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:
primary ovarian cancers tend to spread , at first , within the peritoneal cavity and the omentum , and are frequently associated with ascites , a fluid rich in growth factors and tumor cells disseminated from the primary cancer that fills the peritoneum .
tumor spread to more distant sites , including the contralateral ovary and bilateral ovarian cancers almost always represents a primary tumor and its metastasis rather than dual primary cancers .
the parallel evolution model suggests that cells with metastatic potential separate from the primary tumor at an early stage in development and evolve independently from the primary tumor .
the ovary is a site for a wide range of tumors , both primary and metastatic .
colorectal metastasis from primary ovarian carcinoma account for approximately 4.0% and an isolated rectal metastasis is very rare .
identification of the correct primary tumor is necessary for an optimal management , including , specific chemotherapy ( ct ) in advanced stages . whereas , ovarian adenocarcinomas respond to platinum based ct , cases of colonic adenocarcinomas are candidates for 5-fluorourocil based ct .
a 50-year - old female patient presented with bilateral adnexal lump and dysfunctional uterine bleeding with altered bowel habits . computed tomography of the abdomen and pelvis revealed a bilateral adnexal lump situated in the ovaries of sizes 108 cm and 43 cm , and a lobular mass of 8 cm at the rectum with peritoneal implants ( figure 1 ) .
she underwent a total hysterectomy , a bilateral adnexectomy , and a bilateral iliac lymphadenectomy for the bilateral ovarian lumps .
gross features of the ovaries showed capsular breach with presence of solid and cystic areas on cut sections .
the microscopic examination revealed a bilateral papillary serous adenocarcinoma with psammomatous calcification ( figure 2 ) .
the surgical findings revealed an 8.0 cm submucosal tumor in the rectum and invasion from the serosal side .
the tumor primarily involved the rectal muscularis propria and subserosa with only focal invasion of the rectal mucosa .
the pathological findings of the ovarian tumor specimen were consistent with those of the hemicolectomy specimen .
the patient was staged as t3cn1m1 and stage iv , according to tnm and figo classification respectively .

figure 1computed tomography of the abdomen revealed a bilateral adnexal lump situated in both the ovaries with peritoneal implants .
  computed tomography of the abdomen revealed a bilateral adnexal lump situated in both the ovaries with peritoneal implants .

figure 2carcinoma ovary shows papillary serous adenocarcinoma with psammomatous calcification ( hematoxylin & eosin 40 ) .

carcinoma ovary shows papillary serous adenocarcinoma with psammomatous calcification ( hematoxylin & eosin 40 ) .

figure 3colorectal carcinoma shows moderately differentiated adenocarcinoma ( hematoxylin & eosin 40 ) .
  colorectal carcinoma shows moderately differentiated adenocarcinoma ( hematoxylin & eosin 40 ) .
immunohistochemical staining was positive for cytokeratin 7 ( figure 4 ) and negative for cytokeratin 20 ( figure 5 ) .
this staining pattern was consistent with that of colorectal metastasis from the original ovarian lesion and immunohistochemistry supported the histological interpretation of a metastatic ovarian carcinoma .
post adjuvant 6 cycles of specific ct in the form of cisplatinum ( 50 mg ) and 5-fluorourocil ( 100 mg ) were administered to our patient and after 6 months of follow up period , she is doing well .

figure 4positive immunohistochemical staining for cytokeratin 7 ( immunostain cytokeratin 7  40 ) .

figure 5negative immunohistochemical staining for cytokeratin 20 ( immunostain cytokeratin 20  40 ) .

haraoka et al . in an autopsy series , reported that colorectal metastases present with an ovarian origin in about 6.0% of cases and represent about 30.5% of all ovarian cancers .
their patients ranged in age from 34 to 77 years with an average age of 58.8 years .
the location was ascending colon in 4 patients , transverse in 2 , descending in 5 , sigmoid in 5 , and rectum in 5 .
the tumor appearance was protruding in 13 cases , ulcerative in 2 , and a submucosal tumor type in 1 of the 14 cases in which the macroscopic appearance was reported . in 9 of the 14 cases in which the tumor protruded
, distinguishing colorectal metastasis from ovarian carcinoma and primary colon cancer based on the macroscopic appearance is often difficult .
colorectal metastasis was observed to be synchronous with ovarian carcinoma in 7 patients in a study by loy et al . ,
, elevated levels of tumor markers such as ca-125 and cea may help to make a correct diagnosis .
however , up to 15% of the cases of ovarian carcinoma were present without any elevated levels of serum ca-125 .
reported a cytokeratin 7 positive / cytokeratin 20 negative immunophenotype to be nearly 100% specific for an ovarian origin .
conversely , a cytokeratin 7 negative/ cytokeratin 20 positive immunophenotype was seen in 94% of the tumors of colonic origin . in our case ,
the colonic tumor was positive for cytokeratin 7 and negative for cytokeratin 20 , a pattern consistent with an ovarian origin rather than a colonic one .
in addition , a comparison of the patient 's primary ovarian cancer with the colorectal mass revealed that the two tumors have similar histological features .
the spread of ovarian cancer to the colorectum can occur in four different ways , hematogenous spread , lymphatic spread , direct invasion and peritoneal dissemination .
the most plausible explanation of colorectal involvement in ovarian adenocarcinomas is through intra - peritoneal seedling .
hematogenous spread occurs in advanced peritoneal disease . in a substantial number of autopsy cases of advanced ovarian cancers , reed et al .
identified peritoneal involvement in 83100% cases , with large intestinal involvement in 5060% cases . in most cases of bowel metastases ,
the serosa is affected initially and then invasion extends from serosal and subserosal tissues into the muscularis propria and mucosa of the bowel wall . in the present case , the tumor mainly involved the rectal muscularis propria and subserosa with only focal invasion of the rectal mucosa and invasion of the retroperitoneum .
certain morphological features indicative of metastasis from colorectum include garland - like tumor necrosis , segmental destruction of glands and absence of squamous metaplasia , whereas cribriform growth patterns and intra - luminal dirty necrosis are indicators of ovarian adenocarcinomas .
however , the problem exists in sorting out these tumors , including in cases mucinous adenocarcinomas , when there is simultaneous involvement of the ovary and the colorectum at similar ( synchronous ) or at different ( metachronous ) times .
showed that morphologically , metastatic tumor deposits in the colorectum retained the morphology of ovarian papillary serous cystadeocarcinoma with foci of psammomatous calcification in 6 of their 11 cases .
absence of garland - like tumor and necrosis were pointers towards an ovarian primary , apart from the clinical context of a preceding ovarian tumor in 81.8% such cases .
it is thus important to identify whether or not a tumor has an ovarian origin using immunohistochemical markers , since the occurrence of gastrointestinal metastases from ovarian cancer is very rare .
as described lately , specific cytokeratin immunemarkers like cytokeratin 7 and cytokeratin 20 have been documented to be helpful in resolving these dilemmatic situations of ovarian involvement by colorectal carcinoma and vice versa .
zighelboim et al . described a single case of atypical sigmoid metastasis from a high - grade ovarian adenocarcinoma , using differential expression of ck7 and 20 .
o'hanlan et al . have reported that a longitudinal negative margin of 25 cm in the resected bowel along with a wedge resection of mesentery , including paracolic and intermediate - level nodes might be indicated to achieve optimal debulking of gastrointestinal metastases from ovarian carcinomas .
our patient underwent total hysterectomy , bilateral adnexectomy , and bilateral iliac lymphadenectomy with left hemicolectomy and postoperative chemotherapy .
in cases of colorectal involvement by ovarian adenocarcinomas and vice versa , it can be difficult to ascertain an exact primary .
in such cases , apart from complete clinical details , histomorphological features like garland - like necrosis , desmoplasia and psammomatous calcification are useful pointers towards exact primary and along with differential expression of cytokeratins 7 and 20 by immunohistochemistry can be helpful in solving these dilemmas .

Answer:
this report describes the case of a 50-year - old female patient who presented with bilateral adnexal lump and dysfunctional uterine bleeding with altered bowel habits .
 computed tomography of the abdomen and pelvis revealed a bilateral adnexal lump situated in both the ovaries and a lobular mass of 8 cm in the rectum .
 proctoscopy revealed an elevated irregular rectal lesion .
 the microscopic examination of the ovarian lump revealed a bilateral serous adenocarcinoma with a papillary pattern with psammomatous calcification .
 a left hemicolectomy with lymphadenectomy was also performed .
 immunohistochemical staining was positive for cytokeratin 7 and negative for cytokeratin 20 .
 the use of immunohistochemistry demonstrated the tumor to be of ovarian origin .
 we report this case of synchronous involvement of the ovary and the colorectum because of its rarity and unusual presentation .


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

Paper text:
because motor weakness is one of the most serious disabling sequelae of stroke , so it is important to elucidate the motor recovery mechanism for successful rehabilitation .
many studies have attempted to elucidate the motor recovery mechanism of stroke and several motor recovery mechanisms have been suggested .
however , the majority of these studies focus on cerebral infarct and relatively little is known about the motor recovery mechanism of intracerebral hemorrhage ( ich ) .
diffusion tensor imaging ( dti ) can help to investigate the motor recovery mechanism of ich by enabling the direct visualization and estimation of the corticospinal tract ( cst ) .
, we report on a patient with ich who showed a change in the origin of an injured cst from the premotor cortex ( pmc ) to the primary motor cortex ( m1 ) .
an 86-year - old woman presented with complete paralysis of the right upper and lower extremities , which occurred at the onset of spontaneous ich ( motricity index ( mi ) : 0 ( full mark : 100 ) ) ( table 1 ) .
longitudinal changes in motor function t2-weighted mr images showed a hematoma in the left fronto - parietal lobe , including m1 , at 1 month after onset , that resolved at 5 months after onset ( figure 1a ) . from 1 month to 5 months after onset , she received comprehensive rehabilitative management , which included the administration of neurotrophic drugs ( ropinirole , bromocriptine , levodopa , and amantadine ) , movement therapy , and neuromuscular electrical stimulation of the affected finger extensors and ankle dorsiflexors .
movement therapy focused on improving the motor functions of the right upper and lower extremities and included physical and occupational therapy sessions five times per week .
weakness of her left extremities improved from an mi score of 0 point at 1 month to 27 points at 2 months and to 52 points ( 5 months after ich onset ) after 4 months of rehabilitation . as a result
, she was able to extend the affected fingers against gravity and to walk independently on even ground .
brain magnetic resonance images , diffusion tensor imaging ( dti ) and transcranial magnetic stimulation results of an 86-year - old female patient with a hematoma in the left fronto - parietal lobe .
( a ) t2-weighted magnetic resonance images showed a hematoma in the left fronto - parietal lobe including the primary motor cortex at 1 month after onset , which was resolved at 5 months after onset .
dti results showed that at 1month and 5 months after intracerebral hemorrhage , the right csts originated from the cerebral cortex , including the primary motor cortex , and then passed through the known cst pathway . in the left ( affected ) hemisphere
, the csts originated from the left premotor cortex at 1 month after onset , and from the left primary motor cortex and premotor cortex at 5 months after onset .
a motor evoked potential of low amplitude ( 100 v ) was obtained from right abductor pollicis brevis muscle by the affected ( left ) hemisphere stimulation at 1 month after onset . however , motor evoked potential amplitude was increased to the normal range ( 3.8 mv ) at 5 months after onset .
ich volume was measured on ct image and t2-weighted mri images through picture archived communication system ( pacs , marotech , korea ) .
the maximum width ( x ) , length ( y ) and height ( z ) of lesion at the level where a hematoma was clearly seen were measured .
the ich volume was calculated according to the formula : the volume of ich was 37.19 mv on the ct images at the ich onset and 26.71 mv on the mr images at 1 month after onset .
diffusion tensor images were acquired using a synergy - l sensitivity encoding ( sense ) head coil on a 1.5-t philips gyroscan intera system ( hoffman - laroche , mijdrecht , the netherlands ) using a single - shot echo planar imaging with a navigator echo .
for each of the 32 noncollinear diffusion - sensitizing gradients , 60 contiguous slices ( matrix = 192  192 , field of vision = 240 mm , repetition time / echo time = 10 726/76 ms , b = 600 mm / s , number of excitations = 1 , thickness = 2.5 mm ) were acquired .
three - dimensional reconstructions of fiber tracts were obtained using the dti task card software ( philips extended mr work space 2.6.3 ) ( threshold fractional anisotropy ( fa ) = 0.15 , angle = 45 ) .
fiber tracts passing through both region of interests ( cst portion of the anterior mid - pons and low - pons on the color map ) were designated final tracts of interest . at 1 month and 5 months after ich onset , dti results showed that in the right ( non - affected ) hemisphere , the right cst originated from the cerebral cortex ( including m1 ) and passed through the known cst pathway .
however , in the left ( affected ) hemisphere , the cst originated from the left pmc at 1 month and from the left m1 and pmc at 5 months ( figure 1b ) .
tms was performed using a magstim novametrix 200 magnetic stimulator equipped with a 9-cm mean diameter circular coil ( novametrix medical systems inc , wallingford , ct , usa ) .
the left hemisphere was stimulated by a counterclockwise current and the right hemisphere was stimulated by a clockwise current .
motor - evoked potentials ( meps ) were obtained from both abductor pollicis brevis muscles in a relaxed state . excitatory threshold ( et )
was defined as the minimum stimulus required to elicit an mep with a peak - to - peak amplitude of 50 v or greater during two of four attempts .
each site was stimulated three times with inter - stimulus intervals of  10 seconds , and shortest latency and average peak to peak amplitude were estimated .
mep ( latency : 23.5 ms ; amplitude : 100 v ; et : 100% ) was evoked from the affected ( left ) hemisphere during the tms study conducted at 1 month after ich onset , but the amplitude increased to the normal range at 5 months after ich onset ( latency : 19.7 ms ; amplitude : 3.8 mv ; et : 70% ) ( figure 1c ) .
ich volume was measured on ct image and t2-weighted mri images through picture archived communication system ( pacs , marotech , korea ) . the maximum width ( x ) ,
length ( y ) and height ( z ) of lesion at the level where a hematoma was clearly seen were measured .
the ich volume was calculated according to the formula : the volume of ich was 37.19 mv on the ct images at the ich onset and 26.71 mv on the mr images at 1 month after onset .
diffusion tensor images were acquired using a synergy - l sensitivity encoding ( sense ) head coil on a 1.5-t philips gyroscan intera system ( hoffman - laroche , mijdrecht , the netherlands ) using a single - shot echo planar imaging with a navigator echo .
for each of the 32 noncollinear diffusion - sensitizing gradients , 60 contiguous slices ( matrix = 192  192 , field of vision = 240 mm , repetition time / echo time = 10 726/76 ms , b = 600 mm / s , number of excitations = 1 , thickness = 2.5 mm ) were acquired .
three - dimensional reconstructions of fiber tracts were obtained using the dti task card software ( philips extended mr work space 2.6.3 ) ( threshold fractional anisotropy ( fa ) = 0.15 , angle = 45 ) .
fiber tracts passing through both region of interests ( cst portion of the anterior mid - pons and low - pons on the color map ) were designated final tracts of interest . at 1 month and 5 months after ich onset , dti results showed that in the right ( non - affected ) hemisphere , the right cst originated from the cerebral cortex ( including m1 ) and passed through the known cst pathway .
however , in the left ( affected ) hemisphere , the cst originated from the left pmc at 1 month and from the left m1 and pmc at 5 months ( figure 1b ) .
tms was performed using a magstim novametrix 200 magnetic stimulator equipped with a 9-cm mean diameter circular coil ( novametrix medical systems inc , wallingford , ct , usa ) .
the left hemisphere was stimulated by a counterclockwise current and the right hemisphere was stimulated by a clockwise current .
motor - evoked potentials ( meps ) were obtained from both abductor pollicis brevis muscles in a relaxed state . excitatory threshold ( et )
was defined as the minimum stimulus required to elicit an mep with a peak - to - peak amplitude of 50 v or greater during two of four attempts .
each site was stimulated three times with inter - stimulus intervals of  10 seconds , and shortest latency and average peak to peak amplitude were estimated .
mep ( latency : 23.5 ms ; amplitude : 100 v ; et : 100% ) was evoked from the affected ( left ) hemisphere during the tms study conducted at 1 month after ich onset , but the amplitude increased to the normal range at 5 months after ich onset ( latency : 19.7 ms ; amplitude : 3.8 mv ; et : 70% ) ( figure 1c ) .
in this patient , we investigated changes of the injured left cst and found that the injured cst seemed to recover as detected by dti , tms and clinical observation . at 1 month after ich onset , the left cst originated from the pmc by dti , and the mep obtained at the right hand showed low amplitude and a latency compatible with that of the cst .
by contrast , 5-month results revealed that the left cst originated from the left m1 by dti and that mep amplitude had improved to the normal range by tms .
the m1 is the major origin of the cst , although the cst is known to originate from the extensive cerebral cortex , including the pmc , the primary somatosensory cortex , and the prefrontal cortex . on the other hand ,
consequently , the dti and tms results of this patient suggest that the severely injured left cst had recovered over 4 months in terms of its origin and fiber number .
furthermore , clinically , the finding that the patient was able to flex and extend against gravity at 5 months after ich onset provides additional evidence of left cst recovery . as a result
, right extremity motor functions seemed to have been recovered due to reorganization of the injured left cst originating from the left pmc to left m1 .
it is also possible that compression of the cst into the left pmc recovered in concert with hematoma resolution . for the motor recovery mechanism in ich ,
several dti based studies have described recovery of an injured cst or the contribution made to recovery by the contralateral unaffected cst . during the last 5 years
, a number of serial dti studies have described the recovery of injured cst after ich .
jang et al demonstrated the recovery process of an injured cst in a patient with a subcortical ich by serial dti .
the patient presented with complete paralysis of right extremities at onset , but over 16 months , motor functions of affected extremities slowly recovered to nearly normal .
furthermore , dtt showed that the origin of the cst had changed from the posterior parietal cortex at 1 month to the primary somatosensory cortex at 4 months and m1 at 16 months .
the authors suggested that recovery of the origin of the damaged cst was due to a process of normalization from the parietal cortex to m1 .
by contrast , our patient showed a change in the origin of the injured cst from the pmc to m1 .
this study described changes of an injured cst that occurred in concert with motor recovery in a patient with ich . to the best of our knowledge ,
this is the first longitudinal study to demonstrate a change in the origin of an injured cst from the pmc to m1 in ich .
results from this study suggest a motor recovery mechanism of ich and the important implications regarding brain plasticity and brain rehabilitation after ich .
however , this study is obviously limited by case numbers , and further complementary studies involving larger case numbers are warranted .

Answer:
many studies have attempted to elucidate the motor recovery mechanism of stroke , but the majority of these studies focus on cerebral infarct and relatively little is known about the motor recovery mechanism of intracerebral hemorrhage . in this study , we report on a patient with intracerebral hemorrhage who displayed a change in injured corticospinal tract originating from the premotor cortex to the primary motor cortex on diffusion tensor imaging . an 86-year - old woman presented with complete paralysis of the right extremities following spontaneous intracerebral hemorrhage in the left frontoparietal cortex .
 the patient showed motor recovery , to the extent of being able to extend affected fingers against gravity and to walk independently on even ground at 5 months after onset .
 diffusion tensor imaging showed that the left corticospinal tract originated from the premotor cortex at 1 month after intracerebral hemorrhage and from the left primary motor cortex and premotor cortex at 5 months after intracerebral hemorrhage .
 the change of injured corticospinal tract originating from the premotor cortex to the primary motor cortex suggests motor recovery of intracerebral hemorrhage .


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:
laparoscopic ventral incisional hernia ( vih ) repair has gained wide acceptance and increased popularity over the past decade .
multiple studies have documented the safety , technical feasibility , and efficacy of this technique .
the extremely low rate of wound infection and recurrence are among the most important advantages of the laparoscopic approach .
because the prosthetic mesh is placed intraabdominally , many surgeons use expanded polytetrafluoroethylene ( eptfe ) grafts because of the low adhesive potential . , , high cost , inferior handling characteristics , and poor incorporation into the tissues are among the drawbacks of eptfe mesh . another product , polypropylene ( pp )
nevertheless , long - term complications , such as severe adhesions , obstruction , and fistula formation , have been reported with pp . , these complications seem to occur when the pp mesh is placed in direct contact with the serosal surface of the bowel . however , if omentum is interposed between the mesh and viscera , adhesions should not involve loops of bowel and should be restricted to omentum only . using this technique , franklin
et al reported no adhesion - related complications in over 170 patients undergoing laparoscopic vih repair during a 30-month follow - up .
between 1999 and 2001 , patients undergoing laparoscopic vih repair were prospectively enrolled in a surgical database . in 30 patients , pp mesh ( prolene , ethicon corporation , somerville , nj )
was used for the hernia repair ; omentum was interposed between the mesh and the underlying bowel .
the mesh was secured in place with a hernia stapler along the edges and nonabsorbable transcutaneous sutures at the corners , taking care to ensure that the mesh overlapped the fascial defect by at least 3 cm in each direction . at a mean follow - up of 14 months
twenty patients agreed and were studied using an acuson xp/10 , 7 mhz linear transducer , supplemented by a curvilinear transducer when appropriate .
a visceral slide technique was used specifically to detect adhesions . at the time of follow - up , all patients were also examined for hernia recurrence , wound infection , and seroma formation .
satisfaction with the procedure ( completely / somewhat / not satisfied ) and pain at the operative site ( mild / moderate / severe ) were assessed by using a standard questionnaire .
this method is based on the demonstration of intestinal movement at the abdominal wall interface during real - time ultrasound imaging .
such movement may occur spontaneously as a result of respiratory excursions or may be induced by manual compression . during longitudinal surface scanning ,
a normal spontaneous visceral slide may range from 2 cm to more than 5 cm in distance .
detection of a visceral slide that measures less than 1 cm is considered abnormal due to adhesions .
this method is based on the demonstration of intestinal movement at the abdominal wall interface during real - time ultrasound imaging .
such movement may occur spontaneously as a result of respiratory excursions or may be induced by manual compression . during longitudinal surface scanning ,
a normal spontaneous visceral slide may range from 2 cm to more than 5 cm in distance .
detection of a visceral slide that measures less than 1 cm is considered abnormal due to adhesions .
no detectable omental or bowel adhesions were found in more than half of the patients ( figure 1 ) . in some cases , mesh appeared to be somewhat corrugated , but normal visceral slide was detected in each instance ( figure 2 ) .
five patients had omentum that appeared to be densely adherent to the pp mesh , as detected by the lack of a normal visceral slide . in one of these patients ,
the bowel was visibly tethered underneath the omentum but was not adherent to the mesh .
one patient had tethered bowel at the edge of the hernia repair with thickened omentum underlying the mesh . in another patient ,
the falci - form ligament had been divided to complete the hernia repair in that case .
the incidence of adhesions ( % ) detected by ultra - sonography in 20 patents after laparoscopic ventral incisional hernia repair with polypropylene mesh and omental interposition .
ultrasonogram of the patient after laparoscopic ventral incisional hernia repair : mesh ( arrow ) appears to be corrugated .
nine patients had no pain at the surgery site , while 10 patients stated they experienced mild to moderate pain with activity , usually near the edges of the repair ( figure 3 ) . only 2 patients complained of severe pain at the site of repair .
one of these patients described severe pain with activity even though she had been pain - free for 1 year after surgery .
this patient was noted to have a small recurrence of the hernia just lateral to the edge of the mesh ( figure 4 ) .
her initial repair 3 years earlier was accomplished using the separation of components technique , which led to a subsequent recurrence .
ultrasonogram of the patient with the recurrent hernia : omental herniation ( thick arrow ) is seen just lateral to the mesh ( thin arrow ) .
the reasons for less than complete satisfaction include unexpected postoperative pain in 1 patient and moderate crampy postoperative pain in a second patient .
one patient had problems with a trocar site , and another patient felt that an area of attenuated fascia with underlying mesh constituted a recurrence .
the use of prosthetic materials for the repair of a ventral incisional hernia has significantly decreased the number of recurrences for this condition . moreover ,
the laparoscopic approach has helped to reduce the number of infections , recurrences , and the length of hospital stay .
the formation of adhesions has been studied in numerous experimental models . in 1 such study , increasing adhesion development was noted from day 1 to day 7 after placement of the prosthesis , but surfaces that were already covered with mesothelial cells did not show progression .
thereafter , the bowel had a diminished tendency to form adhesions even in the absence of omentum .
another animal model was used to compare adhesion formation after open and laparoscopic placement of mesh .
the study demonstrated that the area of mesh covered with adhesions and the grade of the adhesions were significantly greater in both groups undergoing celiotomy compared with the adhesion formation in the laparoscopic group . on histologic examination
, the vascularity of the animals that underwent incision through skin and fascia was increased and slower to regress than in the laparoscopically treated animals . in the clinical setting , pp mesh has been used previously for open vih repair with a very low rate of enterocutaneous fistula formation , but fistulas have been reported as late as 15 years after the procedure . in laparoscopic vih repair , pp has been combined with omental interposition as protection against bowel adhesions .
colocutaneous fistula after laparoscopic vih hernia repair with intraperitoneal ptfe has also been reported ; in this case , the laparoscopic staples or external postoperative trauma may have played a role .
ultrasound was used to detect adhesion formation at a time when this process was complete .
visceral slide detection by ultrasound was described by kodama et al in 1992 and was again validated in a french study with intraoperative observation and was noted to have a sensitivity of 77% , specificity of 74% , and a negative predictive value of 84% .
the data in our study were prospectively collected , but the overall number of patients was modest . nonetheless , a low recurrence and infection rate was confirmed as noted in other laparoscopic herniorrhaphy studies , and no mesh - related complications have been noted to date .
only 1 case of bowel adhesions to the edge of the mesh was found using ultrasound scanning at 24-month follow - up .
sixty - five percent of our patients did not have adhesions of bowel or omentum detectable on ultra - sound examination .
this result is similar to that reported by franklin et al where two thirds of the patients had few or no adhesions .
a decreased inflammatory response in the abdominal wall tissue might limit the inflammatory tissue reaction caused by the pp mesh in regards to adhesion with underlying viscera .
the results of this study are important but somewhat limited by the fact that the results of individual sonographic examinations could not be independently verified .
the negative predictive value of the visceral slide method is approximately 80% ; therefore , it is possible that some patients who were deemed free of adhesions might indeed have had mild or filmy adhesions not detectable by ultrasound . in any case , these adhesions , even if present are unlikely to have any clinical impact , because no visceral complications have been observed .
late postoperative pain seemed to be mostly related to the suture points during strenuous activity .
although it was noted by half of the patients , it usually did not require medication and did not interfere with work or recreational activities .
we have now gone to the use of absorbable monofilament material for the transfascial sutures .
our early results indicate that laparoscopic ventral incisional hernia repair with pp mesh and omental coverage is not associated with sonographically detectable visceral adhesions in most patients . moreover , visceral complications such as bowel obstruction or enterocutaneous fistula do not occur .
further accrual of patients and careful follow - up is needed to better understand the problem of ventral hernias and their repair with mesh .

Answer:
objective : laparoscopic repair of ventral incisional hernias is feasible and safe .
 polypropylene mesh is often preferred because of its ease of handling and lower cost .
 complications like adhesion and fistula formation can occur .
 the goal of this study was to determine whether bowel adhesions and their attendant complications could be prevented by interposition of omentum.methods:thirty patients underwent laparoscopic ventral incisional hernias repair with polypropylene mesh .
 omentum was always positioned over the loops of bowel for protection . at a mean follow - up of 14 months
 , 20 patients underwent ultrasonic examination using the previously described visceral slide technique to detect adhesions.results:the mean size of the hernias in the study was 50.3 cm2 , and the mean size of the mesh applied was 275 cm2 .
 thirteen patents ( 65% ) had no sonographically detectable adhesions .
 five patients demonstrated adhesions between the mesh and omentum , 1 patient developed adhesions between the left lobe of the liver and the mesh , and only 1 case of bowel adhesion to the edge of the mesh was found.conclusion:laparoscopic ventral incisional hernias repair with polypropylene mesh and omental interposition is not associated with visceral adhesions in the majority of patients .
 polypropylene mesh can be used safely when adequate omental coverage is available .


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 60-year - old male patient was referred to an otorhinolaryngology clinic due to a lump on the left side of his jaw , which had grown in 2 months .
ultrasound sonography test examination revealed a cystic mass that was 2417 mm in size with smooth contours .
multiple echogenic and reactive lymph nodes with partially visible hila were visualized in the neighboring upper jugular chain , with the largest being 1610 mm in size . following a neck magnetic resonance imaging and a preliminary diagnosis of wt ,
left superficial parotidectomy materials were sent for pathologic examination in two pieces , which were 53.22 cm and 4.531.2 cm in size .
cross section analysis showed an off white - yellowish , well - contoured nodular tumor with a bleeding center of 42.52.2 cm .
microscopic examination indicated that the tumor had epithelial components with basaloid and oncocytic columns of cells neighboring lymphoid components ( fig .
in addition to the lymphoid follicles with distinct germinal centers , infiltration of large neoplastic cells with bizarre and extremely atypical morphology was seen in the lymphoid component ( figs . 2 , 3 ) .
4b ) , leukocyte common antigen , igg , cd138 , mum1 , and focal positivity for kappa .
staining for lambda , igm , iga , cd3 , cd5 , cd10 , cd15 , cd56 , epithelial membrane antigen , bcl2 , bcl6 , cyclind1 , s100 , pancytokeratin , cytokeratin 20 , human melanoma black 45 , actin , and desmin were negative .
latent epstein - barr virus ( ebv ) was shown to be negative in tumor cells by using ebv - encoded rna chromogenic in situ hybridization . due to these findings
, the patient was diagnosed with " wt and cd30 positive diffuse large b - cell lymphoma in the parotid gland . " following the lymphoma diagnosis , a full body screen was performed .
in addition to these findings , the left suprarenal gland showed two nodular mass lesions , which were assessed as likely adenomas ; however , this preliminary diagnosis was not confirmed by histopathology .
the patient was stage 3a and received six courses of rituximab , cyclophosphamide , doxorubicin , vincristine , and prednisone ( r - chop ) therapy . during 6-month follow - up , the patient was free of disease .
wt is the second most common type of salivary gland tumor . in 10 - 15% of cases , it is bilateral , and it accounts for 70% of all bilateral salivary gland tumors.2 the male / female ratio is 1.6/1 , and it typically develops in the 6th and 7th decades . smoking increases the risk of developing wt.5 microscopically the tumors are typically composed of proliferative epithelial components accompanied by lymphoid stroma with lymphoid follicles that have distinct germinal centers .
histogenesis of the lymphoid stroma in wt has been a topic of discussion for many years .
lymphoid stroma can arise as a cell response to epithelial neoplasms or as a normal lymph node due to residue held by the epithelial neoplasm.5,6 the most widely accepted hypothesis suggests that wt is a neoplasm that develops in the heterotopic salivary gland ductus within or around the parotid lymph nodes.7 transformation to carcinoma in wt is a well - known phenomenon ; however , the development of lymphomas from wts is very rare.4,8 although some cases contain a normal residual lymphoid component , in others cases the lymphoid component contains entirely neoplastic lymphoid cells.4 in the present case , non - neoplastic lymphoid tissue was also present in the neighboring areas .
the pathogenesis of malignant transformation of wt remains unclear ; however , exposure to radiation is of particular interest , as the relationship between previous radiotherapy and lymphomas arising from wts has been determined by some authors.4,5,9 chronic immune sialadenitis is thought to play an important role , independent of the presence of sjgren syndrome symptoms.4,7,10 in this case , there was no history of radiotherapy or sialadenitis , but a history of smoking may have provoked the development of wt .
saxena et al.1 state that because the lymphoid stroma of wt is part of the systemic lymphoid tissue , in patients with lymphomatous spread of wt , disseminated disease is present during the staging either at the time of the diagnosis or after . in the present case ,
with screening techniques , lymphadenopathies of a pathologic size were found in the inguinal and iliac regions .
some researchers suggested that although the relationship between wt and lymphoma could be coincidental , it might also be of a pathogenic nature . according to the latter statement , a single agent can affect different tissues or one tumor could trigger the formation of another . from this point of view , the epithelial component is a continuous antigenic stimulator for the lymphoid component , which provides the stimulus for the development of lymphoma.1,6,8 according to this theory , the frequently observed reactive follicular hyperplasia in wt may be histological evidence of chronic antigen stimulation.1 it has been suggested that the lymphomas seen with wt are typically non - hodgkin lymphomas ; however , there are a few cases reporting hodgkin 's lymphomas.11,12 the majority of non - hodgkin 's lymphomas in wt are follicular lymphomas .
dlbcl , small lymphocytic lymphoma , extranodal marginal zone lymphoma of mucosa associated lymphoid tissue , and mantle cell lymphoma have also been reported.4,6,8,9 a small number of t - cell lymphomas such as peripheric t - cell lymphoma and t - cell lymphoblastic lymphoma have also been described in wt.4,8,13 in summary , malignant lymphomas in wt are very rare .
the presented case is a diffuse large b - cell lymphoma expressing cd30 positivity . to the best of our knowledge
this is the first case in literature describing dlbcl with expression of cd30 in wt .

Answer:
warthin 's tumor is the second most common type of salivary gland tumor .
 microscopically , warthin 's tumor displays a proliferative epithelial component and lymphoid stroma .
 carcinomas arising from the epithelial component are well known , but malignant transformations of the lymphoid stroma are rare . when they do occur , they are most commonly b - cell type non - hodgkin lymphomas . a 60-year - old male patient
 underwent surgical resection of a parotid mass .
 after superficial parotidectomy , microscopic examination indicated that the tumor was of epithelial components with basaloid and oncocytic columns of cells neighboring lymphoid components .
 in addition to the lymphoid follicles with distinct germinal centers , there were large , bizarre and extremely atypical neoplastic cells seen in the lymphoid component .
 large neoplastic cells were diffusely cd20 and cd30 positive . the patient was diagnosed with " warthin 's tumor and diffuse large b - cell lymphoma with expression of cd30 . "
 the histopathologic and clinical features are discussed along 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:
rab - type small gtpases are conserved membrane trafficking proteins in all eukaryotes , and they mediate various steps in membrane trafficking , including vesicle budding , vesicle movement along cytoskeletons , vesicle docking to specific membranes , and vesicle fusion .
rabs function as a molecular switch by cycling between two nucleotide - bound states , a gdp - bound inactive state (  off  state ) and a gtp - bound active state (  on  state ) .
rabs are activated by specific guanine nucleotide exchange factors ( gefs ) , which promote the release of gdp from rab and binding of gtp to rab , and the activated rabs are then inactivated by gtpase - activating proteins ( gaps ) or spontaneously inactivated by their intrinsic gtpase activity .
thus , investigation of rab - gefs is crucial to understanding the spatio - temporal regulation of rab gtpase activation .
although a large number of putative rab - gefs , including denn - domain - containing proteins , have recently been reported , very little is known about their in vivo roles in rab targeting to specific membrane compartments .
rab17 was originally described as an epithelial cell - specific rab isoform that regulates polarized trafficking but was subsequently found to be expressed in melanocytes and human breast adenocarcinoma , and more recently we demonstrated that rab17 is also expressed in mouse brain .
localization of rab17 in mouse hippocampal neurons is unique , because rab17 is the only rab isoform that is specifically targeted to the dendrites and is not targeted to the axon .
the targeting of rab17 to the dendrites is neuronal differentiation stage - dependent : at an early stage ( 3 d of in vitro culture ) it localizes only in the cell body , whereas at a later stage ( 11 d of in vitro culture ) some of the rab17 is translocated from the cell body to the dendrites .
by contrast , other rab isoforms are targeted to the axon alone ( e.g. , rab3a ) or to both the axon and dendrites ( e.g. , rab5a ) .
targeting of rab17 to the dendrites is known to be crucial for dendrite morphogenesis and subsequent postsynapse formation , because knockdown of rab17 has been found to result in a marked reduction in both total dendrite length and the number of dendrite branches without affecting axon morphogenesis ( i.e. , total axon length and the number of axon branches ) .
although several mammalian rab isoforms ( e.g. , rab7 and rab11 ) have been shown to regulate dendrite morphogenesis , rab17 is the first reported rab isoform that specifically regulates dendrite morphogenesis , but not axon morphogenesis , in mammalian neurons .
we therefore thought that rab17 would be an ideal rab isoform to use to analyze a rab targeting mechanism at the cellular level .
however , until recently the molecular basis of the specific rab17 targeting to dendrites had completely remained unknown and no physiological rab17-gefs that function in hippocampal neurons had been identified . in our latest study , we screened for rab17-gefs by performing yeast two - hybrid assays with a constitutive negative mutant of rab17 as bait and succeeded in identifying rabex-5 and als2 , both of which were originally described as rab5-gefs , as plausible candidate rab17-gefs in mouse hippocampal neurons .
it is noteworthy that overexpression of rabex-5 , but not of als2 , increased the proportion of rab17 in the dendrites , whereas knockdown of rabex-5 caused a dramatic reduction in the proportion of rab17 in the dendrites .
importantly , overexpression of a gef - activity - deficient mutant of rabex-5 ( rabex-5-d313a ) failed to increase translocation of rab17 from the cell body to the dendrites .
based on these findings , activation of rab17 by rabex-5 is responsible for the stage - dependent movement of rab17 from the cell body to the dendrites of hippocampal neurons . actually , forced activation of rab17 , i.e. , expression of a constitutive active mutant of rab17 ( rab17-q77l ) , increased the dendrite localization of rab17 even in early stage neurons .
more importantly , rabex-5 knockdown was found to cause a significant reduction in total dendrite length , the same as rab17 knockdown did , and the reduction was partially rescued by co - expression with rab17-q77l .
these findings indicated that rabex-5 functions as an upstream activator of rab17 in developing hippocampal neurons ( fig .
proposed model of rabex-5-mediated translocation of its downstream rabs to the neurites of developing hippocampal neurons .
rabex-5 functions not only as a rab17-gef ( a ) but also as a rab5/21-gef ( b ) , and it determines dendrite targeting of rab17 and axon / dendrite targeting of rab5/21 , respectively ( dotted arrows ) .
the solid arrows indicate the gef function of rabex-5 that promotes release of bound gdp from rab5/17/21 in exchange for gtp . because of the different sorting functions of rabex-5
, rab17 specifically regulates dendrite morphogenesis , whereas rabex-5 and rab5 are involved in neurite morphogenesis in general . factor
x  in ( a ) is a putative rab17-specific effector that may also interact with rabex-5 and support dendrite targeting of rab17 .
rabaptin-5 is known to interact with both rab5/21 and rabex-5 at early endosomes , but whether rabaptin-5 is involved in neurite outgrowth remains to be determined ( b ) .
determining the molecular mechanism by which active rab17 is translocated from the cell body to the dendrites is an important task that has yet to be achieved .
active rab17 itself is unlikely to have the ability to target dendrites , because unlike endogenous rab17 , which specifically localizes in the dendrites , rab17-q77l also localizes in the axon .
interestingly , overexpression of a gef domain ( i.e. , vps9 domain ) of rabex-5 alone similarly increased the translocation of rab17 to both the axon and the dendrites , whereas overexpression of full - length rabex-5 increased endogenous rab17 translocation to the dendrites alone .
thus , some additional domains of rabex-5 besides its gef domain ( e.g. , a zinc finger domain and/or a coiled - coil domain ) must also be involved in rab17 targeting .
we speculate that rabex-5 functionally links to dendrite - directed motors and that rab17 activated by rabex-5 is captured by certain motor proteins that transport it to the dendrites .
since some rab effector molecules ( or rabs themselves ) are known to directly associate with motor proteins , in the future it would be interesting to search for rab17-specific effectors that form a link between rabex-5 and motor proteins .
our finding that rabex-5 determines the dendrite localization of its downstream target rab17 is highly consistent with a recent report showing that rab - gefs ( e.g. , rabex-5 and rabin8 ) are major determinants of specific rab membrane targeting .
however , one puzzling result of our research is that rab5 and rab21 , two other downstream targets of rabex-5 , are translocated  both to the axon and to the dendrites  of developing hippocampal neurons in a rabex-5-dependent manner ( fig .
1b ) , meaning that rabex-5 determines not only the dendrite targeting of rab17 but the axon / dendrite targeting of rab5 and rab21 as well .
because of the multiple roles of rabex-5 in rab targeting to neurites , rabex-5 is involved in both the axon morphogenesis and dendrite morphogenesis of developing hippocampal neurons by activating at least two downstream targets , rab5 and rab17 .
however , the molecular mechanism by which rabex-5 sorts different downstream rab proteins into the axon and/or dendrites is completely unknown .
since rabex-5 constitutes a gef cascade by recruiting a rab5 effector , rabaptin-5 , to early endosomes , rabex-5 may also recruit an as yet unidentified rab17-specific effector(s ) ( factor  x  in fig .
1a ) that does not bind rab5 or rab21 and support dendrite targeting of rab17 . thus , identifying rab17-specific effectors will be one of the most important tasks in future rab17 research designed to understand the molecular mechanism by which rabex-5 determines the targeting of its downstream rab proteins to neurites at the cellular level . since rab17 is also expressed in epithelial cells and melanocytes , it would be interesting to investigate whether rabex-5 also contributes to the polarized trafficking of rab17 in other cell types .

Answer:
rab family small gtpases function as molecular switches in the regulation of membrane traffic , and their activity is thought to be controlled by guanine nucleotide exchange factors ( gefs ) .
 however , the role of gefs in targeting rab proteins to specific membrane compartments is poorly understood .
 we have recently reported finding that rabex-5 , originally described as a rab5-gef , also functions as a rab17-gef in mouse hippocampal neurons .
 the rab17 in developing hippocampal neurons is specifically targeted to their dendrites and not to their axons , and the gef activity of rabex-5 is required for translocation of rab17 from the cell body to the dendrites .
 interestingly , rabex-5 is also required for the axon and dendrite localization of rab5 and rab21 in hippocampal neurons .
 our findings indicate that rabex-5 determines the targeting of its downstream rab proteins to the dendrites ( rab17 ) or to both the axon and dendrites ( rab5 and rab21 ) .


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:
medical files of the patients who were referred to the outpatient clinics of children s health and diseases of namik kemal university research , and application hospital were analyzed , and height , bodyweight , waist , and hip circumferences of the patients were recorded . among these cases ,
patients who had undergone complete word counts because of medical requirement or routine control were included in the study , and their neutrophil , and lymphocyte parameters were evaluated . medical files or the patients were screened , and those with viral - bacterial infection , insulin - dependent diabetes , congenital metabolic disease or hormonal disorder were excluded from the study group . a total of 130 obese ( aged 615 years ) and 57 ( aged 715 years ) healthy control subjects were included in the study .
age , and measured body parametres of the healthy control , and obese individuals participating in the study body mass indices ( bmis ) of the children were estimated based on bmi percentiles established by the centers for disease control 2000 ( cdc ) for children , and adolescents .
participants with bmis between 8595 percentiles were defined as overweight , and those over 95 percentile as obese .
blood samples to be analyzed for neutrophils , lymphocytes , and other hemogram parametres were placed in tubes containing k2 edta . following 15 minutes of agitation , the samples were analyzed in pentra dx nexus ( uk ) device under room temperature . for biochemical measurements
all biochemical tests were performed in cobas c 501 roche ( japan ) biochemical analyzer using commercial kits . in all analyses spss 17.0 ( chicago , il . )
normality of continuous variables was checked with kruskal - wallis test . for comparison of data with non - normal distribution mann- whitney
medical files of the patients who were referred to the outpatient clinics of children s health and diseases of namik kemal university research , and application hospital were analyzed , and height , bodyweight , waist , and hip circumferences of the patients were recorded . among these cases ,
patients who had undergone complete word counts because of medical requirement or routine control were included in the study , and their neutrophil , and lymphocyte parameters were evaluated . medical files or the patients were screened , and those with viral - bacterial infection , insulin - dependent diabetes , congenital metabolic disease or hormonal disorder were excluded from the study group . a total of 130 obese ( aged 615 years ) and 57 ( aged 715 years ) healthy control subjects were included in the study .
age , and measured body parametres of the healthy control , and obese individuals participating in the study body mass indices ( bmis ) of the children were estimated based on bmi percentiles established by the centers for disease control 2000 ( cdc ) for children , and adolescents .
participants with bmis between 8595 percentiles were defined as overweight , and those over 95 percentile as obese .
blood samples to be analyzed for neutrophils , lymphocytes , and other hemogram parametres were placed in tubes containing k2 edta . following 15 minutes of agitation , the samples were analyzed in pentra dx nexus ( uk ) device under room temperature . for biochemical measurements
all biochemical tests were performed in cobas c 501 roche ( japan ) biochemical analyzer using commercial kits .
normality of continuous variables was checked with kruskal - wallis test . for comparison of data with non - normal distribution mann- whitney
measured parametres of a total of 187 healthy , and obese children are given as median , minimum , and maximum values in table 2 .
obese , and healthy control groups were compared , and lymphocyte , and neutrophil ratios were found to be significantly higher in the obese group ( p=0.03 , and 0.045 , respectively ) .
similarly , neutrophil / lymphocyte ratio , and crp levels were found to be significantly higher in the obese group ( p=0.03 , p=0.02 , and p=0.00 ) .
besides , mean platelet volume ( mpv ) was significantly higher in the obese group ( p=0.005 ) . both groups did not differ significantly as for platelet / lymphocyte ratio ( p=0.156 ) biochemical , and hematological parametres measured in healthy controls , and obese individuals p<0.05 statistically significant ; hgb : hemoglobin ; hct : hematocrit ; mcv : mean corpuscular volume ; mch : mean corpuscular hemoglobin ; mchc : mean corpuscular hemoglobin concentration ; rdw : red blood cell distribution width ; wbc : white blood cell ; mpv : mean platelet volume ; pdw : platelet distribution width ; crp : c - reactive protein .
in recent years because of diets rich in fats , and sedentary life style , prevalence of obesity has rapidly increased .
obesity plays a central role in insulin resistance which include hyperinsulinemia , hypertension , hyperlipidemia , and type-2 diabetes , and increases the risk of cardiovascular disease .
although , obesity has been demonstrated to be an independent risk factor for atherosclerotic cardiovascular diseases , the mechanism of increased cardiovascular risk in obese individuals has not been clarified yet . in studies performed , the pathogenesis of pathological processes of atherosclerotic cardiovascular disease , and related risk factors have been dated back to the pediatric age .
obesity is a chronic inflamatory disease characterized by altered adipokine production , and increase in the levels of inflammatory cytokines .
kim et al . analyzed levels of leptin , and inflammatory cytokines including hs - crp , tumor - necrosis factor ( tnt- ) , interleukin-6 ( il-6 ) in young obese girls , and they were found to be significantly higher in obese women relative to non - obese women . in recent studies increased levels of crp were detected in obese individuals [ 14 , 15 ] .
high - sensitive c - reactive protein ( hs - crp ) which can be used as a marker of metabolic syndrome is a useful marker of childhood obesity .
prevention of obesity , and inflammation which start in childhood will contribute to the prevention of metabolic syndrome in the future .
similarly , crp level in the obese group was found to be significantly higher in our study when compared with the healthy controls .
arslan and makay have demonstrated that mpv levels were higher in obese adolescents with non - alcoholic fatty liver when compared with healthy controls , and other obese patient groups . however , kilciler et al .
reported that any significant difference was not found between the patients with non - alcoholic fatty liver disease as for mpv levels .
also in our study , we detected higher mpv levels in the obese patient group when compared with the healthy controls .
nlr which is a strong indicator of inflammation has been investigated in various inflammatory , and neoplasic diseases including metabolic syndrome , behcet s disease , coronary artery disease [ 21 , 22 ] , heart failure [ 23 , 24 ] , colorectal cancer , chest , and lung diseases , and hepatocellular carcinoma .
the main fundamental etiological factor of this wide spectrum is that nlr contains two separate inflammation markers .
neutrophils have been reported to migrate into ischemic myocardial tissue before other inflammatory cells , and cause destructive changes by stimulating release of proteolytic enzymes , reactive oxygen radicals , and neutrophils . as a known fact ,
in the pathophysiology of atherosclerotic cardiovascular diseases , increased inflammation , and endothelial dysfunction play fundamental roles .
outcomes of this study suggest that nlr may be one of the markers of endothelial dysfunction , and inflammation in obese patients .
related studies performed in adults have suggested that various comorbidities as diabetes , insulin resistance , hyperlipidemia , and coronary artery disease prevent disclosure of cause - effect relationship between obesity , and inflammation .
therefore this study provides a clarification on this issue which also aids in the evaluation of this correlation between obesity , and inflammation . in conclusion , in chidhood obesity ,
therefore keeping obesity under control using dietary modifications , and other treatment methods carries importance in decreasing mortality , and morbidity rates in adulthood .

Answer:
objective : obesity is a growing health problem in most of the developed countries . it is associated with many chronic diseases , affecting particularly endocrine and cardiovascular systems . inflammation plays a key role in pathophysiology of obesity . in this study , we aimed to investigate the inflammation status in obese children using neutrophil / lymphocyte ratio.methods:in this study 130 obese and 57 healthy children were assessed retrospectively . according to centers for disease control 2000 ( cdc ) bmi percentiles for childhood and adulthood ,
 8595 percentile was considered as overweight and > 95 percentile as obese.results:lymphocyte/neutrophil ratios in the obese group were significantly higher compared to those in healthy controls ( p=0.03 and p=0.045 , respectively )
 . neutrophil / lymphocyte ratio and crp level in the obese group were significantly higher compared to those in healthy controls ( p=0.02 and p=0.00 , respectively ) .
 thrombocyte / lymphocyte ratios were not significantly different between two groups ( p=0.156).conclusion : it is possible that childhood obesity which has been increasingly prevalent recently triggers the pathogenesis of atherosclerosis during the early years of life . increased neutrophil / lymphocyte ratio might be associated with the severity of inflammation which plays a role in the early stages of atherosclerosis . therefore ,
 taking childhood obesity under control using diet and other treatment methods will prevent mortality and morbidity in the elderly .


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:
heterozygous hnf4a mutations cause a beta cell phenotype of neonatal hyperinsulinism with macrosomia and young onset diabetes .
autosomal dominant idiopathic fanconi syndrome ( a renal proximal tubulopathy ) is described but no genetic cause has been defined .
we report six patients heterozygous for the p.r76w hnf4a mutation who have fanconi syndrome and nephrocalcinosis in addition to neonatal hyperinsulinism and macrosomia . all six displayed a novel phenotype of proximal tubulopathy , characterised by generalised aminoaciduria , low molecular weight proteinuria , glycosuria , hyperphosphaturia and hypouricaemia , and additional features not seen in fanconi syndrome : nephrocalcinosis , renal impairment , hypercalciuria with relative hypocalcaemia , and hypermagnesaemia .
this was mutation specific , with the renal phenotype not being seen in patients with other hnf4a mutations .
in silico modelling shows the r76 residue is directly involved in dna binding and the r76w mutation reduces dna binding affinity .
the target(s ) selectively affected by altered dna binding of r76w that results in fanconi syndrome is not known .
the hnf4a r76w mutation is an unusual example of a mutation specific phenotype , with autosomal dominant atypical fanconi syndrome in addition to the established beta cell phenotype .

Answer:
backgroundmutation specific effects in monogenic disorders are rare .
 we describe atypical fanconi syndrome caused by a specific heterozygous mutation in hnf4a .
 heterozygous hnf4a mutations cause a beta cell phenotype of neonatal hyperinsulinism with macrosomia and young onset diabetes .
 autosomal dominant idiopathic fanconi syndrome ( a renal proximal tubulopathy ) is described but no genetic cause has been defined.methods and resultswe report six patients heterozygous for the p.r76w hnf4a mutation who have fanconi syndrome and nephrocalcinosis in addition to neonatal hyperinsulinism and macrosomia .
 all six displayed a novel phenotype of proximal tubulopathy , characterised by generalised aminoaciduria , low molecular weight proteinuria , glycosuria , hyperphosphaturia and hypouricaemia , and additional features not seen in fanconi syndrome : nephrocalcinosis , renal impairment , hypercalciuria with relative hypocalcaemia , and hypermagnesaemia .
 this was mutation specific , with the renal phenotype not being seen in patients with other hnf4a mutations .
 in silico modelling shows the r76 residue is directly involved in dna binding and the r76w mutation reduces dna binding affinity .
 the target(s ) selectively affected by altered dna binding of r76w that results in fanconi syndrome is not known.conclusionsthe
 hnf4a r76w mutation is an unusual example of a mutation specific phenotype , with autosomal dominant atypical fanconi syndrome in addition to the established beta cell phenotype .


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:
primary tumors of the trachea are rare and account for 0.1% of all malignancies . in adults ,
approximately 90% of the primary tracheal tumors are malignant , whereas in children , the majority of these tumors are benign [ 2 , 3 ] . in a retrospective study by webb et al . , 55.4% of the patients were male and 77.3% of them were smokers .
the frequency of this rare disease has been estimated to be 0.10.4% of all malignancies , with an annual incidence of 2.6 new cases per million per year .
primary tracheal tumors can arise from the respiratory epithelium , salivary glands and mesenchymal structure of the trachea .
squamous cell carcinoma ( scc ) and adenoid cystic carcinoma ( acc ) make up about 71.6% of all adult primary tracheal tumors . the remaining portion ( 28.4% )
scc occurs predominantly in men in the sixth and seventh decades , whereas acc is equally distributed between the sexes and peaks in incidence in the fourth and fifth decades .
in contrast to acc , scc ( the most common type of tracheal tumors ) has a more aggressive course .
median survival time ranges from 6 to 14 months , and tumor disappearance is dependent on whether the primary lesion is resected .
sccs spread to the lymph nodes and 1020% of the patients will have distant metastasis at presentation .
carcinoids , lymphomas , granular cell tumors and small cell carcinomas have variable prognoses ; yet they seem to behave better than sccs , adenocarcinomas or sarcomas .
the majority of the tracheal neoplasms are primary in nature , and other primary sites that can metastasize to the trachea are the lung and esophagus , the latter being the most common .
patients with surgically resectable primary tracheal tumors have a better prognosis than those with tumors that can not be resected .
preoperative radiation therapy has been attempted in some patients , yet the most compelling evidence for adjuvant radiation therapy comes from postoperative cases .
the present study reports a rare case of primary tracheal malignancy treated with surgery and adjuvant radiation therapy .
our 60-year - old diabetic and hypertensive male patient had a 1-month history of cough associated with marked respiratory distress and occasional dyspnea in the right lateral lying position .
the patient consulted a chest physician and underwent bronchoscopy , which showed a polypoid growth in the trachea extending to the larynx ( fig .
a computed tomography ( ct ) scan revealed irregular soft tissue thickening in the region of the trachea extending up to the adjacent larynx with no soft tissue calcification , and there was no definite lymphadenopathy in the cervical region and no involvement of the underlying bone . a repeat ct scan of the neck ( fig .
2 ) showed evidence of an ill - defined , irregular , nodular , infiltrating soft tissue growth arising from the posterior tracheal wall , bridging the lumen and reaching up to the anterior wall , with an infiltration of about 2.2  1.8 cm .
the location was opposite the c7-d1 level involving the 5th or 6th tracheal ring , approximately 7 cm proximal to the carina with no significant evidence of cervical and mediastinal lymphadenopathy .
excision of the tracheal growth through a cervical transverse incision was performed , and a tracheostomy tube was inserted .
soon after surgery , the cough subsided and the patient attended square hospital , dhaka , bangladesh , for postoperative irradiation .
ninety - five percent of the planning target volume ( ptv ) covered 97.3% of the prescribed dose .
the minimum and maximum dose received by the ptv was 50.05 and 63.68 gy , respectively .
3 ) . three multileaf collimator fields ( left anterior oblique , right anterior oblique and posterior ) were used for three - dimensional conformal radiation therapy ( 3dcrt ) .
complete response was documented , and the patient is still alive without any evidence of disease during 30 months of follow - up .
primary malignant tumors of the trachea are uncommon , and therefore limited data supporting a standard management are available .
the vast majority of the primary tracheal tumors in adults are malignant and most of them usually diagnosed at a later stage , which is due to a delayed presentation of specific symptoms like cough , dyspnea and hemoptysis .
it is clear that patients who can be resected have a better prognosis than those who can not , prompting the recommendation of surgical resection for most primary tracheal tumors .
all resected patients need postsurgical irradiation , regardless of tumor burden , margin status , histology or nodal status .
grillo and mathisen   experienced a median survival of 34 months in scc and 118 months in acc patients who underwent a combined modality like surgery and radiation therapy .
attained a 61-month median survival using a combined surgery and radiation therapy in their study .
.   showed that 73% of the patients with a 5-year survival underwent radiation therapy postoperatively .
the role of external beam radiation therapy as an adjuvant to surgical resection is better established .
grillo and mathisen   advocated maximal ( 4,5006,500 cgy ) radiation therapy after scc and acc resection because of the close margins necessary for resection and the high likelihood of local recurrence .
modern ct - based 3dcrt or intensity - modulated radiation therapy theoretically allows higher and safer doses delivered to the trachea . for postoperative cases ,
all patients with this tumor in the postoperative or definitive setting should be treated with the 3dcrt technique .
an intraluminal boost technique after external beam radiation therapy may decrease the risk of late side effects .
there are many studies showing the benefit of postoperative irradiation therapy in primary tracheal malignancies such as sccs and accs .
however , little experience has been shared in the case of primary adenocarcinomas of the trachea , the tumor type described in our report .
the prognosis of patients with malignant tumors of the trachea remains gloomy , and long - term median survival of tracheal adenocarcinoma patients undergoing combined modalities is unknown to us .
primary adenocarcinoma of the trachea needs to be diagnosed at an early stage , and combined multimodal approaches may be explored to attain an extended median survival .
none of the authors has any conflicts of interest regarding the content of this article .

Answer:
primary adenocarcinoma of the trachea is extremely rare and a standard treatment does not exist due to nonavailability of evidence - based randomized control studies . this paper reports the case of a 60-year - old male , who presented with cough and occasional respiratory distress .
 bronchoscopic examination and a computed tomography scan revealed a soft tissue mass in the trachea arising from the posterior tracheal wall .
 cytological examination and immunochemistry confirmed primary adenocarcinoma of the trachea .
 excision of the tumor followed by three - dimensional conformal radiation therapy was performed , and a dose of 56 gy was delivered to the primary site .
 two and a half years after treatment , the patient has no clinical or radiological evidence of the disease , and no late complication has occurred .


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:
hyperparathyroidism ( hpt ) occurs when there is an abnormal increase in parathyroid hormone ( pth ) production by the parathyroid gland [ 13 ] .
primary hpt ( phpt ) is caused by parathyroid adenomas in 85% of cases , leading to hyperplasia and over - secretion of pth . in most individuals in western society , it is diagnosed at an asymptomatic stage , without signs or symptoms of ( pth ) calcium excess .
initial symptoms are nonspecific , such as weakness , malaise , fatigue and possible mood disturbances . if not diagnosed and left untreated , it leads to devastating consequences including nephrolithiasis , nephrocalcinosis , renal failure , osteopenia and osteoporosis .
a 22-year - old male student presented to our hospital with a 2-year history of progressive lower extremity weakness .
one year prior to the admission , he had been seen at another medical clinic because of fatigue and difficulty walking .
his radiographs showed no fractures , and he was referred to physiotherapy for muscle strengthening .
further questioning revealed that , despite physiotherapy , his weakness had progressed and he had to quit school as he was having considerable difficulty walking up a flight of stairs .
a thorough investigation was performed and showed a serum calcium level of 3.46 mmol / l ( normal : 2.12.6 mmol / l ) and a pth level of 138 pmol / l ( normal : 1.69.3 pmol / l ) .
he was referred to our general surgery service where he was admitted for excision of the parathyroid adenoma . upon admission ,
one day prior to the scheduled parathyroidectomy , he had a simple , low - energy fall while he was walking on his own to the hospital .
radiographs revealed a displaced subcapital fracture of his left hip , a segmental fracture of his right humerus and extreme osteopenia ( fig .  1 ) .

figure  1:(a ) left femoral neck displaced subcapital fracture and ( b ) right humeral shaft segmental fracture .
( a ) left femoral neck displaced subcapital fracture and ( b ) right humeral shaft segmental fracture .
one day after sustaining this injury , the patient underwent an uncemented left total hip arthroplasty ( tha ) ( fig .
2 ) , and acetabular fixation was supplemented with multiple screws , and he maintained touch - down weight bearing for 6 weeks postoperatively .
postoperatively , the pth level had decreased to 4.9 pmol / l , and the calcium level had returned to normal at 2.42 mmol / l .
the calcium level continued to fall , and 2 weeks after the parathyroidectomy , it had reached 1.70 mmol / l . after a further 20 days , it started to normalize and then continued to remain stable , as shown in fig .  3 .

figure  2:(a ) left thr and ( b ) right humerus in a brace .

( a ) left thr and ( b ) right humerus in a brace . a graph for calcium level from admission to 7 weeks after surgery
we report this case to illustrate the importance of early detection and diagnosis of phpt , which was possible in this young and presumed healthy individual if proper assessment and management were done .
furthermore , sending him for physiotherapy without a clear diagnosis increased the likelihood of missing the diagnosis and progression of the disease .
solitary parathyroid adenoma is the most common cause of phpt , representing 8590% of cases .
symptomatic phpt with skeletal , renal , abdominal and neuro - psychiatric manifestations has become exceedingly rare in developed countries .
our patient was unusual in that he was not diagnosed early and presented with skeletal manifestations resulting in multiple fractures including femoral neck fracture ( fnf ) , which was treated with total hip replacement ( thr ) . at this young age , thr would affect his lifestyle and put him at risk of revision surgery early in his life .
the literature clearly shows that the earlier hpt is detected , the more reversible the disease .
we believe that , despite the young age of our patient , thr was still the preferred treatment in this situation owing to his poor bone quality , which could have led to failure of fixation ; in addition , severe fracture displacement carries a high risk of femoral head avascular necrosis .
yang et al . found that salvage tha for failed internal fixation following fnf is a more technically demanding procedure with prolonged operative time and larger amounts of postoperative drainage ( within 24 h ) and that patients are at increased risk of developing hip complications compared with primary thr for acute displaced fnf .
french et al .   reported a case of a 21-year - old male with parathyroid adenoma who had presented with a left femoral shaft fracture and right fnfs .
although these were treated with fixations , the right side required conversion to thr within a year of his presentation .

Answer:
we present the case of a 22-year - old male with longstanding progressive fatigue , weakness and pain around his hips due to an undiagnosed parathyroid adenoma .
 the resultant primary hyperparathyroidism ultimately caused pathologic fractures .
 he was admitted to the hospital for further assessment and excision of the parathyroid adenoma .
 a few days after admission , he fell down while walking and was referred to our team .
 x - rays showed a displaced left femoral neck fracture ( fnf ) and right humeral shaft fracture with poor bone quality .
 his humeral fracture was treated conservatively , and the fnf was treated with total hip replacement .
 three days later , he underwent parathyroidectomy .
 this case demonstrates the importance of a thorough investigation of progressive weakness even in a young individual and illustrates the importance of early diagnosis of parathyroid adenoma to avoid the devastating end results of this condition .


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:
one of the most major public health problems over the world is cardiovascular disease including coronary heart disease ( chd ) , peripheral vascular disease and stroke.1 countries in the middle east bear a heavy burden from chd .
the prevalence of chd is due to high rate of its risk factors , particularly obesity , smoking , hypertension ( htn ) , dyslipidemia , diabetes , and sedentary lifestyles .
patients in the middle east present with myocardial infarction at a younger age , on average , compared with patients elsewhere .
the projected future burden of mortality from chd in the middle east is set to outstrip that observed in other geographical regions.2 improved socioeconomic conditions in saudi arabia during the past few decades have been accompanied by rapid changes in the lifestyle of the people , particularly unhealthy dietary patterns , and physical inactivity .
consequently , chronic diseases commonly associated with affluent societies , such as chd , diabetes mellitus ( dm ) , obesity have become the dominant illnesses in saudi arabia .
hospital - based studies have shown that smoking , htn , and dm are common risk factors among patients with acute myocardial infarction .
a recent study on chd mortality in the eastern province of saudi arabia , using proportionate mortality ratio , showed that 26% of deaths were caused by chd ( 27.0% of male and 23.5% of female deaths).3 in 2013 , there was study on the prevalence of the obesity in saudi arabia which showed that 28.7% were obese ( body mass index [ bmi ] > 30 ) .
obesity consider as an important risk factor of chd.4 one study in the east province of saudi arabia in 2008 showed that 21% was the prevalence of htn in screening campaign and increase with age , lower educational level , and divorced women.5 in 2009 , there was study on the prevalence of dm in saudi arabia .
the prevalence of dm was 30% and dm increase with obesity and female gender , who more than 50 years compare to male group.6 a national study measured hyperlipidemia and 5-year risk of development of chd among university and school workers in jeddah , saudi arabia .
about half of the participants were overweight , 18.8% were current cigarette smokers and 19.9% were hypertensive .
hyperlipidemia was present in 10.1% and was significantly related to older age ( 40 years and over ) and place of work . according to the previous study , the estimated risk of chd in the coming half - decade for those classified in the fifth quintile was 0.068.7 the government of saudi arabia is becoming increasingly concerned about the high prevalence of chd risk factors .
knowledge of the causative factors and methods of prevention of chd are essential to reduce morbidity and mortality from them .
the objective of this study is to determine the prevalence of chd risk factors among the faculty and staff members of qassim university and also to assess their knowledge of the risk factors of chd and compare the result with other prevalence of risk factors in other area of saudi arabia .
a cross - sectional study was conducted among the faculty and the staff members of qassim university for male and female .
all employees were invited to voluntarily participate in the study by advertisement through email and social network .
data were collected through a self - administered health risk assessment questionnaire , as well as through clinical screening that included measurement of blood pressure , fasting blood glucose ( fbg ) and lipid profile .
the employees working under contract for an outsourcing company ( for example , the housekeeping staff ) were excluded .
participants were recruited through general announcements to staff , as well as among patients visiting the clinic .
this sample is expected to provide sufficiently reliable estimates of the most common risk factors among university staff and faculty .
a self - administered questionnaire was used to collect information on sociodemographic , biological , and behavioral risk factors .
information was collected on personal , past and family history of chronic diseases , cigarette smoking , and stress experienced in the workplace .
we also documented the level of willingness of the participants to engage in a behavior change program .
data were focused on providing point estimates for the risk factors of chd and testing hypotheses regarding expected correlations between these risk factors . the odd ratio and 95% confidence interval were calculated .
we present the results of analysis of data from 233 faculty / staff members ( 157 males , 67% ; 76 females , 33% ) .
more than half of the participants were in the 30 - 49 year age group .
53.6% of study participants have family history of any of risk factor of chd and 20.6% of the staff members and faculties were obese 10.3% were diabetic .
sociodemographic data and risk factor status the most common age group for male who are overweight is more than 50 and for obese is between 30 and 50 years . for female gender we can find the most common age group for overweight and obese is between 30 and 50 years ( 35.7% and 30.2% ) , respectively ( table 2 ) .
prevalence of obesity among male and female there were 16 of the staff members newly diagnosed to have impaired fasting glucose ( 13 male , 3 female ) .
20 of the staff members and faculties were found to have newly diagnosed dm . when the age increase in both gender , the chance of development of dm will be increase with no significant p value as shown in table 3 .
regarding the blood pressure , we found the blood pressure was increased with age and there was no significant difference between male and female ( table 3 ) .
prevalence of dm and htn according to the gender and age group in table 4 , we found that the smoking behavior is among male gender only and there was no smoking behavior among female gender .
relation of gender , age group , and smoking status youngest age group < 30 was expected to have increase in high - density lipoprotein ( hdl ) in both gender ( male and female ) .
low - density lipoprotein ( ldl ) more than 190 mg / dl in age group more than 30 years for both genders ( male and female ) as shown in table 5 .
in our study , the prevalence of dm , dyslipidemia , and smoking was found to be lower than other studies.8,9 according to the 2011 american diabetic association guidelines , based on fbg , 6.9% of the participants were found prediabetic and 8.6% having diabetes .
fbg values were found significantly higher with increasing age especially among more than 50 years old .
no statistically significant difference was found among males or females in the prediabetic category ( p = 0.441 ) .
the ldl levels were found to increase with age with participants more than 50 years of age having ldl values > 190 mg / dl ( p = 0.001 ) .
a study carried out among saudi diabetic patients attending primary health - care ( phc ) service concludes that uncontrolled diabetes was found to be the common risk factor followed by uncontrolled lipid profile , obesity , uncontrolled systolic blood pressure , and smoking .
the result of study revealed that seven percent ( 7% ) of male group felled in highest risk group in comparison with 1% in female group ( p < 0.05 ) , while 31% in male group felled in mild risk group in comparison with 90% in female group ( p
62% in male group felled in high - risk group in comparison with 9% in female group ( p < 0.05).10
the directorate of scientific research at king abdul aziz city for science and technology recognized that there is a major transition going on in the kingdom in terms of lifestyle , featuring a more sedentary lifestyle , increased consumption of fast food and unhealthy diet .
these changes were associated with rapid socioeconomic development , urbanization , and increased purchasing power of the population.2 various other studies in the kingdom have similarly indicated a rise in the lifestyle - related risk factors.11,12 moreover , dm and obesity are the leading risk factors associated with chd .
their study done in king faisal specialist hospital in 2011 showed the prevalence of dm was 30%.6 while the prevalence of obesity is 64% and 70% among males and females , respectively.13 our study aimed to estimate the prevalence of risk factors of chd among qassim university s staff / employees .
the overall prevalence of these risk factors ( dm , dyslipidemia , obesity and overweight , smoking , and sedentary lifestyle ) which is found to be 30% in our study was similar to several other studies done elsewhere in similar setups in educational institutions,12 but was significantly lower than the general population in saudi arabia .
chd in saudi arabia study found a high prevalence of htn ( 26% ) and diabetes ( 22% ) , together with a prevalence of chd of 6% , once again higher in the urban setting .
urban location , age , male gender , bmi , htn , smoking , high serum cholesterol , and triglycerides were significant risk factors for chd.14 in a similar study carried out in jeddah in 2007 among university employees and school teachers estimated the prevalence of htn , smoking , dyslipidemia , and overweight to be 19.9% , 18.8% , 10.1% , and ~50% , respectively.15 a study at qassim university conducted in 2007 estimated the prevalence of low hdl was 73.6% and increased total cholesterol and triglycerides 60.0% and 46.4% , respectively.16 another study among attendees of a phc center in south - west region of saudi arabia found the prevalence of risk factors as follows : diabetes ( 28.2% ) , obesity ( 37.9% ) , and physical inactivity ( 68.3% ) .
less than half of the study participants knew about these risk factors and their importance as preventive measures for noncommunicable diseases .
knowledge of risk factors and prevention was significantly associated with educational level.17 a study in al - rabhwa phc center , riyadh in 2004 among diabetic patients found increased cholesterol ( 5.2
high triglyceride ( 1.7% ) was 50% in both genders ; 13.4% of males were hypertensive as against 44.3% females .
there was no significant difference between risk factors for chd and duration of diabetes except that there were more smokers among those who had diabetes for < 10 years .
most of the diabetics with poor glycemic control ( fasting blood sugar > 8.3 mmol / l ) tended to be smokers , were more obese , had high triglyceride and high total cholesterol.18 the current focus of services at most phc centers and hospitals is curative , not preventive .
health promotion and health education are currently mostly missing from the health - care system of saudi arabia .
phc centers can fill this gap by providing health promotion and education programs , which have been found to play a significant role in improving lifestyle practices .
this could significantly reduce the burden of chronic noncommunicable disease.19 our study has a number of limitations .
it was conducted in a university setting and so the results may not be generalized to the population .
furthermore , the study sample includes only those employees who opted for medical checkup , further restricting the generalizability of our results .
the health risk assessment relied on self - report . in our study , interviewing onsite might have caused limitation in the study as it might have resulted in underestimation in one or overestimation of the figures in other areas .
it is emphasized that only those subjects , who were interested in knowing about their health status might have participated in the study resulting in overestimation of the general health status of the university employees .
it was conducted in a university setting and so the results may not be generalized to the population .
furthermore , the study sample includes only those employees who opted for medical checkup , further restricting the generalizability of our results .
the health risk assessment relied on self - report . in our study , interviewing onsite might have caused limitation in the study as it might have resulted in underestimation in one or overestimation of the figures in other areas .
it is emphasized that only those subjects , who were interested in knowing about their health status might have participated in the study resulting in overestimation of the general health status of the university employees .
the population risk for the development of chd in the coming decades is not trivial .
short - and long - term strategies are recommended to decrease the risk of chd and improve the quality of life .
health education and disease promotion program as worksite wellness program is now recognized almost universally as an important intervention to reduce the occurrence and severity of diabetic complications , and also in reducing the delays to seek care when the first signs and symptoms of a complication are noticed by the patient .
qassim university s employees worksite wellness program is already in place , although it needs to be up scaled and expanded to other universities in saudi arabia mandatory maintenance of a personal health profile , at within the campus clinic with periodic checkups linked with some incentives and gifts are some of the options that could also be used to combat with the situation .
moreover , the university also has the responsibility to develop interventions to be implemented at the community level . prevention research is needed to help design health promotion and disease prevention programs to be implemented through phc centers ; in this regard , a number of studies are already going on with assistance from qassim university s faculty .
further research studies are required to find out the exact current status and how and what are the best available measures and strategies that can be adapted and could be found useful in combating the situation and improving the health status of the qassim university s staff .
research studies at the community and mass scale level are also required to find out the current status of chronic diseases as risk factors for chd and the best behavioral modification , health educational , and other strategies to address the current situation in the general local population .

Answer:
objective : to estimate the risk profile of coronary heart disease ( chd ) among the staff members of qassim university and assess their knowledge in a screening campaign in qassim region , saudi arabia.methods:a cross - sectional study was conducted among male and female staff at qassim university campus .
 all employees of qassim university were invited to participate in the study .
 data were collected through a self - administered questionnaire .
 the study sample size was 233 staff and employees .
 the data were entered and analyzed using spss version 18 . the data analysis focused on providing point estimates for the risk factors.results:the study found that 30% of participants have one or more risk factors for chd , namely obesity 20.6% , diabetes 10.3% , hypertension 12.4% , dyslipidemia 10.7% , and smokers ( 11.6% ) .
 about 54% of the participants have a family history of at least one chronic disease as a risk factor for chd.conclusion:the most common risk factor of chd among the staff members is obesity by 20.6% . risk factors for chd are quite common among qassim university staff . these findings need to increase the health education and disease promotion program as an important intervention to reduce the occurrence and severity of chd risk factors and to improve the quality of the life of the staff members of qassim university .