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:
pneumothorax is more frequent in the neonatal period than at any other time in life .
symptomatic pneumothorax occurs in 0.08% of all live births and 5% to 7% of infants with birth weight of below 1500
the development of a pneumothorax with ensuing hypoxia and hypercapnia is a potentially life - threatening event . to predict who will survive or die for newborns presenting with pneumothorax
traditionally a plain posteroanterior chest radiograph is the most appropriate method in the initial investigation .
the calculation of pneumothorax size on chest x - ray or computed tomography is a significant parameter for decision of treatment in adults .
however , to our knowledge , the clinical significance of this calculation in neonates is still unknown .
therefore we aimed to investigate whether assessment of pneumothorax size on chest x - ray may be a predictor of prognosis in newborns .
this retrospective cohort study was performed on 60 newborns presenting with pneumothorax among 5929 infants admitted to our neonatal intensive care unit ( nicu ) from january 2007 to april 2011 .
our institution is a tertiary hospital and its nicu has an annual admission of 1500 newborns .
the study was approved by the local ethics committee of tepecik teaching and research hospital .
clinical data were collected from patients medical records including gestational age , birth weight , gender , type of delivery , apgar score , side of pneumothorax , mechanical ventilation , surfactant therapy , underlying lung pathology ( transient tachypnea of newborn , pneumonia , meconium aspiration syndrome ) , duration of hospitalization , time of diagnosis and need for chest tube .
the chest tube insertion was performed by the nicu physicians as soon as the clinical indication ( presence of acceptable respiratory distress , abnormal blood gas levels and cardiovascular instability ) was evident .
a common protocol for mechanical ventilation was performed by a positive pressure ventilator ( babylog 8000 plus , draeger , lubeck , germany ) .
fio2 was given when it was needed to achieve arterial oxygen saturation between 85% and 95% by pulse oximetry .
inspiratory time was set at 0.35 - 0.40 sec and positive end - expiratory pressure at 4 - 6 cmh2o according to the status of the patient .
the peak inspiratory pressure was set by the clinician to keep the blood gasses at the target range .
the newborns were switched from the assist / control mode to the simv mode for weaning on the basis of each infant 's blood gasses and clinical status .
ventilatory rate was then reduced using the simv mode of the ventilator . if newborns treated with fio2<30% tolerated it at a respiratory rate of 10 bpm , were extubated .
the calculation was done on the chest x - rays stored electronically in hospital picture archiving and communication system ( pacs ) .
pneumothorax size was calculated as the percentage of the widest transverse diameter of the pneomothorax area in the posteroanterior view to the widest transverse diameter of the thoracic cavity above the diaphragm .
fischer 's exact test was used to compare categorical variables , mann - whitney u test for continuous variables and the wilcoxon rank sum test for ordinal variables .
the regression analysis was performed for evaluating the statistical significance of confounding variables . a receiver - operator characteristic ( roc ) curve
was used to explore various cut - off values of pneumothorax size . in order to determine whether the cut - off value was significant ,
this retrospective cohort study was performed on 60 newborns presenting with pneumothorax among 5929 infants admitted to our neonatal intensive care unit ( nicu ) from january 2007 to april 2011 .
our institution is a tertiary hospital and its nicu has an annual admission of 1500 newborns .
the study was approved by the local ethics committee of tepecik teaching and research hospital .
clinical data were collected from patients medical records including gestational age , birth weight , gender , type of delivery , apgar score , side of pneumothorax , mechanical ventilation , surfactant therapy , underlying lung pathology ( transient tachypnea of newborn , pneumonia , meconium aspiration syndrome ) , duration of hospitalization , time of diagnosis and need for chest tube .
the chest tube insertion was performed by the nicu physicians as soon as the clinical indication ( presence of acceptable respiratory distress , abnormal blood gas levels and cardiovascular instability ) was evident .
a common protocol for mechanical ventilation was performed by a positive pressure ventilator ( babylog 8000 plus , draeger , lubeck , germany ) .
fio2 was given when it was needed to achieve arterial oxygen saturation between 85% and 95% by pulse oximetry .
inspiratory time was set at 0.35 - 0.40 sec and positive end - expiratory pressure at 4 - 6 cmh2o according to the status of the patient .
the peak inspiratory pressure was set by the clinician to keep the blood gasses at the target range .
the newborns were switched from the assist / control mode to the simv mode for weaning on the basis of each infant 's blood gasses and clinical status .
ventilatory rate was then reduced using the simv mode of the ventilator . if newborns treated with fio2<30% tolerated it at a respiratory rate of 10 bpm , were extubated .
the calculation was done on the chest x - rays stored electronically in hospital picture archiving and communication system ( pacs ) .
pneumothorax size was calculated as the percentage of the widest transverse diameter of the pneomothorax area in the posteroanterior view to the widest transverse diameter of the thoracic cavity above the diaphragm .
fischer 's exact test was used to compare categorical variables , mann - whitney u test for continuous variables and the wilcoxon rank sum test for ordinal variables .
the regression analysis was performed for evaluating the statistical significance of confounding variables . a receiver - operator characteristic ( roc ) curve
was used to explore various cut - off values of pneumothorax size . in order to determine whether the cut - off value was significant , sensitivity and specificity values were also calculated .
of 60 newborns ( 1.0% ) presenting with pneumothorax among 5929 patients , 46 ( 76% ) were preterm and 14 ( 24% ) term .
pneumothorax was on the right side in 30 ( 50% ) newborns , on the left side in 21 ( 35% ) and bilateral in 9 ( 15% ) patients .
of 46 preterm infants , 41 were on mechanical ventilation and 28 needed chest tube as overall 6 term infants on mechanical ventilation ( fig .
1 ) . the flowchart of the study group patients characteristics are summarized in table 1 .
the mean gestational age of patients was 33.64.4 weeks and mean birth weight 2282909 g .
of overall 60 newborns , 45 ( 75% ) were male and 15 ( 25% ) female .
forty - three deliveries ( 71.6% ) were by cesarean section , and the remaining by vaginal delivery .
seven patients ( 11% ) had transient tachypnea of the neonate , 10 ( 17% ) pneumonia and 27 ( 45% ) respiratory distress syndrome .
the cause of deaths included sepsis in immaturity and respiratory failure in 8 ( 44.4 % ) patients , sepsis in 5 ( 27.7% ) , severe intraventricular hemorrhage in 3 ( 16.6% ) and hypoxia in 2 ( 11.1% ) .
five patients ( 13.3% ) received prophylactic surfactant whereas 21 ( 35% ) received rescue therapy .
  demographics and patients characteristics ( n = 60 ) sd : standard deviation results of statistical analysis for prognostic significance of pneumothorax size calculated on chest x - ray and clinical parameters are summarized in table 2 .
pneumothorax size was significantly higher in non - survivors ( 31.12.8 vs. 16.41.4 , p<0.001 ) and also in patients treated with a chest tube ( 25.81.9 vs. 14.22.0 , p<0.001 ) .
in addition , mortality discrimination was quantified by calculation of the area under the roc curve .
area under the curve ( auc ) was 0.85 ( good discrimination by an area is 0.80 ) .
the cut - off point of pneumothorax size for predicting survival was determined as 20% .
the sensitivity of the calculation of pneumothorax according to the cut - off value was 72% whereas specificity was 83% .
statistical analysis of significance in predicting mortality data are presented as mean ( standard deviation ) the confounding factors including early gestational age , low birth weight , resuscitation at birth , mechanical ventilation and need for chest tube were of great significance in predicting mortality .
however regression analysis revealed that only pneumothorax size was the independent prognostic factor ( p=0.02 ) .
in contrast , other parameters such as gender , type of delivery , time of diagnosis did not show any statistical significance between survivors and non - survivors .
in the present study we aimed to evaluate significance of pneumothorax size in predicting the mortality of newborns . the development of a pneumothorax with ensuing hypoxia and hypercapnia is a potentially life - threatening condition and 30% of the infants in the present study died in nicu .
this mortality rate is comparible with data in the literature of the last 20 years . even if not fatal , morbidity is a significant risk in these patients .
the risk for developing pneumothorax is increased in infants with respiratory distress syndrome , meconium aspiration syndrome , and pulmonary hypoplasia and in infants who need resuscitation at birth .
pulmonary disease is the underlying condition in 59 - 61% of neonates with pneumothorax . in our study pulmonary pathology
this finding can be explained by the fact that the majority of our cases were preterm . based on our findings
we think that low birth weight and preterm birth are the significant risk factors for developing pneumothorax .
development of pneumothorax is increased in infants resuscitated with positive pressure ventilation and/or chest compression in the delivery room .
the pathogenesis is either the rupture of over distended alveoli during resuscitation or lung injury due to rib fracture fallowing chest compression .
three fourth of our cases had a history of mechanical ventilation which was more common in non - survivors like those who needed chest tube .
although the risk factors related to mortality in the neonates presenting with pneumothorax are well - known , any practical method to predict who will survive or die is still of great importance in the clinical setting .
the diagnosis of pneumothorax is usually confirmed by imaging techniques which may also yield information about its size as well .
the size of pneumothorax on chest x - ray or computed tomography is a significant parameter in adults for treatment of the disease . to the best of our knowledge
, there is no study in the english medical literature investigating the prognostic value of pneumothorax size in newborns .
however the present study was carried out in a single large unit , therefore decreasing variation in the respiratory therapy was applied .
three dimensional lung volumes or lung pathologies like pneumothorax can be calculated by magnetic resonance imaging or computed tomography .
although these techniques are more reliable than routine chest x - ray , they are less practical especially in clinically unstable patients like those in the nicu . in addition chest x - ray
is also a less expensive method . because anteroposterior chest x - ray is a routine method , it is practical for the calculation of pneumothorax size in the nicu like assessment of cardiothoracic index and also reasonable for a retrospective study . in
the present study , calculation of pneumothorax size revealed statistical significance as a prognosticator in the neonatal period .
the pneumothorax size was significantly higher in non - survivors and appeared as an independent prognostic factor among the confounding variables .
the present study also showed that the neonates who had a pneumothorax size greater than 20% calculated by our method were likely to have worse prognosis .
the risk of mortality was 13 times higher in these newborns than in those with smaller pneumothorax size .
categorization of the patients according to the cut - off value appeared to show higher sensitivity and specificity .
although pneumothorax is not a cause of death , patients with pneumothorax usually carry higher risk of death and related complications due to more severe clinical status .
in conclusion development of pneumothorax in the neonatal period carries high risk of mortality especially in low birth weight and premature infants .
therefore identifying the risk groups by calculation of pneumothorax size can be a practical and reliable method .
however further studies are in need to emphasize whether this method has a rationale to be used in clinical protocols .

Answer:
objectivepneumothorax in newborns may result in a significant mortality and morbidity . to predict who will survive or die is of great importance in the clinical management .
 the aim of this study is to address whether assessment of pneumothorax size on chest x - ray may be a predictor of prognosis in newborns presenting with pneumothorax.methodsof 5929 infants admitted to our neonatal intensive care unit ( nicu ) from january 2007 to april 2011 , 60 ( 1.0% ) newborns presenting with pneumothorax were included in the present study .
 pneumothorax size was calculated by measuring the widest transverse diameter of pneumothorax area in the posteroanterior view and dividing it by the widest transverse diameter of thoracic cavity above the diaphragm .
 clinical data were collected from the patients records.findingsoverall mortality rate was 30% ( 18 patients ) .
 pneumothorax size was significantly higher in nonsurvivors ( 31.12.8 vs 16.41.4 , p < 0.001 ) .
 the cut - off point of pneumothorax size for predicting survival was determined as 20% .
 the sensitivity was 72% whereas the specificity 83% .
 preterm birth , low birth weight , resuscitation at birth , need for mechanical ventilation and chest tube insertion were of great significance in predicting mortality .
 however , of overall significant parameters , only pneumothorax size was the independent prognostic factor by regression analysis ( p = 0.02)conclusionwe conclude that the calculation of pneumothorax size in the newborns is a predictor of prognosis with high sensitivity and specificity .
 furthermore newborns with pneumothorax size greater than 20% are likely to have worse prognosis .


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:
eosinophilic chronic rhinosinusitis ( ecrs ) has been established as a subtype of chronic rhinosinusitis ( crs ) .
it is characterized by a resistance to conventional treatment with long - term macrolides , and frequent recurrences develop unless treated by steroids.13 ecrs is common in asians . to make a diagnosis ,
the following must be examined : history of respiratory diseases ; imaging tests of the rhinosinuses ; laboratory data related to allergic reactions ; and histopathological tests.3,4 only one case of ecrs has been published that was associated with optic neuropathy , although several cases with optic nerve complications in cases of allergic fungal sinusitis have been reported.5,6 we have examined a case of ecrs with optic neuropathy probably caused by compression or inflammatory invasion of the optic canal by an expansion of the inflamed tissues . even though endoscopic surgery ( ess ) and steroid therapy were performed on the same day , the vision did not return .
a-68-year - old man noticed a sudden loss of vision in his right eye when he woke up .
he was examined in our hospital the same day and his best - corrected visual acuity ( bcva ) was no light perception in the right eye and 1.2 in the left eye .
the pupillary light reflex was almost absent in the right eye , and a relative afferent pupillary defect was present .
fundus examination showed no optic disc edema and atrophy , and spontaneous venous pulsations were not present .
the macular area was normal , and optociliary shunt vessels were not present . from the clinical findings , we suspected a retrobulbar lesion and ordered an orbital computed tomography ( ct ) on the same day .
his history included nasal polypectomy more than 20 years earlier , and asthma that was not being treated .
the ct scan also showed pan - sinusitis , multilobular nasal polyps , and a defect of the sphenoid bone ( figures 1a  c ) .
the laboratory data showed no elevation of the white blood cell count , eosinophilia , and c reactive protein .
we consulted an otorhinolaryngologist on the same day , and an emergency endoscopic sinus surgery ( ess ) was performed .
intraoperatively , the ethmoid , maxillary , and sphenoidal sinuses were filled with highly viscous mucosal fluid . in addition , several polyps were found in the nasal cavity .
after excision of the polyps and thickened mucosa and drainage of the mucosal fluid , an erosion and thinning of the lateral wall of the sphenoid sinus bone and partial defects of the optic canal were found .
the optic canal was cleared to try to decompress the optic nerve , and betamethasone was applied to the exposed optic nerve to try to suppress the inflammatory changes .
no fungal hyphae were detected by grocott and periodic acid schiff ( pas ) staining ( figures 2a  d ) .
unfortunately , the right visual acuity did not improve and remained at no light perception in spite of the postoperative betamethasone ( total 324 mg ) .
six months later , nasal polyps recurred and nasal administration of betamethasone was started and is currently being continued .
the laboratory data showed an elevation of total ige and eosinophils compared to that before the surgery ( before 1.2% and post - surgery 6.2% ) .
the specific iges against candida and aspergillus were negative with the radioallergosorbent ( rast ) test .
chronic rhinosinusitis ( crs ) is a chronic inflammation of the rhinosinus mucosa and is characterized by the presence of two or more symptoms , viz . , nasal discharge , nasal obstruction , post - nasal drip , and reduction or loss of the sense of smell .
the diagnosis of crs is made by the signs and symptoms that remain for longer than 3 months and opacification of the sinus in x - ray and ct images .
although crs is common , its subclassification , pathology , and treatment have still not been completely established .
cases of crs have been divided into two groups ; chronic rhinosinusitis with nasal polyps ( crswnps ) and chronic rhinosinusitis without polyps ( crssnps ) in europe and the united states .
crswnps has a strong predisposition to recurrences even after ess , and pathological examinations show numerous eosinophils invading the mucosa .
in contrast , crssnp is diagnosed by purulent changes , and histopathological examinations of the nasal polyps and nasal mucosa show lymphocytes and neutrophils as the dominant inflammatory invaders .
however , some cases of crswnp in asians do not show eosinophil - dominant changes in the inflammation .
in addition , this subtype is not fully resolved by conventional long - term macrolide therapy combined with surgical dissection of the mucosal membrane in the sinuses .
these cases have recently been classified as ecrs because they have different clinical characteristics from the more common crss that are associated with asthma , elevation of eosinophilic counts in peripheral blood , and massive invasion of eosinophils into the nasal mucosa .
the diagnosis of ecrs is finally determined by the clinical findings of chronic nasal symptoms , results of imaging tests , peripheral blood tests , and histological tests.4 our case had the nasal symptoms , history of nasal polypectomy , and asthma .
ct showed pan - sinusitis , and histopathological examination of removed mucosal membranes showed intensive invasion of eosinophils .
furthermore , there was a recurrence after surgery and steroid therapy . from the findings and clinical course , our case was diagnosed as ecrs and not the purulent type of crs . unlike the purulent type of crs , the ocular complications of ecrs have not been fully determined .
garg et al reported a case of ecrs associated with optic neuropathy.5 the mri images showed a high intensity area over the left intraorbital optic nerve without any lesions in the paranasal sinuses .
they treated their case with steroid therapy and radical sphenoethmoid clearance , however the visual acuity , which was light perception before treatment , improved only slightly to finger counting .
fungi have received much attention in the united states as candidates for causing ecrs and allergic fungal rhinosinusitis ( afs ) .
the diagnostic criteria for afs include type 1 hypersensitivity to fungi , nasal polyps , and eosinophilic mucin containing fungi.7 it was suggested that fungi in the sinonasal mucosa might be the cause of non - atopic eosinophilia or local ige production.8 the clinical findings of afs overlap those of ecrs , and thus it is necessary to differentiate afs from ecrs .
generally , cases with afs have unilateral lesions , elevation of eosinophils , and ige specific to fungal antigen .
the important findings for diagnosis of afs are the detection of hyphal forms of fungi and positive histopathological findings with pas or grocott staining . as with ecrs
, afs is rarely associated with optic neuropathy.6 the orbital findings of afs are proptosis , ophthalmoplegia , optic neuropathy , and telecanthus .
imaging tests show hyper - attenuating foci along with expansion and destruction of the sinus walls .
most cases of optic neuropathy have an erosion of the lateral wall of the sphenoid and optic canal.6 the incidence of bony erosion in afs is more than 12 times greater than in non - afs.9 whether an erosion of sphenoid bone occurs may determine the visual prognosis .
there is potential for mistaking the size of the lesion with only mri.10 mri of cases with allergic aspergillus sinusitis showed that the lesions were low intensity cystic lesions in both t1 and t2 weighted images .
thus , the lesions may appear to be smaller than the actual size unless enhanced mri is used .
by contrast , ct can accurately detect the area of hyper - attenuation and bone architecture .
our case progressed to bilateral lesions , and the laboratory data were negative for ige specific to fungi .
in addition , there were no hyphae in the biopsy sections with pas and grocott staining . from these findings
it was not definitively determined why the visual acuity did not recover even though the ess was performed within 30 hours after the initial symptoms of optic neuropathy developed .
our case presented with pan - sinusitis and thick mucosal membrane overall of the rhinosinus including the middle meatus and osteomeatal complex . although the inflammatory changes gradually enlarged after the polypectomy , the drainage from the parasinus might have been blocked leading to infection and inflammatory changes .
these changes could then cause the internal pressure in the parasinus to increase and affect the optic canal , even though bacterial infectious changes were not detected .
in addition , local ischemia of the optic nerve might also have occurred secondary to the erosion of the optic canal followed by swelling of the optic nerve because the visual loss was so rapid . an earlier case of ecrs with optic neuropathy
had a different mri performed and an enhancement of the intraorbital optic nerve without extensive opacification of the rhinosinus was found .
although we did not do mri , direct invasion by inflammatory tissues might have occurred in the right optic nerve as seen in the previous case . in conclusion , we documented a rare case of ecrs complicated by optic neuropathy
. unfortunately , the visual acuity did not recover at all even though emergency ess and steroid therapy were performed .
these findings indicate that it is very important to suppress the allergic reaction for the prevention of ocular complications in ecrs cases .

Answer:
we report a case of eosinophilic chronic rhinosinusitis ( ecrs ) associated with optic neuropathy .
 the visual acuity in the right eye was suddenly reduced to no light perception on awakening in the morning .
 fundus examination of both eyes on the same day showed no remarkable changes .
 emergency computed tomography showed pan - sinusitis bilaterally and a partial defect of the sphenoid bone on the right side . from the clinical findings , the case was diagnosed as optic neuropathy associated with chronic sinusitis .
 endoscopic sinus surgery ( ess ) was performed on the same day , and all of the major sinuses were found to be filled with highly viscous fluid .
 part of the optic canal had a defect probably due to inflammatory invasion from the adjacent sphenoid bone .
 steroid therapy was started immediately postoperatively .
 histopathological examination of excised polyps showed that numerous eosinophils had invaded the polyps but no hyphae were present .
 the patient reported that he had bronchial asthma and had had nasal polypectomy .
 six months after the ess and steroid therapy , the patient had a recurrence of the sinusitis . at that time , laboratory examination showed an elevation of total ige and eosinophil numbers . from the clinical findings and course
 , this case was diagnosed as ecrs accompanied by optic neuropathy .
 although ecrs rarely has ocular complications , the inflammation can spread and the optic nerve can be affected .


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:
chronic obstructive pulmonary disease ( copd ) is presented mainly by bronchitis and emphysema in various combinations , often with asthmatic complications .
development of cor pulmonale and/or upper respiratory infections may exacerbate the clinical outcome in chronic course of the disease .
clinical examination as well as objective quantification of oxygenation is often critical for the clinical management of the patients .
arterial blood gas sample is often painful and carries the risk of local hematoma , infection and occlusion / embolization with consequent ischemic injury .
hand - held pulse oximeters are usually applied in primary care due to small size , user - friendliness and affordable prices .
a meta - analysis of published studies has found a weighted mean correlation coefficient of 0.895 between the pulse oximetry and arterial blood sample .
in addition , pulse oximetry can be used in the patients with acute respiratory insufficiency and in the follow - up of chronic respiratory conditions or acute exacerbations of copd .
the available literature suggests that the use of pulse oximetry for copd patients would be limited to acute events or specific situations .
the study was aimed to explore the association between spo2 and spirometer parameters of disease severity in copd patients with a view to identify whether the pulse oximetry can be used as an alternative to arterial values in the clinical management of copd patients in routine practice .
the study sample comprised of 31 patients diagnosed with copd , according to the criteria established by the global initiative for chronic obstructive disease ( gold ) who were consecutively referred to the respiratory outpatient clinic of a university hospital between may 2011 and december 2012 .
all the patients were subjected to full medical history , general and local chest examination and chest x - ray .
spo2 saturation was acquired for every patient using a portable pulse - oximetry device ( oxipen , envitecwismar , germany ) .
the percentage of hemoglobin oxygen saturation was measured after connecting the optical diodes on the patients fingers .
each experiment was performed 3 times and the mean value was considered as the spo2 . in the next step ,
data regarding the spirometry [ forced expiratory volume in 1 second ( fev1 ) and forced vital capacity ] in all the patients were measured .
based on the gold criteria , copd was considered very severe ( gold iv ) if fevi / fvc < 0.7 and fev1 < 30% predicted or fev1
< 50% predicted with respiratory failure or signs of right heart failure ; severe ( gold iii ) if 30  fev  50% ; moderate ( gold ii ) if 50  fev  80% , and mild ( gold i ) if the fev 1 /fvc ratio was < 70 and fev 1  80% of the predicted value ( 8) .
otherwise they were considered to have no lung disease ( normal ) or gold stage 0 if they reported respiratory symptoms .
the study complies with the declaration of helsinki and was approved by the institutional ethics committee of our university , and all patients gave written informed consent . for the statistical analysis , the shapiro - wilk test was used to determine the normality of the quantitative variables .
the data were expressed as median , interquartile range ; man - whitney u test and kruskal - wallis test were applied for quantitative comparison , and differences in categorical variables were examined using chi - square test .
statistical analysis was performed using an ibm computer and pasw software , version 18.0 ( spss , inc . ,
the study sample comprised of 31 patients diagnosed with copd , according to the criteria established by the global initiative for chronic obstructive disease ( gold ) who were consecutively referred to the respiratory outpatient clinic of a university hospital between may 2011 and december 2012 .
all the patients were subjected to full medical history , general and local chest examination and chest x - ray .
spo2 saturation was acquired for every patient using a portable pulse - oximetry device ( oxipen , envitecwismar , germany ) .
the percentage of hemoglobin oxygen saturation was measured after connecting the optical diodes on the patients fingers .
each experiment was performed 3 times and the mean value was considered as the spo2 . in the next step ,
data regarding the spirometry [ forced expiratory volume in 1 second ( fev1 ) and forced vital capacity ] in all the patients were measured .
based on the gold criteria , copd was considered very severe ( gold iv ) if fevi / fvc < 0.7 and fev1 < 30% predicted or fev1
< 50% predicted with respiratory failure or signs of right heart failure ; severe ( gold iii ) if 30  fev  50% ; moderate ( gold ii ) if 50  fev  80% , and mild ( gold i ) if the fev 1 /fvc ratio was < 70 and fev 1  80% of the predicted value ( 8) .
otherwise they were considered to have no lung disease ( normal ) or gold stage 0 if they reported respiratory symptoms .
the study complies with the declaration of helsinki and was approved by the institutional ethics committee of our university , and all patients gave written informed consent .
for the statistical analysis , the shapiro - wilk test was used to determine the normality of the quantitative variables .
the data were expressed as median , interquartile range ; man - whitney u test and kruskal - wallis test were applied for quantitative comparison , and differences in categorical variables were examined using chi - square test .
statistical analysis was performed using an ibm computer and pasw software , version 18.0 ( spss , inc . ,
the study was conducted on 31 patients with copd , including 24 males and 7 females ( mean age : 55.09  11.61 ; range : 35 - 76 years ) .
the pulse oximetry and spirometric variables of the patients are described in the table 1 .
physiological variables of the included patients there was not a significant association between fev1 % predicted and spo2 % ( p value > 0.05 ) , while there was a significant association between fev1/fvc % predicted and spo2 % ( r = 0.556 , p value < 0.001 ) [ figures 1 and 2 ] .
the dotted curves represent the 95% confidence intervals of fev1% for a given spo2% correlation between fev1/fvc% predicted and spo2% in the included patients .
the dotted curves represent the 95% confidence intervals of fev1/fvc% for a given spo2% in addition , the association among age with spo2% , fev1% predicted and also fev1/fvc % predicted was not significant statistically ( p value > 0.05 ) .
the median fev1 % predicted in the stage 0 was [ median 90% , interquartile range ( 90%-95% ) ] ; stage i was 83% , 75%-89% ; stage ii was 62% , 51%-79% ; stage iii was 45% , 38%-48% and also stage iv was 27% , 21%-33% , which was a significant differences among them in five stages of gold using kruskal - wallis test ( p value < 0.05 ) .
the median fev1/fvc % predicted in the stage 0 was [ median 74% , interquartile range ( 73%-89% ] ; stage i was 72.5% , 69%-78% ; stage ii was 70% , 58%-79% ; stage iii was 56% , 52%-70 % and also stage iv was 57.5% , 47%-68% , which was a significant differences among them in five stages of gold ( p value < 0.05 ) .
the median spo2% in the stage 0 was [ median 94% , interquartile range ( 93%-97% ) ] ; stage i was 94.5% , 91%-99% ; stage ii was 92% , 86%-96% ; stage iii was 90% , 74%-96% and also stage iv was 93.5% , 93%-94% , which was not a significant differences among them in five stages of gold ( p value > 0.05 ) .
copd is the sixth prominent cause of death in the world , and is estimated to be the third killing and the fifth debilitating disease by the year 2020 .
direct measurement of the pulmonary function ( spirometry ) and arterial blood gas ( abg ) analysis are indicated for the clinical management of copd . although pulse oximeters are extensively used in emergency departments , anesthesiology , and critical care , data on their efficacy in general practice is limited . in this regard
, studies have shown that these devices are only reliable when saturation is < 80% .
we aimed to investigate the effectiveness of pulse oximetery for the determination of severity of copd and respiratory failure .
the study showed no correlations between the disease severity ( in terms of baseline airflow obstruction ) and spo2 in copd patients .
the recruited patients in the current study mostly have a stable condition and came to the clinic for their routine follow - up .
this finding is in line with a number of studies that have documented a low degree of accuracy for the noninvasive assessment of saturation in stable copd patients .
studied the application of pulse oximetry in 88 patients with deteriorating copd which spearman correlation coefficient for the association between baseline fev1% predicted as documented in the patient 's medical file and spo2 was r = 0.55 ( p = 0.002 ) for the patients with acute exacerbations . on the other hand , in 207 patients with stable copd , a weak correlation existed between post - bronchodilator fev1 % predicted and spo2 values ( spearman r = 0.19 , p = 0.006 ; for current smokers : r = 0.13 , p = 0.252 and for former smokers ; r = 0.19 , p = 0.047 ) . also , median spo2 values did not differ between gold stages ( median test : p = 0.079 ) .
these observations suggest that pulse oximetry is mainly helpful when the symptoms are deteriorated because of severe airflow obstruction ( fev1 % predicted < 50% ) .
this is consistent with the findings of previous studies indicating that the rate of tests with spo2 < 92% increases when the fev1 % predicted value is < 50% in stable copd patients .
it is noteworthy that our population was consisting of those suffering from mild to severe copd who came to an outpatient clinic .
therefore , the findings of this study may be different from those acquired in hospital - based studies . in this regard , a turkish study in the patients with severe copd demonstrated a high sensitivity for both spo2 and fev1 in reflecting hypoxemia and hypercapnia ( 83.9 and 90.3% , respectively ) .
although monitoring of saturation is recommended only for patients with severe disease , pulse oximetry can identify those who might benefit from oxygen therapy or pulmonary rehabilitation .
meanwhile , overestimation of arterial oxyhemoglobin saturation might occur in spo2 values < 80% , especially in the patients with darkly pigmented skin .
oxygen saturations are not helpful for the diagnosis of copd ; saturations of < 98% provides a sensitivity of 79% , but specificity of only 37% .
however , pulse oximetry may help in determining the criteria for long - term oxygen therapy or the need for referral to hospital in acute exacerbations . according to dutch family practice guidelines , if pulse oximetry shows spo2
moreover , initiation of oxygen therapy based on an oxygen saturation value < 90% is considered another possible application for pulse oximetry in the primary care .
although the current oximeters are practically accurate , they may produce false data in the presence of carboxyhemoglobinemia , hemodynamic instability , dark skin pigmentation , jaundice , and also during the exercise .
the oximeter - indicated saturation may significantly overestimate arterial po2 , if the patient is alkalemic .
furthermore , the study depicted a significant association between fev1/fvc% predicted and spo2% ( r = 0.556 , p value = 0.001 ) .
the fev1/fvc ratio , also called tiffeneau - pinelli index , is a calculated ratio for the diagnosis of obstructive or restrictive lung disease .
it represents the proportion of a person 's vital capacity that is exhaled in the first second of expiration .
the above - mentioned finding was observed in nomori et al . on 83 patients who underwent lobectomy for lung cancer .
a number of studies have showed that fev1/fvc depends significantly on age in healthy subjects .
however , the current study did not show the correlation in the copd patients , which could be due to small number of the included cases in our study .
further a larger study may clarify such association in copd patients . in this study the mean age was 55.09  11.61 years with no significant relationship between age and fev1% of predicted in copd patients , and this was matching with the previous studies .
furthermore , the current study may demonstrate that fev1 is essential for the diagnosis and quantification of the respiratory impairment resulting from copd .
but , fev1 is known to poorly correlate with symptoms , quality of life exacerbation frequency and exercise intolerance . in total , the study did not support that oxygen saturation measured by pulse oximetry to replace analysis of an arterial blood gas sample in the clinical evaluation of oxygenation in health care patients with copd .
unfortunately , we did not include a standardized assessment of dyspnoea in our study , which would have enabled us to investigate the relationship between the severity of dyspnoea and spo2 .
another limitation is that we did not measure arterial blood gas components , such as pao2 , which would have allowed us to acquire more comprehensive results .
however , these findings support the claim that spirometric parameters , but not spo2 level , could be useful indicators of the patient outcome , although further evidence needs to be obtained .
the study may demonstrate that oxygen saturation measured by pulse oximetry appears to be independent of the degree of airways obstruction as quantified by the fev1 ; although further evidence needs to be assessed these preliminary findings .

Answer:
background : the study was aimed to explore the association between arterial oxygen saturation ( spo2 ) and spirometer parameters of disease severity in chronic obstructive pulmonary disease ( copd ) patients with a view to identify whether the pulse oximetry can be used as an alternative to arterial values in the clinical management of copd patients in a routine practice.materials and methods : thirty - one patients with copd were included in this study .
 after evaluation of each patient through history taking , physical examination and chest x - ray , spo2 % and data regarding spirometry ( fev1% predicted and fev1/fvc % predicted ) in all patients were measured .
 linear correlations among the variables were analyzed using the regression analysis.results:in total 31 copd patients according to the criteria established by the global initiative for chronic obstructive disease ( gold ) were included in the study .
 there was not statistically significant correlation between fev1 % predicted and spo2 values ( p > 0.05 ) , but a great correlation existed between fev1/fvc % predicted and spo2 values ( r = 0.556 , p < 0.001 ) .
 median spo2 values did not differ between gold stages ( kruskal - wallis test : p = 0.17).conclusion : the study may demonstrate that oxygen saturation measured by pulse oximetry appears to be independent of the degree of airways obstruction as quantified by the fev1 ; although further evidence needs to be assessed these preliminary findings .


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

Paper text:
the unfortunate complication of a colotomy resulting from a colonoscopic polypectomy can be disastrous . using the versatility of laparoscopic surgery
we report a case of cecal perforation , in a 70 year old female , following colonoscopic polypectomy that was treated successfully with laparoscopic application of an endo - gia linear stapler .
four months following staple resection of her cecal perforation , the patient is asymptomatic and has undergone a repeat colonoscopy without any sequelae .
laparoscopic techniques can be safely applied in the treatment of colonic perforations following therapeutic polypectomies .
a suggested management algorithm is provided highlighting the role laparoscopy may provide in selected patients .
colon perforation during therapeutic colonoscopy has been estimated to occur at a rate of approximately 0.1% to 0.3% .
perforation may occur through a variety of mechanisms , including energy application at the polyp site , direct mechanical trauma from the tip of the endoscope , lateral pressure from the side of a bowed endoscope , and pneumatic injury from overinsufflation .
several case reports advocating laparoscopic repair of colonic perforation following colonoscopy have been described in the literature . in our present case report
, we discuss the single application of an endoscopic linear stapler to close the perforation while preserving colonic lumen integrity in the presence of endoscopically placed mucosal clips .
a 70-year - old caucasian female with a past medical history significant for sigmoid diverticulosis and previous benign polyps of the colon was found to have a lipomatous lesion in the ascending colon during routine surveillance colonoscopy .
a complete resection of the polyp was performed using a 15-ml saline injection with india ink lift and a hot snare .
after resection , the mucosal biopsy site was larger than anticipated , and it became difficult to maintain insufflation .
the procedure was halted secondary to progressive abdominal pain and the clinical suspicion of a colonic perforation .
the perforation was confirmed with the presence of substantial free air on radiographs . in this rare situation of early discovery and hemodynamic stability ,
the patient was taken immediately to the operating room for surgical repair . in the operating theater ,
pneumoperitoneum was established with a veress needle , and a 5-mm camera with an optical access trocar was placed in the left lower quadrant . of note , the abdominal pressure at initial access was measured at 10 mm hg , consistent with pneumoperitoneum from insufflation through the colotomy .
a 5-mm anterior perforation of the cecum was clearly visible with an area of circumferential coagulation extending approximately 2 mm ( figure 1a ) .
the cecum was noted to be adhered to the side wall , and hence one additional 5-mm port and one 10-mm port were placed for mobilization in the midline .
the ports were placed in the umbilicus and the suprapubic position . after a sufficient segment of the cecum was freed , a single 30 silk stitch was placed to provide temporary closure and to provide a handle for elevation of the cecum .
an endo - gia 60-mm blue load was applied to preserve the lumen of the cecum while incorporating the entirety of the defect including the area of coagulation necrosis ( figure 1b ) .
the suture line incorporated healthy pink mucosa with preservation of the colonic lumen ( figure 1c ) .
the patient had an uncomplicated recovery with discharge on hospital day 4 . at the 4-month follow - up ,
the patient is without any complaints , tolerating a regular diet , and at baseline health .
she has had an interval surveillance colonoscopy without any abnormalities and a well - healed polypectomy / surgical site .
a : anterior cecal perforation with surrounding circumferential area of necrosis and endoscopically placed clips ( white arrows ) .
b : endo - gia 60 mm stapling with careful preservation of colonic lumen with incorporation of the entirety of the defect and area of coagulation necrosis .
colotomy that occurs during colonoscopy is a specialized subset of colon perforations for a variety of reasons . to begin with , in many cases
the patient is under the care of a physician in a monitored setting with established intravenous access .
although there may be some question as to the precise benefits of mechanical preparation in elective colorectal surgery , in the emergent setting it may be advantageous in minimizing the amount of gross spillage .
in addition , the endoscopist may provide localization of the suspected injury , allowing for more directed treatment .
it has been advocated by some that colonoscopic polypectomy should be performed in conjunction with laparoscopy when a particularly difficult or suspicious polyp is anticipated . in keeping with the success of previous case reports and advances in minimally invasive techniques , we propose an active role of laparoscopy in complex colonoscopies as outlined in figure 2 .
perforations , depending upon their size , may be treated with direct suturing , staple resection or segmental resection .
our approach to this cecal perforation was fundamentally the same as that for an appendectomy .
the technical skills involved in the procedure are well within the capabilities of practicing general surgeons , but several technical tips merit further comment . in this case , primary repair with intracorporeal suturing was technically possible .
however , it seemed ill advised , given the visible zone of coagulation necrosis surrounding the defect . in regards to the surgical stapler
, it would have been technically easier to place a single firing across the cecum rather than 2 angled applications ; however , 2 factors suggested multiple stapling : the endoscopically placed clips may have interfered with proper staple line creation , and a single firing raised the concern for luminal compromise .
it may be argued that in this case the procedure was effective , but that minimally invasive techniques are not broadly applicable .
however , in the analogous situation of perforated appendicitis , there have been multiple studies in which laparoscopy does not have an increased rate of complications over open laparotomy .
conceptually , it seems there is little harm in starting with a diagnostic laparoscopy and proceeding based on the nature of the injury and the experience of the surgeon .
many general surgeons will be confronted with the problem of colon perforation during colonoscopy . in the case
presented here , we modified the established technique of laparoscopic appendectomy to the specific problem of cecal perforation and have demonstrated the feasibility of such an approach .

Answer:
background and objectives : the unfortunate complication of a colotomy resulting from a colonoscopic polypectomy can be disastrous . using the versatility of laparoscopic surgery
 , we aim to provide a treatment algorithm for these colonoscopic perforations.methods:we report a case of cecal perforation , in a 70 year old female , following colonoscopic polypectomy that was treated successfully with laparoscopic application of an endo - gia linear stapler.results:four months following staple resection of her cecal perforation , the patient is asymptomatic and has undergone a repeat colonoscopy without any sequelae.conclusions:laparoscopic techniques can be safely applied in the treatment of colonic perforations following therapeutic polypectomies .
 a suggested management algorithm is provided highlighting the role laparoscopy may provide in selected patients .


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

Paper text:
a malignant peripheral nerve sheath tumor ( mpnst ) is a sarcoma that arises from peripheral nerves or cells of the associated nerve sheath ( schwann cells , perineural cells , fibroblasts ) .
the term " mpnst " has substituted previously used terms such as malignant schwannoma , neurofibrosarcoma , and neurogenic sarcoma1,2 ) .
the mpnsts comprise approximately 5% to 10% of all soft tissue tumors and have an incidence of 0.001% in the general population and the etiology is unknown .
however , more than half of mpnst cases develop in patients with neurofibromatosis type-1 ( nf-1 ) and there is a higher incidence in patients that have undergone prior radiotherapy1,2,5,8,13 ) .
mpnsts are most likely to metastasize to the lungs , followed by the bone and finally the pleura , but , spinal cord and brain metastasis is very rare in non - nf-1 mpnst3,7 ) .
the authors report a very rare case of spinal cord and brain metastasis of mpnst in the lumbar spine that occurred in a 18-year - old man without nf .
an 18-year - old man presented initially with a 6-month history of low back pain that worsened over time .
one month prior to admission , the patient developed radiating pain to his anterior thigh .
neither caf au lait spots nor neurofibromas were seen and his family history was absent of nf-1 .
the neurologic examination showed normal motor power in his lower extremities . magnetic resonance imaging ( mri ) showed a paraspinal mass that extended from the central space of l2 to the right psoas muscle through right l2 - 3 foraminal space .
it was an asymmetrical dumbbell shaped mass and the thecal sac was displaced left by the mass .
the mass showed iso - signal intensity on t1-weighted images and mixed signal intensity on t2-weighted images .
a paramedian incision was made from the l1 to l4 and we exposed the right l2 and l3 lamina with transverse process .
right l2 hemilaminectomy was performed using a high speed drill and kerrison rongeur to expose the thecal sac .
the margin of mass was relatively distinct from neural tissue , thus gross total resection was possible under microscopic view . to remove the mass extended to the psoas muscle ,
the right transverse process of l2 and l3 was resected and the mass was visible .
after the operation , his symptom had improved . however , a few days later , his confirmed pathologic report was presented as mpnst ( fig .
the contrast - enhanced mri was followed at 1 month after the operation and revealed a total removal of tumor ( fig .
however , the patient declined the external beam radiation due to the fear of potential radiation risk .
spine and brain mri showed that the tumor recurrence with leptomeningeal , multiple spinal cord and brain metastases ( fig .
4 ) . complete surgical clearance of the tumor was not technically feasible , owing to the multiple metastases .
therefore , the patient was referred for adjuvant chemotherapy . in addition , intrathecal chemotherapy was performed .
after 4 months of chemotherapy , he was referred to the hospice hospital and died within a month .
an 18-year - old man presented initially with a 6-month history of low back pain that worsened over time .
one month prior to admission , the patient developed radiating pain to his anterior thigh .
neither caf au lait spots nor neurofibromas were seen and his family history was absent of nf-1 .
the neurologic examination showed normal motor power in his lower extremities . magnetic resonance imaging ( mri ) showed a paraspinal mass that extended from the central space of l2 to the right psoas muscle through right l2 - 3 foraminal space .
it was an asymmetrical dumbbell shaped mass and the thecal sac was displaced left by the mass .
the mass showed iso - signal intensity on t1-weighted images and mixed signal intensity on t2-weighted images .
a paramedian incision was made from the l1 to l4 and we exposed the right l2 and l3 lamina with transverse process .
right l2 hemilaminectomy was performed using a high speed drill and kerrison rongeur to expose the thecal sac . for removal of intradural portion
the margin of mass was relatively distinct from neural tissue , thus gross total resection was possible under microscopic view . to remove the mass extended to the psoas muscle ,
the right transverse process of l2 and l3 was resected and the mass was visible .
after the operation , his symptom had improved . however , a few days later , his confirmed pathologic report was presented as mpnst ( fig .
the contrast - enhanced mri was followed at 1 month after the operation and revealed a total removal of tumor ( fig .
however , the patient declined the external beam radiation due to the fear of potential radiation risk .
spine and brain mri showed that the tumor recurrence with leptomeningeal , multiple spinal cord and brain metastases ( fig .
4 ) . complete surgical clearance of the tumor was not technically feasible , owing to the multiple metastases .
in addition , intrathecal chemotherapy was performed . however , no significant effect was observed and the patient 's condition deteriorated gradually .
after 4 months of chemotherapy , he was referred to the hospice hospital and died within a month .
non - nf-1 mpnsts are very rare and the occurrence of mpnsts occurring in adolescents is very rare
. mpnsts generally occur in adulthood typically between the ages of 20 and 50 years of age .
approximately 10 - 20% of cases have been reported to occur in the first 2 decades of life , with occasional cases involving infants as young as 11 months of age5,6 ) .
hruban et al . described 43 patients with mpnst and of these patients , 28 ( 65% ) had distant metastasis3 ) .
sites of metastasis included the lungs ( 22 cases ) , bone ( 9 cases ) , pleura ( 6 cases ) , retroperitoneum ( 4 cases ) , diaphragm ( 3 cases ) , inguinal lymph nodes ( 2 cases ) , liver ( 2 cases ) , chest wall ( 2 cases ) , soft tissue ( 2 cases ) , pulmonary hilum , pericardium , thyroid gland , and adrenal gland ( 1 case each ) .
described 11 distant metastasises in 54 patients with mpnst that included metastases to lymph nodes , pleura , lung , liver , adrenal gland , leptomeninges and brain7 ) .
william et al.4 ) reported a non - nf-1 mpnst case of metastasis to the spinal cord4 ) .
our case showed that leptomeningeal , spinal cord and brain metastasis of non - nf-1 mpnst for relatively short period after tumor removal in young male patient , reflecting aggressive nature of this malignancy .
the outcome with respect to both local recurrence and distant metastasis largely depends on grade of surgical excision .
radiation therapy combined with wide surgical excision offers statistical significant reduction in the rates of local disease recurrence .
however , it has not had a meaningful reduction in either rate of distant metastasis or overall survival15 ) .
benefit of chemotherapy is unproven and its application is limited to high grade metastatic disease3 ) .
the italian and german soft tissue sarcoma cooperative group reported an overall pediatric response rate of 45% , with the highest response noted within the ifosfamide group9,11,12 ) .
the recurrence rate for mpnsts has been reported to range from 40 - 68%7,10,14 ) .
the 5-year survival rate has been reported at 16 - 52% and a favorable prognosis has been related with complete surgical excision of the tumors that are sized less than 5 cm7,10 ) .
historically , mpnsts have been difficult tumors to treat due to their inherently aggressive nature and dismal prognosis .
our patient underwent complete surgical excision , but the patient was not treated with radiotherapy .
follow - up images revealed multiple spinal cord and brain metastases . the patient was managed with chemotherapy , but expired several months later . despite complete surgical excision ,
we reported a case of mpnst that had metastasized to the brain and spinal cord .
because the mpnst showed both rapid and aggressive progression , patients should be followed carefully to identify local recurrence or metastasis and be mandatory an adjuvant radiotherapy .

Answer:
a malignant peripheral nerve sheath tumor ( mpnst ) is a type of sarcoma that arises from peripheral nerves or cells of the associated nerve sheath .
 this tumor most commonly metastasizes to the lung and metastases to the spinal cord and brain are very rare .
 we describe a case of young patient with spinal cord and brain metastases resulting from mpnst .
 an 18-year - old man presented with a 6-month history of low back pain and radiating pain to his anterior thigh . magnetic resonance imaging showed a paraspinal mass that extended from the central space of l2 to right psoas muscle through the right l2 - 3 foraminal space .
 the patient underwent surgery and the result of the histopathologic study was diagnostic for mpnst .
 six months after surgery , follow - up images revealed multiple spinal cord and brain metastases .
 the patient was managed with chemotherapy , but died several months later . despite complete surgical excision ,
 the mpnst progressed rapidly and aggressively .
 thus , patients with mpnst should be followed carefully to identify local recurrence or metastasis as early as possible .


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:

 drug reaction with eosinophilia and systemic symptoms ( dress ) is a life - threatening reaction that necessitates determination and discontinuation of the offending drug.the aromatic structure of teicoplanin is shared by most other medications involved in dress.the use of additional treatment including intravenous immunoglobulins , corticosteroids and antivirals is generally based on experience rather than proven benefits drawn from well - designed clinical trials .

drug reaction with eosinophilia and systemic symptoms ( dress ) syndrome is defined as an idiosyncratic , rare , and life - threatening reaction .
the clinical features of the syndrome , including fever , rash , facial edema , lymphadenopathy , hematological abnormality , and internal organ involvement , arise 1030  days following drug exposure .
this late onset of symptoms discriminates dress from some other drug - induced skin reactions such as erythema morbilliform [ 1 , 2 ] .
the most common suspected medicines causing dress include aromatic anticonvulsants ( carbamazepine , phenytoin , phenobarbital , and lamotrigine ) , allopurinol , and antibiotics ( sulfasalazine , vancomycin , and minocycline ) . to the best of our knowledge ,
there are limited reports of teicoplanin - induced dress in the literature [ 26 ] . here
a 37-year - old woman was admitted to hospital with redness and edema of inguinal area . the involved area was tender and warm on examination . with a presumptive diagnosis of cellulitis ,
after 24  h , due to the acceptable clinical state of the patient , treatment was planned to be completed in the ambulatory setting .
vancomycin was replaced with teicoplanin , considering its ease of administration as an intramuscular injection ( 400  mg every 12  h for three doses , then 400  mg daily ) . on the 14th day of treatment ,
the patient developed generalized maculopapular rash ( fig .  1 ) , accompanied by fever ( 39  c ) , wheezing , shortening of breath , and cervical and axillary lymphadenopathy .
lab tests revealed abnormal liver enzymes [ alanine aminotransferase ( alt ) 134  iu / l , aspartate transaminase ( ast ) 141
iu / l ] , leukocytosis ( white blood cell count 17,000/l ) with eosinophilia to more than 8% ( 1360/l ) , a blood urea nitrogen ( bun ) value of 24  mg / dl , and a serum creatinine ( scr ) value of 0.8  mg / dl .
the follow - up lab test performed 1  month later indicated resolution of liver dysfunction ( alt 22  u / l , ast 18  u / l).fig .
1generalized maculopapular rash on the neck and trunk
  generalized maculopapular rash on the neck and trunk
with respect to diversity in scoring systems and differential diagnoses , the exact incidence of dress , as a life - threatening skin reaction , remains unknown . this could be partially because there is no gold - standard test for diagnosis of dress , and as a result , the diagnosis remains a challenge and is mainly based on conventional proposed scoring systems .
the most common scoring systems to stratify dress are regiscar , the japanese group s criteria for diagnosis of dress / drug - induced hypersensitivity syndrome ( dihs ) , and a system proposed by kardaun et al .
( table  1).table  1kardaun et al.s scoring system reproduced from kardaun et al .
, with permissionitempresentabsentpatient s scorefever 38.5  c ( 101.3  f)010enlarged lymph nodes ( > 1  cm size , at least two sites)101eosinophilia : 700 or 10% ( leucopenia ) ; 1500 or 20% ( leucopenia)1 ; 201atypical lymphocytes100rash 50% of body surface area101rash suggestive ( 2 of facial edema , purpura , infiltration , desquamation)100skin biopsy suggesting alternative diagnosis100organ involvement : 1 ; 21 ; 202disease duration > 15  days020investigation for alternative cause ( blood cultures , ana * , serology for hepatitis viruses , mycoplasma , chlamydia ) , 3 done and negative100total score5total score < 2 : excluded ; 23 : possible ; 45 : probable ; 6 : definite*ana antinuclear antibody
  kardaun et al.s scoring system   reproduced from kardaun et al . , with permission total score < 2 : excluded ; 23 : possible ; 45 : probable ; 6 : definite * ana antinuclear antibody dress is classified as a type iv drug - induced hypersensitivity reaction that is characterized by delayed onset of symptoms .
the rising of eosinophil count and non - necrotizing lesions differentiate dress from other type iv drug - induced hypersensitivity reactions such as stevens - johnson syndrome / toxic epidermal necrolysis ( sjs / ten ) . in regard to delayed onset of signs and symptoms including skin rash ( more than 50% of body surface area ) , fever ( more than 38.5  c ) , and enlarged lymph node ( more than 1  cm in two sites ) , dress was highly suspected .
these findings are in concordance with previous reports of teicoplanin - induced dress [ 3 , 4 , 6 ] .
additional work - up was performed to evaluate hematological abnormalities and organ involvement , which revealed leukocytosis with eosinophilia and liver involvement .
chest x - ray or computerized tomography ( ct ) scan and skin biopsy were not performed due to patient non - compliance .
testing for human herpesvirus-6 , human herpesvirus-7 , and epstein - barr virus antibodies was not requested because of limited resources . in general , our presumptive diagnosis was mainly based on clinical signs and symptoms and accessible lab tests . on the basis of the scoring systems mentioned above , the reaction was rated as probable ( score  =  4 ) according to regiscar and possible ( score  =  5 ) according to kardaun et al.s scoring system . since presence of atypical lymphocytes and reactivation of human herpesvirus were not investigated ,
dress was not confirmed by the japanese group s criteria for diagnosis of dress / dihs .
the aromatic structure of vancomycin and teicoplanin may explain the occurrence of dress with these agents . in this case ,
teicoplanin was used instead of vancomycin according to the summary of product characteristics ( available at http://www.sanofi.com.au ) . given the similar structure of vancomycin and teicoplanin ,
. the implementation of additional treatment including intravenous immunoglobulins , corticosteroids and antivirals is generally based on experience rather than proven benefits drawn from well - designed clinical trials [ 1113 ] .
administration of corticosteroids in severe pulmonary involvement seems to be reasonable according to results from some studies [ 13 , 14 ] .
however , we did not implement these interventions , considering the lack of proven benefit and the patient s overall state of health .
sholeh ebrahimpour , mehdi mohammadi , and kheirollah gholami declare that they have no conflicts of interest relating to the content of this article .

Answer:
intramuscular teicoplanin ( 400  mg every 12  h for three doses , then 400  mg daily , intramuscularly ) was prescribed for a 37-year - old woman with presumptive diagnosis of cellulitis . on the 14th day of treatment , she developed generalized maculopapular rash , accompanied by fever , wheezing , shortening of breath , and lymphadenopathy .
 lab tests revealed abnormal liver enzymes , leukocytosis , and eosinophilia .
 the treatment was interrupted with suspicion of drug reaction .
 fever subsided after 48  h. skin eruption and respiratory symptoms began to resolve within 2  weeks .
 the follow - up lab tests performed 1  month later indicated resolution of liver dysfunction .
 with respect to delayed onset of symptoms including fever , generalized rash , lymphadenopathy , and organ involvement , drug reaction with eosinophilia and systemic symptoms ( dress ) was highly suspected .
 the causality was evaluated by conventional scoring systems .
 the reaction was rated as probable ( score  =  5 ) according to regiscar and possible ( score  =  5 ) based on kardaun et al.s scoring system .
 however , dress was not confirmed by the japanese group s criteria for diagnosis of dress / drug - induced hypersensitivity syndrome ( dihs ) .


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:
eccentric exercise was shown to provoke skeletal muscle damage leading to delayed onset of
 muscle soreness ( doms)1,2,3 .
acute muscle damage can
 cause discomfort at the site of injury , inflammation , oxidative stress , edema , and loss of
 muscular function and strength4 , 5 .
many researchers have attempted to ameliorate symptoms by
 various treatments , such as nutritional interventions3 , 6 , pharmacological
 interventions7 , massage8,9,10 , low - intensity exercise10 , ultrasound application11 , or cryotherapy12 . even though some positive effects have been reported
,
 several studies did not find any reductions in the symptoms of muscle injuries . beside these treatments ,
static or pulsed electromagnetic field therapy have been used for
 the treatment of doms13,14,15 .
again , some
 authors reported positive effects on doms symptoms , whereas others were not able to find
 benefits13 , 14 .
application of a pulsating electrostatic field ( pesf ) , which is a
 comparable but not identical technique , might be a further method capable of reducing the
 symptoms of muscle soreness .
a pesf was shown to increase vasomotion and as a consequence
 blood flow16 , to reduce the formation of
 rouleaux , and to increase metabolic activity16 , 17 .
furthermore , a pesf may function as an
 ion pump able to move calcium ions , the concentration of which was shown to be increased
 after eccentric exercise with detrimental effects2 ,
 18 .
due to these effects , it might be
 speculated that a pesf could prevent the development of doms and muscle strength loss after
 muscle damaging exercise .
therefore , the aim of the present study was to investigate the
 effect of pesf application on sensation of muscle soreness and muscle strength after
 eccentric exercise .
nine sport students ( 5 males , 4 females ) without any medical problems and not adapted to
 eccentric exercise were recruited for the study .
all of them were informed about the study
 aims and gave written informed consent for participation .
two participants ( one male and one
 female ) had to be excluded from the final analysis , one because of a pre - start muscle
 soreness score of already 4 and one because of a pre - start ck value of 333 u / l . therefore , 7
 participants ( 4 males and 3 females ; weight , height , and age : 74.35.7  kg and 71.05.3  kg ,
 183.09.9  cm and 172.36.4  cm , and 26.52.4  years and 24.31.2  years , respectively ) were
 included in the final analysis .
the study was carried out in conformity with the ethical
 standards of the declaration of helsinki and was approved by institutional review board of
 the department of sport science , university of innsbruck .
the study was designed as a single - blinded , placebo - controlled cross - over intervention
 study .
all participants performed 2 downhill running sessions on a treadmill separated by at
 least 4 weeks . before and at different time points after the sessions
, muscle soreness
 score , creatine kinase ( ck ) , and jump ability were assessed as described in detail below .

the first running session was carried out in a slightly modified form according to kingsley
 et al5 .
running sessions started with a
 3  min stage of horizontal running at 5  km / h ( warm - up ) .
thereafter , the inclination was set
 at 17.5% , and the speed was increased every minute by 1  km / h until reaching approximately
 70% of the age - predicted maximal heart rate ( hr ) ( calculated as 220  age ) .
overall , the running duration was 30
 minutes , not including the warm - up time . during the second test
, the speed was regulated in
 the same way as during test one but independent of hr in order to have identical test speeds
 and a comparable muscular stimulus . immediately after each run ,
half of the subjects were
 treated in a sitting position with a pesf for 45  min , and half of the subjects were exposed
 to a sham treatment .
after at least 4 weeks , in which participants were advised not to
 change their physical activity habits , the subjects that were treated with a pesf during the
 first session received the sham treatment and those that were treated with the sham
 treatment during the first session received the pesf treatment .
the ( negative ) pesf was generated with a new health
 9000 device ( akern srl , pontassieve , italy ) and was applied through a mat with a field
 intensity of 9000 v , a current of < 9 ma , and a pulsatile frequency of 50  hz . the
 electrostatic field was confined to the ion mat surface , and it has been proven to be
 safe17 .
the general rating of muscle soreness was assessed as described by trombold et al.3 before and immediately after the runs ,
 immediately after the 45  min treatment or sham treatment , and 48 hours after treatment .

participants subjectively rated the degree of soreness using a visual analog scale of 0 to
 10 , with 0 describing  no soreness  and 10 describing  unbearable soreness  . jump ability
 ( jump and reach test ) was assessed before running , after the 45  min session , and 48 hours
 after the running .
ck activity was assessed before running and 48 hours after running from
 capillary blood samples with a reflotron sprint device ( reflotron sprint , mannheim , germany ;
 reference range for men : 24195 u / l at a measurement temperature of 37  c ) .
delta values (  ) were calculated as post values
 ( at different time points ) minus pre values for both the pesf application and sham setting .

differences at baseline , changes in the course of pesf or sham treatment , and differences
 between conditions (  values for the pesf and sham treatment ) were assessed by paired
 student s t - tests or the wilcoxon test as appropriate .
spearman correlation analyses were
 used to calculate associations between ck and cmj changes and muscle soreness score .
when compared with the pre
 values , the muscle soreness score was increased at all time points and under both conditions
 ( p<0.05 ) .
jump performance was reduced immediately after the sham application ( p=0.038 )
 and tended to be reduced immediately after the pesf application ( p=0.054 ) . table 1table 1.values for jump height , creatine kinase , and muscle soreness score in the courses
 of the pesf and sham treatmentspreafterrunafter45 min 24 hafter48 hafterjump and reach ( cm)pesf276.28.7273.07.03.33.9273.010.53.33.6sham276.521.6272.023.54.55.3272.023.24.56.2creatine kinase ( u / l)pesf133.632.1171.971.338.358.7sham100.141.0271.7274.5171.6285.8muscle soreness scorepesf1.41.43.61.72.12.04.02.02.61.65.10.93.71.64.61.53.12.0sham1.01.04.01.43.01.74.11.73.12.26.71.75.72.26.42.45.43.2pesf : pulsating electrostatic field . the table represents values of the same
 participants receiving the pesf and sham treatments ( n=7 , crossover design ) .

there was a trend toward significant differences in delta values (  =
 after values ( i.e. 45  min , 24 h , and 48  h after ) minus pre value ) between treatments
 ( pesf vs. sham ) . shows values for ck , muscle soreness score , and jump height in the courses of
 the pesf and sham treatments .
twenty - four and 48 hours after downhill running , the muscle
 soreness score ( mss ) tended to be less after pesf administration when compared with the sham
 treatment (  mss : 3.71.6 vs. 5.72.2 after 24  h and 3.12.0 vs. 5.43.2 after 48 h ,
 respectively ; 0.05<p<0.01 ) .
furthermore , the highest muscle soreness scores were found
 after the sham session , with one subject having a score of 9 and two subjects having a score
 of 8 after 24 hours .
after 48 h , one subject had a score of 10 , one subject had a score of
 9 , and one subject had a score of 7 .
after 48 hours , one subject had a score of 7 , whereas all others had
 lower values .
the table represents values of the same
 participants receiving the pesf and sham treatments ( n=7 , crossover design ) .

there was a trend toward significant differences in delta values (  =
 after values ( i.e. 45  min , 24 h , and 48  h after ) minus pre value ) between treatments
 ( pesf vs. sham ) .
the main finding of the present investigation was that pesf application tended to reduce
 muscle soreness scores without significantly affecting ck increase and jump performance
 decrease . to the best of our knowledge ,
this is the first study to use a pesf after downhill running
 for the prevention of muscle soreness . in the literature , different methods , including cold
 or infrared therapy , massage , pharmacological intervention , etc .
, have been applied to
 reduce muscle pain after eccentric exercise7 , 8 , 10 , 12 .
the mechanisms causing beneficial effects
 are as diverse as the methods applied . for cold application ,
the main beneficial effect is
 thought to be the cold - related vasoconstriction , which may limit vessel permeability and
 thus inflammatory processes12 .
the
 mechanism by which infrared therapies might induce potential positive effects is mainly
 based on the increased peripheral flow due to warmth - related vasodilatation , which could
 enhance the evacuation of edema , limiting inflammation and perceived pain12 .
the mechanisms mediating the biological
 benefits of nutritional interventions are not clear but may be linked to the attenuation of
 oxidative stress and inflammation3 . with
 respect to electromagnetic field therapy , it was suggested that the treatment influences
 muscle immune and inflammatory responses by an unknown mechanism , may disrupt afferent input
 from free nerve endings of nociceptors , and may influence excitation - contraction coupling
 processes13 , 15 , 19 . in the present study
additionally , the improvement of
 vasomotor performance might have provoked some beneficial effects16 , 17 .
comparable to
 the effects of infrared application , the increased blood flow might have enhanced the
 removal of edema , limited the inflammatory response , and reduced perception of pain12 . a further mechanism might be the function
 of a pesf as an ion pump moving positively charged ions , e.g. , calcium and hydrogen16 .
the calcium concentration was shown to be
 elevated in skeletal muscle cells following eccentric contractions18 . increased calcium concentrations within the sarcoplasm

have the potential to activate many different molecular pathways in skeletal muscle ,
 including the phospholipase - prostaglandin pathway and the calpain proteolytic pathway , which
 might lead to breakdown of the cell membrane and myofibrils2 . however , whether or not such mechanisms might be involved in
 processes of recovery from exercise - induced muscle damage still needs to be determined .
it
 has to be mentioned that although there was a trend toward a decrease in muscle soreness
 score , ck and jump performance did not seem to be affected by pesf application . in this

regard , the small sample size certainly is a main limitation of the present study and
 outlines its nature as a pilot study . nonetheless ,
when looking at the mss and ck values in
 table 1 , some beneficial effects clearly seem
 to be apparent .
this is supported by the finding that the highest mss values were found
 after the sham treatment .
additionally , pesf application for only 45  min may be considered a
 short exposure time , and it is not known if a longer pesf application time would have been
 more effective . in conclusion ,
application of a pesf might be a promising treatment to reduce muscle
 soreness after exercise - induced muscle damage .
however , further studies are needed to
 confirm the present outcomes and to establish the mechanism by which a pesf may reduce
 muscle pain .

Answer:
[ purpose ] the aim of the study was to establish whether pulsating electrostatic field
 application , shown to increase blood flow and metabolic activity and to function as an ion
 pump , is able to reduce muscle pain after exercise - induced muscle damage .
 [ subjects and
 methods ] seven participants ( 4 males , 3 females ) performed two sessions of downhill
 running separated by at least 4 weeks .
 after the running sessions , participants were
 either treated for 45  min with a pulsating electrostatic field ( field intensity , 9000 v ;
 current , < 9 ma ; frequency , 50  hz ) or a sham treatment .
 the order of the intervention
 was random , and the condition was blinded for the participants .
 muscle soreness score ,
 creatine kinase , and jump ability were assessed before and up to 48 hours after running .

 [ results ] twenty - four and 48 hours after the downhill running , the muscle soreness score
 tended to be less increased after pulsating electrostatic field administration when
 compared with the sham setting ( changes in muscle soreness score : 3.71.6 vs. 5.72.2
 after 24  h and 3.12.0 vs. 5.43.2 after 48 h , respectively ) .
 no further differences were
 detected .
 [ conclusion ] the outcomes show that a pulsating electrostatic field might be a
 promising treatment to reduce muscle soreness after exercise - induced muscle damage
 .
 however , further studies are needed to confirm the present outcomes and to establish the
 mechanism by which a pulsating electrostatic field may reduce muscle pain .


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:
polymerase chain reaction ( pcr ) is a commonly used laboratory procedure nowadays for a variety of tasks , such as dna cloning , sequence determination and snp detection .
consequently , numerous primers need to be designed for dna amplification in order to produce enough dna . for dna sequencing , to design primers for the promoter and exon regions of a gene , one needs to retrieve the required sequence information for each single exon and promoter , including their corresponding flanking sequences , convert them to the correct format , switch to a primer design application like primer 3 ( 1 ) , import the sequence information and adjust parameter settings if necessary before submitting the request . while this is tolerable for primer design for a gene that has a single exon , a human , mouse or rat gene can easily have more than 10 exons , and each of the above steps may thus need to be repeated 10 times or more .
furthermore , if an exon is too long to sequence properly in one run , several primers have to be designed to map overlapping sections of the exon .
the whole process requires many manual steps for repeated window opening , browsing , application switching , copying and pasting , typing and so on , which can be tedious , time - consuming and error prone .
in fact , for a gene with 10 exons , the process can easily exceed 300 steps . to improve the situation , we have developed primerz to replace almost all of these manual steps so that users can easily complete a primer design task using just a few clicks for a gene or batched human snps .
more than 2000 primers have been designed with primerz at our institute since 2004 and the success rate is over 70% .
there are a multitude of user - definable options available including product size , maximum exon length , excluded regions of the query sequence , gc - content and maximum allowable local alignment score . simply by submitting a candidate gene name ,
a snp i d or up to 100 batched snp ids , in most cases all the primer sequences should be returned in a minute or two . the generated information , including gene transcript graph , primer data from primer3 , and direct links to ucsc in - silico pcr ( 3,4 ) for pcr product prediction , to ncbi blast and to ensembl source data , is integrated and displayed on a single page for convenient viewing .
additionally , all the primer data can be exported in csv format for further processing .
primerz takes advantage of the well - developed public - domain database ensembl , through its api ( application programming interface ) .
when a gene query is received , primerz will access the ensembl database through ensj api ( 5 ) to retrieve promoter and exon information . by default but with an adjustable setting ,
primerz retrieves one region of 1440  bp upstream from the start of 5-utr which it treats as the promoter region .
the promoter region is thereafter divided into four 360  bp non - overlapping segments plus their respective flanking sequences .
all exons are directly flanked with 240  bp sequences , except when an exon of the gene is > 360  bp , when the sequence will be split into segments of 360  bp for a better quality sequencing result .
for example , an exon of 1000  bp will produce two 360  bp segments and one 280  bp segment . the above sequence information , plus parametric settings packaged by primerz are then fed into primer3 for primer design .
all returned primer results , together with a transcript graph , are integrated into a one - page report for final output .
the self - explanatory workflow of the whole primerz system is shown in figure 1 .

the software development environment included the following software :
 java , jdk : j2sdk1.4.2_06 , server vmstruts framework 1.2red hat enterprise linux academic editionmysql 4.1tomcat 5.0 web serverensembl java api java , jdk : j2sdk1.4.2_06 , server vm red hat enterprise linux academic edition tomcat 5.0 web server the api provided by ensembl is used for gene information retrieval .
java language is used to pipeline gene data into primer 3 and merge the returned results .
primerz is an easy - to - use tool to design primers for genes and snps , using only a few simple steps to design the wanted primers .
it currently provides gene primer design for all ensembl species while snp primer design is currently only available for human snps . for gene primer design ,
there are some essential parameters required for optimal design of primers , such as maximum exon length , exon flanking region , product size range and excluded region .
the  excluded region value allows the program to bypass regions with low sequence quality or containing repetitive elements such as alus or lines for primer design . for snp primer design , a snp rsid or an affy_probid(6 ) as well as a batch file containing mixed
i d types can be accepted as input , where the maximum number of snps per batch is limited to 100 .
the result page comprises three major parts : initial input data and parameters , the gene transcript diagram ( only available for gene primer design ) and designed primer information .
the first part lists all the input data and parameters plus ensembl database version , for ease of reference .
the second part shows each promoter fragment and exon of a transcript diagram , and links to their accompanying original primer3 output . finally , the third section presents tabulated primer information and incorporates executable links to ncbi blast and ucsc in - silico pcr to check specificity and product prediction .
ensembl link button offers the ensembl exon report of the transcript so that a user can trace all primers to their original sequence information .
a csv format text file of the results can be downloaded at this results page .
in a manual operation benchmarking test , it took a person very familiar with all processes about 1260  s and 380 discrete steps to design the primers of hadhsc ( l-3-hydroxyacyl - coenzyme a dehydrogenase , short chain ) , our benchmark gene with 10 exons .
with automated primerz , the same operation took only 16  s and three steps .
this comparison clearly demonstrates the superior efficiency and ease - of - use of primerz for gene primer design .
a benchmark test on batched snps showed a similar dramatic reduction in workload from 90 discrete steps to two steps , from 840 to 49  s , and from 40 result pages to a single page .
primerz has been designed to obtain reliable primers for pcr experiments and to allow standardized , automated primer design for batch operation .
users can access the ucsc in - silico pcr directly from the result page to verify their primers to achieve higher accuracy and lower cost .
primerz also allows users to modify the conditions of primer design , including the maximum exon size , the flanking region of the target sequence , the exclusion region and the maximum allowed polya and ca - repeats in the pcr products .
in addition , primerz will offer primer design from ncbi transcripts in the near future , which should be of great interest to those users who use ncbi data to design primers .
the results from ncbi and ensembl will be shown in the same page . following the release of primer3 web interface in november 2006 , we are installing and testing a local copy of primer3 web to alleviate the burden on the original primer3 website and the restriction on the number of snps allowed .
primer z is a simple - to - use program that greatly facilitates and enhances the traditionally time - consuming task of accurate primer design for pcr , and should be an excellent additional tool for the modern molecular biologist .

Answer:
primerz ( http://genepipe.ngc.sinica.edu.tw/primerz/ ) is a web application dedicated primarily to primer design for genes and human snps .
 primerz accepts genes by gene name or ensembl accession code , and snps by dbsnp rs or affy_probe ids .
 the promoter and exon sequence information of all gene transcripts fetched from the ensembl database ( http://www.ensembl.org ) are processed before being passed on to primer3 ( http://frodo.wi.mit.edu/cgi-bin/primer3/primer3_www.cgi ) for individual primer design .
 all results returned from primer 3 are organized and integrated in a specially designed web page for easy browsing . besides the web page presentation , csv text file export is also provided for enhanced user convenience.primerz automates highly standard but tedious gene primer design to improve the success rate of pcr experiments .
 more than 2000 primers have been designed with primerz at our institute since 2004 and the success rate is over 70% .
 the addition of several new features has made primerz even more useful to the research community in facilitating primer design for promoters , exons and snps .