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:
type iii dysbetalipoproteinaemia is a kind of lipid metabolism disorders , caused by apo - e deficiency , which leads to accumulation of chylomicrons and very low density lipoprotein remnants in the plasma.123 lipid metabolism disorders are mostly manifested by xanthomas , which are known as yellowish cholesterol - rich material in large foam cells accumulating in the skins and tendons.14 these yellowish lesions may appear all over the body , on the palm of the hands , sole of the foot , tendons , and even on the eyelids.5 these lesions firstly described with or without hyperlipidaemia in association with monoclonal immunoglobulin . based on this fact , there are three forms of xanthoma : hyperlipaemic xanthoma , normolipaemic xanthoma and necrobiotic xanthogranuloma.6 xanthomatosis is usually associated with hyperlipidaemia , and morbidity and mortality of this condition are related to atherosclerosis and pancreatitis.7 hyperlipaemic xanthoma lesions are more polymorphic and can include tuberous , tendinous , palmar or eruptive xanthoma .
verruciform xanthoma usually presents as a hyperkeratotic , cauliflower like , verrucous or papillomatous lesion.6 it initially was described as a unique clinicopathologic lesion of the oral mucosa and was subsequently reported in the skin .
the epidermal - mucosal changes of hyperparakeratosis , neutrophilic infiltrate and dermal - submucosal foam cell reaction are distinctive features of these xanthomas.8 hereby , we present a rare type of xanthomas calling  cauliflower xanthoma  in a 43-year - old man with dysbetalipoproteinaemia .
a 43-year - old man was presented to outpatient endocrine clinic of tabriz university of medical sciences , tabriz , iran , by his sister for evaluation of skin lesions .
he had multiple lesions on shoulders and back , lateral and medial part of dorsal surface of the foot , medial and lateral malleus of both feet , and dorsal and palmar surface of both hands .
siblings of the patient have been followed up in that clinic for clinically diagnosed type - iii dysbetalipoproteinaemia .
this diagnosis was based on characteristic palmar , eruptive , tuberous and trauma site xanthomas with typical high levels of both total cholesterol and triglycerides in the plasma .
history of coronary artery or other atherosclerotic disorders were negative in index case and siblings .
there were not any other complaint , and as a greengrocer , he had an active lifestyle .
he had a pathology report of skin lesion biopsy that was performed by a dermatologist few months ago , with presence of lipid laden macrophages consistent with diagnosis of xanthoma . fasting serum lipid levels reported as : total cholesterol = 507 mg / dl , triglycerides = 470 mg / dl and high density lipoprotein ( hdl ) cholesterol = 41 mg / dl .
he had normal fasting blood sugar , and normal thyroid , renal and liver function tests .
physical examinations revealed numerous xanthomas resembling cauliflower on both knees [ figure 1 ] , unusual eruptive , tuberous xanthomas same as previous lesions , on the lateral malleus of both feet [ figure 2 ] .
cauliflower xanthomas on the knees and lateral malleus of both lower extremities cauliflower xanthomas on the lateral malleus of lower extremities there were lots of smaller xanthomas on the right shoulder [ figure 3 ] , and cauliflower like xanthomas on the extensor side of the left upper extremity , especially on the elbow [ figure 4 ] . based on available information
, the patient diagnosed as familial dysbetalipoproteinaemia ( fdl ) and the unique lesions on the lower limb called  cauliflower xanthoma  .
although siblings of this case had the same disorder , they did nt develop such lesions .
xanthomas on the shoulder and back of the neck xanthomas on the extensor side of the hand by searching in the medical data bases , we can not find a previous such a lesion . therefore , we decided to present this case without revealing patient 's name , after taking his consent .
considering the fact that the treatment with high dose statin was effective in correction of lipid abnormality and regression of skin lesions in his three siblings , we wanted to try the treatment procedure in this patient but he refused any intervention .
fdl , also known as hyperlipoproteinemia type - iii or broad beta disease , is a rare inherited disorder characterised by improper metabolism of certain lipids , specially plasma cholesterol , triglyceride rich chylomicron and very low density lipoproteins ( vldl ) remnants.1 presence or absence of the symptoms of this disease depends on two major risk factors : genetic and diet.910 mutations in the gene for apolipoprotein e ( apo e ) are the main cause of this disease .
replacement of an arginine by a cysteine in position 158 of the 299-amino acid chain of apo e5 is responsible for the defective binding of chylomicron and vldl remnants to cell receptors .
thereafter , slower plasma clearance of these particles occurs , and results in the abnormal accumulation of lipids in the body.9 on the other side , diet has an essential role in the development of the disease .
this means that with standard cholesterol diet , symptoms of fdl will not appear , even in the genetically susceptible person.10 xanthomas can be a symptom of fdl .
xanthomas may also be the symptoms of a generalised histiocytosis , or a local fat phagocytosing storage process.11 they are yellowish lesions on the skins and tendons , macroscopically .
these macrophages are filled with lipid droplets , which are dissolved and removed from tissue during histologic processing.8 fdl is mostly diagnosed by combination of clinical and laboratory findings.12 most cases are inherited as autosomal recessive trait .
men are more susceptible for fdl probably because of protective impact of estrogen in women .
most of the diagnosed patients were typically young males , with strong family history , characteristic skin lesions , high serum levels of cholesterol and triglycerides and confirming skin histology.113 most of these cases have premature atherosclerosis and other signs of ischaemic disorders.9 the patient in this article was a middle aged man with family history of dysbetalipoproteinaemia and high levels of serum lipids as follows : total cholesterol = 507 mg / dl and triglycerides = 470 mg / dl .
he had a rare form of xanthoma all over his body , causing social problems for him .
nicotinic acid , clofibrate , statins or gemfibrozil properly reduce cholesterol and triglycerides in people affected with dysbetalipoproteinaemia.1 the patient mentioned in this article refused receiving any medical intervention .
he has just been advised to have low lipid diet , fish oil and regular moderate exercise in order to reducing serum lipid levels .
there should be distinctive monitoring of fdl patients including regular checking of their serum lipids .
controlling underlying disorders , and reducing excess calories , saturated fat and cholesterol , is the main aim of treating these patients . according to this article
, cauliflower xanthomas could be a symptom of fdl , and it should be considered as a differential diagnosis while approaching to these lesions .

Answer:
familial dysbetalipoproteinaemia ( fdl ) is an inherited disorder in which both cholesterol and triglycerides are elevated in the plasma , pre - disposing the people to coronary artery disease and peripheral vascular disease .
 the disease is mostly manifested by xanthomas , which have variable forms according to lipid amounts in the plasma of the blood .
 hereby , we report a 43-year - old man with fdl , presenting with a rare form of xanthomas calling  cauliflower xanthoma  all over the body .


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 report a case , carbon dioxide ( co2 ) embolism a potentially devastating complication of laparoscopic surgery , during dissection phase and was successfully resuscitated .
a 35-years - old female , weighing 42 kg was posted for transperitoneal laparoscopic boari 's ureteric reimplantation .
her , physical examination and routine investigations were unremarkable . with routine monitoring , balanced general anesthesia was given .
co2 pneumoperitoneum was created uneventfully using open insufflation technique and sustained with pressure of 14 mm hg .
after 2 h , when the surgeon was dissecting the ureters , there was a sudden drop in etco2 ( 8 mm hg ) , tachycardia ( 130/min ) followed by multiple ventricular premature beats ( vpbs ) with blood pressure ( bp ) 110/72 mm of hg and sao2 - 98% .
surgical bleeding and endotracheal tube blockage were ruled out , and gas embolism was suspected .
injection lignocaine 80 mg intravenously was given for vpbs , and the regular rhythm was restored with the heart rate of 42/min .
at this point , the sao2 decreased from 98% to 77% while the breath sounds were normal with no adventitious sounds .
since there was no response to these measures , injection dopamine 20 ug / kg / min and nor - adrenaline 0.36 ug / kg / min were infused .
multiorifice central venous catheter with its tip at the superior vena cava -right atrium ( svc - ra ) junction was inserted via right internal jugular vein but air could not be aspirated .
after 20 min , resuscitative efforts were successful , patient had pulse rate of 120/min , bp 100/54 mm / hg , sao2 100% , etco2
30 mm / hg and ecg showed sinus rhythm with right ventricular strain pattern.at this time the cvp was found to be 10 mm of hg .
two - dimension echocardiography ( 2-d echo ) showed no patent ductus arteriosus or any other congenital defects .
she was shifted to intensive care unit with dopamine 5 ug / kg / min . which was tapered and stopped after  h. the patient did not receive hyperbaric oxygen as we did not have the facility .
co2 embolism can occur either during peritoneal insufflationor during the surgical dissection . in this case ,
possible causes of sudden cardiovascular collapse like hypovolemia , hemorrhage , vaso - vagal reflex , pneumothorax and endotracheal tube blockage were ruled out before considering gas embolism the adhesions caused by previous surgery might have led to vascular injury during dissection and the operating site was above the level of the heart ( trendelenburg position ) creating a pressure gradient thus the open venous channels , at lower pressure were open to gaseous medium at a higher pressure leading to gas embolism . either , slow infusion of air ( 0.01 - 2.00 ml / kg / min ) or bolus of gas ( 25 - 200 ml or 1 - 13 ml / kg ) , creates a  gas
paradoxical air embolism was ruled out by a 2-d echo that showed no intra - cardiac channels .
any kind of pulmonary embolism leads to sudden deterioration of the hemodynamic status associated with decreased etco2 levels . since co2 is a highly soluble gas ( 54 ml / dl ) , prompt recovery of the vital signs is usual .
aspiration of gas through central venous catheter is the definitive means of treating gas emboli . in our case ,
failure to aspirate the gas may suggest that it might have been trapped in the pulmonary vasculature .
tee is the gold standard for detection of pulmonary air embolism , however , it is not indicated routinely for intra - operative monitoring .
sudden decrease in etco2 is an early sensitive but nonspecific sign of venous air embolismprecordial stethoscope enhances specificity of etco2 and mean pulmonary artery pressure values .
immediate treatment of gas embolism requires deflation of pneumoperitonium , placing the patient in durant 's position , hyperventilation and administration of 100% oxygen .
aggressive cardiopulmonary resuscitation should be continued till the acute effects of the embolism abate and one should maintain positive circulating volume to prevent further entrainment of the gas .
thus , in laparoscopic surgeries early detection of gas embolism with prompt resuscitation can result in a favorable post - operative outcome .

Answer:
carbon dioxide ( co2 ) embolism is a rare but potentially fatal complication of laparoscopic surgery .
 we report a case of presumed co2 embolism in a 35-year - old female during laparoscopic ureteric reconstructive surgery .
 after 2 h of operating time , a sudden decrease in end - tidal carbon dioxide and deterioration of hemodynamic status followed by cardiac arrest with pulseless electrical activity suggested gas embolism .
 immediate cardiopulmonary resuscitation and inotropic support resulted in successful outcome .
 thus , early recognition of the complication and prompt treatment can avoid catastrophy .


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:
plasmodium falciparum is one of the major causes of mortality among children in rural india .
states such as odisha have high childhood mortality due to p. falciparum positive malaria often occurring in various forms .
lack of awareness of atypical manifestation leads to delay in diagnosis and early management often leading to death .
upsurge of unusual features are due to development of immunity , increased resistance and injudicious use of antimalarial drugs .
a 15-month - old male child was admitted with the chief complains of high - grade fever for 7 days followed by altered sensorium for 1 day . on examination , child was febrile and unconscious .
the child had uneventful perinatal history , no developmental delay , and no history of seizure .
blood investigations showed hb was 5.8 mg / dl ; total leucocyte count 12,400/cumm , and total platelet count 65,000/cumm .
mpict ( antigen test ) was positive and peripheral smear showed multiple rings of p. falciparum .
patient was treated using intravenous ( iv ) artesunate followed by act according to who guidelines . on follow - up fever decreased and sensorium improved , but on day 4 of the treatment child developed bilateral nystagmus with rapid component towards the right side .
after ruling out all other causes of nystagmus , it was diagnosed as an early complication of cerebellar involvement due to severe malaria .
a 6-year - male child was admitted with the chief complain of high - grade fever for 4 days with abnormal behavior and occasional vomiting .
he had no history of hematemesis , melena , bladder bowel abnormality , abnormal movement or altered sensorium .
all vitals signs were normal except for mild tachycardia . on abdominal examination , liver was around 6 cm palpable .
blood investigation suggested hb was 7.2 mg / dl while other complete blood count ( cbc ) parameters were normal .
patient coming from an endemic region with high - grade fever , antigenic positivity , and the absence of other risk factors for psychosis confirmed diagnosis of malaria with psychosis .
child was treated by iv artesunate with sedatives ( iv lorazepam ) . on day 4 ,
a 11-year - old child was presented to pediatric outpatients department with severe crampy and episodic abdominal pain with urticarial rash over face and abdomen and generalized malaise and lethargy .
he had no history of recent fever , seizure , conjunctivitis , abnormal vomiting , and bowel bladder anomaly .
he was treated using antihistaminic and antispasmodics ( injection cyclopam , injection ranitidine , and oral cetirizine tablet ) . on day 2 of admission
as a child was from an endemic region of p. falciparum , mpict ( antigen ) was performed .
iv artesunate was initiated according to who protocol along with antihistamines and antispasmodics ( injection cyclopam 10 mg / dose t.d.s , injection ranitidine
urticaria in a malaria endemic patient nonresponsive to antihistamine drugs is an indication of underlying malaria and should be managed accordingly .
a 15-month - old male child was admitted with the chief complains of high - grade fever for 7 days followed by altered sensorium for 1 day . on examination , child was febrile and unconscious .
the child had uneventful perinatal history , no developmental delay , and no history of seizure .
blood investigations showed hb was 5.8 mg / dl ; total leucocyte count 12,400/cumm , and total platelet count 65,000/cumm .
mpict ( antigen test ) was positive and peripheral smear showed multiple rings of p. falciparum .
patient was treated using intravenous ( iv ) artesunate followed by act according to who guidelines . on follow - up fever decreased and sensorium improved , but on day 4 of the treatment child developed bilateral nystagmus with rapid component towards the right side .
after ruling out all other causes of nystagmus , it was diagnosed as an early complication of cerebellar involvement due to severe malaria .
a 6-year - male child was admitted with the chief complain of high - grade fever for 4 days with abnormal behavior and occasional vomiting .
he had no history of hematemesis , melena , bladder bowel abnormality , abnormal movement or altered sensorium .
all vitals signs were normal except for mild tachycardia . on abdominal examination , liver was around 6 cm palpable .
blood investigation suggested hb was 7.2 mg / dl while other complete blood count ( cbc ) parameters were normal .
patient coming from an endemic region with high - grade fever , antigenic positivity , and the absence of other risk factors for psychosis confirmed diagnosis of malaria with psychosis .
child was treated by iv artesunate with sedatives ( iv lorazepam ) . on day 4 ,
a 11-year - old child was presented to pediatric outpatients department with severe crampy and episodic abdominal pain with urticarial rash over face and abdomen and generalized malaise and lethargy .
he had no history of recent fever , seizure , conjunctivitis , abnormal vomiting , and bowel bladder anomaly .
he was treated using antihistaminic and antispasmodics ( injection cyclopam , injection ranitidine , and oral cetirizine tablet ) . on day 2 of admission
as a child was from an endemic region of p. falciparum , mpict ( antigen ) was performed .
iv artesunate was initiated according to who protocol along with antihistamines and antispasmodics ( injection cyclopam 10 mg / dose t.d.s , injection ranitidine 1 ml iv bd , and oral cetirizine 5 mg bd ) .
urticaria in a malaria endemic patient nonresponsive to antihistamine drugs is an indication of underlying malaria and should be managed accordingly .
although orissa state has about 3.6% of the total population of the country , it accounts for 47% of p. falciparum cases and 34% of all reported deaths due to malaria .
classic symptoms of severe malaria caused by p. falciparum among pediatric patients include high - grade fever , sweating , jaundice , vomiting , nausea , and pallor . according to who criteria impaired consciousness , prostration , respiratory distress , multiple seizures , jaundice , hemoglobinuria , abnormal bleeding , severe anemia , circulatory collapse and pulmonary edema are features of severe malaria .
the unusual features are due to development of immunity , indiscriminate use and increasing resistance of antimalarial drugs .
cerebellar involvement in p. falciparum malaria can occur during the acute stage of fever as sequelae of cerebral malaria among survivors or as a side effect of drugs , which is evident as delayed cerebellar ataxia .
however , isolated nystagmus in children after severe malaria is very rarely reported although ataxia and tremor are commonly observed .
the cerebellar symptoms are due to injury to purkinje cells as a consequence to hyperpyrexia , anemia , hypoglycemia and persistent seizures eventually leading to hemorrhages , small infarction , and the microglial infiltration in purkinje cells of the cerebellum .
paranoid , agitation , manic symptoms are observed in the acute stage although it can present as confusional state , severe agitation , delirium , delusion , hallucination and transient amnesia in children .
nevertheless these features generally disappear after treatment but can be observed in few patients following chloroquine use . very rarely psychotic features may be the first manifestation in malaria with persistent abnormality .
cerebral malaria can disrupt neuropsychological integration during critical developmental periods resulting in several developmental delays .
it is due to immunological factors , increase vascular permeability and capillary - dilatation due to cell mediators such as histamine , serotonin , heparin , and proteoglycans .
as observed in our case , rarely ( 1.35 - 25.6% incidence rate ) urticaria may also be present without fever as the primary manifestation .
although the deposition of ige in endothelial cells cause itching followed by urticaria , however this generally subsides after 12 - 48 h of antimalarial management .

Answer:
variable atypical symptoms are commonly observed in malaria caused by plasmodium falciparum especially in endemic tropical nations such as india .
 nystagmus is observed following involvement of the cerebellum especially during the postrecovery phase .
 while psychotic features such as severe agitation , hallucination , paranoia may be the early symptoms of falciparum malaria among pediatric patients , urticaria with or without fever can be the initial manifestation of the disease .
 as the morbidity and mortality of severe malaria are very high in india , these atypical presentations should be considered during diagnosis .
 we believe our report on atypical cases of falciparum malaria will sensitize doctors and health personnel about rare presentations in children and help in early diagnosis and management to reduce the severity and death toll due to the disease .


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 sequenced 12 bat brains positive for lyssavirus antigen detected by immunofluorescence and reverse transcription
the 400-bp 5 variable extreme of the nucleoprotein gene of these eblv-1 strains was amplified by specific eblv-1 nested rt - pcr and sequenced by using the following primers : seqvar1f 5-1acgcttaacaaccagatcaaag22 - 3 , seqvar2f 5-51aaaaatgtaacacyyctaca70 - 3 , eblvseqvar1r 5-596cagtctcaaagatctgttccat575 - 3 , and eblvseqvar2r 5-552tagttcccagtattctgtcc533 - 3. all rabies - positive serotine bats came from southern spain ( huelva , seville , murcia , and badajoz ) and were molecularly identified as e. isabellinus ( 8) . an alignment was performed by using clustalx ( www.clustal.org ) to combine the obtained sequences and other available eblv-1 sequences from genbank , including a duvenhage virus used as the outgroup ( table a1 ) . before conducting further analyses , we used jmodeltest ( http://darwin.uvigo.es/software/jmodeltest.html ) to select the best fitting substitution model for our sequences according to the corrected akaike information criterion .
maximum - likelihood phylogenies were reconstructed by using phyml ( http://atgc.lirmm.fr/phyml ) software and by using a generalized time - reversible model and the  parameter estimated in the analyses .
maximum - parsimony analyses were conducted by using paup * 4.0b10 ( http://paup.csit.fsu.edu/ ) weighting transversions 15 according to the transitions / transversion ratio estimated in the jmodeltest analyses .
confidence in the topologies for the maximum - likelihood and the maximum - parsimony analyses was established with 1,000 bootstrap replicates .
a bayesian phylogenetic inference was obtained by using mrbayes version 3.1 ( http://mrbayes.csit/fsu.edu/ ) with random starting trees without constraints .
two simultaneous runs of 10 generations were conducted , each with 4 markov chains , and the trees were sampled every 100 generations .
net p - distances between groups were calculated by using mega4 ( www.megasoftware.net ) ( figure 1 ) .
european bat lyssavirus 1 ( eblv-1 ) phylogenetic reconstruction based on the first 400 bp of the nucleoprotein gene .
the tree was obtained by bayesian inference run for 10 generations ; trees were sampled every 100 generations .
bootstrap supports after 1,000 replicates for each node are also shown for maximum - parsimony ( green numbers ) and maximum - likelihood ( blue numbers ) analyses .
net p - distance values ( as percentages ) between groups are indicated by arrows .
a parsimony - based network is presented for each major lineage ; sizes of yellow circles are proportional to the number of individuals sharing a given haplotype , and reconstructed haplotypes ( median vectors ) are shown in red .
duvv , duvenhage virus . the genetic structure and relationships between haplotypes were examined within the main lineages through a parsimony - based network built with a median - joining algorithm implemented in the network 4.5.1 program ( 11 ) . to evaluate and compare genetic variability and polymorphism among lineages
, we estimated the number of haplotypes , mutations , and segregating sites as well as haplotype diversity and nucleotide diversity by using dnasp version 4.5 ( 12 ) for the major clades ( table ) . finally , to investigate population dynamics across lineages , the fu fs and tajima d statistics were calculated ( table ) .
these 2 statistics are considered to be the most powerful tests for detecting expansion events ( 13 ) . * eblv , european bat lyssavirus ; n , no .
sequences ; s , no . segregating sites ; eta , no . mutations ; hap , no . haplotypes ; hd , haplotype diversity ; varhd , haplotype variance ; pi , nucleotide diversity ; thetanuc , estimated population mutation rate per site ; k , average no .
all phylogenetic analyses , regardless of the reconstruction criterion used , formed a monophyletic cluster of the eblv-1 strains from spain ( only the bayesian inference reconstruction is shown ) .
the bayesian inference , maximum - likelihood , and maximum - parsimony analyses identified the cluster from spain and eblv-1a and eblv-1b as being monophyletic ( figure 1 ) , although only maximum - likelihood and maximum - parsimony analyses suggested a closer relationship between eblv-1a and the cluster from spain .
the genetic differentiation of the eblv-1 strains from the iberian peninsula matches their association with another bat species ( figure 2 ) , which suggests that the host bat s evolutionary history plays a major role in eblv-1 molecular epidemiology , as has been proposed for rabies virus in bats in north america ( 14 ) .
geographic distribution of eptesicus serotinus bats ( red ) , e. isabellinus bats ( blue ) , and cases of rabies in bats ( green dots ) , europe , 19902009 . obtained from rabies bulletin europe ( www.who-rabies-bulletin.org/ ) .
the low genetic diversity and the fu fs and tajima d statistics ( table ) all suggest rapid population expansion of eblv-1a , which is consistent with the star - like structure of the network for this lineage ( figure 1 ) .
conversely , haplotype and nucleotide diversity descriptors ( table ) have the highest values for eblv-1b and a complex network structure with differentiated subnetworks .
the lineage from spain also has low diversity and a star - shaped network , but neutral evolution can not be rejected on the basis of the fs and d statistics .
net distances are similar within and between lineages , except for eblv-1a , which is slightly more differentiated ( figure 1 ) .
consequently , the suggested eblv-1 expansion from spain into europe ( 15 ) is not supported by our results , which record the highest variability and most complex phylogenetic structure for france and the netherlands ( figure 1 ) .
this complex structure suggests either a longer evolutionary history in these areas or a recent contact of distinct bat lineages in this zone .
the results of this study show that the strains from spain do not belong to subtype 1b because of their association with a different reservoir ( e. isabellinus bats ) .
moreover , what is currently considered to be eblv-1b seems to include at least 4 lineages that are more genetically diverse and have a complex history .
eblv-1a , however , has low genetic diversity despite its extensive geographic distribution , suggesting a relatively recent and successful expansion of this lineage .
these results call into question the current classification of eblv-1 into 2 single subtypes . to provide a better understanding of eblv-1 molecular epidemiology in europe ,
additional studies that consider different genes should be conducted and the current classification should be revised accordingly .

Answer:
to better understand the epidemiology of european bat lyssavirus 1 ( eblv-1 ) in europe , we phylogenetically characterized lyssavirus from eptesicus isabellinus bats in spain . an independent cluster of eblv-1 possibly resulted from geographic isolation and association with a different reservoir from other european strains .
 eblv-1 phylogeny is complex and probably associated with host evolutionary history .


Question:
You will be shown the title of a chemistry paper, together with sections excerpted from the body of the paper. The paper sections may include HTML tags like `<p>` and `</p>`; please ignore these. Your task is to write an abstract for the paper. Your response should include the abstract and no other text.

Title:
Heterogeneous palladium-catalysed Catellani reaction in biomass-derived γ-valerolactone

Paper sections:
Introduction

In recent years, the direct C-H functionalization of arenes has emerged as a particularly attractive alternative to classical cross-coupling approaches, allowing for late-stage diversifications without the need of prefunctionalization steps. 1 Typically, directing groups are required for achieving site-selectivity in intermolecular transformations, mostly occurring at the ortho-position. The Catellani reaction represents an alternative strategy in which the palladium-catalysed C-H orthofunctionalization of aryl iodides is mediated by norbornene, which allows for subsequent ipso-substitution. In the original report by Catellani and coworkers the dialkylation of the aryl iodide in the two ortho-positions was followed by an ipso-vinylation through a Mizoroki-Heck-type process. 2 Several modifications to this reaction have subsequently been devised, allowing for different functionalizations to occur both on the ortho-as well as on the ipso-position. The most synthetically useful approaches towards the ipso-functionalization, apart from the Mizoroki-Heck-type alkenylation, include arylations through a Suzuki-Miyaura-type reaction, the alkynylation through a Sonogashira-type process and the hydrogenolysis of the aryl-palladium intermediate. 3 Thus far, the vast majority of C-H functionalization reactions have relied on homogeneous transition metal catalysis. Only recently the attention has shifted to the use of versatile heterogeneous catalysts for C-H activation chemistry. 4 However, to the best of our knowledge, examples of heterogeneous metal-catalysed Catellani reactions have as of yet proven elusive. It is particularly noteworthy that the use of heterogeneous catalysts offers great advantages as compared to homogeneous catalysts, especially in terms of recoverability of the catalysts, ease of purification and minimization of metal contamination.

Thus far, the Catellani reaction has largely been conducted in polar aprotic solvents, such as DMF, DMA or acetonitrile. These solvents, particularly DMF and DMA, present major issues related to their toxicity, and their substitution is highly desirable, especially for large-scale applications. 5 Acetonitrile is typically considered the "greenest" option among polar aprotic solvents. 6 However, this actually represents a rather poor alternative due to its volatility and toxicity. 7 γ-Valerolactone (GVL), is a renewable biomass-derived chemical featuring high polarity, high boiling point, and good stability towards bases and acids. Only few applications employing GVL as reaction media have been disclosed. 8 Recently, we have reported for the first time that GVL can be used as an environmentally-benign alternative to common toxic polar aprotic solvents. 8i-k In some cases we have also observed that the use of GVL in combination with a heterogeneous catalyst lead to lower product contamination by the metal, compared to the same reaction performed in common polar aprotic solvents. 8i-k This is particularly relevant since metal contamination represent a major issue in the synthesis of pharmaceutical compounds. 9,10 In this article we report the first example of a Catellani reaction catalysed by a heterogeneous palladium species. The reaction is performed in a sustainable reaction media (GVL) and the optimal catalyst can be easily recovered and reused for consecutive reaction runs. Experimental mechanistic investigations were also conducted in order to clarify the nature of the catalytically active species.

Results and discussion

At the outset of our studies, we tested representative heterogeneous palladium catalysts in the Catellani reaction with methyl 2-iodobenzoate (1a) and methyl acrylate (2a), using K 2 CO 3 as the base and GVL as the medium (Table 1). 11 Commercially available encapsulated Pd(OAc) 2 , 12 either with or without PPh 3 (Pd EnCat™ 30 and Pd EnCat™ TPP30, respectively) performed with high efficacy, affording the expected product 3a in more than 90% yield (Table 1, entries 1 and 2). The simple Pd/C catalyst gave comparable results, with an isolated yield of 94% (Table 1, entry 3). The addition of 2.5 equivalents of PPh 3 , either soluble or immobilized on a polystyrene support, led to a slight decrease in catalytic activity, with the product being obtained in 82-87% yield (Table 1, entries 4 and  5). Also commercially available Pd/Al 2 O 3 gave excellent results, providing the expected product in 95% yield (Table 1, entry 6). DMF, NMP, and MeCN were also tested as representative aprotic reaction media (Table 1, entries 7-9). While in the case of DMF satisfactory results were obtained, the use of NMP and MeCN led to poor conversion of the substrate 1a.

The effect of different basesboth organic and inorganicon the reaction was also investigated, with K 2 CO 3 giving the best results (see ESI †).

Next, we explored the scope of the reaction between methyl 2-iodobenzoate (1a) and several olefins 2. We chose to conduct all reactions with Pd EnCat™ 30 as well as Pd/Al 2 O 3 , in order to investigate possible differences in reactivity between these two rather diverse heterogeneous catalysts. Generally, both catalysts performed well, providing the expected products in moderate to very good yields. In several cases Pd EnCat™ 30 gave slightly better results in terms of yields than Pd/Al 2 O 3 . α,β-Unsaturated esters and ketones (2a-c) were efficiently converted to the product by either of the two catalytic systems in yields ranging from 60% to 95% (Tables 2 and 3, entries 1-3). Acrylonitrile (2d) furnished good results in the reaction catalysed by Pd EnCat™ 30 (Table 2, entry 4), while much lower yield was obtained using Pd/Al 2 O 3 , which also needed longer reaction times (Table 3, entry 4).

Vinyl alkyl ethers (2e-f ) proved to be more challenging, and the efficacy was strongly dependent on the nature of the catalyst (Tables 2 and 3, entries 5 and 6).

Moreover, the reaction conducted on vinyl ethyl ether (2f ) with Pd EnCat™ 30 delivered the formyl-substituted product through a Domino Catellani reaction along with hydrolysis and keto/enol tautomerization. Styrene (2g) and para-substituted styrenes (2h-i) reacted efficiently with both catalysts (Tables 2 and 3, entries 7-9).

Interestingly, in both the reactions performed with the two catalysts, the chlorine functionality was well tolerated (Tables 2  and 3, entry 9), which should prove instrumental for further late-stage diversifications.

1,1-Disubstituted olefins were also subjected to the optimized reaction conditions with either Pd EnCat™ 30 or  Pd/Al 2 O 3 as the catalysts (Tables 2 and 3, entries 10 and 11).

Their reactivity was in line with that observed for the monosubstituted olefins, with yields ranging from 41% to 68%. However, due to the presence of the methyl group on the substrate, the β-elimination step of the final Mizoroki-Heck-type reaction could occur in two positions, thus generating two isomeric products (3 and 4). As to the substitution pattern on the aryl iodides 1, the optimized palladium catalyst also enabled the synthesis of products 3l-3o (Scheme 1). The coupling of the Catellani reaction with a terminal hydrogenolysis step provides step-economical access to metadifunctionalized aromatic species. 3,13 We tested the applicability of this strategy under the optimized reaction conditions with Pd/Al 2 O 3 as the catalyst and benzyl alcohol as hydride donor (Scheme 2). The reaction proceeded efficiently, affording the expected coupling product 5 in high yield.

A major issue associated with transition metal catalysis, and in particular with palladium chemistry, is the nature of the catalytic active species. Indeed, it frequently was noted that operationally heterogeneous reactions actually occur through the catalysis of soluble leached metal species or, vice versa, that operationally homogeneous reactions were catalysed by in situ formed insoluble metal particles. 14 This problem is also of key relevance for C-H functionalization reactions. 4 It is worth considering that the actual nature of the catalyst is not only important for mechanistic reasons, but also has practical implications, since it finally controls the possibility to reuse the recovered catalyst and the metal contamination of the products. Unfortunately, assessing the nature of the catalytic active species (homogeneous vs. heterogeneous) is not a simple task. Several experiments have been proposed but none of them is able to give conclusive evidence about the mechanism. Instead, it is necessary to rely on multiple experiments in order to possibly obtain sufficient support to one of the mechanistic scenarios. 14 For these reasons, we decided to investigate the nature of the catalytically active species through various approaches, for both the reactions catalysed by Pd EnCat™ 30 and by Pd/ Al 2 O 3 . First, we performed a hot-filtration test by removing the solid catalyst one hour after the beginning of the representative reaction between 1a and 2a, and allowing the filtrate to stir for 3 days at 105 °C. Interestingly, the two catalysts led to quite different results. Thus, while Pd/Al 2 O 3 gave a very low conversion (7%), Pd EnCat™ 30 furnished 3a in 37% conversion. Second, for the same reaction we performed a mercurypoisoning test for both catalysts. Again, the two catalysts behaved differently. In fact, while the addition of Hg(0) completely hampered the catalytic activity of Pd/Al 2 O 3 with only 4% conversion after 20 hours, the reaction with Pd EnCat™ 30 gave 46% conversion under otherwise identical reaction conditions (see ESI †). These results suggest that leached palladium species might play a key role in the reaction catalysed by Pd EnCat™ 30, but not in the reaction with Pd/Al 2 O 3 . 15 Third, we measured the amount of palladium leached into the crude product by inductively coupled plasma optical emission spectrometry (ICP-OES), for both catalysts, before and after aqueous work-up (Table 4). The amount of palladium leached from Pd/Al 2 O 3 was very low, even before aqueous work-up (∼2 ppm). However, the extent of metal leaching from Pd EnCat™ 30 is relatively high (52.4 and 10.5 ppm before and after aqueous work-up, respectively), and in line with previous findings 15 and with our hot-filtration and Hg-poisoning tests.

Overall, these results suggest that the two tested catalysts exert their catalytic activity in different ways. While Pd EnCat™ 30 is proposed to catalyse the reaction by releasing homo-  geneous soluble palladium species, the C-H activation catalysed by Pd/Al 2 O 3 is either genuinely heterogeneous or may proceed through a "release and catch" mechanism. 16 From sustainability and chemical efficiency point of views, it is mostly important that the amount of palladium leached into the product is very low and that the solid catalyst can be efficiently reused. Therefore we tested the recyclability of Pd/ Al 2 O 3 in the reaction between 1a and 2a in GVL, by recovering the catalyst by simple filtration. The catalyst fully retained its activity for at least three reaction runs, constantly giving full conversion to the products. Thus, the reaction of substrates 1a and 2a was repeated for four consecutive runs giving the desired product 3a constantly in 93-95% yield (Fig. 1).

Conclusions

In conclusion, we have developed the first Catellani reaction catalysed by a solid palladium catalyst. The reaction proceeded efficiently on a variety of alkenes in the renewable biomassderived medium GVL. The process could also be merged with a terminal hydrogenolysis, which gave step-economical access to valuable meta-difunctionalized 17 arenes. The nature of the catalytically active species was investigated and provided support for the versatile Pd/Al 2 O 3 catalyst to operate in a heterogeneous fashion. Importantly, the catalyst could be efficiently recovered and reused, featuring a very low metal leaching. Studies on the use of other economically attractive organic electrophiles are currently ongoing in our laboratories and will be reported in due course.

Typical procedure for the Catellani reaction

To a 4 mL vial containing the palladium catalyst (0.00825 mmol, 5 mol%), the base (0.340 mmol), and 2-norbornene (12 mg, 0.127 mmol) was added a GVL solution (3.75 mL) of the aryl iodide 1 (0.33 mmol) and the terminal olefin 2 (0.195 mmol). The resulting mixture was stirred at 105 °C.

The solids were then separated from the solution by vacuum filtration and rinsed with cyclopentyl methyl ether. The organic layer was washed with water and dried over anhydrous Na 2 SO 4 . The products were isolated by flash column chromatography using a 4 : 1 mixture of petroleum ether and ethyl acetate as the eluent.

Procedure for catalyst recovery and recycling

After stirring at 105 °C for 24 h, the reaction mixture was centrifuged and the solvent was decanted. The catalyst was washed, first with water (0.2 mL) and GVL (3.0 mL), then with GVL (3.8 mL). New substrates (1a and 2a), reagents and solvent were added and left for 24 h at 105 °C for the next run. In four consecutive reaction runs Pd/Al 2 O 3 consistently led to full conversion to the expected product in 24 h.

Answer: Herein, we report the unprecedented use of a heterogeneous palladium catalyst for the step-economical Catellani reaction. The substrate scope with encapsulated Pd(OAc) 2 (Pd EnCat™ 30) or Pd/Al 2 O 3 proved to be broad, while the renewable biomass-derived γ-valerolactone (GVL) was identified as an effective reaction medium. Mechanistic studies highlighted the possible heterogeneous nature of the Pd/Al 2 O 3 catalyst, while showing that the reaction performed in the presence of Pd EnCat™ 30 is most likely catalysed by leached homogeneous palladium species. The heterogeneous Pd/Al 2 O 3 catalyst can be easily recovered at the end of the reaction and efficiently reused in consecutive reaction runs. † Electronic supplementary information (ESI) available: Experimental details, characterization data, and copies of NMR spectra of known (3a and 5) and new compounds (3b-3o, 3′h, 4j, 4k).


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:
neonatal group b streptococcus ( gbs ) infection ranging from 0.5 to 2 per 1000 live birth is the result of vertical transmission to the infant during delivery in colonized mothers .
attempts at identifying gbs colonized pregnant women near term by assessing the risk factors for gbs , failed to diagnose all cases .
universal screening of all pregnant women for gbs at 3537 weeks of gestation is currently recommended by the centers for disease control and prevention ( cdc ) in the usa .
despite the variation in the adherence to cdc recommendations among different centers around the world , antimicrobial prophylaxis , offered to women colonized with gbs intrapartum ( after onset of labor or after rupture of membranes ) , lead to more than 70% reduction in early - onset gbs infection in neonates .
however , due to the variation in the rate of gbs colonization during pregnancy , the emergence of resistant colonizing strains   and the virulence potential of these strains , intrapartum screening of gbs genotypes   along with their antimicrobial resistance profiles , and virulence encoding genes become desirable .
fortunately , gbs resistance to penicillin has not been reported so far ; however , rare gbs clinical strains with reduced sensitivity for penicillin have been recorded . on the other hand , early studies on gbs
isolates from pregnant women , showed antimicrobial resistance as high as 18% , 8% , and > 80% for erythromycin , clindamycin , and tetracycline respectively .
the severity of neonatal disease in gbs infections could be determined mostly by a number of virulence factors encoded among others by the cps gene cluster coding for the capsule , the scpb gene coding for surface enzyme scpb ( a c5a peptidase ) which causes impairing of neutrophil recruitment and binds fibronectin to promote bacterial invasion of epithelial cells , the bca gene coding for alpha - c protein , a surface protein that helps the bacteria to enter the host cells , the lmb gene coding for lmb ( laminine - binding protein ) , a surface protein that plays a role in invasion of damaged epithelium , the cyle gene coding for -hemolysin , a toxin that plays a role in tissue injury and systemic spread of the bacteria and contributes to meningitis , and the rib gene encoding the surface rib protein mostly present in invasive strains .
other virulence factors involved in the process of gbs pathogenesis include beta - c protein which is encoded by bac gene .
beta - c protein function is comprised of interaction with iga - fc portion causing the inhibition of phagocytosis   and binding factor - h to maintain its role in inhibiting the complement activation via the alternative pathway .
other important virulence factors of gbs are the fibrinogen - binding proteins : fbsa and fbsb .
it protects the pathogen from opsonophagocytosis , and promotes its adherence to epithelial cells and to the human brain microvascular endothelial cells ( hbmec ) thus helping it to cross the blood brain barrier and developing meningitis [ 18 , 19 ] .
fbsb protein , encoded by fbsb gene , is also a surface protein that helps in gbs invasion of the epithelial cells .
finally , cell - surface - associated protein ( cspa ) is a surface protein encoded by cspa gene .
it is involved in maintaining the pathogen survival in the host by escaping the immune system .        in this study , genotypes were correlated to some of the virulence genes and the antimicrobial susceptibility profiles .
this information is useful to identify particular gbs strains with high virulence potential , with resistance to routinely administered antimicrobial agents , and possibly linked to particular geographical areas .
seventy six gbs isolates were cultured from specimen taken from the vaginas of pregnant women between 35 and 37 weeks of gestation , attending private clinics in two tertiary care centers in beirut , lebanon , between october 2007 and july 2008 . the first center ( a ) is located in the western part of the urban city of beirut , and the second one ( b ) in the eastern part of beirut .
these two hospitals serve two different populations , in the sense that patients attending the hospitals come from 2 different geographical areas , with very minimal intermingling between them . however , the local health care systems of the two areas are similar , and patients have similar antibiotics consumption habits .
the 76  gbs isolates consisted of 47 ( 61.8% ) isolates obtained from the first tertiary care center and 29 ( 38.2% ) isolates obtained from the second tertiary care center .
isolates were identified using conventional methods on the basis of colonial morphology , gram staining , haemolysis , and latex agglutination test with specific antisera using the slidex strepto plus ( biomerieux , marcy l'etoile ; france ) .
antimicrobial susceptibility testing was performed by the disk - diffusion ( kirby - bauer ) method on mueller - hinton agar ( difco laboratories , detroit , michigan ) supplemented with 5% sheep blood , using suspensions of 0.5 macfarland from fresh bacterial cultures .
the test was done using the following antimicrobial agents : penicillin , cefepime , ceftriaxone , chloramphenicol , clindamycin , erythromycin , levofloxacin , and tetracycline .
dna was extracted from all isolates using the illustra bacteria genomicprep mini spin kit ( ge healthcare uk ltd , buckinghamshire , england ) according to the manufacturer 's instructions .
total dna of the 76  gbs isolates was used to amplify five virulence factors encoding genes : cyle , rib , lmb , bca , and scpb   by pcr using specific primers .
standard pcr conditions were used to amplify cyle , lmb , and scpb , rib , and bca gene .
amplicons were subjected to electrophoresis on 2% agarose ( sigma ) gels in 1  tris - borate - edta buffer ph 8.3 ( tris base 0.089  m , boric acid 0.089  m , and edta 0.002  m ) at 120  v for 45 minutes .
agarose gels were stained with ethidium bromide ( sigma ) and photographed using a uv - transilluminator and an olympus digital camera with digi - doc it program .
genotyping using random amplified polymorphic dna ( rapd ) analysis was performed on all the isolates to determine strain diversity .
rapd was performed with the ready - to - go rapd analysis beads kit ( ge healthcare uk ltd , buckinghamshire , england ) and the gbs 2 primer , using sprint , thermo electric thermal cycler .
antimicrobial susceptibility testing showed the following : all gbs isolates were susceptible to penicillin g , cefepime , ceftriaxone , and levofloxacin .
the following percentages of isolates , 4% , 11.8% , 15.8% , and 86.8% , were resistant to chloramphenicol ( chl ) , clindamycin ( cli ) , erythromycin ( ery ) , and tetracycline ( tet ) respectively .
six antimicrobial resistance ( ar ) profiles of isolates were detected : a ( resistant to cli , ery , chl , and tet ; 4.0% ) , b ( resistant to cli , ery , and tet ; 6.6% ) , c ( resistant to cli and tet ; 1.3% ) , d ( resistant to ery and tet ; 5.3% ) , e ( resistant to only tet ; 69.7% ) , and f ( susceptible to all ; 13.2% ) .
genotyping of all the isolates detected seven gbs clusters i , ii , iii , iv , v , vi , and vii with the following prevalence percentages : 18.4% , 13.2% , 19.4% , 7.9% , 11.8% , 11.8% , and 17.1% , respectively . a dendrogram of the seven clusters of genotypes
the most common cluster was iii ( 19.7% ) and the least prevalent was iv ( 7.9% ) .
the data show a prevalence of certain genotype clusters in both tertiary care centers while other genotype clusters were merely confined to a particular tertiary center ( table 2 ) . similarly , certain ar profiles were prevalent in both centers , whereas others were restricted to one center .
pcr detection of the virulence genes showed that cyle , lmb , scpb , bca , and rib genes were positive in 99% , 96.1% , 94.7% , 56.6% , and 33% of the gbs isolates respectively .
there was a wide prevalence of the cyle , lmb , and scpb genes among the total isolates , and hence all 3 genes were evenly distributed among the genotype clusters .
table 3 shows the prevalence of bca and rib genes among the gbs genotype clusters .
sixty eight isolates out of 76 ( 89.5% ) have either the bca or the rib gene and 8 isolates out of 76 ( 10.5% ) have neither bca nor rib detected .
neonatal gbs infection is a serious complication of the vertical transmission of the bacteria , from the mother to the newborn , at the time of vaginal delivery .
this is why universal screening for gbs vaginal colonization in pregnant women near term is recommended .
fortunately , gbs resistant to penicillin has not been reported all around the world , and the drug of choice , in treating the infection , is still penicillin [ 7 , 9 ] .
however , the problem arises in cases , allergic to penicillin , where alternate antimicrobial agents such as cli and ery are commonly administered .
however , de azavedo et al .   found that 18% , 8% , and > 80% of gbs isolates in pregnant women were resistant to ery , cli , and tet . in our study ,
11.8% , 15.8% , and 86.8% of the gbs isolates , were resistant to ery , cli , and tet respectively , indicating percentages similar to previous studies .
the prevalence of this relatively high ar percentages , leads to the recommendation of requesting a sensitivity antibiogram for gbs cultured from women allergic to penicillin .
genotyping of all the gbs isolates , utilizing rapd analysis determined a total of 7 genotype clusters .
the most common was genotype cluster iii ( 19.7% ) and the least common was iv found in 7.9% of all isolates .
a correlation between ar and genotype clusters , showed an association between them ( table 1 ) .
resistance to chl was restricted to genotype clusters v , vi , and vii , whereas resistance to both cli and ery was found only in genotype clusters i , ii , and vii .
all the gbs isolates resistant to cli are also resistant to ery , indicating a correlating pattern of resistance amongst the genes responsible for this phenotype .
this can be expected since cli resistance in gbs is nearly always based on the presence of an ermb gene conferring resistance to macrolides , lincosamides , and streptogramin b .
an important finding in this study was the correlation between the prevalence of particular genotype clusters with certain ar profiles in a given medical center .
this observation denotes that high prevalence of certain genotype clusters resistant to certain antimicrobial agents in a particular medical center entails the practice of caution by extrapolating the ar findings from one medical center to others .
another observation is that bca and rib genes were not present concomitantly in the same genome .
rib protein encoded by the rib gene shares several properties with -c protein encoded by bca gene .
both proteins are resistant to trypsin digestion and belong to the same family of bacterial surface proteins with repetitive structures showing a 47% identity , their n - terminal sequences are related   and are 61% identical to each other .
further investigations are still needed to be performed in order to discover the functional relationship between bca and rib to determine if they have homologous functions .

Answer:
the antimicrobial
                   susceptibility profiles of 76
                   streptococcus agalactiae ( group
                   b streptococci [ gbs ] ) isolates from vaginal
                   specimens of pregnant women near term were
                   correlated to their genotypes generated by
                   random amplified polymorphic dna analysis and
                   their virulence factors encoding genes
                   cyle , lmb , scpb , rib , and bca
                   by pcr . based on the distribution of the
                   susceptibility patterns ,
 six profiles were
                   generated .
 rapd analysis detected 7 clusters of
                   genotypes .
 the cyle gene was
                   present in 99% of the isolates , the
                   lmb in 96% ,
                   scpb in 94.7% ,
                   rib in 33% , and
                   bca in 56.5% of isolates .

 the isolates demonstrated a significant
                   correlation between antimicrobial resistance and
                   genotype clusters denoting the distribution of
                   particular clones with different antimicrobial
                   resistance profiles , entailing the practice of
                   caution in therapeutic options .
 all virulence
                   factors encoding genes were detected in all
                   seven genotypic clusters with
                   rib and bca
                   not coexisting in the same
                   genome .


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:
megalourethra is a rare congenital mesenchymal anomaly of the male anterior urethra characterized by a nonobstructive dilatation of the penile urethra .
nesbitt in 1955 defined it as  a congenital dilatation of penile urethra without distal obstruction  .
dorairajan classified congenital megalourethra into two types based on findings of urethrography . the more common scaphoid type with a deficiency of the corpus spongiosum is seen as bulging of ventral urethra .
the fusifrom type with deficiency of both corpus spongiosum and cavernosum is seen as circumferential expansion of urethra .
a 6-month - old male child presented with dribbling of urine with a noticeable swelling of undersurface of penis which increased during the act of micturition . on examination a scaphoid
swelling of size 4  3 cm was seen on the ventral aspect of shaft of penis which ballooned out during micturition .
ultrasound of abdomen and pelvis showed normal kidneys and bladder with no post void residue .
retrograde urethrogram showed scaphoid dilatation of ventral aspect of distal and mid penile urethra confirming the diagnosis of congenital megalourethra [ figure 1b ] .
cystourethroscopy showed wide saccular dilatation of penile urethra about 1 cm from external urethral meatus .
retrograde urethrogram showing ventral saccular dilatation of urethra a reduction urethroplasty was done through circumcoronal penile incision .
after degloving the penis scaphoid dilatation of ventral aspect of penile urethra was noted [ figure 2 ] .
the dilated urethra was incised in ventral midline and the redundant urethra with deficient corpus spongiosum was excised and the urethra was reconstructed over 6 fr infant feeding tube using 5 - 0 pds suture .
postoperative recovery was uneventful . on removal of the catheter after 2 weeks child voided normally without any penile swelling .
regular follow - up at 1 year showed no recurrence of penile swelling with normal voiding pattern and sonologically normal bladder and upper tracts .
the most commonly held theories propose a defect in the migration , differentiation , or development of the mesenchymal tissues of the phallus .
another assumption is that delayed or deficient canalization of the glandular urethra may be associated with maldevelopment of the corpus spongiosum and corpora cavernosae . due to the poor development of erectile tissue which normally provides support
two types of megalourethra are described depending upon the extent of associated embryonic maldevelopment of erectile tissue .
jones et al . , in a review identified associated anomalies in 66 of 78 reported cases of megalourethra . in this review ,
associated congenital anomalies are seen in 80% of scaphoid type and 100% of fusiform type .
the commonly described genitourinary anomalies include renal dysplasia - hypoplasia , hydronephrosis , hydroureter , vesicoureteric reflux , prune - belly syndrome , urethral duplication , megacystis , hypospadias , posterior urethral valves , and undescended testes .
other system anomalies including vater ( vertebral , anal atresia , trachea - esophageal fistula , and renal anomalies ) and vacteryl ( vertebral , anal atresia , cardiac , trachea - esophageal fistula , renal , and limb deformities ) are described . in view of associated anomalies , the workup of megalourethra should include renal function tests and imaging of upper and lower urinary tracts
urethral anomalies mimicking megalourethra like urethral atresia , a web , duplication , and a diverticulum are considered in the differential diagnosis .
prenatally diagnosed megalourethra has to be thoroughly evaluated for associated congenital anomalies and followed up serially by ultrasound for amniotic fluid index , urinary bladder volume , and upper tract dilatation .
termination of pregnancy may be advised in cases with other severe congenital anomalies and renal impairment . in some milder forms of megalourethra spontaneous resolution has been observed in fetuses at 19 - 34 weeks gestation .
the treatment of megalourethra may be one stage or two stage urethroplasty depending on the age of presentation and general condition of the patient . for scaphoid type , nesbitt described a longitudinal reduction urethroplasty .
heaton and colleagues described a technique of urethral plication for some cases of scaphoid megalourethra .
the management of fusiform type is complicated ranging from sex reassignment to major phallic reconstruction .
long - term follow - up is required in these patients to see for the erectile function and fertility potential .
management has to be individualized depending on type and the presence of associated congenital anomalies . in isolated scaphoid type of megalourethra reduction

Answer:
megalourethra is a rare congenital disorder of anterior urethra and erectile tissue of penis .
 it mainly appears in two types  a milder scaphoid type and severe fusiform type .
 fusiform type is commonly associated with congenital anomalies of various systems of the body .
 isolated megalourethra without other congenital anomalies is extremely rare .
 we report one such case which was detected postnatally and successfully treated by reduction urethroplasty .


Question:
You will be shown the title of a chemistry paper, together with sections excerpted from the body of the paper. The paper sections may include HTML tags like `<p>` and `</p>`; please ignore these. Your task is to write an abstract for the paper. Your response should include the abstract and no other text.

Title:
Suzuki-Miyaura cross-coupling towards 4-amino biphenyl intermediates

Paper sections:
Introduction

The synthesis of biaryl units (mainly amino biphenyls) has attracted a lot of attention and efforts from many research groups, both in academy and industry, due to their importance as key intermediates in the synthesis of pharmaceuticals, agrochemicals, natural products, etc.

The Suzuki-Miyuara cross-coupling reaction is an extremely useful approach for the construction of biaryl units as the reaction is much less sensitive to moisture and oxygen in comparison to other cross-coupling reactions and it allows very low metal catalyst loadings, which has a significant impact on price reduction on industrial scale.

While the Suzuki-Miyaura cross-coupling usually works well with aryl iodides, bromides, and triflates when reacting with boronic acids, the reaction is usually less efficient with aryl chlorides. An even larger challenge is reacting electron-rich aryl chlorides such as chloroanilines, 1,2 which are the desired starting materials towards aminobiphenyl species, as they are much cheaper than the respective aryl bromides. For this reason, few examples in the literature show successful reactions with chloroanilines and these usually with unsubstituted boronic acids. 3 An additional challenge is to perform these reactions with phenylboronic acids substituted by more than two halogens. Barder et al. have presented an example of Suzuki-Miyaura cross coupling of 4-chloroaniline with 2,4-difluorophenylboronic acid with a high yield of 96% in the presence of 1 mol% of  These authors contributed equally. * Corresponding author, e-mail: rafal.lisiak@selvita.com Pd(OAc)2 catalyst and 2 mol% of a bulky phosphine ligand (SPhos). However, when attempting the same reaction with 2,4,6-trifluorophenylboronic acid, it did not proceed efficiently. 4 Here we report an attempt to perform a Suzuki-Miyaura cross coupling reaction of 4-chloroaniline with 3,4,5-trifluoroboronic acid in a similar catalytic system.

In this case, we were able to reach a somewhat low conversion (19%) under these conditions. We managed to slightly improve the conversion to 42% by altering the reaction conditions, but still obtained relatively low yields, which is in line with the significant challenge and unpredictability of reacting chloroanilines with multisubstituted phenylboronic acids in the presence of SPhos and similar ligands.

Experimental procedures Example 1:

26 mg of Pd(OAc)2 (0.12 mmol, 0.01 eq.) and 97 mg of SPhos (0.24 mmol, 0.02 eq.) were dissolved in 15 ml of toluene and 1.5 ml of H2O under nitrogen in a pressure tube, and stirred for 15 min at RT to form a catalyst solution. Then, 4.99 g of K3PO4 (0.0235 mol, 2 eq), 3.1 g of 3,4,5-trifluorophenylboronic acid (0.0176 mol, 1.5 eq) and 1.5 g of 4-chloroaniline (0.01176 mol, 1 eq) were added to the catalyst solution. The reaction mixture was heated to 100° C for 15 h. The reaction mixture was cooled to 25 °C, and the layers were separated. The organic phase was analyzed by GC area %: 19.9 % calculated conversion towards the desired product (3,4,5-trifluoro-4'-aminobiphenyl).

Example 2:

6 mg of palladium chloride (0.03 mmol, 0.1 mol%) and 28 mg of SPhos (0.06 mmol, 0.2 mol%) were dissolved in 20 ml of DMAc -water solution (1:1) at 25°C, under nitrogen, and stirred for 15 min to form a catalyst solution. Then, 7 g of potassium carbonate (0.050 mol, 1.5eq), 6 g of 3,4,5trifluorophenylboronic acid (0.034 mol, 1 eq) and 4.35 g of 4-chloroaniline (0.034 mol, 1 eq) were added to the catalyst solution. 25 ml of additional water -DMAc solution (1:1) were used to transfer the starting materials completely. The reactor was heated to 10 0°C inner temperature for 5 h. The reactor was cooled to 25 °C and the layers were separated. The organic phase was analyzed by GC area %: 42 % calculated conversion towards the desired product (3,4,5-trifluoro-4'-aminobiphenyl).

Answer: The preparation of biphenyl derivatives bearing amino groups via direct cross-coupling reaction is being widely explored due to its importance for many branches of the chemical industry. One of the necessary components for such a transformation are halogenated arenes. In order to make the process more economical, we focus on inexpensive and easily available aryl chlorides which usually are not considered reagents of choice for catalytic couplings. In the following short communication, we report the results of the coupling of relatively unreactive chloroaniline with a fluorinated phenylboronic acid leading to the corresponding aminobiphenyl.


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:
nontyphoidal salmonella species are important food borne pathogens and acute gastroenteritis is the most common clinical manifestation accounting for about 70% of cases .
splenic abscess is a very rare complication of nontyphoidal salmonella infections since the presence of antibiotics . here
a 63-year - old woman from eastern part of turkey was admitted with the complaint of back pain , vomiting and nausea since 20 days .
laboratory findings were as follows : white blood cell ( wbc ) count was 14670/mm ( 88.9% polymorphonuclear cells ) , haemoglobin 9.5 g / dl , platelet count 183000/mm , erythrocyte sedimentation rate 76 mm / h , and c - reactive protein ( crp ) 58 mg / dl ( normal value < 5 mg / l ) .
an abdominal ultrasound revealed a hypoechogenic cystic structure with a diameter of 6172 mm in the upper part of the spleen with calcifications ( figure 1 ) .
salmonella enteritidis was yielded from culture of the samples of the abscess obtained during the operation .
it was sensitive to ampicillin , cotrimoxazole , cephalosporins of third generation , and ciprofloxacin .

after isolation of the s. enteritidis from abscess , the patient was questioned in detail , it was learned that the patient had diarrhoea and fever existed 2 days and recovered without antibiotic treatment one month ago .
the usual clinical presentation of nontyphoidal salmonella infection is self - limited gastroenteritis , however bacteraemia and focal extraintestinal infections may occur .
risk of bacteraemia and focal extraintestinal infections are high in individuals with comorbidities such as malignancy , human immunodeficiency virus ( hiv ) , diabetes mellitus , and patients receiving immunosuppressive therapy .
invasive nontyphoidal salmonellae disease is a major cause of mortality in african children and hiv - infected african adults .
any tissue or organ may be seeded hematogenously by nontyphoidal salmonella and may form a local infection , become obvious months or even years after the initial bacteraemia producing characteristic clinical syndromes .
some serovars of salmonella show a higher tendency for causing bacteraemia and these serovars differ in different countries . non - typhoidal salmonella serovars s. typhimurium and s. enteritidis are cause of invasive disease in industrialized countries , also they are predominant in african region .

s. enteritidis had the highest blood invasiveness among non - typhoidal salmonella species in malaysia . our patient had diabetes mellitus and probably s. enteritidis bacteraemia occurred during the course of diarrhoea one month ago which lead to bacterial seeding in the spleen .
antibiotic treatment for patients with mild to moderate gastroenteritis due to non - typhoidal salmonella is not indicated in healthy adults .
however antimicrobial therapy should be initiated for patients who are severely ill and for patients with risk factors for extraintestinal spread of infection .
the symptoms of splenic abscess are usually nonspecific the most frequent symptoms and signs are fever , abdominal pain and tenderness over left upper quadrant , splenomegaly , leucocytosis , and left lower chest abnormalities .
our patient had back pain , vomiting , nausea and leucocytosis which were not specific for splenic abscess .
computed tomography remains the gold standard and the most sensitive tool for the definitive diagnosis of splenic abscess .
ultrasonography has 76% , ct has 96% sensitivity for the detection of abdominal masses . in our patient ,
diagnosis was confirmed with ct . at present , splenectomy is the gold standard for treatment while ultrasound- or ct - assisted percutaneous drainage and antimicrobial therapy can be considered as therapeutic alternatives especially in the presence of an isolated abscess .
we preferred splenectomy for treatment as the causative microorganism was not known initially . in conclusion , although non - typhoidal salmonella gastroenteritis is rarely resulted with splenic abscess , patients with comorbities are at increased risk .

Answer:
splenic abscess is a very rare complication of non - typhoidal salmonella infections .
 we report a case of splenic abscess caused by salmonella enteritidis .
 the patient is a 63-year - old woman with diabetes mellitus and underwent splenectomy .
 this case suggests that the patients with comorbities are at increased risk for invasive infections in non - typhoidal salmonella infections .


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:
ureteral avulsion is conventionally defined as injuries of the ureter caused by blunt ( non - penetrating ) trauma with acute deceleration or acceleration movement mechanism due to motor vehicle accidents . with the invention of endourology tools ,
ureteral avulsion can also occur as a result of stretching in the weakest point of the ureter .
ureteral avulsion and perforation during ureteroscopy are the most common cause of iatrogenic ureteral injuries .
the rate of ureteral injury dropped to 7% in 1990 due to increased surgical experience and development of more advanced uertroscopy tools .
the incidence of ureteral perforation has been reported in 1.5% of such procedures of which 0.2% have required surgery . in spite of the prevalent use of ureteroscopy in the treatment of ureteral stones and replacement of open surgical procedures with ureteroscopic procedures , the rate major and severe complications such as avulsion and perforation commands attention [ 6 , 7 ] .
ureteral avulsion from the pelvis can be managed by ureteral reimplantation , transureteroureterostomy and ureteroneocystostomy [ 810 ] .
renal autotransplantation can be an appropriate whenever a considerable length of the ureter is lost or a previous surgery has failed .
meanwhile , sometimes after such procedure renal impairment is encountered . in the present case ,
we report a successful autotransplantatioin in a patient who underwent urgent operation following avulsion of the ureter at a distance of 4 cm from the pelvis .
surgeons should be aware of possible complications attributed to transureteral lithotripsy ( tul ) and their knowledge and expertize in managing such complications .
the patient was a 51-year - old lady with left flank colicky pain associated with nauseas and vomiting for a month .
study of kub ( kidney , ureter , and bladder x - ray ) and non - contrast abdominopelvic spiral ct scan images revealed a 1-cm proximal left ureteral stone ( fig .
1 ) . accordingly the patient was selected to undergo tul and ureteral stenting .
 figure 1:abdominopelvic spiral ct scan of the patient before surgery .
abdominopelvic spiral ct scan of the patient before surgery . due to a narrow ureteral lumen proceeding with the procedure seemed impossible and we decided to terminate the surgery . while taking out the ureteroscope we noticed avulsion of the ureter at a point approximately 4 cm from ureteropelvic junction .
the avulsed ureter was handing on the tip of the ureteroscope and the avulsed fragment came out along with the ureteroscope .
after thorough evaluation of various possible methods to approach the problem , the patient was brought to a left flank position from her original lithotomy position . with a left intercostal incision nephrectomy was done .
subsequently , the position of the patient was changed to supine and a gibson incision was made over the right lower quadrant of the abdomen .
following dissection of the iliac vessels , renal vessels were anastomosed to the iliac vessels ( renal artery to the internal iliac artery and renal vein to the external iliac vein ) . using the lich
given the fact that only a short segment of the avulsed ureter ( 4 cm ) was left , we considered implantation of the ureter to the bladder .
a drainage tube was inserted to drain any possible bleeding from the operation site and then the surgical wound was closed .
the patient was discharged in a good general condition after 3 days and the drainage tube removed .
an ultrasound imaging study of the genitourinary system 8 months into the patients follow up showed normal size , echo and cortical thickness in the operated kidney after renal autotransplantation . in follow up , 2 months after renal autotransplantation , the arterial and venous flow of the transplanted kidney were normal on color doppler ultrasound imaging ( figs . 2 and 3 ) .
the mean parenchymal arterial vascular resistance in the transplanted kidney was 0.63 which was in the normal range .
the height , anteroposterior diameter and cortical thickness of the transplanted kidney were 117.41 mm and 13 mm , respectively .
the values of urea and creatinine 3 months after transplantation were 26.4 and 1.09 , respectively .
size , echo and cortical thickness of the transplanted kidney were reported normal in the follow up ultrasound 8 months after autotransplantation ( fig .
figure 3:color doppler ultrasound of the transplanted kidney 2 months after surgery in the zoomed area of the image .

figure 4:gray - scale ultrasonography of the patient 's transplanted kidney 8 months after surgery .
color doppler ultrasound of the transplanted kidney 2 months after surgery in the zoomed area of the image .
ureteroscopy is widely used for lithotripsy procedure and resection of malignant tumors , but this method may lead to urethral mucosal trauma , hematuria , ureteral stenosis , urinary tract infection and ureteral perforation . among all complications of ureteroscopic lithotripsy procedure ,
complete avulsion of the proximal ureter is one of the most challenging that happens in 0.060.45% of the cases .
it is evident that appropriate decision making and a timely surgical intervention can prevent the need for nephrectomy and possible complications in the future .
in general , management of ureteral avulsion depends on the location of injury , the length of the traumatized ureter , time of diagnosis , patient 's age and general health .
boari flap and psoas hitch techniques are used in proximal and distal injury of the ureter .
finally , in the absence of the previous conditions , autotransplantation can be done as a vital method .
it is evident that such surgical procedures require substantial expertize among all healthcare providers , a patient in a suitable physical status and proper age , and an accurate and timely decision making .
autotransplantation was done in our patient after quick evaluation and review of different options to repair a traumatized ureter and clinical evidences supported the accomplishment of a successful outcome .

Answer:
abstractthe patient was a 51-year - old lady with left flank colicky pain accompanied with nausea and vomiting for a month .
 transurethral lithotripsy and ureteral stent placement was considered for the patient .
 the patient had a narrow ureteral lumen and while bringing the ureteroscope out , ureteral avulsion occurred at a distance approximately 4 cm from ureteropelvic junction . after bringing the uretroscope out ,
 the avulsed ureter was observed hanging at the tip of the ureteroscope .
 anastomosis of the ureter to the bladder was accomplished with lich
 gregoir technique .
 a drainage tube was inserted at the site of incision and the surgical wound closed .
 the patient was discharged with acceptable general condition after 3 days and the drainage tube removed .
 the ureteral stent was removed 4 weeks later by cystoscopy .
 an ultrasound imaging study of the genitourinary system 8 months into the patients follow up showed normal size , echo and cortical thickness in the operated kidney after renal autotransplantation .


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:
obstructive sleep apnea ( osa ) is a common public health problem worldwide and it has been shown to be associated with an increased incidence of cardiovascular complications such as death , stroke , or myocardial infarction .
the 2014 american heart association / american stroke association guideline recommends that patients with stroke / transient ischemic disorder ( tia ) showed be worked up for osa . in this study , patients who had osa and stroke had an improved outcome with continuous positive airway pressure .
extrapolating data from western population and implementing in the asian populations may not be possible as there are differences in genetic and anatomical factors .
for example , the cutoff point for obesity based on body mass index ( bmi ) criterion for western population is 30 kg / m meanwhile the bmi for asian population is 25 kg / m .
it is also evident that there are differences in anatomical factors between asian and caucasian population such as retrognathia and oropharyngeal width which are main risk factors for osa .
alternatively , the stop - bang questionnaire developed by chung et al . has been widely used as a sensitive screening tool for osa .
the stop - bang acronym stands for : snoring history , tired during the day , observed stop breathing while sleep , high blood pressure , bmi more than 35 kg / m , age more than 50 years , neck circumference more than 40 cm and male gender .
the authors recommended that if a patient had 3 or more criteria mentioned above , it is strongly suggestive for osa .
however , the cut - off values of this questionnaire are based on the data from caucasians , therefore we hypothesized that to use it in asian population , some adjustments are needed .
we compared the clinical features in the stop - bang questionnaire between osa - induced hypertension patients and healthy control subjects .
the study was conducted in the faculty of medicine , khon kaen university ( thailand ) .
the study protocol was approved by the ethics committee for human research , khon kaen university .
osa induced - hypertension patients were diagnosed by : i ) met the criteria of hypertension ; ii ) having average apnea - hypopnea index ( ahi ) by polysomnography more than or equal 5 times / hours and iii ) no evidence of other secondary hypertension .
the control subjects filled up the modified berlin questionnaire and epworth sleepiness scale less than 10 and defined as low risk for osa with low scores .
demographic data and clinical features of both osa - induced hypertension patients and healthy subjects were recorded and compared .
the clinical features included age , gender , bmi , neck circumference , mallampati classification , torus palatinus , and torus mandibularis .
the mallampati classification was defined by asking the subjects to protrude their tongue as much as possible and classified as class 1 to 4 .
the sample size of the study population was calculated by using the proportion comparison between osa and healthy subjects using winpepi program .
the proportion of osa was 0.35 and the healthy control was 0.07 with deviation of 5% , power of 90% , and missing data of 10% .
the sample size was calculated to be 102 subjects ( osa 34 subjects and healthy control 68 subjects ) . due to the incompleteness of the database of medical students ,
120 healthy controls were selected by systematic sampling from the database ( total of 1174 medical students ) .
baseline and clinical characteristics of the participants in both groups were compared using descriptive statistics .
univariate logistic regression analyses were applied to calculate the crude odds ratios of individual variables for having osa .
all clinically significant variables or p<0.20 by the univariate analyses were included in subsequent multivariate logistic regression analyses .
analytical results were presented as crude odds ratios ( or ) , adjusted or , and 95% confidence intervals ( ci ) .
significant risk factors were calculated for the best cut - off points by the receiver operator characteristic curve ( roc curve ) .
data analyses were performed with stata software ( college station , tx , usa ) and spss software ( chicago , il , usa ) .
in this study , 42 osa - induced hypertension patients and 82 control subjects who had a complete set of clinical data were included . all clinical features of both groups
the osa - induced hypertension patients were significantly older ( 59.5 vs 21.0 years ) , with higher proportion of males ( 64.3 vs 59.8% ) , more obese ( 78.6 vs 6.1% ) , higher incidence of mallampati class 3 or more ( 54.8 vs 24.4% ) , larger neck circumference ( 41.3 vs 32.0 cm ) , higher incidence of torus palatinus ( 26.6 vs 0% ) and of torus mandibularis ( 9.5 vs 0% ) . by multiple logistic regression analysis , only two factors bmi and neck circumference ,
the adjusted odds ratios for both factors were 1.49 ( 95% ci : 1.06 , 2.09 ) and 1.67 ( 95% ci : 1.11 , 2.51 ) , respectively . by the roc curve analyses ,
the best cut - off points for the bmi and the neck circumference were 24.5 kg / m ( figure 1a ) and 36 cm ( figure 1b ) .
the sensitivity and the specificity for bmi cut - off point were 97.2% and 91.4% , whereas those for the neck circumference were 94.7% and 82.9% .
the present results showed that the stop - bang questionnaire needed to adjust the cutoff values of the bmi and neck circumference suitable for thai population .
subjects should referred for polysomnography if positive at least 3 questions : s , snoring history ; t , tired during the day ; o , observed stop breathing while sleep ; h , high blood pressure ; b , bmi more than 25 kg / m ; a , age more than 50 years ; n , neck circumference more than 36 cm ; g , male gender ( modified from chung et al . ) . for
the criteria of obesity for asians , the cut - off of the bmi should lower from 35 kg / m to 24.5 or round up to 25 kg / m .
the cut - off of the neck circumference also should be lowered from 40 cm to 36 cm for asians .
proposed the cutoff points of 24.1 kg / m for the bmi and 35.5 cm for the neck circumference for japanese population .
using stop - bang questionnaire is very suitable for thailand and other developing countries due to limited availability of polysomnography , the standard diagnostic tool for osa .
this low cost tool can select appropriate patients for referral to sleep center for further polysomnography .
healthy control subjects were not performed polysomnography to exclude osa . however , both the berlin questionnaire and the epworth sleepiness scale were used to exclude osa , which has a sensitivity and specificity of 0.86 , 0.95 and 0.49 , 0.80 , respectively .
even though the age is a significant factor by univariate logistic regression , it was not included in the subsequent multivariate regression .
this is because the difference of age group composition between the osa and the healthy control subjects .
further studies , therefore , are needed to confirm the results of this study and to identify the appropriate cut - off point using the age- and sex - matched controls . also , to increase their sensitivity and specificity , osa patients with other complications than hypertension should be included and compared . whether simple measurement of the neck circumference and the bmi calculation are sufficient to identify osa patients in routine practice by primary health care personnel including physicians , nurses and volunteers should be examined in further study .
osa has been proved to be a contributing factor for major cardiovascular diseases ; stroke , hypertension , sudden death , and also coronary artery disease .
treatment of osa may reduce large economic burden from prevention of the morbidity and mortality from stroke and acute coronary syndrome . in conclusion ,
the appropriate cut - off points for the bmi and the neck circumference for stop - bang questionnaire were 25 kg / m and 36 cm for asian people .
all hypertensive patients should have their bmi and neck circumference measured to detect the risk factors for osa .
public health campaign for osa screening is also needed to reduce morbidity and mortality from osa complications .

Answer:
obstructive sleep apnea ( osa ) is a common public health issue . if left untreated , osa may cause a large health economic burden from cardiovascular complications particularly stroke .
 the diagnosis of osa can be made by polysomnography , but its availability is limited in the developing countries in asia .
 stop - bang questionnaire is a good screening tool but may need some adjustment for asian population .
 stop - bang stands for : snoring history , tired during the day , observed stop breathing while sleep , high blood pressure , body mass index ( bmi ) more than 35 kg / m2 , age more than 50 years , neck circumference more than 40 cm and male gender .
 we compared clinical features in stop - bang questionnaire between 42 osa induced hypertension patients and 82 healthy control subjects in the faculty of medicine , khon kaen university , thailand .
 the best cutoff point for the bmi and the neck circumference were 24.5 kg / m2 and 36 cm , respectively .
 the sensitivity and specificity of the bmi cutoff point were 97.2% and 91.40 , while those of the neck circumference were 94.7% and 82.9% . in conclusion , the appropriate cutoff points of bmi and neck circumference for thai stop - bang questionnaire were 25 kg / m2 and 36 cm .