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Sentence: Thumb force deficit after lower median nerve block Abstract Purpose The purpose of this study was to characterize thumb motor dysfunction resulting from simulated lower median nerve lesions at the wrist. Methods Bupivacaine hydrochloride was injected into the carpal tunnel of six healthy subjects to locally anesthetize the median nerve. Motor function was subsequently evaluated by measuring maximal force production in all directions within the transverse plane perpendicular to the longitudinal axis of the thumb. Force envelopes were constructed using these measured multidirectional forces. Results Blockage of the median nerve resulted in decreased force magnitudes and thus smaller force envelopes. The average force decrease around the force envelope was 27.9%. A maximum decrease of 42.4% occurred in a direction combining abduction and slight flexion, while a minimum decrease of 10.5% occurred in a direction combining adduction and slight flexion. Relative decreases in adduction, extension, abduction, and flexion were 17.3%, 21.2%, 41.2% and 33.5%, respectively. Areas enclosed by pre- and post-block force envelopes were 20628 ± 7747 N.N, and 10700 ± 4474 N.N, respectively, representing an average decrease of 48.1%. Relative decreases in the adduction, extension, abduction, and flexion quadrant areas were 31.5%, 42.3%, 60.9%, and 52.3%, respectively. Conclusion Lower median nerve lesion, simulated by a nerve block at the wrist, compromise normal motor function of the thumb. A median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. From our results, such a means of motor function assessment can potentially be applied to functionally evaluate peripheral neuropathies. Introduction The thumb has unique anatomical and biomechanical characteristics that are required to perform many manipulative tasks. Thumb motor dysfunction resulting from neuromuscular and musculoskeletal pathologies severely hinders the performance of these daily tasks. Clinical treatment, prevention protocols, and rehabilitation efficacy requires a thorough understanding of thumb motor capabilities, as well as its associated functional deficit. Investigations of underlying pathological mechanism of the thumb help advance clinical treatments such as tendon transfers [1], functional electrical stimulation [2] and plasticity suppression [3]. Measurement of strength during maximum voluntary contraction is a simple and direct means of assessing neuromuscular function. Popular instruments used for quantitative assessment of thumb strength are pinch dynamometers. The pinch output, however, provides limited information about thumb motor function in that it offers a single generic force in one specific direction. Each muscle/tendon within the thumb has a distinct anatomical origin and insertion, suggesting its external force potential in a particular direction [4-6]. Hence, evaluation of strengths in multiple directions offers insight concerning the motor capacity of individual muscles. Force production of a digit has been measured in various directions such as flexion/extension [7,8], abduction/adduction [9-14], or in combined directions [15,16]. Bourbonnais et al. developed an apparatus to measure thumb force production in eight directions in the transverse plane of the thumb and investigated force dependence on the direction of effort [15]. Yokogawa and Hara measured index fingertip forces in various directions within the flexion/extension plane [8]. Recently, we developed experimental apparatuses to measure multi-directional forces of a digit in its transverse plane [17-19]. From these multi-directional forces we constructed force envelopes representative of the characteristic force output pattern of a digit [17-19]. Disorders resulting from traumatic injuries to and various diseases of these nerves are common in clinical practice. Clinical manifestations of hand dysfunction are distinctive depending on the nerve involved. For example, thenar atrophy is a major clinical observation affecting thumb function at the later stages of compression neuropathy of the median nerve. Several studies have been conducted to investigate the effects of simulated peripheral neuropathies using local anesthetization [5,16,20,21]. Kozin et al. [21] studied the effects of median and ulnar nerve blocks on grip and pinch strength and showed significant decreases following nerve blockage [21]. Boatright and Kiebzak [20] investigated the effects of median nerve block on thumb abduction strength. Kaufman et al. [5] measured isometric thumb forces in eight directions together with electromyographic signals of thumb muscles after block of the median nerve. Labosky and Waggy [22] studied the strength related to grip, pinch, thumb adduction, thumb abduction, and finger flexion after radial nerve block [22]. Kuxhaus studied the three dimensional feasible force set at the thumb-tip before and after ulnar nerve block and reported this to be a reproducible and sensitive means to detect impairment. The purpose of this study was to utilize our developed apparatus and protocols to investigate the effects of lower median nerve lesion on thumb motor function. The lesion was simulated by blocking the median nerve at the wrist using an anesthetic. We hypothesized that a median nerve block would cause (1) a decrease in force production, which would be direction-dependent with the most severe reduction in the abduction direction, and (2) a decrease in the force envelope area and force quadrant area, with the greatest decrease in the abduction quadrant. Methods Subjects Six healthy male subjects (mean age: 26.9 ± 5.1 years) participated in this study. The subjects had no previous history of neuromuscular or musculoskeletal disorders of the upper extremities. Each subject signed an informed consent form approved by the Institutional Review Board prior to participating in the experiment. Median nerve block Injections were performed under aseptic conditions while the subjects sat with the forearm supinated and the wrist slightly extended. After the skin at the palmer area of the wrist was cleaned with alcohol, 4 mL of 0.5% bupivacaine hydrochloride (Astra Pharmaceuticals, Westborough, MA, USA) was injected into the carpal tunnel with a sterile 25-gauge short-bevel needle. The needle was inserted through the transverse carpal ligament in line with the radial border of the fourth digit slightly ulnar to the palmaris longus tendon at the level of the distal wrist crease. Forty minutes was allowed for the median nerve block to reach complete effectiveness [23] and was verified using the Semmes-Weinstein monofilament test. The average monofilament score was 2.85 across the five digits before nerve block. About 40 minutes after nerve injection, little sensory impairment occurred in the ulnar distribution (score = 3.22), while the sensory score in the median distribution was greater than 6.15. The effects of nerve block lasted more than 6 hours with all subjects regaining normal hand function within 12 hours. Testing apparatus The experimental apparatus was designed and constructed to measure maximum voluntary contraction forces of any digit at any point along the digit. Force application was possible in any direction within the transverse plane of the longitudinal axis of the digit. The apparatus consisted of position control accessories, a force transducer, and a custom fitted aluminum ring attached to the transducer (Figure 1A,1B). The transducer (Mini40, ATI Industrial Automation, NC, USA), capable of measuring 6 degrees of freedom forces and moments, was attached to a mounting clamp via an aluminum adapter plate while the aluminum ring was secured to the tool side of the transducer using a custom adapter. The ring served as a connection anchor for the transducer and the digit. The force transducer and ring attachment were positioned in a desired orientation using an aluminum slide rail, tubing, and lockable mounting clamps (80/20 Inc., Columbia City, IN, USA). The slide rail was secured to an aluminum base plate. Foam padded wooden blocks with two locking straps secured the arm to the base plate. The analog outputs from the transducer were digitized using a 16-bit analog-to-digital converter (PCI-6031, National Instruments, TX, USA). The X (abduction/adduction) and Y (flexion/extension) force components in the transverse plane were displayed on the screen while the subject performed a force production task. The resolutions of the force transducer in its axial (flexion/extension) and horizontal (abduction/adduction) directions were 0.16 N and 0.08 N, respectively. A personal computer equipped with LabVIEW (National Instrument, TX, USA) was used for force data acquisition, display, and processing. Experimental procedures Each subject was tested before and after median nerve block. The nerve block procedures were performed immediately after the completion of the first testing session. Post-block testing started after the verification of complete median nerve block, approximately 40 minutes after the injection. During each test, the subject was seated in a chair adjacent to the testing station modified with a wooden board to align their back vertically throughout the trials. The subjects rested their forearm on padded wooden blocks positioning their shoulder in approximately 60° of frontal plane abduction. Nylon straps fitted with plastic snap locking mechanisms secured the forearm and minimized the intervention of the elbow and shoulder during thumb force application. Subjects grasped a vertical dowel secured to the distal end of the wooden blocks in a midprone position. Formable thermoplastic braces were used to fix the elbow in 90° of flexion, and the wrist in 20° of extension and 0° of ulnar deviation. A metallic brace was used to fix the interphalangeal joint of the thumb in full extension. The aluminum ring was placed around the middle of the proximal phalanx and oriented to accommodate comfortable thumb position with the metacarpophalangeal joint flexed approximately 15°. Prior to testing, a line was drawn on the proximal phalange at the midpoint between the interphalangeal and metacarpophalangeal joints. The alignment of the ring with the circumferential line standardized the location of force application within and between subjects. As force application was at the middle of the proximal phalanx, mechanical action pertains to both the metacarpophalangeal and carpometacarpal joints. We chose the terminology of flexion/extension and adduction/adduction based on the mechanical action with respect to the metacarpophalangeal joint. With the thumb in the ring (Figure 1B), extension and flexion occurred in parallel with the palm, and abduction and adduction occurred in a plane perpendicular to the palm. Each subject performed 15 circumferential MVC trials with randomized starting directions (Figure 1C). The subject was allotted 15 seconds to complete each circumferential trial, and was instructed to use the entire time allotted to traverse the perimeter of the ring once. A dot generated on the computer screen was programmed to traverse a circle within 15 seconds to provide the subject with directional feedback of their force application. Subjects were given 60 seconds of rest between each circumferential trial. Each subject was familiarized with the task with a few practice trials. Data were collected from each subject at 100 samples per second producing a total of 22,500 pairs of force components from the 15 circumferential trials. Our previous study [19] indicated that the testing protocol did not cause noticeable fatigue. Force envelope and quadrants Data from multiple circumferential trials were accumulated to construct a force envelope. The procedures to generate a force envelope were as follows: Cartesian force coordinates (Xi, Yi) were transformed into polar coordinates (Rα, α), where Rα was the force magnitude at an angular position α. Each α was rounded to the nearest integer ranging from 0 to 359 degrees. The maximum, Fα, was determined from a string of N data points along each radial line defined by α. At the completion of the 15 trials, there were, on average, N = 63 data points on each radial line of α based on the distribution off the 22,500 data points around 360°. A moving average with an interval of 10° was applied to the maximal series data Fα (α = 0, 1, 2,..., 359) to obtain filtered maximal forces. These forces formed a force envelope. The area formed by a force envelope was divided into adduction-extension, extension-abduction, abduction-flexion, and flexion-adduction quadrants by radial lines oriented at 0°, 90°, 180°, and 270° A quadrant force was represented using the mean magnitude of the forces in that quadrant. The areas of the entire envelope and each quadrant were calculated by summing the areas of individual arc sections formed by the polar coordinates of the force envelope. (Figure 2). Statistical Analyses One- and two-factor repeated measures analyses of variance (ANOVA) were used to analyze outcome measures. The independent variables were testing SESSION (n = 2, i.e., pre- and post-block), force DIRECTION (n = 16), and force QUADRANT (n = 4), with SESSION as a repeated variable. Dependent variables were directional force, individual quadrant area and force envelope area. Statistical analyses were performed using SPSS 11 (SPSS Inc., Illinois) with statistical significance set at α = 0.05. Results Force envelope and directional forces Figure 3 shows the force envelopes produced by each subject (A to F) before and after median nerve block. The post-block force envelope was inside the pre-block envelope for each subject, indicating a decrease in force magnitude in all directions after nerve block. Figure 4 shows the average pre- and post-block force envelope across all subjects. Force magnitudes were significantly reduced after nerve block (p < 0.001) resulting in significantly smaller force envelopes. The average decrease across all directions was 27.9%. A maximum decrease of 42.4% occurred at 199°, corresponding to a combined direction of abduction and slight flexion, while a minimum decrease of 10.5% occurred at 328° corresponding to a combined direction of adduction and slight flexion. Relative decreases at 0° (adduction), 90° (extension), 180° (abduction), and 270° (flexion) directions were 17.3%, 21.2%, 41.2% and 33.5%, respectively. A single force in each quadrant was represented using the mean magnitude of the forces in that quadrant (see description in the Methods). The average quadrant forces were significantly decreased after nerve block (p < 0.001; Figure 5). The amount of decrease was also different between quadrants (p < 0.005). Relative decreases in mean quadrant forces were 24.5%, 38.7%, 32.1%, and 18.1% for extension, abduction, flexion, and adduction, respectively. The maximal decreases in mean quadrant force, 38.7%, occurred in the abduction quadrant. Force envelope areas and quadrant areas Areas enclosed by the post-block envelopes were significantly smaller than the pre-block envelopes (p < 0.001; Figure 4). Post-block force envelope area, 10700 ± 4474 N.N, was 51.9% of pre-block force envelope area, 20628 ± 7747 N.N. Quadrant area decreased significantly (p < 0.001; Figure 6). The maximal percentage decrease in area after nerve block was 60.9% in the abduction quadrant, followed by a 52.3% area decrease in the flexion quadrant. Discussion In this study we simulated a lower median nerve lesion and evaluated the resultant thumb motor function deficit. Our internal control via pre- and post-block design offered a particular advantage of investigating the mechanical role of muscles innervated by a targeted nerve. The testing and analytical methods employed have provided advanced quantification of thumb motor function. The results have confirmed our initial hypotheses that greatest force decreases occurred in directions related to abduction, and that the post-block thumb force envelope area was smaller than the pre-block force envelope area. Preferential force attenuation in the quadrants of abduction and flexion after median nerve block are in agreement with anatomical and neuromuscular features of the thumb. The median nerve innervates the abductor pollicis brevis, the opponens pollicis and superficial head of the flexor pollicis brevis, all of which contribute to the abduction and flexion of the thumb [4]; therefore, denervation of these muscles after median nerve block would cause the greatest force deficit related to median nerve function [5]. Additionally, as force application moved towards adduction, the force deficit decreased as neuromuscular control shifted from the median nerve to the ulnar nerve via the first dorsal interosseous and adductor pollicis brevis. Force deficit in extension was also comparably small as extension forces are mainly produced by the extensors pollicis brevis and longus originating in the forearm. Our reported force decreases following a median nerve block (40.9% in abduction, 34.1% in flexion) were smaller than those reported in the literature. Kozin et al. [21] reported a 60% decrease in pinch strength after a median nerve block using mepivicaine hydrochloride [21]. Boatright and Kiebzak [20] reported an approximate 70% decrease in thumb abduction strength after median nerve block using Lidocaine [20]. Kaufman et al. [5] stated that a median nerve block with Lidocaine almost completely diminished force production in the abduction direction [5]. The discrepancy may be due to the anesthetic used and strength testing method. Although the sensory block appeared to be complete for each method, the motor capabilities of the muscles associated with the median nerve might or might not be completely eliminated. Such a result is largely dependent on a particular anesthetic, its concentration and dosage, as well as the efficacy of the injection technique at immersing the nerve. The methods of strength testing may also help explain the different magnitudes of strength deficit after the nerve block. All previous results were based on forces obtained in discrete direction(s), and focused exertions, while the current study utilized a method of force production in a continuous, circumferential and dynamic manner. Furthermore, thumb motor performance can be maintained despite the absence of certain individual muscles. For example, Britto and Elliot reported that the loss of abductor pollicis longus and extensor pollicis brevis in their two patients did not show functional compromise of strength and grip strength [24]. In a broader sense, the neuromuscular system has remarkable capabilities to accomplish the same motor function goal using different effectors and different goals using the same effectors, a phenomenon so called "motor equivalence" [25]. An unexpected finding from this study was that the force deficit occurred in all directions (Figure 4). In other words, the median nerve block caused reduced force production by those muscles not associated with the median nerve. Several potential explanations exist to describe such a phenomenon. First, the injection into the carpal tunnel at the wrist, although localized, potentially diffused into the intrinsic fascia of the hand partially compromising function of the ulnar nerve, which innervates the adductor pollicis. Although Semmes-Weinstein monofilament testing confirmed the continued sensation of the digits within the ulnar nerve distribution, it is not inconceivable that the injection could have contaminated the ulnar innervated muscles, the first dorsal interosseous and deep head of the flexor pollicis brevis [20]. Secondly, thumb force in any direction is produced by synergistic activation of the many intrinsic muscles, and as a result, the muscular deficiency associated with one direction may hinder the force production in other directions by other muscles [5,22]. For example, Kaufman et al. demonstrated that thumb muscles not innervated by the median nerve displayed lower electromyographical activation and shifted the direction of maximum activation after a median nerve block [5]. Labosky and Waggy showed that a radial nerve block caused a 53% decrease in thumb abduction strength because of the lack of stabilization of the radial innervated extensor muscles [22]. Consequently, deficiency of median innervated muscles inherently limits force production in other directions as neuromuscular switching is necessary to produce force in changing directions. The median innervated muscles are the dominant abductors of the thumb metacarpophalangeal and carpometacarpal joint. The more than 50% residual abduction force found in this study suggests that the injection did not totally block the motor function of these muscles, even though a complete sensory loss was verified. This concurs with clinical observations of median compression neuropathy. Individuals with carpal tunnel syndrome complain of sensory dysfunction early in the disease process (at the beginning), while motor signs of thenar wasting and thumb weakness occur as the disease advances. The concept that the motor deficit is more resistant to peripheral median neuropathy than sensory loss has been well documented [23,26,27]. Butterworth et al. studied the temporal effects on sensory and motor blockade after injection of bupivacaine or mepivacaine, and found that sensory loss was complete but about a 20% compound motor action potential remained after 40 minutes [23]. In conclusion, we have incorporated a method for assessing thumb motor deficit based on strength measurement with a standard local anesthetic to investigate the effects of a simulated median neuropathy on thumb motor function. Median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. Future endeavors using this methodology can potentially further elucidate underlying pathomechanisms of peripheral neuropathies in all digits of the hand. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: species
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Thumb force deficit after lower median nerve block Abstract Purpose The purpose of this study was to characterize thumb motor dysfunction resulting from simulated lower median nerve lesions at the wrist. Methods Bupivacaine hydrochloride was injected into the carpal tunnel of six healthy subjects to locally anesthetize the median nerve. Motor function was subsequently evaluated by measuring maximal force production in all directions within the transverse plane perpendicular to the longitudinal axis of the thumb. Force envelopes were constructed using these measured multidirectional forces. Results Blockage of the median nerve resulted in decreased force magnitudes and thus smaller force envelopes. The average force decrease around the force envelope was 27.9%. A maximum decrease of 42.4% occurred in a direction combining abduction and slight flexion, while a minimum decrease of 10.5% occurred in a direction combining adduction and slight flexion. Relative decreases in adduction, extension, abduction, and flexion were 17.3%, 21.2%, 41.2% and 33.5%, respectively. Areas enclosed by pre- and post-block force envelopes were 20628 ± 7747 N.N, and 10700 ± 4474 N.N, respectively, representing an average decrease of 48.1%. Relative decreases in the adduction, extension, abduction, and flexion quadrant areas were 31.5%, 42.3%, 60.9%, and 52.3%, respectively. Conclusion Lower median nerve lesion, simulated by a nerve block at the wrist, compromise normal motor function of the thumb. A median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. From our results, such a means of motor function assessment can potentially be applied to functionally evaluate peripheral neuropathies. Introduction The thumb has unique anatomical and biomechanical characteristics that are required to perform many manipulative tasks. Thumb motor dysfunction resulting from neuromuscular and musculoskeletal pathologies severely hinders the performance of these daily tasks. Clinical treatment, prevention protocols, and rehabilitation efficacy requires a thorough understanding of thumb motor capabilities, as well as its associated functional deficit. Investigations of underlying pathological mechanism of the thumb help advance clinical treatments such as tendon transfers [1], functional electrical stimulation [2] and plasticity suppression [3]. Measurement of strength during maximum voluntary contraction is a simple and direct means of assessing neuromuscular function. Popular instruments used for quantitative assessment of thumb strength are pinch dynamometers. The pinch output, however, provides limited information about thumb motor function in that it offers a single generic force in one specific direction. Each muscle/tendon within the thumb has a distinct anatomical origin and insertion, suggesting its external force potential in a particular direction [4-6]. Hence, evaluation of strengths in multiple directions offers insight concerning the motor capacity of individual muscles. Force production of a digit has been measured in various directions such as flexion/extension [7,8], abduction/adduction [9-14], or in combined directions [15,16]. Bourbonnais et al. developed an apparatus to measure thumb force production in eight directions in the transverse plane of the thumb and investigated force dependence on the direction of effort [15]. Yokogawa and Hara measured index fingertip forces in various directions within the flexion/extension plane [8]. Recently, we developed experimental apparatuses to measure multi-directional forces of a digit in its transverse plane [17-19]. From these multi-directional forces we constructed force envelopes representative of the characteristic force output pattern of a digit [17-19]. Disorders resulting from traumatic injuries to and various diseases of these nerves are common in clinical practice. Clinical manifestations of hand dysfunction are distinctive depending on the nerve involved. For example, thenar atrophy is a major clinical observation affecting thumb function at the later stages of compression neuropathy of the median nerve. Several studies have been conducted to investigate the effects of simulated peripheral neuropathies using local anesthetization [5,16,20,21]. Kozin et al. [21] studied the effects of median and ulnar nerve blocks on grip and pinch strength and showed significant decreases following nerve blockage [21]. Boatright and Kiebzak [20] investigated the effects of median nerve block on thumb abduction strength. Kaufman et al. [5] measured isometric thumb forces in eight directions together with electromyographic signals of thumb muscles after block of the median nerve. Labosky and Waggy [22] studied the strength related to grip, pinch, thumb adduction, thumb abduction, and finger flexion after radial nerve block [22]. Kuxhaus studied the three dimensional feasible force set at the thumb-tip before and after ulnar nerve block and reported this to be a reproducible and sensitive means to detect impairment. The purpose of this study was to utilize our developed apparatus and protocols to investigate the effects of lower median nerve lesion on thumb motor function. The lesion was simulated by blocking the median nerve at the wrist using an anesthetic. We hypothesized that a median nerve block would cause (1) a decrease in force production, which would be direction-dependent with the most severe reduction in the abduction direction, and (2) a decrease in the force envelope area and force quadrant area, with the greatest decrease in the abduction quadrant. Methods Subjects Six healthy male subjects (mean age: 26.9 ± 5.1 years) participated in this study. The subjects had no previous history of neuromuscular or musculoskeletal disorders of the upper extremities. Each subject signed an informed consent form approved by the Institutional Review Board prior to participating in the experiment. Median nerve block Injections were performed under aseptic conditions while the subjects sat with the forearm supinated and the wrist slightly extended. After the skin at the palmer area of the wrist was cleaned with alcohol, 4 mL of 0.5% bupivacaine hydrochloride (Astra Pharmaceuticals, Westborough, MA, USA) was injected into the carpal tunnel with a sterile 25-gauge short-bevel needle. The needle was inserted through the transverse carpal ligament in line with the radial border of the fourth digit slightly ulnar to the palmaris longus tendon at the level of the distal wrist crease. Forty minutes was allowed for the median nerve block to reach complete effectiveness [23] and was verified using the Semmes-Weinstein monofilament test. The average monofilament score was 2.85 across the five digits before nerve block. About 40 minutes after nerve injection, little sensory impairment occurred in the ulnar distribution (score = 3.22), while the sensory score in the median distribution was greater than 6.15. The effects of nerve block lasted more than 6 hours with all subjects regaining normal hand function within 12 hours. Testing apparatus The experimental apparatus was designed and constructed to measure maximum voluntary contraction forces of any digit at any point along the digit. Force application was possible in any direction within the transverse plane of the longitudinal axis of the digit. The apparatus consisted of position control accessories, a force transducer, and a custom fitted aluminum ring attached to the transducer (Figure 1A,1B). The transducer (Mini40, ATI Industrial Automation, NC, USA), capable of measuring 6 degrees of freedom forces and moments, was attached to a mounting clamp via an aluminum adapter plate while the aluminum ring was secured to the tool side of the transducer using a custom adapter. The ring served as a connection anchor for the transducer and the digit. The force transducer and ring attachment were positioned in a desired orientation using an aluminum slide rail, tubing, and lockable mounting clamps (80/20 Inc., Columbia City, IN, USA). The slide rail was secured to an aluminum base plate. Foam padded wooden blocks with two locking straps secured the arm to the base plate. The analog outputs from the transducer were digitized using a 16-bit analog-to-digital converter (PCI-6031, National Instruments, TX, USA). The X (abduction/adduction) and Y (flexion/extension) force components in the transverse plane were displayed on the screen while the subject performed a force production task. The resolutions of the force transducer in its axial (flexion/extension) and horizontal (abduction/adduction) directions were 0.16 N and 0.08 N, respectively. A personal computer equipped with LabVIEW (National Instrument, TX, USA) was used for force data acquisition, display, and processing. Experimental procedures Each subject was tested before and after median nerve block. The nerve block procedures were performed immediately after the completion of the first testing session. Post-block testing started after the verification of complete median nerve block, approximately 40 minutes after the injection. During each test, the subject was seated in a chair adjacent to the testing station modified with a wooden board to align their back vertically throughout the trials. The subjects rested their forearm on padded wooden blocks positioning their shoulder in approximately 60° of frontal plane abduction. Nylon straps fitted with plastic snap locking mechanisms secured the forearm and minimized the intervention of the elbow and shoulder during thumb force application. Subjects grasped a vertical dowel secured to the distal end of the wooden blocks in a midprone position. Formable thermoplastic braces were used to fix the elbow in 90° of flexion, and the wrist in 20° of extension and 0° of ulnar deviation. A metallic brace was used to fix the interphalangeal joint of the thumb in full extension. The aluminum ring was placed around the middle of the proximal phalanx and oriented to accommodate comfortable thumb position with the metacarpophalangeal joint flexed approximately 15°. Prior to testing, a line was drawn on the proximal phalange at the midpoint between the interphalangeal and metacarpophalangeal joints. The alignment of the ring with the circumferential line standardized the location of force application within and between subjects. As force application was at the middle of the proximal phalanx, mechanical action pertains to both the metacarpophalangeal and carpometacarpal joints. We chose the terminology of flexion/extension and adduction/adduction based on the mechanical action with respect to the metacarpophalangeal joint. With the thumb in the ring (Figure 1B), extension and flexion occurred in parallel with the palm, and abduction and adduction occurred in a plane perpendicular to the palm. Each subject performed 15 circumferential MVC trials with randomized starting directions (Figure 1C). The subject was allotted 15 seconds to complete each circumferential trial, and was instructed to use the entire time allotted to traverse the perimeter of the ring once. A dot generated on the computer screen was programmed to traverse a circle within 15 seconds to provide the subject with directional feedback of their force application. Subjects were given 60 seconds of rest between each circumferential trial. Each subject was familiarized with the task with a few practice trials. Data were collected from each subject at 100 samples per second producing a total of 22,500 pairs of force components from the 15 circumferential trials. Our previous study [19] indicated that the testing protocol did not cause noticeable fatigue. Force envelope and quadrants Data from multiple circumferential trials were accumulated to construct a force envelope. The procedures to generate a force envelope were as follows: Cartesian force coordinates (Xi, Yi) were transformed into polar coordinates (Rα, α), where Rα was the force magnitude at an angular position α. Each α was rounded to the nearest integer ranging from 0 to 359 degrees. The maximum, Fα, was determined from a string of N data points along each radial line defined by α. At the completion of the 15 trials, there were, on average, N = 63 data points on each radial line of α based on the distribution off the 22,500 data points around 360°. A moving average with an interval of 10° was applied to the maximal series data Fα (α = 0, 1, 2,..., 359) to obtain filtered maximal forces. These forces formed a force envelope. The area formed by a force envelope was divided into adduction-extension, extension-abduction, abduction-flexion, and flexion-adduction quadrants by radial lines oriented at 0°, 90°, 180°, and 270° A quadrant force was represented using the mean magnitude of the forces in that quadrant. The areas of the entire envelope and each quadrant were calculated by summing the areas of individual arc sections formed by the polar coordinates of the force envelope. (Figure 2). Statistical Analyses One- and two-factor repeated measures analyses of variance (ANOVA) were used to analyze outcome measures. The independent variables were testing SESSION (n = 2, i.e., pre- and post-block), force DIRECTION (n = 16), and force QUADRANT (n = 4), with SESSION as a repeated variable. Dependent variables were directional force, individual quadrant area and force envelope area. Statistical analyses were performed using SPSS 11 (SPSS Inc., Illinois) with statistical significance set at α = 0.05. Results Force envelope and directional forces Figure 3 shows the force envelopes produced by each subject (A to F) before and after median nerve block. The post-block force envelope was inside the pre-block envelope for each subject, indicating a decrease in force magnitude in all directions after nerve block. Figure 4 shows the average pre- and post-block force envelope across all subjects. Force magnitudes were significantly reduced after nerve block (p < 0.001) resulting in significantly smaller force envelopes. The average decrease across all directions was 27.9%. A maximum decrease of 42.4% occurred at 199°, corresponding to a combined direction of abduction and slight flexion, while a minimum decrease of 10.5% occurred at 328° corresponding to a combined direction of adduction and slight flexion. Relative decreases at 0° (adduction), 90° (extension), 180° (abduction), and 270° (flexion) directions were 17.3%, 21.2%, 41.2% and 33.5%, respectively. A single force in each quadrant was represented using the mean magnitude of the forces in that quadrant (see description in the Methods). The average quadrant forces were significantly decreased after nerve block (p < 0.001; Figure 5). The amount of decrease was also different between quadrants (p < 0.005). Relative decreases in mean quadrant forces were 24.5%, 38.7%, 32.1%, and 18.1% for extension, abduction, flexion, and adduction, respectively. The maximal decreases in mean quadrant force, 38.7%, occurred in the abduction quadrant. Force envelope areas and quadrant areas Areas enclosed by the post-block envelopes were significantly smaller than the pre-block envelopes (p < 0.001; Figure 4). Post-block force envelope area, 10700 ± 4474 N.N, was 51.9% of pre-block force envelope area, 20628 ± 7747 N.N. Quadrant area decreased significantly (p < 0.001; Figure 6). The maximal percentage decrease in area after nerve block was 60.9% in the abduction quadrant, followed by a 52.3% area decrease in the flexion quadrant. Discussion In this study we simulated a lower median nerve lesion and evaluated the resultant thumb motor function deficit. Our internal control via pre- and post-block design offered a particular advantage of investigating the mechanical role of muscles innervated by a targeted nerve. The testing and analytical methods employed have provided advanced quantification of thumb motor function. The results have confirmed our initial hypotheses that greatest force decreases occurred in directions related to abduction, and that the post-block thumb force envelope area was smaller than the pre-block force envelope area. Preferential force attenuation in the quadrants of abduction and flexion after median nerve block are in agreement with anatomical and neuromuscular features of the thumb. The median nerve innervates the abductor pollicis brevis, the opponens pollicis and superficial head of the flexor pollicis brevis, all of which contribute to the abduction and flexion of the thumb [4]; therefore, denervation of these muscles after median nerve block would cause the greatest force deficit related to median nerve function [5]. Additionally, as force application moved towards adduction, the force deficit decreased as neuromuscular control shifted from the median nerve to the ulnar nerve via the first dorsal interosseous and adductor pollicis brevis. Force deficit in extension was also comparably small as extension forces are mainly produced by the extensors pollicis brevis and longus originating in the forearm. Our reported force decreases following a median nerve block (40.9% in abduction, 34.1% in flexion) were smaller than those reported in the literature. Kozin et al. [21] reported a 60% decrease in pinch strength after a median nerve block using mepivicaine hydrochloride [21]. Boatright and Kiebzak [20] reported an approximate 70% decrease in thumb abduction strength after median nerve block using Lidocaine [20]. Kaufman et al. [5] stated that a median nerve block with Lidocaine almost completely diminished force production in the abduction direction [5]. The discrepancy may be due to the anesthetic used and strength testing method. Although the sensory block appeared to be complete for each method, the motor capabilities of the muscles associated with the median nerve might or might not be completely eliminated. Such a result is largely dependent on a particular anesthetic, its concentration and dosage, as well as the efficacy of the injection technique at immersing the nerve. The methods of strength testing may also help explain the different magnitudes of strength deficit after the nerve block. All previous results were based on forces obtained in discrete direction(s), and focused exertions, while the current study utilized a method of force production in a continuous, circumferential and dynamic manner. Furthermore, thumb motor performance can be maintained despite the absence of certain individual muscles. For example, Britto and Elliot reported that the loss of abductor pollicis longus and extensor pollicis brevis in their two patients did not show functional compromise of strength and grip strength [24]. In a broader sense, the neuromuscular system has remarkable capabilities to accomplish the same motor function goal using different effectors and different goals using the same effectors, a phenomenon so called "motor equivalence" [25]. An unexpected finding from this study was that the force deficit occurred in all directions (Figure 4). In other words, the median nerve block caused reduced force production by those muscles not associated with the median nerve. Several potential explanations exist to describe such a phenomenon. First, the injection into the carpal tunnel at the wrist, although localized, potentially diffused into the intrinsic fascia of the hand partially compromising function of the ulnar nerve, which innervates the adductor pollicis. Although Semmes-Weinstein monofilament testing confirmed the continued sensation of the digits within the ulnar nerve distribution, it is not inconceivable that the injection could have contaminated the ulnar innervated muscles, the first dorsal interosseous and deep head of the flexor pollicis brevis [20]. Secondly, thumb force in any direction is produced by synergistic activation of the many intrinsic muscles, and as a result, the muscular deficiency associated with one direction may hinder the force production in other directions by other muscles [5,22]. For example, Kaufman et al. demonstrated that thumb muscles not innervated by the median nerve displayed lower electromyographical activation and shifted the direction of maximum activation after a median nerve block [5]. Labosky and Waggy showed that a radial nerve block caused a 53% decrease in thumb abduction strength because of the lack of stabilization of the radial innervated extensor muscles [22]. Consequently, deficiency of median innervated muscles inherently limits force production in other directions as neuromuscular switching is necessary to produce force in changing directions. The median innervated muscles are the dominant abductors of the thumb metacarpophalangeal and carpometacarpal joint. The more than 50% residual abduction force found in this study suggests that the injection did not totally block the motor function of these muscles, even though a complete sensory loss was verified. This concurs with clinical observations of median compression neuropathy. Individuals with carpal tunnel syndrome complain of sensory dysfunction early in the disease process (at the beginning), while motor signs of thenar wasting and thumb weakness occur as the disease advances. The concept that the motor deficit is more resistant to peripheral median neuropathy than sensory loss has been well documented [23,26,27]. Butterworth et al. studied the temporal effects on sensory and motor blockade after injection of bupivacaine or mepivacaine, and found that sensory loss was complete but about a 20% compound motor action potential remained after 40 minutes [23]. In conclusion, we have incorporated a method for assessing thumb motor deficit based on strength measurement with a standard local anesthetic to investigate the effects of a simulated median neuropathy on thumb motor function. Median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. Future endeavors using this methodology can potentially further elucidate underlying pathomechanisms of peripheral neuropathies in all digits of the hand.
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"extension", ",", "abduction", ",", "and", "flexion", "quadrant", "areas", "were", "31.5", "%", ",", "42.3", "%", ",", "60.9", "%", ",", "and", "52.3", "%", ",", "respectively", ".", "\n\n", "Conclusion", "\n", "Lower", "median", "nerve", "lesion", ",", "simulated", "by", "a", "nerve", "block", "at", "the", "wrist", ",", "compromise", "normal", "motor", "function", "of", "the", "thumb", ".", "A", "median", "nerve", "block", "results", "in", "force", "deficits", "in", "all", "directions", ",", "with", "the", "most", "severe", "impairment", "in", "abduction", "and", "flexion", ".", "From", "our", "results", ",", "such", "a", "means", "of", "motor", "function", "assessment", "can", "potentially", "be", "applied", "to", "functionally", "evaluate", "peripheral", "neuropathies", ".", "\n\n\n\n", "Introduction", "\n", "The", "thumb", "has", "unique", "anatomical", "and", "biomechanical", "characteristics", "that", "are", "required", "to", "perform", "many", "manipulative", "tasks", ".", "Thumb", "motor", "dysfunction", "resulting", "from", "neuromuscular", "and", "musculoskeletal", "pathologies", "severely", "hinders", "the", "performance", "of", "these", "daily", "tasks", ".", "Clinical", "treatment", ",", "prevention", "protocols", ",", "and", "rehabilitation", "efficacy", "requires", "a", "thorough", "understanding", "of", "thumb", "motor", "capabilities", ",", "as", "well", "as", "its", "associated", "functional", "deficit", ".", "Investigations", "of", "underlying", "pathological", "mechanism", "of", "the", "thumb", "help", "advance", "clinical", "treatments", "such", "as", "tendon", "transfers", "[", "1", "]", ",", "functional", "electrical", "stimulation", "[", "2", "]", "and", "plasticity", "suppression", "[", "3", "]", ".", "\n", "Measurement", "of", "strength", "during", "maximum", "voluntary", "contraction", "is", "a", "simple", "and", "direct", "means", "of", "assessing", "neuromuscular", "function", ".", "Popular", "instruments", "used", "for", "quantitative", "assessment", "of", "thumb", "strength", "are", "pinch", "dynamometers", ".", "The", "pinch", "output", ",", "however", ",", "provides", "limited", "information", "about", "thumb", "motor", "function", "in", "that", "it", "offers", "a", "single", "generic", "force", "in", "one", "specific", "direction", ".", "Each", "muscle", "/", "tendon", "within", "the", "thumb", "has", "a", "distinct", "anatomical", "origin", "and", "insertion", ",", "suggesting", "its", "external", "force", "potential", "in", "a", "particular", "direction", "[", "4", "-", "6", "]", ".", "Hence", ",", "evaluation", "of", "strengths", "in", "multiple", "directions", "offers", "insight", "concerning", "the", "motor", "capacity", "of", "individual", "muscles", ".", "Force", "production", "of", "a", "digit", "has", "been", "measured", "in", "various", "directions", "such", "as", "flexion", "/", "extension", "[", "7,8", "]", ",", "abduction", "/", "adduction", "[", "9", "-", "14", "]", ",", "or", "in", "combined", "directions", "[", "15,16", "]", ".", "Bourbonnais", "et", "al", ".", "developed", "an", "apparatus", "to", "measure", "thumb", "force", "production", "in", "eight", "directions", "in", "the", "transverse", "plane", "of", "the", "thumb", "and", "investigated", "force", "dependence", "on", "the", "direction", "of", "effort", "[", "15", "]", ".", "Yokogawa", "and", "Hara", "measured", "index", "fingertip", "forces", "in", "various", "directions", "within", "the", "flexion", "/", "extension", "plane", "[", "8", "]", ".", "Recently", ",", "we", "developed", "experimental", "apparatuses", "to", "measure", "multi", "-", "directional", "forces", "of", "a", "digit", "in", "its", "transverse", "plane", "[", "17", "-", "19", "]", ".", "From", "these", "multi", "-", "directional", "forces", "we", "constructed", "force", "envelopes", "representative", "of", "the", "characteristic", "force", "output", "pattern", "of", "a", "digit", "[", "17", "-", "19", "]", ".", "\n", "Disorders", "resulting", "from", "traumatic", "injuries", "to", "and", "various", "diseases", "of", "these", "nerves", "are", "common", "in", "clinical", "practice", ".", "Clinical", "manifestations", "of", "hand", "dysfunction", "are", "distinctive", "depending", "on", "the", "nerve", "involved", ".", "For", "example", ",", "thenar", "atrophy", "is", "a", "major", "clinical", "observation", "affecting", "thumb", "function", "at", "the", "later", "stages", "of", "compression", "neuropathy", "of", "the", "median", "nerve", ".", "Several", "studies", "have", "been", "conducted", "to", "investigate", "the", "effects", "of", "simulated", "peripheral", "neuropathies", "using", "local", "anesthetization", "[", "5,16,20,21", "]", ".", "Kozin", "et", "al", ".", "[", "21", "]", "studied", "the", "effects", "of", "median", "and", "ulnar", "nerve", "blocks", "on", "grip", "and", "pinch", "strength", "and", "showed", "significant", "decreases", "following", "nerve", "blockage", "[", "21", "]", ".", "Boatright", "and", "Kiebzak", "[", "20", "]", "investigated", "the", "effects", "of", "median", "nerve", "block", "on", "thumb", "abduction", "strength", ".", "Kaufman", "et", "al", ".", "[", "5", "]", "measured", "isometric", "thumb", "forces", "in", "eight", "directions", "together", "with", "electromyographic", "signals", "of", "thumb", "muscles", "after", "block", "of", "the", "median", "nerve", ".", "Labosky", "and", "Waggy", "[", "22", "]", "studied", "the", "strength", "related", "to", "grip", ",", "pinch", ",", "thumb", "adduction", ",", "thumb", "abduction", ",", "and", "finger", "flexion", "after", "radial", "nerve", "block", "[", "22", "]", ".", "Kuxhaus", "studied", "the", "three", "dimensional", "feasible", "force", "set", "at", "the", "thumb", "-", "tip", "before", "and", "after", "ulnar", "nerve", "block", "and", "reported", "this", "to", "be", "a", "reproducible", "and", "sensitive", "means", "to", "detect", "impairment", ".", "\n", "The", "purpose", "of", "this", "study", "was", "to", "utilize", "our", "developed", "apparatus", "and", "protocols", "to", "investigate", "the", "effects", "of", "lower", "median", "nerve", "lesion", "on", "thumb", "motor", "function", ".", "The", "lesion", "was", "simulated", "by", "blocking", "the", "median", "nerve", "at", "the", "wrist", "using", "an", "anesthetic", ".", "We", "hypothesized", "that", "a", "median", "nerve", "block", "would", "cause", "(", "1", ")", "a", "decrease", "in", "force", "production", ",", "which", "would", "be", "direction", "-", "dependent", "with", "the", "most", "severe", "reduction", "in", "the", "abduction", "direction", ",", "and", "(", "2", ")", "a", "decrease", "in", "the", "force", "envelope", "area", "and", "force", "quadrant", "area", ",", "with", "the", "greatest", "decrease", "in", "the", "abduction", "quadrant", ".", "\n\n", "Methods", "\n", "Subjects", "\n", "Six", "healthy", "male", "subjects", "(", "mean", "age", ":", "26.9", "±", "5.1", "years", ")", "participated", "in", "this", "study", ".", "The", "subjects", "had", "no", "previous", "history", "of", "neuromuscular", "or", "musculoskeletal", "disorders", "of", "the", "upper", "extremities", ".", "Each", "subject", "signed", "an", "informed", "consent", "form", "approved", "by", "the", "Institutional", "Review", "Board", "prior", "to", "participating", "in", "the", "experiment", ".", "\n\n", "Median", "nerve", "block", "\n", "Injections", "were", "performed", "under", "aseptic", "conditions", "while", "the", "subjects", "sat", "with", "the", "forearm", "supinated", "and", "the", "wrist", "slightly", "extended", ".", "After", "the", "skin", "at", "the", "palmer", "area", "of", "the", "wrist", "was", "cleaned", "with", "alcohol", ",", "4", "mL", "of", "0.5", "%", "bupivacaine", "hydrochloride", "(", "Astra", "Pharmaceuticals", ",", "Westborough", ",", "MA", ",", "USA", ")", "was", "injected", "into", "the", "carpal", "tunnel", "with", "a", "sterile", "25-gauge", "short", "-", "bevel", "needle", ".", "The", "needle", "was", "inserted", "through", "the", "transverse", "carpal", "ligament", "in", "line", "with", "the", "radial", "border", "of", "the", "fourth", "digit", "slightly", "ulnar", "to", "the", "palmaris", "longus", "tendon", "at", "the", "level", "of", "the", "distal", "wrist", "crease", ".", "Forty", "minutes", "was", "allowed", "for", "the", "median", "nerve", "block", "to", "reach", "complete", "effectiveness", "[", "23", "]", "and", "was", "verified", "using", "the", "Semmes", "-", "Weinstein", "monofilament", "test", ".", "The", "average", "monofilament", "score", "was", "2.85", "across", "the", "five", "digits", "before", "nerve", "block", ".", "About", "40", "minutes", "after", "nerve", "injection", ",", "little", "sensory", "impairment", "occurred", "in", "the", "ulnar", "distribution", "(", "score", "=", "3.22", ")", ",", "while", "the", "sensory", "score", "in", "the", "median", "distribution", "was", "greater", "than", "6.15", ".", "The", "effects", "of", "nerve", "block", "lasted", "more", "than", "6", "hours", "with", "all", "subjects", "regaining", "normal", "hand", "function", "within", "12", "hours", ".", "\n\n", "Testing", "apparatus", "\n", "The", "experimental", "apparatus", "was", "designed", "and", "constructed", "to", "measure", "maximum", "voluntary", "contraction", "forces", "of", "any", "digit", "at", "any", "point", "along", "the", "digit", ".", "Force", "application", "was", "possible", "in", "any", "direction", "within", "the", "transverse", "plane", "of", "the", "longitudinal", "axis", "of", "the", "digit", ".", "The", "apparatus", "consisted", "of", "position", "control", "accessories", ",", "a", "force", "transducer", ",", "and", "a", "custom", "fitted", "aluminum", "ring", "attached", "to", "the", "transducer", "(", "Figure", "1A,1B", ")", ".", "The", "transducer", "(", "Mini40", ",", "ATI", "Industrial", "Automation", ",", "NC", ",", "USA", ")", ",", "capable", "of", "measuring", "6", "degrees", "of", "freedom", "forces", "and", "moments", ",", "was", "attached", "to", "a", "mounting", "clamp", "via", "an", "aluminum", "adapter", "plate", "while", "the", "aluminum", "ring", "was", "secured", "to", "the", "tool", "side", "of", "the", "transducer", "using", "a", "custom", "adapter", ".", "The", "ring", "served", "as", "a", "connection", "anchor", "for", "the", "transducer", "and", "the", "digit", ".", "The", "force", "transducer", "and", "ring", "attachment", "were", "positioned", "in", "a", "desired", "orientation", "using", "an", "aluminum", "slide", "rail", ",", "tubing", ",", "and", "lockable", "mounting", "clamps", "(", "80/20", "Inc", ".", ",", "Columbia", "City", ",", "IN", ",", "USA", ")", ".", "The", "slide", "rail", "was", "secured", "to", "an", "aluminum", "base", "plate", ".", "Foam", "padded", "wooden", "blocks", "with", "two", "locking", "straps", "secured", "the", "arm", "to", "the", "base", "plate", ".", "\n", "The", "analog", "outputs", "from", "the", "transducer", "were", "digitized", "using", "a", "16-bit", "analog", "-", "to", "-", "digital", "converter", "(", "PCI-6031", ",", "National", "Instruments", ",", "TX", ",", "USA", ")", ".", "The", "X", "(", "abduction", "/", "adduction", ")", "and", "Y", "(", "flexion", "/", "extension", ")", "force", "components", "in", "the", "transverse", "plane", "were", "displayed", "on", "the", "screen", "while", "the", "subject", "performed", "a", "force", "production", "task", ".", "The", "resolutions", "of", "the", "force", "transducer", "in", "its", "axial", "(", "flexion", "/", "extension", ")", "and", "horizontal", "(", "abduction", "/", "adduction", ")", "directions", "were", "0.16", "N", "and", "0.08", "N", ",", "respectively", ".", "A", "personal", "computer", "equipped", "with", "LabVIEW", "(", "National", "Instrument", ",", "TX", ",", "USA", ")", "was", "used", "for", "force", "data", "acquisition", ",", "display", ",", "and", "processing", ".", "\n\n", "Experimental", "procedures", "\n", "Each", "subject", "was", "tested", "before", "and", "after", "median", "nerve", "block", ".", "The", "nerve", "block", "procedures", "were", "performed", "immediately", "after", "the", "completion", "of", "the", "first", "testing", "session", ".", "Post", "-", "block", "testing", "started", "after", "the", "verification", "of", "complete", "median", "nerve", "block", ",", "approximately", "40", "minutes", "after", "the", "injection", ".", "During", "each", "test", ",", "the", "subject", "was", "seated", "in", "a", "chair", "adjacent", "to", "the", "testing", "station", "modified", "with", "a", "wooden", "board", "to", "align", "their", "back", "vertically", "throughout", "the", "trials", ".", "The", "subjects", "rested", "their", "forearm", "on", "padded", "wooden", "blocks", "positioning", "their", "shoulder", "in", "approximately", "60", "°", "of", "frontal", "plane", "abduction", ".", "Nylon", "straps", "fitted", "with", "plastic", "snap", "locking", "mechanisms", "secured", "the", "forearm", "and", "minimized", "the", "intervention", "of", "the", "elbow", "and", "shoulder", "during", "thumb", "force", "application", ".", "Subjects", "grasped", "a", "vertical", "dowel", "secured", "to", "the", "distal", "end", "of", "the", "wooden", "blocks", "in", "a", "midprone", "position", ".", "Formable", "thermoplastic", "braces", "were", "used", "to", "fix", "the", "elbow", "in", "90", "°", "of", "flexion", ",", "and", "the", "wrist", "in", "20", "°", "of", "extension", "and", "0", "°", "of", "ulnar", "deviation", ".", "A", "metallic", "brace", "was", "used", "to", "fix", "the", "interphalangeal", "joint", "of", "the", "thumb", "in", "full", "extension", ".", "The", "aluminum", "ring", "was", "placed", "around", "the", "middle", "of", "the", "proximal", "phalanx", "and", "oriented", "to", "accommodate", "comfortable", "thumb", "position", "with", "the", "metacarpophalangeal", "joint", "flexed", "approximately", "15", "°", ".", "Prior", "to", "testing", ",", "a", "line", "was", "drawn", "on", "the", "proximal", "phalange", "at", "the", "midpoint", "between", "the", "interphalangeal", "and", "metacarpophalangeal", "joints", ".", "The", "alignment", "of", "the", "ring", "with", "the", "circumferential", "line", "standardized", "the", "location", "of", "force", "application", "within", "and", "between", "subjects", ".", "As", "force", "application", "was", "at", "the", "middle", "of", "the", "proximal", "phalanx", ",", "mechanical", "action", "pertains", "to", "both", "the", "metacarpophalangeal", "and", "carpometacarpal", "joints", ".", "We", "chose", "the", "terminology", "of", "flexion", "/", "extension", "and", "adduction", "/", "adduction", "based", "on", "the", "mechanical", "action", "with", "respect", "to", "the", "metacarpophalangeal", "joint", ".", "With", "the", "thumb", "in", "the", "ring", "(", "Figure", "1B", ")", ",", "extension", "and", "flexion", "occurred", "in", "parallel", "with", "the", "palm", ",", "and", "abduction", "and", "adduction", "occurred", "in", "a", "plane", "perpendicular", "to", "the", "palm", ".", "\n", "Each", "subject", "performed", "15", "circumferential", "MVC", "trials", "with", "randomized", "starting", "directions", "(", "Figure", "1C", ")", ".", "The", "subject", "was", "allotted", "15", "seconds", "to", "complete", "each", "circumferential", "trial", ",", "and", "was", "instructed", "to", "use", "the", "entire", "time", "allotted", "to", "traverse", "the", "perimeter", "of", "the", "ring", "once", ".", "A", "dot", "generated", "on", "the", "computer", "screen", "was", "programmed", "to", "traverse", "a", "circle", "within", "15", "seconds", "to", "provide", "the", "subject", "with", "directional", "feedback", "of", "their", "force", "application", ".", "Subjects", "were", "given", "60", "seconds", "of", "rest", "between", "each", "circumferential", "trial", ".", "Each", "subject", "was", "familiarized", "with", "the", "task", "with", "a", "few", "practice", "trials", ".", "Data", "were", "collected", "from", "each", "subject", "at", "100", "samples", "per", "second", "producing", "a", "total", "of", "22,500", "pairs", "of", "force", "components", "from", "the", "15", "circumferential", "trials", ".", "Our", "previous", "study", "[", "19", "]", "indicated", "that", "the", "testing", "protocol", "did", "not", "cause", "noticeable", "fatigue", ".", "\n\n", "Force", "envelope", "and", "quadrants", "\n", "Data", "from", "multiple", "circumferential", "trials", "were", "accumulated", "to", "construct", "a", "force", "envelope", ".", "The", "procedures", "to", "generate", "a", "force", "envelope", "were", "as", "follows", ":", "\n", "Cartesian", "force", "coordinates", "(", "Xi", ",", "Yi", ")", "were", "transformed", "into", "polar", "coordinates", "(", "Rα", ",", "α", ")", ",", "where", "Rα", "was", "the", "force", "magnitude", "at", "an", "angular", "position", "α", ".", "Each", "α", "was", "rounded", "to", "the", "nearest", "integer", "ranging", "from", "0", "to", "359", "degrees", ".", "\n", "The", "maximum", ",", "Fα", ",", "was", "determined", "from", "a", "string", "of", "N", "data", "points", "along", "each", "radial", "line", "defined", "by", "α", ".", "At", "the", "completion", "of", "the", "15", "trials", ",", "there", "were", ",", "on", "average", ",", "N", "=", "63", "data", "points", "on", "each", "radial", "line", "of", "α", "based", "on", "the", "distribution", "off", "the", "22,500", "data", "points", "around", "360", "°", ".", "\n", "A", "moving", "average", "with", "an", "interval", "of", "10", "°", "was", "applied", "to", "the", "maximal", "series", "data", "Fα", "(", "α", "=", "0", ",", "1", ",", "2", ",", "...", ",", "359", ")", "to", "obtain", "filtered", "maximal", "forces", ".", "These", "forces", "formed", "a", "force", "envelope", ".", "\n", "The", "area", "formed", "by", "a", "force", "envelope", "was", "divided", "into", "adduction", "-", "extension", ",", "extension", "-", "abduction", ",", "abduction", "-", "flexion", ",", "and", "flexion", "-", "adduction", "quadrants", "by", "radial", "lines", "oriented", "at", "0", "°", ",", "90", "°", ",", "180", "°", ",", "and", "270", "°", "A", "quadrant", "force", "was", "represented", "using", "the", "mean", "magnitude", "of", "the", "forces", "in", "that", "quadrant", ".", "The", "areas", "of", "the", "entire", "envelope", "and", "each", "quadrant", "were", "calculated", "by", "summing", "the", "areas", "of", "individual", "arc", "sections", "formed", "by", "the", "polar", "coordinates", "of", "the", "force", "envelope", ".", "(", "Figure", "2", ")", ".", "\n\n", "Statistical", "Analyses", "\n", "One-", "and", "two", "-", "factor", "repeated", "measures", "analyses", "of", "variance", "(", "ANOVA", ")", "were", "used", "to", "analyze", "outcome", "measures", ".", "The", "independent", "variables", "were", "testing", "SESSION", "(", "n", "=", "2", ",", "i.e", ".", ",", "pre-", "and", "post", "-", "block", ")", ",", "force", "DIRECTION", "(", "n", "=", "16", ")", ",", "and", "force", "QUADRANT", "(", "n", "=", "4", ")", ",", "with", "SESSION", "as", "a", "repeated", "variable", ".", "Dependent", "variables", "were", "directional", "force", ",", "individual", "quadrant", "area", "and", "force", "envelope", "area", ".", "Statistical", "analyses", "were", "performed", "using", "SPSS", "11", "(", "SPSS", "Inc", ".", ",", "Illinois", ")", "with", "statistical", "significance", "set", "at", "α", "=", "0.05", ".", "\n\n\n", "Results", "\n", "Force", "envelope", "and", "directional", "forces", "\n", "Figure", "3", "shows", "the", "force", "envelopes", "produced", "by", "each", "subject", "(", "A", "to", "F", ")", "before", "and", "after", "median", "nerve", "block", ".", "The", "post", "-", "block", "force", "envelope", "was", "inside", "the", "pre", "-", "block", "envelope", "for", "each", "subject", ",", "indicating", "a", "decrease", "in", "force", "magnitude", "in", "all", "directions", "after", "nerve", "block", ".", "Figure", "4", "shows", "the", "average", "pre-", "and", "post", "-", "block", "force", "envelope", "across", "all", "subjects", ".", "Force", "magnitudes", "were", "significantly", "reduced", "after", "nerve", "block", "(", "p", "<", "0.001", ")", "resulting", "in", "significantly", "smaller", "force", "envelopes", ".", "The", "average", "decrease", "across", "all", "directions", "was", "27.9", "%", ".", "A", "maximum", "decrease", "of", "42.4", "%", "occurred", "at", "199", "°", ",", "corresponding", "to", "a", "combined", "direction", "of", "abduction", "and", "slight", "flexion", ",", "while", "a", "minimum", "decrease", "of", "10.5", "%", "occurred", "at", "328", "°", "corresponding", "to", "a", "combined", "direction", "of", "adduction", "and", "slight", "flexion", ".", "Relative", "decreases", "at", "0", "°", "(", "adduction", ")", ",", "90", "°", "(", "extension", ")", ",", "180", "°", "(", "abduction", ")", ",", "and", "270", "°", "(", "flexion", ")", "directions", "were", "17.3", "%", ",", "21.2", "%", ",", "41.2", "%", "and", "33.5", "%", ",", "respectively", ".", "\n", "A", "single", "force", "in", "each", "quadrant", "was", "represented", "using", "the", "mean", "magnitude", "of", "the", "forces", "in", "that", "quadrant", "(", "see", "description", "in", "the", "Methods", ")", ".", "The", "average", "quadrant", "forces", "were", "significantly", "decreased", "after", "nerve", "block", "(", "p", "<", "0.001", ";", "Figure", "5", ")", ".", "The", "amount", "of", "decrease", "was", "also", "different", "between", "quadrants", "(", "p", "<", "0.005", ")", ".", "Relative", "decreases", "in", "mean", "quadrant", "forces", "were", "24.5", "%", ",", "38.7", "%", ",", "32.1", "%", ",", "and", "18.1", "%", "for", "extension", ",", "abduction", ",", "flexion", ",", "and", "adduction", ",", "respectively", ".", "The", "maximal", "decreases", "in", "mean", "quadrant", "force", ",", "38.7", "%", ",", "occurred", "in", "the", "abduction", "quadrant", ".", "\n\n", "Force", "envelope", "areas", "and", "quadrant", "areas", "\n", "Areas", "enclosed", "by", "the", "post", "-", "block", "envelopes", "were", "significantly", "smaller", "than", "the", "pre", "-", "block", "envelopes", "(", "p", "<", "0.001", ";", "Figure", "4", ")", ".", "Post", "-", "block", "force", "envelope", "area", ",", "10700", "±", "4474", "N.N", ",", "was", "51.9", "%", "of", "pre", "-", "block", "force", "envelope", "area", ",", "20628", "±", "7747", "N.N.", "Quadrant", "area", "decreased", "significantly", "(", "p", "<", "0.001", ";", "Figure", "6", ")", ".", "The", "maximal", "percentage", "decrease", "in", "area", "after", "nerve", "block", "was", "60.9", "%", "in", "the", "abduction", "quadrant", ",", "followed", "by", "a", "52.3", "%", "area", "decrease", "in", "the", "flexion", "quadrant", ".", "\n\n\n", "Discussion", "\n", "In", "this", "study", "we", "simulated", "a", "lower", "median", "nerve", "lesion", "and", "evaluated", "the", "resultant", "thumb", "motor", "function", "deficit", ".", "Our", "internal", "control", "via", "pre-", "and", "post", "-", "block", "design", "offered", "a", "particular", "advantage", "of", "investigating", "the", "mechanical", "role", "of", "muscles", "innervated", "by", "a", "targeted", "nerve", ".", "The", "testing", "and", "analytical", "methods", "employed", "have", "provided", "advanced", "quantification", "of", "thumb", "motor", "function", ".", "The", "results", "have", "confirmed", "our", "initial", "hypotheses", "that", "greatest", "force", "decreases", "occurred", "in", "directions", "related", "to", "abduction", ",", "and", "that", "the", "post", "-", "block", "thumb", "force", "envelope", "area", "was", "smaller", "than", "the", "pre", "-", "block", "force", "envelope", "area", ".", "\n", "Preferential", "force", "attenuation", "in", "the", "quadrants", "of", "abduction", "and", "flexion", "after", "median", "nerve", "block", "are", "in", "agreement", "with", "anatomical", "and", "neuromuscular", "features", "of", "the", "thumb", ".", "The", "median", "nerve", "innervates", "the", "abductor", "pollicis", "brevis", ",", "the", "opponens", "pollicis", "and", "superficial", "head", "of", "the", "flexor", "pollicis", "brevis", ",", "all", "of", "which", "contribute", "to", "the", "abduction", "and", "flexion", "of", "the", "thumb", "[", "4", "]", ";", "therefore", ",", "denervation", "of", "these", "muscles", "after", "median", "nerve", "block", "would", "cause", "the", "greatest", "force", "deficit", "related", "to", "median", "nerve", "function", "[", "5", "]", ".", "Additionally", ",", "as", "force", "application", "moved", "towards", "adduction", ",", "the", "force", "deficit", "decreased", "as", "neuromuscular", "control", "shifted", "from", "the", "median", "nerve", "to", "the", "ulnar", "nerve", "via", "the", "first", "dorsal", "interosseous", "and", "adductor", "pollicis", "brevis", ".", "Force", "deficit", "in", "extension", "was", "also", "comparably", "small", "as", "extension", "forces", "are", "mainly", "produced", "by", "the", "extensors", "pollicis", "brevis", "and", "longus", "originating", "in", "the", "forearm", ".", "\n", "Our", "reported", "force", "decreases", "following", "a", "median", "nerve", "block", "(", "40.9", "%", "in", "abduction", ",", "34.1", "%", "in", "flexion", ")", "were", "smaller", "than", "those", "reported", "in", "the", "literature", ".", "Kozin", "et", "al", ".", "[", "21", "]", "reported", "a", "60", "%", "decrease", "in", "pinch", "strength", "after", "a", "median", "nerve", "block", "using", "mepivicaine", "hydrochloride", "[", "21", "]", ".", "Boatright", "and", "Kiebzak", "[", "20", "]", "reported", "an", "approximate", "70", "%", "decrease", "in", "thumb", "abduction", "strength", "after", "median", "nerve", "block", "using", "Lidocaine", "[", "20", "]", ".", "Kaufman", "et", "al", ".", "[", "5", "]", "stated", "that", "a", "median", "nerve", "block", "with", "Lidocaine", "almost", "completely", "diminished", "force", "production", "in", "the", "abduction", "direction", "[", "5", "]", ".", "The", "discrepancy", "may", "be", "due", "to", "the", "anesthetic", "used", "and", "strength", "testing", "method", ".", "Although", "the", "sensory", "block", "appeared", "to", "be", "complete", "for", "each", "method", ",", "the", "motor", "capabilities", "of", "the", "muscles", "associated", "with", "the", "median", "nerve", "might", "or", "might", "not", "be", "completely", "eliminated", ".", "Such", "a", "result", "is", "largely", "dependent", "on", "a", "particular", "anesthetic", ",", "its", "concentration", "and", "dosage", ",", "as", "well", "as", "the", "efficacy", "of", "the", "injection", "technique", "at", "immersing", "the", "nerve", ".", "The", "methods", "of", "strength", "testing", "may", "also", "help", "explain", "the", "different", "magnitudes", "of", "strength", "deficit", "after", "the", "nerve", "block", ".", "All", "previous", "results", "were", "based", "on", "forces", "obtained", "in", "discrete", "direction(s", ")", ",", "and", "focused", "exertions", ",", "while", "the", "current", "study", "utilized", "a", "method", "of", "force", "production", "in", "a", "continuous", ",", "circumferential", "and", "dynamic", "manner", ".", "Furthermore", ",", "thumb", "motor", "performance", "can", "be", "maintained", "despite", "the", "absence", "of", "certain", "individual", "muscles", ".", "For", "example", ",", "Britto", "and", "Elliot", "reported", "that", "the", "loss", "of", "abductor", "pollicis", "longus", "and", "extensor", "pollicis", "brevis", "in", "their", "two", "patients", "did", "not", "show", "functional", "compromise", "of", "strength", "and", "grip", "strength", "[", "24", "]", ".", "In", "a", "broader", "sense", ",", "the", "neuromuscular", "system", "has", "remarkable", "capabilities", "to", "accomplish", "the", "same", "motor", "function", "goal", "using", "different", "effectors", "and", "different", "goals", "using", "the", "same", "effectors", ",", "a", "phenomenon", "so", "called", "\"", "motor", "equivalence", "\"", "[", "25", "]", ".", "\n", "An", "unexpected", "finding", "from", "this", "study", "was", "that", "the", "force", "deficit", "occurred", "in", "all", "directions", "(", "Figure", "4", ")", ".", "In", "other", "words", ",", "the", "median", "nerve", "block", "caused", "reduced", "force", "production", "by", "those", "muscles", "not", "associated", "with", "the", "median", "nerve", ".", "Several", "potential", "explanations", "exist", "to", "describe", "such", "a", "phenomenon", ".", "First", ",", "the", "injection", "into", "the", "carpal", "tunnel", "at", "the", "wrist", ",", "although", "localized", ",", "potentially", "diffused", "into", "the", "intrinsic", "fascia", "of", "the", "hand", "partially", "compromising", "function", "of", "the", "ulnar", "nerve", ",", "which", "innervates", "the", "adductor", "pollicis", ".", "Although", "Semmes", "-", "Weinstein", "monofilament", "testing", "confirmed", "the", "continued", "sensation", "of", "the", "digits", "within", "the", "ulnar", "nerve", "distribution", ",", "it", "is", "not", "inconceivable", "that", "the", "injection", "could", "have", "contaminated", "the", "ulnar", "innervated", "muscles", ",", "the", "first", "dorsal", "interosseous", "and", "deep", "head", "of", "the", "flexor", "pollicis", "brevis", "[", "20", "]", ".", "Secondly", ",", "thumb", "force", "in", "any", "direction", "is", "produced", "by", "synergistic", "activation", "of", "the", "many", "intrinsic", "muscles", ",", "and", "as", "a", "result", ",", "the", "muscular", "deficiency", "associated", "with", "one", "direction", "may", "hinder", "the", "force", "production", "in", "other", "directions", "by", "other", "muscles", "[", "5,22", "]", ".", "For", "example", ",", "Kaufman", "et", "al", ".", "demonstrated", "that", "thumb", "muscles", "not", "innervated", "by", "the", "median", "nerve", "displayed", "lower", "electromyographical", "activation", "and", "shifted", "the", "direction", "of", "maximum", "activation", "after", "a", "median", "nerve", "block", "[", "5", "]", ".", "Labosky", "and", "Waggy", "showed", "that", "a", "radial", "nerve", "block", "caused", "a", "53", "%", "decrease", "in", "thumb", "abduction", "strength", "because", "of", "the", "lack", "of", "stabilization", "of", "the", "radial", "innervated", "extensor", "muscles", "[", "22", "]", ".", "Consequently", ",", "deficiency", "of", "median", "innervated", "muscles", "inherently", "limits", "force", "production", "in", "other", "directions", "as", "neuromuscular", "switching", "is", "necessary", "to", "produce", "force", "in", "changing", "directions", ".", "\n", "The", "median", "innervated", "muscles", "are", "the", "dominant", "abductors", "of", "the", "thumb", "metacarpophalangeal", "and", "carpometacarpal", "joint", ".", "The", "more", "than", "50", "%", "residual", "abduction", "force", "found", "in", "this", "study", "suggests", "that", "the", "injection", "did", "not", "totally", "block", "the", "motor", "function", "of", "these", "muscles", ",", "even", "though", "a", "complete", "sensory", "loss", "was", "verified", ".", "This", "concurs", "with", "clinical", "observations", "of", "median", "compression", "neuropathy", ".", "Individuals", "with", "carpal", "tunnel", "syndrome", "complain", "of", "sensory", "dysfunction", "early", "in", "the", "disease", "process", "(", "at", "the", "beginning", ")", ",", "while", "motor", "signs", "of", "thenar", "wasting", "and", "thumb", "weakness", "occur", "as", "the", "disease", "advances", ".", "The", "concept", "that", "the", "motor", "deficit", "is", "more", "resistant", "to", "peripheral", "median", "neuropathy", "than", "sensory", "loss", "has", "been", "well", "documented", "[", "23,26,27", "]", ".", "Butterworth", "et", "al", ".", "studied", "the", "temporal", "effects", "on", "sensory", "and", "motor", "blockade", "after", "injection", "of", "bupivacaine", "or", "mepivacaine", ",", "and", "found", "that", "sensory", "loss", "was", "complete", "but", "about", "a", "20", "%", "compound", "motor", "action", "potential", "remained", "after", "40", "minutes", "[", "23", "]", ".", "\n", "In", "conclusion", ",", "we", "have", "incorporated", "a", "method", "for", "assessing", "thumb", "motor", "deficit", "based", "on", "strength", "measurement", "with", "a", "standard", "local", "anesthetic", "to", "investigate", "the", "effects", "of", "a", "simulated", "median", "neuropathy", "on", "thumb", "motor", "function", ".", "Median", "nerve", "block", "results", "in", "force", "deficits", "in", "all", "directions", ",", "with", "the", "most", "severe", "impairment", "in", "abduction", "and", "flexion", ".", "Future", "endeavors", "using", "this", "methodology", "can", "potentially", "further", "elucidate", "underlying", "pathomechanisms", "of", "peripheral", "neuropathies", "in", "all", "digits", "of", "the", "hand", ".", "\n\n\n" ]
[ "species" ]
patients is a species
3_task1
Sentence: Thumb force deficit after lower median nerve block Abstract Purpose The purpose of this study was to characterize thumb motor dysfunction resulting from simulated lower median nerve lesions at the wrist. Methods Bupivacaine hydrochloride was injected into the carpal tunnel of six healthy subjects to locally anesthetize the median nerve. Motor function was subsequently evaluated by measuring maximal force production in all directions within the transverse plane perpendicular to the longitudinal axis of the thumb. Force envelopes were constructed using these measured multidirectional forces. Results Blockage of the median nerve resulted in decreased force magnitudes and thus smaller force envelopes. The average force decrease around the force envelope was 27.9%. A maximum decrease of 42.4% occurred in a direction combining abduction and slight flexion, while a minimum decrease of 10.5% occurred in a direction combining adduction and slight flexion. Relative decreases in adduction, extension, abduction, and flexion were 17.3%, 21.2%, 41.2% and 33.5%, respectively. Areas enclosed by pre- and post-block force envelopes were 20628 ± 7747 N.N, and 10700 ± 4474 N.N, respectively, representing an average decrease of 48.1%. Relative decreases in the adduction, extension, abduction, and flexion quadrant areas were 31.5%, 42.3%, 60.9%, and 52.3%, respectively. Conclusion Lower median nerve lesion, simulated by a nerve block at the wrist, compromise normal motor function of the thumb. A median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. From our results, such a means of motor function assessment can potentially be applied to functionally evaluate peripheral neuropathies. Introduction The thumb has unique anatomical and biomechanical characteristics that are required to perform many manipulative tasks. Thumb motor dysfunction resulting from neuromuscular and musculoskeletal pathologies severely hinders the performance of these daily tasks. Clinical treatment, prevention protocols, and rehabilitation efficacy requires a thorough understanding of thumb motor capabilities, as well as its associated functional deficit. Investigations of underlying pathological mechanism of the thumb help advance clinical treatments such as tendon transfers [1], functional electrical stimulation [2] and plasticity suppression [3]. Measurement of strength during maximum voluntary contraction is a simple and direct means of assessing neuromuscular function. Popular instruments used for quantitative assessment of thumb strength are pinch dynamometers. The pinch output, however, provides limited information about thumb motor function in that it offers a single generic force in one specific direction. Each muscle/tendon within the thumb has a distinct anatomical origin and insertion, suggesting its external force potential in a particular direction [4-6]. Hence, evaluation of strengths in multiple directions offers insight concerning the motor capacity of individual muscles. Force production of a digit has been measured in various directions such as flexion/extension [7,8], abduction/adduction [9-14], or in combined directions [15,16]. Bourbonnais et al. developed an apparatus to measure thumb force production in eight directions in the transverse plane of the thumb and investigated force dependence on the direction of effort [15]. Yokogawa and Hara measured index fingertip forces in various directions within the flexion/extension plane [8]. Recently, we developed experimental apparatuses to measure multi-directional forces of a digit in its transverse plane [17-19]. From these multi-directional forces we constructed force envelopes representative of the characteristic force output pattern of a digit [17-19]. Disorders resulting from traumatic injuries to and various diseases of these nerves are common in clinical practice. Clinical manifestations of hand dysfunction are distinctive depending on the nerve involved. For example, thenar atrophy is a major clinical observation affecting thumb function at the later stages of compression neuropathy of the median nerve. Several studies have been conducted to investigate the effects of simulated peripheral neuropathies using local anesthetization [5,16,20,21]. Kozin et al. [21] studied the effects of median and ulnar nerve blocks on grip and pinch strength and showed significant decreases following nerve blockage [21]. Boatright and Kiebzak [20] investigated the effects of median nerve block on thumb abduction strength. Kaufman et al. [5] measured isometric thumb forces in eight directions together with electromyographic signals of thumb muscles after block of the median nerve. Labosky and Waggy [22] studied the strength related to grip, pinch, thumb adduction, thumb abduction, and finger flexion after radial nerve block [22]. Kuxhaus studied the three dimensional feasible force set at the thumb-tip before and after ulnar nerve block and reported this to be a reproducible and sensitive means to detect impairment. The purpose of this study was to utilize our developed apparatus and protocols to investigate the effects of lower median nerve lesion on thumb motor function. The lesion was simulated by blocking the median nerve at the wrist using an anesthetic. We hypothesized that a median nerve block would cause (1) a decrease in force production, which would be direction-dependent with the most severe reduction in the abduction direction, and (2) a decrease in the force envelope area and force quadrant area, with the greatest decrease in the abduction quadrant. Methods Subjects Six healthy male subjects (mean age: 26.9 ± 5.1 years) participated in this study. The subjects had no previous history of neuromuscular or musculoskeletal disorders of the upper extremities. Each subject signed an informed consent form approved by the Institutional Review Board prior to participating in the experiment. Median nerve block Injections were performed under aseptic conditions while the subjects sat with the forearm supinated and the wrist slightly extended. After the skin at the palmer area of the wrist was cleaned with alcohol, 4 mL of 0.5% bupivacaine hydrochloride (Astra Pharmaceuticals, Westborough, MA, USA) was injected into the carpal tunnel with a sterile 25-gauge short-bevel needle. The needle was inserted through the transverse carpal ligament in line with the radial border of the fourth digit slightly ulnar to the palmaris longus tendon at the level of the distal wrist crease. Forty minutes was allowed for the median nerve block to reach complete effectiveness [23] and was verified using the Semmes-Weinstein monofilament test. The average monofilament score was 2.85 across the five digits before nerve block. About 40 minutes after nerve injection, little sensory impairment occurred in the ulnar distribution (score = 3.22), while the sensory score in the median distribution was greater than 6.15. The effects of nerve block lasted more than 6 hours with all subjects regaining normal hand function within 12 hours. Testing apparatus The experimental apparatus was designed and constructed to measure maximum voluntary contraction forces of any digit at any point along the digit. Force application was possible in any direction within the transverse plane of the longitudinal axis of the digit. The apparatus consisted of position control accessories, a force transducer, and a custom fitted aluminum ring attached to the transducer (Figure 1A,1B). The transducer (Mini40, ATI Industrial Automation, NC, USA), capable of measuring 6 degrees of freedom forces and moments, was attached to a mounting clamp via an aluminum adapter plate while the aluminum ring was secured to the tool side of the transducer using a custom adapter. The ring served as a connection anchor for the transducer and the digit. The force transducer and ring attachment were positioned in a desired orientation using an aluminum slide rail, tubing, and lockable mounting clamps (80/20 Inc., Columbia City, IN, USA). The slide rail was secured to an aluminum base plate. Foam padded wooden blocks with two locking straps secured the arm to the base plate. The analog outputs from the transducer were digitized using a 16-bit analog-to-digital converter (PCI-6031, National Instruments, TX, USA). The X (abduction/adduction) and Y (flexion/extension) force components in the transverse plane were displayed on the screen while the subject performed a force production task. The resolutions of the force transducer in its axial (flexion/extension) and horizontal (abduction/adduction) directions were 0.16 N and 0.08 N, respectively. A personal computer equipped with LabVIEW (National Instrument, TX, USA) was used for force data acquisition, display, and processing. Experimental procedures Each subject was tested before and after median nerve block. The nerve block procedures were performed immediately after the completion of the first testing session. Post-block testing started after the verification of complete median nerve block, approximately 40 minutes after the injection. During each test, the subject was seated in a chair adjacent to the testing station modified with a wooden board to align their back vertically throughout the trials. The subjects rested their forearm on padded wooden blocks positioning their shoulder in approximately 60° of frontal plane abduction. Nylon straps fitted with plastic snap locking mechanisms secured the forearm and minimized the intervention of the elbow and shoulder during thumb force application. Subjects grasped a vertical dowel secured to the distal end of the wooden blocks in a midprone position. Formable thermoplastic braces were used to fix the elbow in 90° of flexion, and the wrist in 20° of extension and 0° of ulnar deviation. A metallic brace was used to fix the interphalangeal joint of the thumb in full extension. The aluminum ring was placed around the middle of the proximal phalanx and oriented to accommodate comfortable thumb position with the metacarpophalangeal joint flexed approximately 15°. Prior to testing, a line was drawn on the proximal phalange at the midpoint between the interphalangeal and metacarpophalangeal joints. The alignment of the ring with the circumferential line standardized the location of force application within and between subjects. As force application was at the middle of the proximal phalanx, mechanical action pertains to both the metacarpophalangeal and carpometacarpal joints. We chose the terminology of flexion/extension and adduction/adduction based on the mechanical action with respect to the metacarpophalangeal joint. With the thumb in the ring (Figure 1B), extension and flexion occurred in parallel with the palm, and abduction and adduction occurred in a plane perpendicular to the palm. Each subject performed 15 circumferential MVC trials with randomized starting directions (Figure 1C). The subject was allotted 15 seconds to complete each circumferential trial, and was instructed to use the entire time allotted to traverse the perimeter of the ring once. A dot generated on the computer screen was programmed to traverse a circle within 15 seconds to provide the subject with directional feedback of their force application. Subjects were given 60 seconds of rest between each circumferential trial. Each subject was familiarized with the task with a few practice trials. Data were collected from each subject at 100 samples per second producing a total of 22,500 pairs of force components from the 15 circumferential trials. Our previous study [19] indicated that the testing protocol did not cause noticeable fatigue. Force envelope and quadrants Data from multiple circumferential trials were accumulated to construct a force envelope. The procedures to generate a force envelope were as follows: Cartesian force coordinates (Xi, Yi) were transformed into polar coordinates (Rα, α), where Rα was the force magnitude at an angular position α. Each α was rounded to the nearest integer ranging from 0 to 359 degrees. The maximum, Fα, was determined from a string of N data points along each radial line defined by α. At the completion of the 15 trials, there were, on average, N = 63 data points on each radial line of α based on the distribution off the 22,500 data points around 360°. A moving average with an interval of 10° was applied to the maximal series data Fα (α = 0, 1, 2,..., 359) to obtain filtered maximal forces. These forces formed a force envelope. The area formed by a force envelope was divided into adduction-extension, extension-abduction, abduction-flexion, and flexion-adduction quadrants by radial lines oriented at 0°, 90°, 180°, and 270° A quadrant force was represented using the mean magnitude of the forces in that quadrant. The areas of the entire envelope and each quadrant were calculated by summing the areas of individual arc sections formed by the polar coordinates of the force envelope. (Figure 2). Statistical Analyses One- and two-factor repeated measures analyses of variance (ANOVA) were used to analyze outcome measures. The independent variables were testing SESSION (n = 2, i.e., pre- and post-block), force DIRECTION (n = 16), and force QUADRANT (n = 4), with SESSION as a repeated variable. Dependent variables were directional force, individual quadrant area and force envelope area. Statistical analyses were performed using SPSS 11 (SPSS Inc., Illinois) with statistical significance set at α = 0.05. Results Force envelope and directional forces Figure 3 shows the force envelopes produced by each subject (A to F) before and after median nerve block. The post-block force envelope was inside the pre-block envelope for each subject, indicating a decrease in force magnitude in all directions after nerve block. Figure 4 shows the average pre- and post-block force envelope across all subjects. Force magnitudes were significantly reduced after nerve block (p < 0.001) resulting in significantly smaller force envelopes. The average decrease across all directions was 27.9%. A maximum decrease of 42.4% occurred at 199°, corresponding to a combined direction of abduction and slight flexion, while a minimum decrease of 10.5% occurred at 328° corresponding to a combined direction of adduction and slight flexion. Relative decreases at 0° (adduction), 90° (extension), 180° (abduction), and 270° (flexion) directions were 17.3%, 21.2%, 41.2% and 33.5%, respectively. A single force in each quadrant was represented using the mean magnitude of the forces in that quadrant (see description in the Methods). The average quadrant forces were significantly decreased after nerve block (p < 0.001; Figure 5). The amount of decrease was also different between quadrants (p < 0.005). Relative decreases in mean quadrant forces were 24.5%, 38.7%, 32.1%, and 18.1% for extension, abduction, flexion, and adduction, respectively. The maximal decreases in mean quadrant force, 38.7%, occurred in the abduction quadrant. Force envelope areas and quadrant areas Areas enclosed by the post-block envelopes were significantly smaller than the pre-block envelopes (p < 0.001; Figure 4). Post-block force envelope area, 10700 ± 4474 N.N, was 51.9% of pre-block force envelope area, 20628 ± 7747 N.N. Quadrant area decreased significantly (p < 0.001; Figure 6). The maximal percentage decrease in area after nerve block was 60.9% in the abduction quadrant, followed by a 52.3% area decrease in the flexion quadrant. Discussion In this study we simulated a lower median nerve lesion and evaluated the resultant thumb motor function deficit. Our internal control via pre- and post-block design offered a particular advantage of investigating the mechanical role of muscles innervated by a targeted nerve. The testing and analytical methods employed have provided advanced quantification of thumb motor function. The results have confirmed our initial hypotheses that greatest force decreases occurred in directions related to abduction, and that the post-block thumb force envelope area was smaller than the pre-block force envelope area. Preferential force attenuation in the quadrants of abduction and flexion after median nerve block are in agreement with anatomical and neuromuscular features of the thumb. The median nerve innervates the abductor pollicis brevis, the opponens pollicis and superficial head of the flexor pollicis brevis, all of which contribute to the abduction and flexion of the thumb [4]; therefore, denervation of these muscles after median nerve block would cause the greatest force deficit related to median nerve function [5]. Additionally, as force application moved towards adduction, the force deficit decreased as neuromuscular control shifted from the median nerve to the ulnar nerve via the first dorsal interosseous and adductor pollicis brevis. Force deficit in extension was also comparably small as extension forces are mainly produced by the extensors pollicis brevis and longus originating in the forearm. Our reported force decreases following a median nerve block (40.9% in abduction, 34.1% in flexion) were smaller than those reported in the literature. Kozin et al. [21] reported a 60% decrease in pinch strength after a median nerve block using mepivicaine hydrochloride [21]. Boatright and Kiebzak [20] reported an approximate 70% decrease in thumb abduction strength after median nerve block using Lidocaine [20]. Kaufman et al. [5] stated that a median nerve block with Lidocaine almost completely diminished force production in the abduction direction [5]. The discrepancy may be due to the anesthetic used and strength testing method. Although the sensory block appeared to be complete for each method, the motor capabilities of the muscles associated with the median nerve might or might not be completely eliminated. Such a result is largely dependent on a particular anesthetic, its concentration and dosage, as well as the efficacy of the injection technique at immersing the nerve. The methods of strength testing may also help explain the different magnitudes of strength deficit after the nerve block. All previous results were based on forces obtained in discrete direction(s), and focused exertions, while the current study utilized a method of force production in a continuous, circumferential and dynamic manner. Furthermore, thumb motor performance can be maintained despite the absence of certain individual muscles. For example, Britto and Elliot reported that the loss of abductor pollicis longus and extensor pollicis brevis in their two patients did not show functional compromise of strength and grip strength [24]. In a broader sense, the neuromuscular system has remarkable capabilities to accomplish the same motor function goal using different effectors and different goals using the same effectors, a phenomenon so called "motor equivalence" [25]. An unexpected finding from this study was that the force deficit occurred in all directions (Figure 4). In other words, the median nerve block caused reduced force production by those muscles not associated with the median nerve. Several potential explanations exist to describe such a phenomenon. First, the injection into the carpal tunnel at the wrist, although localized, potentially diffused into the intrinsic fascia of the hand partially compromising function of the ulnar nerve, which innervates the adductor pollicis. Although Semmes-Weinstein monofilament testing confirmed the continued sensation of the digits within the ulnar nerve distribution, it is not inconceivable that the injection could have contaminated the ulnar innervated muscles, the first dorsal interosseous and deep head of the flexor pollicis brevis [20]. Secondly, thumb force in any direction is produced by synergistic activation of the many intrinsic muscles, and as a result, the muscular deficiency associated with one direction may hinder the force production in other directions by other muscles [5,22]. For example, Kaufman et al. demonstrated that thumb muscles not innervated by the median nerve displayed lower electromyographical activation and shifted the direction of maximum activation after a median nerve block [5]. Labosky and Waggy showed that a radial nerve block caused a 53% decrease in thumb abduction strength because of the lack of stabilization of the radial innervated extensor muscles [22]. Consequently, deficiency of median innervated muscles inherently limits force production in other directions as neuromuscular switching is necessary to produce force in changing directions. The median innervated muscles are the dominant abductors of the thumb metacarpophalangeal and carpometacarpal joint. The more than 50% residual abduction force found in this study suggests that the injection did not totally block the motor function of these muscles, even though a complete sensory loss was verified. This concurs with clinical observations of median compression neuropathy. Individuals with carpal tunnel syndrome complain of sensory dysfunction early in the disease process (at the beginning), while motor signs of thenar wasting and thumb weakness occur as the disease advances. The concept that the motor deficit is more resistant to peripheral median neuropathy than sensory loss has been well documented [23,26,27]. Butterworth et al. studied the temporal effects on sensory and motor blockade after injection of bupivacaine or mepivacaine, and found that sensory loss was complete but about a 20% compound motor action potential remained after 40 minutes [23]. In conclusion, we have incorporated a method for assessing thumb motor deficit based on strength measurement with a standard local anesthetic to investigate the effects of a simulated median neuropathy on thumb motor function. Median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. Future endeavors using this methodology can potentially further elucidate underlying pathomechanisms of peripheral neuropathies in all digits of the hand. Instructions: please typing these entity words according to sentence: patients Options: species
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Thumb force deficit after lower median nerve block Abstract Purpose The purpose of this study was to characterize thumb motor dysfunction resulting from simulated lower median nerve lesions at the wrist. Methods Bupivacaine hydrochloride was injected into the carpal tunnel of six healthy subjects to locally anesthetize the median nerve. Motor function was subsequently evaluated by measuring maximal force production in all directions within the transverse plane perpendicular to the longitudinal axis of the thumb. Force envelopes were constructed using these measured multidirectional forces. Results Blockage of the median nerve resulted in decreased force magnitudes and thus smaller force envelopes. The average force decrease around the force envelope was 27.9%. A maximum decrease of 42.4% occurred in a direction combining abduction and slight flexion, while a minimum decrease of 10.5% occurred in a direction combining adduction and slight flexion. Relative decreases in adduction, extension, abduction, and flexion were 17.3%, 21.2%, 41.2% and 33.5%, respectively. Areas enclosed by pre- and post-block force envelopes were 20628 ± 7747 N.N, and 10700 ± 4474 N.N, respectively, representing an average decrease of 48.1%. Relative decreases in the adduction, extension, abduction, and flexion quadrant areas were 31.5%, 42.3%, 60.9%, and 52.3%, respectively. Conclusion Lower median nerve lesion, simulated by a nerve block at the wrist, compromise normal motor function of the thumb. A median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. From our results, such a means of motor function assessment can potentially be applied to functionally evaluate peripheral neuropathies. Introduction The thumb has unique anatomical and biomechanical characteristics that are required to perform many manipulative tasks. Thumb motor dysfunction resulting from neuromuscular and musculoskeletal pathologies severely hinders the performance of these daily tasks. Clinical treatment, prevention protocols, and rehabilitation efficacy requires a thorough understanding of thumb motor capabilities, as well as its associated functional deficit. Investigations of underlying pathological mechanism of the thumb help advance clinical treatments such as tendon transfers [1], functional electrical stimulation [2] and plasticity suppression [3]. Measurement of strength during maximum voluntary contraction is a simple and direct means of assessing neuromuscular function. Popular instruments used for quantitative assessment of thumb strength are pinch dynamometers. The pinch output, however, provides limited information about thumb motor function in that it offers a single generic force in one specific direction. Each muscle/tendon within the thumb has a distinct anatomical origin and insertion, suggesting its external force potential in a particular direction [4-6]. Hence, evaluation of strengths in multiple directions offers insight concerning the motor capacity of individual muscles. Force production of a digit has been measured in various directions such as flexion/extension [7,8], abduction/adduction [9-14], or in combined directions [15,16]. Bourbonnais et al. developed an apparatus to measure thumb force production in eight directions in the transverse plane of the thumb and investigated force dependence on the direction of effort [15]. Yokogawa and Hara measured index fingertip forces in various directions within the flexion/extension plane [8]. Recently, we developed experimental apparatuses to measure multi-directional forces of a digit in its transverse plane [17-19]. From these multi-directional forces we constructed force envelopes representative of the characteristic force output pattern of a digit [17-19]. Disorders resulting from traumatic injuries to and various diseases of these nerves are common in clinical practice. Clinical manifestations of hand dysfunction are distinctive depending on the nerve involved. For example, thenar atrophy is a major clinical observation affecting thumb function at the later stages of compression neuropathy of the median nerve. Several studies have been conducted to investigate the effects of simulated peripheral neuropathies using local anesthetization [5,16,20,21]. Kozin et al. [21] studied the effects of median and ulnar nerve blocks on grip and pinch strength and showed significant decreases following nerve blockage [21]. Boatright and Kiebzak [20] investigated the effects of median nerve block on thumb abduction strength. Kaufman et al. [5] measured isometric thumb forces in eight directions together with electromyographic signals of thumb muscles after block of the median nerve. Labosky and Waggy [22] studied the strength related to grip, pinch, thumb adduction, thumb abduction, and finger flexion after radial nerve block [22]. Kuxhaus studied the three dimensional feasible force set at the thumb-tip before and after ulnar nerve block and reported this to be a reproducible and sensitive means to detect impairment. The purpose of this study was to utilize our developed apparatus and protocols to investigate the effects of lower median nerve lesion on thumb motor function. The lesion was simulated by blocking the median nerve at the wrist using an anesthetic. We hypothesized that a median nerve block would cause (1) a decrease in force production, which would be direction-dependent with the most severe reduction in the abduction direction, and (2) a decrease in the force envelope area and force quadrant area, with the greatest decrease in the abduction quadrant. Methods Subjects Six healthy male subjects (mean age: 26.9 ± 5.1 years) participated in this study. The subjects had no previous history of neuromuscular or musculoskeletal disorders of the upper extremities. Each subject signed an informed consent form approved by the Institutional Review Board prior to participating in the experiment. Median nerve block Injections were performed under aseptic conditions while the subjects sat with the forearm supinated and the wrist slightly extended. After the skin at the palmer area of the wrist was cleaned with alcohol, 4 mL of 0.5% bupivacaine hydrochloride (Astra Pharmaceuticals, Westborough, MA, USA) was injected into the carpal tunnel with a sterile 25-gauge short-bevel needle. The needle was inserted through the transverse carpal ligament in line with the radial border of the fourth digit slightly ulnar to the palmaris longus tendon at the level of the distal wrist crease. Forty minutes was allowed for the median nerve block to reach complete effectiveness [23] and was verified using the Semmes-Weinstein monofilament test. The average monofilament score was 2.85 across the five digits before nerve block. About 40 minutes after nerve injection, little sensory impairment occurred in the ulnar distribution (score = 3.22), while the sensory score in the median distribution was greater than 6.15. The effects of nerve block lasted more than 6 hours with all subjects regaining normal hand function within 12 hours. Testing apparatus The experimental apparatus was designed and constructed to measure maximum voluntary contraction forces of any digit at any point along the digit. Force application was possible in any direction within the transverse plane of the longitudinal axis of the digit. The apparatus consisted of position control accessories, a force transducer, and a custom fitted aluminum ring attached to the transducer (Figure 1A,1B). The transducer (Mini40, ATI Industrial Automation, NC, USA), capable of measuring 6 degrees of freedom forces and moments, was attached to a mounting clamp via an aluminum adapter plate while the aluminum ring was secured to the tool side of the transducer using a custom adapter. The ring served as a connection anchor for the transducer and the digit. The force transducer and ring attachment were positioned in a desired orientation using an aluminum slide rail, tubing, and lockable mounting clamps (80/20 Inc., Columbia City, IN, USA). The slide rail was secured to an aluminum base plate. Foam padded wooden blocks with two locking straps secured the arm to the base plate. The analog outputs from the transducer were digitized using a 16-bit analog-to-digital converter (PCI-6031, National Instruments, TX, USA). The X (abduction/adduction) and Y (flexion/extension) force components in the transverse plane were displayed on the screen while the subject performed a force production task. The resolutions of the force transducer in its axial (flexion/extension) and horizontal (abduction/adduction) directions were 0.16 N and 0.08 N, respectively. A personal computer equipped with LabVIEW (National Instrument, TX, USA) was used for force data acquisition, display, and processing. Experimental procedures Each subject was tested before and after median nerve block. The nerve block procedures were performed immediately after the completion of the first testing session. Post-block testing started after the verification of complete median nerve block, approximately 40 minutes after the injection. During each test, the subject was seated in a chair adjacent to the testing station modified with a wooden board to align their back vertically throughout the trials. The subjects rested their forearm on padded wooden blocks positioning their shoulder in approximately 60° of frontal plane abduction. Nylon straps fitted with plastic snap locking mechanisms secured the forearm and minimized the intervention of the elbow and shoulder during thumb force application. Subjects grasped a vertical dowel secured to the distal end of the wooden blocks in a midprone position. Formable thermoplastic braces were used to fix the elbow in 90° of flexion, and the wrist in 20° of extension and 0° of ulnar deviation. A metallic brace was used to fix the interphalangeal joint of the thumb in full extension. The aluminum ring was placed around the middle of the proximal phalanx and oriented to accommodate comfortable thumb position with the metacarpophalangeal joint flexed approximately 15°. Prior to testing, a line was drawn on the proximal phalange at the midpoint between the interphalangeal and metacarpophalangeal joints. The alignment of the ring with the circumferential line standardized the location of force application within and between subjects. As force application was at the middle of the proximal phalanx, mechanical action pertains to both the metacarpophalangeal and carpometacarpal joints. We chose the terminology of flexion/extension and adduction/adduction based on the mechanical action with respect to the metacarpophalangeal joint. With the thumb in the ring (Figure 1B), extension and flexion occurred in parallel with the palm, and abduction and adduction occurred in a plane perpendicular to the palm. Each subject performed 15 circumferential MVC trials with randomized starting directions (Figure 1C). The subject was allotted 15 seconds to complete each circumferential trial, and was instructed to use the entire time allotted to traverse the perimeter of the ring once. A dot generated on the computer screen was programmed to traverse a circle within 15 seconds to provide the subject with directional feedback of their force application. Subjects were given 60 seconds of rest between each circumferential trial. Each subject was familiarized with the task with a few practice trials. Data were collected from each subject at 100 samples per second producing a total of 22,500 pairs of force components from the 15 circumferential trials. Our previous study [19] indicated that the testing protocol did not cause noticeable fatigue. Force envelope and quadrants Data from multiple circumferential trials were accumulated to construct a force envelope. The procedures to generate a force envelope were as follows: Cartesian force coordinates (Xi, Yi) were transformed into polar coordinates (Rα, α), where Rα was the force magnitude at an angular position α. Each α was rounded to the nearest integer ranging from 0 to 359 degrees. The maximum, Fα, was determined from a string of N data points along each radial line defined by α. At the completion of the 15 trials, there were, on average, N = 63 data points on each radial line of α based on the distribution off the 22,500 data points around 360°. A moving average with an interval of 10° was applied to the maximal series data Fα (α = 0, 1, 2,..., 359) to obtain filtered maximal forces. These forces formed a force envelope. The area formed by a force envelope was divided into adduction-extension, extension-abduction, abduction-flexion, and flexion-adduction quadrants by radial lines oriented at 0°, 90°, 180°, and 270° A quadrant force was represented using the mean magnitude of the forces in that quadrant. The areas of the entire envelope and each quadrant were calculated by summing the areas of individual arc sections formed by the polar coordinates of the force envelope. (Figure 2). Statistical Analyses One- and two-factor repeated measures analyses of variance (ANOVA) were used to analyze outcome measures. The independent variables were testing SESSION (n = 2, i.e., pre- and post-block), force DIRECTION (n = 16), and force QUADRANT (n = 4), with SESSION as a repeated variable. Dependent variables were directional force, individual quadrant area and force envelope area. Statistical analyses were performed using SPSS 11 (SPSS Inc., Illinois) with statistical significance set at α = 0.05. Results Force envelope and directional forces Figure 3 shows the force envelopes produced by each subject (A to F) before and after median nerve block. The post-block force envelope was inside the pre-block envelope for each subject, indicating a decrease in force magnitude in all directions after nerve block. Figure 4 shows the average pre- and post-block force envelope across all subjects. Force magnitudes were significantly reduced after nerve block (p < 0.001) resulting in significantly smaller force envelopes. The average decrease across all directions was 27.9%. A maximum decrease of 42.4% occurred at 199°, corresponding to a combined direction of abduction and slight flexion, while a minimum decrease of 10.5% occurred at 328° corresponding to a combined direction of adduction and slight flexion. Relative decreases at 0° (adduction), 90° (extension), 180° (abduction), and 270° (flexion) directions were 17.3%, 21.2%, 41.2% and 33.5%, respectively. A single force in each quadrant was represented using the mean magnitude of the forces in that quadrant (see description in the Methods). The average quadrant forces were significantly decreased after nerve block (p < 0.001; Figure 5). The amount of decrease was also different between quadrants (p < 0.005). Relative decreases in mean quadrant forces were 24.5%, 38.7%, 32.1%, and 18.1% for extension, abduction, flexion, and adduction, respectively. The maximal decreases in mean quadrant force, 38.7%, occurred in the abduction quadrant. Force envelope areas and quadrant areas Areas enclosed by the post-block envelopes were significantly smaller than the pre-block envelopes (p < 0.001; Figure 4). Post-block force envelope area, 10700 ± 4474 N.N, was 51.9% of pre-block force envelope area, 20628 ± 7747 N.N. Quadrant area decreased significantly (p < 0.001; Figure 6). The maximal percentage decrease in area after nerve block was 60.9% in the abduction quadrant, followed by a 52.3% area decrease in the flexion quadrant. Discussion In this study we simulated a lower median nerve lesion and evaluated the resultant thumb motor function deficit. Our internal control via pre- and post-block design offered a particular advantage of investigating the mechanical role of muscles innervated by a targeted nerve. The testing and analytical methods employed have provided advanced quantification of thumb motor function. The results have confirmed our initial hypotheses that greatest force decreases occurred in directions related to abduction, and that the post-block thumb force envelope area was smaller than the pre-block force envelope area. Preferential force attenuation in the quadrants of abduction and flexion after median nerve block are in agreement with anatomical and neuromuscular features of the thumb. The median nerve innervates the abductor pollicis brevis, the opponens pollicis and superficial head of the flexor pollicis brevis, all of which contribute to the abduction and flexion of the thumb [4]; therefore, denervation of these muscles after median nerve block would cause the greatest force deficit related to median nerve function [5]. Additionally, as force application moved towards adduction, the force deficit decreased as neuromuscular control shifted from the median nerve to the ulnar nerve via the first dorsal interosseous and adductor pollicis brevis. Force deficit in extension was also comparably small as extension forces are mainly produced by the extensors pollicis brevis and longus originating in the forearm. Our reported force decreases following a median nerve block (40.9% in abduction, 34.1% in flexion) were smaller than those reported in the literature. Kozin et al. [21] reported a 60% decrease in pinch strength after a median nerve block using mepivicaine hydrochloride [21]. Boatright and Kiebzak [20] reported an approximate 70% decrease in thumb abduction strength after median nerve block using Lidocaine [20]. Kaufman et al. [5] stated that a median nerve block with Lidocaine almost completely diminished force production in the abduction direction [5]. The discrepancy may be due to the anesthetic used and strength testing method. Although the sensory block appeared to be complete for each method, the motor capabilities of the muscles associated with the median nerve might or might not be completely eliminated. Such a result is largely dependent on a particular anesthetic, its concentration and dosage, as well as the efficacy of the injection technique at immersing the nerve. The methods of strength testing may also help explain the different magnitudes of strength deficit after the nerve block. All previous results were based on forces obtained in discrete direction(s), and focused exertions, while the current study utilized a method of force production in a continuous, circumferential and dynamic manner. Furthermore, thumb motor performance can be maintained despite the absence of certain individual muscles. For example, Britto and Elliot reported that the loss of abductor pollicis longus and extensor pollicis brevis in their two patients did not show functional compromise of strength and grip strength [24]. In a broader sense, the neuromuscular system has remarkable capabilities to accomplish the same motor function goal using different effectors and different goals using the same effectors, a phenomenon so called "motor equivalence" [25]. An unexpected finding from this study was that the force deficit occurred in all directions (Figure 4). In other words, the median nerve block caused reduced force production by those muscles not associated with the median nerve. Several potential explanations exist to describe such a phenomenon. First, the injection into the carpal tunnel at the wrist, although localized, potentially diffused into the intrinsic fascia of the hand partially compromising function of the ulnar nerve, which innervates the adductor pollicis. Although Semmes-Weinstein monofilament testing confirmed the continued sensation of the digits within the ulnar nerve distribution, it is not inconceivable that the injection could have contaminated the ulnar innervated muscles, the first dorsal interosseous and deep head of the flexor pollicis brevis [20]. Secondly, thumb force in any direction is produced by synergistic activation of the many intrinsic muscles, and as a result, the muscular deficiency associated with one direction may hinder the force production in other directions by other muscles [5,22]. For example, Kaufman et al. demonstrated that thumb muscles not innervated by the median nerve displayed lower electromyographical activation and shifted the direction of maximum activation after a median nerve block [5]. Labosky and Waggy showed that a radial nerve block caused a 53% decrease in thumb abduction strength because of the lack of stabilization of the radial innervated extensor muscles [22]. Consequently, deficiency of median innervated muscles inherently limits force production in other directions as neuromuscular switching is necessary to produce force in changing directions. The median innervated muscles are the dominant abductors of the thumb metacarpophalangeal and carpometacarpal joint. The more than 50% residual abduction force found in this study suggests that the injection did not totally block the motor function of these muscles, even though a complete sensory loss was verified. This concurs with clinical observations of median compression neuropathy. Individuals with carpal tunnel syndrome complain of sensory dysfunction early in the disease process (at the beginning), while motor signs of thenar wasting and thumb weakness occur as the disease advances. The concept that the motor deficit is more resistant to peripheral median neuropathy than sensory loss has been well documented [23,26,27]. Butterworth et al. studied the temporal effects on sensory and motor blockade after injection of bupivacaine or mepivacaine, and found that sensory loss was complete but about a 20% compound motor action potential remained after 40 minutes [23]. In conclusion, we have incorporated a method for assessing thumb motor deficit based on strength measurement with a standard local anesthetic to investigate the effects of a simulated median neuropathy on thumb motor function. Median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. Future endeavors using this methodology can potentially further elucidate underlying pathomechanisms of peripheral neuropathies in all digits of the hand.
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"study", "was", "to", "utilize", "our", "developed", "apparatus", "and", "protocols", "to", "investigate", "the", "effects", "of", "lower", "median", "nerve", "lesion", "on", "thumb", "motor", "function", ".", "The", "lesion", "was", "simulated", "by", "blocking", "the", "median", "nerve", "at", "the", "wrist", "using", "an", "anesthetic", ".", "We", "hypothesized", "that", "a", "median", "nerve", "block", "would", "cause", "(", "1", ")", "a", "decrease", "in", "force", "production", ",", "which", "would", "be", "direction", "-", "dependent", "with", "the", "most", "severe", "reduction", "in", "the", "abduction", "direction", ",", "and", "(", "2", ")", "a", "decrease", "in", "the", "force", "envelope", "area", "and", "force", "quadrant", "area", ",", "with", "the", "greatest", "decrease", "in", "the", "abduction", "quadrant", ".", "\n\n", "Methods", "\n", "Subjects", "\n", "Six", "healthy", "male", "subjects", "(", "mean", "age", ":", "26.9", "±", "5.1", "years", ")", "participated", "in", "this", "study", ".", "The", "subjects", "had", "no", "previous", "history", "of", "neuromuscular", "or", "musculoskeletal", "disorders", "of", "the", "upper", "extremities", ".", "Each", "subject", "signed", "an", "informed", "consent", "form", "approved", "by", "the", "Institutional", "Review", "Board", "prior", "to", "participating", "in", "the", "experiment", ".", "\n\n", "Median", "nerve", "block", "\n", "Injections", "were", "performed", "under", "aseptic", "conditions", "while", "the", "subjects", "sat", "with", "the", "forearm", "supinated", "and", "the", "wrist", "slightly", "extended", ".", "After", "the", "skin", "at", "the", "palmer", "area", "of", "the", "wrist", "was", "cleaned", "with", "alcohol", ",", "4", "mL", "of", "0.5", "%", "bupivacaine", "hydrochloride", "(", "Astra", "Pharmaceuticals", ",", "Westborough", ",", "MA", ",", "USA", ")", "was", "injected", "into", "the", "carpal", "tunnel", "with", "a", "sterile", "25-gauge", "short", "-", "bevel", "needle", ".", "The", "needle", "was", "inserted", "through", "the", "transverse", "carpal", "ligament", "in", "line", "with", "the", "radial", "border", "of", "the", "fourth", "digit", "slightly", "ulnar", "to", "the", "palmaris", "longus", "tendon", "at", "the", "level", "of", "the", "distal", "wrist", "crease", ".", "Forty", "minutes", "was", "allowed", "for", "the", "median", "nerve", "block", "to", "reach", "complete", "effectiveness", "[", "23", "]", "and", "was", "verified", "using", "the", "Semmes", "-", "Weinstein", "monofilament", "test", ".", "The", "average", "monofilament", "score", "was", "2.85", "across", "the", "five", "digits", "before", "nerve", "block", ".", "About", "40", "minutes", "after", "nerve", "injection", ",", "little", "sensory", "impairment", "occurred", "in", "the", "ulnar", "distribution", "(", "score", "=", "3.22", ")", ",", "while", "the", "sensory", "score", "in", "the", "median", "distribution", "was", "greater", "than", "6.15", ".", "The", "effects", "of", "nerve", "block", "lasted", "more", "than", "6", "hours", "with", "all", "subjects", "regaining", "normal", "hand", "function", "within", "12", "hours", ".", "\n\n", "Testing", "apparatus", "\n", "The", "experimental", "apparatus", "was", "designed", "and", "constructed", "to", "measure", "maximum", "voluntary", "contraction", "forces", "of", "any", "digit", "at", "any", "point", "along", "the", "digit", ".", "Force", "application", "was", "possible", "in", "any", "direction", "within", "the", "transverse", "plane", "of", "the", "longitudinal", "axis", "of", "the", "digit", ".", "The", "apparatus", "consisted", "of", "position", "control", "accessories", ",", "a", "force", "transducer", ",", "and", "a", "custom", "fitted", "aluminum", "ring", "attached", "to", "the", "transducer", "(", "Figure", "1A,1B", ")", ".", "The", "transducer", "(", "Mini40", ",", "ATI", "Industrial", "Automation", ",", "NC", ",", "USA", ")", ",", "capable", "of", "measuring", "6", "degrees", "of", "freedom", "forces", "and", "moments", ",", "was", "attached", "to", "a", "mounting", "clamp", "via", "an", "aluminum", "adapter", "plate", "while", "the", "aluminum", "ring", "was", "secured", "to", "the", "tool", "side", "of", "the", "transducer", "using", "a", "custom", "adapter", ".", "The", "ring", "served", "as", "a", "connection", "anchor", "for", "the", "transducer", "and", "the", "digit", ".", "The", "force", "transducer", "and", "ring", "attachment", "were", "positioned", "in", "a", "desired", "orientation", "using", "an", "aluminum", "slide", "rail", ",", "tubing", ",", "and", "lockable", "mounting", "clamps", "(", "80/20", "Inc", ".", ",", "Columbia", "City", ",", "IN", ",", "USA", ")", ".", "The", "slide", "rail", "was", "secured", "to", "an", "aluminum", "base", "plate", ".", "Foam", "padded", "wooden", "blocks", "with", "two", "locking", "straps", "secured", "the", "arm", "to", "the", "base", "plate", ".", "\n", "The", "analog", "outputs", "from", "the", "transducer", "were", "digitized", "using", "a", "16-bit", "analog", "-", "to", "-", "digital", "converter", "(", "PCI-6031", ",", "National", "Instruments", ",", "TX", ",", "USA", ")", ".", "The", "X", "(", "abduction", "/", "adduction", ")", "and", "Y", "(", "flexion", "/", "extension", ")", "force", "components", "in", "the", "transverse", "plane", "were", "displayed", "on", "the", "screen", "while", "the", "subject", "performed", "a", "force", "production", "task", ".", "The", "resolutions", "of", "the", "force", "transducer", "in", "its", "axial", "(", "flexion", "/", "extension", ")", "and", "horizontal", "(", "abduction", "/", "adduction", ")", "directions", "were", "0.16", "N", "and", "0.08", "N", ",", "respectively", ".", "A", "personal", "computer", "equipped", "with", "LabVIEW", "(", "National", "Instrument", ",", "TX", ",", "USA", ")", "was", "used", "for", "force", "data", "acquisition", ",", "display", ",", "and", "processing", ".", "\n\n", "Experimental", "procedures", "\n", "Each", "subject", "was", "tested", "before", "and", "after", "median", "nerve", "block", ".", "The", "nerve", "block", "procedures", "were", "performed", "immediately", "after", "the", "completion", "of", "the", "first", "testing", "session", ".", "Post", "-", "block", "testing", "started", "after", "the", "verification", "of", "complete", "median", "nerve", "block", ",", "approximately", "40", "minutes", "after", "the", "injection", ".", "During", "each", "test", ",", "the", "subject", "was", "seated", "in", "a", "chair", "adjacent", "to", "the", "testing", "station", "modified", "with", "a", "wooden", "board", "to", "align", "their", "back", "vertically", "throughout", "the", "trials", ".", "The", "subjects", "rested", "their", "forearm", "on", "padded", "wooden", "blocks", "positioning", "their", "shoulder", "in", "approximately", "60", "°", "of", "frontal", "plane", "abduction", ".", "Nylon", "straps", "fitted", "with", "plastic", "snap", "locking", "mechanisms", "secured", "the", "forearm", "and", "minimized", "the", "intervention", "of", "the", "elbow", "and", "shoulder", "during", "thumb", "force", "application", ".", "Subjects", "grasped", "a", "vertical", "dowel", "secured", "to", "the", "distal", "end", "of", "the", "wooden", "blocks", "in", "a", "midprone", "position", ".", "Formable", "thermoplastic", "braces", "were", "used", "to", "fix", "the", "elbow", "in", "90", "°", "of", "flexion", ",", "and", "the", "wrist", "in", "20", "°", "of", "extension", "and", "0", "°", "of", "ulnar", "deviation", ".", "A", "metallic", "brace", "was", "used", "to", "fix", "the", "interphalangeal", "joint", "of", "the", "thumb", "in", "full", "extension", ".", "The", "aluminum", "ring", "was", "placed", "around", "the", "middle", "of", "the", "proximal", "phalanx", "and", "oriented", "to", "accommodate", "comfortable", "thumb", "position", "with", "the", "metacarpophalangeal", "joint", "flexed", "approximately", "15", "°", ".", "Prior", "to", "testing", ",", "a", "line", "was", "drawn", "on", "the", "proximal", "phalange", "at", "the", "midpoint", "between", "the", "interphalangeal", "and", "metacarpophalangeal", "joints", ".", "The", "alignment", "of", "the", "ring", "with", "the", "circumferential", "line", "standardized", "the", "location", "of", "force", "application", "within", "and", "between", "subjects", ".", "As", "force", "application", "was", "at", "the", "middle", "of", "the", "proximal", "phalanx", ",", "mechanical", "action", "pertains", "to", "both", "the", "metacarpophalangeal", "and", "carpometacarpal", "joints", ".", "We", "chose", "the", "terminology", "of", "flexion", "/", "extension", "and", "adduction", "/", "adduction", "based", "on", "the", "mechanical", "action", "with", "respect", "to", "the", "metacarpophalangeal", "joint", ".", "With", "the", "thumb", "in", "the", "ring", "(", "Figure", "1B", ")", ",", "extension", "and", "flexion", "occurred", "in", "parallel", "with", "the", "palm", ",", "and", "abduction", "and", "adduction", "occurred", "in", "a", "plane", "perpendicular", "to", "the", "palm", ".", "\n", "Each", "subject", "performed", "15", "circumferential", "MVC", "trials", "with", "randomized", "starting", "directions", "(", "Figure", "1C", ")", ".", "The", "subject", "was", "allotted", "15", "seconds", "to", "complete", "each", "circumferential", "trial", ",", "and", "was", "instructed", "to", "use", "the", "entire", "time", "allotted", "to", "traverse", "the", "perimeter", "of", "the", "ring", "once", ".", "A", "dot", "generated", "on", "the", "computer", "screen", "was", "programmed", "to", "traverse", "a", "circle", "within", "15", "seconds", "to", "provide", "the", "subject", "with", "directional", "feedback", "of", "their", "force", "application", ".", "Subjects", "were", "given", "60", "seconds", "of", "rest", "between", "each", "circumferential", "trial", ".", "Each", "subject", "was", "familiarized", "with", "the", "task", "with", "a", "few", "practice", "trials", ".", "Data", "were", "collected", "from", "each", "subject", "at", "100", "samples", "per", "second", "producing", "a", "total", "of", "22,500", "pairs", "of", "force", "components", "from", "the", "15", "circumferential", "trials", ".", "Our", "previous", "study", "[", "19", "]", "indicated", "that", "the", "testing", "protocol", "did", "not", "cause", "noticeable", "fatigue", ".", "\n\n", "Force", "envelope", "and", "quadrants", "\n", "Data", "from", "multiple", "circumferential", "trials", "were", "accumulated", "to", "construct", "a", "force", "envelope", ".", "The", "procedures", "to", "generate", "a", "force", "envelope", "were", "as", "follows", ":", "\n", "Cartesian", "force", "coordinates", "(", "Xi", ",", "Yi", ")", "were", "transformed", "into", "polar", "coordinates", "(", "Rα", ",", "α", ")", ",", "where", "Rα", "was", "the", "force", "magnitude", "at", "an", "angular", "position", "α", ".", "Each", "α", "was", "rounded", "to", "the", "nearest", "integer", "ranging", "from", "0", "to", "359", "degrees", ".", "\n", "The", "maximum", ",", "Fα", ",", "was", "determined", "from", "a", "string", "of", "N", "data", "points", "along", "each", "radial", "line", "defined", "by", "α", ".", "At", "the", "completion", "of", "the", "15", "trials", ",", "there", "were", ",", "on", "average", ",", "N", "=", "63", "data", "points", "on", "each", "radial", "line", "of", "α", "based", "on", "the", "distribution", "off", "the", "22,500", "data", "points", "around", "360", "°", ".", "\n", "A", "moving", "average", "with", "an", "interval", "of", "10", "°", "was", "applied", "to", "the", "maximal", "series", "data", "Fα", "(", "α", "=", "0", ",", "1", ",", "2", ",", "...", ",", "359", ")", "to", "obtain", "filtered", "maximal", "forces", ".", "These", "forces", "formed", "a", "force", "envelope", ".", "\n", "The", "area", "formed", "by", "a", "force", "envelope", "was", "divided", "into", "adduction", "-", "extension", ",", "extension", "-", "abduction", ",", "abduction", "-", "flexion", ",", "and", "flexion", "-", "adduction", "quadrants", "by", "radial", "lines", "oriented", "at", "0", "°", ",", "90", "°", ",", "180", "°", ",", "and", "270", "°", "A", "quadrant", "force", "was", "represented", "using", "the", "mean", "magnitude", "of", "the", "forces", "in", "that", "quadrant", ".", "The", "areas", "of", "the", "entire", "envelope", "and", "each", "quadrant", "were", "calculated", "by", "summing", "the", "areas", "of", "individual", "arc", "sections", "formed", "by", "the", "polar", "coordinates", "of", "the", "force", "envelope", ".", "(", "Figure", "2", ")", ".", "\n\n", "Statistical", "Analyses", "\n", "One-", "and", "two", "-", "factor", "repeated", "measures", "analyses", "of", "variance", "(", "ANOVA", ")", "were", "used", "to", "analyze", "outcome", "measures", ".", "The", "independent", "variables", "were", "testing", "SESSION", "(", "n", "=", "2", ",", "i.e", ".", ",", "pre-", "and", "post", "-", "block", ")", ",", "force", "DIRECTION", "(", "n", "=", "16", ")", ",", "and", "force", "QUADRANT", "(", "n", "=", "4", ")", ",", "with", "SESSION", "as", "a", "repeated", "variable", ".", "Dependent", "variables", "were", "directional", "force", ",", "individual", "quadrant", "area", "and", "force", "envelope", "area", ".", "Statistical", "analyses", "were", "performed", "using", "SPSS", "11", "(", "SPSS", "Inc", ".", ",", "Illinois", ")", "with", "statistical", "significance", "set", "at", "α", "=", "0.05", ".", "\n\n\n", "Results", "\n", "Force", "envelope", "and", "directional", "forces", "\n", "Figure", "3", "shows", "the", "force", "envelopes", "produced", "by", "each", "subject", "(", "A", "to", "F", ")", "before", "and", "after", "median", "nerve", "block", ".", "The", "post", "-", "block", "force", "envelope", "was", "inside", "the", "pre", "-", "block", "envelope", "for", "each", "subject", ",", "indicating", "a", "decrease", "in", "force", "magnitude", "in", "all", "directions", "after", "nerve", "block", ".", "Figure", "4", "shows", "the", "average", "pre-", "and", "post", "-", "block", "force", "envelope", "across", "all", "subjects", ".", "Force", "magnitudes", "were", "significantly", "reduced", "after", "nerve", "block", "(", "p", "<", "0.001", ")", "resulting", "in", "significantly", "smaller", "force", "envelopes", ".", "The", "average", "decrease", "across", "all", "directions", "was", "27.9", "%", ".", "A", "maximum", "decrease", "of", "42.4", "%", "occurred", "at", "199", "°", ",", "corresponding", "to", "a", "combined", "direction", "of", "abduction", "and", "slight", "flexion", ",", "while", "a", "minimum", "decrease", "of", "10.5", "%", "occurred", "at", "328", "°", "corresponding", "to", "a", "combined", "direction", "of", "adduction", "and", "slight", "flexion", ".", "Relative", "decreases", "at", "0", "°", "(", "adduction", ")", ",", "90", "°", "(", "extension", ")", ",", "180", "°", "(", "abduction", ")", ",", "and", "270", "°", "(", "flexion", ")", "directions", "were", "17.3", "%", ",", "21.2", "%", ",", "41.2", "%", "and", "33.5", "%", ",", "respectively", ".", "\n", "A", "single", "force", "in", "each", "quadrant", "was", "represented", "using", "the", "mean", "magnitude", "of", "the", "forces", "in", "that", "quadrant", "(", "see", "description", "in", "the", "Methods", ")", ".", "The", "average", "quadrant", "forces", "were", "significantly", "decreased", "after", "nerve", "block", "(", "p", "<", "0.001", ";", "Figure", "5", ")", ".", "The", "amount", "of", "decrease", "was", "also", "different", "between", "quadrants", "(", "p", "<", "0.005", ")", ".", "Relative", "decreases", "in", "mean", "quadrant", "forces", "were", "24.5", "%", ",", "38.7", "%", ",", "32.1", "%", ",", "and", "18.1", "%", "for", "extension", ",", "abduction", ",", "flexion", ",", "and", "adduction", ",", "respectively", ".", "The", "maximal", "decreases", "in", "mean", "quadrant", "force", ",", "38.7", "%", ",", "occurred", "in", "the", "abduction", "quadrant", ".", "\n\n", "Force", "envelope", "areas", "and", "quadrant", "areas", "\n", "Areas", "enclosed", "by", "the", "post", "-", "block", "envelopes", "were", "significantly", "smaller", "than", "the", "pre", "-", "block", "envelopes", "(", "p", "<", "0.001", ";", "Figure", "4", ")", ".", "Post", "-", "block", "force", "envelope", "area", ",", "10700", "±", "4474", "N.N", ",", "was", "51.9", "%", "of", "pre", "-", "block", "force", "envelope", "area", ",", "20628", "±", "7747", "N.N.", "Quadrant", "area", "decreased", "significantly", "(", "p", "<", "0.001", ";", "Figure", "6", ")", ".", "The", "maximal", "percentage", "decrease", "in", "area", "after", "nerve", "block", "was", "60.9", "%", "in", "the", "abduction", "quadrant", ",", "followed", "by", "a", "52.3", "%", "area", "decrease", "in", "the", "flexion", "quadrant", ".", "\n\n\n", "Discussion", "\n", "In", "this", "study", "we", "simulated", "a", "lower", "median", "nerve", "lesion", "and", "evaluated", "the", "resultant", "thumb", "motor", "function", "deficit", ".", "Our", "internal", "control", "via", "pre-", "and", "post", "-", "block", "design", "offered", "a", "particular", "advantage", "of", "investigating", "the", "mechanical", "role", "of", "muscles", "innervated", "by", "a", "targeted", "nerve", ".", "The", "testing", "and", "analytical", "methods", "employed", "have", "provided", "advanced", "quantification", "of", "thumb", "motor", "function", ".", "The", "results", "have", "confirmed", "our", "initial", "hypotheses", "that", "greatest", "force", "decreases", "occurred", "in", "directions", "related", "to", "abduction", ",", "and", "that", "the", "post", "-", "block", "thumb", "force", "envelope", "area", "was", "smaller", "than", "the", "pre", "-", "block", "force", "envelope", "area", ".", "\n", "Preferential", "force", "attenuation", "in", "the", "quadrants", "of", "abduction", "and", "flexion", "after", "median", "nerve", "block", "are", "in", "agreement", "with", "anatomical", "and", "neuromuscular", "features", "of", "the", "thumb", ".", "The", "median", "nerve", "innervates", "the", "abductor", "pollicis", "brevis", ",", "the", "opponens", "pollicis", "and", "superficial", "head", "of", "the", "flexor", "pollicis", "brevis", ",", "all", "of", "which", "contribute", "to", "the", "abduction", "and", "flexion", "of", "the", "thumb", "[", "4", "]", ";", "therefore", ",", "denervation", "of", "these", "muscles", "after", "median", "nerve", "block", "would", "cause", "the", "greatest", "force", "deficit", "related", "to", "median", "nerve", "function", "[", "5", "]", ".", "Additionally", ",", "as", "force", "application", "moved", "towards", "adduction", ",", "the", "force", "deficit", "decreased", "as", "neuromuscular", "control", "shifted", "from", "the", "median", "nerve", "to", "the", "ulnar", "nerve", "via", "the", "first", "dorsal", "interosseous", "and", "adductor", "pollicis", "brevis", ".", "Force", "deficit", "in", "extension", "was", "also", "comparably", "small", "as", "extension", "forces", "are", "mainly", "produced", "by", "the", "extensors", "pollicis", "brevis", "and", "longus", "originating", "in", "the", "forearm", ".", "\n", "Our", "reported", "force", "decreases", "following", "a", "median", "nerve", "block", "(", "40.9", "%", "in", "abduction", ",", "34.1", "%", "in", "flexion", ")", "were", "smaller", "than", "those", "reported", "in", "the", "literature", ".", "Kozin", "et", "al", ".", "[", "21", "]", "reported", "a", "60", "%", "decrease", "in", "pinch", "strength", "after", "a", "median", "nerve", "block", "using", "mepivicaine", "hydrochloride", "[", "21", "]", ".", "Boatright", "and", "Kiebzak", "[", "20", "]", "reported", "an", "approximate", "70", "%", "decrease", "in", "thumb", "abduction", "strength", "after", "median", "nerve", "block", "using", "Lidocaine", "[", "20", "]", ".", "Kaufman", "et", "al", ".", "[", "5", "]", "stated", "that", "a", "median", "nerve", "block", "with", "Lidocaine", "almost", "completely", "diminished", "force", "production", "in", "the", "abduction", "direction", "[", "5", "]", ".", "The", "discrepancy", "may", "be", "due", "to", "the", "anesthetic", "used", "and", "strength", "testing", "method", ".", "Although", "the", "sensory", "block", "appeared", "to", "be", "complete", "for", "each", "method", ",", "the", "motor", "capabilities", "of", "the", "muscles", "associated", "with", "the", "median", "nerve", "might", "or", "might", "not", "be", "completely", "eliminated", ".", "Such", "a", "result", "is", "largely", "dependent", "on", "a", "particular", "anesthetic", ",", "its", "concentration", "and", "dosage", ",", "as", "well", "as", "the", "efficacy", "of", "the", "injection", "technique", "at", "immersing", "the", "nerve", ".", "The", "methods", "of", "strength", "testing", "may", "also", "help", "explain", "the", "different", "magnitudes", "of", "strength", "deficit", "after", "the", "nerve", "block", ".", "All", "previous", "results", "were", "based", "on", "forces", "obtained", "in", "discrete", "direction(s", ")", ",", "and", "focused", "exertions", ",", "while", "the", "current", "study", "utilized", "a", "method", "of", "force", "production", "in", "a", "continuous", ",", "circumferential", "and", "dynamic", "manner", ".", "Furthermore", ",", "thumb", "motor", "performance", "can", "be", "maintained", "despite", "the", "absence", "of", "certain", "individual", "muscles", ".", "For", "example", ",", "Britto", "and", "Elliot", "reported", "that", "the", "loss", "of", "abductor", "pollicis", "longus", "and", "extensor", "pollicis", "brevis", "in", "their", "two", "patients", "did", "not", "show", "functional", "compromise", "of", "strength", "and", "grip", "strength", "[", "24", "]", ".", "In", "a", "broader", "sense", ",", "the", "neuromuscular", "system", "has", "remarkable", "capabilities", "to", "accomplish", "the", "same", "motor", "function", "goal", "using", "different", "effectors", "and", "different", "goals", "using", "the", "same", "effectors", ",", "a", "phenomenon", "so", "called", "\"", "motor", "equivalence", "\"", "[", "25", "]", ".", "\n", "An", "unexpected", "finding", "from", "this", "study", "was", "that", "the", "force", "deficit", "occurred", "in", "all", "directions", "(", "Figure", "4", ")", ".", "In", "other", "words", ",", "the", "median", "nerve", "block", "caused", "reduced", "force", "production", "by", "those", "muscles", "not", "associated", "with", "the", "median", "nerve", ".", "Several", "potential", "explanations", "exist", "to", "describe", "such", "a", "phenomenon", ".", "First", ",", "the", "injection", "into", "the", "carpal", "tunnel", "at", "the", "wrist", ",", "although", "localized", ",", "potentially", "diffused", "into", "the", "intrinsic", "fascia", "of", "the", "hand", "partially", "compromising", "function", "of", "the", "ulnar", "nerve", ",", "which", "innervates", "the", "adductor", "pollicis", ".", "Although", "Semmes", "-", "Weinstein", "monofilament", "testing", "confirmed", "the", "continued", 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"direction", "of", "maximum", "activation", "after", "a", "median", "nerve", "block", "[", "5", "]", ".", "Labosky", "and", "Waggy", "showed", "that", "a", "radial", "nerve", "block", "caused", "a", "53", "%", "decrease", "in", "thumb", "abduction", "strength", "because", "of", "the", "lack", "of", "stabilization", "of", "the", "radial", "innervated", "extensor", "muscles", "[", "22", "]", ".", "Consequently", ",", "deficiency", "of", "median", "innervated", "muscles", "inherently", "limits", "force", "production", "in", "other", "directions", "as", "neuromuscular", "switching", "is", "necessary", "to", "produce", "force", "in", "changing", "directions", ".", "\n", "The", "median", "innervated", "muscles", "are", "the", "dominant", "abductors", "of", "the", "thumb", "metacarpophalangeal", "and", "carpometacarpal", "joint", ".", "The", "more", "than", "50", "%", "residual", "abduction", "force", "found", "in", "this", "study", "suggests", "that", "the", "injection", "did", "not", 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Sentence: Thumb force deficit after lower median nerve block Abstract Purpose The purpose of this study was to characterize thumb motor dysfunction resulting from simulated lower median nerve lesions at the wrist. Methods Bupivacaine hydrochloride was injected into the carpal tunnel of six healthy subjects to locally anesthetize the median nerve. Motor function was subsequently evaluated by measuring maximal force production in all directions within the transverse plane perpendicular to the longitudinal axis of the thumb. Force envelopes were constructed using these measured multidirectional forces. Results Blockage of the median nerve resulted in decreased force magnitudes and thus smaller force envelopes. The average force decrease around the force envelope was 27.9%. A maximum decrease of 42.4% occurred in a direction combining abduction and slight flexion, while a minimum decrease of 10.5% occurred in a direction combining adduction and slight flexion. Relative decreases in adduction, extension, abduction, and flexion were 17.3%, 21.2%, 41.2% and 33.5%, respectively. Areas enclosed by pre- and post-block force envelopes were 20628 ± 7747 N.N, and 10700 ± 4474 N.N, respectively, representing an average decrease of 48.1%. Relative decreases in the adduction, extension, abduction, and flexion quadrant areas were 31.5%, 42.3%, 60.9%, and 52.3%, respectively. Conclusion Lower median nerve lesion, simulated by a nerve block at the wrist, compromise normal motor function of the thumb. A median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. From our results, such a means of motor function assessment can potentially be applied to functionally evaluate peripheral neuropathies. Introduction The thumb has unique anatomical and biomechanical characteristics that are required to perform many manipulative tasks. Thumb motor dysfunction resulting from neuromuscular and musculoskeletal pathologies severely hinders the performance of these daily tasks. Clinical treatment, prevention protocols, and rehabilitation efficacy requires a thorough understanding of thumb motor capabilities, as well as its associated functional deficit. Investigations of underlying pathological mechanism of the thumb help advance clinical treatments such as tendon transfers [1], functional electrical stimulation [2] and plasticity suppression [3]. Measurement of strength during maximum voluntary contraction is a simple and direct means of assessing neuromuscular function. Popular instruments used for quantitative assessment of thumb strength are pinch dynamometers. The pinch output, however, provides limited information about thumb motor function in that it offers a single generic force in one specific direction. Each muscle/tendon within the thumb has a distinct anatomical origin and insertion, suggesting its external force potential in a particular direction [4-6]. Hence, evaluation of strengths in multiple directions offers insight concerning the motor capacity of individual muscles. Force production of a digit has been measured in various directions such as flexion/extension [7,8], abduction/adduction [9-14], or in combined directions [15,16]. Bourbonnais et al. developed an apparatus to measure thumb force production in eight directions in the transverse plane of the thumb and investigated force dependence on the direction of effort [15]. Yokogawa and Hara measured index fingertip forces in various directions within the flexion/extension plane [8]. Recently, we developed experimental apparatuses to measure multi-directional forces of a digit in its transverse plane [17-19]. From these multi-directional forces we constructed force envelopes representative of the characteristic force output pattern of a digit [17-19]. Disorders resulting from traumatic injuries to and various diseases of these nerves are common in clinical practice. Clinical manifestations of hand dysfunction are distinctive depending on the nerve involved. For example, thenar atrophy is a major clinical observation affecting thumb function at the later stages of compression neuropathy of the median nerve. Several studies have been conducted to investigate the effects of simulated peripheral neuropathies using local anesthetization [5,16,20,21]. Kozin et al. [21] studied the effects of median and ulnar nerve blocks on grip and pinch strength and showed significant decreases following nerve blockage [21]. Boatright and Kiebzak [20] investigated the effects of median nerve block on thumb abduction strength. Kaufman et al. [5] measured isometric thumb forces in eight directions together with electromyographic signals of thumb muscles after block of the median nerve. Labosky and Waggy [22] studied the strength related to grip, pinch, thumb adduction, thumb abduction, and finger flexion after radial nerve block [22]. Kuxhaus studied the three dimensional feasible force set at the thumb-tip before and after ulnar nerve block and reported this to be a reproducible and sensitive means to detect impairment. The purpose of this study was to utilize our developed apparatus and protocols to investigate the effects of lower median nerve lesion on thumb motor function. The lesion was simulated by blocking the median nerve at the wrist using an anesthetic. We hypothesized that a median nerve block would cause (1) a decrease in force production, which would be direction-dependent with the most severe reduction in the abduction direction, and (2) a decrease in the force envelope area and force quadrant area, with the greatest decrease in the abduction quadrant. Methods Subjects Six healthy male subjects (mean age: 26.9 ± 5.1 years) participated in this study. The subjects had no previous history of neuromuscular or musculoskeletal disorders of the upper extremities. Each subject signed an informed consent form approved by the Institutional Review Board prior to participating in the experiment. Median nerve block Injections were performed under aseptic conditions while the subjects sat with the forearm supinated and the wrist slightly extended. After the skin at the palmer area of the wrist was cleaned with alcohol, 4 mL of 0.5% bupivacaine hydrochloride (Astra Pharmaceuticals, Westborough, MA, USA) was injected into the carpal tunnel with a sterile 25-gauge short-bevel needle. The needle was inserted through the transverse carpal ligament in line with the radial border of the fourth digit slightly ulnar to the palmaris longus tendon at the level of the distal wrist crease. Forty minutes was allowed for the median nerve block to reach complete effectiveness [23] and was verified using the Semmes-Weinstein monofilament test. The average monofilament score was 2.85 across the five digits before nerve block. About 40 minutes after nerve injection, little sensory impairment occurred in the ulnar distribution (score = 3.22), while the sensory score in the median distribution was greater than 6.15. The effects of nerve block lasted more than 6 hours with all subjects regaining normal hand function within 12 hours. Testing apparatus The experimental apparatus was designed and constructed to measure maximum voluntary contraction forces of any digit at any point along the digit. Force application was possible in any direction within the transverse plane of the longitudinal axis of the digit. The apparatus consisted of position control accessories, a force transducer, and a custom fitted aluminum ring attached to the transducer (Figure 1A,1B). The transducer (Mini40, ATI Industrial Automation, NC, USA), capable of measuring 6 degrees of freedom forces and moments, was attached to a mounting clamp via an aluminum adapter plate while the aluminum ring was secured to the tool side of the transducer using a custom adapter. The ring served as a connection anchor for the transducer and the digit. The force transducer and ring attachment were positioned in a desired orientation using an aluminum slide rail, tubing, and lockable mounting clamps (80/20 Inc., Columbia City, IN, USA). The slide rail was secured to an aluminum base plate. Foam padded wooden blocks with two locking straps secured the arm to the base plate. The analog outputs from the transducer were digitized using a 16-bit analog-to-digital converter (PCI-6031, National Instruments, TX, USA). The X (abduction/adduction) and Y (flexion/extension) force components in the transverse plane were displayed on the screen while the subject performed a force production task. The resolutions of the force transducer in its axial (flexion/extension) and horizontal (abduction/adduction) directions were 0.16 N and 0.08 N, respectively. A personal computer equipped with LabVIEW (National Instrument, TX, USA) was used for force data acquisition, display, and processing. Experimental procedures Each subject was tested before and after median nerve block. The nerve block procedures were performed immediately after the completion of the first testing session. Post-block testing started after the verification of complete median nerve block, approximately 40 minutes after the injection. During each test, the subject was seated in a chair adjacent to the testing station modified with a wooden board to align their back vertically throughout the trials. The subjects rested their forearm on padded wooden blocks positioning their shoulder in approximately 60° of frontal plane abduction. Nylon straps fitted with plastic snap locking mechanisms secured the forearm and minimized the intervention of the elbow and shoulder during thumb force application. Subjects grasped a vertical dowel secured to the distal end of the wooden blocks in a midprone position. Formable thermoplastic braces were used to fix the elbow in 90° of flexion, and the wrist in 20° of extension and 0° of ulnar deviation. A metallic brace was used to fix the interphalangeal joint of the thumb in full extension. The aluminum ring was placed around the middle of the proximal phalanx and oriented to accommodate comfortable thumb position with the metacarpophalangeal joint flexed approximately 15°. Prior to testing, a line was drawn on the proximal phalange at the midpoint between the interphalangeal and metacarpophalangeal joints. The alignment of the ring with the circumferential line standardized the location of force application within and between subjects. As force application was at the middle of the proximal phalanx, mechanical action pertains to both the metacarpophalangeal and carpometacarpal joints. We chose the terminology of flexion/extension and adduction/adduction based on the mechanical action with respect to the metacarpophalangeal joint. With the thumb in the ring (Figure 1B), extension and flexion occurred in parallel with the palm, and abduction and adduction occurred in a plane perpendicular to the palm. Each subject performed 15 circumferential MVC trials with randomized starting directions (Figure 1C). The subject was allotted 15 seconds to complete each circumferential trial, and was instructed to use the entire time allotted to traverse the perimeter of the ring once. A dot generated on the computer screen was programmed to traverse a circle within 15 seconds to provide the subject with directional feedback of their force application. Subjects were given 60 seconds of rest between each circumferential trial. Each subject was familiarized with the task with a few practice trials. Data were collected from each subject at 100 samples per second producing a total of 22,500 pairs of force components from the 15 circumferential trials. Our previous study [19] indicated that the testing protocol did not cause noticeable fatigue. Force envelope and quadrants Data from multiple circumferential trials were accumulated to construct a force envelope. The procedures to generate a force envelope were as follows: Cartesian force coordinates (Xi, Yi) were transformed into polar coordinates (Rα, α), where Rα was the force magnitude at an angular position α. Each α was rounded to the nearest integer ranging from 0 to 359 degrees. The maximum, Fα, was determined from a string of N data points along each radial line defined by α. At the completion of the 15 trials, there were, on average, N = 63 data points on each radial line of α based on the distribution off the 22,500 data points around 360°. A moving average with an interval of 10° was applied to the maximal series data Fα (α = 0, 1, 2,..., 359) to obtain filtered maximal forces. These forces formed a force envelope. The area formed by a force envelope was divided into adduction-extension, extension-abduction, abduction-flexion, and flexion-adduction quadrants by radial lines oriented at 0°, 90°, 180°, and 270° A quadrant force was represented using the mean magnitude of the forces in that quadrant. The areas of the entire envelope and each quadrant were calculated by summing the areas of individual arc sections formed by the polar coordinates of the force envelope. (Figure 2). Statistical Analyses One- and two-factor repeated measures analyses of variance (ANOVA) were used to analyze outcome measures. The independent variables were testing SESSION (n = 2, i.e., pre- and post-block), force DIRECTION (n = 16), and force QUADRANT (n = 4), with SESSION as a repeated variable. Dependent variables were directional force, individual quadrant area and force envelope area. Statistical analyses were performed using SPSS 11 (SPSS Inc., Illinois) with statistical significance set at α = 0.05. Results Force envelope and directional forces Figure 3 shows the force envelopes produced by each subject (A to F) before and after median nerve block. The post-block force envelope was inside the pre-block envelope for each subject, indicating a decrease in force magnitude in all directions after nerve block. Figure 4 shows the average pre- and post-block force envelope across all subjects. Force magnitudes were significantly reduced after nerve block (p < 0.001) resulting in significantly smaller force envelopes. The average decrease across all directions was 27.9%. A maximum decrease of 42.4% occurred at 199°, corresponding to a combined direction of abduction and slight flexion, while a minimum decrease of 10.5% occurred at 328° corresponding to a combined direction of adduction and slight flexion. Relative decreases at 0° (adduction), 90° (extension), 180° (abduction), and 270° (flexion) directions were 17.3%, 21.2%, 41.2% and 33.5%, respectively. A single force in each quadrant was represented using the mean magnitude of the forces in that quadrant (see description in the Methods). The average quadrant forces were significantly decreased after nerve block (p < 0.001; Figure 5). The amount of decrease was also different between quadrants (p < 0.005). Relative decreases in mean quadrant forces were 24.5%, 38.7%, 32.1%, and 18.1% for extension, abduction, flexion, and adduction, respectively. The maximal decreases in mean quadrant force, 38.7%, occurred in the abduction quadrant. Force envelope areas and quadrant areas Areas enclosed by the post-block envelopes were significantly smaller than the pre-block envelopes (p < 0.001; Figure 4). Post-block force envelope area, 10700 ± 4474 N.N, was 51.9% of pre-block force envelope area, 20628 ± 7747 N.N. Quadrant area decreased significantly (p < 0.001; Figure 6). The maximal percentage decrease in area after nerve block was 60.9% in the abduction quadrant, followed by a 52.3% area decrease in the flexion quadrant. Discussion In this study we simulated a lower median nerve lesion and evaluated the resultant thumb motor function deficit. Our internal control via pre- and post-block design offered a particular advantage of investigating the mechanical role of muscles innervated by a targeted nerve. The testing and analytical methods employed have provided advanced quantification of thumb motor function. The results have confirmed our initial hypotheses that greatest force decreases occurred in directions related to abduction, and that the post-block thumb force envelope area was smaller than the pre-block force envelope area. Preferential force attenuation in the quadrants of abduction and flexion after median nerve block are in agreement with anatomical and neuromuscular features of the thumb. The median nerve innervates the abductor pollicis brevis, the opponens pollicis and superficial head of the flexor pollicis brevis, all of which contribute to the abduction and flexion of the thumb [4]; therefore, denervation of these muscles after median nerve block would cause the greatest force deficit related to median nerve function [5]. Additionally, as force application moved towards adduction, the force deficit decreased as neuromuscular control shifted from the median nerve to the ulnar nerve via the first dorsal interosseous and adductor pollicis brevis. Force deficit in extension was also comparably small as extension forces are mainly produced by the extensors pollicis brevis and longus originating in the forearm. Our reported force decreases following a median nerve block (40.9% in abduction, 34.1% in flexion) were smaller than those reported in the literature. Kozin et al. [21] reported a 60% decrease in pinch strength after a median nerve block using mepivicaine hydrochloride [21]. Boatright and Kiebzak [20] reported an approximate 70% decrease in thumb abduction strength after median nerve block using Lidocaine [20]. Kaufman et al. [5] stated that a median nerve block with Lidocaine almost completely diminished force production in the abduction direction [5]. The discrepancy may be due to the anesthetic used and strength testing method. Although the sensory block appeared to be complete for each method, the motor capabilities of the muscles associated with the median nerve might or might not be completely eliminated. Such a result is largely dependent on a particular anesthetic, its concentration and dosage, as well as the efficacy of the injection technique at immersing the nerve. The methods of strength testing may also help explain the different magnitudes of strength deficit after the nerve block. All previous results were based on forces obtained in discrete direction(s), and focused exertions, while the current study utilized a method of force production in a continuous, circumferential and dynamic manner. Furthermore, thumb motor performance can be maintained despite the absence of certain individual muscles. For example, Britto and Elliot reported that the loss of abductor pollicis longus and extensor pollicis brevis in their two patients did not show functional compromise of strength and grip strength [24]. In a broader sense, the neuromuscular system has remarkable capabilities to accomplish the same motor function goal using different effectors and different goals using the same effectors, a phenomenon so called "motor equivalence" [25]. An unexpected finding from this study was that the force deficit occurred in all directions (Figure 4). In other words, the median nerve block caused reduced force production by those muscles not associated with the median nerve. Several potential explanations exist to describe such a phenomenon. First, the injection into the carpal tunnel at the wrist, although localized, potentially diffused into the intrinsic fascia of the hand partially compromising function of the ulnar nerve, which innervates the adductor pollicis. Although Semmes-Weinstein monofilament testing confirmed the continued sensation of the digits within the ulnar nerve distribution, it is not inconceivable that the injection could have contaminated the ulnar innervated muscles, the first dorsal interosseous and deep head of the flexor pollicis brevis [20]. Secondly, thumb force in any direction is produced by synergistic activation of the many intrinsic muscles, and as a result, the muscular deficiency associated with one direction may hinder the force production in other directions by other muscles [5,22]. For example, Kaufman et al. demonstrated that thumb muscles not innervated by the median nerve displayed lower electromyographical activation and shifted the direction of maximum activation after a median nerve block [5]. Labosky and Waggy showed that a radial nerve block caused a 53% decrease in thumb abduction strength because of the lack of stabilization of the radial innervated extensor muscles [22]. Consequently, deficiency of median innervated muscles inherently limits force production in other directions as neuromuscular switching is necessary to produce force in changing directions. The median innervated muscles are the dominant abductors of the thumb metacarpophalangeal and carpometacarpal joint. The more than 50% residual abduction force found in this study suggests that the injection did not totally block the motor function of these muscles, even though a complete sensory loss was verified. This concurs with clinical observations of median compression neuropathy. Individuals with carpal tunnel syndrome complain of sensory dysfunction early in the disease process (at the beginning), while motor signs of thenar wasting and thumb weakness occur as the disease advances. The concept that the motor deficit is more resistant to peripheral median neuropathy than sensory loss has been well documented [23,26,27]. Butterworth et al. studied the temporal effects on sensory and motor blockade after injection of bupivacaine or mepivacaine, and found that sensory loss was complete but about a 20% compound motor action potential remained after 40 minutes [23]. In conclusion, we have incorporated a method for assessing thumb motor deficit based on strength measurement with a standard local anesthetic to investigate the effects of a simulated median neuropathy on thumb motor function. Median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. Future endeavors using this methodology can potentially further elucidate underlying pathomechanisms of peripheral neuropathies in all digits of the hand. Instructions: please extract entity words from the input sentence
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Thumb force deficit after lower median nerve block Abstract Purpose The purpose of this study was to characterize thumb motor dysfunction resulting from simulated lower median nerve lesions at the wrist. Methods Bupivacaine hydrochloride was injected into the carpal tunnel of six healthy subjects to locally anesthetize the median nerve. Motor function was subsequently evaluated by measuring maximal force production in all directions within the transverse plane perpendicular to the longitudinal axis of the thumb. Force envelopes were constructed using these measured multidirectional forces. Results Blockage of the median nerve resulted in decreased force magnitudes and thus smaller force envelopes. The average force decrease around the force envelope was 27.9%. A maximum decrease of 42.4% occurred in a direction combining abduction and slight flexion, while a minimum decrease of 10.5% occurred in a direction combining adduction and slight flexion. Relative decreases in adduction, extension, abduction, and flexion were 17.3%, 21.2%, 41.2% and 33.5%, respectively. Areas enclosed by pre- and post-block force envelopes were 20628 ± 7747 N.N, and 10700 ± 4474 N.N, respectively, representing an average decrease of 48.1%. Relative decreases in the adduction, extension, abduction, and flexion quadrant areas were 31.5%, 42.3%, 60.9%, and 52.3%, respectively. Conclusion Lower median nerve lesion, simulated by a nerve block at the wrist, compromise normal motor function of the thumb. A median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. From our results, such a means of motor function assessment can potentially be applied to functionally evaluate peripheral neuropathies. Introduction The thumb has unique anatomical and biomechanical characteristics that are required to perform many manipulative tasks. Thumb motor dysfunction resulting from neuromuscular and musculoskeletal pathologies severely hinders the performance of these daily tasks. Clinical treatment, prevention protocols, and rehabilitation efficacy requires a thorough understanding of thumb motor capabilities, as well as its associated functional deficit. Investigations of underlying pathological mechanism of the thumb help advance clinical treatments such as tendon transfers [1], functional electrical stimulation [2] and plasticity suppression [3]. Measurement of strength during maximum voluntary contraction is a simple and direct means of assessing neuromuscular function. Popular instruments used for quantitative assessment of thumb strength are pinch dynamometers. The pinch output, however, provides limited information about thumb motor function in that it offers a single generic force in one specific direction. Each muscle/tendon within the thumb has a distinct anatomical origin and insertion, suggesting its external force potential in a particular direction [4-6]. Hence, evaluation of strengths in multiple directions offers insight concerning the motor capacity of individual muscles. Force production of a digit has been measured in various directions such as flexion/extension [7,8], abduction/adduction [9-14], or in combined directions [15,16]. Bourbonnais et al. developed an apparatus to measure thumb force production in eight directions in the transverse plane of the thumb and investigated force dependence on the direction of effort [15]. Yokogawa and Hara measured index fingertip forces in various directions within the flexion/extension plane [8]. Recently, we developed experimental apparatuses to measure multi-directional forces of a digit in its transverse plane [17-19]. From these multi-directional forces we constructed force envelopes representative of the characteristic force output pattern of a digit [17-19]. Disorders resulting from traumatic injuries to and various diseases of these nerves are common in clinical practice. Clinical manifestations of hand dysfunction are distinctive depending on the nerve involved. For example, thenar atrophy is a major clinical observation affecting thumb function at the later stages of compression neuropathy of the median nerve. Several studies have been conducted to investigate the effects of simulated peripheral neuropathies using local anesthetization [5,16,20,21]. Kozin et al. [21] studied the effects of median and ulnar nerve blocks on grip and pinch strength and showed significant decreases following nerve blockage [21]. Boatright and Kiebzak [20] investigated the effects of median nerve block on thumb abduction strength. Kaufman et al. [5] measured isometric thumb forces in eight directions together with electromyographic signals of thumb muscles after block of the median nerve. Labosky and Waggy [22] studied the strength related to grip, pinch, thumb adduction, thumb abduction, and finger flexion after radial nerve block [22]. Kuxhaus studied the three dimensional feasible force set at the thumb-tip before and after ulnar nerve block and reported this to be a reproducible and sensitive means to detect impairment. The purpose of this study was to utilize our developed apparatus and protocols to investigate the effects of lower median nerve lesion on thumb motor function. The lesion was simulated by blocking the median nerve at the wrist using an anesthetic. We hypothesized that a median nerve block would cause (1) a decrease in force production, which would be direction-dependent with the most severe reduction in the abduction direction, and (2) a decrease in the force envelope area and force quadrant area, with the greatest decrease in the abduction quadrant. Methods Subjects Six healthy male subjects (mean age: 26.9 ± 5.1 years) participated in this study. The subjects had no previous history of neuromuscular or musculoskeletal disorders of the upper extremities. Each subject signed an informed consent form approved by the Institutional Review Board prior to participating in the experiment. Median nerve block Injections were performed under aseptic conditions while the subjects sat with the forearm supinated and the wrist slightly extended. After the skin at the palmer area of the wrist was cleaned with alcohol, 4 mL of 0.5% bupivacaine hydrochloride (Astra Pharmaceuticals, Westborough, MA, USA) was injected into the carpal tunnel with a sterile 25-gauge short-bevel needle. The needle was inserted through the transverse carpal ligament in line with the radial border of the fourth digit slightly ulnar to the palmaris longus tendon at the level of the distal wrist crease. Forty minutes was allowed for the median nerve block to reach complete effectiveness [23] and was verified using the Semmes-Weinstein monofilament test. The average monofilament score was 2.85 across the five digits before nerve block. About 40 minutes after nerve injection, little sensory impairment occurred in the ulnar distribution (score = 3.22), while the sensory score in the median distribution was greater than 6.15. The effects of nerve block lasted more than 6 hours with all subjects regaining normal hand function within 12 hours. Testing apparatus The experimental apparatus was designed and constructed to measure maximum voluntary contraction forces of any digit at any point along the digit. Force application was possible in any direction within the transverse plane of the longitudinal axis of the digit. The apparatus consisted of position control accessories, a force transducer, and a custom fitted aluminum ring attached to the transducer (Figure 1A,1B). The transducer (Mini40, ATI Industrial Automation, NC, USA), capable of measuring 6 degrees of freedom forces and moments, was attached to a mounting clamp via an aluminum adapter plate while the aluminum ring was secured to the tool side of the transducer using a custom adapter. The ring served as a connection anchor for the transducer and the digit. The force transducer and ring attachment were positioned in a desired orientation using an aluminum slide rail, tubing, and lockable mounting clamps (80/20 Inc., Columbia City, IN, USA). The slide rail was secured to an aluminum base plate. Foam padded wooden blocks with two locking straps secured the arm to the base plate. The analog outputs from the transducer were digitized using a 16-bit analog-to-digital converter (PCI-6031, National Instruments, TX, USA). The X (abduction/adduction) and Y (flexion/extension) force components in the transverse plane were displayed on the screen while the subject performed a force production task. The resolutions of the force transducer in its axial (flexion/extension) and horizontal (abduction/adduction) directions were 0.16 N and 0.08 N, respectively. A personal computer equipped with LabVIEW (National Instrument, TX, USA) was used for force data acquisition, display, and processing. Experimental procedures Each subject was tested before and after median nerve block. The nerve block procedures were performed immediately after the completion of the first testing session. Post-block testing started after the verification of complete median nerve block, approximately 40 minutes after the injection. During each test, the subject was seated in a chair adjacent to the testing station modified with a wooden board to align their back vertically throughout the trials. The subjects rested their forearm on padded wooden blocks positioning their shoulder in approximately 60° of frontal plane abduction. Nylon straps fitted with plastic snap locking mechanisms secured the forearm and minimized the intervention of the elbow and shoulder during thumb force application. Subjects grasped a vertical dowel secured to the distal end of the wooden blocks in a midprone position. Formable thermoplastic braces were used to fix the elbow in 90° of flexion, and the wrist in 20° of extension and 0° of ulnar deviation. A metallic brace was used to fix the interphalangeal joint of the thumb in full extension. The aluminum ring was placed around the middle of the proximal phalanx and oriented to accommodate comfortable thumb position with the metacarpophalangeal joint flexed approximately 15°. Prior to testing, a line was drawn on the proximal phalange at the midpoint between the interphalangeal and metacarpophalangeal joints. The alignment of the ring with the circumferential line standardized the location of force application within and between subjects. As force application was at the middle of the proximal phalanx, mechanical action pertains to both the metacarpophalangeal and carpometacarpal joints. We chose the terminology of flexion/extension and adduction/adduction based on the mechanical action with respect to the metacarpophalangeal joint. With the thumb in the ring (Figure 1B), extension and flexion occurred in parallel with the palm, and abduction and adduction occurred in a plane perpendicular to the palm. Each subject performed 15 circumferential MVC trials with randomized starting directions (Figure 1C). The subject was allotted 15 seconds to complete each circumferential trial, and was instructed to use the entire time allotted to traverse the perimeter of the ring once. A dot generated on the computer screen was programmed to traverse a circle within 15 seconds to provide the subject with directional feedback of their force application. Subjects were given 60 seconds of rest between each circumferential trial. Each subject was familiarized with the task with a few practice trials. Data were collected from each subject at 100 samples per second producing a total of 22,500 pairs of force components from the 15 circumferential trials. Our previous study [19] indicated that the testing protocol did not cause noticeable fatigue. Force envelope and quadrants Data from multiple circumferential trials were accumulated to construct a force envelope. The procedures to generate a force envelope were as follows: Cartesian force coordinates (Xi, Yi) were transformed into polar coordinates (Rα, α), where Rα was the force magnitude at an angular position α. Each α was rounded to the nearest integer ranging from 0 to 359 degrees. The maximum, Fα, was determined from a string of N data points along each radial line defined by α. At the completion of the 15 trials, there were, on average, N = 63 data points on each radial line of α based on the distribution off the 22,500 data points around 360°. A moving average with an interval of 10° was applied to the maximal series data Fα (α = 0, 1, 2,..., 359) to obtain filtered maximal forces. These forces formed a force envelope. The area formed by a force envelope was divided into adduction-extension, extension-abduction, abduction-flexion, and flexion-adduction quadrants by radial lines oriented at 0°, 90°, 180°, and 270° A quadrant force was represented using the mean magnitude of the forces in that quadrant. The areas of the entire envelope and each quadrant were calculated by summing the areas of individual arc sections formed by the polar coordinates of the force envelope. (Figure 2). Statistical Analyses One- and two-factor repeated measures analyses of variance (ANOVA) were used to analyze outcome measures. The independent variables were testing SESSION (n = 2, i.e., pre- and post-block), force DIRECTION (n = 16), and force QUADRANT (n = 4), with SESSION as a repeated variable. Dependent variables were directional force, individual quadrant area and force envelope area. Statistical analyses were performed using SPSS 11 (SPSS Inc., Illinois) with statistical significance set at α = 0.05. Results Force envelope and directional forces Figure 3 shows the force envelopes produced by each subject (A to F) before and after median nerve block. The post-block force envelope was inside the pre-block envelope for each subject, indicating a decrease in force magnitude in all directions after nerve block. Figure 4 shows the average pre- and post-block force envelope across all subjects. Force magnitudes were significantly reduced after nerve block (p < 0.001) resulting in significantly smaller force envelopes. The average decrease across all directions was 27.9%. A maximum decrease of 42.4% occurred at 199°, corresponding to a combined direction of abduction and slight flexion, while a minimum decrease of 10.5% occurred at 328° corresponding to a combined direction of adduction and slight flexion. Relative decreases at 0° (adduction), 90° (extension), 180° (abduction), and 270° (flexion) directions were 17.3%, 21.2%, 41.2% and 33.5%, respectively. A single force in each quadrant was represented using the mean magnitude of the forces in that quadrant (see description in the Methods). The average quadrant forces were significantly decreased after nerve block (p < 0.001; Figure 5). The amount of decrease was also different between quadrants (p < 0.005). Relative decreases in mean quadrant forces were 24.5%, 38.7%, 32.1%, and 18.1% for extension, abduction, flexion, and adduction, respectively. The maximal decreases in mean quadrant force, 38.7%, occurred in the abduction quadrant. Force envelope areas and quadrant areas Areas enclosed by the post-block envelopes were significantly smaller than the pre-block envelopes (p < 0.001; Figure 4). Post-block force envelope area, 10700 ± 4474 N.N, was 51.9% of pre-block force envelope area, 20628 ± 7747 N.N. Quadrant area decreased significantly (p < 0.001; Figure 6). The maximal percentage decrease in area after nerve block was 60.9% in the abduction quadrant, followed by a 52.3% area decrease in the flexion quadrant. Discussion In this study we simulated a lower median nerve lesion and evaluated the resultant thumb motor function deficit. Our internal control via pre- and post-block design offered a particular advantage of investigating the mechanical role of muscles innervated by a targeted nerve. The testing and analytical methods employed have provided advanced quantification of thumb motor function. The results have confirmed our initial hypotheses that greatest force decreases occurred in directions related to abduction, and that the post-block thumb force envelope area was smaller than the pre-block force envelope area. Preferential force attenuation in the quadrants of abduction and flexion after median nerve block are in agreement with anatomical and neuromuscular features of the thumb. The median nerve innervates the abductor pollicis brevis, the opponens pollicis and superficial head of the flexor pollicis brevis, all of which contribute to the abduction and flexion of the thumb [4]; therefore, denervation of these muscles after median nerve block would cause the greatest force deficit related to median nerve function [5]. Additionally, as force application moved towards adduction, the force deficit decreased as neuromuscular control shifted from the median nerve to the ulnar nerve via the first dorsal interosseous and adductor pollicis brevis. Force deficit in extension was also comparably small as extension forces are mainly produced by the extensors pollicis brevis and longus originating in the forearm. Our reported force decreases following a median nerve block (40.9% in abduction, 34.1% in flexion) were smaller than those reported in the literature. Kozin et al. [21] reported a 60% decrease in pinch strength after a median nerve block using mepivicaine hydrochloride [21]. Boatright and Kiebzak [20] reported an approximate 70% decrease in thumb abduction strength after median nerve block using Lidocaine [20]. Kaufman et al. [5] stated that a median nerve block with Lidocaine almost completely diminished force production in the abduction direction [5]. The discrepancy may be due to the anesthetic used and strength testing method. Although the sensory block appeared to be complete for each method, the motor capabilities of the muscles associated with the median nerve might or might not be completely eliminated. Such a result is largely dependent on a particular anesthetic, its concentration and dosage, as well as the efficacy of the injection technique at immersing the nerve. The methods of strength testing may also help explain the different magnitudes of strength deficit after the nerve block. All previous results were based on forces obtained in discrete direction(s), and focused exertions, while the current study utilized a method of force production in a continuous, circumferential and dynamic manner. Furthermore, thumb motor performance can be maintained despite the absence of certain individual muscles. For example, Britto and Elliot reported that the loss of abductor pollicis longus and extensor pollicis brevis in their two patients did not show functional compromise of strength and grip strength [24]. In a broader sense, the neuromuscular system has remarkable capabilities to accomplish the same motor function goal using different effectors and different goals using the same effectors, a phenomenon so called "motor equivalence" [25]. An unexpected finding from this study was that the force deficit occurred in all directions (Figure 4). In other words, the median nerve block caused reduced force production by those muscles not associated with the median nerve. Several potential explanations exist to describe such a phenomenon. First, the injection into the carpal tunnel at the wrist, although localized, potentially diffused into the intrinsic fascia of the hand partially compromising function of the ulnar nerve, which innervates the adductor pollicis. Although Semmes-Weinstein monofilament testing confirmed the continued sensation of the digits within the ulnar nerve distribution, it is not inconceivable that the injection could have contaminated the ulnar innervated muscles, the first dorsal interosseous and deep head of the flexor pollicis brevis [20]. Secondly, thumb force in any direction is produced by synergistic activation of the many intrinsic muscles, and as a result, the muscular deficiency associated with one direction may hinder the force production in other directions by other muscles [5,22]. For example, Kaufman et al. demonstrated that thumb muscles not innervated by the median nerve displayed lower electromyographical activation and shifted the direction of maximum activation after a median nerve block [5]. Labosky and Waggy showed that a radial nerve block caused a 53% decrease in thumb abduction strength because of the lack of stabilization of the radial innervated extensor muscles [22]. Consequently, deficiency of median innervated muscles inherently limits force production in other directions as neuromuscular switching is necessary to produce force in changing directions. The median innervated muscles are the dominant abductors of the thumb metacarpophalangeal and carpometacarpal joint. The more than 50% residual abduction force found in this study suggests that the injection did not totally block the motor function of these muscles, even though a complete sensory loss was verified. This concurs with clinical observations of median compression neuropathy. Individuals with carpal tunnel syndrome complain of sensory dysfunction early in the disease process (at the beginning), while motor signs of thenar wasting and thumb weakness occur as the disease advances. The concept that the motor deficit is more resistant to peripheral median neuropathy than sensory loss has been well documented [23,26,27]. Butterworth et al. studied the temporal effects on sensory and motor blockade after injection of bupivacaine or mepivacaine, and found that sensory loss was complete but about a 20% compound motor action potential remained after 40 minutes [23]. In conclusion, we have incorporated a method for assessing thumb motor deficit based on strength measurement with a standard local anesthetic to investigate the effects of a simulated median neuropathy on thumb motor function. Median nerve block results in force deficits in all directions, with the most severe impairment in abduction and flexion. Future endeavors using this methodology can potentially further elucidate underlying pathomechanisms of peripheral neuropathies in all digits of the hand.
[ "Thumb", "force", "deficit", "after", "lower", "median", "nerve", "block", "\n", "Abstract", "\n", "Purpose", "\n", "The", "purpose", "of", "this", "study", "was", "to", "characterize", "thumb", "motor", "dysfunction", "resulting", "from", "simulated", "lower", "median", "nerve", "lesions", "at", "the", "wrist", ".", "\n\n", "Methods", "\n", "Bupivacaine", "hydrochloride", "was", "injected", "into", "the", "carpal", "tunnel", "of", "six", "healthy", "subjects", "to", "locally", "anesthetize", "the", "median", "nerve", ".", "Motor", "function", "was", "subsequently", "evaluated", "by", "measuring", "maximal", "force", "production", "in", "all", "directions", "within", "the", "transverse", "plane", "perpendicular", "to", "the", "longitudinal", "axis", "of", "the", "thumb", ".", "Force", "envelopes", "were", "constructed", "using", "these", "measured", "multidirectional", "forces", ".", "\n\n", "Results", "\n", "Blockage", "of", "the", "median", "nerve", "resulted", "in", "decreased", "force", "magnitudes", "and", "thus", "smaller", "force", "envelopes", ".", "The", "average", "force", "decrease", "around", "the", "force", "envelope", "was", "27.9", "%", ".", "A", "maximum", "decrease", "of", "42.4", "%", "occurred", "in", "a", "direction", "combining", "abduction", "and", "slight", "flexion", ",", "while", "a", "minimum", "decrease", "of", "10.5", "%", "occurred", "in", "a", "direction", "combining", "adduction", "and", "slight", "flexion", ".", "Relative", "decreases", "in", "adduction", ",", "extension", ",", "abduction", ",", "and", "flexion", "were", "17.3", "%", ",", "21.2", "%", ",", "41.2", "%", "and", "33.5", "%", ",", "respectively", ".", "Areas", "enclosed", "by", "pre-", "and", "post", "-", "block", "force", "envelopes", "were", "20628", "±", "7747", "N.N", ",", "and", "10700", "±", "4474", "N.N", ",", "respectively", ",", "representing", "an", "average", "decrease", "of", "48.1", "%", ".", "Relative", "decreases", "in", "the", "adduction", ",", "extension", ",", "abduction", ",", "and", "flexion", "quadrant", "areas", "were", "31.5", "%", ",", "42.3", "%", ",", "60.9", "%", ",", "and", "52.3", "%", ",", "respectively", ".", "\n\n", "Conclusion", "\n", "Lower", "median", "nerve", "lesion", ",", "simulated", "by", "a", "nerve", "block", "at", "the", "wrist", ",", "compromise", "normal", "motor", "function", "of", "the", "thumb", ".", "A", "median", "nerve", "block", "results", "in", "force", "deficits", "in", "all", "directions", ",", "with", "the", "most", "severe", "impairment", "in", "abduction", "and", "flexion", ".", "From", "our", "results", ",", "such", "a", "means", "of", "motor", "function", "assessment", "can", "potentially", "be", "applied", "to", "functionally", "evaluate", "peripheral", "neuropathies", ".", "\n\n\n\n", "Introduction", "\n", "The", "thumb", "has", "unique", "anatomical", "and", "biomechanical", "characteristics", "that", "are", "required", "to", "perform", "many", "manipulative", "tasks", ".", "Thumb", "motor", "dysfunction", "resulting", "from", "neuromuscular", "and", "musculoskeletal", "pathologies", "severely", "hinders", "the", "performance", "of", "these", "daily", "tasks", ".", "Clinical", "treatment", ",", "prevention", "protocols", ",", "and", "rehabilitation", "efficacy", "requires", "a", "thorough", "understanding", "of", "thumb", "motor", "capabilities", ",", "as", "well", "as", "its", "associated", "functional", "deficit", ".", "Investigations", "of", "underlying", "pathological", "mechanism", "of", "the", "thumb", "help", "advance", "clinical", "treatments", "such", "as", "tendon", "transfers", "[", "1", "]", ",", "functional", "electrical", "stimulation", "[", "2", "]", "and", "plasticity", "suppression", "[", "3", "]", ".", "\n", "Measurement", "of", "strength", "during", "maximum", "voluntary", "contraction", "is", "a", "simple", "and", "direct", "means", "of", "assessing", "neuromuscular", "function", ".", "Popular", "instruments", "used", "for", "quantitative", "assessment", "of", "thumb", "strength", "are", "pinch", "dynamometers", ".", "The", "pinch", "output", ",", "however", ",", "provides", "limited", "information", "about", "thumb", "motor", "function", "in", "that", "it", "offers", "a", "single", "generic", "force", "in", "one", "specific", "direction", ".", "Each", "muscle", "/", "tendon", "within", "the", "thumb", "has", "a", "distinct", "anatomical", "origin", "and", "insertion", ",", "suggesting", "its", "external", "force", "potential", "in", "a", "particular", "direction", "[", "4", "-", "6", "]", ".", "Hence", ",", "evaluation", "of", "strengths", "in", "multiple", "directions", "offers", "insight", "concerning", "the", "motor", "capacity", "of", "individual", "muscles", ".", "Force", "production", "of", "a", "digit", "has", "been", "measured", "in", "various", "directions", "such", "as", "flexion", "/", "extension", "[", "7,8", "]", ",", "abduction", "/", "adduction", "[", "9", "-", "14", "]", ",", "or", "in", "combined", "directions", "[", "15,16", "]", ".", "Bourbonnais", "et", "al", ".", "developed", "an", "apparatus", "to", "measure", "thumb", "force", "production", "in", "eight", "directions", "in", "the", "transverse", "plane", "of", "the", "thumb", "and", "investigated", "force", "dependence", "on", "the", "direction", "of", "effort", "[", "15", "]", ".", "Yokogawa", "and", "Hara", "measured", "index", "fingertip", "forces", "in", "various", "directions", "within", "the", "flexion", "/", "extension", "plane", "[", "8", "]", ".", "Recently", ",", "we", "developed", "experimental", "apparatuses", "to", "measure", "multi", "-", "directional", "forces", "of", "a", "digit", "in", "its", "transverse", "plane", "[", "17", "-", "19", "]", ".", "From", "these", "multi", "-", "directional", "forces", "we", "constructed", "force", "envelopes", "representative", "of", "the", "characteristic", "force", "output", "pattern", "of", "a", "digit", "[", "17", "-", "19", "]", ".", "\n", "Disorders", "resulting", "from", "traumatic", "injuries", "to", "and", "various", "diseases", "of", "these", "nerves", "are", "common", "in", "clinical", "practice", ".", "Clinical", "manifestations", "of", "hand", "dysfunction", "are", "distinctive", "depending", "on", "the", "nerve", "involved", ".", "For", "example", ",", "thenar", "atrophy", "is", "a", "major", "clinical", "observation", "affecting", "thumb", "function", "at", "the", "later", "stages", "of", "compression", "neuropathy", "of", "the", "median", "nerve", ".", "Several", "studies", "have", "been", "conducted", "to", "investigate", "the", "effects", "of", "simulated", "peripheral", "neuropathies", "using", "local", "anesthetization", "[", "5,16,20,21", "]", ".", "Kozin", "et", "al", ".", "[", "21", "]", "studied", "the", "effects", "of", "median", "and", "ulnar", "nerve", "blocks", "on", "grip", "and", "pinch", "strength", "and", "showed", "significant", "decreases", "following", "nerve", "blockage", "[", "21", "]", ".", "Boatright", "and", "Kiebzak", "[", "20", "]", "investigated", "the", "effects", "of", "median", "nerve", "block", "on", "thumb", "abduction", "strength", ".", "Kaufman", "et", "al", ".", "[", "5", "]", "measured", "isometric", "thumb", "forces", "in", "eight", "directions", "together", "with", "electromyographic", "signals", "of", "thumb", "muscles", "after", "block", "of", "the", "median", "nerve", ".", "Labosky", "and", "Waggy", "[", "22", "]", "studied", "the", "strength", "related", "to", "grip", ",", "pinch", ",", "thumb", "adduction", ",", "thumb", "abduction", ",", "and", "finger", "flexion", "after", "radial", "nerve", "block", "[", "22", "]", ".", "Kuxhaus", "studied", "the", "three", "dimensional", "feasible", "force", "set", "at", "the", "thumb", "-", "tip", "before", "and", "after", "ulnar", "nerve", "block", "and", "reported", "this", "to", "be", "a", "reproducible", "and", "sensitive", "means", "to", "detect", "impairment", ".", "\n", "The", "purpose", "of", "this", "study", "was", "to", "utilize", "our", "developed", "apparatus", "and", "protocols", "to", "investigate", "the", "effects", "of", "lower", "median", "nerve", "lesion", "on", "thumb", "motor", "function", ".", "The", "lesion", "was", "simulated", "by", "blocking", "the", "median", "nerve", "at", "the", "wrist", "using", "an", "anesthetic", ".", "We", "hypothesized", "that", "a", "median", "nerve", "block", "would", "cause", "(", "1", ")", "a", "decrease", "in", "force", "production", ",", "which", "would", "be", "direction", "-", "dependent", "with", "the", "most", "severe", "reduction", "in", "the", "abduction", "direction", ",", "and", "(", "2", ")", "a", "decrease", "in", "the", "force", "envelope", "area", "and", "force", "quadrant", "area", ",", "with", "the", "greatest", "decrease", "in", "the", "abduction", "quadrant", ".", "\n\n", "Methods", "\n", "Subjects", "\n", "Six", "healthy", "male", "subjects", "(", "mean", "age", ":", "26.9", "±", "5.1", "years", ")", "participated", "in", "this", "study", ".", "The", "subjects", "had", "no", "previous", "history", "of", "neuromuscular", "or", "musculoskeletal", "disorders", "of", "the", "upper", "extremities", ".", "Each", "subject", "signed", "an", "informed", "consent", "form", "approved", "by", "the", "Institutional", "Review", "Board", "prior", "to", "participating", "in", "the", "experiment", ".", "\n\n", "Median", "nerve", "block", "\n", "Injections", "were", "performed", "under", "aseptic", "conditions", "while", "the", "subjects", "sat", "with", "the", "forearm", "supinated", "and", "the", "wrist", "slightly", "extended", ".", "After", "the", "skin", "at", "the", "palmer", "area", "of", "the", "wrist", "was", "cleaned", "with", "alcohol", ",", "4", "mL", "of", "0.5", "%", "bupivacaine", "hydrochloride", "(", "Astra", "Pharmaceuticals", ",", "Westborough", ",", "MA", ",", "USA", ")", "was", "injected", "into", "the", "carpal", "tunnel", "with", "a", "sterile", "25-gauge", "short", "-", "bevel", "needle", ".", "The", "needle", "was", "inserted", "through", "the", "transverse", "carpal", "ligament", "in", "line", "with", "the", "radial", "border", "of", "the", "fourth", "digit", "slightly", "ulnar", "to", "the", "palmaris", "longus", "tendon", "at", "the", "level", "of", "the", "distal", "wrist", "crease", ".", "Forty", "minutes", "was", "allowed", "for", "the", "median", "nerve", "block", "to", "reach", "complete", "effectiveness", "[", "23", "]", "and", "was", "verified", "using", "the", "Semmes", "-", "Weinstein", "monofilament", "test", ".", "The", "average", "monofilament", "score", "was", "2.85", "across", "the", "five", "digits", "before", "nerve", "block", ".", "About", "40", "minutes", "after", "nerve", "injection", ",", "little", "sensory", "impairment", "occurred", "in", "the", "ulnar", "distribution", "(", "score", "=", "3.22", ")", ",", "while", "the", "sensory", "score", "in", "the", "median", "distribution", "was", "greater", "than", "6.15", ".", "The", "effects", "of", "nerve", "block", "lasted", "more", "than", "6", "hours", "with", "all", "subjects", "regaining", "normal", "hand", "function", "within", "12", "hours", ".", "\n\n", "Testing", "apparatus", "\n", "The", "experimental", "apparatus", "was", "designed", "and", "constructed", "to", "measure", "maximum", "voluntary", "contraction", "forces", "of", "any", "digit", "at", "any", "point", "along", "the", "digit", ".", "Force", "application", "was", "possible", "in", "any", "direction", "within", "the", "transverse", "plane", "of", "the", "longitudinal", "axis", "of", "the", "digit", ".", "The", "apparatus", "consisted", "of", "position", "control", "accessories", ",", "a", "force", "transducer", ",", "and", "a", "custom", "fitted", "aluminum", "ring", "attached", "to", "the", "transducer", "(", "Figure", "1A,1B", ")", ".", "The", "transducer", "(", "Mini40", ",", "ATI", "Industrial", "Automation", ",", "NC", ",", "USA", ")", ",", "capable", "of", "measuring", "6", "degrees", "of", "freedom", "forces", "and", "moments", ",", "was", "attached", "to", "a", "mounting", "clamp", "via", "an", "aluminum", "adapter", "plate", "while", "the", "aluminum", "ring", "was", "secured", "to", "the", "tool", "side", "of", "the", "transducer", "using", "a", "custom", "adapter", ".", "The", "ring", "served", "as", "a", "connection", "anchor", "for", "the", "transducer", "and", "the", "digit", ".", "The", "force", "transducer", "and", "ring", "attachment", "were", "positioned", "in", "a", "desired", "orientation", "using", "an", "aluminum", "slide", "rail", ",", "tubing", ",", "and", "lockable", "mounting", "clamps", "(", "80/20", "Inc", ".", ",", "Columbia", "City", ",", "IN", ",", "USA", ")", ".", "The", "slide", "rail", "was", "secured", "to", "an", "aluminum", "base", "plate", ".", "Foam", "padded", "wooden", "blocks", "with", "two", "locking", "straps", "secured", "the", "arm", "to", "the", "base", "plate", ".", "\n", "The", "analog", "outputs", "from", "the", "transducer", "were", "digitized", "using", "a", "16-bit", "analog", "-", "to", "-", "digital", "converter", "(", "PCI-6031", ",", "National", "Instruments", ",", "TX", ",", "USA", ")", ".", "The", "X", "(", "abduction", "/", "adduction", ")", "and", "Y", "(", "flexion", "/", "extension", ")", "force", "components", "in", "the", "transverse", "plane", "were", "displayed", "on", "the", "screen", "while", "the", "subject", "performed", "a", "force", "production", "task", ".", "The", "resolutions", "of", "the", "force", "transducer", "in", "its", "axial", "(", "flexion", "/", "extension", ")", "and", "horizontal", "(", "abduction", "/", "adduction", ")", "directions", "were", "0.16", "N", "and", "0.08", "N", ",", "respectively", ".", "A", "personal", "computer", "equipped", "with", "LabVIEW", "(", "National", "Instrument", ",", "TX", ",", "USA", ")", "was", "used", "for", "force", "data", "acquisition", ",", "display", ",", "and", "processing", ".", "\n\n", "Experimental", "procedures", "\n", "Each", "subject", "was", "tested", "before", "and", "after", "median", "nerve", "block", ".", "The", "nerve", "block", "procedures", "were", "performed", "immediately", "after", "the", "completion", "of", "the", "first", "testing", "session", ".", "Post", "-", "block", "testing", "started", "after", "the", "verification", "of", "complete", "median", "nerve", "block", ",", "approximately", "40", "minutes", "after", "the", "injection", ".", "During", "each", "test", ",", "the", "subject", "was", "seated", "in", "a", "chair", "adjacent", "to", "the", "testing", "station", "modified", "with", "a", "wooden", "board", "to", "align", "their", "back", "vertically", "throughout", "the", "trials", ".", "The", "subjects", "rested", "their", "forearm", "on", "padded", "wooden", "blocks", "positioning", "their", "shoulder", "in", "approximately", "60", "°", "of", "frontal", "plane", "abduction", ".", "Nylon", "straps", "fitted", "with", "plastic", "snap", "locking", "mechanisms", "secured", "the", "forearm", "and", "minimized", "the", "intervention", "of", "the", "elbow", "and", "shoulder", "during", "thumb", "force", "application", ".", "Subjects", "grasped", "a", "vertical", "dowel", "secured", "to", "the", "distal", "end", "of", "the", "wooden", "blocks", "in", "a", "midprone", "position", ".", "Formable", "thermoplastic", "braces", "were", "used", "to", "fix", "the", "elbow", "in", "90", "°", "of", "flexion", ",", "and", "the", "wrist", "in", "20", "°", "of", "extension", "and", "0", "°", "of", "ulnar", "deviation", ".", "A", "metallic", "brace", "was", "used", "to", "fix", "the", "interphalangeal", "joint", "of", "the", "thumb", "in", "full", "extension", ".", "The", "aluminum", "ring", "was", "placed", "around", "the", "middle", "of", "the", "proximal", "phalanx", "and", "oriented", "to", "accommodate", "comfortable", "thumb", "position", "with", "the", "metacarpophalangeal", "joint", "flexed", "approximately", "15", "°", ".", "Prior", "to", "testing", ",", "a", "line", "was", "drawn", "on", "the", "proximal", "phalange", "at", "the", "midpoint", "between", "the", "interphalangeal", "and", "metacarpophalangeal", "joints", ".", "The", "alignment", "of", "the", "ring", "with", "the", "circumferential", "line", "standardized", "the", "location", "of", "force", "application", "within", "and", "between", "subjects", ".", "As", "force", "application", "was", "at", "the", "middle", "of", "the", "proximal", "phalanx", ",", "mechanical", "action", "pertains", "to", "both", "the", "metacarpophalangeal", "and", "carpometacarpal", "joints", ".", "We", "chose", "the", "terminology", "of", "flexion", "/", "extension", "and", "adduction", "/", "adduction", "based", "on", "the", "mechanical", "action", "with", "respect", "to", "the", "metacarpophalangeal", "joint", ".", "With", "the", "thumb", "in", "the", "ring", "(", "Figure", "1B", ")", ",", "extension", "and", "flexion", "occurred", "in", "parallel", "with", "the", "palm", ",", "and", "abduction", "and", "adduction", "occurred", "in", "a", "plane", "perpendicular", "to", "the", "palm", ".", "\n", "Each", "subject", "performed", "15", "circumferential", "MVC", "trials", "with", "randomized", "starting", "directions", "(", "Figure", "1C", ")", ".", "The", "subject", "was", "allotted", "15", "seconds", "to", "complete", "each", "circumferential", "trial", ",", "and", "was", "instructed", "to", "use", "the", "entire", "time", "allotted", "to", "traverse", "the", "perimeter", "of", "the", "ring", "once", ".", "A", "dot", "generated", "on", "the", "computer", "screen", "was", "programmed", "to", "traverse", "a", "circle", "within", "15", "seconds", "to", "provide", "the", "subject", "with", "directional", "feedback", "of", "their", "force", "application", ".", "Subjects", "were", "given", "60", "seconds", "of", "rest", "between", "each", "circumferential", "trial", ".", "Each", "subject", "was", "familiarized", "with", "the", "task", "with", "a", "few", "practice", "trials", ".", "Data", "were", "collected", "from", "each", "subject", "at", "100", "samples", "per", "second", "producing", "a", "total", "of", "22,500", "pairs", "of", "force", "components", "from", "the", "15", "circumferential", "trials", ".", "Our", "previous", "study", "[", "19", "]", "indicated", "that", "the", "testing", "protocol", "did", "not", "cause", "noticeable", "fatigue", ".", "\n\n", "Force", "envelope", "and", "quadrants", "\n", "Data", "from", "multiple", "circumferential", "trials", "were", "accumulated", "to", "construct", "a", "force", "envelope", ".", "The", "procedures", "to", "generate", "a", "force", "envelope", "were", "as", "follows", ":", "\n", "Cartesian", "force", "coordinates", "(", "Xi", ",", "Yi", ")", "were", "transformed", "into", "polar", "coordinates", "(", "Rα", ",", "α", ")", ",", "where", "Rα", "was", "the", "force", "magnitude", "at", "an", "angular", "position", "α", ".", "Each", "α", "was", "rounded", "to", "the", "nearest", "integer", "ranging", "from", "0", "to", "359", "degrees", ".", "\n", "The", "maximum", ",", "Fα", ",", "was", "determined", "from", "a", "string", "of", "N", "data", "points", "along", "each", "radial", "line", "defined", "by", "α", ".", "At", "the", "completion", "of", "the", "15", "trials", ",", "there", "were", ",", "on", "average", ",", "N", "=", "63", "data", "points", "on", "each", "radial", "line", "of", "α", "based", "on", "the", "distribution", "off", "the", "22,500", "data", "points", "around", "360", "°", ".", "\n", "A", "moving", "average", "with", "an", "interval", "of", "10", "°", "was", "applied", "to", "the", "maximal", "series", "data", "Fα", "(", "α", "=", "0", ",", "1", ",", "2", ",", "...", ",", "359", ")", "to", "obtain", "filtered", "maximal", "forces", ".", "These", "forces", "formed", "a", "force", "envelope", ".", "\n", "The", "area", "formed", "by", "a", "force", "envelope", "was", "divided", "into", "adduction", "-", "extension", ",", "extension", "-", "abduction", ",", "abduction", "-", "flexion", ",", "and", "flexion", "-", "adduction", "quadrants", "by", "radial", "lines", "oriented", "at", "0", "°", ",", "90", "°", ",", "180", "°", ",", "and", "270", "°", "A", "quadrant", "force", "was", "represented", "using", "the", "mean", "magnitude", "of", "the", "forces", "in", "that", "quadrant", ".", "The", "areas", "of", "the", "entire", "envelope", "and", "each", "quadrant", "were", "calculated", "by", "summing", "the", "areas", "of", "individual", "arc", "sections", "formed", "by", "the", "polar", "coordinates", "of", "the", "force", "envelope", ".", "(", "Figure", "2", ")", ".", "\n\n", "Statistical", "Analyses", "\n", "One-", "and", "two", "-", "factor", "repeated", "measures", "analyses", "of", "variance", "(", "ANOVA", ")", "were", "used", "to", "analyze", "outcome", "measures", ".", "The", "independent", "variables", "were", "testing", "SESSION", "(", "n", "=", "2", ",", "i.e", ".", ",", "pre-", "and", "post", "-", "block", ")", ",", "force", "DIRECTION", "(", "n", "=", "16", ")", ",", "and", "force", "QUADRANT", "(", "n", "=", "4", ")", ",", "with", "SESSION", "as", "a", "repeated", "variable", ".", "Dependent", "variables", "were", "directional", "force", ",", "individual", "quadrant", "area", "and", "force", "envelope", "area", ".", "Statistical", "analyses", "were", "performed", "using", "SPSS", "11", "(", "SPSS", "Inc", ".", ",", "Illinois", ")", "with", "statistical", "significance", "set", "at", "α", "=", "0.05", ".", "\n\n\n", "Results", "\n", "Force", "envelope", "and", "directional", "forces", "\n", "Figure", "3", "shows", "the", "force", "envelopes", "produced", "by", "each", "subject", "(", "A", "to", "F", ")", "before", "and", "after", "median", "nerve", "block", ".", "The", "post", "-", "block", "force", "envelope", "was", "inside", "the", "pre", "-", "block", "envelope", "for", "each", "subject", ",", "indicating", "a", "decrease", "in", "force", "magnitude", "in", "all", "directions", "after", "nerve", "block", ".", "Figure", "4", "shows", "the", "average", "pre-", "and", "post", "-", "block", "force", "envelope", "across", "all", "subjects", ".", "Force", "magnitudes", "were", "significantly", "reduced", "after", "nerve", "block", "(", "p", "<", "0.001", ")", "resulting", "in", "significantly", "smaller", "force", "envelopes", ".", "The", "average", "decrease", "across", "all", "directions", "was", "27.9", "%", ".", "A", "maximum", "decrease", "of", "42.4", "%", "occurred", "at", "199", "°", ",", "corresponding", "to", "a", "combined", "direction", "of", "abduction", "and", "slight", "flexion", ",", "while", "a", "minimum", "decrease", "of", "10.5", "%", "occurred", "at", "328", "°", "corresponding", "to", "a", "combined", "direction", "of", "adduction", "and", "slight", "flexion", ".", "Relative", "decreases", "at", "0", "°", "(", "adduction", ")", ",", "90", "°", "(", "extension", ")", ",", "180", "°", "(", "abduction", ")", ",", "and", "270", "°", "(", "flexion", ")", "directions", "were", "17.3", "%", ",", "21.2", "%", ",", "41.2", "%", "and", "33.5", "%", ",", "respectively", ".", "\n", "A", "single", "force", "in", "each", "quadrant", "was", "represented", "using", "the", "mean", "magnitude", "of", "the", "forces", "in", "that", "quadrant", "(", "see", "description", "in", "the", "Methods", ")", ".", "The", "average", "quadrant", "forces", "were", "significantly", "decreased", "after", "nerve", "block", "(", "p", "<", "0.001", ";", "Figure", "5", ")", ".", "The", "amount", "of", "decrease", "was", "also", "different", "between", "quadrants", "(", "p", "<", "0.005", ")", ".", "Relative", "decreases", "in", "mean", "quadrant", "forces", "were", "24.5", "%", ",", "38.7", "%", ",", "32.1", "%", ",", "and", "18.1", "%", "for", "extension", ",", "abduction", ",", "flexion", ",", "and", "adduction", ",", "respectively", ".", "The", "maximal", "decreases", "in", "mean", "quadrant", "force", ",", "38.7", "%", ",", "occurred", "in", "the", "abduction", "quadrant", ".", "\n\n", "Force", "envelope", "areas", "and", "quadrant", "areas", "\n", "Areas", "enclosed", "by", "the", "post", "-", "block", "envelopes", "were", "significantly", "smaller", "than", "the", "pre", "-", "block", "envelopes", "(", "p", "<", "0.001", ";", "Figure", "4", ")", ".", "Post", "-", "block", "force", "envelope", "area", ",", "10700", "±", "4474", "N.N", ",", "was", "51.9", "%", "of", "pre", "-", "block", "force", "envelope", "area", ",", "20628", "±", "7747", "N.N.", "Quadrant", "area", "decreased", "significantly", "(", "p", "<", "0.001", ";", "Figure", "6", ")", ".", "The", "maximal", "percentage", "decrease", "in", "area", "after", "nerve", "block", "was", "60.9", "%", "in", "the", "abduction", "quadrant", ",", "followed", "by", "a", "52.3", "%", "area", "decrease", "in", "the", "flexion", "quadrant", ".", "\n\n\n", "Discussion", "\n", "In", "this", "study", "we", "simulated", "a", "lower", "median", "nerve", "lesion", "and", "evaluated", "the", "resultant", "thumb", "motor", "function", "deficit", ".", "Our", "internal", "control", "via", "pre-", "and", "post", "-", "block", "design", "offered", "a", "particular", "advantage", "of", "investigating", "the", "mechanical", "role", "of", "muscles", "innervated", "by", "a", "targeted", "nerve", ".", "The", "testing", "and", "analytical", "methods", "employed", "have", "provided", "advanced", "quantification", "of", "thumb", "motor", "function", ".", "The", "results", "have", "confirmed", "our", "initial", "hypotheses", "that", "greatest", "force", "decreases", "occurred", "in", "directions", "related", "to", "abduction", ",", "and", "that", "the", "post", "-", "block", "thumb", "force", "envelope", "area", "was", "smaller", "than", "the", "pre", "-", "block", "force", "envelope", "area", ".", "\n", "Preferential", "force", "attenuation", "in", "the", "quadrants", "of", "abduction", "and", "flexion", "after", "median", "nerve", "block", "are", "in", "agreement", "with", "anatomical", "and", "neuromuscular", "features", "of", "the", "thumb", ".", "The", "median", "nerve", "innervates", "the", "abductor", "pollicis", "brevis", ",", "the", "opponens", "pollicis", "and", "superficial", "head", "of", "the", "flexor", "pollicis", "brevis", ",", "all", "of", "which", "contribute", "to", "the", "abduction", "and", "flexion", "of", "the", "thumb", "[", "4", "]", ";", "therefore", ",", "denervation", "of", "these", "muscles", "after", "median", "nerve", "block", "would", "cause", "the", "greatest", "force", "deficit", "related", "to", "median", "nerve", "function", "[", "5", "]", ".", "Additionally", ",", "as", "force", "application", "moved", "towards", "adduction", ",", "the", "force", "deficit", "decreased", "as", "neuromuscular", "control", "shifted", "from", "the", "median", "nerve", "to", "the", "ulnar", "nerve", "via", "the", "first", "dorsal", "interosseous", "and", "adductor", "pollicis", "brevis", ".", "Force", "deficit", "in", "extension", "was", "also", "comparably", "small", "as", "extension", "forces", "are", "mainly", "produced", "by", "the", "extensors", "pollicis", "brevis", "and", "longus", "originating", "in", "the", "forearm", ".", "\n", "Our", "reported", "force", "decreases", "following", "a", "median", "nerve", "block", "(", "40.9", "%", "in", "abduction", ",", "34.1", "%", "in", "flexion", ")", "were", "smaller", "than", "those", "reported", "in", "the", "literature", ".", "Kozin", "et", "al", ".", "[", "21", "]", "reported", "a", "60", "%", "decrease", "in", "pinch", "strength", "after", "a", "median", "nerve", "block", "using", "mepivicaine", "hydrochloride", "[", "21", "]", ".", "Boatright", "and", "Kiebzak", "[", "20", "]", "reported", "an", "approximate", "70", "%", "decrease", "in", "thumb", "abduction", "strength", "after", "median", "nerve", "block", "using", "Lidocaine", "[", "20", "]", ".", "Kaufman", "et", "al", ".", "[", "5", "]", "stated", "that", "a", "median", "nerve", "block", "with", "Lidocaine", "almost", "completely", "diminished", "force", "production", "in", "the", "abduction", "direction", "[", "5", "]", ".", "The", "discrepancy", "may", "be", "due", "to", "the", "anesthetic", "used", "and", "strength", "testing", "method", ".", "Although", "the", "sensory", "block", "appeared", "to", "be", "complete", "for", "each", "method", ",", "the", "motor", "capabilities", "of", "the", "muscles", "associated", "with", "the", "median", "nerve", "might", "or", "might", "not", "be", "completely", "eliminated", ".", "Such", "a", "result", "is", "largely", "dependent", "on", "a", "particular", "anesthetic", ",", "its", "concentration", "and", "dosage", ",", "as", "well", "as", "the", "efficacy", "of", "the", "injection", "technique", "at", "immersing", "the", "nerve", ".", "The", "methods", "of", "strength", "testing", "may", "also", "help", "explain", "the", "different", "magnitudes", "of", "strength", "deficit", "after", "the", "nerve", "block", ".", "All", "previous", "results", "were", "based", "on", "forces", "obtained", "in", "discrete", "direction(s", ")", ",", "and", "focused", "exertions", ",", "while", "the", "current", "study", "utilized", "a", "method", "of", "force", "production", "in", "a", "continuous", ",", "circumferential", "and", "dynamic", "manner", ".", "Furthermore", ",", "thumb", "motor", "performance", "can", "be", "maintained", "despite", "the", "absence", "of", "certain", "individual", "muscles", ".", "For", "example", ",", "Britto", "and", "Elliot", "reported", "that", "the", "loss", "of", "abductor", "pollicis", "longus", "and", "extensor", "pollicis", "brevis", "in", "their", "two", "patients", "did", "not", "show", "functional", "compromise", "of", "strength", "and", "grip", "strength", "[", "24", "]", ".", "In", "a", "broader", "sense", ",", "the", "neuromuscular", "system", "has", "remarkable", "capabilities", "to", "accomplish", "the", "same", "motor", "function", "goal", "using", "different", "effectors", "and", "different", "goals", "using", "the", "same", "effectors", ",", "a", "phenomenon", "so", "called", "\"", "motor", "equivalence", "\"", "[", "25", "]", ".", "\n", "An", "unexpected", "finding", "from", "this", "study", "was", "that", "the", "force", "deficit", "occurred", "in", "all", "directions", "(", "Figure", "4", ")", ".", "In", "other", "words", ",", "the", "median", "nerve", "block", "caused", "reduced", "force", "production", "by", "those", "muscles", "not", "associated", "with", "the", "median", "nerve", ".", "Several", "potential", "explanations", "exist", "to", "describe", "such", "a", "phenomenon", ".", "First", ",", "the", "injection", "into", "the", "carpal", "tunnel", "at", "the", "wrist", ",", "although", "localized", ",", "potentially", "diffused", "into", "the", "intrinsic", "fascia", "of", "the", "hand", "partially", "compromising", "function", "of", "the", "ulnar", "nerve", ",", "which", "innervates", "the", "adductor", "pollicis", ".", "Although", "Semmes", "-", "Weinstein", "monofilament", "testing", "confirmed", "the", "continued", "sensation", "of", "the", "digits", "within", "the", "ulnar", "nerve", "distribution", ",", "it", "is", "not", "inconceivable", "that", "the", "injection", "could", "have", "contaminated", "the", "ulnar", "innervated", "muscles", ",", "the", "first", "dorsal", "interosseous", "and", "deep", "head", "of", "the", "flexor", "pollicis", "brevis", "[", "20", "]", ".", "Secondly", ",", "thumb", "force", "in", "any", "direction", "is", "produced", "by", "synergistic", "activation", "of", "the", "many", "intrinsic", "muscles", ",", "and", "as", "a", "result", ",", "the", "muscular", "deficiency", "associated", "with", "one", "direction", "may", "hinder", "the", "force", "production", "in", "other", "directions", "by", "other", "muscles", "[", "5,22", "]", ".", "For", "example", ",", "Kaufman", "et", "al", ".", "demonstrated", "that", "thumb", "muscles", "not", "innervated", "by", "the", "median", "nerve", "displayed", "lower", "electromyographical", "activation", "and", "shifted", "the", "direction", "of", "maximum", "activation", "after", "a", "median", "nerve", "block", "[", "5", "]", ".", "Labosky", "and", "Waggy", "showed", "that", "a", "radial", "nerve", "block", "caused", "a", "53", "%", "decrease", "in", "thumb", "abduction", "strength", "because", "of", "the", "lack", "of", "stabilization", "of", "the", "radial", "innervated", "extensor", "muscles", "[", "22", "]", ".", "Consequently", ",", "deficiency", "of", "median", "innervated", "muscles", "inherently", "limits", "force", "production", "in", "other", "directions", "as", "neuromuscular", "switching", "is", "necessary", "to", "produce", "force", "in", "changing", "directions", ".", "\n", "The", "median", "innervated", "muscles", "are", "the", "dominant", "abductors", "of", "the", "thumb", "metacarpophalangeal", "and", "carpometacarpal", "joint", ".", "The", "more", "than", "50", "%", "residual", "abduction", "force", "found", "in", "this", "study", "suggests", "that", "the", "injection", "did", "not", "totally", "block", "the", "motor", "function", "of", "these", "muscles", ",", "even", "though", "a", "complete", "sensory", "loss", "was", "verified", ".", "This", "concurs", "with", "clinical", "observations", "of", "median", "compression", "neuropathy", ".", "Individuals", "with", "carpal", "tunnel", "syndrome", "complain", "of", "sensory", "dysfunction", "early", "in", "the", "disease", "process", "(", "at", "the", "beginning", ")", ",", "while", "motor", "signs", "of", "thenar", "wasting", "and", "thumb", "weakness", "occur", "as", "the", "disease", "advances", ".", "The", "concept", "that", "the", "motor", "deficit", "is", "more", "resistant", "to", "peripheral", "median", "neuropathy", "than", "sensory", "loss", "has", "been", "well", "documented", "[", "23,26,27", "]", ".", "Butterworth", "et", "al", ".", "studied", "the", "temporal", "effects", "on", "sensory", "and", "motor", "blockade", "after", "injection", "of", "bupivacaine", "or", "mepivacaine", ",", "and", "found", "that", "sensory", "loss", "was", "complete", "but", "about", "a", "20", "%", "compound", "motor", "action", "potential", "remained", "after", "40", "minutes", "[", "23", "]", ".", "\n", "In", "conclusion", ",", "we", "have", "incorporated", "a", "method", "for", "assessing", "thumb", "motor", "deficit", "based", "on", "strength", "measurement", "with", "a", "standard", "local", "anesthetic", "to", "investigate", "the", "effects", "of", "a", "simulated", "median", "neuropathy", "on", "thumb", "motor", "function", ".", "Median", "nerve", "block", "results", "in", "force", "deficits", "in", "all", "directions", ",", "with", "the", "most", "severe", "impairment", "in", "abduction", "and", "flexion", ".", "Future", "endeavors", "using", "this", "methodology", "can", "potentially", "further", "elucidate", "underlying", "pathomechanisms", "of", "peripheral", "neuropathies", "in", "all", "digits", "of", "the", "hand", ".", "\n\n\n" ]
[ "species" ]
EMSA is an assay, Flk-1 / KDR is a protein, Sp1 is a protein, CT - rich recognition sequence is a DNA, Flk-1 / KDR promoter is a DNA
1.0alpha7.train.944_task0
Sentence: 9 EMSA has demonstrated that expression of human Flk-1/KDR is mediated by Sp1 binding to a CT-rich recognition sequence within the -79 to -68 region of the Flk-1/KDR promoter. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: DNA, assay, protein
[ "O", "B-assay", "O", "O", "O", "O", "O", "O", "O", "B-protein", "I-protein", "I-protein", "O", "O", "O", "O", "B-protein", "O", "O", "O", "O", "B-DNA", "I-DNA", "I-DNA", "I-DNA", "I-DNA", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-DNA", "I-DNA", "I-DNA", "I-DNA", "O" ]
9 EMSA has demonstrated that expression of human Flk-1/KDR is mediated by Sp1 binding to a CT-rich recognition sequence within the -79 to -68 region of the Flk-1/KDR promoter.
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[ "DNA", "protein", "assay" ]
EMSA is an assay, Flk-1 / KDR is a protein, Sp1 is a protein, CT - rich recognition sequence is a DNA, Flk-1 / KDR promoter is a DNA
1.0alpha7.train.944_task1
Sentence: 9 EMSA has demonstrated that expression of human Flk-1/KDR is mediated by Sp1 binding to a CT-rich recognition sequence within the -79 to -68 region of the Flk-1/KDR promoter. Instructions: please typing these entity words according to sentence: EMSA, Flk-1 / KDR, Sp1, CT - rich recognition sequence, Flk-1 / KDR promoter Options: DNA, assay, protein
[ "O", "B-assay", "O", "O", "O", "O", "O", "O", "O", "B-protein", "I-protein", "I-protein", "O", "O", "O", "O", "B-protein", "O", "O", "O", "O", "B-DNA", "I-DNA", "I-DNA", "I-DNA", "I-DNA", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-DNA", "I-DNA", "I-DNA", "I-DNA", "O" ]
9 EMSA has demonstrated that expression of human Flk-1/KDR is mediated by Sp1 binding to a CT-rich recognition sequence within the -79 to -68 region of the Flk-1/KDR promoter.
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[ "DNA", "protein", "assay" ]
EMSA, Flk-1 / KDR, Sp1, CT - rich recognition sequence, Flk-1 / KDR promoter
1.0alpha7.train.944_task2
Sentence: 9 EMSA has demonstrated that expression of human Flk-1/KDR is mediated by Sp1 binding to a CT-rich recognition sequence within the -79 to -68 region of the Flk-1/KDR promoter. Instructions: please extract entity words from the input sentence
[ "O", "B-assay", "O", "O", "O", "O", "O", "O", "O", "B-protein", "I-protein", "I-protein", "O", "O", "O", "O", "B-protein", "O", "O", "O", "O", "B-DNA", "I-DNA", "I-DNA", "I-DNA", "I-DNA", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-DNA", "I-DNA", "I-DNA", "I-DNA", "O" ]
9 EMSA has demonstrated that expression of human Flk-1/KDR is mediated by Sp1 binding to a CT-rich recognition sequence within the -79 to -68 region of the Flk-1/KDR promoter.
[ "9", "EMSA", "has", "demonstrated", "that", "expression", "of", " ", "human", "Flk-1", "/", "KDR", "is", "mediated", "by", " ", "Sp1", "binding", "to", "a", " ", "CT", "-", "rich", "recognition", "sequence", "within", "the", "-79", "to", "-68", "region", "of", "the", " ", "Flk-1", "/", "KDR", "promoter", "." ]
[ "DNA", "protein", "assay" ]
colchicine is a Intervention_Pharmacological, placebo is a Intervention_Control, pericardial effusion is a Participant_Condition, open - heart surgery is a Participant_Condition, placebo - controlled is a Intervention_Control, Pericardial effusion ( PE ) is a Outcome_Physical, 149 is a Participant_Sample-size, mild or moderate PE is a Participant_Condition, echocardiography is a Intervention_Physical, 1 mg / d colchicine ( n = 74 ) is a Intervention_Pharmacological, PE sizes is a Outcome_Physical, effusion changes is a Outcome_Physical, posttreatment effusion values and changes is a Outcome_Physical, isolated coronary artery bypass graft surgery patients is a Outcome_Physical, asymptomatic postoperative PE . is a Outcome_Physical, PEs is a Participant_Condition
73158_task0
Sentence: Efficacy of colchicine versus placebo for the treatment of pericardial effusion after open-heart surgery : A randomized , placebo-controlled trial . BACKGROUND Pericardial effusion ( PE ) , a common complication after open-heart surgery , accounts for 50 % to 85 % of patients . Although reversible in most of the cases , it could be life threatening in the occurrence of tamponade in large effusions . We aimed to determine the therapeutic efficacy of colchicine on PE after open-heart surgery . METHODS The study is a prospective , randomized , triple-blind , placebo-controlled single-center trial at Tehran Heart Center . A total of 149 patients with mild or moderate PE in transthoracic echocardiography were randomly assigned to receive 1 mg/d colchicine ( n = 74 ) or 1 tablet of placebo ( n = 75 ) for 2 weeks and then underwent follow-up echocardiography . RESULTS Baseline and clinical characteristics were not significantly different between the 2 study groups except for age ( P = .02 ) and graft numbers ( P = .005 ) . There was no significant difference in pretreatment and posttreatment PE sizes between the 2 study groups ( P = .440 and .844 , respectively ) . Median ( 25th-75th percentiles ) of effusion changes was 5 mm ( 1-7.6 mm ) in the colchicine group and 5 mm ( 1-6.6 mm ) in the placebo group ( P = .932 ) . Intervention had no significant impact on pretreatment and posttreatment effusion values and changes in isolated coronary artery bypass graft surgery patients ( P = .607 , .539 , and .628 , respectively ) . After adjustment for possible confounders , there was still no significant difference in postoperative PE between the 2 study groups ( t = -0.285 , P = .776 ) . CONCLUSION We concluded that prescription of colchicine does not seem to be effective in treatment of asymptomatic postoperative PE . This could be justified in case that the etiology of most of the PEs might be contribution of noninflammatory factors which are better to be dealt with observational approaches . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: Intervention_Pharmacological, Intervention_Physical, Participant_Condition, Intervention_Control, Outcome_Physical, Participant_Sample-size
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Efficacy of colchicine versus placebo for the treatment of pericardial effusion after open-heart surgery : A randomized , placebo-controlled trial . BACKGROUND Pericardial effusion ( PE ) , a common complication after open-heart surgery , accounts for 50 % to 85 % of patients . Although reversible in most of the cases , it could be life threatening in the occurrence of tamponade in large effusions . We aimed to determine the therapeutic efficacy of colchicine on PE after open-heart surgery . METHODS The study is a prospective , randomized , triple-blind , placebo-controlled single-center trial at Tehran Heart Center . A total of 149 patients with mild or moderate PE in transthoracic echocardiography were randomly assigned to receive 1 mg/d colchicine ( n = 74 ) or 1 tablet of placebo ( n = 75 ) for 2 weeks and then underwent follow-up echocardiography . RESULTS Baseline and clinical characteristics were not significantly different between the 2 study groups except for age ( P = .02 ) and graft numbers ( P = .005 ) . There was no significant difference in pretreatment and posttreatment PE sizes between the 2 study groups ( P = .440 and .844 , respectively ) . Median ( 25th-75th percentiles ) of effusion changes was 5 mm ( 1-7.6 mm ) in the colchicine group and 5 mm ( 1-6.6 mm ) in the placebo group ( P = .932 ) . Intervention had no significant impact on pretreatment and posttreatment effusion values and changes in isolated coronary artery bypass graft surgery patients ( P = .607 , .539 , and .628 , respectively ) . After adjustment for possible confounders , there was still no significant difference in postoperative PE between the 2 study groups ( t = -0.285 , P = .776 ) . CONCLUSION We concluded that prescription of colchicine does not seem to be effective in treatment of asymptomatic postoperative PE . This could be justified in case that the etiology of most of the PEs might be contribution of noninflammatory factors which are better to be dealt with observational approaches .
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[ "Outcome_Physical", "Intervention_Pharmacological", "Participant_Condition", "Intervention_Control", "Intervention_Physical", "Participant_Sample-size" ]
colchicine is a Intervention_Pharmacological, placebo is a Intervention_Control, pericardial effusion is a Participant_Condition, open - heart surgery is a Participant_Condition, placebo - controlled is a Intervention_Control, Pericardial effusion ( PE ) is a Outcome_Physical, 149 is a Participant_Sample-size, mild or moderate PE is a Participant_Condition, echocardiography is a Intervention_Physical, 1 mg / d colchicine ( n = 74 ) is a Intervention_Pharmacological, PE sizes is a Outcome_Physical, effusion changes is a Outcome_Physical, posttreatment effusion values and changes is a Outcome_Physical, isolated coronary artery bypass graft surgery patients is a Outcome_Physical, asymptomatic postoperative PE . is a Outcome_Physical, PEs is a Participant_Condition
73158_task1
Sentence: Efficacy of colchicine versus placebo for the treatment of pericardial effusion after open-heart surgery : A randomized , placebo-controlled trial . BACKGROUND Pericardial effusion ( PE ) , a common complication after open-heart surgery , accounts for 50 % to 85 % of patients . Although reversible in most of the cases , it could be life threatening in the occurrence of tamponade in large effusions . We aimed to determine the therapeutic efficacy of colchicine on PE after open-heart surgery . METHODS The study is a prospective , randomized , triple-blind , placebo-controlled single-center trial at Tehran Heart Center . A total of 149 patients with mild or moderate PE in transthoracic echocardiography were randomly assigned to receive 1 mg/d colchicine ( n = 74 ) or 1 tablet of placebo ( n = 75 ) for 2 weeks and then underwent follow-up echocardiography . RESULTS Baseline and clinical characteristics were not significantly different between the 2 study groups except for age ( P = .02 ) and graft numbers ( P = .005 ) . There was no significant difference in pretreatment and posttreatment PE sizes between the 2 study groups ( P = .440 and .844 , respectively ) . Median ( 25th-75th percentiles ) of effusion changes was 5 mm ( 1-7.6 mm ) in the colchicine group and 5 mm ( 1-6.6 mm ) in the placebo group ( P = .932 ) . Intervention had no significant impact on pretreatment and posttreatment effusion values and changes in isolated coronary artery bypass graft surgery patients ( P = .607 , .539 , and .628 , respectively ) . After adjustment for possible confounders , there was still no significant difference in postoperative PE between the 2 study groups ( t = -0.285 , P = .776 ) . CONCLUSION We concluded that prescription of colchicine does not seem to be effective in treatment of asymptomatic postoperative PE . This could be justified in case that the etiology of most of the PEs might be contribution of noninflammatory factors which are better to be dealt with observational approaches . Instructions: please typing these entity words according to sentence: colchicine, placebo, pericardial effusion, open - heart surgery, placebo - controlled, Pericardial effusion ( PE ), 149, mild or moderate PE, echocardiography, 1 mg / d colchicine ( n = 74 ), PE sizes, effusion changes, posttreatment effusion values and changes, isolated coronary artery bypass graft surgery patients, asymptomatic postoperative PE ., PEs Options: Intervention_Pharmacological, Intervention_Physical, Participant_Condition, Intervention_Control, Outcome_Physical, Participant_Sample-size
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Efficacy of colchicine versus placebo for the treatment of pericardial effusion after open-heart surgery : A randomized , placebo-controlled trial . BACKGROUND Pericardial effusion ( PE ) , a common complication after open-heart surgery , accounts for 50 % to 85 % of patients . Although reversible in most of the cases , it could be life threatening in the occurrence of tamponade in large effusions . We aimed to determine the therapeutic efficacy of colchicine on PE after open-heart surgery . METHODS The study is a prospective , randomized , triple-blind , placebo-controlled single-center trial at Tehran Heart Center . A total of 149 patients with mild or moderate PE in transthoracic echocardiography were randomly assigned to receive 1 mg/d colchicine ( n = 74 ) or 1 tablet of placebo ( n = 75 ) for 2 weeks and then underwent follow-up echocardiography . RESULTS Baseline and clinical characteristics were not significantly different between the 2 study groups except for age ( P = .02 ) and graft numbers ( P = .005 ) . There was no significant difference in pretreatment and posttreatment PE sizes between the 2 study groups ( P = .440 and .844 , respectively ) . Median ( 25th-75th percentiles ) of effusion changes was 5 mm ( 1-7.6 mm ) in the colchicine group and 5 mm ( 1-6.6 mm ) in the placebo group ( P = .932 ) . Intervention had no significant impact on pretreatment and posttreatment effusion values and changes in isolated coronary artery bypass graft surgery patients ( P = .607 , .539 , and .628 , respectively ) . After adjustment for possible confounders , there was still no significant difference in postoperative PE between the 2 study groups ( t = -0.285 , P = .776 ) . CONCLUSION We concluded that prescription of colchicine does not seem to be effective in treatment of asymptomatic postoperative PE . This could be justified in case that the etiology of most of the PEs might be contribution of noninflammatory factors which are better to be dealt with observational approaches .
[ "Efficacy", "of", "colchicine", "versus", "placebo", "for", "the", "treatment", "of", "pericardial", "effusion", "after", "open", "-", "heart", "surgery", ":", "A", "randomized", ",", "placebo", "-", "controlled", "trial", ".", "BACKGROUND", "Pericardial", "effusion", "(", "PE", ")", ",", "a", "common", "complication", "after", "open", "-", "heart", "surgery", ",", "accounts", "for", "50", "%", "to", "85", "%", "of", "patients", ".", "Although", "reversible", "in", "most", "of", "the", "cases", ",", "it", "could", "be", "life", "threatening", "in", "the", "occurrence", "of", "tamponade", "in", "large", "effusions", ".", "We", "aimed", "to", "determine", "the", "therapeutic", "efficacy", "of", "colchicine", "on", "PE", "after", "open", "-", "heart", "surgery", ".", "METHODS", "The", "study", "is", "a", "prospective", ",", "randomized", ",", "triple", "-", "blind", ",", "placebo", "-", "controlled", "single", "-", "center", "trial", "at", "Tehran", "Heart", "Center", ".", "A", "total", "of", "149", "patients", "with", "mild", "or", "moderate", "PE", "in", "transthoracic", "echocardiography", "were", "randomly", "assigned", "to", "receive", "1", "mg", "/", "d", "colchicine", "(", "n", "=", "74", ")", "or", "1", "tablet", "of", "placebo", "(", "n", "=", "75", ")", "for", "2", "weeks", "and", "then", "underwent", "follow", "-", "up", "echocardiography", ".", "RESULTS", "Baseline", "and", "clinical", "characteristics", "were", "not", "significantly", "different", "between", "the", "2", "study", "groups", "except", "for", "age", "(", "P", "=", ".02", ")", "and", "graft", "numbers", "(", "P", "=", ".005", ")", ".", "There", "was", "no", "significant", "difference", "in", "pretreatment", "and", "posttreatment", "PE", "sizes", "between", "the", "2", "study", "groups", "(", "P", "=", ".440", "and", ".844", ",", "respectively", ")", ".", "Median", "(", "25th-75th", "percentiles", ")", "of", "effusion", "changes", "was", "5", "mm", "(", "1", "-", "7.6", "mm", ")", "in", "the", "colchicine", "group", "and", "5", "mm", "(", "1", "-", "6.6", "mm", ")", "in", "the", "placebo", "group", "(", "P", "=", ".932", ")", ".", "Intervention", "had", "no", "significant", "impact", "on", "pretreatment", "and", "posttreatment", "effusion", "values", "and", "changes", "in", "isolated", "coronary", "artery", "bypass", "graft", "surgery", "patients", "(", "P", "=", ".607", ",", ".539", ",", "and", ".628", ",", "respectively", ")", ".", "After", "adjustment", "for", "possible", "confounders", ",", "there", "was", "still", "no", "significant", "difference", "in", "postoperative", "PE", "between", "the", "2", "study", "groups", "(", "t", "=", "-0.285", ",", "P", "=", ".776", ")", ".", "CONCLUSION", "We", "concluded", "that", "prescription", "of", "colchicine", "does", "not", "seem", "to", "be", "effective", "in", "treatment", "of", "asymptomatic", "postoperative", "PE", ".", "This", "could", "be", "justified", "in", "case", "that", "the", "etiology", "of", "most", "of", "the", "PEs", "might", "be", "contribution", "of", "noninflammatory", "factors", "which", "are", "better", "to", "be", "dealt", "with", "observational", "approaches", "." ]
[ "Outcome_Physical", "Intervention_Pharmacological", "Participant_Condition", "Intervention_Control", "Intervention_Physical", "Participant_Sample-size" ]
colchicine, placebo, pericardial effusion, open - heart surgery, placebo - controlled, Pericardial effusion ( PE ), 149, mild or moderate PE, echocardiography, 1 mg / d colchicine ( n = 74 ), PE sizes, effusion changes, posttreatment effusion values and changes, isolated coronary artery bypass graft surgery patients, asymptomatic postoperative PE ., PEs
73158_task2
Sentence: Efficacy of colchicine versus placebo for the treatment of pericardial effusion after open-heart surgery : A randomized , placebo-controlled trial . BACKGROUND Pericardial effusion ( PE ) , a common complication after open-heart surgery , accounts for 50 % to 85 % of patients . Although reversible in most of the cases , it could be life threatening in the occurrence of tamponade in large effusions . We aimed to determine the therapeutic efficacy of colchicine on PE after open-heart surgery . METHODS The study is a prospective , randomized , triple-blind , placebo-controlled single-center trial at Tehran Heart Center . A total of 149 patients with mild or moderate PE in transthoracic echocardiography were randomly assigned to receive 1 mg/d colchicine ( n = 74 ) or 1 tablet of placebo ( n = 75 ) for 2 weeks and then underwent follow-up echocardiography . RESULTS Baseline and clinical characteristics were not significantly different between the 2 study groups except for age ( P = .02 ) and graft numbers ( P = .005 ) . There was no significant difference in pretreatment and posttreatment PE sizes between the 2 study groups ( P = .440 and .844 , respectively ) . Median ( 25th-75th percentiles ) of effusion changes was 5 mm ( 1-7.6 mm ) in the colchicine group and 5 mm ( 1-6.6 mm ) in the placebo group ( P = .932 ) . Intervention had no significant impact on pretreatment and posttreatment effusion values and changes in isolated coronary artery bypass graft surgery patients ( P = .607 , .539 , and .628 , respectively ) . After adjustment for possible confounders , there was still no significant difference in postoperative PE between the 2 study groups ( t = -0.285 , P = .776 ) . CONCLUSION We concluded that prescription of colchicine does not seem to be effective in treatment of asymptomatic postoperative PE . This could be justified in case that the etiology of most of the PEs might be contribution of noninflammatory factors which are better to be dealt with observational approaches . Instructions: please extract entity words from the input sentence
[ "O", "O", "B-Intervention_Pharmacological", "O", "B-Intervention_Control", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "B-Intervention_Control", "I-Intervention_Control", "I-Intervention_Control", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Sample-size", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "B-Intervention_Physical", "O", "O", "O", "O", "O", "B-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Condition", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Efficacy of colchicine versus placebo for the treatment of pericardial effusion after open-heart surgery : A randomized , placebo-controlled trial . BACKGROUND Pericardial effusion ( PE ) , a common complication after open-heart surgery , accounts for 50 % to 85 % of patients . Although reversible in most of the cases , it could be life threatening in the occurrence of tamponade in large effusions . We aimed to determine the therapeutic efficacy of colchicine on PE after open-heart surgery . METHODS The study is a prospective , randomized , triple-blind , placebo-controlled single-center trial at Tehran Heart Center . A total of 149 patients with mild or moderate PE in transthoracic echocardiography were randomly assigned to receive 1 mg/d colchicine ( n = 74 ) or 1 tablet of placebo ( n = 75 ) for 2 weeks and then underwent follow-up echocardiography . RESULTS Baseline and clinical characteristics were not significantly different between the 2 study groups except for age ( P = .02 ) and graft numbers ( P = .005 ) . There was no significant difference in pretreatment and posttreatment PE sizes between the 2 study groups ( P = .440 and .844 , respectively ) . Median ( 25th-75th percentiles ) of effusion changes was 5 mm ( 1-7.6 mm ) in the colchicine group and 5 mm ( 1-6.6 mm ) in the placebo group ( P = .932 ) . Intervention had no significant impact on pretreatment and posttreatment effusion values and changes in isolated coronary artery bypass graft surgery patients ( P = .607 , .539 , and .628 , respectively ) . After adjustment for possible confounders , there was still no significant difference in postoperative PE between the 2 study groups ( t = -0.285 , P = .776 ) . CONCLUSION We concluded that prescription of colchicine does not seem to be effective in treatment of asymptomatic postoperative PE . This could be justified in case that the etiology of most of the PEs might be contribution of noninflammatory factors which are better to be dealt with observational approaches .
[ "Efficacy", "of", "colchicine", "versus", "placebo", "for", "the", "treatment", "of", "pericardial", "effusion", "after", "open", "-", "heart", "surgery", ":", "A", "randomized", ",", "placebo", "-", "controlled", "trial", ".", "BACKGROUND", "Pericardial", "effusion", "(", "PE", ")", ",", "a", "common", "complication", "after", "open", "-", "heart", "surgery", ",", "accounts", "for", "50", "%", "to", "85", "%", "of", "patients", ".", "Although", "reversible", "in", "most", "of", "the", "cases", ",", "it", "could", "be", "life", "threatening", "in", "the", "occurrence", "of", "tamponade", "in", "large", "effusions", ".", "We", "aimed", "to", "determine", "the", "therapeutic", "efficacy", "of", "colchicine", "on", "PE", "after", "open", "-", "heart", "surgery", ".", "METHODS", "The", "study", "is", "a", "prospective", ",", "randomized", ",", "triple", "-", "blind", ",", "placebo", "-", "controlled", "single", "-", "center", "trial", "at", "Tehran", "Heart", "Center", ".", "A", "total", "of", "149", "patients", "with", "mild", "or", "moderate", "PE", "in", "transthoracic", "echocardiography", "were", "randomly", "assigned", "to", "receive", "1", "mg", "/", "d", "colchicine", "(", "n", "=", "74", ")", "or", "1", "tablet", "of", "placebo", "(", "n", "=", "75", ")", "for", "2", "weeks", "and", "then", "underwent", "follow", "-", "up", "echocardiography", ".", "RESULTS", "Baseline", "and", "clinical", "characteristics", "were", "not", "significantly", "different", "between", "the", "2", "study", "groups", "except", "for", "age", "(", "P", "=", ".02", ")", "and", "graft", "numbers", "(", "P", "=", ".005", ")", ".", "There", "was", "no", "significant", "difference", "in", "pretreatment", "and", "posttreatment", "PE", "sizes", "between", "the", "2", "study", "groups", "(", "P", "=", ".440", "and", ".844", ",", "respectively", ")", ".", "Median", "(", "25th-75th", "percentiles", ")", "of", "effusion", "changes", "was", "5", "mm", "(", "1", "-", "7.6", "mm", ")", "in", "the", "colchicine", "group", "and", "5", "mm", "(", "1", "-", "6.6", "mm", ")", "in", "the", "placebo", "group", "(", "P", "=", ".932", ")", ".", "Intervention", "had", "no", "significant", "impact", "on", "pretreatment", "and", "posttreatment", "effusion", "values", "and", "changes", "in", "isolated", "coronary", "artery", "bypass", "graft", "surgery", "patients", "(", "P", "=", ".607", ",", ".539", ",", "and", ".628", ",", "respectively", ")", ".", "After", "adjustment", "for", "possible", "confounders", ",", "there", "was", "still", "no", "significant", "difference", "in", "postoperative", "PE", "between", "the", "2", "study", "groups", "(", "t", "=", "-0.285", ",", "P", "=", ".776", ")", ".", "CONCLUSION", "We", "concluded", "that", "prescription", "of", "colchicine", "does", "not", "seem", "to", "be", "effective", "in", "treatment", "of", "asymptomatic", "postoperative", "PE", ".", "This", "could", "be", "justified", "in", "case", "that", "the", "etiology", "of", "most", "of", "the", "PEs", "might", "be", "contribution", "of", "noninflammatory", "factors", "which", "are", "better", "to", "be", "dealt", "with", "observational", "approaches", "." ]
[ "Outcome_Physical", "Intervention_Pharmacological", "Participant_Condition", "Intervention_Control", "Intervention_Physical", "Participant_Sample-size" ]
Depressive symptoms and biochemically verified abstinence is an outcome
1233_task0
Sentence: Depressive symptoms and biochemically verified abstinence were assessed 1 week prior to and 2 , 8 , 16 , and 26 weeks after quit date . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: outcome
[ "B-outcome", "I-outcome", "I-outcome", "I-outcome", "I-outcome", "I-outcome", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Depressive symptoms and biochemically verified abstinence were assessed 1 week prior to and 2 , 8 , 16 , and 26 weeks after quit date .
[ "Depressive", "symptoms", "and", "biochemically", "verified", "abstinence", "were", "assessed", "1", "week", "prior", "to", "and", "2", ",", "8", ",", "16", ",", "and", "26", "weeks", "after", "quit", "date", "." ]
[ "outcome" ]
Depressive symptoms and biochemically verified abstinence is an outcome
1233_task1
Sentence: Depressive symptoms and biochemically verified abstinence were assessed 1 week prior to and 2 , 8 , 16 , and 26 weeks after quit date . Instructions: please typing these entity words according to sentence: Depressive symptoms and biochemically verified abstinence Options: outcome
[ "B-outcome", "I-outcome", "I-outcome", "I-outcome", "I-outcome", "I-outcome", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Depressive symptoms and biochemically verified abstinence were assessed 1 week prior to and 2 , 8 , 16 , and 26 weeks after quit date .
[ "Depressive", "symptoms", "and", "biochemically", "verified", "abstinence", "were", "assessed", "1", "week", "prior", "to", "and", "2", ",", "8", ",", "16", ",", "and", "26", "weeks", "after", "quit", "date", "." ]
[ "outcome" ]
Depressive symptoms and biochemically verified abstinence
1233_task2
Sentence: Depressive symptoms and biochemically verified abstinence were assessed 1 week prior to and 2 , 8 , 16 , and 26 weeks after quit date . Instructions: please extract entity words from the input sentence
[ "B-outcome", "I-outcome", "I-outcome", "I-outcome", "I-outcome", "I-outcome", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Depressive symptoms and biochemically verified abstinence were assessed 1 week prior to and 2 , 8 , 16 , and 26 weeks after quit date .
[ "Depressive", "symptoms", "and", "biochemically", "verified", "abstinence", "were", "assessed", "1", "week", "prior", "to", "and", "2", ",", "8", ",", "16", ",", "and", "26", "weeks", "after", "quit", "date", "." ]
[ "outcome" ]
adrenergic alpha 2 is a GENE-N, 5-HT1A is a GENE-Y
8392199_task0
Sentence: Role of the inhibitory adrenergic alpha 2 and serotonergic 5-HT1A components of cocaine's actions on the DOI-induced head-twitch response in 5-HT2-receptor supersensitive mice. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: GENE-Y, GENE-N
[ "O", "O", "O", "O", "B-GENE-N", "I-GENE-N", "I-GENE-N", "O", "O", "B-GENE-Y", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Role of the inhibitory adrenergic alpha 2 and serotonergic 5-HT1A components of cocaine's actions on the DOI-induced head-twitch response in 5-HT2-receptor supersensitive mice.
[ "Role", "of", "the", "inhibitory", "adrenergic", "alpha", "2", "and", "serotonergic", "5-HT1A", "components", "of", "cocaine", "'s", "actions", "on", "the", "DOI", "-", "induced", "head", "-", "twitch", "response", "in", "5-HT2-receptor", "supersensitive", "mice", "." ]
[ "CHEMICAL", "GENE-N", "GENE-Y" ]
adrenergic alpha 2 is a GENE-N, 5-HT1A is a GENE-Y
8392199_task1
Sentence: Role of the inhibitory adrenergic alpha 2 and serotonergic 5-HT1A components of cocaine's actions on the DOI-induced head-twitch response in 5-HT2-receptor supersensitive mice. Instructions: please typing these entity words according to sentence: adrenergic alpha 2, 5-HT1A Options: GENE-Y, GENE-N
[ "O", "O", "O", "O", "B-GENE-N", "I-GENE-N", "I-GENE-N", "O", "O", "B-GENE-Y", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Role of the inhibitory adrenergic alpha 2 and serotonergic 5-HT1A components of cocaine's actions on the DOI-induced head-twitch response in 5-HT2-receptor supersensitive mice.
[ "Role", "of", "the", "inhibitory", "adrenergic", "alpha", "2", "and", "serotonergic", "5-HT1A", "components", "of", "cocaine", "'s", "actions", "on", "the", "DOI", "-", "induced", "head", "-", "twitch", "response", "in", "5-HT2-receptor", "supersensitive", "mice", "." ]
[ "CHEMICAL", "GENE-N", "GENE-Y" ]
adrenergic alpha 2, 5-HT1A
8392199_task2
Sentence: Role of the inhibitory adrenergic alpha 2 and serotonergic 5-HT1A components of cocaine's actions on the DOI-induced head-twitch response in 5-HT2-receptor supersensitive mice. Instructions: please extract entity words from the input sentence
[ "O", "O", "O", "O", "B-GENE-N", "I-GENE-N", "I-GENE-N", "O", "O", "B-GENE-Y", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Role of the inhibitory adrenergic alpha 2 and serotonergic 5-HT1A components of cocaine's actions on the DOI-induced head-twitch response in 5-HT2-receptor supersensitive mice.
[ "Role", "of", "the", "inhibitory", "adrenergic", "alpha", "2", "and", "serotonergic", "5-HT1A", "components", "of", "cocaine", "'s", "actions", "on", "the", "DOI", "-", "induced", "head", "-", "twitch", "response", "in", "5-HT2-receptor", "supersensitive", "mice", "." ]
[ "CHEMICAL", "GENE-N", "GENE-Y" ]
Hormonal interactions is an other_name, glucocorticoid receptors is a protein_family_or_group, patients is a multi_cell, nephrotic syndrome is an other_name
95319_task0
Sentence: [Hormonal interactions and glucocorticoid receptors in patients with the nephrotic syndrome] Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: protein_family_or_group, multi_cell, other_name
[ "O", "B-other_name", "I-other_name", "O", "B-protein_family_or_group", "I-protein_family_or_group", "O", "B-multi_cell", "O", "O", "B-other_name", "I-other_name", "O" ]
[Hormonal interactions and glucocorticoid receptors in patients with the nephrotic syndrome]
[ "[", "Hormonal", "interactions", "and", "glucocorticoid", "receptors", "in", "patients", "with", "the", "nephrotic", "syndrome", "]" ]
[ "protein_family_or_group", "other_name", "other_organic_compound", "lipid", "body_part", "multi_cell" ]
Hormonal interactions is an other_name, glucocorticoid receptors is a protein_family_or_group, patients is a multi_cell, nephrotic syndrome is an other_name
95319_task1
Sentence: [Hormonal interactions and glucocorticoid receptors in patients with the nephrotic syndrome] Instructions: please typing these entity words according to sentence: Hormonal interactions, glucocorticoid receptors, patients, nephrotic syndrome Options: protein_family_or_group, multi_cell, other_name
[ "O", "B-other_name", "I-other_name", "O", "B-protein_family_or_group", "I-protein_family_or_group", "O", "B-multi_cell", "O", "O", "B-other_name", "I-other_name", "O" ]
[Hormonal interactions and glucocorticoid receptors in patients with the nephrotic syndrome]
[ "[", "Hormonal", "interactions", "and", "glucocorticoid", "receptors", "in", "patients", "with", "the", "nephrotic", "syndrome", "]" ]
[ "protein_family_or_group", "other_name", "other_organic_compound", "lipid", "body_part", "multi_cell" ]
Hormonal interactions, glucocorticoid receptors, patients, nephrotic syndrome
95319_task2
Sentence: [Hormonal interactions and glucocorticoid receptors in patients with the nephrotic syndrome] Instructions: please extract entity words from the input sentence
[ "O", "B-other_name", "I-other_name", "O", "B-protein_family_or_group", "I-protein_family_or_group", "O", "B-multi_cell", "O", "O", "B-other_name", "I-other_name", "O" ]
[Hormonal interactions and glucocorticoid receptors in patients with the nephrotic syndrome]
[ "[", "Hormonal", "interactions", "and", "glucocorticoid", "receptors", "in", "patients", "with", "the", "nephrotic", "syndrome", "]" ]
[ "protein_family_or_group", "other_name", "other_organic_compound", "lipid", "body_part", "multi_cell" ]
Posterior tibial nerve stimulation is an intervention, patients with refractory monosymptomatic nocturnal enuresis is a participant
431_task0
Sentence: Posterior tibial nerve stimulation can be a viable treatment option in some patients with refractory monosymptomatic nocturnal enuresis . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: intervention, participant
[ "B-intervention", "I-intervention", "I-intervention", "I-intervention", "O", "O", "O", "O", "O", "O", "O", "O", "B-participant", "I-participant", "I-participant", "I-participant", "I-participant", "I-participant", "O" ]
Posterior tibial nerve stimulation can be a viable treatment option in some patients with refractory monosymptomatic nocturnal enuresis .
[ "Posterior", "tibial", "nerve", "stimulation", "can", "be", "a", "viable", "treatment", "option", "in", "some", "patients", "with", "refractory", "monosymptomatic", "nocturnal", "enuresis", "." ]
[ "participant", "intervention" ]
Posterior tibial nerve stimulation is an intervention, patients with refractory monosymptomatic nocturnal enuresis is a participant
431_task1
Sentence: Posterior tibial nerve stimulation can be a viable treatment option in some patients with refractory monosymptomatic nocturnal enuresis . Instructions: please typing these entity words according to sentence: Posterior tibial nerve stimulation, patients with refractory monosymptomatic nocturnal enuresis Options: intervention, participant
[ "B-intervention", "I-intervention", "I-intervention", "I-intervention", "O", "O", "O", "O", "O", "O", "O", "O", "B-participant", "I-participant", "I-participant", "I-participant", "I-participant", "I-participant", "O" ]
Posterior tibial nerve stimulation can be a viable treatment option in some patients with refractory monosymptomatic nocturnal enuresis .
[ "Posterior", "tibial", "nerve", "stimulation", "can", "be", "a", "viable", "treatment", "option", "in", "some", "patients", "with", "refractory", "monosymptomatic", "nocturnal", "enuresis", "." ]
[ "participant", "intervention" ]
Posterior tibial nerve stimulation, patients with refractory monosymptomatic nocturnal enuresis
431_task2
Sentence: Posterior tibial nerve stimulation can be a viable treatment option in some patients with refractory monosymptomatic nocturnal enuresis . Instructions: please extract entity words from the input sentence
[ "B-intervention", "I-intervention", "I-intervention", "I-intervention", "O", "O", "O", "O", "O", "O", "O", "O", "B-participant", "I-participant", "I-participant", "I-participant", "I-participant", "I-participant", "O" ]
Posterior tibial nerve stimulation can be a viable treatment option in some patients with refractory monosymptomatic nocturnal enuresis .
[ "Posterior", "tibial", "nerve", "stimulation", "can", "be", "a", "viable", "treatment", "option", "in", "some", "patients", "with", "refractory", "monosymptomatic", "nocturnal", "enuresis", "." ]
[ "participant", "intervention" ]
Gonadotropin - releasing hormone is a GENE-Y
16985933_task0
Sentence: Gonadotropin-releasing hormone antagonist in the management of prostate cancer. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: GENE-Y
[ "B-GENE-Y", "I-GENE-Y", "I-GENE-Y", "I-GENE-Y", "O", "O", "O", "O", "O", "O", "O", "O" ]
Gonadotropin-releasing hormone antagonist in the management of prostate cancer.
[ "Gonadotropin", "-", "releasing", "hormone", "antagonist", "in", "the", "management", "of", "prostate", "cancer", "." ]
[ "GENE-Y", "CHEMICAL", "GENE-N" ]
Gonadotropin - releasing hormone is a GENE-Y
16985933_task1
Sentence: Gonadotropin-releasing hormone antagonist in the management of prostate cancer. Instructions: please typing these entity words according to sentence: Gonadotropin - releasing hormone Options: GENE-Y
[ "B-GENE-Y", "I-GENE-Y", "I-GENE-Y", "I-GENE-Y", "O", "O", "O", "O", "O", "O", "O", "O" ]
Gonadotropin-releasing hormone antagonist in the management of prostate cancer.
[ "Gonadotropin", "-", "releasing", "hormone", "antagonist", "in", "the", "management", "of", "prostate", "cancer", "." ]
[ "GENE-Y", "CHEMICAL", "GENE-N" ]
Gonadotropin - releasing hormone
16985933_task2
Sentence: Gonadotropin-releasing hormone antagonist in the management of prostate cancer. Instructions: please extract entity words from the input sentence
[ "B-GENE-Y", "I-GENE-Y", "I-GENE-Y", "I-GENE-Y", "O", "O", "O", "O", "O", "O", "O", "O" ]
Gonadotropin-releasing hormone antagonist in the management of prostate cancer.
[ "Gonadotropin", "-", "releasing", "hormone", "antagonist", "in", "the", "management", "of", "prostate", "cancer", "." ]
[ "GENE-Y", "CHEMICAL", "GENE-N" ]
interaction is an umlsterm, anxiety is an umlsterm, consciousness is an umlsterm, solution is an umlsterm, sublimations is an umlsterm, defense mechanisms is an umlsterm, society is an umlsterm, ego is an umlsterm
ForumDerPsychoanalyse.80140018.eng.abstr_task0
Sentence: The author investigates the relationships between the concept of functional pleasure as defined by Fenichel and some other psychoanalytic concepts . It is argued that in the realization of formations of repressed genital-sexual drive-wishes the erogenic pleasure which is intended changes into a functional pleasure in which successful defense can be subjectively experienced . At the beginning of a sexual interaction there is an anxiety whether it is possible to keep the repressed wishes with their substitutes out of consciousness . The pleasure-unpleasure-principle as defined by Freud is read as an unpleasure-functional pleasure-principle which is only valid for the realization of substitutes of the repressed . Furthermore the reasons for a solution of the oedipus complex as put forward by Freud are rejected and sublimations are understood as the result of different defense mechanisms which lead to substitutes of the repressed which are in accordance with society and the ego of an individual . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: umlsterm
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "I-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "O", "O" ]
The author investigates the relationships between the concept of functional pleasure as defined by Fenichel and some other psychoanalytic concepts . It is argued that in the realization of formations of repressed genital-sexual drive-wishes the erogenic pleasure which is intended changes into a functional pleasure in which successful defense can be subjectively experienced . At the beginning of a sexual interaction there is an anxiety whether it is possible to keep the repressed wishes with their substitutes out of consciousness . The pleasure-unpleasure-principle as defined by Freud is read as an unpleasure-functional pleasure-principle which is only valid for the realization of substitutes of the repressed . Furthermore the reasons for a solution of the oedipus complex as put forward by Freud are rejected and sublimations are understood as the result of different defense mechanisms which lead to substitutes of the repressed which are in accordance with society and the ego of an individual .
[ "The", "author", "investigates", "the", "relationships", "between", "the", "concept", "of", "functional", "pleasure", "as", "defined", "by", "Fenichel", "and", "some", "other", "psychoanalytic", "concepts", ".", "It", "is", "argued", "that", "in", "the", "realization", "of", "formations", "of", "repressed", "genital", "-", "sexual", "drive", "-", "wishes", "the", "erogenic", "pleasure", "which", "is", "intended", "changes", "into", "a", "functional", "pleasure", "in", "which", "successful", "defense", "can", "be", "subjectively", "experienced", ".", "At", "the", "beginning", "of", "a", "sexual", "interaction", "there", "is", "an", "anxiety", "whether", "it", "is", "possible", "to", "keep", "the", "repressed", "wishes", "with", "their", "substitutes", "out", "of", "consciousness", ".", "The", "pleasure", "-", "unpleasure", "-", "principle", "as", "defined", "by", "Freud", "is", "read", "as", "an", "unpleasure", "-", "functional", "pleasure", "-", "principle", "which", "is", "only", "valid", "for", "the", "realization", "of", "substitutes", "of", "the", "repressed", ".", "Furthermore", "the", "reasons", "for", "a", "solution", "of", "the", "oedipus", "complex", "as", "put", "forward", "by", "Freud", "are", "rejected", "and", "sublimations", "are", "understood", "as", "the", "result", "of", "different", "defense", "mechanisms", "which", "lead", "to", "substitutes", "of", "the", "repressed", "which", "are", "in", "accordance", "with", "society", "and", "the", "ego", "of", "an", "individual", "." ]
[ "umlsterm" ]
interaction is an umlsterm, anxiety is an umlsterm, consciousness is an umlsterm, solution is an umlsterm, sublimations is an umlsterm, defense mechanisms is an umlsterm, society is an umlsterm, ego is an umlsterm
ForumDerPsychoanalyse.80140018.eng.abstr_task1
Sentence: The author investigates the relationships between the concept of functional pleasure as defined by Fenichel and some other psychoanalytic concepts . It is argued that in the realization of formations of repressed genital-sexual drive-wishes the erogenic pleasure which is intended changes into a functional pleasure in which successful defense can be subjectively experienced . At the beginning of a sexual interaction there is an anxiety whether it is possible to keep the repressed wishes with their substitutes out of consciousness . The pleasure-unpleasure-principle as defined by Freud is read as an unpleasure-functional pleasure-principle which is only valid for the realization of substitutes of the repressed . Furthermore the reasons for a solution of the oedipus complex as put forward by Freud are rejected and sublimations are understood as the result of different defense mechanisms which lead to substitutes of the repressed which are in accordance with society and the ego of an individual . Instructions: please typing these entity words according to sentence: interaction, anxiety, consciousness, solution, sublimations, defense mechanisms, society, ego Options: umlsterm
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "I-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "O", "O" ]
The author investigates the relationships between the concept of functional pleasure as defined by Fenichel and some other psychoanalytic concepts . It is argued that in the realization of formations of repressed genital-sexual drive-wishes the erogenic pleasure which is intended changes into a functional pleasure in which successful defense can be subjectively experienced . At the beginning of a sexual interaction there is an anxiety whether it is possible to keep the repressed wishes with their substitutes out of consciousness . The pleasure-unpleasure-principle as defined by Freud is read as an unpleasure-functional pleasure-principle which is only valid for the realization of substitutes of the repressed . Furthermore the reasons for a solution of the oedipus complex as put forward by Freud are rejected and sublimations are understood as the result of different defense mechanisms which lead to substitutes of the repressed which are in accordance with society and the ego of an individual .
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[ "umlsterm" ]
interaction, anxiety, consciousness, solution, sublimations, defense mechanisms, society, ego
ForumDerPsychoanalyse.80140018.eng.abstr_task2
Sentence: The author investigates the relationships between the concept of functional pleasure as defined by Fenichel and some other psychoanalytic concepts . It is argued that in the realization of formations of repressed genital-sexual drive-wishes the erogenic pleasure which is intended changes into a functional pleasure in which successful defense can be subjectively experienced . At the beginning of a sexual interaction there is an anxiety whether it is possible to keep the repressed wishes with their substitutes out of consciousness . The pleasure-unpleasure-principle as defined by Freud is read as an unpleasure-functional pleasure-principle which is only valid for the realization of substitutes of the repressed . Furthermore the reasons for a solution of the oedipus complex as put forward by Freud are rejected and sublimations are understood as the result of different defense mechanisms which lead to substitutes of the repressed which are in accordance with society and the ego of an individual . Instructions: please extract entity words from the input sentence
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "I-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "O", "O" ]
The author investigates the relationships between the concept of functional pleasure as defined by Fenichel and some other psychoanalytic concepts . It is argued that in the realization of formations of repressed genital-sexual drive-wishes the erogenic pleasure which is intended changes into a functional pleasure in which successful defense can be subjectively experienced . At the beginning of a sexual interaction there is an anxiety whether it is possible to keep the repressed wishes with their substitutes out of consciousness . The pleasure-unpleasure-principle as defined by Freud is read as an unpleasure-functional pleasure-principle which is only valid for the realization of substitutes of the repressed . Furthermore the reasons for a solution of the oedipus complex as put forward by Freud are rejected and sublimations are understood as the result of different defense mechanisms which lead to substitutes of the repressed which are in accordance with society and the ego of an individual .
[ "The", "author", "investigates", "the", "relationships", "between", "the", "concept", "of", "functional", "pleasure", "as", "defined", "by", "Fenichel", "and", "some", "other", "psychoanalytic", "concepts", ".", "It", "is", "argued", "that", "in", "the", "realization", "of", "formations", "of", "repressed", "genital", "-", "sexual", "drive", "-", "wishes", "the", "erogenic", "pleasure", "which", "is", "intended", "changes", "into", "a", "functional", "pleasure", "in", "which", "successful", "defense", "can", "be", "subjectively", "experienced", ".", "At", "the", "beginning", "of", "a", "sexual", "interaction", "there", "is", "an", "anxiety", "whether", "it", "is", "possible", "to", "keep", "the", "repressed", "wishes", "with", "their", "substitutes", "out", "of", "consciousness", ".", "The", "pleasure", "-", "unpleasure", "-", "principle", "as", "defined", "by", "Freud", "is", "read", "as", "an", "unpleasure", "-", "functional", "pleasure", "-", "principle", "which", "is", "only", "valid", "for", "the", "realization", "of", "substitutes", "of", "the", "repressed", ".", "Furthermore", "the", "reasons", "for", "a", "solution", "of", "the", "oedipus", "complex", "as", "put", "forward", "by", "Freud", "are", "rejected", "and", "sublimations", "are", "understood", "as", "the", "result", "of", "different", "defense", "mechanisms", "which", "lead", "to", "substitutes", "of", "the", "repressed", "which", "are", "in", "accordance", "with", "society", "and", "the", "ego", "of", "an", "individual", "." ]
[ "umlsterm" ]
consumption is an umlsterm, ecstasy is an umlsterm, MDMA is an umlsterm, intoxications is an umlsterm, symptoms is an umlsterm, hyperthermia is an umlsterm, syndromes is an umlsterm, malignant hyperthermia is an umlsterm, neuroleptic malignant syndrome is an umlsterm, serotonin syndrome is an umlsterm, intoxication is an umlsterm, symptoms is an umlsterm, intensive - care is an umlsterm, therapy is an umlsterm, ecstasy is an umlsterm, review is an umlsterm
DerAnaesthesist.70460697.eng.abstr_task0
Sentence: The increased consumption of " ecstasy " ( MDMA , 3,4-methylenedioxy-methamphetamine) has also increased the number of life-threatening intoxications . From a Medline search of the years 1992-1996 , reports were registered and evaluated . Besides cerebral , cardiorespiratory , renal , and hepatic symptoms , hyperthermia syndromes such as malignant hyperthermia , neuroleptic malignant syndrome , or the serotonin syndrome were common . In addition to a discussion of the intoxication symptoms and their acute and intensive-care therapy , the psychological and physiological effects of " ecstasy " will be described . Some historical considerations of the topic are included in this review . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: umlsterm
[ "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "B-umlsterm", "O", "O", "B-umlsterm", "I-umlsterm", "O", "B-umlsterm", "I-umlsterm", "I-umlsterm", "O", "O", "O", "B-umlsterm", "I-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "O", "B-umlsterm", "I-umlsterm", "I-umlsterm", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O" ]
The increased consumption of " ecstasy " ( MDMA , 3,4-methylenedioxy-methamphetamine) has also increased the number of life-threatening intoxications . From a Medline search of the years 1992-1996 , reports were registered and evaluated . Besides cerebral , cardiorespiratory , renal , and hepatic symptoms , hyperthermia syndromes such as malignant hyperthermia , neuroleptic malignant syndrome , or the serotonin syndrome were common . In addition to a discussion of the intoxication symptoms and their acute and intensive-care therapy , the psychological and physiological effects of " ecstasy " will be described . Some historical considerations of the topic are included in this review .
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[ "umlsterm" ]
consumption is an umlsterm, ecstasy is an umlsterm, MDMA is an umlsterm, intoxications is an umlsterm, symptoms is an umlsterm, hyperthermia is an umlsterm, syndromes is an umlsterm, malignant hyperthermia is an umlsterm, neuroleptic malignant syndrome is an umlsterm, serotonin syndrome is an umlsterm, intoxication is an umlsterm, symptoms is an umlsterm, intensive - care is an umlsterm, therapy is an umlsterm, ecstasy is an umlsterm, review is an umlsterm
DerAnaesthesist.70460697.eng.abstr_task1
Sentence: The increased consumption of " ecstasy " ( MDMA , 3,4-methylenedioxy-methamphetamine) has also increased the number of life-threatening intoxications . From a Medline search of the years 1992-1996 , reports were registered and evaluated . Besides cerebral , cardiorespiratory , renal , and hepatic symptoms , hyperthermia syndromes such as malignant hyperthermia , neuroleptic malignant syndrome , or the serotonin syndrome were common . In addition to a discussion of the intoxication symptoms and their acute and intensive-care therapy , the psychological and physiological effects of " ecstasy " will be described . Some historical considerations of the topic are included in this review . Instructions: please typing these entity words according to sentence: consumption, ecstasy, MDMA, intoxications, symptoms, hyperthermia, syndromes, malignant hyperthermia, neuroleptic malignant syndrome, serotonin syndrome, intoxication, symptoms, intensive - care, therapy, ecstasy, review Options: umlsterm
[ "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "B-umlsterm", "O", "O", "B-umlsterm", "I-umlsterm", "O", "B-umlsterm", "I-umlsterm", "I-umlsterm", "O", "O", "O", "B-umlsterm", "I-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "O", "B-umlsterm", "I-umlsterm", "I-umlsterm", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O" ]
The increased consumption of " ecstasy " ( MDMA , 3,4-methylenedioxy-methamphetamine) has also increased the number of life-threatening intoxications . From a Medline search of the years 1992-1996 , reports were registered and evaluated . Besides cerebral , cardiorespiratory , renal , and hepatic symptoms , hyperthermia syndromes such as malignant hyperthermia , neuroleptic malignant syndrome , or the serotonin syndrome were common . In addition to a discussion of the intoxication symptoms and their acute and intensive-care therapy , the psychological and physiological effects of " ecstasy " will be described . Some historical considerations of the topic are included in this review .
[ "The", "increased", "consumption", "of", "\"", "ecstasy", "\"", "(", "MDMA", ",", "3,4-methylenedioxy", "-", "methamphetamine", ")", "has", "also", "increased", "the", "number", "of", "life", "-", "threatening", "intoxications", ".", "From", "a", "Medline", "search", "of", "the", "years", "1992", "-", "1996", ",", "reports", "were", "registered", "and", "evaluated", ".", "Besides", "cerebral", ",", "cardiorespiratory", ",", "renal", ",", "and", "hepatic", "symptoms", ",", "hyperthermia", "syndromes", "such", "as", "malignant", "hyperthermia", ",", "neuroleptic", "malignant", "syndrome", ",", "or", "the", "serotonin", "syndrome", "were", "common", ".", "In", "addition", "to", "a", "discussion", "of", "the", "intoxication", "symptoms", "and", "their", "acute", "and", "intensive", "-", "care", "therapy", ",", "the", "psychological", "and", "physiological", "effects", "of", "\"", "ecstasy", "\"", "will", "be", "described", ".", "Some", "historical", "considerations", "of", "the", "topic", "are", "included", "in", "this", "review", "." ]
[ "umlsterm" ]
consumption, ecstasy, MDMA, intoxications, symptoms, hyperthermia, syndromes, malignant hyperthermia, neuroleptic malignant syndrome, serotonin syndrome, intoxication, symptoms, intensive - care, therapy, ecstasy, review
DerAnaesthesist.70460697.eng.abstr_task2
Sentence: The increased consumption of " ecstasy " ( MDMA , 3,4-methylenedioxy-methamphetamine) has also increased the number of life-threatening intoxications . From a Medline search of the years 1992-1996 , reports were registered and evaluated . Besides cerebral , cardiorespiratory , renal , and hepatic symptoms , hyperthermia syndromes such as malignant hyperthermia , neuroleptic malignant syndrome , or the serotonin syndrome were common . In addition to a discussion of the intoxication symptoms and their acute and intensive-care therapy , the psychological and physiological effects of " ecstasy " will be described . Some historical considerations of the topic are included in this review . Instructions: please extract entity words from the input sentence
[ "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "B-umlsterm", "O", "O", "B-umlsterm", "I-umlsterm", "O", "B-umlsterm", "I-umlsterm", "I-umlsterm", "O", "O", "O", "B-umlsterm", "I-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "O", "B-umlsterm", "I-umlsterm", "I-umlsterm", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O" ]
The increased consumption of " ecstasy " ( MDMA , 3,4-methylenedioxy-methamphetamine) has also increased the number of life-threatening intoxications . From a Medline search of the years 1992-1996 , reports were registered and evaluated . Besides cerebral , cardiorespiratory , renal , and hepatic symptoms , hyperthermia syndromes such as malignant hyperthermia , neuroleptic malignant syndrome , or the serotonin syndrome were common . In addition to a discussion of the intoxication symptoms and their acute and intensive-care therapy , the psychological and physiological effects of " ecstasy " will be described . Some historical considerations of the topic are included in this review .
[ "The", "increased", "consumption", "of", "\"", "ecstasy", "\"", "(", "MDMA", ",", "3,4-methylenedioxy", "-", "methamphetamine", ")", "has", "also", "increased", "the", "number", "of", "life", "-", "threatening", "intoxications", ".", "From", "a", "Medline", "search", "of", "the", "years", "1992", "-", "1996", ",", "reports", "were", "registered", "and", "evaluated", ".", "Besides", "cerebral", ",", "cardiorespiratory", ",", "renal", ",", "and", "hepatic", "symptoms", ",", "hyperthermia", "syndromes", "such", "as", "malignant", "hyperthermia", ",", "neuroleptic", "malignant", "syndrome", ",", "or", "the", "serotonin", "syndrome", "were", "common", ".", "In", "addition", "to", "a", "discussion", "of", "the", "intoxication", "symptoms", "and", "their", "acute", "and", "intensive", "-", "care", "therapy", ",", "the", "psychological", "and", "physiological", "effects", "of", "\"", "ecstasy", "\"", "will", "be", "described", ".", "Some", "historical", "considerations", "of", "the", "topic", "are", "included", "in", "this", "review", "." ]
[ "umlsterm" ]
nocturnal growth hormone secretion is a Outcome_Physical, slow - wave sleep is a Outcome_Physical, GH is a Outcome_Physical, GHRH is a Intervention_Pharmacological, slow - wave sleep ( SWS ) is a Outcome_Physical, Healthy men ( 20 - 33 years old ) is a Participant_Condition, infusion of GHRH antagonist ( ( N - Ac - Tyr ( 1 ) , D - Arg ( 2 ) ) GHRH-29 ( NH ( 2 ) ) ) is a Intervention_Pharmacological, saline for a 12-h period is a Intervention_Control, Plasma GH concentrations is a Outcome_Physical, Effectiveness is a Outcome_Other, suppression of GH response is a Outcome_Physical, sleep parameters is a Outcome_Physical
19616_task0
Sentence: Blockade of endogenous growth hormone-releasing hormone receptors dissociates nocturnal growth hormone secretion and slow-wave sleep . OBJECTIVES A temporal association between non-rapid eye movement ( NREM ) sleep stages 3 and 4 and nocturnal augmentation of GH release was found long ago , yet the precise mechanism for this association has not been identified . It has been shown , however that pulsatile GHRH administration increases both slow-wave sleep ( SWS ) and GH . Based on these data , a role for GHRH as an inducer of SWS was proposed . To test this hypothesis , we have performed the corollary experiment whereby the action of endogenous GHRH has been antagonized . DESIGN Healthy men ( 20-33 years old ) had an infusion of GHRH antagonist ( ( N-Ac-Tyr ( 1 ) , D-Arg ( 2 ) ) GHRH-29 ( NH ( 2 ) ) ) or saline for a 12-h period , between 2100 and 0900 h. An i.v . bolus of GHRH was given at 0700 h and GH samples were drawn from 0700 to 0900 h to document the efficacy of GH suppression by the GHRH antagonist . METHODS A limited montage sleep study was recorded from 2300 to 0700 h during each admission . Plasma GH concentrations were analyzed by the use of a sensitive chemiluminometric assay . RESULTS Effectiveness of the GHRH antagonist was validated in all subjects by demonstrating 93+/-1.8 % ( P=0.012 ) suppression of GH response to a GHRH bolus . Polysomnography demonstrated that the percentage of SWS was not different when saline and GHRH antagonist nights were compared ( P=0.607 ) ; other quantifiable sleep parameters were also unchanged . CONCLUSIONS We conclude that endogenous GHRH is indispensable for the nocturnal augmentation of GH secretion , but that it is unlikely to participate in the genesis of SWS . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: Intervention_Pharmacological, Intervention_Control, Participant_Condition, Outcome_Physical, Outcome_Other
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Pharmacological", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "B-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "O", "B-Intervention_Control", "I-Intervention_Control", "I-Intervention_Control", "I-Intervention_Control", "I-Intervention_Control", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Other", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Blockade of endogenous growth hormone-releasing hormone receptors dissociates nocturnal growth hormone secretion and slow-wave sleep . OBJECTIVES A temporal association between non-rapid eye movement ( NREM ) sleep stages 3 and 4 and nocturnal augmentation of GH release was found long ago , yet the precise mechanism for this association has not been identified . It has been shown , however that pulsatile GHRH administration increases both slow-wave sleep ( SWS ) and GH . Based on these data , a role for GHRH as an inducer of SWS was proposed . To test this hypothesis , we have performed the corollary experiment whereby the action of endogenous GHRH has been antagonized . DESIGN Healthy men ( 20-33 years old ) had an infusion of GHRH antagonist ( ( N-Ac-Tyr ( 1 ) , D-Arg ( 2 ) ) GHRH-29 ( NH ( 2 ) ) ) or saline for a 12-h period , between 2100 and 0900 h. An i.v . bolus of GHRH was given at 0700 h and GH samples were drawn from 0700 to 0900 h to document the efficacy of GH suppression by the GHRH antagonist . METHODS A limited montage sleep study was recorded from 2300 to 0700 h during each admission . Plasma GH concentrations were analyzed by the use of a sensitive chemiluminometric assay . RESULTS Effectiveness of the GHRH antagonist was validated in all subjects by demonstrating 93+/-1.8 % ( P=0.012 ) suppression of GH response to a GHRH bolus . Polysomnography demonstrated that the percentage of SWS was not different when saline and GHRH antagonist nights were compared ( P=0.607 ) ; other quantifiable sleep parameters were also unchanged . CONCLUSIONS We conclude that endogenous GHRH is indispensable for the nocturnal augmentation of GH secretion , but that it is unlikely to participate in the genesis of SWS .
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[ "Intervention_Pharmacological", "Outcome_Physical", "Participant_Condition", "Intervention_Control", "Outcome_Other" ]
nocturnal growth hormone secretion is a Outcome_Physical, slow - wave sleep is a Outcome_Physical, GH is a Outcome_Physical, GHRH is a Intervention_Pharmacological, slow - wave sleep ( SWS ) is a Outcome_Physical, Healthy men ( 20 - 33 years old ) is a Participant_Condition, infusion of GHRH antagonist ( ( N - Ac - Tyr ( 1 ) , D - Arg ( 2 ) ) GHRH-29 ( NH ( 2 ) ) ) is a Intervention_Pharmacological, saline for a 12-h period is a Intervention_Control, Plasma GH concentrations is a Outcome_Physical, Effectiveness is a Outcome_Other, suppression of GH response is a Outcome_Physical, sleep parameters is a Outcome_Physical
19616_task1
Sentence: Blockade of endogenous growth hormone-releasing hormone receptors dissociates nocturnal growth hormone secretion and slow-wave sleep . OBJECTIVES A temporal association between non-rapid eye movement ( NREM ) sleep stages 3 and 4 and nocturnal augmentation of GH release was found long ago , yet the precise mechanism for this association has not been identified . It has been shown , however that pulsatile GHRH administration increases both slow-wave sleep ( SWS ) and GH . Based on these data , a role for GHRH as an inducer of SWS was proposed . To test this hypothesis , we have performed the corollary experiment whereby the action of endogenous GHRH has been antagonized . DESIGN Healthy men ( 20-33 years old ) had an infusion of GHRH antagonist ( ( N-Ac-Tyr ( 1 ) , D-Arg ( 2 ) ) GHRH-29 ( NH ( 2 ) ) ) or saline for a 12-h period , between 2100 and 0900 h. An i.v . bolus of GHRH was given at 0700 h and GH samples were drawn from 0700 to 0900 h to document the efficacy of GH suppression by the GHRH antagonist . METHODS A limited montage sleep study was recorded from 2300 to 0700 h during each admission . Plasma GH concentrations were analyzed by the use of a sensitive chemiluminometric assay . RESULTS Effectiveness of the GHRH antagonist was validated in all subjects by demonstrating 93+/-1.8 % ( P=0.012 ) suppression of GH response to a GHRH bolus . Polysomnography demonstrated that the percentage of SWS was not different when saline and GHRH antagonist nights were compared ( P=0.607 ) ; other quantifiable sleep parameters were also unchanged . CONCLUSIONS We conclude that endogenous GHRH is indispensable for the nocturnal augmentation of GH secretion , but that it is unlikely to participate in the genesis of SWS . Instructions: please typing these entity words according to sentence: nocturnal growth hormone secretion, slow - wave sleep, GH, GHRH, slow - wave sleep ( SWS ), Healthy men ( 20 - 33 years old ), infusion of GHRH antagonist ( ( N - Ac - Tyr ( 1 ) , D - Arg ( 2 ) ) GHRH-29 ( NH ( 2 ) ) ), saline for a 12-h period, Plasma GH concentrations, Effectiveness, suppression of GH response, sleep parameters Options: Intervention_Pharmacological, Intervention_Control, Participant_Condition, Outcome_Physical, Outcome_Other
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Pharmacological", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "B-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "O", "B-Intervention_Control", "I-Intervention_Control", "I-Intervention_Control", "I-Intervention_Control", "I-Intervention_Control", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Other", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Blockade of endogenous growth hormone-releasing hormone receptors dissociates nocturnal growth hormone secretion and slow-wave sleep . OBJECTIVES A temporal association between non-rapid eye movement ( NREM ) sleep stages 3 and 4 and nocturnal augmentation of GH release was found long ago , yet the precise mechanism for this association has not been identified . It has been shown , however that pulsatile GHRH administration increases both slow-wave sleep ( SWS ) and GH . Based on these data , a role for GHRH as an inducer of SWS was proposed . To test this hypothesis , we have performed the corollary experiment whereby the action of endogenous GHRH has been antagonized . DESIGN Healthy men ( 20-33 years old ) had an infusion of GHRH antagonist ( ( N-Ac-Tyr ( 1 ) , D-Arg ( 2 ) ) GHRH-29 ( NH ( 2 ) ) ) or saline for a 12-h period , between 2100 and 0900 h. An i.v . bolus of GHRH was given at 0700 h and GH samples were drawn from 0700 to 0900 h to document the efficacy of GH suppression by the GHRH antagonist . METHODS A limited montage sleep study was recorded from 2300 to 0700 h during each admission . Plasma GH concentrations were analyzed by the use of a sensitive chemiluminometric assay . RESULTS Effectiveness of the GHRH antagonist was validated in all subjects by demonstrating 93+/-1.8 % ( P=0.012 ) suppression of GH response to a GHRH bolus . Polysomnography demonstrated that the percentage of SWS was not different when saline and GHRH antagonist nights were compared ( P=0.607 ) ; other quantifiable sleep parameters were also unchanged . CONCLUSIONS We conclude that endogenous GHRH is indispensable for the nocturnal augmentation of GH secretion , but that it is unlikely to participate in the genesis of SWS .
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[ "Intervention_Pharmacological", "Outcome_Physical", "Participant_Condition", "Intervention_Control", "Outcome_Other" ]
nocturnal growth hormone secretion, slow - wave sleep, GH, GHRH, slow - wave sleep ( SWS ), Healthy men ( 20 - 33 years old ), infusion of GHRH antagonist ( ( N - Ac - Tyr ( 1 ) , D - Arg ( 2 ) ) GHRH-29 ( NH ( 2 ) ) ), saline for a 12-h period, Plasma GH concentrations, Effectiveness, suppression of GH response, sleep parameters
19616_task2
Sentence: Blockade of endogenous growth hormone-releasing hormone receptors dissociates nocturnal growth hormone secretion and slow-wave sleep . OBJECTIVES A temporal association between non-rapid eye movement ( NREM ) sleep stages 3 and 4 and nocturnal augmentation of GH release was found long ago , yet the precise mechanism for this association has not been identified . It has been shown , however that pulsatile GHRH administration increases both slow-wave sleep ( SWS ) and GH . Based on these data , a role for GHRH as an inducer of SWS was proposed . To test this hypothesis , we have performed the corollary experiment whereby the action of endogenous GHRH has been antagonized . DESIGN Healthy men ( 20-33 years old ) had an infusion of GHRH antagonist ( ( N-Ac-Tyr ( 1 ) , D-Arg ( 2 ) ) GHRH-29 ( NH ( 2 ) ) ) or saline for a 12-h period , between 2100 and 0900 h. An i.v . bolus of GHRH was given at 0700 h and GH samples were drawn from 0700 to 0900 h to document the efficacy of GH suppression by the GHRH antagonist . METHODS A limited montage sleep study was recorded from 2300 to 0700 h during each admission . Plasma GH concentrations were analyzed by the use of a sensitive chemiluminometric assay . RESULTS Effectiveness of the GHRH antagonist was validated in all subjects by demonstrating 93+/-1.8 % ( P=0.012 ) suppression of GH response to a GHRH bolus . Polysomnography demonstrated that the percentage of SWS was not different when saline and GHRH antagonist nights were compared ( P=0.607 ) ; other quantifiable sleep parameters were also unchanged . CONCLUSIONS We conclude that endogenous GHRH is indispensable for the nocturnal augmentation of GH secretion , but that it is unlikely to participate in the genesis of SWS . Instructions: please extract entity words from the input sentence
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Pharmacological", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "B-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "O", "B-Intervention_Control", "I-Intervention_Control", "I-Intervention_Control", "I-Intervention_Control", "I-Intervention_Control", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Other", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Blockade of endogenous growth hormone-releasing hormone receptors dissociates nocturnal growth hormone secretion and slow-wave sleep . OBJECTIVES A temporal association between non-rapid eye movement ( NREM ) sleep stages 3 and 4 and nocturnal augmentation of GH release was found long ago , yet the precise mechanism for this association has not been identified . It has been shown , however that pulsatile GHRH administration increases both slow-wave sleep ( SWS ) and GH . Based on these data , a role for GHRH as an inducer of SWS was proposed . To test this hypothesis , we have performed the corollary experiment whereby the action of endogenous GHRH has been antagonized . DESIGN Healthy men ( 20-33 years old ) had an infusion of GHRH antagonist ( ( N-Ac-Tyr ( 1 ) , D-Arg ( 2 ) ) GHRH-29 ( NH ( 2 ) ) ) or saline for a 12-h period , between 2100 and 0900 h. An i.v . bolus of GHRH was given at 0700 h and GH samples were drawn from 0700 to 0900 h to document the efficacy of GH suppression by the GHRH antagonist . METHODS A limited montage sleep study was recorded from 2300 to 0700 h during each admission . Plasma GH concentrations were analyzed by the use of a sensitive chemiluminometric assay . RESULTS Effectiveness of the GHRH antagonist was validated in all subjects by demonstrating 93+/-1.8 % ( P=0.012 ) suppression of GH response to a GHRH bolus . Polysomnography demonstrated that the percentage of SWS was not different when saline and GHRH antagonist nights were compared ( P=0.607 ) ; other quantifiable sleep parameters were also unchanged . CONCLUSIONS We conclude that endogenous GHRH is indispensable for the nocturnal augmentation of GH secretion , but that it is unlikely to participate in the genesis of SWS .
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[ "Intervention_Pharmacological", "Outcome_Physical", "Participant_Condition", "Intervention_Control", "Outcome_Other" ]
talin is a Individual_protein, actin is a Individual_protein, vinculin is a Individual_protein
746_task0
Sentence: The Pro1176 to Thr substitution found in talin from Wistar-Furth rats does not destroy the capacity of this region of the protein to bind actin or vinculin. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: Individual_protein
[ "O", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "O", "B-Individual_protein", "O" ]
The Pro1176 to Thr substitution found in talin from Wistar-Furth rats does not destroy the capacity of this region of the protein to bind actin or vinculin.
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[ "Individual_protein" ]
talin is a Individual_protein, actin is a Individual_protein, vinculin is a Individual_protein
746_task1
Sentence: The Pro1176 to Thr substitution found in talin from Wistar-Furth rats does not destroy the capacity of this region of the protein to bind actin or vinculin. Instructions: please typing these entity words according to sentence: talin, actin, vinculin Options: Individual_protein
[ "O", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "O", "B-Individual_protein", "O" ]
The Pro1176 to Thr substitution found in talin from Wistar-Furth rats does not destroy the capacity of this region of the protein to bind actin or vinculin.
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[ "Individual_protein" ]
talin, actin, vinculin
746_task2
Sentence: The Pro1176 to Thr substitution found in talin from Wistar-Furth rats does not destroy the capacity of this region of the protein to bind actin or vinculin. Instructions: please extract entity words from the input sentence
[ "O", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "O", "B-Individual_protein", "O" ]
The Pro1176 to Thr substitution found in talin from Wistar-Furth rats does not destroy the capacity of this region of the protein to bind actin or vinculin.
[ "The", "Pro1176", "to", "Thr", "substitution", "found", "in", "talin", "from", "Wistar", "-", "Furth", "rats", "does", "not", "destroy", "the", "capacity", "of", "this", "region", "of", "the", "protein", "to", "bind", "actin", "or", "vinculin", "." ]
[ "Individual_protein" ]
Women is a Person, = 3 is a Multiplier, UTIs is a Condition, within the last 12 months is a Temporal, = 2 is a Multiplier, UTIs is a Condition, within the last 6 months is a Temporal, Laboratory urine culture is a Measurement, < 103 CFUs is a Value, Age is a Person, > 18 years is a Value
NCT03497598_inc_task0
Sentence: Women = 3 UTIs within the last 12 months or = 2 UTIs within the last 6 months; Laboratory urine culture: <103 CFUs Age > 18 years Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: Temporal, Condition, Value, Person, Multiplier, Measurement
[ "B-Person", "O", "B-Multiplier", "I-Multiplier", "B-Condition", "B-Temporal", "I-Temporal", "I-Temporal", "I-Temporal", "I-Temporal", "O", "B-Multiplier", "I-Multiplier", "B-Condition", "B-Temporal", "I-Temporal", "I-Temporal", "I-Temporal", "I-Temporal", "O", "O", "B-Measurement", "I-Measurement", "I-Measurement", "O", "B-Value", "I-Value", "I-Value", "O", "B-Person", "B-Value", "I-Value", "I-Value", "O" ]
Women = 3 UTIs within the last 12 months or = 2 UTIs within the last 6 months; Laboratory urine culture: <103 CFUs Age > 18 years
[ "Women", "\n", "=", "3", "UTIs", "within", "the", "last", "12", "months", "or", "=", "2", "UTIs", "within", "the", "last", "6", "months", ";", "\n", "Laboratory", "urine", "culture", ":", "<", "103", "CFUs", "\n", "Age", ">", "18", "years", "\n" ]
[ "Temporal", "Measurement", "Value", "Person", "Condition", "Multiplier" ]
Women is a Person, = 3 is a Multiplier, UTIs is a Condition, within the last 12 months is a Temporal, = 2 is a Multiplier, UTIs is a Condition, within the last 6 months is a Temporal, Laboratory urine culture is a Measurement, < 103 CFUs is a Value, Age is a Person, > 18 years is a Value
NCT03497598_inc_task1
Sentence: Women = 3 UTIs within the last 12 months or = 2 UTIs within the last 6 months; Laboratory urine culture: <103 CFUs Age > 18 years Instructions: please typing these entity words according to sentence: Women, = 3, UTIs, within the last 12 months, = 2, UTIs, within the last 6 months, Laboratory urine culture, < 103 CFUs, Age, > 18 years Options: Temporal, Condition, Value, Person, Multiplier, Measurement
[ "B-Person", "O", "B-Multiplier", "I-Multiplier", "B-Condition", "B-Temporal", "I-Temporal", "I-Temporal", "I-Temporal", "I-Temporal", "O", "B-Multiplier", "I-Multiplier", "B-Condition", "B-Temporal", "I-Temporal", "I-Temporal", "I-Temporal", "I-Temporal", "O", "O", "B-Measurement", "I-Measurement", "I-Measurement", "O", "B-Value", "I-Value", "I-Value", "O", "B-Person", "B-Value", "I-Value", "I-Value", "O" ]
Women = 3 UTIs within the last 12 months or = 2 UTIs within the last 6 months; Laboratory urine culture: <103 CFUs Age > 18 years
[ "Women", "\n", "=", "3", "UTIs", "within", "the", "last", "12", "months", "or", "=", "2", "UTIs", "within", "the", "last", "6", "months", ";", "\n", "Laboratory", "urine", "culture", ":", "<", "103", "CFUs", "\n", "Age", ">", "18", "years", "\n" ]
[ "Temporal", "Measurement", "Value", "Person", "Condition", "Multiplier" ]
Women, = 3, UTIs, within the last 12 months, = 2, UTIs, within the last 6 months, Laboratory urine culture, < 103 CFUs, Age, > 18 years
NCT03497598_inc_task2
Sentence: Women = 3 UTIs within the last 12 months or = 2 UTIs within the last 6 months; Laboratory urine culture: <103 CFUs Age > 18 years Instructions: please extract entity words from the input sentence
[ "B-Person", "O", "B-Multiplier", "I-Multiplier", "B-Condition", "B-Temporal", "I-Temporal", "I-Temporal", "I-Temporal", "I-Temporal", "O", "B-Multiplier", "I-Multiplier", "B-Condition", "B-Temporal", "I-Temporal", "I-Temporal", "I-Temporal", "I-Temporal", "O", "O", "B-Measurement", "I-Measurement", "I-Measurement", "O", "B-Value", "I-Value", "I-Value", "O", "B-Person", "B-Value", "I-Value", "I-Value", "O" ]
Women = 3 UTIs within the last 12 months or = 2 UTIs within the last 6 months; Laboratory urine culture: <103 CFUs Age > 18 years
[ "Women", "\n", "=", "3", "UTIs", "within", "the", "last", "12", "months", "or", "=", "2", "UTIs", "within", "the", "last", "6", "months", ";", "\n", "Laboratory", "urine", "culture", ":", "<", "103", "CFUs", "\n", "Age", ">", "18", "years", "\n" ]
[ "Temporal", "Measurement", "Value", "Person", "Condition", "Multiplier" ]
disease is an umlsterm, treatment is an umlsterm, pigmented villonodular synovitis is an umlsterm, form is an umlsterm, literature is an umlsterm, surgical procedures is an umlsterm, open is an umlsterm, prevention is an umlsterm, disease progression is an umlsterm, joint is an umlsterm, dysfunction is an umlsterm, diagnosis is an umlsterm, patients is an umlsterm, time is an umlsterm, period is an umlsterm, patients is an umlsterm, patient is an umlsterm, arthrodesis is an umlsterm, MRI is an umlsterm, diagnosis is an umlsterm, treatment is an umlsterm, planning is an umlsterm, form is an umlsterm, diagnostic is an umlsterm, uncertainty is an umlsterm, synovium is an umlsterm, recurrence is an umlsterm, patients is an umlsterm, disease is an umlsterm, secondary is an umlsterm, joint is an umlsterm, findings is an umlsterm, surgical is an umlsterm, therapy is an umlsterm, surgical is an umlsterm, open is an umlsterm, form is an umlsterm, disease is an umlsterm, secondary is an umlsterm, joint is an umlsterm
DerChirurg.80690284.eng.abstr_task0
Sentence: Because this disease is so rare the optimum treatment of pigmented villonodular synovitis ( PVNS ) , in particular the diffuse form differs in the literature . The most important surgical procedures are arthroscopic and open synovectomy . The prevention of disease progression , as well as joint destruction and dysfunction , depends upon the early diagnosis of PVNS . During 1994 and 1995 , we treated four cases of PVNS surgically and followed the patients for a time period of more than 12 months . Two patients were treated with complete synovectomy , one patient underwent partial synovial resection , and in the final case an arthrodesis was performed . Our results indicate that an MRI is essential for diagnosis and treatment planning . For the localized form of PVNS , it appears that a partial synovectomy is appropriate . However , in the event of diagnostic uncertainty or obvious diffuse involvement of the synovium , a total synovectomy is indicated because of the high recurrence rate . In our study , all four patients had disease involving secondary bony lesions and , in one case , joint destruction . Based on our findings , it is clear that early surgical therapy is the only recommended curative intervention . The decision regarding the surgical approach , arthroscopic versus open , depends on the form of PVNS , the extent of the disease and secondary changes of the joint . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: umlsterm
[ "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "I-umlsterm", "I-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "B-umlsterm", "I-umlsterm", "O", "O", "O", "B-umlsterm", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "I-umlsterm", "O", "O", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "O", "B-umlsterm", "O" ]
Because this disease is so rare the optimum treatment of pigmented villonodular synovitis ( PVNS ) , in particular the diffuse form differs in the literature . The most important surgical procedures are arthroscopic and open synovectomy . The prevention of disease progression , as well as joint destruction and dysfunction , depends upon the early diagnosis of PVNS . During 1994 and 1995 , we treated four cases of PVNS surgically and followed the patients for a time period of more than 12 months . Two patients were treated with complete synovectomy , one patient underwent partial synovial resection , and in the final case an arthrodesis was performed . Our results indicate that an MRI is essential for diagnosis and treatment planning . For the localized form of PVNS , it appears that a partial synovectomy is appropriate . However , in the event of diagnostic uncertainty or obvious diffuse involvement of the synovium , a total synovectomy is indicated because of the high recurrence rate . In our study , all four patients had disease involving secondary bony lesions and , in one case , joint destruction . Based on our findings , it is clear that early surgical therapy is the only recommended curative intervention . The decision regarding the surgical approach , arthroscopic versus open , depends on the form of PVNS , the extent of the disease and secondary changes of the joint .
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[ "umlsterm" ]
disease is an umlsterm, treatment is an umlsterm, pigmented villonodular synovitis is an umlsterm, form is an umlsterm, literature is an umlsterm, surgical procedures is an umlsterm, open is an umlsterm, prevention is an umlsterm, disease progression is an umlsterm, joint is an umlsterm, dysfunction is an umlsterm, diagnosis is an umlsterm, patients is an umlsterm, time is an umlsterm, period is an umlsterm, patients is an umlsterm, patient is an umlsterm, arthrodesis is an umlsterm, MRI is an umlsterm, diagnosis is an umlsterm, treatment is an umlsterm, planning is an umlsterm, form is an umlsterm, diagnostic is an umlsterm, uncertainty is an umlsterm, synovium is an umlsterm, recurrence is an umlsterm, patients is an umlsterm, disease is an umlsterm, secondary is an umlsterm, joint is an umlsterm, findings is an umlsterm, surgical is an umlsterm, therapy is an umlsterm, surgical is an umlsterm, open is an umlsterm, form is an umlsterm, disease is an umlsterm, secondary is an umlsterm, joint is an umlsterm
DerChirurg.80690284.eng.abstr_task1
Sentence: Because this disease is so rare the optimum treatment of pigmented villonodular synovitis ( PVNS ) , in particular the diffuse form differs in the literature . The most important surgical procedures are arthroscopic and open synovectomy . The prevention of disease progression , as well as joint destruction and dysfunction , depends upon the early diagnosis of PVNS . During 1994 and 1995 , we treated four cases of PVNS surgically and followed the patients for a time period of more than 12 months . Two patients were treated with complete synovectomy , one patient underwent partial synovial resection , and in the final case an arthrodesis was performed . Our results indicate that an MRI is essential for diagnosis and treatment planning . For the localized form of PVNS , it appears that a partial synovectomy is appropriate . However , in the event of diagnostic uncertainty or obvious diffuse involvement of the synovium , a total synovectomy is indicated because of the high recurrence rate . In our study , all four patients had disease involving secondary bony lesions and , in one case , joint destruction . Based on our findings , it is clear that early surgical therapy is the only recommended curative intervention . The decision regarding the surgical approach , arthroscopic versus open , depends on the form of PVNS , the extent of the disease and secondary changes of the joint . Instructions: please typing these entity words according to sentence: disease, treatment, pigmented villonodular synovitis, form, literature, surgical procedures, open, prevention, disease progression, joint, dysfunction, diagnosis, patients, time, period, patients, patient, arthrodesis, MRI, diagnosis, treatment, planning, form, diagnostic, uncertainty, synovium, recurrence, patients, disease, secondary, joint, findings, surgical, therapy, surgical, open, form, disease, secondary, joint Options: umlsterm
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Because this disease is so rare the optimum treatment of pigmented villonodular synovitis ( PVNS ) , in particular the diffuse form differs in the literature . The most important surgical procedures are arthroscopic and open synovectomy . The prevention of disease progression , as well as joint destruction and dysfunction , depends upon the early diagnosis of PVNS . During 1994 and 1995 , we treated four cases of PVNS surgically and followed the patients for a time period of more than 12 months . Two patients were treated with complete synovectomy , one patient underwent partial synovial resection , and in the final case an arthrodesis was performed . Our results indicate that an MRI is essential for diagnosis and treatment planning . For the localized form of PVNS , it appears that a partial synovectomy is appropriate . However , in the event of diagnostic uncertainty or obvious diffuse involvement of the synovium , a total synovectomy is indicated because of the high recurrence rate . In our study , all four patients had disease involving secondary bony lesions and , in one case , joint destruction . Based on our findings , it is clear that early surgical therapy is the only recommended curative intervention . The decision regarding the surgical approach , arthroscopic versus open , depends on the form of PVNS , the extent of the disease and secondary changes of the joint .
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[ "umlsterm" ]
disease, treatment, pigmented villonodular synovitis, form, literature, surgical procedures, open, prevention, disease progression, joint, dysfunction, diagnosis, patients, time, period, patients, patient, arthrodesis, MRI, diagnosis, treatment, planning, form, diagnostic, uncertainty, synovium, recurrence, patients, disease, secondary, joint, findings, surgical, therapy, surgical, open, form, disease, secondary, joint
DerChirurg.80690284.eng.abstr_task2
Sentence: Because this disease is so rare the optimum treatment of pigmented villonodular synovitis ( PVNS ) , in particular the diffuse form differs in the literature . The most important surgical procedures are arthroscopic and open synovectomy . The prevention of disease progression , as well as joint destruction and dysfunction , depends upon the early diagnosis of PVNS . During 1994 and 1995 , we treated four cases of PVNS surgically and followed the patients for a time period of more than 12 months . Two patients were treated with complete synovectomy , one patient underwent partial synovial resection , and in the final case an arthrodesis was performed . Our results indicate that an MRI is essential for diagnosis and treatment planning . For the localized form of PVNS , it appears that a partial synovectomy is appropriate . However , in the event of diagnostic uncertainty or obvious diffuse involvement of the synovium , a total synovectomy is indicated because of the high recurrence rate . In our study , all four patients had disease involving secondary bony lesions and , in one case , joint destruction . Based on our findings , it is clear that early surgical therapy is the only recommended curative intervention . The decision regarding the surgical approach , arthroscopic versus open , depends on the form of PVNS , the extent of the disease and secondary changes of the joint . Instructions: please extract entity words from the input sentence
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Because this disease is so rare the optimum treatment of pigmented villonodular synovitis ( PVNS ) , in particular the diffuse form differs in the literature . The most important surgical procedures are arthroscopic and open synovectomy . The prevention of disease progression , as well as joint destruction and dysfunction , depends upon the early diagnosis of PVNS . During 1994 and 1995 , we treated four cases of PVNS surgically and followed the patients for a time period of more than 12 months . Two patients were treated with complete synovectomy , one patient underwent partial synovial resection , and in the final case an arthrodesis was performed . Our results indicate that an MRI is essential for diagnosis and treatment planning . For the localized form of PVNS , it appears that a partial synovectomy is appropriate . However , in the event of diagnostic uncertainty or obvious diffuse involvement of the synovium , a total synovectomy is indicated because of the high recurrence rate . In our study , all four patients had disease involving secondary bony lesions and , in one case , joint destruction . Based on our findings , it is clear that early surgical therapy is the only recommended curative intervention . The decision regarding the surgical approach , arthroscopic versus open , depends on the form of PVNS , the extent of the disease and secondary changes of the joint .
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[ "umlsterm" ]
FLI is a protein-family, actin is a protein
1.0alpha7.train.731_task0
Sentence: Thus, FLI bound actin specifically. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: protein-family, protein
[ "O", "O", "O", "B-protein-family", "O", "O", "B-protein", "O", "O" ]
Thus, FLI bound actin specifically.
[ "Thus", ",", " ", "FLI", "bound", " ", "actin", "specifically", "." ]
[ "protein", "protein-family" ]
FLI is a protein-family, actin is a protein
1.0alpha7.train.731_task1
Sentence: Thus, FLI bound actin specifically. Instructions: please typing these entity words according to sentence: FLI, actin Options: protein-family, protein
[ "O", "O", "O", "B-protein-family", "O", "O", "B-protein", "O", "O" ]
Thus, FLI bound actin specifically.
[ "Thus", ",", " ", "FLI", "bound", " ", "actin", "specifically", "." ]
[ "protein", "protein-family" ]
FLI, actin
1.0alpha7.train.731_task2
Sentence: Thus, FLI bound actin specifically. Instructions: please extract entity words from the input sentence
[ "O", "O", "O", "B-protein-family", "O", "O", "B-protein", "O", "O" ]
Thus, FLI bound actin specifically.
[ "Thus", ",", " ", "FLI", "bound", " ", "actin", "specifically", "." ]
[ "protein", "protein-family" ]
Munc18 - 2 is a Individual_protein, syntaxin 3 is a Individual_protein, syntaxin is a Individual_protein, Sec1 is a Individual_protein
79_task0
Sentence: Even the Munc18-2 mutants that do not detectably bind syntaxin 3 were membrane associated in Caco-2 cells, suggesting that the syntaxin interaction is not the sole determinant of Sec1 protein membrane attachment. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: Individual_protein
[ "O", "O", "B-Individual_protein", "I-Individual_protein", "I-Individual_protein", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "I-Individual_protein", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "O", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "O", "O", "O", "O" ]
Even the Munc18-2 mutants that do not detectably bind syntaxin 3 were membrane associated in Caco-2 cells, suggesting that the syntaxin interaction is not the sole determinant of Sec1 protein membrane attachment.
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[ "Individual_protein" ]
Munc18 - 2 is a Individual_protein, syntaxin 3 is a Individual_protein, syntaxin is a Individual_protein, Sec1 is a Individual_protein
79_task1
Sentence: Even the Munc18-2 mutants that do not detectably bind syntaxin 3 were membrane associated in Caco-2 cells, suggesting that the syntaxin interaction is not the sole determinant of Sec1 protein membrane attachment. Instructions: please typing these entity words according to sentence: Munc18 - 2, syntaxin 3, syntaxin, Sec1 Options: Individual_protein
[ "O", "O", "B-Individual_protein", "I-Individual_protein", "I-Individual_protein", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "I-Individual_protein", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "O", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "O", "O", "O", "O" ]
Even the Munc18-2 mutants that do not detectably bind syntaxin 3 were membrane associated in Caco-2 cells, suggesting that the syntaxin interaction is not the sole determinant of Sec1 protein membrane attachment.
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[ "Individual_protein" ]
Munc18 - 2, syntaxin 3, syntaxin, Sec1
79_task2
Sentence: Even the Munc18-2 mutants that do not detectably bind syntaxin 3 were membrane associated in Caco-2 cells, suggesting that the syntaxin interaction is not the sole determinant of Sec1 protein membrane attachment. Instructions: please extract entity words from the input sentence
[ "O", "O", "B-Individual_protein", "I-Individual_protein", "I-Individual_protein", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "I-Individual_protein", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "O", "O", "O", "O", "O", "O", "O", "B-Individual_protein", "O", "O", "O", "O" ]
Even the Munc18-2 mutants that do not detectably bind syntaxin 3 were membrane associated in Caco-2 cells, suggesting that the syntaxin interaction is not the sole determinant of Sec1 protein membrane attachment.
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[ "Individual_protein" ]
stomach cancer is a Diseases & Disorders, Poland is a Diseases & Disorders
3959_task0
Sentence: Genetic polymorphisms in alcohol metabolism, alcohol intake and the risk of stomach cancer in Warsaw, Poland. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: Diseases & Disorders
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Diseases & Disorders", "I-Diseases & Disorders", "O", "O", "O", "B-Diseases & Disorders", "O" ]
Genetic polymorphisms in alcohol metabolism, alcohol intake and the risk of stomach cancer in Warsaw, Poland.
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[ "SNP & Sequence variations", "Genes & Molecular Sequences", "", "Diseases & Disorders" ]
stomach cancer is a Diseases & Disorders, Poland is a Diseases & Disorders
3959_task1
Sentence: Genetic polymorphisms in alcohol metabolism, alcohol intake and the risk of stomach cancer in Warsaw, Poland. Instructions: please typing these entity words according to sentence: stomach cancer, Poland Options: Diseases & Disorders
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Diseases & Disorders", "I-Diseases & Disorders", "O", "O", "O", "B-Diseases & Disorders", "O" ]
Genetic polymorphisms in alcohol metabolism, alcohol intake and the risk of stomach cancer in Warsaw, Poland.
[ "Genetic", "polymorphisms", "in", "alcohol", "metabolism", ",", "alcohol", "intake", "and", "the", "risk", "of", "stomach", "cancer", "in", "Warsaw", ",", "Poland", "." ]
[ "SNP & Sequence variations", "Genes & Molecular Sequences", "", "Diseases & Disorders" ]
stomach cancer, Poland
3959_task2
Sentence: Genetic polymorphisms in alcohol metabolism, alcohol intake and the risk of stomach cancer in Warsaw, Poland. Instructions: please extract entity words from the input sentence
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Diseases & Disorders", "I-Diseases & Disorders", "O", "O", "O", "B-Diseases & Disorders", "O" ]
Genetic polymorphisms in alcohol metabolism, alcohol intake and the risk of stomach cancer in Warsaw, Poland.
[ "Genetic", "polymorphisms", "in", "alcohol", "metabolism", ",", "alcohol", "intake", "and", "the", "risk", "of", "stomach", "cancer", "in", "Warsaw", ",", "Poland", "." ]
[ "SNP & Sequence variations", "Genes & Molecular Sequences", "", "Diseases & Disorders" ]
Manuel is a NOMBRE_SUJETO_ASISTENCIA, Fernandez Garcia is a NOMBRE_SUJETO_ASISTENCIA, 874136 is a ID_SUJETO_ASISTENCIA, 78 64154213 22 is a ID_ASEGURAMIENTO, León is a TERRITORIO, 24094 is a TERRITORIO, 24/04/1965 is a FECHAS, España is a PAIS, 60 años is a EDAD_SUJETO_ASISTENCIA, 25/07/2015 is a FECHAS, Alicia Calleja Fernández is a NOMBRE_PERSONAL_SANITARIO, varón is a SEXO_SUJETO_ASISTENCIA, 60 años is a EDAD_SUJETO_ASISTENCIA, 2004 is a FECHAS, julio de 2008 is a FECHAS, Nestlé Healthcare Nutrition is a INSTITUCION, 2005 is a FECHAS, Alicia Calleja Fernández is a NOMBRE_PERSONAL_SANITARIO, Complejo Asistencial de León is a HOSPITAL, 24008 is a TERRITORIO, León is a TERRITORIO, España is a PAIS, calleja.alicia@gmail.com is a CORREO_ELECTRONICO
140_task0
Sentence: Nombre: Manuel. Apellidos: Fernandez Garcia. NHC: 874136. NASS: 78 64154213 22. Domicilio: Calle Fray Luis de León, 20 7D. Localidad/ Provincia: León. CP: 24094. Datos asistenciales. Fecha de nacimiento: 24/04/1965. País: España. Edad: 60 años Sexo: H. Fecha de Ingreso: 25/07/2015. ServicIO: Endocrinología y Nutrición. Médico: Alicia Calleja Fernández NºCol:24 24 61574. Episodio del paciente: Se trata de un varón de 60 años con antecedentes personales de cardiopatía isquémica (sufrió un infarto agudo de miocardio en 2004) y es ex-fumador. El paciente no presentaba alergias conocidas a medicamentos ni a alimentos. En julio de 2008 fue diagnosticado de amiloidosis primaria y síndrome nefrótico. Al alta hospitalaria recibió unas recomendaciones nutricionales del servicio de Nefrología para realizar una dieta baja en sodio y grasa, así como para la exclusión de alimentos proteicos. Para ello el paciente debía cocer todos los alimentos, no utilizar sal de mesa, y no podía utilizar ninguna otra técnica culinaria (fritura, plancha, asado, microondas, etc.), así como no ingerir los segundos platos (carne, pescado y huevos). El tratamiento farmacológico que recibe en la actualidad es omeprazol, candesartán, enalapril, atorvastatina, ácido acetilsalicílico, ezetimibe, furosemida, barnidipino y espironolactona. Acude a la consulta de dietoterapia para pautar una dieta ajustada a sus necesidades nutricionales. En la consulta inicial se realizó una historia nutricional que incluyó una valoración antropométrica completa, bioquímica y análisis de la ingesta a través de una encuesta dietética de 3 días analizada con el programa Dietsource 3.0 ®Nestlé Healthcare Nutrition (Edición del 2005). Las características de la ingesta basal figuran en la tabla I, junto con las recomendaciones nutricionales para el paciente con síndrome nefrótico: dieta restrictiva en proteínas, sal y perfil lipídico rico en ácidos grasos monoinsaturados y poliinsaturados3. En la exploración inicial se obtuvieron los siguientes resultados: • Antropometría: peso 86,7 kg, talla 171 cm, IMC 29,65 kg/m2. La composición corporal se midió a través de impedancia bioeléctrica (TANITA TBF 300®): 56,1 litros de agua (64,7%), 76,6 kg de masa magra (88.4%) y 10,1 kg de masa grasa (11,6%). El paciente presentaba edemas con fóvea hasta las rodillas. • Analítica: Creatinina: 0,95 (valores normales 0,5-1,1) mg/dL, Filtrado Glomerular: > 60 ml/min/1,72 m2, P: 3,31 (valores normales 2,5-4,5) mg/dL, K: 4,23 (valores normales 3,6-5) mmol/L, Proteínas Totales: 3,8 (valores normales 6.2 - 8) gr/dL. Albúmina: 1.74 (valores normales 3,5-5) gr/dL y prealbúmina: 20 (valores normales 10-40) g/dL. Proteinuria: 14,55 g/24 h. Colesterol total: 180 (valores normales 100-200) mg/dL, Triglicéridos: 110 (valores normales 50-150) mg/dL, HDL: 44 mg/dL (valores normales 40-65), LDL: 68,8 mg/dL, Ácido úrico: 7,23 mg/dL (valores normales 2,4-7). Se elaboró una dieta acorde a las recomendaciones3, según las características del paciente, gustos, costumbres y horarios. Las características nutricionales de la dieta se recogen en la tabla I y la dieta calibrada para el paciente en la tabla II. Tras seis meses realizando la dieta el paciente presentó los siguientes datos: Antropometría: peso 79,4 kg, IMC 27,15 kg/m2. La composición corporal medida con la misma técnica que en la visita inicial indicó 46,5 litros de agua (58,6%), 63,5 kg de masa magra (80,0%) y 15,9 kg de masa grasa (20,0%). Los edemas habían disminuido y estaban presentes sólo en la zona perimaleolar. Analítica: Creatinina: 1,58 mg/100, Filtrado Glomerular: 48 ml/min/1,72 m2. P: 4,4 mg/dL y K: 5,37 mmol/L. Proteínas totales: 4,8 g/L, albúmina: 3,15 mg/dL y prealbúmina: 36,9 mg/dL. Proteinuria: 2.1 g/24 h. Colesterol total: 140 mg/dL, Triglicéridos: 88 mg/dL, HDL: 64 mg/dL, LDL: 58,4 mg/dL, Ácido úrico: 10,75 mg/dL. Adherencia a la dieta: La ingesta dietética se recogió en un recordatorio de 24 horas y se analizó con el mismo programa informático que en la visita inicial. Los datos figuran en la tabla I. En la actualidad el paciente continúa con la dieta pautada y sigue acudiendo a la consulta de dietoterapia bimensualmente. Remitido por: Alicia Calleja Fernández. Sección de Endocrinología y Nutrición. Complejo Asistencial de León. Altos de Nava, s/n. 24008 León, España. E-mail: calleja.alicia@gmail.com Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: TERRITORIO, SEXO_SUJETO_ASISTENCIA, ID_SUJETO_ASISTENCIA, FECHAS, HOSPITAL, CORREO_ELECTRONICO, PAIS, EDAD_SUJETO_ASISTENCIA, INSTITUCION, ID_ASEGURAMIENTO, NOMBRE_SUJETO_ASISTENCIA, NOMBRE_PERSONAL_SANITARIO
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Nombre: Manuel. Apellidos: Fernandez Garcia. NHC: 874136. NASS: 78 64154213 22. Domicilio: Calle Fray Luis de León, 20 7D. Localidad/ Provincia: León. CP: 24094. Datos asistenciales. Fecha de nacimiento: 24/04/1965. País: España. Edad: 60 años Sexo: H. Fecha de Ingreso: 25/07/2015. ServicIO: Endocrinología y Nutrición. Médico: Alicia Calleja Fernández NºCol:24 24 61574. Episodio del paciente: Se trata de un varón de 60 años con antecedentes personales de cardiopatía isquémica (sufrió un infarto agudo de miocardio en 2004) y es ex-fumador. El paciente no presentaba alergias conocidas a medicamentos ni a alimentos. En julio de 2008 fue diagnosticado de amiloidosis primaria y síndrome nefrótico. Al alta hospitalaria recibió unas recomendaciones nutricionales del servicio de Nefrología para realizar una dieta baja en sodio y grasa, así como para la exclusión de alimentos proteicos. Para ello el paciente debía cocer todos los alimentos, no utilizar sal de mesa, y no podía utilizar ninguna otra técnica culinaria (fritura, plancha, asado, microondas, etc.), así como no ingerir los segundos platos (carne, pescado y huevos). El tratamiento farmacológico que recibe en la actualidad es omeprazol, candesartán, enalapril, atorvastatina, ácido acetilsalicílico, ezetimibe, furosemida, barnidipino y espironolactona. Acude a la consulta de dietoterapia para pautar una dieta ajustada a sus necesidades nutricionales. En la consulta inicial se realizó una historia nutricional que incluyó una valoración antropométrica completa, bioquímica y análisis de la ingesta a través de una encuesta dietética de 3 días analizada con el programa Dietsource 3.0 ®Nestlé Healthcare Nutrition (Edición del 2005). Las características de la ingesta basal figuran en la tabla I, junto con las recomendaciones nutricionales para el paciente con síndrome nefrótico: dieta restrictiva en proteínas, sal y perfil lipídico rico en ácidos grasos monoinsaturados y poliinsaturados3. En la exploración inicial se obtuvieron los siguientes resultados: • Antropometría: peso 86,7 kg, talla 171 cm, IMC 29,65 kg/m2. La composición corporal se midió a través de impedancia bioeléctrica (TANITA TBF 300®): 56,1 litros de agua (64,7%), 76,6 kg de masa magra (88.4%) y 10,1 kg de masa grasa (11,6%). El paciente presentaba edemas con fóvea hasta las rodillas. • Analítica: Creatinina: 0,95 (valores normales 0,5-1,1) mg/dL, Filtrado Glomerular: > 60 ml/min/1,72 m2, P: 3,31 (valores normales 2,5-4,5) mg/dL, K: 4,23 (valores normales 3,6-5) mmol/L, Proteínas Totales: 3,8 (valores normales 6.2 - 8) gr/dL. Albúmina: 1.74 (valores normales 3,5-5) gr/dL y prealbúmina: 20 (valores normales 10-40) g/dL. Proteinuria: 14,55 g/24 h. Colesterol total: 180 (valores normales 100-200) mg/dL, Triglicéridos: 110 (valores normales 50-150) mg/dL, HDL: 44 mg/dL (valores normales 40-65), LDL: 68,8 mg/dL, Ácido úrico: 7,23 mg/dL (valores normales 2,4-7). Se elaboró una dieta acorde a las recomendaciones3, según las características del paciente, gustos, costumbres y horarios. Las características nutricionales de la dieta se recogen en la tabla I y la dieta calibrada para el paciente en la tabla II. Tras seis meses realizando la dieta el paciente presentó los siguientes datos: Antropometría: peso 79,4 kg, IMC 27,15 kg/m2. La composición corporal medida con la misma técnica que en la visita inicial indicó 46,5 litros de agua (58,6%), 63,5 kg de masa magra (80,0%) y 15,9 kg de masa grasa (20,0%). Los edemas habían disminuido y estaban presentes sólo en la zona perimaleolar. Analítica: Creatinina: 1,58 mg/100, Filtrado Glomerular: 48 ml/min/1,72 m2. P: 4,4 mg/dL y K: 5,37 mmol/L. Proteínas totales: 4,8 g/L, albúmina: 3,15 mg/dL y prealbúmina: 36,9 mg/dL. Proteinuria: 2.1 g/24 h. Colesterol total: 140 mg/dL, Triglicéridos: 88 mg/dL, HDL: 64 mg/dL, LDL: 58,4 mg/dL, Ácido úrico: 10,75 mg/dL. Adherencia a la dieta: La ingesta dietética se recogió en un recordatorio de 24 horas y se analizó con el mismo programa informático que en la visita inicial. Los datos figuran en la tabla I. En la actualidad el paciente continúa con la dieta pautada y sigue acudiendo a la consulta de dietoterapia bimensualmente. Remitido por: Alicia Calleja Fernández. Sección de Endocrinología y Nutrición. Complejo Asistencial de León. Altos de Nava, s/n. 24008 León, España. E-mail: calleja.alicia@gmail.com
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Manuel is a NOMBRE_SUJETO_ASISTENCIA, Fernandez Garcia is a NOMBRE_SUJETO_ASISTENCIA, 874136 is a ID_SUJETO_ASISTENCIA, 78 64154213 22 is a ID_ASEGURAMIENTO, León is a TERRITORIO, 24094 is a TERRITORIO, 24/04/1965 is a FECHAS, España is a PAIS, 60 años is a EDAD_SUJETO_ASISTENCIA, 25/07/2015 is a FECHAS, Alicia Calleja Fernández is a NOMBRE_PERSONAL_SANITARIO, varón is a SEXO_SUJETO_ASISTENCIA, 60 años is a EDAD_SUJETO_ASISTENCIA, 2004 is a FECHAS, julio de 2008 is a FECHAS, Nestlé Healthcare Nutrition is a INSTITUCION, 2005 is a FECHAS, Alicia Calleja Fernández is a NOMBRE_PERSONAL_SANITARIO, Complejo Asistencial de León is a HOSPITAL, 24008 is a TERRITORIO, León is a TERRITORIO, España is a PAIS, calleja.alicia@gmail.com is a CORREO_ELECTRONICO
140_task1
Sentence: Nombre: Manuel. Apellidos: Fernandez Garcia. NHC: 874136. NASS: 78 64154213 22. Domicilio: Calle Fray Luis de León, 20 7D. Localidad/ Provincia: León. CP: 24094. Datos asistenciales. Fecha de nacimiento: 24/04/1965. País: España. Edad: 60 años Sexo: H. Fecha de Ingreso: 25/07/2015. ServicIO: Endocrinología y Nutrición. Médico: Alicia Calleja Fernández NºCol:24 24 61574. Episodio del paciente: Se trata de un varón de 60 años con antecedentes personales de cardiopatía isquémica (sufrió un infarto agudo de miocardio en 2004) y es ex-fumador. El paciente no presentaba alergias conocidas a medicamentos ni a alimentos. En julio de 2008 fue diagnosticado de amiloidosis primaria y síndrome nefrótico. Al alta hospitalaria recibió unas recomendaciones nutricionales del servicio de Nefrología para realizar una dieta baja en sodio y grasa, así como para la exclusión de alimentos proteicos. Para ello el paciente debía cocer todos los alimentos, no utilizar sal de mesa, y no podía utilizar ninguna otra técnica culinaria (fritura, plancha, asado, microondas, etc.), así como no ingerir los segundos platos (carne, pescado y huevos). El tratamiento farmacológico que recibe en la actualidad es omeprazol, candesartán, enalapril, atorvastatina, ácido acetilsalicílico, ezetimibe, furosemida, barnidipino y espironolactona. Acude a la consulta de dietoterapia para pautar una dieta ajustada a sus necesidades nutricionales. En la consulta inicial se realizó una historia nutricional que incluyó una valoración antropométrica completa, bioquímica y análisis de la ingesta a través de una encuesta dietética de 3 días analizada con el programa Dietsource 3.0 ®Nestlé Healthcare Nutrition (Edición del 2005). Las características de la ingesta basal figuran en la tabla I, junto con las recomendaciones nutricionales para el paciente con síndrome nefrótico: dieta restrictiva en proteínas, sal y perfil lipídico rico en ácidos grasos monoinsaturados y poliinsaturados3. En la exploración inicial se obtuvieron los siguientes resultados: • Antropometría: peso 86,7 kg, talla 171 cm, IMC 29,65 kg/m2. La composición corporal se midió a través de impedancia bioeléctrica (TANITA TBF 300®): 56,1 litros de agua (64,7%), 76,6 kg de masa magra (88.4%) y 10,1 kg de masa grasa (11,6%). El paciente presentaba edemas con fóvea hasta las rodillas. • Analítica: Creatinina: 0,95 (valores normales 0,5-1,1) mg/dL, Filtrado Glomerular: > 60 ml/min/1,72 m2, P: 3,31 (valores normales 2,5-4,5) mg/dL, K: 4,23 (valores normales 3,6-5) mmol/L, Proteínas Totales: 3,8 (valores normales 6.2 - 8) gr/dL. Albúmina: 1.74 (valores normales 3,5-5) gr/dL y prealbúmina: 20 (valores normales 10-40) g/dL. Proteinuria: 14,55 g/24 h. Colesterol total: 180 (valores normales 100-200) mg/dL, Triglicéridos: 110 (valores normales 50-150) mg/dL, HDL: 44 mg/dL (valores normales 40-65), LDL: 68,8 mg/dL, Ácido úrico: 7,23 mg/dL (valores normales 2,4-7). Se elaboró una dieta acorde a las recomendaciones3, según las características del paciente, gustos, costumbres y horarios. Las características nutricionales de la dieta se recogen en la tabla I y la dieta calibrada para el paciente en la tabla II. Tras seis meses realizando la dieta el paciente presentó los siguientes datos: Antropometría: peso 79,4 kg, IMC 27,15 kg/m2. La composición corporal medida con la misma técnica que en la visita inicial indicó 46,5 litros de agua (58,6%), 63,5 kg de masa magra (80,0%) y 15,9 kg de masa grasa (20,0%). Los edemas habían disminuido y estaban presentes sólo en la zona perimaleolar. Analítica: Creatinina: 1,58 mg/100, Filtrado Glomerular: 48 ml/min/1,72 m2. P: 4,4 mg/dL y K: 5,37 mmol/L. Proteínas totales: 4,8 g/L, albúmina: 3,15 mg/dL y prealbúmina: 36,9 mg/dL. Proteinuria: 2.1 g/24 h. Colesterol total: 140 mg/dL, Triglicéridos: 88 mg/dL, HDL: 64 mg/dL, LDL: 58,4 mg/dL, Ácido úrico: 10,75 mg/dL. Adherencia a la dieta: La ingesta dietética se recogió en un recordatorio de 24 horas y se analizó con el mismo programa informático que en la visita inicial. Los datos figuran en la tabla I. En la actualidad el paciente continúa con la dieta pautada y sigue acudiendo a la consulta de dietoterapia bimensualmente. Remitido por: Alicia Calleja Fernández. Sección de Endocrinología y Nutrición. Complejo Asistencial de León. Altos de Nava, s/n. 24008 León, España. E-mail: calleja.alicia@gmail.com Instructions: please typing these entity words according to sentence: Manuel, Fernandez Garcia, 874136, 78 64154213 22, León, 24094, 24/04/1965, España, 60 años, 25/07/2015, Alicia Calleja Fernández, varón, 60 años, 2004, julio de 2008, Nestlé Healthcare Nutrition, 2005, Alicia Calleja Fernández, Complejo Asistencial de León, 24008, León, España, calleja.alicia@gmail.com Options: TERRITORIO, SEXO_SUJETO_ASISTENCIA, ID_SUJETO_ASISTENCIA, FECHAS, HOSPITAL, CORREO_ELECTRONICO, PAIS, EDAD_SUJETO_ASISTENCIA, INSTITUCION, ID_ASEGURAMIENTO, NOMBRE_SUJETO_ASISTENCIA, NOMBRE_PERSONAL_SANITARIO
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Nombre: Manuel. Apellidos: Fernandez Garcia. NHC: 874136. NASS: 78 64154213 22. Domicilio: Calle Fray Luis de León, 20 7D. Localidad/ Provincia: León. CP: 24094. Datos asistenciales. Fecha de nacimiento: 24/04/1965. País: España. Edad: 60 años Sexo: H. Fecha de Ingreso: 25/07/2015. ServicIO: Endocrinología y Nutrición. Médico: Alicia Calleja Fernández NºCol:24 24 61574. Episodio del paciente: Se trata de un varón de 60 años con antecedentes personales de cardiopatía isquémica (sufrió un infarto agudo de miocardio en 2004) y es ex-fumador. El paciente no presentaba alergias conocidas a medicamentos ni a alimentos. En julio de 2008 fue diagnosticado de amiloidosis primaria y síndrome nefrótico. Al alta hospitalaria recibió unas recomendaciones nutricionales del servicio de Nefrología para realizar una dieta baja en sodio y grasa, así como para la exclusión de alimentos proteicos. Para ello el paciente debía cocer todos los alimentos, no utilizar sal de mesa, y no podía utilizar ninguna otra técnica culinaria (fritura, plancha, asado, microondas, etc.), así como no ingerir los segundos platos (carne, pescado y huevos). El tratamiento farmacológico que recibe en la actualidad es omeprazol, candesartán, enalapril, atorvastatina, ácido acetilsalicílico, ezetimibe, furosemida, barnidipino y espironolactona. Acude a la consulta de dietoterapia para pautar una dieta ajustada a sus necesidades nutricionales. En la consulta inicial se realizó una historia nutricional que incluyó una valoración antropométrica completa, bioquímica y análisis de la ingesta a través de una encuesta dietética de 3 días analizada con el programa Dietsource 3.0 ®Nestlé Healthcare Nutrition (Edición del 2005). Las características de la ingesta basal figuran en la tabla I, junto con las recomendaciones nutricionales para el paciente con síndrome nefrótico: dieta restrictiva en proteínas, sal y perfil lipídico rico en ácidos grasos monoinsaturados y poliinsaturados3. En la exploración inicial se obtuvieron los siguientes resultados: • Antropometría: peso 86,7 kg, talla 171 cm, IMC 29,65 kg/m2. La composición corporal se midió a través de impedancia bioeléctrica (TANITA TBF 300®): 56,1 litros de agua (64,7%), 76,6 kg de masa magra (88.4%) y 10,1 kg de masa grasa (11,6%). El paciente presentaba edemas con fóvea hasta las rodillas. • Analítica: Creatinina: 0,95 (valores normales 0,5-1,1) mg/dL, Filtrado Glomerular: > 60 ml/min/1,72 m2, P: 3,31 (valores normales 2,5-4,5) mg/dL, K: 4,23 (valores normales 3,6-5) mmol/L, Proteínas Totales: 3,8 (valores normales 6.2 - 8) gr/dL. Albúmina: 1.74 (valores normales 3,5-5) gr/dL y prealbúmina: 20 (valores normales 10-40) g/dL. Proteinuria: 14,55 g/24 h. Colesterol total: 180 (valores normales 100-200) mg/dL, Triglicéridos: 110 (valores normales 50-150) mg/dL, HDL: 44 mg/dL (valores normales 40-65), LDL: 68,8 mg/dL, Ácido úrico: 7,23 mg/dL (valores normales 2,4-7). Se elaboró una dieta acorde a las recomendaciones3, según las características del paciente, gustos, costumbres y horarios. Las características nutricionales de la dieta se recogen en la tabla I y la dieta calibrada para el paciente en la tabla II. Tras seis meses realizando la dieta el paciente presentó los siguientes datos: Antropometría: peso 79,4 kg, IMC 27,15 kg/m2. La composición corporal medida con la misma técnica que en la visita inicial indicó 46,5 litros de agua (58,6%), 63,5 kg de masa magra (80,0%) y 15,9 kg de masa grasa (20,0%). Los edemas habían disminuido y estaban presentes sólo en la zona perimaleolar. Analítica: Creatinina: 1,58 mg/100, Filtrado Glomerular: 48 ml/min/1,72 m2. P: 4,4 mg/dL y K: 5,37 mmol/L. Proteínas totales: 4,8 g/L, albúmina: 3,15 mg/dL y prealbúmina: 36,9 mg/dL. Proteinuria: 2.1 g/24 h. Colesterol total: 140 mg/dL, Triglicéridos: 88 mg/dL, HDL: 64 mg/dL, LDL: 58,4 mg/dL, Ácido úrico: 10,75 mg/dL. Adherencia a la dieta: La ingesta dietética se recogió en un recordatorio de 24 horas y se analizó con el mismo programa informático que en la visita inicial. Los datos figuran en la tabla I. En la actualidad el paciente continúa con la dieta pautada y sigue acudiendo a la consulta de dietoterapia bimensualmente. Remitido por: Alicia Calleja Fernández. Sección de Endocrinología y Nutrición. Complejo Asistencial de León. Altos de Nava, s/n. 24008 León, España. E-mail: calleja.alicia@gmail.com
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[ "CALLE", "HOSPITAL", "INSTITUCION", "CORREO_ELECTRONICO", "NOMBRE_PERSONAL_SANITARIO", "NOMBRE_SUJETO_ASISTENCIA", "ID_ASEGURAMIENTO", "FECHAS", "ID_TITULACION_PERSONAL_SANITARIO", "EDAD_SUJETO_ASISTENCIA", "PAIS", "ID_SUJETO_ASISTENCIA", "TERRITORIO", "SEXO_SUJETO_ASISTENCIA" ]
Manuel, Fernandez Garcia, 874136, 78 64154213 22, León, 24094, 24/04/1965, España, 60 años, 25/07/2015, Alicia Calleja Fernández, varón, 60 años, 2004, julio de 2008, Nestlé Healthcare Nutrition, 2005, Alicia Calleja Fernández, Complejo Asistencial de León, 24008, León, España, calleja.alicia@gmail.com
140_task2
Sentence: Nombre: Manuel. Apellidos: Fernandez Garcia. NHC: 874136. NASS: 78 64154213 22. Domicilio: Calle Fray Luis de León, 20 7D. Localidad/ Provincia: León. CP: 24094. Datos asistenciales. Fecha de nacimiento: 24/04/1965. País: España. Edad: 60 años Sexo: H. Fecha de Ingreso: 25/07/2015. ServicIO: Endocrinología y Nutrición. Médico: Alicia Calleja Fernández NºCol:24 24 61574. Episodio del paciente: Se trata de un varón de 60 años con antecedentes personales de cardiopatía isquémica (sufrió un infarto agudo de miocardio en 2004) y es ex-fumador. El paciente no presentaba alergias conocidas a medicamentos ni a alimentos. En julio de 2008 fue diagnosticado de amiloidosis primaria y síndrome nefrótico. Al alta hospitalaria recibió unas recomendaciones nutricionales del servicio de Nefrología para realizar una dieta baja en sodio y grasa, así como para la exclusión de alimentos proteicos. Para ello el paciente debía cocer todos los alimentos, no utilizar sal de mesa, y no podía utilizar ninguna otra técnica culinaria (fritura, plancha, asado, microondas, etc.), así como no ingerir los segundos platos (carne, pescado y huevos). El tratamiento farmacológico que recibe en la actualidad es omeprazol, candesartán, enalapril, atorvastatina, ácido acetilsalicílico, ezetimibe, furosemida, barnidipino y espironolactona. Acude a la consulta de dietoterapia para pautar una dieta ajustada a sus necesidades nutricionales. En la consulta inicial se realizó una historia nutricional que incluyó una valoración antropométrica completa, bioquímica y análisis de la ingesta a través de una encuesta dietética de 3 días analizada con el programa Dietsource 3.0 ®Nestlé Healthcare Nutrition (Edición del 2005). Las características de la ingesta basal figuran en la tabla I, junto con las recomendaciones nutricionales para el paciente con síndrome nefrótico: dieta restrictiva en proteínas, sal y perfil lipídico rico en ácidos grasos monoinsaturados y poliinsaturados3. En la exploración inicial se obtuvieron los siguientes resultados: • Antropometría: peso 86,7 kg, talla 171 cm, IMC 29,65 kg/m2. La composición corporal se midió a través de impedancia bioeléctrica (TANITA TBF 300®): 56,1 litros de agua (64,7%), 76,6 kg de masa magra (88.4%) y 10,1 kg de masa grasa (11,6%). El paciente presentaba edemas con fóvea hasta las rodillas. • Analítica: Creatinina: 0,95 (valores normales 0,5-1,1) mg/dL, Filtrado Glomerular: > 60 ml/min/1,72 m2, P: 3,31 (valores normales 2,5-4,5) mg/dL, K: 4,23 (valores normales 3,6-5) mmol/L, Proteínas Totales: 3,8 (valores normales 6.2 - 8) gr/dL. Albúmina: 1.74 (valores normales 3,5-5) gr/dL y prealbúmina: 20 (valores normales 10-40) g/dL. Proteinuria: 14,55 g/24 h. Colesterol total: 180 (valores normales 100-200) mg/dL, Triglicéridos: 110 (valores normales 50-150) mg/dL, HDL: 44 mg/dL (valores normales 40-65), LDL: 68,8 mg/dL, Ácido úrico: 7,23 mg/dL (valores normales 2,4-7). Se elaboró una dieta acorde a las recomendaciones3, según las características del paciente, gustos, costumbres y horarios. Las características nutricionales de la dieta se recogen en la tabla I y la dieta calibrada para el paciente en la tabla II. Tras seis meses realizando la dieta el paciente presentó los siguientes datos: Antropometría: peso 79,4 kg, IMC 27,15 kg/m2. La composición corporal medida con la misma técnica que en la visita inicial indicó 46,5 litros de agua (58,6%), 63,5 kg de masa magra (80,0%) y 15,9 kg de masa grasa (20,0%). Los edemas habían disminuido y estaban presentes sólo en la zona perimaleolar. Analítica: Creatinina: 1,58 mg/100, Filtrado Glomerular: 48 ml/min/1,72 m2. P: 4,4 mg/dL y K: 5,37 mmol/L. Proteínas totales: 4,8 g/L, albúmina: 3,15 mg/dL y prealbúmina: 36,9 mg/dL. Proteinuria: 2.1 g/24 h. Colesterol total: 140 mg/dL, Triglicéridos: 88 mg/dL, HDL: 64 mg/dL, LDL: 58,4 mg/dL, Ácido úrico: 10,75 mg/dL. Adherencia a la dieta: La ingesta dietética se recogió en un recordatorio de 24 horas y se analizó con el mismo programa informático que en la visita inicial. Los datos figuran en la tabla I. En la actualidad el paciente continúa con la dieta pautada y sigue acudiendo a la consulta de dietoterapia bimensualmente. Remitido por: Alicia Calleja Fernández. Sección de Endocrinología y Nutrición. Complejo Asistencial de León. Altos de Nava, s/n. 24008 León, España. E-mail: calleja.alicia@gmail.com Instructions: please extract entity words from the input sentence
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Nombre: Manuel. Apellidos: Fernandez Garcia. NHC: 874136. NASS: 78 64154213 22. Domicilio: Calle Fray Luis de León, 20 7D. Localidad/ Provincia: León. CP: 24094. Datos asistenciales. Fecha de nacimiento: 24/04/1965. País: España. Edad: 60 años Sexo: H. Fecha de Ingreso: 25/07/2015. ServicIO: Endocrinología y Nutrición. Médico: Alicia Calleja Fernández NºCol:24 24 61574. Episodio del paciente: Se trata de un varón de 60 años con antecedentes personales de cardiopatía isquémica (sufrió un infarto agudo de miocardio en 2004) y es ex-fumador. El paciente no presentaba alergias conocidas a medicamentos ni a alimentos. En julio de 2008 fue diagnosticado de amiloidosis primaria y síndrome nefrótico. Al alta hospitalaria recibió unas recomendaciones nutricionales del servicio de Nefrología para realizar una dieta baja en sodio y grasa, así como para la exclusión de alimentos proteicos. Para ello el paciente debía cocer todos los alimentos, no utilizar sal de mesa, y no podía utilizar ninguna otra técnica culinaria (fritura, plancha, asado, microondas, etc.), así como no ingerir los segundos platos (carne, pescado y huevos). El tratamiento farmacológico que recibe en la actualidad es omeprazol, candesartán, enalapril, atorvastatina, ácido acetilsalicílico, ezetimibe, furosemida, barnidipino y espironolactona. Acude a la consulta de dietoterapia para pautar una dieta ajustada a sus necesidades nutricionales. En la consulta inicial se realizó una historia nutricional que incluyó una valoración antropométrica completa, bioquímica y análisis de la ingesta a través de una encuesta dietética de 3 días analizada con el programa Dietsource 3.0 ®Nestlé Healthcare Nutrition (Edición del 2005). Las características de la ingesta basal figuran en la tabla I, junto con las recomendaciones nutricionales para el paciente con síndrome nefrótico: dieta restrictiva en proteínas, sal y perfil lipídico rico en ácidos grasos monoinsaturados y poliinsaturados3. En la exploración inicial se obtuvieron los siguientes resultados: • Antropometría: peso 86,7 kg, talla 171 cm, IMC 29,65 kg/m2. La composición corporal se midió a través de impedancia bioeléctrica (TANITA TBF 300®): 56,1 litros de agua (64,7%), 76,6 kg de masa magra (88.4%) y 10,1 kg de masa grasa (11,6%). El paciente presentaba edemas con fóvea hasta las rodillas. • Analítica: Creatinina: 0,95 (valores normales 0,5-1,1) mg/dL, Filtrado Glomerular: > 60 ml/min/1,72 m2, P: 3,31 (valores normales 2,5-4,5) mg/dL, K: 4,23 (valores normales 3,6-5) mmol/L, Proteínas Totales: 3,8 (valores normales 6.2 - 8) gr/dL. Albúmina: 1.74 (valores normales 3,5-5) gr/dL y prealbúmina: 20 (valores normales 10-40) g/dL. Proteinuria: 14,55 g/24 h. Colesterol total: 180 (valores normales 100-200) mg/dL, Triglicéridos: 110 (valores normales 50-150) mg/dL, HDL: 44 mg/dL (valores normales 40-65), LDL: 68,8 mg/dL, Ácido úrico: 7,23 mg/dL (valores normales 2,4-7). Se elaboró una dieta acorde a las recomendaciones3, según las características del paciente, gustos, costumbres y horarios. Las características nutricionales de la dieta se recogen en la tabla I y la dieta calibrada para el paciente en la tabla II. Tras seis meses realizando la dieta el paciente presentó los siguientes datos: Antropometría: peso 79,4 kg, IMC 27,15 kg/m2. La composición corporal medida con la misma técnica que en la visita inicial indicó 46,5 litros de agua (58,6%), 63,5 kg de masa magra (80,0%) y 15,9 kg de masa grasa (20,0%). Los edemas habían disminuido y estaban presentes sólo en la zona perimaleolar. Analítica: Creatinina: 1,58 mg/100, Filtrado Glomerular: 48 ml/min/1,72 m2. P: 4,4 mg/dL y K: 5,37 mmol/L. Proteínas totales: 4,8 g/L, albúmina: 3,15 mg/dL y prealbúmina: 36,9 mg/dL. Proteinuria: 2.1 g/24 h. Colesterol total: 140 mg/dL, Triglicéridos: 88 mg/dL, HDL: 64 mg/dL, LDL: 58,4 mg/dL, Ácido úrico: 10,75 mg/dL. Adherencia a la dieta: La ingesta dietética se recogió en un recordatorio de 24 horas y se analizó con el mismo programa informático que en la visita inicial. Los datos figuran en la tabla I. En la actualidad el paciente continúa con la dieta pautada y sigue acudiendo a la consulta de dietoterapia bimensualmente. Remitido por: Alicia Calleja Fernández. Sección de Endocrinología y Nutrición. Complejo Asistencial de León. Altos de Nava, s/n. 24008 León, España. E-mail: calleja.alicia@gmail.com
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[ "CALLE", "HOSPITAL", "INSTITUCION", "CORREO_ELECTRONICO", "NOMBRE_PERSONAL_SANITARIO", "NOMBRE_SUJETO_ASISTENCIA", "ID_ASEGURAMIENTO", "FECHAS", "ID_TITULACION_PERSONAL_SANITARIO", "EDAD_SUJETO_ASISTENCIA", "PAIS", "ID_SUJETO_ASISTENCIA", "TERRITORIO", "SEXO_SUJETO_ASISTENCIA" ]
adenocarcinoma is a MORFOLOGIA_NEOPLASIA, implantes peritoneales is a MORFOLOGIA_NEOPLASIA, adenocarcinoma mucinoso bien diferenciado , con aisladas células en anillo de sello is a MORFOLOGIA_NEOPLASIA, Adenocarcinoma mucinoso de uraco estadio IV por afectación peritoneal is a MORFOLOGIA_NEOPLASIA, tumor is a MORFOLOGIA_NEOPLASIA, progresión peritoneal is a MORFOLOGIA_NEOPLASIA
357_task0
Sentence: Anamnesis » Se trata de un paciente de 86 años intervenido en noviembre de 2016 de un adenocarcinoma de uraco estadio II, sin recibir tratamiento complementario. » Datos sociales: 83 años. Vive con su esposa y un hijo. » Enfermedades previas: hipertrofia prostática benigna. No tiene metabolopatías crónicas. Hipoacusia. » Medicación previa: omeprazol 20 mg si precisa, tamsulosina 0,4 mg. Exploración física Exploración física y analítica básica sin particularidades. Pruebas complementarias Los marcadores tumorales evidencian un CEA de 12 y un CA 19,9 de 9.404. Se realiza en agosto de 2017 una TC corporal en la que se evidencia abundante líquido libre intraperitoneal con realce de las hojas pleurales y múltiples implantes sólidos de distribución dispersa. La Anatomía Patológica de uno de los implantes peritoneales evidencia un adenocarcinoma mucinoso bien diferenciado, con aisladas células en anillo de sello. Diagnóstico Adenocarcinoma mucinoso de uraco estadio IV por afectación peritoneal. Tratamiento 1ª línea de tratamiento sistémico: gemcitabina + capecitabina. 2ª línea de tratamiento sistémico: irinotecán + panitumumab. 3ª línea de tratamiento sistémico: oxaliplatino. Evolución Dadas las alteraciones genéticas presentes en este tipo de tumor, descritas recientemente en una serie de 70 casos por Reis H, van der Vos KE et al., publicada en 2018, se solicitan estudios concluyendo ausencia de amplificación del HER-2 y ausencia de mutación en KRAS y BRAF. Dada la buena situación funcional del paciente a pesar de su edad, se decide inicio de tratamiento sistémico ajustado a las características del paciente. No se considera adecuado el uso de tripletes ni de fármacos como cisplatino o doxorrubicina. Se inicia monoterapia con gemcitabina al que posteriormente, dada la excelente tolerancia clínica y analítica, se añade capecitabina. En diciembre de 2018, tras 14 meses desde el inicio del tratamiento, el paciente presenta progresión peritoneal, por lo que se inicia una segunda línea de tratamiento sistémico con irinotecán y panitumumab, que se mantiene durante 4 meses, hasta nueva progresión frente a la que se pautó una tercera línea con oxaliplatino. Dado el empeoramiento progresivo de la enfermedad, con palpación abdominal de diversas nodulaciones, se decide la suspensión de tratamiento activo y se mantiene exclusivamente el tratamiento sintomático, con seguimiento por la Unidad de Cuidados Paliativos. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: MORFOLOGIA_NEOPLASIA
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Anamnesis » Se trata de un paciente de 86 años intervenido en noviembre de 2016 de un adenocarcinoma de uraco estadio II, sin recibir tratamiento complementario. » Datos sociales: 83 años. Vive con su esposa y un hijo. » Enfermedades previas: hipertrofia prostática benigna. No tiene metabolopatías crónicas. Hipoacusia. » Medicación previa: omeprazol 20 mg si precisa, tamsulosina 0,4 mg. Exploración física Exploración física y analítica básica sin particularidades. Pruebas complementarias Los marcadores tumorales evidencian un CEA de 12 y un CA 19,9 de 9.404. Se realiza en agosto de 2017 una TC corporal en la que se evidencia abundante líquido libre intraperitoneal con realce de las hojas pleurales y múltiples implantes sólidos de distribución dispersa. La Anatomía Patológica de uno de los implantes peritoneales evidencia un adenocarcinoma mucinoso bien diferenciado, con aisladas células en anillo de sello. Diagnóstico Adenocarcinoma mucinoso de uraco estadio IV por afectación peritoneal. Tratamiento 1ª línea de tratamiento sistémico: gemcitabina + capecitabina. 2ª línea de tratamiento sistémico: irinotecán + panitumumab. 3ª línea de tratamiento sistémico: oxaliplatino. Evolución Dadas las alteraciones genéticas presentes en este tipo de tumor, descritas recientemente en una serie de 70 casos por Reis H, van der Vos KE et al., publicada en 2018, se solicitan estudios concluyendo ausencia de amplificación del HER-2 y ausencia de mutación en KRAS y BRAF. Dada la buena situación funcional del paciente a pesar de su edad, se decide inicio de tratamiento sistémico ajustado a las características del paciente. No se considera adecuado el uso de tripletes ni de fármacos como cisplatino o doxorrubicina. Se inicia monoterapia con gemcitabina al que posteriormente, dada la excelente tolerancia clínica y analítica, se añade capecitabina. En diciembre de 2018, tras 14 meses desde el inicio del tratamiento, el paciente presenta progresión peritoneal, por lo que se inicia una segunda línea de tratamiento sistémico con irinotecán y panitumumab, que se mantiene durante 4 meses, hasta nueva progresión frente a la que se pautó una tercera línea con oxaliplatino. Dado el empeoramiento progresivo de la enfermedad, con palpación abdominal de diversas nodulaciones, se decide la suspensión de tratamiento activo y se mantiene exclusivamente el tratamiento sintomático, con seguimiento por la Unidad de Cuidados Paliativos.
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[ "MORFOLOGIA_NEOPLASIA" ]
adenocarcinoma is a MORFOLOGIA_NEOPLASIA, implantes peritoneales is a MORFOLOGIA_NEOPLASIA, adenocarcinoma mucinoso bien diferenciado , con aisladas células en anillo de sello is a MORFOLOGIA_NEOPLASIA, Adenocarcinoma mucinoso de uraco estadio IV por afectación peritoneal is a MORFOLOGIA_NEOPLASIA, tumor is a MORFOLOGIA_NEOPLASIA, progresión peritoneal is a MORFOLOGIA_NEOPLASIA
357_task1
Sentence: Anamnesis » Se trata de un paciente de 86 años intervenido en noviembre de 2016 de un adenocarcinoma de uraco estadio II, sin recibir tratamiento complementario. » Datos sociales: 83 años. Vive con su esposa y un hijo. » Enfermedades previas: hipertrofia prostática benigna. No tiene metabolopatías crónicas. Hipoacusia. » Medicación previa: omeprazol 20 mg si precisa, tamsulosina 0,4 mg. Exploración física Exploración física y analítica básica sin particularidades. Pruebas complementarias Los marcadores tumorales evidencian un CEA de 12 y un CA 19,9 de 9.404. Se realiza en agosto de 2017 una TC corporal en la que se evidencia abundante líquido libre intraperitoneal con realce de las hojas pleurales y múltiples implantes sólidos de distribución dispersa. La Anatomía Patológica de uno de los implantes peritoneales evidencia un adenocarcinoma mucinoso bien diferenciado, con aisladas células en anillo de sello. Diagnóstico Adenocarcinoma mucinoso de uraco estadio IV por afectación peritoneal. Tratamiento 1ª línea de tratamiento sistémico: gemcitabina + capecitabina. 2ª línea de tratamiento sistémico: irinotecán + panitumumab. 3ª línea de tratamiento sistémico: oxaliplatino. Evolución Dadas las alteraciones genéticas presentes en este tipo de tumor, descritas recientemente en una serie de 70 casos por Reis H, van der Vos KE et al., publicada en 2018, se solicitan estudios concluyendo ausencia de amplificación del HER-2 y ausencia de mutación en KRAS y BRAF. Dada la buena situación funcional del paciente a pesar de su edad, se decide inicio de tratamiento sistémico ajustado a las características del paciente. No se considera adecuado el uso de tripletes ni de fármacos como cisplatino o doxorrubicina. Se inicia monoterapia con gemcitabina al que posteriormente, dada la excelente tolerancia clínica y analítica, se añade capecitabina. En diciembre de 2018, tras 14 meses desde el inicio del tratamiento, el paciente presenta progresión peritoneal, por lo que se inicia una segunda línea de tratamiento sistémico con irinotecán y panitumumab, que se mantiene durante 4 meses, hasta nueva progresión frente a la que se pautó una tercera línea con oxaliplatino. Dado el empeoramiento progresivo de la enfermedad, con palpación abdominal de diversas nodulaciones, se decide la suspensión de tratamiento activo y se mantiene exclusivamente el tratamiento sintomático, con seguimiento por la Unidad de Cuidados Paliativos. Instructions: please typing these entity words according to sentence: adenocarcinoma, implantes peritoneales, adenocarcinoma mucinoso bien diferenciado , con aisladas células en anillo de sello, Adenocarcinoma mucinoso de uraco estadio IV por afectación peritoneal, tumor, progresión peritoneal Options: MORFOLOGIA_NEOPLASIA
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Anamnesis » Se trata de un paciente de 86 años intervenido en noviembre de 2016 de un adenocarcinoma de uraco estadio II, sin recibir tratamiento complementario. » Datos sociales: 83 años. Vive con su esposa y un hijo. » Enfermedades previas: hipertrofia prostática benigna. No tiene metabolopatías crónicas. Hipoacusia. » Medicación previa: omeprazol 20 mg si precisa, tamsulosina 0,4 mg. Exploración física Exploración física y analítica básica sin particularidades. Pruebas complementarias Los marcadores tumorales evidencian un CEA de 12 y un CA 19,9 de 9.404. Se realiza en agosto de 2017 una TC corporal en la que se evidencia abundante líquido libre intraperitoneal con realce de las hojas pleurales y múltiples implantes sólidos de distribución dispersa. La Anatomía Patológica de uno de los implantes peritoneales evidencia un adenocarcinoma mucinoso bien diferenciado, con aisladas células en anillo de sello. Diagnóstico Adenocarcinoma mucinoso de uraco estadio IV por afectación peritoneal. Tratamiento 1ª línea de tratamiento sistémico: gemcitabina + capecitabina. 2ª línea de tratamiento sistémico: irinotecán + panitumumab. 3ª línea de tratamiento sistémico: oxaliplatino. Evolución Dadas las alteraciones genéticas presentes en este tipo de tumor, descritas recientemente en una serie de 70 casos por Reis H, van der Vos KE et al., publicada en 2018, se solicitan estudios concluyendo ausencia de amplificación del HER-2 y ausencia de mutación en KRAS y BRAF. Dada la buena situación funcional del paciente a pesar de su edad, se decide inicio de tratamiento sistémico ajustado a las características del paciente. No se considera adecuado el uso de tripletes ni de fármacos como cisplatino o doxorrubicina. Se inicia monoterapia con gemcitabina al que posteriormente, dada la excelente tolerancia clínica y analítica, se añade capecitabina. En diciembre de 2018, tras 14 meses desde el inicio del tratamiento, el paciente presenta progresión peritoneal, por lo que se inicia una segunda línea de tratamiento sistémico con irinotecán y panitumumab, que se mantiene durante 4 meses, hasta nueva progresión frente a la que se pautó una tercera línea con oxaliplatino. Dado el empeoramiento progresivo de la enfermedad, con palpación abdominal de diversas nodulaciones, se decide la suspensión de tratamiento activo y se mantiene exclusivamente el tratamiento sintomático, con seguimiento por la Unidad de Cuidados Paliativos.
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[ "MORFOLOGIA_NEOPLASIA" ]
adenocarcinoma, implantes peritoneales, adenocarcinoma mucinoso bien diferenciado , con aisladas células en anillo de sello, Adenocarcinoma mucinoso de uraco estadio IV por afectación peritoneal, tumor, progresión peritoneal
357_task2
Sentence: Anamnesis » Se trata de un paciente de 86 años intervenido en noviembre de 2016 de un adenocarcinoma de uraco estadio II, sin recibir tratamiento complementario. » Datos sociales: 83 años. Vive con su esposa y un hijo. » Enfermedades previas: hipertrofia prostática benigna. No tiene metabolopatías crónicas. Hipoacusia. » Medicación previa: omeprazol 20 mg si precisa, tamsulosina 0,4 mg. Exploración física Exploración física y analítica básica sin particularidades. Pruebas complementarias Los marcadores tumorales evidencian un CEA de 12 y un CA 19,9 de 9.404. Se realiza en agosto de 2017 una TC corporal en la que se evidencia abundante líquido libre intraperitoneal con realce de las hojas pleurales y múltiples implantes sólidos de distribución dispersa. La Anatomía Patológica de uno de los implantes peritoneales evidencia un adenocarcinoma mucinoso bien diferenciado, con aisladas células en anillo de sello. Diagnóstico Adenocarcinoma mucinoso de uraco estadio IV por afectación peritoneal. Tratamiento 1ª línea de tratamiento sistémico: gemcitabina + capecitabina. 2ª línea de tratamiento sistémico: irinotecán + panitumumab. 3ª línea de tratamiento sistémico: oxaliplatino. Evolución Dadas las alteraciones genéticas presentes en este tipo de tumor, descritas recientemente en una serie de 70 casos por Reis H, van der Vos KE et al., publicada en 2018, se solicitan estudios concluyendo ausencia de amplificación del HER-2 y ausencia de mutación en KRAS y BRAF. Dada la buena situación funcional del paciente a pesar de su edad, se decide inicio de tratamiento sistémico ajustado a las características del paciente. No se considera adecuado el uso de tripletes ni de fármacos como cisplatino o doxorrubicina. Se inicia monoterapia con gemcitabina al que posteriormente, dada la excelente tolerancia clínica y analítica, se añade capecitabina. En diciembre de 2018, tras 14 meses desde el inicio del tratamiento, el paciente presenta progresión peritoneal, por lo que se inicia una segunda línea de tratamiento sistémico con irinotecán y panitumumab, que se mantiene durante 4 meses, hasta nueva progresión frente a la que se pautó una tercera línea con oxaliplatino. Dado el empeoramiento progresivo de la enfermedad, con palpación abdominal de diversas nodulaciones, se decide la suspensión de tratamiento activo y se mantiene exclusivamente el tratamiento sintomático, con seguimiento por la Unidad de Cuidados Paliativos. Instructions: please extract entity words from the input sentence
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Anamnesis » Se trata de un paciente de 86 años intervenido en noviembre de 2016 de un adenocarcinoma de uraco estadio II, sin recibir tratamiento complementario. » Datos sociales: 83 años. Vive con su esposa y un hijo. » Enfermedades previas: hipertrofia prostática benigna. No tiene metabolopatías crónicas. Hipoacusia. » Medicación previa: omeprazol 20 mg si precisa, tamsulosina 0,4 mg. Exploración física Exploración física y analítica básica sin particularidades. Pruebas complementarias Los marcadores tumorales evidencian un CEA de 12 y un CA 19,9 de 9.404. Se realiza en agosto de 2017 una TC corporal en la que se evidencia abundante líquido libre intraperitoneal con realce de las hojas pleurales y múltiples implantes sólidos de distribución dispersa. La Anatomía Patológica de uno de los implantes peritoneales evidencia un adenocarcinoma mucinoso bien diferenciado, con aisladas células en anillo de sello. Diagnóstico Adenocarcinoma mucinoso de uraco estadio IV por afectación peritoneal. Tratamiento 1ª línea de tratamiento sistémico: gemcitabina + capecitabina. 2ª línea de tratamiento sistémico: irinotecán + panitumumab. 3ª línea de tratamiento sistémico: oxaliplatino. Evolución Dadas las alteraciones genéticas presentes en este tipo de tumor, descritas recientemente en una serie de 70 casos por Reis H, van der Vos KE et al., publicada en 2018, se solicitan estudios concluyendo ausencia de amplificación del HER-2 y ausencia de mutación en KRAS y BRAF. Dada la buena situación funcional del paciente a pesar de su edad, se decide inicio de tratamiento sistémico ajustado a las características del paciente. No se considera adecuado el uso de tripletes ni de fármacos como cisplatino o doxorrubicina. Se inicia monoterapia con gemcitabina al que posteriormente, dada la excelente tolerancia clínica y analítica, se añade capecitabina. En diciembre de 2018, tras 14 meses desde el inicio del tratamiento, el paciente presenta progresión peritoneal, por lo que se inicia una segunda línea de tratamiento sistémico con irinotecán y panitumumab, que se mantiene durante 4 meses, hasta nueva progresión frente a la que se pautó una tercera línea con oxaliplatino. Dado el empeoramiento progresivo de la enfermedad, con palpación abdominal de diversas nodulaciones, se decide la suspensión de tratamiento activo y se mantiene exclusivamente el tratamiento sintomático, con seguimiento por la Unidad de Cuidados Paliativos.
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[ "MORFOLOGIA_NEOPLASIA" ]
colitis - associated colon cancer is a Disease, chronic colitis is a Disease, colitis is a Disease, corn is a Plant, olive is a Plant, colitis is a Disease, colitis is a Disease, colitis is a Disease, Dysplasia is a Disease, Colitis is a Disease, chronic colitis is a Disease, colitis is a Disease, olive is a Plant, neoplasia is a Disease, chronic colitis is a Disease
16500554_task0
Sentence: OBJECTIVE: The effects of different dietary oils on the development of colitis-associated colon cancer have not been studied. The present study examined the effect of different dietary oils on the severity of chronic colitis, development of colitis-associated premalignant changes, and colonic expression of cyclooxygenase-2 (COX-2) in interleukin-10 knockout (IL-10-/-) mice. METHODS: IL-10-/- mice were fed chow supplemented with corn oil (CO; control, n=28), olive oil (OO; n=29), or fish oil (FO; n=35) for 12 wk and their colons were studied for colitis score, premalignant changes, and COX-2 expression. RESULTS: The average colitis score was higher in the FO than in the CO group. Similarly, the incidence of severe colitis (score>or=3) was significantly higher in the FO than in the CO and OO groups (50% versus 7.7% and 3.7%, respectively, P<0.05). Dysplasia was more frequent in the FO and less frequent in the OO than in the CO group (47% and 4% versus 15%, respectively, P<0.05). Conversely, aberrant crypt foci and crypt index were significantly higher in the FO than in the CO group. Colitis score, aberrant crypt foci, and crypt index did not differ between the OO and CO groups. COX-2 immunostaining was significantly lower in the OO than in CO group (P<0.05) but not different between the FO and CO groups. CONCLUSIONS: In IL-10-/- mice, fish oil exacerbates chronic colitis and colitis-associated premalignant changes. Conversely, olive oil inhibits COX-2 immunostaining and decreases the risk of neoplasia associated with chronic colitis. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: Disease, Plant
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OBJECTIVE: The effects of different dietary oils on the development of colitis-associated colon cancer have not been studied. The present study examined the effect of different dietary oils on the severity of chronic colitis, development of colitis-associated premalignant changes, and colonic expression of cyclooxygenase-2 (COX-2) in interleukin-10 knockout (IL-10-/-) mice. METHODS: IL-10-/- mice were fed chow supplemented with corn oil (CO; control, n=28), olive oil (OO; n=29), or fish oil (FO; n=35) for 12 wk and their colons were studied for colitis score, premalignant changes, and COX-2 expression. RESULTS: The average colitis score was higher in the FO than in the CO group. Similarly, the incidence of severe colitis (score>or=3) was significantly higher in the FO than in the CO and OO groups (50% versus 7.7% and 3.7%, respectively, P<0.05). Dysplasia was more frequent in the FO and less frequent in the OO than in the CO group (47% and 4% versus 15%, respectively, P<0.05). Conversely, aberrant crypt foci and crypt index were significantly higher in the FO than in the CO group. Colitis score, aberrant crypt foci, and crypt index did not differ between the OO and CO groups. COX-2 immunostaining was significantly lower in the OO than in CO group (P<0.05) but not different between the FO and CO groups. CONCLUSIONS: In IL-10-/- mice, fish oil exacerbates chronic colitis and colitis-associated premalignant changes. Conversely, olive oil inhibits COX-2 immunostaining and decreases the risk of neoplasia associated with chronic colitis.
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[ "Disease", "Plant" ]
colitis - associated colon cancer is a Disease, chronic colitis is a Disease, colitis is a Disease, corn is a Plant, olive is a Plant, colitis is a Disease, colitis is a Disease, colitis is a Disease, Dysplasia is a Disease, Colitis is a Disease, chronic colitis is a Disease, colitis is a Disease, olive is a Plant, neoplasia is a Disease, chronic colitis is a Disease
16500554_task1
Sentence: OBJECTIVE: The effects of different dietary oils on the development of colitis-associated colon cancer have not been studied. The present study examined the effect of different dietary oils on the severity of chronic colitis, development of colitis-associated premalignant changes, and colonic expression of cyclooxygenase-2 (COX-2) in interleukin-10 knockout (IL-10-/-) mice. METHODS: IL-10-/- mice were fed chow supplemented with corn oil (CO; control, n=28), olive oil (OO; n=29), or fish oil (FO; n=35) for 12 wk and their colons were studied for colitis score, premalignant changes, and COX-2 expression. RESULTS: The average colitis score was higher in the FO than in the CO group. Similarly, the incidence of severe colitis (score>or=3) was significantly higher in the FO than in the CO and OO groups (50% versus 7.7% and 3.7%, respectively, P<0.05). Dysplasia was more frequent in the FO and less frequent in the OO than in the CO group (47% and 4% versus 15%, respectively, P<0.05). Conversely, aberrant crypt foci and crypt index were significantly higher in the FO than in the CO group. Colitis score, aberrant crypt foci, and crypt index did not differ between the OO and CO groups. COX-2 immunostaining was significantly lower in the OO than in CO group (P<0.05) but not different between the FO and CO groups. CONCLUSIONS: In IL-10-/- mice, fish oil exacerbates chronic colitis and colitis-associated premalignant changes. Conversely, olive oil inhibits COX-2 immunostaining and decreases the risk of neoplasia associated with chronic colitis. Instructions: please typing these entity words according to sentence: colitis - associated colon cancer, chronic colitis, colitis, corn, olive, colitis, colitis, colitis, Dysplasia, Colitis, chronic colitis, colitis, olive, neoplasia, chronic colitis Options: Disease, Plant
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OBJECTIVE: The effects of different dietary oils on the development of colitis-associated colon cancer have not been studied. The present study examined the effect of different dietary oils on the severity of chronic colitis, development of colitis-associated premalignant changes, and colonic expression of cyclooxygenase-2 (COX-2) in interleukin-10 knockout (IL-10-/-) mice. METHODS: IL-10-/- mice were fed chow supplemented with corn oil (CO; control, n=28), olive oil (OO; n=29), or fish oil (FO; n=35) for 12 wk and their colons were studied for colitis score, premalignant changes, and COX-2 expression. RESULTS: The average colitis score was higher in the FO than in the CO group. Similarly, the incidence of severe colitis (score>or=3) was significantly higher in the FO than in the CO and OO groups (50% versus 7.7% and 3.7%, respectively, P<0.05). Dysplasia was more frequent in the FO and less frequent in the OO than in the CO group (47% and 4% versus 15%, respectively, P<0.05). Conversely, aberrant crypt foci and crypt index were significantly higher in the FO than in the CO group. Colitis score, aberrant crypt foci, and crypt index did not differ between the OO and CO groups. COX-2 immunostaining was significantly lower in the OO than in CO group (P<0.05) but not different between the FO and CO groups. CONCLUSIONS: In IL-10-/- mice, fish oil exacerbates chronic colitis and colitis-associated premalignant changes. Conversely, olive oil inhibits COX-2 immunostaining and decreases the risk of neoplasia associated with chronic colitis.
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[ "Disease", "Plant" ]
colitis - associated colon cancer, chronic colitis, colitis, corn, olive, colitis, colitis, colitis, Dysplasia, Colitis, chronic colitis, colitis, olive, neoplasia, chronic colitis
16500554_task2
Sentence: OBJECTIVE: The effects of different dietary oils on the development of colitis-associated colon cancer have not been studied. The present study examined the effect of different dietary oils on the severity of chronic colitis, development of colitis-associated premalignant changes, and colonic expression of cyclooxygenase-2 (COX-2) in interleukin-10 knockout (IL-10-/-) mice. METHODS: IL-10-/- mice were fed chow supplemented with corn oil (CO; control, n=28), olive oil (OO; n=29), or fish oil (FO; n=35) for 12 wk and their colons were studied for colitis score, premalignant changes, and COX-2 expression. RESULTS: The average colitis score was higher in the FO than in the CO group. Similarly, the incidence of severe colitis (score>or=3) was significantly higher in the FO than in the CO and OO groups (50% versus 7.7% and 3.7%, respectively, P<0.05). Dysplasia was more frequent in the FO and less frequent in the OO than in the CO group (47% and 4% versus 15%, respectively, P<0.05). Conversely, aberrant crypt foci and crypt index were significantly higher in the FO than in the CO group. Colitis score, aberrant crypt foci, and crypt index did not differ between the OO and CO groups. COX-2 immunostaining was significantly lower in the OO than in CO group (P<0.05) but not different between the FO and CO groups. CONCLUSIONS: In IL-10-/- mice, fish oil exacerbates chronic colitis and colitis-associated premalignant changes. Conversely, olive oil inhibits COX-2 immunostaining and decreases the risk of neoplasia associated with chronic colitis. Instructions: please extract entity words from the input sentence
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OBJECTIVE: The effects of different dietary oils on the development of colitis-associated colon cancer have not been studied. The present study examined the effect of different dietary oils on the severity of chronic colitis, development of colitis-associated premalignant changes, and colonic expression of cyclooxygenase-2 (COX-2) in interleukin-10 knockout (IL-10-/-) mice. METHODS: IL-10-/- mice were fed chow supplemented with corn oil (CO; control, n=28), olive oil (OO; n=29), or fish oil (FO; n=35) for 12 wk and their colons were studied for colitis score, premalignant changes, and COX-2 expression. RESULTS: The average colitis score was higher in the FO than in the CO group. Similarly, the incidence of severe colitis (score>or=3) was significantly higher in the FO than in the CO and OO groups (50% versus 7.7% and 3.7%, respectively, P<0.05). Dysplasia was more frequent in the FO and less frequent in the OO than in the CO group (47% and 4% versus 15%, respectively, P<0.05). Conversely, aberrant crypt foci and crypt index were significantly higher in the FO than in the CO group. Colitis score, aberrant crypt foci, and crypt index did not differ between the OO and CO groups. COX-2 immunostaining was significantly lower in the OO than in CO group (P<0.05) but not different between the FO and CO groups. CONCLUSIONS: In IL-10-/- mice, fish oil exacerbates chronic colitis and colitis-associated premalignant changes. Conversely, olive oil inhibits COX-2 immunostaining and decreases the risk of neoplasia associated with chronic colitis.
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[ "Disease", "Plant" ]
Tod is an umlsterm, Patienten is an umlsterm, Ueberleben is an umlsterm, Diagnose is an umlsterm, Embolektomie is an umlsterm, Patienten is an umlsterm, Unfall is an umlsterm, Kniegelenken is an umlsterm, transoesophageale Echokardiographie is an umlsterm, TEE is an umlsterm, Thromboembolie is an umlsterm, Arteria pulmonalis is an umlsterm, Embolektomie is an umlsterm, Herzfunktion is an umlsterm, TEE is an umlsterm, Embolektomie is an umlsterm, Patient is an umlsterm, TEE is an umlsterm, Diagnose is an umlsterm, Lungenembolien is an umlsterm, Embolektomie is an umlsterm
DerAnaesthesist.40430398.ger.abstr_task0
Sentence: Massive pulmonale Thromboembolien mit Kreislaufzusammenbruch fuehren meist unmittelbar zum Tod des Patienten . Entscheidend fuer das Ueberleben sind die schnelle Diagnose und die unverzuegliche , operative Embolektomie . Wir berichten ueber einen 67jaehrigen Patienten , der 19 Tage nach einem Unfall an beiden Kniegelenken operiert wurde . Intraoperativ kam es zu einem akuten Kreislaufversagen . Durch transoesophageale Echokardiographie ( TEE ) konnte eine Thromboembolie in den rechten Vorhof und in die Arteria pulmonalis bestaetigt werden . Sofort wurde eine operative Embolektomie durchgefuehrt . Die Kontrolle der Herzfunktion mittels TEE waehrend des Verschlusses der Sternumlaengsspaltung zeigte ein erneutes Einschwemmen von Thromben in den rechten Vorhof , so dass eine zweite Embolektomie am extrakorporalen Kreislauf noetig wurde . Anschliessend erfolgte die Implantation eines Kavafilters . Der Patient ueberlebte die Eingriffe ohne Folgeschaeden . Unser Fall demonstriert eindruecklich den Wert der TEE nicht nur fuer die Diagnose intraoperativer Lungenembolien , sondern auch fuer die Erfolgskontrolle nach operativer Embolektomie . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: umlsterm
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Massive pulmonale Thromboembolien mit Kreislaufzusammenbruch fuehren meist unmittelbar zum Tod des Patienten . Entscheidend fuer das Ueberleben sind die schnelle Diagnose und die unverzuegliche , operative Embolektomie . Wir berichten ueber einen 67jaehrigen Patienten , der 19 Tage nach einem Unfall an beiden Kniegelenken operiert wurde . Intraoperativ kam es zu einem akuten Kreislaufversagen . Durch transoesophageale Echokardiographie ( TEE ) konnte eine Thromboembolie in den rechten Vorhof und in die Arteria pulmonalis bestaetigt werden . Sofort wurde eine operative Embolektomie durchgefuehrt . Die Kontrolle der Herzfunktion mittels TEE waehrend des Verschlusses der Sternumlaengsspaltung zeigte ein erneutes Einschwemmen von Thromben in den rechten Vorhof , so dass eine zweite Embolektomie am extrakorporalen Kreislauf noetig wurde . Anschliessend erfolgte die Implantation eines Kavafilters . Der Patient ueberlebte die Eingriffe ohne Folgeschaeden . Unser Fall demonstriert eindruecklich den Wert der TEE nicht nur fuer die Diagnose intraoperativer Lungenembolien , sondern auch fuer die Erfolgskontrolle nach operativer Embolektomie .
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[ "umlsterm" ]
Tod is an umlsterm, Patienten is an umlsterm, Ueberleben is an umlsterm, Diagnose is an umlsterm, Embolektomie is an umlsterm, Patienten is an umlsterm, Unfall is an umlsterm, Kniegelenken is an umlsterm, transoesophageale Echokardiographie is an umlsterm, TEE is an umlsterm, Thromboembolie is an umlsterm, Arteria pulmonalis is an umlsterm, Embolektomie is an umlsterm, Herzfunktion is an umlsterm, TEE is an umlsterm, Embolektomie is an umlsterm, Patient is an umlsterm, TEE is an umlsterm, Diagnose is an umlsterm, Lungenembolien is an umlsterm, Embolektomie is an umlsterm
DerAnaesthesist.40430398.ger.abstr_task1
Sentence: Massive pulmonale Thromboembolien mit Kreislaufzusammenbruch fuehren meist unmittelbar zum Tod des Patienten . Entscheidend fuer das Ueberleben sind die schnelle Diagnose und die unverzuegliche , operative Embolektomie . Wir berichten ueber einen 67jaehrigen Patienten , der 19 Tage nach einem Unfall an beiden Kniegelenken operiert wurde . Intraoperativ kam es zu einem akuten Kreislaufversagen . Durch transoesophageale Echokardiographie ( TEE ) konnte eine Thromboembolie in den rechten Vorhof und in die Arteria pulmonalis bestaetigt werden . Sofort wurde eine operative Embolektomie durchgefuehrt . Die Kontrolle der Herzfunktion mittels TEE waehrend des Verschlusses der Sternumlaengsspaltung zeigte ein erneutes Einschwemmen von Thromben in den rechten Vorhof , so dass eine zweite Embolektomie am extrakorporalen Kreislauf noetig wurde . Anschliessend erfolgte die Implantation eines Kavafilters . Der Patient ueberlebte die Eingriffe ohne Folgeschaeden . Unser Fall demonstriert eindruecklich den Wert der TEE nicht nur fuer die Diagnose intraoperativer Lungenembolien , sondern auch fuer die Erfolgskontrolle nach operativer Embolektomie . Instructions: please typing these entity words according to sentence: Tod, Patienten, Ueberleben, Diagnose, Embolektomie, Patienten, Unfall, Kniegelenken, transoesophageale Echokardiographie, TEE, Thromboembolie, Arteria pulmonalis, Embolektomie, Herzfunktion, TEE, Embolektomie, Patient, TEE, Diagnose, Lungenembolien, Embolektomie Options: umlsterm
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Massive pulmonale Thromboembolien mit Kreislaufzusammenbruch fuehren meist unmittelbar zum Tod des Patienten . Entscheidend fuer das Ueberleben sind die schnelle Diagnose und die unverzuegliche , operative Embolektomie . Wir berichten ueber einen 67jaehrigen Patienten , der 19 Tage nach einem Unfall an beiden Kniegelenken operiert wurde . Intraoperativ kam es zu einem akuten Kreislaufversagen . Durch transoesophageale Echokardiographie ( TEE ) konnte eine Thromboembolie in den rechten Vorhof und in die Arteria pulmonalis bestaetigt werden . Sofort wurde eine operative Embolektomie durchgefuehrt . Die Kontrolle der Herzfunktion mittels TEE waehrend des Verschlusses der Sternumlaengsspaltung zeigte ein erneutes Einschwemmen von Thromben in den rechten Vorhof , so dass eine zweite Embolektomie am extrakorporalen Kreislauf noetig wurde . Anschliessend erfolgte die Implantation eines Kavafilters . Der Patient ueberlebte die Eingriffe ohne Folgeschaeden . Unser Fall demonstriert eindruecklich den Wert der TEE nicht nur fuer die Diagnose intraoperativer Lungenembolien , sondern auch fuer die Erfolgskontrolle nach operativer Embolektomie .
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[ "umlsterm" ]
Tod, Patienten, Ueberleben, Diagnose, Embolektomie, Patienten, Unfall, Kniegelenken, transoesophageale Echokardiographie, TEE, Thromboembolie, Arteria pulmonalis, Embolektomie, Herzfunktion, TEE, Embolektomie, Patient, TEE, Diagnose, Lungenembolien, Embolektomie
DerAnaesthesist.40430398.ger.abstr_task2
Sentence: Massive pulmonale Thromboembolien mit Kreislaufzusammenbruch fuehren meist unmittelbar zum Tod des Patienten . Entscheidend fuer das Ueberleben sind die schnelle Diagnose und die unverzuegliche , operative Embolektomie . Wir berichten ueber einen 67jaehrigen Patienten , der 19 Tage nach einem Unfall an beiden Kniegelenken operiert wurde . Intraoperativ kam es zu einem akuten Kreislaufversagen . Durch transoesophageale Echokardiographie ( TEE ) konnte eine Thromboembolie in den rechten Vorhof und in die Arteria pulmonalis bestaetigt werden . Sofort wurde eine operative Embolektomie durchgefuehrt . Die Kontrolle der Herzfunktion mittels TEE waehrend des Verschlusses der Sternumlaengsspaltung zeigte ein erneutes Einschwemmen von Thromben in den rechten Vorhof , so dass eine zweite Embolektomie am extrakorporalen Kreislauf noetig wurde . Anschliessend erfolgte die Implantation eines Kavafilters . Der Patient ueberlebte die Eingriffe ohne Folgeschaeden . Unser Fall demonstriert eindruecklich den Wert der TEE nicht nur fuer die Diagnose intraoperativer Lungenembolien , sondern auch fuer die Erfolgskontrolle nach operativer Embolektomie . Instructions: please extract entity words from the input sentence
[ "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "I-umlsterm", "O", "B-umlsterm", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "I-umlsterm", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O" ]
Massive pulmonale Thromboembolien mit Kreislaufzusammenbruch fuehren meist unmittelbar zum Tod des Patienten . Entscheidend fuer das Ueberleben sind die schnelle Diagnose und die unverzuegliche , operative Embolektomie . Wir berichten ueber einen 67jaehrigen Patienten , der 19 Tage nach einem Unfall an beiden Kniegelenken operiert wurde . Intraoperativ kam es zu einem akuten Kreislaufversagen . Durch transoesophageale Echokardiographie ( TEE ) konnte eine Thromboembolie in den rechten Vorhof und in die Arteria pulmonalis bestaetigt werden . Sofort wurde eine operative Embolektomie durchgefuehrt . Die Kontrolle der Herzfunktion mittels TEE waehrend des Verschlusses der Sternumlaengsspaltung zeigte ein erneutes Einschwemmen von Thromben in den rechten Vorhof , so dass eine zweite Embolektomie am extrakorporalen Kreislauf noetig wurde . Anschliessend erfolgte die Implantation eines Kavafilters . Der Patient ueberlebte die Eingriffe ohne Folgeschaeden . Unser Fall demonstriert eindruecklich den Wert der TEE nicht nur fuer die Diagnose intraoperativer Lungenembolien , sondern auch fuer die Erfolgskontrolle nach operativer Embolektomie .
[ "Massive", "pulmonale", "Thromboembolien", "mit", "Kreislaufzusammenbruch", "fuehren", "meist", "unmittelbar", "zum", "Tod", "des", "Patienten", ".", "Entscheidend", "fuer", "das", "Ueberleben", "sind", "die", "schnelle", "Diagnose", "und", "die", "unverzuegliche", ",", "operative", "Embolektomie", ".", "Wir", "berichten", "ueber", "einen", "67jaehrigen", "Patienten", ",", "der", "19", "Tage", "nach", "einem", "Unfall", "an", "beiden", "Kniegelenken", "operiert", "wurde", ".", "Intraoperativ", "kam", "es", "zu", "einem", "akuten", "Kreislaufversagen", ".", "Durch", "transoesophageale", "Echokardiographie", "(", "TEE", ")", "konnte", "eine", "Thromboembolie", "in", "den", "rechten", "Vorhof", "und", "in", "die", "Arteria", "pulmonalis", "bestaetigt", "werden", ".", "Sofort", "wurde", "eine", "operative", "Embolektomie", "durchgefuehrt", ".", "Die", "Kontrolle", "der", "Herzfunktion", "mittels", "TEE", "waehrend", "des", "Verschlusses", "der", "Sternumlaengsspaltung", "zeigte", "ein", "erneutes", "Einschwemmen", "von", "Thromben", "in", "den", "rechten", "Vorhof", ",", "so", "dass", "eine", "zweite", "Embolektomie", "am", "extrakorporalen", "Kreislauf", "noetig", "wurde", ".", "Anschliessend", "erfolgte", "die", "Implantation", "eines", "Kavafilters", ".", "Der", "Patient", "ueberlebte", "die", "Eingriffe", "ohne", "Folgeschaeden", ".", "Unser", "Fall", "demonstriert", "eindruecklich", "den", "Wert", "der", "TEE", "nicht", "nur", "fuer", "die", "Diagnose", "intraoperativer", "Lungenembolien", ",", "sondern", "auch", "fuer", "die", "Erfolgskontrolle", "nach", "operativer", "Embolektomie", "." ]
[ "umlsterm" ]
In situ RT - PCR detection is an other_name, Epstein - Barr virus immediate - early transcripts is a RNA_family_or_group, CD4 + and CD8 + T lymphocytes is a (AND cell_type cell_type)
69133_task0
Sentence: In situ RT-PCR detection of Epstein-Barr virus immediate-early transcripts in CD4+ and CD8+ T lymphocytes. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: (AND cell_type cell_type), RNA_family_or_group, other_name
[ "B-other_name", "I-other_name", "I-other_name", "I-other_name", "I-other_name", "I-other_name", "O", "B-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "O", "B-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "O" ]
In situ RT-PCR detection of Epstein-Barr virus immediate-early transcripts in CD4+ and CD8+ T lymphocytes.
[ "In", "situ", "RT", "-", "PCR", "detection", "of", "Epstein", "-", "Barr", "virus", "immediate", "-", "early", "transcripts", "in", "CD4", "+", "and", "CD8", "+", "T", "lymphocytes", "." ]
[ "other_name", "protein_family_or_group", "RNA_family_or_group", "(AND RNA_molecule RNA_molecule)", "(AND cell_type cell_type)", "", "protein_molecule", "cell_type", "virus", "RNA_molecule" ]
In situ RT - PCR detection is an other_name, Epstein - Barr virus immediate - early transcripts is a RNA_family_or_group, CD4 + and CD8 + T lymphocytes is a (AND cell_type cell_type)
69133_task1
Sentence: In situ RT-PCR detection of Epstein-Barr virus immediate-early transcripts in CD4+ and CD8+ T lymphocytes. Instructions: please typing these entity words according to sentence: In situ RT - PCR detection, Epstein - Barr virus immediate - early transcripts, CD4 + and CD8 + T lymphocytes Options: (AND cell_type cell_type), RNA_family_or_group, other_name
[ "B-other_name", "I-other_name", "I-other_name", "I-other_name", "I-other_name", "I-other_name", "O", "B-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "O", "B-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "O" ]
In situ RT-PCR detection of Epstein-Barr virus immediate-early transcripts in CD4+ and CD8+ T lymphocytes.
[ "In", "situ", "RT", "-", "PCR", "detection", "of", "Epstein", "-", "Barr", "virus", "immediate", "-", "early", "transcripts", "in", "CD4", "+", "and", "CD8", "+", "T", "lymphocytes", "." ]
[ "other_name", "protein_family_or_group", "RNA_family_or_group", "(AND RNA_molecule RNA_molecule)", "(AND cell_type cell_type)", "", "protein_molecule", "cell_type", "virus", "RNA_molecule" ]
In situ RT - PCR detection, Epstein - Barr virus immediate - early transcripts, CD4 + and CD8 + T lymphocytes
69133_task2
Sentence: In situ RT-PCR detection of Epstein-Barr virus immediate-early transcripts in CD4+ and CD8+ T lymphocytes. Instructions: please extract entity words from the input sentence
[ "B-other_name", "I-other_name", "I-other_name", "I-other_name", "I-other_name", "I-other_name", "O", "B-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "I-RNA_family_or_group", "O", "B-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "I-(AND cell_type cell_type)", "O" ]
In situ RT-PCR detection of Epstein-Barr virus immediate-early transcripts in CD4+ and CD8+ T lymphocytes.
[ "In", "situ", "RT", "-", "PCR", "detection", "of", "Epstein", "-", "Barr", "virus", "immediate", "-", "early", "transcripts", "in", "CD4", "+", "and", "CD8", "+", "T", "lymphocytes", "." ]
[ "other_name", "protein_family_or_group", "RNA_family_or_group", "(AND RNA_molecule RNA_molecule)", "(AND cell_type cell_type)", "", "protein_molecule", "cell_type", "virus", "RNA_molecule" ]
psychiatric inpatient treatment : is a Participant_Condition, high standard of care is a Outcome_Other, patients who receive psychiatric treatment . is a Participant_Condition, no pre - discharge contact with outpatient services is a Participant_Condition, not well linked to their outpatient care networks is a Participant_Condition, Post - Discharge Network Coordination Program is a Intervention_Other, frequency and duration of patient re - hospitalization is a Outcome_Other, control is a Intervention_Control, treatment as usual is a Intervention_Control, social support is a Outcome_Mental, change in psychiatric symptoms is a Outcome_Mental, quality of life is a Outcome_Physical, independence in daily functioning is a Outcome_Mental, Computer generated block randomization is a Intervention_Other, 160 is a Participant_Sample-size, post - discharge network coordination program is a Intervention_Educational, integration of the patients into their social networks is a Outcome_Other, coordinating outpatient care is a Outcome_Other, addressing concerns of daily life is a Outcome_Physical
61202_task0
Sentence: Network coordination following discharge from psychiatric inpatient treatment : a study protocol . BACKGROUND Inadequate discharge planning following inpatient stays is a major issue in the provision of a high standard of care for patients who receive psychiatric treatment . Studies have shown that half of patients who had no pre-discharge contact with outpatient services do not keep their first outpatient appointment . Additionally , discharged patients who are not well linked to their outpatient care networks are at twice the risk of re-hospitalization . The aim of this study is to investigate if the Post-Discharge Network Coordination Program at ipw has a demonstrably significant impact on the frequency and duration of patient re-hospitalization . Subjects are randomly assigned to either the treatment group or to the control group . The treatment group participates in the Post-Discharge Network Coordination Program . The control group receives treatment as usual with no additional social support . Further outcome variables include : social support , change in psychiatric symptoms , quality of life , and independence in daily functioning . METHODS/DESIGN The study is conducted as a randomized controlled trial . Subjects are randomly assigned to either the control group or to the treatment group . Computer generated block randomization is used to assure both groups have the same number of subjects . Stratified block randomization is used for the psychiatric diagnosis of ICD-10 , F1 . Approximately 160 patients are recruited in two care units at Psychiatrie-Zentrum Hard Embrach and two care units at Klinik Schlosstal Winterthur . DISCUSSION The proposed post-discharge network coordination program intervenes during the critical post-discharge period . It focuses primarily on promoting the integration of the patients into their social networks , and additionally to coordinating outpatient care and addressing concerns of daily life . TRIAL REGISTRATION ISRCTN ISRCTN58280620 . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: Intervention_Control, Participant_Condition, Intervention_Educational, Intervention_Other, Outcome_Physical, Participant_Sample-size, Outcome_Other, Outcome_Mental
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Network coordination following discharge from psychiatric inpatient treatment : a study protocol . BACKGROUND Inadequate discharge planning following inpatient stays is a major issue in the provision of a high standard of care for patients who receive psychiatric treatment . Studies have shown that half of patients who had no pre-discharge contact with outpatient services do not keep their first outpatient appointment . Additionally , discharged patients who are not well linked to their outpatient care networks are at twice the risk of re-hospitalization . The aim of this study is to investigate if the Post-Discharge Network Coordination Program at ipw has a demonstrably significant impact on the frequency and duration of patient re-hospitalization . Subjects are randomly assigned to either the treatment group or to the control group . The treatment group participates in the Post-Discharge Network Coordination Program . The control group receives treatment as usual with no additional social support . Further outcome variables include : social support , change in psychiatric symptoms , quality of life , and independence in daily functioning . METHODS/DESIGN The study is conducted as a randomized controlled trial . Subjects are randomly assigned to either the control group or to the treatment group . Computer generated block randomization is used to assure both groups have the same number of subjects . Stratified block randomization is used for the psychiatric diagnosis of ICD-10 , F1 . Approximately 160 patients are recruited in two care units at Psychiatrie-Zentrum Hard Embrach and two care units at Klinik Schlosstal Winterthur . DISCUSSION The proposed post-discharge network coordination program intervenes during the critical post-discharge period . It focuses primarily on promoting the integration of the patients into their social networks , and additionally to coordinating outpatient care and addressing concerns of daily life . TRIAL REGISTRATION ISRCTN ISRCTN58280620 .
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[ "Outcome_Other", "Participant_Condition", "Intervention_Other", "Intervention_Educational", "Outcome_Mental", "Outcome_Physical", "Intervention_Control", "Participant_Sample-size" ]
psychiatric inpatient treatment : is a Participant_Condition, high standard of care is a Outcome_Other, patients who receive psychiatric treatment . is a Participant_Condition, no pre - discharge contact with outpatient services is a Participant_Condition, not well linked to their outpatient care networks is a Participant_Condition, Post - Discharge Network Coordination Program is a Intervention_Other, frequency and duration of patient re - hospitalization is a Outcome_Other, control is a Intervention_Control, treatment as usual is a Intervention_Control, social support is a Outcome_Mental, change in psychiatric symptoms is a Outcome_Mental, quality of life is a Outcome_Physical, independence in daily functioning is a Outcome_Mental, Computer generated block randomization is a Intervention_Other, 160 is a Participant_Sample-size, post - discharge network coordination program is a Intervention_Educational, integration of the patients into their social networks is a Outcome_Other, coordinating outpatient care is a Outcome_Other, addressing concerns of daily life is a Outcome_Physical
61202_task1
Sentence: Network coordination following discharge from psychiatric inpatient treatment : a study protocol . BACKGROUND Inadequate discharge planning following inpatient stays is a major issue in the provision of a high standard of care for patients who receive psychiatric treatment . Studies have shown that half of patients who had no pre-discharge contact with outpatient services do not keep their first outpatient appointment . Additionally , discharged patients who are not well linked to their outpatient care networks are at twice the risk of re-hospitalization . The aim of this study is to investigate if the Post-Discharge Network Coordination Program at ipw has a demonstrably significant impact on the frequency and duration of patient re-hospitalization . Subjects are randomly assigned to either the treatment group or to the control group . The treatment group participates in the Post-Discharge Network Coordination Program . The control group receives treatment as usual with no additional social support . Further outcome variables include : social support , change in psychiatric symptoms , quality of life , and independence in daily functioning . METHODS/DESIGN The study is conducted as a randomized controlled trial . Subjects are randomly assigned to either the control group or to the treatment group . Computer generated block randomization is used to assure both groups have the same number of subjects . Stratified block randomization is used for the psychiatric diagnosis of ICD-10 , F1 . Approximately 160 patients are recruited in two care units at Psychiatrie-Zentrum Hard Embrach and two care units at Klinik Schlosstal Winterthur . DISCUSSION The proposed post-discharge network coordination program intervenes during the critical post-discharge period . It focuses primarily on promoting the integration of the patients into their social networks , and additionally to coordinating outpatient care and addressing concerns of daily life . TRIAL REGISTRATION ISRCTN ISRCTN58280620 . Instructions: please typing these entity words according to sentence: psychiatric inpatient treatment :, high standard of care, patients who receive psychiatric treatment ., no pre - discharge contact with outpatient services, not well linked to their outpatient care networks, Post - Discharge Network Coordination Program, frequency and duration of patient re - hospitalization, control, treatment as usual, social support, change in psychiatric symptoms, quality of life, independence in daily functioning, Computer generated block randomization, 160, post - discharge network coordination program, integration of the patients into their social networks, coordinating outpatient care, addressing concerns of daily life Options: Intervention_Control, Participant_Condition, Intervention_Educational, Intervention_Other, Outcome_Physical, Participant_Sample-size, Outcome_Other, Outcome_Mental
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Network coordination following discharge from psychiatric inpatient treatment : a study protocol . BACKGROUND Inadequate discharge planning following inpatient stays is a major issue in the provision of a high standard of care for patients who receive psychiatric treatment . Studies have shown that half of patients who had no pre-discharge contact with outpatient services do not keep their first outpatient appointment . Additionally , discharged patients who are not well linked to their outpatient care networks are at twice the risk of re-hospitalization . The aim of this study is to investigate if the Post-Discharge Network Coordination Program at ipw has a demonstrably significant impact on the frequency and duration of patient re-hospitalization . Subjects are randomly assigned to either the treatment group or to the control group . The treatment group participates in the Post-Discharge Network Coordination Program . The control group receives treatment as usual with no additional social support . Further outcome variables include : social support , change in psychiatric symptoms , quality of life , and independence in daily functioning . METHODS/DESIGN The study is conducted as a randomized controlled trial . Subjects are randomly assigned to either the control group or to the treatment group . Computer generated block randomization is used to assure both groups have the same number of subjects . Stratified block randomization is used for the psychiatric diagnosis of ICD-10 , F1 . Approximately 160 patients are recruited in two care units at Psychiatrie-Zentrum Hard Embrach and two care units at Klinik Schlosstal Winterthur . DISCUSSION The proposed post-discharge network coordination program intervenes during the critical post-discharge period . It focuses primarily on promoting the integration of the patients into their social networks , and additionally to coordinating outpatient care and addressing concerns of daily life . TRIAL REGISTRATION ISRCTN ISRCTN58280620 .
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[ "Outcome_Other", "Participant_Condition", "Intervention_Other", "Intervention_Educational", "Outcome_Mental", "Outcome_Physical", "Intervention_Control", "Participant_Sample-size" ]
psychiatric inpatient treatment :, high standard of care, patients who receive psychiatric treatment ., no pre - discharge contact with outpatient services, not well linked to their outpatient care networks, Post - Discharge Network Coordination Program, frequency and duration of patient re - hospitalization, control, treatment as usual, social support, change in psychiatric symptoms, quality of life, independence in daily functioning, Computer generated block randomization, 160, post - discharge network coordination program, integration of the patients into their social networks, coordinating outpatient care, addressing concerns of daily life
61202_task2
Sentence: Network coordination following discharge from psychiatric inpatient treatment : a study protocol . BACKGROUND Inadequate discharge planning following inpatient stays is a major issue in the provision of a high standard of care for patients who receive psychiatric treatment . Studies have shown that half of patients who had no pre-discharge contact with outpatient services do not keep their first outpatient appointment . Additionally , discharged patients who are not well linked to their outpatient care networks are at twice the risk of re-hospitalization . The aim of this study is to investigate if the Post-Discharge Network Coordination Program at ipw has a demonstrably significant impact on the frequency and duration of patient re-hospitalization . Subjects are randomly assigned to either the treatment group or to the control group . The treatment group participates in the Post-Discharge Network Coordination Program . The control group receives treatment as usual with no additional social support . Further outcome variables include : social support , change in psychiatric symptoms , quality of life , and independence in daily functioning . METHODS/DESIGN The study is conducted as a randomized controlled trial . Subjects are randomly assigned to either the control group or to the treatment group . Computer generated block randomization is used to assure both groups have the same number of subjects . Stratified block randomization is used for the psychiatric diagnosis of ICD-10 , F1 . Approximately 160 patients are recruited in two care units at Psychiatrie-Zentrum Hard Embrach and two care units at Klinik Schlosstal Winterthur . DISCUSSION The proposed post-discharge network coordination program intervenes during the critical post-discharge period . It focuses primarily on promoting the integration of the patients into their social networks , and additionally to coordinating outpatient care and addressing concerns of daily life . TRIAL REGISTRATION ISRCTN ISRCTN58280620 . Instructions: please extract entity words from the input sentence
[ "O", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Other", "I-Intervention_Other", "I-Intervention_Other", "I-Intervention_Other", "I-Intervention_Other", "I-Intervention_Other", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Control", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Control", "I-Intervention_Control", "I-Intervention_Control", "O", "O", "O", "B-Outcome_Mental", "I-Outcome_Mental", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Mental", "I-Outcome_Mental", "I-Outcome_Mental", "I-Outcome_Mental", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "B-Outcome_Mental", "I-Outcome_Mental", "I-Outcome_Mental", "I-Outcome_Mental", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Other", "I-Intervention_Other", "I-Intervention_Other", "I-Intervention_Other", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Sample-size", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Educational", "I-Intervention_Educational", "I-Intervention_Educational", "I-Intervention_Educational", "I-Intervention_Educational", "I-Intervention_Educational", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "O", "O", "O", "O", "B-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O" ]
Network coordination following discharge from psychiatric inpatient treatment : a study protocol . BACKGROUND Inadequate discharge planning following inpatient stays is a major issue in the provision of a high standard of care for patients who receive psychiatric treatment . Studies have shown that half of patients who had no pre-discharge contact with outpatient services do not keep their first outpatient appointment . Additionally , discharged patients who are not well linked to their outpatient care networks are at twice the risk of re-hospitalization . The aim of this study is to investigate if the Post-Discharge Network Coordination Program at ipw has a demonstrably significant impact on the frequency and duration of patient re-hospitalization . Subjects are randomly assigned to either the treatment group or to the control group . The treatment group participates in the Post-Discharge Network Coordination Program . The control group receives treatment as usual with no additional social support . Further outcome variables include : social support , change in psychiatric symptoms , quality of life , and independence in daily functioning . METHODS/DESIGN The study is conducted as a randomized controlled trial . Subjects are randomly assigned to either the control group or to the treatment group . Computer generated block randomization is used to assure both groups have the same number of subjects . Stratified block randomization is used for the psychiatric diagnosis of ICD-10 , F1 . Approximately 160 patients are recruited in two care units at Psychiatrie-Zentrum Hard Embrach and two care units at Klinik Schlosstal Winterthur . DISCUSSION The proposed post-discharge network coordination program intervenes during the critical post-discharge period . It focuses primarily on promoting the integration of the patients into their social networks , and additionally to coordinating outpatient care and addressing concerns of daily life . TRIAL REGISTRATION ISRCTN ISRCTN58280620 .
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[ "Outcome_Other", "Participant_Condition", "Intervention_Other", "Intervention_Educational", "Outcome_Mental", "Outcome_Physical", "Intervention_Control", "Participant_Sample-size" ]
Objectives is an umlsterm, retrospective study is an umlsterm, ticlopidine is an umlsterm, aspirin is an umlsterm, ASA is an umlsterm, patients is an umlsterm, PTCA is an umlsterm, procedures is an umlsterm, complications is an umlsterm, PTCA is an umlsterm, stent is an umlsterm, thrombosis is an umlsterm, stent is an umlsterm, implantation is an umlsterm, ticlopidine is an umlsterm, ASA is an umlsterm, antiplatelet is an umlsterm, ticlopidine is an umlsterm
ZfuerKardiologie.80870872.eng.abstr_task0
Sentence: Objectives : In a retrospective study the effect of a combined pretreatment using ticlopidine and aspirin ( ASA ) in patients undergoing elective PTCA procedures was investigated with respect to in-hospital complications of PTCA and with respect to the efficacy in avoiding a subacute stent thrombosis in case of stent implantation . The systematically performed pretreatment with ticlopidine and ASA takes the delayed begin of full antiplatelet effect of ticlopidine into account . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: umlsterm
[ "B-umlsterm", "O", "O", "O", "B-umlsterm", "I-umlsterm", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "O" ]
Objectives : In a retrospective study the effect of a combined pretreatment using ticlopidine and aspirin ( ASA ) in patients undergoing elective PTCA procedures was investigated with respect to in-hospital complications of PTCA and with respect to the efficacy in avoiding a subacute stent thrombosis in case of stent implantation . The systematically performed pretreatment with ticlopidine and ASA takes the delayed begin of full antiplatelet effect of ticlopidine into account .
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[ "umlsterm" ]
Objectives is an umlsterm, retrospective study is an umlsterm, ticlopidine is an umlsterm, aspirin is an umlsterm, ASA is an umlsterm, patients is an umlsterm, PTCA is an umlsterm, procedures is an umlsterm, complications is an umlsterm, PTCA is an umlsterm, stent is an umlsterm, thrombosis is an umlsterm, stent is an umlsterm, implantation is an umlsterm, ticlopidine is an umlsterm, ASA is an umlsterm, antiplatelet is an umlsterm, ticlopidine is an umlsterm
ZfuerKardiologie.80870872.eng.abstr_task1
Sentence: Objectives : In a retrospective study the effect of a combined pretreatment using ticlopidine and aspirin ( ASA ) in patients undergoing elective PTCA procedures was investigated with respect to in-hospital complications of PTCA and with respect to the efficacy in avoiding a subacute stent thrombosis in case of stent implantation . The systematically performed pretreatment with ticlopidine and ASA takes the delayed begin of full antiplatelet effect of ticlopidine into account . Instructions: please typing these entity words according to sentence: Objectives, retrospective study, ticlopidine, aspirin, ASA, patients, PTCA, procedures, complications, PTCA, stent, thrombosis, stent, implantation, ticlopidine, ASA, antiplatelet, ticlopidine Options: umlsterm
[ "B-umlsterm", "O", "O", "O", "B-umlsterm", "I-umlsterm", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "O" ]
Objectives : In a retrospective study the effect of a combined pretreatment using ticlopidine and aspirin ( ASA ) in patients undergoing elective PTCA procedures was investigated with respect to in-hospital complications of PTCA and with respect to the efficacy in avoiding a subacute stent thrombosis in case of stent implantation . The systematically performed pretreatment with ticlopidine and ASA takes the delayed begin of full antiplatelet effect of ticlopidine into account .
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[ "umlsterm" ]
Objectives, retrospective study, ticlopidine, aspirin, ASA, patients, PTCA, procedures, complications, PTCA, stent, thrombosis, stent, implantation, ticlopidine, ASA, antiplatelet, ticlopidine
ZfuerKardiologie.80870872.eng.abstr_task2
Sentence: Objectives : In a retrospective study the effect of a combined pretreatment using ticlopidine and aspirin ( ASA ) in patients undergoing elective PTCA procedures was investigated with respect to in-hospital complications of PTCA and with respect to the efficacy in avoiding a subacute stent thrombosis in case of stent implantation . The systematically performed pretreatment with ticlopidine and ASA takes the delayed begin of full antiplatelet effect of ticlopidine into account . Instructions: please extract entity words from the input sentence
[ "B-umlsterm", "O", "O", "O", "B-umlsterm", "I-umlsterm", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "B-umlsterm", "B-umlsterm", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "B-umlsterm", "O", "O", "B-umlsterm", "O", "O", "O" ]
Objectives : In a retrospective study the effect of a combined pretreatment using ticlopidine and aspirin ( ASA ) in patients undergoing elective PTCA procedures was investigated with respect to in-hospital complications of PTCA and with respect to the efficacy in avoiding a subacute stent thrombosis in case of stent implantation . The systematically performed pretreatment with ticlopidine and ASA takes the delayed begin of full antiplatelet effect of ticlopidine into account .
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[ "umlsterm" ]
N - terminus is a Entity, prion protein is a Protein, PrP(C ) is a Protein, prion protein is a Protein, prion protein is a Protein, PrP is a Protein, PrP is a Protein, Pro44 is a Entity, PrP is a Protein
31_task0
Sentence: Post-translational hydroxylation at the N-terminus of the prion protein reveals presence of PPII structure in vivo. The transmissible spongiform encephalopathies are characterized by conversion of a host protein, PrP(C) (cellular prion protein), to a protease-resistant isoform, PrP(Sc) (prion protein scrapie isoform). The importance of the highly flexible, N-terminal region of PrP has recently become more widely appreciated, particularly the biological activities associated with its metal ion-binding domain and its potential to form a poly(L-proline) II (PPII) helix. Circular dichroism spectroscopy of an N-terminal peptide, PrP(37-53), showed that the PPII helix is formed in aqueous buffer; as it also contains an Xaa-Pro-Gly consensus sequence, it may act as a substrate for the collagen-modifying enzyme prolyl 4-hydroxylase. Direct evidence for this modification was obtained by mass spectrometry and Edman sequencing in recombinant mouse PrP secreted from stably transfected Chinese hamster ovary cells. Almost complete conversion of proline to 4-hydroxyproline occurs specifically at residue Pro44 of this murine protein; the same hydroxylated residue was detected, at lower levels, in PrP(Sc) from the brains of scrapie-infected mice. Cation binding and/or post-translational hydroxylation of this region of PrP may regulate its role in the physiology and pathobiology of the cell. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: Entity, Protein
[ "O", "O", "O", "O", "O", "O", "B-Entity", "I-Entity", "I-Entity", "O", "O", "B-Protein", "I-Protein", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Protein", "I-Protein", "O", "O", "B-Protein", "I-Protein", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Protein", "I-Protein", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Protein", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Protein", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Entity", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Protein", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Post-translational hydroxylation at the N-terminus of the prion protein reveals presence of PPII structure in vivo. The transmissible spongiform encephalopathies are characterized by conversion of a host protein, PrP(C) (cellular prion protein), to a protease-resistant isoform, PrP(Sc) (prion protein scrapie isoform). The importance of the highly flexible, N-terminal region of PrP has recently become more widely appreciated, particularly the biological activities associated with its metal ion-binding domain and its potential to form a poly(L-proline) II (PPII) helix. Circular dichroism spectroscopy of an N-terminal peptide, PrP(37-53), showed that the PPII helix is formed in aqueous buffer; as it also contains an Xaa-Pro-Gly consensus sequence, it may act as a substrate for the collagen-modifying enzyme prolyl 4-hydroxylase. Direct evidence for this modification was obtained by mass spectrometry and Edman sequencing in recombinant mouse PrP secreted from stably transfected Chinese hamster ovary cells. Almost complete conversion of proline to 4-hydroxyproline occurs specifically at residue Pro44 of this murine protein; the same hydroxylated residue was detected, at lower levels, in PrP(Sc) from the brains of scrapie-infected mice. Cation binding and/or post-translational hydroxylation of this region of PrP may regulate its role in the physiology and pathobiology of the cell.
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[ "Protein", "Entity" ]
N - terminus is a Entity, prion protein is a Protein, PrP(C ) is a Protein, prion protein is a Protein, prion protein is a Protein, PrP is a Protein, PrP is a Protein, Pro44 is a Entity, PrP is a Protein
31_task1
Sentence: Post-translational hydroxylation at the N-terminus of the prion protein reveals presence of PPII structure in vivo. The transmissible spongiform encephalopathies are characterized by conversion of a host protein, PrP(C) (cellular prion protein), to a protease-resistant isoform, PrP(Sc) (prion protein scrapie isoform). The importance of the highly flexible, N-terminal region of PrP has recently become more widely appreciated, particularly the biological activities associated with its metal ion-binding domain and its potential to form a poly(L-proline) II (PPII) helix. Circular dichroism spectroscopy of an N-terminal peptide, PrP(37-53), showed that the PPII helix is formed in aqueous buffer; as it also contains an Xaa-Pro-Gly consensus sequence, it may act as a substrate for the collagen-modifying enzyme prolyl 4-hydroxylase. Direct evidence for this modification was obtained by mass spectrometry and Edman sequencing in recombinant mouse PrP secreted from stably transfected Chinese hamster ovary cells. Almost complete conversion of proline to 4-hydroxyproline occurs specifically at residue Pro44 of this murine protein; the same hydroxylated residue was detected, at lower levels, in PrP(Sc) from the brains of scrapie-infected mice. Cation binding and/or post-translational hydroxylation of this region of PrP may regulate its role in the physiology and pathobiology of the cell. Instructions: please typing these entity words according to sentence: N - terminus, prion protein, PrP(C ), prion protein, prion protein, PrP, PrP, Pro44, PrP Options: Entity, Protein
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Post-translational hydroxylation at the N-terminus of the prion protein reveals presence of PPII structure in vivo. The transmissible spongiform encephalopathies are characterized by conversion of a host protein, PrP(C) (cellular prion protein), to a protease-resistant isoform, PrP(Sc) (prion protein scrapie isoform). The importance of the highly flexible, N-terminal region of PrP has recently become more widely appreciated, particularly the biological activities associated with its metal ion-binding domain and its potential to form a poly(L-proline) II (PPII) helix. Circular dichroism spectroscopy of an N-terminal peptide, PrP(37-53), showed that the PPII helix is formed in aqueous buffer; as it also contains an Xaa-Pro-Gly consensus sequence, it may act as a substrate for the collagen-modifying enzyme prolyl 4-hydroxylase. Direct evidence for this modification was obtained by mass spectrometry and Edman sequencing in recombinant mouse PrP secreted from stably transfected Chinese hamster ovary cells. Almost complete conversion of proline to 4-hydroxyproline occurs specifically at residue Pro44 of this murine protein; the same hydroxylated residue was detected, at lower levels, in PrP(Sc) from the brains of scrapie-infected mice. Cation binding and/or post-translational hydroxylation of this region of PrP may regulate its role in the physiology and pathobiology of the cell.
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[ "Protein", "Entity" ]
N - terminus, prion protein, PrP(C ), prion protein, prion protein, PrP, PrP, Pro44, PrP
31_task2
Sentence: Post-translational hydroxylation at the N-terminus of the prion protein reveals presence of PPII structure in vivo. The transmissible spongiform encephalopathies are characterized by conversion of a host protein, PrP(C) (cellular prion protein), to a protease-resistant isoform, PrP(Sc) (prion protein scrapie isoform). The importance of the highly flexible, N-terminal region of PrP has recently become more widely appreciated, particularly the biological activities associated with its metal ion-binding domain and its potential to form a poly(L-proline) II (PPII) helix. Circular dichroism spectroscopy of an N-terminal peptide, PrP(37-53), showed that the PPII helix is formed in aqueous buffer; as it also contains an Xaa-Pro-Gly consensus sequence, it may act as a substrate for the collagen-modifying enzyme prolyl 4-hydroxylase. Direct evidence for this modification was obtained by mass spectrometry and Edman sequencing in recombinant mouse PrP secreted from stably transfected Chinese hamster ovary cells. Almost complete conversion of proline to 4-hydroxyproline occurs specifically at residue Pro44 of this murine protein; the same hydroxylated residue was detected, at lower levels, in PrP(Sc) from the brains of scrapie-infected mice. Cation binding and/or post-translational hydroxylation of this region of PrP may regulate its role in the physiology and pathobiology of the cell. Instructions: please extract entity words from the input sentence
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Post-translational hydroxylation at the N-terminus of the prion protein reveals presence of PPII structure in vivo. The transmissible spongiform encephalopathies are characterized by conversion of a host protein, PrP(C) (cellular prion protein), to a protease-resistant isoform, PrP(Sc) (prion protein scrapie isoform). The importance of the highly flexible, N-terminal region of PrP has recently become more widely appreciated, particularly the biological activities associated with its metal ion-binding domain and its potential to form a poly(L-proline) II (PPII) helix. Circular dichroism spectroscopy of an N-terminal peptide, PrP(37-53), showed that the PPII helix is formed in aqueous buffer; as it also contains an Xaa-Pro-Gly consensus sequence, it may act as a substrate for the collagen-modifying enzyme prolyl 4-hydroxylase. Direct evidence for this modification was obtained by mass spectrometry and Edman sequencing in recombinant mouse PrP secreted from stably transfected Chinese hamster ovary cells. Almost complete conversion of proline to 4-hydroxyproline occurs specifically at residue Pro44 of this murine protein; the same hydroxylated residue was detected, at lower levels, in PrP(Sc) from the brains of scrapie-infected mice. Cation binding and/or post-translational hydroxylation of this region of PrP may regulate its role in the physiology and pathobiology of the cell.
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[ "Protein", "Entity" ]
HG is a compound, mannitol is a compound, glucose is a compound, TNF - alpha converting enzyme is a protein, TACE is a protein, ADAM17 is a protein, sorbinil is a compound
DS.d1031_task0
Sentence: Treatment with HG, but not equimolar mannitol or 3-O-methyl glucose, resulted in phosphorylation and activation of TNF-alpha converting enzyme (TACE) (ADAM17), which were attenuated by sorbinil or AR-specific small interference RNA. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: compound, protein
[ "O", "O", "B-compound", "O", "O", "O", "O", "B-compound", "O", "O", "O", "O", "B-compound", "O", "O", "O", "O", "O", "O", "O", "B-protein", "I-protein", "I-protein", "I-protein", "I-protein", "O", "B-protein", "O", "O", "B-protein", "O", "O", "O", "O", "O", "O", "B-compound", "O", "O", "O", "O", "O", "O", "O", "O" ]
Treatment with HG, but not equimolar mannitol or 3-O-methyl glucose, resulted in phosphorylation and activation of TNF-alpha converting enzyme (TACE) (ADAM17), which were attenuated by sorbinil or AR-specific small interference RNA.
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[ "protein", "compound" ]
HG is a compound, mannitol is a compound, glucose is a compound, TNF - alpha converting enzyme is a protein, TACE is a protein, ADAM17 is a protein, sorbinil is a compound
DS.d1031_task1
Sentence: Treatment with HG, but not equimolar mannitol or 3-O-methyl glucose, resulted in phosphorylation and activation of TNF-alpha converting enzyme (TACE) (ADAM17), which were attenuated by sorbinil or AR-specific small interference RNA. Instructions: please typing these entity words according to sentence: HG, mannitol, glucose, TNF - alpha converting enzyme, TACE, ADAM17, sorbinil Options: compound, protein
[ "O", "O", "B-compound", "O", "O", "O", "O", "B-compound", "O", "O", "O", "O", "B-compound", "O", "O", "O", "O", "O", "O", "O", "B-protein", "I-protein", "I-protein", "I-protein", "I-protein", "O", "B-protein", "O", "O", "B-protein", "O", "O", "O", "O", "O", "O", "B-compound", "O", "O", "O", "O", "O", "O", "O", "O" ]
Treatment with HG, but not equimolar mannitol or 3-O-methyl glucose, resulted in phosphorylation and activation of TNF-alpha converting enzyme (TACE) (ADAM17), which were attenuated by sorbinil or AR-specific small interference RNA.
[ "Treatment", "with", "HG", ",", "but", "not", "equimolar", "mannitol", "or", "3-O", "-", "methyl", "glucose", ",", "resulted", "in", "phosphorylation", "and", "activation", "of", "TNF", "-", "alpha", "converting", "enzyme", "(", "TACE", ")", "(", "ADAM17", ")", ",", "which", "were", "attenuated", "by", "sorbinil", "or", "AR", "-", "specific", "small", "interference", "RNA", "." ]
[ "protein", "compound" ]
HG, mannitol, glucose, TNF - alpha converting enzyme, TACE, ADAM17, sorbinil
DS.d1031_task2
Sentence: Treatment with HG, but not equimolar mannitol or 3-O-methyl glucose, resulted in phosphorylation and activation of TNF-alpha converting enzyme (TACE) (ADAM17), which were attenuated by sorbinil or AR-specific small interference RNA. Instructions: please extract entity words from the input sentence
[ "O", "O", "B-compound", "O", "O", "O", "O", "B-compound", "O", "O", "O", "O", "B-compound", "O", "O", "O", "O", "O", "O", "O", "B-protein", "I-protein", "I-protein", "I-protein", "I-protein", "O", "B-protein", "O", "O", "B-protein", "O", "O", "O", "O", "O", "O", "B-compound", "O", "O", "O", "O", "O", "O", "O", "O" ]
Treatment with HG, but not equimolar mannitol or 3-O-methyl glucose, resulted in phosphorylation and activation of TNF-alpha converting enzyme (TACE) (ADAM17), which were attenuated by sorbinil or AR-specific small interference RNA.
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[ "protein", "compound" ]
Development is an umlsterm, speech is an umlsterm, recognition is an umlsterm, software is an umlsterm, stage is an umlsterm
Herz.00250627.eng.abstr_task0
Sentence: Development of speech recognition software is at a stage where you can use it effectively for creating cardiological reports or at least parts of it . We were very successful in using the Dragon NaturallySpeaking system for our reports and we don ' t need a secretary for our writings any longer . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: umlsterm
[ "B-umlsterm", "O", "B-umlsterm", "B-umlsterm", "B-umlsterm", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Development of speech recognition software is at a stage where you can use it effectively for creating cardiological reports or at least parts of it . We were very successful in using the Dragon NaturallySpeaking system for our reports and we don ' t need a secretary for our writings any longer .
[ "Development", "of", "speech", "recognition", "software", "is", "at", "a", "stage", "where", "you", "can", "use", "it", "effectively", "for", "creating", "cardiological", "reports", "or", "at", "least", "parts", "of", "it", ".", "We", "were", "very", "successful", "in", "using", "the", "Dragon", "NaturallySpeaking", "system", "for", "our", "reports", "and", "we", "don", "'", "t", "need", "a", "secretary", "for", "our", "writings", "any", "longer", "." ]
[ "umlsterm" ]
Development is an umlsterm, speech is an umlsterm, recognition is an umlsterm, software is an umlsterm, stage is an umlsterm
Herz.00250627.eng.abstr_task1
Sentence: Development of speech recognition software is at a stage where you can use it effectively for creating cardiological reports or at least parts of it . We were very successful in using the Dragon NaturallySpeaking system for our reports and we don ' t need a secretary for our writings any longer . Instructions: please typing these entity words according to sentence: Development, speech, recognition, software, stage Options: umlsterm
[ "B-umlsterm", "O", "B-umlsterm", "B-umlsterm", "B-umlsterm", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Development of speech recognition software is at a stage where you can use it effectively for creating cardiological reports or at least parts of it . We were very successful in using the Dragon NaturallySpeaking system for our reports and we don ' t need a secretary for our writings any longer .
[ "Development", "of", "speech", "recognition", "software", "is", "at", "a", "stage", "where", "you", "can", "use", "it", "effectively", "for", "creating", "cardiological", "reports", "or", "at", "least", "parts", "of", "it", ".", "We", "were", "very", "successful", "in", "using", "the", "Dragon", "NaturallySpeaking", "system", "for", "our", "reports", "and", "we", "don", "'", "t", "need", "a", "secretary", "for", "our", "writings", "any", "longer", "." ]
[ "umlsterm" ]
Development, speech, recognition, software, stage
Herz.00250627.eng.abstr_task2
Sentence: Development of speech recognition software is at a stage where you can use it effectively for creating cardiological reports or at least parts of it . We were very successful in using the Dragon NaturallySpeaking system for our reports and we don ' t need a secretary for our writings any longer . Instructions: please extract entity words from the input sentence
[ "B-umlsterm", "O", "B-umlsterm", "B-umlsterm", "B-umlsterm", "O", "O", "O", "B-umlsterm", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Development of speech recognition software is at a stage where you can use it effectively for creating cardiological reports or at least parts of it . We were very successful in using the Dragon NaturallySpeaking system for our reports and we don ' t need a secretary for our writings any longer .
[ "Development", "of", "speech", "recognition", "software", "is", "at", "a", "stage", "where", "you", "can", "use", "it", "effectively", "for", "creating", "cardiological", "reports", "or", "at", "least", "parts", "of", "it", ".", "We", "were", "very", "successful", "in", "using", "the", "Dragon", "NaturallySpeaking", "system", "for", "our", "reports", "and", "we", "don", "'", "t", "need", "a", "secretary", "for", "our", "writings", "any", "longer", "." ]
[ "umlsterm" ]
bladder neck plication stitch is a Intervention_Surgical, robot - assisted radical prostatectomy . is a Participant_Condition, bladder neck plication stitch technique is a Intervention_Surgical, 158 is a Participant_Sample-size, prostate cancer is a Participant_Condition, with is a Intervention_Educational, 79 is a Participant_Sample-size, or without is a Intervention_Educational
68759_task0
Sentence: Randomized clinical trial of a bladder neck plication stitch during robot-assisted radical prostatectomy . Urinary incontinence after robot-assisted radical prostatectomy ( RARP ) is one of the most bothersome complications affecting patients ' daily lives . The efficacy of the bladder neck plication stitch technique in promoting an earlier return of continence was prospectively evaluated in 158 patients who underwent RARP for clinically localized prostate cancer by a single surgeon at our institute from March 2012 to January 2013 . Patients were randomized 1:1 to undergo surgery with ( n = 79 ) or without ( n = 79 ) the bladder neck plication stitch , and their time to recovery from incontinence , defined as being pad free , was compared . Recovery from incontinence at 1 , 3 , and 6 months were observed in 22 ( 27.8 % ) , 42 ( 53.2 % ) , and 57 ( 72.2 % ) patients , respectively , treated with , and 23 ( 29.1 % ) , 47 ( 59.5 % ) , and 59 ( 74.7 % ) patients , respectively , treated without the bladder neck plication stitch , with no significant difference in time to recovery from incontinence between the two groups . Multivariate analysis showed that age , membranous urethral length and shape of the prostatic apex on magnetic resonance imaging were independent predictors of early recovery from urinary incontinence after RARP . The bladder neck plication stitch had no effect on time to recovery from postoperative urinary incontinence following RARP . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: Intervention_Educational, Intervention_Surgical, Participant_Condition, Participant_Sample-size
[ "O", "O", "O", "O", "O", "B-Intervention_Surgical", "I-Intervention_Surgical", "I-Intervention_Surgical", "I-Intervention_Surgical", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Surgical", "I-Intervention_Surgical", "I-Intervention_Surgical", "I-Intervention_Surgical", "I-Intervention_Surgical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Sample-size", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Educational", "O", "O", "O", "B-Participant_Sample-size", "O", "B-Intervention_Educational", "I-Intervention_Educational", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Randomized clinical trial of a bladder neck plication stitch during robot-assisted radical prostatectomy . Urinary incontinence after robot-assisted radical prostatectomy ( RARP ) is one of the most bothersome complications affecting patients ' daily lives . The efficacy of the bladder neck plication stitch technique in promoting an earlier return of continence was prospectively evaluated in 158 patients who underwent RARP for clinically localized prostate cancer by a single surgeon at our institute from March 2012 to January 2013 . Patients were randomized 1:1 to undergo surgery with ( n = 79 ) or without ( n = 79 ) the bladder neck plication stitch , and their time to recovery from incontinence , defined as being pad free , was compared . Recovery from incontinence at 1 , 3 , and 6 months were observed in 22 ( 27.8 % ) , 42 ( 53.2 % ) , and 57 ( 72.2 % ) patients , respectively , treated with , and 23 ( 29.1 % ) , 47 ( 59.5 % ) , and 59 ( 74.7 % ) patients , respectively , treated without the bladder neck plication stitch , with no significant difference in time to recovery from incontinence between the two groups . Multivariate analysis showed that age , membranous urethral length and shape of the prostatic apex on magnetic resonance imaging were independent predictors of early recovery from urinary incontinence after RARP . The bladder neck plication stitch had no effect on time to recovery from postoperative urinary incontinence following RARP .
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[ "Intervention_Surgical", "Participant_Condition", "Intervention_Educational", "Participant_Sample-size" ]
bladder neck plication stitch is a Intervention_Surgical, robot - assisted radical prostatectomy . is a Participant_Condition, bladder neck plication stitch technique is a Intervention_Surgical, 158 is a Participant_Sample-size, prostate cancer is a Participant_Condition, with is a Intervention_Educational, 79 is a Participant_Sample-size, or without is a Intervention_Educational
68759_task1
Sentence: Randomized clinical trial of a bladder neck plication stitch during robot-assisted radical prostatectomy . Urinary incontinence after robot-assisted radical prostatectomy ( RARP ) is one of the most bothersome complications affecting patients ' daily lives . The efficacy of the bladder neck plication stitch technique in promoting an earlier return of continence was prospectively evaluated in 158 patients who underwent RARP for clinically localized prostate cancer by a single surgeon at our institute from March 2012 to January 2013 . Patients were randomized 1:1 to undergo surgery with ( n = 79 ) or without ( n = 79 ) the bladder neck plication stitch , and their time to recovery from incontinence , defined as being pad free , was compared . Recovery from incontinence at 1 , 3 , and 6 months were observed in 22 ( 27.8 % ) , 42 ( 53.2 % ) , and 57 ( 72.2 % ) patients , respectively , treated with , and 23 ( 29.1 % ) , 47 ( 59.5 % ) , and 59 ( 74.7 % ) patients , respectively , treated without the bladder neck plication stitch , with no significant difference in time to recovery from incontinence between the two groups . Multivariate analysis showed that age , membranous urethral length and shape of the prostatic apex on magnetic resonance imaging were independent predictors of early recovery from urinary incontinence after RARP . The bladder neck plication stitch had no effect on time to recovery from postoperative urinary incontinence following RARP . Instructions: please typing these entity words according to sentence: bladder neck plication stitch, robot - assisted radical prostatectomy ., bladder neck plication stitch technique, 158, prostate cancer, with, 79, or without Options: Intervention_Educational, Intervention_Surgical, Participant_Condition, Participant_Sample-size
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Randomized clinical trial of a bladder neck plication stitch during robot-assisted radical prostatectomy . Urinary incontinence after robot-assisted radical prostatectomy ( RARP ) is one of the most bothersome complications affecting patients ' daily lives . The efficacy of the bladder neck plication stitch technique in promoting an earlier return of continence was prospectively evaluated in 158 patients who underwent RARP for clinically localized prostate cancer by a single surgeon at our institute from March 2012 to January 2013 . Patients were randomized 1:1 to undergo surgery with ( n = 79 ) or without ( n = 79 ) the bladder neck plication stitch , and their time to recovery from incontinence , defined as being pad free , was compared . Recovery from incontinence at 1 , 3 , and 6 months were observed in 22 ( 27.8 % ) , 42 ( 53.2 % ) , and 57 ( 72.2 % ) patients , respectively , treated with , and 23 ( 29.1 % ) , 47 ( 59.5 % ) , and 59 ( 74.7 % ) patients , respectively , treated without the bladder neck plication stitch , with no significant difference in time to recovery from incontinence between the two groups . Multivariate analysis showed that age , membranous urethral length and shape of the prostatic apex on magnetic resonance imaging were independent predictors of early recovery from urinary incontinence after RARP . The bladder neck plication stitch had no effect on time to recovery from postoperative urinary incontinence following RARP .
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[ "Intervention_Surgical", "Participant_Condition", "Intervention_Educational", "Participant_Sample-size" ]
bladder neck plication stitch, robot - assisted radical prostatectomy ., bladder neck plication stitch technique, 158, prostate cancer, with, 79, or without
68759_task2
Sentence: Randomized clinical trial of a bladder neck plication stitch during robot-assisted radical prostatectomy . Urinary incontinence after robot-assisted radical prostatectomy ( RARP ) is one of the most bothersome complications affecting patients ' daily lives . The efficacy of the bladder neck plication stitch technique in promoting an earlier return of continence was prospectively evaluated in 158 patients who underwent RARP for clinically localized prostate cancer by a single surgeon at our institute from March 2012 to January 2013 . Patients were randomized 1:1 to undergo surgery with ( n = 79 ) or without ( n = 79 ) the bladder neck plication stitch , and their time to recovery from incontinence , defined as being pad free , was compared . Recovery from incontinence at 1 , 3 , and 6 months were observed in 22 ( 27.8 % ) , 42 ( 53.2 % ) , and 57 ( 72.2 % ) patients , respectively , treated with , and 23 ( 29.1 % ) , 47 ( 59.5 % ) , and 59 ( 74.7 % ) patients , respectively , treated without the bladder neck plication stitch , with no significant difference in time to recovery from incontinence between the two groups . Multivariate analysis showed that age , membranous urethral length and shape of the prostatic apex on magnetic resonance imaging were independent predictors of early recovery from urinary incontinence after RARP . The bladder neck plication stitch had no effect on time to recovery from postoperative urinary incontinence following RARP . Instructions: please extract entity words from the input sentence
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Randomized clinical trial of a bladder neck plication stitch during robot-assisted radical prostatectomy . Urinary incontinence after robot-assisted radical prostatectomy ( RARP ) is one of the most bothersome complications affecting patients ' daily lives . The efficacy of the bladder neck plication stitch technique in promoting an earlier return of continence was prospectively evaluated in 158 patients who underwent RARP for clinically localized prostate cancer by a single surgeon at our institute from March 2012 to January 2013 . Patients were randomized 1:1 to undergo surgery with ( n = 79 ) or without ( n = 79 ) the bladder neck plication stitch , and their time to recovery from incontinence , defined as being pad free , was compared . Recovery from incontinence at 1 , 3 , and 6 months were observed in 22 ( 27.8 % ) , 42 ( 53.2 % ) , and 57 ( 72.2 % ) patients , respectively , treated with , and 23 ( 29.1 % ) , 47 ( 59.5 % ) , and 59 ( 74.7 % ) patients , respectively , treated without the bladder neck plication stitch , with no significant difference in time to recovery from incontinence between the two groups . Multivariate analysis showed that age , membranous urethral length and shape of the prostatic apex on magnetic resonance imaging were independent predictors of early recovery from urinary incontinence after RARP . The bladder neck plication stitch had no effect on time to recovery from postoperative urinary incontinence following RARP .
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[ "Intervention_Surgical", "Participant_Condition", "Intervention_Educational", "Participant_Sample-size" ]
Patienten is an umlsterm, Geraete is an umlsterm, artefaktfreie is an umlsterm, Intensiv - Patienten is an umlsterm, Patienten is an umlsterm, Blutdruckmessung is an umlsterm, Blutdruck is an umlsterm, Blutdruck is an umlsterm, Algorithmen is an umlsterm, Blutdruckwerte is an umlsterm, Geraete is an umlsterm
DerAnaesthesist.60450453.ger.abstr_task0
Sentence: Mit Hilfe eines Simulators , der reale Biosignale von Patienten verwendet , wurde die Messgenauigkeit der Geraete Dinamap 1846 ( Critikon ) und HP M-1008B ( Hewlett Packard ) untersucht . Es wurden 49 artefaktfreie oszillometrische Signale von 20 Intensiv-Patienten fuer die Simulationsmessungen benutzt . Das Dinamap 1846 konnte nur 41 Signale von Patienten auswerten , das HP M-1008B 47 Signale . Bei dem Vergleich mit der invasiven Blutdruckmessung betrug der mittlere Messfehler fuer den systolischen , diastolischen und mittleren arteriellen Blutdruck fuer das Dinamap 1846 2,50 mm Hg , 3,35 mm Hg ( p 0,05 ) und 1,51 mm Hg , sowie fuer das HP M-1008B -8 , 51 mm Hg ( p 0,001 ) , 5,15 mm Hg ( p 0,001 ) und -5 , 58 mm Hg ( p 0,001 ) . Das 95%-Toleranzintervall fuer den systolischen , diastolischen und mittleren arteriellen Blutdruck betrug 56 mm Hg , 30 mm Hg und 35 mm Hg fuer das Dinamap sowie 50 mm Hg , 38 mm Hg und 35 mm Hg fuer das HP M-1008B. Die unterschiedlichen Messergebnisse sind vermutlich auf verschiedene Algorithmen zur Bestimmung der Blutdruckwerte und verschiedene Artefakterkennungsprogramme der Geraete zurueckzufuehren . Wegen der systematischen und stochastischen Abweichungen sind wir der Auffassung , dass das Dinamap 1846 und das HP M-1008B noch nicht den technischen Stand erreicht haben , um auch bei kritisch Kranken eingesetzt zur werden . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: umlsterm
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Mit Hilfe eines Simulators , der reale Biosignale von Patienten verwendet , wurde die Messgenauigkeit der Geraete Dinamap 1846 ( Critikon ) und HP M-1008B ( Hewlett Packard ) untersucht . Es wurden 49 artefaktfreie oszillometrische Signale von 20 Intensiv-Patienten fuer die Simulationsmessungen benutzt . Das Dinamap 1846 konnte nur 41 Signale von Patienten auswerten , das HP M-1008B 47 Signale . Bei dem Vergleich mit der invasiven Blutdruckmessung betrug der mittlere Messfehler fuer den systolischen , diastolischen und mittleren arteriellen Blutdruck fuer das Dinamap 1846 2,50 mm Hg , 3,35 mm Hg ( p 0,05 ) und 1,51 mm Hg , sowie fuer das HP M-1008B -8 , 51 mm Hg ( p 0,001 ) , 5,15 mm Hg ( p 0,001 ) und -5 , 58 mm Hg ( p 0,001 ) . Das 95%-Toleranzintervall fuer den systolischen , diastolischen und mittleren arteriellen Blutdruck betrug 56 mm Hg , 30 mm Hg und 35 mm Hg fuer das Dinamap sowie 50 mm Hg , 38 mm Hg und 35 mm Hg fuer das HP M-1008B. Die unterschiedlichen Messergebnisse sind vermutlich auf verschiedene Algorithmen zur Bestimmung der Blutdruckwerte und verschiedene Artefakterkennungsprogramme der Geraete zurueckzufuehren . Wegen der systematischen und stochastischen Abweichungen sind wir der Auffassung , dass das Dinamap 1846 und das HP M-1008B noch nicht den technischen Stand erreicht haben , um auch bei kritisch Kranken eingesetzt zur werden .
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[ "umlsterm" ]
Patienten is an umlsterm, Geraete is an umlsterm, artefaktfreie is an umlsterm, Intensiv - Patienten is an umlsterm, Patienten is an umlsterm, Blutdruckmessung is an umlsterm, Blutdruck is an umlsterm, Blutdruck is an umlsterm, Algorithmen is an umlsterm, Blutdruckwerte is an umlsterm, Geraete is an umlsterm
DerAnaesthesist.60450453.ger.abstr_task1
Sentence: Mit Hilfe eines Simulators , der reale Biosignale von Patienten verwendet , wurde die Messgenauigkeit der Geraete Dinamap 1846 ( Critikon ) und HP M-1008B ( Hewlett Packard ) untersucht . Es wurden 49 artefaktfreie oszillometrische Signale von 20 Intensiv-Patienten fuer die Simulationsmessungen benutzt . Das Dinamap 1846 konnte nur 41 Signale von Patienten auswerten , das HP M-1008B 47 Signale . Bei dem Vergleich mit der invasiven Blutdruckmessung betrug der mittlere Messfehler fuer den systolischen , diastolischen und mittleren arteriellen Blutdruck fuer das Dinamap 1846 2,50 mm Hg , 3,35 mm Hg ( p 0,05 ) und 1,51 mm Hg , sowie fuer das HP M-1008B -8 , 51 mm Hg ( p 0,001 ) , 5,15 mm Hg ( p 0,001 ) und -5 , 58 mm Hg ( p 0,001 ) . Das 95%-Toleranzintervall fuer den systolischen , diastolischen und mittleren arteriellen Blutdruck betrug 56 mm Hg , 30 mm Hg und 35 mm Hg fuer das Dinamap sowie 50 mm Hg , 38 mm Hg und 35 mm Hg fuer das HP M-1008B. Die unterschiedlichen Messergebnisse sind vermutlich auf verschiedene Algorithmen zur Bestimmung der Blutdruckwerte und verschiedene Artefakterkennungsprogramme der Geraete zurueckzufuehren . Wegen der systematischen und stochastischen Abweichungen sind wir der Auffassung , dass das Dinamap 1846 und das HP M-1008B noch nicht den technischen Stand erreicht haben , um auch bei kritisch Kranken eingesetzt zur werden . Instructions: please typing these entity words according to sentence: Patienten, Geraete, artefaktfreie, Intensiv - Patienten, Patienten, Blutdruckmessung, Blutdruck, Blutdruck, Algorithmen, Blutdruckwerte, Geraete Options: umlsterm
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Mit Hilfe eines Simulators , der reale Biosignale von Patienten verwendet , wurde die Messgenauigkeit der Geraete Dinamap 1846 ( Critikon ) und HP M-1008B ( Hewlett Packard ) untersucht . Es wurden 49 artefaktfreie oszillometrische Signale von 20 Intensiv-Patienten fuer die Simulationsmessungen benutzt . Das Dinamap 1846 konnte nur 41 Signale von Patienten auswerten , das HP M-1008B 47 Signale . Bei dem Vergleich mit der invasiven Blutdruckmessung betrug der mittlere Messfehler fuer den systolischen , diastolischen und mittleren arteriellen Blutdruck fuer das Dinamap 1846 2,50 mm Hg , 3,35 mm Hg ( p 0,05 ) und 1,51 mm Hg , sowie fuer das HP M-1008B -8 , 51 mm Hg ( p 0,001 ) , 5,15 mm Hg ( p 0,001 ) und -5 , 58 mm Hg ( p 0,001 ) . Das 95%-Toleranzintervall fuer den systolischen , diastolischen und mittleren arteriellen Blutdruck betrug 56 mm Hg , 30 mm Hg und 35 mm Hg fuer das Dinamap sowie 50 mm Hg , 38 mm Hg und 35 mm Hg fuer das HP M-1008B. Die unterschiedlichen Messergebnisse sind vermutlich auf verschiedene Algorithmen zur Bestimmung der Blutdruckwerte und verschiedene Artefakterkennungsprogramme der Geraete zurueckzufuehren . Wegen der systematischen und stochastischen Abweichungen sind wir der Auffassung , dass das Dinamap 1846 und das HP M-1008B noch nicht den technischen Stand erreicht haben , um auch bei kritisch Kranken eingesetzt zur werden .
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[ "umlsterm" ]
Patienten, Geraete, artefaktfreie, Intensiv - Patienten, Patienten, Blutdruckmessung, Blutdruck, Blutdruck, Algorithmen, Blutdruckwerte, Geraete
DerAnaesthesist.60450453.ger.abstr_task2
Sentence: Mit Hilfe eines Simulators , der reale Biosignale von Patienten verwendet , wurde die Messgenauigkeit der Geraete Dinamap 1846 ( Critikon ) und HP M-1008B ( Hewlett Packard ) untersucht . Es wurden 49 artefaktfreie oszillometrische Signale von 20 Intensiv-Patienten fuer die Simulationsmessungen benutzt . Das Dinamap 1846 konnte nur 41 Signale von Patienten auswerten , das HP M-1008B 47 Signale . Bei dem Vergleich mit der invasiven Blutdruckmessung betrug der mittlere Messfehler fuer den systolischen , diastolischen und mittleren arteriellen Blutdruck fuer das Dinamap 1846 2,50 mm Hg , 3,35 mm Hg ( p 0,05 ) und 1,51 mm Hg , sowie fuer das HP M-1008B -8 , 51 mm Hg ( p 0,001 ) , 5,15 mm Hg ( p 0,001 ) und -5 , 58 mm Hg ( p 0,001 ) . Das 95%-Toleranzintervall fuer den systolischen , diastolischen und mittleren arteriellen Blutdruck betrug 56 mm Hg , 30 mm Hg und 35 mm Hg fuer das Dinamap sowie 50 mm Hg , 38 mm Hg und 35 mm Hg fuer das HP M-1008B. Die unterschiedlichen Messergebnisse sind vermutlich auf verschiedene Algorithmen zur Bestimmung der Blutdruckwerte und verschiedene Artefakterkennungsprogramme der Geraete zurueckzufuehren . Wegen der systematischen und stochastischen Abweichungen sind wir der Auffassung , dass das Dinamap 1846 und das HP M-1008B noch nicht den technischen Stand erreicht haben , um auch bei kritisch Kranken eingesetzt zur werden . Instructions: please extract entity words from the input sentence
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Mit Hilfe eines Simulators , der reale Biosignale von Patienten verwendet , wurde die Messgenauigkeit der Geraete Dinamap 1846 ( Critikon ) und HP M-1008B ( Hewlett Packard ) untersucht . Es wurden 49 artefaktfreie oszillometrische Signale von 20 Intensiv-Patienten fuer die Simulationsmessungen benutzt . Das Dinamap 1846 konnte nur 41 Signale von Patienten auswerten , das HP M-1008B 47 Signale . Bei dem Vergleich mit der invasiven Blutdruckmessung betrug der mittlere Messfehler fuer den systolischen , diastolischen und mittleren arteriellen Blutdruck fuer das Dinamap 1846 2,50 mm Hg , 3,35 mm Hg ( p 0,05 ) und 1,51 mm Hg , sowie fuer das HP M-1008B -8 , 51 mm Hg ( p 0,001 ) , 5,15 mm Hg ( p 0,001 ) und -5 , 58 mm Hg ( p 0,001 ) . Das 95%-Toleranzintervall fuer den systolischen , diastolischen und mittleren arteriellen Blutdruck betrug 56 mm Hg , 30 mm Hg und 35 mm Hg fuer das Dinamap sowie 50 mm Hg , 38 mm Hg und 35 mm Hg fuer das HP M-1008B. Die unterschiedlichen Messergebnisse sind vermutlich auf verschiedene Algorithmen zur Bestimmung der Blutdruckwerte und verschiedene Artefakterkennungsprogramme der Geraete zurueckzufuehren . Wegen der systematischen und stochastischen Abweichungen sind wir der Auffassung , dass das Dinamap 1846 und das HP M-1008B noch nicht den technischen Stand erreicht haben , um auch bei kritisch Kranken eingesetzt zur werden .
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[ "umlsterm" ]
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DerOpthalmologe.60930535.eng.abstr_task0
Sentence: Reproducibility of measurements of the " Glaucoma-Scope " , a new topometric device ( software version 3.12 ) , was assessed by optic disk analysis of 10 eyes in 10 healthy subjects . Each analysis was carried out by 4 independent observers . Examinations of one of these eyes were repeated 10 times by each one of the 4 observers . The instrument was also applied to a sample of 117 eyes in 60 patients from a glaucoma clinic . The minimal requirements were determined to be a pupil diameter of 5 mm and lens-related visual acuity > 0.8. The coefficient of variation for the different optic disk parameters in the repeated examinations ranged from 3.5% to 15.7% . The maximal discrepancy between values of vertical C/D ratio within any of the subjects ranged from 0.01 to 0.12 ( mean 0.05 ) . Glaucoma-Scope measurements revealed a smaller value for disk area than those from computer-assisted manual planimetry , with a constant factor of 0.81. The measurement of vertical C/D ratio by Glaucoma-Scope and a stereoscopic estimate correlated highly in a subset consisting of 20 glaucoma patients and the 10 healthy subjects ( r = 0.786 ; p 0.0001 ) . A considerable discrepancy ( larger or smaller ) was apparent between values found through clinical inspection of 6 of the 117 eyes ( 4 of 60 patients ) and those found with the Glaucoma-Scope . In these 6 eyes subsequent analyses utilizing a more recent software version yielded a good correlation between the two methods . The Glaucoma-Scope allows sufficiently reproducible optic disk topometry . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: umlsterm
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Reproducibility of measurements of the " Glaucoma-Scope " , a new topometric device ( software version 3.12 ) , was assessed by optic disk analysis of 10 eyes in 10 healthy subjects . Each analysis was carried out by 4 independent observers . Examinations of one of these eyes were repeated 10 times by each one of the 4 observers . The instrument was also applied to a sample of 117 eyes in 60 patients from a glaucoma clinic . The minimal requirements were determined to be a pupil diameter of 5 mm and lens-related visual acuity > 0.8. The coefficient of variation for the different optic disk parameters in the repeated examinations ranged from 3.5% to 15.7% . The maximal discrepancy between values of vertical C/D ratio within any of the subjects ranged from 0.01 to 0.12 ( mean 0.05 ) . Glaucoma-Scope measurements revealed a smaller value for disk area than those from computer-assisted manual planimetry , with a constant factor of 0.81. The measurement of vertical C/D ratio by Glaucoma-Scope and a stereoscopic estimate correlated highly in a subset consisting of 20 glaucoma patients and the 10 healthy subjects ( r = 0.786 ; p 0.0001 ) . A considerable discrepancy ( larger or smaller ) was apparent between values found through clinical inspection of 6 of the 117 eyes ( 4 of 60 patients ) and those found with the Glaucoma-Scope . In these 6 eyes subsequent analyses utilizing a more recent software version yielded a good correlation between the two methods . The Glaucoma-Scope allows sufficiently reproducible optic disk topometry .
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DerOpthalmologe.60930535.eng.abstr_task1
Sentence: Reproducibility of measurements of the " Glaucoma-Scope " , a new topometric device ( software version 3.12 ) , was assessed by optic disk analysis of 10 eyes in 10 healthy subjects . Each analysis was carried out by 4 independent observers . Examinations of one of these eyes were repeated 10 times by each one of the 4 observers . The instrument was also applied to a sample of 117 eyes in 60 patients from a glaucoma clinic . The minimal requirements were determined to be a pupil diameter of 5 mm and lens-related visual acuity > 0.8. The coefficient of variation for the different optic disk parameters in the repeated examinations ranged from 3.5% to 15.7% . The maximal discrepancy between values of vertical C/D ratio within any of the subjects ranged from 0.01 to 0.12 ( mean 0.05 ) . Glaucoma-Scope measurements revealed a smaller value for disk area than those from computer-assisted manual planimetry , with a constant factor of 0.81. The measurement of vertical C/D ratio by Glaucoma-Scope and a stereoscopic estimate correlated highly in a subset consisting of 20 glaucoma patients and the 10 healthy subjects ( r = 0.786 ; p 0.0001 ) . A considerable discrepancy ( larger or smaller ) was apparent between values found through clinical inspection of 6 of the 117 eyes ( 4 of 60 patients ) and those found with the Glaucoma-Scope . In these 6 eyes subsequent analyses utilizing a more recent software version yielded a good correlation between the two methods . The Glaucoma-Scope allows sufficiently reproducible optic disk topometry . Instructions: please typing these entity words according to sentence: measurements, Glaucoma - Scope, device, software, optic disk, analysis, eyes, analysis, eyes, times, instrument, eyes, patients, glaucoma, pupil, lens - related, visual acuity, variation, optic disk, values, Glaucoma - Scope, measurements, value, manual, measurement, Glaucoma - Scope, glaucoma, patients, values, eyes, patients, Glaucoma - Scope, eyes, analyses, software, methods, Glaucoma - Scope, optic disk Options: umlsterm
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Reproducibility of measurements of the " Glaucoma-Scope " , a new topometric device ( software version 3.12 ) , was assessed by optic disk analysis of 10 eyes in 10 healthy subjects . Each analysis was carried out by 4 independent observers . Examinations of one of these eyes were repeated 10 times by each one of the 4 observers . The instrument was also applied to a sample of 117 eyes in 60 patients from a glaucoma clinic . The minimal requirements were determined to be a pupil diameter of 5 mm and lens-related visual acuity > 0.8. The coefficient of variation for the different optic disk parameters in the repeated examinations ranged from 3.5% to 15.7% . The maximal discrepancy between values of vertical C/D ratio within any of the subjects ranged from 0.01 to 0.12 ( mean 0.05 ) . Glaucoma-Scope measurements revealed a smaller value for disk area than those from computer-assisted manual planimetry , with a constant factor of 0.81. The measurement of vertical C/D ratio by Glaucoma-Scope and a stereoscopic estimate correlated highly in a subset consisting of 20 glaucoma patients and the 10 healthy subjects ( r = 0.786 ; p 0.0001 ) . A considerable discrepancy ( larger or smaller ) was apparent between values found through clinical inspection of 6 of the 117 eyes ( 4 of 60 patients ) and those found with the Glaucoma-Scope . In these 6 eyes subsequent analyses utilizing a more recent software version yielded a good correlation between the two methods . The Glaucoma-Scope allows sufficiently reproducible optic disk topometry .
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[ "umlsterm" ]
measurements, Glaucoma - Scope, device, software, optic disk, analysis, eyes, analysis, eyes, times, instrument, eyes, patients, glaucoma, pupil, lens - related, visual acuity, variation, optic disk, values, Glaucoma - Scope, measurements, value, manual, measurement, Glaucoma - Scope, glaucoma, patients, values, eyes, patients, Glaucoma - Scope, eyes, analyses, software, methods, Glaucoma - Scope, optic disk
DerOpthalmologe.60930535.eng.abstr_task2
Sentence: Reproducibility of measurements of the " Glaucoma-Scope " , a new topometric device ( software version 3.12 ) , was assessed by optic disk analysis of 10 eyes in 10 healthy subjects . Each analysis was carried out by 4 independent observers . Examinations of one of these eyes were repeated 10 times by each one of the 4 observers . The instrument was also applied to a sample of 117 eyes in 60 patients from a glaucoma clinic . The minimal requirements were determined to be a pupil diameter of 5 mm and lens-related visual acuity > 0.8. The coefficient of variation for the different optic disk parameters in the repeated examinations ranged from 3.5% to 15.7% . The maximal discrepancy between values of vertical C/D ratio within any of the subjects ranged from 0.01 to 0.12 ( mean 0.05 ) . Glaucoma-Scope measurements revealed a smaller value for disk area than those from computer-assisted manual planimetry , with a constant factor of 0.81. The measurement of vertical C/D ratio by Glaucoma-Scope and a stereoscopic estimate correlated highly in a subset consisting of 20 glaucoma patients and the 10 healthy subjects ( r = 0.786 ; p 0.0001 ) . A considerable discrepancy ( larger or smaller ) was apparent between values found through clinical inspection of 6 of the 117 eyes ( 4 of 60 patients ) and those found with the Glaucoma-Scope . In these 6 eyes subsequent analyses utilizing a more recent software version yielded a good correlation between the two methods . The Glaucoma-Scope allows sufficiently reproducible optic disk topometry . Instructions: please extract entity words from the input sentence
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Reproducibility of measurements of the " Glaucoma-Scope " , a new topometric device ( software version 3.12 ) , was assessed by optic disk analysis of 10 eyes in 10 healthy subjects . Each analysis was carried out by 4 independent observers . Examinations of one of these eyes were repeated 10 times by each one of the 4 observers . The instrument was also applied to a sample of 117 eyes in 60 patients from a glaucoma clinic . The minimal requirements were determined to be a pupil diameter of 5 mm and lens-related visual acuity > 0.8. The coefficient of variation for the different optic disk parameters in the repeated examinations ranged from 3.5% to 15.7% . The maximal discrepancy between values of vertical C/D ratio within any of the subjects ranged from 0.01 to 0.12 ( mean 0.05 ) . Glaucoma-Scope measurements revealed a smaller value for disk area than those from computer-assisted manual planimetry , with a constant factor of 0.81. The measurement of vertical C/D ratio by Glaucoma-Scope and a stereoscopic estimate correlated highly in a subset consisting of 20 glaucoma patients and the 10 healthy subjects ( r = 0.786 ; p 0.0001 ) . A considerable discrepancy ( larger or smaller ) was apparent between values found through clinical inspection of 6 of the 117 eyes ( 4 of 60 patients ) and those found with the Glaucoma-Scope . In these 6 eyes subsequent analyses utilizing a more recent software version yielded a good correlation between the two methods . The Glaucoma-Scope allows sufficiently reproducible optic disk topometry .
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[ "umlsterm" ]
Suedostasien is an umlsterm, Tumoren is an umlsterm, Westeuropa is an umlsterm, Assoziation is an umlsterm, Epstein - Barr - Virus is an umlsterm, EBV is an umlsterm, Karzinom is an umlsterm, Plattenepithelkarzinom is an umlsterm, EBV is an umlsterm, Membranprotein is an umlsterm, in vitro is an umlsterm, Tumoren is an umlsterm, EBV is an umlsterm, Rolle is an umlsterm, Virus is an umlsterm, Tumortyps is an umlsterm, Assoziation is an umlsterm, Plattenepithelkarzinomen is an umlsterm, Virus is an umlsterm, Plattenepithelkarzinomen is an umlsterm, Tumorgruppe is an umlsterm
DerPathologe.80190337.ger.abstr_task0
Sentence: Nasopharynxkarzinome gehoeren in einigen Regionen , wie z . B. Suedostasien , zu den haeufigsten malignen Tumoren , waehrend sie in Westeuropa nur sporadisch auftreten . Eine Assoziation von Nasopharynxkarzinomen mit dem Epstein-Barr-Virus ( EBV ) , einem transformierenden humanen Herpesvirus , ist seit laengerem bekannt . Die aktuelle WHO-Klassifikation unterscheidet 2 Haupttypen von Nasopharyxnkarzinomen , das nichtkeratinisierende Karzinom und das Plattenepithelkarzinom . Das EBV ist in allen nichtkeratinisierenden Nasopharynxkarzinomen nachweisbar . In einem Teil dieser Faelle wird das virale Onkoprotein LMP ( latentes Membranprotein ) -1 exprimiert . Ferner zeigen nichtkeratinisierende Nasopharynxkarzinome phaenotypische Besonderheiten , von denen bekannt ist , dass sie in vitro durch das LMP-1 induziert werden koennen und die zur Entwicklung des fuer diese Tumoren charakteristischen lymphatischen Stromas beitragen koennen . Da das EBV auch in nasopharyngealen Carcinomata in situ nachweisbar ist , erscheint eine Rolle des Virus in der Pathogenese dieses Tumortyps wahrscheinlich . Die Assoziation von Plattenepithelkarzinomen des Nasopharynx mit dem Virus weist dagegen eine geographische Variabilitaet auf . Es handelt es sich bei den nasopharyngealen Plattenepithelkarzinomen also um eine pathogenetisch heterogene Tumorgruppe , die in dieser Hinsicht von den nichtkeratinisierenden Nasopharynxkarzinomen abzugrenzen ist . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: umlsterm
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Nasopharynxkarzinome gehoeren in einigen Regionen , wie z . B. Suedostasien , zu den haeufigsten malignen Tumoren , waehrend sie in Westeuropa nur sporadisch auftreten . Eine Assoziation von Nasopharynxkarzinomen mit dem Epstein-Barr-Virus ( EBV ) , einem transformierenden humanen Herpesvirus , ist seit laengerem bekannt . Die aktuelle WHO-Klassifikation unterscheidet 2 Haupttypen von Nasopharyxnkarzinomen , das nichtkeratinisierende Karzinom und das Plattenepithelkarzinom . Das EBV ist in allen nichtkeratinisierenden Nasopharynxkarzinomen nachweisbar . In einem Teil dieser Faelle wird das virale Onkoprotein LMP ( latentes Membranprotein ) -1 exprimiert . Ferner zeigen nichtkeratinisierende Nasopharynxkarzinome phaenotypische Besonderheiten , von denen bekannt ist , dass sie in vitro durch das LMP-1 induziert werden koennen und die zur Entwicklung des fuer diese Tumoren charakteristischen lymphatischen Stromas beitragen koennen . Da das EBV auch in nasopharyngealen Carcinomata in situ nachweisbar ist , erscheint eine Rolle des Virus in der Pathogenese dieses Tumortyps wahrscheinlich . Die Assoziation von Plattenepithelkarzinomen des Nasopharynx mit dem Virus weist dagegen eine geographische Variabilitaet auf . Es handelt es sich bei den nasopharyngealen Plattenepithelkarzinomen also um eine pathogenetisch heterogene Tumorgruppe , die in dieser Hinsicht von den nichtkeratinisierenden Nasopharynxkarzinomen abzugrenzen ist .
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[ "umlsterm" ]
Suedostasien is an umlsterm, Tumoren is an umlsterm, Westeuropa is an umlsterm, Assoziation is an umlsterm, Epstein - Barr - Virus is an umlsterm, EBV is an umlsterm, Karzinom is an umlsterm, Plattenepithelkarzinom is an umlsterm, EBV is an umlsterm, Membranprotein is an umlsterm, in vitro is an umlsterm, Tumoren is an umlsterm, EBV is an umlsterm, Rolle is an umlsterm, Virus is an umlsterm, Tumortyps is an umlsterm, Assoziation is an umlsterm, Plattenepithelkarzinomen is an umlsterm, Virus is an umlsterm, Plattenepithelkarzinomen is an umlsterm, Tumorgruppe is an umlsterm
DerPathologe.80190337.ger.abstr_task1
Sentence: Nasopharynxkarzinome gehoeren in einigen Regionen , wie z . B. Suedostasien , zu den haeufigsten malignen Tumoren , waehrend sie in Westeuropa nur sporadisch auftreten . Eine Assoziation von Nasopharynxkarzinomen mit dem Epstein-Barr-Virus ( EBV ) , einem transformierenden humanen Herpesvirus , ist seit laengerem bekannt . Die aktuelle WHO-Klassifikation unterscheidet 2 Haupttypen von Nasopharyxnkarzinomen , das nichtkeratinisierende Karzinom und das Plattenepithelkarzinom . Das EBV ist in allen nichtkeratinisierenden Nasopharynxkarzinomen nachweisbar . In einem Teil dieser Faelle wird das virale Onkoprotein LMP ( latentes Membranprotein ) -1 exprimiert . Ferner zeigen nichtkeratinisierende Nasopharynxkarzinome phaenotypische Besonderheiten , von denen bekannt ist , dass sie in vitro durch das LMP-1 induziert werden koennen und die zur Entwicklung des fuer diese Tumoren charakteristischen lymphatischen Stromas beitragen koennen . Da das EBV auch in nasopharyngealen Carcinomata in situ nachweisbar ist , erscheint eine Rolle des Virus in der Pathogenese dieses Tumortyps wahrscheinlich . Die Assoziation von Plattenepithelkarzinomen des Nasopharynx mit dem Virus weist dagegen eine geographische Variabilitaet auf . Es handelt es sich bei den nasopharyngealen Plattenepithelkarzinomen also um eine pathogenetisch heterogene Tumorgruppe , die in dieser Hinsicht von den nichtkeratinisierenden Nasopharynxkarzinomen abzugrenzen ist . Instructions: please typing these entity words according to sentence: Suedostasien, Tumoren, Westeuropa, Assoziation, Epstein - Barr - Virus, EBV, Karzinom, Plattenepithelkarzinom, EBV, Membranprotein, in vitro, Tumoren, EBV, Rolle, Virus, Tumortyps, Assoziation, Plattenepithelkarzinomen, Virus, Plattenepithelkarzinomen, Tumorgruppe Options: umlsterm
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Nasopharynxkarzinome gehoeren in einigen Regionen , wie z . B. Suedostasien , zu den haeufigsten malignen Tumoren , waehrend sie in Westeuropa nur sporadisch auftreten . Eine Assoziation von Nasopharynxkarzinomen mit dem Epstein-Barr-Virus ( EBV ) , einem transformierenden humanen Herpesvirus , ist seit laengerem bekannt . Die aktuelle WHO-Klassifikation unterscheidet 2 Haupttypen von Nasopharyxnkarzinomen , das nichtkeratinisierende Karzinom und das Plattenepithelkarzinom . Das EBV ist in allen nichtkeratinisierenden Nasopharynxkarzinomen nachweisbar . In einem Teil dieser Faelle wird das virale Onkoprotein LMP ( latentes Membranprotein ) -1 exprimiert . Ferner zeigen nichtkeratinisierende Nasopharynxkarzinome phaenotypische Besonderheiten , von denen bekannt ist , dass sie in vitro durch das LMP-1 induziert werden koennen und die zur Entwicklung des fuer diese Tumoren charakteristischen lymphatischen Stromas beitragen koennen . Da das EBV auch in nasopharyngealen Carcinomata in situ nachweisbar ist , erscheint eine Rolle des Virus in der Pathogenese dieses Tumortyps wahrscheinlich . Die Assoziation von Plattenepithelkarzinomen des Nasopharynx mit dem Virus weist dagegen eine geographische Variabilitaet auf . Es handelt es sich bei den nasopharyngealen Plattenepithelkarzinomen also um eine pathogenetisch heterogene Tumorgruppe , die in dieser Hinsicht von den nichtkeratinisierenden Nasopharynxkarzinomen abzugrenzen ist .
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[ "umlsterm" ]
Suedostasien, Tumoren, Westeuropa, Assoziation, Epstein - Barr - Virus, EBV, Karzinom, Plattenepithelkarzinom, EBV, Membranprotein, in vitro, Tumoren, EBV, Rolle, Virus, Tumortyps, Assoziation, Plattenepithelkarzinomen, Virus, Plattenepithelkarzinomen, Tumorgruppe
DerPathologe.80190337.ger.abstr_task2
Sentence: Nasopharynxkarzinome gehoeren in einigen Regionen , wie z . B. Suedostasien , zu den haeufigsten malignen Tumoren , waehrend sie in Westeuropa nur sporadisch auftreten . Eine Assoziation von Nasopharynxkarzinomen mit dem Epstein-Barr-Virus ( EBV ) , einem transformierenden humanen Herpesvirus , ist seit laengerem bekannt . Die aktuelle WHO-Klassifikation unterscheidet 2 Haupttypen von Nasopharyxnkarzinomen , das nichtkeratinisierende Karzinom und das Plattenepithelkarzinom . Das EBV ist in allen nichtkeratinisierenden Nasopharynxkarzinomen nachweisbar . In einem Teil dieser Faelle wird das virale Onkoprotein LMP ( latentes Membranprotein ) -1 exprimiert . Ferner zeigen nichtkeratinisierende Nasopharynxkarzinome phaenotypische Besonderheiten , von denen bekannt ist , dass sie in vitro durch das LMP-1 induziert werden koennen und die zur Entwicklung des fuer diese Tumoren charakteristischen lymphatischen Stromas beitragen koennen . Da das EBV auch in nasopharyngealen Carcinomata in situ nachweisbar ist , erscheint eine Rolle des Virus in der Pathogenese dieses Tumortyps wahrscheinlich . Die Assoziation von Plattenepithelkarzinomen des Nasopharynx mit dem Virus weist dagegen eine geographische Variabilitaet auf . Es handelt es sich bei den nasopharyngealen Plattenepithelkarzinomen also um eine pathogenetisch heterogene Tumorgruppe , die in dieser Hinsicht von den nichtkeratinisierenden Nasopharynxkarzinomen abzugrenzen ist . Instructions: please extract entity words from the input sentence
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Nasopharynxkarzinome gehoeren in einigen Regionen , wie z . B. Suedostasien , zu den haeufigsten malignen Tumoren , waehrend sie in Westeuropa nur sporadisch auftreten . Eine Assoziation von Nasopharynxkarzinomen mit dem Epstein-Barr-Virus ( EBV ) , einem transformierenden humanen Herpesvirus , ist seit laengerem bekannt . Die aktuelle WHO-Klassifikation unterscheidet 2 Haupttypen von Nasopharyxnkarzinomen , das nichtkeratinisierende Karzinom und das Plattenepithelkarzinom . Das EBV ist in allen nichtkeratinisierenden Nasopharynxkarzinomen nachweisbar . In einem Teil dieser Faelle wird das virale Onkoprotein LMP ( latentes Membranprotein ) -1 exprimiert . Ferner zeigen nichtkeratinisierende Nasopharynxkarzinome phaenotypische Besonderheiten , von denen bekannt ist , dass sie in vitro durch das LMP-1 induziert werden koennen und die zur Entwicklung des fuer diese Tumoren charakteristischen lymphatischen Stromas beitragen koennen . Da das EBV auch in nasopharyngealen Carcinomata in situ nachweisbar ist , erscheint eine Rolle des Virus in der Pathogenese dieses Tumortyps wahrscheinlich . Die Assoziation von Plattenepithelkarzinomen des Nasopharynx mit dem Virus weist dagegen eine geographische Variabilitaet auf . Es handelt es sich bei den nasopharyngealen Plattenepithelkarzinomen also um eine pathogenetisch heterogene Tumorgruppe , die in dieser Hinsicht von den nichtkeratinisierenden Nasopharynxkarzinomen abzugrenzen ist .
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[ "umlsterm" ]
Conserved elements is a DNA_family_or_group, NF - E2 and tandem GATA binding sites is a (AND DNA_domain_or_region DNA_domain_or_region), erythroid - specific chromatin structure reorganization is an other_name, human beta - globin locus control region is a DNA_domain_or_region
71725_task0
Sentence: Conserved elements containing NF-E2 and tandem GATA binding sites are required for erythroid-specific chromatin structure reorganization within the human beta-globin locus control region. Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: DNA_family_or_group, DNA_domain_or_region, (AND DNA_domain_or_region DNA_domain_or_region), other_name
[ "B-DNA_family_or_group", "I-DNA_family_or_group", "O", "B-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "O", "O", "O", "B-other_name", "I-other_name", "I-other_name", "I-other_name", "I-other_name", "I-other_name", "O", "O", "B-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "O" ]
Conserved elements containing NF-E2 and tandem GATA binding sites are required for erythroid-specific chromatin structure reorganization within the human beta-globin locus control region.
[ "Conserved", "elements", "containing", "NF", "-", "E2", "and", "tandem", "GATA", "binding", "sites", "are", "required", "for", "erythroid", "-", "specific", "chromatin", "structure", "reorganization", "within", "the", "human", "beta", "-", "globin", "locus", "control", "region", "." ]
[ "other_name", "(AND DNA_domain_or_region DNA_domain_or_region)", "DNA_substructure", "DNA_domain_or_region", "", "DNA_family_or_group", "protein_molecule" ]
Conserved elements is a DNA_family_or_group, NF - E2 and tandem GATA binding sites is a (AND DNA_domain_or_region DNA_domain_or_region), erythroid - specific chromatin structure reorganization is an other_name, human beta - globin locus control region is a DNA_domain_or_region
71725_task1
Sentence: Conserved elements containing NF-E2 and tandem GATA binding sites are required for erythroid-specific chromatin structure reorganization within the human beta-globin locus control region. Instructions: please typing these entity words according to sentence: Conserved elements, NF - E2 and tandem GATA binding sites, erythroid - specific chromatin structure reorganization, human beta - globin locus control region Options: DNA_family_or_group, DNA_domain_or_region, (AND DNA_domain_or_region DNA_domain_or_region), other_name
[ "B-DNA_family_or_group", "I-DNA_family_or_group", "O", "B-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "O", "O", "O", "B-other_name", "I-other_name", "I-other_name", "I-other_name", "I-other_name", "I-other_name", "O", "O", "B-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "O" ]
Conserved elements containing NF-E2 and tandem GATA binding sites are required for erythroid-specific chromatin structure reorganization within the human beta-globin locus control region.
[ "Conserved", "elements", "containing", "NF", "-", "E2", "and", "tandem", "GATA", "binding", "sites", "are", "required", "for", "erythroid", "-", "specific", "chromatin", "structure", "reorganization", "within", "the", "human", "beta", "-", "globin", "locus", "control", "region", "." ]
[ "other_name", "(AND DNA_domain_or_region DNA_domain_or_region)", "DNA_substructure", "DNA_domain_or_region", "", "DNA_family_or_group", "protein_molecule" ]
Conserved elements, NF - E2 and tandem GATA binding sites, erythroid - specific chromatin structure reorganization, human beta - globin locus control region
71725_task2
Sentence: Conserved elements containing NF-E2 and tandem GATA binding sites are required for erythroid-specific chromatin structure reorganization within the human beta-globin locus control region. Instructions: please extract entity words from the input sentence
[ "B-DNA_family_or_group", "I-DNA_family_or_group", "O", "B-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "I-(AND DNA_domain_or_region DNA_domain_or_region)", "O", "O", "O", "B-other_name", "I-other_name", "I-other_name", "I-other_name", "I-other_name", "I-other_name", "O", "O", "B-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "I-DNA_domain_or_region", "O" ]
Conserved elements containing NF-E2 and tandem GATA binding sites are required for erythroid-specific chromatin structure reorganization within the human beta-globin locus control region.
[ "Conserved", "elements", "containing", "NF", "-", "E2", "and", "tandem", "GATA", "binding", "sites", "are", "required", "for", "erythroid", "-", "specific", "chromatin", "structure", "reorganization", "within", "the", "human", "beta", "-", "globin", "locus", "control", "region", "." ]
[ "other_name", "(AND DNA_domain_or_region DNA_domain_or_region)", "DNA_substructure", "DNA_domain_or_region", "", "DNA_family_or_group", "protein_molecule" ]
Safety is a Outcome_Other, efficacy is a Outcome_Other, irinotecan plus high - dose leucovorin is a Intervention_Pharmacological, 5-fluorouracil is a Intervention_Pharmacological, metastatic colorectal cancer : is a Participant_Condition, southern Italy cooperative oncology group trials . is a Participant_Condition, levo - leucovorin ( LV ) is a Intervention_Pharmacological, 5-fluorouracil ( 5-FU ) is a Intervention_Pharmacological, metastatic colorectal cancer ( CRC ) . is a Participant_Condition, overall response rate ( ORR ) is a Outcome_Other, progression - free survival ( PFS ) is a Outcome_Mortality, overall survival ( OS ) is a Outcome_Mortality, occurrence of severe toxicity is a Outcome_Adverse-effects, weight loss is a Outcome_Mental, Median OS is a Outcome_Mortality, longer OS is a Outcome_Mortality, Grade 4 neutropenia is a Outcome_Physical, diarrhea is a Outcome_Physical, irinotecan/5-FU / LV is a Intervention_Pharmacological, elderly patients . is a Participant_Condition
23757_task0
Sentence: Safety and efficacy of irinotecan plus high-dose leucovorin and intravenous bolus 5-fluorouracil for metastatic colorectal cancer : pooled analysis of two consecutive southern Italy cooperative oncology group trials . BACKGROUND A biweekly regimen of irinotecan 200 mg/m2 on day 1 and levo-leucovorin ( LV ) 250 mg/m2 plus 5-fluorouracil ( 5-FU ) 850 mg/m2 via intravenous bolus on day 2 was assessed in 2 consecutive randomized trials in metastatic colorectal cancer ( CRC ) . PATIENTS AND METHODS Individual data of 254 patients were merged , and baseline features potentially affecting overall response rate ( ORR ) , progression-free survival ( PFS ) , overall survival ( OS ) , and occurrence of severe toxicity were analyzed by univariate and multivariate analyses . RESULTS In the pooled series , ORR was 33 % ( 95 % confidence interval [ CI ] , 27 % -39 % ) . Liver-only disease ( 47 % vs. 25 % ; P=0.0012 ) and absence of previous weight loss ( 38 % vs. 20 % ; P=0.0189 ) were significantly associated with a higher ORR on the multivariate analysis . Absence of weight loss ( hazard ratio , 1.40 ; 95 % CI , 1.02-1.93 ; P=0.0377 ) was significantly associated with a longer PFS ( 7.5 months vs. 6 months ) . Median OS was 15.1 months ( 95 % CI , 13.5-16.6 months ) . Primary surgery , good performance status ( PS ) , only one metastatic site , and oxaliplatin-based second-line treatment independently predicted a longer OS . Grade 4 neutropenia was significantly associated with a PS > or=1 , whereas risk of grade > or=3 diarrhea was directly related to age and previous weight loss . CONCLUSION Patients with no weight loss and/or preserved PS and with a limited disease extent appeared to obtain the greatest benefit from our irinotecan/5-FU/LV regimen , with acceptable toxicity . Notably , the regimen was effective and well tolerated by elderly patients . This regimen may represent the rationale for assessing the addition of novel antiangiogenic drugs to the treatment of metastatic CRC . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: Intervention_Pharmacological, Outcome_Adverse-effects, Participant_Condition, Outcome_Mortality, Outcome_Physical, Outcome_Other, Outcome_Mental
[ "B-Outcome_Other", "O", "B-Outcome_Other", "O", "B-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "O", "O", "O", "B-Intervention_Pharmacological", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "O", "O", "O", "O", "O", "B-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "O", "B-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "O", "B-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "O", "O", "B-Outcome_Adverse-effects", "I-Outcome_Adverse-effects", "I-Outcome_Adverse-effects", "I-Outcome_Adverse-effects", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Mental", "I-Outcome_Mental", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Mortality", "I-Outcome_Mortality", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Mortality", "I-Outcome_Mortality", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Safety and efficacy of irinotecan plus high-dose leucovorin and intravenous bolus 5-fluorouracil for metastatic colorectal cancer : pooled analysis of two consecutive southern Italy cooperative oncology group trials . BACKGROUND A biweekly regimen of irinotecan 200 mg/m2 on day 1 and levo-leucovorin ( LV ) 250 mg/m2 plus 5-fluorouracil ( 5-FU ) 850 mg/m2 via intravenous bolus on day 2 was assessed in 2 consecutive randomized trials in metastatic colorectal cancer ( CRC ) . PATIENTS AND METHODS Individual data of 254 patients were merged , and baseline features potentially affecting overall response rate ( ORR ) , progression-free survival ( PFS ) , overall survival ( OS ) , and occurrence of severe toxicity were analyzed by univariate and multivariate analyses . RESULTS In the pooled series , ORR was 33 % ( 95 % confidence interval [ CI ] , 27 % -39 % ) . Liver-only disease ( 47 % vs. 25 % ; P=0.0012 ) and absence of previous weight loss ( 38 % vs. 20 % ; P=0.0189 ) were significantly associated with a higher ORR on the multivariate analysis . Absence of weight loss ( hazard ratio , 1.40 ; 95 % CI , 1.02-1.93 ; P=0.0377 ) was significantly associated with a longer PFS ( 7.5 months vs. 6 months ) . Median OS was 15.1 months ( 95 % CI , 13.5-16.6 months ) . Primary surgery , good performance status ( PS ) , only one metastatic site , and oxaliplatin-based second-line treatment independently predicted a longer OS . Grade 4 neutropenia was significantly associated with a PS > or=1 , whereas risk of grade > or=3 diarrhea was directly related to age and previous weight loss . CONCLUSION Patients with no weight loss and/or preserved PS and with a limited disease extent appeared to obtain the greatest benefit from our irinotecan/5-FU/LV regimen , with acceptable toxicity . Notably , the regimen was effective and well tolerated by elderly patients . This regimen may represent the rationale for assessing the addition of novel antiangiogenic drugs to the treatment of metastatic CRC .
[ "Safety", "and", "efficacy", "of", "irinotecan", "plus", "high", "-", "dose", "leucovorin", "and", "intravenous", "bolus", "5-fluorouracil", "for", "metastatic", "colorectal", "cancer", ":", "pooled", "analysis", "of", "two", "consecutive", "southern", "Italy", "cooperative", "oncology", "group", "trials", ".", "BACKGROUND", "A", "biweekly", "regimen", "of", "irinotecan", "200", "mg", "/", "m2", "on", "day", "1", "and", "levo", "-", "leucovorin", "(", "LV", ")", "250", "mg", "/", "m2", "plus", "5-fluorouracil", "(", "5-FU", ")", "850", "mg", "/", "m2", "via", "intravenous", "bolus", "on", "day", "2", "was", "assessed", "in", "2", "consecutive", "randomized", "trials", "in", "metastatic", "colorectal", "cancer", "(", "CRC", ")", ".", "PATIENTS", "AND", "METHODS", "Individual", "data", "of", "254", "patients", "were", "merged", ",", "and", "baseline", "features", "potentially", "affecting", "overall", "response", "rate", "(", "ORR", ")", ",", "progression", "-", "free", "survival", "(", "PFS", ")", ",", "overall", "survival", "(", "OS", ")", ",", "and", "occurrence", "of", "severe", "toxicity", "were", "analyzed", "by", "univariate", "and", "multivariate", "analyses", ".", "RESULTS", "In", "the", "pooled", "series", ",", "ORR", "was", "33", "%", "(", "95", "%", "confidence", "interval", "[", "CI", "]", ",", "27", "%", "-39", "%", ")", ".", "Liver", "-", "only", "disease", "(", "47", "%", "vs", ".", "25", "%", ";", "P=0.0012", ")", "and", "absence", "of", "previous", "weight", "loss", "(", "38", "%", "vs", ".", "20", "%", ";", "P=0.0189", ")", "were", "significantly", "associated", "with", "a", "higher", "ORR", "on", "the", "multivariate", "analysis", ".", "Absence", "of", "weight", "loss", "(", "hazard", "ratio", ",", "1.40", ";", "95", "%", "CI", ",", "1.02", "-", "1.93", ";", "P=0.0377", ")", "was", "significantly", "associated", "with", "a", "longer", "PFS", "(", "7.5", "months", "vs", ".", "6", "months", ")", ".", "Median", "OS", "was", "15.1", "months", "(", "95", "%", "CI", ",", "13.5", "-", "16.6", "months", ")", ".", "Primary", "surgery", ",", "good", "performance", "status", "(", "PS", ")", ",", "only", "one", "metastatic", "site", ",", "and", "oxaliplatin", "-", "based", "second", "-", "line", "treatment", "independently", "predicted", "a", "longer", "OS", ".", "Grade", "4", "neutropenia", "was", "significantly", "associated", "with", "a", "PS", ">", "or=1", ",", "whereas", "risk", "of", "grade", ">", "or=3", "diarrhea", "was", "directly", "related", "to", "age", "and", "previous", "weight", "loss", ".", "CONCLUSION", "Patients", "with", "no", "weight", "loss", "and", "/", "or", "preserved", "PS", "and", "with", "a", "limited", "disease", "extent", "appeared", "to", "obtain", "the", "greatest", "benefit", "from", "our", "irinotecan/5-FU", "/", "LV", "regimen", ",", "with", "acceptable", "toxicity", ".", "Notably", ",", "the", "regimen", "was", "effective", "and", "well", "tolerated", "by", "elderly", "patients", ".", "This", "regimen", "may", "represent", "the", "rationale", "for", "assessing", "the", "addition", "of", "novel", "antiangiogenic", "drugs", "to", "the", "treatment", "of", "metastatic", "CRC", "." ]
[ "Participant_Condition", "Intervention_Pharmacological", "Outcome_Mortality", "Outcome_Other", "Outcome_Adverse-effects", "Outcome_Physical", "Outcome_Mental" ]
Safety is a Outcome_Other, efficacy is a Outcome_Other, irinotecan plus high - dose leucovorin is a Intervention_Pharmacological, 5-fluorouracil is a Intervention_Pharmacological, metastatic colorectal cancer : is a Participant_Condition, southern Italy cooperative oncology group trials . is a Participant_Condition, levo - leucovorin ( LV ) is a Intervention_Pharmacological, 5-fluorouracil ( 5-FU ) is a Intervention_Pharmacological, metastatic colorectal cancer ( CRC ) . is a Participant_Condition, overall response rate ( ORR ) is a Outcome_Other, progression - free survival ( PFS ) is a Outcome_Mortality, overall survival ( OS ) is a Outcome_Mortality, occurrence of severe toxicity is a Outcome_Adverse-effects, weight loss is a Outcome_Mental, Median OS is a Outcome_Mortality, longer OS is a Outcome_Mortality, Grade 4 neutropenia is a Outcome_Physical, diarrhea is a Outcome_Physical, irinotecan/5-FU / LV is a Intervention_Pharmacological, elderly patients . is a Participant_Condition
23757_task1
Sentence: Safety and efficacy of irinotecan plus high-dose leucovorin and intravenous bolus 5-fluorouracil for metastatic colorectal cancer : pooled analysis of two consecutive southern Italy cooperative oncology group trials . BACKGROUND A biweekly regimen of irinotecan 200 mg/m2 on day 1 and levo-leucovorin ( LV ) 250 mg/m2 plus 5-fluorouracil ( 5-FU ) 850 mg/m2 via intravenous bolus on day 2 was assessed in 2 consecutive randomized trials in metastatic colorectal cancer ( CRC ) . PATIENTS AND METHODS Individual data of 254 patients were merged , and baseline features potentially affecting overall response rate ( ORR ) , progression-free survival ( PFS ) , overall survival ( OS ) , and occurrence of severe toxicity were analyzed by univariate and multivariate analyses . RESULTS In the pooled series , ORR was 33 % ( 95 % confidence interval [ CI ] , 27 % -39 % ) . Liver-only disease ( 47 % vs. 25 % ; P=0.0012 ) and absence of previous weight loss ( 38 % vs. 20 % ; P=0.0189 ) were significantly associated with a higher ORR on the multivariate analysis . Absence of weight loss ( hazard ratio , 1.40 ; 95 % CI , 1.02-1.93 ; P=0.0377 ) was significantly associated with a longer PFS ( 7.5 months vs. 6 months ) . Median OS was 15.1 months ( 95 % CI , 13.5-16.6 months ) . Primary surgery , good performance status ( PS ) , only one metastatic site , and oxaliplatin-based second-line treatment independently predicted a longer OS . Grade 4 neutropenia was significantly associated with a PS > or=1 , whereas risk of grade > or=3 diarrhea was directly related to age and previous weight loss . CONCLUSION Patients with no weight loss and/or preserved PS and with a limited disease extent appeared to obtain the greatest benefit from our irinotecan/5-FU/LV regimen , with acceptable toxicity . Notably , the regimen was effective and well tolerated by elderly patients . This regimen may represent the rationale for assessing the addition of novel antiangiogenic drugs to the treatment of metastatic CRC . Instructions: please typing these entity words according to sentence: Safety, efficacy, irinotecan plus high - dose leucovorin, 5-fluorouracil, metastatic colorectal cancer :, southern Italy cooperative oncology group trials ., levo - leucovorin ( LV ), 5-fluorouracil ( 5-FU ), metastatic colorectal cancer ( CRC ) ., overall response rate ( ORR ), progression - free survival ( PFS ), overall survival ( OS ), occurrence of severe toxicity, weight loss, Median OS, longer OS, Grade 4 neutropenia, diarrhea, irinotecan/5-FU / LV, elderly patients . Options: Intervention_Pharmacological, Outcome_Adverse-effects, Participant_Condition, Outcome_Mortality, Outcome_Physical, Outcome_Other, Outcome_Mental
[ "B-Outcome_Other", "O", "B-Outcome_Other", "O", "B-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "O", "O", "O", "B-Intervention_Pharmacological", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "O", "O", "O", "O", "O", "B-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "I-Outcome_Other", "O", "B-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "O", "B-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "I-Outcome_Mortality", "O", "O", "B-Outcome_Adverse-effects", "I-Outcome_Adverse-effects", "I-Outcome_Adverse-effects", "I-Outcome_Adverse-effects", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Mental", "I-Outcome_Mental", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Mortality", "I-Outcome_Mortality", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Mortality", "I-Outcome_Mortality", "O", "B-Outcome_Physical", "I-Outcome_Physical", "I-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Outcome_Physical", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Intervention_Pharmacological", "I-Intervention_Pharmacological", "I-Intervention_Pharmacological", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "B-Participant_Condition", "I-Participant_Condition", "I-Participant_Condition", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Safety and efficacy of irinotecan plus high-dose leucovorin and intravenous bolus 5-fluorouracil for metastatic colorectal cancer : pooled analysis of two consecutive southern Italy cooperative oncology group trials . BACKGROUND A biweekly regimen of irinotecan 200 mg/m2 on day 1 and levo-leucovorin ( LV ) 250 mg/m2 plus 5-fluorouracil ( 5-FU ) 850 mg/m2 via intravenous bolus on day 2 was assessed in 2 consecutive randomized trials in metastatic colorectal cancer ( CRC ) . PATIENTS AND METHODS Individual data of 254 patients were merged , and baseline features potentially affecting overall response rate ( ORR ) , progression-free survival ( PFS ) , overall survival ( OS ) , and occurrence of severe toxicity were analyzed by univariate and multivariate analyses . RESULTS In the pooled series , ORR was 33 % ( 95 % confidence interval [ CI ] , 27 % -39 % ) . Liver-only disease ( 47 % vs. 25 % ; P=0.0012 ) and absence of previous weight loss ( 38 % vs. 20 % ; P=0.0189 ) were significantly associated with a higher ORR on the multivariate analysis . Absence of weight loss ( hazard ratio , 1.40 ; 95 % CI , 1.02-1.93 ; P=0.0377 ) was significantly associated with a longer PFS ( 7.5 months vs. 6 months ) . Median OS was 15.1 months ( 95 % CI , 13.5-16.6 months ) . Primary surgery , good performance status ( PS ) , only one metastatic site , and oxaliplatin-based second-line treatment independently predicted a longer OS . Grade 4 neutropenia was significantly associated with a PS > or=1 , whereas risk of grade > or=3 diarrhea was directly related to age and previous weight loss . CONCLUSION Patients with no weight loss and/or preserved PS and with a limited disease extent appeared to obtain the greatest benefit from our irinotecan/5-FU/LV regimen , with acceptable toxicity . Notably , the regimen was effective and well tolerated by elderly patients . This regimen may represent the rationale for assessing the addition of novel antiangiogenic drugs to the treatment of metastatic CRC .
[ "Safety", "and", "efficacy", "of", "irinotecan", "plus", "high", "-", "dose", "leucovorin", "and", "intravenous", "bolus", "5-fluorouracil", "for", "metastatic", "colorectal", "cancer", ":", "pooled", "analysis", "of", "two", "consecutive", "southern", "Italy", "cooperative", "oncology", "group", "trials", ".", "BACKGROUND", "A", "biweekly", "regimen", "of", "irinotecan", "200", "mg", "/", "m2", "on", "day", "1", "and", "levo", "-", "leucovorin", "(", "LV", ")", "250", "mg", "/", "m2", "plus", "5-fluorouracil", "(", "5-FU", ")", "850", "mg", "/", "m2", "via", "intravenous", "bolus", "on", "day", "2", "was", "assessed", "in", "2", "consecutive", "randomized", "trials", "in", "metastatic", "colorectal", "cancer", "(", "CRC", ")", ".", "PATIENTS", "AND", "METHODS", "Individual", "data", "of", "254", "patients", "were", "merged", ",", "and", "baseline", "features", "potentially", "affecting", "overall", "response", "rate", "(", "ORR", ")", ",", "progression", "-", "free", "survival", "(", "PFS", ")", ",", "overall", "survival", "(", "OS", ")", ",", "and", "occurrence", "of", "severe", "toxicity", "were", "analyzed", "by", "univariate", "and", "multivariate", "analyses", ".", "RESULTS", "In", "the", "pooled", "series", ",", "ORR", "was", "33", "%", "(", "95", "%", "confidence", "interval", "[", "CI", "]", ",", "27", "%", "-39", "%", ")", ".", "Liver", "-", "only", "disease", "(", "47", "%", "vs", ".", "25", "%", ";", "P=0.0012", ")", "and", "absence", "of", "previous", "weight", "loss", "(", "38", "%", "vs", ".", "20", "%", ";", "P=0.0189", ")", "were", "significantly", "associated", "with", "a", "higher", "ORR", "on", "the", "multivariate", "analysis", ".", "Absence", "of", "weight", "loss", "(", "hazard", "ratio", ",", "1.40", ";", "95", "%", "CI", ",", "1.02", "-", "1.93", ";", "P=0.0377", ")", "was", "significantly", "associated", "with", "a", "longer", "PFS", "(", "7.5", "months", "vs", ".", "6", "months", ")", ".", "Median", "OS", "was", "15.1", "months", "(", "95", "%", "CI", ",", "13.5", "-", "16.6", "months", ")", ".", "Primary", "surgery", ",", "good", "performance", "status", "(", "PS", ")", ",", "only", "one", "metastatic", "site", ",", "and", "oxaliplatin", "-", "based", "second", "-", "line", "treatment", "independently", "predicted", "a", "longer", "OS", ".", "Grade", "4", "neutropenia", "was", "significantly", "associated", "with", "a", "PS", ">", "or=1", ",", "whereas", "risk", "of", "grade", ">", "or=3", "diarrhea", "was", "directly", "related", "to", "age", "and", "previous", "weight", "loss", ".", "CONCLUSION", "Patients", "with", "no", "weight", "loss", "and", "/", "or", "preserved", "PS", "and", "with", "a", "limited", "disease", "extent", "appeared", "to", "obtain", "the", "greatest", "benefit", "from", "our", "irinotecan/5-FU", "/", "LV", "regimen", ",", "with", "acceptable", "toxicity", ".", "Notably", ",", "the", "regimen", "was", "effective", "and", "well", "tolerated", "by", "elderly", "patients", ".", "This", "regimen", "may", "represent", "the", "rationale", "for", "assessing", "the", "addition", "of", "novel", "antiangiogenic", "drugs", "to", "the", "treatment", "of", "metastatic", "CRC", "." ]
[ "Participant_Condition", "Intervention_Pharmacological", "Outcome_Mortality", "Outcome_Other", "Outcome_Adverse-effects", "Outcome_Physical", "Outcome_Mental" ]
Safety, efficacy, irinotecan plus high - dose leucovorin, 5-fluorouracil, metastatic colorectal cancer :, southern Italy cooperative oncology group trials ., levo - leucovorin ( LV ), 5-fluorouracil ( 5-FU ), metastatic colorectal cancer ( CRC ) ., overall response rate ( ORR ), progression - free survival ( PFS ), overall survival ( OS ), occurrence of severe toxicity, weight loss, Median OS, longer OS, Grade 4 neutropenia, diarrhea, irinotecan/5-FU / LV, elderly patients .
23757_task2
Sentence: Safety and efficacy of irinotecan plus high-dose leucovorin and intravenous bolus 5-fluorouracil for metastatic colorectal cancer : pooled analysis of two consecutive southern Italy cooperative oncology group trials . BACKGROUND A biweekly regimen of irinotecan 200 mg/m2 on day 1 and levo-leucovorin ( LV ) 250 mg/m2 plus 5-fluorouracil ( 5-FU ) 850 mg/m2 via intravenous bolus on day 2 was assessed in 2 consecutive randomized trials in metastatic colorectal cancer ( CRC ) . PATIENTS AND METHODS Individual data of 254 patients were merged , and baseline features potentially affecting overall response rate ( ORR ) , progression-free survival ( PFS ) , overall survival ( OS ) , and occurrence of severe toxicity were analyzed by univariate and multivariate analyses . RESULTS In the pooled series , ORR was 33 % ( 95 % confidence interval [ CI ] , 27 % -39 % ) . Liver-only disease ( 47 % vs. 25 % ; P=0.0012 ) and absence of previous weight loss ( 38 % vs. 20 % ; P=0.0189 ) were significantly associated with a higher ORR on the multivariate analysis . Absence of weight loss ( hazard ratio , 1.40 ; 95 % CI , 1.02-1.93 ; P=0.0377 ) was significantly associated with a longer PFS ( 7.5 months vs. 6 months ) . Median OS was 15.1 months ( 95 % CI , 13.5-16.6 months ) . Primary surgery , good performance status ( PS ) , only one metastatic site , and oxaliplatin-based second-line treatment independently predicted a longer OS . Grade 4 neutropenia was significantly associated with a PS > or=1 , whereas risk of grade > or=3 diarrhea was directly related to age and previous weight loss . CONCLUSION Patients with no weight loss and/or preserved PS and with a limited disease extent appeared to obtain the greatest benefit from our irinotecan/5-FU/LV regimen , with acceptable toxicity . Notably , the regimen was effective and well tolerated by elderly patients . This regimen may represent the rationale for assessing the addition of novel antiangiogenic drugs to the treatment of metastatic CRC . Instructions: please extract entity words from the input sentence
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Safety and efficacy of irinotecan plus high-dose leucovorin and intravenous bolus 5-fluorouracil for metastatic colorectal cancer : pooled analysis of two consecutive southern Italy cooperative oncology group trials . BACKGROUND A biweekly regimen of irinotecan 200 mg/m2 on day 1 and levo-leucovorin ( LV ) 250 mg/m2 plus 5-fluorouracil ( 5-FU ) 850 mg/m2 via intravenous bolus on day 2 was assessed in 2 consecutive randomized trials in metastatic colorectal cancer ( CRC ) . PATIENTS AND METHODS Individual data of 254 patients were merged , and baseline features potentially affecting overall response rate ( ORR ) , progression-free survival ( PFS ) , overall survival ( OS ) , and occurrence of severe toxicity were analyzed by univariate and multivariate analyses . RESULTS In the pooled series , ORR was 33 % ( 95 % confidence interval [ CI ] , 27 % -39 % ) . Liver-only disease ( 47 % vs. 25 % ; P=0.0012 ) and absence of previous weight loss ( 38 % vs. 20 % ; P=0.0189 ) were significantly associated with a higher ORR on the multivariate analysis . Absence of weight loss ( hazard ratio , 1.40 ; 95 % CI , 1.02-1.93 ; P=0.0377 ) was significantly associated with a longer PFS ( 7.5 months vs. 6 months ) . Median OS was 15.1 months ( 95 % CI , 13.5-16.6 months ) . Primary surgery , good performance status ( PS ) , only one metastatic site , and oxaliplatin-based second-line treatment independently predicted a longer OS . Grade 4 neutropenia was significantly associated with a PS > or=1 , whereas risk of grade > or=3 diarrhea was directly related to age and previous weight loss . CONCLUSION Patients with no weight loss and/or preserved PS and with a limited disease extent appeared to obtain the greatest benefit from our irinotecan/5-FU/LV regimen , with acceptable toxicity . Notably , the regimen was effective and well tolerated by elderly patients . This regimen may represent the rationale for assessing the addition of novel antiangiogenic drugs to the treatment of metastatic CRC .
[ "Safety", "and", "efficacy", "of", "irinotecan", "plus", "high", "-", "dose", "leucovorin", "and", "intravenous", "bolus", "5-fluorouracil", "for", "metastatic", "colorectal", "cancer", ":", "pooled", "analysis", "of", "two", "consecutive", "southern", "Italy", "cooperative", "oncology", "group", "trials", ".", "BACKGROUND", "A", "biweekly", "regimen", "of", "irinotecan", "200", "mg", "/", "m2", "on", "day", "1", "and", "levo", "-", "leucovorin", "(", "LV", ")", "250", "mg", "/", "m2", "plus", "5-fluorouracil", "(", "5-FU", ")", "850", "mg", "/", "m2", "via", "intravenous", "bolus", "on", "day", "2", "was", "assessed", "in", "2", "consecutive", "randomized", "trials", "in", "metastatic", "colorectal", "cancer", "(", "CRC", ")", ".", "PATIENTS", "AND", "METHODS", "Individual", "data", "of", "254", "patients", "were", "merged", ",", "and", "baseline", "features", "potentially", "affecting", "overall", "response", "rate", "(", "ORR", ")", ",", "progression", "-", "free", "survival", "(", "PFS", ")", ",", "overall", "survival", "(", "OS", ")", ",", "and", "occurrence", "of", "severe", "toxicity", "were", "analyzed", "by", "univariate", "and", "multivariate", "analyses", ".", "RESULTS", "In", "the", "pooled", "series", ",", "ORR", "was", "33", "%", "(", "95", "%", "confidence", "interval", "[", "CI", "]", ",", "27", "%", "-39", "%", ")", ".", "Liver", "-", "only", "disease", "(", "47", "%", "vs", ".", "25", "%", ";", "P=0.0012", ")", "and", "absence", "of", "previous", "weight", "loss", "(", "38", "%", "vs", ".", "20", "%", ";", "P=0.0189", ")", "were", "significantly", "associated", "with", "a", "higher", "ORR", "on", "the", "multivariate", "analysis", ".", "Absence", "of", "weight", "loss", "(", "hazard", "ratio", ",", "1.40", ";", "95", "%", "CI", ",", "1.02", "-", "1.93", ";", "P=0.0377", ")", "was", "significantly", "associated", "with", "a", "longer", "PFS", "(", "7.5", "months", "vs", ".", "6", "months", ")", ".", "Median", "OS", "was", "15.1", "months", "(", "95", "%", "CI", ",", "13.5", "-", "16.6", "months", ")", ".", "Primary", "surgery", ",", "good", "performance", "status", "(", "PS", ")", ",", "only", "one", "metastatic", "site", ",", "and", "oxaliplatin", "-", "based", "second", "-", "line", "treatment", "independently", "predicted", "a", "longer", "OS", ".", "Grade", "4", "neutropenia", "was", "significantly", "associated", "with", "a", "PS", ">", "or=1", ",", "whereas", "risk", "of", "grade", ">", "or=3", "diarrhea", "was", "directly", "related", "to", "age", "and", "previous", "weight", "loss", ".", "CONCLUSION", "Patients", "with", "no", "weight", "loss", "and", "/", "or", "preserved", "PS", "and", "with", "a", "limited", "disease", "extent", "appeared", "to", "obtain", "the", "greatest", "benefit", "from", "our", "irinotecan/5-FU", "/", "LV", "regimen", ",", "with", "acceptable", "toxicity", ".", "Notably", ",", "the", "regimen", "was", "effective", "and", "well", "tolerated", "by", "elderly", "patients", ".", "This", "regimen", "may", "represent", "the", "rationale", "for", "assessing", "the", "addition", "of", "novel", "antiangiogenic", "drugs", "to", "the", "treatment", "of", "metastatic", "CRC", "." ]
[ "Participant_Condition", "Intervention_Pharmacological", "Outcome_Mortality", "Outcome_Other", "Outcome_Adverse-effects", "Outcome_Physical", "Outcome_Mental" ]
Individuals with ASD is a participant, metaphor is an intervention
490_task0
Sentence: Individuals with ASD performed at greater than chance levels on both metaphor types , although their performance was lower than TD participants . Instructions: please extract entities and their types from the input sentence, all entity types are in options Options: intervention, participant
[ "B-participant", "I-participant", "I-participant", "O", "O", "O", "O", "O", "O", "O", "O", "B-intervention", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O", "O" ]
Individuals with ASD performed at greater than chance levels on both metaphor types , although their performance was lower than TD participants .
[ "Individuals", "with", "ASD", "performed", "at", "greater", "than", "chance", "levels", "on", "both", "metaphor", "types", ",", "although", "their", "performance", "was", "lower", "than", "TD", "participants", "." ]
[ "participant", "intervention", "outcome" ]