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:
divided vascular lesions in the maxillofacial area into two groups : hemangioma and vascular malformations .
they are more common in women than men ( 3:1 ) . about 60% of hemangioma
lips , tongue , and buccal mucosa are the most common sites of involvement . however , it is more likely to occur in the gingiva , mandible , palate , floor of the mouth , and parotid gland .
this report introduces a rare incidence of hemangioma in the buccal fat pad ( bfp ) along with phlebolithiasis .
the patient was a 28-year - old woman who referred with the chief complaint of a swelling and stiffness in the left cheek . from a clinical perspective
on palpation , a moving mass with a stiff area was felt ; and in intraoral examination , its position was felt in the anterior ramus .
the only point in the patient 's history was a course of laser therapy for skin rejuvenation in the left cheek and several other areas in her face . in the medical history of the lesion
, there were 3 times of triamcinolone injection in the area during the last 3 years to treat the lesion by another physician .
the patient said that reduction in tumor size was seen for a while after these injections .
aspiration was performed for the patient through intraoral approach , whose result was negative . magnetic resonance imaging ( mri )
magnetic resonance imaging revealed a solid heterogeneous mass in the pterygopalatine fossa area with penetration and extension towards both buccal and masticator spaces on the left .
the submandibular area and carotid space were normal and no abnormality was seen in the nasopharynx area .
mri revealed a solid heterogeneous mass in the pterygopalatine fossa area with penetration and extension toward both buccal and masticator spaces on the left .
( b ) coronal view of t1 and t2 according to the results of clinical and radiographic examinations of the treatment plan , the excisional biopsy of the studied mass was selected under complete anesthesia . under general anesthesia ,
the patient underwent a surgery with intraoral access through a cut in the upper area of anterior ramus .
after dissection in the upper - side direction , vascular lesion was seen in buccal extension of the bfp [ figure 2 ] .
the bfp capsule was intact and the mass had offended no soft / hard adjacent tissue .
the possibility of a vascular lesion  and second ,  for the purpose of liposuction for cosmetic goal and remove of the swelling on the patient 's cheek ,  the vascular mass was removed along with anterior lobe , as excisional biopsy through intraoral approach and hence that we did not enter into the vascular lesion [ figure 3 ] .
the clinical swelling of the cheek was removed immediately after the surgery . in the macroscopic viewpoint ,
the lesion was a yellow and dark purple mass measuring 2 cm  3 cm  4 cm along with a hard nodule - like area .
microscopic results represented a vascular lesion composed of large amounts of small to large vascular structures covered with endothelial cells .
view of the totally excised lesion showing hemangioma with phlebolith histopathologic view of the lesion showing vascular lesion composed of large amounts of small to large vascular structures covered with endothelial cells .
hemangiomas usually appear within a few weeks after birth and have a growth rate that exceeds the growth rate of children . in this growth phase , hemangioma will have its own characteristics : endothelial cells getting fatter along with frequent mitotic division , increased number of mast cells , and multilayer basement membrane . following this stage ,
flat and inactive endothelial cells are located in a context called fibrous fatty tissue with a normal view .
sometimes , they can even involve all layers of the skin and offend the muscles . at the cellular level , hemangiomas are characterized by increased birth and death rate of endothelial cells and proliferation of mastocytes during the postnatal proliferative phase in the lesion .
derived from young proliferating hemangiomas , capillary endothelium is easily grown in cell culture mediums and forms tubes . in accumulated hemangiomas ,
hence , a normal hemangioma is an endothelial tumor with a very complex life cycle of cell proliferation and natural regression .
. however , their clinical manifestations are not obvious sometimes until late infancy or even childhood .
phleboliths consist of a mixture of calcium carbonate and calcium phosphate salts and are thought to form when a fibrous component attaches to a developing phlebolith and becomes calcified .
radiologically , they have either a radiolucent or a radiopaque core , and repetition of this calcification causes an onion - like appearance or concentric rings .
it should be noted that bfp is also a mass composed of fat tissue covered with a thin capsule membrane and is mainly located in the buccal space .
bfp has a rich blood supply and it is a proven fact that bfp has multipotential cells .
however , there was no report about the incidence of hemangioma in the bfp until 1956 .
deighan and barton first pointed to the incidence of a hemangioma case with phlebolithiasis in the bfp mass in 1956 .
after a review of english literature , only two cases of the incidence of hemangioma in the bfp mass were found , except the above case .
ikegami and nishijima reported the incidence of hemangioma in the bfp mass in a 23-year - old patient in 1984 . in that case , the tumor was enucleated and the presence of a cavernous hemangioma was confirmed .
the last report on the incidence of hemangioma in the bfp was published by tanaka et al . in 2000 .
the patient was a 3-year - old boy whose tumor was diagnosed 4 months after birth .
unlike the report of ikegami and nishijima in which the lesion surface was irregular , in this case , the lesion surface was reported smooth . however , the surface of the removed lesion was also irregular in this report . like the case described in this report
, no involvement was reported in the bfp mass adjacent areas in the previously reported cases .
when radiographic examinations reveal a radiopaque lesion in the tumor , the differential diagnosis will be easier and there will be two possibilities : hemangioma or sialolithiasis of the parotid gland .
however , when phlebolithiasis is not seen , preoperative diagnosis of hemangioma will be very difficult . in the report by tanaka et al .
, the tumor was removed through extraoral access . however , in the extraoral access , the facial nerve is more likely to be damaged and risk of scar is present .
however , tanaka et al . suggested that they used extraoral access because they assumed the probability of large extension of the lesion .
this shows the importance of careful radiographic examinations for accurate diagnosis of the lesion limits and the selection of appropriate surgical technique .
therefore , if the tumor does not have too large extension according to clinical and radiographic examinations , then intraoral access is preferred . in such cases
, the use of only one single imaging modality can not provide enough information with the physician about the diagnosis and treatment of vascular lesions .
therefore , the use of mri and computed tomography ( ct ) is recommended in these cases .
the use of ultrasound / color doppler will also be very helpful for validating the mri and ct interpretational results .
in general , the incidence of hemangioma in the bfp will be very rare , but in cases where this lesion is suspected , precise preoperative clinical and radiographic examinations are recommended .

Answer:
hemangiomas are benign vascular neoplasms characterized by an abnormal proliferation of blood vessels .
 buccal fat pad ( bfp ) is a rare place for hemangioma . in this report
 , clinical , radiographic , and histopathological findings are described in a rare case of hemangioma with phleboliths involving the bfp , and a review is made of the international literature on this subject .


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

Paper text:
a 56-year - old man was referred for biliopancreatic diversion with a duodenal switch ( bpd - ds ) for intractable complications associated with morbid obesity .
he had been unable to lose weight with orlistat 120 mg three times a day for three months .
the patient had diabetes mellitus for twenty years associated with hypertension , " mal perforant " and hepatic steatosis .
he had all features of the metabolic syndrome and was treated for sleep apnea with a nocturnal continuous positive airway pressure device ( c - pap ) .
his body mass index ( bmi ) at the time of the surgery was 48.7 kg / m , weighting 157.7 kg .
the patient 's blood tests showed normal electrolytes and a creatinine of 110 mol / l .
the glycated hemoglobin was 7.1% ( normal range 4.46.5% ) with fasting glucose values ranging from 7 to 11
mmol / l with ldl - cholesterol and hdl - cholesterol levels of 2.63 and 0.99 mmol / l respectively .
rest and exercise electrocardiograms were normal as well as a cardiac dobutamine stress echocardiography . a pseudonormalized pattern of left ventricular filling was present on a standard echocardiogram and a 24-hour holter was normal except for a slight decrease in heart rate variability . his medications before surgery consisted of metformin 850 mg tid ,
rosiglitazone 8 mg daily , irbesartan 300 mg daily , diltiazem 120 mg daily , orlistat 120 mg tid and furosemide 20 mg every other day .
he was on insulin humalog tid ( 4246 u ) with insulin nph 90 u at bed time , for a total of > 200 u of insulin daily .
he underwent a modified scoparino 's biliopancreatic diversion with a duodenal switch [ 1 - 5 ] .
the patient had an hemodynamically stable pulmonary emboli on the day 12 after surgery and was anticoagulated .
anthropometric measurements before and eleven months after the surgery are presented in the table 1 and figure 1 and metabolic improvements and echocardiographic findings are depicted in tables 2 and 3 respectively .
eleven months after the surgery , the medication consisted of metformin 850 mg tid , irbesartan 150 mg daily , 50 000 u of vitamin d2 , ferrous sulfate 300 mg daily , 25 000 u of vitamin a , calcium 500 mg and one tablet of vitamins and mineral supplements daily ( centrum forte ) .
anthropometric variables before and after biliopancreatic bypass surgery anthropometric variables before and after biliopancreatic diversion surgery anthropometric measurements were assessed using a bioimpedance balance ( tanita tbf 350 ) metabolic profile before and after biliopancreatic diversion surgery blood pressure and echocardiographic variables before and after biliopancreatic diversion surgery bp : blood pressure ef : ejection fraction from
obesity is associated with an increased risk of coronary artery disease ( cad ) and mortality [ 6 - 8 ] .
morbidity and mortality rates rise proportionally to the degree of obesity in men and women and the impact of excess body fat is more significant in younger subjects than older ones [ 9 - 12 ] . in a 10-year follow - up ,
men and women with a bmi  35.0 kg / mhad a relative increased risk of developing diabetes of ~23 and ~17 fold respectively compared to a control group with a bmi between 18.5 and 24.9 kg / m . independently of the bmi , the relative risk of developing diabetes mellitus increases with weight gain as shown in the nurse 's health study .
moreover , in that study , women who voluntary lost more than 5.0 kg reduced their risk of diabetes by 50% .
weight loss also lowers blood pressure . in a 3-year follow - up of non - morbidly obese patients with a mean bmi of 31 kg / m
, patients who maintained a 4.5 kg weight loss had a relative risk of hypertension of 0.35 or , a reduction of 0.45 mmhg in systolic blood pressure and 0.35 mmhg in diastolic pressure per kg of weight lost .
in addition to higher cardiac output in obese patients , left ventricular volume and filling pressures are higher than normal .
this usually results in the development of left ventricular strain , which leads to hypertrophy , often of the eccentric type . left ventricular diastolic function is thus frequently impaired .
weight loss has a beneficial impact on the functional and the structural cardiac status . in a study of obese patients with a mean bmi of 32.7 kg / m
, weight loss of 8 kg over a period of 25 weeks was associated with a significant decrease in left ventricular mass .
weight loss lowers oxygen consumption at any given work rate , decreases cardiac output and blood pressure while left ventricular filling pressures decreased as left ventricular stroke volume diminishes . in a study of obese patients with a bmi > 40
kg / min whom surgical weight loss with vertical gastric banding ( vgb ) induced a decrease in body weight of 20% at six months , left ventricular wall thickness , particularly the septal and posterior walls , decreased .
the national institutes of health ( nih ) suggested that surgical therapy be proposed to those patients with a bmi level > 40 kg / mor > 35 kg / mwith serious medical conditions including hypertension and obstructive sleep apnea .
surgical intervention , when indicated , brings significant improvement such as a decrease in excess weight and comorbidities ; these include hypertension , diabetes , dyslipidemia [ 3,14,25 - 28 ] and sleep - related disorders .
one can expect a mean reduction of 60 to 75% of excess body weight with biliopancreatic diversion which can persist for 4 to 8 years after surgery [ 3 - 5,30,31 ] .
the duodenal switch operation , introduced by hess in 1988 , variant of the biliopancreatic diversion of scopinaro , helps in preserving normal eating habits , and the majority of patients undergoing the procedure will have normalization of glucose levels , triglyceride levels and blood pressure early weeks after the surgery [ 3 - 5 ] .
indeed , in a review of 440 obese patients ( mean weight of 183 kg ) who underwent biliopancreatic diversion with duodenal switch , all of the 36 type 2 diabetic patients discontinued their medication over a 7-year follow - up period .
operative mortality is between 0.5% and 2%   and early complications include pulmonary embolus ( 0.5% ) and anastomotic leaks ( 12.5% ) .
late complications presents in the form of anemia , anastomotic ulcerations , bone demineralization , neurological complications and protein malabsorption ; all of which can be addressed with appropriate supplements . moreover , significant nutritional and metabolic complications may be less frequent than previously thought .
eleven months after the surgery , our patient had lost 40% of his body weight , and body fat mass was reduced by 41 % ( figure 1 ) .
the medication was greatly lightened while the patient maintained fasting glucose values ranging from 5 to 7 mmol / l and a blood pressure less than 130/80 mmhg ( table 2 ) .
indeed , rosiglitazone was discontinued , the insulin that averaged > 200 u daily was no more necessary , diltiazem was discontinued and the dose of irbesartan was halved .
the 25% decreased in waist circumference is probably clinically significant   albeit waist circumference may be less reliable in patients with a bmi > 35
kg / m . finally , sleep apnea syndrome improved as the patient was no longer on c - pap .
left ventricle hypertrophy is recognized as a strong independent risk factor for cardiovascular morbidity and death and changes in cardiac structure following surgical weight loss have been observed . in the present case ,
the left ventricle mass index decreased by 15% and the thickness of the septal and posterior walls of the left ventricle were reduced ( table 3 ) .
moreover , using doppler mitral flow velocity with the e / a ratio , we demonstrated that left ventricular diastolic dysfunction actually improved . before the operation , the e / a ratio was higher than 1 with a significant decrease during the valsalva maneuver which corresponds to a pseudonormal ventricular filling or grade 2 filling pattern .
after the operation , the e / a ratio was smaller than 1 indicating a delayed relaxation of grade 1 filling pattern , representing an improvement in the diastolic function   ( table 4 ) .
mitral doppler at rest and during the valsalva maneuver before and after biliopancreatic diversion surgery e wave : early transmitral filling velocity a wave : transmitral atrial filling velocity e / a : early / atrial transmitral filling velocity this case report emphasizes the improvement in cardiovascular parameters , including the diastolic function ( demonstrated by a pseudonormal ventricular filling or grade 2 filling pattern ) and sleep apnea syndrome , following weight loss - induced by the biliopancreatic diversion with duodenal switch .
pp envisioned the paper and pw , pp prepared the initial draft of the article .
bpd - ds : biliopancreatic diversion with a duodenal switch c - pap : continuous positive airway pressure device vgb : vertical gastric banding nih : national institutes of health e / a ratio : early / atrial transmitral filling velocity
the authors want to express their gratitude to suzie laroche , louise marois and claudette fortin for the quality of their intervention and the work on this particular population .

Answer:
backgroundsevere obesity is associated with important morbidity and increased mortality .
 the successes of lifestyle modifications and drug therapy have been partial and mostly unsustained in reducing obesity and its comorbidities .
 bariatric surgery , particularly biliopancreatic diversion with duodenal switch reduces efficiently excess body weight and improves metabolic and cardiovascular functions.case presentationa 56-year - old man with severe clinical obesity underwent a biliopancreatic diversion with a duodenal switch after unsuccessful treatment with weight loss pharmacotherapy .
 he had diabetes , hypertension and sleep apnea syndrome and was on three medications for hypertension and two hypoglycemic agents in addition to > 200 insulin units daily .
 eleven months after the surgery , he had lost 40% of his body weight .
 the lipid profile showed great improvement and the hypertension and diabetes were more easily controlled with no more insulin needed .
 the pseudonormalized pattern of left ventricular diastolic function improved and ventricular walls showed decreased thickness.conclusionbiliopancreatic diversion may bring metabolic and cardiovascular benefits in severely obese patients from a cardiovascular perspective .


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

Paper text:
a 26-year - old female patient was transferred to the samsung medical center from an outside institution due to severe refractory cardiogenic shock .
the patient was diagnosed with non - hodgkin s lymphoma 2 years prior and underwent 6 cycles of chemotherapy , which included doxorubicin .
after chemotherapy treatments were completed , the patient suffered from orthopnea and dyspnea , and an echocardiography revealed a severely depressed left ventricular ( lv ) ejection fraction ( 25% ) and dilated lv . due to complications from cancer treatments , she had an episode of acute decompensated heart failure and was referred to samsung medical center . on initial presentation ,
vital signs included arterial blood pressure of 79/27 mmhg , heart rate of 133 beats / min , respiratory rate of 28 breaths / min , and body temperature of 35.9c .
she had pulmonary edema with bilateral pulmonary congestion ( fig . 1 ) and multiorgan failure with liver and kidney involvement . despite the use of inotropes and vasopressors , we were unable to achieve stable vital signs .
percutaneous extracorporeal life support ( p - ecls ) was then placed using the left femoral artery and vein .
however , the left leg became ischemic after several hours , and we decided to shift the cannulas to the right groin .
the patient was brought to a hybrid operating room , and the groin was opened bilaterally .
then , the arterial and venous cannulas were inserted through the common femoral artery and vein , and the catheter for the superficial femoral artery was inserted at the same time . the following day ,
transthoracic echocardiography revealed a distended left ventricle , and the chest x - ray showed worsening pulmonary edema . in this case , we determined that an atrial septostomy was not a viable option since both the femoral veins were already cannulated or had been surgically repaired .
instead , we performed an emergency standard median sternotomy and inserted a vent catheter ( malleable 20 fr . ) with a tip - cut into the right upper pulmonary vein and passed it into the left ventricle .
then , the inserted vent catheter was connected to the venous line of the p - ecls circuit via a y - shaped connector ( fig .
, the pump flow was maintained at 2.4 l / min / m , obtaining a mean systemic pressure of 60 mmhg and central venous pressure of 8 mmhg .
the flow through the vent catheter was measured to be 1 to 2 l / min .
the patient was on p - ecls and left heart venting for 5 days . during this time ,
3 ) . transthoracic echocardiography revealed improved right and lv function and decreased chamber size .
when the function of the right heart and the lung improved , the drainage from the femoral vein was gradually reduced by progressively clamping the venous line and lowering the r.p.m . in this way , the system was modified from p - ecls to paracorporeal lv assist device ( lvad ) by the complete clamping of the femoral venous drainage catheter .
thus , the femoral venous cannula and the oxygenator were removed on postoperative day 5 .
the reasons for our decision were complete lv support , possible longer - term support due to the absence of the oxygenator and the low level of anticoagulation , and the prevention of recurrent lv distension . on postoperative day 8 , we were able to wean the patient from lvad and remove all cannulas from her chest and groin .
she was extubated and was finally discharged home on hospital day 28 . during follow - up ,
the lv ejection fraction worsened from 40% to 20% , and the symptoms of dyspnea became worse than before hospital discharge .
currently , this patient is on the heart transplant list and is waiting for transplantation .
however , due to its inability to directly drain the left heart , its effectiveness in assisting the heart is limited .
additionally , several factors including severely reduced lv function , blood from native pulmonary and bronchial circulation , and increased afterload due to retrograde perfusion from the arterial cannula may lead to lv distension .
this resultant lv distension can cause pulmonary edema , pulmonary hemorrhage , and myocardial ischemia .
although paracorporeal lvad placed through a median sternotomy provide better hemodynamic support without the risk of lv distension , complications of central cannulation such as bleeding and infection limit the widespread use of this technique .
we report a case in which trans - sternal lv drainage was utilized while the patient was receiving p - ecls that was followed by a subsequent switch to paracorporeal lvad without further surgery .
this strategy allowed the transformation of peripheral circulatory support into effective myocardial and systemic circulatory assistance and minimized the surgical risk .
although p - ecls offers excellent support to the blood circulation , its effect on the heart is less favorable .
the left atrium can receive blood from the right heart and bronchial circulation . in the case of severe lv dysfunction
, the lv can not eject the received blood to overcome the increased afterload due to the retrograde p - ecls flow .
the consequences of lv distension include pulmonary edema , pulmonary hemorrhage , right ventricular distension , and increased intraventricular pressure , which can lead to myocardial hypoperfusion and ischemia .
the effect of p - ecls on lv distension was investigated previously by some authors . in an animal model of acute heart failure ,
kawashima et al .   reported that the resolution of ventricular fibrillation was related to lv unloading and reduction in myocardial oxygen consumption .
myocardial perfusion is proportional to the decrease in the lv wall tension and the compression of intra - myocardial coronary vessels .
therefore , lv decompression favorably affects ventricular recovery and increases the possibility of weaning from p - ecls . for this reason , a careful evaluation of the status of the lv and prompt drainage in the case of a pressure increase
there are several techniques to decompress the lv , including a percutaneous trans - septal left atrial approach , lv venting through the right upper pulmonary vein , and direct lv apex cannulation . although percutaneous lv venting does not require a surgical incision , the effectiveness of lv decompression can be limited according to the degree of mitral regurgitation . thus , surgical venting is a more favorable option than percutaneous septostomy .
reported minimally invasive lv drainage in which an apical cannula is inserted into the lv apex transcutaneously .
although direct drainage of the lv through a trans - sternal approach is technically more complex , it has the advantage of high efficacy with respect to the intraventricular dynamics .
further , our group was more familiar with the trans - sternal approach at that time .
management after an lv venting procedure is still controversial , particularly since there is uncertainty in terms of patient stability after weaning from p - ecls .
there are three ways of weaning from venoarterial ecls , namely the one - stage removal of all ecls cannulae , vent catheter removal and subsequent venoarterial ecls weaning , and venous cannula removal and subsequent paracorporeal lvad weaning . in this case
, we decided to shift to paracorporeal lvad from p - ecls by progressively clamping the venous line and lowering the flow to the oxygenator until complete exclusion from the circuit .
this allows for a heparin- and oxygenator - free trial of extracorporeal circulation , which reduces the chances of bleeding or thromboembolism .
the low risk of bleeding and thromboembolism allows longer - term support for heart transplant than venoarterial ecls
. the other advantages of our strategy include prevention of recurrent lv distension and pulmonary edema . in summary ,
p - ecls offers excellent circulatory support in emergency settings and assures rapid and systemic perfusion .
however , p - ecls can negatively affect lv physiology and can potentially jeopardize myocardial recovery .
thus , a careful evaluation of the lv status and prompt drainage in the case of pressure increases should be considered .
our strategy assures complete lv venting and allows for a simple conversion of p - ecls to paracorporeal lvad .

Answer:
percutaneous extracorporeal life support ( p - ecls ) is a useful modality for the management of refractory cardiac or pulmonary failure .
 however , venoarterial p - ecls may result in a complication of left ventricular distension . in this case report
 , we discuss a patient with drug - induced dilated cardiomyopathy managed with venoarterial p - ecls and a left atrial vent catheter .
 the venoarterial p - ecls was modified to a paracorporeal left ventricular assist device ( lvad ) by removing the femoral venous cannula .
 after 28 days of hospitalization , the patient was successfully weaned from the paracorporeal lvad and discharged home from the hospital .


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 sizing of pda for device implantation is based on the automatic calculations of dimension by the inbuilt sizing software in the cardiac catheterisation laboratory and many experienced interventionists believe their eyeball measurements more .
the estimations can be erroneous if the calibrations are not proper , leading to catastrophic embolisation of the device , needing emergency surgical removal as was needed in our patient .
calibration by comparing with the fluoroscopic images of measured metallic sizing devices placed outside body can be misleading because of magnification errors.1 in order to circumvent these problems we suggest some novel ways which take care of magnification errors and avoid the need for aortic root angiography .
an eight year child with echocardiographically documented 6 mm patent ductus arteriosus ( pda ) was planned for device closure .
femoral venous access was obtained using 8f sidearm sheath and the artery cannulated with a 6f sidearm sheath .
a 6f pigtail catheter was advanced through the femoral arterial sheath into the descending aorta at the mouth of the pda and an angiogram obtained in a lateral projection delineating the ductus ( figure 1 ) .
the minimum diameter at the aortic end was 6 mm and a 8 - 10 mm pda device was selected for deployment .
a 7f swan - ganz catheter was advanced into the the pulmonary artery through venous route and a 0.35 " terumo wire advanced through the pda into the descending aorta .the terumo wire was exchanged with an 0.35 " extra stiff amplatzer wire and the swan - ganz catheter with the pda delivery system . an 8 - 10 mm size pda device was released across the ductus and after confirming the proper position by repeat angiogram which showed a small residual shunt flow which may be expected .
angiogram in lateral plane showing a small residual left to right shunt with pda device in place before unscrewing of the stylet after a short while , the device suddenly embolised into the left pulmonary artery ( figure 2 ) .
the patient had a brief episode of mild hypotension which improved spontaneously and his oxygen saturations remained static .
an attempt was made to retrieve the device percutaneously by a snare and later by a bioptome but the trial was given up as the device tended to go more distally , in which case even surgical removal would be difficult .
the patient was discussed with the cardiac surgeon who shifted the patient for emergency surgery .
after considerable debate surgeon decided for a left thoracotomy hoping to avoid cardiopulmonary bypass and closed the ductus . later the left pulmonary artery was separated from the surrounding tissues and umbilical tape passed around it proximally for control of bleeding . a 1.5 cm longitudinal incision was made distal to the umbilical tape which was kept under traction and a long curved forceps passed toward the pulmonary hilum and the device retrieved .
cine image in lateral plane showing device embolized into left pulmonary artery soon after its release from stylet . showing the pda device being retrieved from left pulmonary artery via left thoracotomy without cardiopulmonary bypass . in order to prevent such eventualities we tried to devise some alternative ways of sizing a pda .the
first involves measuring a fully inflated tyshak pulmonary balloon outside the human body with a caliper and then inflating the balloon to the same pressure in the right ventricular outflow tract passed over a 0.35 " extra - stiff wire , and repeating the measurements , and using the same calibration factor for sizing of pda visualized by aortic arch angiogram .
previously , some radio opaque sizing devices have been used placing them outside human body which can have magnification errors if not placed exactly at the level of heart.2 the second method involves advancing a tyshak balloon 2 - 4 mm bigger than the echocardiographic dimension across the pda and inflating the balloon with dilute dye under low pressure without dilating the ductus so that it forms an impression of the ductus which is recorded in a cine mode in multiple planes , and the plane delineating the exact anatomy of the ductus is used for measurements after proper calibrations as mentioned above without the need for aortic arch angiogram ( figures 4 and 5 ) . showing measurement of diameter of inflated tyshak balloon by a caliper after inflating it with fixed quantity of contrast .
angiogram in lateral plane showing an inflated tyshak balloon across the pda making an impression of the ductus .
technological advances have made nonsurgical closure of the pda a simple and a routine percutaneous intervention .
the use of the amplatzer device occluder ( ado ) has further simplified the method and improved the results with minimal complications .
however there are situations where complications are encountered and surgical help is required to ameliorate them .
faella and colleagues reported 15 procedure related complications in 316 patients which included hemolysis , left pulmonary artery artery stenosis , device protrusion into aorta causing coarctation , device misplacement and one death following device embolisation.2 late embolisation of the device to the left pulmonary artery has been reported with impaired left pulmonary perfusion six months after implantation requiring surgical removal .
m vavuranakis et al reported severe hemolysis with jaundice , anemia and hemogloginura on the second day following deployment of smaller sized coil due to improper sizing which needed removal and replacement by an ado after repeat sizing using balloon tipped catheter.3 the complications can be reduced by proper expertise and optimal sizing of the ductus .
sizing of atrial septal defect ( asd ) by inflating a balloon across the asd till a circumferential waist is created and measuring the waist ( stretched balloon diameter ) and also inflating the balloon outside by same amount of dye across sized rings , is a standard method.45 using a similar method for the pda is not routine since angiographic visualization is usually adequate .
however making an impression of the ductus by inflating a balloon across it can give a detailed anatomy about the length and breadth of the ductus in multiple planes without the need for multiple dye injection and may help in the selection of proper sized device .

Answer:
nonsurgical closure of patent ductus arteriosus ( pda ) using a duct occluder placed percutaneously is currently the first line of therapy and the success rate is quite high .
 several devices are currently available .
 an eight year child underwent device closure of the ductus .
 however after deployment of the device it , became dislodged into the left pulmonary artery .
 several attempts at catheter retrieval failed .
 the child underwent successful surgical removal of the device without cardiopulmonary bypass .


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

Paper text:
primary mesenchymal tumors of the intestinal tract are a heterogeneous group of tumors with a wide clinical spectrum ranging from benign incidentally detected nodules to frank malignant tumors . traditionally the majority of these tumors were thought to be derived from smooth muscle cells .
it has now been realized that the majority of these tumors are not smooth muscle or nerve sheath tumors , but represent a distinct clinico - pathological entity termed as gastrointestinal stromal tumor ( gist ) .
it is currently believed that gist is a specific mesenchymal neoplasm and the term is used to refer to those mesenchymal neoplasms of the gastrointestinal tract ( git ) which express cd117 , a c - kit proto - oncogene protein , and show gain of function mutation of c - kit gene that encodes a growth factor receptor with tyrosine kinase activity .
the introduction of a new targeted treatment for gist in the form of imatinib mesylate , a receptor tyrosine kinase inhibitor , has further validated this entity .
gist can occur at all levels of git and may also arise in extra - gi locations , principally mesentery , omentum and retroperitoneum and occasionally in pancreas .
approximately 50 - 60% of gists arise in the stomach , 20 - 30% in small bowel , 10% in large bowel and 5% in esophagus .
about 30% of gist are malignant and liver is the most common site for metastasis.[710 ] the criteria for differentiation of benign from malignant gist remain controversial .
many parameters have been proposed , tumor size and proliferative activity have been found to be the most important prognostic indicators .
gist reported outside the git t as apparent primary tumors are designated as extra - gastrointestinal stromal tumor ( egist).[1214 ] the frequency of egist is only 5 - 7% .
because of overlapping morphology , gists are cytologically difficult to distinguish from other gastrointestinal mesenchymal neoplasms including smooth muscle tumors and nerve sheath tumors.[1519 ] although many investigators have described various features used in the cytologic diagnosis of gist , few have reported their findings in patients with malignant gist .
the present study is the largest series discussing the cytology of gists and egist from different anatomic sites including extremely rare sites like subcutaneous nodules , fluid cytology samples and metastasis from a primary pancreatic egist . in the present study we studied the cytomorphological features in 33 gist / egist from 27 patients .
all patients of histologically and immunohistochemically confirmed gist and egist who underwent cytological examination over a period of ten years ( jan 2000-july 2010 ) were retrieved from the records of the department of pathology .
33 specimens from 27 patients including 26 gist ( 13 primary , 12 metastatic , one recurrent ) and seven egist ( 5 primary , 1 metastatic , 1 recurrent ) were identified .
these included guided ( 28 ) and unguided ( 2 ) fine - needle aspirates , imprint smear ( 1 ) and fluid cytology ( 2 ) .
fine needle aspiration cytology ( fnac ) was performed using 22 gauge needle attached to 10 ml disposable syringe under ultrasound guidance of intra - abdominal tumors .
fna material was smeared on glass slides and slides fixed in 95% alcohol were stained with papanicolaou and hematoxylin and eosin stain while air dried smears were stained with may - grnwald - giemsa stain ( mgg ) .
histological categorization of gist of different sites into various risk groups was done as suggested recently by miettinen et al .
cytology was reviewed in all cases with emphasis on the following cytological features : overall cellularity , smear pattern ( cohesion vs. dispersed cells ) , palisading , crush artefact , prominent vascular pattern , spindle versus epithelioid cell morphology , nuclear grooves and inclusions , nuclear pleomorphism , presence of nucleoli , round or blunt - ended oval or wavy nuclei , multinucleation / bizarre cells / or giant cells , perinuclear vacuoles , cytoplasmic quality , mitoses and necrosis .
the patients included 20 males and 7 females with male : female ratio of 2.67:1 .
the mean age was 50.6 years ( range : 26 - 76 , median : 52 years ) .
there were 18 primary tumours ( 5 gastric , 5 duodenum , 1 ileum , 1 ileocecal , 1 rectum , 4 intra - abdominal / retroperitoneal tumours , 1 mesentery ) , 9 hepatic metastases ( 5 gastric , 2 duodenum , 1 jejunum , 1 small bowel primary tumours ) , 1 ascitic fluid metastases ( gastric primary ) , 1 pleural fluid metastases ( jejunum primary ) , 1 subcutaneous nodule metastases ( gastric primary ) , 1 lump at base of penis ( rectum primary ) and 2 recurrences ( 1 ileum , 1 intra - abdominal / retroperitoneal ) . the smears were variably cellular .
malignant and metastatic lesions were commonly highly cellular . in patients with predominantly spindle cells on cytology (
n = 18 ) smears showed cells often arranged in cohesive to loose three dimensional clusters and singly scattered or dispersed cells [ figure 1a and b ] .
the tumor cells often formed fascicles with parallel , side - by - side arrangements of nuclei . in these fascicles tumor cells
the stroma of the cohesive sheets present between the nuclei was loosely fibrillary and stained pink to magenta on mgg [ figure 1d ] .
skenoid fibres were noted in a smear from liver metastasis of a patient with primary jejunal gist .
spindle cells with high cellularity , closely packed to loose clusters and dyscohesive cells ( mgg , 100 ) ;
( a ) spindle cells displaying elongated to wavy nuclei with blunt to tapered ends ( mgg , 200 ) ; ( b ) fascicles with parallel , side - by - side arrangements of nuclei with scant cytoplasm .
nuclear palisading is also observed ( mgg , 100 ) ; ( c ) abundant extracellular stromal material ( mgg , 200 ) ; ( d ) ( inset : spindle cells with bipolar cytoplasmic processes ( mgg , 400 ) focal to diffuse epithelioid cell morphology admixed with spindle cells were observed in twelve samples and 3 tumors had only epithelioid cell type [ figure 2a ] .
plasmacytoid appearance was noted in eight samples [ figure 2c ] few demonstrated rossetting and acinar structure arrangement reminiscent of adenocarcinoma [ figure 2d ] .
the nucleoli were indistinct in low grade tumors and prominent or multiple nucleoli were seen in high grade tumors irrelevant of cell type .
the presence of marked cytologic atypia with presence of bizarre and giant cells was identified in 6 tumors .
occasional tumors displayed bubbly appearance due to multiple cytoplasmic vacuoles . in 9 cases mitotic figures were observed .
the pleural and ascitic fluid cytology smears exhibited loosely formed aggregates with epithelioid cell morphology .
smear showing groups of epithelioid tumors cells with round nuclei ( mgg , 200 ) ; ( a ) multinucleation ( mgg , 400 ) ; ( b ) plasmacytoid tumor cells displaying eccentric round nuclei with smooth nuclear membrane and fine chromatin ( mgg , 400 ) ; ( c ) acinar arrangement of tumor cells mimicking epithelial tumor ( mgg , 400 ) ; ( d ) ( inset : mitotic figure in a mixed gist ( mgg , 400 ) histology sections of all primary gist and egist were reviewed .
the majority ( n = 18 , 66.67% ) of tumors were classified as spindle cell type , while 3 ( 11.12% ) were classified as epithelioid type and 6 ( 22.23% ) as mixed cell type .
the cellularity of the majority of tumors was subjectively assessed as moderate ( n = 17 ) .
categorization of gist of different sites into various risk groups was performed as suggested recently by miettinen et al .
there was only one low grade tumor , 4 tumors with moderate risk , and 22 tumors were categorized as high risk .
immunohistochemically all tumors were positive for cd117 with strong intensity of positivity in the majority of tumors .
the cytological studies on gist in literature are not comparable as many of the earlier published cytologic studies have combined gist into a group of neoplasms encompassing leiomyoma , schwannoma , leiomyosarcoma , and an epithelioid leiomyoblastoma.[1517 ] however recently , few authors have established fnac as a reliable method for diagnosing gist and egist before surgical procedure [ table 1].[1830 ] we observed several morphologic features suggestive of high grade gist and egist . in recurrent , metastatic and malignant gist
however , it was difficult to find mitoses in the cytologic smears because most of the tumor cells occurred in closely packed cohesive thick tissue fragments .
li et al . , found that mitoses in the resected malignant gists were seldom seen in fnac smear .
we also found that malignant gists sometimes had no significant pleomorphism in the cytologic smears .
nuclear inclusions were more commonly seen in malignant and metastatic tumors irrespective of cell type in our cases .
dirty or necrotic background again was least reliable indicator of malignancy as it was seen in two samples only .
we agree with earlier descriptions that fna findings alone can not reliably assess behavior of gist .
prediction of behavior by cytological features is likely to result in either underestimation or overestimation of malignant potential.[1825 ] summary of various series of gist and egist cytology cases described in the literature the differential diagnosis between gists and gastrointestinal leiomyomas is difficult owing to their overlapping clinical and cytologic features .
leiomyoma shows varying cellularity and are composed of bland spindle cells with abundant cytoplasm often having a fibrillary appearance .
leiomyosarcomas shows three - dimensional , tightly cohesive , sharply marginated syncytia of spindle cells , often with nuclear crush artefact .
benign and malignant nerve sheath tumors show fibrillar cytoplasm and  wavy  nuclei , similar to a subset of and characteristic features of nerve sheath differentiation , such as nuclear palisading , may be focal .
epithelioid gists may cause significant diagnostic confusion with carcinomas , neuroendocrine tumors , and melanoma , particularly when metastatic and even hepatocellular carcinoma .
the regular round nuclei , with finely granular chromatin seen in many of cases raised the possibility of neuroendocrine tumor .
key features of melanoma are loose aggregates or isolated cells , cellular pleomorphism , enlarged nuclei with macronucleoli , binucleation , multinucleation and intracytoplasmic melanin .
intranuclear inclusions , intracytoplasmic bile pigment and no bile duct epithelium are important distinguishing features .
the separation of metastatic gist from other metastasis is important since these may respond to imatinib . to conclude ,
firstly cytology is a useful method for preoperative diagnosis and follow - up of gists and egist .
gist show a broad morphologic spectrum on cytology and gist should be considered as a differential diagnosis of tumors with spindle or epithelioid morphology . in an appropriate clinical and radiologic setting the presence of closely packed spindle or oval cells forming fascicles with parallel side - by - side arrangements of nuclei suggests gist .
the diagnosis of gist should also be considered in aspirates of the gastrointestinal tract , liver , mesentery , or abdominal wall mass lesions when epithelioid cells are the predominant cell type .
the presence of cellular dyscohesion , nuclear pleomorphism , necrosis and mitosis suggest malignant behavior , however absence of these features on cytology is not diagnostic of low risk benign behavior .

Answer:
background : the term gastrointestinal stromal tumors ( gist ) is used to refer to those mesenchymal neoplasms of the gastrointestinal tract ( git ) which express cd117 , a c - kit proto - oncogene protein.aims:to study the cytological features of gist and extra - gastrointestinal stromal tumors ( egist ) , to correlate them with histology and to determine cytological indicators of malignancy.materials and methods : cytological smears from patients diagnosed as gist / egist on histology were retrieved . from jan 2000 to july 2010 , 26 gist ( 13 primary , 12 metastatic , one recurrent ) and seven egist ( 5 primary , one metastatic , one recurrent ) cytologic samples from 27 patients were identified.results:the patients included 20 males and 7 females with a mean age of 50.6 years .
 tumor sites included stomach ( 5 ) , duodenum ( 5 ) , ileum ( 2 ) , ileocecal ( 1 ) , rectum ( 1 ) , liver ( 9 ) , retroperitoneum ( 5 ) , mesentery ( 1 ) , subcutaneous nodule ( 1 ) , supra - penile lump ( 1 ) , ascitic ( 1 ) and pleural fluids ( 1 ) .
 the smears were cellular with cohesive to loosely cohesive thinly spread irregularly outlined cell clusters held together by thin calibre vessels .
 the tumor cells were mild to moderately pleomorphic , spindle to epithelioid with variable chromatin pattern and variable cytoplasm .
 cellular dyscohesion , nuclear pleomorphism , intranuclear pseudoinclusions , prominent nucleoli , mitosis and necrosis were more prominent in malignant , metastatic and recurrent tumors.conclusions:gists show a wide spectrum of cytological features and the presence of mitosis , necrosis and nuclear pleomorphism can help in prediction of malignant behavior .
 further , cytology is a very useful screening modality in patients of gist and egist to detect early recurrence and metastasis at follow - up .


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

Paper text:
in a recent issue of the new england journal of medicine , greet van den berghe and co - workers   published a confirmation of the life - saving effects of tight glycaemia control by intensive insulin therapy ( iit ) in medical intensive care unit ( icu ) patients .
this second study intended to answer some of the questions and criticisms raised by the landmark leuven study of 2001 , which reported a 4% decrease in mortality in a surgical icu population [ 2 - 7 ] .
hopefully , these questions will be answered by the multi - centre assessments of the effects of iit , the nice - sugar and glucontrol trials , currently underway in australia and europe , respectively . before the completion of these two indispensable studies ,
greet van den berghe and colleagues wanted to confirm the life - saving effects of iit in medical icu patients in order to answer specific criticisms related to the type of patients , mostly surgical with two - thirds being post - cardiac surgery patients , in the first leuven study .
indeed , patients with myocardial ischaemia could particularly benefit from a combination of a high amount of glucose and insulin , as reviewed recently .
interestingly , krinsley   reported a similar reduction in mortality in a mixed population of medical and surgical icu patients .
greet van den berghe and colleagues succeeded but , as in most major contributions , their study raised more questions , which further argue for the importance of multi - centre trials .
, this study can not be considered to be positive , as the long - stayers in whom a survival benefit was found were actually not randomised . the sample of long - stayer patients ( n = 767 ) was smaller than the calculated sample size of 1,200 patients that was required to test the working hypothesis ( a 7% reduction of the absolute risk of death ) with an alpha level of less than 0.05 and a beta level of 0.2 . in the entire set of patients , the intent - to - treat analysis indicated that there was actually no benefit related to iit .
moreover , mortality in the patients in whom the stay was shorter than anticipated ( less than 3 days ) was higher in the iit group ( 26.8% ; 56/209 ) than in the conventional treatment group ( 18.8% ; 42/224 ) .
this increase was found to be significant when analysed by the chi square test , but not by uncorrected proportional - hazards analysis , even after correcting for the difference in baseline risk factors .
compared to the first leuven study , some of the recorded secondary end points that could be considered as surrogate markers of severity ( icu and 28-day mortality , requirement for dialysis , incidence of bacteraemia , requirement for prolonged antibiotic therapy , incidence of hyperbilirubinaemia and ' hyper - inflammation ' ) were not influenced as hospital mortality was .
other local factors could also have influenced the results , thereby questioning the applicability of the findings to patients managed in other icus .
the mean amount of parenteral glucose infused ( a mean of more than 220 g / day in long - stayers ) was probably higher than in most other icus , and parenteral steroids were used in more than half of the patients .
unequivocally , these two factors reduce the risk of hypoglycaemia and the duration of episodes of hypoglycaemia , a major side effect of iit . nonetheless , the risk of hypoglycaemia was substantial , with 25.1% of the patients in the iit group experiencing a blood glucose level below 2.2
mmol / l ( 40 mg / dl ) at least once , compared to only 3.9% in the conventional group .
the safety monitoring board of the german multi - centre study visep considered a similar increase in the incidence of hypoglycaemia important enough to stop this trial .
clearly , the safety of iit needs to be assessed in patients with significant risk of hypoglycaemia .
the target ranges of glycaemia were 4.4 to 6.1 mmol / l ( 80 to 110 mg / dl ) and 10 to 11 mmol / l ( 180 to 200 mg / dl ) , implying that there was no assessment of an intermediary blood glucose value , which is often used .
greet van den berghe and colleagues already answered this question by analysing the data of the first study and concluded that there was a dose - response effect , with the largest improvement found in patients with the lowest blood glucose level .
this hypothesis was found retrospectively , however , and clearly requires confirmation from prospective trials .
the use of iit in leuven is probably easier than in other institutions with a lower nurse - to - patient ratio . for an iit approach ,
lastly , insulin exerts many effects other than a decrease in blood glucose , which could possibly be beneficial or deleterious in different subsets of patients ; these effects can not easily be assessed and monitored in the presently available trials . in summary ,
questions about the efficiency and safety of iit in different icus around the world are far from answered and much work has still to be done to answer the new questions raised by the second leuven study .

Answer:
the second study on tight glycaemia control by intensive insulin therapy ( iit ) confirmed in medical intensive care unit patients the decrease in hospital mortality reported by the same team in the first iit trial in surgical patients .
 however , methodological concerns , the high rate of hypoglycaemia in spite of the infusion of large doses of parenteral glucose and the frequent use of steroids presently preclude considering these results as recommendations in other intensive care units , but rather argue for the need for large - scale assessment of the iit approach by multi - centre studies to confirm the efficacy and safety of this therapeutic modality .


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:
non - specific odontogenic infections are among the most frequent disorders of bacterial origin that affect individuals during the course of their life . before antibiotic treatment was available , the mortality rate of these disorders was 1040% , but the discovery of antibiotics led to a significant improvement of this rate .
however , the last 1015 years have witnessed a rebound of severe odontogenic infections caused by highly aggressive antibiotic - resistant bacteria .
the main cause indicated by the literature for the development of bacteria resistant to antibiotic therapy is the incorrect or inefficient administration of antibiotics .
currently , a number of antibiotics for inflammatory dental pulp disorders or established abscesses are administered .
the efficiency of these antibiotics is extremely limited because of the circulation disorders present in the inflammatory focus and , in addition , there is a high risk for inducing adverse reactions and antibiotic resistance of the bacteria involved in the development of the septic process .
for this reason , we believe that it is extremely important to evaluate the way in which antibiotics are administered and their efficiency on the bacterial flora involved in the development of odontogenic suppurations , in the absence of surgery .
the aim of this study is to prospectively determine the type of antibiotics used by patients with odontogenic head and neck soft tissue infections , from the point of view of their efficiency on the bacterial flora involved in the development of the septic process .
the study included 10 randomly selected patients with suppurations of odontogenic origin who presented to the clinic of oral and maxillofacial surgery cluj - napoca in the period january 2014  july 2014 .
the patient selection criteria were : perimaxillary soft tissue infections of odontogenic origin , disease duration of at least 5 days , antibiotic treatment duration of at least 4 days , known type and mode of administration of antibiotic medication , antibiotic treatment prescribed by the family doctor or the dentist , patient treated under continuous hospitalization , patient from which biological samples were taken for bacteriological examination and antibiogram determination , no other systemic pathology types with a possible influence on the immune response , adult patient having signed an informed consent for participation in the study .
the variables monitored for each patient were : general data ( age , sex ) , location of infection , time from onset to presentation , type of antibiotic treatment and route of administration used , bacteriological examination and antibiogram result , postoperative evolution . after the emergency admission of the patients , surgery was performed under locoregional anesthesia . after the asepsis and antisepsis of the operative field ,
biological samples were collected in a closed environment and were subsequently sent for bacteriological examination and antibiogram determination .
the results obtained were centralized in the study data base . for the development of contingency tables , microsoft excel software
was used , and the statistical interpretation of the results was performed using microsoft excel .
of the patients included in the study , 6 were males and 4 were females .
the mean age of the patients was 35.4 years , with a minimum age of 22 years and a maximum age of 49 years .
the mean age of female patients was 28.75 years and that of male patients 39.83 years .
regarding the location of the septic process in perimaxillary soft tissues , the majority of the infections were located in the submandibular gland area , followed by those located in the genial region ( figs . 1 , 2 ) .
in the case of the patients included in the study , a time period between 5 and 12 days , with a mean of 7.4 days , lapsed from the onset of the septic process to the presentation for specialized treatment . during this time period , all patients used antibiotic treatment , with a mean of 1.2 antibiotic types ; 8 of the 10 patients had one antibiotic type , and 2 patients had 2 antibiotic types .
3 ) , and the most frequent route of administration was the oral route , only in two cases the antibiotics being administered by intravenous route .
the bacteriological result obtained from the purulent secretion samples collected from the septic focus evidenced microbial polymorphism ( tab .
i ) . in half of the patients included in the study , the identified bacterial flora had no sensitivity to the antibiotics
4 ) , and in one patient in whom several bacterial strains were detected , some of these were sensitive to the antibiotic administered to the patient .
after the incision and the drainage of the suppuration were performed , along with the change of the antibiotic scheme according to the antibiogram , the patients postoperative evolution was favorable .
the objectives of the study were reached and the main types of antibiotics administered to patients with odontogenic septic processes complicated by perimaxillary suppurations were determined .
it can be seen that the majority of the patients included in the study were young adults , which is confirmed by other literature studies .
authors analyzing extensive groups of patients evidence the fact that odontogenic infections mainly affect patients in the third decade of life , which is confirmed in this study only by female patients , male patients having a more advanced age , but without a significant difference . of the patients included in the study ,
however , it can not be concluded based on the presented data that the male sex is more frequently affected by cervical inflammatory disorders of odontogenic origin , because the patient inclusion criteria were very restrictive and the number of patients included in the study was limited .
most authors opine that there is a higher incidence of odontogenic infections among male patients , but the differences between the two sexes are extremely varied . regarding the antibiotics prescribed to the patients included in the present study , it can be seen that more than half of the patients received amoxicillin treatment with or without beta - lactamase inhibitors .
the majority of the patients took the antibiotic without beta - lactamase inhibitors , which is contrary to literature studies , which show that the main antibiotic administered for odontogenic infections is amoxicillin with beta - lactamase inhibitors .
the administration of an effective antibiotic in odontogenic infections is particularly important in the attempt to limit the septic process .
when the antibiotic has no effect on the main bacterial strains involved in the development of the infection and only eliminates less aggressive pathogens , the premises for extremely severe and very difficult to control infections are created .
bacteriological examination evidenced the presence of a varied bacterial flora , but in the majority of the cases , a single bacterial strain in each patient was obvious .
the presence of a single bacterial strain in each patient is surprising , given the fact that at the level of the infected dental pulp or periodontal space , the main sources of bacterial flora for odontogenic suppurations , an increased number of bacterial species are concomitantly identified .
thus , it is possible that the early administration of bacterial therapy may select the majority of the bacterial species sensitive to the administered antibiotic and a single bacterial species may remain in the septic focus .
this hypothesis is also supported by the antibiogram result , which evidenced no sensitivity of the identified bacteria to the administered antibiotic .
another possible cause of the identification of a single bacterial strain might be the technical limitations of microbiology laboratories or the way of collecting biological samples , which pose difficulties in identifying some bacterial strains , particularly anaerobic ones .
the fact that most of the administered antibiotics were not active on the identified bacterial flora is an alarm signal .
the lack of efficiency of the antibiotic on the main bacterial strains involved in the development of the septic process implicitly leads to an increase of the difficulty of treatment of these infections .
some authors indicate the use of antibiotics as a single treatment , in the absence of a preliminary bacteriological examination , as the main factor favoring the development of severe odontogenic infections such as necrotizing fasciitis .
the exhaustion of the action of common antibiotics on the bacteria involved in the development of common cervical infections leads the practitioner to use niche antibiotics that should not be used under normal conditions .
a limitation of this study is the fact that it does not take into account possible cases of patients with odontogenic infections who received antibiotic treatment alone and who had a favorable evolution .
these cases can not be monitored in such studies because these patients do not ask for specialized help .
most common antibiotics used as a single therapy for the treatment of cervical infections of odontogenic origin have a limited action , and the association of antibiotic treatment with surgery is recommended .
the administration of antibiotics according to the bacteriological examination and antibiogram , associated with surgery , led to a favorable evolution of the patients included in this study .

Answer:
background and aims.odontogenic infections are among the main types of disorders located in the cephalic extremity .
 the aim of this study was to determine the efficiency of empirically administered antibiotics on the bacterial strains identified at the infection sites.patients and method.the study included 10 randomly selected patients with odontogenic cervical soft tissue infections , who received antibiotic treatment prescribed by the family doctor or the dentist .
 the bacterial flora involved in the development of the septic process , the type of antibiotic administered to the patient and the sensitivity of the identified bacterial flora to the administered antibiotic were determined.results.in the 10 selected patients , 14 bacterial strains were detected ; 7 patients had a single bacterial strain , and 3 patients had two or three types of bacteria .
 of the administered antibiotics , amoxicillin was the most widely used ( 33.3% of the cases ) , followed by amoxicillin with beta - lactamase inhibitors ( 25% of the cases ) . in half of the patients
 , there was no sensitivity of the bacteria detected in the septic focus to the empirically administered antibiotic , and in 10% of the cases , partial sensitivity was evidenced.conclusions.empirical administration of antibiotics without the association of surgery did not prove to be effective in the treatment of cervical infections of odontogenic origin .


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:
myocardial bridging is defined as an epicardial coronary artery that goes intramurally through the myocardium beneath the muscle bridge . while generally benign , myocardial bridges can cause ischemia , ventricular tachyarrhythmias , atrioventricular block , and sudden cardiac death.1)2 ) for symptomatic patients , various therapeutic approaches have been attempted , but the optimal treatment of myocardial bridging still remains controversial.3)4 ) coronary stenting has been another therapeutic option with medical and surgical treatment , but the high risk of perforation and high rate of in - stent restenosis have limited its use.5 - 10 ) recently , we experienced a patient with a perforated coronary artery after implantation of a drug - eluting stent ( des ) that was successfully rescued by deployment of covered stent in symptomatic myocardial bridging .
a 46 year - old woman who had no coronary risk factors , presented with exertional chest pain for several weeks .
the chest pain was typical for angina pectoris and depressed st segments were noted at the exercise test .
echocardiography revealed normal left ventricular ( lv ) systolic function { ejection fraction ( ef)=72% } without any regional wall motion abnormality .
we performed coronary angiography which showed significant stenosis ( up to 80% ) aggravated by severe myocardial bridging at the mid - portion of the left anterior descending ( lad ) artery ( fig .
so we decided to do a percutaneous coronary intervention ( pci ) at the lad lesion . through a 7 fr judkins guiding catheter ,
predilatation was performed with a maverick balloon catheter ( 2.515 mm , boston scientific , natick , ma , usa ) at 10 atmospheres for 20 seconds .
we deployed a taxus stent ( 3.516 mm , boston scientific , natick , ma , usa ) according to the size of the predilated balloon catheter .
but the middle segment of the lesion was not compliant , so the stent was not fully expanded with nominal pressure .
, the coronary artery was perforated and some extravasation of contrast media was observed in the pericardium ( fig .
but , the patient 's vital signs were stable ( blood pressure 115/70 mmhg ) with only a mild increase in heart rate .
however , because the perforated site was entrapped intramurally through the myocardium in the interventricular groove , there was no evidence of accumulated blood at the dependent position of the pericardium on fluoroscopy or echocardiography .
so we decided to observe the patient with close monitoring of symptoms and vital signs .
but echocardiography showed no evidence of pericardial effusion . on an intravascular ultrasound ( ivus ) study , a large perforated site and a perivascular hematoma were observed in the mid - portion of the deployed stent ( fig .
1c ) . based on the ivus findings , a jo covered stent ( 319 mm , jomed international ab , helsingborg , sweden ) was deployed at the perforation site .
four months after the procedure , ct angiography showed no evidence of residual hematoma or pseudoaneurysm ( fig .
2a and b ) . follow - up coronary angiography performed at 8 months after the procedure showed good distal flow with minimal stenosis at the proximal edge of the stent ( fig . 2c ) .
although coronary stenting is an effective interventional approach to improve symptoms in selected patients with myocardial bridging , it is associated with a high risk of coronary perforation.5 - 7 ) the reason for this phenomenon is not clear .
autopsy findings showed that tunneled segments in myocardial bridging tend to be deficient in vascular smooth muscle density , which may be more prone to vascular disruption during high inflation pressures during pci.11)12 ) another study revealed that the vessel area in the myocardial bridge segment was significantly smaller than that in the adjacent reference segments proximal and distal to the myocardial bridge throughout the cardiac cycle.13 ) this finding might explain the higher rate of coronary perforation associated with coronary stent implantation for myocardial bridges .
the histological and anatomical differences in tunneled coronary arteries may require an adjustment in stent diameter and inflation pressures to help reduce the risk of coronary perforation . in our case , we selected an oversized stent , resulting in coronary perforation . pre - interventional ivus may be helpful in selection of an appropriate size of stent and , in particular , in cases that require high inflation pressures for optimal stent implantation .
although coronary perforation is an uncommon complication following pci , it usually causes a catastrophic result including cardiac tamponade , emergency coronary artery bypass surgery , or pseudoaneurysm formation , with the potential for late coronary rupture and death.14)15 ) but , in myocardial bridging as observed in our patient , because the perforation site and extravasated blood are mainly confined in the interventricular groove , perforation itself usually does not cause hemodynamic instability .
we were able to evaluate the lesion using ivus to decide on implantation of a covered stent after perforation .
coronary stenting in myocardial bridging has been associated with a high restenosis rate.9 ) possible factors for this include shear stress from persistent external compression from myocardial bridges , causing neointimal proliferation , and long stent and recoil phenomena when inadequate pressures are used for stent deployment .
a des was chosen as a feasible alternative to surgery because it had the ability to reduce restenosis . in our case , we performed pci with a des , which also showed good distal flow with minimal restenosis at the proximal edge of the stent at follow - up angiography .
our case showed that , even though coronary perforation had occurred in myocardial bridging , the perforation site was confined in the interventricular groove . therefore , it could be managed more easily than conventional coronary perforation .

Answer:
we successfully rescued a patient whose coronary artery perforated following implantation of a drug - eluting stent ( des ) , by deploying a stent - graft in symptomatic myocardial bridging .
 our case demonstrated that coronary perforation could be handled without difficulty when perforated myocardial bridging is confined to the interventricular groove


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:
gestational diabetes mellitus ( gdm ) is defined as abnormal glucose tolerance that is first identified or diagnosed during pregnancy .
it is estimated that approximately 2% to 5% of all pregnancies in korean women are complicated by gdm .
the clinical significance of gdm is that it increases the risk of adverse pregnancy outcomes . in a recent large - scale multinational prospective study ,
increased maternal glucose concentration during pregnancy was significantly associated with increased neonatal birth weight , primary cesarean delivery , neonatal hypoglycemia , and increased placental c - peptide levels .
after parturition , about 15% of gdm women had persistent diabetes at an early postpartum period of 2 months .
women with a previous history of gdm are at increased risk of future development of type 2 diabetes mellitus ( t2 dm ) .
the risk of t2 dm is 3.5 times greater in women with a history of gdm compared to the general population in koreans .
in addition , offspring of gdm women are also at risk of developing obesity and t2 dm .
the incidence of gdm is expected to rise , as it will parallel the increasing rate of obesity and t2 dm .
furthermore , the recent recommendation from the international association of diabetes and pregnancy study group has lowered the diagnostic threshold of gdm and is expected to increase the incidence of gdm .
gdm women have an increased positive family history of t2 dm . compared to pregnant women with normal glucose tolerance ,
gdm women have a significantly greater parental history of t2 dm ( 13.2% vs. 30.1% , p < 0.001 ) .
in addition , both gdm women and their offspring are at increased risk of future development of t2 dm . the heritability estimate of t2 dm was reported to be quite high ( h = 0.69 ) in a recent study performed in europeans .
these findings are indirect evidence that gdm has familial tendency . however , there is no study that has specifically evaluated the heritability of gdm using familial clustering or twins
. it would be important to estimate the heritability of gdm and compare it with that of t2 dm in women .
during normal pregnancy , women experience increased adiposity and weight gain , which begin near mid - pregnancy and progress throughout the third trimester . in this period , insulin resistance ensues as a consequence of multiple factors , including increased production of placental growth hormone , estrogen , and tumor necrosis factor  [ 14 , 15 ] .
pregnant women with normal glucose tolerance can increase their -cell insulin secretion in response to this increased insulin resistance during pregnancy .
although the mechanism of increased -cell insulin secretion during pregnancy is not fully understood , it is reported that prolactin , which increases during pregnancy , can repress islet menin levels and stimulate -cell proliferation in mice .
in addition , recent reports suggest that -cell serotonin signaling is also a major determinant of -cell mass during pregnancy .
it has been suggested from several clinical studies that gdm women have limited insulin secretion capacity that can not compensate for the increased insulin resistance .
similar to gdm , t2 dm is also characterized by relative deficiency in insulin secretion in the face of increased insulin resistance .
various factors , including increased age , obesity , high - fat diet , and sedentary lifestyle , can induce insulin resistance , and those who do not have sufficient -cell insulin secretory capacity are more likely to develop t2 dm .
therefore , it is said that a large proportion of gdm women are experiencing future t2 dm in advance .
based on the findings that gdm women are at high risk of t2 dm and both gdm and t2 dm share similar pathophysiologies , it is reasonable to assume that they might also share similar genetic risk factors .
soon after the initial reports of t2 dm genome - wide association ( gwa ) studies [ 18 - 21 ] , several studies investigated whether genetic variants that were identified through gwa studies of t2 dm were also associated with the risk of gdm [ 22 , 23 ] .
genotyped variants in or near cdkal1 , cdkn2a/2b , fto , hhex , igf2bp2 , slc30a8 , tcf7l2 , kcnj11 , and pparg in 869 gdm women and 632 carefully selected nondiabetic control subjects .
they found that genetic variants in cdkal1 and cdkn2a/2b were highly associated with the risk of gdm ( p < 1  10 ) .
in addition , variants in hhex , igf2bp2 , slc30a8 , and tcf7l2 were all nominally associated with gdm ( p < 0.05 ) . among a total of 18 genetic variants studied , 9 reached a nominal significance level ( p < 0.05 ) . in fig .
1 , the risk allele frequency as well as the odds ratios of known t2 dm variants are compared among a control group ( n = 632 , men : women = 287 : 345 ) , t2 dm group ( n = 761 , men : women = 354 : 407 ) , and gdm group ( n = 869 ) in koreans [ 22 , 24 ] . for most of the variants ,
there was an increasing trend of risk allele frequencies from control to t2 dm and from t2 dm to gdm .
.   also found that variants in tcf7l2 , cdkal1 , and tcf2 were significantly associated with the risk of gdm in europeans , consisting of 283 gdm women and 2,446 glucose - tolerant control women .
variants in kcnq1 , which were first identified in an east asian t2 dm gwa study , were also significantly associated with the risk of gdm in koreans ( p < 0.05 ) .
recently , it was reported that tph1 and htr2b play a crucial role in regulating pancreatic -cell mass during pregnancy in a mouse model and that their genetic alterations could result in gdm .
a total 6 genetic variants in htr2b and 11 variants in tph1 were identified and genotyped in korean gdm women and control subjects .
although there were no significant associations of these variants with the risk of gdm , they were associated with measures of obesity and weight gain during pregnancy .
following these candidate approach studies was a two - staged gwa study that was performed in korean gdm women .
a total of 468 gdm women and 1,242 nondiabetic control women were genotyped using affymetrix genome - wide human snp array 5.0 .
variants that passed the prespecified p - value threshold in the stage 1 genome scan were further genotyped in 931 gdm women and 783 nondiabetic control women .
two variants , one located in an intron of cdkal1 ( rs7754840 ) and one near mtnr1b ( rs10830962 ) , were associated with a risk of gdm at a genome - wide significance level ( p = 6.65  10 and p = 2.49  10 , respectively ) .
although variants in mtnr1b have been previously reported to be associated with increased fasting glucose levels , the study was the first to report that mtnr1b variants are associated with gdm at a genome - wide significance level .
one of the limitations was that it was not sufficiently powered to find truly novel genetic variants that were only specific in gdm .
it should be noted that current gwa and gwa meta - analysis performed in t2 dm recruits more than 100,000 cases and controls .
one of the interesting findings was that genetic variants of t2 dm were enriched in gdm subjects . among
the 34 confirmed t2 dm genetic variants , 8 were associated with a risk of gdm .
in addition , when the -coefficients ( or odds ratio ) of the variants derived from the logistic regression were compared between gdm and t2 dm , there was a significant positive correlation of -coefficients between the two .
these findings suggest that gdm and t2 dm might share similar genetic backgrounds , at least in part .
gwa studies have opened a new era in diabetes research . our knowledge on the genetic predisposition of gdm as well as t2 dm
is expected to increase even faster as next - generation sequencing technology is applied to this field .
there should be even larger gwa studies on gdm , and gwa meta - analyses should be available . in this way , we could find variants that have smaller effect sizes but are more specific to gdm than t2 dm . in order to understand the genetic determinants of glucose and insulin concentration during pregnancy ,
a fast way is to see whether genetic variants that are known to affect glucose or insulin concentration in the normal population also affect glucose or insulin concentration during pregnancy .
in addition , a gwa study on glucose or insulin concentration during pregnancy should also be helpful .
in this way , we would be able to better understand the pathophysiology of gdm . by definition
, gdm encompasses women with pre - exiting t2 dm , maturity onset diabetes of the young ( mody ) , or even type 1 diabetes patients that were not diagnosed previously .
in particular , about 15% of gdm patients remain diabetic at early postpartum periods , and a significant portion of these subjects might fall into the category of mody .
the contribution of genetic variants known to cause mody , such as gck and hnf1a , in gdm has been reviewed in recent literature .
however , whole - exome sequencing will provide us with better bird 's eye view on the contribution of mody genes in gdm .
in addition , it might be able to find novel mody genes in those who have persistent diabetes after gdm pregnancy and also have a strong family history of diabetes .
one of the first steps in translating the genetic information into clinical practice would be to predict the future development of t2 dm in gdm women .
gdm women are at particularly high risk of developing t2 dm and require preventive measures and early screening of t2 dm .
genetic information might improve our prediction of t2 dm in women with a history of gdm .
this is an area of active research [ 31 , 32 ] , and we are looking forward to studies that use genotype risk scores in predicting t2 dm in gdm women
. a similar approach could also be applied in predicting gdm , as more genetic variants associated with gdm are expected to be revealed .
the functional consequences of the current common genetic variants identified through gwa studies of gdm are not well understood yet .
it is not known whether they are markers in linkage disequilibrium with nearby causal variants or whether they have unknown but relevant functional roles .
next - generation sequencing might give answers to these questions , but a huge number of samples and much effort will be required .
gdm women are at increased risk of developing t2 dm and have familial clustering of t2 dm . a common pathophysiology that is shared by gdm and t2 dm is impaired compensatory increase in insulin secretion to overcome the increased insulin resistance .
the gwa study of gdm enabled us to investigate the common genetic risk factors of gdm , and it revealed that gdm and t2 dm share similar genetic backgrounds , at least in part ( fig .
although this information has significantly improved our insight in the pathogenesis of gdm , there are more unanswered questions remaining that should be explicitly expressed . using the technology of next - generation sequencing
in addition , we hope that personalized genomic medicine could be available using the advances in the genetics of gdm and t2 dm .

Answer:
gestational diabetes mellitus ( gdm ) is a complex metabolic disorder of pregnancy that is suspected to have a strong genetic predisposition .
 it is associated with poor perinatal outcome , and both gdm women and their offspring are at increased risk of future development of type 2 diabetes mellitus ( t2 dm ) . during the past several years
 , there has been progress in finding the genetic risk factors of gdm in relation to t2 dm .
 some of the genetic variants that were proven to be significantly associated with t2 dm are also genetic risk factors of gdm . recently ,
 a genome - wide association study of gdm was performed and reported that genetic variants in cdkal1 and mtnr1b were associated with gdm at a genome - wide significance level .
 current investigations using next - generation sequencing will improve our insight into the pathophysiology of gdm .
 it would be important to know whether genetic information revealed from these studies could improve our prediction of gdm and the future development of t2 dm . we hope further research on the genetics of gdm would ultimately lead us to personalized genomic medicine and improved patient care .


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:
diabetes mellitus ( dm ) is a group of disorders associated with a quantitative reduction in insulin production or a qualitative reduction in the action of insulin leading to changes in carbohydrate , protein , and lipid metabolism and accumulation of glucose in the bloodstream .
the prevalence of type 2 diabetes for all age groups worldwide was 2.8% in 2000 and estimated to be 4.4% in 2030 .
the prevalence rate of diabetes in india in urban areas is 9% , in rural areas also increased to 3% of the total population , and the ratio of patients with unknown to known diabetes is 1.8:1 .
this can be primarily attributed to the fact that the condition is usually undetected in its early stages in most individuals , whereas in other individuals , the existing symptoms are often overlooked because of ignorance or negligence on the part of the patient .
clinical studies have established that periodontal diseases are more prevalent and of greater severity in patients with diabetes than in nondiabetic patients .
screening for diseases is to identify those who have an increased likelihood of developing a disease or experiencing an increase in disease severity as a first step in disease prevention and control .
there will be a greater likelihood of a favorable prognosis when a disease is discovered while it is still relatively incipient .
the early diagnosis of diabetes , however , might help to prevent its long - term complications that are responsible for the high morbidity and mortality of diabetes patients . to our knowledge , there are very limited studies on screening of undiagnosed diabetes with gingival blood in dental patients .
therefore , the aim of this study is screening of undiagnosed diabetes with gingival blood sample in patients attending to the dental hospital and to check the reliability with standard method .
after receiving the approval of the ethical committee , rmdc and h , 550 patients age ranged from 30 to 50 years were randomly selected from the outpatient department of periodontics .
patients with no known previous history of diabetes and having any risk factors like family history of diabetes , hypertension , high cholesterol , overweight / obesity with at least one tooth that bleed on probing were included in the study .
patients with known diabetes , pregnancy , any other systemic diseases were excluded from the study .
patients either with known diabetes ( n = 32 ) or with no gingival bleeding ( n = 28 ) were excluded from the study .
a special case history proforma was prepared for a systematic and methodical recording of all observations which included a detailed case history and clinical examination , along with the written consent of the patient for willingness to participate in the study .
for all the 454 patients , a gingival blood sample was collected from bleeding site with the help of a small plastic syringe and analyzed with self - monitoring device .
a minimum of 0.3 l of blood is required for assessment of blood glucose using self - monitoring device ( one touch , johnson and johnson ) .
in addition , all the patients were advised for the second visit with overnight 8 h fasting for fasting blood glucose assessment .
four patients who were found to be diabetic and eight patients who were found to be nondiabetic by chair side assessment failed to report for further assessment . of those 442 ( 202-males , 240-females ) patients returned for fasting blood glucose assessment in laboratory with ( digital colorimeter , elico cl157 ) patients with abnormal blood glucose values were advised to consult a physician for appropriate care [ figure 1 ] .
outline of study design blood glucose values of all the patients were subjected to descriptive statistical analysis with spss version 16 software ( chicago , il , usa ) .
number of patients identified as prediabetes and diabetes were analyzed for both self - monitoring glucose meter assessment and laboratory blood glucose assessment .
after receiving the approval of the ethical committee , rmdc and h , 550 patients age ranged from 30 to 50 years were randomly selected from the outpatient department of periodontics .
patients with no known previous history of diabetes and having any risk factors like family history of diabetes , hypertension , high cholesterol , overweight / obesity with at least one tooth that bleed on probing were included in the study .
patients with known diabetes , pregnancy , any other systemic diseases were excluded from the study .
patients either with known diabetes ( n = 32 ) or with no gingival bleeding ( n = 28 ) were excluded from the study .
a special case history proforma was prepared for a systematic and methodical recording of all observations which included a detailed case history and clinical examination , along with the written consent of the patient for willingness to participate in the study .
for all the 454 patients , a gingival blood sample was collected from bleeding site with the help of a small plastic syringe and analyzed with self - monitoring device .
a minimum of 0.3 l of blood is required for assessment of blood glucose using self - monitoring device ( one touch , johnson and johnson ) .
in addition , all the patients were advised for the second visit with overnight 8 h fasting for fasting blood glucose assessment .
four patients who were found to be diabetic and eight patients who were found to be nondiabetic by chair side assessment failed to report for further assessment . of those 442 ( 202-males , 240-females ) patients returned for fasting blood glucose assessment in laboratory with ( digital colorimeter , elico cl157 ) patients with abnormal blood glucose values were advised to consult a physician for appropriate care [ figure 1 ] .
blood glucose values of all the patients were subjected to descriptive statistical analysis with spss version 16 software ( chicago , il , usa ) .
number of patients identified as prediabetes and diabetes were analyzed for both self - monitoring glucose meter assessment and laboratory blood glucose assessment .
mean age of the patients investigated is 42.45  6.60 . in the 454 patients gingival blood glucose assessment with self - monitoring device
, 64 patients showed 200 mg / dl which indicates diabetes , and the other 390 patients showed 200 mg / dl , which indicates patients are not diabetic .
whereas , the results of the laboratory blood glucose analysis , 24 ( 5.43% ) patients showed 126 mg / dl which indicates diabetes , 36 ( 8.14% ) ( patients showed 100125 mg / dl which indicates prediabetic state and the other 382 patients are not diabetic ( < 100 mg / dl ) . among the 240 male patients 13 patients were diabetic and 20 were in prediabetic status and in 202 female patients , 11 patients were diabetic and 16 were in prediabetic status [ table 1 ] .
when compared male and females in both methods , chi - square test values were not significant [ table 2 ] .
table 3 shows the comparison of gingival blood sample measurement with laboratory blood glucose assessment .
comparison of gingival blood sample measurements obtained by glucometer with the blood sample assessed in the laboratory showed sensitivity 96.6% and specificity 99.47% [ table 3 ] .
distribution and percentage of patients investigated as prediabetes , diabetes comparison of blood glucose assessment by two methods in male and females comparison of the gingival blood sample measurements obtained by glucometer with blood sample assessed in laboratory we also considered the risk factors for diabetes , 122 patients were with risk factors and 320 patients were without any risk factors .
the prevalence of risk factors [ figure 2 ] like hypertension , sedentary lifestyle , family history , and overweight was significantly higher in the patients with abnormal blood glucose levels .
early detection and treatment of dm may reduce the burden of diabetes and its complications .
this is most important in a high - risk population . screening for diabetes should start at 40 years of age and to be repeated every 3 years in persons without risk factors , and earlier and more often in those with risk factors for diabetes .
unfortunately , more than 50% of the diabetic subjects in india remain unaware of their diabetes status , which adds to the disease burden .
this underscores the need for mass awareness and screening programs to identify and reduce the burden due to diabetes in india .
the results of this study conducted to screen patients with diabetes in the dental hospital using gingival blood with self - monitoring device showed 64 ( 13.2% ) patients were with abnormal blood glucose levels , which indicate as diabetic . when the same patients subjected to laboratory fasting blood glucose assessment ,
60 patients were with abnormal blood glucose levels ( 8.14% showed prediabetic status and 5.43% is diabetic ) . among the 202 male patients , 33 patients showed abnormal blood glucose levels suggestive of diabetes , whereas 240 female patients were screened for diabetes 27 patients were with abnormal glucose levels .
this increase in the number of females with abnormal glucose levels may be due to greater psychological stress in asian women as suggested by the authors in their study .
when the risk factors are taken into account , 122 patients were associated with risk factors and 320 patients were without any risk factors .
prevalence of diabetes is significantly associated with risk factors . in a study conducted by the authors , prevalence of risk factors in urban areas
there is higher prevalence of risk factors such as smoking , obesity , hypertension dyslipidemia , sedentary habits and metabolic syndrome . in a longitudinal study from urban india smoking and sedentary habits
the role of obesity in the pathogenesis of type 2 diabetes is complex and is confounded by many heterogeneous factors . in a study conducted in north india concluded that there was a strikingly high prevalence of abdominal obesity and generalized obesity as determined by body fat percentage in type 2 diabetic individuals .
primary disease prevention and control activities are meant to delay disease onset and control disease severity .
there is a huge window of opportunity for prevention , considering the number of modifiable risk factors among the prediabetes group only when the prediabetic stage is identified at earlier , in which periodontist has a key role .
authors developed a clinical guidelines for dental care providers to identify patients with undiagnosed diabetes by means of a periodontal disease examination , as well as asking questions about self - reported or self - measured waist circumference , self - reported age , self - reported weight , self - reported oral health status , self - reported race or ethnicity and family history of diabetes . in view of the growing number of people with undiagnosed diabetes and the increased risk for periodontal patients ,
diabetes screening at the time of the dental visit seems to offer a promising approach .
the limitation of the study includes as with most diagnostic tests , an abnormal result should be repeated to rule out laboratory error and should be coupled with an evaluation by a physician before a diagnosis can be made .
the results of the present study showed blood obtained from periodontal pocket probing is a reliable sample to screen diabetes in periodontal disease population .
early diagnosis of diabetes in the dental hospitals can help improve the patient 's oral health and overall health status by helping patients avoid or reduce complications from diabetes .
however , the present study could also be carried out with a larger survey population for a more effective screening .

Answer:
background : early detection and treatment of diabetes mellitus may reduce the burden of diabetes and its complications .
 screening of undiagnosed diabetes with gingival blood sample in patients attending to the dental hospital and to check the reliability with standard method.methods:five hundred and fifty new patients age ranged from 30 to 50 years were randomly selected .
 of 550 patients examined , gingival blood samples of 454 patients were collected from bleeding site and analyzed with self - monitoring device .
 blood glucose values were recorded .
 in addition , all the patients were advised for the second visit with overnight fasting for fasting blood glucose assessment . among them
 , 442 patients returned for fasting blood glucose assessment in laboratory with blood glucose analyzer.results:in the total of 454 patients gingival blood glucose assessment with self - monitoring device , 64 patients showed 200 mg / dl , which indicates diabetes , and the other 390 patients showed 200 mg / dl , which indicates patients are not diabetic .
 whereas , the results of the laboratory blood glucose analysis , 24 ( 5.43% ) patients showed 126 mg / dl , 36 ( 8.14% ) patients showed 100125 mg / dl and the other 382 patients are not diabetic .
 comparison of blood glucose measurements by two methods showed sensitivity 96.66% and specificity 99.47%.conclusions : the results of the present study showed blood obtained from periodontal pocket probing is a reliable sample to screen diabetes in periodontal disease population .
 early diagnosis of diabetes in the dental hospitals can help improve the patient 's oral health and overall health status by helping patients avoid or reduce complications from diabetes .