis indicates that these events occurred recently ( at least from an evolutionary perspective ) , some time within the last 7 million years . what evolutionary benefit might there be in germline recombination events ?
pre - rearranged immunoglobulin genes may confer certain advantages over genes that must be assembled by recombination in individual lymphocytes .
for example , pre - rearranged genes may encode receptors capable of recognizing common pathogens likely to be encountered during the neonatal period , before the development of a full repertoire of rearranged antigen receptors .
furthermore , germline joining could have contributed to evolution of gene segment clusters , and possibly the evolution of d segments .
to my knowledge , co - expression of both rag proteins outside the lymphoid system has not been reported , but rna species encoding rag-1 and rag-2 have been detected in zebrafish ovary and xenopus oocytes , respectively . even if the recombinase is not normally expressed in these tissues , though , inappropriate expression might occur occasionally , perhaps as a result of improper reprogramming of tissue - specific gene expression during development .
if rag expression does occur during the development of germ cells , another important question arises : how are loci chosen for rearrangement ? during normal b - lymphocyte differentiation , immunoglobulin loci undergo a carefully orchestrated series of rearrangements .
d to j rearrangements of the heavy - chain genes occur first , followed by v to dj rearrangements , followed in turn by rearrangement of the light - chain genes .
the carefully ordered sequence of rearrangements is critical for proper lymphocyte differentiation and is thought to be controlled by accessibility of the loci , mediated by alterations in chromatin structure ( reviewed in ) .
rsss present in antigen - receptor loci that have not been ' targeted ' for rearrangement are used rarely , if at all .
the careful control of locus accessibility seen in lymphocyte differentiation may not be recapitulated in the development of germ cells - after all , these cells are not supposed to be expressing rag recombinase activity . furthermore , the v(d)j recombinase is not particularly picky about the sequences it can target for rearrangement .
lewis and co - workers have found that ' cryptic ' sites capable of supporting rearrangement occur at least once in every 600 base pairs of a commonly used plasmid sequence , and they have estimated that there are at least 10 million such sites in the mammalian genome .
in fact , there is evidence that cryptic sites in the mammalian genome can serve as targets for rag - mediated rearrangement in lymphocytes ( reviewed in ) .
thus , it is possible that rag expression during germ - cell development might cause rearrangements of regions of the genome far removed from the immune receptor loci .
these considerations suggest that the v(d)j recombinase might have been ( and could still remain ) a significant force shaping vertebrate evolution , by catalyzing v(d)j - like rearrangements and , perhaps , transposition .
comparison of genome sequences from a variety of organisms may allow some aspects of this notion to be tested .
first , the rag proteins bind to the rsss ( triangles ) and bring them together into a synaptic complex .
cleavage ensues , generating a pair of blunt signal ends and a pair of dna hairpin coding ends . joining of these ends generates signal and coding joints , respectively .
a fragment of dna generated by rag - mediated cleavage , with rag proteins bound to the signal ends ( the donor ) , can capture another dna duplex ( the target ) .
the rag proteins bound to the signal ends catalyze integration into the target , generating a characteristic duplication of the target sequence at the integration site ( arrowheads ) .
i thank vicky brandt for editorial assistance and mark landree for critical comments on the manuscript .
work in the author 's laboratory is supported by the howard hughes medical institute and by grants from the national institutes of health , the human frontiers science program , and the american cancer society .

Answer:
the antigen - receptor genes of vertebrates are rearranged by a specialized somatic recombination mechanism in developing lymphocytes - and , unexpectedly , also in the germline of cartilaginous fishes .
 the recombination system that carries out these dna rearrangements may thus be a significant evolutionary force , perhaps not limited to rearrangements at antigen - receptor loci .


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:
besides its classical role in calcium and bone homeostasis , vitamin d is considered a potent immunomodulator that can affect the pathogenesis of several autoimmune diseases .
our aim is to evaluate the effect of vitamin d correction to a patient with new onset graves disease ( gd ) with an underlying vitamin d deficiency .
we describe the effect of vitamin d3 on untreated graves disease with vitamin d deficiency .
a healthy saudi woman in her 40s sought consultation with a three - month history of palpitation .
she denied any history of heat intolerance , weight loss , menstrual irregularity or sweating .
. physical examination revealed a mild diffusely enlarged and non - tender thyroid gland with no bruit .
the initial thyroid function test , which was done in an outside hospital , revealed a tsh , 0.01 miu / l ; ft4 , 22.5
vitamin d 25-oh level was done in our hospital and showed a result of 26.0 nmol / l with a tsh , 0.013 miu / l ; ft4 , 16.7
tc-99 m thyroid scintigraphy demonstrated an enlarged thyroid gland with increased radiotracer trapping and heterogeneous distribution .
the patient was given only oral cholecalciferol 4000 iu per day since november 2012 ( prescribed by an outside hospital ) then from may 2013 onwards she was given 50,000 iu per month .
follow - up laboratory exams revealed improved vitamin d levels as well as tsh and ft4 .
vitamin d deficiency may exacerbate the onset and/or development of gd and correction of the deficiency may be able to reverse it .
however , further prospective clinical studies will be needed to define the role of vitamin d treatment in gd .
more recently , vitamin d has been shown to be a modulator in both innate and adaptive immunity.1 there is a well - established link between vitamin d deficiency and various autoimmune diseases , including type 1 diabetes mellitus ( t1 dm ) , systemic lupus erythematosus ( sle ) , rheumatoid arthritis ( ra ) , inflammatory bowel disease ( ibd ) , and multiple sclerosis ( ms ) .
furthermore , it has been found that the supplementation of vitamin d can prevent the onset and/or development of different kinds of autoimmune disorders in human beings and animal models.2 in addition , it has been shown that the prevalence of vitamin d deficiency is common in patients with graves disease ( gd),3 and is associated with higher thyroid volume.4 in our case report , we evaluated the effect of vitamin d correction to a patient with new onset gd with an underlying vitamin d deficiency .
a healthy saudi woman in her 40s sought consultation with a 3 months history of palpitation .
she denied any history of heat intolerance , weight loss , menstrual irregularity , diarrhea , or sweating .
there was no personal or family history of thyroid disease and no specific medication history .
physical examination revealed a mild diffusely enlarged and non - tender thyroid gland with no bruit .
the initial thyroid function test , which was done in an outside hospital , revealed a tsh , 0.01 miu / l ; ft4 , 22.5
vitamin d 25-oh level was done in our hospital and showed a result of 26.0 nmol / l with a tsh , 0.013 miu / l ; ft4 , 16.7
anti - thyroid antibodies showed a tg , 17.1 iu / ml ; tpo , 0.19 iu / ml with a positive tsh receptor antibody .
tc-99 m thyroid scintigraphy demonstrated an enlarged thyroid gland with increased radiotracer trapping and heterogeneous distribution ( fig .
the patient was given only oral cholecalciferol 4000 iu per day since november 2012 ( took it from an outside hospital ) then from may 2013 onwards she was given 50,000 iu per month .
the serial thyroid function tests , vitamin d levels , and titer autoantibodies are summarized in table 1 .
follow - up laboratory exams revealed improved vitamin d levels as well as tsh and ft4 .
written informed consent was obtained from the patient for the publication of this case and accompanying images .
it has become apparent that multiple factors contribute to the etiology of gd , including genetic and environmental factors .
these activated t cells in turn increase the secretion of thyroid - specific autoantibodies from b cells .
the prevalence of vitamin d deficiency was reported to be common in patients with gd.3 whether vitamin d deficiency has a causal relationship with gd remains a controversial issue .
misharin et al.5 observed that vitamin d deficiency was found to modulate graves hyperthyroidism induced in balb / c mice by thyrotropin receptor immunization . in this study ,
balb / c mice on a vitamin d deficient diet were more likely to develop persistent hyperthyroidism than other mice receiving adequate vitamin d supply . in another study ,
combination treatment with methimazole and vitamin d3 ( 1,25 ( oh)2d ) in patients with gd has more rapid euthyroidism achievement compared with patients receiving methimazole alone.6 in addition , vitamin d supplementation has been shown to inhibit inflammatory responses in human thyroid and t cells.7 interestingly , vitamin d deficiency is found to be associated with higher thyroid volume in patients with newly onset gd.4 it has been recently discovered that vitamin d - receptor gene and vitamin d - binding protein gene polymorphisms are associated with gd.8,9
our present case supports the current literature and strongly suggests that vitamin d deficiency may exacerbate the onset and/or development of gd and correction of which may be able to reverse it .
however , further prospective clinical studies will be needed to define the role of vitamin d treatment in gd .

Answer:
objectivebesides its classical role in calcium and bone homeostasis , vitamin d is considered a potent immunomodulator that can affect the pathogenesis of several autoimmune diseases .
 our aim is to evaluate the effect of vitamin d correction to a patient with new onset graves disease ( gd ) with an underlying vitamin d deficiency.methodwe describe the effect of vitamin d3 on untreated graves disease with vitamin d deficiency.resultsa healthy saudi woman in her 40s sought consultation with a three - month history of palpitation .
 she denied any history of heat intolerance , weight loss , menstrual irregularity or sweating .
 she has a history of chronic muscle aches and pains . physical examination revealed a mild diffusely enlarged and non - tender thyroid gland with no bruit .
 she had no signs of graves ophthalmopathy . in laboratory examinations ,
 the initial thyroid function test , which was done in an outside hospital , revealed a tsh , 0.01 miu / l ; ft4 , 22.5
 pmol / l and ft3 , 6.5 pmol / l .
 vitamin d 25-oh level was done in our hospital and showed a result of 26.0 nmol / l with a tsh , 0.013 miu / l ; ft4 , 16.7
 pmol / l ; and ft3 , 3.8 pmol / l .
 tsh receptor antibody was positive .
 tc-99 m thyroid scintigraphy demonstrated an enlarged thyroid gland with increased radiotracer trapping and heterogeneous distribution .
 the patient was given only oral cholecalciferol 4000 iu per day since november 2012 ( prescribed by an outside hospital ) then from may 2013 onwards she was given 50,000 iu per month .
 follow - up laboratory exams revealed improved vitamin d levels as well as tsh and ft4 .
 she eventually improved both clinically and biochemically with a satisfactory outcome.conclusionvitamin d deficiency may exacerbate the onset and/or development of gd and correction of the deficiency may be able to reverse it .
 however , further prospective clinical studies will be needed to define the role of vitamin d treatment in gd .


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:
allergic rhinitis ( ar ) is a recurrent or chronic allergen specific , ige - mediated hypersensitivity disorder affecting the nasal lining and characterized by nasal congestion , rhinorrhea , sneezing , nasal itchiness , and/or postnasal drip .
limited studies on ar exist and epidemiological studies based on the allergic rhinitis and its impact on asthma ( aria ) criteria are lacking . according to aria guidelines , allergic rhinitis is defined if two or more symptoms of rhinorrhea , nasal itching , nasal blockage , or sneezing are present in a patient for at least one hour per day for 4 days or more a week and also for 4 or more weeks a year . based on duration ,
symptoms are intermittent ( < 4 days / week or < 4 weeks / year ) or persistent ( > 4 days / week or > 4 weeks / year ) .
severity grading is either mild or moderate - severe based on the absence or presence of sleep disturbance and impairment in daily activities , school , and work , respectively .
skin prick test ( spt ) is a standardized test widely used in the diagnosis of suspected cases of ige - mediated allergy .
generally accepted indications for spt include allergic rhinitis , asthma , atopic dermatitis , suspected food allergies , latex allergy , and conditions in which specific ige is suggested to play a role in the pathogenesis .
it provides information about the presence of specific ige to protein and peptide antigens ( allergens ) .
identification of common aeroallergens in an area is necessary , in order to educate the patient on what allergens to avoid and also help find the best formulation of allergen immunotherapy for effective ar treatment . to date
, there has been no information regarding the common allergen from the federal capital territory ( fct ) of nigeria , abuja .
the aim of this study is to identify the clinical profile of ar patients according to aria guidelines and investigate the common allergens in abuja , nigeria .
this cross - sectional study was conducted for a period of 18 months ( march 2014 to september 2015 ) .
sample population was based on the ar patients referred to the allergy clinic , affiliated to medicaid radiodiagnostic center , wuse 2 , abuja .
patients were consecutively recruited ( convenient sampling method ) and fall within the age range of 5 to 65 years .
they were patients with a positive history of nasal inflammation ( at least 2 or more of the following symptoms : rhinorrhea , sneezing , nasal blockage , nasal itchiness , and postnasal drip ) for at least one - year duration .
patients ' symptoms were categorized as  sneezers - runners  and  blockers  based on the predominant complaint . patients
whose chief complaints include sneezing , rhinorrhea , and itchy eyes and nose were classified as  sneezers - runners ,  while those with nasal blockage , postnasal drip , and difficulty with breathing were classified as  blockers .
spt was performed on patients who have stopped taking antihistamines at least 5 days before the test , while patients with severe dermatographism were excluded from the study .
a total of 22 allergens were used in this study ; these allergens make up the subtropical prick test batch of alk - abello , denmark .
these include tree pollen ( oak , pecan , black willow , pine , cypress , red cedar , and box elder ) , weed pollen ( pigweed , ragweed , and plantain ) , grass pollen ( bermuda , bahia , johnson grass , and grass mix ( meadow , orchard , timothy , june , rye , and redtop ) ) , house dust mites ( dermatophagoides pteronyssinus and dermatophagoides farinae mix ) , molds ( alternaria tenuis , c. cladosporioides , penicillium mixed , and aspergillus mixed ) , animal dander ( cat hair and dog epithelium ) , and cockroach extracts . of the pollen allergen
used in this study , about 80% of the plants are present in abuja environment .
spt was performed according to international guidelines   as a one - time test done on two forearms with lancets and allergens ( alk - abello skin prick test kit , berge alle , 2970 hrsholm . ,
histamine hydrochloride ( 1% ) and normal saline ( 0.9% ) were used as positive and negative controls , respectively .
the patients ' data was classified according to the aria guidelines and spt results were analysed in allergen - clusters of tree pollen , weed pollen , grass pollen , house dust mites ( hdm ) , molds , animal dander , and cockroach extracts .
spss 16 software ( chicago illinois ) was used in the analysis and p value of less than 0.05 was considered significant .
a total of 96 new patients with suspected allergic rhinitis presented at the allergic clinic within the study period .
only 74 patients from these had a positive spt result and were enrolled into the study .
twenty - one respondents ( 28.4% ) were categorized as children ( 5 to 17 years of age ) with a male  :  female ratio of 1.3  :  1 .
the majority of the study population resided in abuja municipal area council ( amac ) territory which is basically the city center .

the prevalence of asthma , urticaria , and conjunctivitis as comorbidity was lower when compared with comorbidity such as hypertension .
positive family history of atopy was seen in 56.8% of patients and 20.2% of the subjects had animal contact within their environment . according to predominant symptoms , the proportion of  sneezers - runners  was higher than  blockers
 sneezers - runners  tend to have persistent ar , while  blockers  symptoms were more intermittent ( p = 0.007 ) .
based on aria guidelines , most patients ( 67.2% ) had moderate - severe ar ( intermittent and persistent ) and this was significantly related to animal exposure ( p = 0.035 ) and not to age , gender , or family history of atopy .
there was a significant association between ar severity and the predominant complaints ( table 2 ) by the patients ( p = 0.005 ) .
moderate - severe persistent ar was more common among  sneezers ,  while moderate - severe intermittent ar was common with the  blockers .
 there was no significant association between ar severity and the presence of asthma ( p = 0.26 ) or family history of atopy ( p = 0.19 ) .
house dust mites allergen yielded the highest number of positive responses ( 22.6% ) followed by tree pollen ( 16.8% ) .
weed pollen allergen yielded the least ( 7.4% ) , while animal dander and fungi allergen both came to 13.1% each ( figure 1 ) .
also , house dust mites was significantly related to a positive family history of atopy ( p = 0.035 ) .
there was no significant difference between the positive skin tests and gender as well as history of asthma .
furthermore , no relationship was observed between the allergens tested and duration of ar ( intermittent and persistent ) , as shown in table 3 .
most of the patients with a positive spt were in the persistent ar category ( 66.2% ) .
the number of allergens which produced a positive skin response from each patient was closely distributed .
the highest was reaction to 3 or more allergens ( 35.1% ) followed by reaction to 2 allergens ( 33.8% ) and then to one allergen ( 31.1% ) , as shown in table 4 .
statistical analysis did not reveal a relationship between ar severity and skin prick test reactivity .
the prevalence of ar is increasing worldwide , yet it remains underdiagnosed and undertreated especially in developing countries .
a self - reported survey of ar among adult nigerians observed a prevalence of 29.6% and a mean age of 29.3 years   which was close to the mean age observed in this study . the number of patients in this study with concomitant asthma is lower than other nigerian studies [ 7 , 8 ] and this could be due to small sample size or poor awareness of asthma symptoms by the respondents .
.   observed a low level of awareness of asthma by patients in nigeria , such that most people with asthma symptoms do not present to the physician but prefer unorthodox means of medical care . about a third of the children ( 33% ) in this study reported persistence or recurrence of rhinitis symptoms after adenoidectomy .
the slight female predominance observed in our adult ar patients is in consonance with the findings in malaysia and india [ 3 , 5 ] .
we also corroborated the study that showed a higher male predominance of ar among children .
we recorded a higher proportion of  sneezers - runners  to  blockers  similar to the findings by lee et al .   and shah and pawankar   but different from study by deb et al .
sneezers  having persistent ar and more  blockers  having intermittent ar ( p = 0.007 )
. we could not establish any relationship between these predominant symptoms and the aeroallergens used in this study .
blockers  were more sensitized to hdm , house dust , and fungi , while
this study observed that a majority of ar patients were categorized as moderate - severe persistent ar , according to aria classification , while the least were mild intermittent ar .
this has been observed by most studies [ 3 , 5 , 12 ] with warm climate like nigeria .
a constantly high environmental temperature and humidity could lead to a persistently high concentration of indoor and outdoor allergens all year round .
there could also be a selection bias , since patients would more likely present for treatment when their condition is severe and persistent .
no relationship was established between the type of ar and the allergen to which the patients were sensitized .
this was similarly observed in a national , cross - sectional study of ar patients in mexico .
the most common aeroallergen was house dust mites , followed by tree pollen as was seen in other spt studies in nigeria [ 8 , 1416 ]
. however , there are no ar studies in relation to tree pollen sensitivity to compare with .
this study highlights the importance of pollen allergens among ar patients living in nigeria , a tropical country with high humidity .
this supports an earlier observation of increased tree pollen sensitization in tropical environment   and emphasizes the need for increased research in this aspect .
further studies are needed to record the season of pollination of the different pollens found in abuja and to correlate these findings with the timing of symptoms in sensitized patients .
thus a patient with positive sensitization to house dust mites could also be sensitized against pollen , insect , or fungi allergens .
this supports the argument that time of exposure ( seasonal or perennial ) does not properly define ar patients   and also creates difficulty with regard to immune therapy via hyposensitization .
in addition , there is need for the use of spt that incorporates wide variety of allergens within a specific environment in order to avoid skipping some of the sensitive allergens attributed to each individual .
, most ar patients presenting for treatment in abuja , nigeria , have moderate - severe persistent ar and show similar spt sensitization pattern with other countries having similar climatic conditions .
sensitization patterns are not related to aria classification or any predominant ar symptoms but rather may rely on the environmental condition of study area and genetic makeup of the study population .

Answer:
allergic rhinitis ( ar ) is prevalent in nigeria , though little information exists on the allergen .
 we assessed the clinical features of ar patients in our environment based on the allergic rhinitis impact on asthma ( aria ) classification .
 only patients with positive skin prick test ( spt ) were recruited .
 seventy - four patients participated in the study .
 ar and asthma comorbidity were observed in 13.5% .
 the proportion of  sneezers - runners  was higher than  blockers  with significantly more
 sneezers - runners  having persistent ar ( p = 0.007 ) .
 no relationship was established between these predominant symptoms and the aeroallergens used in this study .
 intermittent mild and moderate / severe ar were evident in 13.5% and 31.1% , while persistent mild and moderate / severe were seen in 20.3% and 35.1% , respectively .
 house dust mites allergen yielded the highest number of positive responses ( 22.6% ) followed by tree pollen ( 16.8% ) .
 no relationship was observed between the allergens tested and ar severity .
 majority of patients were oligosensitive ( 33.8% ) and polysensitive ( 35.1% ) and were not significantly associated with ar severity ( p = 0.07 ) .
 most ar patients presenting for treatment in abuja , nigeria , had moderate - severe persistent ar and showed similar spt sensitization pattern with countries having similar climatic conditions .
 sensitization patterns were not related to aria classification or predominant ar symptoms .


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 47-year - old lady presented to us for evaluation of persistent hydroureteronephrosis on imaging .
3 months earlier , she had been treated at another center for a 3 month history of right colicky flank pain associated with malaise and fever , without any lower urinary tract symptoms .
investigations at that time showed raised creatinine ( 4.8 mg / dl ) and bilateral hydroureteronephrosis on ultrasonography .
she was treated with antibiotics for suspected pyelonephritis and serum creatinine showed a downward trend , reaching a nadir creatinine of 1.41 mg / dl over the next 3 months .
her medical history was significant for diabetes for 8 years , hypothyroidism for 4 years and hypertension for 3 years .
evaluation at our centre revealed 2 - 4 red blood cells and 6 - 8 white blood cells in the urine . computed tomography ( ct urography ) showed bilateral hydroureteronephrosis with global caliectasis , right and left ureter were dilated till s1 and l5 vertebral level respectively , at which point there was a hyperdense enhancing lesion within the ureteric lumen , associated with ureteric wall thickening , periureteric and retroperitoneal fat stranding and normal ureteric caliber below this level .
she was planned for cystoscopy and bilateral retrograde pyelography but required emergency bilateral percutaneous nephrostomy for sudden onset anuria , breathlessness , azotemia ( serum creatinine 11.1 mg / dl ) , hypertensive crisis ( blood pressure 210/110 ) and flash pulmonary edema .
she had post obstructive diuresis and the creatinine level reached a nadir of 1.53 mg% at 2 weeks .
cystoscopy and retrograde pyelography revealed bilateral mid - ureteric narrowing [ figure 2 ] , which persisted on balloon dilatation .
a ureteroscope could be negotiated till the lower level of narrowing on both sides and revealed mildly edematous urothelium ; no obvious luminal lesion was identified .
intramural pathology compressing the ureteric lumen symmetrically on both sides was considered , and she was taken up for laparotomy and frozen section histology .
venous phase of contrast - enhanced computed tomography of abdomen and pelvis showing : ( a ) bilateral global dilatation of calyces and pelvis , ( b and c ) red and blue arrows showing right and left ureters respectively , ( d ) showing normal urinary bladder retrograde pyelography done before ureteroscopy : ( a and b ) showing filling defect in right ureter at level of upper sacroiliac joint , both proximal and distal ureter are well opacified with radio contrast , ( c ) showing filling defect in left ureter , faint opacification of proximal ureter is seen at upper sacroiliac joint on laparotomy , the left ureter was found to be thickened and fibrotic from l5 to s1 vertebral level ; similarly , right ureter was thickened and necrotic from l5 to s3 level , retroperitoneal tissue around these ureters was grossly normal .
frozen sections from the ureteric wall on both sides were reported as caseating granulomatous inflammation and later confirmed on routine histopathology .
an ileal segment was used to replace the involved ureteric segments from l3 level to the bladder and she was started on 4 drug antitubercular therapy ( att ) , with which she showed clinical improvement ( absence of fever , malaise and flank pain ) .
six months later , creatinine was 0.66 mg% and follow up ultrasound of abdomen 6 months and 18 months post surgery showed resolution of bilateral hydronephrosis .
she was continued on att beyond 6 months as evaluation for headache revealed an intracranial right cavernous sinus lesion which was not amenable to biopsy and was presumed to be tubercular in etiology .
bilateral synchronous mid - ureteric lesions are rare and may be congenital , or iatrogenic , following radiotherapy or aortic aneurysmal surgery .
bilateral ureteric involvement with acute renal injury has been described due to radiation - induced mid- and lower ureteric strictures ; however , bilateral synchronous mid - ureteric tubercular strictures without obvious radiological renal or bladder involvement as a cause for acute renal injury has not been described in literature .
urinary system involvement in tuberculosis is commonly unilateral , probably due to delayed reactivation of a solitary focus .
ureteric involvement is considered secondary to renal involvement , with the vesicoureteric junction being the most commonly involved .
tuberculosis usually involves the intramural part of the ureteric wall and is characterized by ureteric thickening and post contrast ureteric wall enhancement on contrast - enhanced computed tomography . bilateral involvement with renal failure
is commonly seen after descending infection from one renal unit involving the bladder and subsequent contralateral unit damage due to vesicoureteric reflux and/or small capacity poorly compliant bladder .
this case is unique in many respects and can not be easily explained by accepted theories on the etiopathogenesis of urinary tuberculosis .
there was bilateral , synchronous involvement of the mid - ureter , which , according to existing literature , is the least commonly involved ureteric segment in urinary tb .
this can only be explained by taking into account the following facts : bilateral pathological involvement of the urinary system via hematogenous route is not unusual ; in fact , a seminal study by medlar found bilateral pathological involvement to be the rule , rather than the exception and renal tuberculosis can be clinically silent .
involvement of bilateral ureteric segments either by direct hematogenous spread or following bacilluria from an undetectable renal lesion and subsequent simultaneous activation can explain the findings of the case .
the interaction between host immunity and pathogenicity decides the clinical presentation . at one end of spectrum
is the activation of a single focus of tuberculosis even in the presence of multiple tubercular pathological foci and at the other end is disseminated tuberculosis where more than one tubercular foci become clinically apparent simultaneously . in the case
described above , the simultaneous clinical activation of two pathological foci and later on presentation of an intracranial lesion suggests this patient 's immune response lay somewhere midway along the spectrum .
the presence of caseating necrotizing granulomatous inflammation is almost always associated with tuberculosis and rarely with nocardiosis ( where granuloma formation is rare ) ; however , the clinical features ( no solid organ abscesses , response to att ) are not consistent with the latter . if tuberculosis had been entertained as a differential diagnosis , appropriate microbiological work up could have been initiated and if proven positive , the patient would have benefited from a 4 to 6 week course of anti - tubercular therapy prior to treatment for ureteric stricture , if it failed to resolve with medical therapy .

Answer:
a young female presenting with right flank pain , fever , raised creatinine and bilateral hydronephrosis was treated with antibiotics elsewhere , with presumptive diagnosis of bilateral pyelonephritis .
 she had partial relief in symptoms and her creatinine level showed an improvement .
 three months later during evaluation at our center she had anuria , hypertensive crisis and pulmonary edema which were managed with emergency bilateral percutaneous nephrostomies .
 cross - sectional imaging and ureteroscopy suggested bilateral synchronous intramural mid - ureteric lesions as underlying pathology .
 histopathology of the ureteric segments during laparotomy revealed caseating granulomas suggestive of tuberculosis .
 this clinical presentation has not been previously described in urinary tuberculosis .


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:
corynebacterium urealyticum , a gram - positive bacillus , has been identified as the most frequent causative pathogen .
urinary stasis is highly likely to contribute to stone formation , because large - scale spontaneous precipitation of crystals occurs when a critical concentration ( e.g. , supersaturation ) is exceeded .
failed treatment of encrusted pyelitis in a transplanted kidney can cause graft failure or nephrectomy . to overcome urinary stasis with encrusted pyelitis in a transplanted kidney , we report surgical treatment by ileo - pelvic anastomosis without nephrectomy .
in addition , in this case , augmentation cystoplasty was performed to strengthen the atrophied bladder following tuberculosis .
a 51-year - old female patient received a kidney from her sister after a double nephrectomy owing to renal tuberculosis 12 years previously . at that time , the transplanted ureter was anastomosed to the ileum in the left lower abdomen with an ileal conduit on the opposite side .
the patient experienced no problems for 12 years . at a routine checkup , she complained of abdominal pain , gross hematuria , and increased debris in the ileal conduit .
her serum creatinine was elevated to 1.7 mg / dl ( normal , 0.6 to 1.1 mg / dl ) , and her transplanted kidney developed hydronephrosis with calcified debris observed by sonography ( fig .
neither hydronephrosis nor calcified debris had been observed 6 months before in a routine outpatient checkup .
abdominopelvic computed tomography revealed hydronephrosis with encrusted pyelitis and ureteritis in the transplanted kidney ( fig .
a cystogram showed that the bladder was not refluxed but had a small capacity ( 50 ml ) .
after 3 weeks , we operated to anastomose the transplanted renal pelvis to one end of the ileal conduit , performing augmentation cystoplasty with new ileum and to anastomosis the other end of the remnant ileum with the augmented bladder .
augmentation cystoplasty is a reconstructive technique for creating a compliant , large - capacity urinary storage unit to protect the upper urinary tract .
the operation was performed via a midline incision . because it was difficult to approach the major calices of the transplanted kidney in the left pelvic rim
, we anastomosed one end of the ileal conduit to the pelvis of the transplanted kidney in an end - to - end fashion .
the ileal conduit was lengthened by 30 cm to extend from the pelvis to the augmented bladder chimney .
after exposure of the urinary bladder , a transverse wide v - shaped cystostomy incision was created , with the apex approaching the anterior bladder neck and the base extending posteriorly past the midcoronal plane of the bladder dome .
a 20 cm segment of new ileum at least 15 cm proximal to the ileocecal junction was used for ileocystoplasty . for the small bowel ,
a v - shaped plate was created by a side - to - side anastomosis with 2 - 0 vicryl .
a circumferential , continuous , full - thickness , single layer anastomosis of the bowel to the bladder was started posteriorly by using 2 - 0 braided absorbable sutures .
the other end of the ileal conduit was anastomosed through small separate ileotomies ( 1.5 cm length ) in the limb of the augmentation cystoplasty .
a follow - up cystogram showed increased bladder capacity to approximately 300 ml with well - preserved end - to - end anastomosis of the ileo - pelvic portion with the other end of one chimney of augmentation cystoplasty with the elongated ileal conduit ( figs . 3 , 4 ) .
the most common causative agent in the formation of infection stones is a urease - positive urinary tract infection .
less invasive methods are preferable to preserve the connection between the renal pelvis and the upper ureter .
ileo - pelvic anastomosis must be adjusted for patients with infection stones in the upper urinary tract after renal transplantation . an alternative way to prevent these infection stones
is to ensure a wider pathway through a ureter that has been narrowed in places by these stones . according to a report on the incidence of urolithiasis in cystectomy patients , 5 of 78 patients who had undergone diversion with an intestinal conduit developed urolithiasis , all in the upper tract .
in contrast , 4 of 78 patients who had received a diversion had a renal stone at the time of presentation
. refluxing urine may contribute to an increased risk of stone formation after urinary diversion , whereas pouch stasis may contribute to stone formation in the diversion group .
a case of failed treatment of encrustation in a kidney transplant recipient was reported and graft removal was performed after 6 months of failed management owing to intractable febrile urinary tract infections that became life threatening .
they excised renal parenchyma from the caudal portion of the inferior calyx , which was then anastomosed to the ileostomy . in their case ,
bladder capacity was within the normal limit ; thus , augmentation cystoplasty was not indicated . in conclusion , if urinary tract infection is controlled , we suggest that ileo - pelvic anastomosis   combined with augmentation cystoplasty   is an alternative for the treatment of encrusted pyelitis with atrophied bladder . in our patient , we performed ileo - pelvic anastomosis to prevent urinary stasis by elongating the ileal conduit .
in addition , the augmentation cystoplasty technique is useful for increasing bladder capacity that has been diminished by renal tuberculosis ( fig .

Answer:
infection stones are more likely to form after urinary diversion as the result of urinary stasis . to prevent urinary stasis due to encrusted pyelitis in a transplanted kidney
 , we describe an alternative a surgical treatment : ileo - pelvic anastomosis . in our patient with a transplanted kidney ,
 the ileal conduit had previously been anastomosed end - to - side owing to renal tuberculosis with an atrophied bladder ; the transplanted ureter was anastomosed to the ileum in the left lower abdomen with an ileal conduit on the opposite side .
 routine check - up revealed hydronephrosis with infected pyelitis and ureteritis in the transplanted kidney .
 we performed ileo - pelvic end - to - end anastomosis to prevent urinary stasis by lengthening the ileal conduit and performed augmentation cystoplasty to support the atrophied bladder following tuberculosis .
 we suggest that this approach may be useful in similar cases .


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 anterior choroidal artery ( achoa ) supplies several important structures including the optic tract , geniculate body , posterior limb of internal capsule , globus pallidus , cerebral peduncle , uncus , amygdala , ventrolateral nucleus of thalamus , and choroid plexus .
the vascular injury of achoa may result in severe neurological deficits such as hemiplegia , hemianesthesia , hemianopsia , decreased consciousness , and extrapyramidal symptoms .
therefore , complete knowledge about vascular anatomy of achoa is very important before surgical or endovascular manipulations .
although several detailed reports about anatomical variations of achoa have been reported , transposition of achoa as to posterior communicating artery ( pcoma ) origin was demonstrated only in 3 reports2 - 4 ) .
we report a case with ruptured cerebral aneurysm arising from pcoma , which originated from the internal carotid artery ( ica ) distal to the origin of achoa .
a 40-year - old woman presented with sudden onset of headache . computed tomography ( ct ) revealed subarachnoid hemorrhage ( sah ) which was slightly predominant in the left basal and sylvian cisterns .
two small aneurysms arose from both distal supraclinoid ica , these were observed on ct angiograms ( fig .
cerebral angiography demonstrated a small aneurysm arising from left fetal type of pcoma with suspicion of rupture and the other small aneurysm originating from right pcoma or perforating branch of ica . in this study , left achoa originated from ica proximal to the origin of fetal type of pcoma ( fig .
achoa usually arises from the posterolateral wall of ica , a few mm distal to the origin of pcoma , and it provides blood supply to the important neural structures around crural and ambient cisterns .
the achoa can have several variations in the course , size , number , branching pattern , and brain region supplied by this artery1 ) . among them
, there have been several anomalies related to the origin of achoa including transposition of achoa and pcoma , origin from pcoma , origin from junction of ica and pcoma , and origin from middle cerebral artery4,5 ) .
the clinical findings of transposed achoa cases including present one are summarized in table 1 .
all of the transpositions of achoa occurred in the left side . among all the cases ,
our case showed sah due to ruptured aneurysm arising from fetal type of pcoma among multiple cerebral aneurysms founded and achoa originating from ica proximal to pcoma .
typically , achoa runs posteromedially within the crural cistern and continues ambient cistern to enter the choroidal fissure .
the proximal portion of this artery is cisternal segment and following portion becomes intraventricular segment1 ) .
the transposed achoa in the previous cases including ours did not seem to affect the vascular territory or course despite of unusual vascular arrangements .
the achoa can be exposed or manipulated in surgical approaches into the pathological lesions around temporal lobe or involving supraclinoid ica .
although the achoa aneurysms accounting for 4% of all cerebral aneurysms are not so common , vascular injury of achoa with small caliber supplying the eloquent areas may be critical because of the possibility of significant morbidity and mortality . and
, another caution is that achoa do not have significant collateral flows despite a potential anastomosis with posterior choroidal artery3 ) .
we tried to preserve pcoma itself and all perforating branches arising from it because of the possibility to compromise the collateral flows of fetal type pcoma .
it is notable that careful review of the preoperative angiograms helps to find unexpected vascular anomalies which may impose an additional surgical risk .

Answer:
the anterior choroidal artery has several kinds of variations . among them ,
 the transposition of anterior choroidal artery and posterior communicating artery origins has been extremely rare .
 we report a case with cerebral aneurysm arising from posterior communicating artery which origin was distal to the anterior choroidal artery and review the relevant literature .


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 pure ground - glass nodule ( ggn ) in the lung may represent an early lung malignancy , such as adenocarcinoma in situ ( ais ) or minimally invasive adenocarcinoma ( mia ) ( 1 ) .
approximately 20 - 30% of patients with adenocarcinoma and a predominantly pure ggn who undergo surgery have additional ggn lesions , either in the same or different lung lobes ( 2 ) . in such cases , multiple limited resection may be an appropriate treatment if a few pure ggn lesions are scattered in multiple lobes or peripherally in one lobe , and the patient has sufficient pulmonary functional reserve ( 3 ) .
however , alternative options should be considered if several ggn lesions are scattered in both lungs with multiple lobes involved , and there is a risk for insufficient pulmonary functional reserve after resection .
chemotherapy has been suggested as an additional therapeutic option , if surgery is not possible due to a lack of pulmonary functional reserve ( 4 ) .
another strategy is to rely on serial computed tomography ( ct ) scans until the nodule develops a definite solid portion .
if curative therapy is not performed , there remains a significant chance for progression ( 1 ) .
cryoablation has been explored as an option for treating metastatic lesions in patients with non - small cell lung cancer who can not undergo surgery or chemotherapy ( 5 ) . however , no clinical reports of cryoablation techniques applied to multiple ggns in the lung have been published . here
, we describe a patient with lung cancer and a pure ggn in the left lower lung lobe that persisted after several limited resections and was successfully treated with cryoablation .
a 59-year - old woman visited our hospital due to abnormal chest radiography findings on a health maintenance exam at another hospital .
all pre- and post - procedural ct scans were performed using a multi - detector ct scanner ( somatom definition flash , enlargen siemens , forchheim , germany ) .
the scanning parameters were : 120 kvp , 200 mas , 0.75-mm collimation , 2-mm reconstruction intervals , smooth algorithm , and pitch of 1 .
several ggns were detected by ct scan : a 12-mm - sized , partially solid nodule in the right middle lobe ( fig .
1a ) , a 7-mm - sized pure ggn in the right upper lobe , and two 5-mm - sized pure ggns in each of the lower lobes ( fig .
the patient underwent a right middle lobectomy and wedge resection of the right upper lobe using video - assisted thoracoscopic surgery .
the partially solid nodule in the right middle lobe was diagnosed as adenocarcinoma , and the pure ggn in the right upper lobe was diagnosed as a mia .
the two pure ggns in both lower lobes remained without significant change on a 10-month follow - up ct scan .
an additional wedge resection was performed for the pure ggn in the right lower lobe , and this nodule was diagnosed as ais .
after these surgeries , the patient did not have sufficient pulmonary functional reserve to tolerate any additional surgery .
thus , we decided to perform cryoablation on the pure ggn in the left lower lobe .
the patient fasted for 6 hours before the procedure , and her blood coagulation parameters were checked .
we used an argon and helium gas - based system ( seednet , galil medical , yokneam , israel ) , a 1.5-mm 17-g cryoprobe , and a thermal sensor .
the procedure was performed in a fluoroscopy room by an interventional radiologist . after placing the patient in the prone position on the table ,
a cross - shaped radio - opaque skin marker was applied to determine the needle insertion site under fluoroscopy .
subsequently , a c - arm cone - beam ct ( cbct ) scan ( dynact , enlargen siemens ) was taken ( fig .
1d - f ) to obtain 1.5-mm thick axial , coronal , and sagittal images . based on these images
, we measured the distance from the center of the skin marker to the target ggn .
the area of the skin marker was draped , and a 1% lidocaine solution was injected into the skin down to the pleural surface . after localizing the needle tip , a cbct scan was performed to confirm the probe insertion site . a 17-g cryoprobe (
seednet , galil medical ) was carefully introduced into the pure ggn under fluoroscopic guidance .
we used a fluoroscope and cbct to visualize the size of the ice ball during the procedure .
we took a ct scan to confirm that the ice ball had reached sufficient size , as indicated by a low attenuation region with an envelope of ground - glass opacity and a margin of 1 cm beyond the ggn .
a small pneumothorax was noted after removing the cryoprobe ; however , the patient was asymptomatic with stable vital signs .
we performed a follow - up ct scan 1 day after cryoablation to assess any initial changes in the ablated lesion and procedural - related side effects ( fig .
the scan showed a 3-cm sized ablated zone in the left lower lobe with no major procedure - related complications , such as hemothorax .
the size of the ablated zone had decreased markedly on a follow - up ct scan 2 months later .
the pure ggn in the left lower lobe was judged to have been successfully ablated without recurrence on a 6-month follow - up ct scan ( fig .
our results show the potential of cryoablation as a new treatment method for ggn , particularly in patients in whom surgery is contraindicated .
some controversy exists as to whether some nodules should be resected or followed by serial ct scans .
kim et al . ( 6 ) noted that several pure ggn lesions detected in patients undergoing surgery for bronchioloalveolar carcinoma did not change in size or features during follow - up .
they suggested that surgical resection should be considered in selected cases in which nodules exhibit significant changes in size or appearance during follow - up .
( 7 ) found that all ggn lesions > 10 mm were carcinomas and insisted that these lesions should be resected rather than followed .
partially solid ggn lesions should be resected regardless of size because they represent more invasive lesions than pure ggns .
thus , a non - surgical alternative is needed for patients with insufficient pulmonary functional reserve or in patients in whom surgery is technically not feasible .
minimally invasive ablation techniques , such as radiofrequency ablation ( rfa ) and cryoablation , may be useful adjunctive treatment options for lung cancer or metastatic lesions and preserve pulmonary function ( 5 , 9 , 10 ) .
minimally invasive ablation techniques for lung cancer have several advantages , including selective damage , minimal morbidity and mortality , minimal loss of lung function , repeatability , low cost , excellent monitoring during treatment , less pain , and shorter hospital stay ( 11 ) . ablating lung tumors is currently used for curative treatment of primary lung cancer and metastatic lung malignancies or cytoreduction ( 12 ) .
ablation is also an option in patients with lung metastases from colorectal and renal cell carcinoma , melanoma , hepatocellular carcinoma , or primary sarcoma ( 13 ) .
although rfa is a contemporary tumor ablation technique , it may cause serious complications , such as air embolism or uncontrolled pain ( 9 , 14 ) .
cryoablation is a thermoablational technique that consists of alternating cycles of decreasing ( freezing ) and increasing ( thawing ) temperatures , leading to direct cellular and vascular injury .
cryoablation works by forming an ice ball , which causes increased extracellular osmolarity and , as a consequence , water diffuses from the intracellular space into the extracellular space .
thus , cryoablation may be a better option for patients with extensive emphysema ( 10 ) .
however , percutaneous or surgical biopsy was difficult due to the small size and multiplicity of the ggn lesions .
nevertheless , localized ggns can include invasive disease , such as ais or mia ( 1 ) . in our case ,
two similar nodules in the right upper and right lower lobes were identified during surgery as mia and ais , respectively .
cryoablation may reduce the likelihood that a remnant ggn will progress to advanced cancer and does not require additional surgery .
thus , long - term follow - up may be necessary to determine the outcome of cryoablation for treating pure ggns . in conclusion

Answer:
treatments for pure ground - glass nodules ( ggns ) include limited resection ; however , surgery is not always possible in patients with limited pulmonary functional reserve . in such patients
 , cryoablation may be a suitable alternative to treat a pure ggn . here , we report our initial experience with cryoablation of a pure ggn that remained after repeated surgical resection in a patient with multiple ggns .
 a 5-mm - sized pure ggn in the left lower lobe was cryoablated successfully without recurrence at the 6-month follow - up .


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:
these
 materials are made of either latex ( natural rubber ) or synthetic polymer materials
 ( polyurethane ) .
latex elastics are more commonly used because they present improved
 properties such as : greater flexibility , lower cost and greater capacity of returning to
 the original dimensions after undergoing deformation . in orthodontic practice
, the use of elastics has some advantages , such as
 biocompatibility , low cost , easy installation and removal by the patients .
however , the oral environment may
 interfere negatively in the properties of these materials .
exposure of these elastics to
 oral environment results is degradation of their elastic forces .
literature has reported
 that rubber elastics exposed to oral environment lose between 10 to 40% of their initial
 force .
after 1211 to 24
 h of installation , this
 degradation rate is greatly reduced , resulting in forces with reasonably constant
 intensity . moreover , in spite of being considered a biocompatible material , santos , et
 al .
the elongation of the molecular chains of materials should be considered one of the main
 mechanisms by which the elastic force decay occurs . when the elastic stretches , the
 polymer chains are uncoiled becoming elongated .
if the force is excessive , such chains
 will slide one over another resulting in permanent deformation of the material and
 consequently in the degradation of the force generated by the elastic .
additionally , the oral environment acts as an agent of the elastic force degradation
 because of physical damages , e.g. : mechanical traumas and temperature
 alterations .
moreover , the
 chemical interactions among the material , saliva and dietary substances promote both the
 absorption of water and other salivary constituents and the solubilization / release of
 the material 's components in the saliva , consequently modifying the elastics ' molecular
 structure and favoring their degradation .
most studies on the influence of the oral environment are conducted in
 vitro , evaluating humidity , saliva composition , ph , temperature and stress
 induced by elastic cyclic stretch .
however , few studies on the effects of dietary
 substances are found in the literature .
( 2004 ) evaluated the
 effect of diet on the mechanical properties of intermaxillary elastics .
these authors
 observed that dietary substances did not significantly increase the degradation of the
 mechanical properties of elastics .
( 1998 ) verified that the immersion of elastomeric chains in
 coca - cola resulted in a greater degradation of forces compared with the
 immersion in water .
( 2008 ) demonstrated that immersion in coca - cola was
 not able to alter the pattern of force degradation in two different types of elastomeric
 chains .
intermaxillary elastics have been routinely employed in orthodontics it is thus
 important that orthodontists be aware of the mechanical properties of these materials as
 well as of the influence of oral environment factors on their properties . due to the
 limited number of studies evaluating the effect of diet on force degradation , the aim of
 this study was to evaluate in vitro the effects of frequently ingested
 beverages on the force degradation of intermaxillary elastics .
one hundred and eighty medium force 1/4-inch intermaxillary elastics ( tru - force latex
 elastic system ; tp orthodontics inc . ,
la porte , in , usa ) were used and divided into six
 groups ( n=30 ) : group 1 ( control - artificial saliva ) , group 2 ( coca - cola -
 coca - cola company , so paulo , sp , brazil ) , group 3 ( beer - heineken , so paulo , sp ,
 brazil ) , group 4 ( orange juice - del valle pure squeezed orange juice , coca - cola
 company , so paulo , sp , brazil ) , group 5 ( red wine - santa lucia cabernet sauvignon ,
 henriquez hermanos ltd . ,
talca , chile ) , group 6 ( coffee - nescaf classic , nestl s.a . ,
 araraquara , sp , brazil ) .
the composition of artificial saliva was 0.0625% kcl , 0.0865%
 nacl , 0.0056% mgcl2 , 0.0166% cacl2 , 0.0804%
 na2hpo4 , 0.0326% kh2po4 , 4.274% sorbitol ,
 0.0004% naf , 0.1% c6h5coona , 2% carboxymethylcellulose and
 distilled water .
elastics with tensile strength ranging from 1.55 to 2 n were selected to standardize the
 samples and eliminate possible mechanical behavior bias .
therefore , 282 elastics were
 tested to reach a test sample size of 180 elastics .
initially all elastics were mounted on an epoxy resin board on two steel pins at a
 distance of 26 mm ( figures 1a and 1b ) and their
 forces were measured in a tensile testing machine ( dl1000 ; emic ltda . , so jos dos
 pinhais , pr , brazil ) at a crosshead speed of 150 mm / min .
b )
 elastic stretched at 26 mm next , the samples were randomly divided into six groups .
the test of variance
 homogeneity was applied to verify the baseline forces , showing statistically similar
 mean values of initial forces ( p>0.05 ) among the groups .
after the baseline readings , the elastics were immersed in a glass flask ( 15x9x14 cm )
 containing 300 ml of the tested beverages , according to the experimental groups .

immersion period was 15 min for the first ( t1 ) and second ( t2 ) cycles and 30 min for
 third to fifth ( t3 , t4 , t5 ) cycles . at every immersion cycle ,
the beverages were changed
 ( figure 2 ) and the elastics were washed in
 distilled water and immersed into 300 ml of artificial saliva for 3 min .
next , the
 elastics were again washed in distilled water and removed from the resin board to
 perform a new tensile strength test .
sequence of the experimental groups data were analyzed by one - way repeated measures anova to compare the effects of
 intervals , beverages and the interaction between them .
figure 3 shows the homogenous distribution of the
 sample at t0 , where the groups presented statistically similar mean values of initial
 force ( p>0.05 ) .
since the mean force values of each group were statistically similar ,
 it may be affirmed that the alterations were due to the tested treatments and not to the
 differences in each group behavior .
homogeneous distribution of samples at t0 figure 4 exhibits the mean force values produced
 by the intermaxillary elastics regardless of their groups .
notice that in the first
 moments ( from t0 to t1 ) , there was a greater reduction of the generated forces
 ( p<0.05 ) , followed by a decrease of degradation rate in the following periods .
mean force values of the intermaxillary elastics regardless of the group this same behavior pattern was seen in the tensile strength forces produced by each
 group at all observation periods ( figure 5 ) .
figure 5 reveals that the different groups behaved
 similarly at each study period ( t1 , t2 , t3 , t4 and t5 ) ( p>0.05 ) .
this study evaluated in vitro the effects of frequently ingested
 beverages on the force degradation of intermaxillary elastics .
the force degradation of
 intermaxillary elastics , measured by tensile strength test , was observed at all periods ,
 regardless of the group ( figure 4 ) . the greatest
 degree of force degradation occurred at the initial periods ( from t0 to t1 ) and a
 gradual reduction of this degradation occurred at the following periods , showing a
 tendency to reduction over time .
this was confirmed by the statistically significant
 difference existing between t0 and t1 , t1 and t2 , t2 and t4 , t3 and t5 ( p<0.05 ) .
the mechanical behavior of intermaxillary elastics in the present study was similar to
 the findings of previous studies in which a greater degradation in the elastic forces at the initial
 periods of assessment was detected .
( 2011 ) found a different behavior of the degradation of
 elastic forces : after a first phase of greater force degradation , there was a second
 stage where the elastics partially recovered the force ( negative degradation ) , followed
 by a third stage in which slow and gradual force degradation occurred . due to this behavior ,
andreassen and bishara ( 1970 ) suggested the use of a force magnitude four times greater
 than the intended magnitude for a determined case .
consequently , when the elastics lose
 40% of their initial force , levels close to those required would still be present for
 longer periods .
notwithstanding ,
 such procedure should be carefully analyzed because of the risks of damaging the tooth
 and periodontal tissues by excessively strong forces .
additionally , the findings of an
 in vivo study
 suggested that elastics should be changed daily because the oral activity dynamics would
 increase the fatigue and deformation of material , enhancing the risk of their fracture
 and failure .
some in vitro studies have been conducted using a dynamic experimental
 model in which mouth opening and closing movements are simulated , stretching the
 intermaxillary elastics .
for the present study , a static experimental model was chosen
 based on the results of previous investigations , which demonstrated that
 the cyclic elastic stretching only enhances force degradation in the first hour of the
 experiment ; after this period , the degradation rate returns to its pattern and , by the
 end of the study , cyclic stretching or not exerts no statistically significant influence
 on the elastics . liu , et
 al .
( 1993 ) showed that after
 200 stretching cycles there was no significant force degradation of intermaxillary
 elastics .
the results of this research indicate that the contact of dietary beverages with
 intermaxillary elastics is not able to influence the degradation degree of their forces
 ( figure 5 ) .
the elastics presented the same
 behavior when immersed in either artificial saliva or test beverages at all
 observational periods .
the lack of influence of dietary components on the degradation of
 intermaxillary forces has also been observed in a laboratory study .
other studies have
 demonstrated that the ph of the medium in which the intermaxillary elastics are immersed
 did not influence significantly force decrease of the elastics .
based on this evidence ,
 the beverages used in the present study were not subjected to any ph analysis .
the mechanical behavior of the intermaxillary elastics in the present study can be
 explained by the " swelling phenomenon " .
the chemically cross - linked points among the
 molecular chains enable the absorption of liquid into the latex three - dimensional
 reticulate structure .
the rubber 's free energy decreases with the simultaneous effect of
 mixing entropy . at the same time
, the molecular chains are elongated followed by the
 decrease of elasticity of the rubber .
although this study showed solid evidences , the obtained results should be carefully
 examined because no in vitro study is capable of simulating all factors
 acting on intermaxillary elastics in the oral environment .
notwithstanding , our findings
 contribute to improve the knowledge of the mechanical behavior of the intermaxillary
 elastics employed in orthodontics , enabling greater predictability in the application of
 mechanotherapy involving latex elastics .
the results also have clinical applications
 since no restrictions were found to the consumption of the studied beverages in relation
 to the use of the tested intermaxillary elastics , bringing comfort and freedom for
 patients choosing their own diet during the orthodontic treatment .
the chemical nature of the evaluated beverages was not able of influencing the degree of
 degradation of intermaxillary elastics ' forces .

Answer:
objective : the aim of this study was to evaluate in vitro the effects of
 frequently ingested beverages on force degradation of intermaxillary elastics .

 material and methods : one hundred and eighty 1/4-inch intermaxillary elastics ( tp orthodontics ) were
 immersed into six different beverages : ( 1 ) coca - cola ; ( 2 ) beer ; ( 3 )
 orange juice ; ( 4 ) red wine ; ( 5 ) coffee and ( 6 ) artificial saliva ( control ) .
 the
 period of immersion was 15 min for the first and second cycles and 30 min for the
 third to fifth cycles .
 tensile forces were read in a tensile testing machine
 before and after the five immersion cycles .
 one - way repeated measures anova was
 used to identify significant differences .
 results : force degradation was seen in all evaluated groups and at all observation periods
 ( p<0.05 )
 . a greater degree of degradation was present at the initial periods ,
 decreasing gradually over time .
 however , no statistically significant differences
 were seen among groups at the same periods , showing that different groups behaved
 similarly .
 conclusion : the chemical nature of the evaluated beverages was not able to influence the
 degree of force degradation at all observation periods .


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:
acute promyelocytic leukemia ( apl ) is one of the most characteristic subtypes of aml in which abnormal promyelocytes predominate within peripheral blood or bone marrow .
also , t(15;17)(q22;q21 ) shows a characteristic chromosomal translocation in apl , observable in 70 - 90% of apl patients .
owing to all trans - retinoic acid ( atra ) combined with chemotherapy , apl has one of the highest cure rates of all types of aml .
seventy to eighty percent of newly diagnosed apl patients with the pml - rara rearrangement are cured or under long - term remission , yet some of them have a poor prognosis [ 2 - 5 ] . because cytogenetics is one of the most powerful prognostic factors for the outcome of aml , cytogenetic abnormalities can cause change in treatment response , relapse , and clinicopathological characteristics .
incidence of secondary cytogenetic abnormalities has been observed in ~40% of apl cases , but their prognostic significance is still unclear [ 5 - 7 ] .
about 1% of the reported secondary cytogenetic abnormalities in apl patients are ider(17)(q10)t(15;17)(q22;q12 ) , an infrequent type of additional recurrent chromosomal abnormality , according to a recent study . however , ider(17)(q10)t(15;17 ) associated with the pml - rara rearrangement in microgranular variant apl is even more rare . as far as we know ,
only 2 cases of the ider(17)(q10)t(15;17 ) abnormality in microgranular apl have been previously reported [ 8 , 9 ] . here
, we describe an unusual microgranular apl case associated with ider(17)(q10)t(15;17 ) , identified by both conventional cytogenetics and fish analyses at the initial diagnosis .
a 59-yr - old woman who had previously been diagnosed with cerebral infarction was brought to our hospital due to right side weakness in november 2007 .
the initial complete blood count showed pancytopenia , hb level of 9.9 g / dl ( reference range 12 - 16 g / dl ) , platelet count of 83,000/l ( reference range 150,000 - 350,000/l ) , and white blood cell count of 1,000/l ( reference range 4,000 - 10,000/l ) .
bone marrow aspiration showed a hypercellular marrow replaced by increased promyelocytes with a paucity or absence of granules , accounting for 36% of all nucleated cells ( fig .
the results of special staining of bone marrow specimens were as follows : myeloperoxidase , positive ; periodic acid schiff , negative ; nonspecific esterase , negative .
flow cytometric analysis was conducted and showed that the blasts were positive for cd13 ( 91.1% ) , cd33 ( 83.9% ) , cd117 ( 59.2% ) , cd2 ( 43.9% ) , and cd45 ( 25.4% ) , and negative for hla - dr ( 3.4% ) , cd3 ( 1.3% ) , cd7 ( 0.6% ) , cd10 ( 1.8% ) , cd14 ( 2.4% ) , cd19 ( 5.1% ) , cd34 ( 1.4% ) , cd41 ( 2.9% ) , cd56 ( 1.2% ) , and tdt ( 0.9% ) .
fish signals from pml - rara probes ( abbott molecular / vysis , des plaines , il , usa ) yielded the results of nuc ish(pml , rara)4(rara con pml3)[24/138 ] , ( pml , rara)6(rara con pml5)[14/138 ] , ( pml , rara)3(rara con pml2)[13/138 ] , consistent with the abnormal fusion signal patterns seen in 37% of the nuclei examined ( fig .
the patient was diagnosed with apl and treated with induction chemotherapy consisting of daunorubicin , cytosine arabinoside , and atra . after completing induction chemotherapy ,
follow up bone marrow examination in january 2008 showed no evidence of morphologically visible residual leukemia .
the concurrent karyotype analysis result was 46,xx in all analyzed cells ; and pml - rara fish showed " nuc ish ( pml , rara)2 " in which the abnormal signal pattern was not observed .
there was no evidence of a pml - rara fusion gene in the reverse transcriptase - pcr ( rt - pcr ) analysis .
as indicated by follow - up bone marrow biopsies conducted until september 2008 , the patient remained in complete remission . during this period
, the rt - pcr analysis did not show any signs of the pml - rara fusion gene while other cytogenetic studies also indicated normal findings .
apl is a distinct subtype of aml and constitutes about 5 - 8% of all cases of aml diagnosis . according to the 2008 who classification
, apl can be diagnosed when there is a t(15;17 ) or a pml - rara rearrangement , even if peripheral blood or bone marrow studies show less than 20% promyelocytes . as recently reported by manola et al .   and
our study group , the ider(17)(q10)t(15;17 ) , an isochromosomal abnormality that occurs on the long arm of ider(17)t(15;17 ) after reciprocal translocation of t(15;17 ) , is a relatively rare type of an additional recurrent cytogenetic abnormality that has been reported in 62 apl patients worldwide [ 8 - 13 ] . according to these studies , the influence of ider(17)(q10)t(15 ; 17 ) on the prognosis of adult apl patients
indeed , 4 previously reported apl cases in children were all related to poor prognosis [ 8 , 13 - 15 ] , inferring that a more close and careful interpretation is necessary for childhood apl cases .
what is interesting is that so far , reports of ider(17)(q10)t(15;17 ) from microgranular variant ( aml - m3v ) type are extremely rare .
out of 62 total cases , information on apl morphology type were available in 42 cases , and most of these cases ( 40/42 ) were of the hypergranular apl type , except for 2 cases that clearly indicated aml - m3v ( table 1 ) [ 8 , 9 ] .
therefore , further research is required to determine whether ider(17)(q10 ) and aml - m3v have a low association , and more careful observation should be conducted to prevent underestimating aml - m3v patients among ider(17)(q10)t(15;17 ) cases .
furthermore , double ider(17 ) ( q10)t(15;17 ) is so rare in the international public databases that only 2 cases of apl patients indicating double ider(17)(q10)t(15;17 ) chromosomal abnormalities have been reported ( table 2 ) [ 16 , 17 ] . in double ider(17)(q10)t(15;17 ) , a gene dosage effect is observed owing to chromosomal abnormalities such as the pml - rara fusion gene on chromosome 17 or the quadruplication of der(17q ) . in addition , since the deletion of the tumor suppressor gene tp53 occurs by the loss of 17p , further research is necessary to resolve the adverse prognosis of the apl group related to such copy number variations .
owing to the limited amount of clinical data in the literature , the relatedness between double ider(17)(q10)t(15;17 ) and an adverse prognosis is still unclear [ 16 , 17 ] . in the case of our patient
, it was hard to determine a strong association between the additional genetic aberration and prognosis because of the small clonal size of the " double ider(17)(q10)t(15;17 ) " abnormality .
nevertheless , at least from a diagnostic perspective and as indicated in the authors ' recent studies [ 13 , 18 ] , minimal residual disease detection using such multiple abnormal fusion signals through the pml - rara fish analysis in apl patients associated with ider(17)(q10)t(15;17 ) or double ider(17)(q10)t(15;17 ) would be considered to be a useful follow - up marker in clinical laboratories or hospitals .
additional study would contribute toward a better understanding of the influence of ider(17)(q10)t(15;17 ) on the prognosis , survival , and treatment response of such apl cases in adults or children . to the best of our knowledge
, however , this is the third case report of microgranular variant apl associated with ider(17)(q10)t(15;17 ) .

Answer:
we present a rare case of microgranular variant acute promyelocytic leukemia ( apl ) associated with ider(17)(q10)t(15;17)(q22;q12 ) of an old - age patient .
 the initial chromosome study showed a 46,xx , del(6)(?q21q25),der(15)t(15;17)(q22;q12),ider(17)(q10)t(15;17)[10]/47,sl,+ider(17)(q10)t(15;17)[3]/46,xx[16 ] .
 fish signals from a dual color dual fusion translocation pml - rara probe were consistent with the results of conventional cytogenetics .
 because of the rarity of ider(17)(q10)t(15;17 ) in microgranular apl , further studies on both gene dosage effect of this chromosomal abnormality and the influence of ider(17)(q10)t(15;17 ) on clinical features such as prognosis , survival , and treatment response of apl cases are recommended .