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

Paper text:
the study was conducted at an intensive 4-day teaching program for final - year ophthalmology residents , held at hubli , karnataka state , south india , in january 2014 .
the questionnaire used in this survey was developed and validated in consultation with the division of research and patents of the parent institute of the chief author .
the questionnaire contained 21 questions ( appendix 1 ) , eliciting information from the students about orientation and wet lab training received , operation theatre ( ot ) facilities for training , free surgical camps and detailed information about numbers and types of surgeries observed and performed ; also , questions about what factors influenced the student to pursue ophthalmology residency , about future plans after finishing residency , and if considering fellowship training after residency , which sub - specialties were preferred .
identity information like name was not solicited , and the students were free to not participate in the survey by simply not returning the form . to ensure increased response rate , the students were counseled about the objectives and importance of the survey during the training program .
repeated announcements were made on each day of the training program requesting students to return completed forms .
one hundred and thirteen residents participated in the survey by returning completed forms ( 72.9% ) .
six respondents were found to be 1 year postgraduates ( number of completed months of residency being < 12 ) and were excluded from further analysis in the survey .
the state - wise break - up of students was 76 from karnataka ( 71.02% ) , 16 maharashtra ( 14.95% ) , 8 tamil nadu ( 7.47% ) , 5 andhra pradesh ( 4.67% ) and 2 kerala ( 1.86% ) . the results of this survey , therefore , present a picture mainly from karnataka state and southern india .
twenty - four students were from a government medical college ( 22.42% ) , 38 from private medical colleges ( 35.51% ) , 22 from private eye hospitals ( 20.56% ) and 23 from other hospitals ( 21.49% ) .
residents ( 39.25% ) , 35 were dnb ( 32.71% ) and 30 were diploma residents ( 28.03% ) .
thirty - nine students ( 36.5% ) chose  got seat in the subject through entrance examination  as the most important factor which influenced the decision to pursue ophthalmology residency .
thirty - six students ( 33.6% ) mentioned  offers chance of combined medical and surgical practice  as the most important factor .
eleven students ( 10.3% ) mentioned  workload predictability / flexibility ,  while  positive undergraduate experience  made seven students ( 6.5% ) choose ophthalmology .
( 5 students , 4.6% ) and  earning potential  ( 2 students , 1.8% ) .
forty - one students ( 38.31% ) received orientation / training about ophthalmic surgery / ot .
sixteen of the 41 students ( 39.02% ) had received such orientation from their senior postgraduate / resident , 11 students ( 26.82% ) from senior faculty and 4 students ( 9.75% ) from junior faculty .
sixty - one students ( 57.00% ) had undergone wet lab / simulation lab training .
fifty - six students ( 52.33% ) had attended the wet lab training in their own college / hospital , and five had attended wet lab training in conferences .
eighteen students ( 16.82% ) mentioned that the ot in their center had no closed - circuit television facility for relaying surgical procedures while 37 students ( 34.57% ) mentioned that their ot did not have a microscope with observer arm .
seventy students ( 65.42% ) did their first surgery in ophthalmic residency within the first 6 months , and 34 ( 31.77% ) students did so before the end of the 1 year .
twenty - six students ( 24.29% ) mentioned that free ophthalmic surgical camps were not held in their center . on an average ,
45 students ( 42.05% ) went to the ot 2 times a week and 43 students ( 40.18% ) went 3 times a week .
the details of number of different types of surgeries done per week in the training center of the student , and median and range of number of surgeries done by the student so far are given in tables 1 and 2 .
the number of surgeries done per week in the training center of the students median and range of number of surgeries done per month at training centers and median and range of number of surgeries done by the students so far .
median has been used as measure of central tendency instead of mean , as there are outlier values eighty - eight students ( 82.2% ) mentioned  join fellowship ( or further training )  as the future plan after finishing residency .
six students ( 5.6% ) wanted to join government service and 3 ( 2.8% ) students wanted to join private service after finishing residency .  joining medical college in the teaching profession  and
 start own practice  was chosen as the next step after residency by two students ( 1.8% ) each .
of the 88 students considering fellowship / further training , 37 students ( 42.5% ) mentioned cataract surgery as the most preferred subject and 17 students ( 19.5% ) mentioned cornea / anterior segment .
thirteen students ( 14.9% ) preferred vitreoretina / posterior segment and seven students ( 8.0% ) were considering further training in general ophthalmology .
glaucoma and orbit / oculoplasty were being considered by 6 ( 6.9% ) and five students ( 5.7% ) respectively .
strabismus / pediatric ophthalmology was the first choice for two students ( 2.2% ) while none mentioned uveitis as the preferred subject for further training .
the final question of the survey regarded satisfaction of the student with the surgical training during residency .
six students ( 5.6% ) were  very satisfied  and 20 students ( 18.7% ) were  satisfied  with their surgical training while 37 students ( 34.6% ) found their surgical training during residency to be  fair / average .
totally , 29 students ( 27.1% ) were  not satisfied  with their surgical training and 15 students ( 14.0% ) rated their surgical training as  poor .
this survey with completed responses from 107 final - year residents provides us with a wealth of knowledge on the present status of surgical training in residency , especially in karnataka state and southern india , and on the immediate future plans of these residents .
the residents surveyed in this study were from all types of training institutes in the region , including government and private medical colleges , and private eye hospitals and general hospitals .
less than a quarter of the students had received formal orientation training about ophthalmic surgery from their faculty .
teachers , in their personal capacity , may be teaching students and explaining surgical principles while in the ot , but a formal orientation / training before the student enters the ot will be of benefit and is also desired by the student , as documented by a survey published in indian journal of ophthalmology .
ophthalmic conferences across india have been providing wet lab training for residents , but only a few students in this survey had attended one such .
more students can be encouraged to undergo such training and training institutes can help improve ophthalmic surgical training by establishing wet labs in their centers .
more than a third of the students were training in centers , where the ot did not have a microscope with observer arm ( beam - splitter and assistant scope ) .
the value of such equipment in the ot of a training institute would be immensely beneficial . the vast majority of training centers conducted free ophthalmic surgical camps for patients , as per this survey .
most of the residents surveyed in this study went to the ot more than once a week . these can be termed as desirable statistics .
another statistic which could be termed desirable would be that nearly every student performed his / her first ophthalmic surgery before the end of the 1 year of residency .
this compares favorably with the results of a survey of 129 ophthalmology residency directors in the united states , which had reported that 40% of residents gained experience as primary surgeons during their 1 year and 43% performed only part of the surgery .
when exactly a resident starts his first surgery is dependent on many factors , including personality , temperament and natural , surgical aptitude of the resident , as well as the trainer 's considered judgment about the resident 's readiness to operate . in this
regard , both residents and trainers will find extremely informative kirby 's excellent treatise on surgical technique for residents in ophthalmology , published in 1983 , but still relevant in this era for its sheer wisdom and understanding of teaching and learning methods of ophthalmic surgical techniques .
approximately a third of the respondents indicated that the total number of surgeries done per week in their center is < 20 . increasing the number of operations per week is as much an administrative and logistic issue
as a medical issue and lies under the purview of the respective training institutions , but higher numbers would obviously be desirable for the broader experience and exposure that would be provided . in our country , conducting free ophthalmic camps for the needy can be a win - win situation for ophthalmic care - givers and patients .
needy patients receive quality medical care at the hands of the teachers , which they may not otherwise be able to access , and they act as the providers of exposure and experience to the resident training under the teacher .
conducting such camps will also help increase number of operations done per week in the training center .
most of the students had performed manual small incision cataract surgery ( msics ) , and this was also the surgery performed most commonly by the students table 2 .
an analysis of table 2 shows that the median value of students responses to performance of surgeries other than msics was zero for all surgeries excluding pterygium ( 5 ) , dacryocystectomy ( 2 ) and trauma repair ( 5 ) . increasing the number of noncataract surgeries done by residents
questions 19 and 20 of the survey attempted to read the mind of the student regarding his / her immediate future . a huge majority planned to undergo further training , with cataract surgery and cornea / anterior segment being the most sought after subjects .
it appears that most of the students would prefer to delay further the decision on practice till they are confident of their surgical skills .
a quarter of the respondents in this survey were satisfied with their surgical training while a significant number , more than 40% , were not satisfied with the surgical training during their residency . a brazilian study published in 2013 on recent ophthalmology graduates reported 93.4% satisfaction with the acquisition of surgical skills during residency .
improving satisfaction of residents with their surgical training should become an important goal of trainers .
more than a third of the students in this survey indicated that the most important factor influencing their decision to pursue ophthalmology residency was that they were allotted to the subject through the entrance examination .
a survey of junior residents in saudi arabia had found that the main factor influencing the decision to pursue ophthalmology training ( 97% of the respondents ) was the ability to combine medicine and surgery .
this meant that in our survey , a significant chunk of the students were doing residency in ophthalmology but had not come in desiring the subject specifically .
if a student has come in because he had no perceived better choice , and subsequently , if he also feels that training being received is unsatisfactory , he may then find it difficult to involve himself in the subject , understand the subject and develop a liking for it .
this can prevent the student from reaching his full potential , as he simply does not like what he is doing . training accomplished with modern standards with an aim to also satisfy the students expectations ,
positive under - graduate experience ,   family influence  and  earning potential .
 improving the experience of under - graduate medical students in their ophthalmology training may motivate more students to take up the field ; such motivated students are also likely to strive to improve their own personal learning and satisfaction .
finally , though the study achieved a fairly good response rate ( 72.9% ) , the nonresponse fraction may have an influence on the inferences and conclusions .
the limitations of this study include selection bias owing to purposive sampling , which might influence the results and subsequent conclusions .
ophthalmology residents in the region of karnataka and southern india are performing surgeries on a live human eye within the 1 year of residency and are entering the ot for surgery multiple times a week .
further efforts from trainers can concentrate on adding to the quality of surgical training along with the quantity , by establishing more wet labs / simulation training programs , conducting formal orientation programs for residents before they start surgery and by promoting microscopes with observer arms and closed - circuit television facility . increasing the numbers of noncataract surgeries performed by residents and enhancing satisfaction levels of residents with their surgical training

Answer:
settings and design : this study documents a survey of final - year ophthalmology postgraduates on the subject of their surgical training and their future plans after residency.purpose:this survey aimed to answer the question , what is the present status of surgical training in ophthalmic training centers ? by obtaining information from students about ( 1 ) various methods used in surgical training ( 2 ) numbers and types of surgeries performed by them in the training centers ( 3 ) their plans after residency.materials and methods : a questionnaire containing 21 questions was distributed to 155 students attending an intensive 4-day teaching program .
 the questions related to orientation training , wet lab training , facilities for training , free surgical camps and detailed information about numbers and types of surgeries observed and performed .
 completed questionnaires were collected , and responses analyzed.results:one hundred and seven completed responses were analyzed .
 the majority had not received formal orientation training .
 more than half had undergone wet lab training .
 most residents performed their first ophthalmic surgery during the 1st year of residency and went to the operation theatre multiple times a week .
 most of the students planned to undergo further training after residency .
 more than half of the students found their surgical training to be fair or satisfactory.conclusions:the number and frequency of ophthalmic surgeries done by residents appear satisfactory , but further efforts from trainers on enhancing the quality and range of surgical training would benefit students and improve their satisfaction .


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:
ununited fractures of clavicle are occasionally seen in adults , but are rarely found in children . post - traumatic non - union of the clavicle is a rare complication in adulthood with a frequency of about 1% .
this condition is also exceptional in children , despite the frequency of clavicular fracture at any given age .
clavicular fractures usually occur at the junction of the medial two third with the lateral one third of the bone and usually heal by conservative treatment within three weeks .
surgery is required in about one in 100 cases in which there is remaining deformity .
an 8-year - old male child presented with a right - sided clavicular fracture for one year .
there was a history of fall while playing and the patient sustained injury to the right shoulder , which led to the fracture of the clavicle . both swelling and severe pain were present
the patient had received treatment from an orthopedic surgeon with a figure 8 bandage for three weeks ; however , the pain was not relieved . at one - year follow - up ,
the upper part of the chest , the bony prominence in the clavicular region and the overlying skin appeared normal .
all of the arterial pulses were present in the affected limb ( i.e. , axillary , brachial and radial ) .
diagnosis was made following a radiograph of the right shoulder , which showed old , non - union of the clavicle at the junction of the medial two third with the outer one third .
the patient was treated conservatively with analgesics and shoulder exercise as the movements of the shoulder were within normal range .
x - ray of right shoulder revealed old , non union of clavicle at the junction of medial two 3 with outer one 3 and here was roundening of both ends with no callous formation .
a 26-year - old male patient presented with a history of fracture of the right clavicle six years ago .
he received treatment from an orthopedic surgeon in patna with figure 8 bandages and a shoulder sling for three weeks .
the patient now complained of pain in the right shoulder with limitation of movement for one year . on local examination
, there was no swelling or deformity and shoulder joint movements were within normal limits , up to 90% .
there had been restriction of the movements of the shoulder joint , up to 10 degrees on internal and external rotation .
a radiograph of the shoulder joint revealed an old , non - united fracture of the mid one third of the clavicle on the right side with no callus formation ( fig .
the patient was treated conservatively with analgesics and physiotherapy exercises . at a six - month follow - up visit ,
x - ray revealed old non - united fracture of mid one 3 clavicle of right side and there was no callous formation .
an 8-year - old male child presented with a right - sided clavicular fracture for one year .
there was a history of fall while playing and the patient sustained injury to the right shoulder , which led to the fracture of the clavicle . both swelling and severe pain were present
the patient had received treatment from an orthopedic surgeon with a figure 8 bandage for three weeks ; however , the pain was not relieved . at one - year follow - up ,
the upper part of the chest , the bony prominence in the clavicular region and the overlying skin appeared normal .
all of the arterial pulses were present in the affected limb ( i.e. , axillary , brachial and radial ) .
diagnosis was made following a radiograph of the right shoulder , which showed old , non - union of the clavicle at the junction of the medial two third with the outer one third .
the patient was treated conservatively with analgesics and shoulder exercise as the movements of the shoulder were within normal range .
x - ray of right shoulder revealed old , non union of clavicle at the junction of medial two 3 with outer one 3 and here was roundening of both ends with no callous formation .
a 26-year - old male patient presented with a history of fracture of the right clavicle six years ago .
he received treatment from an orthopedic surgeon in patna with figure 8 bandages and a shoulder sling for three weeks .
the patient now complained of pain in the right shoulder with limitation of movement for one year . on local examination
, there was no swelling or deformity and shoulder joint movements were within normal limits , up to 90% .
there had been restriction of the movements of the shoulder joint , up to 10 degrees on internal and external rotation .
a radiograph of the shoulder joint revealed an old , non - united fracture of the mid one third of the clavicle on the right side with no callus formation ( fig .
the patient was treated conservatively with analgesics and physiotherapy exercises . at a six - month follow - up visit ,
x - ray revealed old non - united fracture of mid one 3 clavicle of right side and there was no callous formation .
an 8-year - old male child presented with a right - sided clavicular fracture for one year .
there was a history of fall while playing and the patient sustained injury to the right shoulder , which led to the fracture of the clavicle . both swelling and severe pain were present
the patient had received treatment from an orthopedic surgeon with a figure 8 bandage for three weeks ; however , the pain was not relieved . at one - year follow - up ,
the upper part of the chest , the bony prominence in the clavicular region and the overlying skin appeared normal .
all of the arterial pulses were present in the affected limb ( i.e. , axillary , brachial and radial ) .
diagnosis was made following a radiograph of the right shoulder , which showed old , non - union of the clavicle at the junction of the medial two third with the outer one third .
the patient was treated conservatively with analgesics and shoulder exercise as the movements of the shoulder were within normal range .
x - ray of right shoulder revealed old , non union of clavicle at the junction of medial two 3 with outer one 3 and here was roundening of both ends with no callous formation .
a 26-year - old male patient presented with a history of fracture of the right clavicle six years ago .
he received treatment from an orthopedic surgeon in patna with figure 8 bandages and a shoulder sling for three weeks .
the patient now complained of pain in the right shoulder with limitation of movement for one year . on local examination
, there was no swelling or deformity and shoulder joint movements were within normal limits , up to 90% .
there had been restriction of the movements of the shoulder joint , up to 10 degrees on internal and external rotation .
a radiograph of the shoulder joint revealed an old , non - united fracture of the mid one third of the clavicle on the right side with no callus formation ( fig .
the patient was treated conservatively with analgesics and physiotherapy exercises . at a six - month follow - up visit ,
x - ray revealed old non - united fracture of mid one 3 clavicle of right side and there was no callous formation .
clavicular non - union is rarely asymptomatic and often results in disability from pain at the site of non - union , altered shoulder mechanics , or a compression lesion involving the underlying brachial plexus or vascular structures .
fractures of the clavicle are usually in the medial two third of the bone , which may result from a fall and subsequent outstretched hand during the fall .
the lateral fragment is displaced forward and downward by the weight of the limb , while the medial fragment is held at a higher level by the sternocleidomastoid muscle .
the essential treatment is to support the weight of the limb by a sling tied over the opposite shoulder .
the fractures are almost always clinically united within three weeks . about one in 100 fractures of the clavicle require primary surgical treatment .
sir robert peel , who established the police force of great britain , died of a fractured clavicle which ruptured the subclavian vein .
peel was attended by sir benjamin brodie who wrote ,  the hemorrhage itself was the consequence of the subclavian vein having been lacerated by splinters of the fractured bone  .
if deformity persists at the bony ends of the clavicle after several months , surgical smoothening of these ends is indicated by a short incision in the line of the skin creases .
this causes less deformity than the scarring resulting from more extensive operative procedures that may be required for primary open reduction with internal fixation .
in addition , major surgical procedures may carry the risk of additional surgery for non - union .
the non - union rate of fractures of the lateral end of the clavicle can rise to 37% when a nonsurgical treatment protocol is initially adopted . reported results for the nonsurgical treatment of fractures of the clavicle
have been uniformly positive ; a combined series of over 3000 fractures showed a rate of non - union of 0.4% .
occult fracture has been well documented in the hip and the scaphoid and failure to recognize this type of fracture could lead to serious consequences . while clavicular fracture is often viewed as benign , it is important for patients to be aware that any fracture may impact expected time of recovery .
in addition , complications such as non - union do occur and inadequate initial immobilization is a common cause .
patients who have suffered a clavicular fracture often recover well in spite of the risk of non - union ; fatal complications that may occur following vascular injuries are extremely rare .
fracture location and the type of immobilization have little effect on the final result or prognosis .
careful attention should be paid when obtaining a detailed history and physical examinations , as traumatic arthritis at either clavicular joint may mimic the symptoms of non - union .
the explicable evidence of osseous non - union on radiographs may be minor and may not correlate with the clinical symptoms .
a patient with an atrophic pattern of non - union may become asymptomatic with time .
surgeons should be cautious when operating on the non - union merely due to its presence , although asymptomatic .
if a surgical procedure is planned , possible outcomes should be communicated to the patient , including the possibility of additional surgery , if required .

Answer:
context : fractures of the clavicle usually occur at the junction of the medial two third with the lateral one third and usually heal by nonsurgical measures . radiographs and mri of the shoulder provide helpful investigations for diagnosis and treatment . in the following cases ,
 an anterior - posterior view revealed non - union of the clavicle on the right side , which is atypical in children.case report : non - union of a clavicular fracture is an extremely rare condition , especially in children .
 we are reporting two cases in this paper ; in the first case ; an 8-year - old male child visited the hospital with a history of fracture of the right clavicle one year ago . in the second case ,
 a 26-year - old male patient presented with a history of fracture of the right clavicle six years ago.conclusion:careful attention should be paid when obtaining a detailed history and physical examinations , as traumatic arthritis at either clavicular joint may mimic non - union .
 the explicable evidence of osseous non - union on radiographs may be minor and may not correlate with the clinical symptoms .


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

Paper text:
we compared the lumbar repositioning error ( re ) according to different lumbar angles in a
 flexion pattern ( fp ) subgroup of patients with non - specific chronic low back pain ( nsclbp ) .

approximately 85% of this population was classified as having nsclbp , with no radiological
 change between the 12th rib and the inferior gluteal fold1 .
the management approach has been the use of subgroups classified on
 the basis of pain - provoking postures and movements in nsclbp2 .
repositioning error ( re ) is defined as proprioceptive impairment ,
 known to result in poor spinal stability3 .

impaired proprioception in positions such as sitting and standing can be related to lbp . in
 particular , it is associated with flexion direction in the subgroup with pain provoked by
 lumbar flexion4 . however , few studies have
 examined re in subjects with flexion - related lbp during the performance of different lumbar
 flexion angles , as in extension on sitting and standing upright postures .
thus , the purpose
 of this study was to compare changes in lumbar re at different angles while standing and
 re - standing and sitting and re - sitting in a subgroup of fp subjects with nsclbp .
s system5 ,
 6 and was defined as subjects with pain
 provoked by postures and movement - related flexion of the lumbar spine . in the fp subgroup
,
 symptoms were relieved by movement associated with extension , lordosis of lumbar segments ,
 and the loss of a neutral spine posture due to a flexed spine5 , 6 .
the subjects were aged
 44.78.2  years ( mean  sd ) with a height of 165.45.1  cm , a body weight of 62.37.2  kg , a
 korean oswestry disability index ( odi ) of 30.04.0% , and a visual analog scale ( vas ) score
 of 5.51.2 .
ethical approval was obtained from the inje university faculty of health science
 human ethics committee .
we used a dual inclinometer ( acumar , lafayette instrument co. ,
 lafayette , usa ) to measure the lumbar re at the main and companion parts ( l1 and sacrum ) .

intra - test reliability of the dual inclinometer was 0.90 , and the inter - test reliability was
 0.85 .
the subjects were required to stand upright for 5  s and to hold lumbar flexion angles
 of 30 and 15 and a lumbar extension angle of 15 for 5  s , followed by return to the
 starting position .
the re of the lumbar spine was defined
 as the difference in the mean sagittal angles between neutral sitting and re - sitting phases
 and between the standing and re - standing phases of the task . the spss software ( ver .
12.0 ;
 spss , chicago , il , usa ) was used for all analyses , and the level of statistical significance
 was set at 0.05 .
one - way repeated - measures analysis of variance and the least significant
 difference ( lsd ) test as a post hoc pair - wise comparison were used to
 determine significant re differences among the six tasks .
the lumbar re increased significantly with flexion at 30 during sitting . upon sitting
 upright , the lumbar re between sitting and re - sitting was significantly greater with a
 flexion of 30 ( 5.13.7 ) than 15 ( 2.03.7 ) or with an extension of 15 ( 1.51.9 ) ( p <
 0.05 ) .
in addition , re while sitting with a flexion of 30 was significantly greater than
 that between the standing and re - standing positions during flexions of 30 ( 1.91.5 ) and
 15 ( 0.70.6 ) and an extension of 15 ( 0.80.6 ) ( p < 0.05 ) . upon standing upright ,
the
 lumbar re between the standing and re - standing positions during a flexion of 30 was
 significantly greater than during a flexion of 15 or extension of 15 ( p < 0.05 ) .
in our study , lumbar spine re increased in a specific direction while in the sitting
 position in the fp subgroup . in accordance with previous research5 , 6 ,
the fp subgroup in
 this study had a deficit in flexed - toward status while sitting , but this was not apparent
 while standing . however , while the previous study used lumbar full flexion in the standing
 position , our study used a flexion angle of 30. the neutral re from 30 of flexion was
 greater than those from 15 of flexion or 15 of extension while standing , and less than
 that from 30 of flexion while sitting .
the standing position would have added
 proprioceptive input from other distant receptors , while the adoption of a seated position
 would minimize other proprioceptive inputs by immobilizing the lower legs and the
 pelvis7 , 8 .
furthermore , this may be due to characteristics of the fp group ,
 where pain is provoked during sitting , whereas the pain tended to be relieved upon
 standing2 .
the results of this study
 revealed the highest displacement changes between sitting and re - sitting on flexion of 30
 of the lumbar spine from the upright sitting posture . when spinal structures , such as
 passive ligaments or active muscles are stretched or flexed during sitting , reflexive muscle
 activity may be reduced , passive structures may be lengthened , and their tension may be
 reduced due to unsuitable stretching stimulation from the central nervous system9 . dolan and green10 reported significantly increased lumbar re following 5  min
 in a slouched posture , but not following a 3-s duration .
our study showed increased re
 immediately while sitting at a flexion angle of 30. we suggest that a higher lumbar flexion
 angle may have a negative impact on lumbar positioning sense while in the sitting posture
 than in the standing posture in fp subjects with nslbp .
we also suggest that the measurement
 method for lumbar res would be more effective while sitting using a flexion angle of 30 in
 fp subjects .

Answer:
[ purpose ] this study determined the change in lumbar position sense according to lumbar
 angles in a flexion pattern ( fp ) subgroup of patients with non - specific chronic low back
 pain ( ncslbp ) . [ subjects ] thirteen subjects with fp low back pain participated .
 [ methods ]
 the lumbar repositioning error ( re ) of subjects was measured between a neutral starting
 position and re - position phases at three angles , in sitting and standing upright
 positions .
 [ results ] lumbar re was significantly greater during lumbar flexion at a 30
 angle in the sitting position than in the other tasks .
 [ conclusion ] in the flexion - related
 subgroup , the lumbar re measurement may be a more sensitive evaluation method using a
 lumbar flexion angle of 30 while in the sitting position , compared with other angles in
 sitting or standing positions .


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

Paper text:
the scope of newborn screening has expanded greatly in the 52 years since robert guthrie published his microbial assay for phenylalanine and the use of dried blood spots in screening for phenylketonuria .
though guthrie and others went on to develop blood - spot screening methods for further disorders none were taken up very widely until the development of immunoassays and the ability to screen for congenital hypothyroidism , now the most widely practiced screen worldwide .
immunoassay - based screens for other disorders followed , cystic fibrosis and congenital adrenal hyperplasia in particular , but none have achieved general acceptance .
more recently , tandem - mass - spectrometry ( ms - ms ) , with its ability to measure a wide range of metabolites simultaneously , has opened up a further range of disorders , many of which are very rare but can be incorporated with screening for phenylketonuria at little additional cost .
thus , in large parts of the usa screening covers over 50 conditions ( 1 ) though this total is inflated counting sickle - associated haemoglobin variants as separate diseases .
european countries with equally well - developed medical systems have very different screening policies : in 2009 , the maximum number of conditions covered was 30 and some countries were screening for four or less ( 2 ) .
there was little consensus regarding information provision , informed consent , storage and disposal of residual specimens , screening technologies and disease definition .
the reasons for these differences are not always obvious though clearly funding issues and the availability of an adequate clinical infrastructure must play a part .
all formal policy reviews have acknowledged the ten  principles  enunciated by wilson and jungner in 1968 ( 3 ) . these are couched largely in qualitative terms
,  there should be a suitable test which should be acceptable to the population  and there should be an accepted treatment .
nevertheless , the uk national screening committee has until very recently emphasized the importance of having firm numerical data and evidence from a high - quality randomized controlled trial before accepting a new condition ( 4 ) .
however , it is recognized that for clinically heterogeneous and relatively rare disorders , such as those now readily accessible through ms - ms screening , a degree of compromise is required .
medium - chain acyl - coa dehydrogenase deficiency was accepted on the basis of a large - scale pilot study ( 5 ) and preliminary studies on five additional disorders detectable by ms - ms are underway .
the approach in the usa has been quite different , with federal policy based largely on the results of a survey carried out by the american college of medical genetics ( 6 ) .
this canvassed opinions ( rather than data ) from a wide range of professional and lay personnel in the usa and abroad and commissioned literature reviews on specific diseases from practicing academic clinicians .
this resulted in the identification of 29 conditions for which screening should be mandated and an additional 25 conditions that would be identified as part of differential diagnosis .
the work was subsequently taken forward and amplified by the secretary s advisory committee on hereditary disorders in infants and children ( 7 ) , forming the basis for both federal and state legislation .
screening policy is ultimately decided at state level and based on explicit legislation , with significant regional variations in both the number of disorders covered ( 1 ) and practices such as how long the blood collecting cards are retained after screening has finished ( 8) . this overt political dimension leaves policy - makers exposed to pressure from groups such as the save babies through screening foundation and there is almost a degree of competition as to which state screens for the most disorders . in countries like the uk where screening is offered as part of the national health service with no direct legislative basis policy tends to attract less public attention though nevertheless the uk screening programmes for cystic fibrosis and sickle cell diseases were introduced following direct pressure at the political level rather than through the formal advisory channels .
the wilson and jungner analysis was based mainly on adult disease and largely neglected the family dimension of newborn screening : the value of genetic information and the way that prompt diagnosis , even of an incurable condition , can ease the family journey .
family impact is the main rationale behind the welsh screening programme for duchenne muscular dystrophy which has been well - accepted locally but requires considerable professional input and is not supported in the rest of the uk .
cystic fibrosis is an obvious example as in the absence of screening diagnosis is often considerably delayed , leading to significantly worse outcomes .
diagnostic odyssey  and has no warning of the possibility of future children also being affected .
attitudes of at - risk couples towards antenatal diagnosis of cystic fibrosis are ambivalent ( 9 ) but overall the introduction of newborn screening has resulted in a significant decrease in the number of babies born with the condition ( 10 ) .
even before antenatal diagnosis became possible families with a phenylketonuric child diagnosed by screening tended to limit family size subsequently ( 11 ) .
however , in general policy - makers focus their attention on the value of newborn screening to the baby concerned and have mixed views about wider genetic implications .
genetic exceptionalism is the view , strongly held by some civil liberties groups , that genetic information is special and must be treated differently from other types of medical information .
dna analysis may reveal carrier status in individuals with no family history of the disorder concerned and in some countries is prohibited without a specific request from a registered medical practitioner .
such sensitivities are reflected in some of the screening protocols , particularly those for cystic fibrosis .
several screening programmes have retained the original two - step irt approach and require a second blood sample despite the convenience and greater specificity of analysing the cftr gene on the initial sample .
programmes that do use dna analysis vary greatly in the mutation panel used : some restricting it to a few relatively common mutations associated with severe disease , others using a much broader panel with a corresponding increase in the number of unaffected carriers found .
other programmes include a pap ( pancreatitis associated protein ) step in an attempt to maintain specificity but minimise or avoid carrier detection ( 12 , 13 ) . the uk protocol attempts to minimise carrier detection but by different means ( figure 1 , panel a ) while also recognising that a mutation panel optimised for northern european populations has inherent disadvantages for those of other geographical origin ( panel b ) .
complicated protocols of this type place a considerable administrative burden on the laboratory . travelling in the opposite direction , studies of the potential of exome sequencing as a first - line method of newborn screening and the possibility that genomic data be made available as a resource for parents and doctors throughout infancy and childhood to inform health care
there is usually less anxiety about genetic information obtained at the protein level even though , with haemoglobin variants for example , this may inform directly on the underlying dna sequence .
indeed , when a baby has received a blood transfusion prior to the screening sample being taken some programmes use dna analysis rather than waiting several weeks for the infused erythrocytes to be removed .
newborn screening for sickle cell diseases and related haemoglobin abnormalities detects a significant number of carriers : 1 baby in 71 born in england in 201112 .
there are different views on whether this is desirable despite the presence of an antenatal screening programme and , as far as possible , linkage between the two programmes .
ms - ms methods capable of detecting individual haemoglobin variants without the corresponding carriers have been developed ( 15 ) and it remains to be seen whether this will affect practice .
with improvements in analytical performance the definition of  normal  has tended to be drawn ever more tightly . however , the primary purpose of screening is prevention or amelioration of disease rather than the detection of a biochemical / genetic abnormality as such .
thus , not all children with a persistently increased blood phenylalanine concentration will become mentally impaired : there is fairly good evidence for a threshold of about 600
this threshold has been adopted in france and germany but is ignored in many other countries .
similarly with congenital hypothyroidism , improvements in assay sensitivity have resulted in many screening centres adopting lower cut - offs and consequently finding an increased number of cases .
however , their gender distribution is markedly different from that in cases diagnosed clinically prior to the start of screening and there is no firm evidence that most of these additional cases benefit from their treatment . the biological level ( gene , protein
, enzymic activity , metabolic pathway , individual metabolite ) at which screening and confirmatory investigations are performed also has an important impact on disease definition .
thus , medium - chain acyl - coa dehydrogenase deficiency ( mcadd ) is readily detectable by increased blood - spot octanoylcarnitine on ms - ms screening . in the netherlands enzyme assay using phenylpropionyl - coa is regarded as the  gold - standard  confirmatory test .
the current uk screening protocol defines mcadd in terms of having two mutations in the mcad ( acadm ) gene and genotyping is central to the clinical follow - up protocol .
however , data from the pilot study ( 5 ) show that all babies except one with genotypes that have previously been reported from clinically - presenting cases showed urinary hexanoylglycine > 5 micromol / mol creatinine on immediate follow - up .
this would appear to be a more effective indicator of the risk of metabolic decompensation ( which is what we are really wishing to screen for ) than mutation analysis and avoids the complication of inadvertent carrier detection .
viewed in the context of everything else that can go wrong in pregnancy , childbirth and afterwards , newborn screening seems a fairly insignificant thing to worry about but the importance of having suitable information available if required is universally recognized . the way that this is provided and the amount of detail given vary considerably .
the uk national screening committee requires that  evidence - based information , explaining the consequences of testing , investigation and treatment , should be made available to potential participants to assist them in making an informed choice  .
the emphasis on choice is in keeping with current political philosophy but it could be argued that if parents were truly informed then choosing to have their baby screened would be automatic .
even carefully worded information can leave room for misunderstanding :  we read the form  and our understanding was that the conditions were hereditary .
we did nt want to cause baby the pain of having a needle in her heel .
come on then let s get on with it. we both looked at each other and were afraid to say anything so the baby screamed and we felt bad for doing it .
she saved our daughter ( with phenylketonuria ) to grow up a lovely healthy bright little girl  ( 17 ) .
should we really be presenting screening as an option which rational parents might like to consider ?
. in some us states screening is compulsory , required by law , so that ( in theory at least ) every baby gets screened .
the supreme court of ireland upheld the right of parents who already had a child with phenylketonuria not to have their newborn baby screened ( 18 ) .
the united nations convention on the rights of the child states that the best interests of the child must be a top priority in all actions .
however , whether screening is truly in the interests of the affected child is sometimes debatable , particularly for disorders where treatment is invasive and the effect is to slow the progression of a debilitating disease rather than prevent it .
most disorders show some degree of heterogeneity and this may make a clear answer impossible : for example , severe propionic acidaemia is almost untreatable , with an inexorable deterioration , but patients with milder variants can survive and go on to lead virtually normal lives if diagnosed and treated early .
the current diversity of national policies relating to newborn screening reflects both practical limitations in health care organization and funding and widely different philosophical approaches to a variety of highly emotive issues .
decisions will become more difficult still as screening technology advances , with the use of orbitrap mass spectrometry for example , and the number and variety of disorders readily accessible increases still further .

Answer:
summarynewborn blood - spot screening to detect potentially treatable disorders is widely practiced across the globe . however , there are great variations in practice , both in terms of disorders covered , screening technologies , disease definition , information provision , parental informed consent , and storage and disposal of residual specimens , partly reflecting the degree to which screening is the subject of explicit legislation ( and thus public and media pressure ) or is embedded in a general health care system and managed at an executive level .
 it is generally accepted that disorders to be screened for should comply with the ten wilson and jungner criteria , but the way that compliance is assessed ranges from broadly - based opinion surveys to detailed analysis of quantitative data .
 consequently , even countries with comparable levels of economic development and health care show large differences in the number of disorders screened for .
 there are several areas on which there are no generally accepted guidelines : how should parents be informed about screening and to what extent should they be encouraged to regard screening as an option to choose to refuse ?
 is dna mutation analysis acceptable as part of a screening protocol ?
 how soon should the blood samples be destroyed once screening has been completed ?
 as technology advances and the potential scope of screening expands at both the metabolite and genome level , challenging policy issues will have to be faced .


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

Paper text:
the term fibromatosis refers to a group of benign soft tissue tumors ( fibromas ) , which have certain characteristics in common , including absence of cytologic and clinical features of malignancy , a histology consistent with proliferation of well - differentiated fibroblasts , an infiltrative growth pattern , and aggressive clinical behavior with frequent local recurrence .
herein we report this unusual presentation of benign fibromatosis over the dorsum of both feet .
a 40-year - old female patient presented with multiple raised growths over both feet since four years .
contractures , bony deformities and keloids were absent . on examination , symmetrical , well - defined
, firm nodules coalescing to form lobulated plaques were noted over the dorsum of both feet extending from base of the 2 , 3 , 4 , and 5 toes to the mid - foot [ figures 1 and 2 ] .
radiographs of both feet showed no bony deformity and ultrasound of both feet showed no significant soft tissue thickening .
an elliptical biopsy of lesion taken for histopathology showed epidermis with hyperkeratosis , acanthosis , mild parakeratosis and prominent granular layer .
superficial dermis was unremarkable and deep dermis showed fibroblastic proliferation with variable vascularity and lack of inflammatory infiltrate , and thick bundles of irregular collagen characteristic of fibromatosis [ figures 3 and 4 ] . with these clinical and histopathological features ,
the patient was advised topical keratolytics along with intralesional steroids for 2 months with minimal response .
the patient was counseled about the benign nature of the disease and measures for lifestyle modification and proper footwear .
multiple well - defined firm nodules coalescing to form lobulated plaques distributed in a symmetrical pattern over dorsum of both feet , extending from base of the 2 , 3 , 4 , and 5 toes to the the mid - foot close - up view of the lesion showing diffuse lobulated plaque over the dorsum of left foot epidermis showing hyperkeratosis and acanthosis with deep dermis showing fibroblastic proliferation with thick bundles of irregular collagen ( hematoxylin and eosin 4 ) epidermis showing hyperkeratosis , acanthosis , mild parakeratosis , and a prominent granular layer .
superficial dermis was unremarkable and deep dermis showed fibroblastic proliferation with variable vascularity and lack of an inflammatory infiltrate , with thick bundles of irregular collagen ( hematoxylin and eosin 40 )
the musculoskeletal fibromatosis represent a wide range of fibroblastic to myofibroblastic proliferations that are grouped together because of their similar pathologic appearances .
the clinical behavior of these tumors is intermediate between that of benign and malignant fibrous lesions ; they commonly manifest infiltrative growth , resulting in frequent local recurrence , but lacking metastatic potential . the world health organization committee for classification of soft tissue tumors in 2002 categorized these lesions as superficial or deep based on their anatomic location . superficial fibromatosis ( palmar , plantar , penile , and knuckle pads ) and deep fibromatosis ( nonmetastasizing fibrosarcoma , and desmoids tumor ) , which are rapidly growing tumors involving the muscular structures or aponeuroses . clinically , it may present as solitary or multiple lesions affecting one or many sites ; the prevalence of palmoplantar involvement may vary 0 - 28 percent of cases .
the superficial fibromatosis , whether they occur in adults ( palmar and plantar ) or children ( calcifying aponeurotic fibroma , lipofibromatosis , and inclusion body fibromatosis ) , are typically small lesions that grow slowly .
the deep fibromatosis in both adults ( desmoid type and abdominal wall ) and children ( fibromatosis colli and myofibroma and myofibromatosis ) are usually larger and often enlarge more rapidly .
the diagnosis of deep fibromatosis may be suggested by their clinical characteristics , particularly anatomic location and patient age : fibromatosis colli that typically involves the lower neck and sternocleidomastoid muscle in a young child ; abdominal wall fibromatosis that manifests as a mass involving the rectus abdominus muscle and is often related to pregnancy ; or myofibromatosis that occurs as multicentric disease in a young child ; palmar fibromatosis , a fibromatous hyperplasia of the palmar aponeurosis characterized by nodular thickening of the fascia associated with flexion contractures of one or more digits ; plantar fibromatosis comprising single or multiple painful nodules over the medial half of mid - foot with a tendency to ulcerate that may be locally invasive and can recur ; penile fibromatosis , characterized by one or more dense fibrous plaques on the penile shaft that occur as an isolated abnormality or as part of polyfibromatosis ; knuckle pads , characterized by circumscribed thickening overlying the proximal interphalangeal joint ; desmoid tumors - histologically benign but locally aggressive fibrous neoplasms originating from the musculoaponeurotic structures with often nonspecific findings .
diagnosis relies on histopathologic findings characterised by multinodular cellular proliferations of uniform , plump , spindle shaped fibroblastic cells within a collagenous stroma .
longstanding lesions are less cellular and contain increased amounts of dense collagen , suggestive of fibromatosis .
cross - sectional imaging ( ultrasonography , computed tomography , or magnetic resonance imaging [ mri ] ) reveals lesion location , extent , and involvement of adjacent structures and thus is useful for tumor staging and evaluation of local recurrences .
additional mri features that are related to underlying pathologic characteristics provide increased specificity for the diagnosis of musculoskeletal fibromatosis .
treatment of musculoskeletal fibromatosis may range from conservative management to surgical resection and is influenced by the specific diagnosis and extent of the lesion determined at imaging evaluation .
local recurrence is common after surgical resection , owing to the infiltrative growth seen pathologically in these lesions .
wide excision of fascia is the treatment of choice for solitary painful lesions or lesions causing flexion contractures .
recurrences are common in aggressive fibromatosis , but not so in superficial benign fibromatosis . in a case series of 14 patients with plantar fibromatosis , it was noted that symptoms improve with time with conservative management and intralesional corticosteroids may not always cause subsidence of symptoms . among the nonsurgical treatments , radiation therapy , vitamin e , local injection of calcium channel blockers , interferon , corticosteroids or collagenase , and colchicine
, we used intralesional injection of triamcinolone in escalating dose of 10 and 40 mg / ml every three weeks along with topical salicylic acid 12% and urea for local application twice daily that showed minimal response .
this case report presents the benign nature of the condition , its relative resistance to treatment and an uncommon symmetrical presentation of fibromatosis over the dorsum of both feet .

Answer:
fibromatosis is benign fibrous tissue condition intermediate between benign fibroma and metastasizing fibrosarcoma .
 the lesion tends to infiltrate and recur when removed , but do not metastasize .
 the lesion may be single or multiple , and the likelihood of recurrence after surgical removal varies with location of the lesion and age . a 40-year - old female presented with multiple raised lesions over both feet since 4 years , they were multiple well - defined firm nodules coalescing to form lobulated plaques distributed in a symmetrical pattern over the dorsum of both feet .
 histopathology of skin showed epidermis with hyperkeratosis , acanthosis , mild parakeratosis , and prominent granular layer .
 superficial dermis was unremarkable and deep dermis showed thick bundles of irregular collagen and fibroblastic proliferation , suggestive of fibromatosis .
 this case is being reported for its unusual presentation of fibromatosis over the dorsum of both feet .


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

Paper text:
the term nonconvulsive status epilepticus ( ncse ) is defined as  a range of conditions in which electrographic seizure activity is prolonged and results in nonconvulsive clinical symptoms  , .
the clinical features of ncse may be subtle and diverse , and confirmation relies on the electroencephalogram ( eeg ) .
several approaches to establishing criteria for ncse in adults have been published ( table  1 ) , , , and some clinical states may lie along an ictal  interictal continuum .
periodic discharges are often regarded on the interictal end of the spectrum , but when accompanied by clinical features including impaired vigilance and when signs resolve proximate to treatment , then this lends evidence to the ictal nature of periodic discharges along this spectrum .
periodic lateralized epileptiform discharges ( pleds ) , in particular , have sparked controversy with regard to being part of the ictal vs. interictal spectrum .
periodic lateralized epileptiform discharges can occur in the temporal vicinity of an overt seizure , thus reflecting an ictal
interictal continuum phenomenon that can continue for weeks ( chronic pleds ) in conscious patients with retained alpha or basic rhythm .
however , when they occur in a patient with altered level of consciousness , some authors regard it as ictal , , , , , , , , . since changes in mental status are common in epileptic encephalopathies and developmental delay such as in patients with cerebral palsy , it can be difficult or impossible to determine whether they are in status epilepticus , unless there is a discernible clinical improvement with treatment .
we report the case of a patient with chronic epilepsy and cerebral palsy ( cp ) who presented with deterioration from an already impaired baseline .
although the eeg revealed slow pleds which are not typical of ncse , the patient showed a good clinical and eeg response to benzodiazepines with pled regression .
this 49-year - old man with cerebral palsy , mental retardation , and epilepsy residing in a long - term care facility for the prior 13  years had been awake , noncommunicative , but responsive to auditory and visual stimuli .
he was treated with phenytoin and levetiracetam and had yearly breakthrough seizures over the prior 10  years .
he had recently developed fever and dyspnea with a drop in oxygen saturation and was suspected of having aspiration pneumonia complicated by sepsis .
he was given intravenous antibiotics , fluids , and supplemental oxygen and was transferred to our facility . following a mild generalized tonic
clonic seizure , his examination remained persistently unchanged but he was now unresponsive to auditory , visual , and noxious stimuli , with a fluctuating level of alertness .
plasma phenytoin level was low at 34.8  mol / l ( normal : 4080  mol / l ) .
1 ) showed intrusions of excess slow left - sided periodic lateralized epileptiform discharges ( pleds ) on a background of normal alpha pattern .
administration of 1  mg of iv lorazepam resulted in resolution of the  slow  pleds ( fig .  2 ) and
improvement in the patient 's neurological status , which now became responsive to auditory , noxious , and visual stimuli that occurred in a matter of 15  min after administration of lorazepam . by the next morning , his condition had greatly improved and he was near his baseline status .
he received additional intravenous loading doses of phenytoin and levetiracetam on the same day , and his maintenance doses were adjusted .
brain ct showed a large central meningioma as well as a small posterior fossa meningioma ( fig .
review of his old brain ct films ( done seven years ago ) showed no such lesions .
because of his poor quality of life and the risks involved , neurosurgery was not considered an option , and the patient was managed medically with antiepileptic medication .
4 ) , and the patient was discharged to a long - term care facility for further care .
this patient with chronic epilepsy and cerebral palsy ( cp ) showed deterioration from a baseline that was already impaired , a finding described in ncse in those with developmental disability , .
the eeg findings were not typical of ncse in that slow pleds lie in the gray zone along the ictal  interictal continuum .
cerebral palsy is a complex , heterogeneous lifelong condition with significant disability and long - term challenges that persist into adult life .
epilepsy is reported in 35% to over 60% of patients with cp ,   and is more frequent in patients with more severe disability
. sixteen percent of children with cp and epilepsy may develop nonconvulsive and/or convulsive status epilepticus .
brain tumors , particularly primary ones , are associated more frequently with both convulsive and nonconvulsive status epilepticus , .
electroencephalographic changes in mass lesions reflect irritability around the penumbra of the lesion , in this case , on the left .
one can speculate that the focal structural lesion in the setting of chronic diffuse brain dysfunction , along with intercurrent infection and low aed levels , represented the multiple risk factors seen in the recurrence of seizures and appearance of ncse , . periodic lateralized epileptiform discharges ( fig .
1 ) consist of periodic spike - and - slow wave or sharp - and - slow wave complexes , typically with a frequency of 12  hz . in our patient , the frequency was ~  0.5  hz .
periodic lateralized epileptiform discharges occur in a variety of conditions such as strokes , tumors , and infections ; these together comprise around 50% of the underlying etiologies .
slow growing extraaxial tumors such as meningiomas usually produce little eeg disturbance unless they compress and displace brain tissue or cause hydrocephalus such as in our case .
periodic lateralized epileptiform discharges are reported to support a diagnosis of ncse if they meet certain conditions , in particular , good proximate clinical and eeg response to benzodiazepines with pled regression   ( table  1 ) .
when eeg and clinical regression are not clear , spect or pet scanning can guide the clinician in the possible ictal ( versus interictal ) nature of the periodic discharges , .
there are diagnostic and management challenges in patients with long - term disability whose cognitive and neurological baselines are impaired and not always known to the clinical caregivers .
additionally , a diagnosis of ncse may be difficult to make when this baseline is unknown and when the eeg findings represent a pattern that lies along the ictal  interictal continuum .
electroencephalogram can establish where along this continuum the patient resides , following which treatment that balances the risk  benefit needs of the patient , and the needs of chronic caregivers , can then be provided and monitored so as to offer the patient the optimal chance for regaining lost function with minimal risk .

Answer:
the presence of cerebral palsy and that of slow growing brain tumors are risk factors for convulsive and nonconvulsive status epilepticus .
 nonconvulsive status epilepticus ( ncse ) needs electroencephalographic ( eeg ) monitoring to be confirmed as it may be clinically subtle .
 furthermore , it may present with a variety of ictal eeg morphologies .
 we report a case of a patient with cerebral palsy and a large central meningioma .
 electroencephalogram showed a slow pattern of periodic lateralized epileptiform discharges ( pleds ) ( a pattern considered as being situated in the ictal
 interictal continuum ) on an alpha background .
 the patient was treated for ncse successfully with benzodiazepines followed by up - titration of his antiepileptic drug doses .


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:
cardiovascular disease is the most common cause of mortality in dialysis patients that is responsible for about 60% of their mortality and is also 30 times more common than in general population .
different cardiovascular disorders , such as left ventricular hypertrophy ( lvh ) , coronary artery diseases , congestive heart failure ( chf ) , and arterial hypertension are commonly seen in these patients .
in addition , calcification of cardiac valves are common and may cause valvular and annular thickening that in turn could lead to valvular stenosis or regurgitation .
some predisposing factors of cardiac disorders in dialysis patients are secondary hyperparathyroidism , long term hypertension , and anemia .
different electrocardiographic abnormality may be seen in dialysis patients , such as st , t change , ventricular and supra - ventricular arrhythmia and qt interval prolongation . in the electrocardiogram ,
qt interval is the time between the start of the q wave and the end of the t wave .
when heart rate increased then qt interval was decreased , so qt interval could be corrected with heart rate .
there are a number of different correction formulas , but the standard clinical correction is to use bazett 's formula ( qt/r - r , where r - r is the rr interval in seconds ) .
the normal corrected qt ( qtc ) interval for males and females are 430 ms and 450 ms , respectively .
the borderline qtc for a male is 431 - 450 and borderline qtc for a female is 451 - 470 and the abnormal qtc range for a male is > 450 and for a female is > 470 .
the qtc interval could be prolonged due to electrolyte abnormalities ( hypomagnesaemia and hypokalemia ) , drug consumption ( antihistaminic , antiarrhythmic , and antibiotics ) , brain trauma and genetic abnormalities ( long qt syndrome ) .
patients with chronic renal failure and dialysis patients had a greater qtc interval and qt dispersion ( qtd ) ( qtd = qtmax  qtmin ) compared with the normal population . a single session of hd could be increased qtc in patients undergoing hd .
moreover , qt interval may be a predictor of ventricular arrhythmia and cardiovascular mortality in chronic kidney disease and dialysis patients .
although there are some studies about qtc and qtc dispersion in hemodialysis ( hd ) patients with different results ; however , there are only a few studies concerning relationship of qtc internal and qtd with echocardiography findings , so the aim of this study was the evaluation of these relationship in dialysis patients .
in a cross - sectional study , 60 hd patients with age > 18 years and the dialysis duration > 3 months were enrolled .
exclusion criteria were : antiarrhythmic drugs consumption , history of cardiac diseases such as arrhythmia , heart block or chf . before dialysis session , electrocardiography ( ecg ) and echocardiography
also , qtd was measured by mentioned formula ( qtd = qtmax  qtmin ) in 12 leads ecg .
the patients were on hd , by fresenius digital machine ( 4008b , germany ) and gambro digital machine ( ak95 and ak96 , sweden ) , 2 - 3 times / week , as a regular method ( 4 - 4.5 h with blood flow of 250 - 350 ml / min , dialysate flow of 500 ml / min and ultra - filtration based on the patient 's condition ) .
the used buffer was bicarbonate powder , and the type of filters were intermediate and high efficient polysulfone membrane ( r5 , r6 ) made by soha factory under license of fresenius company .
serum creatinine , hemoglobin , ca , parathyroid hormone ( pth ) , na , k , hco3 , and ph were checked by ra1000 machine ( made in italy ) .
all laboratory tests were done before the dialysis session and were checked in a single laboratory .
echocardiography and ecg were done before the dialysis session and by single cardiologist and technician respectively .
all data and information were confidential , and for ecg and echocardiography taking an informed consent was taken from each patient . in echocardiography , left ventricular ejection fraction ( lvef ) , lvh , pulmonary artery pressure ( pap ) and valvular disorders were evaluated .
at the end of the study , data were analyzed using spss software ( version 19 , ibm corporation ) .
pearson correlation coefficient , two - independent samples t - test and anova were used for statistical analysis .
this study was approved by ethical committee of shahrekord university of medical sciences with the grant number of 904 .
mean body mass indexes ( bmis ) ( post dialysis ) and duration of dialysis were 21.77  3.6
mean qtc interval of the patients was 0.441  0.056 s ; however , qtc interval in men and women were 0.43  0.04 s and 0.45  0.07 s , respectively ( p > 0.05 ) .
qtd in all of the patients was 64.17  25.93 ms , however in men and women were 62.70  28.05 ms and 66.52  22.48 ms respectively ( p = 0.87 ) .
mean urea reduction ratio in men and women were 68.14%  9.34% and 68.22%  3.88% ; however , kt / v was 1.45  0.17 and 1.49  0.16 among men and women , respectively . characteristics of patients and their association with qtc and qtd sd = standard deviation , bmi = body mass index , pth = parathyroid hormone , qtc = corrected qt , qtd = qt dispersion there was no statistically significant relationship between qtc interval or qtd with duration of dialysis , bmi , age , and gender ( p > 0.05 ) .
in ecg , lvh was seen in 23 ( 38.3% ) patients and st change in 14 patients ( 23.3% ) . in echocardiography ,
mitral regurgitation ( mr ) , tricuspid regurgitation ( tr ) , and aortic insufficiency ( ai ) were found in 54 , 47 , and 11 patients respectively [ table 2 ] .
in addition , no significant relation was found between qtc interval and qtd with mr , tr , ai , lvh , septal thickness ( st ) and pap [ table 3 ] . qtc interval and qtd has also no correlation with serum pth or ca , k or hco3 .
severity of valvular disorders in the patients mr = mitral regurgitation , tr = tricuspid regurgitation , ai = aortic insufficiency echocardiographic findings and their association with qtc and qtd qtc = corrected qt , qtd = qt dispersion , pap = pulmonary artery pressure , lvef = left ventricular ejection fraction , lvh = left ventricular hypertrophy , mr = mitral regurgitation , tr = tricuspid regurgitation , ai = aortic insufficiency , pe = pericardial effusion
our findings revealed that , in hd patients , qtc interval and qtd had not any correlation with valvular disorders ( mr , ai , and tr ) , lvh or other echocardiographic findings such as pap and st .
furthermore , there was no relationship between qtc interval and qtd with serum ca , k , hco3 , pth . in hd patients , cardiac abnormalities such as vascular calcification
are common and are associated with the development of lvh , that may cause increased cardiac arrhythmias and mortality .
elevation of calcium - phosphorus product can also cause valvular calcification and stenosis in these patients .
mitral and aortic calcification and stenosis are common in these patients ; however , tricuspid and pulmonic valve calcification is rare .
qtc interval prolongation in chronic kidney disease and hd patients was shown in some studies such as covic et al . and ljutic et al .
studies which postdialysis qtc interval was 434  29 ms and 445.7  36.9 ms respectively , while in our patients qtc interval was 444.6  54.5 ms . selby and mcintyre in a review article reported that hd can increase qtc interval and qtd and is also capable of inducing arrhythmias and increasing mortality especially in patients with ischemic heart disease . in nakamura
study on 48 dialysis patients , throughout the follow - up period , there was a higher incidence of cardiovascular death in patients with prolongation of qtc dispersion after hd .
showed that the serum potassium was significantly higher in hd patients when compared to continuous ambulatory peritoneal dialysis ( capd ) patients and rate of qt interval dispersions was significantly higher in hd and capd patients when compared with healthy controls .
they concluded that there is a tendency to cardiac arrhythmias in hd patients during the postdialysis period .
maule et al . showed that after the hd session , qtc increased in 56% and decreased in 43% of the patients
after dialysis session , cell - associated mg levels and qtd increased significantly in averbukh et al .
study , so he concluded that excess daily mg intake and increased concentrations of cell - associated mg could be responsible for qtc prolongation in these patients .
change in serum electrolytes during hd may also be responsible at least partially , to increase qtc or qtd .
for example , increase of qtc interval after a dialysis session , and its correlation with plasma calcium level , postdialysis blood pressure , lvef and st was shown in covic et al .
showed that qtd increased during hd due to serum k depletion and then return to baseline 2 h after the end of dialysis .
qt prolongation during dialysis may also predispose to arrhythmia especially in the cardiac disease patients , nppi et al . demonstrated that hd increases qtd if a low - calcium dialysate is used . therefore
, use of a low - calcium dialysate may predispose hd patients to ventricular arrhythmias .
16 hd patients showed that qtc interval has a reverse correlation with k and ca concentrations of dialysate .
however , in hd children , ozdemir et al . found that qtc interval has no correlation with the patients sex , age and presence of hypertension or lvh but patients with left ventricular systolic dysfunction had significantly greater qtc dispersion .
similar to our study , the changes in serum ca or k of the patients during dialysis were not associated with the qtc interval in this study . moreover , in hekmat et al.s study on 49 hd patients , qtc interval had not correlation with serum electrolytes and blood gas findings . in voiculescu
study , there was no statistically significant correlation between qt interval and serum concentrations of mg , po4 in hd patients too .
in addition , qtc interval was not dependent from lvef , arrhythmias or sudden death .
our results had some similarities with some of above - mentioned studies as well as some differences with the others .
the observed controversy between our study and some of these studies might be due to the discrepancy in the number of cases or racial differences of the patients , and more importantly , the fact that we did not compare predialysis and postdialysis qtc interval .
we could not find any study on the correlation of qtc interval with lvh or valvular heart disease in hd patients ; however , there are some studies related to the correlation of qtc and lvh with other diseases or conditions .
for example , mayet et al . reported that qtd has correlated with left ventricular mass index in hypertensive individuals .
found that in athletes , lvh induced by physical training activity is not associated with an increase in qtd , whereas pathological increase in lvh secondary to hypertension could increase qtd .
the study of dimopoulos et al . on the evaluation of qtd and left ventricular mass index in elderly hypertensive and normotensive patients reported that hypertensive patients had greater left ventricular mass index and higher qtd .
the study had some limitations such as small sample size and lack of qtc measurement after hd session and comparison of it before and after procedure .
by our knowledge , this is one of the first studies on the correlation of qtc or qtd with valvular abnormality and lvh in hd patients .
there were a few studies about the relationship of qtc and lvh in nonrenal patients , so we could not compare our results with other studies .
based on our results , in hd patients , qtc interval or qtd was not correlated with echocardiographic findings or laboratory exam results .
therefore , it can be concluded that qtc interval prolongation probably has not any correlation with cardiac mortality of the hd patients .

Answer:
introduction : cardiovascular disease is the most common cause of mortality in dialysis patients . chronic renal failure and hemodialysis ( hd ) patients may have longer corrected qt ( qtc ) interval compared with the normal population .
 long qtc interval may be a predictor of ventricular arrhythmia and cardiovascular mortality in these patients and hence the aim of this study was the evaluation of the relationship between qtc interval and some echocardiographic findings and laboratory exam results in hd patients.materials and methods : in a cross - sectional study , 60 hd patients with age > 18 years and the dialysis duration > 3 months were enrolled .
 blood samples were taken , and electrocardiography and echocardiography were done before the dialysis session in the patients.results:mean age of the patients was 56.15  14.6 years .
 qtc interval of the patients was 0.441  0.056 s and qt dispersion ( qtd ) was 64.17  25.93 ms .
 there was no statistically significant relationship between qtc interval and qtd with duration of dialysis , body mass index , age , and gender ( p > 0.05 ) .
 there was also no significant relationship between qtc interval and qtd with mitral regurgitation , tricuspid regurgitation and aortic insufficiency ( p > 0.05 ) .
 in addition , qtc interval and qtd of the patients had not any correlation with serum parathormon and serum ca , k , hco3 ( p > 0.05).conclusion : based on our results , in hd patients , qtc interval and qtd were not correlated with echocardiographic findings or laboratory exam results .
 therefore , it can be concluded that qtc interval prolongation probably has not any correlation with cardiac mortality of the hd patients .


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

Paper text:
an 18-year - old male transferred to the emergency department presented loss of consciousness , cyanosis , and deteriorated vital signs . according to the rescue team transfer records , he called the control center himself because he was home alone .
he complained of aggravating dyspnea after eating dinner and of sudden onset vomiting . during ambulance transfer
the patient could not remember what happened after the arrival of the rescue team at his house and had no memory of his stay at the emergency room and intensive care unit ( icu ) .
upon arrival to the emergency room , the patient presented with a cyanotic lip , stupor or semi - comatose mental state , and severe tachyarrhythmia .
endotracheal intubation was performed immediately . after drawing blood for an emergency laboratory study and portable chest x - ray ,
1 ) , a large bore needle ( 16 g ) was inserted into the second intercostal space of the mid - clavicular line to decompress intrathoracic pressure .
immediately after insertion of the needle , percutaneously checked sao2 increased dramatically to higher than 95% . closed bilateral thoracostomy followed , using a 24 fr chest tube .
the patient was transferred to the icu for close monitoring of the patient 's mental state and other parameters related to tension pneumothorax .
the abga results upon arrival and after insertion of the chest tube were a ph of 7.272 , pco2 of 56.1 mmhg , po2 of 78.6 mmhg , and sao2 78.6% , and a ph of 7.373 , pco2 of 42.7 mmhg , po2 of 171.3 mmhg , and a sao2 of 99.3% , respectively .
within several hours after admission into the icu , the patient 's mental state and vital signs were restored to within normal limits .
two hours after admission into the icu , endotrachial intubation was removed and spontaneous breathing was maintained with an adequate sao2 level .
the possibility of hypoxic brain damage was evaluated by a neurosurgeon , who confirmed that there were no significant sequela . on the second day at the hospital ,
bilateral pneumothorax recurred during the application of continuous negative wall suction ( -18 cmh2o ) .
the operation was performed under general anesthesia with double - lumen endotracheal intubation . to avoid hemodynamic instability during the operation ,
the patient was positioned with the head elevated 30 degrees ( semifowler 's position ) and with the legs slightly elevated , with both upper arms extended . during the operation , to improve the operation field view , the operation table was tilted to the contralateral side ( fig .
a large bullae on the left lung and single giant bulla on right upper lung were resected with an endo - gia linear stapling device .
one long thoracic drain ( 28 fr ) was inserted bilaterally into the thoracic cavity after mechanical abrasion of upper portion of the parietal pleura .
the incidence of simultaneous bilateral primary spontaneous pneumothorax has been reported to be as low as 1.4% to 7.6% .
simultaneous bilateral primary spontaneous pneumothorax can result in a severely deteriorated condition , usually requiring intubation or resuscitation .
the reported causes of bilateral pneumothorax include trauma , tumor , and iatrogenic causes [ 1 - 3 ] .
other more rare causes have been reported , including catamenial pneumothorax , sarcoidosis , pregnancy , and radiation .
simultaneous spontaneous bilateral tension pneumothorax is defined as when no tracheal shift occurs and when the degree of bilaterally lung collapse is similar in a chest x - ray .
patients with simultaneously developed bilateral tension pneumothorax may deteriorate rapidly , and immediate decompression is recommended .
a vicious cycle may occur , leading to a deteriorated condition , with a chain reaction consisting of lowered venous return , lowered preload , lowered cardiac output and so on .
the patient under study experienced a critically life threatened state , loss of consciousness , cyanosis , and tachyarrhythmia .
the treatment methods include needle aspiration , percutaneous catheter drainage , and tube thoracostomy [ 1 - 4 ] .
indication for surgical management of pneumothorax include continuous air leakage after insertion of chest tube , recurring pneumothorax on the same side , simultaneous bilateral pneumothorax , pneumothorax developed after pneumonectomy , and having an occupational cause . at present , video - assisted thoracic surgery ( vats ) is the most frequently used form of surgery for treating pneumothorax .
kim et al . reported a series of 66 patients that were randomized to treatment with either transaxillary minithoracotomy ( tamt ) or vats .
first , a smaller incision was required when compared with tamt , which generally resulted in less pain .
second , the cosmetic effect is superior to that of tamt . finally , most procedures are possible ( mechanical pleurodesis , chemical pleurodesis , etc . ) . prospective studies of simultaneous bilateral spontaneous pneumothorax management are rare .
generally , cases of bilateral pneumothorax require definitive surgical therapy to reduce the risk of recurrence .
this can be done either through vats or open thoracotomy , depending on the surgeon 's preference .
our case presented the rare clinical situation of simultaneous bilateral tension pneumothorax , and a decision was made to treat with immediate large size needle decompression at the emergency room by a properly trained doctor .
the procedure was a critical step which restored this patient from life - threatening tension pneumothorax .

Answer:
spontaneous pneumothorax is a common clinical problem in emergency care .
 however , the overall incidences of primary spontaneous pneumothorax has been reported from as low as 1.4% to 7.6% .
 the clinical findings of simultaneous bilateral spontaneous pneumothorax can be variable .
 clinical presentation is variable , ranging from mild dyspnea to tension pneumothorax .
 bilateral tension pneumothorax can defined as cases where no tracheal deviation is detected in chest x - ray , and symptoms may be equal bilaterally . herein , we present a case with simultaneous bilateral tension pneumothorax , severely deteriorated ( i.e. with loss of consciousness , cyanosis , and hemodynamically unstable ) , that was successfully treated with immediate large - size needle decompression .


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

Paper text:
it is widely accepted that mutation is the main causal factor for diverse tumorigenesis [ 1 , 2 ] .
the recent development of next - generation sequencing ( ngs ) technologies has revolutionized the speed and throughput of dna sequencing , which facilitates the discovery of new driver mutations .
for example , the arid1a gene is mutated in 83% of gastric cancers with microsatellite instability and the sf3b1 gene is somatically mutated in 9.7% of chronic lymphocytic leukemia patients [ 4 , 5 ] . in colorectal cancers , although the majority of recurrent mutations have been previously known , some novel mutations , such as the mutations in the sox9 and fam123b genes , were also identified by ngs technology , which may have implications for colorectal tumorigenesis . in melanoma , approximately 40% was found to have causal mutations affecting b - raf function .
along with the well - known driver mutations , the novel mutations identified by ngs will be useful for predicting the prognosis and molecular characterization of cancers [ 8 , 9 ] .
recently , a number of mutation calling tools , such as varscan , genome analysis toolkit , and mutect , have been developed to detect single - nucleotide variants ( snvs ) or indels from ngs data . however , snv calling from a single cancer case is not the final step for defining clinically meaningful mutations . to define the pathogenic snvs in human cancers ,
a commonly used approach is to identify the phenotype - associated recurrent mutations in the study group . due to the data size burden of ngs output , profiling the mutations associated with a certain phenotype or prognosis in a study group by a researcher who does not have a bioinformatics background or facilities
is very difficult . currently , there is no user - friendly tool supporting methods for the detection of recurrent or phenotype - specific mutations . in this study , in order to support the definition of recurrent mutations or phenotype - specific mutations from ngs data of a group of cancers with diverse phenotypes , we aimed to develop a user - friendly tool , named mutation arranger for defining phenotype - related snv ( map ) .
map software was designed as a standalone program , compatible in microsoft windows environments with a user - friendly graphic interface , and compiled codes of map can be easily installed .
both variant call format   and its annotation files , such as annovar output , can be used as input files for map .
when a user loads the input file , called sample descriptor file ( gsf ) , map software displays the sample set information and filter options ( fig .
1 ) . once data are loaded , the user can filter the data using the ' analysis options ' tab in map software based on annotation information . by using the sample set and analysis options
summary metrics include the mutation status for each sample , total mutation frequency , p - values for differences between phenotype groups based on clinical information , genomic position , reference / observed sequence , and additional information , such as read depth by default . map software also displays more detailed information in summary metrics based on the user - selected ' analysis options . ' in the ' analysis result ' tab , map software provides the frequency- or p - value - based filter function .
this functionality supports detection of the recurrent mutations in study subjects and identification of the phenotype - specific mutation that occurs significantly in a certain phenotypic subclass .
then , map software represents the user - selected mutations graphically in the ' visualization ' tab . to sort the variants by genomic position , p - value , or frequency , users can use the sort function in the ' analysis result ' tab .
details of the program download , installation , and analysis procedures are available in the user manual .
the major steps of map are as follows .
 - generating mutation summary metrics in study subjects- determination of recurrent mutations by frequency- determination of phenotype - specific mutations by association test- graphical illustration of user - selected mutations
  - generating mutation summary metrics in study subjects - determination of recurrent mutations by frequency - determination of phenotype - specific mutations by association test - graphical illustration of user - selected mutations
mutation calling files from genome analysis toolkit   can be used directly as input files for ' sample descriptor . ' alternatively , manually prepared standard variant call format   is also available .
annotation information files , such as annovar outputs , can be used as input files for sample descriptor .
gsf is a comma - separated values text file that describes the input files , such as gatk output files and annovar output files , and phenotype information .
when users load the input file , map software displays the sample set information and filter options in the ' source ' tab .
if any file is not prepared properly , map software informs the user in the ' sample set files ' tab .
after data are loaded , the user can filter the data using the ' analysis option ' tab based on annotation information .
based on user - selected filters in the ' analysis options ' tab , summary metrics represent additional annotation information , such as gene name , function , known variant , and amino acid change .
the additional annotations can be hidden using the snp filter option in the ' analysis option ' tab .
these mutation metrics are exported into a comma - separated values text file for further investigation .
in the ' analysis result ' tab , map software defines the recurrent mutations in study subjects by frequency .
the frequency threshold can be determined arbitrarily by the user in the ' frequency filter ' function .
map also defines the phenotype - specific mutations using the mutation metrics and phenotype information .
phenotype - specific mutations that occur more frequently in one of two clinical conditions ( e.g. , drug - responder vs. non - responder ) are determined by chi - square test under the user - defined significance level .
the graphic user interface is implemented in the software for users to easily handle large - scale data or access the analysis result ( fig . 2b and 2c ) .
the recurrent or phenotype - specific mutations can also be demonstrated visually in heat - map style .
for example , the left and right of the heat - map represent the sample name and mutational spectrum , respectively .
the bottom of the heat - map represents the gene name by color for mutational spectrum . frequency or p - value plots
are represented on top of the heat - map ( fig . 2b and 2c ) .
map is a user - friendly program with multiple functions that supports the determination of recurrent or phenotype - specific mutations and provides graphic illustration images to the users .
its operation environment , microsoft windows , enables more researchers who can not operate linux to define clinically meaningful mutations with ngs data from cancer cohorts .

Answer:
next - generation sequencing ( ngs ) is widely used to identify the causative mutations underlying diverse human diseases , including cancers , which can be useful for discovering the diagnostic and therapeutic targets . currently , a number of single - nucleotide variant ( snv)-calling algorithms are available ; however , there is no tool for visualizing the recurrent and phenotype - specific mutations for general researchers . in this study , in order to support defining the recurrent mutations or phenotype - specific mutations from ngs data of a group of cancers with diverse phenotypes , we aimed to develop a user - friendly tool , named mutation arranger for defining phenotype - related snv ( map ) .
 map is a user - friendly program with multiple functions that supports the determination of recurrent or phenotype - specific mutations and provides graphic illustration images to the users .
 its operation environment , the microsoft windows environment , enables more researchers who can not operate linux to define clinically meaningful mutations with ngs data from cancer cohorts .