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:
Gromologist: a Gromacs-Oriented Utility Library for Structure and Topology Manipulation

Paper sections:
Introduction

Molecular dynamics (MD) simulations are a cornerstone of modern-day computational chemistry and biology, and in the last 40 years a range of general-purpose codes have been developed to make simulations more reproducible and accessible to the community [1][2][3][4][5][6][7]. Although the preparation of typical biomacromolecular systems, e.g. proteins, lipid membranes or nucleic acids containing standard residues, has become extremely streamlined and automated [8][9][10], the corresponding topology files -containing a full description of the system's connectivity and energetics -can be unreadable and not amenable to simple manual manipulation. As a result, any non-automated departure from these standards, such as removing atoms or adding bonds, can become a painstakingly complex process, in particular for novice users not aware of nuances and caveats of these fixed file formats.

To deal with these routine but non-standard tasks, high-level utility libraries are needed that can accommodate the increasing complexity of inputs and dynamically respond to popular requests from the community. One notable example of such a library, Parmed, has already been incorporated into Amber and contains many OpenMM-specific functions [11], but its primary goal is to provide easy access to general properties and allow for smooth interconversion between standard file formats. Another one, pmx, serves to prepare hybrid topologies for "alchemical" simulations and the analysis of thus obtained results [12]. Many routine tasks, though, are not covered by any popular library, leaving plenty of room for new developments.

In an attempt to fill that gap, we present Gromologist, a Pythonic utility library oriented at custom manipulation of Gromacs topologies. For many years now, Gromacs has been not only the most broadly used but also one of the fastest-growing MD engines in the field of molecular simulations [13,1] and has a well-established user base, whichcombined with the ease of format interconversion allowed by other tools -makes Gromologist a broadly applicable tool for all types of non-standard operations including, but not limited to, adding and removing atoms and bonds, introducing amino acid mutations in both the structure and topology, checking and listing force field parameter compatibilities, looking for mismatches between structures and topologies, merging files, manipulating alchemical states, modifying force field types or combination rules, parameter optimization or automated editing of structures. In addition, we maintain a strict zero-dependency policy (except for a few very specific features), so that the library is conveniently lightweight and can be easily installed with any modern Python distributions without causing dependency conflicts.

Features Topology manipulation

To handle Gromacs topologies, Gromologist implements a hierarchical representation of sections, subsections and entries. Sections represent high-level abstractions, such as individual molecule definitions, force field parameter sets or headers/footers. Subsections correspond to individual fragments of the topology file, delimited with the [ subsection name ] syntax, and directly handle most operations. Entries correspond to individual lines and provide a low-level access to all key features of the contents of a topology.

Splitting and merging. By default, topologies are saved as a single standalone file, including all .itp files referenced therein, but splitting to individual .itp is also supported. If needed, files can be made lightweight by keeping (a) only molecules listed in the [ system ] subsection and/or (b) only parameters used by the system.

Bonds and atoms. Primitive operations on topologies include adding, removing or swapping atoms in molecules while preserving a correct numbering scheme across all sections. Adding or removing bonds is also supported, including new bonds between two molecules, in which case the two become merged into a single molecule entry, and all new bonded terms (pairs, angles, dihedrals) are automatically identified and added, while existing ones are preserved and renumbered correctly. This allows for easy creation of chemical adducts or cyclic molecules, as well as editing of protonation states or simple chemical modifications without the need of extending the basic residue library (.rtp/.hdb files). Another heavily requested feature was the automated introduction of ,,special bonds" -disulfides and transition metal coordination bonds -that are not always correctly guessed by default Gromacs tools. Finally, Gromologist also provides a low-level interface for the mutation library, and can be easily incorporated into custom modification workflows.

Mutations. In this vein, a mutations module allows to introduce standard amino acid mutations to the topology without the need to go through the full process of topology generation. This has proven particularly useful in the study of heavily glycosylated systems, such as the SARS-CoV-2 Spike [14], where ready-made topologies and systems were often shared publicly but introducing even minor changes (such as a point mutation) would entail going through the same complicated server-based pipeline, risking introducing additional errors at this stage. This idea is also extended to protonation states, so that individual titratable residues can be protonated or deprotonated easily and in a consistent manner. As long as standard atom name conventions are followed, the mutation module is force-field agnostic, and the user can point to a specific .rtp file containing the respective residue definitions.

Alchemistry. Another set of utilities is related to the management of alchemical states. Gromologist can add or remove selected alchemical states, or swap them -a useful feature e.g. for the equilibration of B-states that helps avoid the computational overhead associated with the use of the free energy code.

Force fields. Finally, some features are meant to facilitate force field development and the implementation of selected methods such as solute tempering (REST2) [15]. These include the possibility of automatically cloning types along with all their bonded interaction parameters and renaming all selected atoms to the new type, or by automatically adding NBFIX-type modifications just by specifying the deviation from the standard Lorentz-Berthelot rules [16,17]. An additional module implements a generic strategy for multiple dihedral fitting to QM data, akin to that available in the FFTK module of VMD for NAMD topologies [18].

Structure manipulation

The structure module can deal with both PDB and GRO files, interconverting between them when necessary. Common operations include constructing new atoms from existing ones, interpolating between structures, atom/residue renumbering according to custom rules or generation of virtual sites, e.g. upgrading 3-point water molecules to 4-point ones.

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In addition, many often-required features of the PDB files can be filled in automatically. Chain assignment, an information typically lost in PDB to GRO conversion can be inferred based on a simple distance criterion, similarly to the CONECT entries required by some analysis programs. Elements can be inferred from atom names, and beta-factors can be set to reflect external data sets, including an option to smooth the values out spatially.

To assist with these operations, Gromologist implements a robust selection language akin to that of VMD [19], allowing for logical operations, selections "within X of Y", and a number of predefined molecule classes such as "protein", "nucleic" or "solvent". Periodic boundary condition (PBC) treatment is also implemented for any generalized triclinic box.

Simultaneous processing of topology and structure

In Gromologist, topologies can be matched with a compatible structure, so that where relevant, topology operations can be simultaneously performed on the structure attribute (and vice versa), facilitating the work with simulation-ready systems, and fully leveraging the information available in both files. Examples of such procedures include atom addition/removal, or introduction of mutations. When a topology is available, chain assignment can be made using molecule definitions therein. Moreover, when Gromacs often only indicates an unspecified mismatch between e.g. the number of atoms in structure and topology, Gromologist provides a specific list of all unmatched atom names, facilitating the identification of missing atoms or residues in either one.

Checking and printing

The last area of applications of Gromologist covers extracting information about the topologies and structures, or making it better visible to the user. On the most basic level, one can list molecules in the system, atoms in the molecule, as well as selected bonded terms (bonds, 1-4 pairs, angles, dihedrals) using atom names or atom types. Charges and masses of both the whole system and individual molecules are easy-to-access attributes. For a protein or a nucleic acid structure, the sequence can be printed chain by chain, and per-residue missing atoms identified, helping identify cases in which residues have to be rebuilt. Gradually diagnostic functions are being incorporated to quickly identify structural issues prior to simulation, like one currently allowing for validation of all chiral centres in a protein.

When required, atom names can be explicitly stated in the comments of bonded interaction entries to facilitate debugging, and numerical values of the parameters can be explicitly included in the topology. In the same vein, fields set using the define syntax can be set to their explicit values. Parameters whose numerical definitions are missing can also be identified with a single function call.

Dependencies

To be applicable as broadly as possible, Gromologist uses no dependencies other than base Python libraries. Although a few optional features, such as smoothing of beta-factors or dihedral optimization, do require numpy and scipy, these make up extremely rare use cases and therefore do not form part of the official dependency list.

Outlook

Given the existing set of capabilities, Gromologist is becoming an easily extensible platform for the introduction of further convenience functions, editing tools and workflows. Further development of the platform could benefit the Gromacs community by rapidly implementing utilities tailored to new or popular protocols, and a closer collaboration with the Gromacs development team is expected to directly address these issues. Moreover, extensive testing and some code reorganization will be required to ensure that the library covers all features supported by Gromacs, including more cryptic ones. In the long run, however, we expect Gromologist to become a stable element of the Gromacs environment and a valuable contribution to the broad simulation community.

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Answer: Despite the increasing automation of workflows for the preparation of systems for molecular dynamics simulations, the custom editing of molecular topologies to accommodate non-standard modifications remains a daunting task even for experienced users. To alleviate this issue, we created Gromologist, a utility library that provides the simulation community with a toolbox of primitive operations, as well as useful repetitive procedures identified during years of research. The library has been developed in response to users' feedback, and will continue to grow to include more use cases, thorough automatic testing and support for a broader spectrum of rare features. The program is available at gitlab.com/KomBioMol/gromologist and via Python's pip.


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:
thyroid incidentalomas are newly detected thyroid nodules , discovered during a computed tomography ( ct ) , magnetic resonance imaging ( mri ) , ultrasound ( us ) , or positron emission tomography ( pet ) exam for nonthyroid diseases .
focal type is defined as an area of uptake of 2-fluorodeoxyglucose ( fdg ) in less than one lobe , whereas diffuse type is fdg uptake in the entire thyroid gland .
there are guidelines for managing palpable thyroid nodules but there are no such guidelines for nonpalpable nodules .
fdg - pet has a reported sensitivity of 7590% and a specificity of 90% for detecting thyroid malignancies .
whole body fdg - pet / ct combines the technology of whole body ct scan with fdg uptake localization to assess glucose utilization rates .
the vast majority of solid tumors have an enhanced glycolytic rate , and they are therefore amenable of being imaged with fdg - pet .
fdg - pet has become the standard of practice for staging , restaging , and assessment of therapy response in a variety of malignant solid tumors .
normal thyroid gland shows very low fdg uptake , and some data suggest that a moderate diffuse uptake can represent a normal variant . however , fdg has high accumulation in tumors because of increased glucose transport and glycolysis .
benign diseases of the thyroid such as graves ' disease and thyroiditis can have high standard uptake values ( suv ) because of increased blood flow , increased glucose metabolism , autoimmune response by lymphocytes , and inflammation .
therefore , areas with high fdg uptake can be nonspecific and can range from benign processes to malignant neoplasms .
thyroid nodules have different morphologic appearances , and they can be seen as diffuse or focused lesions on the pet / ct .
us is usually the first step in the management of thyroid abnormalities found in physical and laboratory exams .
the overall incidence of thyroid incidentalomas is on the rise with 2.4 times increase in the last decade .
based on the pet / ct alone , definite diagnosis can not be made since there are no established criteria to diagnose benign or malignant incidentalomas .
current practice is to biopsy all nodules > 1  cm and all nodules < 1  cm with risk factors for malignancy .
this study also aims to assess the value of pet / ct as a screening tool to screen for thyroid incidentalomas .
there is no report on the prevalence of pet / ct thyroid incidentalomas in the general population . yet ,
thyroid incidentalomas are quite common , and their prevalence depends on the population studied , region or country where the study was conducted , and the diagnostic methods used .
we performed a retrospective analysis of all whole body fdg - pet / ct done at our institution between 1/1/2000 and 8/20/2008 ( figure 1 ) .
an inclusion criteria was that the lesions were not visible or palpable during routine clinical exam .
we excluded from our study all cases with prior histories of thyroid neoplasms and thyroidectomies or any type of thyroid surgery .
a total of 156 patients who had abnormal fdg uptake were further selected for secondary analysis . from this group ,
univariate one - way analysis of variance ( anova ) was performed to characterize differences between segments classified according to the results of diagnostic methods . a p value of < 0.05 was considered statistically significant .
in this study , only 40 out of 156 incidentalomas ( 25.6% ) had biopsies .
there are lesions with low , hyperdense , and a mixture of low and high attenuations .
our results show no correlation between the size of the lesion and the suv value .
there are papers that show the correlation between size and suv value while some show no correlation . in the group of cancerous incidentalomas , there are 6 males ( mean age 53.3 , age range 3378 ) and 9 females ( mean age 56.2 , age range 3873 ) . for the group with benign incidentalomas , there are 4 males ( mean age 76.5 , age range 6983 ) and 21 females ( mean age 59.1 , age range 3986 ) .
14 out of 15 ( 93% ) malignant lesions have focal uptake , and the remaining 1 has diffuse uptake .
this finding agrees with prior studies in that focal uptake lesions have > 30% increase in malignancy rates compared to diffuse uptake lesions . among cancerous nodules ,
the highest suv value is 9.9 and the lowest is 2.5 ( figure 2 ) , and for the benign lesions , the highest is 46 and the lowest is 0.8 . from the 40 biopsy reports , there are 15 cancerous nodules , corresponding to about 38% .
there are 11 papillary carcinomas ( 6 right lobe , 3 left lobe , 2 both lobes ) , 1 follicular carcinoma ( left lobe ) , 1 anaplastic carcinoma ( right lobe ) , 1 adenocarcinoma from the breast primary ( left lobe ) , and 1 metastasis of unknown origin ( right lobe ) .
among benign incidentalomas , there are 2 nonspecific benign lesions ( 1 left lobe and 1 right lobe ) , 18 colloid lesions ( 10 left lobe and 8 right lobe ) , 1 chronic lymphocytic thyroiditis ( right lobe ) , 3 follicular adenomas ( 2 left lobe and 1 right lobe ) , and 1 hurthle cell lesion ( right lobe ) .
generally , incidentalomas found in males at young age carry a risk of being malignant .
we also find that incidentalomas are far more common in females than males , and this is in agreement with other studies .
framingham population - based study reported the thyroid nodule prevalence of 6.4% for females versus 1.6% for males .
the average size of nodules in the malignant group ( n = 12 ) is 2.0  cm ( range 0.66  cm ) , and that in the benign group ( n = 20 ) is 1.4  cm ( range 0.22.4  cm ) .
the graphical representation of sizes in figure 3 shows that the majority of sizes of benign and malignant incidentalomas are in the same range ( i.e. , below 3  cm ) with only 2 of the lesions in the malignant group ( 5  cm and 6  cm , resp . ) outside this range .
we can not safely conclude that small nodules are benign and large nodules are cancerous , and there is no agreement yet on the cutoff value of the size of the lesion to warrant further workup .
adequate samples are difficult to obtain from lesions < 8  mm . on the other hand
, studies have shown that cancer prevalence for lesions < 1 and > 1  cm is the same , and so we must take the other risk factors into consideration besides the size . moreover ,
papini et al . who examined us features of thyroid nodules also found no correlation between malignancy and the dimensions of the lesion or the multinodularity .
attenuation is a feature of ct , and low attenuation means that a particular area is less intense than the surrounding .
all of the malignant nodules confirmed by biopsy have low attenuation , with the exception of two which have a mixture of high and low attenuation . for this study ,
some studies associate low attenuation with malignancy while some suggest high attenuation for malignancy [ 4 , 6 ] .
diffuse fdg uptake is often due to hypothyroidism or thyroiditis , especially hashimoto 's or autoimmune thyroiditis .
one study reported higher likelihood of cancer when the average suv is greater than 5.69   but most other studies can not find a correlation between suv and malignancy [ 9 , 19 ] . in our study ,
the average suv value of the malignant group ( n = 15 ) is 5.5 , and that of the benign group ( n = 25 ) is 7.2 . as a result ,
considering these information , we can not set a threshold suv value for malignant lesions .
our prevalence of 38% falls within the range of 1850% reported in the literature for prevalence of malignancy among incidentalomas . in our study , most of the malignant incidentalomas are primary thyroid malignancies , and this is similar to other studies where most cancerous incidentalomas are thyroid primary .
papillary carcinomas are most common , and the majority of them occur as right lobe lesions
. prevalence of incidentalomas found by pet / ct at our institution is 1.84% , which is within the range of 1.24.3% reported by liu .
the results of our study are compared to studies done on incidentalomas at other institutions ( table 3).the investigations at various hospitals mentioned in table 3 reflect different study designs , patient populations , and institutional practices .
the prevalence of incidentalomas range from 1.1% to 7% and the prevalence of malignancy among incidentalomas ranges from 14% to 66% .
a new thyroid nodule appears at the rate of 0.08% per year in the general population , and the incidence of thyroid malignancy is 0.0040.1% per year .
not surprisingly , the incidence and prevalence of thyroid cancer in the patient population we see at the nuclear medicine department at ucsf is much higher than the general population .
if we perform pet / ct scans to screen for incidentalomas in the general population , it will increase the health care costs with little benefit to the patients .
the cost of pet / ct far outweighs the reduced mortality associated with early diagnosis of thyroid cancers . a paper by ohba et al . , who prospectively followed patients for 3 years , mentioned that repeated fdg - pet to follow up patients with thyroid nodules is ineffective .
diffuse - type incidentalomas with the absence of risk factors can be managed by physician visits , lab tests , and monitoring with us .
yet , we can not rule out malignancy based on the diffuse pattern alone because the diffuse uptake can mask the focal lesions .
one of the limitations of our study is that out of 156 abnormal pet / ct thyroid exams , only 40 had biopsy reports .
the prevalence of malignancy among incidentalomas may be different from the current one if all underwent biopsy .
we must be aware that pet / ct can not detect small lesions such as micropapillary thyroid carcinomas which can have normal or low suv uptake .
our data suggest that focal fdg uptake representing incidentalomas should be followed by pathologic diagnosis , especially in those with chronic conditions or known diagnosis of a solid tumor .
this study did not support the idea for using pet / ct to screen the general population for incidentalomas .

Answer:
objectives . to determine the prevalence of incidentalomas in a patient population with no known thyroid malignancy who underwent whole body fdg - pet / ct for staging or restaging of neoplasia .
 the additional aim of the study was to evaluate the feasibility of using petct as a screening tool for malignant thyroid incidentalomas .
 methods .
 retrospective review of medical records of all the thyroid exams done at our institution between january 1 , 2000 and august 20 , 2008 .
 we made a criterion of pet / ct as the primary method of detection of incidentalomas .
 results . from a total of 8464 thyroid exams ,
 156 incidentalomas were found and 40 incidentalomas underwent anatomopathology analysis , which was used as gold standard .
 chi - square analysis was used to analyze the data .
 there is no significant association between suv value and the prevalence of incidentalomas . discussion . from january 1 , 2000 to august 20 , 2008
 , incidentalomas have a prevalence of 1.84% at our institution .
 38% of the incidentalomas that were biopsied were characterized as representing malignant tumors . conclusion .
 focal , abnormal fdg uptake representing incidentalomas must be followed up with biopsies .
 it is impractical to use pet / ct as a screening tool to detect incidentalomas for the general population but it must be done in patients with history of any type of cancer .


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

Paper text:
the study was approved by the joint ethics committee of the institute of neurology and the national hospital for neurology and neurosurgery , london , uk .
all structural and functional scans at time 1 and time 2 were acquired from the same siemens 1.5 t sonata mri scanner ( siemens medical systems , erlangen , germany ) .
the structural images were acquired using a t1-weighted modified driven equilibrium fourier transform sequence with 176 sagittal partitions and an image matrix of 256  224 , yielding a final resolution of 1 mm [ repetition time / echo time / inversion time = 12.24 ms / 3.56 ms / 530 ms ] .
pre - processing of 66 structural images ( 33 participants  2 time points ) used spm8 ( http://www.fil.ion.ucl.ac.uk/spm ) with the dartel toolbox to segment and spatially normalize the brains into the same template ; with and without modulation .
modulated images incorporate a measure of local brain volume while unmodulated images , used with proportional scaling to correct for global grey matter , provide a measure of regional grey matter density .
previous studies have shown the correlations between brain structure and cognitive ability are better detected by grey matter density .
images were smoothed using an 8 mm isotropic gaussian kernel at full width half maximum ( fwhm ) . the relationship between change in iq and change in brain structure
was investigated by entering the appropriate pre - processed images ( modulated or unmodulated grey or white matter ) into within subjects paired t - tests , with change in iq ( viq , piq or fsiq ) and year of scan as covariates . the degree to which time 2 iq was predicted by changes in brain structure
was investigated in a hierarchical regression analysis with time 1 iq entered before change in brain structure .
details of the functional imaging paradigm have been reported elsewhere and are summarised in supplementary information ) .

Answer:
intelligence quotient ( iq ) is a standardized measure of intellectual ability that taps a wide range of cognitive skills1 . across life span
 , iq is generally considered to be stable with scores at one time point used to predict educational achievement and employment prospects in later years1 .
 neuro - imaging allows us to test whether unexpected longitudinal fluctuations in measured iq are related to brain development .
 here we show that verbal and nonverbal iq can rise or fall in the teenage years , with these changes in performance validated by their close correlation with changes in local brain structure .
 a combination of structural and functional imaging showed that verbal iq changed with grey matter in an area that was activated by speech , while nonverbal iq changed with grey matter in an area that was activated by finger movements . by using longitudinal assessments of the same individuals
 , we eschewed the many sources of variation in brain structure that confound cross sectional studies .
 this allowed us to dissociate neural markers for verbal and nonverbal iq and to show that these general abilities are closely linked to the sensorimotor skills involved in learning .
 more generally , our results emphasize the possibility that an individual s intellectual capacity relative to their peers can weaken or strengthen in the teenage years .
 this would be encouraging to those whose intellectual potential may improve ; and a warning that early achievers may not maintain their potential .


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 fibrosarcoma is diagnosed during the early years of life , it is called congenital infantile fibrosarcoma ( cif ) , representing less than 1% of all pediatric malignant tumors ( 1 , 2 ) .
in contrast with adult fibrosarcoma , infantile fibrosarcoma ( if ) rarely exhibits distant metastasis and has a good prognosis ; greater than 90% of patients may be cured with appropriate management .
the tumor usually occurs in soft tissues of the extremities and is often asymptomatic . in such cases ,
rarely , if may occur in the gastrointestinal tract ; a few cases of gastrointestinal fibrosarcoma have been reported in the literature .
necrotizing enterocolitis ( nec ) , which is a primary intestinal wall pathology , has been cited as the major cause of pneumoperitoneum in most published literatures ( 3 , 4 ) .
however some conditions , not affected by a primary pathology of intestinal wall itself ( e.g. intestinal atresia , stenosis , meconium ileus , colonic aganglionosis or volvulus ) , may lead to neonatal pneumoperitoneum .
this case was a pneumoperitoneum not associated with a nec also . in this report , we present an extraordinary case of cif of the sigmoid colon causing pneumoperitoneum in a newborn baby .
a 2-day - old korean boy , delivered at 37 weeks by cesarean section owing to fetal bradycardia , with a birth weight of 3,420 g , was referred to the neonatal intensive care unit in pusan national university children 's hospital because of abdominal distension and free air in the peritoneal cavity at may 1st , 2011 .
a plain abdominal radiograph showed normal air - filled loops of bowel ; however a large amount of free air occupied the central portion of the abdomen ( fig .
1 ) . the patient underwent an emergency laparotomy on the day of admission to the neonatal intensive care unit . a large amount of bile - stained
a round mass , about 5 cm in diameter , was observed in the left lower abdominal cavity , and it seemed to wrap around a loop of sigmoid colon ( fig .
pathologic analysis report described an infantile fibrosarcoma , measuring about 4.7  2.8 cm , involving mainly the submucosa and muscularis propria with an infiltrative growth pattern ( fig .
the immunohistochemical stain of the tumor was positive for vimentin and sma , and negative for h - caldesmon , s-100 , cd34 , c - kit , desmin , and alk-1 ( fig .
4 ) . the ki-67 proliferation index was 20% . because complete surgical resection was performed and the surgical resection margins were free tumor , the patient was observed without adjuvant therapy .
fibrosarcoma is a tumor that arising from mesenchymal cells and composed of malignant fibroblasts within a collagen background . after infantile fibrosarcoma
first recognized in 1962 ( 5 ) , it has been generally studied . congenital infantile fibrosarcoma ( cif ) is a very rare type of nonrhabdomyosarcoma soft - tissue sarcomas , usually occurring in the 1st year of life , with approximately 40% of lesions present at birth and more than 80% diagnosed within 1 yr ( 6 ) .
it accounts for 5%-10% of all soft - tissue sarcomas in infants younger than 1 yr and is slightly more common in boys ( 7 , 8) .
in contrast with adult fibrosarcoma , infantile fibrosarcoma ( if ) is considered a low - grade malignant tumor and carries an excellent prognosis , with survival rates of 80%-90% ( 9 ) . if is usually located in subcutaneous tissues at various anatomic sites , most frequently involving the extremities and the axial regions . especially in older children , if less frequently involves the trunk , head and neck ( 6 ) .
the manifestation of infantile fibrosarcoma in the reported cases is generally a painless swelling , exhibiting steady growth .
however , it may rarely involve the retroperitoneum , mesentery , mouth , presacral region , lung , or gastrointestinal tract .
a few cases have been reported recently about if involving the gastrointestinal tract ( e.g. , the duodenum , jejunum , ileum , and hepatic and splenic flexures of the colon ( 10 - 12 ) .
intestinal obstruction or meconium peritonitis due to bowel perforation was the primary manifestation in the reported cases involving intestine . in our patient , pneumoperitoneum was the presenting problem , but there were no gross findings at surgery implying a definite perforation of the colon or rupture of the mass ; neither was there any ischemic change or obstruction , or apparent necrosis of the tumor on histologic examination .
we found no obvious explanation for the large amount of free - air in the peritoneal cavity seen on radiologic examination prior to surgery ; we assume that a sealed - off microperforation was responsible for the condition .
pneumoperitoneum in neonates accounts for about 1% of total admission at a neonatal intensive care unit .
most cases occur in relation to a primary intestinal wall pathology such as necrotizing enterocolitis ; however , pneumoperitoneum may rarely be associated with intestinal atresia , stenosis , meconium ileus , colonic aganglionosis , or volvulus .
it is necessary to distinguish if from other stromal tumors , particularly in cases involving the gastrointestinal tract .
. molecular biological analysis may be useful when identifying the presence of specific transcription errors , e.g. , the evt6-ntrk3 translocation , but it is not always used ( 6 , 9 , 11 )
. surgical excision remains the principal component of treatment , showing a good result when complete resection with tumor - free margins is achieved .
there is no defined role for adjuvant chemotherapy or radiotherapy after complete surgical excision ( 9 , 13 ) .
the prognosis is generally favorable with more than 90% long - term survival ( 9 ) . in our patient
, we could not identify any evidence of local recurrence or distant metastasis during a 1-yr follow - up period . in conclusion ,
cif of the sigmoid colon is a rare soft tissue tumor , with a favorable outcome likely after appropriate surgical resection .
it may present with bowel perforation in the early neonatal period ; therefore a neonatal pneumoperitoneum not related to necrotizing enterocolitis requires attention for management .

Answer:
congenital infantile fibrosarcoma ( cif ) is a rare soft - tissue tumor in the pediatric age group and seldom involves the gastrointestinal tract .
 a 2-day - old boy was transferred to our hospital with a pneumpoperitoneum .
 after emergency operation , we could find a solid mass wrapping around a sigmoid colon and performed a segmental resection of sigmoid colon including a mass .
 histopathologic examination showed an infantile fibrosarcoma origining from the muscular layer of colon .
 the baby was discharged on the 17th hospital day and followed for 1 yr without recurrence .


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:
postoperative pulmonary complications are found to be associated with increased morbidity and mortality following abdominal surgeries .
they also lead to additional health cost and prolonged length of hospital stay . according to the findings reported in an australian study , postoperative pulmonary complications are 13% prevalent and significantly prolong length of hospital stay .
however , various rates of pulmonary complications had been reported in the literature due to lack of proper criteria for pulmonary complications .
available evidences suggest that early postoperative mobilization following abdominal surgery contributes to improved lung volume which eventually reduces incidences of postoperative pulmonary complications [ 5 , 6 ] .
preoperative counseling regarding hospital stay and patient 's role in recovery has proven to reduce anxiety , reduce length of stay , and have better compliance with postoperative care plan including early mobilization .
eventually , preoperative counseling may contribute towards early mobilization that can reduce postoperative pulmonary complications following abdominal surgery .
counseling regarding surgical procedures is commonly employed at every setup but less importance is given to additional counseling regarding postoperative management .
this study aims at evaluating the effect of preoperative counseling regarding postoperative mobilization and its impact on reducing pulmonary complications in a developing world .
the randomized control trial was conducted at the department of general surgery of a tertiary care hospital of karachi , pakistan , from september 2012 to march 2013 .
participants were recruited from outpatient clinic as well as from emergency department of the hospital .
minimally invasive surgeries and patients whose score was > 2 on the american society of anesthesiologist ( asa ) scale were excluded .
moreover , patients who were smokers and had abnormal findings on x - ray were also excluded .
every second patient who visited selected study setting was recruited in group i , whereas others were kept in group ii .
group i received informed consent regarding surgical procedure as well as counseling related to early postoperative mobilization and its impact on surgical outcome , whereas group ii received information regarding surgical procedure only . to reduce biasness , senior residents who were not part of the study conducted these counseling sessions .
explanation was given about nature of study , rights of study participants , privacy and confidentiality of participants , and rights of withdrawal from study .
in addition , history of previous illness , comorbidity , and any barrier to early postoperative mobilization were assessed .
both groups received counseling regarding nature of surgery and its complications , what to expect during hospitalization , postoperative pain management , and possible complications associated with surgery and anesthesia , whereas group i received additional information regarding postoperative mobilization and its impact .
patients were encouraged and assisted to mobilize once they were fully awake , with stable blood pressure and pulse , no dyspnea on rest , and pain score of < 8 on visual analogue scale .
the time at which surgery ended and the time when patient first got out of the bed ( bed to chair ) were recorded .
in addition , time from end of surgery to first mobilization of > 10 minutes was also recorded .
patients who had prolonged duration of surgery and who were smokers underwent chest physiotherapy and incentive spirometry with the help of physiotherapy staff .
postoperative pulmonary complications following abdominal surgery were assessed via criteria of scholes et al .
postoperative pulmonary complications are as follows.chest x - ray showing collapsed lung or consolidation.increased body temperature > 38c for more than one consecutive postoperative day.sputum culture providing evidence of infection.productive yellow or greenish sputum.unexplained increased white blood cell count.abnormal breath sound on auscultation.diagnosis of pulmonary complication by physician .
the criteria for postoperative pulmonary complications were reviewed from preoperative health status . in the current study ,
2 participants in group i and 5 participants in group ii were excluded from study because of poor surgical outcomes . 1 participant from group
i declined to continue further as part of the study because of low pain threshold .
data from 113 participants from group i and 111 participants from group ii were analyzed .
mean age of participants in group i was 36.70  8.69 years ( median : 37 years , range : 38 years ) with male to female ratio of 49  :  64 , whereas in group ii mean age of participants was 37.01  8.43 years ( median : 38 years , range 33 years ) with male to female ratio of 38  :  73 .
there was no significant difference noted in mode of admission among these two groups ( p = 0.43 ) .
diagnosis of the patients and procedure performed in both groups were almost the same as shown in table 1 .
similarly , there was no significant difference in the duration of surgery ( p = 0.51 ) and pain score ( p = 0.32 ) among both groups .
mean duration of surgery for group i was 64.91  mins ( median : 65  mins , range : 75  mins ) , whereas for group ii it was 63.3  mins ( median : 60  mins , range : 80  mins ) .
similarly , participants in group i reported mean pain score on 3.8 ( median : 5 , range : 3 ) on given visual analogue scale ( vas ) ; however , mean pain score for participants in group ii was 3.9 ( median : 4 , range 5 ) . on evaluating postoperative status of patients ,
significant difference was observed in participants of both groups in terms of early mobilization to bed to chair and upright mobilization for more than 10 minutes ( p < 0.001 ) .
patients in group i were mobilized earlier from bed to chair ( mean : 342.9  mins , median : 340  mins , and range : 105  mins ) in comparison to patients in group ii ( mean : 1511.1  mins , median : 1500  mins , and range : 680  mins ) .
likewise , patients in group i had earlier mobilization for more than 10 minutes ( mean : 360.7  mins , median : 360  mins , and range : 125  mins ) in contrast to patients in group ii ( mean : 1570.5  mins , median : 1570  mins , and range : 680  mins ) .
participants in group i who were early mobilized had fewer pulmonary complications ( 7.1% ) compared to group ii who had 29.7% participants suffering from pulmonary complications .
as shown in table 2 , whoever fulfilled any three of the scholes et al .
on exploring the impact of counseling and support from staff for physiotherapy from group i participants , the majority of them ( 68.14% ) reported that counseling was very effective in providing them with motivation for early mobilization , as shown in table 3 .
the primary aim of this study was to evaluate effect of preoperative counseling along with physiotherapy support on facilitating early mobilization among patients undergoing abdominal surgery .
the findings of current study revealed that early mobilization is not associated with type of abdominal surgery and its duration .
likewise , previous study has also indicated no significant difference in length of anesthesia and mobility .
postoperative early mobilization in combination with physiotherapy serves as a prophylaxis to reduce postoperative pulmonary complications .
it has also been reported that change of position from supine to fowlers increases minute ventilation significantly .
similarly , findings of current study revealed that delayed mobilization increases the risk of postoperative pulmonary complications as indicated by presence of fever , abnormal breath sounds , and cough .
this finding supports that early mobilization can prevent postoperative complications associated with surgery . in line with findings of current study
. moderate level of mobility also improves muscle strength and alleviates adverse effects of immobility .
hence , optimal level of mobilization is desirable among surgical patients to prevent morbidity associated with inappropriate mobilization . in the current study ,
patients who were mobilized earlier reported that preoperative counseling and support of physiotherapy staff were effective . in line with the current study findings
, the literature revealed that increase in physical activity can be achieved among preoperative patients via continuous support .
postoperative physical activity interventions have also proved to be effective in providing better surgical outcome [ 14 , 15 ] .
one of the study findings revealed that preoperative instructions about exercise impact postoperative compliance with exercise .
such preoperative cognition interventions have proved to be effective in increasing postoperative physical activity . moreover , in developing countries where literacy level is low such interventions can significantly affect outcome of abdominal surgeries .
thus , preoperative counseling and support of physiotherapy staff can improve compliance with early mobilization which is proved to be effective in reducing postoperative pulmonary complications .
early postoperative mobilization following abdominal surgery is proved to be effective in reducing pulmonary complications . in addition , preoperative counseling along with physiotherapy support can foster early mobilization among patients undergoing abdominal surgery .
hence , counseling regarding early postoperative mobilization should be promoted among patients undergoing abdominal surgery to improve surgical outcome .

Answer:
background and objectives .
 preoperative counseling is effective to foster early postoperative mobilization that reduces pulmonary complications following abdominal surgery .
 this study aims at evaluating the effect of preoperative counseling regarding postoperative mobilization and its impact on reducing pulmonary complications .
 design and setting .
 randomized control trial was conducted at the department of surgery of a tertiary care hospital , karachi .
 patients and materials . patients who underwent abdominal surgery and
 met inclusion criteria were recruited .
 all participants were randomly divided into two groups .
 both groups received information about the surgery and group i received additional counseling for postoperative mobilization .
 all patients were encouraged for postoperative mobilization .
 scholes et al .
 criteria were used to evaluate postoperative pulmonary complications .
 results . in total 232 participants were recruited and divided into two groups .
 there was no significant difference in participants ' age ( p = 0.79 ) , duration of surgery ( p = 0.5 ) , and pain score ( p = 0.1 ) of both groups .
 however , significant difference was identified in mobilization from bed to chair and mobilization for > 10 minutes .
 patients in group i experienced less pulmonary complications in comparison with group ii .


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

Paper text:
it provides an impervious seal , fills the irregularities and minor discrepancies between the root canal wall and core filling material , and assists in microbial control if microorganisms were left on the root canal walls or in the tubules.[15 ] ideally , a thin layer of the sealer should be evenly applied to canal walls prior to the placement of the core filling material .
the thickness of the endodontic sealer layer is very influential in the quality of the root canal filling.[612 ] an inadequate sealer coating may result in voids and permit bacterial microleakage which leads to endodontic failure . on
the other hand , excess placement of the sealer can result in its extrusion beyond the apical foramen which can prevent or delay healing .
moreover , most sealers dissolve over time and the dissolution is probably responsible for the increase in leakage along the root fillings over time.[1720 ] therefore , the amount of sealer should be kept to a minimum and should only be found in a thin layer between the gutta - percha and the wall of the canal .
several techniques of sealer placement have been described in the literature , such as the use of a file , lentulo spiral , absorbent paper point , gutta - percha cone , and an ultrasonic file .
each technique may produce different distribution of the sealer onto the canal walls , which may affect the sealing . at present
, there is no evidence to suggest that one method is better and reliable than others .
hence , the purpose of this study was to evaluate the influence of three most commonly used methods of sealer placement on the sealing ability of the sealer .
one hundred and nineteen ( 119 ) human permanent central incisors teeth that had no caries , restorations , or any other noticeable defects were collected , stored in 0.9% isotonic saline , and used in this in vitro study .
the crowns of the teeth were removed at the cementoenamel junction by using a hard tissue cutter ( exact , germany ) under water cooling .
the working length was determined by introducing a size 10 k file into the canal until it could be seen at the apical foramen .
this length was measured and the working length was set 1 mm short of the resultant measurement .
all the teeth were instrumented to a size f3 protaper ( dentsply maillefer , switzerland ) following the full sequence recommended by the manufacturer . during preparation and between each protaper file ,
the canals were irrigated with 2 ml of 5.25% naocl by using a disposable syringe and a 25-gauge needle .
also a size 10 hand file was introduced to remove any debris and to ensure the patency of the apical foramen .
all root canals were then irrigated with 5 ml of 17% ethylene diamine tetra acetic acid ( edta ) followed by 5 ml of 5.25% naocl .
finally , the root canals were flushed with distilled water and dried with absorbent paper points .
the instrumented teeth were divided randomly into 3 experimental groups of 33 teeth each in addition to 2 groups which served as positive and negative control groups of 10 teeth each [ table 1 ] .
groups , number of specimens , and sealer placement techniques root canal obturation was performed by using the cold lateral condensation technique .
after sealer application according to the groups as shown in table 1 , the prefitted size 30 master gutta - percha cone was placed .
the process was repeated until the spreader penetrated only into the coronal one - third of the root canal space .
excess gutta - percha was removed with a heated instrument and the remainder was condensed vertically with a cold plugger .
the teeth were stored in 100% humidity at 37c for 7 days to allow the sealer to set completely .
after 7 days the external root surfaces were coated by two layers of nail polish except the coronal orifices . in the positive control group ,
no sealer was used and the nail polish was applied as the experimental group . while in the negative control group , the instrumented canals were filled with the sealer using rotary lentulo spiral and cold lateral compaction .
then , the external root surfaces were entirely coated with two layers of nail polish , including the coronal orifices . each tooth was subsequently immersed in an aqueous solution of 2% methylene blue dye with ph 7.0 in an individual container and kept in the incubator at 37c for 3 days .
the specimens were then decalcified in 5% nitric acid for 72 h and dehydrated gradually in ascending concentrations of alcohol to 100% .
methyl salicylate was used overnight to clear the teeth . for linear dye penetration assessment ,
each tooth was sectioned longitudinally by using a hard tissue cutter ( exakt , japan ) .
measurements were done by a blinded assessor under a light microscope ( leica , germany ) at x20 magnification .
the coronal leakage was measured to the nearest 0.01 mm , from the coronal end of gutta - percha , to the most apical extent of dye , taking into consideration the region of highest penetration .
this was completed using leica image analyzer software ( leica , germany ) , connected to the microscope .
ten teeth of each experimental group were randomly selected and dye penetration was measured again after 1 week by the same investigator to determine examiner reliability .
the data of the first and second measurements were tested using a single - measured intraclass correlation statistic ( icc ) .
the difference in the amount of linear dye penetration between groups was compared using anova .
the icc was 0.99 ( 95% ci : 0.991.00 ) suggestive of a high examiner reliability . due to technical problems during the experiment , one specimen was lost in group g1 , resulting in 32 samples for this group .
the positive controls demonstrated complete dye penetration throughout the length of the canal in all teeth .
in contrast , the negative controls showed no evidence of leakage in any of the samples .
means of linear dye penetration and standard deviations for all groups are summarized in table 2 .
there was no significant difference ( p = 0.305 ) of dye penetration among all groups .
one of the objectives of root canal treatment is to provide a hermetic seal of root canal space .
this seal is usually produced by using a semisolid or solid core material in a combination with the endodontic sealer .
a solid core can not produce the desired hermetic seal ; thus , the endodontic sealer is required to provide three - dimensional obturation .
the experimental system of this study was tested by using both positive and negative control groups .
the positive control specimens showed total dye penetration throughout the root canal , which indicated that it is absolutely necessary to use a sealer to fill voids and gaps between the core material and the root canal walls and further confirmed the fact that filling the root canal with only the core obturating material without a sealer resulted in an increased leakage .
however , the negative control specimens demonstrated no dye penetration , which indicated that two coatings of nail polish were an effective means of preventing dye penetration .
the results of this study showed no statistically significant difference ( p = 0.305 ) in microleakage among the three different tested techniques of sealer placement .
however , the rotary lentulo spiral group produced the highest value of microleakage and the master gutta - percha coating group had the smallest mean microleakage value .
it was expected that the rotary lentulo spiral group will produce a better adaptation of the sealer onto the canal walls with even thickness which in turn leads to a better seal but the results of this study did not support our assumption .
first , more amount of sealer was introduced into the canal as compared with other techniques , and as the sealer shrunk during setting , more gaps and voids might had been created that had contributed to the highest value of microleakage .
second , a high volume of the sealer material may also interfere with the placement of additional accessory points which leads to less gutta - percha volume percentage compared to the amount of sealer .
third , the use of rotary lentulo spiral during sealer placement may force some air bubbles into the material that will lead to void formation and microleakage , whereas , the endodontic sealer coating of master gutta - percha cone produced less sealer thickness with less potential void formation compared to the other techniques that eventually might have contributed to the smallest microleakage value obtained by this group .
our results are in accordance with wiemann et al . 's , who compared the influence of four methods , file , lentulo spiral , ultrasonic files , and master gutta - percha , of sealer placement on the sealer sealing ability .
in addition , they reported that less sealer was present in the apical third compared to the coronal and middle thirds of the root canal .
kahn et al . investigated the efficacy of six methods of sealer placement using clear plastic blocks with simulated curved canals .
they concluded that the lentulo spiral and the max - i - probe delivery system were the most effective means of sealer placement , followed by ultrasonic and sonic files , and the least effective methods were the paper point and the k file . in this study ,
the three methods of sealer placement showed comparable results and could be used in clinical practice .
however , as the master gutta - percha coating technique had produced the lowest microleakage values , it would be suggested to be used for better results .
the master gutta - percha coating technique is the simplest method among the three methods tested and it requires no additional instruments and procedures .
further research perhaps is needed to study the effect of different sealer placement methods with different obturation techniques .
within its limitations , this study showed that the three tested techniques of sealer placement provided a comparable seal .
however , the master gutta - percha coating technique could be preferable as it produced the least leakage value , and no extra instrumentation and procedures are needed in its application .

Answer:
aim : the aim of this in vitro study was to evaluate the sealing ability of an endodontic sealer following different techniques of its placement.materials and methods : a total of 119 permanent human anterior teeth were prepared by using manual protaper and randomly divided into three equal groups of 33 teeth each .
 the teeth were obturated with the cold lateral condensation technique and ah26 sealer which was placed by using the following : g1 : rotary lentulo spiral ; g2 : manual lentulo spiral ; and g3 : master gutta - percha coating . the remaining 20 teeth served as positive and negative controls . the samples were immersed in the methylene blue solution for 3 days and longitudinally sectioned for dye penetration assessment and analyzed using a stereomicroscope.results:there was no statistically significant difference ( p = 0.305 ) among the three groups .
 however , the rotary lentulo spiral technique and the master gutta - percha coating technique showed the highest ( 4.5 mm ) and the lowest ( 3.8 mm ) microleakage values , respectively.conclusion:different techniques of sealer placement used in this study provided a comparable seal .
 however , the master gutta - percha coating technique might be preferable because of its ease of use .


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

Paper text:
a rare , potentially fatal and usually self - limiting adverse effect of therapy with enalapril , the angioedema , is always a challenging encounter for an intensive care specialist .
the unpredictability of clinical course and the risk of airway compromise with not so high end airway management gears at hand make it more challenging in a rural health setup .
incidence of enalapril - induced angioedema is three times more common in population of african origin .
botswana provides universal health care to its citizens , and health sector is almost completely under government management .
we came across two cases in a very short window of about a month at a rural health center .
a 74-year - old female was admitted to the emergency department of sekghoma memorial hospital , serowe village , botswana , past midnight with progressive swelling of her face , tongue and breathing difficulty for about 8 h. the family gave a history of change of antihypertensive medication recently .
she has been started on tablet enalapril , 20 mg , once daily , orally , 2 days back . on examination , she was conscious , coherent but very anxious .
on auscultation of chest , air entry was good bilaterally and there were some conducted sounds from pharynx due to excessive secretions .
the tongue was grossly swollen , hard in consistency , it was wedged between the teeth and she was not able to close her mouth [ figure 1 ] .
it was not possible to transfer this case to a tertiary care hospital by helicopter as there were landing issues in darkness .
the patient was started on oxygen support at the rate of 5 l / min by facemask for building up her oxygen reserves in case of airway emergency .
lateral view x - ray of neck was done which showed airway patency as fine [ figure 3 ] .
elective blind nasal intubation as a proactive airway management was risky due to less chances of success and more risk of further airway compromise .
there were no ear , nose , and throat ( ent ) specialists available for either evaluation or surgical airway management .
she was injected with 100 mg of hydrocortisone , intravenously and 0.5 ml of injection adrenaline ( 1:1000 ) subcutaneously .
she was observed for about 30 min in which she gradually became worse and swelling of face and tongue increased .
we decided to go ahead with fresh - frozen plasma infusion under intravenous beta - blocker antihypertensive coverage .
her blood group was o - positive and hospital being a peripheral center ; we had only blood storage facility where o - positive fresh - frozen plasma was not available .
we decided to go ahead with transfusion of the only pint of o - negative fresh - frozen plasma available at our storage facility .
injection metoprolol , 5 mg , intravenously was instituted and then we started with o - negative fresh - frozen plasma infusion intravenously , 220 ml over next 30 min . on post - fresh - frozen plasma infusion ,
, she recovered grossly and after 6 h she was able to close her mouth completely .
the patient on arrival to intensive care unit the patient after fresh - frozen plasma transfusion lateral x - ray of neck taken to decide the airway management
ace inhibitors are one from the most widely used antihypertensive worldwide , particularly for the diabetics to prevent nephropathy and in cases of left ventricular dysfunction or heart failure . soon after the development of ace inhibitors , wilkin et al . reported angioedema and proposed enhanced kinin effects from inhibition of kininase ii as the underlying mechanism .
later , reports of ace inhibitor - related angioedema estimated an incidence between 1/1000 and 3/1000 .
angioedema was about three times more likely to occur among black patients ( 1.62% vs. 0.55% for white patients ) and slightly more likely in women ( 0.84% vs. 0.54% for men ) .
the incidence of angioedema was lower in diabetic patients ( 0.43% ) and higher in patients with renal disease ( 1.63% ) or a history of rash ( 2.48% ) .
the most common sites of angioedema were the lips ( 49% ) and the face ( 52% ) .
swelling of the tongue , neck , or eyelids occurred in approximately 1 of 5 patients with angioedema .
the incidence of angioedema was not affected by prior or current use of ace inhibitors at randomization .
they identified black race , history of drug rash , age > 65 years , and seasonal allergies as independent risk factors for angioedema related to enalapril .
slater et al . reported a 14-fold higher incidence of angioedema in the 1 week compared with later time intervals .
hedner et al . reported that about half of the cases occurred in the 1 week of therapy .
, these patients should be carefully examined for any evidence of respiratory compromise such as stridor , a markedly enlarged tongue , symptoms of dyspnea , acutely presenting dysphagia , and drooling of saliva .
lateral view x - ray of neck may be an important tool to decide about intubation .
the decision of when to intubate should be made early based on standard physiologic criteria , recognizing that intubation may be difficult secondary to edema of the airway .
cricothyrotomy or emergency tracheostomy is required for maintenance of the airway if oropharyngeal and nasopharyngeal intubation fails .
fluid resuscitation and therapy with vasopressors may be required if the patient is hemodynamically unstable .
hypotension can be seen in severe cases secondary to the extravasation of large amounts of fluid into the extravascular space .
patients presenting with respiratory symptoms should immediately receive 0.5 ml epinephrine ( 1:1000 ) subcutaneously .
therapy with antihistamines and steroids should be started initially in all patients , as a true allergic reaction can not be excluded . although the role of epinephrine , antihistamines , and corticosteroids is controversial in nonmast cell - mediated angioedema , i.e. ace inhibitor - related angioedema , in our case , we used all the three above - mentioned agents but there was no clinical improvement .
fresh - frozen plasma has been used successfully for the treatment of resistant , life - threatening angioedema induced by ace inhibitor .
the benefit of fresh - frozen plasma in this condition may be due to the effect of kininase ii in breaking down accumulated bradykinin . in this case , we used fresh - frozen plasma , and the clinical improvement was observed .
we recommend that in case of life - threatening enalapril - induced angioedema in rural setup , where advanced airway management procedures may be difficult , we must give an early thought about starting fresh - frozen plasma .
the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s )
has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal .
the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed .
the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s )
has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal .
the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed .
the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s )
has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal .
the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed .

Answer:
angioedema , a rare , potentially fatal and usually self - limiting adverse effect of therapy with enalapril , is always a challenging encounter for an intensive care specialist in a rural setup . here
 , we present a 74-year - old female , who presented to the emergency department of sekgoma memorial hospital , serowe village , botswana , with progressive swelling of her face , tongue and breathing difficulty just 2 days after starting tablet enalapril .
 she failed to respond to usual treatment with adrenaline , steroids , and h1-antihistaminic agent , but she responded well with intravenous fresh - frozen plasma infusion .
 this helped us manage a difficult airway situation in a less equipped rural health center .


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:
dr clark is the director of the centre for gambling research at ubc , which is supported by funding from the province of british columbia and the british columbia lottery corporation ( bclc ) .
dr clark has provided paid consultancy to cambridge cognition ltd . on issues relating to neurocognitive assessment .
dr clark has not received any other direct or indirect payments from the gambling industry or any other groups substantially funded by gambling to conduct research or to speak at conferences or events .

Answer:
billieux et al . ( 2015 ) propose that the recent proliferation of behavioral addictions has been driven by deficiencies in the underlying research strategy .
 this commentary considers how pathological gambling ( now termed gambling disorder ) traversed these challenges to become the first recognized behavioral addiction in the dsm-5 .
 ironically , many similar issues continue to exist in research on gambling disorder , including question - marks over the validity of tolerance , heterogeneity in gambling motives , and the under - specification of neuroimaging biomarkers .
 nevertheless , i contend that the case for gambling disorder as a behavioral addiction has been bolstered by the existence of clear and consistent functional impairment ( primarily in the form of debt ) , coupled with the development of a public health approach that has given emphasis to product features ( i.e. the structural characteristics of gambling forms ) as much as individual dispositions ( the  addictive personality ) .


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:
most pituitary adenomas are clinically inactive . in patients with long - standing compression of the optic chiasm , ganglion cells may undergo axonal degeneration .
spectral domain optical coherence tomography ( sd - oct ) is able to identify retinal nerve fiber layer ( rnfl ) and ganglion cell loss in the retina .
we present a case in which sd - oct was used to diagnose an asymptomatic pituitary macroadenoma .
sd - oct identified atrophy of the ganglion cell and nerve layers , with preservation of outer layers bilaterally .
as macroadenomas enlarge , they can induce uncrossed axon loss , resulting in nasal field defects and reduced visual acuity . in these cases , there is atrophy of the nasal and temporal portions of the optic disc , thus occupying a horizontal band across the disc .
sd - oct is able to identify rnfl loss in eyes with band atrophy of the optic nerve , which correlates with visual field defects found in perimetry .
sd - oct is a useful tool to assess the structural and functional damage of ganglion cells . in our case
the sd - oct demonstrated a symmetrical loss of the rnfl and the ganglion cell layer in both eyes , indicating important optic nerve damage .
pituitary adenoma is the most common cause of the chiasmal syndrome.1 the tumor is classified based on size as microadenoma , smaller than 10 mm , or as macroadenoma when it exceeds 10 mm in diameter.2 some tumors secrete one or more hormones in excess , so - called secretory pituitary adenomas , but most are clinically inactive.3 classically , the nonsecretory tumors present with vision loss,4 whereas patients with secretory tumors are usually referred to ophthalmologists for evaluation due to hormonal imbalances that affect bodily functions.5 in patients with long - standing compression of the optic chiasm , ganglion cells may undergo axonal degeneration4 .
optical coherence tomography ( oct ) is able to identify retinal nerve fiber layer ( rnfl ) and ganglion cell loss in retina.6,7 we present a case in which the oct ( 3d oct-2000 spectral domain oct , topcon corporation , tokyo , japan ) was used to diagnose an asymptomatic pituitary macroadenoma .
the authors adhere to the international standards developed in the 2 conference on research integrity in singapore ( 2010 ) , while performing this study .
the patient agreed to have their case published , and all information presented is non - identifiable.8
a 48-year - old , caucasian female presented with progressive vision loss in both eyes for several months .
her past ocular , medical , and family history was non - contributory with no fatigue , loss of libido , no mood change , and no weight change . on examination , best - corrected visual acuity was hand motion in the right eye and 2/3 in the left eye .
spectral domain optical coherence tomography ( sd - oct ) demonstrated diffuse atrophy of the ganglion cell and nerve layers , with preservation of outer layers bilaterally ( figure 1 and figure 2 ) .
magnetic resonance imaging of the brain was performed and a pituitary macroadenoma with suprasellar extension was observed ( figure 3 ) .
pituitary adenomas are common benign tumors of the pituitary gland that account for 12% of all intracranial tumors.9 people can develop pituitary adenomas at any age .
some adenomas secrete hormones in excess . of the secretory tumors , the most common are prolactinomas.5 they may be relatively small when detected .
the most common symptoms include headaches , menstrual changes in females , sexual dysfunction in males , vision problems , and behavioral changes.5 diagnostic imaging may include a high - resolution , t1 weighted , gadolinium enhanced magnetic resonance imaging.10 other secretory tumors may secrete corticotropin , growth hormone , gonadotropins , or thyroid - stimulating hormone.11 adenomas remain confined to the pituitary gland , but when a pituitary adenoma is 10 mm it is called a macroadenoma .
macroadenomas can compress the rest of the pituitary gland and surrounding structures , such as the crossing retinal ganglion cell axons in the optic chiasm , resulting in bitemporal visual field loss.4 as the tumor enlarges , it has been shown to induce uncrossed axons loss , resulting in nasal field defects and reduced visual acuity . in these cases , there is atrophy of the nasal and temporal portions of the optic disc with relative sparing of the superior and inferior parts where the majority of temporal fibers enter .
the optic atrophy occupies a horizontal band across the disc , called bowtie or band atrophy.12,13 oct is a noninvasive technique that allows cross - sectional imaging of the retina and quantifies the thickness of the rnfl around the optic nerve head .
a number of studies have demonstrated that oct is able to identify rnfl loss in eyes with band atrophy of the optic nerve.6,7 the degree of rnfl thickness reduction has been shown to correlate with that of visual field defects using goldmann perimetry4 and automated static perimetry.14,15 this fact gives oct prognostic value regarding the visual outcome , as demonstrated in different studies.16,17 oct is a useful tool to assess the structural and functional damage of ganglion cells , objectively and quantitatively.4 in our case the sd - oct demonstrates a symmetrical loss of the rnfl and the ganglion cell layer in both eyes , indicating important optic nerve damage .
sd - oct can help in the diagnosis of adenomas in equivocal situations in which there is only subtle optic nerve pallor in the setting of nonspecific visual complaints or visual field defects , or when patients are referred to screen for subclinical compressive optic neuropathies .

Answer:
introductionmost pituitary adenomas are clinically inactive . in patients with long - standing compression of the optic chiasm
 , ganglion cells may undergo axonal degeneration .
 spectral domain optical coherence tomography ( sd - oct ) is able to identify retinal nerve fiber layer ( rnfl ) and ganglion cell loss in the retina .
 we present a case in which sd - oct was used to diagnose an asymptomatic pituitary macroadenoma.clinical casea 48-year - old female presented with progressive vision loss in both eyes .
 sd - oct identified atrophy of the ganglion cell and nerve layers , with preservation of outer layers bilaterally .
 magnetic resonance imaging of the brain showed a pituitary macroadenoma .
 the pathological diagnosis was nonfunctioning adenoma.discussionas macroadenomas enlarge , they can induce uncrossed axon loss , resulting in nasal field defects and reduced visual acuity . in these cases , there is atrophy of the nasal and temporal portions of the optic disc , thus occupying a horizontal band across the disc .
 sd - oct is able to identify rnfl loss in eyes with band atrophy of the optic nerve , which correlates with visual field defects found in perimetry .
 sd - oct is a useful tool to assess the structural and functional damage of ganglion cells . in our case
 the sd - oct demonstrated a symmetrical loss of the rnfl and the ganglion cell layer in both eyes , indicating important optic nerve damage .


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:
cerebral palsy ( cp ) is a non - progressive neurodevelopmental disorder that includes a wide
 spectrum of syndromes related to the early onset of posture and motor impairment1 .
dysfunctional postural control and movement
 patterns lead to limitations in participation in activities of daily living ( adl)2 .
according to jeong et al.3 cp is the most common infant brain injuries
 in south korea , representing 57.8% of brain injuries in the 09 years category .
management
 of children with cp requires various rehabilitative approaches that draw on the expertise of
 many specialists in different disciplines .
some of the current clinical therapeutic
 interventions include traditional physical and occupational therapy , neurodevelopmental
 treatment , the vojta method , and sensory integration to improve postural control , balance ,
 and locomotion for improved participation in adl4 .
many children with cp not only exhibit neuromotor deficits but demonstrate difficulties
 with sensory processing and praxis5 .

sensory integration is a dynamic process that synthesizes , organizes and processes incoming
 sensory information from the body and the environment in order to create purposeful and
 goal - directed responses6 .
good sensory
 integration leads to the development of good body scheme , self - image , integration of
 primitive reflexes , balance , postural stability , ability to motor plan , coordination of two
 sides of the body , and eye - hand coordination7 . among the sensory systems ,
although it may be important to apply sensory integration treatment
 techniques and sensory based activities for children with cerebral palsy , therapists maybe
 reluctant to do so as the evaluation of vestibular processing can prove to be difficult9 and vestibular activities may increase
 muscle tone in unwanted areas5 .
the
 purpose of this case report is to present the effects of vestibular stimulation on a child
 with hypotonic cerebral palsy through the use of swings .
this case was referred to this author via the child s occupational therapist who felt the
 child would benefit from this study .
inje university affiliated hospital ethics review board
 approved this case study and informed consent was obtained from the child s mother .
the subject was a 19-month - old boy with a diagnosis of hypotonic cerebral palsy ( cp ) and
 oscillating nystagmus .
he was born at 39 weeks of gestation via caesarian section and there were no
 complications reported at birth .
however his mother reported him to be a fussy baby who
 cried often and appeared to be colicky .
he started to demonstrate head
 control at about 8 months and ability to maintain the ring - sitting position for less than 30
 seconds using his hands to prop himself up when put in a seated position ; however he had not
 made any further progress in gross motor skills since . at 5 months of age
, he started to
 receive therapy for developmental delays , including hospital based occupational therapy 2
 times per week , physical therapy using the neurodevelopmental treatment ( ndt ) technique and
 the vojta method 2 times per week , and sensory stimulation once a week .
he was reported to
 cry incessantly and was inconsolable in all of his therapy sessions from when he started
 therapies at 5 months to his initial assessment for this case study .
pre and post - intervention tests were completed by the researcher using the bayley scales of
 infant and toddler development ii .
after the pre - intervention test and during the
 intervention phase all of the subject s other therapies were stopped to control the effect
 of vestibular stimulation without other interventions .
the subject was provided with
 vestibular stimulation 3 times per week for 10 weeks in 1 hour sessions conducted by his
 mother as instructed by the researcher .
each session started with 30 minutes of swinging on
 an infant swing for all 10 weeks .
the vestibular stimulation protocol using different swings
 is shown in table 1
 table 1.vestibular stimulation protocol
 .
the subject s mental raw score was 21 with a corresponding developmental age of 1 month ,
 and his motor raw score was 40 with a corresponding developmental age of 6 months ,
 pre - intervention .
the subject s mental score increased to 46 with a corresponding
 developmental age of 4 months , and his motor score increased to 58 with a corresponding
 developmental age of 10 months ( tables 2table 2.results of bayleyscalepre - testpost - testraw scorepercentile % raw scorepercentile % mental 2146motor4058behavior ratingorientation e111%3223%emotional r121%286%motor q151%251%additional i14total r score391%897% , 3table 3.results of bayley , developmental agepre - testpost - testmental developmental age1 month4 monthsmotor developmental age6 months10 months ) .
the results show that the subject exhibited improved mental and motor skills of 3 and 4
 months respectively which is a significant improvement at this age of development .
the
 subject was able to ring - sit for less than 30 seconds at pre - test , and was not able to
 transition from supine or prone to sitting or from sit to pull to stand .
however after 10
 weeks of intervention he was able to walk with his hand held and independently for about 15
 meters before losing balance , and he was able to transition from supine or prone to sit to
 pull to stand independently .
as for mental skills , the subject showed no interest in toys or
 people and he cried throughout the entire therapy session at the beginning of this study ;
 however once he was introduced to vestibular stimulation by swinging , he smiled , laughed and
 started to interact with both toys and people .
postural control is dependent on the integration of proprioception , vision and vestibular
 systems of which vestibular input is particularly important10 .
adequate motor performance and postural control is needed for an
 infant or a young child to independently perform and participate in play , activities of
 daily living and social interactions .
infants diagnosed with cerebral palsy demonstrate
 difficulties with postural control and locomotion and can miss opportunities to explore
 their environment11 .
the subject in this
 case study was diagnosed with hypotonic cerebral palsy and demonstrated poor postural
 control , only being able to maintain a ring - sit position using his hands to prop himself up
 for 30 seconds .
the subject was not able to explore his environment due to lack of mobility
 and he did not use his hands at the beginning of this research .
one possible explanation for
 his incessant crying during all of his therapy sessions in the past year is that he had an
 inefficient vestibular system .
sensory integration of the vestibular system provides a
  gravitational security  which helps with the emotional well - being5 however , due to the subject s poor integration of the
 vestibular system , he may have been fearful of being moved during all of his therapies which
 made him resistant and cry .
when the subject was presented with intense vestibular inputs on
 different swings , he stopped crying very quickly and responded by holding his head and trunk
 more erect and eventually improved his postural control enough for him to walk . at the
 beginning of this study ,
the subject made no attempt to move his body and spent most of his
 waking hours lying in supine .
when his mother put him in sitting position or moved him , he
 cried and was resistant to being moved .
however by the end of this research the subject
 demonstrated improvements in movement in space and transitioning from supine or prone to
 sitting and from sitting to pull to stand independently .
the vestibular system is thought to be a primary organizer of sensory information and
 contributes to physical and emotional security12 .
this case study shows that improving the integration of the
 vestibular system through the use of swings resulted in the improvement of the subject s
 postural control , movement , exploration , and emotional well - being .
the subject s mother
 reported feeling anxious and helpless as she did not know how to console or interact with
 her crying child .
however once the subject had been introduced to vestibular inputs on
 different swings , he responded almost immediately by not crying , and started to laugh out
 aloud and babbling .
both the subject and his mother appeared much more relaxed with each
 other and able to interact with each other better as the subject decreased crying and
 started to explore his environment .
the subject s mother reported that at the beginning of
 this study she could not take him anywhere to play as he cried the entire time when she took
 him to playgroups and playgrounds but from about the middle of the intervention of this
 study , he started to feel comfortable when taken to new environments .
the level of subject s
 comfort , exploration , interaction , and play had improved significantly by the end of this
 study .
this study has demonstrated that vestibular inputs through the use of swings has improved
 the subject s postural control , movement in space , emotional well - being , interaction with
 people and environment and participation in play .
therefore therapists may wish to consider
 providing vestibular inputs for children with hypotonic cerebral palsy in treatments to
 facilitate postural control and emotional well - being .
sensory based activities must be
 provided by a well trained and experienced therapist as children with cerebral palsy present
 neuromotor deficits as well as sensory issues .
a limitation of this case study is that there
 was only one subject which makes it difficult to generalize the findings to a wider
 population .
therefore , further research with larger sample sizes are needed to determine the
 effectiveness of vestibular inputs through the use of swings on children with hypotonic
 cerebral palsy .
future studies should also look at the effectiveness of sensory integration
 and ndt in the treatment of children with cerebral palsy .

Answer:
[ purpose ] the purpose of this case report is to present the effects of vestibular
 stimulation on a child with hypotonic cerebral palsy through the use of swings .
 [ case
 description ] the subject was a 19-month - old boy with a diagnosis of hypotonic cerebral
 palsy ( cp ) and oscillating nystagmus .
 the subject had received both physical therapy and
 occupational therapy two times per week since he was 5 months old but showed little to no
 improvement .
 [ methods ] pre and post - intervention tests were completed by the researcher
 using the bayley scales of infant and toddler development ii . the subject was provided
 with vestibular stimulation 3 times per week for 10 weeks in 1 hour sessions conducted by
 his mother as instructed by the researcher . during this research
 all other therapies were
 stopped to determine the effects of the vestibular stimulation and to exclude the effects
 of other therapies .
 [ results ] the subject demonstrated improvement of 4 months in motor
 skills and of 3 months in mental skills as shown by the bayley scales of infant and
 toddler development ii . [ conclusion ] vestibular stimulation was effective in improving
 postural control , movement , emotional well - being , and social participation of a child with
 hypotonic cerebral palsy .


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:
data on all campylobacter isolates obtained from fecal or lower gastrointestinal tract samples , reported in england and wales from 1990 through 2007 , were extracted from the national laboratory database ( labbase ) and stored in a microsoft access ( microsoft corp . ,
cases were assigned to 10-year age groups and to geographic areas on the basis of laboratory location ( northern , mid - country , southern ) .
the season was assigned on the basis of the earliest available specimen date ( spring , march  may ; summer , june  august ; autumn , september
data on cases of cryptosporidiosis and nontyphoidal salmonellosis for the same period were extracted , grouped , and categorized and manipulated as above for comparative purposes .
denominator data for england and wales for the same period were obtained from the office for national statistics .
data were analyzed in microsoft excel 2003 and stata version 10 ( statacorp , college station , tx , usa ) .
estimates of incidence per 100,000 population were calculated throughout ; relative risks ( rr ) and 95% confidence intervals ( cis ) were calculated as required . from 1990 through 2007 in england and wales , 838,436 cases of campylobacter infection were reported ; patient age was available for 810,632 case - patients ( 96.7% ) . from 1990 through 1999 , incidence increased in all age groups ( figure 1 ) , but the increase was proportionate to increasing age ( 09 years of age rr 1.07 [ 95% ci 1.031.10 ] ; 1019 years rr 1.47 [ 95% ci 1.411.55 ] ; 2059 years rr 1.78 [ 95% ci 1.751.81 ] ; > 60 years rr 2.51 [ 95% ci 2.412.61 ] ) . from 2000 through 2004 , incidence declined in all age groups .
however , although the degree of decline was similar for those 09 years of age ( rr 0.77 [ 95% ci 0.740.8 ] ) , 1019 years ( rr 0.73 [ 95% ci 0.700.76 ] ) , and 2059 years ( rr 0.75 [ 95% ci 0.740.76 ] ) , for patients > 60 years of age , the degree of decline was significantly lower ( rr 0.88 [ 95% ci 0.860.91 ] ;  p<0.001 ) .
finally , although the incidence increased only moderately among those 1019 years of age ( rr 1.02 [ 95% ci 0.981.07 ] ) and 2059 years ( rr 1.04 [ 95% ci 1.031.06 ] ) from 2005 through 2007 , greater increases were observed for those 09 years ( rr 1.12 [ 95% ci 1.081.17 ] ) and those > 60 years ( rr 1.33 [ 95% ci 1.291.36 ] ) . during the surveillance period , therefore , the incidence among patients > 60 years of age , compared with the incidence among younger patients , increased markedly ( rr 0.45 [ 95% ci 0.440.47 ] in 1990 to rr 1.17 [ 95% ci 1.151.19 ] in 2007 ) .
this effect was observed for campylobacteriosis in both sexes , in 3 geographic areas of england and wales , and in all 4 seasons , but was not observed for nontyphoidal salmonellosis or cryptosporidiosis ( figure 2 ; technical appendix ) .
incidence of laboratory - reported campylobacteriosis , england and wales , by age group , 19902007 .
relative incidence of campylobacteriosis by sex , region , and season , compared with rates of salmonellosis and cryptosporidiosis , among patients > 60 years of age , england and wales , 19912007 .
northern , northwest , northeast , as well as yorkshire and the humber regions ; mid - country , wales , west midlands , east midlands , and east of england regions ; southern , london as well as southeast and southwest regions .
salmonellosis includes nontyphoidal salmonellae , with age data available for 356,270 of 380,915 case - patients ( 94% ) ; cryptosporidiosis includes age data for 76,462 of 79,808 case - patients ( 96% ) .
we report a striking change in the population at risk for campylobacteriosis in england and wales , which is independent of gender , geography , or season .
the absence of a similar change in the age distribution of laboratory - reported salmonellosis or cryptosporidiosis from the same population suggests that this is unlikely to be a surveillance artifact .
campylobacter infections are rarely typed beyond the genus level in england and wales , so infections are routinely reported as campylobacter species .
therefore , changes in the incidence of the various species that constitute this broad case definition could possibly explain some of the altered disease pattern reported .
for example , infections caused by certain species ( e.g. , c. fetus ) are more often associated with coexisting conditions that might occur more frequently in the elderly .
first , isolation methods used in england and wales favor the growth of c. jejuni and c. coli ( 4,5 ) over that of other species , including c. fetus . furthermore , c. fetus normally causes systemic infections detected through blood culture , and the proportion of blood to fecal isolations of campylobacter species in patients > 60 years of age reported in england and wales remained constant from 1990 through 1999 ( 275/58,139 fecal isolations ; 0.47% ) , from 2000 through 2004 ( 185/44,349 ; 0.42% ) , and from 2005 through 2007 ( 135/31,637 ; 0.42% ) ( health protection agency , unpub . data ) . when disease incidence was ranked according to specific population group , children 09 years of age had the highest ranking in 1990 , but by 2007 , incidence for this age group ranked seventh of 9 age groups .
this finding led to the hypothesis that the introduction and increased utilization of the national health service s nhs direct ( a 24-hour telephone , online , and interactive digital tv service , which provided health advice and information ) at this time had a  triage effect  on those seeking care for children in this age group .
the 2 events are correlated in time ( initial nhs direct pilot sites began taking calls in march 1998 ; by april 1999 , 40% of the population of england had access , and by november 2000 , the service was available throughout england and wales ) , nhs direct has had a demonstrable negative effect on the use of general practice ( 7 ) , and infants and young children are overrepresented among calls to nhs direct about gastrointestinal conditions ( 8) .
the second infectious intestinal disease study in england , currently under way ( 9 ) , will provide further information upon which to assess this hypothesis , which is not readily testable by using laboratory data . by far the most striking
finding of this study is the emergence of older persons as the population most at risk for campylobacteriosis in england and wales .
although the elderly were not the only group at risk in 2007 ( because of increasing incidence ) , the overall trend singles them out as the main emerging at - risk group ( the increase in other age groups requires continued monitoring , however ) .
the pattern of infection in older patients is perhaps predictable , given the similar pattern for incidence of listeriosis in england and wales since 2001 ( 10 ) . as life expectancy increases in the united kingdom ,
the number of persons living with chronic conditions is likely to increase ; these factors suggest that the incidence of campylobacteriosis in older persons will continue to increase in the future .
therefore , risk factors for campylobacter infection specific to older uk residents must be identified .
relative incidence of campylobacter infection in each year compared with that in 1990 among patients > 60 years of age infected with selected gastrointestinal pathogens , england and wales , 1991 - 2007

Answer:
to explore hypotheses for age - related changes in the incidence of campylobacter infections in england and wales during 19902007 , we analyzed electronic laboratory data .
 disease incidence was reduced among children , and the greatest increase in risk was for those > 60 years of age .
 risk factors for campylobacteriosis in the elderly population should be identified .