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:
anthrax , a zoonotic disease caused by bacillus anthracis ( b. anthracis ) , primarily affects herbivores including sheep , cattle , horses , and other domestic animals.1 humans may be affected as a result of exposure to an infected animal or animal products .
this organism has received recent attention as a potential agent of bioterrorism.1 three forms are described : cutaneous , inhalational , and gastrointestinal.1 we describe a patient with oculocutaneous anthrax .
a 39-year - old male presented to our outpatient clinic with a 4-day history of fever and swelling of the left upper and lower eyelids associated with pain , watering , and difficulty in opening the eyelids .
the patient reported that he was prescribed tablets and injections by a general practitioner , but was unable to provide details of this treatment to us . on examination
, there was brawny nonpitting edema of the upper and lower eyelids of the left eye and left side of the face ( figure 1 ) .
there was an ulceration and black discoloration along the left lower lid margin with serosanguinous discharge .
serous fluid from the eyelid and blood were collected and sent for conventional cultural methods and polymerase chain reaction ( pcr ) test .
a 39-year - old male presented to our outpatient clinic with a 4-day history of fever and swelling of the left upper and lower eyelids associated with pain , watering , and difficulty in opening the eyelids .
the patient reported that he was prescribed tablets and injections by a general practitioner , but was unable to provide details of this treatment to us . on examination
, there was brawny nonpitting edema of the upper and lower eyelids of the left eye and left side of the face ( figure 1 ) .
there was an ulceration and black discoloration along the left lower lid margin with serosanguinous discharge .
serous fluid from the eyelid and blood were collected and sent for conventional cultural methods and polymerase chain reaction ( pcr ) test .
the patient s dna was extracted using the qia amp dna blood mini kit ( qiagen , hilden , germany ) according to the manufacturer s instruction . a 596-bp fragment of the protective antigen ( pa ) gene , pa ( f)-tcc taa cac taa cga agt cg and pa ( r)-gag gta gaa gga tat acg gt and a 846-bp fragment of the capsule ( cap ) gene , cap ( f)-ctg agc cat taa tcg ata tg and cap ( r)2,3 of b. anthracis were used as the target for anthrax pcr .
the dna was amplified in a total volume of 50 l with the above mentioned primers , 200 m ( each ) deoxynucleotide triphosphates , 1x pcr buffer , 1.5 mm mgcl2 and 2.5 units of taq polymerase ( amplitaq gold - applied biosystems , california , usa ) and followed by the addition of 5 l of the template dna .
thermal cycling was performed at 94c for 5 minutes ( initial denaturation ) followed by 35 cycles at 94c for 1 minute , 52c for 1 minute ( annealing ) , 72c for 2 minutes ( extension ) and the final extension at 72c for 5 minutes ; cooled to 4c.4 thermal cycling was done in the gene amp pcr system 9200 ( applied biosystems , california , usa ) .
a 15 l portion of the pcr product and 5 l of 10% tracking dye ( 0.02% xylene cyanol , 0.02% bromophenol blue and 50% glycerol ) was added to the pcr tube .
fifteen microliters of this mix were loaded into the wells in the agarose ( amersham pharmacia , new jersey , usa ) .
the pcr products were analyzed by submarine gel electrophoresis through a 1% agarose gel in 1x tae buffer .
the gel was run at 120 volts for 60 minutes , stained with 0.5 g / ml of ethidium bromide ( amersham pharmacia , new jersey , usa ) , visualized and recorded under uv4 in the gel doc 2000 system ( bio - rad , california , usa ) .
the gene ruler 100-bp ( 3000100bp ) dna ladder plus ( mbi fermentas , usa ) was used as the molecular standard .
the pcr from the fluid and the blood were positive for the gene encoding the protective antigen ( pa gene ) and the capsule ( cap gene ) of b. anthracis ( figure 2 ) .
the patient was started on injection crystalline penicillin , 2 million international units ( 1250 mg ) every 2 hours intravenously .
no topical therapy was prescribed , however , the patient was given anti - inflammatory agents ( ibuprofen ) .
on completion of a 10-day course of intravenous antibiotics , he was discharged on oral penicillin g 500 mg every 6 hours .
although the eschar reduced in size over time , it was firmly adhered to the underlying tissue . when the eschar was removed after 1 month of the onset of illness , an ulcerated undersurface was observed ( figure 4 ) .
the ulceration healed over the next 2 weeks with scarring and ectropion of the left lower lid ( figure 5 ) . the low grade lid edema and mechanical ptosis of the left upper eyelid resolved over the next few weeks .
b. anthracis is commonly found in agricultural environments . it is a gram - positive , aerobic , endospore - forming bacilli that , in the vegetative form , has a poor survival rate outside an animal or human host.5 it is capable of producing fatal infection in livestock and in humans.1 anthrax
is considered to be one of most dangerous biological weapons.6 humans are infected when spores are introduced into the body by contact with infected animals or animal products.1 cutaneous anthrax has been reported to occur as preseptal cellulitis in the eyelids.7,8 cutaneous anthrax , if untreated , leads to life - threatening septicemia.1 this report highlights that a high index of clinical suspicion and prompt institution of appropriate therapy are essential for a successful outcome . since lesions can become sterile within 24 hours of antimicrobial therapy , confirmation of diagnosis can be made using pcr,24,9 as was done in our patient , when the conventional cultural methods fail to identify the etiology or when patients have already received antimicrobial therapy .

Answer:
anthrax , a zoonotic disease that primarily affects herbivores , has received recent attention as a potential agent of bioterrorism .
 we report a patient who presented with a 4-day history of pain , watering and difficulty in opening the left upper and lower eyelids , and fever .
 clinical examination revealed brawny nonpitting edema with serosanguinous discharge .
 the history of the death of his sheep 1 week prior to the illness provided the clue to the diagnosis . although standard cultures of the blood and the serous fluid from the lesion were negative , probably as a result of prior treatment ,
 the diagnosis of cutaneous anthrax was made by a polymerase chain reaction ( pcr ) test of the serous fluid .
 serial photographs demonstrating resolution of the lesion with appropriate antibiotic therapy are presented .


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:
recently , new oral anticoagulants have been approved as alternatives to warfarin for patients with atrial fibrillation .
rivaroxaban is one of the novel anticoagulants , which is an oxazolidinone derivative and inhibits both free factor xa and factor xa bound with the prothrombinase complex .
it is a highly selective direct factor xa inhibitor with oral bioavailability and rapid onset of action .
there are some advantages of the new agents compared with warfarin including rapid anticoagulation after an oral dose and lack of dietary or drug - drug interaction . however , there are no specific antidotes for the anticoagulant effect of rivaroxaban in the event of a major bleeding , unlike warfarin
. we present a case of spontaneous rectus sheath hematoma ( rsh ) during rivaroxaban therapy for atrial fibrillation in an elderly female patient .
a 75-year - old woman presented to the emergency department with the complaints of fatigue and abdominal pain after coughing .
the patient had been started on new oral anticoagulant agent rivaroxaban therapy for nonvalvular atrial fibrillation for 3 days .
the dose of 20 mg / day rivaroxaban was started because the creatinin clearance of the patient was above 50 ml / min .
she had a blood pressure of 70/40 mmhg and an irregular heart rate of 115 beats / min on admission .
the patient had no history of any trauma or surgery ; she reported that the symptoms started after vigorous coughing .
blood analyses revealed leukocytosis ( 26.5 k / ul ) accompanied by severe anemia ( 5.4 g / dl ) .
platelet counts were within normal ranges and her international normalized ratio ( inr ) was 1.48 .
her abdominal x - ray was normal and the stool occult blood test was negative .
after the first treatment , the patient was transferred to the intensive care unit ( icu ) .
repeated abdominal examination in the icu revealed increased tenderness and a palpable mass on the left side of the umbilicus .
noncontrast abdominal computerized tomography scan showed a left - sided rsh , 102  45 mm in size [ figure 1 ] . a specific antidote for rivaroxaban
is not available then the patient was treated with fluid resuscitation and packed red blood cells .
computed tomography scan of the abdomen shows a left - sided rectus sheath hematoma ( arrow )
rivaroxaban is an oral anticoagulant agent that directly inhibits factor xa and interrupts both the intrinsic and extrinsic pathway of the coagulation cascade .
rivaroxaban is currently indicated for use in patients for atrial fibrillation and prophylaxis of deep venous thrombosis .
it does not require inr monitoring like warfarin . with the increasing use of the new anticoagulant agents like rivaroxaban in atrial fibrillation , bleeding complications due to these agents
there are no specific antidotes for the anticoagulant effect of rivaroxaban and other new oral anticogulants unlike warfarin , thus the management of the bleeding complications include support and observation .
currently , no available specific antidote exists for the management of rivaroxaban - associated bleeding events , but supporting therapy is useful which are likely to be effective for the majority of patients because of the short half - lives of these agents .
recent studies showed that rivaroxaban was noninferior to warfarin for the primary endpoint of stroke and systemic embolism .
there was no reduction in rates of mortality or ischemic stroke , but a significant reduction in hemorrhagic stroke and intracranial hemorrhage .
the primary safety endpoint was the composite of major and clinically relevant nonmajor bleeding , which was not significantly different between rivaroxaban and warfarin but , with rivaroxaban , there was a significant reduction in fatal bleeding , as well as an increase in gastrointestinal bleeds and bleeds requiring transfusion .
the main causes of the rsh include anticoagulant therapy , hematological disorders , trauma , excessive physical exercise , coughing , sneezing , and pregnancy . especially in elderly patients the risk of rsh may be increased due to the impaired functional status and weakened rectus muscle
. early recognition , rapid assessment and treatment are important to reduce the complications such as hemodynamic instability , abdominal compartment syndrome , multiorgan dysfunction and even death .
the treatment of such a hematoma includes transfusion with packed red blood cells and supporting therapy based on regularly monitoring of hemoglobin levels .
rivaroxaban has a mean terminal half - life of 7 - 11 h so in bleeding events supporting therapies are likely to be effective for the majority of patients .
several studies have shown that prothrombin complex concentrate may be useful in reversing the effects of rivaroxaban .
other possible measures include the use of recombinant factor viia to reduce bleeding or the use of activated charcoal to reduce absorption in cases of overdose .
several factors are reported which increase the risk of patients developing hemorrhage while receiving rivaroxaban , these include advanced age , hypertension , history of hepatic / renal disease , previous stroke , coagulopathy , concomitant use of antiplatelet agents and alcohol consumption .
jaeger et al . have reported a 61-year - old female patient who developed a spontaneous spinal epidural hematoma after being treated by rivaroxaban .
boland et al . also reported acute onset severe gastrointestinal tract hemorrhage in a postoperative patient taking rivaroxaban after total hip arthroplasty . in our patient
, there was no other medication except rivaroxaban that could cause the hematoma . based on naranjo 's scale
, a score of 7 showed that the rivaroxaban was the probable cause of the rsh .
several case reports of muscle hematoma due to the antiplatelet and anticoagulant agents have been reported previously , but this is the first reported case of spontaneous rsh due to the rivaroxaban .

Answer:
rivaroxaban is an oral anticoagulant agent that directly inhibits factor xa and interrupts both the intrinsic and extrinsic pathway of the coagulation cascade and is currently indicated for use in patients for atrial fibrillation and prophylaxis of deep venous thrombosis .
 the present case reports of spontaneous rectus sheath hematoma during rivaroxaban therapy for atrial fibrillation in a 75-year - old woman .


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

Title:
Enantioselective Synthesis of Pyrroloindolines by a Formal [3+2] Cycloaddition Reaction

Paper sections:

Pyrroloindoline alkaloids are an important class of natural products1 that exhibit an impressive array of promising biological properties, including anticholinesterase,2 antiinflammatory,3 and anticancer activities.4 Owing to their medicinal relevance and structural complexity, pyrroloindoline alkaloids have served as a fertile area for the discovery and development of new chemical reactions.5,6 As part of a program targeting new methods for the total synthesis of alkaloid natural products, we sought to develop a convergent method to prepare enantioenriched pyrroloindolines.

From a design perspective, it was hypothesized that pyrroloindolines (5) could be assembled through the union of a C(3)-substituted indole (1) and a 2-amidoacrylate (2) in what would constitute a formal [3+2] cycloaddition reaction (Scheme 1). It was envisioned that the reaction would proceed through a stepwise mechanism in which a Lewis acid activates 2-amidoacrylate 2, promoting conjugate addition by the indole to give iminium ion 4. Subsequent intramolecular attack of the nucleophilic amide would provide pyrroloindoline 5.

The proposed reaction would harness the intrinsic C(3)-nucleophilicity of the indole substrate and, in principle, could provide rapid access to a variety of pyrroloindolines from simple C(3)-substituted indole precursors.7,8 Although 2-amidoacrylates are typically poor electrophiles for conjugate addition reactions due to the electron donating effects of the nitrogen lone pair, Piersanti and coworkers recently reported that EtAlCl2 promotes the reaction of indole (1, R=R1=R2=H) and methyl 2-acetamidoacrylate to provide the C(3)-Friedel-Crafts type product 3 (R=R2=H, R3=R4=Me, Scheme 1).9

Preliminary experiments were conducted in which equimolar mixtures of commercially available methyl 2-acetamidoacrylate (8) and 1,3-dimethylindole (6) were exposed to various Lewis acids. We were pleased to find that strong Lewis acids such as EtAlCl2, TiCl4, and SnCl4 provided isolable quantities of the desired pyrroloindoline 7a, as well as varying amounts of the C(2)-Friedel-Crafts type product analogous to 3 (not shown). After a preliminary survey of reaction parameters, the use of SnCl4 (1.2 equivalents) in dichloroethane at room temperature was found to provide pyrroloindoline 7a in 64% yield as a 6:1 mixture of exo and endo diastereomers (Table 1, entry 1; exo diastereomer is shown).

At this stage we wished to determine the feasibility of accessing enantioenriched pyrroloindolines using this formal [3+2] cycloaddition reaction. To this end, a screen of chiral diol additives anticipated to form chiral Lewis or Brønsted acid complexes with SnCl4 was conducted.10 Of the conditions evaluated, it was found that utilization of a 1.1:1 mixture of (R)-BINOL and SnCl4 provided pyrroloindoline 7a in 86% yield as a 4:1 diastereomeric mixture favoring exo-7a, which was formed in 64% ee (Table 1, entry 2).11,12 Interestingly, the minor, endo diastereomer was formed in 83% ee. In follow-up studies, a side-by-side comparison of two reactions varying only by the presence or absence of (R)-BINOL showed that it accelerates the rate of 7a formation and increases the overall conversion.13

Based on these observations, it was hypothesized that catalytic quantities of (R)-BINOL may still provide pyrroloindoline 7a with good levels of enantioselectivity. Indeed, use of as low as 10 mol % (R)-BINOL furnished 7a without significantly affecting the observed enantioselectivity (Table 1, entries 3–5). Whereas 10 mol % (R)-BINOL provided comparable selectivities for the formation of 7a, 20 mol % (R)-BINOL imparted consistently higher enantioselectivities for more functionalized substrates (vide infra), and was therefore utilized in subsequent experiments. Control experiments confirmed that no reaction occurred in the absence of SnCl4, and that 1.2 equivalents SnCl4 were required to drive the reaction to high conversions.14

In an effort to improve the enantioselectivity of the reaction, the amide and ester groups of the acrylate were modified.15,16 An increase in ee was observed when methyl 2-trifluoroacetamidoacrylate (9) was employed (Table 1, entry 7). A similar increase was observed using benzyl 2-acetamidoacrylate (10, entry 8). Gratifyingly, these effects proved to be additive: use of benzyl 2-trifluoroacetamidoacrylate (11) provided pyrroloindoline 7d in 81% yield and 91% ee. Preliminary studies indicated that chlorinated solvents provided the best combination of yields and selectivities. A further screen identified methylene chloride as the solvent of choice. Under our optimized conditions, pyrroloindoline 7d was isolated in 86% yield as a 4:1 mixture of exo and endo diastereomers, which are formed in 94% and 91% ee, respectively (entry 10).17

Having identified conditions to prepare 7d in high yields and enantioselectivities, a survey of indole substrates was conducted. Substrates substituted at C(5) with electron-donating and electron-withdrawing substituents provided uniformly high ee's, although a moderate decrease in yield was observed with electron poor substrates (Scheme 2, 13a–d). 1,3,6-Trimethylindole reacts smoothly to give a 4:1 mixture of exo- and endo-13e in 91% yield (94% and 90% ee, respectively).

More functionalized substituents are also tolerated at C(3) of the indole substrate. Pyrroloindolines bearing t-butyldimethylsiloxyethyl (13f) and phenylethyl (13h) substituents are prepared in moderate to good yield and high enantioselectivity (Scheme 2). Most notably, use of N-methyl-1,2,3,4-tetrahydrocarbazole provided a single diastereomer of pyrroloindoline 13g in 65% yield and 86% ee. Using this reaction, the aza-propellane core of natural products such as vincorine18 and minfiensine19 was prepared in only two steps from commercially available 1,2,3,4-tetrahydrocarbazole.

Whereas the exo diastereomer predominates in the (R)-BINOL•SnCl4-catalyzed formation of the pyrroloindolines shown in Scheme 2, it is known that the endo diastereomer of similar compounds is favored thermodynamically.20,21 Accordingly, treatment of a 4:1 mixture of exo-7d and endo-7d diastereomers (94% and 91% ee, respectively) with excess DBU in CD2Cl2 resulted in epimerization to give a greater than 10:1 endo:exo mixture of products after 72 h (Scheme 3). Interestingly, the endo-7d product was recovered in 56% ee, favoring the opposite enantiomer.22 In a subsequent experiment, exposure of diastereomerically pure exo-7d to DBU (10 equiv) provided ent-endo-7d in 94% ee. Exposure of diastereomerically pure endo-7d to the epimerization conditions returned endo-7d without significant erosion of enantiomeric excess. Taken together, these studies suggest that the initially formed exo and endo diastereomers of 7d must be of opposite enantiomeric series. From a synthetic perspective, the diastereomers can be separated prior to subsequent functionalization to avoid erosion of optical activity through this epimerization mechanism.

At this time the mechanism of the reaction remains to be elucidated. As exo- and endo-7d have opposite configurations at C(3), analysis of the diastereomeric and enantiomeric ratios suggests that the first step of the reaction (conjugate addition) occurs with modest levels of catalyst control, whereas the enolate protonation step occurs with high levels of catalyst control.23 In effect, the catalyst-controlled protonation step serves to resolve the mixture of enantiomeric intermediates. Yamamoto and coworkers have demonstrated that BINOL•SnCl4 behaves as a Lewis acid-assisted Brønsted acid that promotes a number of enantioselective protonation reactions.11a–c It is unusual, however, for high enantioselectivities to be observed when employing an excess of SnCl4 relative to BINOL. The observation that at least 1 equivalent SnCl4 is required for high conversions, coupled with the fact that use of strong Brønsted acids24 in the absence of SnCl4 fail to provide 7d, may suggest that this reaction benefits from cooperative Lewis acid-Brønsted acid activation.

In conclusion, a convergent method to prepare enantioenriched pyrroloindolines is described. The optimal conditions employ (R)-BINOL as a catalyst in the presence of stoichiometric SnCl4, and provide access to functionalized pyrroloindolines in uniformly high ee's. The application of this methodology to the total synthesis of pyrroloindoline natural products, as well as studies aimed at understanding the mechanism of this new transformation are the focus of ongoing research in our laboratory.25

Answer: (R)-BINOL\xe2\x80\xa2SnCl4 was found to catalyze a formal [3+2] cycloaddition reaction between C(3)-substituted indoles and 2-amidoacrylates to provide pyrroloindolines. A variety of pyrroloindolines were prepared with high enantioselectivity in one step from simple precursors. This methodology is expected to facilitate the total synthesis of pyrroloindoline alkaloids, an important class of biologically active natural products.


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:
split - liver   transplantation ( slt ) is an   attractive alternative procedure to expand the donor pool in patients waiting for liver transplantation .
the standard split - liver procedure for a child and an adult ( adult / pediatric split liver ttransplantation , a / p slt ) , by splitting segment ii - iii for pediatric recipient and segment i - iv - v - vi - vii - viii for an adult , is an accepted surgical option with good results both for the adult and for pediatric recipient .
biliary complications continue to be the major cause of morbidity after slt with a reported high incidence ranging between 10% and 32% [ 1 , 2 ] . as a consequence of bile duct anatomic variations
, slt requires a precise knowledge of the liver anatomy [ 3 , 4 ] .
the challenge of this procedure is represented by a preoperative radiological assessment of the biliary anatomy often unavailable at the donor 's hospital .
thus the risk of biliary duct injury during the splitting procedure is usually considered higher than during living donor procedure .   in this report
we describe an uncommon late biliary complication that occurred after slt and was successfully treated by a multidisciplinary approach .
a 63-year - old male with hepatitis c - related cirrhosis was referred for liver transplantation to our institution .
we performed a conventional a / p slt with in situ technique providing the left lateral segment for a child ( segments ii - iii ) and leaving the right lobe graft ( segment i - iv - v - vi - vii - viii ) for an adult recipient .
the celiac trunk was left on the left graft while the right hepatic artery remained on the right graft .
the patient was transplanted using the piggy - back technique without a veno - venous bypass .
the biliary tract was reconstructed performing a duct - to - duct anastomosis using a t - tube by our standard technique previously described .
a cholangiography through the t - tube was performed on postoperative day 14 , and the t - tube was clamped before patient discharge .
three months after a / pslt the t - tube was removed after a cholangiography with normal findings .
one year after transplant the patient showed abnormal liver function tests , hyperbilirubinemia , leukocytosis , and elevated g - glutamyl transpeptidase ( ggt ) , and mild elevation in alanine transaminase ( alt ) .
the patient underwent a doppler ultrasound that showed ( a patent hepatic artery )   an intrahepatic bile duct dilatation and an anastomotic biliary stricture .
the anastomotic stricture was treated by stenting the main biliary duct during an endoscopic retrograde cholangiopancreatoghaphy ( ercp ) without any evidence of intrahepatic biliary dilatation .
after this procedure the patient was submitted to a percutaneous transhepatic cholangiography ( ptc ) showing a complete obstruction of segments vi and vii biliary branches near the duct - to - duct biliary anastomosis ( figure 1 ) .
the patient was discharged leaving the external biliary drain open allowing bile drainage and an easy access for repeated radiologic treatment and an internal stent in the common bile duct .
three months later the patient underwent a surgical revision because of repeated episodes of cholangitis . during surgery
an intraoperative cholangiography was performed through the biliary drain   confirming a bile duct dilatation at the level of segments vi and vii .
it was impossible to cross the biliary stricture by a torque catheter and by hydrophilic guide wire ( figure 2 ) .
we supposed that the segmentary bile duct branch of   posterior segments vi and vii draining in the left bile duct was unidentified and tied at the time of the in situ split - liver procedure during the parenchymal transection .
a primary biliary reconstruction by biliary repair or biliodigestive anastomosis was considered at high risk because of the presence of postsurgical   adhesions   sand due to fibrotic tissue replacing   the parenchymal transected area . a liver resection of the dilated segments vi and vii was considered at high risk of leaving an inadequate liver mass .
we decided to perform a permanent intraoperative obliteration of the dilated intrahepatic ducts by a percutaneous embolization using a nonresorbable agent . with a fluoroscopic guidance through the transhepatic access we positioned a 5-french polyethylene catheter inside the ducts , preliminary flushed by a nonionic dextrose solution .
we then injected the tissue adhesive agent n - butyl cyanoacrylate ( nbca , glubran 2 , gem , viareggio , italy ) mixed with ionized oil ( lipiodol , guebert , aulnay - sous - bois , france )   for opacization in a ratio of 1:5 .
this solution completely filled the biliary duct , and the occlusion was totally accomplished in a few seconds ( figure 3 ) . during the first 3 days after the chemical bile duct embolization , the patient had a low fever with a slightly abnormal liver function test .
a computed tomography ( ct ) scan performed 6 months later showed no sign of hepatic abscesses , and the bile duct dilatation was completely occupied by the nbca - lipiodol mixture .
one year after the procedure patient showed normal liver function tests without no episodes of cholangitis .
chemical bile duct embolization treatment could represent a valuable   solution to treat uncommon biliary complications .
these tissue adhesive glues are low - viscosity liquid monomers that undergo rapid polymerization and solidification when they come into contact with organic fluids such as bile .
nbca is a permanent liquid embolic material that produces long - term occlusion in vessels of various size through an inflammatory tissue response resulting in vessel thrombosis or tissue   atrophy .
little is known about the use of cyanoacrylate compounds , and unlike european countries   the use of glubran has not been approved by the food and drug administration yet .
other authors have described the efficacy of biliary duct ablation by nbca in patients with persistent postsurgical bile leaks after lobectomy or cholecystectomy .
vu et al . treated six patients with persistent postsurgical bile leaks as a complication after hepatic lobectomy or cholecistectomy using nbca glue for the obliteration of isolated segmental bile ducts in four cases .
endoscopic treatment of biliary leakage by nbca has been described by seewald in nine patients in whom primary stent placement or nasobiliary drain was unsuccessful .
described the use of a cyanoacrlylate in the treatment of a pancreatic fistula after distal pancreatectomy .
the percutaneous interventional technique represents an effective valuable approach to reduce mortality and morbidity in the treatment of biliary complications after liver transplantation .
the use of nbca in obliteration of a dilated bile duct seems to be a safe procedure with good results providing a less invasive option than hepatic resection above all in high - risk patients with posttransplant bile duct injuries , decreasing the morbidity associated with chronic external biliary drainage .
futher studies are needed to determine whether this approach is effective and safe and whether it could reduce hospital stay and costs .

Answer:
biliary complications continue to be a major cause of morbidity after split - liver transplantation ( slt ) . in this report
 we describe an uncommon late biliary complication .
 one year after slt the patient showed an intrahepatic bile dicy dilatation with severe cholangitis episodes .
 the segmentary bile duct of hepatic segment vi - vii draining in the left duct was unidentified and tied at the time of the in situ split - liver procedure .
 we perform a permanent obliteration of the dilated intrahepatic ducts by a percutaneous embolization using an n - butyl cyanoacrylate ( nabc ) . the management of biliary complications after slt requires a multidisciplinary approach .
 the use of   nbca in obliteration of a dilated bile duct seems to be a safe procedure with good results providing a less invasive option than hepatic resection and decreasing the morbidity associated with chronic external biliary drainage .
 further studies are needed to determine   whether this approach is effective and safe and whether it could reduce hospital stay and cost .


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:
when a body part is under pressure , tissue cells do not
 receive nutrients properly , thereby resulting in their death and the appearance of a lesion .

in addition to exposure to pressure , an elevated body temperature and a high skin humidity
 may also contribute to pressure ulcer formation , which appears as an irritation in the upper
 layers of the skin and may reach muscles and bone tissue2 .
pressure ulcers are harmful to subjects , particularly those who
 have additional risk factors related to poor health3 . in this sense ,
therefore , it is important to prevent pressure
 ulcers . the correlation between being seated and
the presence of pressure ulcers has been reported
 frequently since epidemiological studies of pressure ulcers were first conducted4 .
barbenelet et al . reported the pressure
 ulcer prevalence survey in the united kingdom and noted that chair - bound patients
 consistently exhibited a higher frequency of developing pressure sores compared with
 bed - bound patients with a similar degree of helplessness5 .
other surveys have also shown this association between being seated
 and the presence of pressure ulcers6 , 7 .
the guidelines concerning pressure ulcers issued by the national institute for health and
 care excellence ( nice ) in the united kingdom include a statement regarding seating , in which
 the authors stressed the need for qualified assessment of seating needs , the importance of
 correct eating positions , and the need to maintain posture and support the feet when using a
 wheelchair8 . in people who are at risk
 for pressure ulcers or in those with bedsores , pressure redistribution must be tended to
 such that no pressure is applied to the pressure ulcer9
. a number of management strategies , including a number of
 commercially available alternating pressure cushions and wedges , can provide pressure
 redistribution10 , 11 .
lee reported the effectiveness of cushions and an anterior wedge sitting position in
 pressure ulcers . in their study
, they showed that the type of cushion and appropriate height
 wedges made a statistically significant difference in sitting pressure12 .
several studies found a correlation between cushion types
 and sitting pressure or between anterior wedge height and sitting pressure .
however ,
 pressure redistribution when cushions and wedges are applied simultaneously has not been
 investigated .
consequently , the purpose of this study was to analyze user  cushion interface pressure
 redistribution when different cushion types and height anterior wedges are applied
 simultaneously for healthy volunteers .
this
 study was a pilot study to direct future research , to perform adult norm pressure
 mapping .
all participants were identified as able - bodied subjects , and the
 procedure was fully explained to them .
the exclusion criteria included any type of sitting problems , or
 hearing , visual , or cognitive impairments that interfere with accurate participant
 assessments .
the subjects were informed that they could withdraw from the study at any
 stage for whatever reason .
participant characteristics are provided in table 1table 1.general characteristics of the subjectsmale ( n=15)female ( n=21)age ( years)21.7  2.020.1  0.5weight ( kg)66.1  8.753.9  9.2height ( cm)171.8  6.2158.4  5.1seat to footplate ( cm)46.7  5.343.8  4.6seat depth ( cm)49.5  3.545.9  4.9seat width ( cm)36.0  3.434.3  3.6hip ( )99.9  5.599.5  7.2knee ( )93.9  5.999.5  6.8ankle ( )93.4  5.797.3  6.3 .
the conformat system and research software v.7.2 were used for pressure mapping and data
 acquisition , respectively .
one occupational therapist and three university students
 collected the pressure data while the participants were sitting on a firm surface without a
 cushion , a 5-cm height gel cushion , a 5-cm height memory foam cushion , a 3-cm anterior wedge
 without cushion , a 3-cm anterior wedge with a 5-cm height gel cushion , a 3-cm anterior wedge
 with a 5-cm height memory foam cushion , a 6-cm anterior wedge without cushion , a 6-cm
 anterior wedge with a 5-cm height gel cushion , and a 6-cm anterior wedge with a 5-cm height
 memory foam cushion .
the participants were instructed to keep their chins tucked in , spines
 straight , hands on their thighs , and pelvis neutrally positioned when sitting on the
 cushions .
they were initially instructed to flex their hips , knees , and ankles at
 approximately 90 and to put their feet flat on the floor . each joint angle and sitting
 position were checked for each measurement .
after measurement , the pressure map was divided into four quadrants on screen graphics , with
 each quadrant representing the left hip , left thigh , right hip , and right thigh . for the
 quadrant division ,
the mergl method was adapted and used to analyze the sitting pressure on
 the cushion .
the peak pressure
 was the mean of the maximum pressures measured with four sensors in each quadrant .
the mean
 pressure was the mean of the pressures measured with every sensors in each quadrant .
the participant characteristics were
 tested by descriptive statistical analysis , and results were tested by a one - way analysis of
 variance and post - hoc analysis .
general demographic information , including age , weight , height , and sitting position , is
 shown in table 1 . in both genders ,
the mean and
 peak pressures were the lowest when sitting on a 5-cm foam cushion .
the mean pressure in the
 hip and thigh was the highest on a 6-cm wedge and on a firm surface , respectively .
the mean
 pressure was observed to increase in the following order : a foam cushion , a 3-cm anterior
 wedge with a 5-cm foam cushion , a 6-cm anterior wedge with a 5-cm foam cushion , a 5-cm gel
 cushion , a 3-cm anterior wedge with a 5-cm gel cushion , a 6-cm anterior wedge with a 5-cm
 gel cushion , a 3-cm anterior wedge without cushion , without cushion , and a 6-cm anterior
 wedge without cushion ( tables 2table 2.peak pressure distribution according to wedge height and cushion type ( n=36 ,
 mmhg)firm surface5  cm gel cushion5  cm foam cushion3  cm wedge5  cm gel cushion with 3  cm wedge5  cm foam cushion with 3  cm wedge6  cm wedge5  cm gel cushion with 6  cm wedge5  cm foam cushion with 6  cm wedgerhpp*304.43  95.46123.04  71.21116.09  69.57308.64  91.46131.88  55.87122.25  67.42346.25  91.69158.92  55.58168.22  43.09rtpp*62.83  19.9352.49  17.7943.85  24.2877.73  29.5757.01  21.3948.19  18.1585.52  39.8966.28  25.9465.20  27.81lhpp*305.89  85.11120.03  40.14127.96  42.27321.21  88.04130.64  57.14130.03  92.82321.91  94.82146.31  65.99166.83  88.00ltpp*71.47  25.2454.61  24.8141.93  17.0567.99  37.9858.01  24.6143.75  17.4792.15  38.3757.52  25.0761.00
 21.22r / lhpp : right / left hip pressure peak pressure ; r / ltpp : right / left thigh pressure
 peak , * p<0.05 and 3table 3.mean pressure distribution according to wedge height and cushion type ( n=36 ,
 mmhg)firm surface5  cm gel cushion5 cm foam cushion3  cm wedge5  cm gel cushion with 3  cm wedge5  cm foam cushion with 3  cm wedge6  cm wedge5  cm gel cushion with 6  cm wedge5  cm foam cushion with 6  cm wedgetpm*59.09  10.2937.86  9.2429.45  9.3057.00  11.4939.14  6.5029.60  6.4360.45  10.0441.70  7.1330.92  8.52rhpm*85.04  17.6249.76  15.3939.41  13.0484.55  19.6454.74  14.0541.80  12.7288.61  18.3067.02  48.0342.65  15.67rtpm*31.88  11.7325.45  12.4117.78  7.1127.04  9.8524.93  6.6818.81  5.5629.26  9.3225.31  7.5822.59  19.51lhpm*85.86  16.4349.53  16.4142.53  18.7287.96  17.4967.39  6.0842.58  16.9288.68  17.0258.01  17.4545.83  17.91ltpm*30.84  11.1325.92  8.1218.19  6.9227.07  9.3426.61  6.7219.15  5.8129.06  9.6526.43  7.9027.71  8.02tpm : total pressure mean ; r / lhpm : right / left hip pressure mean ; r / lhpp : right / left
 hip pressure peak , * p<0.05 ) .
r / lhpp : right / left hip pressure peak pressure ; r / ltpp : right / left thigh pressure
 peak , * p<0.05 tpm : total pressure mean ; r / lhpm : right / left hip pressure mean ; r / lhpp : right / left
 hip pressure peak , * p<0.05
prolonged mechanical loading can lead to breakdown of the skin and underlying tissues ,
 which can , in turn , develop into a pressure ulcer13 .
it may be caused by inadequate blood supply and resulting
 reperfusion injury when blood re - enters the tissue .
when sitting in the same position for
 extended periods , the dull ache experienced is indicative of impeded blood flow to affected
 areas .
the shortage of blood supply may lead to tissue damage and cell death within 2 h14 .
one of the assessment factors relating to
 the prevention of pressure sores is the pressure of cushions on clients15 .
the benefits of pressure relief and/or redistribution in minimizing pressure - related health
 risk ( including of pressure ulcer ) , among other issues , have been well documented .
however , few studies have offered information on the
 combination effects of cushions with anterior wedges . hence , the objective of this study was
 to evaluate pressure redistribution effects on the user  cushion interface pressure of
 healthy volunteers in their 20s when applying different cushions , including a firm surface
 with and without different height anterior wedges .
our results show that the mean and peak pressures were greatest when sitting without a
 cushion with 3-cm and 6-cm anterior wedges and without anterior wedge compared with the
 other sitting arrangements .
the mean pressure in the hip was the highest when sitting on a
 6-cm anterior wedge without a cushion , whereas the mean pressure in the thigh was the
 highest when sitting on a firm surface without an anterior wedge .
in addition , the mean and
 peak pressures were the lowest when sitting on a foam cushion without an anterior wedge .

gong and an reported that the mean and peak pressures were the lowest when a 6-cm anterior
 wedge was used . however , in this study , these two variables were the lowest when sitting on
 a foam cushion without an anterior wedge11 .
the participants of this study sit with the hip , knee , and ankle joint at
 an angle of more than 90. therefore , the sitting professional must assess posture before
 recommending the use of cushions and wedges .
from the results , we presumed that the foam cushion could be the best choice for pressure
 redistribution .
these results suggest that people who sit , particularly those with diseases ,
 seek out professional support in choosing the appropriate cushion and height of their chair
 based on their needs .
the present study only compared the performance of two cushions , including a firm surface ,
 and two types of anterior wedges , in redistributing user
hence , the number of participants , cushions , and wedge types , as well
 as the height of the cushion and wedges , must be expanded for generalization in future
 studies .
cushion
 interface pressure redistribution , the relationship between sitting positions and interface
 pressure redistribution must be investigated .
as the proper cushion types and anterior
 height wedges for people with or without diseases , such as stroke , spinal cord injury , and
 muscular dystrophy , must be established , this study establishes important guidelines for
 future research for establishing a sitting environment .

Answer:
[ purpose ] the purpose of this study was to investigate interface pressure redistribution
 in healthy volunteers when applying different cushions and anterior wedge heights .
 [ subjects and methods ] this study included 36 healthy individuals in their 20s .
 the peak
 and mean pressures were measured by applying different cushions and anterior wedge
 heights .
 the results were analyzed by using a one - way analysis of variance and post - hoc
 analysis .
 [ results ] the peak and mean pressures were statistically significant based on
 the cushion types and anterior wedge height .
 the peak pressure was at its highest and
 lowest when sitting on a 6-cm anterior wedge and a foam cushion , respectively .
 the mean
 pressure was greatest when sitting on a 6-cm anterior wedge of a firm surface and smallest
 when sitting on a 5  cm foam cushion .
 [ conclusion ] this study shows that the most effective
 method for pressure redistribution was sitting on a 5  cm foam cushion without an anterior
 wedge .


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

Paper text:
these lesions though may cause life threatening hemorrhage , watchful observation is still considered as a treatment option in these patients .
a 71-year - old male presented with pulsatile swelling over the right side of face and over the forehead in october 2009 .
patient is a known diabetic and hypertensive for the past 9 years on regular medications .
patient was evaluated with computed tomography ( ct ) angiogram , which showed aneurysm of the external carotid artery with thrombus within and multiple aneurysm of the branches of external carotid arteries .
treatment option of excising the aneurysm with ligation of external carotid aneurismal branches was discussed with the patient . since the swelling was asymptomatic for the past 34 years , patient was not willing for any procedure .
he is assessed with clinical examination on each visit and ultrasound examination performed once in a year to assess the size of the aneurysm .
the patient has been on follow up for the past 4 years without any new symptoms or increase in size of the aneurysm .
aneurysm of the external carotid artery and its branches have been described in cases due to trauma , iatrogenic injury , dental extraction , and also due to head and neck cancer because of tumor infiltration or due to radiation therapy .
geriatric patients with aneurysm are first consulted by a primary care physician and hence primary care physician at the community level has a major role in following these patients and referring these patients to specialized vascular centre .
increase in size of the aneurysm or impending rupture necessitates the need for referral to specialized center .
the need for surgical intervention or endovascular stenting does not arise in our patient who has this aneurysm for 34 years and was on follow up for the past 4 years without any symptoms [ figure 1 ] .
pulsatile swelling over the face , forehead , and scalp in this setting , the role of primary care physician is important to decide upon surgical or conservative management after having discussion with the patient .
multiple aneurysm of external carotid artery this case was discussed for the rarity of idiopathic multiple aneurysm [ figure 3 ] of the external carotid artery [ figure 4 ] and the need for individualized treatment protocol to be followed , as in this case , only watchful observation . in this world of evolving surgical techniques and newer treatment modalities , conservative treatment still has a role to play .
even in the era of advanced medical technology practices , treatment should be individualized and the choice rests with the patient .
primary care physicians have a major role in follow up of these patients and decide upon referring these patients to specialized vascular center thus lessen the burden of vascular centre in following these patients .

Answer:
aneurysms of external carotid artery are rare .
 treatments for these are undertaken for the prevention of complications like hemorrhage or rupture , and embolism .
 we present a 71-year - old male with idiopathic multiple aneurysm for the past 34 years on conservative management and regular follow up for the past 4 years .
 this case was discussed for the rarity of idiopathic multiple aneurysm of the external carotid artery and the need for individualized treatment protocol to be followed as in this case , only watchful observation considering the age and patient compliance . in this world of evolving surgical techniques and newer treatment modalities , conservative treatment still has a role to play .
 primary care physicians at the community level have a major role in following these patients and referring them as and when the need arises .


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:
various -glucans have been extracted from various sources such as fungi , baker 's yeast , barley , oats , and seaweed .
the physicochemical properties of -glucans differ depending on characteristics of their primary structure , including linkage type , degree of branching , molecular weight , and conformation ( e.g. , triple helix , single helix , and random coil structures ) [ 1 , 2 ] .
-glucans extracted from barley , which mainly contains -(1,3 - 1,4)-d - glucan , have been demonstrated to reduce blood lipid levels , including cholesterol and triglyceride levels [ 35 ] .
the mechanisms by which -glucans reduce blood lipid levels have been shown to include prevention of cholesterol reabsorption by adsorption , elimination of bile acid by adsorption , an increase in bile acid synthesis , and suppression of hepatic cholesterol biosynthesis by short - chain fatty acids produced by fermentation with intestinal bacteria [ 68 ] .
claims that barley products reduce the danger of coronary heart disease have been endorsed by the food and drug administration of the united states .
in addition , -glucans extracted from barley have also been reported to possess various other biologic activities , for example , reducing blood glucose level , enhancing insulin response , protecting against stress ulcers , and restraining allergic reactions .
furthermore , -glucans extracted from barley have been used in health products as a diet food , because glucan is a dietary fiber .
thus , -glucans extracted from barley have been used extensively as supplements and food additives .
whole grain products are recommended for healthy diets , as they are recognized sources of dietary fiber .
furthermore , ragaee et al .   demonstrated the antioxidant activity of various cereals such as barley , millet , rye , and sorghum .
oxidative stress is considered one of the primary causal factors for aging and various diseases such as arteriosclerosis , cardiovascular disease , cerebral diseases , diabetes , inflammatory diseases , and cancer [ 14 , 15 ] .
it is thought that scavenging of reactive oxygen species ( ros ) is important for the prevention of these diseases .
if it were to be shown that -glucan , a natural component of grain , exerts antioxidant activity , the utility of -glucan as a polymeric excipient for supplement or food additive would increase further .
therefore , the aim of the present study was to examine the antioxidant activity of -glucan to assess potential new health benefits associated with -glucan as a polymeric excipient for supplement and food additive .
the effects of the extraction source , extraction method , and molecular size of -glucan on antioxidant activity were also investigated .
furthermore , the antioxidant activity of -glucan was compared with that of polymers that are commonly used as food additives .

 -glucans extracted from barley using different extraction methods and of different molecular sizes , contained more than 70%  -(1,3 - 1,4)-d - glucan ( figure 1(a ) ) , and -glucan isolated from black yeast ( aureobasidium pullulans ) , which contained more than 85%  -(1,3 - 1,6)- d - glucan ( figure 1(b ) ) , were donated by adeka co. ( tokyo , japan ) .
-glucan extracted from oats , with an unknown composition , was purchased from megazyme international ireland ltd .
gelatin , pectin from apple , pectin from citrus , curdlan , gellan gum , and xanthan gum were purchased from wako pure chemical industrial ltd .
concentrations of 0.52.0  w / v% of -glucans or other polymers were prepared by dissolving the molecules in ion - exchanged water .
chitosan was dissolved in 0.1  m acetate buffer solution ( ph 4.5 ) , because chitosan did not dissolve in ion - exchanged water .
antioxidant activity against hydroxyl radicals in the solution was determined using a radical catch kit ( aloka co. ltd . ,
the kit measures the amount of hydroxyl radicals generated by the fenton reaction with hydrogen peroxide catalyzed by cobalt using luminol luminescence .
briefly , 50  l of cobalt chloride reagent , 50  l of luminal reagent , and 20  l of sample solution were mixed , and , after preincubation at 37c for 5  min , 50  l of hydrogen peroxide reagent was added .
the amount of luminescence generated from 80 seconds to 120 seconds after the addition of hydrogen peroxide reagent was detected with a luminescence reader ( accuflex lumi 400 ; alola co. ltd . ,
was estimated using the following equation :
 ( 1)radical  scavenge  ( % )  = amount  of  hydroxy  radical  scavengedamount  of  hydroxy  radical  generated100 .

as shown in figure 2 , the hydroxyl radical scavenging activity of -glucan differed between different sources of -glucan . in particular , -glucan extracted from barley showed the strongest hydroxyl radical scavenging activity . on the other hand , the hydroxyl radical scavenging activity of -glucans extracted from black yeast or oats was fairly low .
furthermore , 0.1  w / v% of -glucan extracted from barley scavenged approximately 60% of the hydroxyl radicals in the system , and the hydroxyl radical scavenging activity of the -glucan increased gradually with an increase in -glucan concentration ( figure 3 ) .
-glucans extracted from both barley or oats were found to comprise mainly -(1,3 - 1,4)-d - glucan ( figure 1(a ) ) . on the other hand , -glucan extracted from black yeast comprised mainly -(1,3 - 1,6)-d - glucan ( figure 1(b ) ) .
in addition to these differences in linkage type , the properties of -glucans are influenced by the degree of branching , molecular weight , and conformation [ 1 , 2 ] .
although the mechanisms by which -glucan scavenges hydroxyl radicals are not yet clarified , the different structures of -glucan , which may be associated with the source and extraction method of obtaining -glucan , may influence antioxidant activity .

first , the barley was crushed and then extracted under neutral , acidic ( 50  mm citrate buffer aqueous solution ( ph 4.0 ) ) , or alkaline ( 50  mm carbonate buffer aqueous solution ( ph 9.0 ) ) conditions with warm water at 50c . after solid - liquid separation , the liquid phase was condensed .
the hydroxyl radical scavenging activity of -glucan extracted from barley using the different extraction methods is shown in figure 4 .
the hydroxyl radical scavenging activity of -glucans extracted under an acid condition or an alkali condition was slightly higher compared with that when -glucans were extracted under a neutral condition with warm water .
the -glucans extracted from barley used in this study comprised more than 70%  -(1,3 - 1,4)-d - glucan , but also contained other components ( i.e. , proteins , lipids , saccharides , and dietary fiber ) .
the hydroxyl radical scavenging activity of almost pure -(1,3 - 1,4)-d - glucan , which was obtained by repeated recrystallization of -glucan extracted under neutral conditions with warm water ( 50c ) , was 43  1% .
although the possibility that other components contributed to the radical scavenging activity of -glucan can not be completely ruled out , this finding shows that the greater part of the hydroxyl radical scavenging activity was caused by -(1,3 - 1,4)-d - glucan .
however , -glucan extract is generally used without further refinement for supplements or food additives .
these findings demonstrate that -glucans extracted using a variety of extraction methods , from acidic to alkaline conditions , have high radical scavenging activity .
the molecular weight of -glucan extracted from barley with warm water is 40,000100,000  da ; the oligomer prepared from the macromolecule -glucan by enzymatic degradation with lichenase has a molecular weight of approximately 2,000  da ( as described by the manufacturer ( adeka co. , tokyo , japan ) ) .
as shown in figure 5 , the hydroxyl radical scavenging activity of -glucan was reduced with a decrease in molecular size .
however , antioxidant activity was reduced only by about half , even when molecular weight was reduced by about 1/201/50 .
this finding indicates that -glucan exerts hydroxyl radical scavenging activity across a wide range of molecular sizes .
the hydroxyl radical scavenging activity of various polymers was determined and compared with that of -glucan . in this experiment
, the hydroxyl radical scavenging activity of 1% xanthan gum could not be determined due to its high viscosity ; therefore , 0.5% was used .
as shown in figure 6 , pectin from apple or citrus , chitosan , and xanthan gum showed hydroxyl radical scavenging activity .
however , the hydroxyl radical scavenging activity of each of these polymers , which are used as food additives , was inferior to that of -glucan extracted from barley .
the polymers pullulan , dextrin , and curdlan , which are copolymers of glucose , were also assessed .
pullulan is a linear -1,4  :  1,6-d - glucan consisting predominantly of repeating maltotrioses ( consisting of 3 d - glucose molecules linked with -1,4 glycosidic bonds ) linked by -1,6-glucosidic bonds .
dextrin is also a -1,4-d - glucan or -1,6-d - glucan , whereas curdlan is a linear -1,3-d - glucan consisting of -(1,3)-linked d - glucose residue .
hydroxyl radical scavenging activity was not observed for curdlan , though curdlan is a -glucan ; further , no antioxidative activity was observed for pullulan or dextrin .
this finding indicates that the hydroxyl radical scavenging activity of -glucan is affected by the primary structure of the molecule , including linkage type , degree of branching , molecular weight , and conformation .
hydroxyl radicals have the strongest reactivity and oxidation power among ros . the ability to scavenge
ros is a precious property for the prevention of various diseases and aging . in this study
, it was shown that -glucan extracted from barley exerts significant antioxidant activity , in addition to the various biologic activities previously described .
the amount of antioxidant activity of -glucan was influenced by the different physiologic properties ( e.g. , structure and molecular size ) of -glucan , which varied depending on the source and extraction method used .
furthermore , the hydroxyl scavenging activity of -glucan was significantly higher than that of various polymers that are used as food additives .
these results indicate that -glucan has promise as a polymeric excipient for supplement and food additive with antioxidant and other benefits , which may contribute to enhancing health and beauty .

Answer:
-glucans extracted from barley , which mainly contains -(1,3 - 1,4)-d - glucan , are used extensively as supplements and food additives due to their wide biologic activities , including a reduction in blood lipid level . in this study ,
 the antioxidant activity of -glucan was examined to assess potential new benefits associated with -glucan , because oxidative stress is considered one of the primary causal factors for various diseases and aging .
 -glucan extracted from barley was found to possess significant antioxidant activity .
 the amount of antioxidant activity was influenced by different physiologic properties ( e.g. , structure and molecular size ) of -glucan , which varied depending on the source and extraction method used .
 the antioxidant activity of -glucan was significantly higher than that of various polymers that are used as food additives .
 these results indicate that -glucan has promise as a polymeric excipient for supplement and food additive with antioxidant and other benefits , which may contribute to enhancing health and beauty .


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:
although herpes simplex virus ( hsv ) infections are very common worldwide , herpes simplex encephalitis ( hse ) is a rare disease with an incidence of one case per 250,000500,000 individuals per year .
approximately 50% of patients with hse are older than 50 years.1 cytomegalovirus ( cmv ) , another member of the herpesvirus family , is the most common cause of congenital infection , with a prevalence rate of 0.2%2.5% in all live newborns.2,3 in adults , most reported cmv infections are seen in immunocompromised patients such as those with hiv ( human immunodeficiency virus)4,5 and after chemoradiotherapy.6 in these cases , the patients were also co - infected with hsv . here ,
we present a patient with coinfection of cmv and hsv type ii ( hsv - ii ) , who was admitted to the hospital for acute psychotic symptoms , but never treated with immunosuppressants before this admission .
for acute psychotic symptoms of delirium , delusion of persecution , fidget , over - alertness , and aggressive behaviors , a 67-year - old chinese man was sent to the outpatient department of the shantou central hospital , guangdong province , people s republic of china , on october 15 , 2013 .
on october 14 , he became suspicious , had delusion of persecution , and ran around . on the same day , he was sent to the local hospital where a magnetic resonance imaging was performed showing multiple hyperintensities in the left occipital lobe and temporal lobes in the t2-weighted images ( figure 1a ) .
in addition , multiple hyperintensity lesions were seen in the temporal and parietal lobes and demyelination lesions in the white matter surrounding the lateral ventricles in the fluid - attenuated inversion recovery images ( figure 1b ) .
then , the patient was referred to the shantou central hospital , affiliated shantou hospital of sun yat - sen university on october 15 . on examination ,
but , physical examinations showed no abnormalities ( normal blood pressure and there was no fever ) .
the positive and negative syndrome scale score was 109 ( positive syndrome score of 36 , negative of 14 , and general of 59 ) .
the patient had no history of head trauma and hospitalization for mental disorders or any tumors , according to the family members .
emergency treatment was started with the administration of the tranquilizer sodium phenobarbital ( 100 mg ) to reduce dysphoria and aggressive behaviors , the mood stabilizer sodium valproate ( 100 mg , administered in two fractions ) to stabilize the mental state of the patient , and the antipsychotic olanzapine ( 10 mg , administered in four fractions ) for the delusion of persecution .
in addition , along with supportive treatments ( piracetam 20 grams in 100 ml 0.9% sodium chloride ) , empirical administration of antiviral treatment ( ganciclovir 250 mg in 0.9% sodium chloride ) was instituted under suspicion of viral encephalitis .
on october 16 , a blood examination was performed which showed no anemia and leukocytosis , but presented a higher percentage of neutrophil number ( 80.60% ; reference range 40%75% ) , a lower percentage of lymphocytes ( 11.70% ; reference range 20%50% ) , very high levels of creatine kinase ( ck ; 619 u / l , reference range 0174 u / l ) and its isoenzyme ( ckmb ; 39 u / l , reference range 024 u / l ) .
in addition , a higher level of c - reactive protein ( crp , 113 mg / l ; 08
chest radiographs ( october 17 ) showed stale tuberculous lesions in the upper lobe of right lung .
on october 18 , while the psychotic symptoms were improved , rough breath sounds were heard in the lungs , suggesting the presence of an infection there .
therefore , the antibiotic treatment with piperacillin - tazobactam ( 4,500 mg in 0.9% sodium chloride ) was initiated while the other treatments continued . on the same day
, an electroencephalogram was performed showing slow waves characterized by strong peaks of delta and theta frequencies in the frontal lobe of the right hemisphere ( figure 2 ) .
on october 19 , a susceptibility - weighted imaging was performed , which more clearly showed the stale hemorrhages in the frontal lobe of the right hemisphere ( figure 1c ) , in addition to those seen in the left occipital lobe and temporal lobes of both sides .
the outcomes of cerebrospinal fluid ( csf ) examination came out on october 20 , 21 , and 22 , respectively , showing blood cells in normal ranges , mild lower levels of chloride ( 117 mmol / l ; reference range 120132 mmol / l ) , and glucose ( 2.41 mmol / l ; reference range 2.84.5 mmol / l ) .
no bacteria were found . but both anti - cmv igg and anti - hsv - ii igm were positive , supporting a diagnosis of coinfection with hsv - ii and cmv in the brain .
on october 28 , as required by the family members , the patient was discharged .
his psychotic symptoms were significantly improved as evidenced by the reduction of positive and negative syndrome scale from 109 to 71 ( positive syndrome score of 14 , negative of 13 , and general of 44 ) .
the patient continued the antiviral and antipsychotic treatments at home after the discharge from the hospital .
he died of progressive cachexia 4 months after the discharge ( february 26 , 2014 ) , although his psychotic symptoms did not relapse .
the ethics committee of the shantou central hospital did not require approval for this case study .
except for one early case report,7 all other double infections of the central nervous system ( cns ) with cmv and hsv were reported in immunocompromised patients.46,8 the patient reported here had no history of being treated with immunosuppressants .
his blood examination showed normal cell count despite of the presence of anti - cmv igg and anti - hsv - ii igm in csf , which is in accordance with the reported evidence for increased production of antibodies against several neurotropic infectious pathogens including hsv - i , hsv - ii , and cmv , in the csf of individuals with bipolar disorder9 or autism spectrum disorders.10,11 the mild signs of cns inflammation in this patient may account for the absence of seizures and focal neurological signs although he presented primarily acute psychotic symptoms and mental status changes . in line with this patient with hsv - ii infection , neurological sequelae were more frequent among patients with hsv - i compared with those infected with hsv - ii.12 in addition , cmv encephalitis in immunocompetent individuals has been associated with mild signs of cns inflammation , including absent to moderate pleocytosis.1315 in contrast , cmv in immunocompromised patients was featured with more severe clinical manifestations.5,6,16 the pathological hallmark of hse is hemorrhagic necrosis in the medial part of the temporal lobes .
in addition , adjacent areas such as the orbital surface of the frontal lobe and cingulate gyrus may be involved . in line with these ,
magnetic resonance imaging of this patient showed hemorrhages in multiple regions of the brain , including the right frontal lobe , left occipital lobe , and the temporal lobes of both sides .
the hemorrhage in the right frontal lobe may be related to the peaks of delta and theta frequencies seen in electroencephalogram of this brain region .
in addition , this patient showed multiple small infarctions and demyelination in the white matter surrounding the lateral ventricles .
the multiple small infarctions may be the consequence of cmv infection . in line with this speculation , animal , and human studies1720
have shown the cmv - induced damage of microvascular endothelium , vasculitis , thrombotic occlusions , and hemorrhages .
another feature of this patient is a very high level of crp in his blood .
the co - existence of high crp level and the antibodies to cmv and hsv - ii reminded us of a recent human study , in which the crp level was strongly associated with viral detection rate and mixed viral / bacterial detection rate ; whereas the rate of bacterial detection was not associated with the crp level.21 more significantly , plasma crp was an independent predictor of mortality in patients with chronic obstructive pulmonary disease caused by virus infections.21,22 in summary , we present a case of a 67-year - old male with coinfection of cmv and hsv - ii and without history of being treated with immunosuppressants .
the presence of his psychosis symptoms and absence of neurological manifestations may represent the clinical features of coinfection of cmv and hsv - ii .

Answer:
herpes simplex encephalitis is a rare disease . in adults , most of the reported cytomegalovirus ( cmv )
 infections are seen in immunocompromised patients .
 we present a case of 67-year - old chinese male with the coinfection of cmv and herpes simplex virus type ii ( hsv - ii ) .
 he had no history of being treated with immunosuppressants , showed symptoms of psychosis and was scored 109 on the positive and negative syndrome scale .
 this patient presented with a rare case of coinfection of cmv and herpes simplex virus type ii with psychotic symptoms .


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

Paper text:
maxillofacial injuries have the potential to cause airway compromise and are associated with pain and swelling causing difficulty in mouth opening , chewing and deglutition .
it helps in intraoperative pain relief and also helps in early post operative rehabilitation of maxilla facial trauma patients
mandibular nerve block is often performed for diagnostic , therapeutic and anesthetic purposes for surgery involving mandibular region .
we report a case where intraoperative and post - operative pain in a case of unilateral fracture mandible was effectively managed through intermittent mandibular nerve block via a catheter .
a 30-year - old male with right sided parasymphyseal fracture mandible was scheduled for open reduction and internal fixation .
the patient had difficulty in opening the mouth due to pain ( 3 cm ) .
informed written consent for the nerve block was obtained and visual analogue scale ( vas ) of 0 - 10 , was explained to patient . in the operation theater ,
neuromuscular blockade was achieved with vecuronium and anesthesia was maintained with o2 and n2o using controlled ventilation .
the right side of the face was prepared for mandibular nerve block with lateral extraoral approach [ figure 1 ] .
arrow showing skin site of epidural needle insertion for mandibular nerve block an 18-gauge i.v .
cannula was inserted at midpoint of lower border of the zygomatic arch and was advanced perpendicular to face until it contacted the lateral pterygoid plate .
the length of the cannula outside the skin was marked and cannula was redirected slightly posterior to reach behind the posterior border and was advanced further by 0.5 cm .
catheter was tunnelled subcutaneously and the filter was attached to its other end [ figure 2 ] . for surgical analgesia , a bolus dose of 4 ml of 0.25% bupivicaine was given through the catheter .
fentanyl 1mg/ kg i.v . was given only when there was more than 20% increase in heart rate or blood pressure above base line .
the surgery lasted for 2 h. at the end of surgery , neuromuscular blockade was reversed and the trachea extubated .
following extubation , the patient was conscious and pain free and then shifted to ward .
post operatively , he received 4 ml of 0.25% bupivacaine through the epidural catheter every 12 h for two days .
vas score was measured immediately after surgery and thereafter at 1 , 2 , 4 , 6 , 12 , 24 , and 48 h respectively .
patient was observed for numbness at the surgical site , need for rescue analgesia , complications ( nausea , vomiting ) .
numbness in area of lower jaw line was present throughout the period but subsided after discontinuation of local anesthetic through epidural catheter .
he was discharged on fourth post operative day with advice for follow up in o.p.d .
mandibular nerve block can be used to manage intra as well as post operative pain in cases of fracture mandible .
we performed lateral extra oral approach because of restricted mouth opening and the need to retain the catheter for post operative analgesia .
18 g cannula instead of epidural needle was used to minimize the bleeding from pterygoid plexus of veins .
the cannula was advanced further after contacting lateral pterygiod plate so that the catheter comes in vicinity of mandibular nerve and there is no displacement during jaw movements .
the catheter was further tunnelled subcutaneously to prevent dislodgement and filter was used to prevent infection .
there was excellent post operative analgesia achieved with this technique as shown in decreased pain scores , both static as well as dynamic .

Answer:
mandibular nerve block is often performed for diagnostic , therapeutic and anesthetic purposes for surgery involving mandibular region .
 advantages of a nerve block include excellent pain relief and avoidance of the side effects associated with the use of opiods or non - steroidal anti - inflammatory drug ( nsaids ) .
 a patient with maxillo facial trauma was scheduled for open reduction and internal fixation of right parasymphyseal mandibular fracture .
 the mandibular nerve was approached using the lateral extraoral approach with an 18-gauge i.v .
 cannula under general anesthesia .
 he received 4 ml boluses of 0.25% plain bupivacaine for intraoperative analgesia and 12 hourly for 48 h post operatively .
 vas scores remained less than 4 through out observation period .
 the only side effect was numbness of ipsilateral lower jaw line , which subsided after local anesthetic administration was discontinued .
 patient was discharged after four days .


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:
balantidium coli ( b. coli ) is the only ciliated protozoan that is known to infect humans .
balantidiasis is a zoonotic disease occurring in humans via the feco - oral route from the normal host , the pig .
however , it may be found in rare extraintestinal sites such as liver , lung , and genitourinary tract .
b. coli can become an opportunistic parasite in immunosuppressed hosts living in urban environments , where pigs are not a factor in infection . in this case report
, b. coli was incidentally found in the urine of a patient having chronic obstructive pulmonary disease ( copd ) who was on steroids for a long time .
the patient had no history of diarrhea , other gastrointestinal ( gi ) symptoms , previous urinary tract infection , or urethral discharge .
he was also taking bone broth / soup . as a routine work - up urine sample was received .
, several oval - to - oblong ciliated parasites that were approximately 75  50 m in size were seen swimming rapidly across the slide [ figure 1a ] .
two to three pus cells per high power field and few candidal pseudohyphae and spores were also present .
cytosmears were prepared from the urine sediment to identify the morphology . both hematoxylin and eosin ( h&e ) and giemsa staining were done . in h&e
stained smears [ figure 1b ] , cytoplasmic food vacuoles and macronucleoli were seen and faint impression of cilia was noted . in giemsa stained smears [ figure 1c and d ] ,
the parasite was identified and the body was covered with short and delicate cilia that were all of uniform length . to exclude contamination , we examined two repeat urine samples that were collected under sterile condition .
based on the morphology and swimming pattern , a diagnosis of urinary balantidiasis was made .
oval - to - oblong ciliated trophozoites containing cytoplasmic food vacuoles ( thin arrows ) .
( b ) ( h&e , 40 ) trophozoites of b. coli in urine showing cytoplasmic food vacuoles and faint impression of cilia ( thick arrow ) .
( c and d ) ( giemsa , 40 ) trophozoite of b. coli in urine covered with short and delicate uniform length cilia ( thin arrows ) complete hemogram and biochemistry profiles were within normal limits .
serology for human immunodeficiency virus ( hiv ) and hepatitis b surface antigen ( hbsag ) were negative .
his fecal samples and bronchoalveolar lavage fluid samples were negative for trophozoites / cysts of b. coli .
the patient was very sick at the time of admission , later he was intubated and kept on ventilator .
malmsten was the first to recognize b. coli in two humans with dysentery in the year 1857 .
the pig is the common reservoir of infection but the parasite is harmless to the host as the parasite thrives mainly on starchy food that is abundant in pig 's intestine .
the scarcity of starchy food in the human bowel explains the rarity of balantidial infection in man .
cyst is the infective stage , when ingested liberates trophozoites in the large intestine , which may remain in the bowel or may invade submucosal coat of the bowel .
the trophozoites and cysts of b. coli are shed in feces and if the cysts , in particular , contaminate drinking water or food , the infection can be spread to other pigs or humans .
the trophozoite measures 30 - 150 m in length and 25 - 120 m in width ; the cyst , which may be spherical or slightly ovoid , measures 40 - 60 m in diameter .
the mouth ( oral apparatus ) is located at the tapering anterior end , and the cytopyge ( anus ) is located at the rounded posterior end .
balantidium causes no serious disease of the gi tract ; however , in conditions such as malnutrition , alcoholism , or a compromised immune system , it can lead to disease . in our case , the source of infection is not clear .
the patient had no history of contact with pigs , but he had history of intake of bone broth .
third hypothetical possibility is the ascending infection from the urine pot that was washed with plain contaminated water .
b. coli should be differentiated from trichomonas vaginalis ( t. vaginalis ) , entamoeba histolytica ( e. histolytica ) , ciliocytophthoria phenomenon . in urine
it can be differentiated easily from b. coli by its morphology and motility . in stool ,
it moves on the slide surface by means of an anterior ectoplasmic pseudopod and is smaller ( around 25 m ) in diameter .
in addition , mature cysts are smaller and quadrinucleate as compared to binucleate b. coli cysts . in case of samples taken from anatomic locales that are lined by ciliated columnar epithelium
ciliocytophthoria are much smaller ( average 12  10 m ) anucleated cells with cilia along one edge
. many cases of b. coli infection in the stool sample have been reported worldwide . however , in urine there were only a few case reports available .
we have found only two case reports of isolated urinary balantidiasis from india while the rest showed coinfection with t. vaginalis .
umesh reported a case of a 29-year - old woman with cystitis due to b. coli .
reported urinary balantidiasis in a 68-year - old farmer having diabetes and chronic kidney disease .
to the best of our knowledge , this is the third case report of isolated urinary balantidiasis from india .
rapid spiraling motility and cytosmears stained with giemsa and h&e satins are very useful in morphological identification .
effective sanitation , use of clean water , and consumption of properly cooked food are probably the most effective ways to prevent balantidiasis in humans .

Answer:
balantidiasis is a rare zoonotic disease in humans .
 balantidium coli is the causative ciliated protozoan .
 we present a case of urinary balantidiasis in a patient having chronic obstructive pulmonary disease ( copd ) who was on steroids for a long time .
 he has no symptoms of bowel or urinary involvement .
 we are reporting this case because of its rarity in human urine and also for future references .


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:
malaria control programmes utilising indoor residual spraying are only effective if a high coverage of targeted structures is achieved and an insecticide that is effective against the specific mosquito vector is correctly applied .
ongoing monitoring of spraying operations is essential to assure optimal programme performance and early corrective action , where indicated .
successful development and application of a computerised spraying operations management system in mpumalanga province , south africa during 1998 resulted in its adaptation and introduction in neighbouring maputo province , southern mozambique during 2000 .
the structure and components of this computerised management system are described , and its ' operational benefit in southern mozambique , where community - based spray operators apply intradomiciliary insecticide , are reviewed .
the computerised management system allowed malaria programme management and field supervisors to monitor spraying coverage , insecticide consumption and application rates on an ongoing basis .
the system supported a successful transition to community - based spraying , while assuring correct insecticide application and spraying completion according to schedule .
in 1946 , south africa introduced intradomiciliary spraying with residual insecticides , ddt ( dichlorodiphenyltrichloroethane ) and bhc ( benzene hexachloride ) , to kill indoor - resting vector mosquitoes and thereby control malaria .
this resulted in a 75 percent reduction in the geographic extent of the malaria - affected area , with malaria occurrence limited to summer epidemics in the low - lying northern and eastern border areas with botswana , zimbabwe and mozambique .
similar malaria control programmes were initiated in other southern african countries . in mozambique , spraying operations for malaria control collapsed during the 1970s due to the protracted civil war with a resulting high burden of endemic malaria throughout the country .
recently there has been a resurgence of malaria in southern africa , attributed to a number of factors , including parasite drug - resistance , mosquito insecticide - resistance , climate changes and large - scale population migration .
the hiv / aids epidemic has resulted in a simultaneous dwindling of resources available for public health programmes , thus placing an onus on programme managers to ensure optimal efficiency of their activities .
an efficient spraying programme is characterized by application of the correct volumes of insecticide on surfaces suitable for mosquito resting .
this should be achieved before the onset of peak malaria transmission with a high coverage of targeted structures .
a formal spraying management system was introduced in south africa for the first time in 1973 , with activity forms being completed by the field officials responsible for each spraying team and a " hut - card " left under the eave of each sprayed dwelling .
this was expanded to a set of seven different spraying record forms in 1975 under the auspices of the world health organization .
this set consisted of a spray operator record , a daily spray - team report , a weekly report , a monthly report , a locality completion report , a sector completion report and a spraying completion report .
although this manual system was cumbersome it became entrenched , and remained essentially unaltered in south africa for more than 20 years .
a major flaw of this data system was that field staff were not trained to use the data for programme monitoring .
thus serious programme deficiencies usually only became apparent at the end of the spraying season when the data were centrally analysed .
mpumalanga province , located on the border with mozambique in the north - east of south africa , began to replace permanently employed spray personnel with temporary spray personnel recruited from each malaria - affected community .
one hundred community - based spray personnel were appointed , each accountable to their local community , and the team was responsible for spraying almost 170,000 structures during each annual spraying round . with supervisory support limited to one field manager and six field officers , it was postulated that unless an improved spraying management system was introduced , programme performance and efficiency might deteriorate .
a computerised management system was developed in mpumalanga province to enable malaria programme management and field supervisors to monitor , even on a daily basis when required , spraying coverage , individual spray operator 's performance , and insecticide consumption and application rates .
the success of this computerised management system resulted in it being extended to neighbouring swaziland and also to southern mozambique , where a malaria vector control programme was recently re - introduced through the multilateral lubombo spatial development initiative ( lsdi ) , a partnership between the governments of mozambique , swaziland and south africa .
we describe the structure and components of this computerised management system , and provide operational evidence of its value in the southern mozambique malaria control programme .
the computerised spraying management system in southern mozambique was designed prior to the first round of spraying early in 2000 .
the area targeted for spraying included the rural districts of namaacha and matutuine , and sections of the peri - urban districts of matola and boane in maputo province , covering an area of 7,962 square kilometres with an estimated 200,000 homes .
the management system comprises two platforms , a spraying database and a spatial mapping platform .
a microsoft access 2000 database was used with front - end data entry and output screens .
the data entry screen mirrors the manually completed weekly spraying form , which collates data from daily spraying report forms that are submitted each week by spray operators to their supervisor ( figure 1 ) .
" drop - down " menus ensure speed , ease and accuracy of data entry .
a number of datasets have been integrated to form the basis of the spraying data base , including a comprehensive listing of place names to be sprayed , number of homes ( ministry of health database ) , demographic data for each electoral area ( 1995 electoral census by the department of planning and cooperation ) , spray operator identification codes and details of insecticides used during spraying operations .
each record is automatically allocated a unique number and all information can be linked through a relational database to a specific spray operator , team , time - period or administrative area .
additional information collected includes the number of visits made to a specific house , reasons for not spraying ( where applicable ) , insecticide used by each spray operator and number of spray - can refills . data is automatically backed up after each day of data entry onto an external zip drive .
data entry screen of the malaria information system the geographic information system ( gis ) platform required both spatial ( roads , clinics , locality boundaries ) and attribute data ( locality or clinic names , population figures ) .
the gis software package mapinfo professional[mapinfo corporation , 4 global view , troy , new york , 12189 , usa .
] was used and maps of southern mozambique ( scale 1:250,000 ) were obtained from the direco nacional de geografia e cadastro in maputo .
the south african medical research council digitally captured relevant geographical and cadastral features , including roads , rivers , towns and different administrative level boundaries .
the smallest administrative unit boundaries at which data was captured ( localities ) were drawn onto local maps by the staff of the ministry of health involved in the project and then digitally captured for inclusion in the gis display .
preset queries , to generate standardized management reports , were planned and designed in partnership with field supervisors and programme management staff to meet their specific needs .
however , the system was designed to allow user - friendly production of customized additional reports where required .
specific training was provided for programme supervisors on making sense of data and interpreting reports , with a spraying database manual developed for ready reference .
a major emphasis in training has been on identifying operational problems and implementing timely remedial action .
as field managers enter the summary data at the namaacha field office on a weekly basis , necessary remedial action is taken within a week .
the ongoing monitoring of individual spray operator 's productivity , in terms of number of structures sprayed each day and volume of insecticide sprayed per structure , has facilitated early detection of operational problems , leading to prompt investigation and supportive corrective action by supervisors .
a standardized aid for evaluating individual operators ' spraying quality during field visits was designed and implemented .
field managers discuss evaluation results with spray operators on - site in order to eliminate mistakes .
the frequency of required supervisory corrective interventions has steadily decreased since the beginning of the programme and it is likely that some of this effect is due to the enhanced monitoring and response made possible by the computer management system .
insecticide application rates ( grams per square meter ) are constantly monitored for under- and over - application
. under - application reduces insecticide residual activity and thus effectiveness , while over - application is wasteful . where sub - optimal application rates were detected , investigation included scrutiny of insecticide preparation , nozzle condition , application pressure , distance of nozzle tip from sprayed surface , and spraying rhythm .
spraying coverage exceeded 90% of 222,000 structures in southern mozambique , a level that is considered more than adequate . in areas where the management system repeatedly identified lower coverage than expected , investigations were conducted to determine whether this was the result of diminished community support , absenteeism or poor motivation of the specific spray operator .
maps depicting the coverage achieved by each team proved useful to malaria control programme management for tracking teams ' progress , providing ongoing updates to senior health management and encouraging spray personnel to attain their target ( figure 2 ) .
an example of a spraying progress map by locality in maputo province , mozambique , 2003 an additional benefit was that data captured during the first spraying round during 2000 was used to verify official data sources and provide actual household figures to replace official government estimates .
this provided more precise information for malaria control planning and demographic data needed by other government agencies for planning .
competition for ever - dwindling public health resources is a major challenge for malaria control programmes in sub - saharan africa .
constant monitoring and evaluation of spraying activities is obligatory where indoor residual spraying is an important component of malaria control , to ensure effective application and prevent wastage .
computerised management systems are proving useful tools for providing timely information to address potentially deleterious human , social and technical factors that could negatively impact on malaria control .
the computerised management system has been in operation for three years supporting the mainly rural vector control programme that now covers an area of 13,770 square kilometres in southern mozambique .
not only has it supported a successful and cost - effective transition to a community - based spraying approach , but it has also ensured that spraying was completed to schedule . the ability to immediately identify problems at the level of an individual spray operator and institute appropriate remedial action assured good coverage and programme efficiency .
the computerised management system is a useful method for enhancing malaria control by improving application of existing tools .
note : a powerpoint presentation providing more detail on the malaria management information system and database is available at .
mb , bs , cm , jlg , dd conceptualised , developed and implemented the mpumalanga computerised management system prototype ; mb , bs , cm , bm adapted this system for application in maputo province , mozambique .
all authors contributed to the review of the system and the preparation of this manuscript .

Answer:
backgroundmalaria control programmes utilising indoor residual spraying are only effective if a high coverage of targeted structures is achieved and an insecticide that is effective against the specific mosquito vector is correctly applied .
 ongoing monitoring of spraying operations is essential to assure optimal programme performance and early corrective action , where indicated.methodssuccessful development and application of a computerised spraying operations management system in mpumalanga province , south africa during 1998 resulted in its adaptation and introduction in neighbouring maputo province , southern mozambique during 2000 .
 the structure and components of this computerised management system are described , and its ' operational benefit in southern mozambique , where community - based spray operators apply intradomiciliary insecticide , are reviewed.conclusionsthe computerised management system allowed malaria programme management and field supervisors to monitor spraying coverage , insecticide consumption and application rates on an ongoing basis .
 the system supported a successful transition to community - based spraying , while assuring correct insecticide application and spraying completion according to schedule .