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

Paper text:
in 2012 , an estimated 790,000 women in the united states were diagnosed with cancer , of whom 10% were of reproductive age ( american cancer society , 2012 , schover , 2005 ) .
[ nih surveillance ] ( national institute of health , 2010 , society of family planning , 2012 ) addressing the possibility of future pregnancy is an important aspect of survivorship and quality of life for patients undergoing cancer treatment , and several ways to preserve fertility during cancer therapy have been developed and studied ( letourneau et al . , 2012 ,
as background , 49% of pregnancies in the united states are unintended and unplanned ( the alan guttmacher institute ( agi ) , 2013 ) .
patients with medical co - morbidities , including those undergoing cancer treatment and/or surveillance , are among this group .
it is estimated the incidence of malignancy and pregnancy is approximately 1:1000 ( pavlidis , 2002 , smith et al . , 2003 ) . although rare , pregnancy in the setting of cancer treatment may create clinical and ethical dilemmas , with potential increased risks for both the patient and gestation .
these dilemmas are further compounded when a pregnancy in this setting is unplanned . among women who have undergone or are currently undergoing cancer treatment
, there is limited data regarding the rate of unintended pregnancy or patients ' impression of fertility .
it has been previously reported that childhood cancer survivors between 15 and 30  years old were more likely to terminate a pregnancy compared to age - matched controls ( green et al . , 2002 ) .
a survey of female cancer patients revealed that 55% believed that they could not become pregnant after cancer treatment , and 45% of the same group denied using any contraception method ( patel et al . , 2009 ) .
both of the aforementioned studies support the notion that we could improve counseling in this patient population regarding fertility potential and contraception planning . in gynecologic cancer patients , women with early stage cancers may be eligible for fertility sparing treatment , and therefore may be at risk for unplanned pregnancy after therapy if contraception is not addressed as well ( mclaren and bates , 2012 ) . for this reason
, we conducted a survey of current members of the society of gynecologic oncology ( sgo ) regarding reproductive counseling , practices , and experience with unplanned pregnancy in this population .
after obtaining approval from our institutional review board , a list of member email addresses was obtained from the sgo .
an email statement of confidentiality with the questionnaire link was emailed to all listed members . following the initial e - mail , members received two additional follow - up e - mails , two and four weeks respectively , after the initial contact .
the survey remained open for responses for two weeks following the third , and final , reminder .
survey monkey was utilized to create and administer a nineteen question survey regarding demographics , contraception counseling and use practices , referral patterns , and incidence of unplanned pregnancy .
demographic data queried were age , gender , region of country of current residence , medical specialty , level of training , description of clinical practice , and number of years caring for gynecologic oncology patients .
questions regarding consistency to which the provider addresses contraception and fertility concerns were answered using a likert - type scale ( i.e. , always , sometimes , rare , never , not applicable ) .
the remaining questions were answered using a yes / no or a multiple - choice format .
the multiple - choice questions specifically addressed the frequency of contraception methods counseling and administration , and number of patients experiencing unplanned pregnancy .
participants were asked to check all contraceptive methods that they counseled and administered / prescribed .
contraceptive methods specifically included were the oral contraception pill ( ocp ) , injectable , intrauterine device ( iud ) , or subdermal levonorgestrel implant .
prevalence of unplanned pregnancy was evaluated by asking practitioners to estimate prevalence of unplanned pregnancy among their patients ( during or after treatment ) in the previous one and five years respectively .
we excluded the responses of anyone who reported that he / she was retired or did not provide information on their reproductive counseling patterns .
logistic regression analysis was used to model separately the odds of  always  or  sometimes  offering fertility and/or contraceptive counseling .
all analyses were conducted using stata 13.0 ( statacorp , college station , texas ) .
questionnaires were completed by 261 respondents , yielding a response rate of 18% . among the respondents 21 ( 8% ) reported that they were retired and/or did not provide information regarding their reproductive counseling patterns and thus were excluded from the analysis .
overall , the respondents had a mean age of 47  years with a slight predominance of females ( 52% ) , which is consistent with sgo demographics ( mean age of male members 50  years old , mean age of female members 45  years old ) .
our survey had a higher proportion of fellow respondents ( 24% ) than sgo as a whole ( 9% ) [ gynecologic oncology 2015 : state of the subspecialty ] selected characteristics of respondents are presented by reproductive counseling status in table 2 . among respondents ,
34.6% reported sometimes or always providing counseling on fertility and contraception , 19.2% reported providing fertility counseling only , 15.8% reported providing contraception counseling only , while 30.4% reported not routinely providing counseling on either topic .
in general , providers who reported providing reproductive counseling on neither topic were more likely to be male and/or a fellow .
they also tended to be <  40  years of age , though this difference was not statistically significant .
physicians who reported not routinely counseling on either topic were less likely to report prescribing or administering contraception and/or were less likely to report referring to reproductive endocrinology .
in contrast , those who reported providing counseling on both fertility and contraception were more likely to be female and/or an attending .
they also were more likely to be older ; although that difference was not statistically significant . providers who reported sometimes or always providing counseling on both reproductive topics were also more likely to report providing or administering contraception and/or to refer to reproductive endocrinology . there were no notable differences in reproductive counseling status by u.s .
next , we examined what factors were associated with an increased odds of reporting providing fertility counseling sometimes or always ( table 3 ) .
after adjustment for gender , we found that the odds of reporting providing fertility counseling were nearly three times higher among attending physicians as compared to fellows [ aor  =  2.72 ; 95% ci  =  ( 1.44 , 5.12 ) ] . in examining contraceptive counseling ( table 4 )
, we found that the odds of reporting providing contraceptive counseling was 2.8 times higher in women as compared to men and was 4.91 times higher in individuals age 50  + compared to those <  40 after adjustment for level of practice .
overall , 81.7% of providers reported counseling , prescribing , or administering contraception to their patients . among these individuals ,
the most frequently cited contraceptive that providers reported addressing with their patients included : oral contraceptive pills ( 81% ) , intrauterine devices ( 73% ) , depot medroxyprogesterone acetate ( dpma ) injections ( 56% ) , and contraceptive implants ( 21% ) .
the most frequently cited contraceptives that providers reported prescribing or administering included : oral contraceptive pills ( 80% ) , intrauterine devices ( 62% ) , dpma injections ( 48% ) , and contraceptive implants ( 9% ) .
the reported prevalence of unplanned pregnancy among the surveyed providers ' patients was relatively rare , perhaps because it is not routinely addressed .
most providers ( 95% ) reported 05 unplanned pregnancies among their patients in the last 5  years , with only 3 providers ( 1% ) reporting more than ten unplanned pregnancies .
unplanned pregnancy in the setting of cancer treatment or surveillance is a complicated issue , and may create clinical and ethical dilemmas for the patient , partner , family , and treatment team .
the majority of survey respondents appropriately acknowledged the risk of unplanned pregnancy among gynecologic cancer patients maintaining fertility potential .
however , only half reported addressing contraception planning in this population on a consistent basis ( 52%  always  addressing contraception , versus 35%  sometimes  ) . regarding the consistency with which contraception is addressed ,
these findings are consistent with a retrospective chart review completed at our institution where 45% of initial consultations documented a contraception plan in fertile patients of reproductive age , and 32% of follow - up visits for those that maintained fertility potential after cancer treatment ( crafton et al . , 2016 ) . depending on individual circumstances
patient 's reproductive goals should be determined in order to tailor fertility - sparing treatment , when possible , versus contraception planning .
unfortunately , only half of respondents reported always addressing fertility concerns with patients in this population .
this is consistent with the fact 59% of those surveyed routinely offer referral for preconception counseling for those patients considering fertility preservation options or planned pregnancy .
referral specifically for contraception counseling was reported less frequently , and even fewer reported follow up for plan establishment .
our study was unable to determine which patients or providers relied on the patient 's primary care physician or gynecologist for the establishment of a contraception plan .
the incidence of unplanned pregnancy in this population is reportedly rare , with 96% of responding physicians experiencing <  5 unplanned pregnancies in the previous five years .
this may be under - reported , as oncologists may be unaware of pregnancies , especially during disease surveillance . despite the rarity ,
eleven providers report experiencing an estimated 620 unplanned pregnancies during that time same . the opportunity to avoid even a fraction of those merits further acknowledgement of this topic .
it is reassuring that the large majority of providers reportedly counsel for and administer contraception methods , including 89% reportedly counseling for the iud and 77% employing its use .
however , it was not specified in this survey if the indication for oral contraceptive pills ( ocps ) or an iud was for contraception planning or cancer therapeutic purposes . of reported methods ,
ocps were the most frequent contraception method both counseled for and administered . when compared to implantable methods , both the iud and subdermal implant , both actual and ideal use of ocps
have a higher failure rate , and therefore more reliable methods should be considered first , barring contraindications ( centers for disease control and prevention , 2010 ) .
given our findings that the attending cohort was more likely to provide contraception and/or fertility counseling sometimes or always compared to the fellow respondents ( table 2 , table 3 ) , there seems to be an opportunity to improve education for fellows regarding fertility preservation options for these patients . as seen in other survey - based studies ,
the primary limitation of the study is the modest response rate , despite multiple recruitment attempts and limiting the length of the survey ( cunningham et al . , 2015 ) .
given the response rate , the potential for selection and survey content bias ( i.e. , only those who were interested in the topic responded ) is present thus the results may have limited external validity .
however , as aforementioned , our respondent cohort is comparable to the data published in the 2015 society of gynecologic oncology : state of the subspecialty .
inclusion of both fellows in training and retired members also limits the external validity of the survey regarding current members , but we felt inclusions of these populations were interesting and important in order to compare potential generational differences .
many gynecologic cancer diagnoses are made in peri - menopausal or postmenopausal women ; therefore assessing what portion of a provider 's practice is of reproductive age could aid discussion and interpretation of results .
likewise , as the type of cancer and respective treatment options may change the potential for or etiology of infertility , assessing providers ' experience with specific disease processes , such as gestational trophoblastic neoplasia , also could aid discussion , and intervention .
we acknowledge that a contraception plan may not appropriate for all patients undergoing cancer care , especially for who decline fertility sparing treatment , have been previously sterilized , or are actively attempting conception / currently pregnant .
however , routine recognition of reproductive goals should be addressed by providers to alleviate potential biases or assumptions regarding patients ' reproductive goals or sexual activity .
previous literature has reported providers ' lack of counseling and patients ' misunderstanding of reproductive potential after cancer treatment , and therefore a patient survey would be as valuable as the provider 's impression we report ( patel et al . , 2009 , karaoz et al . , 2010 ) .
as life expectancy following cancer treatment diagnosis and treatment improves , and quality of life of survivors is emphasized , helping women meet their reproductive goals should remain an important focus .
comprehensive reproductive counseling should be emphasized , including both fertility sparing options and contraception planning , with the ultimate goal of decreasing unplanned pregnancy .

Answer:
we sought to identify how gynecologic oncologists approach reproductive counseling for their fertile , reproductive age patients , and their experience with unplanned pregnancies.members of the society of gynecologic oncology ( sgo ) were surveyed electronically regarding consistency of counseling patterns of contraception and fertility concerns , most and least common contraceptive methods utilized , referral patterns , and incidence of unplanned pregnancy . of the 1424 sgo members identified , 261 participated in the questionnaire , yielding a response rate of 18% .
 eighty - two percent of respondents agreed unplanned pregnancy is a potential problem , but only 57% believed their patients understood unplanned pregnancy is possible during treatment .
 half of respondents report  always  in terms of frequency that contraception is addressed among their high - risk patients . after adjustment for gender
 , we found that the odds of reporting providing fertility counseling were nearly three times higher among attendings as compared to fellows [ aor  =  2.72 ; 95% ci  =  ( 1.44 , 5.12 ) , three times higher in women as compared to men [ aor  =  2.80 ; 95% ci  =  ( 1.46 , 5.38 ) ] , as well as in individuals 50  + years as compared to those <  40  years old [ aor  =  4.91 ; 95% ci  =  ( 2.05 , 11.74 ) ] .
 ninety - six percent reported <  5 unplanned pregnancies , to their knowledge , in the previous five years of clinical practice .
 most providers acknowledge that unplanned pregnancy is a potential risk in fertile gynecologic oncology patients , but only half believe their patients understand an unplanned pregnancy is possible .
 an opportunity exists to provide more directed counseling regarding fertility during and after cancer therapy , and to educate patients and providers regarding more reliable , long acting contraceptive methods .


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:
psychiatric and psychological morbidity has been reported in patients with genital warts . even though , genital warts are generally not associated with severe symptoms , they have profound adverse impact on quality of life of patients .
if patient with genital warts , complains of severe and unusual symptoms are often considered psychological .
we report a case of giant genital warts where the patient complained of formication ( insect - crawling sensation ) which was subsequently found to be due to maggot infestation in the warts .
a 23-year - old married woman presented with large exophytic growth arising from perineum , vulva , introitus of the vagina , and inner aspect of thighs for past 4 months [ figure 1a ] .
patient developed severe itching and formication in the lesions for 1 week , though she had never seen or recovered any insect .
sexual history of the patient and her husband was unremarkable . in view of giant genital wart
, serum enzyme - linked immuno sorbent assay ( elisa ) for hiv and venereal disease research laboratory ( vdrl ) test for syphilis was done for both husband and the wife but were negative .
( c ) three months after complete excision using a radiofrequency device cutaneous examination revealed an approximately 10  5 cm
hyperpigmented , pedunculated growth with verrucous surface over both the labial folds symmetrically , completely obliterating the introitus . on per speculum examination ,
a diagnosis of giant condylomata acuminata was made and it was thought that patient 's unusual complaint about the
the hpv viral genotyping using linear array ( roche ) showed hpv 6 and 11 .
histopathology from the warts did not show any evidence of bushke lwenstein tumor or squamous cell carcinoma . on histopathological examination hyperkeratosis , papillomatosis , koilocytosis and dilated and congested
capillaries in the dermis were found . within few days of presentation , she started complaining of paroxysms of severe perineal scratching consequent to increased sensation of crawling insects . but
thinking that the disease was causing immense psychological stress hence leading to the strange symptoms , serial excision of the warts with a radiofrequency device ( ellman , oceanside , ny , usa ) was planned . during the procedure ,
local anaesthetic ( 2% lignocaine with adrenaline ) was infiltrated in the lesion and the procedure was started .
suddenly , perhaps due to irritation caused by radiofrequency current , multiple live maggots were seen coming out of verrucous masses [ figure 1b ] .
the procedure was abandoned and thick white petrolatum was applied to the area . approximately 20 live maggots were then removed with the help of forceps [ figure 2 ] and few of them were sent for entomological examination .
the patient was given intravenous antibiotics ( ceftriaxone and amikacin ) in view of some denuded area produced due to radiofrequency excision of few warts .
a magnetic resonance imaging ( mri ) of abdomen and pelvis was done to rule out deeper soft tissue infestation and damage by the maggots which turned out to be normal .
patient 's symptoms completely resolved with few more sessions of extraction of maggots over the next 2 days and subsequent examination did not reveal any maggots .
some of the removed maggots later , external genital warts were completely excised with radiofrequency [ figure 1c ] .
there was no recurrence of excised warts in 4-month post - operative follow - up .
warts inside the vagina are being treated with imiquimod and at the time of writing this report , they have reduced substantially in size and this treatment is being continued .
myiasis is a parasitic infestation of human or animal skin , necrotic tissues and natural cavities by fly larvae or pupa .
human myiasis is caused by fly larvae capable of penetrating body orifices as well as healthy or necrotic tissue .
patton divided myiasis - causing flies into three parasitologic categories : obligatory , facultative , and accidental .
cochliomyia hominivorax , chrysomya bezziana , and wohlfahrtia magnifica are the most common flies worldwide that cause human wound myiasis .
chrysomia bezziana is the most common cause of cutaneous myiasis in india but usually infests wounds and mucous membranes .
predisposing factors for human wound myiasis include open wounds , poor hygiene , advanced age , psychiatric illness , diabetes , vascular occlusive disease , and physical handicap .
the clinical manifestations of wound myiasis vary according to the affected body area and the extent of the infestation .
patients may present with fever , pain , bleeding from the infested site or may be complicated by secondary infection and tetanus .
as far as ascertained , there is only one report in literature on myiasis in genital warts from brazil in which the patient was pregnant and after removal of maggots the pregnancy ended in spontaneous abortion .
myiasis in our case was unusual in view of its site and its occurrence in the absence of the usual risk factors .
due to rarity of condition , and our unfamiliarity we did not consider infestation by maggots though patient complained of crawling sensation and severe itching in the genital warts . the lesson learnt is to examine and investigate the patient thoroughly before dismissing patient 's complaints as irrelevant , psychogenic or functional , however unusual and unexplainable they are for the disease .
the simplest treatment for myiasis is application of an occlusive agent such as white soft paraffin , wax , glue , adhesive tape or chewing gum followed by physical removal of maggots .

Answer:
a 23-year - old woman presented with large exophytic genital wart arising from perineum , vulva , introitus of the vagina , and inner aspect of thighs .
 patient developed severe itching and formication ( insect - crawling sensation ) in the lesions for past 1 week , though careful examination did not reveal any insects . considering that the disease was causing psychological stress and physical symptoms , radiofrequency excision was planned .
 however , during the procedure , several maggots appeared from the crypts .
 the procedure was abandoned and maggots were removed manually . subsequently external giant warts were removed using radiofrequency device .
 there was no recurrence of excised warts during 3 month follow - up .
 to our knowledge , this is the second reported case of maggots in genital warts .


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

Paper text:
in a recent article in genome research , thompson and colleagues present a development of a next - generation sequencing technology - the heliscope sequencer - that enabled them to detect mutations in the human breast cancer 1 ( brca1 ) gene , as a model of a clinical diagnostic protocol .
it therefore holds great promise for overcoming the emerging problem in clinical genetics of target overload : the presence of a large number of gene mutations of clinical relevance in a single disease entity . in no field is this challenge more apparent than in the genomics of cancer .
the past few years have seen an unprecedented deluge of data on the genes mutated in cancer and other diseases . so far , the sequences of over 50 individual cancer genomes have been published and this number is set to increase exponentially .
the advent of next - generation technologies ( such as the roche 454 gs flx+ , llumina hiseq 2000 , applied biosystems solid and heliscope single - molecule sequencer machines ) , which allow a human genome to be sequenced in a single week - long run , has led to a large shift in our understanding of the mutations that drive cancers . for the clinician , mutations in cancer can have relevance for diagnosis , prognosis and treatment choice .
however , it is now apparent that these clinically relevant mutations will be both numerous and found at low prevalence in individual cancer types . in particular , for the majority of cancers there will be no single ' magic bullet ' targeted therapy .
the breakpoint cluster region - abelson murine leukemia homolog ( bcr - abl ) fusion kinase , which is characteristic of chronic myeloid leukemia , is the exception not the rule when it comes to druggable cancer genes ; it seems , instead , that multiple drug targets will be mutated at low frequency throughout common cancers .
this target overload is not restricted to the management of cancers and is also seen with monogenic disorders , for example , mental retardation and hereditary cancer pre - disposition .
it is therefore necessary to screen numerous genetic loci to decide on the best course of clinical management for an individual patient and this must be done in a rapid and cost - effective manner .
the current technology for searching for mutations is to amplify a region of interest - in multiple fragments of a few hundred base pairs each in separate pcr reactions - then sequence the products by standard sanger chain terminator sequencing . although highly accurate for the detection of single - nucleotide variants and small insertions or deletions , this approach is expensive , labor intensive and unable to detect large - scale insertions or deletions .
this is because sanger sequencing can reliably detect mutant alleles only when they are present in more than about 20% of the relevant dna , and this will not be the case , for example , for a heterozygous mutation in a tumor contaminated with 60% normal dna , a scenario that is not uncommon .
thompson and colleagues   have used a next - generation true single - molecule sequencing ( tsms ) system , the heliscope sequencer , to profile the mutational pattern of the human cancer gene brca1 .
germline mutations in the genes brca1 and brca2 are associated with dramatically increased rates of breast and ovarian cancers and contribute to about 10% of all breast cancer cases .
in addition , poly - adp ribose polymerase inhibitors , a recently developed family of pharmaceutical agents , seem to show selective toxicity for cancers with mutations in the brca genes . cost - effective sequencing of these genes is therefore a highly desirable clinical tool for the management of breast cancer patients and those with strong family histories of the disease .
the technology used is a development of the heliscope tsms platform . in the standard heliscope protocol
, dna is fragmented and poly(a ) adaptors are added to the ends of fragments .
they are then captured on a glass slide coated with covalently bound poly(dt ) oligonucleotides , and sequenced .
thompson et al .   were able to dispense with the initial sample preparation steps ( addition of poly(a ) adaptors and 3 ' blocking - performed to prevent extension of the 3 ' end of bound poly(a)-tagged dna molecules ) and instead directly captured only the fragments of dna belonging to the brca1 locus , using oligonucleotides that match sequences in the brca1 region ( figure 1 ) .
approximately 20% of the sequenced reads mapped to brca1 , which equates to about 100,000-fold enrichment of the target sequence . as the length of sequence that can be read in this system
is limited , oligonucleotides were designed at 20 - 30 base pair intervals throughout the coding sequence of the gene , to ensure complete coverage .
importantly , the authors   were able to obtain sequencing results from as little as 100 ng of input material - thus showing that the technology could be used with samples collected as diagnostic biopsies .
tumor material can be collected and ( a ) snap frozen to preserve intact dna and rna or ( b ) fixed in formalin then embedded in paraffin for section and histopathological review . following ( c ) dna extraction , ( d ) the dna
( e ) dna fragments are hybridized to the flow cell , which is covered with oligonucleotides with sequence complementary to the region corresponding to the brca1 gene .
( f ) each individual molecule of dna is then sequenced simultaneously by sequential addition of fluorescently labeled nucleotides ( purple ) .
this approach   has several advantages over the more traditional sanger sequencing commonly used for the detection of mutations .
firstly , there is little required in the way of sample preparation - only sonication of the dna , and in the case of archival formalin - fixed material it is possible that even this step could be dispensed with - therefore reducing cost , turn - around time and the risk of errors in sample handling . secondly ,
unlike sanger sequencing , the heliscope system allows the detection of large deletions , by determining the number of fragments of dna that are present from a specific location ; a decreased number of fragments from a region suggests a loss of genetic material .
finally , the heliscope system directly sequences individual molecules rather than - as with sanger sequencing - examining the average sequence of many millions of dna molecules .
this should provide increased sensitivity for the detection of low prevalence mutations , an essential feature in the sequencing of a heterogeneous cancer sample .
the present technology   is an advance over recently presented techniques for analyzing the mutational status of target genes using next - generation sequencing instruments . with the advent of more competitively priced next - generation sequencing machines , which can provide sequence data in a matter of hours , not days ( such as life technologies ' ion - torrent and illumina 's miseq ) , it is feasible that such approaches could be used routinely in the clinical setting .
however , the instruments involved still require the selective amplification of target dna and the relatively complex preparation of this material for sequencing .
thus , although they take advantage of the exceptionally cheap per - base cost of next - generation sequencing , competing techniques are still limited by its flaws : high complexity and slow turnaround time . genotyping by mass spectrometry has also been applied to the resequencing of relevant mutations . this approach , although sensitive , is limited , in that it is capable of detecting only known mutations and will therefore miss novel gene lesions .
for the foreseeable future , the high cost and complexity of data analysis will limit the application of whole - genome sequencing for the detection of mutations in a clinical setting .
targeted resequencing of areas of interest will therefore remain key to determining mutational status . the method published by thompson et al .
although currently only a single gene is screened , there is clearly scope for the creation of multi - gene capture arrays , allowing large numbers of loci to be analyzed rapidly and cost - effectively with low dna input requirements . in its simplicity
, this approach provides an opportunity to truly begin integrating the vast quantity of genomic data generated in this next - generation era with clinical practice .
we would like to thank claire pike and karen howarth for helpful discussion and reading of the manuscript and the wellcome trust translational medicine and therapeutics program , breast cancer campaign and cancer research uk for funding .

Answer:
in many fields it is now desirable to sequence large panels of genes for mutation , to aid management of patients .
 the need for extensive sample preparation means that current approaches for assessing mutation status in the clinical setting are limited .
 a recent publication demonstrates a single - step , targeted , true single - molecule sequencing approach to assessing the mutational status of brca1 .
 fragmented dna samples are loaded directly onto a flow cell and sequenced , thus detecting both small- and large - scale mutations with minimal sample preparation and high accuracy .


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

Paper text:
in february 2007 , the board and the assembly of deans of medical schools of the dutch federation of university medical centres decided to institute a project group to revise the 2001 medical education blueprint .
the main reasons for undertaking this project were developments in medical scientific disciplines , such as biotechnology and genetics , and developments in medical education , such as the introduction of the bachelor - master structure and the ongoing modernization of postgraduate speciality training programmes . in revising the 2001 blueprint
the project group was specifically asked to establish the attainment levels of both the bachelor and the master programme in medicine , to consider whether the canmeds   model or a similar competency profile could also be serviceable in revising the new framework for medical education and to reconsider the level of detail of the revised 2001 blueprint , aiming to find formulations that are realistic and testable and that facilitate external accountability for programme content .
framework was thought to reflect bettter the nature of the document ) . on august 12 , 2009 ,
the 2009 framework for undergraduate medical education in the netherlands was presented to the dutch minister for health .
a translation in english is available from the website of the dutch federation of university medical centres ( http://www.nfu.nl/fileadmin/documents/raamplan2009engelstalige_versie.pdf ) .
the 2009 framework consists of nine chapters : introductionexplanationdevelopments in dutch and european legislationstages , cycles and levels in medical education in the netherlandsmaster s degree programme in medicine : target profilemaster s degree programme in medicine : competenciesmaster s degree programme in medicine : issues relating to illness and healthbachelor s degree programme in medicine : profile and learning outcomesbasic sciences in the medical curriculum developments in dutch and european legislation stages , cycles and levels in medical education in the netherlands master s degree programme in medicine : target profile master s degree programme in medicine : competencies master s degree programme in medicine : issues relating to illness and health bachelor s degree programme in medicine : profile and learning outcomes basic sciences in the medical curriculum in an appendix the final document also includes a skills list .
in 2002 , the bachelor - master structure was introduced in the dutch system for higher education , establishing bachelor s degree and master s degree programmes as independent study programmes .
this change followed in the wake of the signing of the bologna declaration in 1999 .
this declaration , signed by 29 european countries , aims to promote greater overall convergence in higher education in europe , based on a two - cycle degree structure . in the transitional period ,
permission to use the protected title of physician and qualification to perform certain actions reserved for physicians are linked to registration in the individual health care professions act register .
registration is only open to those who have completed the degree programme in medicine and therefore to those who , following the introduction of the bachelor - master structure , have obtained the master of science ( msc ) degree on completion of the master s degree programme in medicine .
the project group decided to define students learning outcomes upon completion of the master s degree programme in terms of competencies .
a competency is defined as the ability to adequately perform a professional activity in a specific , authentic context , using an integrated body of knowledge , understanding , skills and professional behaviour .
after careful consideration , the canmeds model was chosen , because , firstly , this model involves an excellent and useful division into physicians roles and competencies in a variety of professional situations , and secondly , this model is also used in the framework of the modernization of postgraduate specialty training .
together , the seven roles or competency domains in the canmeds model constitute the target profile in chapter 5 of the 2009 framework ( see table 1 ( tab .
the profile is elaborated in terms of key competencies and their constituent sub - competencies .
as the project group felt that bachelor students in medicine do not yet operate in an authentic professional setting , the bachelor s degree programme is described in terms of knowledge , skills , and behaviour and not competencies .
knowledge and understanding relate to the basic sciences , the foundation of medicine in the natural sciences , and aspects of behavioural and social sciences .
the 2001 blueprint included a list of clinical conditions which comprised about 330 clinical conditions in all .
issues relating to illness and health was more appropriate to the wide - ranging field in which today s physicians are operating , as a fair share of physicians work is not directly patient or disease related . the list of issues described in chapter 7 has been subdivided into several categories .
the first and most voluminous one comprises the complaints that induce patients to consult their physician .
the next two , smaller , categories deal with findings upon physical and additional examinations .
the introduction of a list of issues meant that the list of clinical conditions that was included in the 2001 blueprint was not to return in the 2009 framework : on the one hand , the contemplation of each issue would involve a series of clinical presentations anyway , and , on the other hand , a list of clinical conditions would require ceaseless maintenance in the wake of ongoing developments in medical disciplines . in the 1994 blueprint and the 2001 blueprint ,
the project group felt that the aspect of required knowledge had been somewhat eclipsed by lists of problems , clinical conditions and skills .
right from the start , the project group wished to give the basic sciences a more prominent place in medical education .
the model of competencies selected by the project group also carried the risk of outlining required knowledge only implicitly .
therefore , in the 2009 framework , a separate chapter is devoted to basic sciences in the medical curriculum dealing with both the foundation of medicine in the natural sciences and aspects of the behavioural and social sciences .
spot - checking at the eight dutch medical faculties showed that all medical faculties still used this list , sometimes with minor adjustments .
after discussion in the project group , the skills list from the previous blueprint , with minor adjustments , was added to the appendices to the 2009 framework .
the project group was asked to pay special attention to finding formulations that are realistic and testable and that allow external accountability for medical education programme content .
this prompted the project group to clearly define the competencies in terms of levels that are to be attained .
medical education in the netherlands involves a training sequence with two stages that medical students pass through in succession .
the first stage of this training sequence comprises two cycles : a three - year bachelor s degree programme in medicine , followed by a three - year master s degree programme in medicine . in the second stage of the training sequence , following upon completion of the bachelor and master programmes ,
medical graduates undertake postgraduate specialist training to become medical specialists in primary or secondary healthcare .
having completed that stage , medical practitioners then engage in lifelong learning activities both in practice and in formal continuing education courses .
the levels linked to the successive stages can be called starter level , beginning practitioner level and experienced practitioner level . after completion of their bachelor programme in medicine , medical students can be characterized as starters .
these students have mastered a basic body of knowledge and understanding of scientific disciplines that are relevant to their subsequent professional practice .
they have also acquired a set of basic skills and are able to show appropriate professional behaviour in training - related situations .
they are able to apply knowledge , skills and behaviour in dealing with issues that involve a relatively low level of complexity .
after completion of the master programme in medicine , medical graduates can be characterized as beginning practitioners .
newly graduated physicians demonstrate a basic competence in practice , possess an integrated body of knowledge , skills and professional behaviour and can handle issues involving higher levels of complexity .
medical graduates are capable of performing independent consultations but only perform these under supervision during postgraduate medical training . after a number of subsequent years of further schooling , training and experience in medical specialist training in the discipline of their choice , physicians operate independently without supervision .
an element of independent practice is participation in interprofessional coaching activities and lifelong continuing - education courses . in the 2009 framework ,
the levels of proficiency to be achieved in the bachelor and master programmes in medicine are defined in a five - level structure ( see table 2 ( tab .
the project group also had to consider the level of difficulty of the issues that are presented to students .
on the one hand , these are medical factors , such as typical and atypical presentations or co - morbidity problems ; on the other hand , these are contextual factors from the psychosocial model . the level of difficulty is then codetermined by the availability of standard solutions to a problem and the applicability of protocols and guidelines .
the level of difficulty also lies in the degree to which different physician roles must be integrated in dealing with the issue in question .
graduates in medicine must be able to handle issues involving varying - including higher - levels of difficulty , with the proviso that the degree of required supervision increases with the degree of difficulty of the case presented . in this respect ,
there is one sub - competency incorporated in the role of medical expert that is of particular importance : students ability to recognize and name the personal limits to their knowledge and skills and to decide in time if , and , if so , when a third party needs to be called in , including their supervisor .
the 2009 framework states that graduates in medicine must have mastered all issues related to illness and health that are included in the list at least at level ii .
some of the issues , depending on the specifics of individual training programmes , will be included in additional competency testing at higher levels .
the formulations of sub - competencies specify the levels ( iii , iv , or v ) that have to be attained .
to illustrate the assignment of levels some examples are given in table 3 ( tab .
major changes are the definition of competencies , the indication of the levels of competency to be attained and the introduction of a list of issues related to health and disease .
the 2009 framework will be used as the basis for accreditation and for a revision of the legislation that outlines the educational requirements of physicians .
laan , md phd , is professor of rheumatology and medical education , radboud university medical centre , institute for medical education , nijmegen , the netherlands.r.r.m .
leunissen , msc , is senior staff member , radboud university medical centre , institute for medical education , nijmegen , the netherlands.c.l.a .
van herwaarden , md phd , is professor of pulmonology and former dean of the radboud university medical centre , nijmegen , the netherlands .
laan , md phd , is professor of rheumatology and medical education , radboud university medical centre , institute for medical education , nijmegen , the netherlands .
leunissen , msc , is senior staff member , radboud university medical centre , institute for medical education , nijmegen , the netherlands .
van herwaarden , md phd , is professor of pulmonology and former dean of the radboud university medical centre , nijmegen , the netherlands .

Answer:
the 2009 framework defines the joint dutch national learning outcomes to be attained by medical students after completing their three - year master programme in medicine .
 the framework thus helps to guarantee to society at large and to patients in particular that medical graduates who are starting out as practitioners have attained a certain professional level .
 this level is the aggregate of the physicians target profile , physicians ( sub- ) competencies to be achieved and the list of issues relating to illness and health .
 in addition , the framework also defines the profile of the bachelor and the learning outcomes of the bachelor programme in medicine .


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:
screening for gestational diabetes mellitus is routinely programmed to prevent complications caused by elevated blood glucose levels in pregnancy , including macrosomia , cesarean delivery , shoulder dystocia , neonatal metabolic problems , perinatal mortality , and pre - eclampsia.1 diabetes mellitus during pregnancy also appears to be associated with an increased risk of cardiovascular diseases even in later life.2 moreover , this underlying co - morbidity is an independent risk factor for subsequent coronary artery disease . in this context ,
diabetes mellitus during pregnancy has been identified as a major etiology for atherosclerosis in large elastic arteries.3 one of the main indicators for assessing atherosclerotic lesions during this period is the increased intima - media thickness ( imt ) of carotid arteries.4 it has been well known that , as opposed to the blood flow through the other arteries of the maternal organs , the blood flow through the carotid artery is decreased during pregnancy , which has been attributed to pregnancy - mediated increased responsiveness of the carotid artery to vasoconstrictors and decreased responsiveness to vasodilators.5 also , the endothelial hypertrophy of the carotid artery can be a common finding , leading to changes in the carotid blood flow and its complications.6 , 7 thus , increased carotid imt can be deemed a validated endothelial dysfunction surrogate endpoint during pregnancy .
some studies have recently shown that pregnant women with previous gestational diabetes mellitus are at increased risk of carotid artery disorders.8 , 9 be that as it may , the scarcity of research into this hypothesis means that it is still unknown whether or not gestational diabetes mellitus causes increased imt .
the current study was performed to evaluate carotid imt in diabetic pregnant women with gestational diabetes and to ascertain if an impaired oral glucose challenge test ( ogct ) correlates with the development of increased imt .
this cohort study included 50 women ranging from 18 to 35 years of age at high risk of diabetes during pregnancy .
gestational diabetes mellitus was screened with a one - hour 50 g oral glucose challenge test ( ogct ) .
abnormal results were , thereafter , confirmed with a three - hour 100 g oral glucose tolerance test ( ogtt ) .
eligible women were nulliparous with a singleton pregnancy , had a normal blood pressure at the time of recruitment , and gave informed consent .
women with any of the following were excluded : family history of cardiovascular disorders ; history of hypertension ; anti - hypertensive and cholesterol medication use ; hyperlipidemia ; overt diabetes or fasting plasma glucose ( fpg ) > 125 mg / dl according to the american diabetes association ( ada ) definition;10 chronic renal or hepatic diseases ; malignancies ; recent hormonal medications ; cigarette smoking ; severe obesity ( body mass index [ bmi ] > 35 kg / m ) ; and history of infertility or polycystic ovarian disease .
those with the status of plaques / shadowing ( > 1.0 mm ) at any carotid site were also excluded .
the study protocol was approved by the research and ethics committees at kerman university of medical sciences .
baseline demographic variables were collected either from the women s medical records or self - completed questionnaires at trial entry and comprised maternal age , height , weight , bmi , smoking status , and blood pressure at trial entry .
total cholesterol was measured enzymatically with standard methods and total triglyceride was measured via standard spectrophotometric techniques . after the precipitation of low - density lipoprotein ( ldl ) particle with phosphotungstic acid , high - density lipoprotein ( hdl ) cholesterol was measured enzymatically in the supernatant by a modification of the method for total cholesterol .
b - mode ultrasound scans were performed at baseline and at two time points of mid - term pregnancy ( 20 to 24 weeks ) and full - term pregnancy ( 36 to 38 weeks ) on all the participants .
carotid ultrasound scans were carried out by a single trained sonographer unaware of the study protocols and methodology .
b - mode ultrasound images were equipped with a 7.5-mhz linear array transducer and captured with a ge log 200 ultrasound machine .
the ultrasonic variable used in the statistical analysis was the mean of the imt of common carotids and internal carotid arteries from two walls ( near and far walls ) at four different angles .
the mean of carotid imt was compared between the women with impaired ogct and those who screened normal on ogct at the two study time points . for the statistical analyses , the statistical software spss version 19.0 for windows ( spss inc .
the continuous variables , if normally distributed , were analyzed using the student - test and presented as mean differences , while the mann - whitney test was employed for skewed data .
the baseline characteristics of the pregnant women with impaired and normal ogct tests are presented in table 1 .
the two groups were similar in terms of pregnancy age , height , weight , bmi , and baseline laboratory parameters .
there were no significant associations between carotid imt and maternal indices , including the demographic variables and laboratory parameters .
an overall comparison between the impaired ogct test group and the control group via the mann - whitney u test revealed significant differences in carotid imt in the midterm and full - term pregnancy ( table 2 ) .
the trend of the changes in carotid imt during the mid - term to full - term pregnancy was , however , insignificant in each group .
an increased carotid imt can be observed not only in long - standing type ii diabetic but also in newly detected type ii diabetic patients . especially in pregnant women , carotid imt gradually increases from the first to the third trimester of normal pregnancy and regresses in the postpartum period .
nevertheless , the trend of the increase in pregnant women with gestational diabetes is still unclear . in our study , with the aid of carotid ultrasound , arterial examination was performed at mid - term and full - term pregnancy and both controls and the women with an impaired ogct test were assessed and compared with regard to the changes in carotid imt .
we showed that although carotid imt was more increased in those with impaired ogct , the trend of this change was similar between the impaired and normal ogct groups .
furthermore , we observed that carotid imt was significantly higher in the diabetic group than in the normoglycemic group in different trimesters , but the trend of these gradual changes from the first to the third trimester was similar in both groups .
totally , effective glycemic control seems to be helpful for the prevention of increased carotid imt . during the pregnancy period ,
peripheral vascular resistance is physiologically paralleled by improved macrovascular compliance.11 , 12 some researchers have shown that 2 - 4 years after previous gestational diabetes mellitus , a significantly higher arterial stiffness can be found compared with reference women without a history of diabetes.13 pregnancies complicated by diabetes not only are associated with increased carotid imt but also can lead to increased maternal arterial stiffness.9 this study demonstrates increased imt of the carotid artery in a group of women who had a pregnancy complicated by impaired ogct .
this finding is in line with the literature confirming that women with a history of gestational diabetes have a higher risk of developing increased carotid imt .
one of the first steps in the development of atherosclerosis is endothelial activation , followed by endothelial dysfunction .
thus , in diabetes mellitus , vascular endothelial activation or dysfunction is considered to play a key role in the development of many of the clinical manifestations related to carotid artery disease , several years after delivery .
some epidemiological studies have found positive associations between parity and risk of carotid artery plaques in elderly women and , therefore , age of pregnancy can be a trigger for this phenomenon.14 also , multi - gravidity and previous history of coronary diseases have been also identified to be related to the appearance of carotid artery plaques.15 folate deficiency during pregnancy is another probable triggering factor for progressing carotid imt .
folate deficiency is linked with hyperhomocystinemia,16 which is associated with accelerated progression of atherosclerosis17 and , thereby , carotid artery imt .
pregnancy is potentially a cause of folate deficiency.18 consequently , it is possible that multiparous women are at risk of prolonged folate deficiency ; this may explain their susceptibility to the development of carotid artery imt .
in the present study , the main limitation was blood glucose controlled by insulin ; we could not hold treatment because of ethical issues .
also , we did not assess the confounding effects of the triggering variables such as age of pregnancy , multi - parity , or medication during this period on increasing carotid imt ; that should be considered in further studies .
prospective follow - up studies will also be needed and have meanwhile been started to determine whether diabetes during pregnancy itself is responsible for the increase in imt .
in conclusion , an impaired ogct test is proven to be an independent risk factor for increased carotid imt and subsequent coronary artery disease .
even with this small study , we were able to find an increased imt after diabetes appearance , which might be used as an indicator of a potential increased vascular risk .
furthermore , imt measurements in diabetic pregnant women could offer an opportunity to identify a high - risk group of women who might benefit from early screening and preventive measures .
these measures could include lifestyle interventions such as improving diet and physical activity as well as increased surveillance of blood pressure , serum lipids , and particularly blood glucose .

Answer:
background : pregnant women with previous gestational diabetes mellitus are at increased risk of progressive carotid artery disorders .
 the current study evaluated carotid intima - media thickness ( imt ) in pregnant women with gestational diabetes at two time points of mid - term and full - term pregnancy to determine whether gestational diabetes mellitus causes increased imt.methods:this cross - sectional study carried out at afzalipour hospital ( kerman , iran ) between 2009 and 2010 , recruited 50 women who were at high risk of gestational diabetes during pregnancy and had an oral glucose challenge test ( ogct ) as screening for gestational diabetes .
 b - mode ultrasound scans were performed at baseline and at two time points of mid - term pregnancy ( 20 to 24 weeks ) and full - term pregnancy ( 36 to 38 weeks ) on all the participants .
 the mean imt of common carotids and internal carotid arteries from two walls ( near and far walls ) at four different angles was assessed.results:an overall comparison between the impaired ogct test group and the control group revealed significant differences in carotid imt in the mid - term ( 0.65  0.07 vs. 0.59  0.06 mm ; p value = 0.002 ) and full - term ( 0.65  0.05 vs. 0.59  0.04 mm ; p value
 < 0.001 ) pregnancy ; however , the trend of the changes in carotid imt during mid to full - term pregnancy was insignificant in each group ( p value > 0.05).conclusion : carotid imt was significantly higher in the women with gestational diabetes than that in the normoglycemic group in different trimesters .
 this finding denotes that atherosclerosis might start years before the diagnosis of gestational diabetes in vulnerable women .


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:
ganglioside may influence growth and cell - to - cell interactions may be of importance in the development of malignancy . in the present study , we used a transplantable murine hepatoma as the experimental model , and treated the animals with 5-fluorouracil ( 5-fu ) as the active therapeutic drug to determine the membrane glycolipids content variety .
kunming mice ( normal mice ) were obtained from the animal center at fu - dan university shanghai medical college .
mice containing the ascites - form transplantable hepatoma were obtained from the cancer institute of jiangsu province .
the ascites was drawn from the transplantable hepatoma mice by a sterilized injector and placed into bacteria - free 0.9% nacl for dilution ( 1/3 , v / v ) .
subsequently , the normal mice were inoculated with 0.2 ml of diluted cells under the skin in the foreleg and armpit regions .
the tumors were allowed to grow for 13 days . usually , solid tumors weighing 12 g were found afterwards .
the animals were injected with 5-fu ( 0.2 mg/0.2 ml / day ) i.p . at 48 h after tumor cell transplant . in the control group
the animals were injected with a sterilized solution of 0.2 ml of 0.9% nacl instead of 5-fu .
a third group of animals , raised without hepatoma transplant or any other form of treatment , was used as the normal group .
after the administration of 5-fu or saline , the animals were sacrificed , and tissue and blood samples were collected for examination . based on the method of sevenerholom , the contents of ganglioside , tsa lsa , and r - sa were determined .
one - way anova was conducted to compare the biochemistry index of membrane glycolipids between the 2 groups .
kunming mice ( normal mice ) were obtained from the animal center at fu - dan university shanghai medical college .
mice containing the ascites - form transplantable hepatoma were obtained from the cancer institute of jiangsu province .
the ascites was drawn from the transplantable hepatoma mice by a sterilized injector and placed into bacteria - free 0.9% nacl for dilution ( 1/3 , v / v ) .
subsequently , the normal mice were inoculated with 0.2 ml of diluted cells under the skin in the foreleg and armpit regions .
the tumors were allowed to grow for 13 days . usually , solid tumors weighing 12 g were found afterwards .
the animals were injected with 5-fu ( 0.2 mg/0.2 ml / day ) i.p . at 48 h after tumor cell transplant . in the control group
the animals were injected with a sterilized solution of 0.2 ml of 0.9% nacl instead of 5-fu .
a third group of animals , raised without hepatoma transplant or any other form of treatment , was used as the normal group . after the administration of 5-fu or saline , the animals were sacrificed , and tissue and blood samples were collected for examination .
based on the method of sevenerholom , the contents of ganglioside , tsa lsa , and r - sa were determined .
one - way anova was conducted to compare the biochemistry index of membrane glycolipids between the 2 groups .
in evaluating the ability of antimetabolic drug 5-fu to inhibit tumor growth , we found that the weight of tumors was significantly different between the 2 groups ( p<0.05 ) ( table 1 ) .
ganglioside content in hepatoma tissue was significantly different among the 3 groups ( p<0.01 ) , and those in the therapeutic group were significantly lower than in the control group ( p<0.01 ) . in the plasma of the hepatoma mice ,
the tsa and lsa contents were higher in in the control group than in the normal group ( p<0.05 ) , but the tsa and lsa content in the therapeutic group was lower than in the control group ( table 3 ) .
the tsa and lsa contents in the plasma of the hepatoma mice were higher in the control group than in the therapeutic and normal groups ( p<0.05 ) .
no significant difference was found in the r - sa between the therapeutic and control groups .
percent inhibition was calculated from the following equation : [ ( tumor weight of control group  tumor weight of the therapeutic group)/tumor weight of the control group ] 100% . * * p<0.05 . to observe the ability of antimetabolism drug 5-fu in the inhibition of tumor growth
are showed in table 4 , the transplanted hepatoma group weight of tumor was significance higher than that of normal control group ( p<0.05 ) .
therapeutic group , control group and normal group membrane content variety the ganglioside content in hepatoma tissue from the control group was significantly higher than that in normal mouse liver ( p<0.01 ) , whereas those in the therapeutic group was significantly lower than in the control group ( p<0.01 ) . in the plasma of the hepatoma mouse ,
the tsa and lsa content was significantly higher in the control group than the normal group ( p<0.05 ) , and the therapeutic group was significantly lower than the control group ( table 6 ) .
the ability to produce transplantable hepatoma and the effect of 5-fluorouracil ( 5-fu ) in the inhibition of tumor growth are depicted in table 4 .
our data reconfirm the ability of 5-fu to inhibit the proliferation of tumor cells by competitive inhibition of the synthesis of thymidine monophosphate .
the mechanism could involve sialic acid , a family of acylated derivatives of neuragmic acid , which usually occurs as a terminal component at the nonreducing end of carbohydrate chains of glycolipids .
cell surface and membrane components play a vital role in neoplastic behavior . increasing concentrations of sialic acid are common on the tumor cell surfaces of neoplasms .
the carbohydrate moiety may have an influence on growth , as well as cell - to - cell interaction and the development of malignancy .
the biochemistry index of membrane glycolipids may be considered as an ancillary indicator for judging therapy effect in transplanted hepatomas in mice .

Answer:
backgroundthe aim of this study was to investigate the variety of plasma contents of membrane glycolipids in 65 gastrointestinal tumors and 31 transplant hepatomas in mice.material/methodsthe experimental model was a transplantable murine hepatoma .
 experimental mice were divided into 3 groups.resultsthe lsa and tsa content in the 2 groups were significantly difference ( p<0.01 ) , and were significantly lower in the therapeutic group than in the control group ( p<0.01).conclusionsthese results indicate that membrane glycolipids index lsa and tsa are sensitive markers in gastrointestinal tumors . in the transplanted hepatomas in mice , they may be considered as ancillary indicators for judging the therapeutic effect of hepatoma .


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:
celiac artery aneurysm is a quite uncommon vascular lesion , accounting for 5.1% of all splanchnic artery aneurysms . although rare , celiac artery aneurysm carries a definite risk for rupture and other complications .
however , because of its rarity , no strong consensus concerning indications for intervention of asymptomatic celiac artery aneurysm exists in the literature . due to more frequent use of cross - sectional imaging , the dilemma of choosing the appropriate therapeutic option has become increasingly more important .
herein , we present a case of an un - ruptured celiac artery aneurysm that was treated by surgical repair and also discuss the appropriate therapeutic strategy based on a literature review .
a 72-year - old female visited our department with complaints of fever and general fatigue .
the patient s medical history included type 2 diabetes mellitus with poor control and hypertension .
arrival revealed that her blood pressure was 147/62  mmhg , heart rate was 104 beats / min with regular rhythm , blood oxygen saturation was 95% under atmospheric conditions , and body temperature was 38.7  c .
blood analyses revealed 11,260 white blood cells/l with 80.6% neutrophils and 0.69  mg / dl c - reactive protein ) ; mild hypoalbuminemia ( 3.3  g / dl ) ; coagulant dysfunction ( fibrin / fibrinogen degradation products ; 7  g / dl fibrinogen ; and 2.1  g / ml d - dimer ) , and severely impaired glucose tolerance ( 157  mg / dl and 11.2% hemoglobin a1c ) .
she weighed 52.4  kg , was 150  cm tall , and had a body mass index was 23.3  kg / m . inspection of the palpebral conjunctiva revealed no evidence of anemia .
chest auscultation revealed no signs of abnormal heart murmurs and no rales or other abnormal respiratory sounds .
the abdomen was slightly distended and her peristalsis was normal ; no tenderness was observed in the upper abdomen .
she was then diagnosed with bacteremia by urinary tract infection and antibacterial medicine ( cefmetazole 2  g per day ) was initiated .
transesophageal echocardiography was performed to investigate infective endocarditis , revealing no vegetation at her valves .
contrast - enhanced computed tomography ( ct ) was performed for investigating her urological abnormalities , revealing no urological deformities but a 28    30  mm sized aneurysm at the trunk of the celiac artery ( fig .
the proper hepatic artery was dominantly supplied from the celiac artery , the left gastric artery being bifurcated from the celiac trunk , and the celiac artery and the splenic and common hepatic artery had a common trunk ( fig .
surgical repair of the aneurysm was performed after confirmation of negative blood culture for bacteria on day 32 .
firstly , lesser omentum and crus of diaphragm were incised to expose abdomen aorta at the level of the trunk of the celiac artery .
after that , the superior mesenteric artery was taped at the trunk of the small bowel mesentery .
abdominal aorta was clamped both at the head of celiac artery and at the level of renal artery to prevent blood flow .
the distal celiac artery of the aneurysm was cut and 8  mm size prosthetic graft was anamotosed .
another end of the prosthetic graft was anamostosed through the dorsum of duodenum to abdominal aorta below the level of renal artery ( fig.1d , e , f ) .
celiac artery aneurysm is an uncommon type of splanchnic artery aneurysm that carries a high risk for mortality if it ruptures .
a total of 9.1% of celiac artery aneurysms are accompanied by abdominal aortic aneurysms  ; solitary celiac artery aneurysms not accompanied by other aneurysms are extremely rare .
etiology of celiac artery aneurysm includes infectious diseases , atherosclerosis , trauma , or congenital conditions .
other causes of celiac artery aneurysm include medial necrosis , inflammation , trauma , and median arcuate ligament syndrome . in our patient ,
the cause of the aneurysm was presumably derived from atherosclerosis due to the poor - controlled diabetes mellitus , hypertension , and aging .
since most patients are asymptomatic , celiac artery aneurysm is frequently incidentally discovered by imaging modalities for the investigation of other conditions or diseases .
the major presentation of celiac artery aneurysm is gastrointestinal symptoms , including abdominal pain , nausea , vomiting , appetite loss , or symptoms of mesenteric ischemia .
the risk of rupture of 1522  mm diameter celiac artery aneurysms is 5% ; in contrast , the risk of rupture in > 30  mm diameter aneurysms is 5070% . in general ,
treatment is considered for asymptomatic patients when the aneurysm is larger than 20  mm in diameter , .
the rudiment of operative treatment is the resection or closure of the aneurysm along with revascularization of peripheral branches that bifurcate from the celiac artery aneurysm .
surgical repair of the aneurysm with prosthetic grafts demonstrated more preferable long - term results than by using saphenous veins ; thereby , prosthetic grafts might become the mainstay of surgical aneurysm repair .
surgical treatment of a celiac artery aneurysm that involves the confluence of trifurcation is challenging , with a mortality risk of 5% , .
when the aneurysm is removed without the vascular reconstruction , the blood flow from the super mesenteric artery to the hepatic artery should be carefully examined before surgery . in recent years , with advances in interventional radiology , catheter embolization is also attempted . when catheter embolization is adopted , the blood flow from the super mesenteric artery to the hepatic artery should be confirmed . clearly , if gross liver ischemia is found after aneurysm resection , revascularization of the hepatic artery is necessary , either by antegrade supraceliac aortohepatic bypass or retrograde inflow from the infrarenal segment of the aorta or the common iliac arteries . in our case ,
angiography confirmed that the blood flow of the proper hepatic artery was dominantly supplied by the celiac artery and the gastroduodenal artery was patent and large .
endovascular techniques , including stent implantation and embolization of aneurysms are feasible in the setting of advanced age and underlying diseases ; while surgical intervention is a safe and effective method in selected cases , . in our patient ,
endovascular treatment was considered unsuitable because the patient just recovered from bacteremia and the possibility of an infective aneurysm could not be excluded .
in addition , surgical intervention was not likely to be challenging considering the anatomical location of the aneurysm and the patient s favorable general condition . clearly , the celiac artery aneurysm in our patient was concluded not derived from infections based on the clinical course and operative findings .
a question may be raised about why this patient should have undergone ct although she did not present any abdominal complaints .
patients with urosepsis should be scrutinized with imaging modalities in search of urological abnormalities or malformations irrespective of their symptoms .
although rare , clinicians should be aware of celiac artery aneurysms and make efforts to discover them at an early stage , even during the investigation of other diseases or symptoms .
furthermore , early treatment of unruptured celiac artery aneurysm may sometimes be required to protect rupture or mesenteric ischemia from distal embolization .
written informed consent was obtained from the patient for publication of this case report and accompanying images .
a copy of the written consent is available for review by the editor - in - chief of this journal on request  .
hiromichi naito , atsuyoshi iida , tetsuya yumoto and kohei tsukahara contributed to the study design , data collections , data analysis , writing and review .
consents , permissions , and releases were obtained where authors wished to include case details or images of patients and any other individuals in an elsevier publication .

Answer: highlightsalthough rare , celiac artery aneurysm may carry a definite risk for rupture and other complications.because of its rarity , no strong consensus concerning indications for intervention of asymptomatic celiac artery aneurysm exists in the literature.clinicians awareness regarding this rare entity and efforts to discover before rupturing are imperative .


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:
parrots are among the most endangered group of birds worldwide , and 15 of the 84 brazilian species are classified as being vulnerable or critically endangered .
studies on parrot populations are important to establish a database that can be assessed in the event of outbreaks , which could also be useful for subsequent epidemiological studies and conservation efforts
. however , health surveys of free - ranging wild animals are mostly focused on retrospective studies on mortality [ 3 , 4 ] .
research on diseases affecting free - ranging parrots is still scarce and studies performed often fail to maximize the scientific information that could be gathered [ 2 , 58 ] .
such data could be of extreme importance in guiding conservation measures ex situ and in situ .
the hyacinth macaw and lear 's macaw are well - known flagship species that have suffered heavily owing to the destruction of habitat and illegal trade . a number of studies aimed at promoting their recovery have been performed and actions taken ; however , they are still classified as endangered species and face severe threats to their long - term survival . on the other hand ,
the blue - fronted amazon parrot is rated as a species of least concern regarding its conservation status .
it is , however , the most illegally traded parrot species in brazil , and therefore , it is possible that decades of successive capturing of nestlings and concomitant ageing of the adult population could cause local extinctions in several areas where it is still common today .
studies have established that the intestinal flora of most species of healthy captive psittacines is composed essentially of gram - positive bacteria [ 11 , 12 ] .
parrots in captivity are frequently affected by infections caused by gram - negative bacteria , and these microorganisms are considered either pathogenic or opportunistic .
one such bacterium , escherichia coli ( e. coli ) , is frequently involved in respiratory , digestive , and septicemic disorders in captive parrots .
it is possible to classify e. coli into pathotypes by using genes responsible for the expression of virulence factors .
commonly described pathotypes include epec ( enteropathogenic e. coli ) , apec ( avian pathogenic e. coli ) , and upec ( uropathogenic e. coli ) [ 14 , 15 ] .
epec is an important category of diarrheagenic e. coli and a major cause of infant diarrhea in developing countries , while apec is recognized for significant economic losses to the poultry industry , resulting in respiratory diseases and septicemia [ 14 , 15 ] .
upec is a serious cause of urinary diseases in humans , causing cystitis that may progress to pyelonephritis .
although , certain e. coli classification studies performed on wild birds [ 1722 ] and those involving captive psittacines have found a certain degree of correlation between disease and specific pathotypes [ 2325 ] , current serological methods to determine the pathogenicity of e. coli strains do not accurately predict which strains will be pathogenic in which birds .
the purpose of this study was to test cloacal samples from asymptomatic free - living nestlings ( blue - fronted amazon parrots as well as hyacinth and lear 's macaws ) to determine if they could be carriers of recognized e. coli pathotypes .
in addition , we discuss the role that these strains could play in both free - living and captive parrots .
the samples of this study were collected during field surveys of the nestlings of hyacinth macaws and blue - fronted amazon parrots in the pantanal ( wetlands ) region of the refgio ecolgico caiman and neighboring farms ( 1958s , 5624w ) in mato grosso do sul state , and of lear 's macaws at the estao ecolgica de canudos ( 095348s , 390135w ) in the caatinga ( semi - arid ) of the bahia state .
cloacal swabs ( cultureswab sterile , difco becton dickenson and company , sparks , maryland , usa ) were moistened with care using a sterile saline solution so as not to contaminate the swab during insertion in the cloaca .
all chicks had no evident signs of disease ( soiled vent , emaciation , prostration , or delays in development according to their estimated age ) . in total ,
44 samples were obtained , of which 10 were from hyacinths , 13 from lear 's , and 21 from blue - fronted amazon parrots .
the swabs were refrigerated up to processing at which point they were aerobically incubated in bhi broth ( brain heart infusion , difco ) for 24 hours at 37c .
they were then streaked onto macconkey ( difco ) agar plates and incubated for another 24 hours at 37c .
bacteria were identified using a specific enterobacteria identification kit ( newprov , pinhais , paran , brazil ) and stored at 20c .
isolates were tested using polymerase chain reaction ( pcr ) ( table 2 . ) , for the presence of e. coli attaching and effacing ( eae ) gene and bundle - forming pili structural ( bfpa ) gene of epec . for apec ,
the aerobactin ( iucd ) , cytotoxic necrotizing factor ( cnf1 ) , s fimbrial adhesin ( sfa ) , and p fimbrial adhesin ( papef ) genes were amplified .
upec utilized alpha hemolysin ( hlya ) in addition to the genes used for apec .
additional apec genes for serum resistance ( iss ) and temperature - sensitive hemagglutinin ( tsh ) were also tested .

 e. coli was obtained from all 44 samples . details on the positive samples are given in table 1 .
one sample was positive solely for eae and not for bfp and was characterized as atypical epec .
a large number of samples were positive for virulence factors commonly found in apec ( 14 samples ) , with most originating from blue - fronted amazon chicks .
this gene was also found associated with other virulence factors in 4 samples , all from blue - fronted amazon parrots .
there was also an association between other virulence factors among some isolates ( table 1 ) .
epec have the ability to cause lesions on the intestinal mucosa , leading to severe diarrhea .
this process is initiated by adherence to the epithelial cell membrane and is mediated by the adhesin intimin ( encoded by the eae gene ) .
typical epec strains possess both intimin and bundle - forming pili ( encoded by the bfp gene ) , which are responsible for the initial contact between the bacteria and the host cell ; atypical isolates , on the other hand , lack the bfp gene .
humans are considered the primary reservoir for the typical pathotype although it has also been found in dogs and cats [ 29 , 30 ] .
there are few reports of the presence of atypical epec in birds , especially the isolates obtained from poultry [ 3032 ] .
there are also reports of atypical epec causing fatal outbreaks in backyard passerine species , and carriers have been found among feral pigeons and rehabilitated seagulls [ 20 , 22 ] .
a study using 103 samples from captive psittacines detected 4 samples characterized as typical epec and 3 others as atypical isolates , all of which originated from clinical cases of diarrhea , enteritis , or septicemia .
another survey conducted in brazil regarding necropsy cases of symptomatic parrots also showed the presence of the eae gene in 2 atypical samples of e. coli isolated from the livers of 2 individual pet amazon parrots .
the fact that we found an atypical isolate in an asymptomatic bird , especially a free - ranging individual , suggests that this pathotype is not pathogenic in all parrots depending on the situation to which the birds are subjected .
apec and upec share several genes that encode virulence factors such as p fimbrial adhesin ( pap gene ) and s fimbrial adhesin ( sfa gene ) .
apec has been extensively studied in poultry where it has been observed that the p fimbrial adhesion enables binding of bacteria to internal organs and protects against heterophilic inflammation , while the s fimbrial adhesin is associated with omphalitis , salpingitis , chronic respiratory diseases , and sepsis .
although several virulence factors have been associated with clinical cases of apec in poultry , no specific factor has been confirmed to be responsible for contributing to the pathogenicity observed , which makes it difficult to interpret results among lesser - studied groups such as wild birds .
siderophores , such as aerobactin ( iuc gene ) , enable e. coli to obtain iron stores from the host , and strains with this gene are quite frequently associated with clinical cases of poultry .
toxins , such as alpha hemolysin ( hlya gene  characteristic of upec ) and cytotoxic necrotizing factor 1 ( cnf1 gene ) , provide the ability to cause tissue damage , contributing to dissemination and release of host nutrients while impairing the immune defenses . in this investigation , 2 samples were positive for the sfa and 1 was positive for the cnf1 gene .
these genes have been reported in pathogenic strains of e. coli isolated from septicemic poultry , as well as from human and domestic animals with extraintestinal pathogenic e. coli infections [ 16 , 34 ] .
a survey dealing with healthy feral pigeons detected a number of positive cloacal - swab specimens for the cytotoxic necrotizing factor 1 , showing the potential for disease spread by carriers of this species .
other genes such as the tsh ( temperature - sensitive hemagglutinin ) and the iss ( increased serum survival ) are reported to be present in apec strains .
the increased serum survival causes sepsis by conferring resistance to the bacteria against the host immune bactericidal defenses .
the exact function of tsh is largely unknown , but it has been shown to be involved in mechanisms of adherence to the respiratory tract of poultry . in this study ,
however , it has been shown in poultry that the presence of the iss gene alone may not be sufficient to identify apec isolates because this gene can also be found in the intestinal microbiota of healthy individuals , and an association with the iuc gene was reported to be necessary for achieving higher levels of virulence .
interestingly , a sample from an asymptomatic blue - fronted amazon chick in this study showed an association between the iss and iuc genes .
this research also found 1 positive sample for the iss / tsh association . in domestic turkeys ,
a relationship between clinical cases of colibacillosis and the presence of iss and tsh has been described .
the occurrence of gene associations such as iss / pap , iss / iuc / tsh , and pap / iuc / tsh has previously been reported in e. coli isolated from fecal , liver , and blood samples collected during necropsies performed in symptomatic psittacines in brazil .
these results in captive birds demonstrate that there is a connection between the presence of these genes and some clinical cases of colibacillosis as a contributing cause of death whether as primary or opportunistic pathogens . even though the sample numbers were too small to reach definite conclusions , we observed differences in the presence of virulence factors among the different species .
apec / upec genes were found mostly in species that usually nest on trees and live in a tropical climate ( at least in this studied area , for the species a. hyacinthinus and a. aestiva ) .
epec was found in species that nest on limestone cliffs and inhabit semi - arid regions ( a. leari ) .
differences among feeding habits , direct or indirect contact with other wild animals , and human activities ( interference due to human settlements and domestic animals ) could possibly have influenced these results , and thus , these results should be further investigated .
although previous studies showed that some virulence factors are indeed involved in clinical cases of colibacillosis in psittacines [ 2325 ] , this investigation found a number of carriers for virulence factors .
these unusual findings focus the attention on the fact that , at least at the time of sampling , there was a stable host / parasite relationship . unlike wild birds , parrots maintained in captivity are frequently exposed to a number of factors that cause immunosuppression and increase their susceptibility to disease . these include deficient diets , inadequate hygiene , and lack of mental and physical stimuli ; all of these are factors that may determine the course of the disease when the animal is exposed to a microorganism .
the concept of disease is considered the result of an interactive relationship among the causative agent , the animal , and environmental factors , and a multitude of factors act together in order to initiate the disease process .
if a factor is not present , it is probable that the organism will be capable of fighting the pathogen without showing overt clinical signs .
the nestlings in our study successfully fledged , indicating that although the potential for disease was present , birds living in their natural environment , without the factors induced by captivity , are more likely to remain disease free .
the results presented here are also important for the future conservation of the 2 endangered species ( a. hyacinthinus and a. leari ) as well as the heavily trafficked a. aestiva because they could better guide ex situ husbandry practices involved in captive breeding and rehabilitation / relocation programs , besides assisting monitoring of the overall health of the wild population . in conclusion , to our knowledge , this is the first study that tested e. coli virulence factors in wild psittacines .
it is also the first to describe e. coli carriers in free - ranging parrots , and the results indicate that although the potential to develop disease was present , several factors that are most likely to be found in captivity needed to be involved in triggering disease development .
other studies involving different species as well as a higher number of samples are important to further define the role and risks involved with specific e. coli pathotypes in the case of both wild and captive psittacines .

Answer:
parrots in captivity are frequently affected by escherichia coli ( e. coli ) infections .
 the objective of this study was to collect information on the carrier state for e. coli pathotypes in asymptomatic free - ranging parrots .
 cloacal swabs were collected from nestlings of hyacinth , lear 's macaws and blue - fronted amazon parrots and tested by polymerase chain reaction ( pcr ) for virulence factors commonly found in enteropathogenic , avian pathogenic , and uropathogenic e. coli strains . in total , 44 samples were cultured and e. coli isolates were yielded , from which dna was extracted and processed by pcr .
 genes commonly found in apec isolates from blue - fronted amazon parrots and hyacinth macaws were expressed in 14 of these 44 samples .
 one atypical epec isolate was obtained from a sample from lear 's macaw .
 the most commonly found gene was the increased serum survival ( iss ) gene .
 this is the first report , that describes such pathotypes in asymptomatic free - living parrots .
 the findings of this study suggest the presence of a stable host / parasite relationship at the time of the sampling brings a new understanding to the role that e. coli plays in captive and wild parrots .
 such information can be used to improve husbandry protocols as well as help conservation efforts of free - living populations .


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:
double male syndrome  is a rare sex chromosome aneuploidy condition characterized by presence of two extra x and y chromosomes with an incidence of 1:18,000 - 1:40,000 male births .
this syndrome is clinically manifested later in life with developmental delays , learning disabilities , behavioral problems , and delayed or incomplete puberty .
many cases go undiagnosed as most of the above mentioned abnormalities do not develop until early puberty .
the term taurodontism was coined by sir arthur kein to describe the bull - like appearance of the teeth .
taurodontism can be defined as a morphological variation of a tooth in which the pulp chamber is vertically elongated and the roots are reduced in size .
the etiology of taurodontism is attributed to the failure of hertwig epithelial root sheath diaphragm to invaginate at the proper horizontal level .
based on the severity , taurodontic teeth can be classified ashypo- , meso- , and hypertaurodont forms .
hypotaurodont expresses the least pronounced changes , while mesotaurodont expresses moderate variation , and hypertaurodont is characterized by the most severe variation in which the roots bifurcate or trifurcate close to the apices .
this is the first reported incidence of the endodontic management of a hypertaurodontic mandibular molar tooth in a patient diagnosed with 48 , xxyy syndrome .
a 19-year - old male reported to the postgraduate department of endodontics of our dental school , for management of multiple carious teeth . during history taking , it was elicited that the patient was a school dropout due to difficulty in coping with the educational curriculum .
it was also evident , that the patient had below average communication skills with low self - esteem .
( b and c ) postsurgical photograph after bilateral sagittal split osteotomy and genioplasty intraoral examination revealed dental caries in relation to teeth 15 , 37 , and 47 and multiple missing teeth ( 14 , 13 , 22 , 23 , and 36 ) .
an orthopantomograph revealed multiple taurodontic teeth in relation to 37 , 46 , 47 , 17 , 26 , and 27 [ figure 2a ] .
the taurodontic teeth exhibited large pulp chamber extending beyond the cervical area and reaching the furcation suggestive of hypertaurodontism .
the tooth was nonsensitive to percussion , and radiographic interpretation was suggestive of asymptomatic apical periodontitis .
( c ) a 2-year follow - up post endodontic restoration in 37 the complete endodontic management of the case was performed by one of the author , while the other author took care of post - endodontic restoration and clinical follow - up with department of oral surgery .
the patient was anesthetized with 1.7 ml of 4% articaine with 1:100,000 epinephrine ( septocaine , septodont , new castle , de , usa ) and access opening was performed under rubber dam isolation .
endodontic treatment in taurodontic teeth has been described as difficult as the complex morphology could hamper the location of the root canal orifices .
the access opening and canal tracing was performed with the help of adental operating microscope ( g6 , global microscope , usa ) .
careful inspection and exploration revealed a large coronal pulp chamber extending 8 - 10 mm below the cervical margin ( cementoenamel junction ( cej ) ) .
the presence of two canals ( mesial and distal ) bifurcating 3 - 4 mm short of the radiographic apex was identified .
an electronic apex locator ( root zx , morita , tokyo japan ) was used to determine the working length .
the shaping and cleaning of all canals was done using nickel - titanium rotary instruments , k3 ( sybron endo , orange , ca , usa ) .
irrigation was done with 5.2% sodium hypochlorite solution ( naocl ) during shaping and cleaning of the root canal system .
passive ultrasonic irrigation ( pui ) activation was employed using # 20/0.00 taper ss noncutting ultrasonic tip ( irrisafe , satelec , acteon , merignae , france ) followed by 1 min flush of 17% ethylenediaminetetraacetic acid ( edta ; smearclear , sybronendo , ca , usa ) .
the canals were dried using sterile paper points and dressed with intracanal calcium hydroxide medicament and the tooth was sealed temporarily with an intermediate restorative material ( cavitg , 3m - espe , seefeld , germany ) . the patient was asked to return after 2 weeks . at the second appointment
, copious irrigation was done in order to remove the calcium hydroxide and the canals were made dry with sterile paper points . following radiographic control of the fit of gutta - percha mastercone ( guttapercha , sybronendo ,
ca , usa ) , the apical part of the main root canals was obturated with vertically compacted warm gutta - percha using the touch&heat 5004 device ( sybron endo , ca , usa ) .
the coronal portion of the main canal was backfilled with thermoplasticized gutta - percha using the obtura iigun ( obtura - spartan corp , fenton , mo , usa ) .
the access cavity was sealed with dualcuredcomposite resin ( paracore , coltene / whaledent , nj , usa ) .
the patient was then referred to the department of oral surgery for surgical correction of prognathic mandible .
the first stage involved a bilateral sagittal split osteotomy followed after 3 months by a second stage surgical advancement genioplasty procedure .
follow - up was at 6-months and 2-year intervals [ ure 1b and c ] .
a normal individual has 22 pairs of autosomes ( numbered chromosomes ) and one pair of autosomes and a single x and y chromosome , making a karyotype or chromosomal makeup of 46 , xy .
similarly , a normal female has 22 pairs of autosomes and two x chromosomes , making a karyotype 46 , xx .
48 , xxyy syndrome is characterized by an extra x chromosome and an extra y chromosome .
this , in addition to the 22 pairs of autosomes , males with 48 , xxyy syndrome has four sex chromosomes , making a karyotype 48 , xxyy .
successive meiotic nondisjuctional events during spermatogenesis , resulting in a xyy sperm have been attributed as the most probable etiological mechanism of 48 , xxyy syndrome .
the presence of extra sex chromosomes may lead to altered deoxyribonucleic acid ( dna ) methylation at various loci in genome leading to altered gene expression and subsequent phenotype variation . according to gardner and girgis ,
a patient with multiple taurodontic teeth without known association of any systemic syndrome should be consulted for chromosomal analysis , as there is a higher association of taurodontic teeth with x - chromosome aneuploidy syndromes .
hence , we referred our patient to the department of human genetics for chromosomal analysis .
chromosome analysis with gtg banding with a resolution of 450 - 550 bp , showed a numerical abnormality in all cells analyzed , with the presence of an extra x and an extra y chromosome resulting in 48 chromosomes and a diagnosis of 48 , xxyy syndrome was made [ figure 3 ] .
chromosome analysis with gtg banding showing numerical abnormality in all cells with presence of extra x and y chromosome the prevalence of taurodontism ranges from 2.5 to 11.3% of the human population .
taurodontism can occur either as an isolated manifestation or in association with various systemic syndromes .
a literature search for relevant articles regarding endodontic management of taurodontic tooth associated with systemic syndromes was performed using ovid medline , cochrane database of systemic reviews , embase , and pubmed .
table 1 summarizes the chronological order of case reports of taurodontism associated with systemic syndromes .
chronological reports of systemic syndromes associated with taurodontism this case showing 48 , xxyy karyotype is recognized as a distinct clinical and genetic entity .
this syndrome was previously considered to be a variant of klinefelter syndrome ( 47 , xxy ) ; however , it is now considered to be a distinct phenotype with more significant cognitive and psychological impairments .
the characteristic differences between these two syndromes have been well documented by tartaglia et al .
comparison of 47 , xxy klienfelter syndrome and 48 , xxyy syndrome ( adapted from tartaglia et al .
, 48 , xxyy , 48 , xxxy , and 49 , xxxxy syndromes : not just variants of klinefelter syndrome , acta paediatr : 2011 ; 100(6):851 - 860 )
knowledge regarding 48 , xxyy syndrome and its dentofacial manifestations is important for early diagnosis and long - term predictable medical and dental health management .
an early recognition of such a disorder is crucial in improving the psychological as well a dental quality of life in affected patients .

Answer:
taurodontism is a developmental anomaly of a tooth characterized by large pulp chamber and short roots .
 patients with multiple taurodontic teeth are associated with the probability of a systemic syndrome or chromosomal anomaly .
 this is the first reported incidence of the endodontic management of a hyper taurodontic mandibular second molar in a patient diagnosed with 48 , xxyy syndrome .